Physical Disability Research Articles

School performance readiness of elementary students with disabilities before starting the occupational therapy program in special education schools

Background: School-based occupational therapists (SBOTs) work as health professionals in educational settings. School performance readiness is within the scope of SBOTs in providing a service for students who might have experienced decreasing performance during their school life. Objective: This study aimed to explore the school performance readiness of elementary students with disabilities before starting the occupational therapy program in special education schools. Materials and methods: The school performance readiness checklist for students with disabilities in special education schools was the research instrument. It comprised four areas: physical, social and emotional, pre-academic, and self-care readiness. Seventy-five elementary students with disabilities participated in this study. They consisted of 41 students with intellectual disability, 21 students with physical disability, and 13 students with sensory disability. Results: Results from the initial semester in special education schools showed that most of the students with disabilities (85.33%) needed support in promoting their school performance readiness, particularly in pre-academic readiness. This included most of those with intellectual disability (33.33%) and all of those with sensory disabilities, while all of the students with physical disabilities needed support in promoting physical readiness. Conclusion: Most students with disabilities needed support in promoting their school performance readiness according to their type of disability. Although the special education schools had enrolment criteria, SBOTs and school professionals should be concerned with providing related intervention programs to promote school readiness, particularly pre-academic readiness.

Mitoregulin modulates inflammation in osteoarthritis: Insights from synovial transcriptomics and cellular studies

Osteoarthritis is a prevalent musculoskeletal disease that involves cartilage degradation, subchondral bone remodeling, and synovial inflammation and ultimately causes physical disability. Common risk factors for osteoarthritis include age, sex, obesity, and genetic predispositions. Treatment includes nonpharmaceutical and pharmacological approaches; however, disease-modifying osteoarthritis drugs remain undeveloped. We aimed to identify key regulatory factors underlying the etiology of osteoarthritis. We studied alterations of the inflammatory responses after manipulating the expression of MTLN, which we selected after sequencing and transcriptomics of the patients’ synovial tissues. MTLN expression was increased in synovial tissues of patients and in SW982 human synovial sarcoma cells following inflammatory stimuli. We found that MTLN overexpression or knockout respectively decreased or increased expression of the inflammation-associated genes, including IL-6, IL-8, and TNF-α. Thus, high levels of MTLN in osteoarthritis may protect tissues against excessive inflammation, thereby offering therapeutic potentials.

The interface of dementia and physical disability; causative factors and associations in the elderly population from Pakistan: evidence from the nationally representative cross-sectional Demographic and Health Survey (DHS, 2017-18) of Pakistan

Objectives : The interface of dementia and physical disability is poorly characterized in the elderly population. We used the 2017-2018 Demographic and Health Survey (DHS) (PKPR71FL) to investigate the prevalence and interface of dementia and physical disability in Pakistan. Study design : A cross-sectional study design was used by analyzing the latest DHS conducted for Pakistan from 22 November 2017 to 30 April 2018. Methods : We used Gamma correlation to evaluate the effects of several demographic and socioeconomic factors on dementia and physical disability in 2,899 males and 2,284 females. Results : The prevalence of both forms of disabilities increased with advancing age with a higher preponderance among females. Being unmarried, not educated, having a smaller household, and poverty was associated with a greater disability. Having four or more children was associated with a higher disability in men but lower disability in women. The prevalence of disability was highest in Punjab and lowest in Balochistan. Conclusion : Altogether, we describe several factors associated with the burden of disability in Pakistan. Community-based interventions are recommended to reduce the disability of the elderly in Pakistan.

Prospective Memory Complaints Are Related to Objective Performance in People With Multiple Sclerosis

