Severe Functional Limitations Research Articles

Progress, Persistence, and Hope: Building a System of Services for CYSHCN and Their Families.

Progress, Persistence, and Hope: Building a System of Services for CYSHCN and Their Families.

C48 PROGNOSTIC IMPACT OF ECHOCARDIOGRAPHIC RESTRICTIVE FILLING PATTERN IN PATIENTS AFFECTED BY HYPERTROPHIC CARDIOMYOPATHY AND PRESERVED SYSTOLIC EJECTION FRACTION

Abstract Background “Restrictive phenotype” is an uncommon presentation of Hypertrophic Cardiomyopathy (HCM), associated with severe functional limitation and poor prognosis. For this reason, current therapeutic aims are prevention of complications through periodic follow–ups and diagnostic investigations, up to the ICD placement. Objectives The primary aim of this study was to evaluate the impact of the restrictive filling pattern in HCM on the incidence of complex composite outcome included arrhythmic events, events related to heart failure and general events, correlating it to clinical and imaging data. Methods This study is an experimental, multicentric, retrospective and non–randomized analysis, including all patients over the age of 18 suffering from classical HCM, excluding phenocopies and systolic dysfunction. Patients were followed up and selected by specialized Centers of Trieste and Turin and divided by degree of diastolic dysfunction, particularly on the basis of the presence or absence of the restrictive filling pattern. Results A total of 367 patients with HCM were included. Restrictive filling pattern was present in 23 patients (6.3%). This subgroup of patients was younger than all other patients (P < 0.001); percentage of ICD patients suffering from severe diastolic dysfunction at follow–up is significantly higher than patients without restrictive filling pattern (39.1% vs 4.1%, P < 0.001). On average, left atrial volume has larger sizes in restrictive filling pattern (109.7ml, SD 43.06 vs 82.8ml, SD 35.81, P = 0.003). Patients with restrictive filling pattern, compared to other patients, are more subjected to heart transplantation (8.7% vs 0.3%, P = 0.009) and hospitalized for heart failure (21.7% vs 7.8%, P = 0.028). Restrictive pattern was not an independent predictor of adverse events at the multivariable analysis. In our cohort, the independent predictors were found to be the left atrium diameter and the presence of LGE on CMR. Conclusions In patients with HCM and preserved EF, the evidence of a restrictive diastolic pattern identifies a poor prognosis subgroup. Severe diastolic alteration was not associated with a significant independent role either for events related to heart failure, or for arrhythmic events during a median follow up of 7 years. However, the high rate of ICD implantation in patients with severe diastolic dysfunction suggests a high clinical perception of adverse events in this subgroup.

Model-Based Analysis of the Influence of Alcohol Use and Age on Pharmacokinetics-Pharmacodynamics of Oral Oxycodone in Middle-Age and Older Community-Dwelling Adults.

Little is known about how opioid responses vary by age and in the presence of alcohol consumption. This model-based pharmacokinetic (PK)-pharmacodynamic (PD) analysis quantified the impact of age and alcohol use on pupillometry and cold pressor test (CPT) PD based on data from an open-label study of a single, immediate-release 10-mg oral oxycodone in middle-age and older adults (aged 35-85) without severe functional limitations. PK and pupillometry assessments were obtained on 11 occasions over 8 hours. Cold pressor test was administered at 1.5, 5, and 8 hours after oxycodone dosing. The study population consisted of 62 older adults (aged ≥60) and 66 middle-aged adults (aged 35-59), with 82% meeting the unhealthy drinking criteria. Oral oxycodone PK were well described using a 1-compartment model with a sequential 0 to first-order absorption process. Inhibitory maximum effect and linear direct effect PD models described the respective pupillometry and cold pressor test data using simultaneous PK-PD analysis in MONOLIX. Recent alcohol use measures were selected a priori as covariates. This analysis demonstrated an influence of age on clearance and body weight on the distribution volume of oxycodone; alcohol consumption was not noted to alter oxycodone PK. Oxycodone pupillometry PD were influenced by the level of subject-reported alcohol consumption (Alcohol Use Disorders Identification Test for Consumption), alcohol use biomarker-blood phosphatidylethanol, previous cannabis use, and age. Over the opioid exposure range of the study, none of the covariables including alcohol and age were noted to affect cold pressor test pharmacodynamics. Additional clinical studies are needed to further investigate the clinical consequences of opioid-alcohol-age interaction.

