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We identified data-driven multidimensional physical activity (PA) profiles using several novel accelerometer-derived metrics. Participants aged 75, 80, and 85 (n = 441) wore triaxial accelerometers for 3–7 days. PA profiles were formed with k-means cluster analysis based on PA minutes, intensity, fragmentation, sit-to-stand transitions, and gait bouts for men and women. Associations with physical capacity and life-space mobility were examined using age-adjusted general linear models. Three profiles emerged: "Exercisers" and "actives" accumulated relatively high PA minutes, with actives engaging in lighter intensity PA. "Inactives" had the highest activity fragmentation and lowest PA volume, intensity, and gait bouts. Inactives showed lower scores in physical capacity and life-space mobility compared with exercisers and actives. Exercisers and actives had similar physical capacity and life-space mobility, except female exercisers had higher walking speed in the 6-min walk test. Our findings demonstrate the importance of assessing PA as multidimensional behavior rather than focusing on a single metric. [ABSTRACT FROM AUTHOR]

Background: Fall risk and incidence increase with age, creating significant physical and mental burden for the individual and their care provider. Lift assistive devices are used in multiple healthcare facilities, but are generally not portable nor self-operational, limiting their use outside of medical supervision. The Raymex™ lift is a novel lift assistance device within a rollator to address these limitations. We aim to gather user-centered feedback on the Raymex™ lift, set up instructions, safety protocols to improve feasibility and usability, and explore the potential usability as a fall recovery or prevention device. Methods: Four older adults, two informal caregivers and 16 formal caregivers (clinicians and continuing care assistants) participated in a focus group. Participants provided feedback on the Raymex™ lift after viewing a demonstration and using the device. Qualitative and quantitative data were analysized using thematic and descriptive analysis respectively. Results: Participants highlighted three major themes: (1) Design features requiring improvement, (2) Positive feedback and suggestions to optimize the Raymex™ lift and (3) Pricing vs. social utility. Participants suggested widening the seat, changing the braking button layout, and lowering the device weight to improve usability. Participants believed the main device feature was fall recovery and had implications for social utility by reducing the need for ambulance visits to the home. Price point led to a concern on affordability for older adults. Conclusion: The feedback gained will advance the development of the Raymex™ lift and may highlight cost-effective design choices for other developers creating related aging assistive technologies. [ABSTRACT FROM AUTHOR]

Purpose: The aims were to translate the Evaluation of Daily Activity Questionnaire (EDAQ) into Turkish, then test validity and reliability in people with rheumatoid arthritis (RA) in Turkey. Material and Methods: Phase 1: The EDAQ was forward and backward translated, culturally adapted following cognitive debriefing interviews with participants with RA (n = 10) and finalized by an expert committee. Phase 2: Participants (n = 215) completed a questionnaire including the EDAQ, Health Assessment Questionnaire (HAQ), and Short-Form 36 v1 (SF-36v1). Two weeks later, the EDAQ was again completed for test–retest reliability (n = 82:38%). Internal construct validity was assessed using Rasch analysis. Internal consistency, concurrent validity, and test–retest reliability were assessed. Results: Following cultural adaptation, one item was removed, and examples increased or changed. Cronbach's α values were 0.71 − 0.93 for all EDAQ domains, that is, acceptable to good. The EDAQ met Rasch model requirements for fit (excellent construct validity: p > 0.05). Concurrent validity was moderate to strong for most EDAQ domains with HAQ (rs 0.49–0.81) and SF-36-v1 Physical Function (rs 0.42–0.70). There was excellent test–retest reliability for all domains (ICC (2,1): 0.95–1.00). Conclusion: The Turkish EDAQ is a valid, reliable measure of daily activity ability for use in practice and research with Turkish speakers with RA. IMPLICATIONS FOR REHABILITATION: The Evaluation of Daily Activity Questionnaire provides a comprehensive evaluation of daily activity ability for people with rheumatic and musculoskeletal diseases. The Turkish Evaluation of Daily Activity Questionnaire is a valid, reliable patient-reported outcome measure in patients with rheumatoid arthritis, who considered it easy to complete. The Turkish Evaluation of Daily Activity Questionnaire is suitable for use in clinical practice and research to evaluate daily activity ability in people with rheumatoid arthritis. [ABSTRACT FROM AUTHOR]

Purpose: Little is known about the outcomes that are most important to prosthesis users and funders. A Prosthetic Interventions Core Outcome Set (PI-COS) will help researchers and practitioners measure outcomes that are the most important to prosthesis users and funders. Materials and methods: Prosthesis users and funders rated the importance of 121 International Classification of Functioning, Disability, and Health (ICF) second-level categories using a two-round Delphi survey. A Consensus Meeting using the nominal group technique resolved rating differences between groups. The ICF second-level categories were ranked according to importance and a K-Means Cluster Analysis helped establish the PI-COS. Results: 65 users and 8 funders completed the Delphi surveys, followed by a Consensus Meeting. 26 ICF second-level categories were considered important to prosthesis users and funders and a PI-COS of 14 ICF second-level categories drawn predominantly from five ICF chapters was established: Sensory Functions and Pain (b2), Neuromusculoskeletal and Movement-related Functions (b7), General Tasks and Demands (d2), Mobility (d4), and Products and Technology (e1). Conclusions: The PI-COS describes the outcomes that are most important to prosthesis users and funders. The PI-COS can help focus on the most important outcome measures in clinical practice and research, including future prosthetic health economic evaluations. [ABSTRACT FROM AUTHOR]

Background: The University of Jyvaskyla Active Aging Scale (UJACAS) assesses active aging through willingness, ability, opportunity, and frequency of involvement in activities. Recognizing the lack of a German version, the Finnish original was translated (UJACAS-G). This study aimed: (1) to evaluate the test-retest reliability of UJACAS-G; and (2) to explore correlations with health-related parameters (concurrent validity). Methods: The study (test-retest design) targeted healthy older adults aged 65+. Reliability of UJACAS-G (total and subscores) was assessed using Bland-Altman analyses and Intraclass Correlation Coefficients (ICCs). Furthermore, correlations (Spearman's rho) between UJACAS-G scores and physical function (walking speed, handgrip strength, balance, 6-minute walk distance), physical activity (International Physical Activity Questionnaire), life-space mobility (Life-Space Assessment), and health-related quality of life (Short Form-36 Health Survey) were calculated. Results: Bland-Altman analyses (N = 60; mean age 72.3, SD 5.9 years; 50% women) revealed mean differences close to zero and narrow limits of agreement for all scores (total score: mean difference −1.9; limits −31.7 to 27.9). The ability subscore showed clustering at its upper limit. ICC was 0.829 (95% CI 0.730 to 0.894) for the total score and ranged between 0.530 and 0.876 for subscores (all p-values < 0.001). The total score correlated with walking speed (rho = 0.345; p = 0.008), physical activity (rho = 0.279; p = 0.033) and mental health (rho = 0.329; p = 0.010). Conclusions: UJACAS-G is reliable for assessing active aging among German-speaking healthy older adults. A potential 'ceiling effect' regarding the ability subscore should be considered when applying UJACAS-G to well-functioning populations. Analyses of concurrent validity indicated only weak correlations with health-related parameters. [ABSTRACT FROM AUTHOR]

