Daily Activities Scale Research Articles

Pain catastrophizing and trunk co-contraction during lifting in people with and without chronic low back pain: A cross sectional study.

Trunk co-contraction during lifting may reflect a guarded motor response to a threatening task. This work estimated the impact of pain catastrophizing on trunk co-contraction during lifting, in people with and without low back pain. Adults with high pain catastrophizing (back pain: n = 29, healthy: n = 7) and low pain catastrophizing (back pain: n = 20, healthy: n = 11), performed 10 repetitions of a lifting task. Electromyography data of rectus abdominis, erector spinae and external oblique muscles were collected, bilaterally. Co-contraction indices were determined for rectus abdominis/erector spinae and external oblique/erector spinae pairings, bilaterally. Pain catastrophizing was measured using the pain catastrophizing scale and task-specific fear using the Photograph series of daily activities scale. Three-way mixed ANOVAs tested the effects of group (back pain vs. healthy), pain catastrophizing (high vs. low), lifting phase (lifting vs. replacing) and their interactions. There were no main effects of pain catastrophizing, lifting phase, nor any interactions (p > 0.05). Group effects revealed greater co-contraction for bilateral erector spinae/rectus abdominis pairings (but not erector spinae-external oblique pairings) in people with back pain, compared to healthy participants, independent of pain catastrophizing and lifting phase (p < 0.05). Spearman correlations associated greater task-specific fear and greater erector spinae-left external oblique co-contraction, only in people with back pain (p < 0.05). Greater co-contraction in the back pain group occurred independent of pain catastrophizing, as measured with a general questionnaire. A task-specific measure of threat may be more sensitive to detecting relationships between threat and co-contraction. This work contributes evidence that people with back pain commonly exhibit trunk co-contraction when lifting. The lack of a relationship between pain catastrophizing and trunk co-contraction, however, challenges evidence linking psychological factors and guarded motor behaviour in this group. Together, this suggests that other factors may be stronger determinants of co-contraction in people with LBP or that a general construct like pain catastrophizing may not accurately represent this relationship.

Hyperadrenergic Postural Tachycardia Syndrome: Clinical Biomarkers and Response to Guanfacine.

A subset of patients with postural tachycardia syndrome (POTS) are thought to have a primary hyperadrenergic cause. We assessed clinical biomarkers to identify those that would benefit from sympatholytic therapy. We measured sympathetic function (supine muscle sympathetic nerve activity, upright plasma norepinephrine, and blood pressure responses to the Valsalva maneuver) in 28 patients with POTS (phenotyping cohort) to identify clinical biomarkers that are associated with responsiveness to the central sympatholytic guanfacine in a separate uncontrolled treatment cohort of 38 patients that had received guanfacine clinically for suspected hyperadrenergic POTS (HyperPOTS). In the phenotyping cohort, an increase in diastolic blood pressure (DBP) >17 mm Hg during late phase 2 of the Valsalva maneuver identified patients with the highest quartile of resting muscle sympathetic nerve activity (HyperPOTS) with 71% sensitivity and 85% specificity. In the treatment cohort, patients with HyperPOTS, identified by this clinical biomarker, more often reported clinical improvement (85% versus 44% in nonhyperadrenergic; P=0.016), had better orthostatic tolerance (∆Orthostatic Hypotension Daily Activities Scale: -1.9±0.9 versus 0.1±0.5; P=0.032), and reported less chronic fatigue (∆PROMIS Fatigue Short Form 7a: -12.9±2.7 versus -2.2±2.2; P=0.005) in response to guanfacine. These results are consistent with the concept that POTS is caused by a central sympathetic activation in a subset of patients, which can be identified clinically by an exaggerated DBP increase during phase 2 of the Valsalva maneuver and improved by central sympatholytic therapy. These results support further clinical trials to determine the safety and efficacy of guanfacine in patients with POTS enriched for the presence of this clinical biomarker.

