Total Activities Of Daily Living Research Articles

Community rehabilitation by the trained village health volunteers on activities of daily living and quality of life in stroke survivors

Background: The number of people with disabilities resulting from strokes is increasing in Thailand. The major sequela of the disease was weakness in one side of the body that causes difficulty in activities of daily living (ADL) and poor quality of life (QOL) for stroke survivors. Community-based rehabilitation could be one of the strategies that enhances functional performance and improves QOL in these individuals. There were many disabled people in Mae Ka subdistrict, San Pa Tong District, Chiang Mai Province, where health care providers and local people were enthusiastic to take care of each other’s health in the community. Objective: The present study aimed to investigate rehabilitation outcomes in ADL and QOL of stroke participants who received rehabilitation services from trained village health volunteers (VHVs). Materials and methods: This study was a quasi-experimental research design. Subjects were recruited using purposive sampling, including 10 stroke survivors. Instruments used were 1) ADL Assessment for Occupational Therapy Clients; and 2) World Health Organization Quality of Life Assessment, Short Form-Thai version. The statistics used were descriptive, as well as the Wilcoxon Signed Ranks Test. Results: Results demonstrated that scores of basic activities of daily living (BADL) in the participants increased significantly (p<0.05) except for sexual expression. The score in the instrumental activities of daily living (IADL) was also significantly higher at post-rehabilitation than pre-intervention (p<0.05), as was the total ADL score. Stroke patients had significantly higher QOL scores after intervention than the pretest (p<0.05). Conclusion: These indicated that the community rehabilitation center at Mae Ka Subdistrict Administrative Organization, San Pa Tong District, Chiang Mai Province, run by the trained VHVs could promote ability in daily activities and improve QOL in stroke participants who come for their services.

Prevalence and risk factors for impaired activities of daily living in patients with neo-vascular age-related macular degeneration who present for anti-VEGF treatment

Background/ObjectivesTo assess the prevalence and correlates of impaired activities of daily living (ADLs) in patients with neovascular age-related macular degeneration (nAMD) who present for anti-vascular endothelial growth factor (VEGF) therapy.MethodsIn a clinic-based cohort of 437 patients with nAMD who presented for anti-VEGF therapy, the Older American Resources and Services Scale (OARS) was administered to assess for impairments in basic, instrumental and total ADL. Logistic regression analyses were conducted to determine odds ratios (OR) and 95% confidence intervals (CI) for factors associated with ADL impairment.ResultsThe prevalence of impaired basic, instrumental and total ADL was 37.76%, 67.82% and 39.59%, respectively. In multivariate-adjusted models, moderate visual impairment [OR 5.65, 95% CI (2.31–13.83) and blindness [OR 5.43, 95% CI (2.09–14.12)] were associated with greater odds of impaired total ADL. Depressive symptoms [OR 2.08, 95% CI (1.08–4.00)], the presence of any disability [OR 3.16, 95% CI (1.64–0.07)] and never driving [OR 4.00, 95% CI (1.60–10.00)] were also positively associated with total ADL impairment. Better vision-related quality of life (QoL) was inversely associated with impaired instrumental ADL whilst higher health-related QoL scores were associated with decreased odds of total ADL impairment.ConclusionsThere is a high prevalence rate of ADL impairment among nAMD patients presenting for therapy. Visual impairment, never driving, poor physical and mental health increased the odds of experiencing ADL impairment whilst better VRQoL and HRQoL reduced the odds of impairment.

Neurofunctional Correlates of Activities of Daily Living in Patients with Posterior Cortical Atrophy

AbstractBackgroundResearch on posterior cortical atrophy (PCA) has concentrated on cognitive decline, especially visual processing deficits. However, few studies have focused on the activities of daily living (ADL), and no study has investigated the neurometabolic basis of ADL impairments. We aimed to identify regions of hypometabolism associated with ADL in PCA patients.MethodTwenty‐nine PCA patients, 35 typical Alzheimer’s disease (tAD) patients, and 26 healthy volunteers were recruited. Each subject completed a scale for total ADL [TADL, including basic ADL (BADL) and instrumental ADL (IADL) subscales] and 18F fluorodeoxyglucose positron emission tomography. Voxel‐wise multivariable regression analysis was conducted at the level of the whole‐brain, PCA‐related hypometabolism patterns, and PCA‐specific hypometabolism patterns.ResultThe general cognitive status of PCA patients was similar to tAD patients; however, they performed worse in TADL, BADL, and IADL. In all analysis levels, TADL was associated with the bilateral parietal lobe, including the right superior parietal lobe, right inferior parietal cortex, right angular gyrus, and left superior parietal lobe. BADL was associated with the bilateral parietal lobe located in the right superior parietal lobe, right inferior parietal cortex, and left superior parietal lobe. IADL was associated with the bilateral superior parietal lobe. Bilateral superior parietal lobe hypometabolism was associated with TADL, BADL, and IADL.ConclusionHypo‐metabolism in the bilateral superior parietal lobes contributes to the decline of ADL in PCA, which is a promising target for future non‐invasive neuromodulation interventions.