Background: Urinary incontinence (UI) is a highly prevalent condition in women with a profound influence on their well-being and quality of life. Pelvic floor muscle training (PFMT) is a widely accepted conservative management of incontinence. Adequate knowledge of PFMT can enhance the ability of individuals to perform them effectively unsupervised. Objectives: This study aimed to determine the prevalence of UI and knowledge of PFMT among older women in a selected suburban community in Nigeria. Design: A cross-sectional design. Methods: This study consecutively recruited 121 older women (65 years and above) with a mean age of 68.59 ± 4.94 years in Nnewi North LGA Anambra state, Nigeria. The International Consultation on Incontinence Questionnaire Short Form and an adopted pre-tested questionnaire were used to assess the prevalence of UI and knowledge of PFMT. Data was analyzed using Statistical Package of Social Sciences (SPSS) version 26 Descriptive statistics, and the chi-square test was utilized with significance determined at an alpha level of 0.05. Results: The results revealed that 33.88% of the respondents experience UI, and 3.3% of them have heard about PFMT. There was significant association between prevalence of UI and number of pregnancies (χ2 = 11.16, p = 0.03) and children (χ2 = 9.77, p = 0.04). There was no significant association between the prevalence of UI and level of education (χ2 = 4.20, p = 0.12) and knowledge of PFMT (χ2 = 0.48, p = 0.42). There was no significant association between knowledge of PFMT and number of pregnancies (χ2 = 04.25, p = 0.37), and number of children (χ2 = 4.02, p = 0.40). There was a significant association between knowledge of PFMT and level of education among the participants (χ2 = 7.46, p = 0.02). Conclusion: The study showed a significant prevalence of UI and poor knowledge of PFMT in older women. Health professionals should sensitize older women in hospitals and care homes on the benefits of PFMT to improve their knowledge of PFMT. [ABSTRACT FROM AUTHOR]

Introduction: Studies analyzing postures and mobility of the thoracic spine in the context of cervicogenic headache are missing. Insight in these parameters is needed since the cervical and thoracic spine are biomechanically related. Objective: To compare self-perceived optimal and habitual postures, active-assisted maximal range of motion, and repositioning error of the upper-thoracic and lower-thoracic spine between a cervicogenic headache-group and matched healthy control-group before and after a 30 min-laptop-task. Methods: A non-randomized longitudinal design was used to compare thoracic postures and mobility between 18 participants with cervicogenic headache (29–51 years) and 18 matched healthy controls (26–52 years). Outcomes were: self-perceived optimal and habitual postures, active-assisted maximal range of motion, and repositioning error of the upper-thoracic and lower-thoracic spine evaluated in sitting with a 3D-Vicon motion analysis system. Results: Habitual upper-thoracic postures in the cervicogenic headache-group were significantly (p =.04) less located toward the maximal range of motion for flexion compared to the control-group, self-perceived optimal upper-thoracic posture was significantly (p =.004) more extended in the cervicogenic headache-group compared to the control-group, and self-perceived optimal lower-thoracic posture could not be reestablished in the cervicogenic headache-group after the laptop-task (p =.009). Conclusion: Thoracic postures differ between a cervicogenic headache-group and control-group. These differences were detected by expressing the habitual thoracic posture relative to its maximal range of motion, and by analyzing the possibility of repositioning the thoracic spine after a headache provoking activity. Longitudinal studies are needed to determine the contribution of these musculoskeletal dysfunctions to the pathophysiology of cervicogenic headache. [ABSTRACT FROM AUTHOR]

To investigate the effect of dual-task training on balance and knee proprioception in both weight-bearing and non-weight-bearing conditions in older adults with significant imbalance and high risk of falling. This pre-posttest experimental design included 83 older adults (43 males, 40 females), selected based on age criteria (65–75 years) and specific inclusion and exclusion criteria. Participants underwent dual-task training consisting of 30-minute sessions, three times per week, for four weeks (totaling 12-sessions). Measures included Berg Balance Scale and knee proprioception deficit before and after dual-task training. The study showed statistically significant effect of dual-task training on balance (p < 0.001) and knee proprioception in both weight-bearing (p < 0.001) and non-weight-bearing (p < 0.001) in older adults. Pre-and post-measurements of independent variables between male and female older adults showed no significant difference. Dual-task training improves balance and knee proprioception in both weight-bearing and non-weight-bearing conditions in older individuals, thereby enhancing stability and reducing the risk of falls. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the effect of hippotherapy simulator on balance, postural control, mobility, functional capacity and independence level in people with stroke. This study involved 26 people with stroke aged 18–65, who were randomly assigned to a Hippotherapy Simulator Group (HSG; n = 13) and a Conventional Exercise Group (CEG; n = 13). Patients underwent assessments using the Berg Balance Scale (BBS), Postural Assessment Scale for Stroke (PAS-S), Timed Up and Go Test (TUG), Rivermead Mobility Index (RMI), 2-Minute Walking Test (2-MWT), and Barthel Daily Living Activity Index (BI) to evaluate balance, postural control, mobility, functional capacity, and independence before and after treatment. In the HSG, participants received 30 sessions of conventional exercises and hippotherapy simulator – a mechanical and robotic equipment with a dynamic saddle simulating horse movement – exercises over 6 weeks. Meanwhile, the CEG underwent 30 sessions of conventional exercises alone for 6 weeks. In the post-therapy evaluation between groups, BBS (p = 0.004) and 2-MWT (p < 0.001) scores were higher in HSG compared to CEG. However, no statistically significant difference was found between the two groups in terms of PAS-S, RMI, TUG and BI scores (p > 0.05). Statistically significant differences were found between BBS, PAS-S, RMI, TUG, BI and 2-MWT scores before and after treatment in both groups (p < 0.05). Hippotherapy simulator can be added to conventional exercises to improve balance and functional capacity in people with stroke. [ABSTRACT FROM AUTHOR]

Background: Adoption of early mobility interventions into intensive care unit (ICU) practice has been slow and varied. Objectives: To examine factors associated with early mobility performance in critically ill adults and evaluate factors' effects on predicting next-day early mobility performance. Methods: A secondary analysis of 66 ICUs' data from patients admitted for at least 24 hours. Mixed-effects logistic regression modeling was done, with area under the receiver operating characteristic curve (AUC) calculated. Results: In 12 489 patients, factors independently associated with higher odds of next-day mobility included significant pain (adjusted odds ratio [AOR], 1.16; 95% CI, 1.09–1.23), documented sedation target (AOR, 1.09; 95% CI, 1.01–1.18), performance of spontaneous awakening trials (AOR, 1.77; 95% CI, 1.59–1.96), spontaneous breathing trials (AOR, 2.35; 95% CI, 2.14–2.58), mobility safety screening (AOR, 2.26; 95% CI, 2.04–2.49), and prior-day physical/occupational therapy (AOR, 1.44; 95% CI, 1.30–1.59). Factors independently associated with lower odds of next-day mobility included deep sedation (AOR, 0.44; 95% CI, 0.39–0.49), delirium (AOR, 0.63; 95% CI, 0.59–0.69), benzodiazepine administration (AOR, 0.85; 95% CI, 0.79–0.92), physical restraints (AOR, 0.74; 95% CI, 0.68–0.80), and mechanical ventilation (AOR, 0.73; 95% CI, 0.68–0.78). Black and Hispanic patients had lower odds of next-day mobility than other patients. Models incorporating patient, practice, and between-unit variations displayed high discriminant accuracy (AUC, 0.853) in predicting next-day early mobility performance. Conclusions: Collectively, several modifiable and nonmodifiable factors provide excellent prediction of next-day early mobility performance. [ABSTRACT FROM AUTHOR]

