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Background: Frailty is a geriatric syndrome characterized by chronic inflammation and metabolic insufficiency that creates vulnerability to poor outcomes with aging. We hypothesize that interventions which target common underlying mechanism of aging could ameliorate frailty. Ketone bodies are metabolites produced during fasting or on a ketogenic diet that have pleiotropic effects on inflammatory and metabolic aging pathways in laboratory animal models. Ketone esters (KEs) are compounds that induce ketosis without dietary changes, but KEs have not been studied in an older adult population. Our long-term goal is to examine if KEs modulate aging biology mechanisms and clinical outcomes relevant to frailty in older adults. Objectives: The primary objective of this randomized, placebo-controlled, double-blinded, parallel-group, pilot trial is to determine tolerability of 12-weeks of KE ingestion in a broad population of older adults (≥ 65 years). Secondary outcomes include safety and acute blood ketone kinetics. Exploratory outcomes include physical function, cognitive function, quality of life, aging biomarkers and inflammatory measures. Methods: Community-dwelling adults who are independent in activities of daily living, with no unstable acute medical conditions (n = 30) will be recruited. The study intervention is a KE or a taste, appearance, and calorie matched placebo beverage. Initially, acute 4-hour ketone kinetics after 12.5g or 25g of KE consumption will be assessed. After collection of baseline safety, functional, and biological measurements, subjects will randomly be allocated to consume KE 25g or placebo once daily for 12-weeks. Questionnaires will assess tolerability daily for 2-weeks, and then via phone interview at bi-monthly intervals. Safety assessments will be repeated at week 4. All measures will be repeated at week 12. Conclusion: This study will evaluate feasibility, tolerability, and safety of KE consumption in older adults and provide exploratory data across a range of aging-related endpoints. This data will inform design of larger trials to rigorously test KE effects on aging mechanisms and clinical outcomes relevant to frailty. [ABSTRACT FROM AUTHOR]

Background: Post-stroke depression (PSD) is a frequent problem in stroke patients, affecting their rehabilitation process and functional outcomes. Several studies have investigated the relationship between PSD and functional outcomes, but the results have been inconsistent. Objective: This systematic review of non-experimental studies aims to investigate the prevalence of post-stroke depression and the association between post-stroke depression and functional outcomes. Method: A search of PubMed, MEDLINE, Web of Science, and CINAHL Plus with Full Text was carried out from inception until January 2024. The literature was screened using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with relevant papers included. We extracted data from non-experimental studies that examined associations between PSD and functional outcomes. The Joanna Briggs Institute for systematic reviews was used for critical appraisal. Results: Twenty-one studies met the study criteria, including sixteen cohort studies, four cross-sectional studies, and one case-control study. PSD prevalences ranged from 12.2% to 32.2% in the first two weeks, 17.9 to 35.5% in the first month, and 10.4% to 32.0% in the third month following a stroke. Functional outcomes were evaluated in four domains: degree of dependence, basic activity of daily living, instrumental activity of daily living, and physical and cognitive function. Significant associations between PSD and functional outcomes were identified after controlling potential factors such as age, comorbidities, and stroke severity. PSD had negative associations with functional outcomes in all four measure domains from one month to five years after a stroke. Depression treatment showed positive results on functional outcomes in stroke patients. Conclusion: PSD prevalence was high in the first three months after stroke. PSD is significantly associated with poor functional outcomes. PSD assessment and management should be performed on a frequent basis in the early stages of stroke to achieve the best possible functional recovery. [ABSTRACT FROM AUTHOR]

Physical function is the physical ability to fulfill one's daily roles and responsibilities. Poor physical function is detrimental to health and income-generating activities. Unfortunately, there is a lack of validated methods to measure physical function in adult women in low- and middle-income countries, including Ethiopia, the locus of this study. This study evaluated the feasibility, reliability, and validity of physical tests, including the sit-to-stand (STS) and usual gait speed (UGS) and a context-appropriate instrumental activities of daily living (IADL) survey. The results of the STS were used to calculate a muscle quality index (MQI, STS accounting for body mass and leg length). Feasibility was ascertained qualitatively based on reports from the enumerators on their ability to administer the tests. Reliability was assessed by comparing the results of the tests and questions between each visit using either Cohen's κ or Pearson's ρ. The validity of MQI was assessed using relevant participant characteristics such as age and self-reported disability. The validity of the IADL was assessed using MQI. Study participants comprised 316 women between the ages of 18 and 45 years, living in rural Tigray, Ethiopia, who had previously participated in an impact evaluation of a safety net program. Over a one-week period, participants completed the STS and UGS tests and responded to the IADL survey questions three times. MQI was determined to be a feasible, reliable, and valid physical function test for women in rural, highland Ethiopia. UGS lacked feasibility and reliability; validity was not ascertained. The IADL questions were feasible and reliable, but validity was inconclusive. In rural Ethiopia, the MQI will be a valuable tool to develop interventions for improving physical function, which will have positive impacts on health and quality of life. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the effect of continuing care based on WeChat platform and MDT (multidisciplinary team) on outcomes and negative emotions in young and middle-aged patients with stroke sequelae. Methods: A retrospective study was conducted on clinical data of 109 young patients with post-stroke sequelae in our hospital. Based on the nursing approach, the patients were divided into two groups. Group A received conventional continued care (including reinforcing health education upon discharge, providing relevant precautions after discharge, regular follow-up of patients, and others), while Group B received continued care based on the WeChat platform and multidisciplinary team (MDT) collaboration. A comparative analysis was performed on NHISS (National Institutes of Health Stroke Scale) scores, Barthel Index (activities of daily living), FMA (Fugl-Meyer Assessment of Motor Recovery after Stroke) scores, disease awareness and attitude scores, selfefficacy scores, self-care ability scores, SAS (Self-Rating Anxiety Scale) scores, SDS (Self-Rating Depression Scale) scores, quality of life scores, and social support levels before intervention and 6 months after interventions in both groups. Results: Compared with Group A, Group B had lower NHISS scores (30.08 vs. 17.08) and higher Barthel Index (73.35 vs. 94.48) and FMA scores (68.06 vs. 90.08) (P<0.05); higher disease awareness scores (40.18±2.15 vs. 48.96±3.66) (P<0.05), higher self-efficacy scores (105.56 vs. 119.26) and self-care scores (98.18 vs. 110.06) (P<0.05), lower SAS scores (56.06 vs. 40.06) (P<0.05), higher quality of life (125.63±3.12 vs. 185.12±2.52) as well as higher nursing satisfaction scores (56.63±3.16 vs. 92.15±3.15) (P<0.05). Conclusions: Continuing care based on the WeChat platform and MDT is beneficial to promote the recovery of neurological and physical functions, improve abilities of daily living, self-efficacy, selfcare and quality of life in young and middle-aged patients with stroke sequelae, and relieve the impact of negative emotions on the recovery. [ABSTRACT FROM AUTHOR]

