Self-reported Physical Disability Research Articles

Real World Effectiveness of Orphenadrine Citrate 35 mg + Paracetamol 450 mg (Norgesic®) on Low Back Pain of Filipino Patients

Introduction: Low back pain (LBP) is a prevalent musculoskeletal condition, believed to impact as many as 84% of adults during their lifetime. It ranks among the primary reasons for limitations in activity, absenteeism from work, and reduced productivity, resulting in significant costs to health, social, and economic systems. Furthermore, the Philippines has been identified as one of the countries where 56% of its population suffers from weekly body aches. Thus, the study determined the effectiveness of orphenadrine citrate 35 mg + paracetamol 450 mg (Norgesic®) in relieving acute, non-specific moderate to severe musculoskeletal LBP among adult Filipino patients in a real-world setting. Methods: A prospective, multi-center, uncontrolled, open label, longitudinal study was done. Study participants were recruited via purposive sampling by their attending physicians, and they were given Norgesic® according to local prescribing guidelines and standard clinical practices. Pain levels were measured using the visual analogue scale (VAS), while self-reported physical disability was assessed using the Roland-Morris Disability Questionnaire (RMDQ). Patients were monitored until their low back pain completely resolved or for a maximum of ten (10) days. This real-world evidence study also documented any adverse effects occurring during this ten-day period. Results: The median onset of pain relief in the 255 study participants occurred an hour after the first dose of Norgesic® tablet, the fastest by 30 minutes and the slowest by the 8th hour, and it lasted for six (6) hours. At baseline, the median VAS score was seven (7) which subsequently decreased to 0 by day 7 up to day 10 and differed significantly from baseline (p<0.0001). The median number of Norgesic® tablets consumed for pain relief likewise decreased from three tablets on day 1 to one tablet on day 7 to none on the succeeding days until the end of study period. The mean duration of LBP before total resolution, was 5.1 SD ± 2.2 days. The incremental increase in the proportion of those with complete resolution (VAS score=0) was highest by day 7. The median physical disability score significantly decreased to zero (0) on day 11 from nine (9) at baseline. Adverse events reported in 22 participants were generally mild dizziness and somnolence, which lasted for 1-6 days and resolved with rest. Conclusion: In this study, orphenadrine 35 mg + paracetamol 450 mg (Norgesic®) was noted to be effective in alleviating acute nonspecific moderate to severe musculoskeletal LBP of Filipino patients. In addition, Norgesic® aided study subjects in regaining functional capacity for them to continue with their impaired activities of daily living. Only few non-severe, self-limiting adverse reactions were noted during the treatment period.

THE EFFECT OF FINANCIAL STRAIN AND LANGUAGE OF INTERVIEW ON DEPRESSIVE SYMPTOMS IN MEXICAN AMERICAN OLDER ADULTS

Abstract We used data from the Hispanic Established Population for the Epidemiological Study of the Elderly to examine the relationship of financial strain and interview language to high depressive symptoms among Mexican Americans aged ≥75 years without history of depressive symptoms at baseline over a 12-year period (2004/05-2016; N=1157). Participants scored < 16 in the Center for Epidemiologic Studies Depression Scale at baseline. Measures included age, marital status, years of formal education, body mass index, social isolation, church attendance, self-reported medical conditions, cognitive and physical function, pain, falls, disability, and hand grip strength. We used a generalized estimating equation model to estimate the odds ratio (OR) and 95% confidence interval (CI) of depressive symptoms as a function of financial strain and interview language over time, adjusting for all covariates. We found that participants experiencing financial strain and interviewed in Spanish had greater odds of experiencing high depressive symptoms (OR=2.48, 95% Cl=1.37-4.48) compared to those who were not experiencing financial strain and selected be interviewed in English. No significant association with depressive symptoms was found in participants with financial strain and interviewed in English or those without financial strain and interviewed in Spanish. In conclusion, Mexican American older adults were at a high risk for high depressive symptoms over time if they were experiencing financial strain and preferred be interviewed in Spanish. Early screening for depression may prevent or delay depressive symptoms for individuals in this population at high risk for depression.