Introduction: The C-Brace microprocessor stance and swing control orthosis was designed to overcome safety and functional limitations of traditional knee-ankle-foot orthoses (KAFOs) for individuals with lower limb paresis. However, a systematic comparison to established KAFO types has not been performed in a bigger sample. Methods: International multicenter, randomized, controlled, cross-over clinical trial. Legacy KAFO users at risk of falling were randomized to KAFO/C-Brace or C-Brace/KAFO use for three months with each orthosis. Primary outcome was balance assessed with the Berg Balance Scale (BBS). Secondary outcomes were falls, mobility, function, and quality of life. Results: Intention-to-treat analysis with 102 participants. With the C-Brace, the BBS improved by 3.3 ± 6.3 points (p < 0.0001). Significantly fewer participants presented BBS scores <40 indicative of increased fall risk (16 vs. 36, p = 0.018). Mean falls reduced from 4.0 ± 16.8 to 1.1 ± 3.3 (p = 0.002). Outcomes for function, mobility, and quality of life showed significant improvements with the C-Brace. Discussion: The improvements in fall risk and mobility can be attributed to the stumble recovery and controlled knee flexion during weight bearing of the C-Brace and have a positive impact on the quality of life of users. Conclusion: The C-Brace represents an option for KAFO users with increased fall risk and reduced mobility. IMPLICATIONS FOR REHABILITATION: When prescribing traditional knee-ankle-foot orthoses (KAFOs), their known limitations, such as limited function and mobility, and the requirement to walk with compensatory mechanisms, especially on non-level terrains, should be considered. For patients with compromised balance and increased risk of falling when using a traditional KAFO, a microprocessor stance and swing control orthosis (MP-SSCO) may be considered as an orthotic option to reduce their fall risk. For patients with mobility restrictions using a traditional KAFO, a MP-SSCO may be considered to improve function, mobility, reintegration into normal living, and quality of life. [ABSTRACT FROM AUTHOR]

Purpose: Measures of physical capacity and self-efficacy may help rehabilitation professionals better understand and detect frailty in older adults. We aimed to characterize frailty, walking self-efficacy, physical capacity, and their inter-relationships in older adults with difficulty walking outdoors. Materials and methods: A secondary analysis of baseline data from 187 older adults (age ≥ 65 years) with mobility limitations was performed. Frailty was evaluated using the cardiovascular health study frailty index. Physical capacity was measured using the 10-meter walk test (10mWT), 6-min walk test (6MWT), 30-second sit-to-stand test (30STST), mini balance evaluation systems test (mini-BESTest), and hand dynamometry. Self-efficacy was assessed using the ambulatory self-confidence questionnaire (ASCQ). We evaluated associations between scores on physical capacity and walking self-efficacy measures and frailty level using an ANOVA or the Kruskal Wallis H-test. Results: The percentage of participants not frail, pre-frail, and frail was 33.7%, 57.2%, and 9.1%, respectively. Median score on the 10mWT-comfortable pace, 10mWT-fast pace, 6MWT, 30STST, mini-BESTest, grip strength, and ASCQ was 1.06 m/s, 1.42 m/s, 354.0 m, 9.0 repetitions, 22 points, 23.0 kg, and 8.1 points, respectively. Scores on physical capacity and walking self-efficacy measures were associated with frailty level (p < 0.01). Conclusions: Findings provide insight into the utility of rehabilitation measures to indicate frailty among older adults with mobility limitations. [ABSTRACT FROM AUTHOR]

Background: This study investigates the effectiveness of a self-developed intelligent monitoring system for home-based knee rehabilitation following total knee arthroplasty (TKA). Methods: In this randomized controlled trial, 120 patients undergoing TKA were divided using random digit allocation. Preoperative and one-month postoperative assessments of knee function, quality of life, and isometric knee extension strength were conducted with the Intelligent Monitoring System. Patients received group-specific rehabilitation instructions pre-discharge and performed exercises for one month. Results: Changes in isometric knee extensor strength on the affected side within one month post-surgery for the brace-monitored rehabilitation group showed a significant decrease three days after surgery compared to one day before surgery. Subsequent measurements taken at postoperative days 5, 7, 14, and 21 indicated a gradual increase in strength, although these increases did not reach statistical significance when compared with previous measurements. One month post-surgery, all groups demonstrated significant improvements in knee joint function and mobility compared to pre-surgery levels. Notably, the brace-monitored group showed statistically significant improvements in 36-Item Short-Form Health Survey (SF-36) scores over the conventional rehabilitation group. Conclusions: The Intelligent Monitoring System provides effective real-time monitoring and guidance for home-based knee rehabilitation post-TKA. It significantly enhances knee joint function, isometric knee extension strength, and quality of life shortly after surgery compared to traditional rehabilitation methods. This system offers a promising approach for improving postoperative recovery in TKA patients. Trial registration: This study was approved by the Medical Ethics Committee of Xiangya Hospital, Central South University (Ethics Approval Number 202209008-2). It was registered with the China Clinical Trial Registry, a primary registry of the World Health Organization's International Clinical Trials Registry Platform (Registration Number ChiCTR2300068852). [ABSTRACT FROM AUTHOR]

Background: Non-specific lower back pain (NSLBP) is prevalent among female police officers, influenced by genetic factors, aging, and occupational risks such as heavy lifting. This study evaluates a 6-week program combining core strengthening and hip mobility exercises to alleviate NSLBP. Objective: To assess the effectiveness of core strengthening and dynamic hip mobility exercises in reducing NSLBP among female officers. Methods and Material: The study involved 40 female officers aged 25-55 with NSLBP lasting at least 6 weeks using simple random sampling technique. Participants were randomly assigned to Group A (control) or Group B (experimental). Group B underwent a 6-week core strengthening and hip mobility exercise regimen, with pain intensity (NPRS) and low back disability (ODI) measured before and after. Results: Group B exhibited significantly lower pain intensity (3.5 ± 1.147 vs 7.3 ± 0.9234) and reduced low back disability (13.6 ± 2.909 vs 28.65 ± 2.207) compared to Group A. Conclusions: The study revealed that among female officers with NSLBP, core strengthening and hip mobility exercises proved more effective than traditional exercises in alleviating pain and reducing low back instability [ABSTRACT FROM AUTHOR]

Objectives: To analyze our patient's complication profile and rate after removal of hardware (ROH) surgery, and survey our patients to ask their overall status and improvement in symptomatology post-operatively. Design: Retrospective chart review and survey. Setting: Academic, tertiary referral center. Patients/participants: 173 patients with 314 pieces of hardware. Seventy-six patients (43.9%) responded to our survey. Intervention: ROH surgery. Main outcome measurements: Patient demographics and complications were recorded. All patients were sent a brief 3-question survey which asked: (1) Why did you get your hardware removed? (2) How did your overall status change after ROH? (3) How did the ROH affect your stiffness, pain, swelling, and mobility? Results: There were 10 complications (5.5%): 5 infections, 2 with unresolved pain, 1 hematoma, 1 chronic regional pain syndrome exacerbation, and 1 recurrent deformity. All infections were treated with oral antibiotics and improved. All other complications resolved with treatment except for the patient who developed recurrent deformity. Patients underwent ROH surgery because their doctor suggested it (76.3%) and to improve mobility (39.5%). 86.9% reported their overall status improved after ROH. They improved regarding stiffness (73.7%), pain (73.6%), swelling (61.8%), and mobility (76.3%). Similar results were seen among different implants removed. Conclusions: The majority of patients who underwent percutaneous ROH were satisfied. They reported improvement in stiffness, pain, swelling and mobility (greatest improvement). The complication rate was low (5.5%). ROH can be a meaningful operation to patients allowing them to improve their quality of life with a low complication rate. Level of Evidence: Level IV. [ABSTRACT FROM AUTHOR]

