Physical Functional Disability Research Articles

Understanding the factors that influence stroke survivors to begin or resume exercise: a qualitative exploration

ABSTRACT Background Exercise after stroke has the potential to increase survivors’ physical function and decrease disability. However, despite health professional reporting they recommend exercise to stroke survivors, the majority are physically inactive. Stroke survivors have previously expressed a lack of adequate knowledge and skills to engage in exercise. Objectives The aim of this study was to understand why active stroke survivors chose to (re)engage in exercise and how they went about doing so. A secondary aim was to understand if health professionals had a role in facilitating exercise engagement. Methods Semi-structured interviews were conducted with stroke survivors who regularly engaged with exercise. Seven people aged between 60 and 71 years participated in the study. Time since stroke varied from 1 to 13 years. A reflexive thematic analysis approach was used to analyze interviews. Results Exercise was spoken about in a positive light. For some, exercise had always been important, for others it became important after their stroke. The themes of Changing Support Over Time, Old and New Identity and Proactively Impacting the Future were developed. The participants felt that health professionals often facilitated engagement in exercise, although the type of support that was most valued differed at different points in the post-stroke journey. Conclusions Authoritative support from health professionals and family members helped participants to engage in exercise in the early stages after stroke. Collaboration and being part of a team was appreciated for ongoing exercise engagement. Exercise provided hope as participants developed their identity after stroke.

Physical Impairment versus Functional Disability: The Need for Awareness for the Medical Fraternity

Physical Impairment versus Functional Disability: The Need for Awareness for the Medical Fraternity

Walking Activity and Physical Function Among Mexican American Older Adults Over 9 Years of Follow Up

Background: Walking activity has been associated with reduction in the development of chronic disease, cognitive and physical function impairment, disability, and mortality. The objective of this study was to examine the relationship between walking activity and physical function over 9 years of follow-up among Mexican Americans aged 78 years and older. Methods: Participants (N = 998) were from the Hispanic Established Population for the Epidemiologic Study of the Elderly (2007–2016). Measures included walking activity duration and frequency, socio-demographics, body mass index, medical conditions, pain, depressive symptoms, limitation in activities of daily living, and the Mini-Mental State Examination. Low physical function was defined as scoring <7 on the Short Physical Performance Battery. At baseline, participants were grouped into nonwalkers (n = 653), walked <150 minutes/week (n = 144), and walked 150 minutes/week or more (n = 201). A Generalized Estimating Equation model was used to estimate the odds ratio and 95% CI of low physical performance as a function of walking activity status. Results: Compared with nonwalkers, participants walking < 150 minutes/week had lower odds (odds ratio = 0.66, 95% CI, 0.51–0.86) of low physical function over time, after controlling for all covariates, as did those walking ≥ 150 minutes/week (odds ratio = 0.54, 95% CI, 0.41–0.71). Conclusions: Mexican American older adults who engage in any walking activity are at reduced risk of low physical function, even those with disability. Interventions at the individual and community level are recommended to reduce physical function impairment, even in those with preexisting medical conditions or disability.

Improved physical disability and nutritional status by bovine colostrum supplementation in adults with traumatic peri-trochanteric femoral fracture: A randomized, controlled, clinical trial

ObjectivesPatients with femur fracture after surgery are at risk of malnutrition, weight loss, disability, and mobility complications. In the present study the role of colostrum supplementation on physical disability, and some nutritional variables after surgery has been investigated. Research Methods & ProceduresPatients were randomly assigned to two groups. The intervention group received 45 g colostrum and the control group received 15 g whey protein daily for 21 days (each containing 12 g of protein). The trend comparison during 30 days of variables including weight, appetite, serum albumin level, hemoglobin and lymphocytes between the two groups was modeled with the generalized estimation equation. Moreover, the trend comparison during 90 days of Oswestry Disability Index (ODI) between the two groups was calculated. ResultsThe basic characteristics were the same between the two groups (colostrum, n = 46; control, n = 48). Protein intake was the same in both groups during the study period. There was a significant difference in weight gain (ß = 0.32, 95 % CI: 0.09–0.54; P = 0.005) within 30 days after operation between the colostrum and control groups in favor of the increase in the colostrum group. Compared to the control group, patients in the colostrum group had a 0.31 score more appetite (P < 0.001), 0.17 g/dL higher serum albumin level (P = 0.001), 0.5 mg/dL higher hemoglobin level and 440 more blood lymphocytes (P < 0.001) during the 30 days of intervention. Regarding physical function disability, patients in the colostrum group had about 4 ODI scores lower than the control group during the study period. ConclusionColostrum supplement can increase appetite, hemoglobin, serum albumin level and the number of blood lymphocytes more than the control group. It can also accelerate weight gain and physical performance after surgery.