Assessment of Post – COVID 19 Sequelae: A Retrospective Study

Background: COVID–19 is an acute respiratory illness caused by SARS–CoV–2. COVID-19created a major impact on physical, cognitive, mental health and social status in patients withSARS–CoV–2. Aim and Objective: To assess the post COVID sequelae in COVID19 recoveredindividuals. To assess the functional limitations using post COVID functional status scale after4weeks of onset of illness. Materials and Methods: Subjects were selected from compiled list ofTriage OP from Chengalpattu Medical College and Hospital. The semi structured questionnaireenclosed with Socio – demographic details, physical and socio – psychological domains based onCOVID-19 Yorkshire Rehabilitation Screening tool (C19-YRS) were assessed and the impact ofeach domain was graded using a Likert scale. Post – COVID 19 functional status scale (PCFS)to assess functional limitations was also sent through Google form and the details were collected.Analysis: Collected data was analyzed using Microsoft Excel with descriptive statistics. Result:1044 individuals participated in the study. On Assessment of post COVID sequelae fatigue wasmajor symptom reported followed by cough and other neuropsychiatric symptoms. 53.4% ofCOVID recovered individuals had functional limitations and 2.4% of these individuals had severefunctional limitations and they require assistance for daily living. Conclusion: Most COVID–19recovered individuals had persistence of some clinical symptoms. From PCFS it was observedthat 23% individuals had moderate to severe functional limitations, therefore early detection andrehabilitation measures are recommended.

Which psychosocial factors are related to severe pain and functional limitation in patients with low back pain?: Psychosocial factors related to severe low back pain

BackgroundLow back pain (LBP) is a global public health issue. Psychosocial factors are linked to LBP. However, there is a lack of knowledge about the relation of psychosocial factors to clinical outcomes of patients with severe LBP. ObjectiveTo investigate the relationship between specific psychosocial factors with severe pain and functional limitation of patients with LBP. MethodsA cross-sectional study of 472 participants with LBP was conducted. Participants completed self-reported questionnaires, including psychosocial factors, characteristics of pain, and functional limitations. Two multivariable logistic regression models were performed with severe pain intensity (≥ 7 out of 10) and functional limitation (≥ 7 out of 10) (dependent variables) and 15 psychosocial factors (independent variables). ResultsOne hundred twenty-five (26.5%) participants had severe LBP. Patients with catastrophising symptoms were 2.21 [95%Confidence Interval (CI): 1.30, 3.77] times more likely to have severe pain and 2.72 (95%CI: 1.75, 4.23) times more likely to have severe functional limitation than patients without catastrophising symptoms. Patients with maladaptive beliefs about rest were 2.75 (95%CI: 1.37, 5.52) times more likely to present with severe pain and 1.72 (95%CI: 1.04, 2.83) times more likely to have severe functional limitation. Patients with kinesiophobia were 3.34 (95%CI: 1.36, 8.24) times more likely to present with severe pain, and patients with social isolation were 1.98 (95%CI: 1.25, 3.14) times more likely to have severe functional limitation. ConclusionCatastrophising, kinesiophobia, maladaptive beliefs about rest, and social isolation are related to unfavourable clinical outcomes of patients with LBP.

Screening to Identify Postoperative Pain and Cross-Sectional Associations Between Factors Identified in This Process With Pain and Function, Three Months After Total Knee Replacement.

ObjectiveTo describe the screening and recruitment process of a randomized trial and evaluate associations with knee pain and function 3 months after total knee replacement (TKR).MethodsIn order to screen for a multicenter trial, a total of 5,036 patients were sent the Oxford Knee Score (OKS) questionnaire 10 weeks post‐TKR. Patients who reported pain in their replaced knee (score of ≤14 on the OKS pain component) completed a second OKS questionnaire 12 weeks post‐TKR. Those patients who were still experiencing pain 12 weeks post‐TKR completed a detailed questionnaire 13 weeks post‐TKR. These data were used to characterize pain in a cross‐sectional analysis. Multivariable regression was performed in order to identify factors associated with pain and function at 13 weeks post‐TKR.ResultsWe received OKS questionnaires from 3,058 of 5,063 TKR patients (60%), and 907 of the 3,058 (30%) reported pain in their replaced knee 10 weeks post‐TKR. By 12 weeks, 179 of 553 patients (32%) reported improved pain (score of >14 on the OKS pain component). At 13 weeks, 192 of 363 patients (53%) who completed a detailed questionnaire reported neuropathic pain, 94 of 362 (26%) reported depression symptoms, and 95 of 363 (26%) anxiety symptoms. More severe pain at 13 weeks postoperatively was associated with poorer general health, poorer physical health, more pain worry, and lower satisfaction with surgery outcome. More severe functional limitation was associated with higher levels of depression, more pain worry, lower satisfaction with surgery outcome, and higher pain acceptance.ConclusionScreening after TKR identified individuals with pain. We identified several potential targets (physical and mental health outcomes, acceptance of pain, and quality of life) for tailored intervention to improve outcomes for patients. Future trials of multidisciplinary interventions warranted.

