Barthel Index Total Score Research Articles

Factors associated with eating performance in nursing home residents living with dementia and other comorbidities.

Eating performance is the functional ability to get food into the mouth and chew/swallow it. Nursing home residents with dementia commonly experience compromised eating performance and subsequent consequences. Prior work examined the association between resident eating performance and their cognitive and functional ability. Yet, the associations between resident eating performance and behavioral and psychological symptoms, psychotropic medication use, and comorbidities are less studied. This study aimed to examine the association between eating performance and cognition, functional ability, behavioral and psychological symptoms, psychotropic medication use, and comorbidities in nursing home residents with dementia. This was a secondary analysis using baseline data from two randomized controlled trials, testing the impact of Function Focused Care on function and behavioral symptoms in 882 residents with moderate-to-severe dementia (mean age 86.55 years, 71% female, 30% non-white, 68.5% severe dementia) from 67 nursing homes in two states between 2014 and 2020. Eating performance (dependent variable) was measured using the single self-feeding item of Barthel Index. Independent variables included cognitive impairment, functional ability (Barthel Index total score excluding the self-feeding item score), behavioral and psychological symptoms (agitation, depression, resistiveness-to-care), psychotropic medication use (anti-depression, sedative, anti-psychotics, anti-seizure, anti-anxiety), and comorbidities. Nearly 39% of residents were dependent in eating. On average, residents had five documented comorbidities (SD = 3.06, range = 0-12) and were on approximately one psychotropic medication (SD = 1.25, range = 0-5). Eating performance was associated with cognitive impairment (OR = 0.53, 95% CI = 0.35, 0.79, p = .002), functional ability (OR = 1.05, 95% CI = 1.04, 1.06, p < .001), depressive symptoms (OR = 0.94, 95% CI = 0.89, 0.98, p = .007), and anxiolytic use (OR = 0.64, 95% CI = 0.42, 0.99, p = .046). Findings supported that better eating performance was associated with less cognitive impairment, higher functional ability, fewer depressive symptoms, and less anxiolytic use. Targeted interventions to accommodate to cognitive function, optimize functional ability, minimize anxiolytic use, and manage depressive symptoms are encouraged to support eating performance in residents with dementia.

Assessing Daily Function and Sleep Disorders in Hemodialysis Patients with End-Stage Renal Disease.

Chronic, end-stage renal disease significantly impacts patients' daily activities and sleep quality, particularly those undergoing hemodialysis. However, there is limited research on the extent of these challenges and their correlation with this population. This study aims to assess the level of activity of daily living and the prevalence of sleep disturbances in patients with end-stage renal disease undergoing hemodialysis. A cross-sectional study involved 130 patients receiving hemodialysis in two public General Hospitals in Greece. The Barthel Index was used to measure daily living activity, while the Athens Insomnia Scale assessed sleep disorders. The data were analyzed using SPSSV25.0. Of the 210 questionnaires, 130 were returned fully completed (response rate 62%). Most of the sample participants suffered from comorbidities (76.9%). The total Barthel Index score showed moderate dependence for patients, significantly related to the years and hours of dialysis (p = 0.007 and p = 0.000, respectively). The total score of the Athens Insomnia Scale was also significantly associated with age (p = 0.029), marital status (p = 0.015) and the years and hours of hemodialysis (p = 0.004 and p = 0.001, respectively). A statistically significant difference was recorded between the daily activity of patients with end-stage renal failure and their sleep quality (p = 0.000) Finally, the physical activity level of the participants was related to the existence of another physical health (p = 0.000) or mental health problem (p = 0.000). Hemodialysis patients with chronic, end-stage renal disease experience significant challenges in maintaining daily activities and are prone to sleep disorders. These findings suggest a need for integrated care strategies that address both physical function and sleep quality to improve the overall well-being of this population.

Katz index of activities of daily living in assessing functional status of older people: Reliability and validity of Sinhala version.

