The prevalence of disability from chronic conditions due to injury among adults ages 18-69 years: United States, 1994

Purpose: To describe the causes and determine the prevalence of disability from chronic conditions due to injury among US civilian non-institutionalized persons aged 18-69 years. Methods: Data from the National Health Interview Survey Disability (NHIS-D) Supplement Phase I, United States 1994 were analysed and six disability categories were examined: activities of daily living (ADL), instrumental activities of daily living (IADL), functional activities (FA), sight, hearing, and communication. Results: In 1994, 5.6 million persons aged 18-69 years reported a disability because of a chronic condition that was caused by injury. The prevalence of ADL disability due to chronic conditions caused by injury was 370 per 100000 population; IADL disability was 1256; FA disability was 2512; sight was 231; hearing was 339; and communication was 91 per 100000 population. Fifty per cent of ADL, IADL, and FA disabilities were attributed to motor vehicle crashes and falls, as were 31% of sight, 19% of hearing, and 23% of communication disabilities. Conclusions: Though these estimates may be conservative, this study indicates that injury is a major cause of disability in addition to a leading cause of death in the US.     

Activity limitation and chronic conditions in Canada's elderly, 1986 2011

Together with all other developed countries, Canada's population is experiencing a significant increase in the proportion that is elderly. This paper examines basic linkages between individual ageing, the prevalence of various chronic health conditions, functional limitation and the receipt of help in activities of daily living (ADL) and instrumental activities of daily living (IADL) for the Canadian population using recent data from the National Population Health Survey (NPHS) as well as the Health and Activity Limitation Surveys (HALS) and the two General Social Surveys (GSS) with health data. Presented are age- and sex-specific prevalence of chronic conditions and logistic regression is used to assess the impacts of different chronic conditions on the receipt of help for IADL and ADL. The importance of gender and living alone in influencing the receipt of help and also of use of formal agencies is presented using additional data from HALS. Findings from these analyses are also used to project changes in the distribution of health status defined by disability and receipt of help with IADL ADL and, secondarily, by chronic condition. These analyses imply increases in demand for a range of health related services which will be 50 to 100% greater than the growth in the total elderly population.     

Activity limitation and chronic conditions in Canada's elderly, 1986-2011.

Together with all other developed countries, Canada's population is experiencing a significant increase in the proportion that is elderly. This paper examines basic linkages between individual ageing, the prevalence of various chronic health conditions, functional limitation and the receipt of help in activities of daily living (ADL) and instrumental activities of daily living (IADL) for the Canadian population using recent data from the National Population Health Survey (NPHS) as well as the Health and Activity Limitation Surveys (HALS) and the two General Social Surveys (GSS) with health data. Presented are age- and sex-specific prevalence of chronic conditions and logistic regression is used to assess the impacts of different chronic conditions on the receipt of help for IADL and ADL. The importance of gender and living alone in influencing the receipt of help and also of use of formal agencies is presented using additional data from HALS. Findings from these analyses are also used to project changes in the distribution of health status defined by disability and receipt of help with IADL/ADL and, secondarily, by chronic condition. These analyses imply increases in demand for a range of health related services which will be 50 to 100% greater than the growth in the total elderly population.     

Factors associated with ADL/IADL disability in community dwelling older adults in the Irish longitudinal study on ageing (TILDA)

Purpose: To identify the factors associated with disability across many domains using a large powered sample in the activities of daily living (ADL) and instrumental activities of daily living (IADL). Methods: Those aged?≥65 years from the Irish longitudinal study on ageing (TILDA) were included in this cross sectional analysis. Three logistic regression models were used to examine the relationships between 25 health, psychological and sociodemographic variables and difficulties in ADL, IADL and ADL/IADL combined. Results: The proportion of those reporting combined ADL/IADL difficulties was 18%. More individuals reported difficulty with ADLs (13%) than IADLS (11%). The main model showed that after age, the top three factors associated with difficulty in ADL/IADL combined were pain, taking five or more medications and depression. After age, the factors with the highest impact on ADL disability were pain, taking five or more medications and body mass index (BMI); the factors with the highest impact on IADL were being separated or divorced, living with others (non-spouse) and self-rated memory. Conclusions: Awareness of sociodemographics and early interventions for pain and cognitive deficits could reduce ADL/IADL disability and promote successful ageing. Identification of variables that influence ADL/IADLs can be used to inform policy and practice.