ObjectivesTo examine the association between subjective and objective prospective memory (PM) in people with multiple sclerosis (PwMS). DesignSecondary analysis of a cross-sectional cohort study. SettingCommunity-based comprehensive multiple sclerosis center. ParticipantsPwMS (N=112) who completed a battery that included measures of PM, depression, and fatigue. InterventionsNot applicable. Main Outcome MeasuresObjective PM was measured with the performance-based Memory for Intentions Test (MIST), whereas subjective PM was assessed with the self-report Perceived Deficits Questionnaire-Prospective Memory (PDQ-PM). ResultsPwMS had low scores on the PDDS (median=2) and HADS-D (median=5.29), with 26.8% scoring 1 standard deviation or lower (≤15th percentile) on the MIST. Objective PM was significantly associated with subjective PM in a multivariate model (β=−0.18, P=.036), which accounted for demographics, physical disability, retrospective memory, and depressive and fatigue severity. Physical disability, depression, and fatigue were also significant contributors to subjective PM. Time-based PM performance emerged as the specific component that was associated with subjective PM. ConclusionsThese findings suggest that among PwMS with relatively mild impairment and symptomatology, their objective PM performance was associated with their self-assessments, even when considering retrospective memory and factors that influence their cognitive perceptions. The results expand upon the subjective-objective cognition discrepancy literature in multiple sclerosis and highlights how the PDQ-PM could be used as a complementary measure to help identify difficulties with PM.

Promoting and accelerating muscle regeneration through cell therapy in a mouse model

ObjectivesSkeletal muscle injuries and disorders are universal clinical challenges with direct and indirect mechanisms and notable residual effects, such as prolonged, intense pain and physical disability. Stem cells, an innovative tool for cell therapy for musculoskeletal disorders, specifically promote skeletal muscle regeneration. This study was aimed at investigating the use of mesenchymal stem cells (MSCs) and their differentiated myocytes as a cell-based therapy to promote regeneration in damaged or diseased skeletal muscle. MethodsBone marrow mesenchymal stem cells (BM-MSCs) were isolated from the bone marrow of adult mice and grown in tissue culture flasks. The BM-MSCs were positive for CD90 and CD105, and negative for CD45 and CD34. These cells were induced with specific differentiation medium in vitro to differentiate into a skeletal muscle cell lineage over 7 days. Skeletal muscle differentiation was characterized according to morphology through hematoxylin and eosin staining, and scanning electron microscopy. Immunostaining for Myf-6, myosin heavy chain (MHC), and desmin—specific factors for skeletal muscle development—was performed to confirm skeletal muscle differentiation. An in vivo study in a muscle injury model was used to evaluate cell therapy based on naïve stem cells and differentiated myocytes. ResultsCultured mouse BM-MSCS were positive for CD90 and CD105, and negative for CD45 and CD34. These cells developed into skeletal muscle with strong skeletal muscle differentiation potential, as confirmed by immunohistochemistry for the markers Myf6, MHC, and desmin. The differentiated myocytes showed better repair enhancement than undifferentiated stem cells after transplantations into a mouse model of skeletal muscle atrophy. ConclusionsMyocytes derived from BM-MSCs may be incorporated into muscular atrophy treatment as a biological strategy for managing skeletal muscle diseases and injuries, thus advancing cell-based clinical treatments.

Exploring the experience of multiple sclerosis patients in Turkey: Insights from a national survey

Objective: To evaluate sociodemographic profile, clinical characteristics, disability and treatment status of multiple sclerosis (MS) patients in Turkey with respect to patient perspectives and expectations. Methods: A total of 2,176 MS patients participated in this cross-sectional questionnaire survey including items on sociodemographic, disease and treatment characteristics, daily life and perspectives and expectations. Results: Mean (SD) patient age was 36.4(9.4) years and 76.3% of patients were females. The numbness/weakness in the extremities (57.3%) was the most common presenting symptom. Overall, 56.8% reported treatment switch (due to attacks in 47.3%), while 22.2% reported physical disability and 39.7% reported work-related problems. Males had higher rate of MS-related physical disability (33.0% vs. 19.0%, p<0.001) than females. Use of an assistive device was a more common in patients with longer disease duration (≥15 years; 39.0%) and in those under IV treatment (64.0%). Nearly half of patients reported significant concerns related to uncertainty of the future and impaired quality of life as well as lack of hope for future improvement. The majority of patients reported that they would prefer less frequent SC injection dosing and 43.3% reported preference for monthly high- efficacy SC injection. Conclusion: This nationwide questionnaire-based study in Turkish MS patients revealed the altered disability status with respect to sociodemographic profile, and altered treatment expectations specific to the route of administration, in addition to significant concerns regarding the uncertainty of the future, impaired quality of life and lack of hope for future improvement in nearly half of patients.