This study evaluated the reliability and validity of the Sinhala version of Katz index of activities of daily living (ADL) in assessing the functional status of older people aged >65years. The Katz index was translated to Sinhala, cross-culturally adapted and administered in two stages. In stage 01, 200 patients aged ≥65years, selected randomly from out-patient medical clinics, were asked to fill the Sinhala version of Katz index along with the Sinhala version of the 10-item Barthel index (BI). The Katz index was re-administered after two weeks among a subgroup of 45 patients selected randomly. In stage 02, Katz index was administered among randomly selected 200 community dwelling older people, aged ≥65years. In addition, performance-based physical functions [gait speed (GS) and short physical performance battery (SPPB)] were also measured. The analysis of stage 01 data showed internal consistency measured with Cronbach's alpha of 0.82 and test-retest reliability evaluated with intra-class correlation (ICC) (95% CI) of 0.94 (0.89-0.96) (p<0.001). Exploratory Factor Analysis with the Principal Component Analysis revealed the presence of two factors with Eigen value exceeding 01, explaining 75.9% of cumulative variance. Further, the Sinhala version of Katz index total score showed a strong correlation with the BI total score (r=0.91, p<0.001) indicating strong concurrent validity. The stage 02 data revealed that older people with poor perception of general health status had lower mean (SD) Katz index score (3.58±1.82) compared to those with good perception of health (5.56±0.79) (p<0.001). Similarly older people with prevalent diseases had comparatively lower scores of Katz index, compared to those without, indicating the known group validity (p<0.05). Further, moderate correlations between the Katz index and performance based physical functions were observed showing the agreement (with GS - r; -0.26, p<0.001, with SPPB - r; 0.31, p<0.001). We conclude that the Sinhala version of Katz index has satisfactory psychometric properties and it is a reliable and valid tool to assess the functional status of Sinhala conversant older people in Sri Lanka.

FACTORS ASSOCIATED WITH EATING PERFORMANCE IN NURSING HOME RESIDENTS WITH DEMENTIA AND MULTIPLE COMORBIDITIES

Abstract Eating performance is the functional ability to get food and drink into the mouth. Nursing home residents with dementia commonly experience compromised eating performance and subsequent nutritional consequences. Resident characteristics including cognition, physical capacity, and functional ability are associated with eating performance. This study aimed to test the association between functional ability, behavioral symptoms, psychotropic medication use, and comorbidities and eating performance. This was a secondary analysis using baseline data from two randomized controlled trials testing the impact of Function Focused Care on function and behavioral symptoms between 2014-2020. A total of 889 residents with moderate-to-severe dementia (mean age 86.58 years, 72% female, 70% white, 69.5% severe dementia) from 67 nursing homes in two states were recruited. Eating performance (dependent variable) was measured using the single self-feeding item on the Barthel Index. Independent variables included functional ability (Barthel Index total score excluding self-feeding item score), behavioral symptoms (agitation, depression, resistiveness to care), and psychotropic medication use (anti-depression, sedative, anti-psychotics, anti-seizure, anti-anxiety), and comorbidities. Residents had on average 5 documented comorbidities (SD=3.06, range=0-12) and were on approximately 1 psychotropic medication (range=0-5, SD=1.24). Thirty-eight percent of residents were dependent in eating performance. Functional ability (OR=1.052, 95% CI=1.043,1.061, p&amp;lt;.001), depression(OR=.931, 95% CI=.887,.978, p=.004), and anti-anxiety medication use(OR=.632, 95% CI=.409, .978, p=.039) were associated with eating performance. Findings supported better functional ability, lower depression, and less anti-anxiety medication use were associated with better eating performance. Targeted efforts including maintaining functional ability, minimizing anti-anxiety medication use, and managing depression are encouraged to support eating performance.

Acupuncture and Traditional Chinese Herbal Medicine Integrated With Conventional Rehabilitation for Post-stroke Functional Recovery: A Retrospective Cohort Study.