ORTHOSTATIC HYPOTENSION AND FRAILTY SYNDROM

The objective of our research was to define the relationship between orthostatic hypotension (OH) and frailty syndrome (FS) in the older age group. Materials and methods: the cross-sectional study involved patients of the older age group diagnosed with Parkinson's disease (PD) and cerebrovascular disease (CVD - chronic cerebral ischemia, chronic phase of ischemic stroke). All patients had comorbid OH. OH was established on the basis of a classical orthostatic test [10]. Each group included patients with different functional classes of OH (FC OH), from 1 to 4 [7]. The functional class of OH was determined using the orthostatic hypotension questionnaire (assessment of OH symptoms and the OH daily activity scale) [8]. All participants were assessed for the FS index based on the Edmonton Frail Scale [9]. Results: OH and FS has a close relationship, which is reflected in the direct correlation between OH and FS index (r=0.9). The higher FC OH, the more severe FS (p=0.001). The FC OH 1 corresponds to vulnerable, FC OH 2 to mild FS, FC OH 3 to moderate FS, and FC OH 4 to severe FS. Conclusions: OH, having a close relationship with FS, may make an additional contribution to the reduction of the duration and quality of life of patients with FS and elderly patients [3, 5]. Unfortunately, currently, OH has not been included in the criteria of FS and is not evaluated in this cohort [9]. Therefore, we believe it is important to perform orthostatic testing in all patients with FS, which will prevent the occurrence of life-threatening complications caused by the persistence of OH [3, 5]. In the future, OH should be included in the criteria of FS.

«Locomotive syndrome» in patients in the geriatric hospital

The study aim was to analyze the prevalence and course of locomotive syndrome in patients in the geriatric hospital.Materials and methods. This work was a cross-sectional study performed on the basis of the Moscow War Veterans Hospital N3. The study enrolled 58 patients – 43 women (74.1%) and 15 men (25.9%) hospitalized in the geriatric department of the hospital. The mean age of study patients was 82.7+5.9 years, varying from 75 to 96 years. A comprehensive geriatric assessment was performed, including the Age Is Not a Barrier Questionnaire, the Basic Daily Activity Scale (Bartel Index), the Instrumental Activities of Daily Living (IADL) Scale, and the Morse Falls Scale. Questionnaires were filled out to assess the locomotive syndrome – GLFS‑5 and GLFS‑25. A 2 step test was carried out.Results. In 48 out of 58 patients (82.8%), locomotive syndrome was found: in 88.4% of women and in 66.7% of men (p=0.05). Locomotive syndrome was diagnosed in all centenarians, in 82.7% of patients aged 80 to 89 years and in 75% of patients aged 75–79 years. The main cause of the locomotive syndrome was degenerative-dystrophic changes in the spine and joints observed in all patients. Only 1 patient had stage I locomotive syndrome, all the rest had stage II. Patients with locomotive syndrome had lower levels of activity in everyday life – 84.3±11.2 and 93.0±6.3 points according to the Barthel index, respectively (p=0.01), greater severity of pain syndrome according to VAS – 4.2±1.8 and 1.7±1.6 points, respectively (p=0.003) and a shorter distance of 2 steps (123.3±30.9 and 148.1±20.7 cm, respectively (p=0.003). Direct correlations were established between the values of the GLFS‑5 locomotive function scale and the age of patients (r=0.33; p=0.01), as well as the severity of chronic pain syndrome according to VAS (r=0.55; p=0.00007). Inverse relationships were registered between the indicators of the GLFS‑5 scale and the Barthel index (r= –0.44; p=0.0005), the IADL scale (r= –0.41; p=0.001) and the distance traveled in the «2 steps» test (r= –0.52; p=0.0007). Inverse correlations were observed between the values of the GLFS‑25 scale and the Barthel index (r= –0.41; p=0.008), the IADL scale (r= –0.59; p=0.00008), the Mini-COG test (r= –0.37; p=0.02), as well as indicators of bone mineral density in the proximal femur (r= –0.39; p=0.04 – r= –0.54; p=0.002). Conclusions. The study results indicate that patients in the geriatric hospital very often have locomotive syndrome associated with the pathology of the musculoskeletal system. The severity of the locomotive syndrome correlates with the indicators of the functional activity of patients, the intensity of the pain syndrome and the bone mineral density.

Pain and health-related quality of life in Duchenne muscular dystrophy: A multiple mediator analysis.