• Implications for rehabilitation

• After age, pain and taking five or more medications were the strongest factors associated with difficulty in ADL/IADL combined and ADL alone. Practice therefore needs to be cognizant that it is not the disease label but the symptoms of a disease that affect ADL and IADL activities.

• Given the strong influence of pain on difficulties with ADL and IADL, there is a need for early interventions from a multidisciplinary perspective for pain reduction, control, and self-management. These interventions should include development of pain-coping strategies and exercises to maintain mobility.

• After age, being separated/divorced or living with non-spouse others are the strongest factors associated with IADL difficulties. Awareness of these social factors can be used to inform support mechanisms, such as development of community services and suitable housing for those with these changing sociodemographics.

• Unsurprisingly, cognitive impairments were strongly associated with IADL difficulties. Simple cognitive screening assessments could be used for early detection of cognitive changes. In order to maintain optimal cognitive functioning, rehabilitation professionals should facilitate older adults’ engagement in activities that are cognitively demanding and socially interactive.

     

Frailty as a predictor of disabilities among community-dwelling older people: a systematic review and meta-analysis

Background: Frailty has been shown to be associated with disability in the previous studies. However, it is not clear how consistently or to how much degree frailty is actually associated with the future disability risks.

Methods: A systematic review of the literature was conducted using Embase, MEDLINE, CINAHL, PsycINFO, and the Cochrane Library for any prospective studies published from 2010 to September 2015 examining associations between baseline frailty status and subsequent risk of developing or worsening disabilities among community-dwelling older people. A meta-analysis was performed to synthesize pooled estimates.

Results: Of 7012 studies identified through the systematic review, 20 studies were included in the meta-analysis. Twelve studies examined activities of daily living (ADL) disability risks, two studies examined instrumental activities of daily living (IADL) disability risks, and six studies examined both ADL and IADL disability risks. Overall, frail older people were more likely to develop or worsen disabilities in ADL (12 studies, pooled OR?=?2.76, 95% CI?=?2.23–3.44, p?p?p?p?=?0.08). Prefrailty was also associated with incident or worsening disability risks to a lesser degree in most pooled analyses. High heterogeneity observed among 12 studies with OR of ADL disability risks for frailty was explored using subgroup analyses, which suggested methodological quality and mean age of the cohort were the possible causes.

Conclusion: This systematic review meta-analysis quantitatively showed that frail older people are at higher risks of disabilities. These results are important for all related parties given population aging worldwide. Interventions for frailty are important to prevent disability and preserve physical functions, autonomy, and quality of life.

• Implications for Rehabilitation

• Although frailty has been shown to be associated with disability and considered as a precursor of disability, it is not clear how consistently or to how much degree frailty is actually associated with the future disability risks.

• This systematic review and meta-analysis quantitatively shows frailty is a significant predictor of incident and worsening ADL and IADL disabilities.

• It is a pressing priority to develop interventions for frailty to prevent disability and preserve older people’s physical functions, autonomy, and quality of life.

     

A hierarchical categorisation of tasks in mobility disability

Purpose.?In the field of long-term care, disability usually refers to difficulties in instrumental activities of daily living (IADL) or basic activities of daily living (BADL); this term may also refer to difficulties in mobility for those more interested in preventive intervention or general health promotion. The aims of this study were to (1) categorise a complete set of mobility tasks according to a revealed hierarchy, and (2) examine the relationship between this mobility hierarchy and IADL/BADL disabilities.

