Self-care Tasks Research Articles

Transitioning Together: Collaborative Work in Adolescent Chronic Illness Management

Adolescents with chronic illnesses need to learn self-management skills in preparation for the transition from pediatric to adult healthcare, which is associated with negative health outcomes for youth. However, few studies have explored how adolescents in a pre-transition stage practice self-management and collaborative management with their parents. Through interviews with 15 adolescents (aged 15-17), we found that adolescents managed mundane self-care tasks and experimented with lifestyle changes to be more independent, which sometimes conflicted with their parents' efforts to ensure their safety. Adolescents and their parents also performed shared activities that provided adolescents with the opportunity to learn and practice self-management skills. Based on our findings, we discuss considerations for technology design to facilitate transition and promote parent-adolescent collaboration in light of these tensions.

Sleep Management: The Use of Continuous Physiological Monitoring to Support Patient Self-Care

Circadian misalignment (CM) is a sleep disruption where an individual’s circadian rhythm and actual sleep-wake cycle are unsynchronized. CM is frequently misdiagnosed and difficult to treat but can adversely impact short-term and long-term health outcomes. CM often interacts bidirectionally with chronic conditions affecting cognitive and physical functionality. Continuous physiological monitoring (CPM) of the hormone melatonin would support real-time, patient-driven interventions to address CM. However, patient-driven self-care tasks involve complex information processing and decision-making. Effective CPM use requires situation awareness regarding current circadian health and projected future status, sufficient background knowledge to identify circadian intervention alternatives, and selection of appropriate alternatives given their current state. Melatonin data has characteristics distinct from biomarkers previously subject to CPM, introducing further challenges around data presentation. Task analysis efforts can identify the cognitive processes involved in five different tasks associated with a continuous melatonin monitor to identify necessary informational elements to include in interface design.

Risks and Outcomes of New Onset of Unmet Need for Mobility and Self-care Daily Activities.

Among community-living older adults who have limitations in completing Activities of Daily Living (ADLs), unmet need occurs when they cannot complete an ADL task because no one was available to help. Prior research described correlates of existing unmet needs but did not consider which older adults are at risk for new onset of unmet needs. This study assessed health characteristics that increased risk for new onset of unmet needs within a year and subsequent health outcomes. Data are from the 2011-2019 annual interviews of the National Health and Aging Trends Study. For each pair of two consecutive annual interviews, we determined whether new onset of unmet needs occurred between the first and second consecutive interviews. Mixed effects logistic regression models were computed to assess risks for new onset of unmet need across 14,890 paired observations from persons who needed help with mobility tasks and 12,514 paired observations from persons who needed help with self-care tasks. Although demographic characteristics and chronic conditions had modest associations with new onset of unmet need, hospitalization between the two consecutive interviews was associated with a two-fold increase in risk for new onset of unmet need. New onset of unmet need was associated with hospitalization, nursing home placement, and death in the year following the two consecutive annual interviews. The findings inform the need for frequent assessments of ADL care needs with the goal of preventing new onset of unmet needs, especially after hospitalization.

Characterisation of Patients with Self-Neglect – `Room to Improve' with a New Potential Geriatric Giant?

Abstract Background Self-Neglect is an under-reported and often veiled diagnosis which is defined as ‘an adult’s inability due to physical or mental impairment or diminished capacity to perform essential self-care tasks. Self-Neglect is an independent risk factor for death and is associated with morbidity, heavy utilisation of healthcare services and safeguarding issues. Self-Neglect affects more older persons and is more commonly seen in people with cognitive deficits and social isolation. Methods Using HIPE data, patients were selected for a Descriptive Retrospective Chart Review with a diagnosis of Self-Neglect and under the care of a Consultant Geriatrician within a 2-year timeframe from April 2022 to April 2024. Data was compiled and demographics were collated. Charlson Co-Morbidity Index, Adult Comorbidity Evaluation-27 and Clinical Frailty Scores were employed. Results Twenty patient's charts were reviewed retrospectively. Of the twenty patients 65% were male, 40% are rural dwelling and 70% live alone. 95% of patients have an underlying cognitive impairment, and over 90% have a current or remote history of substance abuse. All 20 patients had significant concerns highlighted about their housing and 60% of patients required alternative accommodation while their home was updated or cleaned. All 20 patients required discharge planning with many requiring complex multi-disciplinary input regarding their safe discharge and had prolonged inpatient stays. Conclusion Recognition and resourcing ‘Self Neglect’ pathways will remain an issue in the health service in Ireland and worldwide. Patients presenting to hospitals with Self-Neglect are multi-morbid, socially complex and tread the line between autonomy and public health issues. Creating a service pathway that puts this vulnerable cohort at the centre and that could span both inpatient and community streams would be beneficial to the over-stretched health service but most importantly to the patient.