Influence of falls, fall-related injuries, and fear of falling on social participation in people aging with long-term physical disability: a cross-sectional study

Purpose This study examined prevalence and relationships among falls, injuries, fear of falling, and social participation in people aging with long-term physical disability (PAwLTPD). Materials and methods A convenience sample of 474 PAwLTPD recruited from community agencies and social media as baseline of a longitudinal cohort study. Inclusion criteria: 45–65 years, self-reported physical disability for ≥5 years, and English-speaking. Self-report surveys of physical/mental health, falls in the past year, fear of falling, and Patient-Reported Outcomes Measurement Information System (PROMIS) ability and satisfaction with participation in social roles and activities measures were collected. Results Mean age 56.8 years; participants were mostly female (66.7%) and White (61.4%). Nearly 65% reported a fall; 56.6% of falls resulted in injury. Falls and fall-related injuries were associated with worse physical/mental health and presence of >5 health conditions. Seventy-five percent of participants reported fear of falling. Lower ability and satisfaction with participation were found in participants who fell and worried about falls. Conclusions PAwLTPD are at increased risk of falls, fall-related injuries, and fear of falling, which affects their ability to engage in social activities. Future research is needed to understand circumstances associated with falls and to develop effective interventions to address falls in PAwLTPD.

Eight Week Telewellness Program Improves Nutrition Knowledge Among People with Physical Disabilities

<h3>Research Objectives</h3> To evaluate the effectiveness of an eight-week telewellness program for improvements in nutrition knowledge among people with physical disabilities. <h3>Design</h3> Retrospective study of people with disabilities who participated in the Mindfulness, Exercise, and Nutrition to Optimize Resilience (MENTOR) Program from January-December 2021. <h3>Setting</h3> Virtual telewellness program. <h3>Participants</h3> Adults (n=89) ages 22-77 yrs. (mean 52.1±14.4) with a self-reported physical disability with 67.4% using an assistive device for ambulation (n=60). <h3>Interventions</h3> Eight-week, synchronous telewellness program using a commercial platform (Healthie) with built-in Zoom videoconferencing software. Participants attended weekly group classes in mindfulness, exercise, nutrition, and health coaching. A Registered Dietitian led the nutrition classes and offered optional nutrition counseling. <h3>Main Outcome Measures</h3> Participants completed the General Nutrition Knowledge Questionnaire- Revised (GNKQ-R) via the Healthie platform before and after the program. The GNKQ-R consists of four knowledge domains (Dietary Recommendations, Food Groups, Healthy Food Choices, & Diet, Disease and Weight Management) with a total composite score of 0-88 with higher scores indicating higher knowledge. The hypothesis for this retrospective analysis was that participants' GNKQ-R scores would increase as a result of the MENTOR program. Differences between pre and post total score and sub-scores were assessed using general linear models and reported as mean±standard error. <h3>Results</h3> Pre-intervention total scores ranged from 8-79 and post-intervention total scores ranged from 14-81. Post-intervention scores improved on total GNKQ-R (58.4±1.6 vs. 64.4±1.2 p< 0.001) and the four knowledge domains (Dietary Recommendations: 12.3±.0.3 vs. 13.4±0.2, p< 0.001; Food Groups: 23.1±0.8 vs. 26.5±0.6, p< 0.001; Healthy Food Choices 9.0 ± 0.3 vs. 9.7±0.4, p=0.01; Diet, Disease, and Weight Management 14.0±0.4 vs 15.0±0.4, p=0.007). <h3>Conclusions</h3> A comprehensive eight-week telewellness program (MENTOR) resulted in statistically significant improvements in nutrition knowledge among people with disabilities. Future research is examining MENTOR's effects on adoption of healthy food choices and dietary behaviors over the long term. <h3>Author(s) Disclosures</h3> The authors report no conflicts of interest.

Couple similarity with respect to physical and mental disabilities.