BackgroundStroke leads to tremendous impacts on patients and the healthcare system. It is crucial to explore the potential management of rehabilitation. Acupuncture and traditional Chinese herbal medicine (TCHM) integrated with conventional rehabilitation benefit post-stroke functional recovery.MethodsWe retrospectively reviewed the medical records of all patients included in the Integrated Traditional Chinese-Western Medicine care program for stroke (ITCWM-stroke care program) in 2019 in Taipei Tzu Chi Hospital to investigate the effects of acupuncture and TCHM integrated with conventional rehabilitation on National Institutes of Health Stroke Scale (NIHSS) and Barthel Index (BI) scores before and after the program.ResultsA total of 255 stroke inpatients were retrieved and divided into acupuncture and acupuncture + TCHM group by hemorrhagic and ischemic stroke types, respectively. All the patients were recruited in the program at the early subacute phase after stroke onset. Of the hemorrhagic and ischemic stroke subjects, the NIHSS and BI total scores were significantly improved in the acupuncture and acupuncture + TCHM groups. The subgroup analysis results showed that in subjects with a baseline BI score ≤ 40, the acupuncture + TCHM group significantly improved BI total score better than the acupuncture group in both hemorrhagic (p < 0.05) and ischemic (p < 0.05) stroke subjects.ConclusionAcupuncture and TCHM integrated with conventional rehabilitation significantly improve stroke patients’ functional recovery at the early subacute phase. Acupuncture + TCHM contributes to better activities of daily living (ADL) improvements in stroke patients with a baseline BI score ≤ 40. We suggest integrating acupuncture and TCHM into the post-stroke rehabilitation strategy, especially for stroke patients with poor ADL function.

The Role of Pharmacists in Home Health Care: A Study Set in a Regional Hospital in Taipei City

In response to population aging, there is an increase in demand for the coverage of and the necessary services provided by home health care and home care for socially vulnerable groups. This study explored whether the instructions and recommendations offered by pharmacists during their home visits play a key role in the factors that influence a patient’s prognosis. A home health care database was analyzed in this study. The subjects received home visits from pharmacists. There were 262 subjects following the exclusion of closed cases that were not due to improved outcomes or death. To validate the research framework, multiple regression analysis was employed for model validation. The level of consciousness and Barthel Index score mediated the effects of multimorbidities, and these mediating effects significantly affected patient outcomes (improvement or death). The medication-related knowledge and instructions for correct medication use provided by pharmacists did not exhibit significant moderating effects on the influence of a patient’s level of consciousness and Barthel Index score on their improved outcomes. However, the pharmacists’ provision of instructions and recommendations for patient self-care had significant moderating effects on the path by which patients with multimorbidities experienced improved outcomes through higher total Barthel Index scores. In comparison with physician home visits, which merely cover the treatments for diseases, pharmacists also play a vital role in home health care. Pharmacists provide patients with medication-related knowledge and instructions for correct medication use. This study addressed aspects that have not been considered in previous studies.

Clinical prediction model for postoperative ambulatory ability outcomes in patients with trochanteric fractures

IntroductionRegaining independent ambulatory ability is one of the primary goals of treatment in patients with trochanteric fractures. This study aimed to develop and evaluate the discriminative accuracy of a clinical prediction model for ambulatory ability outcomes 3 months after surgery for trochanteric fractures. MethodsThis retrospective cohort study included 346 patients treated with intramedullary nailing for trochanteric fractures who had independent ambulatory ability before their injury. Multiple regression models with preoperative and postoperative factors were used to predict ambulatory ability outcomes at 3 months. A clinical prediction model (CPM) was created based on a decision tree developed using a chi-square automatic interaction detector technique. ResultsThree months after surgery, 263 (76.0%) and 83 (24.0%) patients regained and lost independent ambulatory ability, respectively. Univariate analysis showed that the Barthel index (BI) total score at 2 weeks predicted the ambulatory ability outcome at 3 months with good discriminative accuracy (area under the receiver operating characteristic curve [AUROC]: 0.819; 95% confidence interval [CI]: [0.769, 0.868], cut-off value: 22.5; sensitivity: 69.5%; specificity: 82.3%). Multiple logistic regression analysis showed that preoperative factors (residence before injury, diagnosis of dementia, and serum albumin at admission) and postoperative factors (BI total score at 2 weeks) predicted ambulatory ability outcomes at 3 months (AUROC: 0.710; 95%CI: [0.636, 0.783]; sensitivity: 91.3%; specificity: 41.8%). The CPM with the BI total score at 2 weeks (≤10; 10<, ≤50; >50 points) and dementia status (present; absent) had a moderate discriminative accuracy (AUROC: 0.676; 95%CI: [0.600, 0.752]; sensitivity: 94.7%; specificity: 40.5%). ConclusionsWe developed a CPM with moderate accuracy to predict ambulatory ability outcomes in patients 3 months after surgery for trochanteric fractures. Our results demonstrate the importance of the BI score measured soon after surgery and dementia status for the prediction of postoperative ambulation.