Background/Objectives: Population aging is rapidly increasing, and the importance of preventive medicine has been stressed. Health checkups, diet, and exercise are of paramount importance. This study aimed to evaluate the effectiveness of a personalized dual-task intervention that combined exercise with cognitive tasks in improving physical and cognitive functions among independently living older individuals. Methods: Participants aged >65 years who were mostly independent in their activities of daily living were divided into two groups. The group receiving the 20 min robot-assisted session was compared with the group receiving traditional functional restoration training. This randomized trial assessed the impact of this intervention on the 30 s chair stand test score and Montreal Cognitive Assessment—Japanese version score of the participants. Results: Both scores significantly improved in the intervention group, indicating enhanced lower-limb function and cognitive capabilities. Conclusions: These findings suggest that integrating cognitive tasks with physical exercise can stand as an effective strategy to improve overall well-being in older people, offering valuable insights for designing comprehensive preventive health programs tailored to this demographic. [ABSTRACT FROM AUTHOR]

Objective: The objective of this review is to conduct a comprehensive and systematic assessment of the efficacy of Yoga as an intervention for knee osteoarthritis (KOA). Methods: We searched PubMed, Cochrane Library, Embase, Web of Science, and PEDro as of January 3, 2024. Retrieved a total of 200 articles. Standardised mean differences (SMDs) and 95% confidence intervals (CI) were calculated. Results: The study included a total of 8 trials and involved 756 KOA patients. The results indicated that compared to the control group, Yoga exercise showed significant improvements in alleviating pain (SMD = -0.92; 95% CI = -1.64 ~ - 0.20; P = 0.01, I2 = 94%), stiffness (SMD = -0.51; 95% CI = -0.91 ~ -0.12; P = 0.01; I2 = 66%) and physical function (SMD = -0.53; 95% CI = -0.89 ~ -0.17; P = 0.004; I2 = 59%) among KOA patients. However, there was no significant improvement observed in terms of activities of activity of daily living (ADL) (SMD = 1.03; 95% CI = -0.01 ~ 2.07; P = 0.05; I2 = 84%), and quality of life (QOL) (SMD = 0.21; 95% CI = -0.33 ~ 0.74; P = 0.44; I2 = 83%) with the practice of Yoga. Conclusions: In general, Yoga has been found to be effective in reducing pain and stiffness in KOA patients, it can also improve the physical function of patients. However, there is limited evidence to suggest significant improvements in terms of ADL and QOL. [ABSTRACT FROM AUTHOR]

Introduction: Public health strategies aim to promote and maintain older people's functional capacity for health and well-being. However, little is known about the functional capacity in Colombian older adults. Objective: To describe the functional capacity of institutionalized and non-institutionalized older people in the Social and Health Care Centers of Quindío, Colombia. Method: A descriptive study was designed with a stratified probabilistic sampling of older adults. Functional capacity was assessed with the Barthel Index and the Short Physical Performance Battery. Results: 306 older adults participated in the study. 57.5% of non- institutionalized people attended Day Centers, and 42.5% of the institutionalized population attended Social Protection Centers for the Elderly. 37.6% of the population presented some level of functional dependency, and 64.0% some degree of fragility. Conclusions: The prevalence of frailty in the population participating in social health centers is significantly high, representing an imminent risk of loss of functionality in the short term. It is necessary to design intervention strategies to prevent or delay the appearance of dependence and disability. [ABSTRACT FROM AUTHOR]

Background: There is a call for gathering more evidence on the effectiveness of telerehabilitation in stroke. In particular, a previous systematic review reported substantial variability in the types of technologies used in telerehabilitation interventions. The purpose of this study will be to summarize and synthesize findings on the effects of telerehabilitation based on real-time intervention between therapist and participants for patients with stroke. Methods and analysis: This systematic review will follow the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. This systematic review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) on 25 May 2023 (registration number: CRD420234265527). Electronic searches will be performed in the following databases: MEDLINE, Pubmed, Web of Science, PsycINFO and CINAHL electronic databases, using a date range from inception to November 2023. We will include only randomized controlled trials for patients diagnosed with stroke who received telerehabilitation based on real-time interaction between therapist and patients. The exploration will be restricted to publications in the English language. Physical function, activities of daily living and quality of life are the outcomes. We will examine the changes of the outcomes at baseline, at the end of the intervention, and at specific time points during the follow-up after the intervention. Discussion: This systematic review will provide evidence regarding telerehabilitation for people with stroke. [ABSTRACT FROM AUTHOR]

Age‐related alterations in physiology lead to declines in physical function that are associated with numerous adverse outcomes among older adults. Utilizing a hybrid design, we aimed to understand whether both long‐term and short‐term Tai Chi (TC) training are associated with age‐related decline in physical function in healthy older adults. We first conducted cross‐sectional comparisons among TC‐naïve older adults (n = 60, 64.2 ± 7.7 years), TC‐expert older adults (n = 27, 62.8 ± 7.6 years, 24.5 ± 12 years experience), and TC‐naïve younger adults (n = 15, 28.7 ± 3.2 years) to inform long‐term effects of TC training on physical function, including single leg stance time with eyes closed, grip strength, Timed Up and Go, maximum walking speed, functional reach, and vertical jump for lower‐extremity power. There were significant differences among the three groups on all the six tests. For most functional tests, TC‐experts performed better than age‐matched TC‐naïve controls and were statistically indistinguishable from young healthy adult controls. Long‐term TC training was associated with higher levels of physical function in older adults, suggesting a potential preventative healthy aging effect. In the randomized longitudinal trial, TC‐naïve subjects were randomized (n = 31 to Tai Chi group, n = 29 to usual care control group) to evaluate the short‐term effects of TC over 6 months on all outcomes. TC's short‐term impacts on physical function were small and not statistically significant. The impact of short‐term training in healthy adults is less clear. Both potential longer‐term preventive effects and shorter‐term restorative effects warrant further research with rigorous, adequately powered controlled clinical trials. [ABSTRACT FROM AUTHOR]

Background: In current years, the increase in older population has led to creating one of the main public health challenges, worldwide. Because of the special characteristics of older adults, this age group is exposed to possible problems, such as mental and physical disorders, that usually affect their functional independence. The study aimed to determine the psychosocial determinants (e.g., depression, social support, and self-efficacy) affecting functional independence among older population. Methods: Our search was conducted on three international databases (Web of Sciences, PubMed/Medline, and Scopus) for all the observational studies (cross-sectional, cohort or longitudinal designs) on the social and psychological determinants of functional independence among older adults. Papers published in English without limitation of time were reviewed from inception to 26 August 2023. The quality assessment tool was the Newcastle-Ottawa Scale (NOS). The I2 index was used to quantify the degree of heterogeneity among the studies. In the case of heterogeneity higher than 50%, the random effects model has been used for overall estimation of the effects; otherwise, the fixed effects model was used. The pooled associations were expressed as odds ratio (OR) and 95% confidence intervals (CIs). Stata version 14 software (StataCorp LP) was used for data analysis. The significance level was considered at 0.05. Results: In the initial search, 6978 articles were retrieved, and finally, considering the inclusion criteria, 46 articles were examined. Finally, 18 articles were eligible for meta-analysis. The findings indicated that among all the determinants affecting functional independence among older adults, depression could lead to a 76% increase in functional dependence. Conclusion: The findings provide a statistically significant relationship between psychosocial factors and functional independence. Depression was the strongest determinant of functional dependence among older adults. [ABSTRACT FROM AUTHOR]