Engineering of Viscosupplement Biomaterials for Treatment of Osteoarthritis: A Comprehensive Review

Osteoarthritis (OA) is a progressive degenerative disease that causes severe pain and functional limitation, especially during locomotion. It is the most common arthritis type that damages the surface of articular cartilage until the underlying bone. In the past decade, the scientific community has made a considerable effort to improve or discover therapeutical products used as a form of conservative treatment capable of restoring the damaged articular tissue, avoiding, as far as possible, the use of surgical practices. The most common and direct nonoperative application available for OA treatment is the viscosupplementation (VS) procedure that demonstrates a safe, effective method and is less painful for the patients. The most recent works dealing with the design, development, and validation of viscosupplement products in preclinical and clinical trials for OA treatment are overviewed herein. In general, despite the development of new products, hyaluronic acid continues to be among the most reported intra‐articular viscosupplement products used in clinical trials, typically used as an isolated product or conjugated with other biologicals or drugs, such as platelet‐rich plasma and corticosteroids (CS). However, this issue is still demanding innovation. Approaches comprising new biomaterials as VS products, with intrinsic bioactivity, economical, and environmental friendliness, are required.

Association between daily activities and fall in older adults: an analysis of longitudinal ageing study in India (2017\u201318)

BackgroundDeclining functionality affects an individual’s musculoskeletal integrity increasing the risk of fall and disability. Individuals with severe functional limitations are 5 times more likely to experience a fall. Thus, this paper investigated the association between functional decline and falls in older adults.MethodsThis study uses secondary data from the Longitudinal Aging Study in India (2017–18). A total of 31,477 people over the age of 60 are included in the study. Descriptive statistics and bivariate analysis were performed to determine the association between activities of daily living (ADL), instrumental activities of daily living (IADL) and fall. Adjusted odds ratio was used to determine the association of ADL and IADL with fall while controlling for age, gender, balance and gait impairments.ResultsThe study reported 6352 fall episodes in 3270 participants aged 60 and above, over a period of 2 years. More than 30% of participants reported difficulty in ADL and IADL. Age and gender adjusted odds of fall were higher in participants with difficulty in more than 4 ADLs (AOR:1.32; CI:1.08 – 1.67) and in more than 2 IADL (AOR: 1.39; CI:1.02 – 1.89). Similarly, the odds of fall were higher for difficulty in ADL (AOR:1.31; CI:1.11 – 1.73) and IADL (AOR of 1.18; CI:1.07 – 1.29) controlling for gait and balance impairment. Difficulty in pushing-pulling objects (AOR: 1.30; CI: 1.15 – 1.46 & AOR: 1.40; CI: 1.21–1.61) and getting up from the chair (AOR: 1.12; CI:1.01–1.26 & AOR: 1.27; CI: 0.99 – 1.26) was significantly associated with fall when adjusted for age, gender and balance and gait parameters.ConclusionsThis study provides the new insights into the association of fall and risk of functional decline, especially difficulty in pushing and pulling objects and getting up from a chair, can be incorporated in the primary screening of fall risk assessment.

Patalla Fractures

Patella fractures are rare injuries, accounting for 0.5 - 1.5% of all fractures, but they can lead to severe functional limitations if they do not heal properly. In addition to a prompt diagnosis, surgical treatment is usually necessary for multi-fragment fractures. The goals of every treatment are a biomechanically stable joint as well as a congruent restoration of the retropatellar joint surface. These results often remain a challenge, especially in multiple fragment fractures. The surgical treatment strategies have steadily evolved from tension band and screw osteosyntheses in combination with wire cerclages. Currently, angular stable plate systems are increasingly being used. This article gives an overview of the fracture anatomy, the classification and diagnosis of patella fractures and the currently used surgical treatment options.

