Self-care Capabilities Research Articles

Sleep and self-care correlates before and after implantation of a left-ventricular assist device (LVAD).

The impact of sleep on LVAD patients' self-care behaviors is unknown. This study examined the patterns and changes of patients sleep quality (SQ), daytime sleepiness (DS), instrumental activities of daily living (IADL), and self-care capability (SCC) before and after LVAD. In addition, the relationships among these variables were explored. This observational study consisted of 38 subjects from two VAD Centers in Michigan. The subjects completed self-reported demographics and psychometrically sound SQ, DS, IADL, and SCC questionnaires before LVAD implant and at 1, 3, and 6months after implant. Data were analyzed using descriptive statistics, linear mixed models, and partial least square models. Subjects (mean age, 56.3 ± 10.3years) were predominantly white (63%), male (68%), married (60%), and living with caregivers (92%). Over 70% had axial flow LVADs implanted as bridge-to-transplant (55%). Subjects' SQ was poor throughout the study period, along with high normal-to-excessive levels of DS. Problems with IADL before implant were significantly reduced at 1 through 6months after implant. SCC ranged from "good" to "excellent" before and after implant. Significant relationships between SQ and IADL (β = 0.43, p < 0.01) and DS and SCC (β=- 0.62, p < 0.01) were found. In conclusion, poor SQ and high degrees of DS were prevalent before and up to 6months after LVAD implant. The data inferred that the improvement in IADL was associated with an improvement in SQ. Research is needed to clarify the negative impact of DS on SCC and explain the contributions of caregivers on patients' SCC over time.

Randomized Trial of Modified Stretching Exercise Program for Menstrual Low Back Pain.

This study aimed to examine the effectiveness of a modified stretching exercise program on young women with menstrual low back pain. Overall, 127 young women were randomly assigned to the experimental ( n = 63) and control ( n = 64) groups. The experimental group followed the modified stretching exercise program, whereas the control group performed their usual activities. At 1, 4, 8, and 12 months, the experimental group had significantly lower scores on the visual analog scale for pain (95% confidence interval [CI] = [0.73, 1.96]; p < .05) and the Oswestry Low Back Pain Disability Questionnaire than the control group (95% CI = [0.68, 2.03]; p < .001). At 12 months, the experimental group showed significantly higher exercise self-efficacy than the control group (95% CI = [-6.87, 0.62]; p = .003). These findings can be used to enhance self-care capabilities by using the modified stretching exercise program for young women with menstrual low back pain.

Effectiveness of topical gel of medical leech (Hirudo medicinalis) saliva extract on patients with knee osteoarthritis: A randomized clinical trial

Leech saliva extract (LSE) in the liposome-based gel was used as a supplementary treatment to relief the signs and symptoms of osteoarthritis (OA).The saliva of medical leech was extracted and nano liposomes were used to formulate the supplement to enhance skin absorption. A clinical trial was designed to evaluate the therapeutic effects of LSE liposomal gel. Lenquesne and VAS questionnaires were used as indexes of this supplement therapy efficacy for 30 days.Questionnaires analysis showed that after one-month administration of LSE liposomal gel, patients' pain was relieved approximately up to 50%; also, due to reduction in joint inflammation and stiffness, the range of motion was increased and the patients' quality of life was enhanced (p < 0.001).LSE nano scaled liposomal gel as an innovative supplement therapy in OA patients, makes desirable therapeutic approach, which seems to make a significant impact on patient's quality of life and self-care capability.

Self-care behavior of type 2 diabetes mellitus patients in Bandar Abbas in 2015.