Intensive care unit-acquired weakness (ICU-AW) is the most common complication found in the intensive care unit (ICU) patients, especially those on prolonged use of mechanical ventilation (MV). It is known to cause poor long-term outcomes, and early rehabilitation (ER) intervention has been proved to be useful in improving muscle strength, physical function, and quality of life of ICU survivors. Several obstacles, such as patients' medical condition and limited availability of equipment or trained personnel, interfere with ER. Passive ER including functional electrical stimulation (FES) and cycling were found to be effective. The combination of FES with a cycle ergometer (FES cycling) can be implemented, but research on using this modality in the ICU is still limited. This review aimed at providing information on the use of FES cycling in ICU patients to explain its effect on physiological changes and functional abilities. The physiological effects of FES cycling are obtained through local metabolic changes in muscles due to FES and increased cardiovascular responses due to muscle contraction during cycling. Its effects on muscle strength, cross-section area, days free of MV, mobilization, cognitive ability, delirium, and quality of life were positive, and only rarely adverse events occurred during the intervention. To conclude, the use of FES cycling in the prevention and treatment of ICU-AW can be considered since this modality causes positive physiological effects and has proven safe. [ABSTRACT FROM AUTHOR]

Objective: To systematically review the efficacy of e-Health interventions on physical performance, activity and quality of life in older adults with sarcopenia or frailty. Methods: A systematic review was conducted by searching the MEDLINE, Embase, Cochrane Library, CINHAL, Web of Science, and the Physiotherapy Evidence Database for experimental studies published in English from 1990 to 2021. E-Health studies investigating physical activity, physical performance, quality of life, and activity of daily living assessment in adults aged ≥65 years with sarcopenia or frailty were selected. Results: Among the 3,164 identified articles screened, a total of 4 studies complied with the inclusion criteria. The studies were heterogeneous by participant characteristics, type of e-Health intervention, and outcome measurement. Age criteria for participant selection and sex distribution were different between studies. Each study used different criteria for frailty, and no study used sarcopenia as a selection criteria. E-Health interventions were various across studies. Two studies used frailty status as an outcome measure and showed conflicting results. Muscle strength was assessed in 2 studies, and meta-analysis showed statistically significant improvement after intervention (standardized mean difference, 0.51; 95% confidence interval, 0.07-0.94; p=0.80, I²=0%). Conclusion: This systematic review found insufficient evidence to support the efficacy of e-Health interventions. Nevertheless, the studies included in this review showed positive effects of e-Health interventions on improving muscle strength, physical activity, and quality of life in older adults with frailty. [ABSTRACT FROM AUTHOR]

Introduction: Falls are an important health problem among elderly, with various consequences. The objectives of this study were to estimate 1-year incidence of falls, distribution, and severity of fall-related injuries and to determine risk factors for fall risk among the elderly population aged =60 years. Methods: A total of 140 urban community-dwelling participants aged =60 years were studied using an investigator-administered questionnaire. Short physical performance battery, chair stand test, handgrip strength, and anthropometric measurements were done. The Chi-square test was done to compare fallers and nonfallers. Logistic regression was done for independently associated risk factors. Results: One-year incidence of falls was 14.3%; 17.6% among women and 9.1% among men. Sixty percent of participants had multiple falls. Seventy-five percent of the fallers were overweight or obese. Sprain was the most common reported fall-related injury (20%), whereas 45% had no injuries. Depression (60%), osteoporosis (80%), poor activities of daily living (90%), and polypharmacy (35%) were significantly associated with falls. Osteoporosis (odds ratio: 14.89; 95% confidence interval: 1.91-115.95) was independently associated with fall risk. Conclusions: The burden of falls among urban elderly was low. The majority of the population experienced multiple falls. Since chronic diseases including osteoporosis and poor mobility were directly associated with the risk of falls, further longitudinal studies may explore the health-related and socioenvironmental risks further. [ABSTRACT FROM AUTHOR]

Previous systematic review and meta-analysis indicates that rehabilitation within a week of intensive care unit (ICU) admission benefits physical function in critically ill patients. This updated systematic review and meta-analysis aim to clarify effects of initiating rehabilitation within 72 h of ICU admission on long-term physical, cognitive, and mental health. We systematically searched the MEDLINE, Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi for randomized controlled trials (RCTs) between April 2019 and November 2022 to add to the previous review. Two investigators independently selected and extracted data. Pooled effect estimates for muscle strength, cognitive function, mental health after discharge, and adverse events were calculated. Evidence certainty was assessed via Grading of Recommendations, Assessment, Development, and Evaluations. Eleven RCTs were included in the meta-analysis. Early rehabilitation may improve muscle strength (three trials; standard mean difference [SMD], 0.16; 95% confidence interval [CI], −0.04–0.36) and cognitive function (two trials; SMD, 0.54; 95% CI, −0.13–1.20). Contrastingly, early mobilization showed limited impact on mental health or adverse events. In summary, initiating rehabilitation for critically ill patients within 72 h may improve physical and cognitive function to prevent post-intensive care syndrome without increasing adverse events. The effect on mental function remains uncertain. [ABSTRACT FROM AUTHOR]

This article discusses the experience of disability in ancient Rome through the letters Ep. 1.12 and Ep. 8.18 of Pliny the Younger (1st-2nd centuries CE). The main characters of these letters, Corellius Rufus and Domitius Tullus, were two senators with reduced mobility and assisted in their daily tasks by relatives and enslaved people. Based on the methodology provided by Disability Studies, we analyse the agency of the subjects of study as disabled people, as well as the role that assistance played in their lives and how their environment conditioned their life decisions. Finally, we address Pliny the Younger's personal perspective and the bias this may entail when interpreting the meaning of the letters. [ABSTRACT FROM AUTHOR]

Multidisciplinary approach, to Breast Cancer (BC) has significantly improved patient survival time, but the patients suffer from adverse effects of cancer and anti-cancer treatment affecting their functionality and overall quality of life. This case series aimed to identify limitations in physical functioning among patients with breast cancer. An interview guide was developed on the basis of literature definition of ‘physical function’, its determinants, International Classification of Functioning, Disability and Health criteria on functioning, and literature published on relevant factors in BC. Fifteen women diagnosed with BC, who were either undergoing active treatment or completed it, with age ranging between 26-75 years, were included. Semi-structured interviews were conducted using interview guide and responses were audio-recorded. The responses obtained were then coded and analysed using thematic analysis. Out of total 15 participants, three were on ongoing active treatment and 12 had completed it (nine were within one year of completion of active treatment). Thematic analysis revealed that the subjects experienced impairments in upper quarter flexibility (n=7), upper limb functional strength (n=9), limitations in basic (n=5) and instrumental activities of daily living (n=12) and many had done changes in performing activities at home or workplace (n=12). Many women had pain (n=13) in neck or arm after sustained activity, swelling in arm, cording, fatigue, impairment of balance (n=6) and negative body image perception. Such limitations were more prevalent among old and frail. Limitations in physical functioning were found prevalent among participants in the present case series which points out the need for long term surveillance of women with breast cancer for physical functional limitations. [ABSTRACT FROM AUTHOR]