Building independence in self-care and household tasks: a qualitative study with adolescents with cerebral palsy and their caregivers

Purpose Adolescents with cerebral palsy (CP) may experience limitations in self-care and household tasks. The aim of the study was to understand the process of building independence in self-care and household tasks from the perspective of adolescents and their caregivers. Materials and methods We conducted a qualitative study with a phenomenological approach with 10 adolescents (15–17 years old) and 11 caregivers from a transition service in Brazil. Semistructured, remote interviews were conducted with each participant. The interviews were recorded for transcription and content analysis. Results Two thematic categories emerged: (1) “Thinking about independence” and (2) “Possible ways to foster independence.” The first category was divided into three subcategories: “Expectations and the desire to be independent,” “Obstacles to independence,” “Concerns about the future.” The second category was divided into four subcategories: “People and places,” “Opportunities for practice,” “Personal attitude” and “Adaptations that facilitate.” Conclusion Adolescents’ independence in several everyday activities involves physical, socioemotional and environmental aspects. Enabling opportunities for practice, an adapted environment, support from rehabilitation services and developing collaborative relationships with caregivers are elements that may favor the independence of adolescents with CP.

Aging in Place

What Is the Issue? Canada is experiencing an important demographic transition toward an increasingly diverse aging population with an increased need for care and support during the later stages of life. Despite older adults’ strong preferences to live in their home or community for as long as possible, health systems are challenged to keep up with growing demands for home care, community care and support services to support conditions to age in place, when appropriate. What Did Canada’s Drug Agency Do? Canada’s Drug Agency prepared an Evidence Assessment report that identified and described the current context of aging and hinderances to aging in place in Canada, considerations relevant to aging in place for equity-deserving groups, strategies and initiatives intended to address unmet needs and improve outcomes, and systemic considerations related to implementing initiatives supporting aging in place. The Health Technology Expert Review Panel (HTERP) used the Canada’s Drug Agency Evidence Assessment report to inform deliberations and to develop objective, impartial, trusted pan-Canadian guidance for decision-makers when considering evidence-informed aging-in-place initiatives to support equitable aging in place in jurisdictions in Canada. What Is HTERP’s Position on Aging in Place? Everyone has the right to age with dignity. Aging is a normal part of life and may be accompanied by changes in health status and/or abilities to complete everyday self-care tasks. Older adults comprise a heterogenous population with a continuum of health care needs and risks, including people living with vitality, those with moderately complex care issues, and those with complex care issues. Health and social systems were originally designed to meet the less complex acute care needs of a younger population and operate largely in silos. They cannot adequately or proactively address the continuum of needs of many older adults and their caregivers. Aging in place is a dynamic and complex experience that occurs within a larger context that is not limited to health systems. Older adults’ autonomy and preferences for care are realized by the active role of informal unpaid caregivers. The population of older adults in Canada is diverse with varying needs, risks, and cultural norms and values related to aging in place. Barriers to aging in place may disproportionately affect members of equity-deserving groups that experience multiple and often intersecting historical, social, cultural, medical, structural, institutional, and environmental barriers to care and support. There must be equity in access to safe, appropriate, and ongoing care to support dignity in living in a place of one’s choosing for older adults as they age. What Is HTERP’s Guidance to Support Aging in Place? foster a system that prioritizes integrated models of care to address current and future unmet needs and bridge gaps in and between services identify interventions that are aligned within an integrated model of care and are responsive to the unique and complex needs of older adults and their unpaid caregivers ensure culturally appropriate and equitable opportunities for positive outcomes standardize core measures or indicators to guide data collection, analysis, use, and reporting that support robust evaluation and cross-jurisdictional comparisons of interventions.

