Impact of frailty on risk of long-term functional decline following vascular surgery

ObjectiveFrailty is a clinical syndrome associated with slow recovery after vascular surgery. However, the degree and length of functional impairment frail patients experience after surgery is unclear. The objective of this study was to prospectively measure changes in functional status among frail and non-frail patients undergoing a spectrum of different vascular surgery procedures.MethodsPatients consented to undergo elective minor and major vascular surgery procedures at an academic medical center between May 2018 and March 2019 were prospectively identified. Prior to surgery, all patients underwent provider assessment of frailty using the validated Clinical Frailty Scale (CFS), as well as baseline assessment of functional status using the Katz Activities of Daily Living (ADL) index and the Lawton Instrumental Activities of Daily Living (iADL) index. These same instruments were used to evaluate each patient’s functional status at 2-weeks, 1-month, 1-year, and 2-year time points following surgery. Changes in iADL and ADL scores among frail (CFS ≥5) and non-frail patients were compared using paired Wilcoxon signed-rank tests and logistic regression models.ResultsA total of 126 patients were assessed before and after minor (55%) and major (45%) vascular procedures, of which 43 patients (34%) were determined to be frail prior to surgery. Frail patients were older and more likely than non-frail patients to have medical comorbidities including chronic kidney disease, chronic obstructive pulmonary disease, or diabetes (all P < .05). When compared with the non-frail cohort, frail patients had significantly lower ADL and iADL scores before surgery and experienced a greater decline in ability to independently complete ADL and iADL activities after surgery that was sustained at 2 years (P < .05 and P < .001, respectively). After risk-adjustment, frailty was associated with an increased likelihood of decline in ADLs (odds ratio, 5.4; 95% confidence interval, 1.9-15.4; P < .05) and iADLs (odds ratio, 6.3; 95% confidence interval, 2.6-15.1; P < .001) at 2 years following surgery.ConclusionsFrail patients experience a significant decline in ability to perform ADL and iADLs that persists 2 years following vascular surgery. These data highlight the degree of functional decline occurring immediately following surgery, as well as risk for long-term, sustained impairment that should be shared with frail patients before undergoing a procedure.     

Trunk deformity is associated with a reduction in outdoor activities of daily living and life satisfaction in community-dwelling older people

We have evaluated the association between trunk deformities of the sagittal plane and functional impairment of daily living in community-dwelling elderly subjects. The analysis involved a detailed assessment of indoor and outdoor activities of daily living, satisfaction with life, and mental status. The participants in this study were 236 community-dwelling older adults, aged 65 years and older, living in Kahoku district of Kochi in Japan. The participants were classified based on their posture, which was assessed using photographs of the subjects, and interviewed to assess their basic activities of daily living (BADL), instrumental ADL (IADL), and cognitive well-being in the cross-sectional study. The statistical analysis was performed using the Mann-Whitney U-test. The lumbar kyphosis group received significantly lower BADL and IADL scores than the normal group. The trunk deformity group which were defined as kyphosis, flat back, and lumbar lordosis groups exhibited decreases in activities that included going out, shopping, depositing and withdrawing money, and visiting friends in the hospital. These activities require going outdoors; thus, this study showed that the trunk deformity group had limitations in outdoor activities. There was no significant difference between the geriatric depression score (GDS) and the pattern of posture. The abnormal trunk deformity groups tended to score lower than the normal group with regard to subjective healthiness and life satisfaction measures, including subjective health condition, everyday feeling, satisfaction with human relationships, satisfaction with economic condition, and satisfaction with present life.     

Functional and environmental factors affecting work status in individuals with longstanding poliomyelitis

Introduction

Remunerative employment is a major concern of individuals with chronic disabilities, among them, those with longstanding poliomyelitis (LSP). Although LSP is not rare there are almost no data related to work participation.

Purpose

The aims of the current study were to determine the effects of a number of social and functional variables as barriers or facilitators to work participation in persons with LSP.

Patients and methods

Charts of 123 LSP patients of working age that were seen in the post-polio outpatient clinic, between the years 2000 and 2005 were reviewed for the study. Data on age, gender, family status, level of function in activities of daily living, basic, and extended (B-ADL and E-ADL), and mobility were then analyzed for correlation to the vocational status.