The objective was to investigate the serial mediating effects of daily activities, patient health communication, and disease-specific worry in the relationship between pain intensity and overall generic health-related quality of life (HRQOL) in pediatric patients with Duchenne muscular dystrophy from the patient perspective. Pain Intensity Item, Daily Activities Scale, Communication Scale and Worry Scale from Pediatric Quality of Life Inventory (PedsQL) Duchenne Muscular Dystrophy Module and PedsQL 4.0 Generic Core Scales were completed by 110 pediatric patients with Duchenne muscular dystrophy ages 8-17. A serial multiple mediator model analysis was conducted to test the hypothesized sequential mediating effects of daily activities, patient health communication, disease-specific worry as intervening variables in the association between the pain intensity predictor variable and overall generic HRQOL. Pain predictive effects on overall generic HRQOL were serially mediated by daily activities, patient health communication, and disease-specific worry. In a predictive analytics model utilizing hierarchical multiple regression analysis with age demographic covariate, patient-reported pain intensity, daily activities, patient health communication, and disease-specific worry accounted for 47% of the variance in overall generic HRQOL (P<0.001), representing a large effect size. Pain intensity, daily activities, patient health communication, and disease-specific worry explain in part the mechanism of pain predictive effects on overall generic HRQOL in pediatric patients with Duchenne muscular dystrophy. Identifying the mediators of pain intensity on overall generic HRQOL from the patient perspective may inform targeted clinical interventions and future patient-centered clinical research to improve overall daily functioning.

Ampreloxetine Versus Droxidopa in Neurogenic Orthostatic Hypotension: A Comparative Review.

Neurogenic orthostatic hypotension (nOH) is a disabling problem of autonomic dysfunction in patients with Parkinson's disease, which is associated with poor quality of life and higher mortality rates. The purpose of this literature review was to explore and compare the efficacy and safety of droxidopa (an existing treatment) and ampreloxetine (a newer medication) in the treatment of nOH. We used a mixed-method literature review that addresses the epidemiology, pathophysiology, and pharmacological and non-pharmacological management of nOHin Parkinson's disease in a general way, with a more exploratory approach to droxidopa- and ampreloxetine-controlled trial studies. We included a total of 10 studies of randomized controlled trials with eight studies focused on droxidopaand two studies focused on ampreloxetine. These two drugs were analyzed and compared based on the collected individual study results. Treatment of nOH inParkinson's disease patients with droxidopa or ampreloxetine showed clinically meaningful and statistically significant improvements relative to placebo on the components of the OHSA (Orthostatic Hypotension Symptom Assessment) composite score and OHDAS (Orthostatic Hypotension Daily Activity Scale composite scores) composite score. Droxidopa had an improved effect on daily activities, with an associated increase in standing systolic blood pressure (BP), but the long-term efficacy of droxidopa has not been documented. Standing systolic BP was maintained by ampreloxetine and worsened after the withdrawal phase. This highlights the importance of conducting further researchwhich will help us to improve the therapeutic approach for patients with nOH and Parkinson's disease.

Treatment of chronic migraine and insomnia with cognitive behavioral therapy

Introduction. Chronic migraine (CM) is a neurological disease which is often comorbid with chronic insomnia (CI). The interdisciplinary approach including the cognitive behavioural therapy (CBT) is recommended for the treatment of patients with CM and comorbid CI.Aim. To evaluate the effectiveness of the interdisciplinary treatment program including CBT in the treatment of patients with CM and CI. Materials and methods. A total of 54 patients with CM and CI (19 men and 35 women, mean age 34.1 ± 8.5 years), were enrolled in the study. The clinical and psychological characteristics were assessed before and after treatment (at Month 3, 6, 12) using interviewing, testing, headache and sleep diaries. All patients received the interdisciplinary treatment, including pharmacotherapy, discontinuation of pain medications in the presence of drug-induced headache (DIHA), CBT for headache and insomnia.Results. Three months after treatment, there was a statistically significant decrease in mean scores for headache frequency, pain drugs dosing interval, insomnia severity index, as well as according to the Spielberger Khanin's Reactive and Personal Anxiety Scale, Beck Depression Scale, Impact of Migraine on Daily Activities Scale (p &lt; 0.05). The achieved improvements were maintained at Months 6 and 12 of the follow-up period. At Month 3, 35 (65%) patients achieved a clinical effect in the treatment of CM: the frequency of headache decreased by 50% or more, 41 (76%) patients achieved a clinical effect in the treatment of CI: the insomnia severity index decreased by 8 scores and more. At Month 6, 42 (77.8%) patients had a clinical effect in CM therapy, and 44 (81.5%) patients in CI therapy. The achieved clinical effects have been shown to be maintained by Month 12 of the follow-up period.Conclusion. The interdisciplinary program including CBT is effective in the treatment of patients with CM and CI over the shortand long-term horizon.