Adverse Childhood Experiences and Aging-Associated Functional Impairment in a National Sample of Older Community-Dwelling Adults.

Prior research on the health implications of adverse childhood experiences (ACEs) has focused on early or midlife adults, not older adults who bear the greatest burden of health-related functional impairment. To examine associations between ACEs, objectively measured physical mobility and cognitive impairment, and functional disability in older community-dwelling adults. Cross-sectional analysis. Community-dwelling older U.S. adults ages 50years and older. Participants completed structured questionnaires assessing history of ACEs (childhood experience of violence/abuse, witnessing of violence, financial insecurity, parental separation, or serious illness), underwent standardized physical performance testing (tandem balance, 3-m walk, chair stand test) and cognitive testing (survey adaptation of the Montreal Cognitive Assessment), and reported functional disability (difficulty with activities of daily living). Among the 3387 participants (aged 50 to 97years; 54% female), 44% reported a history of one or more types of ACEs. Thirty-five percent met criteria for physical mobility impairment, 24% for cognitive impairment, and 24% for functional disability. After adjusting for age, gender, race, and ethnicity, participants reporting any ACE history were more likely to demonstrate physical mobility impairment (OR 1.30, 95% CI 1.11-1.52) and cognitive impairment (OR 1.26, 95% CI 1.03-1.54) and report functional disability (OR 1.69, 95% CI 1.38-2.07), compared to those with no ACE history. Childhood experience of violence was associated with greater physical mobility impairment (OR 1.38, 95% CI 1.11-1.71) and functional disability (OR 1.86, 95% CI 1.49-2.33). Older adults with a history of ACEs are more likely to experience physical and cognitive functional impairment, suggesting that efforts to mitigate ACEs may have implications for aging-associated functional decline. Findings support the need for trauma-informed approaches to geriatric care that consider the potential role of early life traumatic experiences in shaping or complicating late-life functional challenges.

Change in health-related quality of life and functional disability over time post-concussion in youth.

Concussions can have detrimental on children's cognitive, emotional, behavioral, and/or social functioning. We sought to examine changes in health-related quality of life (HRQOL) and functional disability from pre-injury to 1-week post-concussion, and to symptom resolution among youth ages 11-17 with a concussion. In this prospective, longitudinal cohort study, 83 concussed youth, ages 11-17, self-reported post-concussion symptoms daily as well as HRQOL and functional disability at baseline (pre-injury, retrospective), 1-week post-concussion, and symptom resolution. We modeled changes in overall and sub-scale HRQOL and functional disability scores over time from pre-injury to 1-week post-concussion and from 1-week post-concussion to symptom resolution using a piecewise linear mixed model, adjusting for potential covariables. Estimated fixed effects with a corresponding adjusted coefficient (beta), along with their 95% confidence intervals are presented. Overall HRQOL worsened from pre-injury to 1-week post-injury (β = -5.40, 95%CI -9.22, -1.58) but did not change from 1-week post-injury to symptom resolution. Physical HRQOL worsened from pre-injury to 1-week post-injury (β = -9.90, 95%CI -14.65, -5.14) but improved from 1-week post-injury to symptom resolution (β = 1.64, 95%CI 0.50, 2.78), while psychosocial HRQOL showed no change over time. Functional disability worsened from pre-injury to 1-week post-injury (β = 8.36, 95%CI 5.93, 10.79) but with no change from 1-week post-injury to symptom resolution. Youth with symptom duration > 14days reported worse HRQOL and functional disability than those who recovered in ≤ 14days and greater daily post-concussion symptom scores were associated with worse HRQOL and functional disability. Concussions have a negative impact on overall and physical HRQOL and functional disability in youth acutely post-injury. Ratings of HRQOL could be used to inform clinical treatment decisions to assist with the recovery process.