Existing research on relationships provides strong evidence of couple similarity on a wide range of variables including physical attributes, abilities, and attitudes. However, couple similarity with respect to disability has not been researched. This study investigated couple similarity with respect to both physical and mental disabilities, as well as associations with life satisfaction, among adult cohabiting couples in Denmark. The study analysed data on self-reported mental and physical disabilities from a national survey involving 18,957 participants aged 16 to 65 years. The results showed that participants with a disability were more likely to have a partner with a disability. Further, results showed similarity by type and severity of disability as well as age of onset of disability. Having a partner with a disability was found to be associated with low life satisfaction among men with a disability. Results also showed an association among men with a disability between low life satisfaction and the onset of their disability after (as opposed to before) the start of their relationship. These associations were not found among women with a disability. The findings provide clear evidence for couple similarity with respect to disability. Findings on life satisfaction showed gender differences that might be explained by cultural gender norms that may play a particular role with respect to disability. Longitudinal research is required to research the factors that mediate how having or developing a disability affects relationships and wellbeing over time.

Addressing chronic pain with Focused Acceptance and Commitment Therapy in integrated primary care: findings from a mixed methods pilot randomized controlled trial

BackgroundOver 100 million Americans have chronic pain and most obtain their treatment in primary care clinics. However, evidence-based behavioral treatments targeting pain-related disability are not typically provided in these settings. Therefore, this study sought to: 1) evaluate implementation of a brief evidence-based treatment, Focused Acceptance and Commitment Therapy (FACT-CP), delivered by an integrated behavioral health consultant (BHC) in primary care; and 2) preliminarily explore primary (self-reported physical disability) and secondary treatment outcomes (chronic pain acceptance and engagement in valued activities).MethodsThis mixed-methods pilot randomized controlled trial included twenty-six participants with non-cancer chronic pain being treated in primary care (54% women; 46% Hispanic/Latino). Active participants completed a 30-min individual FACT-CP visit followed by 3 weekly 60-min group visits and a booster visit 2 months later. An enhanced treatment as usual (ETAU) control group received 4 handouts about pain management based in cognitive-behavioral science. Follow-up research visits occurred during and after treatment, at 12 weeks (booster visit), and at 6 months. Semi-structured interviews were conducted to collect qualitative data after the last research visit. General linear mixed regression models with repeated measures explored primary and secondary outcomes.ResultsThe study design and FACT-CP intervention were feasible and acceptable. Quantitative analyses indicate at 6-month follow-up, self-reported physical disability significantly improved pre-post within the FACT-CP arm (d = 0.64); engagement in valued activities significantly improved within both the FACT-CP (d = 0.70) and ETAU arms (d = 0.51); and chronic pain acceptance was the only outcome significantly different between arms (d = 1.04), increased in the FACT-CP arm and decreased in the ETAU arm. Qualitative data analyses reflected that FACT-CP participants reported acquiring skills for learning to live with pain, consistent with increased chronic pain acceptance.ConclusionFindings support that FACT-CP was acceptable for patients with chronic pain and feasible for delivery in a primary care setting by a BHC. Results provide preliminary evidence for improved physical functioning after FACT-CP treatment. A larger pragmatic trial is warranted, with a design based on data gathered in this pilot.Trial registrationclinicaltrials.gov, NCT04978961 (27/07/2021).

Birth Cohort Differences in Multimorbidity Burden Among Aging U.S. Adults

Multimorbidity is the co-occurrence of two or more chronic health conditions and affects more than half of the US population aged 65 and older. Recent trends suggest increased risk of poor self-reported health, physical disability, cognitive impairment, and mortality among later born birth cohorts, yet we are unaware of work examining cohort trends in multimorbidity among aging US adults. Observations were drawn from the Health and Retirement Study (2000–2018) and included adults aged 51 and older across 7 birth cohorts (1923 and earlier, 1924–1930, 1931–1941, 1942–1947, 1948–1953, 1954–1959, and 1960–1965). Multimorbidity was measured as a count of 9 chronic conditions including heart disease, hypertension, stroke, diabetes, arthritis, lung disease, cancer (excluding skin cancer), depression, and cognitive impairment. General linear models adjusting for repeated measures and covariates including age, sex, race/ethnicity, and education were used to identify whether trends in multimorbidity varied across birth cohort. 31,923 adults contributed 153,940 total observations, grand mean age was 68.0 (SD=10.09), and mean multimorbidity was 2.19 (SD=1.49). In analyses adjusted for age and other covariates, adults born 1948–1953 reported .34 more chronic conditions (SE=.03, p<.001), adults born 1954–1959 reported .42 more chronic conditions (SE=.03, p<.001), and adults born 1960–1965 reported .55 more chronic conditions (SE=.03, p<.001), than those born 1931–1941, respectively. Our preliminary results confirm increasing multimorbidity among later birth cohorts of older Americans and should help guide policy to manage impending health declines among older Americans.