Tele-rehabilitation on independence in activities of daily living after stroke: A Matched Case-Control Study

ObjectivesTo compare independence in activities of daily living (ADLs) in post-acute patients with stroke following tele-rehabilitation and matched in-person controls. Materials and MethodsMatched case-control study. A total of 35 consecutive patients with stroke who followed tele-rehabilitation were compared to 35 historical in-person patients (controls) matched for age, functional independence at admission and time since injury to rehabilitation admission (<60 days). The tele-rehabilitation group was also compared to the complete cohort of historical controls (n=990). Independence in ADLs was assessed using the Functional Independence Measure (FIM) and the Barthel Index (BI). We formally compared FIM and BI gains calculated as discharge score - admission scores, efficiency measured as gains / length of stay and effectiveness defined as (discharge score-admission score)/ (maximum score-admission score). We analyzed the minimal clinically important difference (MCID) for FIM and BI. ResultsThe groups showed no significant differences in type of stroke (ischemic or hemorrhagic), location, severity, age at injury, length of stay, body mass index, diabetes, dyslipidemia, hypertension, aphasia, neglect, affected side of the body, dominance or educational level. The groups showed no significant differences in gains, efficiency nor effectiveness either using FIM or Barthel Index.We identified significant differences in two specific BI items (feeding and transfer) in favor of the in-person group. No differences were observed in the proportion of patients who achieved MCID. ConclusionsNo significant differences were seen between total ADL scores for tele-rehabilitation and in-person rehabilitation. Future research studies should analyze a combined rehabilitation approach that utilizes both models.

Impact of Light Conditions on Visual Performance following Premium Pseudophakic Presbyopia Corrections.

The primary objective of this study was to objectively compare the visual performance of patients following premium pseudophakic presbyopia corrections in different light combinations for near- and intermediate-vision activities of daily living (ADLs). This is a prospective, comparative study. A total of 75 patients populated three study groups: G1-patients with bilateral trifocal implantation, G2-patients with bilateral bifocal implantation, and G3-patients with bilateral monofocal implantation. All participants addressed 10 ADLs in nine combinations of light temperature (3000 K, 4000 K, and 6000 K) and light intensity (25 fc, 50 fc, and 75 fc) and declared their subjectively optimal light combination while reading. G2 and G3 had the best total ADL scores in 6000 K/75 fc, while G1 had the best total ADL score in 4000 K/75 fc. Total ADL, easy ADL, and moderate difficulty ADL scores were significantly better in G2, while difficult ADL score was significantly better in G1. The majority of all groups selected 6000 K/75 fc as the most comfortable light combination, and no group selected 3000 K and 25 fc. In conclusion, trifocal patients benefit from intense daylight, while bifocal and monofocal patients benefit from intense, cold lighting. Trifocal patients present superior near-vision capacity in difficult near-vision daily tasks, while bifocal patients present superiority in easy and moderate-difficulty ADLs.

Neurofunctional Correlates of Activities of Daily Living in Patients with Posterior Cortical Atrophy.