Impact of blood pressure on the outcomes of inpatients with Subarachnoid hemorrhage: A retrospective cross-sectional study.

It is unclear whether antihypertensive treatment should be indicated after subarachnoid hemorrhage (SAH). Hence, we investigated the impact of blood pressure on inpatient outcomes after SAH rehabilitation.This retrospective cross-sectional study analyzed data of SAH inpatients, as obtained from the Japan Association of Rehabilitation Database for inpatients undergoing SAH rehabilitation. Inpatients admitted to a conventional ward with a diagnosis of cerebrovascular disease were voluntarily registered in this database between January 2006 and December 2013 from hospitals in Japan. Patients were categorized into hypertensive and non-hypertensive populations and assessed using the Barthel Index (BI) and the total BI score at hospital discharge. We compared the independent population (patients with the highest score for each activity) with its non-independent counterpart. Data on the patients’ age, BI score on admission, total BI score, BI score increase, daily BI score increase, hospitalization duration, BI activities, patients’ sex, and Brunnstrom recovery stage were compared.Eighty-eight patients with SAH were analyzed; 43 were hypertensive and 45 non-hypertensive. Hypertension was associated with increased non-independence levels (hypertensive versus non-hypertensive patients, transfers [bed to chair and back]: 15 versus 24, P = .03, odds ratio (OR) = 2.532 (95% confidence interval [CI], 1.065–6.024); toilet use: 15 versus 24, P = .03, OR = 2.532 (95% CI, 1.065–6.024); bathing: 23 versus 34, P = .0061, OR = 3.623 (95% CI, 1.414–9.259); stair climbing: 22 versus 31, P = .03, OR = 2.703 (95% CI, 1.114–6.579); and bladder control: 14 versus 24, P = .02, OR = 2.801 (95% CI, 1.170–6.711)). The total BI score of the hypertensive inpatients at discharge was lower than that of their non-hypertensive counterparts (0–75 versus 80–100, 30 versus 19, P = .03). Moreover, the BI score increase per day was significantly lower in the hypertensive group than in the non-hypertensive group (.67 versus 1.8, P = .02). The hypertensive group also had a significantly longer duration of hospitalization than the hypertensive group (52 versus 30 days, P = .02).Hypertension was associated with longer hospitalization and poorer outcomes post-discharge, suggesting the importance of strict blood pressure control in patients who have experienced SAH.

NONİNVAZİV MEKANİK VENTİLASYON DESTEĞİ OLAN VE OLMAYAN AKUT SOLUNUM YETMEZLİĞİNDE FONKSİYONEL BAĞIMSIZLIK VE KAS KUVVETİ

Purpose: Development of muscle weakness is common in the course of acute respiratory failure (ARF). This study aimed to compare muscle strength and physical function in subjects with ARF undergoing noninvasive mechanical ventilation (NIV) added to standard medical treatment (SMT) and SMT only in the intensive care unit. Methods: Thirty-two subjects with ARF (19 NIV and 13 SMT) were included. Subject characteristics were recorded. Peripheral muscle strength was measured using the Medical Research Council Scale (MRC) and handgrip strength. Functional independence was evaluated using the Barthel Index (BI). Results: In the NIV group, proximal muscle strength (shoulder abduction) was significantly lower than distal limb strength (wrist extension) (p=0.030). In both groups, proximal lower limb strength (hip flexion) was also significantly lower than distal limb strength (ankle dorsiflexion) (p=0.002). The BI total score was significantly lower in the NIV group than that of the SMT group (p=0.016). The BI score was significantly related to the MRC sum score (r=0.633) and handgrip strength (r=0.629, p&amp;lt;0.05). Conclusion: Functional independence and proximal muscle strength compared to distal adversely affected in patients undergoing NIV for ARF. Weakness or functional limitations may prevent patients from functioning adequately in rehabilitation practices in intensive care.