Background. Patients with multiple chronic conditions often have complex medication regimes which negatively impact their health-related quality of life (HRQoL), and there is limited evidence on this topic, particularly from the resource limiting set-up. Hence, this study is aimed at assessing the impact of medication regimen complexity on HRQoL in patients with multiple chronic conditions at a university hospital in Ethiopia. Method. A cross-sectional study was conducted on adult patients who had at least two long-term diseases and were already receiving medical therapy for the relevant disorders. The validated 65-item Medication Regimen Complexity Index (MRCI) and the EuroQol-5-Dimensions-5-Levels (EQ-5D-5L) instruments were used to assess MRC and HRQoL, respectively. The Welch test for unequal variance and Fisher's exact test were used to assess the impact of different variables on HRQoL. Results. The study surveyed 416 participants, with a 98.3% response rate, the majority of whom were female (n = 267, 64.2%) and had two chronic conditions (n = 215, 51.7%). About 46.4% of patients were taking five or more medications, with a significantly higher proportion at the high regimen complexity level (P = 0.001). The average MRCI score was 9.73 ± 3.38, indicating a high level of complexity. Patients with high MRCI scores reported more problems in mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. There was a negative correlation between the MRCI score and HRQoL as measured by the EQ-5D-Index (r = −0.175; P < 0.001) and the EuroQol-Visual Analogue Scale score (r = −0.151; P = 0.002). In addition, there was a statistically significant difference in the mean EQ-5D-Index (P = 0.001) and EQ-VAS scores (P = 0.001) across low, medium, and high MRCI levels. Conclusion. Medication regimen complexity was prevalent among patients with multimorbidity and was associated with a decrease in HRQoL. Therefore, interventions addressing medication-related issues should be a priority to improve the well-being of patients with multiple chronic conditions. [ABSTRACT FROM AUTHOR]

Background. In orthopedics, the patients’ quality of life relative to the preoperative and postoperative phase is referred with a low impact compared to other branches of medicine. In this context, our interest focused on assessing the quality of life in patients with traumatic and non-traumatic coxarthrosis by longitudinally following the evolution of the patients. Materials and Methods. The well-established instrument Short Form Survey SF-36 was applied in a retrospective study, conducted on a cohort of 203 participants who underwent THA (Total Hip Arthroplasty). Statistical analysis was generated using GraphPad Prism (version 9.5.1). Results. In the pre-operative phase, physical functioning was more affected in participants with traumatic coxarthrosis, while fatigue was specific to nontraumatic coxarthrosis. Emotional well-being and social functioning were high in patients with traumatic coxarthrosis. One month after surgery, we recorded an increased physical functioning and improvement in the perception of the ability to exercise roles in non-traumatic group. Energy/vitality and general health and wellbeing were at high level in traumatic group, 1st month post-surgery, although pain was still frequent. Age was the sole strong independent predictor of postoperative physical functioning in the traumatic group, while in the non-traumatic group, we identified gender, age, symptoms and type of prosthesis as strong predictors of postoperative physical functioning. The overall results related to daily living activities indicated that the traumatic group displayed more favorable post-surgery evolution and higher autonomy compared to the non-traumatic one. Conclusions. We conclude that SF-36 questionnaire is a specific, useful and inexpensive tool for evaluating the outcomes of orthopedic treatment and patients’ evolution after arthroplasty, especially in terms of functional outcome scores relative to coxarthrosis etiology. [ABSTRACT FROM AUTHOR]

With the COVID-19 pandemic, the existence of the post-COVID-19 Syndrome or Covid Longa became evident through the perception of resistant signs and symptoms. The assessment and rehabilitation of the present sequelae should consider functional mobility and hand grip strength for a total return to activities of daily living. The present study aimed to evaluate the functional mobility and hand grip strength in the post-COVID-19 period of Basic Health Units (UBS's) users in the city of São João del-Rei/MG. It was a cross-sectional study where 35 users of Primary Health Care (ABS) were evaluated, and the following assessments were used: a questionnaire containing 11 questions about the disease; assessment of vital signs; upper limb muscle strength with dynamometer; two-minute stationary gait test (TME´2) and time up and go (TUG). The SPSS 11.0 statistical package with the Chi-Square test was used for data analysis, considering the value of p<0.05 and the description of mean values and standard deviation. It was evidenced an average handgrip strength equal to 44.52 Kgf, average knee elevation in TME'2 being equal to 80 elevations and in TUG an average of 25 seconds (p<0.05). It was observed that individuals showed significant changes in functional mobility, while vital data, grip strength and aerobic capacity were within normal values for average age. It is concluded that the evaluated users presented functional mobility limitation as a sequel during the post-COVID-19 Syndrome, making it necessary to outline forms of functional rehabilitation aimed at improving the functional mobility of these users. [ABSTRACT FROM AUTHOR]

Objective: To compare functioning, quality of life (QoL), pain, and depression at one year between adults under and over 60 years of age who had moderate and severe injuries in traffic accidents in Medellin and its metropolitan area. Methods: Secondary analysis of two cohorts of patients with moderate and severe injuries that occurred in Medellín and its metropolitan area in 2009-2010 and 2015-2016. They were evaluated at baseline and 12 months with functioning (whodas ii), QoL (sf-36), pain (vas), and depression (phq-9). The differences between cohorts 12 months after the accident were compared with t-Student test. A multiple linear regression analysis was done to determine factors related to disability and QoL. Results: 837 patients were included, 84,8% completed the follow-up. The motorcycle was the main vehicle involved (86,1% vs. 60,7). Better functioning was observed in people over 60 years of age in personal care, and greater commitment in activities of daily living, work and global functioning. QoL was significantly better in minors, in emotional performance, physical performance and physical function. In the multivariate analysis, the greater compromise in functioning was explained by being female, older, more severe injury, greater pain, and depression. The best QoL was explained by being male, younger, less severe injury, pain, and depressive symptoms. Conclusions: Age, sex, injury severity, pain, and depression explain disability and QoL dimensions 12 months after the traffic accident. [ABSTRACT FROM AUTHOR]

Background and Objectives: To describe nutritional status and inflammation of elderly patients with chronic kidney disease and to confirm the association between a Malnutrition-Inflammation Score and physical function and functional disability. Methods and Study Design: A total of 221 chronic kidney disease patients (aged ≥60 years) were included. A Malnutrition-Inflammation Score was used to assess malnutrition and inflammation. Physical function was assessed using the SF-12. Functional status was evaluated using basic activities of daily living and instrumental activities of daily living. Results: Thirty percent of participants had a Malnutrition-Inflammation Score ≥6, which denoted poor nutritional status. Participants with a Malnutrition-Inflammation Score ≥6 had decreased concentration of hemoglobin, albumin, prealbumin, handgrip strength and walking speed and increased concentration of inflammatory markers, including CRP, IL-6 and fibrinogen. Physical function and physical component summary were lower and basic activities of daily living dependence and instrumental activities of daily living dependence were higher among patients with higher Malnutrition-Inflammation Score than those with a lower Malnutrition-Inflammation Score. The Malnutrition-Inflammation Score was an independent risk factor for physical function and instrumental activities of daily living dependence. Conclusions: The elderly chronic kidney disease patients with a high Malnutrition-Inflammation Score had a decreased physical function and an increased risk of functional instrumental activities of daily living dependence. [ABSTRACT FROM AUTHOR]

