A comparison of swallowing dysfunction in Becker muscular dystrophy and Duchenne muscular dystrophy

Purpose: Swallowing dysfunction has been reported in Duchenne muscular dystrophy (DMD), but has not been studied in Becker muscular dystrophy (BMD). The aims of this study were to report the characteristics of swallowing dysfunction in BMD compared with DMD.

Materials and methods: The study participants were 18 patients with BMD and 18 patients with DMD. All the patients were examined using videofluorography during swallowing of 5?mL of fluid. The penetration–aspiration scale (P–A scale) and the videofluorographic dysphagia scale (VDS) were used to evaluate dysphagia.

Results: Swinyard functional ability stage was not significantly different between the BMD and DMD groups. Rate of aspiration, P–A scale score, and total VDS score did not differ across groups, but the VDS item score for laryngeal elevation was lower in the BMD group than in the DMD group (median scores 4.5 and 9, respectively; p?r?=?0.78, p?Conclusion: Patients with BMD have swallowing problems similar to those observed in patients with DMD when matched according to physical functional status. These patients should be evaluated and followed-up for the duration of their disease.

• Implications for rehabiliation

• Dysphagia is one of the most critical problems in patients with progressive neuromuscular disease but dysphagia in patients with Becker muscular dystrophy (BMD) was not well known.

• Eighteen patients with BMD and 18 patients with Duchenne muscular dystrophy were examined with videofluorography.

• Patients with BMD have swallowing problems similar to those observed in patients with DMD.

     

Clinical validation of a novel postural support device for hospitalized sub-acute post-stroke wheelchair users

Purpose: We present a novel wheelchair posture support device (WPSD) and its clinical validation. The device was developed in order to assure correct sitting posture and to reduce the time spent by caregivers for re-positioning of hospitalized, wheelchair-bound, post-acute stroke patients. Method: The device was validated with 16 subjects during a period of 5 days in which use of the device was compared with regular care practice. Results: The device was used for the five consecutive days in 69% of patients, while for 6% it was not suitable; 25% did not complete the 5 days for reasons unrelated to the device. Caregivers needed to re-position the patients that used the device for the full 5 days (n?=?11) on an average 52% less often when using the device, as compared to regular practice. Furthermore, the device was rated as usable and functional by the caregivers while significantly reducing perception of trunk and shoulder pain in patients during its use. Conclusions: The newly designed WPSD is a valuable system for the improvement of medical assistance to wheelchair-bound post-stroke patients by reducing pain and number of re-positioning manoeuvres. The WPSD might be applicable to any group of patients who need posture control in either wheelchair or common chair with arms support.

• IMPLICATIONS FOR REHABILITATION

• Advanced supports and cushions that can be shaped to individual needs, may help assure correct sitting posture in wheelchair-bound post-acute stroke patients.

• Advanced supports and cushions that can be shaped to individual needs, may reduce the number of times a caregiver has to re-position a hospitalized wheelchair-bound post-acute stroke patient on overall average by 52%.

• Advanced personalized supports and cushions may improve sitting comfort and reduce pain complaints for post-acute hospitalized stroke patients using a wheelchair.

     

Previous gestational diabetes history is associated with impaired coronary flow reserve

Abstract

Background Gestational diabetes mellitus (GDM) is a prediabetic state that is known to increase the risk of cardiovascular diseases. We have investigated coronary flow velocity reserve (CFVR) and epicardial fat thickness (EFT), and left ventricular diastolic function in patients with a history of previous GDM (p-GDM).

Methods Ninety-three women with GDM history and 95 healthy women without GDM history were recruited. We used transthoracic Doppler echocardiography to assess CFVR, EFT, and left ventricular diastolic function. Insulin resistance of each subject was assessed with homeostasis model assessment insulin resistance (HOMA-IR). Hemoglobin A1c and high-sensitivity C-reactive protein (hsCRP) were also measured in all patients.

Results CFVR values were significantly lower (2.34?±?0.39 versus 2.80?±?0.24, p?<?0.001) and EFT values were significantly higher in patients with p-GDM than the control group (5.5?±?1.3 versus 4.3?±?1.1, p?<?0.001). E/E' ratio (7.21?±?1.77 versus 6.53?±?1.38, p?=?0.003), hemoglobin A1c (5.2?±?0.4 and 5.0?±?0.3, p?=?0.001), HOMA-IR (2.8?±?1.4 versus 1.7?±?0.9, p?=?0.04), and hsCRP levels were significantly higher in the p-GDM group than the control group. Multivariate analysis revealed that gestational diabetes history is independently associated with CFVR.

