Cervical auscultation as an adjunct to the clinical swallow examination: A comparison with fibre-optic endoscopic evaluation of swallowing

Abstract

This prospective, single-blinded study investigated the validity and reliability of cervical auscultation (CA) under two conditions; (1) CA-only, using isolated swallow-sound clips, and (2) CSE + CA, using extra clinical swallow examination (CSE) information such as patient case history, oromotor assessment, and the same swallow-sound clips as condition one. The two CA conditions were compared against a fibre-optic endoscopic evaluation of swallowing (FEES) reference test. Each CA condition consisted of 18 swallows samples compiled from 12 adult patients consecutively referred to the FEES clinic. Patients’ swallow sounds were simultaneously recorded during FEES via a Littmann E3200 electronic stethoscope. These 18 swallow samples were sent to 13 experienced dysphagia clinicians recruited from the UK and Australia who were blinded to the FEES results. Samples were rated in terms of (1) if dysphagic, (2) if the patient was safe on consistency trialled, and (3) dysphagia severity. Sensitivity measures ranged from 83–95%, specificity measures from 50–92% across the conditions. Intra-rater agreement ranged from 69–97% total agreement. Inter-rater reliability for dysphagia severity showed substantial agreement (r_s = 0.68 and 0.74). Results show good rater reliability for CA-trained speech-language pathologists. Sensitivity and specificity for both CA conditions in this study are comparable to and often better than other well-established CSE components.     

The Modified – Modified Schober Test for range of motion assessment of lumbar flexion in patients with low back pain: A study of criterion validity,intra- and inter-rater reliability and minimum metrically detectable change

Purpose.?The objective was to estimate the psychometric properties of the Modified?–?Modified Schober Test (MMST).

Design.?This study compared range of motion measurements of lumbar flexion in low back pain (LBP) patients using the MMST with measurements calculated on X-rays as the gold standard, and compared the measurements taken by two independent examiners.

Method.?This study was conducted at the main hospital in the Outaouais area, Quebéc, Canada. Thirty-one subjects with LBP from private and public clinics participated in the study. After a warm-up session, measurements with the MMST were taken in neutral position and an X-ray technician took an exposure in the same position.

Results.?Pearson's correlation test (r) between measurements made with the MMST and the gold standard, intra-class correlation coefficient (ICC), minimum metrically detectable change (MMDC) and confidence interval (CI) were used to analyze the data. The MMST demonstrated moderate validity (r?=?0.67; 95%CI 0.44?–?0.84), excellent reliability (intra: ICC?=?0.95; 95%CI 0.89?–?0.97; inter: ICC?=?0.91; 95%CI 0.83?–?0.96) and a MMDC of 1?cm.

Conclusions.?In our sample of LBP patients, the MMST showed moderate validity but excellent reliability and MMDC.     

Ultrasound-based motor control training for the pelvic floor pre- and post-prostatectomy: Scoring reliability and skill acquisition

Aim: This study documents a protocol designed to evaluate pelvic floor motor control in men with prostate cancer. It also aims to evaluate the reliability of therapists in rating motor control of pelvic floor muscles (PFMs) using real time ultrasound imaging (RUSI) video clips. We further determine predictors of acquiring motor control. Methods: Ninety-one men diagnosed with prostate cancer attending a physiotherapy clinic for pelvic floor exercises were taught detailed pelvic floor motor control exercises by a physiotherapist using trans-abdominal RUSI for biofeedback. A new protocol to rate motor control skill acquisition was developed. Three independent physiotherapists assessed motor control skill attainment by viewing RUSI videos of the contractions. Inter-rater reliability was evaluated using intra-class correlation coefficients. Logistic regression analysis was conducted to identify predictors of successful skill attainment. Acquisition of the skill was compared between pre- and post-operative participants using an independent-group t-test. Results: There was good reliability for rating the RUSI video clips (ICC 0.73 (95%CI 0.59–0.82)) for experienced therapists. Having low BMI and being seen pre-operatively predicted motor skill attainment, accounting for 46.3% of the variance. Significantly more patients trained pre-operatively acquired the skill of pelvic floor control compared with patients initially seen post-operatively (OR 11.87, 95%CI 1.4 to 99.5, p = 0.02). Conclusions: A new protocol to evaluate attainment of pelvic floor control in men with prostate cancer can be assessed reliably from RUSI images, and is most effectively delivered pre-operatively.     