Statistical analysis plan for the coaching for healthy AGEing trial – a cluster-randomised controlled trial to enhance physical activity and prevent falls in community-dwelling older people

BackgroundThis statistical analysis plan details the Coaching for Healthy AGEing (CHAnGE) trial analysis methodology. ObjectiveTo investigate the effect of a combined physical activity and fall prevention program on physical activity and falls compared to a healthy eating among people aged 60 years and over. MethodsThe CHAnGE trial is a pragmatic parallel-group cluster-randomised controlled trial with allocation concealment and blinded assessors. Clusters are allocated to either (1) a physical activity and fall prevention intervention or (2) to a healthy eating intervention. The primary outcomes are: objectively measured physical activity at 12 months post-randomisation, and self-reported falls throughout the 12-month trial period. Secondary outcomes include the proportion of participants reporting a fall, the proportion of participants meeting the Australian physical activity guidelines, body mass index, eating habits, mobility goal attainment, mobility-related confidence, quality of life, fear of falling, risk-taking behaviour, mood, well-being, self-reported physical activity, disability, and use of health and community services. AnalysisWe will follow the intention-to-treat principle. All analysis will allow for cluster randomisation using a generalised estimating equation approach. The between-group difference in the number of falls per person-year will be analysed using negative binomial regression models. For the continuously scored primary and secondary outcome measures, linear regression models adjusted for corresponding baseline scores will assess the effect of group allocation. Analyses will take into account cluster randomisation and will be adjusted for baseline scores. A subgroup analysis will assess differential effects of the intervention by baseline physical activity levels and history of falls.

An epidemiological study of externally determined and self-identified mental and physical disability across the spectrum of bipolar disorders

Background: Studies exploring disability in bipolar disorder (BD) have primarily assessed clinical samples of full-threshold BD-I and BD-II alongside so-called objective criteria such as unemployment or receipt of government disability payments. This study extends research on disability by examining externally determined and self-identified disability in a community sample and by including subthreshold BD (BDS). Methods: Data were extracted from the USA Collaborative Psychiatric Epidemiology Surveys about individuals who met recognized criteria for BD-I, BD-II and BDS who had completed self-ratings of physical and mental disability, comorbidities, and health risk factors (e.g., obesity). Rates of disability were estimated, and logistic regression analyses were used to determine demographic and clinical variables associated with externally determined and self-identified of disability. Results: Of 408 individuals who met eligibility criteria (BD-I = 100; BD-II=104; BDS=204), 35% met criteria for externally determined disability, about 40% self-reported mental disability and about 23% self-reported physical disability. The odds were three-fold (Odds Ratio (OR): 3.05; 95% Confidence Intervals (CI): 1.69, 5.53) that someone with self-identified physical disability would meet criteria for externally determined disability, but associations with mental disability were non-significant (OR: 1.06; 95% CI: 0.63, 1.80). Regression analyses demonstrated that mental disability was associated with being a current or past smoker and physical disability was associated with BD-I. Limitations: the adequacy of the assessments of disability and definition of BDS can be questioned. Conclusions: Future clinical and community studies need to consider both externally determined and self-identified disability across the entire Bd spectrum.