Research on posterior cortical atrophy (PCA) has focused on cognitive decline, especially visual processing deficits. However, few studies have examined the impact of PCA on activities of daily living (ADL) and the neurofunctional and neuroanatomic bases of ADL. To identify brain regions associated with ADL in PCA patients. A total of 29 PCA patients, 35 typical Alzheimer's disease (tAD) patients, and 26 healthy volunteers were recruited. Each subject completed an ADL questionnaire that included basic and instrumental subscales (BADL and IADL, respectively), and underwent hybrid magnetic resonance imaging and 18F fluorodeoxyglucose positron emission tomography. Voxel-wise regression multivariable analysis was conducted to identify specific brain regions associated with ADL. General cognitive status was similar between PCA and tAD patients; however, the former had lower total ADL scores and BADL and IADL scores. All three scores were associated with hypometabolism in bilateral parietal lobes (especially bilateral superior parietal gyri) at the whole-brain level, PCA-related hypometabolism level, and PCA-specific hypometabolism level. A cluster that included the right superior parietal gyrus showed an ADL×group interaction effect that was correlated with the total ADL score in the PCA group (r = -0.6908, p = 9.3599e-5) but not in the tAD group (r = 0.1006, p = 0.5904). There was no significant association between gray matter density and ADL scores. Hypometabolism in bilateral superior parietal lobes contributes to a decline in ADL in patients with PCA and can potentially be targeted by noninvasive neuromodulatory interventions.

Functionality and Performance Assessment of Assistive Robots’ Grippers Performing Activities of Daily Livings

<h3>Research Objectives</h3> Two assistive robotic prototype devices were designed to assist people with upper extremity disorders in performing Activities of Daily Living (ADL). This study aimed to compare the functionality and performance of the 2-finger gripper and the 3-finger gripper while performing ADL tasks. <h3>Design</h3> Experimental study. <h3>Setting</h3> In the BioRobotics Lab. <h3>Participants</h3> Six healthy participants with a mean (SD) age of 26.3 (2.6) years old. <h3>Interventions</h3> Participants were seated in a wheelchair and used an integrated Finger Joystick to control an assistive robotic device to perform 19 essential daily tasks. At the conclusion of the study, the participants were asked to complete a user experience survey. <h3>Main Outcome Measures</h3> We assessed the device in 3 ways: (1) the total ADL coverage using the 2-finger gripper, (2) the limitations and issues of the 2-finger gripper performing activities of daily living, and (3) the total ADL coverage using the 3-finger gripper. <h3>Results</h3> The results show that the 3-finger gripper covers more daily living activities than the 2-finger gripper. The 2-finger gripper covers 47.36 percent of the 19 essential ADLs listed, while the 3-finger gripper covers 78.94 percent. The 2-finger gripper's shape and hinges caused issues opening/closing standard drawers, ovens, and doors, but not for the 3-finger gripper. The 2-finger gripper was able to hold up to 5 lbs whereas the 3-finger gripper was able to hold up to 20 lbs. Both grippers were able to hold the phone but could not put it in speaker mode. The 2-finger gripper could not hold medicine and maneuver it near the mouth but not with the 3-finger gripper. Both grippers were unable to complete the opening/closing lid of a jar, holding/swiping credit cards, and turning pages of a book. <h3>Conclusions</h3> The 3-finger gripper seemed to be more functional than the 2-finger gripper. Our next step is to test the feasibility and usability in people with upper extremity disorders. <h3>Author(s) Disclosures</h3> The authors have no conflicts of interest to declare.

ORIHIME II Study: Background, Treatment Status, and Outcomes of Patients with Acquired Hemophilia A with Low Activities of Daily Living Scores or Undergoing Rehabilitation - a Japanese Health Claims Database Analysis