Activity behaviours and quality of life in patients with malignant pleural effusion

Background and objectiveAccelerometery is used to measure activity behaviours in patients with malignant pleural effusion (MPE). This study aimed to evaluate physical activity and sedentary behaviour profiles of patients with MPE in Hong Kong, and to explore relationships between activity behaviours and quality of life (QoL). We also compared clinician-recorded performance status measures with objective measures of activity levels.MethodsParticipants wore an Actigraph GT3X+ accelerometer continuously for 7 consecutive days. The EuroQoL­5 Dimensions­5 Levels (EQ­5D­5 L) was used to assess five dimensions of QoL and correlated with activity behaviours. The Eastern Cooperative Oncology Group (ECOG) performance status was documented by clinicians at baseline.Results51 patients with MPE received accelerometers; 94% had ≥1 valid day of data. Participants spent 76% (sd2.32) of waking hours sedentary, 23% (sd1.40) of waking hours in light activities and 0.3% [median, IQR 0.0–1.5] in moderate-to-vigorous physical activity (MVPA). Higher light and MVPA behaviours were associated with increased participation in self-care tasks (rs= −0.43, p= 0.003; rs= −0.45, p= 0.001 respectively) and usual activities (rs= −0.42, p= 0.003; rs= −0.45, p= 0.001 respectively). Patients with an ECOG status of 0 or 1 spent an average of 75% of waking hours sedentary.ConclusionThis is the first report of physical activity behaviours in patients with MPE in Hong Kong, demonstrating high sedentary behaviours and low physical activity which correlated to dimensions of QoL. Clinician-rated performance status was not reflected in accelerometery data, suggesting a discrepancy between performance status measures and objective measures of activity in patients with MPE.

Identification of challenges and leveraging mHealth technology, with need-based solutions to empower self-management in type 2 diabetes: a qualitative study

IntroductionEffective diabetes management relies mainly on an individual’s ability to perform self-care tasks. However, this process is influenced by a complex interplay of factors. This study explores the multifaceted influences on Diabetes Self-Management (DSM), examining both factors influencing and affecting DSM. Understanding these influences is crucial for developing targeted Digital Health Interventions that empower individuals with diabetes to achieve successful self-management.ObjectivesTo identify problems faced by Type 2 Diabetes Mellitus (T2DM) individuals in self-managing diabetes and leveraging mHealth technology, with need-based solutions to Empower Self-Management in T2DM.MethodologyIn-depth semi-structured interviews were conducted among ten patients with T2DM visiting the outpatient department of a tertiary care hospital in coastal Karnataka. Additionally, six healthcare professionals (HCPs) working closely with T2DM patients were interviewed to understand their perspectives on using mHealth to manage T2DM effectively. The themes for the solutions described were analyzed using ATLAS-TI software.ResultsOur research examined certain factors that might have influenced effective diabetes self-management and investigated patient perspectives on using digital health solutions in diabetes self-management. This study found that technology skills, duration of diabetes, knowledge, and personal beliefs were all significant factors affecting self-management in participants with T2DM. Additionally, socioeconomic factors were also seen to influence effective diabetes self-management. The Google search engine was used by 50% of the participants interviewed to learn about T2DM. Diet management through Google searches was used by a minority (30%) of the patients. None of the participants had previously used any mobile health applications (mHealth apps) to manage T2DM. 20% of the participants expressed limited knowledge about using smartphones or wearables to track health parameters. The study also identified potential non-technological barriers to mHealth adoption. To address these concerns, researchers used an empathy map to develop solutions that promote mHealth use.ConclusionSeveral challenges and need-based mHealth solutions were identified to empower diabetes self-management education among T2DM patients. Implementing need-based mHealth solutions such as data tracking, personalized feedback, and access to educational resources can lead to better disease control and a higher quality of life for those with T2DM. Further research and development in mHealth interventions, and collaborative efforts among healthcare providers, patients, and technology developers, hold a promising future for the healthcare sector in providing efficient, effective, and accessible care.