Financial incentives and wearable activity monitors to increase ambulation after cystectomy: A randomized controlled trial

ObjectivesFinancial incentive programs are effective in increasing physical activity for overweight, ambulatory adults. We sought to determine the potential effect size and direction of financial incentives on ambulation after radical cystectomy. Materials and MethodsWe performed a pilot randomized controlled trial of daily financial incentives to meet postoperative step goals among adults with Eastern Cooperative Oncology Group performance status ≤2 who underwent radical cystectomy for bladder cancer at a single center. Step counts were measured over a 3- to 14-day preoperative period and 30-day postoperative period using a wearable activity monitor. Postoperative daily step goals of 10%, 25%, 40%, and 55% of mean preoperative daily step counts were set for postoperative weeks 1 through 4, respectively. The primary outcome was the number of postoperative days on which the step goals were met. Secondary outcomes included the number of daily postoperative steps taken and the length of stay. Participants randomized to the intervention arm received $1.50 for every day the goal was met with a 20% chance of a $100 reward if the step goal was met on >75% of the first 30 postoperative days. Questionnaires assessing self-reported physical activity, disability, and social support were administered preoperatively at 30 days postoperatively. ResultsThirty-three patients were analyzed, 11 in the control and 22 in the intervention arms. There were no statistically significant differences between incentive and control arms for the primary outcome (4.5/30 days vs. 9/30 days, P = 0.53). Results after adjusting for differences in baseline characteristics were similar (RR 1.00, 95% CI 0.24–4.19, P = 1.00). There were also no differences in average daily postoperative steps (median 979 vs. 1191, 95% CI −810 to 1,400, P = 0.59), length of stay (7.5 vs. 7, 95% CI −2.7 to 5.1, P = 0.56), or self-reported measures of disability, activity, and social support. ConclusionsWhile this trial was a pilot study and not powered to detect a difference between groups, there was no suggestion of any clinically important impact of this financial incentive on postoperative ambulation. While a fully-powered trial is feasible, given the small range of plausible benefit, such a trial would be unlikely to influence clinical practice.

Mindfulness-Related Variables and Sexual/Relationship Satisfaction in People with Physical Disabilities

ObjectivesResearch has shown the role of mindfulness and self-compassion in promoting resilience while living with a disabling condition. However, little is known on the influence of these variables on sexual and relationship satisfaction of people with physical disabilities. This cross-sectional study aimed to explore the contribution of mindfulness, self-compassion, and acceptance in predicting sexual and relationship satisfaction, above and beyond experiencing physical disability.MethodsA sample of 377 participants, aged between 18 and 55 years old, took part in a survey. Of these, 189 participants had a self-reported physical disability, the majority (70.1%) being either motor or neuromuscular health conditions.ResultsFindings showed that higher levels of mindfulness, self-compassion, and acceptance significantly predicted higher sexual (ΔR2 = between .081 and .166; p < .05) and relationship satisfaction (ΔR2 = between .072 and .106; p < .05), above and beyond the physical condition of the participants. Additionally, the physical condition was a moderator for the relationship between the mindfulness dimension of self-compassion and sexual satisfaction (ΔR2 = .024; p = .037), as this association was only significant for people with physical disabilities.ConclusionsThis study explores possible vulnerability and protective psychological mechanisms that may be involved in sexual and relationship satisfaction, above and beyond the effects of the physical disability. Despite its limitations, findings call into attention for the importance of further research on mindfulness-related variables in optimizing sexual health in people with and without physical disabilities.

Reproductive Health in Women with Physical Disability: A Conceptual Framework for the Development of New Patient-Reported Outcome Measures.

Background: Barriers in the built environment, enduring stereotypes and biases, and limited disability competency of health care providers compromise access to and quality of reproductive health care for women with physical disabilities. One way to improve our understanding of critical factors that drive reproductive health inequity and its impact on access to care is to use patient-reported outcome measures (PROMs) that capture relevant and meaningful information about experience. In this study, we developed a conceptual framework as the foundation for relevant and clinically meaningful patient-reported outcome measures targeting the interface of disability and reproductive health. Materials and Methods: We conducted semistructured focus groups and interviews to assess women's experiences around their reproductive health and contextual factors related to disability. We used deductive and inductive qualitative coding approaches to develop the conceptual framework. Results: Eighty-one women between the ages of 16 and 50 with a self-reported physical disability, defined by an impairment of mobility, participated in 13 focus groups (N = 64) and 17 individual interviews. Five major themes characterized the conceptual framework that emerged-knowledge about reproductive health, communication about reproductive health, relationships, the reproductive health care environment, and self-advocacy/identity-all of which had some relationship with five major reproductive health issues-pregnancy and labor/delivery, periods and menstrual management, contraception, sexuality and sexual functioning, and pelvic examinations. Conclusions: This conceptual framework will serve as a foundation for PROM and guide intervention development to reduce reproductive health inequity and improve reproductive health outcomes of women with physical disabilities.

