Limitations In Activities Of Daily Research Articles

Homoeopathic rare remedies for osteoarthritis of knee joint

The 2 nd most common rheumatological problem and most frequent joint disease is osteoarthritis. The prevalence of osteoarthritis in India ranges from 22% to 39%. OA is more common in females than males and its prevalence increases with advanced age. As per the literature available osteoarthritis of the knee joint is mostly seen in the population. Various complementary and alternative therapy is open to the patients to choose the best for themselves. There are side effects seen with NSAID’s thus patients are moving towards modalities in CAM. The homeopathic system of medicine has remedies that are already proven on human beings having no side effects to the patients, yet are effective. Homoeopathy offers a great chance for patients suffering from the pain, stiffness and limitation in daily activities. This particular article is listed with a few rare homoeopathic remedies indicated in homoeopathic materia medica for osteoarthritis like Angustura vera, ArgemoneMexicana, Formica rufa, Jacaranda Caroba, Osteoarthritic Nosode, Salicylic acid, Slag.

Biological, Psychiatric, Psychosocial, and Cognitive Factors of Poststroke Depression

Depression is the most common psychiatric condition that occurs after cerebrovascular accident, especially within the first year after stroke. Poststroke depression (PSD) may occur due to environmental factors such as functional limitations in daily activities, lower quality of life, or biological factors such as damage to areas in the brain involved in emotion regulation. Although many factors are hypothesized to increase the risk of PSD, the relative contribution of these factors is not well understood. We evaluated which cross-sectional variables were associated with increased odds of PSD in our adult outpatient stroke neuropsychology clinic population. The sample included 325 patients (49.2% female; mean age of 59-years old) evaluated at an average of 8.1 months after an ischemic or hemorrhagic stroke. Variables included in logistic regression were stroke characteristics, demographics, psychosocial factors, comorbid medical problems, comorbid psychiatric conditions, and cognitive status. The Mini International Neuropsychiatric Inventory was used to determine DSM-defined PSD and anxiety disorders. A standard neuropsychological test battery was administered. PSD occurred in 30.8% of the sample. Logistic regression indicated that increased odds of PSD were associated with a comorbid anxiety disorder (5.9 times more likely to suffer from PSD, p < 0.001). Further, increased odds of PSD were associated with a history of depression treatment before stroke (3.0 times more likely to suffer from PSD), fatigue (2.8 times more likely), memory impairment (2.4 times more likely), and younger age at stroke (all p values < 0.006). Results suggest that PSD is likely multifactorial and extends the literature by demonstrating that a comorbid anxiety disorder correlated strongest with PSD. Poststroke screening and treatment plans should address not only depression but comorbid anxiety.

Post-Intensive Care Syndrome in Patients Suffering From Acute Subarachnoid Hemorrhage: Results From an Outpatient Post-ICU Aftercare Clinic.

Introduction Survivors of an acute subarachnoid hemorrhage (aSAH) may suffer from a long-term neurological disability, cognitive impairment, anxiety, and depression, which can also be related to post-intensive care syndrome (PICS). The aim of this study was to examine the prevalence of PICS symptoms in post-intensive care (ICU) aftercare aSAH patients. Methods We conducted an observational cohort study in aSAH patients from a post-ICU aftercare clinic (ICU-AC). PICS symptoms were evaluated using the Impact of Event Scale-Revised (IES-R), Hospital Anxiety and Depression Scale (HADS), and a medical questionnaire for physical and cognitive functioning. Results A total of 110 patients were included. The prevalence of anxiety and depressive symptoms was 23.6% and 19.1%, respectively. Post-traumatic stress disorder (PTSD) was seen in 26.4%. Cognitive complaints were lack of concentration (63.6%), short-term memory loss (45.8%), and reduced speed of thinking (60.9%). The most reported physical complaints were fatigue (73.6%), limitations in daily activity (72.7%), muscle weakness (41.8%), pain (36.4%), and weight loss (30.9%). PICS symptoms related to all three domains were present in 30% of patients. Conclusion The prevalence of PICS in patients after aSAH is high. Even in patients without aSAH-related neurological impairment who were discharged home, a high prevalence of PICS symptoms was reported. Early screening for PICS should comprise all three domains and is important to facilitate a better tailored rehabilitation of these patients.