Correction: Development of a New Daily Activities Scale for the Affected Hand after Stroke

Correction: Development of a New Daily Activities Scale for the Affected Hand after Stroke

Effect of Otago exercise programme on limb function recovery in elderly patients with hip arthroplasty for femoral neck fracture.

Hip arthroplasty is the most important surgical method for the treatment of hip fractures and necrosis in the femoral head. Limb function recovery is an important criterion to reflect the efficacy of surgery and the quality for life of patients. Postoperative rehabilitation exercises are crucial for limb function recovery. Otago exercise programme (OEP) is a safe, effective, practical, and economical rehabilitation exercise, which has been proven to prevent falls, improve limb function and walking ability, and lower limb strength. This study aims to explore the effect of OEP on limb function rehabilitation in elderly patients with hip arthroplasty for femoral neck fractures. A total of 77 elderly patients with hip arthroplasty for femoral neck fractures who met the criteria for inclusion and exclusion were enrolled for this study. They were randomly divided into a control group ( n =39) and an intervention group ( n =38). The control group was given routine rehabilitation training, and the intervention group performed OEP on the basis of the control group. Time get up and go test (TGUT), five times sit to stand test (FTSST), 10-meter walking test (10MWT), Harris Hip Score (HHS), Daily Activity Scale (Barthel index), and the Mos 36-Item Short Form Health Survey (SF-36) were used before the intervention, at discharge, and the 12th week after discharge. Before the intervention, there were no differences in TGUT, FTSST, 10MWT, HHS score, Barthel index, and SF-36 score between the 2 groups (all P >0.05). At the discharge after the intervention, there was no difference in TGUT between the 2 groups ( P >0.05), but the FTSST and 10MWT in the control group were longer than those in the intervention group (both P <0.05), and the HHS score, Barthel index, and SF-36 score in the control group were lower than those in the intervention group ( P <0.05). At the 12th week after discharge, TGUT, FTSST, 10MWT, HHS score, Barthel index, and SF-36 score in the intervention group were better than those in the control group ( P <0.05). OEP can effectively promote limb stability and hip function recovery in elderly patients with hip arthroplasty for femoral neck fractures, improve daily mobility and quality of life, and it is suitable for clinical application.

Abstract P063: Long-term Efficacy Of Atomoxetine For The Treatment Of Symptomatic Neurogenic Orthostatic Hypotension

Patients with neurogenic orthostatic hypotension (NOH) are at risk for syncope, falls and have poor quality of life. Only two drugs (midodrine, droxidopa) are FDA-approved for the treatment of NOH. We previously reported that atomoxetine, a norepinephrine transporter inhibitor, acutely improved upright blood pressure and symptoms in NOH, mostly in multiple system atrophy (MSA) patients. However, the long-term efficacy of atomoxetine for the treatment of NOH is unknown. We hypothesize chronic treatment with atomoxetine improves pre-syncopal symptoms in NOH We conducted multicenter, randomized, double-blind, placebo-controlled, 2X2 crossover design with initial atomoxetine dose-titration phase. NOH patients were randomized to two, 4-week treatment sequence (period 1: atomoxetine (10 or 18 mg TID) followed by placebo) or vice versa (period 2). The primary outcome was a reduction in pre-syncopal symptoms using the orthostatic hypotension questionnaire (OHQ) composite score, calculated from the OH symptoms Assessment (OHSA) and the OH Daily Activity Scale (OHDAS). Secondary endpoints were orthostatic vital signs. We screened 68 patients, 48 were enrolled in the dose-titration and 40 were randomized (68 ± 8 yo, %60 males, BMI 26.2 ± 4.8 kg/m 2 ). We found no difference in the OHQ score between atomoxetine and placebo at 2-week (4.8±2.4 vs 4.5±2.1, P=0.73). Sub-analyses between MSA and non-MSA patients showed significant decline in OHSA with atomoxetine (2.6±1.8 vs 3.6±1.8, p=0.03) in non-MSA patients, specifically in vision disturbance (p=0.04) and in weakness (p=0.03). At 4-week, atomoxetine effect on upright SBP persisted (3.4±20.61 vs. -5.5±14.82 mm Hg, p=0.037). Atomoxetine was well-tolerated. Even though we found no significant reduction in OHQ with atomoxetine. Sub-analyses based on diagnosis, found that non-MSA patients had a significant improvement in OHSA. Atomoxetine effect on upright SBP persisted after 4-week treatment suggesting no tachyphylaxis.

