Severe Disability Research Articles

Healthcare Cost of Multiple Sclerosis and in Relation to Disability Level in Alberta.

We aimed to (1) report updated estimates of direct healthcare costs for people living with MS (pwMS), (2) contrast costs to a control population and (3) explore differences between disability levels among pwMS. Administrative data were used to identify adult pwMS (MS cohort) and without (control cohort) in Alberta, Canada; disability level (based on the Expanded Disability Status Scale) among pwMS was estimated. One- and two-part generalized linear models with gamma distribution were used to estimate the incremental direct healthcare cost (2021 $CDN) of MS during a 1-year observation period. Adjusting for confounders, the total healthcare cost ratio was higher in the MS cohort (n = 13,089) versus control (n = 150,080) (5.24 [95% CI: 5.08, 5.41]) with a predicted incremental cost of $15,016 (95% CI: $14,497, $15,535) per person-year. Among the MS cohort, total predicted direct healthcare costs were higher with greater disability, $14,430 (95% CI: $13,980, $14,880) to $58,697 ($51,514, $65,879) per person-year in mild and severe disability, respectively. The primary health resource cost component shifted from disease-modifying therapies in mild disability to supportive care in moderate and severe disability. Adult pwMS had greater direct healthcare costs than those without. Extrapolating to the population level (where 14,485 adult pwMS were identified in the study), it is estimated that $218 million per year in healthcare costs may be attributable to MS in Alberta. The significantly larger economic impact associated with greater disability underscores the importance of preventing or delaying disease progression and functional impairment in MS.

Menstrual hygiene management among reproductive-aged women with disabilities in Bangladesh.

Women with disabilities in low- and middle-income countries face unique challenges in managing menstruation, affecting their health, dignity, and quality of life. This study aimed to explore menstrual hygiene management (MHM) practices among reproductive-aged women with disabilities in Bangladesh and its impact on social participation. We analyzed data from 51,535 women from the 2019 Multiple Indicator Cluster Survey (MICS). The outcome variables were: (i) material used to manage blood flow while menstruating (appropriate, inappropriate), (ii) availability of a private place for washing and changing menstruation rags (yes, no), and (iii) impact on attendance of social activities, school, or work during menstruation (yes, no). Disability status was considered as a major explanatory variable and categorized as no disabilities, moderate disabilities, and severe disabilities. Associations of outcome variables with explanatory variables were determined using a multilevel mixed-effects binary logistic regression model adjusted for individual-level factors, household-level factors, and community-level factors. Among the sample, 2.7% reported severe disability and 19.2% moderate disabilities, with vision-related disabilities (12.2%) being the most prevalent, followed by cognitive (9.5%) and walking disabilities (8.2%). Overall, 4% reported using inappropriate materials for menstrual flow, rising to 8.0% among those with severe disabilities and 5.8% for moderate disabilities. Women with moderate to severe disabilities had 33%-47% lower odds of using appropriate materials and 34%-44% lower odds of having a private place to change at home. Additionally, women with severe disabilities were 1.66 times more likely to report that menstruation impacted their social activities. Women with disabilities in Bangladesh face significant barriers to effective MHM. Addressing these issues requires targeted interventions, including disability-inclusive menstrual health education, improved access to menstrual products and sanitation facilities, and community initiatives to reduce stigma.

Trends and Factors Affecting Functional Limitations on Activities of Daily Living Performance Among Korean Adults With Disabilities, 2008–2020: A Longitudinal Study