185 What matters most for physical activity participation? A national Delphi study identifying the top ten priorities of adolescents with physical disability

185 What matters most for physical activity participation? A national Delphi study identifying the top ten priorities of adolescents with physical disability

Abstract P345: Long-Term Blood Pressure Variability and Physical Performance Measures in Community-Dwelling Older Adults

High degrees of long-term, visit-to-visit blood pressure variability (BPV) independently predict increased risks of cardiovascular disease, cognitive decline, and frailty in older adults. Measures of physical performance such as gait speed and grip strength can predict loss of independence and mortality in older adults, but are not routinely measured in practice. Shared pathways of underlying physiologic deterioration may exist between high BPV and progressive loss of gait speed and grip strength. We examined the association between long term, visit-to-visit BPV and change in gait speed and grip strength in participants of the ASPirin in Reducing Events in the Elderly (ASPREE) study, a randomized primary prevention trial of low-dose aspirin conducted in 19,114 community-dwelling adults in Australia and the U.S. who were without independence-limiting physical disability at enrollment, and its extended long-term observational follow-up (ASPREE-XT). Long-term BPV was estimated in each participant using the standard deviation (SD) of the means of three within-visit systolic BPs obtained using a validated automated oscillometric BP monitor from the baseline and first two annual ASPREE visits. During ASPREE and continued into ASPREE-XT, participants underwent annual/biennial measures of grip strength using a Jamar hand grip dynamometer, and completed a timed 3 meter walk at normal pace. Linear mixed models were used to examine changes in gait speed and grip strength trajectories over a median of 5.2 years of follow-up after the second annual ASPREE visit (end of BPV estimation window). After covariate adjustment, the highest SD tertile of BPV, compared to the lowest SD tertile, was associated with greater declines in gait speed over time, and reduced grip strength cross-sectionally (see accompanying Table). Our findings suggest that long-term BPV is an important predictor of progressive loss of physical performance, particularly gait speed, in older adults. Since BP is routinely measured in practice, characterization of the visit-to-visit BPV may help identify older adults at risk of future declines in physical function and loss of independence.

Analytical HPLC Method for Determination of Miconazole Nitrate and Eugenol in Formulated Emulgel

A diabetic foot ulcer (DFU) is the prime cause of poor quality of life among diabetic patients. DFU leads to physical disability and an enormous economic burden on diabetic patients. The development and prognosis of DFU are preventable in most patients by modifying the risk factors for DFU. Programs intervened by clinical pharmacists can enhance rational drugs use and improve the early identification and prevention of DFU. This study intended to prove the beneficial outcome in identifying the risk factors and the provision of patient-tailored referral advice regarding DFU among diabetic patients. This cross-sectional study assessed the neuropathy through Michigan Neuropathy Screening Instrument (MNSI), Monofilament and Vibration test using Tuning Fork and Handheld Doppler for assessing the lower limb vascular disease as per NICE guideline among 137 diabetic patients. 64% of patients were found to have symptoms of neuropathy through the neuropathy assessment test whereas 36% did not have the symptoms. Foot sensory using monofilament test was found to be normal in 49.64% of DFU patients, reduced in 43.80%, and absent in 6.57% of DFU patients. The Ankle Brachial Index (ABI) was found to be normal in 48% of patients, mild in 34% of patients, moderate in 12% of patients, and incompressible in 6% of patients. Clinical Pharmacist intervened risk assessment through Hand-held Doppler, MNSI instrument, and Vibration test helped in screening the DFU patients for Neuropathy, and implementation of effective per patient-tailored education was found to be beneficial in the early identification of DFU and referral to specialty hospitals

Facial Gesture Recognition with Human Computer Interaction for Physically Impaired

