Self-care Function Research Articles

The patient work system: An analysis of self-care performance barriers among elderly heart failure patients and their informal caregivers

Human factors and ergonomics approaches have been successfully applied to study and improve the work performance of healthcare professionals. However, there has been relatively little work in “patient-engaged human factors,” or the application of human factors to the health-related work of patients and other nonprofessionals. This study applied a foundational human factors tool, the systems model, to investigate the barriers to self-care performance among chronically ill elderly patients and their informal (family) caregivers. A Patient Work System model was developed to guide the collection and analysis of interviews, surveys, and observations of patients with heart failure (n = 30) and their informal caregivers (n = 14). Iterative analyses revealed the nature and prevalence of self-care barriers across components of the Patient Work System. Person-related barriers were common and stemmed from patients' biomedical conditions, limitations, knowledge deficits, preferences, and perceptions as well as the characteristics of informal caregivers and healthcare professionals. Task barriers were also highly prevalent and included task difficulty, timing, complexity, ambiguity, conflict, and undesirable consequences. Tool barriers were related to both availability and access of tools and technologies and their design, usability, and impact. Context barriers were found across three domains—physical–spatial, social–cultural, and organizational—and multiple “spaces” such as “at home,” “on the go,” and “in the community.” Barriers often stemmed not from single factors but from the interaction of several work system components. Study findings suggest the need to further explore multiple actors, contexts, and interactions in the patient work system during research and intervention design, as well as the need to develop new models and measures for studying patient and family work.

Effects of a safe patient handling and mobility program on patient self-care outcomes.

OBJECTIVE. The aim of this study was to determine the effect of a safe patient handling and mobility (SPHM) program on patient self-care outcomes. METHOD. We used a retrospective cohort design. Data were obtained from the electronic medical records of 1,292 patients receiving inpatient rehabilitation services. Self-care scores from the FIM™ for patients who participated in rehabilitation before implementation of an SPHM program were compared with the scores of patients who participated after implementation of the program. RESULTS. Patients who received inpatient rehabilitation services with an SPHM program were as likely to achieve at least modified independence in self-care as those who received inpatient rehabilitation services without an SPHM program. CONCLUSION. SPHM programs may not affect self-care performance in adults receiving inpatient rehabilitation services. However, more work must be done to define specific and effective methods for integrating patient handling technologies into occupational therapy practice.

Self-Care Performance in Children and Adolescents With Type 1 Diabetes Mellitus

examined and approved before administration to the subjects. The data were analyzed using SPSS. Results: The items were quantified on a five-point Likert scale. With regard to nutrition, 36.4% of children and 40.9% of adolescents had moderate performance. Moreover, 56.3% of children and 47% of adolescents showed moderate performance regarding DM management and 37.9% of adolescents had moderate performance in exercise training. The subjects had good and very good self-care performance scores. The results showed no significant difference in the mean scores of overall self-care performance between children and adolescents; however, there was a significant difference in the mean scores of exercise training and glucose self-monitoring between males and females, which indicated females’ weaker performance in comparison to that of males regarding these two factors (P = 0.02). Conclusions: Identifying the needs of children and adolescents with DM-1 in terms of self-care and education may help them to have better performance in management, control, and prevention of DM complications.

Avaliação da capacidade funcional de crianças com paralisia cerebral

Objetivo descrever a capacidade funcional de crianças com paralisia cerebral que realizavam atendimentos de Fisioterapia e Fisioterapia e Fonoaudiologia. Métodos estudo descritivo, de caráter transversal, composto por 14 crianças com PC do tipo quadriplegia espástica (6 realizavam Fisioterapia e 8 Fisioterapia e Fonoaudiologia). Foram utilizados para avaliação o Inventário de Avaliação Pediátrica de Incapacidade (PEDI) e o Sistema de Classificação da Função Motora Grossa (GMFCS). As associações entre as variáveis categóricas foram analisadas por meio do teste exato de Fisher. Comparações entre médias foram realizadas utilizando-se o teste t de Student. Resultados não se obteve melhora estatisticamente significante nas áreas de autocuidado, mobilidade e função social entre os dois grupos nos domínios de habilidade funcional e assistência ao cuidador. Conclusão as crianças do grupo Fisioterapia tiveram escores funcionais mais elevados que as do grupo Fisioterapia associado à Fonoaudiologia, mas não houve diferença estatisticamente significante entre os grupos. Isso se deu, provavelmente, devido ao reduzido número de participantes, à diversidade de quadros clínicos que a patologia pode apresentar e a possíveis diferenças na intervenção fisioterapêutica realizada nos dois estados, que possuem situações socioeconômicas bem diversas.

