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Introduction: This study aims to verify if older adults with mixed anxiety-depressive disorder are more prone to euthanasia and identify factors that interfere with their satisfaction with health and capacity for well-informed decisions. Material and Methods: The study applied a paper questionnaire composed of a sociodemographic section and a battery of scales (to assess depression, anxiety, cognitive performance, suicide risk, therapeutic adhesion, functionality, loneliness, attitude towards euthanasia, decision pattern, personality, empathy, and health status) in the Psychogeriatric Unity of Senhora da Oliveira Hospital in Portugal. The sample was collected by convenience to include patients and controls of the same age. Six months later, a reassessment was performed. Patients and controls were compared using descriptive statistics and a multiple-regression model. Results: A total of 114 patients and 25 controls were included. Eighty-one point six percent of patients had four or fewer years of schooling. Contrary to controls, they presented mild depressive and anxiety symptoms, loneliness feelings, worse cognitive performance, a more fragile personality, higher personal distress, and a poorer health state. No statistically significant differences were found between controls and patients regarding their attitudes towards euthanasia. Patients more favourable to euthanasia had higher empathic concern, conscientiousness, and fantasy, and lower personal distress. Discussion and Conclusion: When addressing euthanasia in these patients, it is crucial to ensure they are fully self-determinate and that all the necessary treatment and support are available. It may not be the case when the educational level is low and a mild disease persists, significantly affecting their well-being and cognitive performance. [ABSTRACT FROM AUTHOR]

Heart transplantation is the gold-standard treatment for terminal heart failure. Despite being successful, pre- and post-transplant limitations interfere with patients' functional capacity, self-care, and quality of life post-surgery. Rehabilitation is necessary to address these limitations, prevent complications, and promote a safe return home. This study analyzes the safety of a phase 1 cardiac rehabilitation protocol (RN4HTx) in heart transplant patients and its effects on self-care capacity. A quantitative, descriptive study was conducted with 19 heart transplant recipients. The protocol was implemented in collaboration with a rehabilitation professional, who monitored adverse events, hemodynamic variables, self-care capacity (Barthel) pre- and post-transplant, and functional capacity at discharge (6 min walk test). The results showed that 68.42% of recipients were men, with an average age of 50.21 years and 15 days of hospitalization post-transplant. Approximately 73.68% of recipients were transferred from other wards with changes in functional capacity. All patients progressed to the final stage of the program without adverse events. There was a notable improvement in self-care capacity before and after transplantation, with a measure of functional status of 310.035 m (6MWT). The study found that RN4HTx is a feasible cardiac rehabilitation program without adverse events in the immediate postoperative period following heart transplantation, positively impacting functional recovery and therapeutic self-care capacity, thus increasing the safety of returning home. This study was retrospectively registered on Clinical Trials—NCT06552390. [ABSTRACT FROM AUTHOR]

Background: Cancer is a leading cause of morbidity and mortality globally. Dyspnea, affecting up to 60% of cancer patients, exacerbates physical and psychological distress, reducing quality of life. This study aims to explore the relationship between dyspnea and factors such as age, sex, clinical diagnosis, and treatment lines in cancer patients, with the goal of improving understanding and management of this debilitating symptom to enhance patient care and quality of life. Methods: This study employed an observational, cross-sectional, and descriptive approach to investigate patients with oncological disease at the University Hospital of Salamanca between March 2021 and April 2024. A convenience sample was selected, including patients over 18 years old with a pathological diagnosis of cancer, experiencing any degree of dyspnea, and who consented to participate by signing the informed consent. Exclusion criteria included lack of consent and clinical conditions that prevented an interview. The studied variables encompass sociodemographic (age, gender, diagnosis, tumor stage, number of treatment lines) and clinical aspects (daily activities, degree of dyspnea, functional capacity, physical performance), evaluated using the Barthel Index, the mMRC Dyspnea Scale, the ECOG Scale, and the Short Physical Performance Battery (SPPB). Data were collected through semistructured interviews and medical records, and analyzed using specialized software. This research has ethical approval CEiM Code 2023 12 1472, Reference 2024/01. Results: The mean age was 66.82 years. Lung cancer was predominant (60.2%), with most patients in stage 3 (65.7%) and receiving three treatment lines (68.7%). Higher age, advanced disease stage, and more treatment lines correlated with lower Barthel and SPPB scores, and higher ECOG and mMRC scores, indicating worse functionality, physical performance, and greater dyspnea. No significant correlations were found between gender or pathological diagnosis and the studied variables. Conclusions: Advanced age, higher disease stage, and more treatment lines are associated with decreased functionality, poorer physical performance, and increased dyspnea in cancer patients. Gender and specific cancer diagnosis do not significantly affect these relationships. Addressing dyspnea is crucial to improving the quality of life and physical performance in this population. Future studies should explore additional factors like treatment types and nutritional status. [ABSTRACT FROM AUTHOR]

Motor impairment is a common issue in stroke patients, often affecting the upper limbs. To this standpoint, robotic neurorehabilitation has shown to be highly effective for motor function recovery. Notably, Machine learning (ML) may be a powerful technique able to identify the optimal kind and intensity of rehabilitation treatments to maximize the outcomes. This retrospective observational research aims to assess the efficacy of robotic devices in facilitating the functional rehabilitation of upper limbs in stroke patients through ML models. Specifically, clinical scales, such as the Fugl-Meyer Assessment (A-D) (FMA), the Frenchay Arm Test (FAT), and the Barthel Index (BI), were used to assess the patients' condition before and after robotic therapy. The values of these scales were predicted based on the patients' clinical and demographic data obtained before the treatment. The findings showed that ML models have high accuracy in predicting the FMA, FAT, and BI, with R-squared (R2) values of 0.79, 0.57, and 0.74, respectively. The findings of this study suggest that integrating ML into robotic therapy may have the capacity to establish a personalized and streamlined clinical practice, leading to significant improvements in patients' quality of life and the long-term sustainability of the healthcare system. [ABSTRACT FROM AUTHOR]