Strategies Used to Manage Chronic Pain in HIV-Disease: Comparing Persons Prescribed Opioids Versus Persons not Receiving Opioids.

Chronic pain is common in people living with HIV (PLWH), causes substantial disability and is associated with limitations in daily activities. Opioids are commonly prescribed for pain treatment among PLWH, but evidence of sustained efficacy is mixed. There is little information available on how PLWH who have chronic pain use multimodal strategies in pain management. The current cross-sectional study examined background characteristics, self-reported pain, and the use of other pain treatments among 187 PLWH with chronic pain and depressive symptoms who were and were not prescribed opioids. Approximately 20.9% of participants reported using prescription opioids at the time of the study interview. These individuals were significantly more likely to report having engaged in physical therapy or stretching, strengthening or aerobic exercises in the previous 3 months, recent benzodiazepine use, and receiving disability payments. There were no significant differences in pain characteristics (pain-related interference, average pain severity, and worst pain severity) between the two groups. Those not prescribed opioids were more likely to report better concurrent physical functioning and general health, and fewer physical role limitations, but higher depression symptom severity. Our findings suggest that many PLWH with chronic pain and depressive symptoms express high levels of pain with deficits in physical function or quality of life despite their use of opioids. The high rate of co-use of opioids and benzodiazepines (30.8%) is a concern because it may increase risk of overdose. An integrated care approach that includes a variety of effective non-pharmacologic treatment strategies such as physical therapy may be beneficial in reducing the reliance on opioids for pain management.

Updated S1guideline on long/post-COVID: relevant aspects for pain medicine

The S1guideline on long/post-COVID of the AWMF [German Association of the Medical Scientific Societies] registration number 020-027) was updated in August2022. Under the coordination of the German Society of Pneumology, the guideline was updated by 21scientific associations, two professional associations and clinical centers each and one institute and statutory accident insurance each. Each scientific association was responsible for its own chapter. The German Pain Society prepared the chapter "Pain". The coordinators of each chapter performed aselective literature search and also received approval for the chapter within their scientific association. During an internal period of comments, all representatives of the participating institutions could comment on all chapters. The AWMF task force commented on the draft of the guideline, which was then finally approved by the boards of all participating institutions. Coronavirus disease 2019 (COVID-19) increases the risk of persistent headache and musculoskeletal pain. Long/Post-COVID pain is frequently associated with fatigue and cognitive problems. Aspecialist assessment might be considered if symptoms with limitations of daily activities persist 3months after the infection. The diagnostic workup of long/post-COVID-associated pain should be performed according to the standards of pain medicine. Management should follow the pain guidelines of the AWMF. The updated S1guideline on long/post-COVID is aclinical manual which offers orientation for diagnostics and treatment despite limited data.

The Trend of Increasing Primary Dysmenorrhea Prevalence in Mexican University Students

Background: Dysmenorrhea is a menstrual condition characterized by severe and frequent pain related to menstruation. Primary dysmenorrhea is a major problem worldwide since its prevalence ranges from 28% to 94% in some populations. Studies in specific populations of changes in the prevalence of dysmenorrhea over time have been scarce. Therefore, the aim of the present study was to compare the prevalence and characteristics of primary dysmenorrhea between two independent populations of Mexican university women over time (2010 versus 2020). Methods: An anonymous multiple-choice questionnaire was completed by two independent groups of students. Variables from the two studies were extracted and compared between them. The degree of dysmenorrheic pain was assessed by a 100 mm visual analog scale (VAS) ranging from “no pain” to “the worst pain imaginable”. Study A included 1539 women (published in 2010), and Study B included 2154 women (realized in 2020). Results: A total of 3693 students were surveyed. Dysmenorrhea prevalence was established in 62.4% (n = 961) in survey A and 78.9% (n = 1699) in survey B (p &lt; 0.05). The pain means were 54.1 ± 23.4 mm and 64.0 ± 20.6 mm for Studies A and B, respectively (p &lt; 0.05). Moderate-severe pain was reported by 753 (78.4%) women in Study A and 1546 (91.0%) women in Study B. Significantly more students from Study B (90.4%) had limitations in daily activities due to dysmenorrhea compared to women from Study A (65.0%) (p &lt; 0.05). School absenteeism in Study B (50.6%) was significantly higher than that in Study A (27.4%) (p &lt; 0.05). Conclusions: The prevalence of primary dysmenorrhea and the presence of symptoms in students showed statistically significant increases over time (2010 versus 2020). Similarly, due to the symptoms of dysmenorrhea, school absenteeism increased significantly, and daily activities were progressively affected.