Low assistive technologies for persons with spinal cord injury (SCI) in Bangladesh

Assistive technology can play an important role in allowing a person with spinal cord injury (SCI) to live as independently as possible. The Centre for the Rehabilitation of the Paralysed (CRP) is the only specialized hospital and rehabilitation center in Bangladesh providing rehabilitation for people with SCI. Occupational therapists working in the multidisciplinary team in the Inpatient Unit at CRP play an important role in recommending appropriate assistive technologies for people with SCI. As most of the people with SCI in Bangladesh come from a low socioeconomic background, occupational therapists need to consider low cost assistive technologies. Occupational therapists design and provide a wide range of assistive devices to maximize performance in self-care, productivity, and leisure for people with different levels of SCI. Case examples demonstrate clients’ use of assistive technologies in their local communities. Currently, there is a very limited amount of research on low cost assistive devices in Bangladesh. Thus, ongoing research is required in this area.

통풍 환자의 자가 간호 수행에 영향을 미치는 요인

Purpose: This study identified the factors influencing the self-care performance among gout patients to provide the basis of the development of a nursing intervention program that can improve the self-care performance. Methods: A survey was conducted of 132 gout patients who visited the departments of rheumatology and orthopedics from September to November 2013. The data were collected using the instruments for knowledge of gout, self-care performance, and self-efficacy. Results: The gout patients' knowledge, self-efficacy, exercise pattern, and drink pattern accounted for 71.2% of the self-care performance. Among them, the most important factor affecting on self-care behaviors was knowledge levels, showing the variance of 51.0%. Conclusion: The strategy for improving the knowledge and self -efficacy level should be considered in the development of educational programs for gout patients.

Gross motor function, functional skills and caregiver assistance in children with spastic cerebral palsy (CP) with and without cerebral visual impairment (CVI)

Aim: To determine whether the level of gross motor function and functional skills in children with cerebral palsy (CP) and cerebral visual impairment (CVI) as well as caregiver assistance are lower in comparison with the corresponding group of children experiencing CP without CVI. Method: Data aggregated from 23 children experiencing CP with CVI were compared with data from children with CP without CVI matched for Gross Motor Function Classification System, mental development and age at testing. Scores for Gross Motor Function Measure-88 (GMFM-88) and the Pediatric Evaluation of Disability Inventory-NL (PEDI-NL) were employed to compare the level of gross motor function, functional skills and caregiver assistance between both groups. The Wilcoxon Signed Rank Test was utilized with a significance level of p < 0.05. Results: Children with CP with CVI, mean (± SD) age 6.4 ± 1.5, scored significantly lower than those with CP without CVI, mean age 6.3 ± 1.6, on all GMFM-88 dimensions and the total score (p < 0.001) and on the PEDI-NL in the sections of Functional Skills and Caregiver Assistance as well as in those of domains self-care (p < 0.001), mobility (p < 0.001) and social functioning (p < 0.001). Concerning the modifications scale, the scores for children with CP and CVI were significantly lower regarding mobility (no modification, p < 0.05), social functioning (no modification, p < 0.05) and social functioning (child-oriented, p < 0.05). Conclusion: CVI contributes to diminished gross motor function and functional skills in children experiencing CP with CVI compared with children with CP without CVI. Children with CP and CVI also require increased support at the level of caregiver assistance. Specific interventions need to be developed for children experiencing CP with CVI in order to improve gross motor function, functional skills and caregiver assistance.