BackgroundDiabetes self-care helps to control the blood sugar which, in turn, results in a better state of health. However, more than 50% of diabetic patients do not have self-care capabilities.ObjectiveTo determine type 2 diabetes self-care capabilities among patients visiting a Bandar Abbas diabetes clinic in 2016.MethodsThe present descriptive-analytical research was of a cross-sectional type. The sample was comprised of 120 patients afflicted with type 2 diabetes, who had been selected through the simple randomized sampling method. The data collection instrument was a questionnaire comprised of two sections: demographic information, and a summary of patients’ diabetes self-care activities. A 7-point Likert scale was used for the rating. The final score would be interpreted as any of the three levels: good (acceptable) (75–100), moderate (50–74) and poor (below 50). The data entered SPSS version 18.0 for the required statistical analyses.ResultsThe mean age of the sample was 51.88±10.12 years. Of the 120 subjects, 86 were female (71.7%) and 34 were male (28.3%). The findings revealed that the self-care capability of 83 subjects (69.2%) was poor; capability of 28 subjects was moderate (23.3%) and the same score of good/acceptable in 9 subjects (7.5%).ConclusionThe results of the present research indicate that a large number of diabetic patients have a poor self-care capability. Due to the key role of such activities in a diabetic patient’s life, it is suggested to include educational programs to increase the level of self-care capabilities among these patients.

Group Medical Visits for patients with chronic disease – innovative tool to improve patient’s outcomes through inter-patient interaction and inter-patient empowerment

Introduction : (comprising context and problem statement) The increase of patients affected by multiple chronic conditions requires a shift in health care delivery from acute episodic interactions towards continuous, proactive care. In order to be effective, chronic care needs to put the patients’ personal needs, experiences and values are in the center of care delivery. Yet, interventions translating these policies into everyday care delivery are scarce and highly sought after by healthcare policy makers and health practitioners. One answer to these imperatives are “Group Medical Visits” (GMV). GMVs are an innovative primary care intervention empowering and engaging chronically ill patients not only in their own care delivery. GMV have been recognized to be an effective and efficient tool improving outcomes for chronically ill patients, and to decreasing costs. Short description of practice change implemented : Out of various GMV models, Cooperative Health Care Clinics (CHCCs), developed at Kaiser Permanente, is the most commonly one used. In CHCC the same 10-12 patients, affected by the same chronic disease, meet bi-monthly in a group session with their GP, instead of seeing him individually in one-on-one visits. Each CHCC session is composed of five phases conducted in the group setting, concluded by optional one-on-one patient-physician-time. Table 1. Template CHCC model Phase Duration Introduction / Warm up ~ 5-10 Minutes Patient centered group discussion ~ 20-30 Minutes Treatment ~ 30-50 Minutes Questions and Answers ~ 10-15 Minutes Closing and Planning ~ 5-10 Minutes Brief one-on-one visits as necessary Aim and theory of change : CHCC reside on the facts, that patients have accumulated comprehensive disease specific knowledge and gained a wealth of problem solving skills and personal experience in how to overcome disease related challenges. By providing a supportive, physician guided peer group format for patients to exchange their individual knowledge, their “real-world-tested” coping strategies and their personal experience, CHCC aim to utilize and foster the patients’ self-care capabilities and strengthen their health literacy. Targeted population and stakeholders : Chronically ill patients were targeted to improve their ability to better self-manage and engage in their healthcare. Stakeholders are GPs as well as patients themselves, fostering… …exchange of problem solving strategies and coping mechanisms for disease specific challenges …motivation to alter hazard lifestyles …dealing with psychosocial aspects of chronic care Timeline :3 years Highlights : (innovation, impact and outcomes) Proven CHCCs outcomes: patient satisfaction physician satisfaction quality of care effectiveness and efficiency in care provision Comments on sustainability : CHCC constitute an efficient alternative to one-on-one visits, as they require less physician time per patient. Comments on transferability : Developed by Kaiser Permanente, CHCCs have now been successfully trialed in various integrated and non-integrated healthcare systems. Conclusions : (comprising key findings) Aiming at supporting chronically ill to manage their conditions, to access and adapt coping strategies via peers affected from the same challenges, has been proven an effective tool. CHCCs… improve user experience as chronic care is translated from episodic to continuous interactions with the primary care provider in a group setting with peers improve health of chronically ill, by inter-patient exchange of knowledge and coping strategies increase the efficiency of primary care provision by replacing one-on-one visit Discussions : GMVs are not the panacea for chronic care delivery; however they are an instrument every GP should have in his “chronic care toolbox”. CHCC support GPs to help patients self-manage effectively, improve health outcomes and avoid inappropriate usage of healthcare resources. They are an instrument to enable patients to make choices of treatment options, to alter hazard lifestyles, and to access coping strategies. Lessons learned : Implementing GMVs to multiply self-care skills and enhance health literacy for the entire chronically ill patient panel at physician clinics requires change management and project management capabilities, which are not necessarily present in small independent GP practices.