Background: Community reintegration is one of the ultimate goals of stroke rehabilitation. The increasing burden of stroke morbidity by other non-communicable diseases in Nigeria indicated the need for our study. Objectives: The authors explored the factors contributing to successful community reintegration among Nigerian stroke survivors. Method: We conducted an explorative qualitative study design to achieve this aim using indepth semi-structured interviews with 12-purposively sampled stroke survivors. Results: Three overarching themes emerged: restriction of participation experienced by stroke survivors, activity limitation as pointers to the quality-of-life experience of stroke survivors and enablers or barriers to community reintegration for stroke survivors. Among the core, sub-themes included incapability of returning to work, difficulty performing domestic activities, social isolation or separation, recreation and leisure time. Enablers of community reintegration included creating a positive mindset, encouragement and social support, while barriers included mobility and speech or language challenges. Conclusion: Stroke survivors have challenges in returning to work and experience varying levels of activity limitation, which affects their quality of life with identifiable enablers or barriers to community reintegration. Clinical implications: Stroke survivors with severe functional deficits should be monitored closely and given further rehabilitative assistance to aid functional recovery, thereby facilitating community reintegration. [ABSTRACT FROM AUTHOR]

Background and purpose -- Little is known about the activities of daily living (ADL) of patients with a bone-anchored prosthesis (BAP). We aimed to objectively measure ADL without and with BAP during standard care of follow-up. Our secondary aim was to measure mobility and walking ability. Patients and methods -- Patients aged 18-99 years who underwent surgery for transfemoral or transtibial BAP between September 11, 2017, and February 11, 2021, were eligible for inclusion in this retrospective case series of patients with socket prosthesis. ADL was measured with a continuous recording activity monitor (hours [h]) before surgery, and at 6, 12, and 24 months with BAP. Mobility and walking ability were assessed by the Timed Up and Go test (TUG) (seconds [s]) and 6 Minute Walk Test (6MWT) (meters [m]), respectively. Results -- 48 of the 57 eligible patients provided informed consent and were included. Their age was 59 (1st quartile to 3rd quartile 51-63) years. Total daily activity before BAP was 1.6 h (0.82-2.1) and increased to 2.1 h (1.4-2.5) at 6, 2.0 h (1.5-2.7) at 12, and 2.7 h (2.0-3.3) at 24 months with BAP. Daily walking increased from 1.3 h (0.79-1.9) before BAP to 1.8 h (1.6-2.3) at 6, to 1.7 h (1.2-2.4) at 12, and 2.0 h (1.6-2.6) at 24 months. Median TUG decreased from 12 (9.1-14) before BAP to 8.9 s (7.7-10) at 24 months. Mean 6MWT increased from 272 m (SD 92) before BAP to 348 m (SD 68) at 24 months. Conclusion -- Objective measurements on ADL positively changed in patients with BAP. This effect was also seen in mobility and walking ability at 24 months. [ABSTRACT FROM AUTHOR]

Objective: Prior studies have found evidence of a relationship between food insecurity and functional limitations among older populations in the USA. Design: This is a longitudinal investigation of food security in relation to functional limitations, assessed as Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scores. Setting: The Greater Boston, MA area. Participants: 1461 Boston Puerto Rican Health study participants, predominantly (70·5 %) female and aged 57·1 years (sd ± 7·6) at baseline followed for 6·2 (sd ± 0·98) years. Results: In cross-sectional analysis at baseline, participants reporting severe food insecurity had greater functional limitations (higher ADL; β = 2·34; 95 % CI (1·48, 3·19)) and higher IADL (β = 1·17, 95 % CI (0·68, 1·65)) compared with food secure participants. In longitudinal linear mixed models, severely food insecure participants at baseline had greater functional limitations over 5 years, as assessed by ADL (β = 1·74; 95 % CI (0·95, 2·53); P < 0·001) and IADL (β = 0·93, 95 % CI (0·48, 1·38)) compared with food secure participants. However, baseline food security did not significantly alter the 5-year trajectory in ADL (P -interaction between baseline food security and time for ADL and IADL = 0·41 and 0·47, respectively). Conclusions: In this cohort of Boston area Puerto Rican adults, those who are food insecure had consistently higher ADL and IADL scores over time, compared with those who are food secure. Baseline food security did not appear to alter the trajectory in ADL or IADL score. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to investigate the effectiveness and clinical outcomes of inpatient rehabilitation for patients with severe COVID-19 in Japan. Methods: Patients with severe COVID-19 who underwent rehabilitation during hospitalization were included. The Medical Research Council (MRC) score and short physical performance battery (SPPB), such as physical function assessment and the intensive care unit (ICU) mobility scale, the functional status score for the ICU, and Barthel index as activities of daily living (ADLs) were evaluated at admission and discharge or transfer from the hospital. The correlation between SPPB at discharge and each factor at admission were also analyzed. Furthermore, the prevalence of sarcopenia was evaluated by defining SPPB of <9 points at discharge as sarcopenia. Results: The median age of the total of 23 patients was 59 years (interquartile range (IQR): 47–67), 73.9% were male, and the median PaO2/FiO2 at admission was 172.0 (IQR: 123.0–209.0). All physical function and ADL parameters were significantly improved from the time of admission to discharge (p = 0.014 for the MRC score and p < 0.001 for all others). Moreover, SPPB at discharge significantly correlated with WBC (Spearman's rho = −0.473, p = 0.041), C-reactive protein (Spearman's rho = −0.468, p = 0.044), and exhibited a significant trend with PaO2/FiO2 (Spearman's rho = 0.429, p = 0.067) and age (Spearman's rho = 0.409, p = 0.083). Although the median Barthel index at discharge was 90 points, 47% of patients had sarcopenia as defined by an SPPB of <9 points. Conclusions: Early rehabilitation for patients with severe COVID-19 improved physical function and ADLs during hospitalization. However, 47% of patients had the same level of sarcopenia at discharge. [ABSTRACT FROM AUTHOR]

Objective: Impaired daily physical function has become a common health problem among Chinese middle-aged and elderly people. The aim of this study was to investigate the effects of physical activity on daily physical function in Chinese middle-aged and older adults. Methods: Data from 9056 participants in the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018 were included in this study. Physical activity levels were expressed as metabolic equivalents, and the impairment of daily physical function was determined in a self-reported format by the Activities of Daily Living Scale and the Instrumental Activities of Daily Living Scale. The association between different levels of physical activity and impaired daily physical function was analyzed using Cox proportional hazards regression models. Results: During a mean follow-up period of 6.73 years, 1379 middle-aged and older adults had impaired physical function. After adjusting for all covariates, participants with a physical activity volume (PAV) ≥ 600 MET-minutes/week had a 61% lower risk of impaired daily physical function than those who were physically inactive (HR = 0.39, 95% CI 0.35–0.44). Participants with a PAV of 1800–2999 MET-minutes/week had the lowest risk of impaired daily physical function (HR = 0.33, 95% CI 0.26–0.42). Subgroup analysis showed that participants with a PAV ≥ 600 MET-minutes/week had a greater reduction in the risk of impaired daily physical function among participants who were male, older than or equal to 65 years, and without respiratory disease compared to participants who were physically inactive. Conclusions: This study showed that a PAV ≥ 600 MET-minutes/week could reduce the risk of impaired daily physical function in Chinese middle-aged and elderly people. However, a higher PAV is not better; a PAV in the range of 1800–2999 MET-minutes/week can be more effective in preventing daily physical function impairment in Chinese middle-aged and elderly people. [ABSTRACT FROM AUTHOR]