The impact of childhood language difficulties on healthcare costs from 4 to 13 years: Australian longitudinal study

Purpose: This study investigated the relationship between children’s language difficulties and health care costs using the 2004–2012 Longitudinal Study of Australian Children (LSAC).

Method: Language difficulties were defined as scores ≤1.25SD below the standardised mean on measures of directly assessed receptive vocabulary (4–9 years) and teacher-reported language and literacy (10–13 years). Participant data were individually linked to administrative data, which were sourced from Australia’s universal subsidised healthcare scheme (Medicare).

Result: It was found that healthcare costs over each 2-year age band were higher for children with language difficulties than without in the 4–5-year-age bracket (mean difference?=?AU$357, 95%CI $59, $659), in the 6–7-year-age bracket (mean difference?=?AU$602, 95%CI $136, $1068) and in the 10–11-year-age bracket (mean difference?=?AU$504, 95%CI $153, $854). Out-of-pocket costs, that is the portion of healthcare costs paid for by the family, were also higher for children with than without language difficulties in the 4–5-year-age bracket (mean difference?=?AU$123, 95%CI $46, $199), in the 6–7-year-age bracket (mean difference?=?AU$176, 95%CI $74,278) and in the 10–11-year-age bracket (mean difference?=?AU$79, 95%CI $6, $152). Medical services accounted for 97% of total healthcare cost differences.

Conclusion: Overall the findings from this study suggest that language difficulties are associated with increased healthcare costs at key developmental milestones, notably early childhood and as a child approaches the teenage years.     

Predictors of referral uptake in children with disabilities in Bangladesh – Exploring barriers as a first step to improving referral provision

Purpose: Making services available to children with disabilities in low- and middle-income countries does not guarantee their use. This study aims to identify factors associated with the uptake of referrals in order to investigate barriers to service use. Methods: Children with impairments identified in two districts of Bangladesh were invited to attend screening camps where their condition was confirmed; they were provided with referrals for rehabilitation and treatment services. Predictors of referral uptake were identified using logistic regression. Results: Overall referral uptake was 47%, 32% in Sirajganj and 61% in Natore. There was no association between age or gender and referral uptake. Factors predictive of referral uptake were higher income in Sirajganj (OR?=?2.6 95%CI 1.4–5.0), and the districts combined (OR?=?1.6 95%CI 1.1–2.1); maternal literacy in Natore (OR?=?1.6 95%CI 1.0–2.5); and epilepsy in all three models (Sirajganj: OR?=?2.6 95%CI 1.7–4.0; Natore: OR?=?13.5 95%CI 6.5–28.3; Combined: OR?=?4.6 95%CI 3.3–6.5). Physical impairment was associated with increased odds of uptake in Sirajganj and in the combined model (OR?=?2.7 95%CI 1.8–4.1; OR?=?3.34 95%CI 2.2–5.2). Conclusions: Even when some logistical and financial assistance is available, children with impairment from low-income families may require additional support to take up referrals. There may be greater willingness to accept treatment that is locally provided, such as medication for epilepsy or therapy at village level.

Implications for Rehabilitation

• Providing a referral for treatment or rehabilitation is often not enough to ensure access to service for children with disabilities in low and middle income countries.

• Uptake of referral can be influenced by many factors, and individuals face different types of barriers.

• Financial and logistical support can help increase referral uptake.

• Low monthly income and maternal illiteracy is associated with lower uptake even when assistance is provided.

     

Factors predictive of alcohol consumption among senior high school students in Phayao province,Thailand

Abstract

Objectives: To identify factors predictive of alcohol consumption among senior high school students in Phayao province, Thailand, where there is a high prevalence of alcohol consumption among adolescents.

Methods: A cross-sectional study in which 317 grade 11 senior high school students participated in a survey during June 2012. Data were collected by face-to-face interviews. Chi-square and multivariate logistic regression were used to determine the factors predictive of alcohol consumption among the subjects.