Cognitive processing speed in multiple sclerosis clinical practice: association with patient-reported outcomes, employment and magnetic resonance imaging metrics.

To analyze the relationship between cognitive processing speed, patient-reported outcome measures (PROMs), employment and magnetic resonance imaging (MRI) metrics in a large multiple sclerosis cohort. Cross-sectional clinical data, PROMs, employment and MRI studies within 90days of completion of the Processing Speed Test (PST), a technology-enabled adaptation of the Symbol Digit Modalities Test, were collected. MRI was analyzed using semi-automated methods. Correlations of PST score with PROMs and MRI metrics were examined using Spearman's rho. Wilcoxon rank sum testing compared MRI metrics across PST score quartiles and linear regression models identified predictors of PST performance. Effects of employment and depression were also investigated. In 721 patients (mean age 47.6±11.4years), PST scores were significantly correlated with all MRI metrics, including cord atrophy and deep gray matter volumes. Linear regression demonstrated self-reported physical disability, cognitive function, fatigue and social domains (adjusted R2 =0.44, P<0.001) as the strongest clinical predictors of PST score, whereas that of MRI variables included T2 lesion volume, whole-brain fraction and cord atrophy (adjusted R2 =0.42, P<0.001). An inclusive model identified T2 lesion volume, whole-brain fraction, self-reported upper extremity function, cognition and social participation as the strongest predictors of PST score (adjusted R2 =0.51, P<0.001). There was significant effect modification by depression on the relationship between self-reported cognition and PST performance. Employment status was associated with PST scores independent of age and physical disability. The PST score correlates with PROMs, MRI measures of focal and diffuse brain injury, and employment. The PST score is a feasible and meaningful measure for routine multiple sclerosis care.

Association and Dose-Response Relationship of Self-Reported Physical Activity and Disability Among Adults ≥50 Years: National Health and Nutrition Examination Survey, 2011-2016.

Disability is a tremendous public health challenge. No study has assessed whether meeting U.S. Physical Activity guidelines is associated with disability in mobility tasks, activities of daily living, and social participation among U.S. older adults. Using 2011-2016 National Health and Nutrition Examination Survey data, this study examined this relationship among 8,309 individuals aged ≥50years. Most participants (n = 4,272) did not achieve guidelines, and 2,912 participants were completely inactive. People who did not meet guidelines had higher odds of disability compared with those who did (adjusted odds ratio [AOR] = 1.80) in addition to difficulty with mobility tasks (AOR = 1.85), activities of daily living (AOR = 1.66), and social participation (AOR = 2.09). There was a dose-response effect for each level of activity (inactive, insufficient, and meeting and exceeding recommendations). Among adults aged ≥50years, meeting the U.S. guidelines was associated with better social and physical functioning.

Cognitive functioning as a predictor of employment status in relapsing-remitting multiple sclerosis: a 2-year longitudinal study

BackgroundCognitive functioning has been linked to employment outcomes in multiple sclerosis (MS) in cross-sectional studies. Longitudinal studies are however lacking and previous studies did not extensively examine executive functioning.ObjectivesWe examined whether baseline cognitive functioning predicts a change in employment status after 2 years, while taking into account mood, fatigue and disability level.MethodsA total of 124 patients with relapsing-remitting MS (pwMS) and 60 healthy controls were included. They underwent neurological and neuropsychological examinations and completed online questionnaires. PwMS were divided into a stable and deteriorated employment status group (SES and DES), based on employment status 2 years after baseline. We first examined baseline differences between the SES and DES groups in cognitive functioning, mood, fatigue and disability level. A logistic regression analysis was performed, with change in employment status (SES/DES) as dependent variable.ResultsThe DES group included 22% pwMS. Group differences were found in complex attention, executive functioning, self-reported cognitive functioning, fatigue and physical disability. More physical disability (OR = 1.90, p = 0.01) and lower executive functioning (OR = 0.30, p = 0.03) were retained as independent predictors of DES (R2 = 0.22, p ≤ 0.001).ConclusionsBaseline physical disability and executive functioning, but none of the other variables, moderately predicted a deterioration in employment status 2 years later.Trial registrationThis observational study is registered under NL43098.008.12: ‘Voorspellers van arbeidsparticipatie bij mensen met relapsing-remitting Multiple Sclerose’. This study is registered at the Dutch CCMO register (https://www.toetsingonline.nl).

