Levels Of Physical Disability Research Articles

Clinicopathological Profile of Muscle Diseases Presenting the Adult Population in Northern India: Preliminary Analysis in a Limited Resource Setting.

Muscle diseases are of various types, viz., muscular dystrophies, inflammatory myopathies, myotonic disorders, congenital myopathies, and metabolic myopathies. They all present with muscle weakness, be it proximal or distal. The assessment of muscle biopsy with the help of enzyme histochemistry, histopathological, and immunohistochemical methods is an essential component in the diagnosis of neuromuscular disorders. The authors outline brief data on muscle diseases prevalent in the North Indian region. Muscle biopsy was done, and the biopsy was freshly frozen in liquid nitrogen and sections were taken on a cryostat. Slides were then stained with hematoxylin and eosin (H&E), modified Gomori trichome (MGT), nicotinamide adenine dinucleotide hydrogenase (NADH), and succinic dehydrogenase (SDH) stains. Further specific immunohistochemistry tests were also done. Out of n=16 cases, three cases were diagnosed as Becker's muscular dystrophy, two cases were diagnosed as inflammatory myopathy, four cases were diagnosed as Facioscapulohumeral muscular dystrophy, and one each case of dysferlinopathy and alpha sarcoglycanopathy. Muscle diseases can cause different levels of physical disability and thus it is important to diagnose at the appropriate time to ensure proper treatment.

Clinical and radiological correlates of apathy in multiple sclerosis

Background: Although apathy has been associated with fronto-striatal dysfunction in several neurological disorders, its clinical and magnetic resonance imaging (MRI) correlates have been poorly investigated in people with multiple sclerosis (PwMS). Objectives: To evaluate clinical variables and investigate microstructural integrity of fronto-striatal grey matter (GM) and white matter (WM) structures using diffusion tensor imaging (DTI). Methods: A total of 123 PwMS (age: 40.25 ± 11.5; female: 60.9%; relapsing–remitting multiple sclerosis: 75.6%) were prospectively enrolled and underwent neurological and neuropsychological evaluation, including Expanded Disability Status Scale (EDSS), Apathy Evaluation Scale (AES-S), Hospital Anxiety and Depression Scale (HADS), Modified Fatigue Impact Scale (MFIS) and brain 3T-MRI volumes of whole brain, frontal/prefrontal cortex (PFC) and subcortical regions were calculated. DTI-derived metrics were evaluated in the same GM regions and in connecting WM tracts. Results: Apathetic PwMS (32.5%) showed lower education levels, higher HADS, MFIS scores and WM lesions volume than nonapathetic PwMS. Significant differences in DTI metrics were found in middle frontal, anterior cingulate and superior frontal PFC subregions and in caudate nuclei. Significant alterations were found in the right cingulum and left striatal-frontorbital tracts. Conclusions: Apathy in PwMS is associated with higher levels of physical disability, depression, anxiety and fatigue together with lower educational backgrounds. Microstructural damage within frontal cortex, caudate and fronto-striatal WM bundles is a significant pathological substrate of apathy in multiple sclerosis (MS).

Age differences in emotional support buffering on the relationship between physical disability and psychological distress

Greater levels of physical disability are often accompanied by greater levels of psychological distress. Stress Buffering Theory ( Cohen & Wills, 1985 ; Thoits, 2011 ) posits that the level of social support buffers this relationship. Life Stage Theory proposes the previously untested hypothesis that the salience of the buffering offered by social support may decrease with age – i.e., that as individuals age, emotional support offers a weaker buffer of the effect of disability on psychological distress ( Segrin, 2003 ). This research tested a unified Stress Buffering/Life Stage model of psychological distress. We hypothesized that the buffering effect of emotional support is greater for younger adults than for older adults. Study data were drawn from 293 adults who self-identified as having a physical disability. Respondents’ age, emotional support, psychological distress, and disability were assessed. A saturated three-way interaction analysis of covariance model was used to evaluate the association of disability and psychological distress, as buffered by emotional support, for older versus younger people. Results were consistent with a unified Stress Buffering Life Stage model. Greater levels of emotional support attenuated the relationship between disability and psychological distress for younger, but not for older, study participants. Self-reported measures and the cross-sectional design precludes making causal inferences. Emotional support may be particularly salient for younger people in buffering the effects of disability on psychological distress.