Conclusion Women with a GDM history may be at more risk regarding coronary microvascular dysfunction compared to the healthy ones.

• Key Messages

• What is already known about this subject?

• Impairment of CFVR reflects coronary microvascular dysfunction and has been shown to be an early manifestation of atherosclerosis and coronary artery disease.

• Several studies have shown an association between p-GDM and atherosclerosis by measuring intima-media thickness.

• What are new findings?

• This preliminary study on coronary microvascular function of patients with p-GDM revealed that CFVR is significantly impaired in p-GDM patients.

• Although the number of patients included in this study is limited, these results suggest that impaired CFVR may be an early manifestation of coronary vascular involvement in patients with p-GDM.

• How might it impact on clinical practice in the foreseeable future?

• In patients with p-GDM, the presence of impaired CFVR should render the clinician aware of the development of coronary artery disease.

     

Construct validity of the pediatric evaluation of disability inventory computer adaptive test (PEDI-CAT) in children with medical complexity

Purpose: To assess construct (convergent and divergent) validity of the Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) in a sample of children with complex medical conditions.

Method: Demographics, clinical information, PEDI-CAT normative score, and the Post-Acute Acuity Rating for Children (PAARC) level were collected for all post-acute hospital admissions (n?=?110) from 1 April 2015 to 1 March 2016. Correlations between the PEDI-CAT Daily Activities, Mobility, and Social/Cognitive domain scores for the total sample and across three age groups (infant, preschool, and school-age) were calculated. Differences in mean PEDI-CAT scores for each domain across two groups, children with “Less Complexity,” or “More Complexity” based on PAARC level were examined.

Results: All correlations for the total sample and age subgroups were statistically significant and trends across age groups were evident with the stronger associations between domains for the infant group. Significant differences were found between mean PEDI-CAT Daily Activities, Mobility, and Social/Cognitive normative scores across the two complexity groups with children in the “Less Complex” group having higher PEDI-CAT scores for all domains.

Conclusion: This study provides evidence indicating the PEDI-CAT can be used with confidence in capturing and differentiating children’s level of function in a post-acute care setting.

• Implications for Rehabilitation

• The PEDI-CAT is measure of function for children with a variety of conditions and can be used in any clinical setting.

• Convergent validity of the PEDI-CAT’s Daily Activities, Mobility, and Social/Cognitive domains was significant and particularly strong for infants and young children with medical complexity.

• The PEDI-CAT was able to discriminate groups of children with differing levels of medical complexity admitted to a pediatric post-acute care hospital.

     

Dysphagia in Duchenne muscular dystrophy: practical recommendations to guide management

Purpose: Duchenne muscular dystrophy (DMD) is a rapidly progressive neuromuscular disorder causing weakness of the skeletal, respiratory, cardiac and oropharyngeal muscles with up to one third of young men reporting difficulty swallowing (dysphagia). Recent studies on dysphagia in DMD clarify the pathophysiology of swallowing disorders and offer new tools for its assessment but little guidance is available for its management. This paper aims to provide a step-by-step algorithm to facilitate clinical decisions regarding dysphagia management in this patient population.

Methods: This algorithm is based on 30 years of clinical experience with DMD in a specialised Centre for Neuromuscular Disorders (Inkendaal Rehabilitation Hospital, Belgium) and is supported by literature where available.

Results: Dysphagia can worsen the condition of ageing patients with DMD. Apart from the difficulties of chewing and oral fragmentation of the food bolus, dysphagia is rather a consequence of an impairment in the pharyngeal phase of swallowing. By contrast with central neurologic disorders, dysphagia in DMD accompanies solid rather than liquid intake. Symptoms of dysphagia may not be clinically evident; however laryngeal food penetration, accumulation of food residue in the pharynx and/or true laryngeal food aspiration may occur. The prevalence of these issues in DMD is likely underestimated.

Conclusions: There is little guidance available for clinicians to manage dysphagia and improve feeding for young men with DMD. This report aims to provide a clinical algorithm to facilitate the diagnosis of dysphagia, to identify the symptoms and to propose practical recommendations to treat dysphagia in the adult DMD population.