Modern technologies have succeeded in reducing human effort and risks in doing many activities. As physical disability is a barrier for computer interaction based on electronic devices, modern advancements like human-computer interaction (HCI) have proven to be a dynamic field of study in the last few decades which is a major milestone to uphold the lives of the physically impaired in terms of utilizing technology. In this study we projected a method that provides assistance to the physically impaired people for communicating with these techniques. We accomplished this task by considering the facial gestures, assuming that the disability of the physically challenged having no limbs. Distinguished facial gestures, like eye-blinks, mouth open/close, and head position, are captured and fed as input by a camera as a video stream to the operating system. For example, consider a television where a normal human being can perform various operations in it by a remote control with his/her arms but imagine a physically challenged person who cannot interact with the television without human intervention. We used HCI in the form of facial gestures to establish an interaction with the television and physically impaired participants. We incorporated eye-blink as a gesture to switch on/off, mouth open/close to intimate the Operating system to start/stop taking input commands, and the Position of the head is monitored as the input command and is used to alter the volume of the television. An interactive model that recognizes all of these facial gestures provides a great support for the physically impaired people to interact with the systems.

Identifying optimum implementation for human papillomavirus self-sampling in underserved communities: A systematic review.

To review the existing evidence to identify the optimum methods for implementing human papillomavirus self-sampling to increase screening uptake for underserved groups. Specific groups are less likely to participate in cervical screening. These include individuals from low socioeconomic status groups, ethnic minority groups, younger age groups (25-29), older age groups (≥50), with a physical disability, with a learning disability and with an LGBTQ+ identity. The advent of human papillomavirus self-sampling for cervical screening presents an opportunity to promote equitable access to screening. Implementation for human papillomavirus self-sampling can vary, for example, opt-out or opt-in approaches. However, it is unclear which of these is the best method of offering human papillomavirus self-sampling to underserved groups. Six databases were searched through May 2023. Studies comparing cervico-vaginal human papillomavirus self-sampling provision using different implementation strategies with the standard screening pathway in underserved groups were identified. A narrative synthesis was conducted. In total, 4574 studies were identified; 25 studies were included, of which 22 were from high-income countries. Greater uptake was found for offering human papillomavirus self-sampling compared to standard clinician-based sampling. Directly mailing human papillomavirus self-sampling kits to participants resulted in higher uptake of screening than using an 'opt-in' approach or standard recall in low socioeconomic status and ethnic minority groups, and older women. Strategies that used community health workers or educational materials increased uptake in ethnic minority and low socioeconomic status groups. Directly mailing human papillomavirus self-sampling kits to low socioeconomic status groups, ethnic minority groups and older women has the potential to increase uptake of human papillomavirus self-sampling. Using community health workers to offer human papillomavirus self-sampling should be considered for ethnic minority and low socioeconomic status groups. Further research exploring the preferences of younger women is needed.

A cross-sectional study to assess the pattern of work-related musculoskeletal disorder among class-IV workers of tertiary care centres in central India

Background: Musculoskeletal disorders (MSDs) are typically characterized by persistent pain and limitations in mobility and dexterity. They are highly prevalent and are the leading cause of severe long-term pain and physical disability. Providing stress-management training, encouraging regular breaks, and offering physical therapy and other treatments can alleviate the physical symptoms of work-related MSDs (WMSDs). Objectives were to assess the prevalence and patterns of WMSDs among class-IV workers and to identify the key factors contributing to WMSDs. Methods: The study was conducted at the Hamidia Hospital and Gandhi Medical College Bhopal. 350 class IV workers were selected using random sampling, and data were collected by direct interview. Results: Among all housekeeping staff, 82% showed symptoms of MSDs. Pain was predominantly reported in the lower back (49.3%), followed by the lower leg (32.9%). Among the 350 participants, 72 experienced mental stress manifested as difficulty falling asleep, restlessness, and anxiety. Gutkha, followed by smoking, was the most common substance abused by Class IV workers, which correlated with musculoskeletal pain. Participants with a BMI<18.5 and 25-29.99 reported more MSD pain compared to those with a normal BMI (18.5-24.99). Additionally, workers who did not exercise or exercised only 1-2 times a month experienced higher levels of pain. Conclusions: Class IV workers face physically demanding tasks, so regular breaks should be advised. Promoting literacy can aid in the prevention and early detection of MSDs. Basic interventions and counselling are essential to prevent chronic pain, mental stress, and the development of MSDs.

Constraint-Induced Movement Therapy (CIMT) and Neural Precursor Cell (NPC) Transplantation Synergistically Promote Anatomical and Functional Recovery in a Hypoxic-Ischemic Mouse Model.