Results: Over two-thirds of the students (66.9%) had consumed alcohol in their lifetime, 58.7% in the previous year and 17.4% in the previous month. Following univariate analysis, seven factors – gender, age, GPA, allowance, first age of drinking, peer drinking and alcohol knowledge were identified as being significantly associated with drinking (p?<?0.05). Multivariate analysis revealed four factors to be predictive of alcohol among high school students: peer drinking (OR?=?3.59, 95%CI?=?1.99–6.44), alcohol knowledge (OR?=?2.64, 95%CI?=?1.47–4.72), GPA?≥?2.5 (OR?=?0.32, 95%CI?=?0.16–0.64) and allowance (OR?=?0.15, 95%CI?=?0.04–0.58).

Conclusion: Peer drinking was the strongest predictor of adolescent alcohol consumption, while alcohol knowledge had negative correlation with alcohol consumption. Hence, peer influence and appropriate alcohol knowledge should be considered as key areas in attempts to reduce alcohol consumption among senior high school students.     

Dysarthria and dysphagia are highly prevalent among various types of neuromuscular diseases

Abstract

Purpose: Patients with a neuromuscular disease (NMD) can present with dysarthria and/or dysphagia. Literature regarding prevalence rates of dysarthria and dysphagia is scarce. The purpose of this study was to determine prevalence rates, severity and co-presence of dysarthria and dysphagia in adult patients with NMD. Method: Two groups of adult patients with NMD were included: 102 consecutive outpatients (the “unselected cohort”) and 118 consecutive patients who were referred for multidisciplinary assessment (the “selected cohort”). An experienced speech-language pathologist examined each patient in detail. Results: The pooled prevalence of dysarthria was 46% (95% CI: 36.5–55.9) and 62% (95% CI: 53.3–70.8) in the unselected and selected cohorts, respectively. The pooled prevalence of dysphagia was 36% (95% CI: 27.1–45.7) and 58% (95% CI: 49.4–67.2) in the unselected and selected cohorts, respectively. There was a modest but significant association between the presence of dysarthria and dysphagia (r_s?=?0.40; p?<?0.01). Although the dysphagia was generally mild, dysarthria was moderate to severe in 15% of the dysarthric patients. Conclusion: The prevalence rates of dysarthria and dysphagia among patients with various types of NMD are high. Physicians should therefore be aware of this prevalence and consider referring NMD patients to a speech-language pathologist.

• Implicatons of Rehabilitation

• Both dysarthria and dysphagia are highly prevalent among patients with neuromuscular diseases; moreover, although often mild, these disorders can occur relatively early in the course of the disease.

• Clinicians should routinely check for signs and symptoms related to dysarthria and/or dysphagia in patients who present with a neuromuscular disease, preferably using standardised instruments.

     

Factors Associated with Transition Planning in Autism and Other Developmental Disabilities

Objective

To determine whether functional self-care skills and presence of behavior problems in youth with developmental disabilities are associated with parents planning for the youth’s transition to adulthood.

Methods

This multi-site study consisted of 167 parents of youth aged 10–22 years with autism spectrum disorder, ADHD and/or other developmental disabilities who completed a questionnaire on transition to adulthood. Parent-rated child self-care status was measured using a six-item scale that had excellent reliability (Cronbach’s alpha=0.90).

Results

Multivariable logistic regression models revealed that parents were less likely to plan for the youth’s transition to adulthood if their child needed more assistance with functional self-care skills (OR 0.78, 95% CI 0.63–0.96, p=.021). Despite this unexpected finding, greater child need for assistance with self-care was associated with lower parental expectations that their children would live independently by age 22 (OR 0.40, 95%CI 0.24–0.66, p<.001) and 35 (OR 0.47, 95%CI 0.35–0.63, p<.001). The presence of behavioral problems (aggression, sexual behaviors and safety issues) was also associated with lower odds of parental expectations that their child would live independently in adulthood.

Conclusions

Despite this unexpected finding, greater child need for assistance with self-care was associated with lower parental expectations that their children would live independently by age 22 (OR 0.40, 95%CI 0.24–0.66, p<.001) and 35 (OR 0.47, 95%CI 0.35–0.63, p<.001). The presence of behavioral problems (aggression, sexual behaviors and safety issues) was also associated with lower odds of parental expectations that their child would live independently in adulthood. Despite parents’ awareness of the difficulties their children will face, less youth independence with self-care skills was associated with lower odds of plans for transition to adulthood and expectations for independent living. Results support the need for continued interventions targeted at improving daily living skills to achieve functional independence in adulthood, as well as interventions focused on aggression, safety and sexuality of the individuals.