• Implications for Rehabilitation

• Little guidance is available for the management of dysphagia in Duchenne dystrophy.

• Food can penetrate the vestibule, accumulate as residue or cause aspiration.

• We propose recommendations and an algorithm to guide management of dysphagia.

• Penetration/residue accumulation: prohibit solid food and promote intake of fluids.

• Aspiration: if cough augmentation techniques are ineffective, consider tracheostomy.

     

2nd International Symposium on Gait and Balance in Multiple Sclerosis: interventions for gait and balance in MS

Abstract

Purpose: To provide a review of the 2nd International Symposium on Gait and Balance in Multiple Sclerosis (MS), emphasizing interventions in gait and balance for people with MS. Method: Review of current research on interventions used with people having MS and with people having other disorders that may provide novel insights into improving gait and balance and preventing falls in people with MS (pwMS). Results: Nine speakers provided evidence-based recommendations for interventions aimed at improving gait and balance dysfunction. Speaker recommendations covered the following areas: balance rehabilitation, self-management, medications, functional electrical stimulation, robotics, sensory augmentation, gait training with error feedback and fall prevention. Conclusions: The causes of gait and balance dysfunction in pwMS are multifactorial and therefore may benefit from a wide range of interventions. The symposium provides avenues for exchange of evidence and clinical experience that is critical in furthering physical rehabilitation including gait and balance dysfunction in MS.

• Implications for Rehabilitation

• Approaches to improve Gait and Balance dysfunction in Multiple Sclerosis.

• Balance exercises that include training of sensory strategies.

• Self-management and self-management support.

• Pharmacologic intervention, such as Dalfampradine.

• Functional electrical stimulation that may provide the extra stimulation to influence coordinated leg movements needed for walking.

     

Sexuality after stroke: patient counseling preferences

Abstract

Purpose: Sexual dysfunction is common after stroke, but is frequently not addressed by healthcare providers. The aim of this study was to examine patient preferences for counseling related to sexuality post-stroke. Method: Two hundred and sixty-eight patients from a stroke registry were provided an anonymous paper or online survey. Thirty-eight patients responded and completed the survey. The survey included demographic information, and scales of sexual dysfunction, fatigue, depression and functional independence. In addition, we queried subjects about stroke-related sexual dysfunction and their preferences for counseling and education materials. Results: Most respondents (71%) identified sexuality as a moderately to very important issue in their post-stroke rehabilitation. Sexual dysfunction was common, with 47% of respondents indicating that their sexual function had declined since the stroke. Eighty-one percent reported receiving insufficient information about sexuality post-stroke, and the majority (60%) expressed a preference for receiving counseling regarding sexuality from a physician. A substantial portion (26.5%) of patients wanted to receive counseling prior to discharge from a hospital or rehabilitation center, with 71% wishing to receive counseling within 1 year post-stroke. Conclusions: Many stroke survivors experience sexual dysfunction and indicate a desire for additional information and counseling from healthcare providers. Preferences regarding the timing of such counseling vary, creating challenges for optimizing the delivery of this care.

• Implications for Stroke Rehabilitation

• Sexual dysfunction is common after stroke, but is frequently not addressed by healthcare providers.

• Many stroke survivors experience sexual dysfunction and indicate a desire for additional information and counseling from healthcare providers.

• Most stroke survivors identify sexuality as an important issue in their post-stroke rehabilitation.

• Exploring individual stroke survivor counseling preferences periodically over the course of recovery may be a useful strategy for delivering the desired information at the most appropriate time.

     

Patient reported outcomes in GNE myopathy: incorporating a valid assessment of physical function in a rare disease

Background: The aim of this analysis was to evaluate the psychometric properties of three patient reported outcome (PRO) measures characterizing physical function in GNE myopathy: the Human Activity Profile, the Inclusion Body Myositis Functional Rating Scale, and the Activities-specific Balance Confidence scale.

Methods: This analysis used data from 35 GNE myopathy subjects participating in a natural history study. For construct validity, correlational and known-group analyses were between the PROs and physical assessments. Reliability of the PROs between baseline and 6 months was evaluated using the intra-class correlation coefficient model; internal consistency was tested with Cronbach’s alpha.

Results: The hypothesized moderate positive correlations for construct validity were supported; the strongest correlation was between the human activity profile adjusted activity score and the adult myopathy assessment endurance subscale score (r?=?0.81; p?α?>?0.8) and there was strong reliability (ICC >0.62).