A-110 The Virtual Environment Grocery Store Explains Variance in Older Adults’ Adaptive Functioning Beyond Age

Abstract Objective: The Virtual Environment Grocery Store (VEGS; Parsons &amp; McMahan, 2017) has demonstrated relationships with older adults’ adaptive functioning as measured both by self-report and with a performance-based test (Hardesty et al., 2021). However, age is an important predictor of adaptive functioning among older adults (Weber et al., 2019). The purpose of this study was to investigate the incremental validity of the VEGS. We hypothesized that the VEGS long delay free recall would explain variance in adaptive functioning beyond that which is accounted for by age. Method: Older adults (n = 98; age 65–90, M = 75.82, SD = 6.27) were administered the Virtual Environment Grocery Store (VEGS) and the Texas Functional Living Scale (TFLS) and completed the Instruments of Daily Activities Scale (IADLS) Questionnaire. Results: Age explained 30.8% of the variance in TFLS. Inclusion of the VEGS long delay free recall meant that the model was able to explain 48.0% of the variance (R2 change F = 1.28, p &amp;lt; 0.001). Age explained 17.2% of the variance in IADLS scores; the inclusion of the VEGS long delay free recall brought this to 21.5% (R2 change F = 7.03, p = 0.03). Conclusion: Among older adults, age is an important predictor of adaptive functioning as measured by self-report and performance-based test. The VEGS was able to explain substantial variance in older adults’ adaptive functioning beyond age, particularly when measured with a performance-based test. These results are consistent with the notion that the VEGS measures abilities relevant to older adult’s daily functioning.

The Multi-Sites Trial on the Effects of Therapeutic Gardening on Mental Health and Well-Being.

Although many people affected by COVID-19 suffer from some form of psychological distress, access to proper treatment or psychosocial interventions has been limited. This study aimed to examine the feasibility and preliminary effects of a therapeutic gardening program conducted during the COVID-19 pandemic. The program consisted of 30 sessions and was conducted at 10 nationwide sites in Korea from June to November 2021. Mental health and well-being were assessed using the Mental Health Screening Tool for Depressive Disorders, Mental Health Screening Tool for Anxiety Disorders, Engagement in Daily Activity Scale, brief version of World Health Organization Quality of Life, and Mindful Attention Awareness Scale. Cohen’s d value was calculated for the effect size, and a multilevel analysis was used to determine the longitudinal effects of therapeutic gardening. The effect sizes for depression, anxiety, daily activities, quality of life, and mindfulness were 0.84, 0.72, 0.61, 0.64, and 0.40, respectively. Multilevel analyses showed that all five mental health variables improved significantly over time as the therapeutic gardening program progressed. Therapeutic gardening is promising and applicable as a nature-based intervention to improve the mental health of individuals experiencing psychological distress especially in the COVID-19 pandemic.

Durability of the Clinical Benefit of Droxidopa for Neurogenic Orthostatic Hypotension During 12 Weeks of Open-Label Treatment.

IntroductionDroxidopa is approved to treat neurogenic orthostatic hypotension (nOH) symptoms in patients with autonomic failure based on short-term clinical trial data. Additional data on the long-term efficacy of droxidopa are needed. We have evaluated the 12-week efficacy and tolerability of droxidopa in patients with nOH in an open-label period of an ongoing phase 4 study .MethodsPatients received 12 weeks of open-label treatment with an individually optimized droxidopa dose (100–600 mg, 3 times daily) as identified during a preceding titration period. Patient-reported outcomes included the Orthostatic Hypotension Symptom Assessment (OHSA), Orthostatic Hypotension Daily Activity Scale (OHDAS), and clinician- and patient-rated Clinical Global Impression–Severity (CGI-S) scales. Supine blood pressure (BP) and adverse events (AEs) were recorded.ResultsData from 114 patients enrolled into the 12-week open-label period were available for analyses. After 12 weeks of droxidopa treatment, patients reported significant (P < 0.0001) improvements from baseline in OHSA and OHDAS composite and individual item scores and on clinician and patient CGI-S scores. Mean ± SD supine systolic and diastolic BP at week 12 increased by 15.5 ± 22.9 and 7.8 ± 11.7 mmHg from baseline, respectively (P < 0.0001 for both). The most frequently reported AEs were falls (17%), headache (13%), and dizziness (9%); one (0.9%) patient reported an AE of supine hypertension.ConclusionDuring 12 weeks of open-label treatment, droxidopa was associated with significant improvement from baseline in nOH symptoms and activities of daily living. No clinically important changes in supine hypertension or AEs of concern were observed. These results support the efficacy of droxidopa beyond 2 weeks of treatment. Trial RegistrationNCT02586623.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40120-021-00317-5.

