Physical Function In Patients Research Articles

Yoga in the Rehabilitation of Post-Stroke Sequelae: A Non-Inferiority Randomized Controlled Trial.

Introduction: Stroke survivors can experience various consequences that affect their physical and psychological balance. Yoga seems to be relevant for this population as it allows to work on both the body and the mind. The first objective of this study was to investigate the non-inferiority of yoga compared with conventional physical activity in improving physical function in patients with chronic post-stroke sequelae. The secondary objective was to investigate the superiority of yoga in improving the mental health of these patients. Methods: A randomized controlled trial was conducted. Thirty-six patients were randomized into two groups to practice a yoga program (YOG'AVC) or the Fitness and Mobility Exercise (FAME) program. Patients were assessed in a blinding mode pre- (T0) and post-program (T1) and 3-4 months after completion (T2). The physical assessments were the Berg Balance Scale, timed up and go test, 6-minute walk test, and quadriceps strength measured by hand-held dynamometer. Questionnaire assessments were: Activities-specific Balance Confidence Scale-Simplified, State-Trait Anxiety Inventory, Beck's Depression Inventory, and the Reintegration to Normal Living Index. Results: The YOG'AVC program was not inferior to the FAME program in improving balance, functional mobility and muscle strength. Both groups showed significant improvement (p < 0.05) between T0 and T1 in their anxiety, depression, and reintegration to normal life scores, with no significant difference between groups. Discussion: Both programs seem to be valuable in improving the physical abilities and psychological well-being of chronic post-stroke patients. However, further studies are required to confirm the difference between these programs.

Exercise intervention for patients with chronic low back pain: a systematic review and network meta-analysis.

Chronic low back pain (CLBP) is an aging and public health issue that is a leading cause of disability worldwide and has a significant economic impact on a global scale. Treatments for CLBP are varied, and there is currently no study with high-quality evidence to show which treatment works best. Exercise therapy has the characteristics of minor harm, low cost, and convenient implementation. It has become a mainstream treatment method in clinics for chronic low back pain. However, there is insufficient evidence on which specific exercise regimen is more effective for chronic non-specific low back pain. This network meta-analysis aimed to evaluate the effects of different exercise therapies on chronic low back pain and provide a reference for exercise regimens in CLBP patients. We searched PubMed, EMBASE, Cochrane Library, and Web of Science from inception to 10 May 2022. Inclusion and exclusion criteria were used for selection. We collected information from studies to compare the effects of 20 exercise interventions on patients with chronic low back pain. This study included 75 randomized controlled trials (RCTs) with 5,254 participants. Network meta-analysis results showed that tai chi [standardized mean difference (SMD), -2.11; 95% CI, -3.62 to -0.61], yoga (SMD, -1.76; 95% CI -2.72 to -0.81), Pilates exercise (SMD, -1.52; 95% CI, -2.68, to -0.36), and sling exercise (SMD, -1.19; 95% CI, -2.07 to -0.30) showed a better pain improvement than conventional rehabilitation. Tai chi (SMD, -2.42; 95% CI, -3.81 to -1.03) and yoga (SMD, -2.07; 95% CI, -2.80 to -1.34) showed a better pain improvement than no intervention provided. Yoga (SMD, -1.72; 95% CI, -2.91 to -0.53) and core or stabilization exercises (SMD, -1.04; 95% CI, -1.80 to -0.28) showed a better physical function improvement than conventional rehabilitation. Yoga (SMD, -1.81; 95% CI, -2.78 to -0.83) and core or stabilization exercises (SMD, -1.13; 95% CI, -1.66 to -0.59) showed a better physical function improvement than no intervention provided. Compared with conventional rehabilitation and no intervention provided, tai chi, toga, Pilates exercise, sling exercise, motor control exercise, and core or stabilization exercises significantly improved CLBP in patients. Compared with conventional rehabilitation and no intervention provided, yoga and core or stabilization exercises were statistically significant in improving physical function in patients with CLBP. Due to the limitations of the quality and quantity of the included studies, it is difficult to make a definitive recommendation before more large-scale and high-quality RCTs are conducted.

Body Mass Index, Quality of Life and Activity Limitation Trajectories over 2 Years in Patients with Knee or Hip Osteoarthritis: A Dual Trajectory Approach Based on 4265 Patients Included in the AktivA Quality Register.