Conclusion: The PROs are valid and reliable measures of physical function in GNE myopathy and should be incorporated in investigations to better understand the impact of progressive muscle weakness on physical function in this rare disease population.

• Implications for Rehabilitation

• GNE myopathy is a rare muscle disease that results in slow progressive muscle atrophy and weakness, ultimately leading to wheelchair use and dependence on a caregiver.

• There is limited knowledge on the impact of this disease on the health-related quality of life, specifically physical function, of this rare disease population.

• Three patient reported outcomes have been shown to be valid and reliable in GNE myopathy subjects and should be incorporated in future investigations to better understand how progressive muscle weakness impacts physical functions in this rare disease population.

• The patient reported outcome scores of GNE myopathy patients indicate a high risk for falls and impaired physical functioning, so it is important clinicians assess and provide interventions for these subjects to maintain their functional capacity.

     

Impaired albumin function: a novel potential indicator for liver function damage?

Abstract

Albumin is the most abundant plasma protein and albumin infusion is commonly used. Conventionally, the biologic and therapeutic effects of albumin have been thought to be due to its oncotic properties. However, albumin has a variety of biologic functions, including molecular transport, anti-oxidation, anti-inflammation, endothelial stabilisation, anti-thrombotic effects, and the adjustment of capillary permeability. Despite this, the functions of albumin have not been thoroughly investigated. Recent studies have shown non-alcoholic fatty liver disease (NAFLD), viral hepatitis, cirrhosis, and liver failure to be associated with impairments in albumin function, which are associated with impairments in liver function and disease prognosis. Post-translational modifications of albumin cause structural modifications that affect protein function. Recently, the concentration of albumin associated with normal function, the ‘efficient albumin concentration’, has been attracting more interest. In addition, although many biologic markers, including albumin concentration, are widely used for the assessment of early liver dysfunction in patients with liver diseases, the predictive values are unsatisfactory. However, clinical evidence has suggested that albumin function may represent a novel biomarker of early impairment in liver function. In this review, we summarise the factors affecting albumin function and discuss the clinical significance of impairments in albumin function in various liver diseases.

1. Key messages

2. The importance of albumin depends not only on its concentration, but also on its various physiological functions.

3. Impaired albumin function has been reported in a variety of liver diseases, and is associated with disease severity and prognosis, thereby proposing the concept of ‘effective albumin concentration’.

4. Albumin dysfunction occurs earlier than other conventional indicators, and albumin dysfunction may be a new biomarker of early impairment in liver function.

5. Many exogenous and endogenous factors lead to post-translational modifications of albumin, which alters the three-dimensional structure of albumin, resulting in a decrease in its biological activity.

     

A review of technological and clinical aspects of robot-aided rehabilitation of upper-extremity after stroke

Cerebrovascular accident (CVA) or stroke is one of the leading causes of disability and loss of motor function. Millions of people around the world are effected by it each year. Stroke results in disabled arm function. Restoration of arm function is essential to regaining activities of daily living (ADL). Along with traditional rehabilitation methods, robot-aided therapy has emerged in recent years. Robot-aided rehabilitation is more intensive, of longer duration and more repetitive. Using robots, repetitive dull exercises can turn into a more challenging and motivating tasks such as games. Besides, robots can provide a quantitative measure of the rehabilitation progress. This article overviews the terms used in robot-aided upper-limb rehabilitation. It continues by investigating the requirements for rehabilitation robots. Then the most outstanding works in robot-aided upper-limb rehabilitation and their control schemes have been investigated. The clinical outcomes of the built robots are also given that demonstrates the usability of these robots in real-life applications and their acceptance. This article summarizes a review done along with a research on the design, simulation and control of a robot for use in upper-limb rehabilitation after stroke.

• Implications for Rehabilitation

• Reviewing common terms in rehabilitation of upper limb using robots

• Reviewing rehabilitation robots built up to date

• Reviewing clinical outcomes of the mentioned rehabilitation robots

     

Place orientation and visual construction subdomains of the Mini Mental State Examination test as predictors of rehabilitation outcome of post-acute hip-fractured patients

Purpose: The study aimed at assessing the relationship between various Mini Mental State Examination (MMSE) subdomains and rehabilitation achievements in post-acute hip-fractured patients.