Cerebral palsy (CP) is a common neurodevelopmental disorder characterized by pronounced motor dysfunction and resulting in physical disability. Neural precursor cells (NPCs) have shown therapeutic promise in mouse models of hypoxic-ischemic (HI) perinatal brain injury, which mirror hemiplegic CP. Constraint-induced movement therapy (CIMT) enhances the functional use of the impaired limb and has emerged as a beneficial intervention for hemiplegic CP. However, the precise mechanisms and optimal application of CIMT remain poorly understood. The potential synergy between a regenerative approach using NPCs and a rehabilitation strategy using CIMT has not been explored. We employed the Rice-Vannucci HI model on C57Bl/6 mice at postnatal day (PND) 7, effectively replicating the clinical and neuroanatomical characteristics of hemiplegic CP. NPCs were transplanted in the corpus callosum (CC) at PND21, which is the age corresponding to a 2-year-old child from a developmental perspective and until which CP is often not formally diagnosed, followed or not by Botulinum toxin injections in the unaffected forelimb muscles at PND23, 26, 29 and 32 to apply CIMT. Both interventions led to enhanced CC myelination and significant functional recovery (as shown by rearing and gait analysis testing), through the recruitment of endogenous oligodendrocytes. The combinatorial treatment indicated a synergistic effect, as shown by newly recruited oligodendrocytes and functional recovery. This work demonstrates the mechanistic effects of CIMT and NPC transplantation and advocates for their combined therapeutic potential in addressing hemiplegic CP.

Factors Related to Family Attitudes in Helping Patients Adapt to Meet Basic Needs and Prevention of Post-Stroke Depression

Stroke is the leading cause of disability and death. One of the major problems faced by individuals who have a stroke is physical disability and depression. Strokes often interfere with the ability to move, speak, and perform daily activities. It can lead to dependence on others for self-care. The study aimed to find out the relationship between gender, education, experience, knowledge, and family attitudes in helping patients adapt to meet basic needs and prevent post-stroke depression at the Indrasari Rengat Hospital. The design of the research was a cross-sectional survey with a sample of 54 respondents in the nerve center and intensive care room of the Indrasari Rengat hospital unit from May 4 to August 9, 2023.A data collection tool using a questionnaire that contains questions about adaptation in the fulfillment of basic needs and prevention of post-stroke depression, as well as statements of family attitudes toward meeting basic needs and post-stroke prevention. The data analysis in this study is descriptive analysis and bivariate analysis with a chi-square test. The results show that there is a meaningful relationship between gender, experience, knowledge, and family attitudes in helping patients adapt to meet basic needs and prevent post-stroke depression. Family attitudes toward helping stroke patients adapt and prevent post-stroke depression are generally positive.

Prevalence, associated factors and consequence of problematic smartphone use among adolescents and young adults in Bangladesh: A cross-sectional study.

Problematic smartphone use (PSU) and attention deficit hyperactivity disorder (ADHD) in children, adolescents, and young adults are of major concern to parents. However, the prevalence and associated factors related to these issues in Bangladeshi adolescents and young adults remain unclear to the best of our knowledge. The aim of this study is to assess PSU and ADHD in the context of adolescent and young adult age groups in Bangladesh. The present study collected data from diverse geographical locations in Bangladesh via face-to-face surveys using stratified random sampling methods. We considered age, sex, and geographic location stratification criteria. A total of 578 respondents participated in the survey initially. From this, we discarded 36 responses after screening because the information provided was insufficient or incomplete response. In the end, 542 replies were incorporated into the final analysis. PSU and ADHD depend on several factors, including the individual's demographic background. The prevalence of PSU and ADHD symptoms in adolescents and young adults in Bangladesh is 61.44% and 37.45%, respectively based on our findings. The symptoms of PSU are correlated with age, education level, family type (nuclear/joint), sleeping pattern, physical exercise, and residence area. ADHD symptoms are correlated with age, education level, living with family, smoking habit, physical disability, sleeping pattern, physical exercise, residence area, and PSU. Also, we observed that ADHD and PSU symptoms are positively correlated with each other. A large proportion of young adults and adolescents reported PSU and ADHD symptoms. The present findings have practical implications in clinical psychology, psychotherapy, and related policy considerations. We propose to develop an inclusive interventional strategy and community-based programs to address PSU and ADHD-related issues.