PACIENTŲ PO GALVOS SMEGENŲ INSULTO FUNKCINĖS BŪKLĖS POKYČIAI REABILITACIJOS PROCESE

Visuomenėje pripažinta, kad galvos smegenų insultas (GSI) yra gyvybei pavojinga būklė. Nors mirtingumas nuo insulto mažėja, cerebrovaskulinės ligos lieka viena pagrindinių mirties ir negalios priežasčių daugelyje Europos Sąjungos šalių, o aukšti sergamumo rodikliai ir sunkios insulto pasekmės yra viena svarbiausių šiandieninės medicinos problemų. Darbo tikslas buvo įvertinti asmenų po GSI funkcinės būklės pokyčius reabilitacijos procese. Tirti 112 GSI sergančių ir besigydančių reabilitacijos įstaigoje pacientų, kurių amžiaus vidurkis 46 metai. Iš jų 53,6 proc. sudarė moterys. Pacientams buvo taikomas kompleksinis reabilitacinis gydymas, kurio metu su pacientais dirbo visa reabilitacijos komanda. Duomenų analizei buvo panaudoti ligos istorijos duomenys. Pacientų sveikatos būklė buvo vertinama du kartus, pacientams atvykus ir išvykstant iš gydymo įstaigos. Jų pažintinės funkcijos buvo vertintos naudojant standartizuotą trumpą protinės būklės tyrimą (MMSE), o savarankiškumas kasdieniame gyvenime vertintas standartizuotu funkcinio nepriklausomumo testu (FNT). Tyrimo duomenys apdoroti SPSS ir STATSTICA programiniais paketais. Statistinės duomenų analizės rezultatai parodė, kad pacientų po GSI funkcinės būklės pokyčiai kito teigiamai, nes reabilitacijos metu pagerėjo tiek pažintinės, tiek kasdienės apsitarnavimo funkcijos. Bendra pacientų pažintinių funkcijų būsena statistiškai reikšmingai skyrėsi, reabilitacijos eigoje gautas stiprus teigiamas ryšys, ką parodo p koeficientas (0,85), kuris reiškia stiprų teigiamą ryšį. O analizuojant bendrą tiriamųjų būklę priklausomai nuo insulto tipo, buvo išsiaiškinta, kad pacientų, sergančių išeminiu GSI, bendroji pažintinių funkcijų būklė buvo geresnė prieš reabilitaciją negu pacientų, sergančių hemoraginiu GSI. Sveikdami jie taip pat pasiekė geresnių rezultatų, jų duomenys statistiškai reikšmingai skiriasi (p0,05). Bendra pacientų savarankiškumo kasdieniame gyvenime būsena taip pat statistiškai reikšmingai skyrėsi reabilitacijos eigoje, o koreliacijos koeficientas p (0,93) parodė labai stiprų teigiamą ryšį. Mūsų tyrimo rezultatai parodė, kad pagerėjo pacientų po GSI, tiek pažintinės, tiek savirūpos funkcijų pokyčiai stacionarinės reabilitacijos eigoje. Taip pat nustatyta, kad gerėjant pažintinėms funkcijoms gerėja ir apsitarnavimas kasdieniame gyvenime. Tą parodo koreliacijos koeficientas p (0,54). Analizuojant sergančiųjų GSI reabilitacijos efektyvumą priklausomai nuo demografinių rodiklių, išsiaiškinta, kad pacientų funkcinės būklės dinamika statistiškai reikšmingai gerėjo priklausomai nuo insulto tipo. Taip pat nustatyta, kad geriau jautėsi pacientai, gyvenantys mieste, negu kaime, nors šie duomenys statistiškai reikšmingai nesiskiria. Išanalizavus funkcinės būklės pokyčius priklausomai nuo lyties, nustatyta, kad geresnė bendra savijauta buvo vyrų nei moterų. Taip pat jų reabilitacija buvo sėkmingesnė nei moterų, nors šie duomenys statistiškai reikšmingai nesiskyrė.

Assessment on self-care, mobility and social function of children with spina bifida in Turkey.