Method: Six hundred and five hip-fractured patients admitted during 2010–2013 to a post-acute geriatric rehabilitation center were included in the study. Main outcome measures were the Functional Independence Measure (FIM) instrument, the motor FIM (mFIM), the Montebello Rehabilitation Factor Score (MRFS) on the mFIM and length of stay (LOS). A logistic regression analysis tested the predictive value of MMSE subdomains for achieving a satisfactory functional gain (mFIM MRFS >30%) on operated patients admitted from community.

Results: Of all the six MMSE subdomains, place orientation and visual construction demonstrated significant predictive values for rehabilitation outcome. Patients who did not err on place orientation and visual construction MMSE domains had better probabilities [(OR 1.28, 95%CI, 1.05–1.58; p?=?0.017); (OR 2.15, 95%CI, 1.28–3.59; p?=?0.004), respectively] of achieving better rehabilitation achievements. Similar results were obtained for cognitively impaired patient groups [(OR 1.40 95%CI, 1.11–1.77; p?=?0.005); (OR 2.47, 95%CI, 1.15–5.30; p?=?0.021), respectively]. For the cognitively intact patient group, the variables with significant predictive value were time orientation and visual construction MMSE subdomains [(OR 2.26, 95%CI, 1.18–4.33; p?=?0.014); (OR 2.87, 95%CI, 1.16–7.09; p?=?0.022), respectively].

Conclusions: Post-acute hip-fractured patients scoring normally on place orientation and visual construction MMSE subdomains have a better chance of achieving favorable rehabilitation outcome.

• Implications for Rehabilitation

• Post-acute hip-fractured patients have a better chance to achieve a favorable rehabilitation outcome when scoring normally on place orientation and visual construction MMSE subdomains.

• Patients having difficulties in orientation and visual construction may need more rehabilitation time as they lack planning and organizational capacity to follow instructions.

• Assessing MMSE subdomains may reveal subtle cognitive impairment in patients scored within the normal range on the MMSE test.

• Identifying subtle cognitive impairment may assist in coordinating the patients and their caregivers' expectations, efficiently allocating resources and help in advanced care planning.

     

Discourses in stroke rehabilitation as they present themselves in current physiotherapy and occupational therapy

Aim This study aims to discuss current perceptions of rehabilitation and how present rehabilitation practice is affected by dominating discourses in Danish society by exploring discourses expressed in official publications and the constructed journal notes of occupational and physiotherapists’ practice of stroke rehabilitation. Method The frame of reference is Fairclough’s critical discourse analysis. The analysis comprises seven official documents relevant to stroke rehabilitation provided in Danish health services in 2012–2013. Also, notes written by occupational therapists and physiotherapists in medical records of 10 patients with a stroke diagnosis admitted to hospital in 2012. The documents included were read thoroughly. The texts were analyzed deductively, focusing on discursive practice on articulated understandings of rehabilitation, health practice approaches, and social practice. Results The dominating discourses seem to be Western neoliberalism organizational, medical and ethical discourses. The macro level of discourses consisted of political documents addressing rehabilitation nationally. The meso level mainly concerned medical discourses within stroke rehabilitation whereas the micro level represented local medical and ethical discourses. Conclusion The neoliberal discourse supports the medical discourse with strong emphasis on evidence-based interventions. In contrast to ethical discourses, documentation of rehabilitation practice marked more attention being paid to facilitating the patient’s independence than to enabling the regaining of meaningful activities and participation.

• Implications for Rehabilitation

• Individualized rehabilitation must be organized with flexibility as it is a complex process

• Critical reflectiveness among health professionals is needed to provide individualized rehabilitation of high quality

• A broader range of stake holders, including patient organizations, are in demand within health policy making

• The discourses that construct rehabilitation policy and practices are sometimes in conflict, which may impact on, and impede, the rehabilitation for the individual patient

     

“Whenever I can I push myself to go to work”: a qualitative study of experiences of sickness presenteeism among workers with rheumatoid arthritis

Purpose: UK government policy emphasizes the importance of continuing to work for recovery from poor health, yet sickness presenteeism (going to work whilst ill) is commonly regarded as having negative consequences for organizations and individuals. Our study explores experiences of working after onset of rheumatoid arthritis (RA), a chronic musculoskeletal disorder characterized by high rates of work disability.

Materials and methods: An exploratory qualitative study consisting of in-depth interviews and six-month follow-up with 11 men and women with RA employed at disease onset.