Background: Chronic conditions may limit older peoples' social engagement and wellbeing. Reduced social connections can result in loneliness and social isolation. This study aimed to explore the experience of social connection in older people living with chronic conditions, and the factors influencing their social participation. Methods: A purposive sample of 19 community-dwelling older Australians (mean age 75.5 years) with one or more chronic conditions participated in a qualitative descriptive study. Semi-structured interviews explored participants' perceptions of their social connections and the potential impact of their chronic conditions. Views about the role of general practice in supporting older persons' wellbeing were discussed. Data were analysed inductively using thematic analysis. Results: Five themes were identified: (1) the experience of loneliness, (2) managing diminishing social contacts, (3) living with chronic conditions, (4) barriers to social connection, and (5) facilitators of social connection. Participants felt that ageing with chronic conditions contributed to loss of function and independence, which limited social connections, and increased loneliness and social isolation. Barriers to social connections included issues with mobility, transport and forming new networks. Families were a primary support, with continued community engagement and general practice support crucial to staying well and socially connected. Conclusions: Understanding older peoples' experiences, and the barriers and facilitators of social connections can guide clinicians' interventions. General practice is a promising intervention point because of its high use by those with chronic conditions to stay well. General practice nurses are well-placed to collaboratively address the barriers older people face in maintaining social connections. Chronic conditions may limit older peoples' social engagement, with diminished social connections leading to loneliness, social isolation and other serious health consequences. This study explored the experience of social connection in older people living with chronic conditions and factors influencing their social participation. Older people identified the importance of family, community engagement and staying well through primary care support. Understanding the barriers and facilitators of social connections for older people can guide the general practice team in developing appropriate interventions. [ABSTRACT FROM AUTHOR]

Introduction: Avascular Necrosis (AVN) of the femoral head, a condition characterized by the interruption of blood supply leading to bone tissue death, presents significant therapeutic challenges. Recent advancements in orthobiologics, including the use of Autologous Adult Live-Cultured Osteoblasts (AALCO), combined with core decompression, offer a novel approach for managing AVN. This study assesses the efficacy of this treatment modality in improving functional outcomes and hindering disease progression. Materials and methods: This retrospective observational study encompassed 30 patients treated between 2020 and 2023 for idiopathic AVN of the femoral head, grades I to III, who had not responded to conservative treatment. Patients were excluded based on specific criteria including age, secondary AVN causes, and certain health conditions. The treatment involved a two-stage surgical procedure under spinal anesthesia with OSSGROW® for AALCO generation. Post-operative care emphasized early mobilization, DVT prevention, and avoidance of NSAIDs. Outcome measures were evaluated using the Visual Analog Scale (VAS) for pain, modified Harris Hip Score, and annual MRI imaging for up to 36 months. Results: Among 26 patients (41 hips) completing the study, statistically significant improvements in pain and hip functionality were documented, alongside positive radiological signs of osteogenesis in the majority of cases. However, four instances required advancement to total hip replacement due to disease progression. Conclusion: The combination of core decompression and AALCO implantation shows promise as an effective treatment for AVN of the femoral head, with notable improvements in functional and radiological outcomes. This study supports the potential of orthobiologic approaches in AVN treatment, warranting further investigation through comprehensive randomized controlled trials. [ABSTRACT FROM AUTHOR]

The priorities of individuals with chronic stroke are not always reflected in clinical practice. This study provides insight into meaningful factors related to long-term motor recovery in stroke survivors. Thirty individuals with chronic stroke participated in semi-structured interviews about movement, recovery, and barriers to and facilitators of mobility and paretic arm use. The interviews were analyzed using inductive thematic analysis. Three categories, the individual, environment, and task, defined five emergent themes. Individual: (1) mindset is a strong and consistent influencer of daily physical activity and overall recovery; (2) severe physical impairment limits physical activity and recovery, regardless of other factors; and (3) a negative perception of disability impacts mindset and willingness to move in public. Environment: (4) social and physical environments influence physical activity and recovery. Task: (5) participation in meaningful activities increases physical activity and promotes long-term recovery. Strategies to incorporate paretic arm use, exercise, and encouragement from others facilitate physical activity. Insufficient paretic limb function, environmental obstacles, and fear are barriers to physical activity. Neurorehabilitation must address the factors that are meaningful to stroke survivors. Building motor capacity is essential and must be integrated with factors such as a positive mindset and proper environment. Individual differences reinforce the need for personalized care. [ABSTRACT FROM AUTHOR]

Intorduction: Most studies on the progression of childhood-onset multiple sclerosis (MS) involve relatively short follow-up periods, focusing primarily on neurological outcomes and disability progression. The influence of these and other factors on the health-related quality of life is not known. To gain a comprehensive understanding of early-onset MS, it is crucial to evaluate the effects of treatment and the disease on quality of life. Method: This pilot project aimed to evaluate the feasibility of using an online survey tool for long-term follow-up data collection from patients with childhood-onset MS. An anonymized, monocentric, prospective survey was conducted on a convenience cohort of patients treated at a certified centre for neuromuscular diseases in childhood between 2007 and 2019. Results: A total of 27 patients completed the survey. There were no mandatory items, therefore some patients chose not to answer all the questions in the questionnaire. Patients exhibited promising educational achievements, low neurological disease burden, and high resilience. However, anxiety, depression, and pain significantly impacted their perceived health status. Conclusion:This single-centre study has yielded new insights into childhood-onset MS. To enable more accurate comparisons across different centres and countries, it is essential to establish a minimum data set and questionnaire subset for patients with paediatric-onset MS transitioning into adulthood. [ABSTRACT FROM AUTHOR]

Physiotherapists working in hospitals have a key role in decisions about when a person with stroke is safe to walk independently. The aim of this study was to explore the factors influencing decision-making of physiotherapists in this situation. A qualitative design with semi-structured interviews and reflexive thematic analysis was used. Fifteen physiotherapists with recent experience working in inpatient stroke rehabilitation participated. Multiple factors influence decision-making about walking independence after stroke in hospitals. Four themes were identified: (1) Assessment of walking safety involves observation of walking function and consideration of complex individual factors; (2) Perspectives on risk vary, and influence whether a person is considered safe to walk; (3) Institutional culture involves background pressures that may influence decision-making; and (4) Physiotherapists adopt a structured, individualised mobility progression to manage risk. Physiotherapists consistently use observation of walking and understanding of attention and perception in this decision-making. There can sometimes be a conflict between goals of independence and of risk avoidance, and decisions are made by personal judgements. Decision-making about independent walking for people in a hospital after a stroke is complex. Improved guidance about clinical assessment of capacity and determining acceptable risk may enable physiotherapists to engage more in shared decision-making. Regaining independence in walking after a stroke comes with the potential risk of falls. Assessment of walking safety should be specific to the complexity of the situation and consider perception and cognition. Benefits of activity and autonomy, and the risk of falls need to be considered in decisions about walking independence. Patients with the capacity to understand consequences and accept risk can be active participants in determining what is sufficiently safe. [ABSTRACT FROM AUTHOR]