ABSTRACT Background Loss of the ability to perform activities of daily living (ADLs) leads to negative health outcomes such as reduced quality of life, institutionalization, and mortality. In Korea, the proportion of older adults with disabilities is increasing along with rapid population aging. Therefore, providing a comprehensive approach to the prevention and management of ADL limitations in people with disabilities is necessary. This can be accomplished by understanding the trends and factors affecting these limitations over time. Purpose This study was developed to examine the longitudinal trend and factors affecting ADL limitations over time among people with disabilities in Korea. Methods Data from 346 people with disabilities in the 2008–2020 Korean Welfare Panel Study were used. Bivariate analysis and a Kendall trend test were performed to determine the longitudinal trends for ADL limitations, and multiple logistic regression was used to evaluate whether relevant variables could predict these limitations. Results The prevalence of ADL limitations among people with disabilities increased by 16.5% over the 12 years of the study. The highest rate of increase in these limitations over time was found in people with mental disorders (27.8%), those over 65 years of age (27.3%), and those with depression (25.6%). In multiple logistic regression, the odds ratios of the variables were slightly different at each survey wave. However, severe disability and low educational level were consistently found to be associated with ADL limitations over time. Conclusions The findings provide evidence of a significant relationship between level of disability and/or educational status and ADL limitations in people with disabilities in Korea. To prevent the development of ADL limitations in people with disabilities, comprehensive identification of longitudinal trends and factors affecting ADL limitations is necessary. Early intervention, including integrated services such as home rehabilitation services to prevent ADL limitations, especially for disabled people with severe disabilities and low educational levels, has the potential to delay ADL limitations.

Specific phobias in children with moderate to severe intellectual disabilities: SPIRIT, an adaptation and feasibility study.

There is a lack of interventions for specific phobia in children and adolescents with moderate to severe intellectual disabilities. The objectives were to: (a) develop an intervention for specific phobia, together with an intervention fidelity checklist and logic model, and evaluate candidate outcome measures, together with parents/carers and clinicians; (b) describe treatment as usual; (c) model the intervention to determine the acceptability and feasibility for all stakeholders, judge the appropriateness of outcome measures, explore recruitment pathways, and examine the feasibility and acceptability of consent and associated processes; and (d) describe factors that facilitate or challenge the intervention. Phase 1a: using consensus methods, an Intervention Development Group was established who met to develop the intervention, review candidate outcome measures and contribute to the development of the intervention fidelity checklists and logic model. Phase 1b: a national online survey was conducted with parents and professionals to describe treatment as usual. Phase 2: a single-group non-randomised feasibility study was designed to model the intervention and to test intervention feasibility and acceptability, outcome measures and aspects of the research process. Phase 2: participants were recruited from National Health Service community child learning disabilities teams and special schools in England. Treatment was delivered in the child learning disabilities teams. Children aged 5-15 years with moderate to severe learning disability and specific phobia, and their parents/carers. The SPIRIT intervention comprised two half-day workshops and eight support sessions plus treatment as usual. The feasibility and acceptability of the intervention and research processes, recruitment, outcome measure completion rates and acceptability, and intervention adherence. Parents completed all of the outcome measures, with very low rates of missing data. The recruitment of sites and participants was impacted by the COVID-19 pandemic. The intervention was successfully developed and modelled with 15 participants with moderate to severe learning disabilities and their parents. The intervention was judged to be feasible and acceptable by parents/carers and therapists. Parents/carers and therapists suggested minor intervention revisions. Randomisation was not modelled within this feasibility study, although the majority of parents and therapists indicated that this would be acceptable. The SPIRIT intervention and associated study processes were judged to be feasible and acceptable. The intervention requires minor revisions. The SPIRIT intervention should be tested further within a clinical trial. Current Controlled Trials ISRCTN34766613. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR130177) and is published in full in Health Technology Assessment; Vol. 28, No. 64. See the NIHR Funding and Awards website for further award information.