Physical Activity and Life Stress Are Associated With Illness Intrusiveness in Persons With Multiple Sclerosis

ObjectivesTo explore which modifiable lifestyle behaviors contribute to illness intrusiveness in persons with multiple sclerosis (MS). DesignCohort study. SettingCommunity-based comprehensive MS center. ParticipantsAdults with MS (N=154) who completed an online battery of self-report questionnaires. InterventionsNot applicable. Main Outcome MeasuresIllness intrusiveness was measured with the 13-item Illness Intrusiveness Ratings Scale. Lifestyle behaviors were measured using the respective components of the Simple Lifestyle Indicator Questionnaire (ie, Diet, Physical Activity, Alcohol, Smoking, and Life Stress) and self-reported body mass index (BMI). ResultsAfter controlling for age, race, sex, disease duration, and level of physical disability (“disability”), life stress was associated with greater illness intrusiveness (b=4.65, P<.001), and physical activity was associated with less illness intrusiveness (b=-0.67, P=.009). Exploratory mediation analyses revealed physical activity had an indirect effect on illness intrusiveness through disability (b=-0.39, 95% CI: -0.68, -0.16). Conversely, disability also displayed an indirect effect on illness intrusiveness through physical activity (b=0.57, 95% CI: 0.12, 1.16). ConclusionsLife stress and physical activity are 2 modifiable lifestyle behaviors that contribute to illness intrusiveness, with the latter also having an indirect effect through disability. These findings may help inform future behavioral interventions for improving health-related quality of life in persons with MS.

Type of Home Care-Informal Versus At Least Some Formal-Matters for Recipients' Perceived Control.

Perceived control is an important psychological resource for middle-aged and older adults. Aging in place may help foster feelings of control, yet many community-dwelling older adults must rely on others-whether family, friends, or professionals-for physical assistance. This study investigated how receiving home care from different sources was associated with two facets of perceived control (mastery and perceived constraints) among adults with varying levels of physical disability. Data were drawn from the 2012 and 2014 waves of the Health and Retirement Study. Community-dwelling adults aged 50 years and older receiving help for at least one activity of daily living (ADL) impairment (N = 884) reported their relationship to each respective caregiver (formal professional and/or informal family or friend), level of ADL impairment, and ratings of perceived control. Ordinary least squares regression was used to examine the association between type of support and perceived control, as well as the moderating effect of physical disability on that relationship. Compared to receipt of informal support alone, receiving a combination of formal and informal support was related to perceptions of greater control over one's life, but only in terms of mastery. The level of one's ADL impairment did not have a moderating effect on the relationship between support type and perceived control. Findings suggested that the type of instrumental support adults receive in their home has implications for specific facets of perceived control. These findings can help inform home care program development.

Cognitive trajectories in relapsing-remitting multiple sclerosis: Evidence of multiple evolutionary trends.

Cognitive impairment (CI) frequently occurs in multiple sclerosis (MS) and is assumed to increase over time. However, recent studies have suggested that the evolution of cognitive status in patients with MS may be more heterogeneous than expected. Predicting CI remains also challenging, and longitudinal studies exploring the baseline determinants of cognitive performances are limited. No studies have explored the predictive value of patient-reported outcome measures (PROMs) regarding future CI. To explore the evolutionary patterns of cognitive status in a cohort of RRMS patients initiating a new disease modifying treatment (DMT), and to determine whether PROMs may have a predictive value for future CI. The present prospective study is a 12-month follow-up of a cohort of 59 RRMS patients who underwent yearly a comprehensive, multiparametric assessment combining clinical (with EDSS assessment), neuropsychological (BVMT-R, SDMT, CVLT-II), MRI-derived metrics and a set of self-reported questionnaires. Lesion and brain volumes were analyzed and processed by the automated MSmetrix® software (Icometrix®, Leuven, Belgium). Spearman's correlation coefficient was used to evaluate the association of collected variables. A longitudinal logistic regression analysis was performed to find baseline correlates of CI at 12 months (T1). A total of 33 patients (56%) were defined as cognitively impaired at baseline, and 20 (38%) were defined as impaired at follow-up after 12 months. The mean raw scores and Z-scores of all the cognitive tests were significantly improved at T1 (p<0.05). There was a statistically significant improvement in most PROM scores at T1 (p<0.05) in comparison with baseline scores. Among the variables assessed, lower education and physical disability level at baseline correlated with impaired SDMT (OR: 1.68, p=0.01; OR: 3.10, p=0.02, respectively) and impaired BVMT-R (OR: 4.08, p=<0.001; OR: 4.82, p=0.001, respectively) at T1. Neither baseline PROMs nor MRI volumetric parameters were predictive of cognitive performances at T1. These findings provide additional evidence that evolution of CI in MS may be a dynamic phenomenon and will not usually follow an inevitable, declining trajectory, and do not support the utility of PROMs in predicting CI in RRMS. The present study is still ongoing to determine whether our findings are confirmed at 2 and 3 years of follow-up.