Influence of authorization capability intervention on the self-care capability and living quality of the patients of chronic obstructive pulmonary disease

Objective To explore the influence of authorization capability intervention on the self-care capability and living quality of the patients of chronic obstructive pulmonary disease. Methods A total of 80 patients of chronic obstructive pulmonary disease received from January, 2014 to January, 2015 in the respiratory medicine department of North China Petroleum Administration Bureau General Hospital were selected as the study objects, which were divided into control group and observation group according to random number table where there were 40 patients each.Regular health education was given to the control group and authorization education was carried out to the observation group.The intervention time was 3 months.Authorized simplified scale and self-care capability scale were used to evaluate the authorization capability and self-care capability of patients in both groups 3 months before and after intervention respectively. Results With regard to the comparison of the authorization capability and self-care score of all study objects before intervention, the difference had no statistical significance(P>0.05).3 months after intervention, the authorization capability and self-care score of the observation group were superior to that of the control group, and the difference had statistical significance(P<0.05). Conclusions Doctor-nurse-patient cooperation mode can be used.The authorization education based on patients can improve the authorization capability and self-care capability of COPD patients, change the lifestyle of patients, improve the symptoms, delay the illness progress, and promote the life quality. Key words: Chronic obstructive pulmonary disease; Authorization education; Self-care; Living quality

Influence of periodical health education on self-care capability and living quality of patients with connective tissue diseases complicated with interstitial lung disease

Objective To explore the influence of periodical health education on self-care capability and living quality of patients with connective tissue diseases complicated with interstitial lung disease. Methods A total of 92 cases of patients with connective tissue diseases complicated with interstitial lung disease who were received and treated from January 2013 to October 2015 were selected as objects of study. The patients were divided into the observation group and the control group with 46 cases in each group according to the admission time. Both of the two groups were given conventional oxygen uptake therapy, non-steroidal anti infection therapy, expansion of blood vessels therapy and immune regulation therapy. The control group adopted usual care, while the observation group adopted periodical health education. The clinical efficacy, self-management ability, living quality and other indicators of the two groups were compared. Results The effective rate of observation group was 93.48% (43/46), and the effective rate of control group was 78.26% (36/46), The difference between the 2 groups was statistically significant (χ2=4.389, P < 0.05). The observation group related disease knowledge, self-care behavior, attitude adjustment, oxygen inhalation and respiratory function exercise with 5 self-care scores were higher than control group, the difference between the 2 groups was statistically significant (t=3.468-4.348, P < 0.05). The observation group related physiological function, physiological rate function, physical pain, overall health, vitality, social function, emotional function, mental health 8 quality of life scores were higher than control group, the difference between the 2 groups was statistically significant (t=2.261-5.456, P < 0.05). Conclusions Periodical health education is conductive to improving the self-care capability and living quality of patients with connective tissue diseases complicated with interstitial lung disease. Key words: Connective tissue diseases; Quality of life; Interstitiallung disease; Periodical health education; Self-care capability

The effect on patient outcomes of a nursing care and follow-up program for patients with heart failure: A randomized controlled trial