Background: Acquired hemophilia A (AHA) is a rare disease in which autoantibodies (inhibitors) develop against blood coagulation factor (F)VIII, resulting in significantly reduced FVIII activity, with onset of bleeding symptoms such as sudden subcutaneous hemorrhage and muscular hemorrhage. The database-based study, 'Obtain Real-World Insights of Acquired Hemophilia A Patients in Japan' (the ORIHIME study) first reported data on rehabilitation and activities of daily living (ADL) scores for patients with AHA in Japan, which had previously been scarce (Ogawa et al. Blood 2021). The need to clarify the clinical experience of patients undergoing rehabilitation and patients with low ADL scores, who are considered to have relatively poor treatment and prognosis among AHA patients, has become apparent. This study evaluated the association between patient background, medication use, and outcomes among patients with AHA who underwent rehabilitation or had low ADL scores between April 1, 2008, and October 31, 2021. Methods: The study was conducted using the Medical Data Vision Co., Ltd. database. Patients with a diagnosis of AHA who were hospitalized and were administered immunosuppressants following admission were included. The primary endpoint examined the association of actual rehabilitation practices and total ADL score (measured using the Barthel Index) at discharge with patient background, medication use, and clinical outcomes. Total ADL score was calculated by adding together the scores for each of the following activities: eating, transferring (e.g. from bed to chair and back), ambulating, toilet use, bathing, mobility, stairs, dressing, and control of bladder and bowel movement. A score of 85 or higher corresponds with 'independence with minimal assistance' in the Barthel Index, therefore, in this analysis, participants are categorized by scores of <85 and ≥85 (Sulter et al. Stroke 1999). The risk of infection due to immunosuppressive therapy was a secondary endpoint. Results: Overall, 427 patients were included in this study. The mean (standard deviation [SD]) age of the patients was 76.3 (11.3) years, and 264 (61.8%) were male. A total of 249 patients underwent rehabilitation following admission to hospital. The median (range) time to the start of rehabilitation from the date of admission to hospital was 10.0 (1.0-133.0) days, and a high proportion of patients had a period of <2 weeks between admission to hospital and the start of rehabilitation (n=142/249 [57.0%]). Hemostatic agents used during rehabilitation were bypassing agents in 44 cases, FVIII in two cases, and tranexamic acid in 50 cases. Of the patients who received hemostatic agents, 36/44 (81.8%) patients who received bypassing agents, 2/2 (100.0%) patients who received FVIII, and 38/50 (76.0%) patients who received tranexamic acid started rehabilitation <2 weeks after the date of admission (Table 1). The ADL score at discharge was ≥85 points in 192 patients (45.0%) and <85 points in 186 patients (43.6%). Most patients with an ADL score at discharge of ≥85 (n=144/192 [75.0%]) were discharged from the hospital to home (attending outpatient visits at the same hospital), and for patients with ADL scores of <85 at discharge, the highest proportion of patients were transferred to other hospitals (n=92/186 [49.5%]; Table 2). Conclusions: Hemostatic agents may be necessary to start rehabilitation earlier. Post-discharge outcomes may be related to ADL scores at discharge. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Continuous care intervention with carbohydrate restriction improves physical function of the knees among patients with type 2 diabetes: a non-randomized study

BackgroundIn a previous study, we assessed a novel, remotely monitored carbohydrate restricted diet regimen including nutritional ketosis in patients with type 2 diabetes and reported significant improvements in weight, glycemic control, abdominal fat and inflammation from baseline to 2 years. Knee outcome measures were collected as a secondary outcome in the trial. This study aims to assess the effect of this intervention on knee functional scores and to identify if changes in weight, central abdominal fat (CAF), glycemic status and high sensitivity C-reactive protein (hsCRP) were associated with its improvement.MethodsThis prospective analysis included continuous care intervention (CCI, n = 173) and usual care (UC, n = 69) trial participants with type 2 diabetes that reported knee pain at baseline. Knee outcome measures included the Knee injury and Osteoarthritis Outcome Score (KOOS) pain, symptoms, activities of daily living (ADL), sports and recreation function, and knee-related quality of life subscales, and total KOOS score were assessed from baseline to 2 years. Missing data at each time point were replaced with multiple imputation under the assumption of missing at random. To assess if the primary analysis of the knee scores changed under plausible missing not at random assumptions, sensitivity analysis was also performed using pattern mixture models. In CCI, we also assessed factors associated with the improvement of knee scores.ResultsIn the primary analysis, CCI participants demonstrated a statistically significant improvement in total KOOS and all KOOS individual subscale scores at 1 year and maintained through 2 years as opposed to UC patients who showed no significant changes from baseline to 2 years. The significant improvement in total KOOS and its individual subscale scores from baseline to 2 years remained relatively stable in CCI in the sensitivity analysis under different missing not at random scenarios confirming the robustness of the findings from the primary analysis. Approximately 46% of the CCI participants met the 10 points minimal clinically important change at 2 years. A reduction in CAF was associated with improvement in total KOOS and KOOS ADL, while a decrease in hsCRP was associated with improvement in KOOS symptoms scores.ConclusionA very low carbohydrate intervention including nutritional ketosis resulted in significant improvements in knee pain and function among patients with T2D. The improvements in knee function were likely secondary to a reduction in central adiposity and inflammation. Future research on the applicability of this intervention in radiographically confirmed OA patients is important.Trial registrationClinical trial registration: NCT02519309 (10/08/2015).