Stroke survivors often face diverse unmet needs highlighting the significance of identifying and addressing these needs to enhance rehabilitation outcomes and overall quality of life. This study aimed to validate the modified Needs Assessment Questionnaire (mNAQ) as a reliable and valid tool for assessing the needs of stroke patients in the Greek context. Additionally the research sought to identify potential differences in the assessment of stroke patients' needs based on their stroke phase and National Institutes of Health Stroke Scale (NIHSS) scores. A sample of 71 adult stroke survivors adhering to World Health Organization guidelines and providing autonomous consent participated in the study. The mNAQ comprising 141 items across 12 domains was utilized to evaluate stroke patients' needs. The NIHSS and Barthel Index (BI) were employed for functional independence and mobility assessment. Data analysis incorporated confirmatory factor analysis, exploratory factor analysis and Cronbach's reliability analysis to establish construct validity and internal consistency. Concurrent and known-groups validity analyses were conducted; and Spearman's rho correlation explored the relationship between mNAQ and BI scores. Non-parametric analyses were applied to identify differences based on stroke phase and NIHSS scores. The study revealed that the mNAQ initially lacked satisfactory psychometric properties in the Greek context. Subsequent modifications guided by confirmatory and exploratory factor analyses resulted in a refined three-factor scale encompassing 31 items in the domains of communication, mobility, and social functioning needs. This adapted measure effectively differentiated between acute and chronic stroke patients and those with minor and moderate strokes. In conclusion, the validated 31-item Greek mNAQ emerges as a crucial tool for comprehensively assessing the needs of stroke patients. Its application holds promise for optimizing post-stroke care improving functional outcomes and ultimately enhancing the overall well-being and quality of life for stroke survivors. [ABSTRACT FROM AUTHOR]

The aim of this retrospective, cross-sectional, observational study was to assess the frequency of falls and evaluate the predictive validity of the Johns Hopkins Fall Risk Assessment Tool (JHFRAT) among patients aged ≥65 years, transferred to the rehabilitation ward of a university hospital. The predictive ability was assessed using receiver operating characteristic curve analysis, and the optimal threshold was established using the Youden index. We analyzed the overall cohort (N = 175) with subacute stroke and the subgroup with a low unaffected handgrip strength (HGS; men: <28 kg, women: <18 kg). Overall, 135/175 patients (77.1%) had a low HGS. The fall rate was 6.9% overall and 5.9% for patients with a low HGS. The JHFRAT predictive value was higher for patients with a low HGS than that for the overall cohort, but acceptable in both. The optimal cutoff score for the overall cohort was 11 (sensitivity, 67%; specificity, 68%), whereas that for the subgroup was 12 (sensitivity, 75%; specificity: 72%). These results are expected to aid nurses working in rehabilitation wards in more effectively utilizing JHFRAT outcomes for post-stroke older patients with a low HGS and contribute to the development of more appropriate fall prevention strategies for high-risk patients in the future. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the effects of neuromuscular electrical stimulation (NMES) with gastrocnemius (GCM) strength exercise on foot morphology in patients with stroke. Herein, 31 patients with chronic stroke meeting the study criteria were enrolled and divided into two groups; 16 patients were randomized to the gastrocnemius neuromuscular electrical stimulation (GCMNMES) group, and 15 patients to the conventional neuromuscular electrical stimulation (CNMES) group. The GCMNMES group conducted GCM-strengthening exercise with NMES. CNMES group conducted NMES at paretic tibialis anterior muscle with ankle dorsiflexion movement. These patients underwent therapeutic interventions lasting 30 min/session, five times a week for 4 weeks. To analyze changes in foot morphology, 3D foot scanning was used, while a foot-pressure measurement device was used to evaluate foot pressure and weight-bearing area. In an intra-group comparison of 3D-foot-scanning results, the experimental group showed significant changes in longitudinal arch angle (p < 0.05), medial longitudinal arch angle (MLAA) (p < 0.01), transverse arch angle (TAA) (p < 0.01), rearfoot angle (RA) (p < 0.05), foot length (FL) (p < 0.05), foot width (FW) (p < 0.05), and arch height index (AHI) (p < 0.01) of the paretic side and in TAA (p < 0.05) and AHI (p < 0.05) of the non-paretic side. The CNMES group showed significant changes in TAA (p < 0.05) and FW (p < 0.05) of the paretic side and TAA (p < 0.05) and AHI (p < 0.05) of the non-paretic side. An inter-group comparison showed significant differences in MLAA (p < 0.05) and RA (p < 0.05) of the paretic side. In an intra-group comparison of foot pressure assessment, the experimental group showed significant differences in footprint area (FPA) (p < 0.05) of the paretic side and FPA symmetry (p < 0.05). The CNMES group showed a significant difference in only FPA symmetry (p < 0.05). An inter-group comparison showed no significant difference between the two groups (p < 0.05). Thus, NMES with GCM-strengthening exercises yielded positive effects on foot morphology in patients with stroke. [ABSTRACT FROM AUTHOR]