BackgroundHeart failure is associated with exacerbated symptoms such as dyspnea and edema and results in frequent hospitalization and a poor quality of life. With the adoption of a comprehensive nursing care and follow-up program, patients with heart failure may exhibit improvements in their self-care capabilities and their hospitalizations may be reduced. ObjectiveThe purpose of this study was to examine the effect of a nursing care and follow-up program for patients with heart failure on self-care, quality of life, and rehospitalization. Design and settingThis research was conducted as a single-center, single-blind, randomized controlled study at the heart failure outpatient clinic of a university hospital in Turkey. ParticipantsA total of 90 patients with heart failure were randomly assigned into either the specialized nursing care group (n=45) or the control group (n=45). MethodsThe nursing care and follow-up program applied in the intervention group was based on the Theory of Heart Failure Self-care. Data were collected at the beginning of the trial, and at three and six months after the study commenced. Self-care of the patients was assessed by the Self-Care of Heart Failure Index. Quality of life was assessed with the “Left Ventricular Dysfunction Scale”. Rehospitalization was evaluated based on information provided by the patients or by hospital records. ResultsA statistically significant difference was found between the intervention and control group with respect to the self-care and quality of life scores at both three and six months. While the intervention group experienced fewer rehospitalizations at three months, no significant differences were found at six months. ConclusionThe results obtained in this study show that the nursing care and follow-up program implemented for patients with heart failure improved self-care and quality of life. Although there were no significant differences between the groups at six months, fewer rehospitalizations in the intervention group was considered to be an important result.

Narrative Pedagogy in Nursing Education: The Essence of Clinical Nursing Process Recording

Clinical nursing process recording (CNPR) has been shown to be an effective tool for facilitating student-centered teaching and learning in nursing education. Yet, the essence and process of this tool have yet to be sufficiently explored and clarified. To explore the essence of CNPR in the contexts of clinical teaching and learning. Reflective analysis was used as the phenomenological approach to analyze the qualitative data, which were transcribed from the oral responses of the six participants who were attending the Clinical Nursing Education Forum. A total of five sessions of the Clinical Nursing Education Forums were conducted. The content of the Clinical Nursing Education Forums consisted of a series of 12 narrative writings of CNPR that were written by a senior student and read and commented on by the student's clinical instructor. Three groups of the essence and process of clinical teaching and learning were inductively identified as: (a) mobilizing autonomous, self-directed learning behavior from self-writing and re-storying; (b) establishing the student-instructor dialogical relationship from mutual localization; and (c) co-creating a learning environment in education and in clinical practice. When used as an interactive teaching and learning tool, CNPR promotes mutual understanding by re-locating the self in the coexisting roles of student nurse, instructor, and patient in a series of nursing care situations. This re-location facilitates students' self-directed learning, enhances the abilities of asking question, waiting for and accompany with the instructor; and promotes the self-care capabilities of patients.

Effect evaluation of quality control circle on the health promotion of diabetic patient

Objective To investigate the effect of quality control circle on the health promotion of diabetic patient. Methods Diabetes activity group of quality control circle was organized to have continuous disease control management on diabetic patients. Self-care capability, blood glucose, blood fat and body mass index variation of patients before and after the management were analyzed and controlled. Results After QCC management, the self-care capability of patients was significantly improved before admission to hospital(P<0.01). After being controlled by QCC activity group, 6 months after discharge from hospital, the fasting blood glucose, blood glucose 2 hours after dinner and blood fat declined dramatically, and the average body mass index also relieved significant, which was significantly different from it before admission to hospital (P<0.01). Conclusion Continuous and effective service conducted by quality control circle activity to diabetic patients can not only reach self-management, but also an effective way to cure diabetes and control complications, which is worth popularizing. Key words: Diabetic patients; Quality control circle; Self-care ability; Blood glucose control

Developmental trajectories of self-care capabilities among children and adolescents (1-16y) with cerebral palsy

Developmental trajectories of self-care capabilities among children and adolescents (1-16y) with cerebral palsy

An investigation of the health value and self-care capabilities of the elderly in urban-rural fringe area nursing homes and the related influencing factors

Abstract Objective To investigate the health value and self-care capabilities of the elderly living in urban-rural fringe area nursing homes and the factors that influence these variables. Methods A cluster sampling method was used to select 280 elderly individuals from seven urban-rural fringe communities in Xianning to complete a survey regarding their health value and self-care capabilities. Results The total health value and self-care capability scores of the elderly were 7.45 ± 1.45 and 100.25 ± 22.56, respectively. Both of these scores significantly differed by age, education level, marital status, and income ( P P r = 0.521). A multivariate linear regression analysis showed that health value, marital status, and age predicted self-care capability. Conclusions Elderly people living in the urban-rural fringe area with higher health values also had higher self-care capabilities. The self-care capabilities of the elderly can be enhanced by improving their health value using the “knowing-trusting-acting” model.