Methods.?We categorised nine mobility tasks according to appearance order in self-reported difficulties data obtained from a Taiwanese national database of community-dwelling elders aged over 65. We also performed correlation tests to explore the relationships of these mobility tasks with six tasks each of IADL and BADL.

Results.?The results revealed a three-level hierarchy of mobility disability: (1) mild disability indicated by difficulties in four mobility tasks, which correlated with difficulty in one IADL task; (2) moderate disability indicated by difficulties in three mobility tasks, which correlated with difficulties in most IADL tasks; and (3) severe disability indicated by difficulties in two mobility tasks, which correlated with difficulties in all BADL tasks. The same hierarchy was observed for males and females.

Conclusions.?There is a clear hierarchical structure of mobility disability that correlates differently with IADL and BADL disabilities. These results suggest that different mobility tasks should be included in disability assessments to suit specific purposes.     

Functional Disability in Older Adults Maintained on Peritoneal Dialysis Therapy

♦ Background:

Older in-center hemodialysis patients have a high burden of functional disability. However, little is known about patients on home chronic peritoneal dialysis (PD). As patients opting for home dialysis are expected to play a greater role in their own dialysis care, we hypothesized that a relatively low number of PD patients would require help with basic self-care tasks (ADL) and instrumental activities of daily living (IADL).

♦ Methods:

We used a cross-sectional study design to measure the proportion of patients aged 65 years and older undergoing outpatient PD who needed help with day-to-day activities. Patients living in nursing homes were excluded from the study. Functional dependence in ADL and IADL tasks were measured by the Barthel and Lawton Scales. Physical performance measures used included the timed up-and-go (TUG) test, chair stands and Folstein mini-mental score (MMSE).

♦ Results:

A total of 74 of 76 (97%) eligible PD patients participated. Patients had a mean age of 76.2 ± 7.5 years. Thirty-six percent had impaired MMSE scores, 69% were unable to stand from a chair without the use of their arms and 51% had abnormal TUG scores. Only 8 patients (11%) were fully independent for both ADL and IADL activities. Dependence in one or more ADL activity was reported by 64% of participants, while 89% reported dependence in one or more IADL.

♦ Conclusions:

Impaired physical and functional performance is common in older patients maintained on PD. Collaborative geriatric-renal programs may be beneficial within the dialysis community.     

The effect of diabetes combined with stroke on disability,self-rated health,and mortality in older Mexican Americans: results from the Hispanic EPESE

OBJECTIVE: To examine how diabetes in combination with stroke affects functional activities of daily living (ADLs) and instrumental activities of daily living (IADLs), self-rated health, and 5-year mortality in elderly Mexican Americans with or without other comorbid conditions. DESIGN: Longitudinal study. SETTING: Five southwestern states. PARTICIPANTS: A total of 3050 subjects of age 65 years or older, of whom 23% had diabetes and 6% had a stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: ADL and IADL disabilities, self-rated health, and 5-year mortality. RESULTS: Subjects with both diabetes and stroke but without other comorbid conditions had almost 18 times higher risk of having any ADL disability (odds ratio [OR]=18.8; 95% confidence interval [CI], 3.3-105.2) and 10 times higher risk of having any IADL disability (OR=10.6; 95% CI, 1.1-101.5), compared with subjects without either of the 2 conditions. The risk of disability was further increased if the subject had a comorbid condition (hypertension, heart attack, cancer, hip fracture, arthritis). The risk of fair or poor self-rated health was 3.5 (95% CI, 1.4-8.6) and the hazard ratio for 5-year mortality was 2.4 (95% CI, 1.7-3.4) in people with both diseases. CONCLUSIONS: Diabetes and stroke in combination is strongly associated with a higher risk of disabilities, poor self-rated health, and 5-year mortality in elderly Mexican Americans. The effect on outcomes appears to follow an additive model. Information on disability risk and morbidity and mortality should be useful to rehabilitation professionals in discharge planning and allocation of therapy resources.     