Prevalence and factors associated with probable sarcopenia in southern Brazil: a population-based study.

There are few studies on probable sarcopenia in rural areas. This study aims to assess prevalence of probable sarcopenia and its associated factors in older adults living in the rural area of a municipality in southern Brazil. This cross-sectional study assessed data from the second wave of the EpiRural Cohort Study. Structured questionnaires, handgrip strength, gait speed, and anthropometric measurements were collected from 651 older adults. The criteria from the European Working Group on Sarcopenia in Older People 2 were used in this study. Chi-square test and logistic regression with robust variance were performed. Prevalence of probable sarcopenia was 19.2% (95% confidence interval (CI): 16.3-25.2%). Male sex (prevalence ratio (PR) 1.61; 95%CI 1.17-2.21), age ≥80 years (PR 4.15; 95%CI 2.65-6.50), underweight (PR 1.90; 95%CI 1.23-2.93), diabetes mellitus (PR 1.80; 95%CI 1.20-2.73), and hospitalization in the past year (PR 2.00; 95%CI 1.36-2.91) were significantly associated with probable sarcopenia. One in five rural older adults have probable sarcopenia. Older adults living in rural areas need frequent measurements of muscle strength, and greater investments should be made to minimize the physical disability caused by sarcopenia among this population.

Risk of depression in amyotrophic lateral sclerosis: A nationwide cohort study in South Korea

Depression is frequently reported in amyotrophic lateral sclerosis (ALS) due to the disastrous prognosis of progressive motor impairment, but the risk of depression in ALS is still unclear. Therefore, we investigated the risk of depression in ALS and analyzed the effect of ALS-related physical disability on the risk of developing depression using the Korean National Health Insurance Service (KNHIS) database. A total of 2241 ALS patients, as defined by the International Classification Diseases (ICD, G12.21) and Rare Intractable Disease codes (V123), and 1:10 sex- and age-matched controls were selected from the KNHIS. After applying exclusion criteria (non-participation in national health screening, history of depression, or having missing data), 595 ALS patients and 9896 non-ALS individuals were finally selected. Primary outcome is newly diagnosed depression during follow-up duration defined by ICD code (F32 or F33). A Cox regression model was used to examine the hazard ratios (HRs) after adjustment for potential confounders. During the follow-up period, 283 cases of depression in the ALS group and 1547 in the controls were recorded. The adjusted HR for depression in ALS was 9.1 (95% confidence interval [CI] 7.87−10.60). The risk of depression was slightly higher in the disabled ALS group (aHR 10.1, 95% CI 7.98−12.67) than in the non-disabled ALS group (aHR 8.78, 95% CI 7.42−10.39). The relative risk of depression was higher in younger patients than in older patients, and in obese patients than in non-obese patients. Our study showed that ALS patients have an increased risk of depression compared to non-ALS individuals.

Agreement between patient- and proxy-reported outcome measures in adult musculoskeletal trauma and injury: a scoping review.

Patient-reported outcome measures (PROMs) are widely used in medicine. As older adults, who may rely on a proxy caregiver for answers due to cognitive impairment, are representing an increasing share of the traumatically injured patient population, proxy-reported outcome measures (proxROMs) offer a valuable alternative source of patient-centered information although its association with PROMs is unclear. The objective of this scoping review is to discuss all available literature comparing PROM and proxROMs in adult patients with musculoskeletal trauma to guide future research in this field. The PRISMA extension for Scoping Reviews was used to guide this review. MEDLINE, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials were searched without date limit for articles comparing PROM and proxROMs in setting of musculoskeletal trauma. Abstract and full-text screening were performed by two independent reviewers. Variables included study details, patient and proxy characteristics, and reported findings on agreement between PROMs and proxROMs. Of 574 unique records screened, 13 were included. Patient and proxy characteristics varied greatly, while patients' cognitive status and type of proxy perspective were poorly addressed. 18 different PROMs were evaluated, mostly reporting on physical functioning and disability (nine, 50%) or quality of life (six, 33%). Injury- and proxy-specific tools were rare, and psychometric properties of PROMs were often not described. Studies reported moderate to good agreement between PROMs and proxROMs. There is less agreement on subjective outcome measures (e.g., depression score) compared to observable items, and proxy bias results in in worse outcomes compared to patient self-reports. Current literature, though limited, demonstrates moderate to good agreement between injured patients' self- and proxy-reports. Future studies should be mindful of current guidelines on proxy reporting when developing their studies and consider including neglected populations such as cognitively impaired patients to improve clinical validity.