Benefits and Challenges of Pediatric-to-Adult Health Care Transition in Childhood-Onset Neurologic Conditions.

Although the importance of pediatric-to-adult health care transition (HCT) has been recognized, individuals with childhood-onset neurologic conditions often encounter challenges during pediatric-to-adult HCT, and HCT benefits for this population remain elusive. We assessed the current HCT situation in individuals with childhood-onset neurologic conditions to develop an improved transition system that incorporates patient perspectives. This cross-sectional study was conducted at the Tokyo Metropolitan Kita Medical and Rehabilitation Center for the Disabled from November 2020 to December 2020. We targeted adults with childhood-onset neurologic conditions who visited the Department of Internal Medicine and their families. Questionnaires provided to 127 patients asked them about their experiences with pediatric-to-adult HCT (i.e., educational opportunities regarding HCT during pediatric visits, difficulties in transition, and the merits/demerits of adult practice) and their families' perspectives regarding pediatric-to-adult HCT. We also reviewed the patients' medical records to examine the severity of their disabilities. Responses were collected from 111 patients (response rate: 87%). Most patients had both severe physical and intellectual disabilities, and approximately half had a physical disability level of Gross Motor Function Classification System V and a profound intellectual disability. Half of the respondents were not transitioned through pediatric-to-adult HCT by their pediatricians, and they visited adult departments by themselves without a formal referral process. They experienced difficulties during HCT, such as a lack of knowledge regarding adult health care providers and consultants. However, those who underwent HCT benefited from it in terms of their health, experience, and service use, such as age- and condition-appropriate care, seeing adult specialists, and the introduction of adult services. They also addressed challenges in managing appointments and having adult doctors understand their medical history. Nonetheless, they were not informed about diseases and medical and welfare resources for adulthood during pediatric visits and desired to discuss future plans with pediatricians. Systems that provide sufficient pediatric-to-adult HCT for individuals with childhood-onset neurologic conditions are required. Lifelong education for patients and families, training for pediatricians on HCT and neurologists on childhood-onset conditions and disabilities, and clinical practice and human resources that support patients and families are warranted.

Risk factors and characteristics of new-onset coronary heart disease in adults with physical disabilities: A retrospective cohort study

ObjectivesThere is limited information about coronary heart disease (CHD) in adults with physical disabilities. This study was performed to assess the incidence and predictors of the new development of CHD in adults with physical disabilities. MethodsA retrospective cohort study was performed on 3902 physically disabled people in Shanghai, China. Baseline information was collected in January 2012, and participants were followed-up with for 7.5 years for CHD events. Risk factors for demographic characteristics, disease history, electrocardiography, and blood biochemical indicators were evaluated using a Cox proportional hazard model. Subgroup analyzes were performed according to gender and level of physical disability. ResultsOut of the total 3902 adults with physical disabilities (average age 55.9 ± 8.5 years), 468 (12.0%) developed CHD, during a median follow-up period of 7 years. Independent predictors of CHD included the following: age (HR = 1.411, 95% CI = 1.255–1.587, p＜0.001), gender (HR = 0.773, 95% CI = 0.637–0.940, p = 0.010), abnormal electrocardiogram(HR = 1.396, 95% CI = 1.088–1.792, p = 0.009), hypertension (HR = 1.657, 95% CI = 1.369–2.006, p＜0.001), diabetes (HR = 1.649, 95% CI = 1.307–2.081, p＜0.001), serum uric acid (HR = 1.001, 95% CI = 1.000–1.002, p = 0.046), and total cholesterol (HR = 1.416, 95% CI = 1.054–1.902, p = 0.021). In addition to the risk factors of the total population with physical disability, triglyceride was also a significant risk factor for CHD in the subgroup with women and mild disability. ConclusionsDuring a 7.5 years period, the CHD incidence rate among physically disabled people was 12.0%. We identified the role of CHD risk factors such as age, gender, hypertension, diabetes, serum uric acid, total cholesterol, and abnormal electrocardiogram.