Disability, cognitive impairment and depression in patients with Traumatic Brain Injury (TBI) – A Prospective Study

Introduction: Traumatic brain injuries are most commonly caused due to RTA in India, which has become the biggest killer. Physical deficits are given importance in the early phase of recovery post-head injury but it is the cognitive impairments and behavioural issues that lead to disability and prevent patients from returning back to work, causing an emotional and financial burden to families.Aims and objective: Purpose of the study was to assess for disability and cognitive impairment associated with post TBI. Also to assess for the presence and severity of depression in patients suffering from TBI.Methodology: 110 patients of TBI from the neurosurgery in-patient department, recruited from January 2016 to June 2016 consenting to study from a tertiary care hospital are considered for assessment for a period of 6 months by follow up. Disability is assessed by using the WHO-DAS scale, cognitive impairment is assessed by the HMSE scale and severity of depression is assessed by the HAM-D scale.Results: In this study out of 110 TBI patients, 21.8% had moderate disability and 8.2% had severe disa-bility. In this study 52.6% suffered from depression and among these 25% had mild depression, 55%had moderate and 20% had severe depression.Conclusions: This is one of few studies done in south India specifically in Karnataka to assess for the disability associated with post TBI and also to assess for cognitive impairment that patients with TBI suffer post injury. TBI patients suffer from depression, cognitive impairment and significant disability, hence early assessment is required.

187P French HCPs approach to evaluating SMA adult patients with severe disabilities: a qualitative study

187P French HCPs approach to evaluating SMA adult patients with severe disabilities: a qualitative study

Neurobiological Insights Into Cerebral Palsy: A Review of the Mechanisms and Therapeutic Strategies.

Cerebral palsy (CP) is a common neurodevelopmental disorder characterized by impaired mobility and posture caused by brain injury or abnormal development. CP relates to a variety of neurological mechanisms and pathways that impact the type and severity of motor disability, as well as comorbidities. The heterogeneity in clinical phenotype, pathogenesis, and etiology poses significant challenges for effective therapeutic intervention. The review aims to provide a comprehensive analysis of the neurobiological mechanisms underlying CP and evaluate current and prospective therapeutic strategies, highlighting the necessity for targeted interventions to address the disorder's multifaceted nature. A thorough literature review was conducted, focusing on studies published in peer-reviewed journals that explore the pathophysiological mechanisms, clinical interventions, and therapeutic strategies for CP. The pathogenesis of CP involves a complex interplay of genetic, environmental, and perinatal factors leading to brain injury. Inflammatory processes, oxidative stress, and excitotoxicity are critical in CP development. Current therapeutic approaches primarily focus on symptom management through physical and occupational therapy, as well as pharmacological interventions. Emerging therapies, including anti-inflammatory agents, antioxidants, and neuroprotective and neurotrophic agents, show potential but require further validation. Notably, although steroids provide anti-inflammatory benefits, their use in pediatric patients raises concerns regarding long-term adverse effects such as osteoporosis. Despite advances in understanding CP's neurobiological underpinnings, effective therapeutic targets remain elusive. A comprehensive approach addressing CP's heterogeneity is essential. Future research should emphasize in-depth evaluations of the efficacy and safety of therapeutic agents, particularly in pediatric populations, to develop targeted and effective treatments for CP.

Kinesiophobia, anxiety and depressive symptoms are associated with the severity of Achilles tendinopathy related disability: a cross-sectional study

Kinesiophobia, anxiety and depressive symptoms are associated with the severity of Achilles tendinopathy related disability: a cross-sectional study

Macrophages dying from ferroptosis promote microglia-mediated inflammatory responses during spinal cord injury

The neurological deficits following traumatic spinal cord injury are associated with severe patient disability and economic consequences. Currently, an increasing number of studies are focusing on the importance of ferroptosis during acute organ injuries. However, the spatial and temporal distribution patterns of ferroptosis during SCI and the details of its role are largely unknown. In this study, in vivo experiments revealed that microglia are in close proximity to macrophages, the major cell type that undergoes ferroptosis following SCI. Furthermore, we found that ferroptotic macrophages aggravate SCI by inducing the proinflammatory properties of microglia. In vitro studies further revealed ferroptotic macrophages increased the expression of IL-1β, IL-6, and IL-23 in microglia. Mechanistically, due to the activation of the NF-κB signaling pathway, the expression of IL-1β and IL-6 was increased. In addition, we established that increased levels of oxidative phosphorylation cause mitochondrial reactive oxygen species generation and unfolded protein response activation and trigger an inflammatory response marked by an increase in IL-23 production. Our findings identified that targeting ferroptosis and IL-23 could be an effective strategy for promoting neurological recovery after SCI.