Social and physical environment effects on toileting disability among older adults in India

BackgroundTo examine the prevalence of toileting disability among older adults in India and its association with broad aspects of the physical and social environment.MethodsWe use data from the inaugural wave of the Longitudinal Ageing Study in India and focus on adults aged 65 and older (N = 20,789). We draw on the disablement process model and existing frameworks to identify environmental factors and other risk factors that may be associated with toileting disability. Hierarchical logistic regressions are implemented to analyze the health impacts from physical and social environment characteristics.ResultsOne in five older Indian adults had difficulties with toileting, and the prevalence rate of this functional disability varied across sub-national regions. We find that low neighborhood trust was associated with an increased likelihood of toileting disability, as was the use of assistive mobility devices. The negative effects of these social and external environment characteristics hold when we stratified the sample by rural and urban residency. Also, older adults in urban areas without access to toilets and using shared latrines had higher odds of being disabled in terms of toileting. Other factors important in explaining toileting disability among older adults included poor self-rated health, arthritis, currently working, living in the East or West region, and having functional limitations.ConclusionsPoor person-environment fit can compromise older adults’ ability to perform self-care tasks. Policymakers need to look beyond the physical environment (e.g., dedicating resources to construct toilet facilities) to adopt a more holistic, multi-faceted approach in their sanitation policies. Improving the safety of neighborhood surroundings in which shared latrines are located and the availability of accessible toilets that cater to those with mobility impairments can help improve independence in toileting among older adults.

What matters to you? A mixed-method evaluation of goal setting and attainment within reablement from a client perspective

Background Goal setting is an essential component of reablement programmes. At the same time it is also an important aspect in the evaluation of reablement from the perspective of clients. Objectives As part of the TRANS-SENIOR project, this research aims to get an in-depth insight of goal setting and goal attainment within reablement services from the perspective of the older person. Material and methods A convergent mixed methods design was used, combining data from electronic care files, and completed Canadian Occupational Performance Measure (COPM) forms with individual interviews. Results In total, 17 clients participated. Participants’ meaningful goals mainly focused on self-care, rather than leisure or productivity. This mattered most to them, since being independent in performing self-care tasks increased clients’ confidence and perseverance. Regarding goal attainment, a statistically significant and clinically relevant increase in self-perceived performance and satisfaction scores were observed. Conclusion Although most goals focused on self-care, it became apparent that these tasks matter to participants, especially because these often precede fundamental life goals. Significance Reablement can positively contribute to goal setting and attainment of clients and may contribute to increased independence. However, effectiveness, and subsequently long-term effects, are not yet accomplished and should be evaluated in future research.

Challenging Case: New-Onset Hallucinations and Developmental Regression in a Child with Autism Spectrum Disorder.