(1) Background: Recent studies claim that weight-neutral approaches emphasizing physical activity might be as effective as weight-loss-centered approaches for improving pain and physical function in patients with knee and hip osteoarthritis. The objectives were to identify distinctive groups of individuals with similar BMI, quality of life and activity limitation trajectories over two years, to compare the overall differences between BMI trajectory groups for baseline variables and to explore the probabilities of the quality of life and activity limitation trajectory groups conditional on the BMI group. (2) Methods: Baseline data for age, gender, BMI, quality of life, activity limitations, pain, general health, knee or hip osteoarthritis and follow-up data on BMI, quality of life and activity limitations at 3, 12 and 24 months were retrieved from the "Active with osteoarthritis" (AktivA) electronic quality register. Group-based trajectory modeling was used to identify distinct trajectories for BMI, quality of life and activity limitations. (3) Results: 4265 patients were included in the study. Four distinct BMI trajectories were identified, normal weight (31%), slightly overweight (43%), overweight (20%) and obese (6%). At baseline, there were highly significant differences between all BMI groups, pain increased and age and general health decreased with higher BMI. Irrespective of weight category, minimal changes in BMI were found over the two-year follow-up period. Over 80% of the participants showed moderate-to-considerable improvements both in quality of life and activity limitations. (4) Conclusions: Almost 70% of the participants belonged to the overweight trajectories. Despite no significant weight reduction over the two years, eight in every 10 participants improved their quality of life and reduced their activity limitations after participating in the AktivA program.

Psychometric Properties of the Japanese Version of the Edmonton Functional Assessment Tool 2

ContextPhysical symptoms such as pain and cancer-related fatigue limit physical function and activities of daily living among patients with terminal cancer, which can lead to a decline in quality of life. Therefore, comprehensive functional impairments should be evaluated to determine the progression of the disease and the effectiveness of palliative treatment. ObjectiveTo validate the psychometric properties of the Japanese version of the Edmonton Functional Assessment Tool 2 (EFAT2-J). MethodsWe developed a Japanese version of the EFAT-2 in accordance with international guidelines. To verify the reliability and validity of the EFAT2-J, patients were evaluated by a physiotherapist and a nurse separately, and correlations with existing evaluation scales for physical function, physical symptoms, and quality of life were analyzed, respectively. The significance level was set at 5%. ResultsTwenty patients participated in the reliability measurement. The average EFAT2-J scores were 7.95 ± 4.12 for physical therapists and 7.20 ± 4.23 for nurses, and the intraclass correlation coefficient was 0.95. The weighted kappa coefficient (κ) for each item was 0.57–1.00. Fifty-five patients participated in the validity measurement. The EFAT2-J showed significant correlations with Eastern Cooperative Oncology Group Performance Status and the Karnofsky Performance Scale, Barthel Index, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative Care sub-item “physical function.” ConclusionThese results indicate that the EFAT2-J has robust psychometric properties and is useful for evaluating physical function in patients with terminal cancer, and thus may be an acceptable clinical instrument in research and practice.

Symptoms of anxiety and depression in patients with amyotrophic lateral sclerosis and their relatives during the disease trajectory

ObjectsThe aim of this study was to describe the presence of anxiety and depression among patients with Amyotrophic Lateral Sclerosis (ALS) and their relatives from diagnosis and during the disease progression. An additional aim was to explore if the patient's physical function correlated with the patients' or relatives' anxiety and depression. MethodsA prospective and longitudinal study, including 33 patients with ALS and their relatives who filled out the Hospital Anxiety and Depression Scale (HADS) at the time of diagnosis and over a period of two years. The patient's physical function was measured with the revised Amyotrophic Lateral Sclerosis Functional and Rating Scale (ALS FRS-R). ResultsThe results showed that many patients (45%) and relatives (58%) had symptoms of anxiety and that 13% of the patients and 29% of the relatives had symptoms of depression soon after the patient had been diagnosed with ALS. The prevalence of anxiety decreased over time in the group of patients but remained stable in the group of relatives. Relatives had more symptoms of anxiety compared to patients. There was a correlation between the patient's physical function and HADS in the group of relatives; however, no correlation was found in the group of patients. ConclusionThe results showed that many patients and relatives suffered from symptoms of anxiety quite soon after their diagnosis, and that many relatives had symptoms of anxiety during the disease trajectory. This highlights the need to continuously measure patients' anxiety/depression level but also to pay attention to symptoms among relatives.