Effect of standard feeding with a high-protein diet on arterial blood gases in patients admitted to the intensive care units: A study protocol for a double-blinded, randomized controlled clinical trial

Critically ill patients admitted to the intensive care units (ICUs) often face numerous challenges, including severe metabolic stress, systemic inflammation, and compromised immune function. Studies have suggested that critically ill patients frequently experience a negative nitrogen balance due to a hypercatabolic state, leading to impaired organ function and muscle wasting, which can cause severe muscle weakness and physical disability for years after discharge. Arterial blood gases (ABG) reflect patients' oxygenation and acid-base status and are crucial indicators of respiratory and metabolic function in critically ill individuals. We aim to address this by conducting a double-blinded, randomized controlled clinical trial to compare the effects of standard feeding with a high-protein diet on ABG in ICU patients. In this double-blinded, randomized controlled clinical trial, we will use block randomization of 80 patients aged between 18 to 65 years old and Patients expected to be hospitalized in the ICU for at least 3 days from Kosar Hospital, Kurdistan, Iran. The intervention group (n=40) will receive a protein diet (consisting of 18.7% protein, 45% carbohydrates, and 35% fat per 1000cc). A control group (n=40) will receive a standard diet (14.4% protein, 54% carbohydrates, and 32.4% fat per 1000cc) for the same duration in addition to usual care. The caloric requirements of each patient will be determined by a nutritionist based on their nutritional status, height, weight, age, and initial diagnosis, utilizing the Harris-Benedict formula. The parameters of ABG, including PO2, PCO2, SAO2, HCO3, BE, and pH, will be assessed. By optimizing protein intake through a high-protein diet, we aim to improve the nutritional status of patients and enhance their overall clinical outcomes. This reassures us of the potential benefits of our study.

Deep phenotyping of 11 individuals with pathogenic variants in RNU4-2 reveals a clinically recognizable syndrome

PurposeDespite ever-increasing knowledge of the genetic etiologies of neurodevelopmental disorders, approximately half remain undiagnosed after exome or genome sequencing. Here, we provide a deep clinical characterization of 11 previously unreported patients with a recently described neurodevelopmental disorder (NDD) due to pathogenic variants in RNU4-2. MethodsThe 11 patients were identified in a pool of 70 patients selected for targeted RNU4-2 sequencing on the basis of their clinical phenotypes from a cohort of 1032 individuals with a NDD and without a prior genetic diagnosis. ResultsThe 11 patients were aged between 13 months and 36 years. All patients showed moderate to severe developmental delay and/or intellectual disability. Height and weight were below 10th percentile and most showed microcephaly. In almost 50% of the patients, intrauterine growth retardation was detected. All patients showed a distinctive pattern of dysmorphic features, including hooded upper eyelid and epicanthus, full cheeks, tented philtrum, mouth constantly slightly open with an everted lower lip vermilion, high palate, and profuse drooling. Of 11 patients, 64% also presented with ophthalmological problems (mainly strabismus, nystagmus, and refraction errors) and 64% had musculoskeletal features (joint hypermobility, mild scoliosis, and easy fractures). ConclusionThis work provides an improved characterization of the phenotypic spectrum of RNU4-2 syndrome across different age groups and demonstrates that thorough clinical assessment of patients with an NDD can be enhanced significantly for this novel syndrome.