Spaulding REhabilitation and COVid Recovery study (RECOVR): Preliminary Findings at 6 Months

Research ObjectivesTo identify distinct post-acute COVID-19 phenotypes among adults hospitalized for severe SARS-CoV-2 infection and describe multidimensional outcomes at 6 months post-hospitalization.DesignProspective, longitudinal data collection in functional, physical, cognitive, and psychological domains at 3, 6, and 12 months post-hospitalization. Retrospective data collection from the acute care and post-acute care settings.SettingAcute care and post-acute telephone follow-up.ParticipantsSpanish- and English-speaking adults, with decision-making capacity, admitted for inpatient rehabilitation following inpatient hospitalization for acute COVID-19 related illness (N = 52).InterventionsN/A.Main Outcome MeasuresPhysical, cognitive, and psychological symptoms; Self-reported employment status and assistance with ADLs.ResultsMedian age was 60.96 (IQR = 20.89), with race/ethnicity representative of the US adult population (71% White; 13% Black; 27% Hispanic). Compared to premorbid status, 33% of individuals were no longer employed full-time and 23% were no longer independent in basic ADLs. Latent profile analysis identified distinct subgroups within physical, cognitive, and emotional domains of functioning. Approximately 31% were in either the moderately or most symptomatic groups for both cognitive and emotional functioning, with 88% of these also falling into the most symptomatic group for physical functioning. There were 29% in the least symptomatic group across all domains.ConclusionsPersons with severe COVID-19 illness experience persistent functional limitations that interfere with employment and ADLs up to 6 months post-hospitalization. Although symptom variability is high at 6 months, we identified distinct subgroups, including those with co-occurring emotional and cognitive symptoms, that suggest the need for comprehensive assessment and tailored treatment for physical, emotional, and cognitive symptoms.Author(s) DisclosuresThe author's declare no relevant conflict of interests.

Airway Management in Pediatric Patients With Burn Contractures of the Face and Neck.

Burn injury is a common cause of trauma. Non-fatal burn injuries are a leading cause of morbidity, and significant numbers of the victims are children. Scar contracture after burn injury can cause severe functional limitation, pain, and aesthetic and psychological problems and patients may present for contracture release and reconstructive surgery. The aim of this systematic review was to identify research relevant to airway management of children with burn contracture of the face and neck with special emphasis on awake airway management and airway anesthesia, and synthesize results that can aid practice. Literature search was performed on Medline, PubMed, Cochrane Library, and Google Scholar with selected keywords. The search was restricted to human subjects of ≤18 year age, there was no language or time restriction, and the final search was concluded in July 2021. The review included 41 articles involving airway management of 56 patients in 61 anesthesia episodes. Patients aged between 8 months to 18 years. Mask ventilation and direct laryngoscopy, video laryngoscopy, optical stylet, supraglottic airway, flexible scope intubation and tracheostomy, and extracorporeal membrane oxygenation were the devices and methods used for securing the airway and oxygenation while the patients were awake or after anesthesia induction. Detailed planning and patient preparation are the fundamentals of airway management of pediatric patients with burn contracture of the face and neck; awake airway management with airway anesthesia can be safely used in selected patients. This review provides information for good clinical practice and might serve to improve the care of such children.

Turalio risk evaluation and mitigation strategy for treatment of tenosynovial giant cell tumor: framework and experience.

For drugs with enhanced serious safety risks, Risk Evaluation and Mitigation Strategy (REMS) may be required. Pexidartinib is approved for treatment of adult symptomatic tenosynovial giant cell tumor (TGCT) associated with severe morbidity or functional limitations and not amenable to improvement with surgery. Its approval was conditional on its prescription via a mandatory REMS due to serious and potentially fatal liver injury seen in clinical trials. Turalio® REMS aims to mitigate this risk by ensuring provider education on pexidartinib use and required REMS components, prescriber adherence to baseline and periodic monitoring, and enrolling patients in a registry to further assess safe use and acute, chronic and irreversible hepatotoxicity. Through Turalio REMS, benefits of treating patients with pexidartinib may be preserved.

Suffering is not enough: Assisted dying for people with mental illness.