Background: Patient portal secure messaging can support age‐friendly dementia care, yet little is known about care partner use of the portal and how message concerns relate to age‐friendly issues. Methods: We conducted a two‐part observational study. We first assessed the feasibility of automating care partner identification from patient portal messages by developing and testing a natural language processing (NLP) rule‐based classification system from portal messages of 1973 unique patients 65 and older. Second, two independent reviewers manually coded a randomly selected sample of portal messages for 987 persons with dementia to identify the frequency of expressed needs from the 4M domains of an Age‐Friendly Health System (medications, mentation, mobility, and what matters). Results: A total of 267 (13.53%) of 1973 messages sent from older adults' portal accounts were identified through manual coding as sent by a nonpatient author. The NLP model performance to identify nonpatient authors demonstrated an AUC of 0.90. Most messages sent from the accounts of persons with dementia contained content relevant to the 4Ms (60%, 601/987), with the breakdown as follows: medications—36% (357/987), mobility—10% (101/987), mentation—16% (153/987), and what matters (aligning care with specific health goals and care preferences)—21%, 207/987. Conclusions: Patient portal messaging offers an avenue to identify care partners and meet the informational needs of persons with dementia and their care partners. [ABSTRACT FROM AUTHOR]

Background: FUNDES‐Child‐SE is a proxy rating questionnaire for measuring participation and independence in children with disabilities in a Swedish context. It includes the components of frequency of attendance, engagement and independence. The original, Taiwanese FUNDES‐Child 7.0, has previously been found to have a four‐factor structure for frequency of participation and a two‐factor structure for independence. The aim of this study was to test the factor structure in FUNDES‐Child‐SE. The factor structure is an important part of construct validity. Methods: Caregivers of 163 children with disabilities aged 6–18 years participated in this cross‐sectional study. Exploratory factor analysis was used to find the factor structure for Engagement. Confirmatory factor analysis was used to test the factor structure for all three components. Results: The proposed factor structure for frequency of participation (daily living participation frequency, mobility participation frequency, learning participation frequency and community participation frequency) and independence (daily living independence and social participation independence) fit with data from FUNDES‐Child‐SE after excluding three to five items and adding two to five covariances of residuals. In the engagement component, two factors, named engagement in informal activities and engagement in formal activities, were found. After excluding one item and adding 10 covariances of residuals, the factor structure had an acceptable fit to data. Conclusions: Differences in components' factor structure indicate that attendance and engagement are separate aspects of participation. Before using numeric scores from FUNDES‐Child‐SE in clinical settings, responsiveness and interpretability should be evaluated. [ABSTRACT FROM AUTHOR]

Aim(s): To demonstrate how interoperable nursing care data can be used by nurses to create a more holistic understanding of the healthcare needs of multiple traumas patients with Impaired Physical Mobility. By proposing and validating linkages for the nursing diagnosis of Impaired Physical Mobility in multiple trauma patients by mapping to the Nursing Outcomes Classification (NOC) and Nursing Interventions Classification (NIC) equivalent terms using free‐text nursing documentation. Design: A descriptive cross‐sectional design, combining quantitative analysis of interoperable data sets and the Kappa's coefficient score with qualitative insights from cross‐mapping methodology and nursing professionals' consensus. Methods: Cross‐mapping methodology was conducted in a Brazilian Level 1 Trauma Center using de‐identified records of adult patients with a confirmed medical diagnosis of multiple traumas and Impaired Physical Mobility (a nursing diagnosis). The hospital nursing free‐text records were mapped to NANDA‐I, NIC, NOC and NNN linkages were identified. The data records were retrieved for admissions from September to October 2020 and involved medical and nursing records. Three expert nurses evaluated the cross‐mapping and linkage results using a 4‐point Likert‐type scale and Kappa's coefficient. Results: The de‐identified records of 44 patients were evaluated and then were mapped to three NOCs related to nurses care planning: (0001) Endurance; (0204) Immobility Consequences: Physiological, and (0208) Mobility and 13 interventions and 32 interrelated activities: (6486) Environmental Management: Safety; (0840) Positioning; (3200) Aspiration Precautions; (1400) Pain Management; (0940) Traction/Immobilization Care; (3540) Pressure Ulcer Prevention; (3584) Skincare: Topical Treatment; (1100) Nutrition Management; (3660) Wound Care; (1804) Self‐Care Assistance: Toileting; (1801) Self‐Care Assistance: Bathing/Hygiene; (4130) Fluid Monitoring; and (4200) Intravenous Therapy. The final version of the constructed NNN Linkages identified 37 NOCs and 41 NICs. Conclusion: These valid NNN linkages for patients with multiple traumas can serve as a valuable resource that enables nurses, who face multiple time constraints, to make informed decisions efficiently. This approach of using evidence‐based linkages like the one developed in this research holds high potential for improving patient's safety and outcomes. No Patient or Public Contribution: In this study, there was no direct involvement of patients, service users, caregivers or public members in the design, conduct, analysis and interpretation of data or preparation of the manuscript. The study focused solely on analysing existing de‐identified medical and nursing records to propose and validate linkages for nursing diagnoses. [ABSTRACT FROM AUTHOR]

The Freezing of Gait Severity Tool (FOG Tool) was developed because of limitations in existing assessments. This cross-sectional study investigated its validity and reliability. People with Parkinson's disease (PD) were recruited consecutively from clinics. Those who could not walk eight-metres independently (with or without an assistive device), comprehend instructions, or with co-morbidities affecting walking were excluded. Participants completed a set of assessments including the FOG Tool, Timed Up and Go (TUG), and Freezing of Gait Questionnaire. The FOG Tool was repeated and those reporting no medication state change evaluated for test-retest reliability. Validity and reliability were investigated through Spearman's correlations and ICC (two-way, random). McNemar's test was applied to compare the FOG Tool and TUG on the proportion of people with freezing. Thirty-nine participants were recruited [79.5%(n = 31) male; Median(IQR): age–73.0(9.0) years; disease duration–4.0(5.8) years]. Fifteen (38.5%) contributed to test-retest reliability analyses. The FOG Tool demonstrated strongest associations with the Freezing of Gait Questionnaire (ρ = 0.67, 95%CI 0.43–0.83). Test-retest reliability was excellent (ICC = 0.96, 95%CI 0.88–0.99). The FOG Tool had 6.2 times the odds (95%CI 2.4–20.4, p < 0.001) of triggering freezing compared to the TUG. The FOG Tool appeared adequately valid and reliable in this small sample of people with PD. It was more successful in triggering freezing than the TUG. The Freezing of Gait Severity Tool's assessment course is more effective than the commonly-used Timed Up and Go's assessment course for eliciting freezing of gait for clinical evaluation in people with Parkinson's disease. The Freezing of Gait Severity Tool can be considered for scoring freezing of gait severity in people with Parkinson's disease in the clinical setting. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of diadynamic currents administered prior to exercises on pain and disability in patients with osteoarthritis of the knee. Design: A randomized-controlled trial. Setting: Special Rehabilitation Services in Taboão da Serra. Participants: Patients with bilateral knee osteoarthritis. Intervention: Participants were randomly allocated to Group I (diadynamic currents and exercises; n = 30, 60 knees) or Group II (exercises alone; n = 30, 60 knees) and were treated three times a week for 8 weeks. Main outcome measures: The primary outcome measures were change in knee pain evaluated by visual analog scale and disability Index Score (Lequesne). Secondary outcomes included change in mobility (Timed Up and Go test), range of motion (goniometer), muscle strength (dynamometer), a composite score for pain and disability (Western Ontario and McMaster Universities Osteoarthritis questionnaire), and a drug diary to measure consumption of rescue pain medication (paracetamol). All measurements were collected at baseline, 8 weeks, and 6 months from baseline (follow-up). Results: There were 60 participants with a mean (SD) age of 63.40 (8.20) years. Between-group differences in the follow-up (8 weeks and 6 months) were observed for pain at rest, pain during activities of daily living and disability. There was improvement in Group I that was maintained for the three variables 6 months after treatment. Mean difference for pain at rest was −3.08 points (95% confidence interval −4.13; −2.02), p < 0.01 with an effect size of 1.4; mean difference for pain during activities of daily living was −2.40 points (95% confidence interval −3.34; −1.45), p < 0.01 with an effect size of 1.24; and mean difference for disability was −4.08 points (95% confidence interval −5.89; −2.26), p < 0.01 with an effect size of 1.04. Conclusion: Patients with symptomatic knee osteoarthritis receiving 8 weeks of treatment with diadynamic currents as an adjunct to a program of exercises had significantly greater improvements in pain and disability than those receiving exercises alone. Beneficial effects were sustained for 6 months. [ABSTRACT FROM AUTHOR]