Study of correlation between arches of foot and lower back pain in Eastern India

Background: Low back pain is one of the most common disorders of the musculoskeletal system, leading to impaired function and decreased quality of life in many patients. Foot arch alterations may lead to structural changes and/or affect its load distribution. It should be noted that even slight elevations of the foot’s medial longitudinal arch above the norm may lead to changes in load and pressure distribution. Hence, it becomes important to find the relationship between low back pain and altered foot arch indices leading to improper body balance. Aims and Objectives: The aims and objectives of the study are to find any correlation between lower back pain and an altered foot arch index in the Eastern Indian population. Materials and Methods: A total of 60 subjects aged 20–40 years with varying degrees of low back pain were selected. Low back pain scores of the subjects were found using modified oswestry low back pain disability questionnaire. Footprints in standing position using ink were taken on graph paper and the foot arch indices were calculated. Results: 54.16% of the male and 36.11% of female participants had low arched feet, 20.83% of male and 52.78% of female participants had normal arched feet, and 25% of male and 11.11% of female participants had high arched feet with varying degrees of low back pain. 77.42% of the participants with minimal disability due to low back pain were having normal arched feet, 71.43% of the participants with moderate disability due to low back pain were having low arched feet, and 100% of the participants with severe disability due to low back pain were having either high or low arched feet. Conclusion: This study showed that people having either low or high arched feet are at an increased risk of developing acute or chronic low back pain at some stage in their lives. Knowledge of this risk factor might even help people to choose appropriate occupations in the future.

From Handouts to Empowerment: Impacts of Policy Subsidies and Employment Support on the Well-Being of Disabled Veterans

Balancing policy subsidies and employment support is crucial for developing effective assistance policies for disabled veterans. This study conducted an empirical investigation in China using 315 survey questionnaires. The findings indicate that, first, subsidies have a positive impact on the well-being of disabled veterans, but this effect diminishes as disability severity increases. Second, employment emerges as a crucial factor that surpasses subsidies in contributing to overall well-being. As disability severity increases, the relative impact of employment on well-being strengthens. Third, employment enhances well-being by improving self-identity, while the influence of subsidies on self-identity is relatively minimal. Additionally, a policy model demonstrates that subsidies enhance individual well-being but increase group uncertainty, whereas employment support improves individual well-being and reduces group uncertainty. These insights are valuable for governments when formulating policies related to social security, employment stability, and welfare protection.

Implementation of Augmentative and Alternative Communication for People with Severe Intellectual Disabilities: Specialist Perceptions

This study aimed to identify the perceptions of specialists working with people with severe intellectual disabilities regarding the implementation of augmentative and alternative communication. A qualitative approach was used to analyse semi-structured interviews with nine specialists working with people with severe intellectual disabilities at the Comprehensive Rehabilitation Centres in Saudi Arabia. The main results indicated that all specialists had some knowledge of the use of augmentative and alternative communication methods for facilitating communication with people with severe intellectual disabilities, and a diversity of means and methods were discussed. Visual methods were the most widely used at these centres, however, while technological means were the least commonly used by specialists, despite their acknowledged importance. Near consensus also emerged among the specialists regarding the effectiveness and success of such methods in terms of communicating with people with severe intellectual disabilities. The results of the study also indicated that specialists faced numerous challenges in terms implementing augmentative and alternative communication from the people with severe intellectual disabilities themselves, as well as other specialists and centre procedures and staff. The most important proposed solutions for overcoming these challenges was the implementation of training courses to enable specialists to develop their capabilities regarding the use of more diverse methods and the implementation of augmentative and alternative communication with people with severe intellectual disabilities in a manner that allowed them to identify and select those augmentative and alternative communication methods that best align with the capabilities and needs of the relevant persons with severe intellectual disabilities.

The association between anxiety and depression symptoms and clinical and pain characteristics in patients with hip and knee osteoarthritis.