Introduction: With improved HIV treatment availability in sub‐Saharan Africa, the population of older people with HIV (PWH) is growing. In this qualitative study, we intended to understand (1) the lived experiences of ageing people in rural Uganda, with and without HIV, (2) their fears and health priorities as they grow older. Methods: We conducted 36 semi‐structured interviews with individuals with and without HIV in Mbarara, Uganda from October 2019 to February 2020. Interview guide topics included priorities in older age, physical functioning in daily activities, social functioning, HIV‐related stigma and the impact of multimorbidity on health and independence. Interviews were conducted in Runyankole, transcribed, translated and inductively coded thematically by two researchers with tests for inter‐coder reliability. Results: The respondents were purposively sampled to be evenly divided by sex and HIV serostatus. The median age of respondents was 57 (49–73). Two‐thirds were married or cohabitating, 94% had biological children and 75% cited farming as their primary livelihood. Overall, PWH considered themselves as healthy or healthier than people without HIV (PWOH). PWH rarely considered their HIV status a barrier to a healthy life, but some reported a constant sense of anxiety as it relates to their long‐term health. Irrespective of HIV status, nearly all respondents noted concerns about memory loss, physical pain, reductions in energy and the effect of these changes on their ability to complete physical tasks like small‐scale farming, and activities of daily living important to the quality of life, such as participating in community groups. Increasing reliance on others for social, physical and financial support was also a common theme. The most prevalent health concern among participants involved the threat of non‐communicable diseases and perceptions that physical functioning may diminish. Conclusions: In rural Uganda, we found that PWH consider themselves to be healthy and do not anticipate a different ageing experience from PWOH. Common priorities shared by both groups included the desire for physical and financial independence, health maintenance and social support for daily functioning and social needs. Entities supporting geriatric care in Uganda would benefit from attention to concerns about functional limitations and reported needs as people age with and without HIV. [ABSTRACT FROM AUTHOR]

Objective. To explore the degree of psychological distress in patients with lung cancer during the perioperative period and analyze its influencing factors. Method. A cross-sectional survey was conducted on 372 perioperative patients with lung cancer admitted to our hospital by a convenience sampling method using general data collection and psychological pain thermometer scores. Results. The psychological distress score of 372 patients with lung cancer in the perioperative period was 4.10 ± 2.88. The psychological distress of patients was related to physical problems, practical problems, medical expenses, and family communication problems. Logistic regression analysis showed that gender, economic burden caused by disease, child care, lack of interest in daily activities, and anxiety were the main factors affecting the degree of suffering of lung cancer patients. Conclusion. The proportion of perioperative lung cancer patients with a psychological distress score ≥4 points was 55.6%, and more than half of the perioperative patients with lung cancer had a moderate level of psychological distress. Medical staff should pay attention to the management of the psychological distress of patients with lung cancer during the perioperative period, help patients solve practical problems in the process of cancer treatment, strengthen society's attention to female lung cancer patients, and establish a comprehensive cancer public welfare organization group. [ABSTRACT FROM AUTHOR]

Purpose: Information about mobility and physical function may be encoded in the complexity of daily activity pattern. Therefore, daily activity pattern complexity metrics could provide novel insight into the relationship between daily activity behavior and health. The purpose of the present study was to examine the association between the complexity of daily activity behavior and the mobility and physical function among community-dwelling older adults 75, 80, and 85 yr of age. Methods: A total of 309 participants wore accelerometers concurrently on the thigh and the trunk for at least three consecutive days. Five activity states (lying, sitting, standing, walking, or activity other than walking) were defined in three different temporal grains (5 s, 1 min, and 5 min), and Lempel–Ziv complexity was evaluated. We assessed complexity of daily activity behavior using the life-space mobility and physical function with distance in preferred pace 6-min walk and the Short Physical Performance Battery. Results: Weak positive associations were observed between the complexity of daily activity and the mobility and physical function at the finest temporal grains in both sexes (Spearman rho = 0.19 to 0.27, P < 0.05). No significant associations were observed in the coarsest temporal grain in either sex. Conclusions: Lempel–Ziv estimates of daily activity complexity with a fine temporal grain seem to be associated with community-dwelling older adults' physical function. The coarsest 5-min temporal grain may have smoothed out physiologically meaningful short activity bouts. Because complexity encodes information related to timing, intensity, and patterning of behavior, complexity of activity could be an informative indicator of future physical function and mobility. [ABSTRACT FROM AUTHOR]

Introduction: It is important to sustain mobility in order to maintain functionality and physical independence in the elderly. The aim was to evaluate the perception of exercise in the elderly in terms of the benefits of and barriers to exercise and determine the related factors. Materials and Method: 138 elderly people aged 65 and over were included in the study. Demographics, ambulation status and duration, history of falls, spontaneous/low-energy fractures, exercise/walking activities were recorded. Depression states, benefits and barriers of exercise, risk of falling, balance and Daily activities were evaluated. Results: The average age of the patients was 71.59±6.21 years and 52.2% were female. Only a quarter (24.6%) reported regular exercise, 50.7% had history of falling, and 18.8% had a fracture history. Only 24.6% of the patients walked for exercise purposes and 44.2% did exercise. The perception of exercise benefit was significantly higher in those with a history of falling (p=0.012) and significantly lower in those who walked for exercise purposes and did exercise (p<0.001 and p<0.001). Perception of exercise benefit was positively correlated with depression, negatively correlated with Lawton-Brody, and perception of obstacle was negatively correlated with balance (r=0.333, r=-0.375, r=-0.383, respectively). Depression level, perceived benefit of exercise, risk of falling were higher in women whereas balance disorder was higher in men (p<0.001, p=0.049, p=0.004, respectively). Conclusion: In the elderly, exercise is associated with the perception of benefit/obstacle, depression, risk of falling/fracture, balance and functional dependence. Active life should be supported by strengthening the perception of benefit and reducing the perception of obstacles. [ABSTRACT FROM AUTHOR]

Simple Summary: Heavy-resistance training can offer physicians a viable option for improving functional performance, helping their patients stay independent, active and healthy. The present results clearly demonstrate that circuit weight training is as effective as traditional resistance training for improving functional mobility but is more effective in stimulating positive perception of health-related quality-of-life adaptations in older women. Regular physical exercise has shown great benefits in preventing age-related functional losses and in improving the perception of health-related quality of life (HRQoL) in older people. To optimize these benefits, it would be interesting to evaluate what type of exercise is better. Therefore, the purpose of this study was to assess the effects of heavy-resistance training on mobility and HRQoL in older women. Forty healthy, untrained older women (60–75 years) were randomly assigned to three groups: circuit resistance training (CRT, n = 15), traditional resistance training (TRT, n = 15) or the control group (CG, n = 10). During the 12-week training period, both experimental groups performed training with heavy loads, twice a week. Before and after the training period, the Timed Up and Go test, as a proxy of mobility, and the perception of HRQoL were evaluated. TRT and CRT resulted in a statistically significant improvement in the Timed Up and Go test (−5.4 and −10.3%, respectively; p < 0.05), but only the improvement after CRT was significantly greater than changes in the CG (p < 0.001). Only CRT elicited improvements in several dimensions of the perception of the HRQoL questionnaire, such as: physical functioning (13%, p < 0.001), general health (8.1%; p = 0.048), vitality (17.7%; p < 0.001), role emotional (6.7%; p = 0.044) and physical component summary (6.3%; p = 0.001). The change in the CRT group was greater than in the CG (p < 0.001) in the physical functioning score. The present findings show that CRT might be a time- (and hence cost-) effective alternative to trigger multiple positive functional and psychological adaptations in older women. [ABSTRACT FROM AUTHOR]