Objective: This systematic review and meta-analysis aimed to analyze the published randomized controlled trials (RCTs) that investigated the effects of exercise interventions on functioning and health-related quality of life following hospital discharge for recovery from critical illness. Design: Systematic review and meta-analysis of RCTs. Data sources: We searched PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, PEDro data base, and SciELO (from the earliest date available to January 2023) for RCTs that evaluated the effects of physical rehabilitation interventions following hospital discharge for recovery from critical illness. Review methods: Study quality was evaluated using the PEDro Scale. Mean differences (MDs), standard MDs (SMD), and 95% confidence intervals (CIs) were calculated. Results: Fourteen studies met the study criteria, including 1259 patients. Exercise interventions improved aerobic capacity SMD 0.2 (95% CI: 0.03–0.3, I 2 = 0% N = 880, nine studies, high-quality evidence), and physical component score of health-related quality of life MD 3.3 (95% CI: 1.0–5.6, I 2 = 57%, six studies N = 669, moderate-quality evidence). In addition, a significant reduction in depression was observed MD −1.4 (95% CI: −2.7 to −0.1, I 2 = 0% N = 148, three studies, moderate-quality evidence). No serious adverse events were reported. Conclusion: Exercise intervention was associated with improvement of aerobic capacity, depression, and physical component score of health-related quality of life after hospital discharge for survivors of critical illness. [ABSTRACT FROM AUTHOR]

Background and Objectives Social isolation has been recognized as a social problem with negative health consequences. Using data from 3 waves of the Health and Retirement Study, this study aimed to examine the long-term impact of social isolation on loneliness and depressive symptoms and to explore the moderating effect of resilience. Research Design and Methods This study comprised 3,681 U.S. adults aged 60 and older at the baseline wave. Social isolation index was constructed using 5 indicators, including not married or cohabitating with a partner, no social participation, and less than monthly contacts with children, family members, or friends. Loneliness was measured by the University of California Los Angeles (UCLA) Loneliness Scale and depressive symptoms were measured by the Center for Epidemiological Studies—Depression scale. The moderator of resilience was assessed by the simplified resilience score. Latent growth curve models with robust standard errors were estimated. Results The results of latent growth curve models showed that social isolation was significantly associated with more initial loneliness and depressive symptoms. However, social isolation was associated with a slower increasing rate of loneliness, but no significant relationship with the change rate of depressive symptoms. Furthermore, resilience significantly buffered the negative effect of social isolation on the initial level of depressive symptoms. Discussion and Implications The findings underscore the importance of enacting strategies and interventions targeting resilience to address social isolation and its negative consequences among older adults. [ABSTRACT FROM AUTHOR]

BACKGROUND: Patients with COPD and other lung diseases are treated with long-term oxygen therapy (LTOT). Portable oxygen sources are required to administer LTOT while maintaining patient autonomy. Existing portable oxygen equipment has limitations that can hinder patient mobility. A novel nasal interface is presented in this study, aiming to enhance breath detection and triggering efficiency of portable pulsed-flow oxygen devices, thereby improving patient mobility and independence. METHOD: To examine the effectiveness of the new interface, 8 respiratory therapists participated in trials using different oxygen sources (tank with oxygen-conserving device, SimplyGo Mini portable oxygen concentrator [POC], and OxyGo NEXT POC) and breathing types (nasal and oral) while using either the new nasal interface or a standard cannula. Each trial was video recorded so participant breaths could be retroactively matched with a pulse/no-pulse response, and triggering success rates were calculated by dividing the number of oxygen pulses by the number of breaths in each trial. After each trial, volunteers were asked to rate their perceived breathing resistance. RESULTS: Nasal breathing consistently resulted in higher triggering success rates compared to oral breathing for pulsed-flow oxygen devices. POCs exhibited higher triggering success rates than did the oxygen tanks with conserving device. However, there were no significant differences in triggering success rates between the two POC models. The new nasal interface demonstrated improved triggering success rates compared to the standard cannula. Whereas the new nasal inter- face was associated with a slight increase in perceived breathing resistance during nasal breathing trials, participants reported manageable resistance levels when using the interface. CONCLUSIONS: This study demonstrates that the new nasal interface can improve triggering success rates of pulsed-flow oxygen devices during both nasal and oral breathing scenarios. Further research involving patient trials is recommended to understand the clinical implications of improved pulse triggering. [ABSTRACT FROM AUTHOR]

To prioritize and achieve consensus on mobility determinant factors [cognitive, financial, environmental, personal, physical, psychological, social] considered critical to include in the COmprehensive Mobility Discharge Assessment Framework (COMDAF) for older adults transitioning from hospital-to-home. We conducted a three-round modified e-Delphi process with 60 international experts (seven older adults, nine family caregivers, 24 clinicians, and 20 researchers) from nine countries with universal or near-universal health coverage. Expert members rated 91 factors identified from scoping reviews using a 9-point scale: not important (1-3), important (4-6), and critical (7-9). A total of 41 of 91 factors (45.1%) met the a-priori consensus criterion after three rounds: five cognitive, five environmental, two personal, 19 physical, six psychological, and six social factors. No financial factors reached a consensus. The older adult steering committee member recommended the addition of two environmental factors, resulting in 43 mobility factors included in the COMDAF. We advanced a comprehensive mobility framework by developing, through consensus, 43 mobility factors to be assessed as part of a COMDAF. However, its use in hospital-to-home may not be feasible. Therefore, future research will determine the core mobility factors for COMDAF and which measurement instruments best measure these factors. An interdisciplinary discharge rehabilitation team can utilize the COMDAF during hospital-to-home transition. Mobility assessment following a hospital discharge is a complex process requiring an interdisciplinary discharge rehabilitation team. This study provided a comprehensive list of 91 factors across all seven mobility determinants (cognitive, environmental, financial, personal, physical, psychological, and social) for clinicians in other care settings to use as a starting point to determine which mobility factor should be assessed during older adults' hospital-to-home transition. This international e-Delphi study identified 43 factors within mobility determinants (cognitive, environmental, personal, physical, psychological, and social) to be included in a Comprehensive Mobility Discharge Assessment Framework to assess older adults' mobility during the hospital to home transition. Using these 43 factors, clinicians can identify which assessment tool is best suited to assess the factors while reflecting on the logistics and feasibility; this is the next phase of this project [ABSTRACT FROM AUTHOR]