Functional Limitations, Medication Support, and Responses to Drug Costs among Medicare Beneficiaries.

ObjectiveStandard Medicare Part D prescription drug benefits include substantial and complex cost-sharing. Many beneficiaries also have functional limitations that could affect self-care capabilities, including managing medications, but also have varying levels of social support to help with these activities. We examined the associations between drug cost responses, functional limitations, and social support.Data Sources and Study SettingWe conducted telephone interviews in a stratified random sample of community-dwelling Medicare Advantage beneficiaries (N = 1,201, response rate = 70.0%). Participants reported their functional status (i.e., difficulty with activities of daily living) and social support (i.e., receiving help with medications). Drug cost responses included cost-reducing behaviors, cost-related non-adherence, and financial stress.Study DesignWe used multivariate logistic regression to assess associations among functional status, help with medications, and drug cost responses, adjusting for patient characteristics.Principal FindingsRespondents with multiple limitations who did not receive help with their medications were more likely to report cost-related non-adherence (OR = 3.2, 95% CI: 1.2–8.5) and financial stress (OR = 2.4, 95% CI: 1.3–4.5) compared to subjects with fewer limitations and no help; however, those with multiple limitations and with medication help had similar odds of unfavorable cost responses as those with fewer limitations.ConclusionThe majority of beneficiaries with functional limitations did not receive help with medications. Support with medication management for beneficiaries who have functional limitations could improve adherence and outcomes.

The Development of the Japanese Psychiatric Nursing Assessment Classification System (PsyNACS&lt;sup&gt;&#169;&lt;/sup&gt;)

The purpose of this study was to develop the Japanese Psychiatric Nursing Assessment Classification System (PsyNACS)&copy. This study used the on-line survey method from February to April 2015. There were 644 respondents comprised of professional nurses with minimum qualification of 3 years’ experience being in a psychiatric unit of a stand-alone 200-bed or more Psychiatric Hospital in Japan. Assessment items were derived from 211 specific items selected from nursing textbooks, excluding the North-American-Nursing-Diagnosis-Association (NANDA). The questionnaire contained Cover Letter, Demographic Data Sheet, and the PsyNACS&copy questionnaire. There were 644 questionnaires accessed but only 435 were completed and valid. Item levels of importance were evaluated: 1) Unnecessary, 2) Not very important, 3) Important and 4) Very important. Data analysis used descriptive and multivariate statistics. Factor analysis (principal factor analysis, varimax rotation), the Kaiser-Meyer-Olkin (KMO) and the Bartlett’s test of Sphericity assessed the adaptive validity of the factor analysis. Factor loadings were set at 0.4 or more for the configuration of items. Internal consistency and reliability were established using Cronbach’s alpha coefficient. Mean factor points were calculated, including standard deviation, range, and confidence interval at 95%. Statistical significance was at 0.05 level. Nine Patient Assessment Data (PAD) with 2 to 5 Cluster Assessment Data (CAD) each were categorized. Thirty one CADs comprised the Patient Assessment Data: (PAD1) Psychological symptom and stress, (PAD2) Information about treatment, (PAD3) Function of eating and balance of water, (PAD4) Life and value, (PAD5) Vital signs and health assessment, (PAD6) Self-care, (PAD7) Social support, (PAD8) Activity, sleeping and mobility capability, and (PAD9) Sexual function and sexual behavior. The PsyNACS&copy is a classification of items assessing health care needs within the Japanese psychiatric nursing care environment, and also can be used in various psychiatric patient care situations in all psychiatric units.