The broader impact of specialized outpatient cancer rehabilitation on health and quality of life among breast cancer survivors.

e18881 Background: After diagnosis and treatment, women with cancer often experience significant functional decline from which most do not recover. Functional deficits, especially when persistent, are related to poorer health and quality of life (QOL). Interventions to mitigate declines in function, health and QOL are necessary given their known associations with morbidity and mortality yet are understudied and underutilized. While there is evidence supporting cancer rehabilitation’s (Physical or Occupational therapy, PT/OT) ability to improve physical function and upper extremity disability among breast cancer survivors (BCS), the impact of cancer PT or OT on health and QOL is unknown. To understand this broader impact, we examined the rehabilitation needs and outcomes of BCS who attended specialized, community-based cancer PT/OT. Methods: In this retrospective study, we extracted case characteristics and patient-reported outcomes (PRO) measures of health, function and QOL from a national sample of BCS who attended cancer-specialized outpatient PT or OT. We examined ICD-10 codes to identify rehabilitation needs. PROs collected at baseline and discharge from rehabilitation included: Patient Reported Outcome Measuring System (PROMIS) global physical health, global mental health, physical function, and ability to participate in social roles and activities. To examine change from baseline to discharge we used paired t-tests ( p&lt; .05) and calculated effect size (Cohen’s d). Results: PT/OT patients (N = 2,706; PT, n = 2,245; OT, n = 461) were 99.6% female, 58.33±12.50 years old and attended approximately 10 (IQR: 7.0 – 17.0) sessions. Needs included: muscle atrophy, weakness or ataxia (PT: 44%, OT: 32%); lymphedema (PT: 40%, OT: 56%); upper extremity impairment (PT: 44%, OT: 28%); pain (PT: 44%, OT: 25%); and scar tissue or fibrosis (PT: 15%, OT: 16%). At discharge, all health, function and QOL-related outcomes improved significantly (p &lt; .001) in both PT and OT. Specifically, significant gains in PROMIS global physical health (PT: M∆ = 3.56±7.21, d= 0.49; OT: M∆ = 2.26±7.03, d= 0.32), global mental health (PT: M∆ = 2.01±6.91, d= 0.29; OT: M∆ = 1.34±7.20, d= 0.19), physical function (PT: M∆ = 2.81±7.45, d= .38, M∆ = 1.91±7.39, d= .26), and participation in social roles &amp; activities (PT: M∆ = 3.24±9.09, d= .36; OT: M∆ = 1.91±8.41, d= .23) were observed. Conclusions: BCS presented to community-based outpatient rehabilitation with a variety of needs yet, despite this variety, demonstrated significant improvement in self-perceived health, physical function and QOL. Significant gains were reported for both PT and OT interventions. For providers working with BCS, these results can be used to increase awareness of the role of cancer rehabilitation and support referral to these services. Future research should evaluate the impact of specialized PT/OT on individuals with other cancer types.

Cross-country comparison of income-related inequality in physical functional disability among middle-aged and older adults: Evidence from 33 countries

Physical functional disability is prevalent among middle-aged and older adults, with substantial health inequality. This study compared cross-country variation in the prevalence and inequality of physical functional disability and investigated the potential determinants of household income-related inequality.This cross-sectional study used data from 33 countries between 2017 and 2020, containing 141 016 participants aged 55 years and older. Physical functions were grouped into three domains: activities of daily living (ADLs), instrumental activities of daily living (IADLs), and mobility function. Physical functional disability of each domain was indicated by having some difficulty with the activity. We first estimated the prevalence of physical functional disability in each country. Second, the concentration index was used to quantify household income-related health inequality. Finally, recentred influence function (RIF) decomposition method was used to decompose the inequality into individual and country-level determinants.Physical functional disability prevalence was higher in lower-middle-income countries than in high-income countries and more prevalent in the poor-income groups in all study countries. Besides, health inequality in different domains of disability was higher in high-income countries than in low-income countries. Regarding determinants of health inequality, we found that individual married, tertiary education, and country-level health infrastructure and resources were associated with reduced health inequality. In contrast, age, unhealthy lifestyles, and chronic diseases were associated with increased health inequality.Inequality in physical functional disability among middle-aged and older adults varies substantially across countries, with individual and macro determinants being contributing factors. Policies to achieve healthy ageing and reduce the inequality of physical function disability can focus on improving individual healthy lifestyles and country health care facilities.