The aim of the study was to investigate the functional performance in children with spina bifida, using the Pediatric Evaluation of Disability Inventory (PEDI) to look into capacity of twenty-eight children with spina bifida with lesions at different levels in different dimensions of self-care, mobility and social function. Mean age of the patients was 3.5 ± 2.3 (1–10) years. In the muscle test carried out, 13 patients (44.8%) had no movements including pelvic elevation in lower extremity muscles and they were at level 5. Sixteen patients (54%) were non-ambulatory according to the Hoofer ambulation classification. Raw and scale scores in the self-care, mobility and social function domains both in the functional skill scale and in the caregiver scale were found to be lower compared to the data of the normal population. A statistically significant correlation was observed in the self-care values of the Functional Skills Scales and the Caregiver Assistance Scale measurements, which was positive for age and negative for Functional Ambulation Scale and muscle test (P < 0.05). A positive relation was found between the Functional Skills Scales-mobility area and age while a negative relation was observed between Functional Ambulation Scale and muscle test (P < 0.005). A negative relation was also found between Caregiver Assistance Scale-mobility and Functional Ambulation Scale and muscle test (P < 0.005). In our study, the functional performance of the children was found to be low. Low-level lesions, encouraging muscular strength and independence in mobility are all very important factors for functional independence.

Dialectic and Who We Are in the Alcibiades

Abstract In the Platonic Alcibiades, Socrates raises two central philosophical questions: Who are we? and: How ought we to take care of ourselves? He answers these questions, I argue, in his famous comparison between eyes and souls. Both answers hinge upon dialectic: self-care functions through dialectic because we are communicating beings. I adduce arguments for this from the set-up and language of the comparison passage. Another important indication is that Socrates expressly refers back to an earlier, aborted attempt to describe who we are in terms of using discourse. Rather than recommending to Alcibiades a life of contemplation apart from interpersonal exchange, Socrates presents such exchange as central to our self-improvement and identity.

The effect of self-care education program on reducing HbA1c levels in patients with type 2 diabetes.

Background:Diabetes as the most common diseases caused by metabolic disorders is an important global challenge. This is a disease that requires lifelong self-care because self-care and improved quality of life is cost effective. This study is aimed to determine the impact of self-care education program on reducing HbA1c, type 2 diabetic patients and was conducted in Zahedan.Materials and Methods:This is an experimental study done on 138 diabetic female patients in Zahedan city, in 2011 (1390). This sampling method of patients was based on inclusion and exclusion criteria of the Diabetes Center, at Hazrat Ali Asghar Hospital (AS) in Zahedan. Samples were divided randomly in to two groups: 69 cases and 69 controls. Data collected included validity and reliability confirmed questionnaire. Checklist was based on patients ‘performance of reporting and (HbA1c) testing. Before the educational intervention, the checklist of questions for recording the (HbA1c) test for both the groups were completed, and study samples received 5 sessions of education (with the group discussion and film show) for a month. However, the control group received only routine training. Three months after the educational intervention, both groups completed the questionnaire and the check list and data using SPSS software and the appropriate tests were analyzed.Results:Findings showed that the mean domain scores of area of knowledge, attitude and practice educational groups, were recorded as (46.6 ± 8.57, 46.5 ± 0.86 and 29.06 ± 10.02), respectively. And after education scores of knowledge, attitude and practice were recorded as (52.80 ± 2.20, 12.98 ± 1.02 and 39.69 ± 4.74), respectively, and in study group significant difference (P < 0/001) was seen.Conclusion:Self-care training in striation leads to improve knowledge, attitude and self-care performance of the study samples and also improves the average (HbA1c). Because it seems to increase the active participation of learners in their care that they have experienced with this training method and their motivation enhanced them to learn better self-care. So this type of care education should be given to the attention of nurses and healthcare's staff.