Evaluating Functional Outcomes of Botulinum Toxin Type A Injection Combined with Occupational Therapy in the Upper Limbs of Children with Cerebral Palsy: A 9-Month Follow-Up from the Perspectives of Both Child and Caregiver.

ObjectiveTo assess the effectiveness of combining botulinum toxin type A (BoNT-A) with functional occupational therapy (OT) at 9-month follow-up in children with cerebral palsy (CP) with bilateral upper limb impairments from the perspectives of both child and caregiver.MethodsTwelve children with CP and their caregivers were assessed across 5 time points over 9 months based on the ICF after BoNT-A injection and functional OT in this open-label study.ResultsSignificant differences were found across the 5 time points (p < .05) for both grasp and visual-motor integration with small effects (effect sizes = 0.12–0.24) and the self-care capability and performance of social function (p < .05). However, based on the effect sizes (0.02–0.14), no significant effects were found at the 4 post-test time points. Small effects were found on the psychological domain (effect sizes = 0.25–0.37) and environmental domains (effect size = 0.27) at follow-ups.ConclusionCombining a BoNT-A injection with OT not only reduced the muscle tone and increased ROM but also improved the upper limb function and self-care capability in children with CP. More importantly, these effects persisted for up to 9 months. Functional OT extends the effectiveness of a BoNT-A injection.

Study of the correlation between self-care capability and prognosis of patients with upper gastroin-testinal bleeding caused by liver cirrhosis

Objective To investigate the self-care agency level and analysis the relationship between the self-care ability level and the prognosis of the patients with upper gastrointestinal bleeding caused by liver cirrhosis. Methods In the first stage, 78 cases of liver cirrhosis patients complicated with first eruption of upper gastrointestinal bleeding were selected, the Exercise of Self Care Agency Scale (ESCA) was adopted to assess the self care ability of patients, the results underwent analysis. In the second stage, according to the results that the proportion of scores accounted for total score ratio, the patients were divided into low, medium and high level groups. By prospective studies, through telephone follow-up and clinic follow-up, the evaluation items of patients were collected, and the survival status of patients within 3 months after discharge was compared. Results For patients with upper digestive tract bleeding caused by liver cirrhosis, the self-care scored (84.07±17.38)totally, among 78 patients selected, 15.4% (12/78)was in the low level, 75.6% (59/78) was in the medium level, 9.0% (7/78)was in the high level. The self-care ability increased in conjunction with decreased mortality rate. The mortality rate in the lower level group was 8/12, 33.9% (20/59) in the medium level group, 1/7 in the higher level group, there was statistically significant difference, χ2=6.3,P<0.05. The MELD-Na scores in the lower, medium and higher level groups were respectively 34.03±4.62, 22.57±3.05, 12.87±1.36,F=6.0,P<0.05. Likewise, complication incidence rates were negatively correlated with self-care ability,r = -(0.525-0.189). Conclusions The self-care ability of patients with gastrointestinal bleeding caused by liver cirrhosis is in the medium level, and it exer-cises certain influence on prognosis of patients. Attention should be paid to cultivation of self-care abil-ity of patients in clinic. Key words: Liver cirrhosis; Self care; Prognosis; Gastrointestinal hemorrhage

Frailty syndrome and self-care ability in elderly patients with heart failure.

BackgroundChronic heart failure is a serious medical condition. Recently, there has been an increasing interest in frailty syndrome and self-care levels among patients with cardiovascular conditions. Demonstrating the influence of frailty syndrome on self-care could improve the quality of self-care and prevent the adverse effects of frailty syndrome. The purpose of this study was to assess the influence of frailty syndrome on the self-care capabilities of patients with chronic heart failure, and to identify factors associated with frailty.MethodsThe data were collected between January and July 2014. The study included 110 patients with chronic heart failure who were hospitalized in the cardiology clinic. Frailty syndrome was assessed using the Tilburg Frailty Indicator, a self-report questionnaire, and self-care behavior was assessed using the European Heart Failure Self-Care Behavior Scale.ResultsFifty-four percent of the study patients were male and 46% were female. The mean age was 66±11 years, the mean Tilburg Frailty Indicator score was 7.45±3.02 points, and the mean self-care level was 27.6±7.13 points. Correlation analyses showed that patients with higher scores in the social components of the frailty scale had better self-care capabilities. Frailty was associated with age, education, duration of heart failure, number of hospitalizations, and New York Heart Association class. The effects of these patient characteristics differed across components of frailty (physical, psychological, social).ConclusionThe social components of frailty syndrome adversely affect the ability to self-care in elderly patients with heart failure. It is relevant to use a multidimensional measurement of frailty.