No previous study has evaluated the effectiveness of routine physical therapy with and without neural mobilization for patients with chronic musculoskeletal neck disorders and cervical radiculopathy. The objective is to evaluate the effectiveness of routine physical therapy with and without neural mobilization on pain and mobility in patients with chronic musculoskeletal neck disorders and cervical radiculopathy. A systematic review with meta-analysis of randomized clinical trials involving the use of neural mobilization techniques for the treatment of chronic musculoskeletal neck disorders and cervical radiculopathy was conducted. Methodological quality was assessed by the Cochrane Risk of Bias Tool and PEDro scale. Data were pooled and a meta-analysis was performed using a random effects model with Review Manager 5 software. Seven articles were included in our review. Significant differences were found in mobility but not in pain in favor of using routine physical therapy with neural mobilization for the treatment of chronic musculoskeletal neck disorders and cervical radiculopathy. Our results show that routine physical therapy accompanied by neural mobilization is superior for improving mobility in comparison with routine physical therapy alone in patients with musculoskeletal neck disorders and cervical radiculopathy. [ABSTRACT FROM AUTHOR]

The recent increase in the number of frail older adults has led to increased attention being paid to care services in communities such as senior day care centers. Maintaining health-related quality of life (HRQOL) in frail older adults is important for managing long-term care. The purpose of this study was to comprehensively explore the impact of physical, mental, and cognitive factors, particularly central sensitization-related symptoms (CSSs), on the HRQOL among frail older adults in senior day care centers. HRQOL, physical, mental, and cognitive factors, and severity of CSSs were comprehensively measured using validated methods. Correlation and multiple regression analyses were used to examine factors affecting HRQOL among frail older adults in senior day care centers. The results showed that the timed up and go test significantly affected the HRQOL among frail older adults at senior day care centers. Additionally, knee extension muscle strength, number of pain sites, depressive tendencies, and CSS severity showed a significant negative correlation with HRQOL but were not significant influencing factors. This suggests that functional mobility assessments and approaches are important for maintaining and improving the HRQOL in frail older adults at senior day care centers. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore the impact of sarcopenia on clinical outcomes after percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF). Methods: We retrospectively analyzed the medical records of patients with single-segment OVCF who underwent percutaneous kyphoplasty (PKP) between September 2021 and August 2022. Patients were categorized into a sarcopenia group (43 patients) and a non-sarcopenia group (125 patients) based on their Advanced Skeletal Muscle Index (ASMI). Clinical and radiological data were collected and analyzed. Results: There were no significant differences between the sarcopenia and non-sarcopenia groups in age, sex, bone mineral density (BMD), body mass index (BMI), fractured segment, fracture type, surgical approach, bone cement volume, bone cement distribution, comorbidities, preoperative and immediate postoperative VAS and ODI scores (P >.05). However, the time to ambulation, hospital stays, VAS and ODI scores at follow-up, excellent/good rate, and the incidence of residual pain and re-fractures in the non-sarcopenia group were significantly better than those in the sarcopenia group (P <.05). Meanwhile, radiological outcomes, including regional kyphosis and vertebral height loss rate, were significantly better in the non-sarcopenia group than in the sarcopenia group at 6 and 12 month follow-ups (P <.05). Conclusion: Clinical outcomes after PKP in patients with OVCF could be negatively affected by sarcopenia. Therefore, prevention and treatment of sarcopenia should be actively considered in the management of patients with OVCF. [ABSTRACT FROM AUTHOR]

Background: This study conducted to determine the prevalence and severity of musculoskeletal discomfort among two-wheeler riders; however, musculoskeletal discomfort refers to pain, discomfort, or impairment in the muscles, bones, joints, tendons, ligaments, or other structures that support the body's movement. It is a common problem experienced by individuals involved in various physical activities, including motorcycle riding. Methods: This investigation was longitudinal research in which the Nordic muscular questionnaire (NMQ) was used to rule out the possibility of musculoskeletal disorders in motorcyclists. In Karachi, Pakistan, data were collected beginning in September of 2021 and continuing through February of 2022 using the convenience sampling method. Sixty-four individuals made up the sample. Participants were males ranging between the ages of 19 and 50 who rode standard motorcycles for their commute for about 6 to 8 h daily. Participants who had a tumor, an infection, or other comorbid are excluded. Results: Sixty-four participants were included in this study, out of which 40 (62.5%) reported difficulty and discomfort in their neck, followed by their lower back (48.5%), shoulders (34.4%), and hips (26.6%). Sixteen motorcyclists (25%) complained wrist pain. When asked out their level of discomfort. However, 51.6% of individuals experienced lower back pain at the 12th month, while 46.9% had neck pain. 28.1%, 17.2%, and 14.1% reported shoulder, hip, and upper back discomfort. 51.6% of individuals had not seen a specialist for lower back symptoms. Lower back, neck, shoulders, and hip have been affected the longest, according to participants. Conclusion: In conclusion, motorcyclists had a substantially greater rate of musculoskeletal problems than other drivers. Regulating musculoskeletal disorders in motorcyclists helps reduce symptoms and clinical indications of disease. [ABSTRACT FROM AUTHOR]

Introduction: Stroke survivors can experience various consequences that affect their physical and psychological balance. Yoga seems to be relevant for this population as it allows to work on both the body and the mind. The first objective of this study was to investigate the non-inferiority of yoga compared with conventional physical activity in improving physical function in patients with chronic post-stroke sequelae. The secondary objective was to investigate the superiority of yoga in improving the mental health of these patients. Methods: A randomized controlled trial was conducted. Thirty-six patients were randomized into two groups to practice a yoga program (YOG'AVC) or the Fitness and Mobility Exercise (FAME) program. Patients were assessed in a blinding mode pre- (T0) and post-program (T1) and 3–4 months after completion (T2). The physical assessments were the Berg Balance Scale, timed up and go test, 6-minute walk test, and quadriceps strength measured by hand-held dynamometer. Questionnaire assessments were: Activities-specific Balance Confidence Scale–Simplified, State-Trait Anxiety Inventory, Beck's Depression Inventory, and the Reintegration to Normal Living Index. Results: The YOG'AVC program was not inferior to the FAME program in improving balance, functional mobility and muscle strength. Both groups showed significant improvement (p < 0.05) between T0 and T1 in their anxiety, depression, and reintegration to normal life scores, with no significant difference between groups. Discussion: Both programs seem to be valuable in improving the physical abilities and psychological well-being of chronic post-stroke patients. However, further studies are required to confirm the difference between these programs. [ABSTRACT FROM AUTHOR]

Background: Critically ill patients often experience distressful and impactful symptoms and conditions that include pain, agitation/sedation, delirium, immobility, and sleep disturbances (PADIS). The presence of PADIS can affect recovery and long-term patient outcomes. An integral part of critical care nursing is PADIS prevention, assessment, and management. Ethical sensitivity of everyday nursing practice related to PADIS is an imperative part of implementing evidence-based care for patients. Objective: The first 2 aims of this study were to determine the measured level of ethical awareness as an attribute of ethical sensitivity among the critical care nurse participants and to explore the ethical sensitivity of critical care nurses related to the implementation of PADIS care. The third aim was to examine how the measured level of ethical awareness and ethical sensitivity exploration results converge, diverge, and/or relate to each other to produce a more complete understanding of PADIS ethical sensitivity by critical care nurses. Methods: This was a convergent parallel mixed methods study (QUAL + quant). Ethical sensitivity was explored by conducting an ethnography of critical care nurses. The participants were 19 critical care nurses who were observed during patient care, interviewed individually, participated in a focus group (QUAL), and were administered the Ethical Awareness Scale (quant). Findings: Despite high levels of individual ethical awareness among nurses, themes of ambiguous beneficence, heedless autonomy, and moral distress were found to be related to PADIS care. Conclusions: More effort is needed to establish moral community, ethical leadership, and individual ethical guidance for nurses to establish patient-centered decision-making and PADIS care. [ABSTRACT FROM AUTHOR]

