Objective: To examine the sensitivity of the Mobility Activities Measure for lower extremities and to compare it to the sensitivity of the Physical Functioning Scale (PF-10) and the Patient-Specific Functional Scale (PSFS) at week 4 and week 8 post-hospitalization in outpatient rehabilitation settings.
Background: Mobility Activities Measure is a set of short mobility measures to track outpatient rehabilitation progress: its scales have shown good properties but its sensitivity to change has not been reported.
Methods: Patients with musculoskeletal conditions were recruited at admission in three outpatient rehabilitation settings in Spain. Data were collected at admission, week 4 and week 8 from an initial sample of 236 patients (mean age?±?SD?=?36.7?±?11.1). Main outcome measures: Mobility Activities Measure scales for lower extremity; PF-10; and PSFS.
Results: All the Mobility Activities Measure scales were sensitive to both positive and negative changes (the Standardized Response Means (SRMs) ranged between 1.05 and 1.53 at week 4, and between 0.63 and 1.47 at week 8). The summary measure encompassing the three Mobility Activities Measure scales detected a higher proportion of participants who had improved beyond the minimal detectable change (MDC) than detected by the PSFS and the PF-10 both at week 4 (86.64% vs. 69.81% and 42.23%, respectively) and week 8 (71.14% vs. 55.65% and 60.81%, respectively).
Conclusions: The three Mobility Activities Measure scales assessing the lower extremity can be used across outpatient rehabilitation settings to provide consistent and sensitive measures of changes in patients’ mobility.
- Implications for rehabilitation
All the scales of the Mobility Activities Measure for the lower extremity were sensitive to both positive and negative change across the follow-up periods.
Overall, the summary measure encompassing the three Mobility Activities Measure scales for the lower extremity appeared more sensitive to positive changes than the Physical Functioning Scale, especially during the first four weeks of treatment.
The summary measure also detected a higher percentage of participants with positive change that exceeded the minimal detectable change than the Patient-Specific Functional Scale and the Physical Functioning Scale at the first follow-up period.
By demonstrating their consistency and sensitivity to change, the three Mobility Activities Measures scales can now be considered in order to track patients’ functional progress.
Mobility Activities Measure can be therefore used in patients with musculoskeletal conditions across outpatient rehabilitation settings to provide estimates of change in mobility activities focusing on the lower extremity.
Methods: In the fall of 2016, we searched Psycinfo (OVID), ERIC, CINAHL and Web of Science to identify studies that used participatory photography with children with disabilities. The search was repeated in January 2018 to retrieve any new publications. The first author extracted data that described the characteristics of each study and the modifications used.
Results: Of the 258 articles identified, 19 met inclusion criteria. Participants ranged from 4–21?years old and had a variety of disabilities. Study topics included education, leisure activities and adulthood. Researchers modified participatory photography to enhance accessibility by: modifying cameras; providing individual training; teaching consent through role play; allowing children to direct adults to take photographs; including additional forms of media; using diaries and questionnaires; providing individual interviews with simplified questions; using multiple forms of communication; and modifying how photographs are shared.
Conclusions: Participatory photography can be an effective method for studying the lived experiences of children with disabilities, particularly those with communication impairments. Methodological modifications can enhance the accessibility of this approach for this population.
- Implications for Rehabilitation
Participatory photography may be an effective qualitative research method for learning about the perspectives and experiences of children with disabilities on a wide array of topics.
There are many specific modifications that researchers can use to support the inclusion of children with disabilities in participatory photography research.
The findings of studies that use participatory photography methodology may provide rehabilitation professionals with important insights into the lives of children with disabilities.
Design and setting: Cohort study in a Primary Health Care Center and a University Hospital.
Subjects: Somali women skin type V, n?=?114, aged 18–56 years, from latitude 0–10○ N, living in Sweden, latitude 57○ N?>?2 years were compared with women from a population sample, skin type II-III, n?=?69, aged 38–56 years, the WHO MONICA study, Gothenburg, Sweden.
Main outcome measures: Serum (S)-25(OH)D, S-parathyroid hormone (PTH), comorbidity and Health-Related Quality of Life (HRQoL) using the Short Form-36 (SF-36) and part of the EQ-5D questionnaires. All calculations were corrected for age.
Results: Vitamin D deficiency (S-25(OH)D?<?25?nmol/l) was found in 73% of the Somali women and in 1% of the controls (p?<?.0001). S-PTH was elevated (>6.9?pmol/l) in 26% and 9%, respectively (p?<?.004). Somali women used less medication, 16% vs. 55%, p?<?.0001) but more allergy medication, 11% vs. 7% (p?=?.006), had fewer fractures, 2% vs. 28% (p?<?.0001) and lower HRQoL in 7 out of 9 scales (p?<?.05–.001), than native controls. There were no differences in the prevalence of diabetes mellitus, hypothyroidism, positive thyroid peroxidase antibodies, vitamin B12 deficiency, celiac disease or hypertension.