Impact of key manifestations of psoriatic arthritis on patient quality of life, functional status, and work productivity: findings from a real-world study in the United States and Europe.

To determine the individual impact of key manifestations of psoriatic arthritis (PsA) on quality of life (QoL), physical function, and work disability. Data from the Adelphi 2018 PsA Disease-Specific Programme, a multinational, cross-sectional study of PsA patients were used. PsA manifestations included peripheral arthritis (number of joints affected), psoriasis (body surface area [BSA]), axial involvement (inflammatory back pain [IBP] and sacroiliitis) enthesitis, and dactylitis. General, and disease-specific QoL, physical function, and work disability were measured with EQ-5D-5L, PsAID-12, HAQ-DI, and WPAI, respectively. Multivariate regression adjusting for potential confounders evaluated the independent effect of PsA manifestations on each outcome. Among the 2,222 PsA patients analysed, 77.0% had active psoriasis and 64.4% had peripheral arthritis; 5.9%, 6.8%, 10.2%, and 3.6% had enthesitis, dactylitis, IBP, or sacroiliitis, respectively. Mean EQ VAS scores were significantly poorer in patients with vs. without enthesitis (59.9 vs. 75.6), dactylitis (63.6 vs. 75.4), and with greater peripheral joint involvement (none: 82.5; 1-2 affected joints: 74.1; 3-6 joints: 74.2; >6 joints: 65.0). Significantly worse mean PsAID-12 scores were associated with vs. without enthesitis (4.39 vs. 2.34) or dactylitis (4.30 vs. 2.32), and with greater peripheral joint involvement (none: 1.21; 1-2 joints: 2.36; 3-6 joints: 2.74; >6 joints: 3.92), and BSA (none: 1.49; >3-10%: 2.96; >10%: 3.43). Similar patterns were observed with HAQ-DI and WPAI scores. Most PsA manifestations were independently associated with worse general, and PsA-specific QoL, physical function, and work disability, highlighting the need for treatments targeting the full spectrum of PsA symptoms to lower the burden of disease.

Physical activity and functional disability among older adults in Ghana: The moderating role of multi-morbidity.

Knowledge about how physical activity levels relate to functional disability is essential for health promotion and planning older adults' care or rehabilitation. The risk of living with one or more chronic health conditions increases with increasing age in lower and higher income countries-many of which are associated with physical inactivity. We conducted a cross-sectional study to examine the moderating role of multimorbidity on physical activity and its measures on functional disability among older adults in Ghana. Data from WHO's Study on global AGEing and adult health Ghana Wave 2 with a sample of 4,446 people aged 50+ years was used for this study. Functional disability was assessed using the 12-item WHO Disability Assessment Schedule 2.0. Three categories of physical activity levels were used: vigorous intensity, moderate intensity, and walking. Past month diagnosis by a doctor was used to assess the presence of a chronic condition, and the presence of two or more conditions was used to define multi-morbidity. Logistic regressions with a post hoc interactional tests were used to examine the associations. Overall, physical activity had a significant association with functional disability (OR = 0.25, 95%CI; 0.12, 0.32). A similar relationship was found for vigorous-intensity (OR = 0.19, 95%CI: 0.12, 0.29), moderate-intensity (OR = 0.19, 95%CI: 0.15, 0.25) and walking (OR = 0.41, 95%CI: 0.33, 0.51). Older adults living with one condition and physically active were 47% less likely to experience functional disability compared with the less active counterparts living with at least two chronic conditions. Among the three measures of physical activity, multimorbidity moderated the relationship between walking and functional disability. Future strategies for meeting the health and long-term care needs of older adults, particularly those living with only one chronic condition in Ghana should consider encouraging walking. Policies, financial assistance, family, and community level interventions aimed to promote and sustain physical activity among older adults should be a priority for stakeholders in Ghana.