Persons with mental disorders who are resistant to evidence‐based treatment can be referred to as patients with severe and persistent mental illness (SPMI). Some patients with SPMI develop a strong wish for assisted dying. Switzerland has the longest history of non‐medicalized assisted dying, which is considered a civil right even in non‐pathological situations. Public debate in Switzerland about the issue of suffering in the context of assisted dying is current and ongoing. The Swiss Academy of Medical Sciences recently revised its end‐of‐life policy and specified intolerable suffering due to severe illness or functional limitations (and acknowledged as such by a physician) as a core criterion for assisted dying. We argue that suffering is a necessary but insufficient condition for assisted dying, and that the criteria should also include decision‐making capacity and refractoriness of suffering. We further contend that suffering is a subjective experience that can only be quantified by the patient and cannot be objectively compared across individuals. Some patients with SPMI and refractory suffering who maintain decision‐making capacity will meet the criteria for assisted dying. We advocate for palliative psychiatric care that relinquishes any disease‐modifying therapy, accepts limited survival chances, and focuses on measures that enhance the patient's quality of life, understood in a very broad sense beyond only health‐related quality of life. This approach should also relieve suffering as much as possible while remaining open to the possibility of assisted dying following conscientious assessment of the criteria.

Profile of functional limitation using Screening of Activity Limitation and Safety Awareness Scale in leprosy population of Mysore district

INTRODUCTION: Leprosy is known as Hansen's disease, a chronic disease caused by Mycobacterium leprae. It can be seen in all ages, from early infancy to old age. It is a significant cause of preventable disability. The impairments give rise to disabilities, such as limitations in performing activities involving using hands, feet, and eyes and restrictions in social participation. Functional movements are most important to fulfill one's activities of daily living.OBJECTIVES: The objectives of this study were to identify the functional limitations using the Screening of Activity Limitation and Safety Awareness (SALSA) Scale in the leprosy population of Mysore district.METHODS: This cross-sectional study included 92 participants diagnosed with leprosy and collected socioeconomic and clinical data. Each participant was evaluated for functional limitations using the SALSA Scale.RESULTS: The participants were mainly male (58) and fewer female (34) with a minimum of one impairment. The result is written based on the five primary domains of the SALSA Scale. The study showed that 39.65% of participants did not present significant functional limitations and 24.36% of participants reported mild functional limitations. In comparison, 12.35% were moderately functionally limited, 14.32% had severe functional limitations, and 9.32% showed extremely severe limitations which described the most difficult activity were fine motor activity.CONCLUSION: The study concludes that difficult functional activity reported by participants with leprosy was fine motor activity and hand sensation to carry the hot objects according to the profiling by SALSA Scale which intern leads to difficulty in quality of life.

Metabolomics of peripheral artery disease.

The science of metabolomics has emerged as a novel tool for studying changes in metabolism that accompany different disease states. Several studies have applied this evolving field to the study of various cardiovascular disease states, which has led to improved understanding of metabolic changes that underlie heart failure and ischemic heart disease. A significant amount of progress has also been made in the identification of novel biomarkers of cardiovascular disease. Another common atherosclerotic disease, peripheral artery disease (PAD) affects arteries of the lower extremities. Although certain aspects of the disease pathophysiology overlap with other cardiovascular diseases in general, PAD patients suffer unique manifestations that lead to significant morbidity and mortality as well as severe functional limitations. Furthermore, because over half of PAD patients are asymptomatic, there is a need for improved diagnostic and screening methods. Identification of metabolites associated with the disease may thus be a promising approach for PAD. However, PAD remains highly understudied. In this chapter, we discuss the application of metabolomics to the study of PAD.

THE POSSIBILITIES OF DISABILITY LEVEL DETERMINATION BASED ON THE INTERNATIONAL CLASSIFICATION OF FUNCTIONING WITH THE WHO DISABILITY ASSESSMENT SCHEDULE (WHODAS 2.0).

The aim: To explore the possibilities of using the WHODAS 2.0 questionnaire in the field of medical and social expertise in Ukraine as an additional tool for the determination of the levels of human functioning in the main spheres of life. Materials and methods: A check-up of 125 disabled people was conducted, their scores were determined using the WHODAS as well as their degree of disability according to generally accepted criteria in Ukraine. The study object was the disability level. The study subject - levels of functioning and disability assessment with the WHODAS 2.0. Results: It is shown that most disabilities occur in the spheres of participation, life activity, and mobility, which is the biggest obstacle to the functioning of such people. An interval gradation of disability level determination is proposed based on the scores obtained by the respondent according to the WHODAS 2.0 with the selection of criteria for mild, moderate, severe, and very severe functional limitations. Conclusions: Correlation analysis of indicators in different sections of the WHODAS 2.0 questionnaire with the disability criteria used in the practice of medical and social examination proves that the disability level assessment according to the WHODAS 2.0 meets the generally accepted criteria, therefore, this disability scale can be an objective tool for functional level assessment and disability group determination.