Results

Seventy-two people (58.5%) were employed at the time of the survey. Gender and marital status were not found to significantly differ as regard to employment. Using assistive devices for mobility or being dependent for basic ADL were associated with lower levels of employment. Driving was positively associated with the employment status of the LSP individuals.

Conclusion

Persons with LSP encounter important barriers to work participation, particularly on the International Classification of Functioning, Disability, and Health (ICF) components of activity and environment.     

Variables affecting functional improvement in chordoma patients admitted to an inpatient rehabilitation facility: A retrospective review

Study Design: Retrospective chart review of patients after surgical resection of chordoma admitted to an inpatient rehabilitation facility.

Objective: To evaluate the characteristics associated with improving two or more functional levels and therefore classifying as a substantial responder after an inpatient rehabilitation facility stay in post-resection chordoma patients.

Setting: Acute inpatient rehabilitation facility in the United States.

Methods: A total of 40 patients were admitted to an inpatient rehabilitation facility from 2010–2015 after chordoma resection. Demographics, tumor management information, lengths of stay and functional independence measures on admission and discharge were collected. Substantial responders were identified as individuals who improved two or more functional levels based on total FIM score change. Logistic regression was used to analyze the available data for association of quantitative and categorical variables with being a substantial responder.

Results: The categorical variables analyzed in this study (sex, readmission to an acute hospital, Charlson Comorbidity Index, tumor level, nerve sacrifice, recurrent tumor and metatases) were not associated with being a substantial responder. The quantitative variables age and length of stay at the inpatient rehabilitation facility were individually associated with being a substantial responder, while length of stay at the acute hospital was not.

Conclusions: Patients who were younger were more likely to be classified as substantial responders. Patients with longer lengths of stay at the inpatient rehabilitation facility were also more likely to be classified as substantial responders.     

Unilateral hand training on functional performance in patients with upper extremity trauma

Study Design

Case series.

Association Among Geriatric Nutritional Risk Index and Functional Prognosis in Elderly Patients with Osteoporotic Vertebral Compression Fractures

BackgroundOsteoporotic vertebral compression fractures (OVCF) are common among the elderly, and malnutrition has also been identified as a poor prognostic factor in elderly patients with fractures. However, the relationship between nutrition status and functional prognosis in OVCF is unclear. The aim of this study was to investigate the association between nutritional status using geriatric nutritional risk index (GNRI), activities of daily living (ADL), and fall after fracture in patients with OVCF.MethodsThe clinical information of 187 conservatively treated OVCF patients was retrospectively examined. This information included: age, sex, body mass index, total number of drugs used for treatment at admission, bone mineral density, use of drugs for osteoporosis, fracture type, comorbidity severity, nutritional status, Barthel Index (BI), and fall after OVCF. Subjects were divided into two groups according to their GNRI. Propensity score matching was used to confirm factors affecting BI and falls after OVCF.ResultsSixty-eight patients (36.4%) presented with malnutrition at fracture. According to multiple linear regression analysis, GNRI positively affected BI gain (β = 0.283, 95% confidence interval [CI] − 122.2 to − 0.706, p = 0.001). Furthermore, on logistic regression analysis, fall after OVCF was associated with GNRI (odds ratio = 0.896, 95% CI 0.832–0.964, p = 0.003).ConclusionsMalnutrition in elderly OVCF patients decreases the acquisition of ADL and increases fall risk. Improvement of nutritional status during OVCF treatment may lead to improvement of ADL and prevention of falls.     

Normative data on functional grip strength of elderly in Singapore

Study Design

Cross-sectional study for clinical measurement.

Pediatric Evaluation of Disability Inventory: its application to children with obstetric brachial plexus palsy

PURPOSE: A standardized method of measurement of self-care ability in children with obstetric brachial plexus palsy (OBPP) has not been universally adopted. A study was conducted to determine if the Pediatric Evaluation of Disability Inventory (PEDI) was able to discriminate between the self-care ability of children with OBPP and their peers and distinguish between those with differing severities of OBPP. METHODS: The PEDI self-care domain results for 45 children with OBPP (30 without hand impairment, 15 with hand impairment) were reviewed retrospectively. RESULTS: The group performance of children without hand impairment was within 1 SD above the mean. The group performance of children with hand impairment was more than 2 SDs below the mean. The difference between the 2 groups was statistically significant. CONCLUSIONS: In this study children without hand impairment did not have a self-care activity limitation as measured by the PEDI. A deficit in self-care ability was found in those with hand impairment. The PEDI was able to differentiate between the performances of reported self-care activities of children with differing severities of OBPP; however, it was unable to discriminate between those without hand impairment and their peers. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic, Level II.     