Activity limitation and chronic conditions in Canada's elderly, 1986 2011

Together with all other developed countries, Canada's population is experiencing a significant increase in the proportion that is elderly. This paper examines basic linkages between individual ageing, the prevalence of various chronic health conditions, functional limitation and the receipt of help in activities of daily living (ADL) and instrumental activities of daily living (IADL) for the Canadian population using recent data from the National Population Health Survey (NPHS) as well as the Health and Activity Limitation Surveys (HALS) and the two General Social Surveys (GSS) with health data. Presented are age- and sex-specific prevalence of chronic conditions and logistic regression is used to assess the impacts of different chronic conditions on the receipt of help for IADL and ADL. The importance of gender and living alone in influencing the receipt of help and also of use of formal agencies is presented using additional data from HALS. Findings from these analyses are also used to project changes in the distribution of health status defined by disability and receipt of help with IADL ADL and, secondarily, by chronic condition. These analyses imply increases in demand for a range of health related services which will be 50 to 100% greater than the growth in the total elderly population.     

Measuring disability in Medicare home care patients: application of Rasch modeling to the outcome and assessment information set

BACKGROUND: The Outcome and Assessment Information Set (OASIS) is the universal clinical assessment tool for adult nonmaternity patients receiving skilled care at home from Medicare-certified home health agencies in the United States. Anticipating increased use of OASIS data for research purposes, this article explored the usefulness of Rasch modeling to address disability measurement challenges presented by the unique response category structure of the seven activities of daily living (ADL) and eight instrumental ADL (IADL) items in the OASIS. OBJECTIVES: To illustrate how Rasch model statistics can be used to evaluate OASIS ADL and IADL item unidimensionality and model fit; to illustrate how Rasch modeling simultaneously estimates ADL and IADL item difficulty, thresholds between item response categories, and person disability; and to compare Rasch estimates of item difficulty and person disability scores to estimates based on more conventional Likert scoring techniques. SUBJECTS: Medicare-eligible home health care patients (n = 583) served by one of 12 home care agencies in Ohio between November 1999 and September 2000. MEASURES: ADL and IADL items were measured three ways: according to the original OASIS scoring (raw Likert); transformed raw Likert scores accounting for the nonuniform item structure (corrected Likert); and Rasch Partial Credit model scores. RESULTS: The items bathing and telephone use showed evidence of unexpected response patterns; recoding of these items was necessary for good Rasch model fit. Partial Credit model results revealed that interval distances between response categories varied widely across the 15 ADL and IADL items. When ADL and IADL items were ranked by level of difficulty, results were similar between Rasch and corrected Likert measurement approaches; however, corrected Likert person scores were found to be nonlinear at highest and lowest disability levels when plotted against Rasch person scores. CONCLUSIONS: Rasch modeling can help improve the precision of disability measurement in Medicare home care patients when using ADL and IADL items from the OASIS instrument.     

Disability occurrence and proximity to death

Purpose.?This paper aims to assess whether disability occurrence is related more strongly to proximity to death than to age.

Method.?Self reported disability and vital status were available from six annual waves and a subsequent 12-year mortality follow-up of the Dutch GLOBE longitudinal study. Logit and Poisson regression methods were used to study associations of disability occurrence with age and with proximity to death.

Results.?For disability in activities of daily living (ADL), regression models with proximity to death had better goodness of fit than models with age. With approaching death, the odds for ADL disability prevalence and incidence rates increased 20.0% and 18.9% per year, whereas severity increased 4.1% per year. For the ages younger than 60, 60–69 and older than 70 years, the odds for ADL disability prevalence increased 6.4%, 16.0% and 23.0% per year. Among subjects with asthma/chronic obstructive pulmonary disease, heart disease and diabetes increases were 25.1%, 19.5% and 22.7% per year. Functional impairments were more strongly related to age.