Análisis de la capacidad de autocuidados en pacientes en diálisis peritoneal

Introducción: La Insuficiencia renal crónica es considerada una enfermedad de alto costo por sus efectos sobre la calidad de vida del paciente, la familia y el impacto en los servicios de salud, aspectos posibles de mitigar fortaleciendo el autocuidado. Objetivo: Medir la operatividad de la capacidad de autocuidado y establecer su relación con características sociodemográficas y clínicas en pacientes del programa de diálisis peritoneal en unidades renales de Bogotá, Colombia. Métodos: Estudio cuantitativo descriptivo transversal, población: 915 pacientes mayores de 18 años en diálisis peritoneal; se realizó muestreo probabilístico estratificado, se seleccionaron 105 pacientes en diálisis peritoneal automatizada y 174 en manual. Enfermeras especializadas en nefrología y urología les aplicaron tres instrumentos: Escala de Actividades de Autocuidado (ASA-A), Test de Morinski Green y formulario para caracterización sociodemográfica y clínica. Los datos se trataron mediante análisis descriptivo, utilizando tablas de frecuencia y correspondencias múltiples. Resultados: El promedio de la capacidad de autocuidado es de 78.7, desviación estándar 16.5, el 72% de los pacientes obtuvo puntuaciones superiores al mismo. El 77.42% de los participantes se clasificó en el rango de operatividad de la capacidad de agencia de autocuidado alta, el 9.32% media y el 13.98% baja. La mediana se ubicó en 78 puntos, rango intercuartílico de 77-88, y la moda fue de 86 puntos. La puntuación máxima fue de 96 reportado por tres pacientes y la mínima fue 27. En conclusión el 22.30% de los participantes requiere que el personal de salud diseñe estrategias que fortalezcan la operatividad de agencia de autocuidado.

Developmental Trajectories of Mobility and Self-Care Capabilities in Young Children with Cerebral Palsy

To describe development of mobility and self-care capabilities in young children (aged 1-4 years) with cerebral palsy, and to examine whether the development of mobility and self-care capabilities differs by cerebral palsy severity in terms of 5 distinct Gross Motor Function Classification System (GMFCS) levels. This prospective longitudinal cohort study included 100 children with cerebral palsy (aged 1.5 or 2.5 years at baseline) and their parents. Mobility and self-care capabilities were assessed by the Pediatric Evaluation of Disability Inventory during yearly assessments from inclusion up to age 4.5 years. Longitudinal data for 92 children were available for analysis. Repeated-measures analyses with random coefficient analysis were performed using linear mixed models. Despite large variations among individuals in the development of mobility and self-care capabilities in young children with cerebral palsy, distinct developmental trajectories were found for children in different GMFCS levels. The estimated change per month differed significantly by GMFCS level for both outcomes. This longitudinal study provides an evidence base for prognosis in daily mobility and self-care skills in young children with cerebral palsy. The developmental trajectories for GMFCS levels can be helpful in communication between professionals and also in discussions of expectations and goal setting with families regarding mobility and self-care in the daily life of young children with cerebral palsy in neonatal follow-up and pediatric practice.

PS2-18: Functional Limitations, Home Support, and Responses to Drug Costs Among Medicare Beneficiaries

Background/Aims Many Medicare beneficiaries have conditions or disabilities that affect their functional status and self-care capabilities. There is limited information on the potential associations between functional limitations, home support, and self-care activities such as managing and taking medications.