What instruments have been used to assess the mobility of community-dwelling older adults?

Abstract

Background: The primary aim of this review was to identify existing instruments that have been used to assess the mobility status of community-dwelling older adults. The secondary aims were to identify instruments that have face validity for measuring across the full mobility spectrum and to summarise and compare their clinimetric properties.

Methods: MEDLINE, CINAHL, PEDro, and EMBASE were searched until April 2007. The first stage included searching for papers that reported mobility outcome measures that had been applied to healthy community-dwelling older adults. The second stage identified these outcome measures and the third stage compared clinimetric properties of the instruments that had face validity for measuring across the full mobility spectrum (from bed-bound to high levels of independent mobility). Two independent reviewers extracted data from the included studies.

Results: From the 128 included papers, 14 outcome measures were identified, two of which, the Lower Extremity Functional Scale (LEFS) and the Elderly Mobility Scale (EMS), measured across the full spectrum of mobility. No clinimetric evidence was found for the LEFS amongst a community-dwelling older population and only evidence of known groups validity was identified for the EMS.

Discussion: An outcome measure that has face validity for measuring across the full mobility spectrum and has sufficient clinimetric evidence in a community dwelling population was not identified.

Conclusion: This review supports the need for the development of such an instrument.     

Clinically useful outcome measures for physiotherapy airway clearance techniques: a review

Abstract

A lack of good outcome measures has been a barrier to the development of an evidence base for all areas of respiratory physiotherapy. Many of the clinically available outcome measures are not specifically related to the physiotherapy intervention employed and may be affected by other factors. In this paper, the outcome measures currently clinically available to UK NHS physiotherapists to assess the response to alveolar recruitment and airway clearance interventions have been reviewed. It is clear that there is an urgent need to increase the accuracy, reliability, and sensitivity of the outcome measures employed, or to develop new measures to assess the effectiveness of respiratory physiotherapy. Lung sounds provide useful, specific information, but standard auscultation is too subjective to allow them to be used as an outcome measure. Computer Aided Lung Sound Analysis (CALSA) is proposed as a new objective, non-invasive, bedside clinical measure with the potential to monitor and assess the effects of airway clearance therapy.     

Prognostic Factors and Treatment-Related Changes Associated with Return to Work in the Multimodal Treatment of Chronic Back Pain

The goals of the current study were to determine those preprogram (=prognostic) variables and treatment-related changes that predict return to work in the multimodal management of chronic back pain. The outcome measures for 143 patients at 6-month follow-up were analyzed. The program had a duration of 4 weeks, was based largely on the functional restoration approach (Mayer and Gatchel, 1998), and occurred within a workers' compensation framework. Some 87% of the patients successfully returned to work. Three sets of predictor variables were considered: demographic/socioeconomic data, physical measures, and psychological measures. Three prognostic variables proved to be significant negative predictors of return to work: time off work, previous spinal surgery, and a clinically elevated (preprogram) score on the MMPI-2 scale Lassitude-Malaise (Hy3). A repeated-measures MANOVA showed an incomplete return to work to be associated with only limited improvement in self-reported disability and pain report. However, patients who failed to return to work did not differ with regard to improvement in objective physical functioning or psychological distress. It is therefore hypothesized that a change in the perceived disability status is the key element necessary to return patients with chronic back pain to work, although ongoing reinforcement schemes operative in the home work environment may lead to a relapse in the post treatment phase.     

Cultural Differences, Perfectionism, and Suicidal Risk in a College Population: Does Social Problem Solving Still Matter?

The relations between cultural influences,perfectionism, social problem solving, and subsequentsuicidal risk (viz., hopelessness and suicide potential)were examined among 148 college students. Hierarchical regression analyses were conducted to determinewhether social problem solving predicted suicidal risk(1 month later) beyond what was accounted for by ethnicstatus (Asian American or Caucasian American) and perfectionism. Results of these analysesindicated that ethnic status (Step 1) was a significantpredictor of both hopelessness and suicide potential.Furthermore, perfectionism (Step 2) was found to add significant incremental validity forpredicting variance in both outcome criteria. Incontrast, social problem solving (Step 3) addedsignificant incremental validity for predicting variancein suicide potential, but not for predicting hopelessness.Results indicate that social problem solving is a moreuseful predictor of suicide potential than ofhopelessness. Implications for future research arediscussed.     