Background: Chronic heart failure (CHF) is a complex clinical syndrome associated with muscle wasting, which can progress to cardiac cachexia. Myostatin, a negative regulator of muscle growth, has been implicated in the pathophysiology of muscle wasting in CHF patients and suggested as a potential biomarker. The objective of this study was to investigate serum myostatin concentration in patients with CHF with preserved and reduced ejection fraction. Methods: The authors conducted a single-centre study comparing serum myostatin levels, functional and echocardiographic parameters, muscle mass, strength and function in patients with CHF to a control group without CHF. The study group was further divided into sub-groups with preserved and reduced or mildly reduced ejection fraction. Results: Results showed no significant differences in myostatin concentration between CHF patients and controls, and no correlation with sarcopenia or dynapenia. However, a higher myostatin concentration was found in patients with impaired systolic function (Me = 1675 pg/mL vs. Me—884.5 pg/mL; p = 0.007). A positive correlation between myostatin concentration and muscle mass (r = 0.27; p = 0.04), and functional parameters such as Norton (r = 0.35; p < 0.01), I-ADL (r = 0.28; p = 0.02) and Barthel scale (r = 0.27; p = 0.03) scores, was also observed. Conclusions: Myostatin appears to play a role in muscle wasting and its progression to cardiac cachexia in patients with impaired ejection fraction. Further research is needed to confirm these findings and explore myostatin's potential as a biomarker for muscle loss and a target for pharmacotherapeutic agents in this population of patients. [ABSTRACT FROM AUTHOR]

Low muscle strength, functional score at discharge, and complications during a ten-day rehabilitation hospital stay can affect mortality rates in bedridden geriatric patients. This was a prospective observational study in a cohort of 105 bedridden geriatric patients admitted to the Rehabilitation ward after a major illness or surgery. All participants had a severe dependency on another person (Barthel's Index < 60). The one-year mortality rate in this cohort was 15.2%, with further subdivision according to the number of complications: 61.5% in patients with ≥3 complications during hospitalization, 17.6% in patients with two complications, 9.5% with one complication, and 3% in patients with no complications. The Barthel Index at discharge (OR = 0.95; p = 0.003) and ≥3 medical complications (OR = 8.33; p = 0.005) during rehabilitation ward stay were significant predictors for one-year mortality. The odds of one-year mortality after discharge increased eightfold in patients with ≥3 medical complications. Sarcopenia, age, and sex were not significant predictors of mortality in this cohort. The 10-day acute rehabilitation was too short to achieve progress from severe to moderate independence in 60% of patients. The Barthel Index at discharge and a number of complications affect the mortality rate. These findings provide valuable insights into the complex dynamics of mortality and functional outcomes in bedridden geriatric patients. [ABSTRACT FROM AUTHOR]

During the pandemic, nursing homes in the Netherlands were heavily affected by COVID-19. This study assesses the impact of COVID-19 on infection rate, survival rate, and daily functioning over the course of two years among residents of a nursing home in the Netherlands that was amongst the first nursing homes to be affected by the pandemic. This retrospective study followed 70 residents during a two-year period, starting in March 2020. Data were collected on baseline characteristics of participants and the onset, duration, and sequelae of COVID-19 infections. Primary outcomes were mortality and infection rate. The secondary outcome was daily functioning using the Barthel Index at intervals of six months. Within two years, 44 (62.9%) residents were diagnosed with COVID-19. During this study, 72.7% (n = 32) of the COVID-positive residents died, of which 22 deaths were related to the COVID-19 infection. Overall mortality was 60% (n = 42), while COVID-related mortality was 31.4% (n = 22). COVID-19 and multimorbidity (>3 morbidities) were independent risk factors for mortality. Barthel Index scores showed no significant difference in daily functioning. Overall, a high COVID-19 infection rate was seen and was the most common cause of death. COVID-19 did not affect functional status over time. [ABSTRACT FROM AUTHOR]

Gerontechnology is an interdisciplinary field of research involving gerontology and technology in order to help older adults identify and slow down the effects of age-related physical and cognitive decline. It has enormous potential to allow individuals to remain in their own homes and improve their quality of life. This study aims to assess the impact of a multicomponent platform, consisting of an ambient sensor, wearable devices, and a cloud application, as an intervention in terms of usability and acceptance as primary outcomes and well-being, quality of life, and self-efficacy as secondary outcomes in a sample of 25 older adults aged over 65 after 21 days of non-supervised usage at home. This research involved the use of a mixed-methods approach, in which both qualitative and quantitative data were collected in three different measurements. Overall, the participants shared good engagement with the integrated platform. The system achieved positive results in terms of both usability and acceptance, especially the smartwatch. The state of complete well-being slightly improved over the period, whereas self-efficacy remained stable. This study demonstrates the ability of target users to use technology independently in their home environment: it strengthens the idea that this technology is ready for mainstream use and offers food for thought for developers who create products for the aging population. [ABSTRACT FROM AUTHOR]

Background: In order to be used safely, accurately and reliably, measuring instruments in the health field must first be validated, for which the study of their psychometric properties is necessary. The Short Physical Performance Battery (SPPB) tool is a widely used clinical assessment test that has been approved for usage across several nations, languages and demographics. Finding SPPB's psychometric properties for a sample of institutionalized older individuals is the aim of this research. Methods: This is a multicenter, retrospective and observational study of the psychometric properties of the Short Physical Performance Battery tool with a convenience sample of 194 institutionalized older adults. Reliability (internal consistency) and validity (construct validity and convergent validity) tests were performed. Results: The results show a very good internal consistency, construct validity and convergent validity. In addition, the factorial structure of the SPPB is provided, which reflects that it is a unidimensional scale. Conclusions: In conclusion, the Short Physical Performance Battery is a valid and reliable tool for use with institutionalized older adults. Its use is recommended as part of the Comprehensive Geriatric Assessment for the evaluation of the physical or functional sphere. This study was not registered. [ABSTRACT FROM AUTHOR]