     

Utility of QT interval corrected by Rautaharju method to predict drug-induced torsade de pointes

Introduction: New QT correction formulae derived from large populations are available such as Rautaharju’s [QTcRTH?=?QT * (120?+?HR)/180] and Dmitrienko’s [QTcDMT?=?QT/RR^0.413]. These formulae were derived from 57,595 and 13,039 cases, respectively. Recently, a study has shown that they did not experience errors across a wide range of heart rates compared to others.

Objectives: (1) To determine the best cut-off value of QTcRTH and QTcDMT as a predictor of torsade de pointes (TdP) and (2) to compare the sensitivity and specificity using the cut-off value of QTcRTH with those of the QTcBazett (QTcBZT), QTcFridericia (QTcFRD), and QT nomogram.

Methods: Data were derived from two data sets. All cases aged over 18 years with an exposure to QT-prolonging drugs. Group-1, all cases developed TdP. Data in Group-1 were obtained from systematic review of reported cases from Medline since its establishment until 10 December 2015. Group-2 is composed of those who overdosed on QT prolonging drugs but did not develop TdP. This data set was previously extracted from a chart review of three medical centers from January 2008 to December 2010. Data from both groups were used to calculate QTcRTH and QTcDMT. The cut-off values from QTcRTH and QTcDMT that provided the best sensitivity and specificity to predict TdP were then selected. The same method was applied to find those values from QTcBZT, QTcFRD, and QT nomogram. The receiver operating characteristic curve (ROC) was applied where appropriate.

Results: Group-1, 230 cases of drug-induced TdP were included from the systematic review of Medline. Group-2 (control group), which did not develop TdP, consisted of 292 cases. After applying all of the correction methods to the two datasets, the best cut-off values that provided the best accuracy (Ac) with the best sensitivity (Sn) and specificity (Sp) for each formula were as follows: QTcRTH at 477 milliseconds (ms), Ac?=?89.08%, Sn?=?91.30% (95%CI?=?86.89–94.61), Sp?=?87.33%(95%CI?=?82.96–90.92); QTcDMT at 475?ms, Ac?=?88.31%, Sn?=91.30% (95%CI?=?86.89–94.61), Sp?=?85.96%(95%CI?=?81.44–89.73); QTcBZT at 490?ms, Ac?=?86.97%, Sn?=?88.26% (95%CI?=?83.38–92.12), Sp?=?85.96% (95%CI?=?81.44–89.73); QTcFRD at 473?ms, Ac?=?88.89%, Sn?=?89.13% (95%CI?=?84.37–92.84), Sp =88.70% (95%CI?=?84.50–92.09). We found a significant difference (p-value?=?0.0020) between area under the ROC of the QTcRTH (0.9433) and QTcBZT (0.9225) but not QTcFRD (0.9338). The Ac, Sn, and Sp of the QT nomogram were 89.08%, 91.30% (95%CI?=?86.89–94.61), and 87.33% (95%CI?=?82.96–90.92), respectively, and they were all equal to those of QTcRTH.

Conclusion: Rautaharju method not only produced minimal errors for QT interval correction but also at QTcRTH 477?ms, it could predict TdP as accurately as QT nomogram and was better than the QTcBZT.     

Fundamental movement skills testing in children with cerebral palsy

Purpose.?To examine the inter-rater reliability and comparative validity of product-oriented and process-oriented measures of fundamental movement skills among children with cerebral palsy (CP).

Method.?In total, 30 children with CP aged 6 to 14 years (Mean == 9.83, SD == 2.5) and classified in Gross Motor Function Classification System (GMFCS) levels I–III performed tasks of catching, throwing, kicking, horizontal jumping and running. Process-oriented assessment was undertaken using a number of components of the Test of Gross Motor Development (TGMD-2), while product-oriented assessment included measures of time taken, distance covered and number of successful task completions. Cohen's kappa, Spearman's rank correlation coefficient and tests to compare correlated correlation coefficients were performed.