Working mode of oncology surgical pharmacy in China

Surgery plays an irreplaceable role in the prevention, diagnosis, staging, reconstruction, and rehabilitation in the overall management of cancer. Nevertheless, it is difficult for surgeons and nurses to take into account the details of medication management, considering the impact of surgery on the patient's physical function and the complexity of anti-tumor treatment with comorbidity. The pharmaceutical care services previously provided by pharmacists in oncology focus more on the internal medicine system, not widely the surgical field. At present, the pharmaceutical working mode in oncology surgery has not well been formed around China, and the whole process medication management needs to be improved. In 2015, the GuangDong Pharmaceutical Association came up with the concept of surgical pharmacist in China and subsequently created its position. In 2021, the GuangDong Pharmaceutical Association established a new discipline termed “surgical pharmacy”, which is the knowledge system of surgical pharmacists, and also tried to differentiate surgical pharmacy into diverse areas, such as oncology surgical pharmacy. This article introduced a working mode of surgical pharmacists in China that providing pharmaceutical care services in perioperative period around anti-tumor, anti-infection, anesthesia, anticoagulation, blood pressure, blood glucose, nutrition, and pain management, to improve quality of life for patients.

SIOG2023-1-OA-100 - Effect of geriatric intervention on physical function in patients operated for colorectal cancer

SIOG2023-1-OA-100 - Effect of geriatric intervention on physical function in patients operated for colorectal cancer

Single-facility study of the effectiveness of rehabilitation therapy using wearable hybrid assistive limb for patients with bleeding disorders: study protocol for a randomised controlled trial

IntroductionHaemophilic arthropathy, a serious complication of haemophilia, results from recurrent joint bleeding, causing progressive joint damage and severely impacting patient quality of life. Rehabilitation therapy (RT) effectively addresses declining physical...

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

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

Impact of walk advice alone or in combination with supervised or home-based structured exercise on patient-reported physical function and generic and disease-specific health related quality of life in patients with intermittent claudication, a secondary analysis in a randomized clinical trial

BackgroundSupervised exercise is an integral part of the recommended first-line treatment for patients with intermittent claudication (IC). By reflecting the patients’ perspectives, patient-reported outcome measurements provide additional knowledge to the biomedical endpoints and are important outcomes to include when evaluating exercise interventions in patients with IC. We aimed to evaluate the one-year impact of three strategies: unsupervised Nordic pole walk advice (WA), WA + six months of home-based structured exercise (HSEP) or WA + six months of hospital-based supervised exercise (SEP) on health-related quality of life and patient-reported physical function in patients with IC.MethodsThis secondary exploratory analysis of a multi-center, randomized clinical trial compared three exercise strategies. The primary outcome of the secondary analysis was the one-year change in the 36-Item Short-Form (SF-36). Secondary outcomes were three- and six-months SF-36 changes alongside three, six- and 12-months changes in the disease-specific Vascular Quality of Life instrument (VascuQoL) and the Patient-Specific Functional Scale (PSFS). The Kruskal–Wallis test with Bonferroni-adjusted post-hoc tests were used for between-group comparisons. Effect size calculations were used to describe the size of observed treatment effects, and the clinical meaningfulness of observed changes in the VascuQoL summary score at one year was studied using established minimally important difference (MID) thresholds.ResultsA total of 166 patients with IC, mean age: 72.1 (SD 7.4) years, 41% women, were randomized. No significant between-group differences were observed over time for the SF-36 or the PSFS scores whereas some significant between-group differences were observed in the VascuQoL domain and summary scores over time, favoring SEP and/or HSEP over WA. The observed SF-36 and VascuQoL domain and summary score effect sizes were small to moderate, and many domain score effect sizes also remained unchanged over time. A significantly higher proportion of the patients in the SEP group reached the VascuQoL summary score MID of improvement in one year.ConclusionClinically important improvements were observed in SEP using the VascuQoL, while we did not observe any significant between-group differences using the SF-36. Whereas effect sizes for the observed changes over time were generally small, a significantly higher proportion of patients in SEP reached the VascuQoL MID of improvement.Trial registrationNCT02341716, January 19, 2015 (retrospectively registered).