The TOR concept (training, operation, and rehabilitation) applied to a cohort of postpartum women with training-resistant symptomatic rectus diastasis: evaluation 1 year after surgery.

Rectus diastasis is a common sequela of pregnancy and is associated with functional disabilities such as back pain, abdominal core instability, abdominal muscle weakness, urinary incontinence, and psychological issues such as a negative body image. The aim of this study was to evaluate the effect of the TOR concept (training, operation, and rehabilitation), a novel concept for treating abdominal wall insufficiency combined with rectus diastasis, after pregnancy. TOR consists of preoperative evaluation of symptoms and custom-designed abdominal core training, tailored rectus diastasis repair, and individual progressive postoperative rehabilitation. A consecutive series of women diagnosed with rectus diastasis and core dysfunction resistant to training, underwent plication of the linea alba between 2018 and 2020. After surgery, all patients participated in an individually designed rehabilitation programme over a 4-month interval. Physical function was recorded before surgery and 1 year after surgery using the disability rating index questionnaire. Symptoms associated with core instability were recorded before and 1 year after surgery. Quality of life was assessed using the SF-36. The abdominal wall anatomy was assessed with ultrasound before and 1 year after surgery. Seventy-one women were included and all attended 1-year follow-up. Response rate was 81.7 per cent (58) for the disability rating index, and 59.2 per cent (42) for SF-36. Self-reported physical function (disability rating index) improved in 54 of 58 patients (93.1 per cent), with a median score reduction of 91.3 per cent. Core instability symptoms decreased significantly. All SF-36 subscales improved significantly compared with preoperative scores, reaching levels similar to or higher than the normative Swedish female population. No recurrence of rectus diastasis was seen at the 1-year follow-up. Surgical reconstruction within the TOR concept resulted in significant improvements in physical function and quality of life as well as a significant decrease in symptoms of core instability.

Association of the malnutrition-inflammation score with physical function and functional disability in elderly patients with chronic kidney disease.

To describe nutritional status and inflammation of elderly patients with chronic kidney disease and to confirm the association between a Malnutrition-Inflammation Score and physical func-tion and functional disability. A total of 221 chronic kidney disease patients (aged ≥60 years) were included. A Malnutrition-Inflammation Score was used to assess malnutrition and inflammation. Physical function was assessed using the SF-12. Functional status was evaluated using basic activities of daily living and instrumental activities of daily living. Thirty percent of participants had a Malnutrition-Inflammation Score ≥6, which denoted poor nutritional status. Participants with a Malnutrition-Inflammation Score ≥6 had decreased concentration of hemoglobin, albumin, prealbumin, handgrip strength and walking speed and increased concentration of inflammatory markers, including CRP, IL-6 and fibrinogen. Physical function and physical component summary were lower and basic activities of daily living dependence and instrumental activities of daily living dependence were higher among patients with higher Malnutrition-Inflammation Score than those with a lower Malnutrition-Inflammation Score. The Malnutrition-Inflammation Score was an independent risk factor for physical function and instrumental activities of daily living dependence. The elderly chronic kidney disease patients with a high Malnutrition-Inflammation Score had a decreased physical function and an increased risk of functional instrumental activities of daily living dependence.