Cyclin D1 expression in B-cell non Hodgkin lymphoma

Disorders of the cell cycle regulatory machinery playa key role in the pathogenesis of cancer. Over-expression of cyclin D1 protein has been reported in several solid tumors and certain lymphoid malignancies, but little is known about the effect of its expression on clinical behavior and outcome in B-cell Non-Hodgkin lymphoma (NHL).

In this study, we investigated the expression of cyclin D1 in group of patients with NHL and correlated the results with the clinical and laboratory data. The degree of expression of cyclin D1 protein was evaluated by flow cytometry in a group of NHL patients (n = 46) and in normal control group (n = 10). Cyclin D1 over expression was detected in 10 out of 46 (21.7%) patients; they were 5/5-mantle cell lymphoma (MCL) (100%) and 5/28 large B-cell lymphoma (17.8%). All other NHL subtypes showed normal cyclin D1 expression. The clinical signs (hepatomegaly, splenomegaly and B-symptoms, clinical staging) and laboratory data (hemoglobin, white cell count (WBCs), platelet count, and bone marrow infiltration) were not significantly different between NHL subgroup with cyclin D1 over expression and that with normal cyclin D1 expression. Serum lactic dehydrogenase (LDH) levels and lymphadenopathy were significantly higher in NHL group with cyclin D1 over expression as compared to those without. Also, cyclin Dl over expression is associated with poor outcome of NHL patients.

Cyclin D1 over expression was evident among all cases of MCL and few cases of large B-cell lymphoma. Cyclin D1 over expression might be used as adjuvant tool for diagnosis of MCL; has role in NHL biology and is bad prognostic index in NHL.     

Weight Reduction after an Early Version of the Open Gastric Bypass for Morbid Obesity: Results after 23 Years

Background: While numerous promising short-term results of open gastric bypass for morbid obesity were published, the long-term outcome of earlier versions was somewhat disappointing. Thus, it was not until 1993 that this procedure was reintroduced with current modifications and now performed laparoscopically. Published long-term results of gastric bypass are still lacking. Methods: Out of an original population of 195 patients, we retrospectively analyzed the outcome of 98 patients (82 women, 16 men, mean age 32 years [range 17-54], mean weight 132 kg [range 65-200], mean BMI 46.6 kg/m²) operated on in Erlangen with mean follow-up 22.9 years (range 16.5-25.4). 3 different bariatric operations were performed: horizontal gastroplasty (HGP, n=18), stapled Roux-en-Y gastric bypass (S-RYGBP, n=14) and transected Roux-en-Y gastric bypass (T-RYGBP, n=66). BMI and percentage of excess weight loss (%EWL) were calculated at time 0, and after 1, 2, 3, 10, 15, 20 and 25 years. Results: Statistically significant weight loss was found for the whole patient population at every postoperative time-point compared to preoperative values. Maximal weight loss was achieved mainly during the first 3 years. However, initial and long-term outcome after HGP was significantly worse than after S-RYGBP or T-RYGBP. Gender did not significantly influence the results. Conclusion: Traditional open gastric bypass resulted in acceptable and safe long-term weight reduction. It may be assumed that laparoscopic gastric bypass with modern tiny pouch volumes based on the lesser curvature achieves even better and life-long weight reduction.     

Skeletal Muscle Fatigue

Abstract

Skeletal muscle fatigue is a complex problem which deserves attention from physiotherapists and other clinical practitioners. This article will discuss the findings of recent literature to explore some of the main mechanisms thought to underlie fatigue in skeletal muscles. These mechanisms may be peripheral in origin, occurring within the muscle fibres themselves, or central, affecting the neural control of muscle contraction. Peripheral mechanisms of fatigue include metabolic factors such as the availability and utilization of metabolic substrates (e.g. glycogen, phosphocreatine and adenosine triphosphate) during muscle activity as well as the influence of muscle pH on both metabolism and muscle contractile properties. Impairment in neuromuscular transmission and excitation–contraction coupling may also cause muscle fatigue. Central fatigue mechanisms include both psychological and physiological factors which may influence motor cortex activity and hence muscle force output. Pathological factors which may cause abnormal muscle fatigue are also discussed.     