Conclusions.?The strong association of (ADL) disability occurrence with proximity to death implies that a substantial part of the disability burden may shift to older ages with further increases in life expectancy.     

The Quality of Life of Family Caregivers of Adults with Intellectual Disabilities in Taiwan

Background Taiwanese family carers of people with intellectual disabilities not only suffer from long‐term stress but also need to cope with social difficulties. The aim of this study is to evaluate the quality of life (QOL) among family carers of people with intellectual disabilities. Materials and methods A census interview survey was conducted in Hsin‐Chu City in Taiwan and included the primary family caregivers of 792 adults with intellectual disability who were living with their families. The survey packet contained the WHOQOL‐BREF Taiwan‐version scale with four core domains and the activities of daily life/instrumental activities of daily life (ADL/IADL) scales. Results The mean score for ‘physical’ was highest and that for ‘environment’ was lowest. The strongest predictors of caregivers QOL were the caregiver's health status, their family income and the level of severity of the intellectual disability of the adult. Conclusions The results of the study support the need to expand services and individualize support to families of adults with intellectual disability living in family homes.     

地震伤残人员躯体康复现状的调查分析

目的调查地震伤残人员的日常生活活动能力（ADL）,分析影响伤残人员躯体康复的相关因素,为进一步的社区康复提供依据。方法利用ADL量表对283例地震伤残人员的日常生活活动能力进行测量。结果地震伤残人员ADL平均得分为（85．08±14．73）分,其中地震前后居住环境变化、年龄、社会参与、职业状况、家庭支持、伤残程度以及家庭人均月收入等因素对伤残人员ADL的影响差异有统计学意义（P〈0．05）。结论伤残人员ADL影响关键在于残疾程度,因此要加强地震伤残人员的健康宣教,避免并发症和二次残疾的发生,开展与残疾人相关的活动,增加伤残人员的社会参与度促进其日常生活活动能力的提高,有利于伤残人员的躯体康复。     

四川汶川地震伤残人员日常生活活动能力的调查分析

目的 调查汶川地震伤残人员的日常生活活动能力（ADL）,分析影响伤残人员日常生活活动能力的相关因素,为汶川地震伤残人员的社区康复提供依据。方法 利用ADL量表对283名汶川地震伤残人员的日常生活活动能力进行测量。结果 283名伤残人员地震伤残人员ADL平均得分为85.08±14.73,其中20.8%ADL完全正常,71.0%的伤残人员ADL日常生活能力轻度障碍,8.2%ADL中重度障碍;经多因素分析,地震伤残人员ADL的主要影响因素依次是：伤残程度、伤残合并疾病、伤残并发症、是否参与残疾人组织或相关活动（P〈0.05）。结论 伤残人员ADL关键在于残疾程度,避免伤残并发症和二次残疾的发生,控制伤残合并疾病的发生,增加伤残人员的社会参与度,均有利于伤残人员ADL的提高。     

Using Timed Up and Go and Usual Gait Speed to Predict Incident Disability in Daily Activities Among Community-Dwelling Adults Aged 65 and Older

Objectives

To compare the ability of Timed Up and Go (TUG) and usual gait speed (UGS) to predict incident disability completing basic activities of daily living (ADL) and instrumental ADL (IADL) in older adults free of disability at baseline, and to provide estimates for the probability of incident disability at different levels of baseline mobility performance.

Design

Data from the first 2 waves of The Irish Longitudinal Study on Ageing, a study assessing health, economic, and social aspects of ageing in adults aged ≥50 years.

Setting

A nationally representative, population-based sample of community-dwelling adults.

Participants

Participants aged ≥65 years who completed mobility tests during a health assessment, had no reported difficulty in ADL/IADL, and had a Mini-Mental State Examination score ≥24 were re-interviewed after 2 years (n=1664).

Interventions

Not applicable.

Main Outcome Measures

Participants completed the TUG and UGS at baseline and indicated difficulty in a number of basic ADL and IADL at follow-up.