Association of Self-Rated Health With Functional Limitations in Patients With CKD

Rationale & ObjectiveIn patients with chronic kidney disease (CKD), self-rated health (“In general, how do you rate your health?”) is associated with mortality. The association of self-rated health with functional status is unknown. We evaluated the association of limitations in activities of daily living (ADLs) with self-rated health and clinical correlates in a cohort of patients with CKD stages 1-5.Study DesignProspective cohort study.Setting & ParticipantsPatients with CKD at a nephrology outpatient clinic in western Pennsylvania.OutcomePatients participated in a survey assessing their self-rated health (5-point Likert scale) and physical (ambulation, dressing, shopping) and cognitive (executive and memory) ADLs. Adjusted analysis was performed using logistic regression models.Analytical ApproachLogistic regression was conducted to examine the adjusted association of 3 dependent variables (sum of total, physical, and cognitive ADL limitations) with self-rated health (independent variable of interest).ResultsThe survey was completed by 1,268 participants (mean age, 60 years; 49% females, and 74% CKD stages 3-5), of which 41% reported poor-to-fair health. Overall, 35.9% had at least 1 physical ADL limitation, 22.1% had at least 1 cognitive ADL limitation, and 12.5% had at least 3 ADL limitations. Ambulation was the most frequently reported limitation and was more common in patients reporting poor-to-fair self-rated health compared with those with good-to-excellent self-rated health (58.1% vs 17.4%, P < 0.001). In our fully adjusted model, poor-to-fair self-rated health was strongly associated with limitations in at least 3 ADLs (total ADL) [OR 8.29 (95% CI, 5.23-13.12)]. There was no significant association of eGFR with ADL limitations.LimitationsSelection bias due to optional survey completion, residual confounding, and use of abbreviated (as opposed to full) ADL questionnaires.ConclusionsPoor-to-fair self-rated health is strongly associated with physical ADL limitations in patients with CKD. Future studies should evaluate whether self-rated health questions may be useful for identifying patients who can benefit from additional evaluation and treatment of functional limitations to improve patient-centered outcomes.

Clinical and radiological correlates of activities of daily living in cerebellar atrophy caused by PMM2 mutations (PMM2-CDG)

We aimed to identify clinical, molecular and radiological correlates of activities of daily living (ADL) in patients with cerebellar atrophy caused by PMM2 mutations (PMM2-CDG), the most frequent congenital disorder of glycosylation. Twenty-six PMM2-CDG patients (12 males; mean age 13 ± 11.1 years) underwent a standardized assessment to measure ADL, ataxia (brief ataxia rating scale, BARS) and phenotype severity (Nijmegen CDG rating scale, NCRS). MRI biometry of the cerebellum and the brainstem were performed in 23 patients (11 males; aged 5 months–18 years) and 19 control subjects with equal gender and age distributions. The average total ADL score was 15.3 ± 8.5 (range 3–32 out of 36 indicating severe functional disability), representing variable functional outcome in PMM2-CDG patients. Total ADL scores were significantly correlated with NCRS (r2 = 0.55, p < 0.001) and BARS scores (r2 = 0.764; p < 0.001). Severe intellectual disability, peripheral neuropathy, and severe PMM2 variants were all significantly associated with worse functional outcome. Higher ADL scores were significantly associated with decreased diameters of cerebellar vermis (r2 = 0.347; p = 0.004), hemispheres (r2 = 0.436; p = 0.005), and brainstem, particularly the mid-pons (r2 = 0.64; p < 0.001) representing the major radiological predictor of functional disability score in multivariate regression analysis. We show that cerebellar syndrome severity, cognitive level, peripheral neuropathy, and genotype correlate with ADL used to quantify disease-related deficits in PMM2-CDG. Brainstem involvement should be regarded among functional outcome predictors in patients with cerebellar atrophy caused by PMM2-CDG.

The impact of pain on the course of ADL functioning in patients with dementia.

Understanding if and how pain influences activities of daily living (ADL) in dementia is essential to improving pain management and ADL functioning. This study examined the relationship between the course of pain and change in ADL functioning, both generally and regarding specific ADL functions. Participants were Dutch nursing home residents (n = 229) with advanced dementia. ADL functioning was assessed with the Katz ADL scale, and pain with the Dutch version of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC-D). Changes of PACSLAC-D and Katz ADL scores were computed based on the difference in scores between baseline, 3-month and 6-month follow-up. Multivariate linear regression models were used to assess the relationships between change in pain score, change in total ADL score and specific ADL item scores during follow-up. At baseline, residents had a median ADL score of 18 (interquartile range 13-22, range 6-24) and 48% of the residents were in pain (PACSLAC-D ≥ 4). Residents with pain were more ADL dependent than residents without pain. A change in pain score within the first 3 months was a significant predictor for a decline in ADL functioning over the 6-month follow-up (B = 0.10, SE = 0.05, P = 0.045), and specifically, a decline on the items 'transferring' over the 6-month follow-up and 'feeding' during the first 3 months of follow-up. Pain is associated with ADL functioning cross-sectionally, and a change in pain score predicts a decline in ADL functioning, independent of dementia severity. Awareness of (changes in) ADL activities is clearly important and might result in both improved recognition of pain and improved pain management.