Background: The neuroprotective effect of statins has become a focus of interest in spontaneous intracerebral hemorrhage (sICH). The purpose of this study was: (1) to evaluate the effect of statin use by the analyzed patients with sICH in the period preceding the onset of hemorrhage on their baseline neurological status and baseline neuroimaging of the head; (2) to evaluate the effect of statin use in the acute period of hemorrhage on the course and prognosis in the in-hospital period, taking into account whether the statin was taken before the hemorrhage or only after its onset; (3) to evaluate the effect of continuing statin treatment after in-hospital treatment on the functional performance and survival of patients up to 90 days after the onset of sICH symptoms, taking into account whether the statin was taken before the onset of sICH. Material and Methods: A total of 153 patients diagnosed with sICH were analyzed, where group I were not previously taking a statin and group II were taking a statin before sICH onset. After lipidogram assessment, group I was divided into patients without dyslipidemia and without statin treatment (Ia) and patients with dyslipidemia who received de novo statin treatment during hospitalization (Ib). Group II patients continued taking statin therapy. We evaluated the effect of prior statin use on the severity of hemorrhage; the effect of statin use during the acute period of sICH on its in-hospital course; and the effect of statin treatment on the severity of neurological deficit, functional capacity and survival of patients up to 90 days after the onset of sICH symptoms. Results: There was no effect of prior statin use on the severity of hemorrhage as assessed clinically and by neuroimaging of the head. At in-hospital follow-up, subgroup Ia was the least favorable in terms of National Institutes of Health Stroke Scale (NIHSS) score. This subgroup had the highest percentage of deaths during hospitalization. In the post-hospital period, the greatest number of patients with improvement in the NIHSS, modified Rankin Scale (mRS) and Barthel scales were among those taking statins, especially group II patients. At 90-day follow-up, survival analysis fell significantly in favor of subgroup Ib and group II. Conclusions: 1. The use of statins in the pre-sICH period did not adversely affect the patients' baseline neurological status or the results of baseline neuroimaging studies. 2. Continued statin therapy prior to the onset of sICH or the inclusion of statins in acute treatment in patients with sICH and dyslipidemia does not worsen the course of the disease and the in-hospital prognosis. Statin therapy should not be discontinued during the acute phase of sICH. 3. To conclude the eventual beneficial effect on the functional performance and survival of patients after sICH onset, comparability of the analyzed groups in terms of clinical, radiological and other prognostic factors in spontaneous intracerebral hemorrhage would be needed. Future studies are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

The main objective of this study was to analyze the impact of a multifaceted strategy to improve the assessment of functional capacity, risk of pressure injuries, and risk of falls at the time of admission of patients in adult hospitalization units. This was a secondary analysis of the VALENF project databases during two periods (October–December 2020, before the strategy, and October–December 2021, after the strategy). The quantity and quality of nursing assessments performed on patients admitted to adult hospitalization units were evaluated using the Barthel index, Braden index, and Downton scale. The number of assessments completed before the implementation of the new strategy was n = 686 (28.01%), versus n = 1445 (58.73%) in 2021 (p < 0.001). The strategy improved the completion of the evaluations of the three instruments from 63.4% (n = 435) to 71.8% (n = 1038) (p < 0.001). There were significant differences depending on the hospitalization unit and the assessment instrument (p < 0.05). The strategy employed was, therefore, successful. The nursing assessments show a substantial improvement in both quantity and quality, representing a noticeable improvement in nursing practice. This study was not registered. [ABSTRACT FROM AUTHOR]

The incidence of fragility fractures of the pelvis (FFPs) is currently rising. Surgical treatment, which is performed using sacroiliac screws, is complicated by compromised bone quality, oftentimes resulting in implant failure. The iFuse implant system aims to improve attachment and durability with promising results for sacroiliac dysfunction, though data for its feasibility on FFPs are rare. Consequently, this study aims to evaluate the feasibility of the iFuse for FFPs. A total of 10 patients with FFPs were treated with the iFuse in this study. Pre- and postoperatively, both mobility using an established insole force sensor for an inpatient gait analysis and general well-being and pain using questionnaires were evaluated. When comparing pre- and postoperative findings, this study demonstrated a significant increase in the average (8.14%) and maximum (9.4%) loading (p < 0.001), a reduction in pain, as measured by the visual analog scale (VAS), from 4.60 to 2.80 at rest (p = 0.011) and from 7.00 to 4.40 during movement (p = 0.008), an increase in the Barthel Index by 20 points (p < 0.001) and an increase in the Parker Mobility Score by 2.00 points (p = 0.011). All this contributes to the possibility of early postoperative mobilization and improved general well-being, ultimately preventing the late consequences of postoperative immobilization and maintaining patients autonomy and contentment. [ABSTRACT FROM AUTHOR]