The prevalence and characteristics of diffuse idiopathic skeletal hyperostosis in the community-living middle-aged and elderly population: The Yakumo study

BackgroundThe incidence of diffuse idiopathic skeletal hyperostosis (DISH) is increasing with the aging of the population. Asymptomatic DISH can decrease the spinal range of motion (ROM) and cause fractures. However, the prevalence or physical function of patients with DISH before experiencing fractures and other serious conditions is unclear. This study aimed to investigate the prevalence of DISH in the community residents on the basis of age and sex and characterize their physical function, ROM, and bone fragility. MethodsThe subjects were community volunteers who attended a health checkup in 2018 and 2019. Overall, 455 subjects (mean age, 64.2 ± 9.7 years; 177 men) were included for analysis. We performed whole-spine lateral radiography for detecting DISH according to the criteria reported by Resnick. We compared the age, sex, body mass index (BMI), results of muscle strength and walking tests, ROM measured by SpinalMouse®, and quantitative ultrasound (QUS) of calcaneus with and without DISH. ResultsDISH was detected in 83 (18.2%) cases. The DISH group was older (69.8 y.o. vs. 63.0 y.o.; p < 0.05) and comprised more men (prevalence: men, 27.7%; women, 12.2%; p < 0.001). BMI was high in the DISH group (24.8 vs. 23.3 kg/m2, p < 0.05). SpinalMouse measurements showed the DISH group had a significantly decreased ROM in the lumbar spine (43.2°, 57.2°, p < 0.05). The DISH group had a significantly lower T-score on the QUS measurement in the calcaneus (−2.0, −1.5, p < 0.05). There were, however, no significant differences between groups in both muscle strength test and walking test. ConclusionSubjects with DISH had decreased ROM in the lumbar spine and bone mineral density in calcaneal QUS. However, physical functions such as muscle strength and walking ability were similar among subjects with and without DISH without subjective symptoms.

PROMIS Scores for Chronic Plantar Fasciitis Before and After Gastrocnemius Recession

Category: Ankle; Hindfoot Introduction/Purpose: There has been an established relationship between increased loading on the Achilles tendon and tension on the plantar fascia. This supports the idea that either tight gastrocnemius and soleus muscles or contractures of the Achilles tendon are risk factors for plantar fasciitis. Gastrocnemius recession has gained popularity as a viable surgical intervention for cases of chronic plantar fasciitis due to isolated gastrocnemius contracture. To our knowledge, this is the first study to investigate PROMIS scores in patients with plantar fasciitis before and after gastrocnemius recession. Methods: The Electronic Medical Record was queried for medical record numbers associated with Current Procedural Terminology code 27687 (gastrocnemius recession). Our study included all patients with a preoperative diagnosis of chronic plantar fasciitis with treatment via isolated gastrocnemius recession with one-year minimum follow-up. 40 patients were included in our study. Patient variables were collected via chart review. Preoperative and postoperative PROMIS scores were collected in the clinic. Results: Preoperative and postoperative PROMIS scores improved for physical function and pain interference from 39.27 and 62.78 to 44.54 and 56.5 (p=0.0005, p=0.0001) respectively, PROIMS Depression scores were not significantly different (p=0.6727). VAS scores significantly decreased from 7.05 to 1.71 (p &lt; 0.0001). Patients with preoperative peripheral neuropathy had significantly lower improvement in PROMIS physical function scores (p=0.0029). Tobacco use led to significantly lower improvement in in PROMIS depression (p=0.0202). Conclusion: Gastrocnemius recession is an effective option for patients with refractory pain in plantar fasciitis. Our PROMIS and VAS data confirm this procedure's utility and highlight its ability to significantly decrease pain and improve physical function in patients with chronic plantar fasciitis. We believe we have added to the literature by incorporating the, inherently superior, PROMIS scores. Based on the results of this study, the authors recommend gastrocnemius recession for patients who fail conservative management for plantar fasciitis.

A Comprehensive Exercise (COMEX) Intervention to Optimize Exercise Participation for Improving Patient-Centered Outcomes and Physical Functioning in Patients Receiving Hemodialysis: Development and Pilot Testing