Validation of a Brief Multi-Dimensional Assessment of Dementia Severity.

Briefer measures of symptoms and functional limitations may reduce assessment burden and facilitate monitoring populations of persons with dementia (PWD). Prospective follow-up study. University-based dementia care management program. 1,091 PWD. We assessed cognition (Mini Mental State Examination (MMSE)-11 tasks), neuropsychiatric symptom severity (Neuropsychiatric Inventory Questionnaire Severity Scale (NPIQ-S)-12 items), and functional ability (Activities of Daily Living (ADL)-6 items; Functional Activities Questionnaire (FAQ)-10 items). Item response theory was used to select subsets of items by identifying low item discrimination (<1.50), poor item fit (χ2 ), local dependence (LD), and with difficulty similar to other items. We estimated correlations between original and shorter scales and compared their associations with mortality. We added two symptoms (trouble swallowing, coughing when eating) reflecting late-stage dementia complications, created a multi-dimensional dementia assessment composite, and examined its association with mortality. Five MMSE tasks were eliminated: two with low discrimination, two with difficulty similar to other items, and one with poor fit. The remaining tasks were correlated with the full MMSE at r = 0.82. We retained three ADLs that were correlated with the total ADL set at r = 0.95 and kept five FAQ items that were not LD (correlation with full FAQ, r = 0.97). Associations with mortality were similar between the longer and shorter scales. A higher score on the composite (range 0-100) indicates worse dementia impact and was associated with mortality (hazard ratio (HR) per scale point: 1.03 (1.02-1.04)). These brief assessments and dementia composite may reduce administration time while preserving validity.

The role of physical and cognitive function in performance of activities of daily living in patients with mild-to-moderate Alzheimer\u2019s disease \u2013 a cross-sectional study

BackgroundSeveral factors may play a role in the ability of patients with Alzheimer’s disease to perform activities of daily living (ADL). The aim of this study was to examine the impact of different aspects of physical performance and cognitive functions on ADL in patients suffering from mild-to-moderate Alzheimer’s disease.MethodsWe conducted secondary analyses on cross-sectional baseline data from the randomized controlled multicentre study “Preserving quality of life, physical health and functional ability in Alzheimer’s Disease: The effect of physical exercise” (ADEX). In total, 185 AD patients (76 women and 109 men), with a mean age on 70,4 years, were included. Data from physical performance tests (Astrand cycle test, Timed up & Go (TUG), Sit to Stand test (STS)) and cognitive tests (Mini Mental Status Examination (MMSE), Symbol Digit Modalities Test (SDMT), Stroop Color and Word test (Stroop)) were used. Their associations with ADL, measured on the ADCS-ADL scale was assessed in multivariable regression analyses.ResultsSDMT and MMSE had significant, moderate correlations with total ADL (SDMT: r = 0.33, MMSE: r = 0.42) and instrumental ADL (SDMT: r = 0.31, MMSE: r = 0.42), but not with basic ADL. Adjusting for age and sex, the associations between SDMT and MMSE to total ADL and instrumental ADL persisted. No significant associations were found between Astrand, TUG, STS or Stroop and total ADL, basic ADL or instrumental ADL.ConclusionTotal ADL and instrumental ADL are associated with cognitive functions, including executive function. No significant association between examined physical performance parameters and ADL functions was observed, and consequently does not support an impact of physical function on ADL functions in patients with mild-to-moderate Alzheimer’s disease and relatively well-preserved physical function. Strategies aimed to improve cognition may be better suited to improve ADL function in patients with mild-to-moderate Alzheimer’s disease.Trial registrationNCT01681602. Registered 10 September 2012, retrospectively registered.

Improvement in Activities of Daily Living during a Nursing Home Stay and One-Year Mortality among Older Adults with Sepsis.