Managing patient expectations about recovery after a distal radius fracture based on patient reported outcomes

IntroductionPROMs are increasingly used by clinicians to evaluate recovery after distal radius fractures, but can also be used as benchmark data to help patients managing their expectations about recovery after DRF. Purpose of the StudyThe study aimed to determine the general course of patient-reported functional recovery and complaints during 1 year after a DRF, depending on fracture type and age. The study aimed to determine the general course of patient-reported functional recovery and complaints during one year after a DRF, depending on fracture type and age. MethodsRetrospectively analyzed PROMs of 326 patients with DRF from a prospective cohort at baseline and at 6, 12, 26 and 52 weeks included PRWHE questionnaire for measuring functional outcome, VAS for pain during movement, and items of the DASH for measuring complaints (tingling, weakness, stiffness) and limitations in work and daily activities. The effect of age and fracture type on outcomes were assessed using repeated measures analysis. ResultsPRWHE scores after one year were on average 5.4 points higher compared to the patients’ pre-fracture scores. Patients with type B DRF had significantly better function and less pain than those with types A or C at every time point. After six months, more than 80% of the patients reported mild or no pain. Tingling, weakness or stiffness were reported by 55-60% of the overall cohort after six weeks, while 10-15% had persisting complaints at one year. Older patients reported worse function and more pain, complaints and limitations. ConclusionsFunctional recovery after a DRF is predictable in time with functional outcome scores after one-year follow-up that are similar to pre-fracture values. Some outcomes after DRF differ between age and fracture type groups.

Musculoskeletal pain patterns and association between dizziness symptoms and pain in patients with long term dizziness – a cross-sectional study

BackgroundThe impact of long-term dizziness is considerable both on the personal level and in society and may lead to self-imposed restrictions in daily activities and social relations due to fear of triggering the symptoms. Musculoskeletal complaints seem to be common in persons with dizziness, but studies addressing these complaints as a widespread occurrence, are scarce. This study aimed to examine the occurrence of widespread pain in patients with long-term dizziness and investigate the associations between pain and dizziness symptoms. Further, to explore whether diagnostic belonging is related to the occurrence of pain.MethodsThis cross-sectional study was conducted in an otorhinolaryngology clinic and included 150 patients with persistent dizziness. The patients were categorized into three groups: episodic vestibular syndromes, chronic vestibular syndromes, and non-vestibular group. The patients completed questionnaires on dizziness symptoms, catastrophic thinking, and musculoskeletal pain when entering the study. Descriptive statistics were used to describe the population, and associations between pain and dizziness were investigated by linear regression.ResultsPain was reported by 94.5% of the patients. A significantly higher prevalence of pain was reported in all the ten pain sites examined compared to the general population. Number of pain sites and pain intensity were associated with the dizziness severity. Number of pain sites was also associated with dizziness-related handicap, but not with catastrophic thinking. There was no association between pain intensity and dizziness-related handicap or catastrophic thinking. Pain was equally distributed in the diagnostic groups.ConclusionPatients with long-term dizziness have a considerably higher prevalence of pain and number of pain sites than the general population. Pain co-exists with dizziness and is associated with dizziness severity. These findings may indicate that pain should be systematically assessed and treated in patients with persisting dizziness.