Conclusions: Vitamin D deficiency was common in Somali women living in Sweden, 73%, but comorbidity was low. Both mental, and especially physical HRQoL scores were lower in the Somali women. The effects of long-lasting deficiency are unknown.
- Key points
The aim was to explore the relationship between vitamin D deficiency (S-25(OH)D?<?25?nmol/l) and comorbidity in immigrants.
Vitamin D deficiency was common in Somali women living in Sweden, 73%, but comorbidity of hypothyroidism, diabetes mellitus, hypertension, fractures and use of medications was low.
Both mental, and especially physical, Health-Related Quality of Life were lower in the Somali women than in native Swedish women.
The effects of long-lasting deficiency are unknown.
Method: We used participatory action research to guide the iterative development, usability testing, and within-subject pilot testing of the ProSolv programme. The finalized programme was then evaluated in a between-subjects group study and a non-experimental single case study.
Results: Results were mixed across studies. Participants demonstrated that it was feasible to learn and use the ProSolv programme for support in problem solving. They highly recommended the programme to others and singled out the importance of the coach. Limitations in app design were cited as a major reason for infrequent use of the app outside of coaching sessions.
Conclusions: Results provide mixed evidence regarding the utility of web-based mobile apps, such as ProSolv to support problem solving following brain injury.
- Implications for Rehabilitation
People with cognitive impairments following brain injury often struggle with problem solving in everyday contexts.
Research supports problem solving skills training following brain injury.
Assistive technology for cognition (smartphones, selected apps) offers a means of
supporting problem solving for this population.
This project demonstrated the feasibility of a web-based programme to address this need.
Purpose: To map the evidence on physical activity and cognition in HIV.
Methods: We searched five databases using terms related to physical activity and HIV. Two authors independently reviewed titles and abstracts for studies that addressed physical activity/exercise and cognition in people with HIV. Authors reviewed full texts to identify articles that met our inclusion criteria. One author extracted the data, then we collated the results and summarized the characteristics of included studies.
Results: Sixteen studies from high-income countries were included; eight were interventional (five randomized controlled trials and three pre-post single group observational studies) and eight were non-interventional studies. The interventional studies included aerobic, resistive, and Tai Chi exercise for 8?weeks to 12?months in duration. Two of eight interventional studies found exercise to benefit self-reported cognition. All eight non-interventional studies showed a positive relationship between physical activity and cognitive function.
Conclusions: Results of this study suggest that physical activity may preserve or improve cognition in people living with HIV.
- Implications for Rehabilitation
Physical activity may play a role in preserving or improving cognition in the human immunodeficiency virus population.
Exercise should be prescribed for people with human immunodeficiency virus based on the stage of infection.
Rehabilitation professionals should follow current exercise guidelines when prescribing exercise for people living with human immunodeficiency virus.
Design: A qualitative study employing a participatory design approach, with an inductive analytical thematic approach utilising semi-structured interviews. Empirical data was analysed using the qualitative data analysis software (QDAS) Nvivo.
Setting: General practices in Denmark.
Subjects: Eight interviews were conducted with an average duration of 60?min. The interviewees were GPs from different geographical settings and different organisational structures, varying in age and professional interests.
Main outcome measures: Barriers and facilitators for future use of the HIT application for patients with LBP.
Results: Through the inclusion of healthcare professionals in the design process, this study found that in order for GPs to recommend a HIT application it is essential to target the application towards their patients. Furthermore, GPs required that the HIT application should support patient self-management. Additionally, the content of the HIT application should support the initiated treatment and it should be easy for GPs to recommend the HIT application. Finally, healthcare professionals need to be involved in the design process.
Conclusion: When designing health IT applications for patients with LBP in general practice it is important to include both patients and GPs in the design process. GPs would be more willing to recommend a HIT application that: applies content in line with frequently used recommendations; targets patients; supports patients’ self-management; and supports the patients’ needs.