Using a biopsychosocial approach to examine parental sense of burden and competency associated with raising a child with a physical disability.

Parents report both positive and negative experiences associated with raising a child with a physical disability. However, distinctive factors may affect children and families differently. Using a biopsychosocial approach, the current study expands on the existing literature on the general impact of raising a child with a disability. Participants were 98 parents of children/youth with a physical disability. Parents reported on child's level of physical disability, the impact of the disability on the family (financial, social, personal strain and mastery) and their general health. Data were analysed to examine how different biopsychosocial factors are associated with raising a child with a physical disability. Parents reported that child's disability had a higher social impact, compared with the financial and personal burden, as well as compared with their sense of competency and mastery. Child's level of disability was associated with financial burden, whereas parental emotional distress was associated with parents' personal and social burden, with the latter also associated with parent's religiosity. Total impact was associated with parental emotional distress and educational level. Altogether, parental characteristics, but not child's characteristics, were associated with greater caregiver burden. Furthermore, the social impact a child's physical disability has on the family exceeded other sources of burden within the family. Providing parents social and emotional support, tailored to their unique biopsychosocial needs, may mitigate burden and distress, and increase sense of competency among families of children with a physical disability.

Health anxiety in stroke survivors: a cross-sectional study on the prevalence of health anxiety in stroke survivors and its impact on quality of life

Purpose To explore the prevalence of health anxiety in stroke survivors and its relative impact on quality of life. Materials and methods A cross-sectional design was used including between group comparisons of high and low health anxious stroke survivors. Stroke survivors (n = 105) were recruited via online stroke community forums. Participants completed measures of health anxiety (Short Health Anxiety Inventory), general anxiety and depression (Hospital and Anxiety and Depression Scale), disability (WHO Disability Assessment Schedule), and quality of life (Quality of Life Index). Demographics and medical histories were also assessed. Results Thirty percent of the sample scored above the clinical cut off for health anxiety. Stroke survivors with high health anxiety (HiHA) were found to have significantly lower quality of life (p < 0.001) and higher rates of depression (p < 0.001). Regression analysis found health anxiety to be a significant predictor of quality of life (β = –0.12; p < 0.05) in addition to levels of depression (β = –0.33; p < 0.001) and disability (β = –0.53; p < 0.001). Conclusions Almost a third of stroke survivors were experiencing clinical levels of health anxiety, with HiHA significantly associated with lower quality of life. Future research should explore the use of existing evidence based psychological interventions for health anxiety in this population. Implications for rehabilitation Our findings suggest almost one in three stroke survivors residing in the community have clinical levels of health anxiety. High health anxiety in stroke survivors was significantly related to lower levels of quality of life. Given this finding, evidence-based treatments for health anxiety may improve quality of life and reduce distress for a significant proportion of stroke survivors. Rehabilitation approaches aimed at improving overall quality of life for stroke survivors should consider both physical and psychological interventions, with levels of physical disability, depression and anxiety all significantly associated with quality of life.

Uncovering Heterogeneous Associations Between Disaster-Related Trauma and Subsequent Functional Limitations: A Machine-Learning Approach.

This study examined heterogeneity in the association between disaster-related home loss and functional limitations of older adults, and identified characteristics of vulnerable subpopulations. Data were from a prospective cohort study of Japanese older survivors of the 2011 Japan Earthquake. Complete home loss was objectively assessed. Outcomes in 2013 (n= 3,350) and 2016 (n= 2,664) included certified physical disability levels, self-reported activities of daily living, and instrumental activities of daily living. We estimated population average associations between home loss and functional limitations via targeted maximum likelihood estimation with SuperLearning and its heterogeneity via the generalized random forest algorithm. We adjusted for 55 characteristics of survivors from the baseline survey conducted 7 months before the disaster. While home loss was consistently associated with increased functional limitations on average, there was evidence of effect heterogeneity for all outcomes. Comparing the most and least vulnerable groups, the most vulnerable group tended to be older, not married, living alone, and not working, with preexisting health problems before the disaster. Individuals who were less educated but had higher income also appeared vulnerable for some outcomes. Our inductive approach for effect heterogeneity using machine learning algorithm uncovered large and complex heterogeneity in postdisaster functional limitations among Japanese older survivors.