This study aimed to estimate the prevalence of anxiety and depression symptoms and explore the association between these symptoms and clinical and pain characteristics in patients with chronic pain (CP) due to hip and knee osteoarthritis (OA). In this cross-sectional study, adult patients with CP and knee and/or hip OA were included. Anxiety and depression symptoms were assessed using the Hospital Anxiety and Depression Scale. Visual analogue scale, Western Ontario and McMaster Universities Arthritis Index (WOMAC) and PainDetect Questionnaire assessed pain characteristics and Health Assessment Questionnaire (HAQ) evaluated functional disability. Correlation coefficients were used to explore the associations between anxiety and depression symptoms and clinical and pain characteristics. A total of 61 patients (age 66.2±9.4 years, 67.2% female) were included. Most patients (70.5%) had clinically significant anxiety and/or depression symptoms. Patients with anxiety and/or depression symptoms had higher pain severity (p=0.032) and disability (p=0.014). Depression symptoms had a moderate positive correlation with WOMAC physical function subscale (r=0.520), WOMAC total (r=0.511) and HAQ (r=0.405). Anxiety and depression symptoms are prevalent in knee or hip OA patients with CP and were associated with higher pain severity and functional disability. These findings support the screening of anxiety and depression symptoms in OA patients, in order to develop more effective multidisciplinary treatments.

SCLEROSE EN PLAQUE ET GESTION DE LAPTITUDE : A PROPOS DE DEUX CAS SUIVIS AU CENTRE DEXPERTISE MEDICAL DU PERSONNEL NAVIGANT DE RABAT

Multiple sclerosis (MS) is the most common inflammatory demyelinating disease of the central nervous system, with variable manifestations, it evolves in two main forms (relapsing and remitting) with an unpredictable evolution, theprognosis may range from minimal neurological deficit to severe disability. It mainly affects the young population. Several manifestations (organic and psychological) of MS can lead to an overall decrease in flight crew performance. It includes cognitive impairment, fatigue and depression. Episodes of spasms, dysarthria, ataxia, paresthesia, diplopia and also hemiplegia can that can affect flight safety. Disease-modifying therapiescould minimize relapse rates and slow disease progression, but are not free from sometimes major side effects that can compromise flight safety. We report our experience with two cabin crew members affected by MS and fitness management. The different manifestations of MS will be discussed with an emphasis on aeromedical implications.

Clinical prognostication in acute necrotizing encephalopathy of childhood: the role of magnetic resonance imaging severity assessment.

Acute necrotizing encephalopathy of childhood is a unique entity with bilateral gray and white matter involvement. The aim of this study is to explore whether the severity of findings on imaging scans is indicative of the prognosis and clinical outcomes for pediatric patients with acute necrotizing encephalopathy. A retrospective cross-sectional study was conducted on 42 patients diagnosed with acute necrotizing encephalopathy. A severity score based on MR imaging was computed for each patient, utilizing a point system determined by the existence of factors such as hemorrhage, cavitation, enhancement, diffusion restriction, and lesion location. The scoring was categorized into mild, moderate, and severe. Clinical outcomes were determined at the time of discharge and at follow-ups as mild disability, moderate disability, severe disability, and death according to the modified Rankin Scale. Associations were determined by Fisher's exact test, chi-square test, and one-way ANOVA. The study included 21 boys and 21 girls with a mean age of 71.5months. A statistically significant connection (P=0.027) was found between the severity score from MR imaging and the clinical outcome. A statistically significant relationship was also observed between diffusion restriction (P=0.008), cerebellar involvement (P=0.048), and an unfavorable clinical outcome. Additionally, individuals who experienced shock exhibited a correlation with adverse outcomes (P=0.01). In predicting the outcome of acute necrotizing encephalopathy, cerebellar involvement and presence of diffusion restriction were associated with worse clinical outcomes in our study. Developing a comprehensive MR-based severity score is crucial for improving diagnostic accuracy and patient outcomes. Our findings underscore the importance of including diffusion restriction and cerebellar involvement in the scoring system.

Predictive value of serum interleukin-6 for neonatal encephalopathy outcomes.