Results: We expand upon previous models of sickness presenteeism by distinguishing between presenteeism that occurs voluntarily (wanting to work despite illness) and involuntarily (feeling pressured to work when ill). RA onset affected participants’ ability to work, yet motivation to remain working remained high. The implementation of workplace adjustments enabled participants to stay working and restore their work capacity. Conversely, managers’ misinterpretation of organizational sickness absence policies could lead to involuntary presenteeism or delayed return to work, conflicting with the notion of work as an aid to recovery.

Conclusion: Workplace adjustments can facilitate voluntary sickness presenteeism. To reduce work disability and sickness absence, organizational policies should be sufficiently flexible to accommodate the needs of workers with fluctuating conditions.

• Implications for rehabilitation

• Individuals with rheumatoid arthritis (RA) are at high risk of work disability.

• Individuals’ motivation to remain in work following onset of RA remains high, yet sickness presenteeism (working while ill) has received largely negative attention.

• It is important to distinguish between voluntary and involuntary forms of sickness presenteeism.

• Workplace adjustments facilitate voluntary sickness presenteeism (wanting to work despite illness) and improve job retention and productivity among workers with RA.

• Involuntary presenteeism (feeling pressured to work while ill) may occur if organizational policies are not sufficiently flexible to accommodate the needs of workers with RA.

     

Patient education and basic body awareness therapy in hip osteoarthritis – a qualitative study of patients’ movement learning experiences

Background: Osteoarthritis (OA) is associated with pain, dysfunction and reduced quality of life. Patient education (PE) followed by 12 weekly sessions of Basic Body Awareness Therapy (BBAT) was offered to patients with hip OA, aiming to strengthen their ability to move and act functionally in daily life.

Aim: To explore how patients described their experiences and outcome from participating in PE and BBAT.

Method: Individual, semi-structured interviews with five patients, aged 52-78 years, were performed after PE and BBAT at four and ten months. Interview data were analyzed by systematic text condensation.

Results: Three main themes emerged. “Becoming motivated and involved” reflected experiences of encouragement and support from information given and communication with group members. In “Movement awareness learning” patients described becoming aware of and improving functional movement, alleviating symptoms and increasing daily functioning. “Movement and disease in a long-term perspective” reflected patient? experience of increased self-awareness and taking better care of themselves at 10 months after baseline. Practicing basic movement principles, they felt empowered to handle daily life challenges in more functional and energy-economical ways.

Conclusion: PE followed by BBAT in groups may be beneficial to patients with hip OA, and provide lasting benefits regarding daily life function.

• Implications for Rehabilitation

• Insight into disease process and relationship to functional movement gained through patient education may empower patients with hip osteoarthritis in management of daily life

• Movement awareness and exploration of movement quality using principles from Basic Body Awareness Therapy was found to support patients in finding resources for functional movement, implemented in daily actions

• Movement strategies characterized by adjustment rather than force was experienced by the patients to support their general functioning, despite of prevailing hip pain

• Implementing group therapeutic factors (Yalom) in physiotherapy was found to strengthen patients’ motivation and belief in functional improvement

     

Patient experience after lower extremity amputation for sarcoma in England: a national survey

Purpose: After amputation, rehabilitation and limb fitting services are critically important to optimise outcomes. We investigated the reported patient experience and variation in limb fitting services after amputation for musculoskeletal tumours in England.

Methods: A postal survey instrument was developed following literature review, patient and clinician consultation and piloting. The survey was sent from each of the five bone tumour surgical centres in England.

Results: One hundred and five responses were received from 250 patients (42%). The number of limb fitting centres accessed by each surgical centre varied from 2 to 28. Many patients reported care falling short of national standards in areas including pre-amputation counselling, information provision, meeting someone with a similar amputation before surgery, psychological support and falls management. Patients were seen sooner where limb fitting services were on site. Many patients rely on being driven, ambulance and public transport to access services.

Conclusion: This study demonstrates variation in the reported experience of limb fitting services by sarcoma patients. Areas for improvement include information provision, pre-amputation counselling, psychological support and falls management. Clinicians should be aware services are highly variable, and this may impact on outcomes. Patients treated in sarcoma centres with limb fitting services on site may experience better care.

• Implications for Rehabilitation

• Rehabilitation services should strive to meet agreed national standards consistently.

• Where preamputation counselling involving meeting someone with a similar amputation is not possible, good information including video could be helpful.