P113 The prevalence of depression and anxiety at first presentation to rheumatology outpatients

Abstract Background/Aims Depression and anxiety are more common in patients with rheumatic diseases and have been associated with higher levels of fatigue, pain and levels of physical disability. Although this has been described in distinct rheumatic conditions, the burden of psychological morbidity across the diseases presenting to rheumatology outpatients is not as well known. The prevalence of anxiety and depression in the UK was reported to be 5.9% and 3.3% respectively. Here, we report rates of depression and anxiety in a cross-section of new patients referred to rheumatology outpatients. Methods All new patients referred to a rheumatology outpatient clinic in London, UK for a 10-week period in February to May 2019 received a digital pre-appointment questionnaire which included Patient Health Questionnaire (PHQ8) and Generalised Anxiety Disorder Questionnaire (GAD7) questionnaire for detecting depression and anxiety respectively. A retrospective analysis was performed to assess the prevalence of significant depression and/or anxiety in various rheumatic diseases, defined as PHQ8 or GAD7 ≥ 10, signifying at least moderate depression or anxiety respectively. Results 464 patients completed the questionnaire, 338 female (73%), with a mean ± SD age of 44.3 ± 13.6 years. 41.2% of patients screened positive for depression and 26.5% for anxiety, with 24.4% screening positive for both. Of the patients screening positive for anxiety, 91.9% were also depressed. The four most prevalent conditions were rheumatoid arthritis (RA, 8.6%), osteoarthritis (OA, 15.3%), psoriatic arthritis (PsA, 8.4%) and fibromyalgia (FM, 24.4%). The prevalence of at least moderate depression and/or anxiety in RA, OA, PsA and FM was 22.5%, 35.2%, 46.1% and 77% respectively. Logistic regression determined odds ratios relative to RA for significant depression and/or anxiety as follows: OA 1.89 (95% CI 0.76-4.67), PsA 2.75 (1.02-7.41), FM 11.80 (4.91-28.36). Conclusion The burden of psychological illness is high across the population of patients presenting to rheumatology outpatients. Our findings show significant prevalence of psychological illness at first presentation. Early identification of psychological distress is important as it can predict adverse long-term outcomes in patients with rheumatic conditions. These results justify an integrated approach between rheumatology and mental health services. Disclosure N. Arumalla: None. R. Littlewood: None. W. Chen: None. T. Garrood: None.

Real-life evidence of treatment with alemtuzumab in patients diagnosed with relapsing-remitting multiple sclerosis in Colombia

Physical disability, cognitive impairment, depression, and fatigue are poorly understood in Latin American patients with multiple sclerosis following alemtuzumab infusion. To describe Sustained changes in physical disability in an average 22-month follow-up period after alemtuzumab infusion, and which demographical or clinical variables modulate change in EDSS, and adverse events, changes in cognition, fatigue, and depressive symptoms after an average 15-month follow-up period. Retrospective cohort observational study. Following the review of medical records, 23 patients with Relapsing Remitting Multiple Sclerosis treated with alemtuzumab were identified; of these, 17 had a baseline neuropsychological assessment and 12 had at least one follow-up neuropsychological assessment. Most of the patients presented a low level of physical disability, depression, fatigue, and cognitive impairment, which was more pronounced in the processing speed and visuospatial memory at baseline. Fifteen of 23 (65.2%) of patients showed disability improvement, 7 (30.1%) patients remained stable, and 1 (4.3%) patient worsened, and change was not influenced by age or baseline disability score. Twenty (87%) patients remained free of clinical relapses. Performance improved on the BVMT-R visual memory test, 9 (75%) remained stable or improved on the BICAMS, and 66.6% perceived decreased fatigue on the d-FIS. Adverse events occurred in 7 (30.1%) of patients, the most common were opportunistic infections in 2 (8.6%) patients, and one 29-year-old patient presented papillary thyroid carcinoma after infusion of the second course of alemtuzumab. Results suggest that treatment with alemtuzumab has a beneficial impact on disability, cognitive impairment, and perception of fatigue. The percentage and type of adverse events observed in the cohort are similar to those reported for other real-life studies.