To describe the recovery of activities of daily living (ADLs) during a skilled nursing facility (SNF) stay and the association with 1-year mortality after SNF discharge among Medicare beneficiaries treated in intensive care for sepsis. Retrospective cohort study. Skilled nursing facilities in the United States. Medicare fee-for-service beneficiaries admitted to an SNF within 3 days of discharge from a hospitalization that included an intensive care unit (ICU) stay for sepsis between January 1, 2013, and September 30, 2015 (N = 59,383). Data from the Minimum Data Set (MDS) were used to calculate a total score for seven ADLs. Improvement was determined by comparing the total ADL scores from the first and last MDS assessments of the SNF stay. Proportional hazard models were used to estimate the association between improvement in ADL function and 1-year mortality after SNF discharge. Approximately 58% of SNF residents had any improvement in ADL function. Residents who had improvement in ADL function had 0.72 (95% confidence interval (CI) = 0.69-0.74) lower risk for mortality following SNF discharge than residents who did not improve. Residents who improved 1-3 points (hazard ratio (HR) = 0.82, 95% CI = 0.79-0.84) and four or more points (HR = 0.57, 95% CI = 0.55-0.60) in ADL function had significantly lower mortality risk than residents who did not improve. Older adults treated in an ICU with sepsis can improve in ADL function during an SNF stay. This improvement is associated with lower 1-year mortality risk after SNF discharge. These findings provide evidence that ADL recovery during an SNF stay is associated with better health outcomes for older adults who have survived an ICU stay for sepsis.

Occupational and leisure-time physical activity decreases the odds of disability in older adults: Prospective study

Aging decreases physical function which can increase dependence in activities of daily living (ADL) and disability. However, physical activity (PA) may improve physical function and prevent disability in older adults. In addition, it is important to emphasize that research concerning the domains in which PA is practiced and the benefits for physical function of older adults is also important for the elaboration of preventative health measures for this population. Thus, the aim of this study was to analyse the association of total PA and PA in different domains and odds of disability in older adults in a 24-month follow-up. The study included 211 older adults, aged ≥60 years (72 ± 7 years, 72% women). Handgrip strength was measured using a digital dynamometer, gait speed and chair stand by functional tests. PA and dependence in ADL were self-reported. Older adults who remained sufficiently active in the occupational (OR:0.11;CI95%:0.01–0.93, OR:0.21;CI95%:0.07–0.69, and OR:0.13;CI95%:0.05–0.34) domain presented protection for high dependence in basic (BADL), instrumental (IADL) and advanced (AADL), respectively, as well as in total ADL (OR:0.25;CI95%:0.07–0.92). Older adults who remained sufficiently active in the leisure-time exercise (OR:0.28;CI95%:0.11–0.72, OR:0.44;CI95%:0.20–0.93 and OR:0.15;CI95%:0.04–0.49) domain presented protection for high dependence in IADL, AADL and total ADL, respectively. Moreover, older adults who remained sufficiently active in total PA (OR:0.11;CI95%:0.01–0.94, OR:0.30;CI95%:0.11–0.80 and OR:0.21CI95%:0.10–0.46) presented protection for high dependence in BADL, IADL and AADL, respectively, as well as in total ADL (OR:0.28;CI95%:0.09–0.86). The odds of disability are lower in older adults who are sufficiently active, especially in occupational and leisure-time exercise domains.

Pronounced Impairment of Activities of Daily Living in Posterior Cortical Atrophy

Introduction: The impact of several dementia syndromes on activities of daily living (ADLs) has been well documented, but no study has yet investigated functional ability in posterior cortical atrophy (PCA). The primarily visual nature of deficits in this condition is likely to have a pronounced impact on ADLs. Objective: The aim of this study was to profile functional change in PCA and identify predictors of change. Method: Twenty-nine PCA patients and 25 patients with typical Alzheimer’s disease (AD) and their caregivers were included in this cross-sectional study. ADLs were assessed using the Disability Assessment for Dementia (DAD), administered to caregivers, assessing basic ADLs (e.g., eating, dressing) and instrumental ADLs (e.g., managing finances, meal preparation). The predictive utility of cognitive domains (Addenbrooke’s Cognitive Examination), behavioural impairment (Cambridge Behavioural Inventory-Revised) and demographic variables on ADL ability was also examined. Results: PCA patients showed significantly reduced total ADL scores compared to AD patients (medium effect size, d = –0.7; p < 0.05), with significantly more impairment on basic ADLs (large effect size, d = –0.8; p < 0.05) but similar impairment on instrumental ADLs (medium effect size, d = –0.5; p > 0.05). A model combining patient mood, disinhibition, apathy, symptom duration, and memory and attention/orientation scores explained the variance of scores in functional decline (61.2%), but the key factor predicting ADL scores was attention/orientation (p = 0.048). Conclusion: This study shows the profound impact of PCA on ADLs and factors underpinning patients’ disability. Attention/orientation deficits were found to correlate and contribute to variance in ADL scores. Future work to develop tailored interventions to manage ADL impairment in PCA should take these findings into account.