Results.?Very good inter-rater reliability was found. Process-oriented measures for running and jumping had significant associations with GMFCS, as did seven product-oriented measures for catching, throwing, kicking, running and jumping. Product-oriented measures of catching, kicking and running had stronger associations with GMFCS than the corresponding process-oriented measures.

Conclusion.?Findings support the validity of process-oriented measures for running and jumping and of product-oriented measures of catching, throwing, kicking, running and jumping. However, product-oriented measures for catching, kicking and running appear to have stronger associations with functional abilities of children with CP, and are thus recommended for use in rehabilitation processes.     

Modified Rivermead Mobility Index: a reliable measure in people within 14 days post-stroke

Abstract

Purpose: The reliability of the Modified Rivermead Mobility Index (MRMI) has not previously been investigated in the very early post-stroke phase. The aim of the study was to evaluate inter-rater and intra-rater reliability and internal consistency in patients, 1–14?d post-stroke. Method: A cohort study with repeated measures within 24?h, on 37 patients, 1–14?d post-stroke was conducted. Inter-rater (two raters) and intra-rater (one rater) reliability was analyzed using weighted kappa (κ) statistics and internal consistency with Cronbach’s alpha and intra-class correlation (ICC), 3.k. Results: Inter-rater and intra-rater reliability was excellent (ICC coefficient 0.97 and 0.99) for MRMI summary score. Intra-rater exact agreement for separate items was between 77% and 97%; κ between 0.81 and 0.96. Inter-rater exact agreement for separate items was between 68% and 92%; κ 0.59–0.87. The internal consistency was high (α 0.96; ICC 3.k 0.99). Conclusion: The MRMI is a reliable measure of physical mobility in the early post-stroke phase.     

Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis†

Diabetic foot is a severe public health issue, yet rare studies investigated its global epidemiology. Here we performed a systematic review and meta-analysis through searching PubMed, EMBASE, ISI Web of science, and Cochrane database. We found that that global diabetic foot ulcer prevalence was 6.3% (95%CI: 5.4–7.3%), which was higher in males (4.5%, 95%CI: 3.7–5.2%) than in females (3.5%, 95%CI: 2.8–4.2%), and higher in type 2 diabetic patients (6.4%, 95%CI: 4.6–8.1%) than in type 1 diabetics (5.5%, 95%CI: 3.2–7.7%). North America had the highest prevalence (13.0%, 95%CI: 10.0–15.9%), Oceania had the lowest (3.0%, 95% CI: 0.9–5.0%), and the prevalence in Asia, Europe, and Africa were 5.5% (95%CI: 4.6–6.4%), 5.1% (95%CI: 4.1–6.0%), and 7.2% (95%CI: 5.1–9.3%), respectively. Australia has the lowest (1.5%, 95%CI: 0.7–2.4%) and Belgium has the highest prevalence (16.6%, 95%CI: 10.7–22.4%), followed by Canada (14.8%, 95%CI: 9.4–20.1%) and USA (13.0%, 95%CI: 8.3–17.7%). The patients with diabetic foot ulcer were older, had a lower body mass index, longer diabetic duration, and had more hypertension, diabetic retinopathy, and smoking history than patients without diabetic foot ulceration. Our results provide suggestions for policy makers in deciding preventing strategy of diabetic foot ulceration in the future.

• Key messages

• Global prevalence of diabetic foot is 6.3% (95%CI: 5.4–7.3%), and the prevalence in North America, Asia, Europe, Africa and Oceania was 13.0% (95%CI: 10.0–15.9%), 5.5% (95%CI: 4.6–6.4%), 5.1% (95%CI: 4.1–6.0%), 7.2% (95%CI: 5.1–9.3%), and 3.0% (95% CI: 0.9–5.0%).

• Diabetic foot was more prevalent in males than in females, and more prevalent in type 2 diabetic foot patients than in type 1 diabetic foot patients.

• The patients with diabetic foot were older, had a lower body mass index, longer diabetic duration, and had more hypertension, diabetic retinopathy, and smoking history than patients without diabetic foot.