- KEY POINTS
Online information is currently applied in general practice to some patients with low back pain
Online information cannot replace the GP, but can rather be a bonding tool between the patient and the GP
It is important to address both GP and patient barriers to applying new technology and to consider the literacy level
Participatory methods could play a central role in the future development of online information material
Methods: Cross-sectional validation study: After forward and back translation of the Dutch version of the Child Activity Limitation Interview 21-Child adolescents (11–21 years old) with chronic musculoskeletal pain completed an assessment. The assessment contained the Dutch Child Activity Limitation Interview, and questionnaires about demographics, pain intensity, functional disability, anxiety and depression. Internal consistency and construct validity were evaluated through exploratory factor analysis (principal axis factoring with oblique rotation) and hypotheses testing using pain intensity, activity limitations, anxiety and depression as comparative constructs.
Results: Seventy-four adolescents completed the assessment. Exploratory factor analysis resulted in a two-factor structure, explaining 50% of the variance. Internal consistency was good (Cronbach’s α?=?0.91 total scale, α?=?0.90 Factor 1, α?=?0.80 Factor 2). All nine hypotheses were confirmed.
Conclusion: The Dutch version can be used to assess pain-related disability in Dutch-speaking adolescents comparable to the study sample. Scores on both subscales provide insight into the severity of the pain-related disability in both daily routine and more physically vigorous activities.
- Implications for Rehabilitation
Chronic pain is a disabling disorder which not only impacts physically but restricts quality of life.
This study provides clinicians a questionnaire to measure pain-related disability and quantify the impact of pain on the daily living of adolescents.
The advantage of the Dutch version of the Child Activity and Limitations Interview over other measurements is that it can distinguish limitations in daily activities from more physically vigorous activities.
Methods: The nationwide FinnValve registry included data from 6463 patients who underwent TAVR or SAVR with a bioprosthesis for aortic stenosis from 2008 to 2017.
Results: The annual number of treated patients increased three-fold during the study period. Thirty-day mortality declined from 4.8% to 1.2% for TAVR (p?=?.011) and from 4.1% to 1.8% for SAVR (p?=?.048). Two-year survival improved from 71.4% to 83.9% for TAVR (p?<?.001) and from 87.2% to 91.6% for SAVR (p?=?.006). During the study period, a significant reduction in moderate-to-severe paravalvular regurgitation was observed among TAVR patients and a reduction of the rate of acute kidney injury was observed among both SAVR and TAVR patients. Similarly, the rate of red blood cell transfusion and severe bleeding decreased significantly among SAVR and TAVR patients. Hospital stay declined from 10.4?±?8.4 to 3.7?±?3.4 days after TAVR (p?<?.001) and from 9.0?±?5.9 to 7.8?±?5.1 days after SAVR (p?<?.001).
Conclusions: In Finland, the introduction of TAVR has led to an increase in the invasive treatment of severe aortic stenosis, which was accompanied by improved early outcomes after both SAVR and TAVR.
Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT03385915
- Key Messages
This study demonstrated that the introduction of transcatheter aortic valve replacement has led to its widespread use as an invasive treatment for severe aortic stenosis.
Early and 2-year survival after transcatheter and surgical aortic valve replacement has improved during past decade.
Transcatheter aortic valve replacement has fulfilled its previously unmet clinical needs and has surpassed surgical aortic valve replacement as the most common invasive treatment for aortic stenosis.
Methods: A search of available literature was done using PubMed, SPORTDiscus, CINAHL, and Scopus databases. Studies were included if they contained the following: (1) individuals with chronic low back pain 3?months or longer; (2) healthy control group; (3) quantified pain measurement; and (4) center of pressure measurement using a force plate. Two authors independently reviewed articles for inclusion, and assessed for quality using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross Sectional Studies. Cohen’s d effect size was calculated to demonstrate the magnitude of differences between groups.
Results: Nine articles were included in this review. Quality scores ranged from 5/8 to 8/8. Although center of pressure measures were nonhomogeneous, subjects with chronic low back pain had poorer performance overall compared to healthy controls. Despite inconsistencies in statistical significance, effect sizes were frequently large, indicating a lack of sufficient power in the included studies. Data were insufficiently reported among certain studies, limiting the ability of direct study comparison.
Conclusions: Results suggest that balance is impaired in individuals with chronic low back pain when compared to healthy individuals.
- Implications for rehabilitation
Static balance is affected in individuals with chronic low back pain.
Balance assessments should be completed for individuals with chronic low back pain.
Results from balance assessments should be used to indicate areas of improvement and help guide the course of treatment, as well as reassess as treatment progresses.
Method: An association between the Rosén and Lundborg Score and the Screening Activity Limitation and Safety Awareness scale for hand was evaluated in a cross-section study with 25 people of a mean age of 51?years old (SD 14), undergoing drug treatment for leprosy.