The fourier M2 robotic machine combined with occupational therapy on post-stroke upper limb function and independence-related quality of life: A randomized clinical trial

ABSTRACT Most post-stroke patients experience upper limb functionality challenges. Emergent therapies using upper limb-based robot machines present opportunities to resolve the limitations inherent in Occupational therapy such as increased therapist-patient exhaustion, monotonous methods, and so forth. The aim of this parallel trial was to compare the effects of the upper limb robotic training with matched Occupational therapy training on upper limb function and independence-related quality of life in post-stroke patients within the Brunnstrom arm motor recovery stages 1 to 4. During one-year (2018–2019), 50 post-stroke patients were enrolled and randomly assigned to 2 groups; robot and Occupational therapy (n = 25) and Occupational therapy (n = 25). Both groups were trained for 50–70 minutes per day, 5 days a week for 6 weeks. The Chinese-adapted Fugl-Meyer Assessment-Upper Extremity (FMA-UE) was the primary outcome measure. The secondary outcome measures were the Brunnstrom Recovery Stages Scale (BRS) and the Chinese-adapted Barthel Index (BI). The treatment effect sizes of both groups were large in the following variables; transfers (1), BI total score (2.2), FMA-UE upper limb (1.1), wrist (1.8), elbow (1), fingers (0.9), and FMA-UE total scores (1.4). The treatment group in comparison to the control group had larger BRS changes, significant improvements in upper limb function, and partial independence in activities of daily living during the baseline to post-treatment period. Robotic-assisted training with occupational therapy may improve the upper limb movement foundation blocks; however, it does not translate into complete functional independence and improved quality of life. This study has been registered at the ISRCTN registry, https://doi.org/10.1186/ISRCTN84804731

Randomized Efficacy and Safety Trial with Oral S 44819 after Recent ischemic cerebral Event (RESTORE BRAIN study): a placebo controlled phase II study

BackgroundThe GABAA-α5 receptor antagonist S44819 is a promising candidate to enhance functional recovery after acute ischemic stroke (IS). S44819 is currently evaluated in this indication; RESTORE brain study started in Dec 2016 and was completed in March 2019.Methods/designThe study is a 3-month international, randomized, double-blind, parallel group, placebo-controlled phase II multicentre study. Patients in 14 countries who suffered an IS leading to a moderate or severe deficit defined by NIHSS score ranging from 7 to 20 and are aged between 18 to 85 years are included between 3 and 8 days after the stroke onset. Approximately 580 patients are to be included.The primary objective of the study is to demonstrate the superiority of at least one of the two doses of S44819 (150 or 300 mg bid) compared to placebo on top of usual care on functional recovery measured with the modified Rankin scale at 3 months. Comparisons between two doses of S44819 and placebo are assessed with ordinal logistic regression evaluating the odds of shifting from one category to the next in the direction of a better outcome at day 90. Secondary objectives include the evaluation of S44819 effects on neurological examination using the National Institute of Health Stroke Scale total score, activities of daily living using the Barthel Index total score, and cognitive performance using the Montreal Cognitive Assessment scale total score and Trail Making Test times. Safety and tolerability of the two doses of S44819 will also be analyzed.DiscussionThe RESTORE BRAIN study might represent the first proof of concept study of an innovative therapeutic approach that is primarily based on enhancing functional recovery after IS.Trial registrationRandomized Efficacy and Safety Trial with Oral S 44819 after Recent ischemic cerebral Event, an international, multi-centre, randomized, double-blind placebo-controlled phase II study. ClinicalTrials.gov, NCT02877615; Eudract 2016–001005-16. Registered 24 August 2016

Association of Anemia with Activities of Daily Living in Chinese Female Centenarian.