Correlation and Crosswalks Between Patient-Reported Functional Outcomes and PROMIS Physical Function Among Medically Ill Patients

ObjectivesTo develop scoring crosswalks between a new multidomain patient-reported outcome measure, the Functional Assessment in Acute Care (FAMCAT), with a Patient-Reported Outcomes Measurement (PROMIS) measure of physical function, and examine correlations with existing legacy instruments. DesignCross-sectional, single-group design study. SettingLarge, Midwestern academic teaching hospital. ParticipantsA sample of patients (N=1885; 53% men; average age, 62±16y) hospitalized on the general medical services between May 2016 and June 2017. InterventionNot applicable. Main Outcome MeasuresScores from the FAMCAT administered via computerized adaptive testing were compared with scores on the 8-item PROMIS Physical Function (PROMIS PF) short form. ResultsCorrelations with the FAMCAT and the PROMIS PF were strong for initial scores (MCAT_Mobilty: r=0.78, P<.0001; MCAT_DailyAct: r=0.81, P<.0001). The Applied Cognition scale did not demonstrate adequate correlations and thus was not a candidate for crosswalk scores. Although the MCAT_Mobility scale could be initially linked, subsequent analysis did not support a valid crosswalk. Linking criteria were applied with the Daily Activity scale to developing a final concordance table. ConclusionsThe FAMCAT Daily Activity scale yielded robust correlations to develop crosswalk scores with the PROMIS PF. The resulting crosswalk conversion metric may be useful to compare outcomes across these constructs for assessing functional abilities among patients on general medical services. The Applied Cognition and Basic Mobility scales did not meet the criteria; therefore, alternate legacy instruments are needed to develop additional crosswalks.

Circulating levels of growth hormone in postural orthostatic tachycardia syndrome

Postural orthostatic tachycardia syndrome (POTS) is a cardiovascular autonomic disorder with poorly understood etiology and underlying pathophysiology. Since cardiovascular morbidity has been linked to growth hormone (GH), we studied GH levels in patients with POTS. We conducted an age-sex-matched case–control study in patients with POTS (age 31 ± 9 years; n = 42) and healthy controls (32 ± 9 years; n = 46). Plasma GH levels were measured using high-sensitivity chemiluminescence sandwich immunoassay. The burden of orthostatic intolerance symptoms was assessed by the Orthostatic Hypotension Questionnaire (OHQ), consisting of a symptom assessment scale (OHSA) and a daily activity scale (OHDAS). POTS patients had significantly higher composite OHQ score than controls, more symptoms and less activity. Supine heart rate and diastolic blood pressure (BP), but not systolic BP, were significantly higher in POTS. Median plasma GH levels were significantly lower in POTS (0.53 ng/mL) than controls (2.33 ng/mL, p = 0.04). GH levels were inversely related to OHDAS in POTS and supine systolic BP in POTS and controls, but not heart rate neither group. POTS is associated with lower GH levels. Impairment of daily life activities is inversely related with GH in POTS. A higher supine diastolic BP is inversely associated with GH levels in POTS and healthy individuals.