To address the need for an intradialytic exercise program that is easily delivered in clinical setting, engaging and scalable, we developed a novel COMprehensive EXercise (COMEX) program based on input from patients receiving hemodialysis (HD), dialysis staff members and nephrologists. The objective of this study was to determine the feasibility, safety, and acceptance of COMEX during HD. Single-arm prospective pilot feasibility study. Seventeen patients receiving in-center HD. Three-month participation in the COMEX program, which included video-based dialysis chair exercises (aerobic and resistance) integrated with educational and motivational components. Data on recruitment, adherence, safety and acceptability were collected. Additional assessments were performed to evaluate changes in physical functioning, patient-reported symptoms, and objectively measured sleep and physical activity. We also examined the feasibility of obtaining skeletal muscle biopsies and blood samples to explore molecular mechanisms of muscle atrophy and to assess platelet mitochondrial function and adaptation to exercise during HD. Thirteen of the 17 (76%) participants completed the 3-month intervention. The mean participant age was 63.6±15.1 years. In total, 46% of participants were males, and 55% were White. The mean body mass index was 38.7±11.6kg/m2. There were no reported adverse effects, and the adherence rate to exercise sessions was high with 88% of the sessions completed. Patient satisfaction was high, as 100% of the patients would recommend the program to other dialysis patients. It was feasible to collect data on physical functioning, patient-reported symptoms, and objective sleep and physical activity and to obtain muscle biopsies and blood samples. Small sample size, lack of an onsite exercise professional, and technological issues with telemedicine behavioral motivation. The COMEX intradialytic exercise intervention is safe and acceptable to patients, and outcome measures were feasible to obtain. Future studies should consider including exercise professionals to facilitate progression through a personalized exercise protocol. This work is supported by pilot award from P30 DK079307 (PI, Jhamb). ClinicalTrials.gov, NCT03055299. We tested a new COMprehensive EXercise (COMEX) program to deliver exercise during dialysis. This 3-month program included video-based dialysis chair exercises (aerobic and resistance) integrated with educational and motivational components. Our study shows COMEX was feasible, had high satisfaction and adherence, and was safe. It was feasible to collect data on physical functioning, patient-reported symptoms, and objective sleep and physical activity and to obtain muscle biopsies and blood samples. Future studies should consider including exercise professionals to facilitate progression through a personalized exercise protocol.

Effectiveness of exercise on pain intensity and physical function in patients with knee and hip osteoarthritis: an umbrella and mapping review with meta-meta-analysis

Purpose The aim of this review was to provide a qualitative and quantitative overview of the effects of exercise on pain, physical function, and quality of life for patients with knee and hip osteoarthritis. Materials and methods This study was an umbrella and mapping review with meta-meta-analysis. Meta-analyses of randomized controlled trials were included. The methodological quality and risk of bias were evaluated using the Modified Quality Assessment Scale for Systematic Reviews and the Risk of Bias in Systematic Reviews tool. The quality of evidence was evaluated using the Physical Activity Guidelines Advisory Committee Grading Criteria. Results 41 meta-analyses were included, 43.9% of the studies had adequate methodological quality, and 56.1% of the studies had a low risk of bias. Moderate evidence was found that exercise decreases pain intensity (33 meta-analyses; SMD = −0.49; 95% CI −0.56 to −0.42), improves function (19 meta-analyses; SMD = −0.50; 95% CI −0.58 to −0.41), strength (6 meta-analyses; SMD = −0.57; 95% CI −0.70 to −0.44) and quality of life (SMD = −0.36; 95% CI −0.46 to −0.27) for patients with hip and knee osteoarthritis. Conclusion Exercise is an effective intervention to decrease pain intensity and improve function in patients with hip and knee osteoarthritis. (PROSPERO, CRD42020221987)

The effects of end-range interventions in the management of primary adhesive capsulitis of the shoulder: a systematic review and meta-analysis

Purpose To compare the effects of end-range manual therapy versus other conservative intervention on pain intensity, shoulder range of movement (ROM), and physical function in adhesive capsulitis (AC). Methods Two reviewers conducted a comprehensive search from inception to December 2022. PUBMED, Cochrane Library, CINAHL, EMBASE, and PEDro databases were searched. Clinical trials investigating the effects of end-range mobilisation techniques on pain, ROM, and physical function in patients with AC were included. Methodological quality was evaluated using the PEDro scale, and bias risk was assessed using the Cochrane Collaboration tool. GRADE was used to assess the certainty of the evidence. Data were presented using forest plots, and the random effects models were applied according to the Cochrane handbook. Results Ten randomised controlled trials were reviewed, involving 424 AC patients aged 20–70 years. Methodological quality of studies ranged from high to low. The end-range mobilisation showed improvements in pain intensity, shoulder abduction, internal rotation, and external rotation, and physical function compared to other conservative interventions in the short-and medium-terms. Certainty of the evidence was downgraded to very low. Conclusions Very low certainty evidence suggests that end-range mobilisation techniques improve pain intensity, shoulder ROM, and physical function in the short-and medium-term in AC.