Although anemia and activities of daily living (ADL) disability in female elderly are common conditions and are more likely to occur as people age, little is known about the association of anemia with ADL in female centenarians. The objective of this study was to examine the relationship between anemia and ADL disability in Chinese female centenarians. We conducted a population-based cross-sectional study of a sample of 822 Chinese female centenarians from 2014 to 2016. Blood analysis, home interview, and physical examination were performed following standard procedures. ADL disability was defined as a Barthel Index total score≤60. The prevalence of anemia and ADL disability were 66.8% and 29.7% respectively in Chinese female centenarians. Multiple logistic regression analyses revealed that inflammation (OR = 2.280, 95% CI, 1.524-3.410), underweight (OR = 1.653, 95% CI, 1.186-2.303), anemia (OR = 1.775, 95% CI, 1.250-2.521), and living with family (OR = 0.518, 95% CI, 0.302-0.888) were significant factors related to ADL disability. Centenarians with severe anemia had an approximately fourfold greater likelihood of ADL disability than those without anemia (OR =3.747; 95% CI 1.525-9.206). An apparent dose-response relationship was found between anemia and ADL disability. These findings may provide some insights into targeted intervention for maintaining ADL independence in female centenarians, especially encouraging the interventions of anemia to improve ADL.

Factors affecting the performance of activities of daily living in patients with advanced cancer undergoing inpatient rehabilitation: results from a retrospective observational study.

[Purpose] Many clinicians believe that rehabilitation for patients with advanced cancer is futile. We determined factors affecting the performance of activities of daily living in patients with advanced cancer based on age, gender, marital status, living arrangement, rehabilitation intensity, type of cancer, impairment, metastasis, and active cancer treatment. [Participants and Methods] We assessed the Barthel Index to evaluate the performance of activities of daily living. Of the 120 adult patients with cancer who underwent inpatient rehabilitation, we analyzed the Barthel Index scores, consisting of 10 items, and reviewed the clinical characteristics from the medical records of 48 patients who completed supportive or palliative rehabilitation according to Dietz and showed an increased or maintained total Barthel Index score at final evaluation. [Results] The median total Barthel Index score increased from 45 (5–95) to 72.5 (5–100); the rehabilitation intensity was 320 (40–1,240) minutes. The analytical results showed that the increase of total Barthel Index score was positively associated with rehabilitation intensity (β=0.350) and negatively associated with the initial grooming score (β=−0.277). [Conclusion] Adequate rehabilitation positively affects performance of activities of daily living, especially in patients with advanced cancer who lost their grooming ability at the onset of rehabilitation. Importantly, rehabilitation may be beneficial for patients with advanced cancer.

Physical Disabilities Related to the Depressive Mental States of Japanese Patients with Subacute Myelo-optico-neuropathy.

Objective The aim of this study was to clarify the clinical conditions related to the depressive mental states in Japanese patients with subacute myelo-optico-neuropathy (SMON), caused by clioquinol intoxication more than 40 years previously. Methods The changes in the mental states with aging were investigated in 25 Japanese SMON patients (mean age: 77.2 years old, range: 53-90) using a Japanese version of the Zung Self-rating Depression Scale (J-SDS) questionnaires with supportive interviews by the clinical psychotherapist and medical checkup records. These mental and medical examinations were repeated more than twice within 2 to 11 years' interval. The J-SDS questionnaires were also examined in 25 age-matched non-SMON elderly people. Results The total J-SDS scores of most of the SMON patients decreased with age without significant changes in the mean Barthel index scores during this study period. The mean J-SDS scores at the first and latest studies were significantly higher than in the age-matched healthy elderly people. The total J-SDS scores of the latest study were significantly correlated with the degree of physical disability, such as the inverse total Barthel index scores, severity of SMON or gait disturbance, but not with the age. Conclusion The total J-SDS scores of most of the SMON patients tended to decrease with age. Repeating mental supportive interviews and medical examinations by experts helped to improve the depressive mental state and revealed close relationship between the mental state and the physical disabilities of the SMON patients.

Patients’ Expectations in a Geriatric Rehabilitation Ward: Matching with Actual Outcomes