The Relations of depression, anxiety and daily life activity patients with different levels of severity of chronic obstructive pulmonary disease

Introduction and aim: COPD is one of the leading causes of morbidity and mortality worldwide and it leads to economic and social burdens at significant and increasing levels. We aimed to investigate the relationship between daily living activities and depression, anxiety and disease levels in patients with COPD in our study. Materials and methods: Patients diagnosed with COPD were randomly enrolled to the study who admitted to the university polyclinics. Socio-demographic information form, mMRC dyspnea scale, COPD Assessment Test (CAT), London Chest Activity of Daily Living (LCADL) scale and Hospital Anxiety and Depression Scale (HADS) were applied. The collected data were evaluated by using statistical program. Results: In the study, 119 patients were enrolled, 94 participants were male (79%) and 25 were female (21%). Thirteen people (10.9%) who never smoked during their lifetime, 67 people (56.3%) who left the cigarette and 39 people (32.8%) were still smoking from the patients who participated in the study. There were 19 clinical cases (16%) and 100 (84%) normal cases for anxiety and 35 clinical cases (29.4%) and 84 (70.6%) normal cases for depression in the whole group. The correlation coefficient between the total score of daily living activity scale and anxiety was found as r: .289, and there is a weak level meaningful relationship between them (p<0.01). The correlation coefficient between daily life activity scale total score and depression was found as r: .259 and there is a weak level meaningful relationship between them (p<0.01). The correlation coefficient between total daily activity score and CAT total score was calculated as r: .552, and there is a moderate level meaningful relationship between them (p<0.01). Conclusion: In this study, it was concluded that activity of daily living in COPD patients was weakly correlated with depression and anxiety, and moderately correlated with disease level of severity. We believe that anxiety, depression, and severity of illness affects daily life activity in COPD patients, even if they are weak or moderate needed to be treated with a holistic approach.

Downregulation of growth hormone in postural orthostatic tachycardia syndrome: insights from the SYSTEMA cohort

Abstract Background Postural orthostatic tachycardia syndrome (POTS) is a variant of cardiovascular autonomic disorder occurring predominantly in young women. POTS is characterized by an excessive heart rate increase when assuming upright posture accompanied by symptoms of orthostatic intolerance. The pathophysiology of POTS has not been fully established and is believed to be multifactorial. Purpose We aimed to investigate the alterations in circulating growth hormone level in POTS. Methods We conducted an age-matched case-control study enrolling 42 patients with POTS (age 31±9 years; 36 women) verified by positive head-up tilt testing and cardiovascular autonomic tests, and 46 controls (32±9 years; 35 women) with negative active standing test and no history of syncope, orthostatic intolerance and endocrine disease. We measured plasma levels of growth hormone using a high-sensitivity chemiluminescence immunoassay in relation to presence of POTS diagnosis. All study participants completed the validated Orthostatic Hypotension Questionnaire (OHQ), consisting of two components: the symptoms assessment scale (OHSA) and daily activity scale (OHDAS) to evaluate the burden of symptoms. We applied standard statistical tests for group differences. Growth hormone values were log-transformed and standardized before the group comparison. Results POTS patients had significantly lower plasma levels of growth hormone (ng/mL) (median=0.53, IQR, 0.10–2.83 vs. median=2.33, IQR, 0.26–7.2, p=0.04) than controls. Levels of growth hormone were reversely related to OHDAS (p=0.049) among POTS patients. Supine heart rate was significantly higher in POTS patients (69.0±11.1 beats/min vs. 63.3±10.8 beats/min, p=0.02), as well as diastolic blood pressure (72.9±9.1 mmHg vs. 69.0±8.5 mmHg, p=0.04). We observed no significant difference in supine systolic blood pressure (116.6±13.3 mmHg vs. 115.2±10.0 mmHg, p=0.60). POTS patients had a significantly higher composite OHQ score than controls (60.0±18.6 vs. 4.2±7.5, p&amp;lt;0.001), as well as OHSA (36.2±10.0 vs. 3.6±6.4, p&amp;lt;0.001) and OHDAS (23.8±9.7 vs. 0.6±1.3, p&amp;lt;0.001). Conclusion(s) Our study shows that patients with POTS have significantly reduced plasma levels of circulating growth hormone. Lower growth hormone levels among POTS patients are associated with increased impairment of daily life activities. Further studies are necessary to confirm our findings in the independent populations and explain the mechanisms behind this alteration. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Crafoord Foundation, Swedish Heart and Lung Foundation