Spasticity is a common comorbidity of spinal cord injury (SCI) that is characterized by velocity dependent tone and spasms manifested by uninhibited reflex activity of muscles below the level of injury. For some, spasticity can be beneficial and facilitate functional standing, transfers, and some activities of daily living. For others, it may be problematic, painful, and interfere with mobility and function. This manuscript will address the anatomy and physiology of neuromuscular reflexes as well as the pathophysiology that occurs after SCI. Spasticity assessment will be discussed in terms of clinical history and findings on physical examinations, including responses to passive and active movement, deep tendon reflexes, and other long tract signs of upper motor neuron injury, as well as gait and function. Management strategies will be discussed including stretch, modalities, pharmacotherapy, neurolysis, and surgical options. [ABSTRACT FROM AUTHOR]

The incidence of aortic stenosis (AS) increases with age and is a serious problem in an aging society. In recent years, transcatheter aortic valve implantation (TAVI) has been performed widely; however, older patients may be ineligible for TAVI or surgical treatment because of medical ineligibility. Symptom‐based rehabilitation is required for these patients to maintain and improve their physical function and ability to perform activities of daily living. No studies have examined exercise safety for older patients with severe AS who are ineligible for TAVI or surgery. We summarized the safety of exercise for older patients with severe AS, collecting 7 studies on maximal exercise stress tests and 16 studies on preoperative physical examinations. From this review, it may be unlikely that exercise under appropriate management can cause hemodynamic changes, leading to death. However, there were no studies on exercise intervention for older patients with AS who are chosen for conservative management. The optimal exercise intensity for symptomatic older patients with AS undergoing conservative management and the effects of continuous exercise intervention require future study. [ABSTRACT FROM AUTHOR]

Objective. The aim of this study was to determine the correlation between manual dexterity evaluated with the Box and Block Test (BBT) and the performance of daily activities in children with bilateral cerebral palsy (CP). Methods. The BBT was applied to 162 children with cerebral palsy of bilateral distribution aged 6 to 13 years. The level of performance was evaluated according to the Manual Ability Classification System (MACS), Gross Motor Function Classification System (GMFCS), and Pediatric Evaluation of Disability Inventory (PEDI) in the domains of self-care, mobility, and social function. Correlations between the findings of the BBT and the PEDI were determined, and additionally, some specific toileting tasks of the PEDI were evaluated. Results. The results of the BBT were lower in the lowest functional levels of the MACS (p ≤ 0.001). The BBT showed a strong correlation with the domains' self-care (r = 0.8), mobility (r = 0.7), and social function (r = 0.6) of the PEDI. The BBT was different between children who were able and children who were not able to perform the toileting tasks that were evaluated. A lower capacity in the BBT obtained in children with functional status GMFCS III, IV, and V was associated with poor performance in toileting tasks evaluated in the PEDI. Conclusion. The results of the BBT are correlated with the activities of daily living of children with bilateral CP. The data obtained from this test is used to predict the performance of daily activities of these patients in settings such as school and home and helps to identify contextual factors that influence the level of independence in children with bilateral CP. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to determine whether responses to Patient-Reported Outcomes Measurement Information System Short Form v2.0 - Physical Function 8c (PROMIS PF8c) items differed when the use of a 7-day recall period was compared with no specified recall period.Methods: Using a within-subject design, we surveyed 1810 individuals from the US general population, administering PROMIS PF8c at survey beginning and end. The order of measure presentation was randomly assigned. We calculated recall difference scores (RDSs) as no recall score minus 7-day recall score using both item response theory-based T scores and raw summed scores. We examined the distribution and created Bland-Altman plots for both RDSTscore and RDSRaw. We also calculated correlations between no recall versus 7-day recall T score and raw scores. Finally, we determined whether differences in no recall versus 7-day recall scores were associated with patient-reported PF.Results: RDSTscore and RDSRaw had means (root mean square differences) of 0.00 (5.43) and -0.04 (3.79), respectively. The vast majority (%) of RDSTscore and RDSRaw values fell between the Bland-Altman limits of agreement (-10.65 to 10.66 and -7.46 to 7.38, respectively). Pearson's correlations between no recall and 7-day recall for T scores and raw scores were 0.88 and 0.87, respectively. Effect sizes for mean RDSTscore and RDSRaw compared across level of Eastern Oncology Cooperative Group performance status, patient global impression of PF severity, and single PF items were near 0.Conclusions: We did not find any significant recall period effect on PF8c responses. Therefore, we recommend the use of the PROMIS physical function standard, with no specified recall time period. [ABSTRACT FROM AUTHOR]

Background and Objective. Knee osteoarthritis is a serious epidemiological problem that causes severe pain and impairs abilities. We investigated the effects of adductor canal blockade (ACB) on chronic osteoarthritis knee pain, motor function, and mobility. Methods. Seventy-seven patients with chronic knee osteoarthritis pain received ultrasound-guided ACB with 14 ml 0.25% levobupivacaine and 100 mcg clonidine. At baseline and 1 month after the blockade, we assessed maximal and minimal pain intensity in the knee using a numeric rating scale (NRS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS). The range of motion in extension and flexion (ROMext and ROMflex) and quadriceps muscle strength of both knees (QS), Timed Up and Go Test (TUG), and 30-Second Chair Stand Test (30CST) results were determined at baseline, 1 hour, 1 week, and 1 month after the blockade. Results. ACB with levobupivacaine and clonidine appeared to decrease pain severity (NR S max 8.13 to 4.2, p < 0.001 and NR S min 3.32 to 1.40, p < 0.001). Similarly, knee ROMext decreased from 3.90 preintervention to 2.89 postintervention at 1 month, p < 0.001 ; ROMflex decreased from 5.70 to 3.29, p < 0.001 ; TUG time decreased from 3.22 to 2.93, <0.001; QS increased from 18.43 to 22.77, p < 0.001 ; CST increased from 8.23 to 10.74, p < 0.001. The KOOS for pain (36.40 to 58.34), symptoms (52.55 to 64.32), activities of daily living functions (ADLs, 36.36 to 60.77), and quality of life (QoL, 17.87 to 30.97) also increased, all p < 0.001. Conclusion. ACB appeared to decrease pain and increase ambulation. If our preliminary results are reproducible in a planned randomized controlled trial, ACB could be a useful adjunctive pain therapy in patients with disabling pain due to knee OA. [ABSTRACT FROM AUTHOR]