Aim: Person-centered care is a core issue in rehabilitation; the study aims at: 1) enquiring the outcome expectations of patients in a geriatric rehabilitation ward; 2) matching outcome expectations with actual outcomes. Methods: Expectations of 186 patients [79.4 (8.7) years, 70% females] analyzed through a questionnaire. 80.6% of patients were discharged home; functional recovery = 17.7 (22) points in Barthel Index total score, and 5 (4.2) points in Barthel Index walking subscore; also conditions with nursing needs improved significantly. Results: Patients’ expectations were coded as: functional (31.4%), overall (29.6%), and clinical improvement (21.5%), discharge home (7%); no answers or explicit lack of expectations (7.5%). Walking ability recovery differed according to outcome expectations. Highest improvements were achieved by patients wishing clinical improvement, followed by those expecting functional or overall improvement (5 points) [p = 0.009 (Welch)/p = 0.041 (Brown- Forsythe)]; worst improvement in walking ability (2.8 points) were got by patients faulting or declaring explicit failure of expectations. Conditions with nursing needs improved most in those expecting clinical improvements [p = 0.029 (Brown-Forsythe)], and less in case of expectation default. No further matching was found. Conclusions: Improvement in actual outcomes matched expected improvements in two circumstances: recovery in walking ability and in conditions with nursing needs. The high yield of different favorable outcomes may have masked the statistical significance for correspondence between actual and expected results. Special attention is worthy towards patients short of expectations, as their actual outcomes result poorer.

The Association Between the Probability of Sarcopenia and Functional Outcomes in Older Patients Undergoing In-Hospital Rehabilitation

ObjectiveSarcopenia is a geriatric syndrome with a prevalence ranging from 5% to 50% in community-dwelling adults. It is associated with adverse outcomes including worse functional status, falls, and mortality. A paucity of studies have included an assessment of sarcopenia among older adults receiving in-hospital rehabilitation. This is, at least partially, due to the lack of simple assessment methods to reliably measure muscle mass. The objective of this study was to evaluate the probability of sarcopenia using a validated simple method and examine the association between sarcopenia and functional outcomes at discharge. SettingOne in-hospital rehabilitation setting. DesignProspective cohort study. ParticipantsA total of 280 patients 65 years and older who were admitted to in-hospital rehabilitation. MeasurementsThe probability of sarcopenia was determined using a validated method that includes 3 variables: age, grip strength, and calf circumference. Two multivariable linear regression models were used to analyze the association between the probability of sarcopenia and the following functional outcome measures: (1) total Barthel index (BI) score; and (2) BI walking mobility subitem. Each analysis adjusted for the following covariates: age, gender, admission diagnoses, body mass index, comorbidity, C-reactive protein, number of medications on admission, Mini- Mental State Examination total score, and change in the functional outcome measure from admission to discharge. ResultsPatients were mainly female (66%) with a mean age of 82 ± 7 years. The mean probability of sarcopenia overall was 60%. About one-half of the patients had a probability of sarcopenia ≥75% (N = 140). The remaining patients were distributed as follows: probability of sarcopenia <25% (N = 79); 25%–49% (N = 26); and 50%–74% (N = 34). The probability of sarcopenia was significantly associated with an overall worse functional status at discharge based on total BI score (point estimate −8.5; standard error 17.1; P < .0001) and ability to walk at discharge as measured with the BI walking mobility subitem (point estimate −1.3; standard error 0.5; P = .02) after adjusting for relevant covariates. ConclusionsThese findings support the use of a simple screening tool for probable sarcopenia among older adults receiving in-hospital rehabilitation to increase the ability of clinicians to initiate early interventions to improve functional outcomes at discharge.

Old benefit as much as young patients with stroke from high-intensity neurorehabilitation: cohort analysis

Background and objectiveIn current clinical practice, old patients with stroke are less frequently admitted to neurorehabilitation units following acute care than younger patients based on an assumption that old age...