     

Association of shift-work,daytime napping,and nighttime sleep with cancer incidence and cancer-caused mortality in Dongfeng-tongji cohort study

Background: Few studies investigated the combined effects of night-shift work, daytime napping, and nighttime sleep on cancer incidence and mortality.

Methods: A total of 25,377 participants were included in this study. Information on sleep habits, cancer incidences, and mortalities were collected. Cox proportional hazards models were used to calculate the adjusted hazard ratios and 95% confidence intervals (HRs, 95%CIs).

Results: Male subjects experienced ≥20 years of night-shift work, or without daytime napping had an increased risk of cancer, when compared with males who did not have night-shift work or napped for 1–30?min [HR (95%CI)?=?1.27 (1.01–1.59) and 2.03 (1.01–4.13), respectively]. Nighttime sleep for ≥10?h was associated with a separate 40% and 59% increased risk of cancer [HR (95%CI)?=?1.40 (1.04–1.88)] and cancer-caused mortality [HR (95%CI)?=?1.59 (1.01–2.49)] than sleep for 7–8?h/night. Combined effects of three sleep habits were further identified. Male participants with at least two above risk sleep habits had a 43% increased risk of cancer [HR (95%CI)?=?1.43 (1.07–2.01)] and a 2.07-fold increased cancer-caused mortality [HR (95%CI)?=?2.07 (1.25–3.29)] than those who did not have any above risk sleep habits. However, no significant associations were observed among women.

Conclusions: Long night-shift work history, without daytime napping, and long nighttime sleep duration were independently and jointly associated with higher cancer incidence among males.

• KEY MESSAGES

• Night-shift work of ≥20 years, without napping, and nighttime sleep of ≥10?h were associated with increased cancer incidence.

• Nighttime sleep ≥10?h was associated with a 2.07-fold increased cancer-caused mortality among males.

• Combined effects of night-shift work ≥20 years, without napping, and nighttime sleep ≥10?h on increasing cancer incidence were existed among males.

     

Classification of childhood hearing impairment: implications for rehabilitation in developing countries

Aim:?To ascertain the rehabilitation needs of hearing impaired school entrants in developing countries based on current criteria for evaluating classification of childhood hearing impairment.

Methods:?The profile of hearing impairment was examined in 50 children from eight randomly selected mainstream schools, based on findings from medical history, physical examination, otoscopy, pure-tone audiometry and tympanometry. The hearing thresholds across frequencies 0.25?–?8.0 kHz were analysed. The results were compared with conventional pure-tone averages (0.5?–?4.0 kHz) and WHO's criteria/threshold for disabling hearing impairment.

Results:?Seventeen (94.4%) of the 18 children with conductive hearing loss based on conventional audiometry had high-frequency hearing loss. Similarly, 10 children (83.3%) of the 12 children with sensorineural hearing loss and 19 children (95%) of the 20 children with mixed hearing loss had high-frequency hearing loss. Forty-six hearing impaired children (92%): comprising those with permanent unilateral hearing loss >?30 dBHL, permanent hearing loss would have been missed by WHO criteria.

Conclusions:?Conventional school audiometry and WHO criteria for disabling hearing impairment are unlikely to detect the full spectrum of hearing disability in relation to activity limitation and participation restriction. The rehabilitation needs of the affected children cannot therefore be appropriately addressed by these approaches.     

Foot and leg problems are important determinants of functional status in community dwelling older people

Purpose.?To determine whether foot and leg problems are independently associated with functional status in a community sample of older people after adjusting for the influence of socio-demographic, physical and medical factors.

Method.?Data were analysed from the Health Status of Older People project, a population-based study involving a random sample of 1000 community-dwelling people aged 65?–?94 years (533 females, 467 males, mean age 73.4 years?±?5.87). A structured interview and brief physical examination were used to investigate the associations between self-reported foot and leg problems and functional status. Functional status was assessed using: (i) timed ‘Up & Go’ test, (ii) self-reported difficulty climbing stairs, (iii) self-reported difficulty walking one kilometer, (iv) self-reported difficulty performing instrumental activities of daily living (IADLs), and (v) self-reported history of one or more falls in the previous 12 months. These associations were then explored after adjusting for socio-demographic, physical and medical factors.