Worsening physical functioning in patients with neuroinflammatory disease during the COVID-19 pandemic

ObjectiveTo quantify changes in psychological wellbeing and physical function as reported by people with neurological inflammatory disease (PwNID) during the COVID-19 pandemic. Methods1134 PwNID and 868 control participants were recruited through five major academic medical centers in the Northeast/Mid-Atlantic U.S. beginning in April 2020. Participants completed serial surveys throughout the COVID-19 pandemic that aimed to quantify mood symptoms and physical function, analyzed cross-sectionally with a smaller cohort analyzed longitudinally. ResultsThroughout the pandemic, depression scores were not significantly different between PwNID and controls, although a higher proportion of PwNID reported clinically significant depression at study entry. Depression scores did not worsen over time for either group. Loneliness was the strongest predictor of worse depression, along with older age, male gender in both PwNID and controls, as well as lack of disease modifying therapy use, and disease duration in PwNID only. In contrast, physical disability worsened significantly over time for both PwNID and controls. Age, DMT status and comorbid health conditions emerged as significant predictors of physical function. ConclusionsDepressive symptoms remained consistent for both PwNID and controls throughout the COVID-19 pandemic, but physical function worsened significantly over time for both groups. This is particularly impactful for PwNID, who have higher baseline levels of physical disability, and underscores the importance of reinstituting services and interventions that facilitate exercise and reconditioning for this population.

Characteristics of cognitive impairment in multiple sclerosis patients depending on different risk factors

Cognitive impairment (CI), along with motor deficit, is a crucial component of a disability aggravation in multiple sclerosis (MS) patients. The aim of this study was to asses characteristics of CI in separate cognitive domains depending on socio-demographic (age, sex, level of education), disease parameters (severity, course type and disease duration) and external factors (smoking). The current study enrolled 137 MS patients (102 women and 35 men) aged from 22 to 69 years. All participants were divided into two groups depending on the disease course: group А – patients with relapsing-remitting (RR-MS) type (n=106) and group B – participants with progressive forms of the disease (n=31). The following study discovered that disruption of separate cognitive domains was present even without the apparent CI according to MоCA (Montreal Cognitive Assessment): executive functions impairment (p=0,0013) was found most frequently in case of RR-MS, and memory (p=0,0233) decline in case of progressive forms. In the group A moderate CI were associated with decrease of memory (p&lt;0,0001), attention (p=0,0061), executive functions (p=0,0005), language (p=0,0080) and abstract thinking (p=0,0018); severe CI – with disorders of attention (p=0,0055), language (p&lt;0,0001) and abstract thinking (p=0,0144). As for the group B, moderate CI were associated with decline of abstract thinking (p&lt;0,0001), and severe CI – with impairment of memory and executive functions (p=0,0337). Level of physical disability and smoking impact CI independently of MS course, meanwhile, presence of higher education proves to be beneficial for preserving cognitive functions. In addition, disease duration, number of exacerbations and male gender (concerning attention decline) can affect cognition in relapsing-remitting course of MS.

Circulatory antioxidant and oxidative stress markers are in correlation with demographics but not cognitive functions in multiple sclerosis patients