Cross-cultural validity of the Pulmonary Embolism Quality of Life questionnaire in the quality of life survey after pulmonary embolism: A Persian-speaking cohort

BackgroundThe Pulmonary Embolism Quality of Life (PEmb-QoL) questionnaire is the first disease-specific scale for assessing the quality of life in patients with a history of pulmonary embolism (PE). ObjectivesTo assess the cross-cultural validity and reliability of the disease-specific PEmb-QoL questionnaire. MethodsThe Persian version was prepared through the forward and backward translation of the English questionnaire. Six months after the diagnosis of acute PE, consecutive Persian-speaking patients were asked to complete the PEmb-QoL, the generic 36-item Short Form (SF-36) questionnaires and undertake a 6-minute walk test (6MWT). Acceptability was assessed via item missing rate, reproducibility by the test-retest method, and internal consistency reliability by Cronbach’s α and McDonald’s ω coefficients. Convergence validity was assessed using the Spearman rank correlation between scores of PEmb-QoL, SF-36, and 6MWT. The questionnaire structure was evaluated through exploratory factor analysis. ResultsNinety-six patients with a confirmed diagnosis of PE completed the questionnaires. The Persian version of PEmb-QoL had good internal consistency (α = 0.95, 3-factor ω = 0.96), inter-item correlation (0.3–0.62), item-total correlation (0.38–0.71), reproducibility (test-retest ICC with 25 participants = 0.92–0.99), and good discriminant validity. Convergence validity was confirmed by the moderate-to-high correlations between PEmb-QoL and SF-36 scores, and a good correlation between the “limitation in daily activities” dimension of the PEmb-QoL questionnaire and 6MWT results. Exploratory factor analysis suggested a 3-component structure with functional (items 1h, 4b-5d, 6, 8, 9i, and 9j), symptoms (1b-h, 7, and 8), and emotional (5a, 6, and 9a-h) components. ConclusionThe Persian version of the PEmb-QoL questionnaire is valid and reliable for measuring the disease-specific quality of life in patients with PE.

Relationship Between Location of Pregnancy-Related and Postpartum-Related Back Pain and Limitations of Daily Activities and Work Participation

ObjectiveThe aims of this study were to (1) examine if the location of pregnancy-related back pain impacts activities of daily living and absence from work and (2) determine which types of pain were more likely to persist postpartum. MethodsThis was a secondary analysis of data from an observational cohort study. Data were collected in Ontario between 2013 and 2014. Four pain location groups were identified, including low back pain (LBP), pelvic girdle pain (PGP), combined pain, and mixed pain. Logistic regression models were used to examine the impact of pain location on activity and absence from work. Descriptive analyses explored the association between pregnancy pain location and postpartum pain patterns. ResultsWe surveyed 305 pregnant participants and followed up with 80 of these participants up to 6 months postpartum. Data analysis showed approximately a 2-fold increase in interference with employment (outside the home) and self-grooming for those with combined pain compared to those only experiencing LBP. Respondents with PGP and combined PGP and LBP had approximately a 5-fold increased likelihood of absence from work compared to respondents with only LBP; those with a mixture of LBP and PGP had a 13-fold increase in likelihood. Approximately 50% of respondents reported being pain-free, 16% experienced lingering pain, and 38% experienced persistent pain within 6 months postpartum. Those with combined pain during pregnancy continued to have persistent pain up to 6 months postpartum. ConclusionThe results suggest that the location of pregnancy-related back pain is associated with interference in daily activities, an increase in absence from work, and the persistence of postpartum pain. For this cohort, back pain did not always resolve after delivery, and those experiencing pregnancy-related combined pain continued to experience symptoms postpartum.