OA10 Sequential biologic usage in refractory psoriatic arthritis using ultrasound to detect psoriatic arthritis specific sub-clinical active disease

OA10 Sequential biologic usage in refractory psoriatic arthritis using ultrasound to detect psoriatic arthritis specific sub-clinical active disease

P-037: EXPLORATION OF THE REAL-WORLD IMPACTS OF SLEEP UPON QUALITY OF LIFE IN PATIENTS WITH SICKLE CELL DISEASE

Purpose: Previous studies have identified sleep-related metrics as important players in patient wellbeing, with links between sleep disturbances to both acute and chronic pain, as well as quality of life (QoL), overall physical health, functional disability, and clinical depression in Sickle Cell Disease (SCD). This work therefore aimed to improve patient QoL and overall outcomes through the identification of key underlying factors in patients with SCD. This focused on generating real-world evidence that describes the potential impact of live sleep biometrics upon patient QoL, driving understanding of causal factors and potential preventative best practice at a patient self-management and clinical level. Materials and methods: An FDA approved, CE marked wearable monitoring device (Withings ScanWatch) was provided to 85 patients and worn over a 12-month period, automatically recording key biometrics including sleep quality and heart rate. This was supplemented by manual patient self-reported EQ-5D scores, entered via a patient-reported outcomes (PRO) portal. Analysis was conducted within a final cohort of 54 patients (64%) who had both recorded sleep data and EQ-5D data. Patients were stratified into low, average, and high categories regarding their averages across several key sleep metrics, and where these averages fell within the calculated cohort percentiles. A comparison of the average EQ-5D score was then compared across patients between the three categories for each sleep metric, in order to identify any measures with potentially statistically significant impacts upon resulting patient QoL. Results: While no statistically significant differences were seen between the three categories in terms of their EQ-5D score across the measures ‘total sleep duration’, ‘sleep heart rate’, ‘number of wake ups per night’, ‘time spent awake’, ‘time to sleep’, and ‘time to wake up’, a potential link was seen between EQ-5D scores and ‘deep sleep’ levels. Indeed, analysis of the link between patients’ average percentage of deep sleep (as a proportion of total sleep duration) and EQ-5D score found that patients within the lower range (0-39%) had statistically significantly higher average EQ-5D scores than those in the high ranges (50-83%) of deep sleep (p = 0.030), as shown in Image 1 below. Conclusion: Our data identified an early association between the amount of deep sleep patients with SCD have and their self-reported EQ-5D scores, as an indicator of QoL, suggesting longer periods of deep sleep each night may be linked to lower patient-perceived wellbeing. Moreover, previous publications have indicated an optimal deep sleep percentage between 13-23% of total sleep duration, our data suggesting that a significant proportion of this patient cohort exceeded the accepted levels of “healthy” deep sleep (96%, 52/54). Further investigation is required to explore any potential causal relationship, in order to establish whether poorer QoL may see patients enter longer periods of deep sleep, or whether this widespread excess in deep sleep itself exerts an impact upon patient QoL in SCD. Future Steps Expansion to a larger cohort of patients, with analysis for breakdown between different patient subgroups, including genotype, age, and gender. Exploration of any additional links to measures such as healthcare utilisation, comorbidities, or pathology results. Correlation between deep sleep percentage and EQ-5D score (left), with associated statistical significance analysis between patients within the low vs. high deep sleep categories (right). The authors do not declare any conflict of interest

Physical Symptoms, Distress, and Functional Disability in Youth With Chronic Orthostatic Intolerance.

Youth with chronic orthostatic intolerance (OI) can experience significant physical, social, and academic functional debilitation. Previous studies have indicated associations among symptom severity, psychosocial factors, and functional disability. However, empirically tested models explaining how different medical and psychosocial factors may contribute to functional disability are lacking. The current cross-sectional study aimed to evaluate mediation, moderation, and additive models of the effect of physical symptoms and psychological distress on functional disability. One hundred and sixty-five youth (13-22 years old) undergoing medical evaluation of chronic OI symptoms completed measures of autonomic dysfunction symptom severity, depressive and anxiety symptoms, and functional disability. Models were evaluated using tests of indirect effects and linear and logistic regression analyses. Results supported the mediation and additive effects models for depressive symptoms. Mediation, moderation, and additive models for hypothesized effects of anxiety symptoms were not supported. Results provide preliminary support for models in which OI symptoms affect functional debility via their effects on mood and in which depressive symptoms have unique and additive effects on functioning. Findings lay the foundation for longitudinal and experimental evaluation of biopsychosocial models of functional disability in youth with chronic OI and related conditions. Implications include the importance of a biopsychosocial conceptualization of OI symptoms and debility as a complex interplay of factors rather than as a purely physiological or psychological process.