A Case Report of Capitellum Fracture Treated using Herbert Screw

Capitellar fractures are intra-articular elbow injury & it is an uncommon type of elbow injuries that can cause and affect severe functional limitation if not treated correctly. Various treatment options have evolved over the years, from cast immobilization to closed reduction fixation and now finally open reduction fixation is used as a better treatment option. Open reduction internal fixation provides excellent fixation to the fracture site and helps in achieving a stable joint that help in early mobilization of the elbow joint after trauma. Which also prevents late complications such as myositis ossificans. This is a case report of capitellar fracture, a typical type -1 Hahn-Steinthal fracture of left elbow joint in a 14 year old adolescent male treated using Herbert’s screw fixation. Here after three months of post-op follow-up it shows good interfragmental compression, early mobilization, excellent recovery & Implant removal is rarely necessary.

Arthroscopic vs open ankle arthrodesis: A prospective case series with seven years follow-up.

BACKGROUNDThe osteoarthritis of the ankle, although less common than other joints, is associated with severe functional limitation. Surgical options are ankle arthroscopic debridement, osteotomies, ankle arthrodesis and ankle arthroplasty. Ankle arthroplasty is increasingly used thanks to the new implants design, but ankle arthrodesis still represents the most used technique and it can be performed arthroscopically or with an open procedure. AIMTo compare mid-term results of arthroscopic vs open ankle arthrodesis of patients affected by end-stage ankle arthritis.METHODSThis study enrolled 23 patients, which underwent ankle arthrodesis. The patients were divided into 2 groups: group A (open procedure; n = 11) and group B (arthroscopic procedure, n = 12), the two groups were homogeneous with regard to age and body mass index (P = 0.347). The American Orthopaedic Foot and Ankle score (AOFAS), Freiburg Ankle score (FAS) and visual analogue scale for pain intensity were evaluated preoperatively, at six months and at final follow-up of 7.6 years in group A and 7.3 years in group B (P = 0.364).RESULTSPatients in the arthroscopic group showed better results at six-month follow-up compared to the open group at the AOFAS (group A, 62.2; group B, 78.5; P < 0.05) and the FAS (group A, 61.1; group B, 70.3; P = 0.015) scores. Pain relief was achieved in both groups at six-month follow-up (group A, 1.4; group B, 0.9; P = 0.162). Both open and arthroscopic groups showed improved clinical outcomes from baseline to final follow-up (P > 0.05). Hospital stay was shorter in group B than in group A (P = 0.001). More complications were reported in the open group than in the arthroscopic group (P = 0.459).CONCLUSIONThe arthroscopic and the open arthrodesis are valid and safe options for the treatment of ankle arthritis on the basis of clinical outcomes at 7 years follow-up. Moreover, the arthroscopic treatment shows faster improvement at six-month follow-up in comparison with the open group.

Is Central Sensitisation the Missing Link of Persisting Symptoms after COVID-19 Infection?

Patients recovered from a COVID-19 infection often report vague symptoms of fatigue or dyspnoea, comparable to the manifestations in patients with central sensitisation. The hypothesis was that central sensitisation could be the underlying common aetiology in both patient populations. This study explored the presence of symptoms of central sensitisation, and the association with functional status and health-related quality of life, in patients post COVID-19 infection. Patients who were previously infected with COVID-19 filled out the Central Sensitisation Inventory (CSI), the Post-COVID-19 Functional Status (PCFS) Scale and the EuroQol with five dimensions, through an online survey. Eventually, 567 persons completed the survey. In total, 29.73% of the persons had a score of <40/100 on the CSI and 70.26% had a score of ≥40/100. Regarding functional status, 7.34% had no functional limitations, 9.13% had negligible functional limitations, 37.30% reported slight functional limitations, 42.86% indicated moderate functional limitations and 3.37% reported severe functional limitations. Based on a one-way ANOVA test, there was a significant effect of PCFS Scale group level on the total CSI score (F(4,486) = 46.17, p < 0.001). This survey indicated the presence of symptoms of central sensitisation in more than 70% of patients post COVID-19 infection, suggesting towards the need for patient education and multimodal rehabilitation, to target nociplastic pain.