This study suggests using wearable activity trackers to identify mobility patterns in chronic complex patients (CCPs) and investigate their relation with the Barthel index (BI) to assess functional decline. CCPs are individuals who suffer from multiple, chronic health conditions that often lead to a progressive decline in their functional capacity. As a result, CCPs frequently require the use of healthcare and social resources, placing a significant burden on the healthcare system. Evaluating mobility patterns is critical for determining a CCP's functional capacity and prognosis. To monitor the overall activity levels of CCPs, wearable activity trackers have been proposed. Utilizing the data gathered by the wearables, time series clustering with dynamic time warping (DTW) is employed to generate synchronized mobility patterns of the mean activity and coefficient of variation profiles. The research has revealed distinct patterns in individuals' walking habits, including the time of day they walk, whether they walk continuously or intermittently, and their relation to BI. These findings could significantly enhance CCPs' quality of care by providing a valuable tool for personalizing treatment and care plans. [ABSTRACT FROM AUTHOR]

Determining the walking ability of post-stroke patients is crucial for the design of rehabilitation programs and the correct functional information to give to patients and their caregivers at their return home after a neurorehabilitation program. We aimed to assess the convergent validity of three different walking tests: the Functional Ambulation Category (FAC) test, the 10-m walking test (10MeWT) and the 6-minute walking test (6MWT). Eighty walking participants with stroke (34 F, age 64.54 ± 13.02 years) were classified according to the FAC score. Gait speed evaluation was performed with 10MeWT and 6MWT. The cut-off values for FAC and walking tests were calculated using a receiver-operating characteristic (ROC) curve. Area under the curve (AUC) and Youden's index were used to find the cut-off value. Statistical differences were found in all FAC subgroups with respect to walking speed on short and long distances, and in the Rivermead Mobility Index and Barthel Index. Mid-level precision (AUC > 0.7; p < 0.05) was detected in the walking speed with respect to FAC score (III vs. IV and IV vs. V). The confusion matrix and the accuracy analysis showed that the most sensitive test was the 10MeWT, with cut-off values of 0.59 m/s and 1.02 m/s. Walking speed cut-offs of 0.59 and 1.02 m/s were assessed with the 10MeWT and can be used in FAC classification in patients with subacute stroke between the subgroups able to walk with supervision and independently on uniform and non-uniform surfaces. Moreover, the overlapping walking speed registered with the two tests, the 10MeWT showed a better accuracy to drive FAC classification. [ABSTRACT FROM AUTHOR]

(1) Background: Existing treatment methods for neglect are concentrated on egocentric neglect and may lead to various problems such as cost/space constraints and portability. Therefore, this study seeks to determine how a new treatment (also known as twins therapy, TT) for stroke patients can improve an existing problem associated with neglect. (2) Method: A pre/post-test control group research design was used and both groups continued to receive existing rehabilitation treatment, whilst TT intervention was only added to the experimental group. TT intervention was conducted for a total of 20 sessions (1 session for 30 min/day, 5 days/week, for 4 weeks). (3) Result: There was no significant difference in the manual function test (MFT) and the Korean version of the Modified Barthel Index (K-MBI) items (p > 0.05) before and after the TT intervention. However, the score and execution time of the apple cancellation test showed a significant reduction only in the experimental group (p < 0.05). (4) Conclusion: TT not only improved egocentric neglect, but also allocentric neglect symptoms in stroke patients. [ABSTRACT FROM AUTHOR]

(1) Background: Observational scales are the most common methodology used to assess postural control and balance in people with stroke. The aim of this paper was to analyse the construct validity of the Postural Assessment Scale for Stroke Patients (PASS) scale in post-stroke patients in the acute, subacute, and chronic stroke phases. (2) Methods: Sixty-one post-stroke participants were enrolled. To analyze the construct validity of the PASS, the following scales were used: the Functional Ambulatory Category (FAC), the Wisconsin Gait Scale (WGS), the Barthel Index (BI) and the Functional Independence Measure (FIM). (3) Results: The construct validity of the PASS scale in patients with stroke at acute phase was moderate with the FAC (r = −0.791), WGS (r = −0.646) and FIM (r = −0.678) and excellent with the BI (r = 0.801). At subacute stage, the construct validity of the PASS scale was excellent with the FAC (r = 0.897), WGS (r = −0.847), FIM (r = −0.810) and BI (r = −0.888). At 6 and 12 months, the construct validity of the PASS with the FAC, WGS, FIM and BI was also excellent. (4) Conclusions: The PASS scale is a valid instrument to assess balance in post-stroke individuals especially, in the subacute and chronic phases (at 6 and 12 months). [ABSTRACT FROM AUTHOR]

Cancer is one of the major socio-health problems in the world. The level of education, the profession and/or employment status of the patient and the family can influence the amount of household income, the additional expenditure, and the possible socio-economic impact of the disease. The main objective of the study is to analyse and evaluate the influence of the level of education, the employment status of the patient, and the need for care and how these factors influence the additional expenditure and the possible socio-economic impact. Methods: descriptive cross-sectional randomised observational epidemiological study without replacement at the Hospital Universitario de Salamanca (CAUSA). Results: total sample (n = 365) comprised 53.2% of patients with no education or primary education, 25.8% with secondary education and 21.1% with higher education. Overall, 36.4% of patients were employed, 10.1% were self-employed, 53.0% were not employed, and 38.9% were experiencing other conditions. Significant statistics were found for educational level, employment status of the patient and main caregivers in terms of financial expenditure. Conclusions: Oncology patients with more education spend more on home help and/or accompanying the patient and transfers to the hospital for treatment. Higher incomes are not synonymous with higher expenditure in the sample. The patient's main caregivers are a fundamental pillar of the patient's household income and additional spending on orthopaedic material. [ABSTRACT FROM AUTHOR]