Results.?Thirty-six percent of the sample reported having foot or leg problems. Univariate analyses revealed that people with foot and leg problems were significantly more likely to exhibit poorer functional status in all parameters measured. After adjusting for socio-demographic, physical and medical factors, foot and leg problems remained significantly associated with impaired timed ‘Up & Go’ performance (OR?=?2.15, 95%CI 1.55?–?2.97), difficulty climbing stairs (OR?=?3.33, 95%CI 1.98?–?5.61), difficulty walking one kilometer (OR?=?3.13, 95%CI 2.09?–?4.69), and history of falling (OR?=?1.73, 95%CI 1.26?–?2.37).

Conclusions.?Foot and leg problems are reported by one in three community-dwelling people aged 65 years and older. Independent of the influence of age, gender, common medical conditions and other socio-demographic factors, foot and leg problems have a significant impact on the ability to perform functional tasks integral to independent living.     

Active listing and more consultations in primary care are associated with shorter mean hospitalisation and interacting with psychiatric disorders when adjusting for multimorbidity,age and sex

Objective: Patient-provider relationships with primary care and need for hospitalisations are related within the complex networks comprising healthcare. Our objective was to analyse mean days hospitalised, using registration status (active or passive listing) with a provider and number of consultations as proxies of patient-provider relationships with primary care, adjusting for morbidity burden, age and sex while analysing the contribution of psychiatric disorders. The Johns Hopkins Adjusted Clinical Groups Case-Mix System was used to classify morbidity burden into Resource Utilization Band (RUB) 0-5.

Design: Cross-sectional population study using zero-inflated negative binomial regression.

Setting and subjects: All population in the Swedish County of Blekinge (N?=?151 731) in 2007.

Main outcome measure: Mean days hospitalised.

Results: Actively listed were in mean hospitalised for 0.86 (95%CI 0.81–0.92) and passively listed for 1.23 (95%CI 1.09–1.37) days. For 0–1 consultation mean days hospitalised was 1.16 (95%CI 1.08–1.23) and for 4–5 consultations 0.68 (95%CI 0.62–0.75) days. At RUB3, actively listed were in mean hospitalised for 3.45 (95%CI 2.84–4.07) days if diagnosed with any psychiatric disorder and 1.64 (95%CI 1.50–1.77) days if not. Passively listed at RUB3 were in mean hospitalised for 5.17 (95%CI 4.36–5.98) days if diagnosed with any psychiatric disorder and 2.41 (95%CI 2.22–2.60) days if not.

Conclusions: Active listing and more consultations were associated with a decrease in mean days hospitalised, especially for patients with psychiatric diagnoses.

Implications: Promoting good relationships with primary care could be an opportunity to decrease mean days hospitalised, especially for patients with more complex diagnostic patterns.

• Key Points

• Primary care performance, patient-provider relationships and need for hospitalisation are related within the complex networks comprising healthcare systems.

• Good patient-provider relationships, i.e. more consultations and active listing, with primary care are associated with decreasing mean days hospitalised.

• The impact of patient-provider relationships in primary care on mean days hospitalised increased when psychiatric disorders added to patient complexity.

     

Disability,caregiver’s dependency and patterns of access to rehabilitation care: results from a national representative study in Peru

Purpose: To determine the prevalence of disability in Peru, explore dependency on caregiver’s assistance and assess access to rehabilitation care. Method: Data from Disability National Survey (ENEDIS), including urban and rural areas, were analyzed. Disability was defined as a permanent limitation on movement, vision, communication, hearing, learning/remembering or social relationships. Dependency was defined as the self-reported need for a caregiver to help with daily activities; and access to rehabilitation care was defined as the self-report of any therapy for disabilities. Estimates and projections were calculated using sample strata, primary sampling units and population weights, and prevalence ratios (PRs) and 95%CI were reported. Results: From 798?308 people screened, 37?524 (5.1%; 95%CI 4.9--5.2%) had at least one disability. A total of 37?117 were included in further analysis, mean age 57.8 (SD?±?24.1) years, 52.1% women. Dependency was self-reported by 14?980 (40.5%; 95%CI: 39.2–41.9%) individuals with disabilities. A family member, usually female, was identified as a caregiver in 94.3% (95%CI: 93.3–95.3%) of dependent participants. Only 2881 (10.7%; 95%CI: 9.7–11.9%) of people with disabilities reported access to rehabilitation care. Major inequality patterns of disability burden versus access to rehabilitation care were observed by age and education level. Older age groups had higher disability burden yet lower chances of access to rehabilitation care. Conversely, the higher the education level, the lesser the overall disability burden but also the higher chances of reporting receiving care. Private healthcare insurance doubled the probability of having access to rehabilitation compared with those without insurance. Conclusions: Approximately 1.6 million Peruvians have at least one disability, and 40% of them require assistance with daily activities. Informal caregiving, likely female and relative-provided, is highly common. Rehabilitation care access is low and inequitable. Our results signal a major need to implement strategies to guarantee the highest standard of health care for people with disabilities.