Serum interleukin-6 (IL-6) may predict adverse outcomes of neonatal encephalopathy (NE); however, limited data regarding the predictive utility of IL-6 during neurodevelopmental follow-up are available. We aimed to determine the utility of IL-6 for predicting adverse outcomes at 18 to 22 months of age. Eighty-seven patients with NE who received therapeutic hypothermia were enrolled in this study. Serial serum IL-6 levels during the first 3 postnatal days were collected. Patients were classified into three groups: 1) death, 2) survival with moderate to severe neurodevelopmental disability (NDD) at 18-22 months of age, and 3) survival without NDD (favorable outcome). The predictive ability of IL-6 was determined by the area under the receiver-operating characteristic curve (AUC). Serial IL-6 data of 80 patients with NE were available and showed peak levels on postnatal day 1; these levels gradually decreased toward day 3. By 18-22 months of age, 13 and 17 patients died and experienced moderate to severe NDD without death, respectively. Fifty patients experienced favorable outcomes. Higher IL-6 levels on day 1 predicted the composite adverse outcome (including death and survival with NDD; n = 30; AUC, 0.648). Higher IL-6 levels on day 1 predicted death (n = 13; AUC, 0.799), whereas higher IL-6 levels on day 1 predicted survival with NDD (n = 17; AUC, 0.536). The AUC of IL-6 that predicted survival with NDD was lower than the AUC of IL-6 that predicted death; therefore, IL-6 may have insufficient utility for predicting NDD without death.

Chronic non-specific low back pain disability and depressive symptoms in working men and women: a cross-sectional study.

Chronic non-specific low back pain (LBP) is a serious public health issue that impairs the functional abilities of working men and women. The burden and experience of chronic non-specific LBP are largely influenced by psychological and psychosocial aspects. The objective was to investigate the association between the severity of chronic non-specific LBP disability and depressive symptoms in a sample of Croatian working active men and women with an age distribution from 35 to 65 years. The Roland Morris Disability Questionnaire (RMDQ) assessed disability, whereas the Beck Depression Inventory-II assessed depressive symptoms. During the routine outpatient visit self-reported RMDQ and BDI-II were completed from 203 recruited patients, divided into categories concerning disability scores. The median (IQR) age of 48.59 ± 6.48 was in the lower and the median (IQR) age of 50.65 ± 7.68 in the higher disability category. Disability was significantly associated (p < 0.05) with higher age (r = 0.177), working experience (r = 0.161), LBP duration (r = 0.195), greater pain intensity (r = 0.474 during activity, r = 0.227 at rest), and BDI-II score (r = 0.466). Higher BDI-II scores were associated with confirmatory answers on the 15th, 19th, and 22nd questions in RMDQ (p < 0.05). In patients with chronic non-specific LBP, higher degrees of disability were linked to severe depressive symptoms, aging, longer working experience, and increased pain intensity. These findings support pretreatment screening for depressive symptoms in order to develop individually customized and efficient multidisciplinary therapies.

How Are FIM Gains Improved after Intensive Rehabilitation for Cerebrovascular Diseases?

The purpose of this study was to determine functional independence measure (FIM) gains based on clinical factors after rehabilitation for cerebrovascular diseases, and to determine how FIM scores and FIM gains can predict rehabilitation outcomes. Of the 181 patients in the study 161 suffered strokes (cerebral infarction 107, cerebral hemorrhage 41, subarachnoid hemorrhage 12, subdural hematoma 1). There were also 12 traumatic brain injuries, and 8 other miscellaneous cases. Dementia, higher brain dysfunction, etiology, sex, age, history of cerebrovascular diseases, location involvement, disability severity, duration of hospitalization and period from onset to rehabilitation were analyzed using FIM. FIM gains decreased in relation to an increase in age. Patients with intermediate disability (FIM 41-80) on admission showed significantly higher FIM-total gain on discharge than others. Factors influencing FIM gain were revealed to be age, duration of hospitalization, FIM gain 4 weeks after admission, etiology, disability severity, dementia and past history of cerebrovascular diseases. Multiple regression analysis determined that significant factors to contribute FIM gain were duration of hospitalization, FIM gain at 4 weeks after admission, age, and disability severity. FIM scores and FIM gains could predict rehabilitation outcomes.