Highlight: The AOT facilitates motor learning in patients with cognitive impairment. Intervention with AOT in patients with cognitive impairment may be effective in improving functionality of their dominant upper limb and independence in basic activities of daily living. What is the implication of the main finding? AOT could be an effective therapeutic tool in the approach to older adults with cognitive imparirment. Group therapy itself may be a determining factor in the therapeutic approach for patients with cognitive impairment. Cognitive impairment is frequent in elderly subjects. It is associated with motor impairment, a limitation in quality of life and frequently, institutionalization. The aim of this work is to test the efficacy of a therapeutic group program based on action-observation learning. Methods: a non-randomized controlled trial study was conducted. We included 40 patients with cognitive impairment from a nursing home who were categorized into mild and moderate cognitive impairment and divided separately into a control and experimental group. Experimental group performed a 4-week group work, in which each patient with mild cognitive impairment was paired with a patient with moderate cognitive impairment. Thus, patients with mild cognitive impairment observed a series of functional exercises performed by their peers and replicated them. Simultaneously, the patients with moderate cognitive impairment replicated the movement after observing it performed by a patient with mild cognitive impairment. The control group continued to receive their usual care at the center. The upper limb function, cognitive level and function in basic activities of human daily life were measured before and after the intervention and compared with the control group. Results: statistically significant differences were found in the functionality of basic activities of daily living, in the functionality of the upper limb and in the cognitive level in all patients in the experimental group regardless of the initial cognitive level. No statistically significant differences were found in the control group. Conclusions: the implementation of a group, peer-based, action-observation learning therapeutic program is effective in improving the basic activities of human daily life, cognitive level and upper limb functionality in patients with mild and moderate dementia. [ABSTRACT FROM AUTHOR]

Background and Objectives: Stroke patients have different levels of functional impairment, and rehabilitation is essential to achieving functional recovery. Many post-stroke patients transition from acute treatment to post-acute care (PAC) with nasogastric tubes (NGTs) for rehabilitation. However, long-term NGT placement can lead to several complications, and its earlier removal can effectively reduce the incidence of mortality. This study aimed to use a PAC–cerebrovascular disease (CVD) program and physical functional evaluation scale tools to demonstrate the factors associated with NGT removal before post-stroke patient discharge. Materials and Methods: In this retrospective cohort study, data were collected between January 2017 and August 2022. We divided patients who had NGTs at admission into discharged with and without NGT groups to compare their baseline characteristics and physical functional status. Logistic regression analysis was used to detect the predictive factors for NGT removal. Results: There were 63 participants: 22 without NGT removal and 41 with NGT removal. The NGT removal rate was 65%. Age and scores for the activities of daily living by the Barthel index (BI), Functional Oral Intake Scale (FOIS), Mini-Mental State Examination, and Concise Chinese Aphasia Test were significantly different in terms of NGT removal status, but only the BI and FOIS were significantly correlated with NGT removal. Patients' BI scores indicating severe to moderate dependence (21–90) had a 4.55 times greater chance of NGT removal (odds ratio, 4.55; p < 0.05) than patients who had total dependence (<20). Every one-point increase in FOIS score indicated a 3.07 times greater chance of NGT removal (odds ratio, 3.07; p < 0.05). Conclusions: The BI and FOIS evaluations may indicate the probability of NGT removal in patients. [ABSTRACT FROM AUTHOR]

Background and Objectives: The recovery of stroke patients with severe impairment is usually poor and limited and, unfortunately, under-investigated in clinical studies. In order to support neuroplasticity and modulate motor recovery, Cerebrolysin combined with rehabilitation treatment has proven effective in the acute stroke phase in moderate to severe motor impairment. The aim of this study was to determine the efficacy of extended poststroke rehabilitation combined with Cerebrolysin on upper limb motor recovery in subacute stroke patients with severe upper limb motor impairment. Materials and Methods: A randomized, double-blind, placebo-controlled study was conducted. Sixty patients at the early stage of severe sub-acute stroke who fulfilled all eligibility criteria were randomly assigned to the Cerebrolysin group or placebo group (= 30 each). Both groups, after conducting three weeks of conventional rehabilitation treatment five days per week, continued to perform conventional rehabilitation treatment three times per week until 90 days of rehabilitation treatment. The primary outcome measure was the Action Research Arm Test (ARAT), and the secondary outcomes were the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) motor score, Barthel index (BI), and the National Institutes of Health Stroke Scale (NIHSS). The outcome data were evaluated before, after three weeks of treatment, and on the 90th day of rehabilitation treatment, and compared within groups and between the two groups. There were no adverse events. Results: Both groups showed a significant improvement (p < 0.001) over time in BI, FMA-UE, ARAT, and NIHSS scores. Patients receiving Cerebrolysin showed more significant improvement in post-stroke upper limb motor impairment and functioning compared to the placebo group after only three weeks, and the trend was maintained after 90 days of follow up. Conclusion: Cerebrolysin delivered in the early subacute post-stroke phase added to extended conventional rehabilitation treatment is beneficial and improves motor functional recovery in patients with severe motor impairment, especially on the paretic upper extremity. [ABSTRACT FROM AUTHOR]