Предиктори потреби у сторонній допомозі у повсякденному житті серед пацієнтів, які перебували на стаціонарному лікуванні в інтегрованому інсультному блоці

Актуальність. Інсульт залишається провідною причиною інвалідності, але якісна медична допомога може поліпшити результати лікування. Мета дослідження: визначити предиктори збереження потреби у сторонній допомозі у пацієнтів з інсультом, які виписані з інтегрованого інсультного блоку (ІІБ). Матеріали та методи. Учасниками дослідження стали пацієнти з мозковим інсультом, які у 2010–2018 рр. перебували на стаціонарному лікуванні в Інсультному центрі (ІЦ), що розташований у багатопрофільній лікарні та функціонує за принципами ІІБ. Усі пацієнти були ретельно обстежені та отримували належне лікування, у кожного з них при надходженні та перед випискою було проведено оцінювання за основними інсультними шкалами. Дані пацієнтів проспективно вносились до спеціального реєстру. Як результат лікування розглядали прикінцеву оцінку за індексом Бартел (ІБ): при ІБ ≥ 85 балів ефект лікування вважався досягнутим, у разі ІБ ≤ 80 балів — недосягнутим. Для оцінки ступеня впливу 40 факторних ознак на ймовірність неповного функціонального відновлення був використаний метод побудови та аналізу логістичних моделей регресії. Результати. У дослідження були включені 677 пацієнтів віком від 20 до 95 років (медіана — 65,9 року), із них 271 (40,4 %) жінка. У 80,8 % пацієнтів був діагностований ішемічний, а у 19,2 % — геморагічний інсульт. Медіана оцінки за NIHSS при надходженні становила 10 балів. Терміни госпіталізації до ІЦ коливались від &lt; 24 год (17,5 % пацієнтів) до понад 180 днів (17,2 % пацієнтів), 59,7 % учасників були госпіталізовані протягом перших 30 днів від початку захворювання. Згідно з результатами однофакторного аналізу, статистично значущий зв’язок з ризиком недосягнення ефекту лікування мали 27 факторних ознак, зокрема тип та підтип інсульту, вік, наявність фібриляції передсердь, інсульт в анамнезі, тяжкий неврологічний дефіцит, когнітивні порушення та значна функціональна неспроможність при госпіталізації, окремі неврологічні порушення (пригнічення свідомості, дисфагія, геміанопсія, геміпарез) та підвищений рівень маркерів запалення (С­реактивний білок, швидкість осідання еритроцитів) у крові. Відповідно до результатів багатофакторного аналізу, сильний та незалежний зв’язок з ризиком недосягнення бажаного ефекту лікування мали вік пацієнта (відношення шансів (ВШ) 1,06; 95% довірчий інтервал (ДІ) 1,03–1,10 в середньому на кожен додатковий рік; р &lt; 0,001), повторний інсульт (ВШ 2,8; 95% ДІ 1,3–6,2; р = 0,01), початкові оцінки за ІБ (ВШ 0,97; 95% ДІ 0,95–0,98 в середньому при зменшенні оцінки на кожний бал; р &lt; 0,001), модифікованою шкалою Ренкіна (ВШ 1,7; 95% ДІ 1,0–2,8 в середньому при збільшенні оцінки на кожний бал; р = 0,05) та індексом мобільності Рівермід (ВШ 0,87; 95% ДІ 0,76–0,99; р = 0,05), а також початкова оцінка сили рук у відповідних розділах NIHSS (ВШ 1,5; 95% ДІ 1,1–1,9 в середньому на кожний додатковий бал; р = 0,003) та пізня госпіталізація до ІЦ (при надходженні пізніше 180 днів від початку захворювання ВШ 9,6; 95% ДІ 3,1–29,4; р &lt; 0,001). Площа під кривою операційних характеристик AUC = 0,95 (95% ДІ 0,93–0,97) свідчить про відмінну узгодженість моделі прогнозування. Висновки. Найбільший вплив на збереження потреби у сторонній допомозі після лікування в ІІБ мають вік пацієнта, тяжкість початкових порушень та період захворювання. Незалежні предиктори збереження функціональної неспроможності можуть допомогти кращому оцінюванню прогнозу та оптимізації прийняття рішень щодо лікувальної тактики.