Nick is a 5-year-old boy who began displaying self-stimulating behaviors and decreased social interactions shortly before turning 3 years. At the age of 3.5 years, he was diagnosed with autism spectrum disorder by a local developmental-behavioral pediatrician. His parents recall that the physician described Nick to be "high functioning" and encouraged them to expect that he would attend college and live independently as an adult. Upon receiving the diagnosis, intervention was initiated using an applied behavioral analysis (ABA) approach. With this intervention, he demonstrated initial gains in the use of complex language and improved social interactions.Concerns regarding suspected psychosis emerged just before starting kindergarten when Nick began experiencing ego-dystonic visual and auditory hallucinations. Initially, Nick verbally responded to the hallucinations and vividly described what he was experiencing. Shortly after the onset of these hallucinations, Nick experienced a significant decrease in the frequency and complexity of his expressive language and became more withdrawn. Over time, his hallucinations intensified, and his parents became increasingly fearful for his safety. Various antipsychotic and mood-stabilizing medications, steroids, and immunotherapy have been trialed with limited improvement of his symptoms.An extensive medical evaluation yielded the following:1. Magnetic resonance imaging of the brain: dilated perivascular spaces.2. Urine organic acids: ketosis and increased lactic acid.3. Antinuclear antibody: minimally positive.4. Vitamin B12: elevated.All other studies, including lumbar puncture, electroencephalogram (awake and asleep), genetic studies (chromosomal microarray, fragile X testing, and whole exome sequencing), metabolic studies, inflammatory markers, and thyroid panel, were negative/normal.Nick is enrolled in a special education classroom within a school that utilizes an ABA-based approach for all students. As part of his educational programming, he receives 25 hours of ABA in a 1:1 setting, 2 hours of speech therapy, 3 hours of occupational therapy, 1 hour of physical therapy, and 30 minutes of music therapy weekly. Current concerns include significant head-banging and thrashing before falling asleep, hyperactivity, unsafe behaviors (e.g., banging on windows, climbing high to reach desired items), aggression toward caregivers, limited ability to complete self-care tasks (e.g., personal hygiene, toileting), significant decline in expressive language, and continued response to internal stimuli.Nick's parents now present to a multidisciplinary center seeking guidance regarding additional therapies/interventions to assist in management of his current developmental and behavioral challenges as well as information regarding his expected developmental trajectory as he reaches adulthood.

From wernicke-korsakoff to central pontine myelinolysis: the potentially irreversible risks of alcohol use

Introduction Sustained alcohol intake, when combined with incomplete treatment, can result in chronic structural changes in the Central Nervous System, including generalized cortical and cerebellar atrophy, amnesic syndromes like Korsakoff’s syndrome, and white matter disorders such as Central Pontine Myelinolysis and Marchiafava-Bignami syndrome. It is crucial to prevent these complications due to their potential for irreversible and debilitating consequences. For Wernicke-Korsakoff syndrome, early recognition and thiamine administration for prevention are paramount, as it arises from thiamine deficiency due to malnutrition caused by persistent alcohol use. In the case of Central Pontine Myelinolysis, which is caused by abrupt fluctuations in serum osmolality, controlled sodium correction is essential.ObjectivesThrough a clinical case and a review of published literature, this study aims to reflect on the importance of preventing neurological injuries associated with chronic alcohol consumption, specifically Wernicke-Korsakoff Syndrome and Central Pontine Myelinolysis.Methods A literature review was conducted by searching for articles on PubMed using the terms “Alcohol Use Disorder,” “Wernicke-Korsakoff syndrome,” and “Central pontine myelinolysis.” A clinical case is presented, featuring a 50-year-old patient with alcohol use disorder who developed Wernicke-Korsakoff syndrome and Central Pontine Myelinolysis. Considering this case, we reflect on the primary approaches that could have been beneficial in preventing these complications and propose a straightforward method for doing so.Results A 50-year-old patient presented with poor general condition, characterized by low weight, significant loss of strength in the limbs and arms, and incoherent speech with anterograde amnesia and confabulation. This condition had progressed to a point where the patient could no longer walk, perform basic self-care tasks such as bathing, dressing, and eating independently, underscoring the severity of his condition. The diagnoses of Wernicke-Korsakoff syndrome and Central Pontine Myelinolysis were established based on clinical manifestations and the presence of hyperintense lesions observed in the central pons on T2/FLAIR axial MRI scans. This clinical case highlights the importance of proper and precocious prevention of complications in patients with alcohol use disorder. The foremost step in preventing these complications is to treat alcohol dependence effectively, even when faced with patient resistance. It’s vital to remain vigilant about potential complications and implement suitable prophylactic measures.ConclusionsThe devastating effects of complications arising from Alcohol Use Disorder, such as Wernicke-Korsakoff syndrome and Central Pontine Myelinolysis, underscore the importance of enhanced attention that clinicians should provide when approaching these patients at all clinical interactions.Disclosure of InterestNone Declared

Identification of Social Determinants of Education Among Pharmacy Students: Results From a Single-Institution Survey