Functional performance among children with cochlear implants and additional disabilities

ObjectiveTo assess daily functional skills among young cochlear implant (CI) recipients with additional disabilities.MethodsChildren with CI and developmental disabilities and a hearing control group containing similar ages and similar disabilities were enrolled in a cross-sectional study of language and functional skills. Daily functional skills were measured using the Pediatric Evaluation of Disability Inventory (PEDI), which provides standard and scaled scores in Self-Care, Mobility, and Social Functioning domains. Language was assessed using the Preschool Language Scales, 4th edition which provides standard scores and age equivalents.ResultsFourteen children with CIs and seven hearing controls were included in this analysis. Most children in this study (90.5%) had cognitive disabilities and 57% had motor disabilities. Compared with the hearing controls, children with CIs were less likely to have functional independence in any PEDI domain. Children with CI had significantly lower median social functioning standard scores compared with controls (17.3 vs. 27.5, P = 0.009). After controlling for nonverbal cognitive abilities and language level, the difference was no longer significant (19.1 vs. 24, P = 0.3). Among children with CI, age at implant and duration with device were not associated (P > 0.4) with PEDI scores.DiscussionAlthough children with CI and developmental disabilities had similar functional skills as hearing children with similar disabilities regarding the PEDI domains of Self-Care and Mobility, they had lower Social Function standard scores. This lower social functioning among children with implants may be related to lower language levels and possible language deficits seen in the CI group. Regular assessments of functional abilities coupled with language abilities are essential in providing every child with the opportunity for maximizing the potential for independence.

The Effects of Physical Diseases on Elderly Depression and Moderate Effects of the Self-Care Performance

The Effects of Physical Diseases on Elderly Depression and Moderate Effects of the Self-Care Performance

P.3.1 GNE myopathy functional activity scale (GNEM-FAS): Development of a disease-specific instrument for measuring function and independence

GNE myopathy or hereditary inclusion body myopathy (HIBM) is an autosomal recessive myopathy presenting with distal leg weakness in early adulthood. Progressive weakness results in greater dependence and disability over time. A disease-specific measurement of functional activity is needed to better understand the burden of illness, inform the design of clinical studies and optimize care. After clinical interview of patients, a 25-item questionnaire was developed to assess ability and independence in three domains: mobility, upper extremity (UE) use and self-care. Each item was rated from 0 to 4 with higher scores representing better function. Total scores range from 0 to 100; subscale scores range from 0 to 40 for Mobility, 0–32 for UE and 0–28 for Self-Care. The GNE Myopathy Functional Activity Scale (GNEM-FAS) was administered to 47 ambulatory subjects enrolled in a Phase 2 study of extended release sialic acid. Physical therapists completed the GNEM-FAS based on clinical observation and subject interview. Scores were compared to performance on volitional measures of strength and function, as well as scores on the Inclusion Body Myositis Functional Rating Scale (IBMFRS), a validated instrument for myositis. The mean GNEM-FAS total score was 69 out of 100 (23–94). Mobility subscores averaged 50%, UE, 81% and Self-Care, 82% of the maximum possible. Higher Mobility scores were associated with greater lower extremity strength ( r =0.83) and longer 6MWT distances ( r =0.83). A moderate association was seen between the UE domain scores and UE strength ( r =0.66). Self-care domain scores and the stair climb time were negatively related ( r =−0.68). There was a strong correlation between GNEM-FAS total scores and IBMFRS scores ( r =0.94). Mobility was limited more than UE or self-care function in this cohort of ambulatory subjects with GNE myopathy. Repeat administration in treated and untreated patients with varying degrees of severity is underway to further validate the instrument.

Self-care and renal dysfunction in patients with chronic heart failure

Purpose: It has been shown that impaired renal function is a strong predictor of mortality in patients with chronic heart failure (HF). From a behavioural perspective, self-care has been assumed to be a crucial factor in chronic HF patients to maintain health. However, no prior studies have examined whether self-care is associated with improved renal function. Therefore, we prospectively examined the association between HF self-care and renal function at 1-year follow-up. Methods: In total, 482 chronic HF outpatients (mean age 66.2±9.5 years, 74% men) were recruited from 4 teaching hospitals in the Netherlands. All patients completed the shortened 9-item version of the European Heart Failure Self-care Behaviour scale to assess HF self-care and consultation behaviour at baseline and at 1-year follow-up. Renal function was measured at both consecutive time points using glomerular filtration rates of creatinine. Other HF-related pathophysiological markers of HF disease progression were also measured at both time points including heart pump function (left ventricular ejection fraction and brain natriuretic peptide), liver function, and anemia. Results: By means of linear mixed modeling using maximum likelihood estimation, better HF self-care and consultation behaviour were associated with lower glomerular filtration rates over time (p=.009 and p=.06, respectively), indicating worse renal functioning even after controlling for age, sex, disease severity using New York Heart Association functional class, and standard risk factors. In contrast, regular physical activity was associated with better renal function (p=.03). HF self-care was not associated with other pathophysiological markers of disease severity. Conclusions: HF self-care was associated with renal dysfunction over time. While there was no association between self-care and other pathophysiological markers of HF disease severity, physical activity activity was associated with improved renal function over time. Patient's awareness of their renal dysfunction might prompt better self-care, but the true nature of the link between self-care and clinical outcomes in patients with chronic HF warrants more attention in future research.