Intrathecal baclofen: Its effect on symptoms and activities of daily living in severe spasticity due to spinal cord injuries: A pilot study

Background:

Spasticity is a major problem related to spinal cord injuries. Use of intrathecal baclofen with an implanted pump seems a very useful mode of therapy in patients in whom oral antispasmodic agents are either not effective or produce intolerable side-effects.

Materials and Methods:

Twenty-four patients with mean age 50 years (range 32-72 years) had intrathecal baclofen pump implanted for the severe spasticity of spinal origin. One patient died following implantation of pump due to natural causes and was not included in the study. The patients were followed up for mean 22 months (range, one to five years).

Results:

All 24 patients showed improvement in their spasm following the procedure. Improvement was noted in pain (12), sleep disturbance (20) and sphincter control (14). Patients had improvement in activities of daily living such as feeding ability (10), self care (10), indoor and outdoor mobility (19), and driving (4). One patient had catheter leakage immediately after the surgery and required change of catheter. The radio telemetry allows very good adjustment of the dose according the individual patients needs.

Conclusion:

Intrathecal baclofen pump improves the symptoms of spasm and also the quality of life. It helps the patient to live more independently. It is not an irreversible surgery for the patient and hence it is very useful in the changing the dynamics in this group of patients.     

重力肌群锻炼对胸腰椎骨折术后患者功能恢复的影响

目的探讨重力肌群锻炼对胸腰椎骨折术后患者功能恢复的影响。方法将60例胸腰椎骨折术后患者依据入院时间分为对照组和重力组各30例,对照组给予常规功能锻炼,重力组在此基础上给予重力肌群锻炼。结果两组术后1、3个月疼痛视觉模拟评分法(VAS)评分、ADL评分显著优于术后第1天,重力组显著优于对照组(均P<0.01)。结论重力肌群锻炼可有效缓解胸腰椎骨折术后患者疼痛症状,有利于患者功能恢复,且可提高患者的日常生活能力。     

The Natural-Fit Handrim: Factors Related to Improvement in Symptoms and Function in Wheelchair Users

Background/Objective:     

能量代谢对腹膜透析患者代谢综合征发生及维持的影响

目的 探讨腹膜透析患者代谢综合征（MS）的发生及维持与其能量代谢的关系,尤其透析液糖负荷在其中的作用。 方法 采用回顾性自身前后对照的方法观察126例腹膜透析患者近1年前后MS、透析液糖负荷及摄入能量的变化情况,研究能量摄入对MS的影响。采用横断面研究的方法对MS状态稳定的患者测定静息能量代谢,并通过活动记录评估身体活动水平来研究能量消耗对腹膜透析患者MS的影响。 结果 由非MS变为MS的患者在糖负荷增加组中的比例明显高于在糖负荷不变或减少组中的比例（κ2 = 9.552,P = 0.002）。在糖负荷增加的非MS变为MS亚组中,后半年比与前半年比较,血三酰甘油（TG）显著升高（P < 0.01）,高密度脂蛋白胆固醇（HDL-C）显著下降（P < 0.05）,而腰围及血糖无显著变化;MS变为非MS组患者后半年C反应蛋白（CRP）比前半年显著下降（P < 0.05）。MS变为非MS组患者前后半年饮食能量摄入差异无统计学意义（P > 0.05）,非MS变为MS组患者后半年饮食能量摄入没有比前半年增加,反而有所减少（P < 0.05）。在36例MS状态稳定且透析液糖负荷稳定的患者中,MS组和非MS组的每日每体表面积静息能量消耗水平差异无统计学意义（t = 0.840,P > 0.05）,但MS组的身体活动水平显著低于非MS组（t = 2.358,P < 0.05）。 结论 透析液糖负荷的增加是MS发生的重要影响因素之一,主要通过对血TG、血HDL-C的影响改变腹膜透析患者MS状态。炎性反应也是腹膜透析患者MS维持或改变的重要影响因素。尽管研究未发现饮食能量摄入和静息能量代谢影响腹膜透析患者MS的发生及维持,但活动少的生活习惯在腹膜透析患者MS的维持中起到重要作用。     

The inclusion of activities of daily living in flexor tendon rehabilitation: A survey