BackgroundMultiple sclerosis (MS) is the most common non-traumatic cause of disability in younger adults. MS can be presented with a wide range of symptoms such as cognitive impairment (CI). Oxidative stress (OXS) is a major basis of the pathogenesis of MS. There is a positive correlation between OXS factors and the progression of the disease in MS patients. There are limited studies regarding the role of OXS in MS-related CI. In this study, as an exploratory analysis, we assess the role of endogenous antioxidants and OXS factors in cognitive function, the severity of disability due to MS, and demographic findings in a sample of MS patients. MethodsAdult (>18 years old) patients with a definite diagnosis of MS based on 2017 revised MacDonald criteria were included in this study. The neurophysiological assessment was conducted, using the validated Persian version of minimal assessment of cognitive function in multiple sclerosis (MACFIMS) battery, which is composed of seven different tests. Based on the structure of the battery, CI was defined as a failure in at least two different components of the MACFIMS battery. The patients were separated into two groups of CI and non-CI. Examined antioxidant factors included catalase Activity (CAT), Glutathione Peroxidase 1 (GPX1), Glutathione Peroxidase 2 (GPX2), Reduced Glutathione (GSH), Superoxide Dismutase (SOD), and serum total antioxidant capacity (TAC). Malondialdehyde (MDA) was also measured as an OXS marker. Results71 patients were involved in this study. The type of MS was relapsing-remitting MS (RRMS) in 80.28% of the participants. Disease duration (P<0.01), type of MS (p<0.01), and EDSS score (p<0.01) were different between CI and non-CI groups, but there were not any significant differences in CAT (p = 0.80), GPX1 (p = 0.71), GPX2 (p = 0.41), GSH (p = 0.96), TAC (p = 0.13), SOD (p = 0.37), and MDA (p = 0.82). A significant difference between RRMS and progressive MS (PMS) patients in the levels of GPX1 (p = 0.01), GPX2 (p = 0.01), and SOD (p = 0.01) was observed. Also, we found higher circulatory levels of CAT (p = 0.02) and TAC (p<0.01) in male MS patients. We found significant correlations between aging and CAT (R = 0.28; p = 0.01), GPX1 (R = 0.36; p<0.01), GPX2 (R = 0.34; p<0.01), and SOD (R = 0.40; p<0.01). EDSS, the duration of the disease, relapse rate, and the number of impaired cognitive tasks were not correlated with any of investigated OXS or antioxidant factors (p>0.05). In terms of a detailed investigation of associations between MACFIMS battery components and levels of OXS and antioxidant factors, there were no significant relations in this regard (p>0.05). Based on the logistic regression multivariate analysis, only disease duration (p = 0.03) and GPX1 (p = 0.01) were independently associated with CI in MS patients in our sample. ConclusionThe circulatory levels of GPX1, GPX2, and SOD are significantly different between RRMS and PMS patients. Neither endogenous antioxidants nor MDA, as an OXS biomarker, are associated with the cognitive function or level of physical disability in MS patients. Limitations of this study suggest a need for future studies in a larger sample of MS patients.

Patient Perceived Disability after an Interdisciplinary Treatment Approach for Chronic Musculoskeletal Pain Syndromes

<h3>Research Objectives</h3> To investigate the perceived disability of child and the family impact with chronic Musculoskeletal Pain Syndrome before and after receiving an intense, interdisciplinary treatment approach. <h3>Design</h3> The design is a retrospective look at the pre and post assessment measures in a cohort of 119. <h3>Setting</h3> The study setting is full day pain program within a private institution for children and adolescents. <h3>Participants</h3> Patients who participated in the program between 2015 and 2019, retrospective chart review was performed to abstract data on patients' Functional Disability Index (FDI) and PedsQL. <h3>Interventions</h3> Daily occupational and physical therapy, weekly psychology (CBT-model), social work services, school re-integration planning, and art and music therapies. OT included strengthening, functional activities and desensitization for 3 hours a day and PT included strength and endurance training 2 hours a day. <h3>Main Outcome Measures</h3> The outcome measures were the PedsQL and FDI. The PedsQL is a brief health-related quality of life measure looking at physical, emotional, social, and school functioning in children (Varni, J.W., Seid, M. & Kurtin, P.S. 2001). The FDI is a well-established and frequently used measure of physical functioning and disability in adolescents with chronic pain (Kashikar-Zuck, et al 2011). <h3>Results</h3> Patients were given the PedsQL on their first and last day and the FDI during their OT initial and discharge evaluations. <h3>Conclusions</h3> An intense, Interdisciplinary treatment approach for chronic musculoskeletal pain syndromes can reduce a patients perceived level of physical disability and measure their quality of life in the four domains mentioned. In the cohort of 119, the difference between FDI scores at admission vs FDI scores at discharge was assessed using Wilcoxon Signed Rank test, which found to be statistically significant with the p-value < 0.0001. In the cohort of 119, we observed that PedsQL inventory total scores as well as individual domains' scores were improved (higher scores) at discharge vs admission. These changes were statistically significant (all p-values < 0.05), indicating improvement in HRQoL (overall and at individual domain level) at discharge in comparison to admission. <h3>Author(s) Disclosures</h3> None.