• Implications for Rehabilitation

• Major inequality patterns in terms of burden of disability versus access to rehabilitation care were observed: those groups who concentrate more disability reported receiving less rehabilitation care.

• Caregiving is mostly informal and provided by a direct relative, mainly a woman, who resigned to their usual activities in order to help care for the person with disability. As a result, there is a need to develop appropriate support and training for caregivers.

• Access to care services in Peru is low and inequitable, but especially for people with disabilities: they experience greater barriers when accessing healthcare services even in the case of having health insurance.

     

Reliability,validity, and norms of the 2-min walk test in children with and without neuromuscular disorders aged 6–12

Purpose: The 2-min walk test may be more appropriate functional exercise test for young children. This study aimed to examine the 2-min walk test’s reliability; validity; and minimal clinically important difference; and to establish norms for children aged 6–12.

Methods: Sixty-one healthy children were recruited to examine the 2-min walk test’s reliability. Forty-six children with neuromuscular disorders (63% cerebral palsy) were recruited to test the validity. The normative study involved 716 healthy children without neuromuscular disorders (male?=?51%, female?=?49%). They walked at a self-selected speed for 2?min along a smooth, flat path 15 m in length.

Results: The mean distance covered in the 2-min walk test was 152.8 m (SD?=27.5). No significant difference was found in the children’s test-retest results (p?>?0.05). The intra- and inter-rater reliability were high (all intra-class correlation coefficients >0.8). All children, except one with neuromuscular disorders, completed the 2-min walk test, of which the minimal clinically important difference at 95% confidence interval was 23.2 m for the entire group, 15.7 m for children walking with aids, and 16.6 m for those walking independently.

Conclusions: The 2-min walk test is a feasible, reliable, and valid exercise test for children with and without neuromuscular disorders aged 6–12. The first normative references and minimal clinically important difference for children with neuromuscular disorders were established for children of this age group.

• Implications for rehabilitation

• The 2-min walk test is a feasible, safe, reliable, and valid time-based walk test for children aged 6–12 years.

• Normative references have been established for healthy children aged 6–12 years.

• Minimal clinically important difference at 95% confidence interval were calculated for children with neuromuscular disorders who walked without aids (i.e., independent and stand-by supervision) and those who walked with aids equal to 16.6 and 15.7 m, respectively.

• Distance covered by the healthy children in the 2?min did not correlate with age, gender, height, and weight of the children.

     

Evaluation of a parent-report diary of the home use of assistive devices by young children with cerebral palsy

Purpose.?To develop and evaluate the preliminary measurement properties of a parent-report diary of the home use of seating and mobility devices by young children with cerebral palsy (CP).

Method.?Four AT experts reviewed the home use of technology for children (HUTCH) diary to confirm its coverage of AT devices, and six parents of young children with CP examined its content, wording and organization. A random sample of 12 other parents independently completed a HUTCH diary daily for 1 week to record their child's use of seating, mobility and orthotic devices at home. Two to three weeks later, parents completed a second diary of AT device use over another seven consecutive days.

Results.?The face validity, content validity and test–retest reliability (ICC = 0.91; 95% CI = 0.69–0.97) of the HUTCH were very good. Parents reported that they completed the diary quickly and easily.

Conclusions.?The HUTCH diary shows promise as a reliable and practical way to record the frequency and number of hours that children use different types of seating and mobility-related devices at home. Testing the concurrent validity of the HUTCH diary against an acceptable criterion measure will improve its acceptance as measure of AT device use.