Studies have shown that patients restricted to one-handed use due to trauma or surgery often have difficulty with activities of daily living (ADLs). In order to assess hand therapists' perspectives and practices regarding ADL assessment and intervention, a 21-item survey was e-mailed to members of the American Society of Hand Therapists (ASHT). Results of the survey indicate that the majority of hand therapists surveyed (97.5%) feel that ADL performance is an important part of hand therapy practice and that teaching adaptive strategies is a high priority in the early weeks of flexor tendon rehabilitation, but less than half (45.5%) actually provide a formal assessment of ADL performance in order to discover patients' ADL needs. Reasons for this discrepancy between beliefs and practices are explored through participants' comments in the survey. Level of evidence: 3b.     

社交活跃度对老年人抑郁症状的影响

目的 探究社交活跃度对老年人抑郁症状的影响。 方法 利用中国健康与养老追踪调查2018年数据,通过构建4个logistic回归模型控制老年人一般资料、健康状况、每日睡眠时长与日常生活能力,以及通过限制性立方样条分析6 328名60岁及以上老年人社交活跃度对抑郁症状的影响。 结果 6 328名老年人中,抑郁症状检出率为44.56%。控制混杂因素后,社交活跃度为老年人抑郁症状发生的保护因素（OR=0.952,95%CI：0.926~0.978）;限制性立方样条模型显示,随着社交活跃度的增加,抑郁症状出现的风险持续降低（P＜0.05）。 结论 老年人的抑郁症状受社交活跃度的影响,提高老年人的社交活跃度有利于预防抑郁症状的发生。     

Relationship of occupational therapy inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: The SCIRehab Project

Background/objective

Describe associations of occupational therapy (OT) interventions delivered during inpatient spinal cord injury (SCI) rehabilitation and patient characteristics with outcomes at the time of discharge and 1-year post-injury.

Methods

Occupational therapists at six inpatient rehabilitation centers documented detailed information about treatment provided. Least squares regression modeling was used to predict outcomes at discharge and 1-year injury anniversary for a 75% subset; models were validated with the remaining 25%. Functional outcomes for injury subgroups (motor complete low tetraplegia and motor complete paraplegia) also were examined.

Results

OT treatment variables explain a small amount of variation in Functional Independence Measure (FIM) outcomes for the full sample and significantly more in two functionally homogeneous subgroups. For patients with motor complete paraplegia, more time spent in clothing management and hygiene related to toileting was a strong predictor of higher scores on the lower body items of the self-care component of the discharge motor FIM. Among patients with motor complete low tetraplegia, higher scores for the FIM lower body self-care items were associated with more time spent on lower body dressing, manual wheelchair mobility training, and bathing training. Active patient participation during OT treatment sessions also was predictive of FIM and other outcomes.

Conclusion

OT treatments add to explained variance (in addition to patient characteristics) for multiple outcomes. The impact of OT treatment on functional outcomes is more evident when examining more homogeneous patient groupings and outcomes specific to the groupings.

Note

This is the third of nine articles in the SCIRehab series.     

200例慢性肾脏疾病患者营养状况与病程进展的关系

目的探讨主观综合营养评估法（subjective global assessment of nutrition,SGA）评价慢性肾脏疾病（chronic kidney disease,CKD）2～4期患者营养状态并分析其与病程进展的关系。方法对200例CKD患者进行分组：①根据肾小球滤过率（estimated glomerular filtration rate,eG-FR）分为CKD2期组、3期组、4期组;②根据SGA评估分为营养正常组、轻一中度营养不良组和重度营养不良组;③根据病程进展分为进展1组、进展2组、进展3组。于随访第1天、第12个月、第24个月分别检测血红蛋白（hemoglobin,Hb）,白蛋白（albumin,Alb）,前白蛋白（prealbumin,PA）,血清钙（Ca）,血清磷（P）,分析CKD患者的营养状况与病程进展的关系。结果在随访第1天、第12个月、第24个月,CKD4期组与2期组Hb比较有显著性差异;4期组与3期组比较,差异有统计学意义（P〈0．05）,但2期组与3期组比较无统计学差异;CKD2期组第1天与12个月Hb比较差异有统计学意义（P〈O．05）。CKD4期组随访第1天、第12个月、第24个月PA比较,均有统计学差异（P〈0．05）。在第1天、12个月,营养正常组、轻一中度营养不良组、重度营养不良组Alb组间比较,差异有统计学意义;轻一中度营养不良组随访第1天、第12个月、第24个月比较,均有统计学差异（P〈0．05）。重度营养不良组随访第1天、第12个月、第24个月PA比较,均有统计学差异（P〈0．05）。CKD患者不同营养状况与病程进展发生率差异有统计学意义（P〈0．05）,且重度营养不良患者进展3组发生率为92．6％。结论Alb可作为营养状况的评价指标之一。CKD患者PA随着肾功能下降及病程的延长而升高。重度营养不良对CKD患者病程进展影响较大,SGA评估CKD患者的营养状态具有一定临床参考价值。     