The effect of COVID-19 pandemic on depression and suicidal ideation in Korean community dwelling elderly

IntroductionThe impacts of the coronavirus disease of 2019 (COVID-19) pandemic on mental health have been relatively severe.ObjectivesThis study examined the influence of the COVID-19 especially on depression and suicidal ideation in community-dwelling elderly in Korea.MethodsData were employed from a survey on elderly mental health in Jeollanam-do (southwest province in Korea). A total of 2,423 elderlies were recruited from 22 counties in Jeollanam-do between April and October 2021. We used self-reported questionnaires, including sociodemographic factors, COVID-19 related stress, suicidal ideation, Geriatric Depression Scale-Short Form Korean Version (GDS-SF). Logistic regression was performed to examine the factors on depression and suicidal ideationResultsOf the 2423 subjects, 622 (25.7%) reported depressive symptoms and 518 (21.4%) reported suicidal ideation. The multivariate logistic regression analysis revealed that living alone, poor perceived health status, the worry of COVID-19 infection and restriction of daily activity due to COVID-19 pandemic were significantly associated with depression. Male sex, poor perceived health status, disability in house chores and depressive symptom are risk factors for suicidal ideation.Image:Image 2:Image 3:ConclusionsThese findings showed that increased risk factor for depression and suicidal ideation in community dwelling elderly during COVID-19 pandemic. We confirmed that feelings of isolation and negative perception of health were risk factors on depression in community dwelling elderly in the context of the COVID –19 pandemic. Also male, poor self-perceived health status, difficulty of independent living and worry and depression are increased the risk of suicidal ideation among the elderly.Disclosure of InterestNone Declared

Knowledge, attitude, and practices of adolescent school girls regarding menstrual hygiene in Lucknow district

Background: Girls’ adolescence has been recognized as a unique period that occurs as they cross the threshold from childhood to adulthood. Menstruation is typically viewed in Indian society as unclean. A negative attitude about this condition has been perpetuated by efforts to isolate and restrict menstruation females in the household. Numerous investigations have discovered restrictions in daily activities. On the other hand, maintaining good cleanliness habits during menstruation is important for reproductive health since it reduces vulnerability to infections of the reproductive tract. Aims and Objectives: The aim of the study was to assess knowledge and attitude about menstrual health among adolescent girls in rural and urban schools in Lucknow district and to find out practices of menstrual hygiene among them. Materials and Methods: The study unit consists of 410 teenage school-going females who live in both urban and rural regions of the Lucknow district. There was a multi-stage random sampling. A pre-developed and pre-tested interview schedule was employed toobtain data. Participants were questioned about their personal cleanliness, which need to be covered in the academic program. Results: Four hundred and ten adolescent girls who were enrolled in school participated in the study. The majority of girls in this survey (52.8%) are between the ages of 17 and 19. 87.6% of the girls reported being ignorant of menstruation before menarche. While 41.6% of the girls were unaware of the organ from which bleeding originates, around 68.2% of the girls believed that the primary reason of menstruation is physiological and unrelated to any sickness. At the age of 10–13 years, 42.60% of the girls reached menarche. The majority of participants (60.80%) gave accurate responses to the question about the typical menstrual cycle’s average length. Only 35.27% of the girls were aware of the proper menarche age. Of them, 65.50% were aware of the issues with their reproductive health. Conclusion: Lack of education among mothers and other female family members may contribute to girls’ lack of knowledge and awareness of menstruation. Misinformation, pre-conceptions, limitations, and a lack of knowledge around menstruation come in many different forms. As a result, when the entire family is familiar with the phenomena of menstruation, age-old prohibitions, conventional preconceptions, incorrect ideas, and negative attitudes may be successfully erased.

How mild is mild haemophilia?