Effect of the level of manual performance disability caused by exposure to vibration among sailors working on sailing speed vessels

Backgroundhand-arm vibration is one of the typical annoying physical factors. Hand-arm vibration syndrome (HAVS) is a disorder caused by vibrating working tools which vibrate hands beyond the threshold. Long-term HAVS may result in damage to blood vessels, chronic numbness in the fingers, bone injury, and muscular weakness. People are exposed to high-rate noise vibration in a variety of situations, including vessel employment and operating in tiny boats. Moreover, the extant study was conducted to examine manual function disability levels caused by Sailing Speed Vessels (SSV) vibration.MethodsThe extant study was quasi-experimental research in which, 52 male sailors in SSVs were chosen as the experimental group, and 27 office personnel were selected as the control group. The demographic factors questionnaire, DASH questionnaire, grip and pinch strength tests, the neurosensory exam, and the skill-dexterity test were all employed in this study. SPSS23 software was used to analyze the data.ResultsThe findings suggested that the experimental group experienced greater vibration disorder symptoms than the control group. Because the experimental group had a higher score, the individuals experienced poorer circumstances in terms of arm, shoulder, and hand impairment as compared to the control group. The mean grip strength of hands and fingers in two hands of the experimental group was lower than the control group (P < 0.05). There was a statistically significant relationship among grip strengths of both experimental and control groups (P < 0.05). There was a reduction in skill and dexterity of both dominant and non-dominant hands of members in the experimental group. According to the statistical tests, there was no significant association between dominant (P = 0.001) skills and non-dominant (P = 0.010) hands in experimental and control groups. There was not also any significant relationship between skill and dexterity of both hands (P = 0.001) and the dominant hand tweezer test (P = 0.001) in two experimental and control groups. There was a statistically significant association between experimental and control groups in terms of assembly skill and dexterity (P = 0.482).ConclusionIndividuals who are at risk of vibration experience less physical and sensory function. DASH score, grip strength, skill, and dexterity could predict the reduction in physical function disability.

Examining the impact of functional disability and cognitive impairment on mental health of Chinese elderly

ABSTRACT Depression and anxiety, as the two most prevalent psychiatric disorders, pose a huge challenge to the quality of life of the elderly. Using a sample of 7,721 elderly from the latest Chinese Longitudinal Health and Longevity Survey (CLHLS), the present study intended to explore the association between mental health and socioeconomic status, physical functional disability, and cognitive impairment among Chinese elderly by adopting multivariate logistic regression analyses. The results revealed that depression, anxiety, and their comorbidity are significantly higher in the elderly with instrumental activities of daily living (IADL) disability, cognitive impairment, financial strain, and living alone. Findings of the study will provide implications for policymakers, social workers, and individual caregivers to develop necessary intervention measures to improve the mental health of the elderly and promote successful aging.

Longitudinal Trajectories of Quality of Life Among People With Mild-to-Moderate Dementia: A Latent Growth Model Approach With IDEAL Cohort Study Data.

ObjectivesWe aimed to examine change over time in self-rated quality of life (QoL) in people with mild-to-moderate dementia and identify subgroups with distinct QoL trajectories.MethodsWe used data from people with mild-to-moderate dementia followed up at 12 and 24 months in the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort study (baseline n = 1,537). A latent growth model approach examined mean change over time in QoL, assessed with the QoL-AD scale, and investigated associations of baseline demographic, cognitive, and psychological covariates with the intercept and slope of QoL. We employed growth mixture modeling to identify multiple growth trajectories.ResultsOverall mean QoL scores were stable and no associations with change over time were observed. Four classes of QoL trajectories were identified: 2 with higher baseline QoL scores, labeled Stable (74.9%) and Declining (7.6%), and 2 with lower baseline QoL scores, labeled Stable Lower (13.7%) and Improving (3.8%). The Declining class had higher baseline levels of depression and loneliness, and lower levels of self-esteem and optimism, than the Stable class. The Stable Lower class was characterized by disadvantage related to social structure, poor physical health, functional disability, and low psychological well-being. The Improving class was similar to the Stable Lower class but had lower cognitive test scores.DiscussionUnderstanding individual trajectories can contribute to personalized care planning. Efforts to prevent decline in perceived QoL should primarily target psychological well-being. Efforts to improve QoL for those with poorer QoL should additionally address functional impairment, isolation, and disadvantage related to social structure.