A randomized controlled trial of routines-based early intervention for children with or at risk for developmental delay

Routines-based early intervention (RBEI) for children with or at risk for developmental delay encourages collaboration between professionals and families to enhance children's participation in family routines with family-selected goals. We conducted the first single-blinded randomized control trial to examine the effectiveness of a 6-month RBEI vs. traditional home visiting (THV), which uses a curriculum focused on children's developmental domains. Thirty-one families with children aged 5-30 months (mean age 17.4 months) with or at risk for developmental delay were randomly assigned to an RBEI group (n=15) or a THV group (n=16). The enrolled children were evaluated using the Chinese version of Pediatric Evaluation of Disability Inventory (PEDI-C) and the Comprehensive Development Inventory for Infants and Toddlers (CDIIT) at 5 time points. Two-way mixed analysis of variance (ANOVA) was used to examine the group by stage interactions. Goal Attainment Scaling (GAS) and the Canadian Occupational Performance Measure (COPM) were applied to explore between-group differences on individualized goal achievement. PEDI-C showed that the RBEI group had a faster progress rate in self-care functions and independence in social functions in the first 3 months of intervention and at the 6-month follow-up. The RBEI group also scored higher on the GAS in the first 3 months of intervention. However, between-group differences in changes in the developmental domains on the CDIIT were not significant. Thus, RBEI was more effective than THV in promoting functional outcomes and reaching family-selected goals, while both interventions allowed equal improvement in developmental domains.

Comparison of Discharge Functional Status After Rehabilitation in Skilled Nursing, Home Health, and Medical Rehabilitation Settings for Patients After Hip Fracture Repair

ObjectiveTo examine differences in rehabilitation outcomes across 3 post-acute care (PAC) rehabilitation settings for patients after hip fracture repair. DesignProspective, observational cohort study. SettingSix skilled nursing facilities (SNFs), 4 inpatient rehabilitation facilities (IRFs), and 8 home health agencies (HHAs) in 10 states. ParticipantsPatients (N=181) receiving PAC rehabilitation following hip fracture with internal fixation (n=116) or total hip replacement (n=64), or no surgical intervention (n=1). InterventionsNot applicable. Main Outcome MeasureSelf-care and mobility status at PAC discharge measured by the Inpatient Rehabilitation Facility Patient Assessment Instrument. ResultsIRF and HHA patients had lower self-care function at discharge relative to SNF patients controlling for patient characteristics, severity, comorbidities, and services. Adding length of stay (LOS) resulted in nonsignificant differences between IRFs and SNFs. In contrast, there was no setting-specific advantage in discharge mobility for patients with or without the addition of LOS. The average LOS of HHA patients was 2 weeks longer than that of SNF patients, whose average LOS was 9 days longer than that of IRF patients (average, 15d). IRF and SNF patients received about the same total minutes of therapy over their PAC stays (∼2100min on average), whereas HHA patients received only approximately 25% as many minutes. ConclusionsSetting-specific effects varied depending on whether self-care or mobility was the outcome of focus. It remains unclear to what extent rehabilitation intensity or natural recovery effects changes in functional status for patients with hip fracture. This study points to important directions for PAC setting comparative effectiveness studies in the future, including uniform measurement, limited consensus on factors affecting recovery, accounting for selection bias, and using end-point data collection that is at the same follow-up time periods for all settings.