Results: The mean quantitative score in the Screening Activity Limitation and Safety Awareness scale was 27.9 (SD 10.5). Rosén and Lundborg Score for the median nerve were 2.43 (SD 0.38) on the right hand and 2.41 (SD 0.54) on the left hand whilst for the ulnar nerve, the scores observed were 2.33 (SD 0.42) for the right hand and 2.31 (SD 0.61) for the left hand. Significant correlations between the two instruments in assessment of the median and ulnar nerves on both hands were found.
Conclusions: Due to the association found between the scales, the Rosén and Lundborg Score may be used in assessment of the hand in patients diagnosed with leprosy, as a tool to assist the result evaluation after the drug treatment, surgical treatment, rehabilitation and follow-up in the hand dysfunction in leprosy.
- Implications for Rehabilitation
The leprosy inflammatory neuropathy may cause limitations and disabilities related to hand functions of patients.
Instruments with quantitative scores provide a reliable basis for therapeutic intervention prognosis.
New evaluation methods promote a better monitoring of treatment and hand function evolution of people with leprosy.
Methods: Twenty-nine adults with severe mental illness and 27 controls matched by gender and age were enrolled into the study using convenience sampling. They were assessed for gross and fine motor hand functioning, job attitudes, work performance, and cognition.
Results: People with mental illness scored lower on work performance, cognitive functioning, and hand dexterity while sitting and working with tools. They were assigned lower job loads than were controls, and perceived the physical environment at work as more constraining than did controls. Assembling motor skills significantly explained the work performance of people with mental illness.
Conclusions: The results expand our understanding of the complexities involved in the employment of people with severe mental illness, and point to new paths for improving vocational outcomes of people with severe mental illness, taking into account their motor skills and job attitudes.
- Implications for rehabilitation
Therapists should be aware that employed people with severe mental illness may have various unmet needs, affecting their work performance and experience of stress.
This study results demonstrate importance of motor skills and perception of the work environment for the promotion of vocational outcomes among individuals with severe mental illness.
Employment of people with severe mental illness should be viewed from holistic perspective as with general population, rather than focused on traditionally illness-related factors.
Methods: Massive transfusion was defined as transfusion with ≥10 units of red blood cells within the first 24?h. Data were extracted from a 10-year, six-hospital database. Logistic regression was applied to derive a risk score for massive transfusion using data from 2006 to 2010, in 24,736 patients (developmental cohort). The score was then validated using data from 2011 to 2015 in 27,449 patients (validation cohort). Area under the receiver operating characteristic (AUROC) curve was performed to assess prediction accuracy.
Results: Five characteristics were independently associated (p?<?.001) with massive transfusion: presence of band-form cells among white blood cells (band form >0), international normalized ratio (INR) >1.5, pulse >100 beats per minute or systolic blood pressure <100?mmHg (shock), haemoglobin <8.0?g/dL and endoscopic therapy. The new scoring system successfully discriminated well between UGIB patients requiring massive transfusion and those who did not in both cohorts (AUROC: 0.831, 95%CI: 0.827–0.836; AUROC: 0.822, 95% CI: 0.817–0.826, respectively).
Conclusions: The new scoring system predicts massive transfusion requirement in patients with UGIB well.
- Key messages
Massive transfusion is a life-saving management in massive upper gastrointestinal bleeding. How to identify patients requiring massive transfusion in upper gastrointestinal bleeding is poorly documented.
Approximately 3.9% of upper gastrointestinal bleeding patients require massive transfusion.
A new scoring system is developed to identify patients requiring massive transfusion with high accuracy.
Methods: In addition to the medical history questionnaire, patients aged 16?years and older were asked to complete activities of daily living and quality of life surveys using the Barthel Index, MOS 36-Item Short-Form Health Survey, and Health Assessment Questionnaire. The surveys were conducted over a 4-years period.
Results: Of the 15 participating patients, 13 reported swelling during the study period. The Barthel Index and Health Assessment Questionnaire surveys indicated a tendency for questionnaire items related to arm function to reflect early decreases in the activities of daily living. Decreases in activities of daily living functioning were closely related to decreases in the quality of life in physical function domains. Activities of daily living and quality of life were maintained at a similar level to baseline values over the study period (Barthel Index: p?=?0.42, MOS 36-Item Short-Form Health Survey: p?=?0.43, Health Assessment Questionnaire: p?=?0.87).
Conclusions: We obtained longitudinal information relating to natural history on fibrodysplasia ossificans progressiva patients.
- Implications for rehabilitation
Fibrodysplasia ossificans progressiva is a rare congenital disease that causes heterotopic ossification of muscle tissue throughout the body, leading to systemic ankyloses and mobility losses.