Results

Receiver operating characteristic analysis indicated that TUG and UGS are acceptable tools to predict disability in ADL and IADL (area under the curve [AUC]=.65–.75) with no significant difference between them (P>.05). Both were excellent predictors of difficulty in higher-level functioning tasks such as preparing hot meals, taking medications, and managing money (AUC>.80). Predictive probabilities were obtained across a range of performance levels.

Conclusions

TUG and UGS have similar predictive ability in relation to incident disability in basic ADL and IADL. Predictive probabilities can be used to identify those most at risk and in need of particular services. Since improving physical function can prevent or delay dependence in ADL/IADL, TUG and UGS can also provide performance goals and feedback during exercise interventions.     

Diabetes as a predictor of change in functional status among older Mexican Americans: a population-based cohort study

OBJECTIVE: Epidemiological studies have demonstrated that older Mexican Americans are at high risk for type 2 diabetes and its complications. Type 2 diabetes leads to a more rapid decline in functional status among older Mexican Americans with diabetes. This study was designed to examine the impact of diabetes on change in self-reported functional status over a 2-year period among older Mexican Americans with diabetes. RESEARCH DESIGN AND METHODS: We performed a longitudinal analysis with repeated measurements of functional limitations in a cohort of Mexican Americans aged > or =60 years in the Sacramento Area Latino Study on Aging (SALSA). Diabetes was diagnosed on the basis of self-report of physician diagnosis, medication use, and fasting plasma glucose. Functional status was measured by assessment of activities of daily living (ADL) and instrumental activities of daily living (IADL) at baseline and 1 and 2 years. RESULTS: Of 1,789 SALSA participants, 585 (33%) had diabetes at baseline. Diabetic subjects reported 74% more limitations than nondiabetic subjects in ADL (summary score for number of limitations, 0.99 vs. 0.57; P = 0.002) and 50% more limitations in IADL (summary score for number of limitations, 7.83 vs. 5.25; P < 0.0001). The annual rate of increase in limitations of ADL and IADL was 0.046 and 0.033 (log scale) on each scale among diabetic subjects compared with 0.013 and 0.003 (log scale) among nondiabetic subjects (P < 0.0005). Complications of diabetes were found to increase ADL and IADL limitations among diabetic subjects. Longer duration of diabetes was also associated with an increase in ADL and IADL limitations. CONCLUSIONS: There was lower baseline functional status and a more rapid decline in functional status among older Mexican Americans with diabetes versus those without diabetes.     

Factors associated with the self-care of home-dwelling elderly

The purpose of this study was to examine how functional capacity, activities of daily living (ADL), instrumental activities of daily living (IADL), life satisfaction and self-esteem are related to the self-care behaviour styles of home-dwelling elderly persons. Data were collected by qualitative interviews (self-care) and structured interviews (functional capacity, life satisfaction and self-esteem) from home-dwelling elderly persons (n=40) aged 75 or more. The persons were living in a medium-sized city in northern Finland. The qualitative data were analysed using deductive content analysis. The classification frame consisted of a theoretical classification developed in an earlier study. The categories were quantified and the relationship between the variables analysed by cross-tabulation. The persons whose self-care behaviour style was responsible, formally guided or independent carried out their daily activities without assistance from others, while those who showed abandoned self-care did not manage their daily activities without help. Life satisfaction was the highest among the formally guided persons and self-esteem among the responsible ones. Poor life satisfaction and self-esteem correlated with abandoned self-care behaviour.     