People with mild haemophilia (PWMH) experience sporadic bleeds and are less likely to receive an early diagnosis, appropriate treatment and medical care. Arthropathy is a key determinant of health-related quality of life (QoL), producing pain, limitations in mobility and daily activities. The aim of this study is to evaluate the incidence, risk factors and QoL associated with arthropathy in PWMH. Observational, cross-sectional cohort study. Data were collected in a single interview and evaluated by a physiotherapist and an orthopaedist and analysed on demographics; baseline factor levels; as well as clinical (Haemophilia Joint Health Score [HJHS]), ultrasound (Haemophilia Early Arthropathy Detection with Ultrasound [HEAD-US]), radiological (Pettersson score [PS]), pain (visual analogue scale [VAS]) and QoL evaluations. We defined arthropathy when at least one of the joints shown with a HEAD-US score≥1. Eighty-five patients and 510 joints were included. Patients' mean age was 35.9years-old. Median age was 44.2 in patients with arthropathy versus 14.9 in patients without; the difference was statistically significant (p<.001). In patients over 20years old, 90.5% shown arthropathy. Only 24 (28%) patients had no joint damage (HEAD-US=0), and 61 (72%) had at least one joint with a HEAD-US≥1. The ankle was the most affected joint. Patient age was found to be the most important risk factor associated with the development of arthropathy. Joint damage as a result of prior hemarthrosis was the most relevant factor associated with lower QoL, and emphasised the importance of early diagnosis and appropriate management in this particular population.

Features of the clinical picture and severity of pain syndrome in girls with genital endometriosis on the background of conservative therapy of the disease in adolescence

Introduction. Endometriosis is characterised by a chronic course and significantly affects the quality of life of young patients. Aim. To study the features of the clinical picture and pain syndrome in adolescent girls with genital endometriosis against the background of 1 year of therapy.Materials and methods. A prospective longitudinal study included 32 girls (14–17 years old) with a confirmed diagnosis of genital endometriosis. The clinical picture and severity of pain syndrome were assessed against the background of conservative therapy with NSAID (naproxen) to relieve dysmenorrhea and gestagen (dienogest) for 1 year.Results. The main complaint of girls with endometriosis was pain, which appeared on the day before menstruation or in the middle of the cycle since menarche (64%) or increased in 1–1.5 years after menarche (23%) to very intense pain (8.3 ± 1.6 V scale) of a tensive (44%) or clutching (25%) nature. One third of adolescents reported daily pain (24%), the majority (75%) complained of restricted daily activity and performance, gastrointestinal symptoms (44%) and dysuria (22%). After 1 year of treatment with gestagens and NSAIDs patients had a significant decrease in pain on the days of menstruation (p &lt;0,001), as well as outside menstruation (p &lt;0,001), frequency of restriction of daily activities (p &lt;0,001), weakness, lowered working capacity on menstrual days (p &lt; 0.001), gastrointestinal symptoms (p &lt; 0.001) and urinary disorders (p &lt; 0.001) and the need for mandatory pain medication (p &lt; 0.001).Conclusion. A significant reduction in pain syndrome and clinical manifestations of dysmenorrhea against the background of an improved quality of life was observed in the adolescent patients during 1 year of conservative endometriosis therapy. No intensification or increase in the frequency of headache attacks or significant changes in BMI were observed in the study group, which is indicative of good tolerance and contributes to treatment adherence in young female patients.

Everyday Discrimination, Neighborhood Perceptions, and Incidence of Activity Limitations Among Middle-Aged and Older African Americans.

This study aims to examine the relationship between everyday discrimination, neighborhood perceptions, and the incidence of daily activity limitations (i.e., activities of daily living [ADL] and instrumental activities of daily living [IADL]) among middle-aged and older African Americans. This study also examines whether neighborhood perceptions moderate the association between discrimination and the incidence of daily activity limitations. Data were from the 2006 to 2016 waves of the Health and Retirement Study. African Americans aged 50 or older free of ADL limitations (N=1,934) and IADL limitations (N=2,007) at baseline were selected. Cox proportional hazards regression models were performed to test the study aims. Multiple imputations were applied to handle missing data. One-unit increase in everyday discrimination was associated with a 25% (p < .05) higher risk of ADL limitation onset. Perceived neighborhood social cohesion and physical disadvantage moderated the association between discrimination and IADL limitation onset. Everyday discrimination represents a significant stressor that negatively affects older African Americans' performance of daily activities. Community-level efforts that improve neighborhood perceptions are needed to alleviate the negative effects of discrimination on the incidence of activity limitations.