Minimal Clinically Important Differences of Patient-Reported Outcomes Measurement Information System Physical Function in Patients With Tibial Shaft Fracture.

To calculate the minimal clinically important differences (MCIDs) of patient-reported outcomes measurement information system physical function (PROMIS PF) scores for patients with operatively treated tibial shaft fractures. Retrospective Cohort Study. A Level 1 trauma center. All operatively treated tibial shaft fractures identified by Current Procedural Terminology codes. Enrolled patients treated acutely with operative fixation of their tibia. MCIDs were calculated by distribution-based and anchor-based methods, calculated from PROMIS PF scores completed at least at two-time points postoperatively. MCIDs were calculated at different time points including overall, 7-12 weeks, 3-6 months, and 6-24 months. MCIDs were calculated for different subgroups including open fractures, closed fractures, any complications, and no complications. MCID for PROMIS PF scores was 5.7 in the distribution-based method and 7.84 (SD 18.65) in the anchor-based method. At 6-24 postoperatively, the months the distribution-based MCID was 5.95 from a postoperative baseline 27.83 (8.74) to 42.85 (9.61), P < 0.001. At 6-24 months, the anchor-based MCID was 10.62 with a score difference between the improvement group of 16.03 (10.73) and the no improvement group of 5.41 (15.75), P < 0.001. Patients with open fractures (distribution-based 6.22 and anchor-based 8.05) and any complications (distribution-based 5.71 and anchor-based 9.29) had similar or higher MCIDs depending on the methodology used than the overall cohort MCIDs. This study identified distribution-based MCID of 5.7 and anchor-based MCID of 7.84 calculated from PROMIS PF scores in operative tibial shaft fractures. Distribution-based methods yielded smaller MCIDs than anchor-based methods. These MCID scores provide a standard to compare clinical and investigational outcomes.

Impact of Vutrisiran on Quality of Life and Physical Function in Patients with Hereditary Transthyretin-Mediated Amyloidosis with Polyneuropathy.

Hereditary transthyretin (ATTRv; v for variant) amyloidosis, also known as hATTR amyloidosis, is a progressive and fatal disease associated with rapid deterioration of physical function and patients' quality of life (QOL). Vutrisiran, a subcutaneously administered RNA interference (RNAi) therapeutic that reduces hepatic production of transthyretin, was assessed in patients with ATTRv amyloidosis with polyneuropathy in the pivotal HELIOS-A study. The phase 3 open-label HELIOS-A study investigated the efficacy and safety of vutrisiran in patients with ATTRv amyloidosis with polyneuropathy, compared with an external placebo group from the APOLLO study of the RNAi therapeutic patisiran. Measures of QOL and physical function were assessed. At month 18, vutrisiran improved Norfolk Quality of Life-Diabetic Neuropathy (Norfolk QOL-DN) total score (least squares mean difference [LSMD] in change from baseline [CFB]: -21.0; p=1.84×10-10) and Norfolk QOL-DN domain scores, compared with external placebo. This benefit relative to external placebo was evident across all baseline polyneuropathy disability (PND) scores and most pronounced in patients with baseline PND scores I-II. Compared with external placebo, vutrisiran also demonstrated benefit in EuroQoL-Visual Analog Scale (EQ-VAS) score (LSMD in CFB: 13.7; nominal p=2.21×10-7), 10-m walk test (LSMD in CFB: 0.239m/s; p=1.21×10-7), Rasch-built Overall Disability Score (LSMD in CFB: 8.4; p=3.54×10-15), and modified body mass index (mBMI) (LSMD in CFB: 140.7; p=4.16×10-15) at month 18. Overall, Norfolk QOL-DN, EQ-VAS, and mBMI improved from pretreatment baseline with vutrisiran, whereas all measures worsened from baseline in the external placebo group. At month 18, Karnofsky Performance Status was stable/improved from baseline in 58.2/13.1% with vutrisiran versus 34.7/8.1% with external placebo. Vutrisiran treatment provided significant clinical benefits in multiple measures of QOL and physical function in patients with ATTRv amyloidosis with polyneuropathy. Benefits were most pronounced in patients with earlier-stage disease, highlighting the importance of early diagnosis and treatment. ClinicalTrials.gov: NCT03759379.