Emergency Department Case-finding for High-risk Older Adults: The Brief Risk Identification for Geriatric Health Tool (BRIGHT)

Objective:  The objective was to test the ability of the Brief Risk Identification for Geriatric Health Tool (BRIGHT) to identify older emergency department (ED) patients with functional and physical impairment.
Methods:  This was a cross-sectional study in which 139 persons ≥75 years, who presented to an urban New Zealand ED over a 12-week period, completed the 11-item BRIGHT case-finding tool. Then, within 10 days of their index ED visit, 114 persons completed a comprehensive geriatric assessment. A "yes" response to at least 3 of the 11 BRIGHT items was considered "positive." Primary outcome measures were instrumental activities of daily living (IADL), cognitive performance scale (CPS), and activities of daily living (ADL).
Results:  The BRIGHT-identified IADL deficit (64% prevalence) with a sensitivity of 0.76, specificity of 0.79, and receiver operating characteristic (ROC) of 0.83 (95% confidence interval [CI] = 0.74 to 0.91, p < 0.01); cognitive deficit (35% prevalence) sensitivity of 0.78, specificity of 0.54, and ROC of 0.66 (95% CI = 0.55 to 0.76, p = 0.006); and ADL deficit (29% prevalence) sensitivity of 0.83, specificity of 0.53, and ROC of 0.64 (95% CI = 0.53 to 0.75, p = 0.020). Positive likelihood ratios (LR+) for the three outcomes of interest were 3.6, 1.7, and 1.8, respectively. Negative likelihood ratios (LR−) were 0.3, 0.4, and 0.3.
Conclusions:  The 11-item BRIGHT successfully identifies older adults in the ED with decreased function and may be useful in differentiating elder patients in need of comprehensive assessment.     

住院老年患者日常生活能力与淋巴细胞亚群相关性调查

目的：探讨住院老年患者日常生活能力与淋巴细胞亚群的相关性。方法：采用日常生活能力量表（ADL）及淋巴细胞及亚群检测对101例住院老年男性进行调查。结果：生活自理能力（PSMS）、工具性日常生活能力（IADL）、CD＋56、CD^＋19均与病情相关,IADL、CD8＋、CD^＋56与年龄相关（P〈0．05）;CD^＋56与PSMS、IADL、ADL呈正相关,CD^＋19与IADI—ADL呈负相关（P〈0．05）。影响日常生活能力的逐步回归分析,PSMS与CD^＋4,IADL、ADL与CD^＋56相关;影响淋巴细胞亚群的逐步回归分析,CD^8与年龄、CDG与病情、CD^＋56与IADL相关（P〈0．05）。结论：日常生活能力、CD南及CD^＋56与病情相关,日常生活能力对淋巴细胞亚群有影响。     

Functional disability and rehabilitation outcome in right hemisphere damaged patients with and without unilateral spatial neglect

OBJECTIVE: To evaluate the impact of unilateral spatial neglect (USN) on the rehabilitation outcome and long-term functioning in activities of daily living (ADL) and instrumental ADL (IADL) of right hemisphere damaged (RHD) stroke patients. DESIGN: Assessments of sensory-motor and cognitive impairment and of functional disability were conducted upon admission to rehabilitation, upon discharge from the rehabilitation hospital, and 6 months after discharge, up to a year postonset. SETTING: The Loewenstein Rehabilitation Hospital, which receives patients from all general hospitals in Israel. PATIENTS: Forty consecutive admissions of adult right-handed patients with a first, single, right hemispheric stroke proven by computed tomography. Based on their total score in the Behavioral Inattention Test for neglect, patients were divided into two groups: 19 with neglect (USN+) and 21 without neglect (USN-). OUTCOME MEASURES: Functional Independence Measure, for ADL; The Rabideau Kitchen Evaluation, for IADL. RESULTS: Impairment and disability levels of RHD patients with and without USN were clearly differentiated. Neglect is associated with lower performance on measures of impairment (sensory-motor and cognitive), as well as on measures of disability in ADL and IADL. Differences were significant in all testing periods. The recovery pattern of USN+ patients is slower and more attenuated. In both groups, most improvement occurs in the first 5 months after onset. USN is the major predictor of rehabilitation outcome from admission to follow-up. CONCLUSIONS: The significance of neglect as a major source of stroke-related long-term disability justifies further research efforts to develop appropriate therapeutic modalities for this complex, multifactorial syndrome.