Sex Differences in Heart Failure—Female Representation in Heart Failure Studies

The prevalence of heart failure (HF) continues to grow in the USA, and approximately 50% of these patients are women. Despite this, there has been an underrepresentation of women in HF clinical trials, which has led to limitations in understanding of sex-related differences in HF pathophysiology, diagnosis, and treatment. The purpose of this review is to highlight the differences between men and women in various heart failure trials conducted in the last century and emphasize new findings from recent trials in the management of, and outcomes in, women with HF. HF trials have shown that women have improved survival with guideline-directed medical therapy, and the most recent analysis from PARADIGM-HF showed women had lower mortality and hospitalization rate compared with men. Furthermore, despite comprising only 20% of subjects in cardiac resynchronization therapy (CRT) trials, we now know that women are likely to benefit from a CRT device, in particular those with left bundle branch block. Advanced therapies for heart failure including durable mechanical circulatory support remain underused in women, and female patients are less likely to undergo heart transplantation when compared with men of similar risk profiles. The latest studies have shown women receiving continuous-flow left ventricular assist device support had lower chances of heart transplantation, increased risk of waitlist mortality, and higher rates of delisting for worsening clinical status. However, post transplantation, women have better survival when compared with men. Although several studies have shown that women with HF live longer than men, they experience greater self-reported psychological and physical disability and poorer overall quality of life. The cause of sex differences in morbidity and mortality remains unknown, but as the therapeutic options for HF expand, sex-based differences in treatment would need to be considered.

Differential Impact of Heart Failure With Reduced Ejection Fraction on Men and Women

BackgroundHeart failure (HF) trials initiated in the last century highlighted many differences between men and women. Of particular concern was undertreatment of women compared with men, but much has changed during the past 20 years. ObjectivesThis study sought to identify these changes, which may give a new perspective on the management of, and outcomes in, women with HF. MethodsThe study analyzed 12,058 men and 3,357 women enrolled in 2 large HF with reduced ejection fraction (HFrEF) trials with near identical inclusion and exclusion criteria and the same principal outcomes. Outcomes were adjusted for other prognostic variables including N-terminal pro–B-type natriuretic peptide. ResultsWomen were older and more often obese than men were, had slightly higher systolic blood pressure and heart rate, and were less likely to have most comorbidities, except hypertension. Women had more symptoms and signs (e.g., pedal edema 23.4% vs 19.9%; p < 0.0001) and worse quality of life—median Kansas City Cardiomyopathy Questionnaire Clinical Summary Score 71.3 (interquartile range: 53.4 to 86.5) versus 81.3 (interquartile range: 65.1 to 92.7; p < 0.0001)—despite similar left ventricular ejection fraction and N-terminal pro–B-type natriuretic peptide. However, women had lower mortality (adjusted hazard ratio: 0.68; 95% confidence interval: 0.62 to 0.74; p < 0.001) and risk of HF hospitalization (hazard ratio: 0.80; 95% confidence interval: 0.72 to 0.89; p < 0.001). Diuretics and anticoagulants were underutilized in women. Device therapy was underused in both men and women, but more so in women (e.g., defibrillator 8.6% vs. 16.6%; p < 0.0001). ConclusionsAlthough women with HFrEF live longer than men, their additional years of life are of poorer quality, with greater self-reported psychological and physical disability. The explanation for this different sex-related experience of HFrEF is unknown as is whether physicians recognize it. Women continue to receive suboptimal treatment, compared with men, with no obvious explanation for this shortfall.