Personalised exercise therapy and self-management support for people with multimorbidity: feasibility of the MOBILIZE intervention

BackgroundExercise therapy is safe and effective in people with single conditions, but the feasibility in people with two or more conditions is unclear. Therefore, the aim was to evaluate the feasibility of exercise therapy and self-management in people with multimorbidity prior to a randomised, controlled trial (RCT).MethodsThis was a mixed-methods feasibility study performed in two general hospitals and one psychiatric hospital. 20 adult patients (8 females; mean age (SD) 67 (6.9)) with at least two long-term conditions and a score of ≥ 3 on Disease Burden Impact Scale for at least one condition (at least moderate limitations of daily activities) and of ≥ 2 for at least one other condition. Patients with unstable health conditions, at risk of serious adverse events (SAE) or with terminal conditions were excluded. Participants received 12 weeks of exercise (18 60-min group-based and 6 home-based sessions) and self-management support (6 90-min group-based sessions) supervised by physiotherapists. Pre-defined progression to RCT criteria were the primary outcomes and included recruitment rate (acceptable 20 participants in 3 months), retention through follow-up (75% retention), compliance (75% complete > 9 of exercise and > 3 self-management sessions), outcome burden (80% do not find outcomes too burdensome), improvement in quality of life (EQ-5D-5L) and function (6-min walk test; ≥ 50% experience clinically relevant improvements) and intervention-related SAEs (No SAEs). Furthermore, a purposeful sample including eleven participants and two facilitators were interviewed about their experiences of participating/facilitating. Qualitative data was analysed using thematic analysis.ResultsRecruitment rate (20 in 49 days), retention (85%), outcome burden (95%), and SAEs (0 related to intervention) were acceptable, while compliance (70%) and improvements (35% in quality of life, 46% in function) were not (amendment needed before proceeding to RCT). The intervention was found acceptable by both participants and physiotherapists with some barriers among participants relating to managing multiple chronic conditions while caring for others or maintaining a job. Physiotherapists expressed a need for additional training.ConclusionsExercise therapy and self-management are feasible in people with multimorbidity. The subsequent RCT, amending the intervention according to progression criteria and feedback, will determine whether the intervention is superior to usual care alone.Trial registrationClinicalTrials.gov registration: NCT04645732Open Science Framework https://osf.io/qk6yg/

Canadian Physicians' Use of Intramuscular Botulinum Toxin Injections for Shoulder Spasticity: A National Cross-Sectional Survey.

Spasticity of the upper extremity can result in severe pain, along with many complications that can impair a patient's activities of daily living. Failure to treat patients with spasticity of the upper limb can result in a decrease in the range of motion of joints and contracture development, leading to further restriction in daily activities. We aimed to investigate the practice patterns of Canadian physicians who utilize Botulinum toxin type-A (BoNT-A) injections in the management of shoulder spasticity. 50 Canadian Physical Medicine and Rehabilitation (PM&R) physicians completed a survey with an estimated completion rate of (36.23%). The demographics of the survey participants came from a variety of provinces, clinical settings, and patient populations. The most common muscle injected for shoulder adduction and internal rotation spasticity was the pectoralis major, this was followed by latissimus dorsi, pectoralis minor, subscapularis and teres major. Injection of BoNT-A for problematic post-stroke shoulder spasticity was common, with (81.48%) of participants responding that it was always or often used in their management of post-stroke spasticity (PSS). Dosing of BoNT-A demonstrated variability for the muscle injected as well as the type of toxin used. The goals of the patients, caregivers, and practitioners were used to help guide the management of these patients. As a result, the practice patterns of Canadian physicians who treat shoulder spasticity are varied, due to numerous patient factors. Future studies are needed to analyze optimal treatment patterns, and the development of algorithms to standardize care.