Background: Communication and advance care directives may be affected by the presence of dementia. We sought to describe the information and end-of-life preferences provided to nursing homes residents and their families. Methods: Trained nurses collected information from 124 residents randomly selected with palliative care needs from eight nursing homes. Results: A total of 54.4% of the residents with dementia had been provided with information about their state of health, compared to 92.5% of the residents without dementia (p < 0.01); family members exhibited no differences regarding information (p = 0.658), regardless of whether the resident was cognitively impaired. Most advance care interventions remained unexplored, except for cases where a transfer to hospital (81.5%) or serotherapy (69.4%) was desired. Decisions regarding palliative sedation (p = 0.017) and blood transfusion (p = 0.019) were lower among residents with dementia. Conclusions: Residents, especially residents with dementia, are provided with limited information and their preferences are inadequately explored. [ABSTRACT FROM AUTHOR]

Background Gait speed represents a functional predictor and an impairment severity index in stroke survivors; gait analysis parameters are descriptors of walking strategies used to compensate for the muscle impairment such as vaulting, circumduction and hip hiking. The aim of this study was to assess if there is a relationship between the gait compensatory strategy and gait speed of progression. Methods A sample of 30 patients with post-stroke hemiparesis was assessed for gait compensatory patterns through gait analysis and videorecording. BMI, pain-VAS, Barthel Index, Nottingham Extended ADL Scale, Motricity Index, lower limb muscles strength and aROMs were also included in the assessment. Results In 19 patients it was possible to identify one or more compensatory strategies; in 11 patients no specific gait pattern was found. The vaulting and hip hiking combined gait strategy had an effect on gait speed. Gait speed was directly related to Barthel Index, Nottingham Extended ADL Scale, Motricity Index of the paretic side and in particular with quadriceps and iliopsoas strength and hip extension aROM. Gender, age and paretic side did not influence gait speed. Conclusion Compensatory gait strategies influence gait speed but studies with larger sample size are needed to better highlight their impact. [ABSTRACT FROM AUTHOR]

Life satisfaction is increasingly important for older cancer survivors as the global population ages and the life expectancy 29 of cancer survivors increases. This study sought to identify factors associated with physical symptoms, quality of life under treatment, and current life satisfaction in cancer survivors aged 75 years and older receiving outpatient chemotherapy. Information about treatment for cancer survivors was collected from electronic medical records, and interviews were conducted to assess life satisfaction under treatment. Participants were older cancer survivors in Ishikawa, Japan. Of the participants, 80% lived on the Noto Peninsula. The average linear distance traveled for treatment was 40.7 km. The factors associated with patients' dissatisfaction with their current lives included general malaise (odds ratio: 9.61; 95% confidence interval: 1.28–72.22) and being less happy now than when they were younger (odds ratio: 10.559; 95% confidence interval: 1.50–74.24). In outpatient cancer treatment for survivors aged 75 years and older, support should consider the distance to the hospital. As in past studies, general malaise was shown to have a negative impact on the lives of cancer survivors aged 75 years or older. Support providers should pay attention to patients' general malaise when providing support. [ABSTRACT FROM AUTHOR]

Post-intensive care syndrome (PICS) comprises physical, mental, and cognitive disorders following a severe illness. The impact of PICS on long-term prognosis has not been fully investigated. This study aimed to: (1) clarify the frequency and clinical characteristics of PICS in sepsis patients and (2) explore the relationship between PICS occurrence and 2-year survival. Patients with sepsis admitted to intensive care unit were enrolled. Data on patient background; clinical information since admission; physical, mental, and cognitive impairments at 3-, 6-, and 12-months post-sepsis onset; 2-year survival; and cause of death were obtained from electronic medical records and telephonic interviews with patients and their families. At 3 months, comparisons of variables were undertaken in the PICS group and the non-PICS group. Among the 77 participants, the in-hospital mortality rate was 11% and the 2-year mortality rate was 52%. The frequencies of PICS at 3, 6, and 12 months were 70%, 60%, and 35%, respectively. The 2-year survival was lower in the PICS group than in the non-PICS group (54% vs. 94%, p < 0.01). More than half of the survivors had PICS at 3 and 6 months after sepsis. Among survivors with sepsis, those who developed PICS after 3 months had a lower 2-year survival. [ABSTRACT FROM AUTHOR]

This study evaluated changes of cognitive, physical, and nutritional status before and after the interruption and resumption of daycare services during the COVID-19 pandemic in older dementia people in a daycare center. Comprehensive geriatric assessment data were analyzed before and after the lockdown of daycare center services, including mini-mental state examination, activities of daily living (ADL) scores, mini-nutritional assessment-short forms (MNA-SF), and timed up-and-go (TUG) tests. Among 19 dementia people participating in daycare services, 17 participants were enrolled in the study with, finally, two excluded because of incomplete follow-ups. They had a median age of 81 years; their MNA-SF scores and TUG values deteriorated significantly after a 3-month closure of daycare services (p < 0.05), and after resumption of daycare services the MNA-SF scores and TUG values recovered to near the pre-lockdown levels (p < 0.05). Besides, baseline ADL scores predicted a decline and recovery of TUG and MNA-SF values. Our findings suggest that planning continuous support for older dementia adults is important for daycare facilities during COVID-19 pandemic confinement. [ABSTRACT FROM AUTHOR]