ObjectiveTo identify social determinants of education (SDOE) among pharmacy students enrolled in the entry-level Doctor of Pharmacy program at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences. MethodsAn original 28-item survey was developed and disseminated to first through fourth year students enrolled in the entry-level Doctor of Pharmacy program at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences during the spring 2023 semester. The survey evaluated student demographics, educational performance, and SDOE in 6 categories: physical health, psychosocial health, economic stability, self-motivation, social environment/community, and physical environment/community. ResultsA total of 133 students responded to the survey. Over half of the respondents acknowledged difficulties completing errands or self-care tasks owing to their physical, mental, or emotional health. Over half of respondents also reported concerns about covering expenses at the end of the month. Respondents also reported eating less because of financial restraints (20.0%), worrying about housing (22.9%), feeling unsafe in their neighborhood (29.0%), and feeling lonely or isolated (63.4%). In the secondary analysis, the respondents who had concerns with covering expenses, affording food, or losing housing had significantly lower academic performance. ConclusionThis study identified several SDOE among pharmacy students at our institution, suggesting that students at even the highest levels of education may be subject to disparities. The identification of SDOE provides insight into barriers that are potentially hidden but are highly likely to impact student engagement and success. Efforts toward reducing disparities and promoting equitable opportunities for students are necessary to ensure continued growth and diversification of the pharmacy profession.

Abstract 4832: The impact of neighborhood-level disadvantage on the patient-reported outcomes of primary brain tumor patients

Abstract There is increased recognition that social determinants of health may impact well-being and health in those with various cancers, but they have not been systematically evaluated in primary brain tumor (PBT) patients. Here, we examined the association between Area Deprivation Index (ADI), a measurement of sociodemographic neighborhood disadvantage, and patient-reported outcomes (PROs) in a cohort of adult PBT patients enrolled in a large National Institutes of Health observational trial (NHS, NCT02851706, PI: Armstrong). We utilized linear regression to assess the relationship between ADI (less advantaged [ADI≥40, n=153, 24%], more advantaged [ADI<40, n=490, 76%]) and patient symptom burden (MDASI-BT), anxiety, and depression (PROMIS Short Forms v1.0 8a). Logistic regression was used to evaluate the association between ADI and health-related quality of life using the 5 dimensions of the EQ-5D-3L. Models were adjusted for age, sex, race/ethnicity, tumor grade, Karnofsky Performance Score (KPS), and tumor recurrence. A sub-analysis stratifying by tumor grade (low, high) was completed. Among 643 PBT patients, the majority resided in more advantaged areas (n=490; 76%) and had high-grade tumors (n=448; 70%). Those who were less advantaged reported more symptom severity (β=1.10, SE=1.05, P=0.041), more activity-related interference (β=1.11, SE=1.05, P=0.03), and had 4.68 times the odds of having moderate-severe difficulty completing self-care tasks (95% confidence interval [1.46, 14.96], P=0.009) compared to those who were more advantaged. KPS was a significant predictor for all three outcomes, and age at diagnosis was significant for PBT symptom severity. Among patients with low-grade tumors, those who were less advantaged reported higher symptom interference (β=1.24, SE=1.10, P=0.020), affective symptoms (β=1.24, SE=1.08, P=0.007), treatment-related symptoms (β=1.21, SE=1.08, P=0.021), general disease symptoms (β=1.26, SE=1.10, P=0.016), activity-related interference (β=1.26, SE=1.09, P=0.006), mood-related interference (β=1.20, SE=1.09, P=0.039), and anxiety (β=1.03, SE=1.02, P=0.023), with KPS being a significant predictor for all outcomes except anxiety. Overall, less advantaged PBT patients reported worse symptom severity and activity-related interference, and those with low-grade tumors experienced more affective symptoms, including fatigue, general disease and treatment-associated symptoms, and symptoms of anxiety, but not neurologic or cognitive symptoms. Living in less advantaged areas may lead to barriers to care access, symptom management medications, or other neighborhood resources that could alleviate PBT patient symptom burden but may compound over time for those with poor performance status or low-grade tumors. These results highlight the need for targeted supportive interventions for PBT patients living in less advantaged areas. Citation Format: Zuena A. Karim, Kimberly Reinhart, Orieta Celiku, Yeonju Kim, Hope Miller, Elizabeth Vera, Jacqueline B. Vo, Terri S. Armstrong, Macy L. Stockdill. The impact of neighborhood-level disadvantage on the patient-reported outcomes of primary brain tumor patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4832.