Potential utility of physical function measures to improve the risk prediction of functional disability in community-dwelling older Japanese adults: a prospective study

BackgroundWhile gait speed, one-leg standing balance, and handgrip strength have been shown to be independent predictors for functional disability, it is unclear whether such simple measures of physical function contribute to improved risk prediction of functional disability in older adults.Methods A total of 1,591 adults aged ≥ 65 years and without functional disability at baseline were followed up for up to 7.9 years. Functional disability was identified using the database of Japan’s Long-term Care Insurance System. Maximum gait speed, one-leg standing time, and handgrip strength were measured at baseline. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95 % confidence intervals (CIs) for the association of physical function and functional disability incidence. The incremental predictive value of each physical function measure for risk prediction was quantified using the difference in overall C-statistic, category-free net reclassification improvement (NRI), and integrated discrimination improvement (IDI) index.ResultsDuring follow-up (median: 7.8 years), functional disability was identified in 384 participants. All of the physical function measures were inversely associated with the risk of functional disability, independent of potential confounding factors. The multivariable adjusted HRs (95 % CIs) for functional disability per one standard deviation increment of maximum gait speed, one-leg-standing time, and hand grip strength were 0.73 (0.65–0.83), 0.68 (0.59–0.79), and 0.72 (0.59–0.86), respectively. Incorporation of each of maximum gait speed, one-leg-stand time, and hand grip strength into a basic model with other risk factors significantly improved C-statistic from 0.770 (95 % CIs, 0.751–0.794) to 0.778 (0.759–0.803), 0.782 (0.760–0.805), and 0.775 (0.756–0.800), respectively (all p < 0.05). A model including all three measures had the highest C-statistic of 0.787 (0.765–0.810). The improvements in risk prediction were also confirmed by category-free NRI and IDI index.ConclusionsAdding any of the three measures to a basic model with other known risk factors significantly improved the prediction of functional disability and addition of all three measures provided further improvement of the prediction in older Japanese adults. These data provide robust evidence to support the practical utility of incorporating these simple physical function measures into functional disability risk prediction tools.

Malnutrition Risk, Physical Function Decline and Disability in Middle-Aged and Older Adults Followed Up in the Singapore Longitudinal Ageing Study.

PurposeMalnutrition and population ageing are doubly global healthcare challenges. It is widely recognized that disability is a major contributor to malnutrition among older people, but the importance of reducing malnutrition risk (MR) for disability prevention is given little attention. We investigated the association between MR and risk of incident disability and functional decline among community-dwelling older persons.Materials and MethodsProspective cohort study of community-dwelling older adults aged 55 and above (Singapore Longitudinal Ageing Study) with 3–5 years follow-up. MR was measured at baseline using an appropriate and validated index (ENIGMA); physical and functional measures at baseline and follow-up included instrumental and basic activity of daily living (ADL), knee extension (KES), gait velocity (GV), timed up-and-go (TUG).ResultsCompared to low MR, mild-moderate MR (OR = 1.43, 95% CI = 1.02–2.01) and severe MR (OR=1.74, 95% CI=1.10–2.74) were associated with higher risks of incident disability. Severe MR was associated with functional decline (OR = 1.69, 95% CI = 1.11–2.57). Estimates were adjusted for demographic, social, lifestyle behaviour and health variables. In particular, eating difficulty was associated with incident disability and functional decline, and low lymphocyte with functional decline. Severe MR and low albumin were associated with 37% worse GV and 126% worse TUG declines; consuming few vegetables or fruits with 34% worse KES decline; polypharmacy with 56% worse TUG decline.ConclusionMalnutrition risk increased the risk of incident disability and functional decline in non-disabled persons, it worsened physical performance declines. Further studies should investigate the effectiveness of nutritional interventions in reducing the risk of disability among older people.