Psychometric properties of the Roland-Morris Disability Questionnaire compared to the Oswestry Disability Index: a systematic review

Abstract

Objectives: To compare the psychometric properties of the Roland-Morris Disability Questionnaire and the Oswestry Disability Index used to measure physical ability in people with low back pain.

Methods: A literature search of computerised databases from 1980 through June 2009 was performed using search terms: clinical assessment tools, Roland-Morris, questionnaires, back, spine, back pain, Oswestry Disability Index, psychometrics, reliability, validity, specificity and sensitivity. Twenty-three articles were reviewed using an adult population over 18 years old with acute, sub-acute and chronic low back pain.

Results: The Roland-Morris Disability Questionnaire and the Oswestry Disability Index demonstrate good reliability in test–retest performance clinically at initial evaluation and up to 6 weeks following interventions. Two studies described the construct validity of the two measures as highly correlated with each other. Overall, it appears that both questionnaires have similar responsiveness rates of 0·76–0·78 but two studies report a responsiveness rate of 0·94 for the Oswestry.

Discussion/Conclusion: The Roland-Morris Disability Questionnaire is most sensitive for patients with mild to moderate disability while the Oswestry Disability Index is most effective for persistent severe disability. Clinically, both questionnaires should be considered depending on the patient's objective presentation of disability. The clinician needs to determine either 'mild to moderate' or 'severe persistent disability' after a thorough history and physical exam is completed so that the appropriate questionnaire can be administered. This helps support the clinician's assessment of function, determine a patient's level of disability and provide outcome information.     

Bisphosphonate Use Is Protective of Radiographic Knee Osteoarthritis Progression Among those With Low Disease Severity and Being Non-Overweight: Data From the Osteoarthritis Initiative

Antiresorptive medications have been explored for treating knee osteoarthritis (OA); however, little data exist on the effects of today's more potent nitrogen-containing oral bisphosphonates on radiographic disease-progression in patients with varying disease-severity, especially those who are not overweight. The primary objective of this cohort study was to determine if the use of bisphosphonates is protective against 2-year radiographic-progression of knee OA in Osteoarthritis Initiative (OAI) participants, stratified by baseline radiographic disease status. Secondary objectives were to examine effects in non-overweight participants (body mass index [BMI] < 25 kg/m²) and cumulative bisphosphonate exposure effects. We identified female OAI participants aged ≥50 years and excluded those missing baseline radiograph readings, bisphosphonate use information, or all clinical questionnaire information at baseline. Participants reporting bisphosphonate use (69% alendronate) were propensity-matched 1:1 to non–bisphosphonate users and followed until first radiographic knee OA progression (1-unit increase in Kellgren and Lawrence [KL] grade) or data were censored (first missed visit or end of 2-year follow-up). Discrete-time logistic regression models estimated hazard ratios (HRs) between bisphosphonate users versus nonusers, with an interaction term for baseline KL grade (KL <2 or KL ≥2). We identified 1977 eligible women (n = 346 bisphosphonate users). Propensity-matched results indicated that bisphosphonate users with KL grade <2 were protected against progression (HR_KL<2 0.53; 95% CI, 0.35 to 0.79), while bisphosphonate use was not associated with radiographic progression in those with KL grade ≥2 (HR_KL≥2 1.06; 95% CI, 0.83 to 1.35). When restricting analyses to those with BMI <25 kg/m², effects were strengthened (HR_KL<2 0.49 [95% CI, 0.26 to 0.92]; HR_KL≥2 0.69 [95% CI, 0.33 to 1.26]). Duration of bisphosphonate use had no effect on progression, though sample size was limited. Bisphosphonate therapy may be protective against radiographic knee OA progression in early-stage patients, particularly those who are non-overweight, but less so for those with more advanced disease or more weight-bearing joint stress. © 2020 American Society for Bone and Mineral Research (ASBMR).     

Self-Efficacy as a Psychological Moderator of Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS) is characterized by debilitating fatigue and a variety of somatic symptoms. Few studies have examined psychological aspects of CFS. In the present study, self-efficacy is shown to be a significant predictor of CFS symptoms beyond the variance accounted for by demographic variables and distress. Further psychological CFS research is encouraged by (1)identifying dimensions that are salient in the experience and study of CFS, (2) providing preliminary psychometric data for measures of those dimensions, and (3)identifying psychological variables that serve as moderators of the experience of CFS.