1025Social interaction of middle-aged and older people with and without cardiovascular disease in Australia

Abstract Background Social interaction is important for social wellbeing and may be adversely affected in people with cardiovascular disease (CVD). Large-scale evidence on social interaction among older people with versus without CVD is limited. We quantified and compared social interaction in older people with and without CVD. Methods Survey data (2006-2009) from the 45 and Up Study were linked to hospitalisations data through CHeReL to ascertain CVD status. Four items from the Duke Social Support Index (social-visits/week, telephone-contacts/week, social-group-contact/week, and number of people to depend on) were examined, using generalised linear models to estimate prevalence ratios (PRs) of no social interaction in people with versus without CVD, adjusting for relevant factors, and separately according to CVD subtype and level of physical disability. Results There were 266,504 study participants, 21.4% had CVD. People with CVD were 8%, (95%CI: 5-11%), 7% (2-12%), 4% (3-5%) and 7% (3-11%) more likely than people without CVD to have no social-visits/week, telephone-contacts/week, social-group-meetings/week and people to depend on respectively. The magnitude but not direction of results varied by CVD subtype. People with CVD and severe physical functioning limitations were 30-80% more likely than those with neither of these to have no social interaction. Conclusions Levels of social interaction were slightly lower in people with versus without CVD, but they varied by social interaction items, CVD subtypes, population characteristics and physical disability. Key messages Management to improve quality of life for people living with CVD should consider the role of physical disability for social connectedness.

What underlies the difference between self-reported health and disability after stroke? A qualitative study in the UK

BackgroundLevels of self-reported health do not always correlate with levels of physical disability in stroke survivors. We aimed to explore what underlies the difference between subjective self-reported health and objectively measured disability among stroke survivors.MethodsFace to face semi-structured interviews were conducted with stroke survivors recruited from a stroke clinic or rehabilitation ward in the UK. Fifteen stroke survivors purposively sampled from the clinic who had discordant self-rated health and levels of disability i.e. reported health as ‘excellent’ or ‘good’ despite significant physical disability (eight), or as ‘fair’ or ‘poor’ despite minimal disability (seven) were compared to each other, and to a control group of 13 stroke survivors with concordant self-rated health and disability levels. Interviews were conducted 4 to 6 months after stroke and data analysed using the constant comparative method informed by Albrecht and Devlieger’s concept of ‘disability paradox’.ResultsIndividuals with ‘excellent’ or ‘good’ self-rated health reported a sense of self-reliance and control over their bodies, focussed on their physical rehabilitation and lifestyle changes and reported few bodily and post-stroke symptoms regardless of level of disability. They also frequently described a positive affect and optimism towards recovery. Some, especially those with ‘good’ self-rated health and significant disability also found meaning from their stroke, reporting a spiritual outlook including practicing daily gratitude and acceptance of limitations. Individuals with minimal disability reporting ‘fair’ or ‘poor’ self-rated health on the other hand frequently referred to their post-stroke physical symptoms and comorbidities and indicated anxiety about future recovery. These differences in psychological outlook clustered with differences in perception of relational and social context including support offered by family and healthcare professionals.ConclusionsThe disability paradox may be illuminated by patterns of individual attributes and relational dynamics observed among stroke survivors. Harnessing these wider understandings can inform new models of post-stroke care for evaluation.

Disability trajectories prior to death for ten leading causes of death among middle-aged and older adults in Taiwan

BackgroundProlonged life expectancy is associated with increased prevalence of chronic diseases. The aim of this study was to determine the different disability trajectories for the top ten leading causes of death in Taiwan .MethodsA total of 2,431 participants aged 50–96 in 1996 from the Taiwan longitudinal study on aging (TLSA) who died from 1996 to 2016 were analyzed. Integration of Cause of Death Data and TLSA helped sort out participants who had died from the ten leading causes of death. The level of physical disability was evaluated with the Activities of Daily Living Scale (ADLs), ranging from 0 to 6 points, in 1996, 1999, 2003, 2007, and 2011. A multilevel model was used to investigate the levels and rates of change in disability development before death.ResultsThe outcome of the research showed that the earliest group to experience physical limitation was individuals living with diabetes. The groups with the highest ADL scores were participants with diabetes, cerebrovascular disease, and hypertension-related diseases. Most groups reach ADL scores ≥ 1 (mild-level) during 4–6 years before death except chronic hepatitis and cirrhosis and injury.ConclusionsPeople who had died from the ten leading causes of death experienced different disability trajectories before death. The trajectory of the participants who had died from diabetes showed a unique pattern with the earliest occurrence and more severe deterioration in terms of development of disabilities. Disability trajectories provide a prediction of survival status for middle-aged and older adults associated with the ten leading causes of death.