This study was designed to determine the best intervention time (acute, subacute, and chronic stages) for Walkbot robot-assisted gait training (RAGT) rehabilitation to improve clinical outcomes, including sensorimotor function, balance, cognition, and activities of daily living, in hemiparetic stroke patients. Thirty-six stroke survivors (acute stage group (ASG), n = 11; subacute stage group (SSG), n = 15; chronic stage group (CSG), n = 10) consistently received Walkbot RAGT for 30 min/session, thrice a week, for 4 weeks. Six clinical outcome variables, including the Fugl–Meyer Assessment (FMA), Berg Balance Scale (BBS), Trunk Impairment Scale (TIS), Modified Barthel Index (MBI), Modified Ashworth Scale (MAS), and Mini-Mental State Examination, were examined before and after the intervention. Significant differences in the FMA, BBS, TIS, and MBI were observed between the ASG and the SSG or CSG. A significant time effect was observed for all variables, except for the MAS, in the ASG and SSG, whereas significant time effects were noted for the FMA, BBS, and TIS in the CSG. Overall, Walkbot RAGT was more favorable for acute stroke patients than for those with subacute or chronic stroke. This provides the first clinical evidence for the optimal intervention timing for RAGT in stroke. [ABSTRACT FROM AUTHOR]

Background: Information regarding short-term vital prognosis in patients with heart failure at advanced stages of the disease is scarce. Objective: To develop a three-month mortality predictive model for patients with advanced heart failure. Methods: Prospective observational study carried out in primary care and a convalescence community facility. Heart failure patients either New York Heart Association (NYHA) III with at least two HF hospitalizations during the previous six months or NYHA IV with/without previous recent hospitalization were included in the study. Multivariable predictive models using Cox regression were performed. Results: Of 271 patients included, 55 (20.3%) died during the first three months of follow-up. Mean age was 84.2 years (SD 8.3) and 59.8% were women. Predictive model including NT-proBNP had a C-index of 0.78 (95% CI 0.71; 0.85) and identified male gender, low body mass index, high potassium and NT-proBNP levels, and moderate-to-severe dependence for daily living activities (Barthel index < 40) as risk factors of mortality. In the model without NT-proBNP, C index was 0.72 (95% CI 0.64; 0.79) and, in addition to gender, body mass index, low Barthel index, and severe reductions in glomerular filtration rate showed the highest predictive hazard ratios for short-term mortality. Conclusions: In addition to age, male gender, potassium levels, low body mass index, and low glomerular filtration, dependence for activities of daily living add strong power to predict mortality at three months in patients with advanced heart failure. [ABSTRACT FROM AUTHOR]

(1) Background: It is important to evaluate the attention in the basic activities of daily life in the early hours of the day to evaluate the quality of care and to be able to increase the attention of human resources in case of observing an increase in dependency. The purpose was to improve healthcare quality in nursing homes, correctly identifying the work burden and incidents of daily planning, and completing the work plan by nursing assistant staffing. (2) Methods: The sample is based on 70 elderly people. The analysis used an observational trial every workday over a six-month period. An ad hoc sheet was prepared to collect socio-demographic data on each participant, and the Barthel Index was applied to the study subjects. A daily record of three basic activities of daily living (BADL), such as dressing, bathing, and eating, was kept. (3) Results: Our results showed a significant evolution in both units, but it was in the psychogeriatric unit in which higher compliance with the schedule and higher maintained stability was reached. (4) Conclusions: The use of some BADL registers helped us address situations of imbalance in terms of user assistance and establish an interdisciplinary communication with the nursing team as a way of achieving better organization and compliance with care protocols. [ABSTRACT FROM AUTHOR]

Stroke results in paretic limb disabilities, but few studies have investigated the impacts of stroke on muscle perception deficits in multiaxis movements and related functional changes. Therefore, this study aimed to investigate stroke-related changes in muscle perceptions using a multiaxis ankle haptic interface and analyze their relationships with various functions. Sixteen stroke patients and 22 healthy participants performed active reproduction tests in multiaxis movements involving the tibialis anterior (TA), extensor digitorum longus (EDL), peroneus longus, and flexor digitorum longus (FDL) of the ankle joint. The direction error (DE), absolute error (AE), and variable error (VE) were calculated. The lower extremity of Fugl-Meyer Assessment (FMA-LE), Barthel Index (BI), Postural Assessment Scale for Stroke Patients, Tinetti Performance-Oriented Mobility Assessment (POMA), and 10-m walk test (10MWT) were evaluated. VE of EDL for the paretic ankle was significantly lower than that for the nonparetic ankle (p = 0.009). AE of TA, EDL, and FDL and VE of EDL and FDL of muscle perceptions were significantly lower in healthy participants than in stroke patients (p < 0.05 for both). DE of TA for the paretic ankle was moderately correlated with FMA-LE (r = −0.509) and POMA (r = −0.619) scores. AE and VE of EDL for the paretic ankle were moderately correlated with the 10MWT score (r = 0.515 vs. 0.557). AE of FDL for the paretic ankle was also moderately correlated with BI (r = −0.562). This study indicated poorer accuracy and consistency in muscle perception for paretic ankles, which correlated with lower limb functions of stroke patients. [ABSTRACT FROM AUTHOR]

Physical function is a patient-oriented indicator and can be considered a proxy for the assignment of healthcare personnel. The study aims to create an algorithm that classifies patients into homogeneous groups according to physical function. A two-step machine-learning algorithm was applied to administrative data recorded between 2015 and 2018 at the University Hospital of Padova. A clustering-large-applications (CLARA) algorithm was used to partition patients into homogeneous groups. Then, machine learning technique (MLT) classifiers were used to categorize the doubtful records. Based on the results of the CLARA algorithm, records were divided into three groups according to the Barthel index: <45, >65, ≥45 and ≤65. The support vector machine was the MLT showing the best performance among doubtful records, reaching an accuracy of 66%. The two-step algorithm, since it splits patients into low and high resource consumption, could be a useful tool for organizing healthcare personnel allocation according to the patients' assistance needs. [ABSTRACT FROM AUTHOR]