• Services should support rehabilitation in the form of early walking aids and efficient prosthetic repair and maintenance.

• Psychological support, occupational therapy and physiotherapy support must be provided in the acute and chronic phases, including access to long-term rehabilitation care.

• Rehabilitation programmes must include training to patients and families on reporting, prevention and management of falls.

• On site services may support better care.

• Mechanisms for delivering expert specialist care close to home are needed.

     

Six-minute walking test in children

• Implications for Rehabilitation

• Six-minute walking test.

• The six-minute walking test is safe and widely performed in the world because of its easy implementation and low cost.

• Many countries have established normal values to the six-minute walking test in healthy children.

• However, the applicability of this test also gains popularity among children with other disease conditions.

     

The Pediatric Version of the Eating Assessment Tool: a caregiver administered dyphagia-specific outcome instrument for children

Purpose: To develop and evaluate the psychometric properties of the Pediatric version of the caregiver administered Eating Assessment Tool.

Methods: The study included developmental phase and reported content, criterion validity, internal consistency and test–retest reliability of the Pediatric Eating Assessment Tool. Literature review and the original Eating Assessment Tool were used for line-item generation. Expert consensus assessed the items for content validity over two Delphi rounds. Fifty-one healthy children to obtain normative data and 138 children with cerebral palsy to evaluate test–retest reliability, internal consistency, and criterion validity were included. The Penetration-Aspiration Scale was used to assess criterion validity.

Results: All items were found to be necessary. Content validity index was 0.91. The mean score of Pediatric Eating Assessment Tool for healthy children and children with cerebral palsy was 0.26?±?1.83 and 19.5?±?11, respectively. The internal consistency was high with Cronbach’s alpha =0.87 for test and retest. An excellent correlation between the Pediatric Eating Assessment Tool and Penetration-Aspiration score for liquid and pudding swallowing was found (p?r?=?0.77; p?r?=?0.83, respectively). A score >4 demonstrated a sensitivity of 91.3% and specificity of 98.8% to predict penetration/aspiration.

Conclusions: The Pediatric Eating Assessment Tool was shown to be a valid and reliable tool to determine penetration/aspiration risk in children.

• Implications for rehabilitation

• The pediatric eating assessment tool: a new dyphagia-specific outcome survey for children.

• The Pediatric Version of the Eating Assessment Tool is a dysphagia specific, parent report outcome instrument to determine penetration/aspiration risk in children.

• The Pediatric Version of the Eating Assessment Tool has good internal consistency, test–retest reliability and criterion-based validity.

• The Pediatric Version of the Eating Assessment Tool may be utilized as a clinical instrument to assess the need for further instrumental evaluation of swallowing function in children.

     

Longer time spent in bed attempting to sleep is associated with rapid renal function decline: the Dongfeng–Tongji cohort study

Introduction: Prospective evidence on the relation between time in bed and renal dysfunction remains limited. We aimed to investigate the association of time spent in bed attempting to sleep (TSBS) with renal function decline in a middle-aged and elderly Chinese population.

Methods: About 16,733 eligible participants with a mean age of 62.3 years at baseline were included. Rapid renal function decline was defined as (baseline eGFR???revisit eGFR)/years of follow-up ≥5?mL/min per 1.73 m²/year. A total of 1738 study participants experienced rapid renal function decline after a median 4.6-year follow-up. Logistic regression models were used for multivariate analyses.

Results: The adjusted odds ratio (OR) of rapid renal function decline was 1.18 (95% CI: 1.02, 1.37) for TSBS ≥9?h/night compared with TSBS 7 to <8?h/night. This association remained significant (OR?=?1.19, 95% CI: 1.03, 1.38) after further adjustment for sleep quality, midday napping and usage of sleeping pills. Particularly, the association appeared to be prominent in individuals with diabetes.

Conclusions: Longer TSBS (≥9?h) was independently associated with an increased risk of rapid renal function decline. Our findings emphasized the importance to have optimal TSBS.

• Key messages

• Our study firstly investigated the association between time spent in bed attempting to sleep (TSBS) and renal dysfunction in Chinese adults.

• Compared with individuals TSBS 7 to <8?h, individuals with TSBS ≥9?h had 19% increased risk for rapid renal function decline after adjustment for multivariate confounders.

• The association appeared to be prominent in individuals with diabetes.