The impact of manual handling training on beliefs regarding low back pain

Purpose Despite widespread use, the impact of manual handling (MH) training on low back pain (LBP) beliefs is unclear, with some data suggesting MH instructors hold outdated beliefs about LBP. This study aimed to examine the effect of MH training on a range of LBP beliefs. Materials and methods Ethics committee approval (University of Limerick) was obtained prior to the study. A pre-post design study of healthcare workers prior to, and after, MH training. 129 participants completed questionnaires regarding their demographics, their LBP history, as well as a range of LBP beliefs using the Back Beliefs Questionnaire (BBQ), the modified Tampa Scale of Kinesiophobia (TSK) and the modified Photograph Series of Daily Activities (mPHODA) scale. Results BBQ (mean difference = 3.12 (95% CI: 1.72, 4.52), p < .001) and TSK (mean difference = −1.43 (95% CI: −2.38, −0.49), p = .004) scores were more positive after MH training. In contrast, common daily activities on the mPHODA were considered significantly more harmful after MH training (mean difference = 6.95 (95% CI: 4.62, 9.28), p < .001). Conclusions A single day of MH training can change LBP beliefs, with improvements exhibited in the BBQ and TSK, whereas scores on the mPHODA were worse after training. While the changes are small, these results confirm that the TSK and BBQ have similarities, and differ from the mPHODA. The content and delivery of MH training courses may need to better align participant learning with evidence regarding the safety of gradual exposure to spinal loading.

The Orthostatic Hypotension Questionnaire in Swedish tested in patients with parkinsonism.

BackgroundOrthostatic hypotension (OH) is common among older people and in particular in conditions like Parkinson’s disease (PD). The OH Questionnaire (OHQ) has been proposed as a useful patient‐reported assessment tool consisting of the OH Symptom Assessment (OHSA), OH Daily Activity Scale (OHDAS), and a composite score.Aims of the StudyTo translate the OHQ into Swedish and assess its psychometric properties.MethodsFollowing forward–backward translation, the Swedish OHQ was field‐tested (n = 6) for relevance, comprehensibility, and respondent burden. It was then tested regarding scaling assumptions, targeting, reliability, and construct validity in persons with PD (n = 27) and multiple system atrophy (n = 2).ResultsThe Swedish OHQ was considered relevant and easy to use, with a mean completion time of 5.3 min. Scaling assumptions were acceptable for OHSA and OHDAS (corrected item‐total correlations, .30–.67) but not for the total score (.12–.69). Floor/ceiling effects were ≤3.4% and reliability was >.64. Construct validity was supported by expected correlations with the SCOPA‐AUT, RAND‐36, and blood pressure measurements.ConclusionsThe Swedish OHQ was well received, and psychometric results suggest that the OHQ (particularly the OHDAS) is a useful tool for OH assessment in parkinsonian disorders. Further testing in larger samples is needed.

The role of continuity of systematic treatment and rehabilitation in patients with metastatic colorectal cancer in elderly and senile age.

e16041 Background: The concomitant pathology, cancer and geriatric status affect the organism of a sick elderly person. In routine clinical practice elderly patients require comprehensive geriatric assessment (CGO). Despite many treatment strategies for elderly patients with metastatic colorectal cancer (mCRC), there are no use of rehabilitation programs and the assessment of their impact on the treatment tolerability and survival. Methods: The study includes patients with newly diagnosed mCRC stage IV, receiving the first line of chemotherapy (FOLFOX). Patients are given CGO before starting chemotherapy and in dynamics.The following scales are used for geriatric examination: Cumulative Illness Rating Scale for Geriatrics (CIRS-G); Activities of Daily Living (ADL); Daily instrumental activity scale (IADL); Mini nutritional assessment (MNA); Clock Drawing Test (CDT); Geriatric depression scale (GDS). Results: At the moment 29 patients are included in the study. According the results of CGO we determined that elderly and middle-aged patients are similar in cognitive, mental, and nutritional status, but they have statistically significant differences on the MMSE scale (P=0,014). In both groups patients have a decrease in IADL and cognitive functions, the presence of depression. Elderly patients (&gt; 60 years old) are more likely to experience chronic pain (P&lt;0.05) and increased blood pressure (P&lt;0.05) (Table). Conclusions: The management tactics of patients with mCRC in elderly age shouldn't be based only on chronological age, ECOG or the Karnovsky index, that don't reflect functional disorders in patients of the older age group. It is necessary to define algorithms for medical rehabilitation in cancer patients of the older age group. A CGO is aimed at developing a medical rehabilitation plan together with an elderly patient and his environment, and an algorithm for supporting his health status during and after specialized treatment. [Table: see text]