Body Composition, Physical Function and Exercise Capacity in Chronic Obstructive Pulmonary Disease

Current literature yields unequivocal results regarding the effect of body composition on physical function in patients with chronic obstructive pulmonary disease and disproportionately includes a majority of males. The purpose of this study was to determine whether specific body composition measures are significantly associated with physical function and exercise capacity in patients with chronic obstructive pulmonary disease with equal representation of males and females. Independent variables included sex, total body mass, total body lean and fat mass, appendicular total mass, and appendicular lean and fat mass. Dependent variables included peak oxygen consumption, 6-minute walk distance and self-reported physical function. Patients (n = 170) with dual-energy X-ray absorptiometry data, 6-minute walk distance, and self-reported physical function were used for these analyses. A sub-set of 145 of these patients with peak oxygen consumption data were also analysed. Hierarchical multiple regression analysis was used to determine if sex and body composition measures correlated with physical function and exercise capacity and if they explained additional variance after controlling for disease severity. After controlling for disease severity, appendicular lean mass, total body fat mass, and sex explained an additional 16.5% of the variance in peak oxygen consumption (p < 0.001). Appendicular lean mass explained an additional 8.9% of the variance in 6-minute walk distance (p < 0.001) and an additional 2.5% of the variance in self-reported physical function (p = 0.057). Body composition measures may further predict exercise capacity, 6-minute walk distance, and self-reported physical function in patients with chronic obstructive pulmonary disease.

Predictive Value of Malnutrition, Identified via Different Nutritional Screening or Assessment Tools, for Functional Outcomes in Patients with Stroke: A Systematic Review and Meta-Analysis.

Malnutrition affects more than half of patients with stroke. Although malnutrition leads to more deaths, a longer hospital stay, and higher costs, there is still a lack of consensus regarding the impact of malnutrition on physical functional outcomes in patients with stroke, and there are large differences in the diagnostic effects of nutritional screening or assessment tools for malnutrition. This study aimed to explore the impact of malnutrition in patients with stroke and assess the significance of current nutritional screening and assessment tools for these patients. Six databases were systematically searched until October 2022. Cohort studies meeting the eligibility criteria were included. Pooled effects were calculated using random-effects models. Twenty-six studies with 21,115 participants were included. The pooled effects of malnutrition on poor functional outcome, FIM points, and dysphagia were OR = 2.72 (95% CI = 1.84-4.06), WMD = -19.42(95% CI = -32.87--5.96), and OR = 2.80 (95% CI = 1.67-4.67), respectively. Malnutrition adversely affects the recovery of physical and swallowing functions in patients with stroke. Nutritional assessments consistently predict the outcomes of physical function in patients with stroke.

The Impact of Self-acupressure on the Pain, Joint Stiffness, and Physical Functioning of Patients With Knee Osteoarthritis

Background: People with knee osteoarthritis have a low quality of life due to joint pain and stiffness, severely limiting their daily activities. This study aims to investigate the impact of self-acupressure on the pain, joint stiffness, and physical functioning of patients with knee osteoarthritis. Methods: This randomized clinical trial was conducted on 78 patients aged 50 to 70 with knee osteoarthritis, referred to Imam Khomeini Hospital and private orthopedic clinics in Ahvaz City, Iran, in 2018. The patients were recruited based on the inclusion criteria and then randomly assigned to three groups: self-acupressure (n=26), sham (n=26), and control (n=26). Patients in the intervention group applied daily self-acupressure to 5 specific points around their knees for 8 consecutive weeks. The sham group applied pressure on the points different from those used by the intervention group. The control group received no intervention. The study data were collected using the Western Ontario and McMaster osteoarthritis index (WOMAC), visual analog scale (VAS), and a checklist for daily recordings of pain medication. The obtained data were analyzed using the chi-square test and analysis of variance in SPSS software, version 20. The significance level was set at P&lt;0.05. Results: The comparison of changes within the group showed that the intensity of pain in the intervention group decreased over time (P&lt;0.0001). Also, the joint stiffness, physical functioning, and total WOMAC score significantly decreased in the intervention group (P&lt;0.0001). The frequency of analgesic use was also reduced in the intervention group over time (P=0.026). Conclusion: According to the results, self-acupressure effectively reduces the intensity of pain and joint stiffness and improves the physical performance of older adults with knee osteoarthritis. Overall, this easy and affordable intervention is recommended for this group.