ACUTE ISCHEMIC STROKE

Among all deaths, 40-50% are due to vascular events and out of these 10% aredue to stroke. More than 66% of the global stroke occurrence is in developing countries, wherethe average age of patients with stroke is 15 years less than in developed countries. Objectives:To determine the correlation between higher total cholesterol level and high Barthel Indexscore(estimate of functional daily independent activity level) in patients with acute ischemicstroke. Design: Cross sectional study. Period: May 2013 to Apr 2014. Setting: Medical Units ofDHQ and Allied Hospital, Faisalabad. Methodology: Sample size of 200 patients was collectedand patients were included through Consecutive (non-probability) sampling technique. Allpatients underwent CT scan Brain from the radiology department of the hospital to determinethe respective changes (hypo dense area) of the ischemic stroke. Fasting serum cholesterolwas measured in all patients after an overnight fast of 12 hours. Then patients were assessed byusing Barthel Index score (BI). The data was analyzed by using SPSS version 16.0. SpearmanRank correlation coefficient was calculated to BI score in patients with ischemic stroke. Results:The mean age of the patients was noted as 61.76±11.55 years. In this study 55.50% weremales and 44.50% patients were females. The mean total cholesterol value of patients wasnoted as 251.58±71.15 mg/dl. Out of 200 patients, 111(55.5%) patients had high cholesterol(&gt;200mg/dl) whereas 89(44.5%) patient had low cholesterol of(&lt;200mg/dl).In statical analysisthe results showed that the mean value of total Barthel index score was 57.50±19.52. The studyresults described that 51.50% patients had high Barthel index score (&gt;53) whereas 48.50%patients had low Barthel index score (&lt;53). Spearman correlation coefficient was calculatedbetween high TC and high BI score as r= 0.641. This value was statistically significant i.e.p-value=0.000*. Conclusions: With the help of this study, we found a significant positiverelationship between high TC and high BI score in patients presented with ischemic stroke.Now we can better prognosticate the functional outcome of ischemic stroke in our patients.

Age Scale for Assessing Activities of Daily Living

The purpose of this study was to develop an age scale for assessing activities of daily living (ADL) among community-dwelling adults aged 75 years or older. Participants were 1006 older Japanese: 312 men (79.6 ± 4.3 years) and 694 women, (79.9 ± 5.5 years). Participants completed a battery of 8 performance tests related to ADL and the Barthel index (BI) questionnaire. Spearman rank-order correlation analysis was applied to obtain the correlation of the 8 ADL performance tests with the total BI score. Three variables were high rank-order correlated with BI, secondly those items were subjected to the principal component analysis. The weighted combination of the principal component scores was summed. Resulting in an ADL score (ADLS), women = 0.075 X1 – 0.082 X2 – 0.063 X3 + 0.124, men = 0.051 X1 – 0.105 X2 – 0.099 X3 + 0.249, where X1 = hand-grip strength, X2 = timed up and go, X3 = five-chair sit to stand. Individual ADLS was transformed to an ADL age scale (ADLA). The estimation was – 5.493 ADLS + 79.90 for women, and – 4.272 ADLS + 79.57 for men. Due to the distortion at the regression edges, the equation was corrected as suggested by Dubina et al. ADLA women after correction was = 0.447 (chronological age: CA) – 5.49ADLS + 44.17, men = 0.519CA – 4.27ADLS + 38.26. ADLA can be used to identify or monitor the characteristics of the ADL levels of physical abilities in older Japanese aged 75 years or older.

Determinants of the Health-related Quality of Life for Stroke Survivors

To identify the factors that greatly influence stroke-specific health-related quality of life (HRQoL). The following 5 categories were explored simultaneously in a cross-sectional study: (1) sociodemographic, (2) clinical, (3) symptom severity and physical, (4) neurocognitive, and (5) psychosocial factors. A total of 134 patients who experienced a stroke at least 6 months prior were recruited by convenience sampling. Subjective HRQoL levels were measured using disease-specific scales, the Stroke-specific Quality of Life (SS-QoL)-12, and the modified SS-QoL-8, with a newly added subscale, "activities," as well as the total score. After sociodemographic and clinical data were collected, patients were scored with the National Institutes of Health Stroke Scale, Mini-Mental State Examination, and the Barthel Index (BI). All patients completed the SS-QoL-12, SS-QoL-8, and Stroke Impact Scale (SIS) version 3.0 by self-report. Multiple hierarchical regressions were conducted using the stepwise method. Compared with neurocognitive (type 4) factors, the stroke-specific HRQoL levels were significantly impacted by psychosocial (type 5) and "symptom severity and physical" (type 3) factors. The individual factors that significantly influenced stroke-specific HRQoL were the SIS 3.0 social participation subscore and the BI total score. None of the neurocognitive (type 4) factors were significantly associated with the either SS-QoL-12 score or SS-QoL-8 score. Research and health care aimed to facilitate social participation and limitations in performing daily activities can be beneficial to improve the HRQoL levels of the patients with stroke.