Background: An increased focus on patient-reported outcome measures (PROMs) has led to a proliferation of these measures in orthopaedic surgery. Mandating a single PROM in clinical and research orthopaedics is not feasible given the breadth of data already collected with older measures and the emergence of psychometrically superior measures. Creating crosswalk tables for scores between measures allows providers to maintain control of measure choice. Furthermore, crosswalk tables permit providers to compare scores collected with older outcome measures with newly collected ones. Given the widespread use of the newer Patient-reported Outcome Measure Information System Physical Function (PROMIS PF) and the established Knee Outcome and Osteoarthritis Score (KOOS), it would be clinically useful to link these two measures.Question/purpose: Can the KOOS Function in Activities of Daily Living (ADL) subscale be robustly linked to the PROMIS PF to create a crosswalk table of equivalent scores that accurately reflects a patient's reported physical function level on both scales?Methods: We sought to establish a common standardized metric for collected responses to the PROMIS PF and the KOOS ADL to develop equations for converting a PROMIS PF score to a score for the KOOS-ADL subscale and vice versa. To do this, we performed a retrospective, observational study at two academic medical centers and two community hospitals in an urban and suburban healthcare system. Patients 18 years and older who underwent TKA were identified. Between January 2017 and July 2020, we treated 8165 patients with a TKA, 93% of whom had a diagnosis of primary osteoarthritis. Of those, we considered patients who had completed a full KOOS and PROMIS PF 10a on the same date as potentially eligible. Twenty-one percent (1708 of 8165) of patients were excluded because no PROMs were collected at any point, and another 67% (5454 of 8165) were excluded because they completed only one of the required PROMs, leaving 12% (1003 of 8165) for analysis here. PROMs were collected each time they visited the health system before and after their TKAs. Physical function was measured by the PROMIS PF version 1.0 SF 10a and KOOS ADL scale. Analyses to accurately create a crosswalk of equivalent scores between the measures were performed using the equipercentile linking method with both unsmoothed and log linear smoothed score distributions.Results: Crosswalks were created, and adequate validation results supported their validity; we also created tables to allow clinicians and clinician scientists to convert individual patients' scores easily. The mean difference between the observed PROMIS PF scores and the scores converted by the crosswalk from the KOOS-ADL scores was -0.08 ± 4.82. A sensitivity analysis was conducted, confirming the effectiveness of these crosswalks to link the scores of two measures from patients both before and after surgery.Conclusion: The PROMIS PF 10a can be robustly linked to the KOOS ADL measure. The developed crosswalk table can be used to convert PROMIS PF scores from KOOS ADL and vice versa.Clinical Relevance: The creation of a crosswalk table between the KOOS Function in ADL subscale and PROMIS PF allows clinicians and researchers to easily convert scores between the measures, thus permitting greater choice in PROM selection while preserving comparability between patient cohorts and PROM data collected from older outcome measures. Creating a crosswalk, or concordance table, between the two scales will facilitate this comparison, especially when pooling data for meta-analyses. [ABSTRACT FROM AUTHOR]

Purpose: Being able to rise from a chair is paramount for independent living and is strongly influenced by the ability of the lower limbs to exert mechanical power. This study assessed minimal thresholds of lower-limb relative muscle power required to perform the sit-to-stand (STS) task in older adults and its association with mobility limitations and disability. Methods: A total of 11,583 older adults (age, 60--103 yr) participated in this investigation. The 5-rep and 30-s versions of the STS test were used to assess chair rising ability. Relative power was calculated by the STS muscle power test. The minimum thresholds of power required to perform the STS tests were derived from the minimum values (i.e., "floor" effect) reported in the power tests through regression analyses. Mobility limitations and disability in activities of daily living (ADL)were recorded. Results: For the average olderman and woman, the thresholds to complete five STS repetitions were 1.1 and 1.0 W⋅ kg-1, respectively, whereas the thresholds to complete one STS repetitionwere 0.3 W⋅ kg-1 in both sexes. These thresholds increased linearly with height (5-and 1-rep, respectively: +0.13 and +0.03 W⋅ kg-1 per 10-cm increase; both P < 0.001) and did not differ by sex or testing condition (both P ≥ 0.259). All participants with relative power below the 5-rep threshold presented mobility limitations, and 51%--56% of women and 36%--49% of men also showed disability in ADL (all χ² ≥ 290.4; P < 0.001). Conclusion: A minimum level of relative muscle power is required to rise from a chair independently, which depends on the individual height and is associated with increased mobility limitations and disability. This information will help interpret data yielded by the STS muscle power test and may contribute to the prevention and treatment of mobility limitations in older people. [ABSTRACT FROM AUTHOR]

• Intensive exercise in the early postoperative rehabilitation after hip fracture (up to 3 months postoperatively) is beneficial to the recovery of physical function in older adults. • Intensive exercise with more load lead to greater improvements in muscle strength, balance, and functional ability. • Older adults with cognitive impairment were not included in the studies selected for this review, conclusions about the training results may not be extended to this population. Individuals commonly experience age-related systemic decreases in skeletal muscle strength, physical function, and mobility, leading to falls and potential associated hip fractures. To evaluate whether intensive exercise can improve physical function, mobility, and independence in activities of daily living (ADL) and shorten the length of hospital stay in older adults after hip fracture surgery. This systematic review was conducted under the PRISMA guidelines. Searches were performed on January 5, 2022 in eight databases. Randomized controlled trials (RCTs) were included. The participants included older adults with hip fracture, and the intervention studied was intensive exercise. The outcomes were physical function, mobility, ADLs, and the length of hospital stay. Meta-analyses were conducted using RevMan 5.3. Fifteen studies were included in this review. After hip fracture surgery, intensive exercise improved participants' physical function to a greater extent than regular or no exercise (standardized mean difference [SMD] = 0.74; 95% CI: 0.25, 1.23). Intensive exercise was particularly more effective for gait speed (SMD = 0.15, 95% CI: 0.01, 0.30), the timed up-and-go test results (mean difference [MD] = -4.34, 95%CI: -6.74, -1.94), balance (SMD =0.42, 95% CI: 0.38, 0.89), and ADLs (SMD = 0.55, 95% CI: 0.24, 0.87). The quality of the evidence was low due to risk of bias, inconsistency, and imprecision. Intensive exercise early post-operation provides potential additional benefits compared to no or regular exercises on older adults after hip fracture surgery. [ABSTRACT FROM AUTHOR]

Introduction Falls are a common cause of injuries in people over 65 years, usually resulting in life-threatening or life-altering sequalae for affected individuals. Falls risk assessment typically requires a face-to-face evaluation delivered by a trained professional in a clinical setting, thus limiting their application for many older people with falls. Therefore, there is a need for a remote monitoring system (RMS) that captures mobility data to assess comprehensively an older individual's true falls risk undertaking their everyday activities in their usual environment. Methods A pilot study was conducted with 16 participants over 65 years classified as high (n = 9) or low falls risk (n = 7) based on their fall's history. A RMS was developed, which combines inertial measurement unit (IMU) data from a wearable device and online real-time Machine Learning (ML) to generate a two-stage fall risk assessment. In stage one, a ML activity motion classifier identified raw IMU data from participants as either, walking, resting or transitional movements (turning or sitting to standing). In stage two, previously classified motion segments were analysed by a ML fall-risk classifier, providing an objective risk assessment based on gait characteristics during everyday motion. Falls incidence was recorded prospectively at one year follow-up. Results The motion classifier achieved an 94.8% accuracy in differentiating between resting, walking and transitional movements. The fall risk classifier initially trained with retrospective fall history data achieved an 87.5% accuracy with 88.9% sensitivity and specificity, which is comparable to other accurate classifiers in published literature. The fall risk classifier retrained with prospective one year follow-up data achieved a 73% accuracy which was superior to the 67% accuracy of the Timed Up and Go test for falls prediction. Conclusion Our study shows the potential of a machine-learning remote monitoring system using information from mobility data to classify an older person's falls' risk. [ABSTRACT FROM AUTHOR]