The Impact of Legalizing Medical Aid in Dying on Patient Trust: A Randomized Controlled Survey Study.

Background: Some commentators and several professional medical associations have expressed concern that legalizing medical aid in dying ("MAID") will undermine patient trust in the medical profession, particularly among historically disadvantaged patient populations. While this concern remains influential, it has been subject to limited empirical scrutiny. Objectives: This study aims to empirically assess whether MAID legalization undermines patient trust, with considerations of potential trust/demographic correlations in marginalized and minority patient populations. Design: We developed an RCT survey study that assessed patients' trust in the medical professional using the Abbreviated Wake Forest Scale ("AWFS"). Two versions of the survey were used, each distributed at random to half of participants. One survey version included notification that MAID had been legalized in the jurisdiction where patients were receiving care and the other version omitted this information. Setting/Population: We surveyed capacitated, English-speaking adult patients who were receiving care at a not-for-profit, 912-bed academic and research hospital in Washington, D.C. Of those invited to participate, 494 patients (63.2%) completed all AWFS questions, and 70.1% identified as Black or African American and 32.9% as having a physical or mental disability. Conclusions: Most of the participants not notified that MAID was legal in DC were not aware of this fact (92.5%). Patients who were notified that MAID was legal in DC were significantly more likely to report approval of MAID legalization (p = 0.0410), but showed no significant difference in AWFS score for trust in their physicians. The study did not substantiate concerns that legalizing medical aid in dying undermines patient trust in the medical profession.

Influence of unilateral versus bilateral patellofemoral pain on physical activity, pain self-efficacy, and disability

BackgroundPatellofemoral pain (PFP) affects physical and psychosocial health; however, it is unclear if unilateral and bilateral PFP induce similar levels of impairments. ObjectivesWe aimed to compare physical activity (PA), pain self-efficacy, and disability between individuals with unilateral and bilateral PFP, and to compare these groups against pain-free controls. DesignCross-sectional case-control. MethodSixty-two individuals with PFP (25 unilateral and 37 bilateral) and 20 pain-free controls completed the PA assessment using an accelerometer by daily steps, light PA, and moderate-to-vigorous PA (MVPA). We also calculated variability in each PA variable. Pain self-efficacy and disability were measured using the Pain Self-Efficacy Questionnaire and Anterior Knee Pain Scale, respectively. ResultsIndividuals with bilateral PFP took fewer daily steps compared to pain-free controls (9568.1 ± 3827.0 vs. 12,285.8 ± 2821.2 steps/day; P = 0.018, Cohen d = 0.79), whereas individuals with unilateral PFP did not (11,099.2 ± 3547.1 steps/day; P = 0.503, Cohen d = 0.37). Individuals with bilateral PFP showed greater variability in MVPA compared to individuals with unilateral PFP (42.9 ± 23.1 vs. 29.0 ± 15.9; P = 0.011, Cohen d = 0.91) and pain-free controls (42.9 ± 23.1 vs. 17.6 ± 6.1; P < 0.001, Cohen d = 1.21). Individuals with unilateral and bilateral PFP similarly exhibited less time spent in MVPA, greater variability in daily steps, lower pain self-efficacy, and greater disability compared to pain-free controls (P < 0.001, Cohen d = 1.14–3.89). ConclusionsVersus pain-free controls, individuals with bilateral PFP displayed greater variability in MVPA than individuals with unilateral PFP. However, it is important to note that unilateral PFP influenced time spent in MVPA, variability in daily steps, pain self-efficacy, and disability at similar levels to bilateral PFP.