A Multidimensional Exercise Program in the Home for Older Adults Designed to Improve Function

The purpose of this study was to determine whether there was difference in the OASIS (Outcome and Assessment Information Set) activities of daily living (ADL) items scores between the Safe Strides program and Safe Strides plus Zōntago program. Eight home care offices were selected for this prospective randomized quality improvement study where Safe Strides versus Safe Strides plus Zōntago were compared. Rehabilitation outcome OASIS ADL change scores were analyzed for 112 total patient care episodes. The Safe Strides + Zōntago mean total ADL score change and ADL change per visit were higher than the Safe Strides group. Differences in ADL outcomes in older adults undergoing home care provided by physical therapists and physical therapist assistants in the Safe Strides exercise program versus the Safe Strides plus Zōntago program were noted. The Safe Strides + Zōntago compared with Safe Strides alone improved patient functional outcomes as measured by the OASIS.

Carbohydrate nutrition variables and risk of disability in instrumental activities of daily living.

We aimed to examine the prospective association between dietary glycemic index (GI) and glycemic load (GL) of foods consumed, intakes of carbohydrates and fiber, and the ability to perform activities of daily living (ADL) in older adults. A total of 844 participants from the Blue Mountains Eye Study aged 60years or older were examined from 2002-2004 to 2007-2009. Dietary information was collected using a validated, semi-quantitative food-frequency questionnaire. The Older Americans Resources and Services activities of daily living scale were administered to assess the functional status of participants. Multivariable logistic regression analysis was performed. After multivariable adjustment, participants who were in the second and third quartiles of energy-adjusted total fiber intake compared to those in the first quartile of intake (reference group) at baseline had reduced risk of incident impaired instrumental activities of daily living (IADL) 5years later: OR, 0.39 (95% CI 0.22-0.70) and OR 0.54 (95% CI 0.30-0.95), respectively. Analyses that involved dichotomized total fiber intake showed that participants in the upper three quartiles of total fiber intake (> 19g/day), compared to those in the lowest quartile of intake (≤ 19g/day) or reference group, had reduced IADL disability risk 5years later: OR 0.49 (95% CI 0.31-0.79). Non-significant associations were observed with total carbohydrates, GI, and GL and with risk of impaired total and basic ADL at 5-year follow-up. Habitual fiber consumption might be beneficial in leading to improved health status subserving performance of instrumental daily activities, needed to function in the community.

Application value of real-time B type ultrasound guidance in resection of low-grade gliomas

Objective To investigate the application value of real-time B type ultrasound guidance in resection of low-grade gliomas. Methods Seventy-two cases of patients with low-grade gliomas were selected, who were treated at Department of Neurosurgery, Central Hospital of Jiamusi from June 2012 to June 2016, and were divided into observation group (36 cases) and control group (36 cases). Conventional tumor localization method was used in control group prior to resection, while the patients in observation group underwent tumor resection under real-time B type ultrasound guidance. The following aspects were compared between 2 groups including surgical operation, accuracy of tumor localization, total resection rate, ADL (activities of daily living) score and KPS (Karnofsky performance status) score. Results The operation time in the observation group were significantly less than that in control group (P 0.05). The 6-month follow-up showed that the patients’ preoperative KPS scores in observation (81.1±7.8) and control (71.4±9.9) groups were significantly higher than postoperative scores (58.1±8.2, 56.9±9.2, respectively) (P<0.001) and the improvement in observation group was even greater (P<0.01). Conclusion Real-time B type ultrasound guidance used for low-grade gliomas resection could achieve good clinical results, significantly reduce the operation time and improve the patient’s quality of life. Key words: Glioma; Neurosurgical procedures; Treat outcome; Quality of life; Real-time guided B-ultrasonography