Physical functional status and factors contributing to disability in Japanese chronic dialysis patients

SUMMARY: Four hundred and eight non-hospitalized chronic dialysis patients were surveyed to evaluate functional status by the modified Karnofsky Performance Scale (KPS), and the correlation of clinical variables with functional status and the factors contributing to disability were assessed. Sixty-seven patients (16.4%) had a score less than 75, which indicated limited daily activities inside the home. the percentages of diabetic patients significantly increased in those with a low KPS level (P<0.0001). the mean KPS was significantly lower in the older age group, however there were no significant differences in the mean KPS among groups with different duration of dialysis except for between non-diabetic patients less than 5 years and those longer than 20 years. Serum urea nitrogen, serum creatinine, serum albumin and intra-dialytic weight gain tended to be lower in patients with a low KPS level. Visual impairment and muscle weakness of the extremities was the most common factor contributing to disability in diabetic patients and non-diabetic patients scoring less than 75, respectively. In addition, osteoarticular impairment was characteristically associated with disability in non-diabetic patients. In conclusion, although a great number of chronic dialysis patients maintain a good functional status, there is a small percentage of patients with poor physical activities. the aetiology of poor functional status is multifactorial, and visual impairment for diabetic patients, muscle weakness and osteoarticular impairment for non-diabetic patients require special attention and efforts to ameliorate various factors which negatively affect functional ability in these patients are needed.     

The effect of a single haemodialysis session on functional mobility in older adults: a pilot study

Objectives To undertake balance and functional mobility assessments in older maintenance haemodialysis patients before and after haemodialysis as a pilot study in order to gain initial data and to assess the feasibility and acceptability of this type of study. Design Postural sway, three-metre timed “up and go” test (TGUGT), and dynamic single leg extensor power (LEP) were measured before and after a haemodialysis session. Setting and subjects Male and female maintenance haemodialysis patients aged over 60 years attending the Nottingham City Hospital. Main measures Objective outcome measures were postural sway number and sway path (mm) by balance performance monitor, timed three-metre “up and go” test (s), and leg extensor power (W). Blood pressure and weight reductions were also measured. Subjective assessments of practicality and acceptability were made. Results Twenty-two patients enrolled. Complete data sets were collected for 14 subjects (11 male, three female). Results were analysed using the Wilcoxon signed ranks test for nonparametric data. There was no significant difference before and after dialysis in postural sway, timed “up and go” or leg extensor power. Eight patients did not complete the study and the reasons are examined. Conclusions There was no significant single-session effect. Results suggest that haemodialysis patients may be weaker and have reduced postural stability when compared to historical data on comparable undialysed patients. The study was logistically complex and would be difficult to expand using these methods, but the issues merit further consideration.     

青岛市社区老年人居家不出现状及影响因素研究

目的了解社区老年人居家不出现状及影响因素,为针对性干预提供参考。方法对587名老年人采用一般资料调查问卷、居家不出状态量表、日常生活能力量表、老年抑郁量表和社会支持评定量表进行问卷调查。结果 587人中居家不出107人(占18.2%),不同性别、年龄、婚姻状况、经济来源、患病种数、吸烟饮酒情况、活动爱好、锻炼身体、助行器使用、日常生活能力、抑郁及社会支持度的老年人居家不出发生率差异有统计学意义(均P0.01),其中高龄、缺乏活动爱好、疏于锻炼身体、抑郁状态、日常生活能力及收入低下是居家不出的危险因素(OR=3.062～33.199)。结论社区老年人居家不出发生率较高,应针对主要影响因素制订切实可行的干预措施,帮助老年人尽可能多地外出,以丰富老年人生活,实现积极养老。