Improved Disabilities of the Arm, Shoulder and Hand scores after myoelectric arm orthosis use at home in chronic stroke: A retrospective study.

Most stroke survivors have persistent upper limb impairments after completing standard clinical care. The resulting impairments can adversely affect their quality of life and ability to complete self-care tasks and remain employed, leading to increased healthcare and societal costs. A myoelectric arm orthosis can be used effectively to support the affected weak arm and increase an individual's use of that arm. The study objective was to retrospectively evaluate the outcomes and clinical benefits provided by the MyoPro® orthosis in individuals 65 years and older with upper limb impairment secondary to a stroke. The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was administered to individuals who have chronic stroke both before and after receiving their myoelectric orthosis. A Generalized Estimating Equation model was analyzed. After using the MyoPro, 19 individuals with chronic stroke had a mean improvement (decrease) in DASH score of 18.07, 95% CI = (-25.41, -10.72), adjusted for 8 covariates. This large change in DASH score was statistically significant and clinically meaningful as participants self-reported an improvement with engagement in functional tasks. Use of the MyoPro increases independence in functional tasks as reported by the validated DASH outcome measure for older participants with chronic stroke.

Investigating the impact of developmental coordination difficulties across home, school, and community settings: Findings from the Australian Impact for DCD survey

AimTo evaluate the participation difficulties experienced by children with developmental coordination disorder (DCD) in home, school, and community environments. MethodsThe Impact for DCD survey was completed by primary caregivers of 4–18-year-old children with DCD (or synonymous diagnosis) (n = 429). Outcomes and resultsThe greatest participation difficulties experienced at home included dressing, eating with utensils, self-care tasks and drawing/writing reported by over 70% of families. At school, fine motor difficulties were also frequently reported, with additional difficulties keeping up or completing tasks, and not feeling supported at school. Socialisation challenges and bullying were also commonly reported (34.9%). As a result of participation difficulties at school, 5.4% were home schooled. Many children engaged in community activity, with 72.0% currently engaged in at least one organised sports-based activity. Conclusions and implicationsIncreased recognition of the widespread impact of DCD in a child’s life is crucial at an individual and societal level. Parents reported their children experiencing significant participation restrictions and difficulties. The findings of this large-scale study have revealed that most children with DCD are not receiving the support they need to thrive, especially at school. This largely reflects a lack of understanding and recognition of the condition and its associated challenges.

Self-care activities in pediatric patients with type 1 diabetes mellitus.

Effective diabetes self-management and collaborative responsibility sharing with parents are imperative for pediatric patients with type 1 diabetes mellitus, particularly as they gradually assume more self-care responsibilities. The primary goal of this study was to assess differences in adherence to self-care activities regarding sociodemographics and clinical characteristics in pediatric patients with type 1 diabetes. The secondary goal of this study was to understand the level of parental involvement in diabetes management and to assess the pediatric patients' behaviors (independent or dependent on disease self-management) that relate to sociodemographic and clinical characteristics. This was a comparative cross-sectional and correlational study. The study sample included 182 children and adolescents who had been diagnosed with type 1 diabetes at least 3 months prior. Data collection instruments included a sociodemographic and questionnaire about Adherence to self-care activities and parental involvement in diabetes self-management, as well as a documentation sheet for recording clinical data. A majority of participants (71%) exhibited non-adherence to self-care tasks, despite 78.0% asserting their independence in diabetes self-management. Notably, insufficient parental involvement in administering insulin therapy significantly predicted severe hypoglycemic episodes. Pediatric patients dealing with type 1 diabetes demonstrate a substantial degree of autonomy in managing their condition, paradoxically coupled with self-reported non-adherence to critical self-care responsibilities. Notably, children (aged 8-12) rely more heavily on parental support, especially concerning insulin therapy administration. The study underscores the crucial role of parental engagement in insulin therapy, as its deficiency significantly predicts the likelihood of severe hypoglycemic episodes.