Donor site morbidity after computer assisted surgical reconstruction of the mandible using deep circumflex iliac artery grafts: a cross sectional study

BackgroundComputer Assisted Design and Computer Assisted Manufacturing (CAD/CAM) have revolutionized oncologic surgery of the head and neck. A multitude of benefits of this technique has been described, but there are only few reports of donor site comorbidity following CAD/CAM surgery.MethodsThis study investigated comorbidity of the hip following deep circumflex iliac artery (DCIA) graft raising using CAD/CAM techniques. A cross-sectional examination was performed to determine range of motion, muscle strength and nerve disturbances. Furthermore, correlations between graft volume and skin incision length with postoperative donor site morbidity were assessed using Spearman's rank correlation, linear regression and analysis of variance (ANOVA).ResultsFifteen patients with a mean graft volume of 21.2 ± 5.7 cm3 and a mean incision length of 228.0 ± 30.0 mm were included. Patients reported of noticeable physical limitations in daily life activities (12.3 ± 11.9 weeks) and athletic activities (38.4 ± 40.0 weeks in mean) following surgery. Graft volume significantly correlated with the duration of the use of walking aids (R = 0.57; p = 0.033) and impairment in daily life activities (R = 0.65; p = 0.012). The length of the scar of the donor-site showed a statistically significant association with postoperative iliohypogastric nerve deficits (F = 4.4, p = 0.037). Patients with anaesthaesia of a peripheral cutaneous nerve had a larger mean scar length (280 ± 30.0 mm) than subjects with hypaesthesia (245 ± 10.1 mm) or no complaints (216 ± 27.7 mm).ConclusionsDespite sophisticated planning options in modern CAD/CAM surgery, comorbidity of the donor site following iliac graft harvesting is still a problem. This study is the first to investigate comorbidity after DCIA graft raising in a patient group treated exclusively with CAD/CAM techniques. The results indicate that a minimal invasive approach in terms of small graft volumes and small skin incisions could help to reduce postoperative symptomatology.Trial registration Retrospectively registered at the German Clinical Trials Register (DRKS-ID: DRKS00029066); registration date: 23/05/2022

Kecemasan Sebagai Faktor Determinan Kualitas Hidup Lansia pada Masa Pandemi Covid-19

The Covid-19 pandemic is a challenge for the elderly as a group that is vulnerable to being exposed to the virus. This pandemic condition causes worry, excessive fear, and in others, because of social conditions, it results in limited daily activities that have an impact on the quality of life of the elderly. This study aims to determine the relationship between anxiety levels and the quality of life of the elderly during the Covid-19 pandemic at Posbindu Kendang Village. This research uses quantitative methods with analytical descriptive design and cross sectional approach. The research sample was 67 elderly with purposive sampling technique. Collecting data using a questionnaire and data analysis techniques using Chi Square. The results of the study elderly were in the category of mild anxiety 40 elderly (59.7%), and had a good quality of life 31 elderly (53.7%). The results of the Chi-Square test obtained p-value 0.000 &lt;0.05. It can be said that the world level is related to the quality of life of the elderly. Therefore, there is a need for interventions to increase interaction and sharing among the elderly to reduce and improve the quality of life of the elderly.

Τhe impact of fear on the elderly during the COVID-19 pandemic, social support and depressive symptoms: a cross-sectional study

The COVID-19 pandemic has had a worldwide impact on all age groups, and in particular on the elderly who constitute a vulnerable section of the population which is constantly increasing in number. The adverse effects of the pandemic have been associated with increased rates of geriatric depression and the feeling of fear among the elderly, leading to social isolation, increased stress and limitation of daily activities. These factors negatively influence both the mental and physical health of the elderly whose aging deficits already render them more prone to physical, mental, social and economic deprivation. This cross-sectional study aimed to investigate how fear caused by the pandemic has affected the lives, the daily habits, the social support network and the emotional and physical state of the senior citizens in the wider area of Phaistos, in Crete, and how the impact of the pandemic is linked to geriatric depression. With a total sampling of 200 participants over 65 years of age, the measuring instruments used in the study were the SSQ-6 (Social Support Questionnaire) to investigate social support and the GDS-15 (Geriatric Depression Scale) to investigate depression.&#x0D;