Cognitive impairment, oral self‐care function and dental caries severity in community‐dwelling older adults

To investigate whether oral self-care function mediates the associations between cognitive impairment and caries severity in community-dwelling older adults. Cognitive impairment affects activities of daily living and compromises oral health, systemic health and quality of life in older adults. However, the associations among cognitive impairment, oral self-care capacity and caries severity remain unclear. This increases difficulty in developing effective interventions for cognitively impaired patients. Medical, dental, cognitive and functional assessments were abstracted from the dental records of 600 community-dwelling elderly. 230 participants were selected using propensity score matching and categorised into normal, cognitive impairment but no dementia (CIND) and dementia groups based on their cognitive status and a diagnosis of dementia. Multivariable regressions were developed to examine the mediating effect of oral self-care function on the association between cognitive status and number of caries or retained roots. Cognitive impairment, oral self-care function and dental caries severity were intercorrelated. Multivariable analysis showed that without adjusting for oral self-care capacity, cognition was significantly associated with the number of caries or retained roots (p = 0.003). However, the association was not significant when oral self-care capacity was adjusted (p = 0.125). In contrast, individuals with impaired oral self-care capacity had a greater risk of having a caries or retained root (RR = 1.67, 95% CI 1.15, 2.44). Oral care capacity mediates the association between cognition and dental caries severity in community-dwelling older adults.

A new intervention to improve work participation of young adults with physical disabilities: a feasibility study

The aim of the study was to evaluate the feasibility of a new intervention to improve work participation of young adults with physical disabilities, addressing (1) implementation and costs and (2) preliminary effectiveness. Twelve young adults with physical disabilities (six males, six females; age 19-28 y, median age 21 y 6 mo) participated in a 1-year multidisciplinary vocational rehabilitation intervention. In a pre-post intervention design, we assessed implementation and costs as well as preliminary effectiveness in terms of employment and occupational performance using questionnaires and interviews. We tested pre-post differences with the McNemar test for proportions and the Wilcoxon signed-rank test for scores on occupational performance; p-values less than 0.05 were considered statistically significant. Additionally, we assessed work participation at follow-up after 2 years and 3 years. The intervention was implemented in an outpatient rehabilitation clinic for young adults. The median cost per participant for 1 year was €3128, which is an equivalent to the cost of 72 contact hours per participant. Post intervention, and at 2 years and 3 years follow-up, a significantly higher proportion of participants were employed (8/12 post vs 2/12 pre-intervention; p<0.05), with the ratio of those in paid to unpaid employment being 4:4, 5:3, and 7:1 respectively. Participants showed improved occupational performance in work, self-care, and leisure. Feasibility and preliminary effectiveness of the intervention are promising. Employed participants seemed to have achieved suitable and continuous employment.

Temporal recovery and predictors of upper limb dexterity in the first year of stroke: A prospective study of patients admitted to a rehabilitation centre

To document temporal recovery of upper extremity dexterity and establish predictors of limb dexterity in a cohort of stroke patients in the first year after stroke. Prospective cohort study. One hundred patients with a first-ever ischemic stroke admitted to a rehabilitation centre. Assessment of upper extremity dexterity, motor power and selfcare function using the Motor Assessment Scale (MAS), Upper Extremity Motor Index (UEMI) and Modified Barthel Index (MBI) respectively. Eighteen percent, 25.5% and 31.6% of patients recovered limb dexterity at 3, 6 and 12 months after stroke respectively. Patients who recovered dexterity late (≥6 months after stroke) were significantly younger with lower rehabilitation admission UEMI scores than those who recovered dexterity early. The UEMI score was the most significant correlate of limb dexterity at all follow up periods. Recovery of limb dexterity at 12 months was predicted by UEMI (OR1.54, 95% CI 1.13-2.10) and MBI (OR 1.03, 95% CI 1.00-1.07) scores on admission to rehabilitation. In this study, 31.6% of patients recovered upper extremity dexterity at 12 months after stroke. Although late recovery of dexterity occurs only in a small proportion of patients, this finding is still pertinent given the significant impact of dexterity on upper limb and selfcare function.