Type 1 Diabetes in Singapore: Self-Care Challenges, Diabetes Technology Awareness, Current Use, and Satisfaction, an Online Survey.

To describe the self-care challenges, diabetes technology awareness, current use, and satisfaction among adults with type 1 diabetes and parents of children with type 1 diabetes in Singapore. An anonymous online survey was administered between November 2020 and October 2021. Data are presented as mean (standard deviation) or count (percentages). Comparisons between groups were done using the independent samples T-test. 251 people (176 adults, 75 parents) participated. The most challenging self-care burdens were carbohydrate counting (24.4%) among adults and insulin dose calculations (28%) among parents. Nocturnal awakenings for diabetes care of their child were a common event (25.3%). Despite high awareness about continuous glucose monitoring devices (77.8% adults, 78.7% parents) the use (24.9% adults, 55% children) remained low. Both adults and parents of children with type 1 diabetes found continuous glucose monitoring to be liberating and less restrictive. Despite overall low insulin pump use (23.9% adults, 29.3% children); satisfaction scores were higher among insulin pump users than insulin pen users (P = 0.02). Carbohydrate counting and insulin dose calculations were the most challenging self-care tasks among people with type 1 diabetes in Singapore. Diabetes technology use was relatively low in Singapore. Continuous glucose monitoring and Insulin pump users found them to be beneficial.

Physical Fitness and Cognitive Function in Persons with Dementia and their Caregiver

A cross-sectional design investigated the physical attributes of 15 dyads of people with dementia and their caregivers. Physical and cognitive markers determined deviations from clinical thresholds for loss of functional independence, where 100% of participants performed below criterion-referenced threshold values for aerobic endurance. Walking distance for people with dementia was associated with bath/shower activity (p = .007), transfers (p < .001), and mobility (p = .013). Less distance walked was associated with more assistance with self-care tasks. Physical deficits associated with low aerobic endurance and lower body strength compromised independence, placing dyads at risk for falls and mobility-related health issues.

Five Functional Classes Identified Among Patients Hospitalized for Pneumonia Characterized by Activity Limitations With Mobility and Self-Care Tasks

ObjectiveLatent class analysis was used to identify functional classes among patients hospitalized for pneumonia. Then, we determined predictors of class membership and examined variation in distal outcomes among the functional classes. DesignAn observational, cross-sectional study design was used with retrospectively collected data between 2014 and 2018. SettingThe study setting was a single health system including 5 acute care hospitals. ParticipantsA total of 969 individuals hospitalized with the primary diagnosis of pneumonia and receipt of an occupational and/or physical therapy evaluation were included in the study. InterventionsNot applicable. Main OutcomesThe following 5 distal outcomes were examined: (1) occupational therapy treatment use, (2) physical therapy treatment use, (3) discharge to home with no services, (4) discharge to home with home health, and (5) institutional discharge. ResultsFive functional classes were identified and labeled as follows: Globally impaired, Independent with low-level self-care, Independent low-level mobility, Independent self-care, and Independent. Probability of occupational therapy treatment use (χ2[4]=50.26, P<.001) and physical therapy treatment use (χ2[4]=50.86, P<.001) varied significantly across classes. The Independent with low-level self-care class had the greatest probability of occupational therapy treatment use and physical therapy treatment use. Probability of discharging to home without services (yes/no; χ2[4]=88.861, P<.001), home with home health (yes/no; χ2[4]=15.895, P=.003), and an institution (yes/no; χ2[4]=102.013, P<.001) varied significantly across the 5 classes. The Independent class had the greatest probability of discharging to home without services. ConclusionsFive functional classes were identified among individuals hospitalized for pneumonia. Functional classes could be used by the multidisciplinary team in the hospital as a framework to organize the heterogeneity of functional deficits after pneumonia, improve efficiency of care processes, and help deliver targeted rehabilitation treatment.