When the Barthel Index was high and the activities of daily living were relatively stable, the items on the Health Assessment Questionnaire that are related to arm function began to show impairment.
Early focus on upper extremity function that includes the use of assistive devices during the period when a patient is still able to perform many activities of daily living is important.
Although decreases in activities of daily living functioning were closely related to decreases in the quality of life in the physical function domains, the scores of the domains other than physical function were similar to the national standard score.
Materials and methods: Five series of neck muscle vibration were delivered to 15 neck pain patients and 11 healthy controls in this case control study. Outcomes were cervical joint position sense, arm-matching acuity, and pressure pain threshold at the zygapophyseal joint of C2/C3, the angulus superior, and the tibialis anterior muscle.
Results: Cervical joint position sense acuity improved in neck pain patients and declined in healthy controls even after 24?h. Arm-matching acuity improved in patients assessed after 15?min, as was pressure pain threshold at the angulus superior in neck pain patients. In contrast, changes in the pressure pain threshold at the tibia were only observable immediately after vibration.
Conclusion: Neck muscle vibration induced short-lasting general as well as longer-lasting specific effects on analgesia and sensorimotor function. Based on our observations, future studies should investigate potential benefits of neck muscle vibration as adjunct to physical therapy in order to improve cervical sensorimotor function.
- Implications for Rehabilitation
A single session of neck muscle vibration improves cervical joint position sense in neck patients for up to 24?h.
Neck muscle vibration improves arm-matching acuity in neck pain patients.
Neck muscle vibration increases pressure pain thresholds at the stimulated place but decrease pressure pain thresholds more distally.
Neck muscle vibration shows distinct effects in neck pain patients and healthy control.
Methods: We enrolled patients with type 2 diabetes hospitalized in non-cardiac surgery departments with admission glycated haemoglobin level < 8%, admission blood glucose concentration < 240?mg/dL, and no at-home injectable treatments who were treated with basal-bolus (n?=?347) or linagliptin-basal (n?=?190) regimens between January 2016 and December 2017. To match patients on the two regimens, a propensity matching analysis was performed.
Results: After matching, 120 patients were included in each group. No differences were noted in mean blood glucose concentration after admission (p?=?.162), number of patients with a mean blood glucose 100–140?mg/dL (p?=?.163) and > 200?mg/dL (p?=?.199), and treatment failures (p?=?.395). Total daily insulin and number of daily insulin injections were lower in the linagliptin-basal group (both p?<?.001). Patients on linagliptin-basal insulin had fewer hypoglycaemic events (blood glucose < 70?mg/dL) (p?<?.001).
Conclusion: For type 2 diabetes surgery patients with mild to moderate hyperglycaemia without pre-hospitalization injectable therapies, linagliptin-basal insulin was an effective, safe alternative with fewer hypoglycaemic events in real-world practice.
- Key messages
Treatment with basal-bolus insulin regimens is the standard of care for non-critically ill hospitalized patients with type 2 diabetes.
A differentiated treatment protocol that takes into account glycaemic control and clinical factors should be implemented in the hospital setting.
Linagliptin-basal insulin is an effective, safe alternative with fewer hypoglycaemic events during the hospitalization of non-critically ill non-cardiac surgery patients with T2D in real-world practice.
Methods: Before and after 12?weeks of high-intense concurrent training (interval and strength training, 5 sessions per 2?weeks, n?=?16) body composition, resting blood pressure and heart rate, 2-h oral glucose tolerance (insulin sensitivity, glycosylated hemoglobin, blood glucose and insulin concentrations), blood lipids (high- and low-density lipoprotein, total cholesterol, triglyceride levels) and C-reactive protein were analyzed.
Results: Twelve weeks of high-intense concurrent training significantly improved resting heart rate (?6%), 2-h blood glucose concentrations (?13%) and insulin sensitivity (?24%). Blood pressure, body composition, blood lipids and C-reactive protein did not seem to be affected.
Conclusions: Under the conditions of this pilot study, 12?weeks of concurrent high-intense interval and strength training improved resting heart rate, 2-h glucose and insulin sensitivity in multiple sclerosis but did not affect blood C-reactive protein levels, blood pressure, body composition and blood lipid profiles. Further, larger and controlled research investigating the effects of high-intense concurrent training on cardiovascular risk factors in multiple sclerosis is warranted.
- Implications for rehabilitation
High-intensity concurrent training improves cardiovascular fitness.
This pilot study explores the impact of this training on cardiovascular risk factors in multiple sclerosis.
Despite the lack of a control group, high-intense concurrent training does not seem to improve cardiovascular risk factors in multiple sclerosis.