Contraceptive use by disability status: new national estimates from the National Survey of Family Growth

ObjectiveThe objective was to determine population-based estimates of use of contraception among women 15–44 years of age in the United States by disability status. Study designWe examined the relationship between disability status and use of contraception among 7505 women at risk of unintended pregnancy using data from the 2011–2015 National Survey of Family Growth. ResultsAfter examining the full distribution of contraceptive method use by disability status, we found that disability status was significantly associated with differences in three categories of use: female sterilization, the oral contraceptive pill and nonuse of contraception. Multivariate analysis shows that use of female sterilization was higher among women with cognitive disabilities (aOR=1.54, 95% CI=1.12–2.12) and physical disabilities (aOR=1.59, CI=1.08–2.35) than for those without disabilities after controlling for age, parity, race, insurance coverage and experience of unintended births. Use of the pill was less common among women with physical disabilities than for those without disabilities (aOR=0.57, CI=0.40–0.82). Finally, not using a method was more common among women with cognitive disabilities (aOR=1.90, CI=1.36–2.66). ConclusionsSelf-reported cognitive disabilities (“serious difficulty concentrating, remembering or making decisions”), as well as physical disabilities, are significant predictors of contraceptive choices after controlling for several known predictors of use. ImplicationsThe patterns found here suggest that screening for self-reported cognitive and physical disabilities may allow health care providers to tailor counseling and sex education to help women with disabilities prevent unintended pregnancy and reach their family size goals.

Long-term effects of self-reported physical function and disability after participation in an individually adjusted and specific progressive balance training programme for older adults with fear of falling and tendency to fall

Purpose: To evaluate the long-term effects from a 12-week balance-training programme on self-rated physical function and disability in healthy older adults with a tendency to fall and fear of falling.Method: RCT, 59 participants, 67–93 years (42 women). The participants were randomised to an exercise group (n = 38) and a control group (n = 21). The intervention consisted of a specific and progressive balance-training programme three times/week for 12 weeks and was evaluated using the Late-Life Function and Disability Instrument (LLFDI) before training, directly after the training period and 6 and 12 months thereafter training. Data were analysed using a mixed model.Results: Significant effects were found regarding physical function:‘Functioning total’, ‘Basic lower extremity’ and ‘Advanced lower extremity’ in favour for the Exercises group. The exercise group improved significantly from baseline to directly after the training. At the 6 months follow-up, the effects had decreased to values similar to before the training, and remained unchanged until the 12 months follow-up. No significant effects regarding disability were found. The control group remained unchanged over time.Conclusion: No long-term effects were found for physical function or disability assessed with the LLFDI after participation in a specific and progressive balance-training programme for healthy older adults.

SARCOPENIA VERSUS DYNAPENIA: FUNCTIONAL PERFORMANCE AND PHYSICAL DISABILITY IN CROSS SECTIONAL STUDY

Background: The magnitude of “Sarcopenia” and “Dynapenia” as a public health problem is not well established, nor is the relationship of declines strength and muscle mass to physical disability and/or loss of mobility. Objectives: Test the hypothesis that the elderly with sarcopenia are more likely to physical disability than are those with dynapenia. Design: Cross-sectional study. Setting/Participants: A total of 387 older adults (≥65 years old) from the FIBRA Study in Cuiabá, Mato Grosso, Brazil. Measurements: Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People (EWGSOP), which includes the presence of low muscle mass, plus low muscle strength or low physical performance. Dynapenia was defined as handgrip strength &lt;30kgf (men) and &lt;20kgf (women). Data relating to socio-demographic, behavioral, health conditions, physical disability, the level of physical activity, body composition, hand grip strength and the Short Physical Performance Battery were collected. Results: Regarding the loss of mobility, sarcopenia was associated with age ≥75 years, female, sedentary lifestyle, stroke, arthritis, and falls (OR = 2.95, 95% CI: 1.07 – 8.09); with no association for physical disability in BADL and IADL. Dynapenia had no association with loss of mobility; however, for disability in BADL and IADL, it was associated with the elderly aged ≥80 years old and arthritis (OR = 2.35, 95% CI: 1.42 – 3.88). Conclusion: Dynapenia is more sensitive to the prevention of future self-reported physical disability, in comparison to sarcopenia which can be used in clinical practice as a screening tool for the early decline in mobility.