Objective: Although Ireland has one of the highest levels of well‐being in Europe, having a health condition has been found to have a direct negative impact. The aim of this study is to evaluate the current situation and the experiences of patients with epidermolysis bullosa (EB), a rare genetic skin disease, and their relatives living in Ireland, with a focus on burdens and helpful practices. Methods and Measures: In a mixed‐methods design, a series of standardised questionnaires were combined with open‐ended questions. Via an online survey, data from n = 59 EB patients and relatives of EB patients living in Ireland were collected. Results: EB affects both the patients and their relatives. Burdens were found in relation to the visibility of EB, the degree of severity, the current health status, reduced mobility, the financial impact of EB, the psychosocial impact and personal and social resources. The paper also analyses existing resources and highlights opportunities for support and needs of improvement. Conclusion: Quality of life with EB is influenced by somatic symptoms and the psychosocial burden. Individual helpful practices in dealing with this rare disease can be considered as mediators, but they need to be supported by structural and healthcare improvements. Patient or Public Contribution: The perspective of EB patients, their relatives and EB experts were taken into account in the development of the study design via two feedback loops with the EB patient organisations DEBRA Ireland and DEBRA Austria. The design was adapted accordingly. Additionally, by including open‐ended questions, patients and relatives could contribute their individual perspectives and add insights into their lives with EB that might not have been captured with the structured online survey alone. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the effects of exercises by mechanical hippotherapy devices on postural control, balance, mobility, and Quality of Life in patients with stroke. This was a randomized controlled clinical trial with a total of 30 which were randomly divided into two groups. The participants in the mechanical hippotherapy group (MHG) (n = 15) were given exercises with a mechanical hippotherapy device for 15 min in addition to intensive conventional treatments (45 min), while the control group (CG) (n = 15) received additional 15 min of postural control and balance exercises for five days per week for four consecutive weeks. The primary outcome was The Berg Balance Scale (BBS). Secondary outcomes were the Fugl–Meyer (FM) Rating Scale, Biodex Balance Measurement (BBM), Trunk Impairment Scale (TIS), the Timed Up and Go Test (TUG) and quality of Life Short Form (SF-36). In the MHG, FM-Lower extremity score (−6.4, p = 0.024), FM-Upper extremity score (−12.87, p = 0.013), TIS (−5.87, p = 0.04) and TUG (5.73, p = 0.027) improved statistically significant compared to CG. Exercises using mechanical hippotherapy devices could improve postural control, functional mobility and balance in patients with stroke. It may also improve the quality of life. NCT03528993 NCT03528993 It was concluded from our results that mechanical hippotherapy could be included in the treatment programs of stroke patients. [ABSTRACT FROM AUTHOR]

This study investigated the longitudinal assessment of step-up performance in patients undergoing total joint arthroplasty (TJA) and correlation with subjective patient reported outcome measures (PROMs). In this sub-analysis of the ADAPT study, PROMs were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Block step-up (BS) transfers were assessed by wearable-derived measures of time. 76 patients undergoing TJA were included. Subgroups were formed isolating the worst performing quartile (low functioning (LF)) from the high functioning (HF), and outcomes were compared– One-year post-surgery, WOMAC function demonstrated strong correlations to WOMAC pain (Pearson's r = 0.67–0.84) and moderate correlations to BS performance (Pearson's r = 0.31–0.54). Both WOMAC and BS significantly improved with a larger effect size for the HF subgroup (0.62 vs. 0.43; p < 0.05). Patients designated to the LF subgroup at 3 months had increased odds of representing the LF subgroup at 12 months (WOMAC = 19; BS = 4). WOMAC defined 18 LF patients at 12 months follow-up. BS performance identified 9 additional LF patients. WOMAC function scores seem pain dominated. Measures of BS performance allow assessment of otherwise hidden residual functional impairment. Lower functioning 3 months post-surgery is predictive of longer-term impairment. Severe hip or knee osteoarthritis is a disabling condition which not only impacts patients' mobility but restricts quality of life due to constant pain and consequential lifestyle changes. Total joint arthroplasty (TJA) has developed into a successful intervention for patients with advanced hip or knee osteoarthritis. Some patients are dissatisfied after TJA due to residual functional impairment and the inclusion of performance-based tests in the post-operative evaluation and rehabilitation allows for the assessment of otherwise hidden residual impairment. Early detection of functional impairment using the repeated block step-up (BS) transfers allows to facilitate more targeted rehabilitation for better functional outcomes. [ABSTRACT FROM AUTHOR]

Objective: To report the treatment effects of early use kinesiotaping on pain, range of motion, mobility, and edema outcomes following total knee arthroplasty. Data Sources: Cochrane Central Register of Controlled Trials, PubMED, SPORTDiscus, Biosis Citation Index, and the Cumulative Index to Nursing and Allied Health Literature were searched for potential randomized control trials from inception to 8 January 2024. Review Methods: Randomized control trials evaluating the effect of kinesiotaping published in English were included. Reference lists for relevant reviews were searched. Study quality was assessed using the Cochrane Risk of Bias 2 tool. Certainty of evidence was determined using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results: Seven articles totaling 534 participants were included for meta-analysis. Kinesiotaping with standard rehabilitation when compared to standard rehabilitation alone had very low certainty of evidence in pain and knee flexion range of motion. Kinesiotaping was favored at post-operative days two to four for pain (P = 0.03, standard mean difference = −0.77 [−1.45, −0.09]) and range of motion (P = 0.002, standard mean difference = −0.24 [−0.44, −0.03]). Kinesiotaping was favored at post-operative days six to eight for pain (P = 0.02, standard mean difference = −0.76 [−1.41, −0.12]) and range of motion (P = 0.04, standard mean difference = −0.63 [−1.22, −0.04]). Edema and mobility could not be meta-analyzed. Conclusion: The use of kinesiotaping early in post-operative rehabilitation could be a useful modality for reducing pain and increasing the range of knee flexion, however, the certainty of evidence is very low. [ABSTRACT FROM AUTHOR]

Objectives. Post-COVID-19 condition (PCC) may impact mobility and balance and affect physical function. The objectives of the study were to estimate the prevalence of decline in balance and mobility in individuals with PCC; explore the association between comorbidities and sociodemographic characteristics with decline in balance and mobility; and evaluate correlations between decline in mobility and balance with change in performance of usual activities, personal care, and global health perception. Methods. The design was a cross-sectional study of persons with a COVID-19 diagnosis that was confirmed at least 3 months before the study. Those with PCC, defined as those still troubled by symptoms, were evaluated for decline in mobility and balance and with associated clinical and demographic factors using bivariate analysis and multivariable logistic regression. Correlations between decline in mobility and balance were also examined with change in ability to perform usual activities, personal care, and global health perception. Results. In 1031 persons with PCC, mobility deteriorated in 44.9%, and balance deteriorated in 37.1%. Older age, hospitalization, comorbidities, and obesity were associated with decline in mobility, while decline in balance was associated with older age and comorbidities. Reduced mobility was associated with changes in ability to carry out usual activities (rp = 0.6), conduct personal care (rp = 0.6), and global health status (rp = 0.5). Correlations between decline in balance and these same outcomes were 0.5, 0.5, and 0.45, respectively. Conclusions. Almost half the participants with PCC had reduced mobility, and over a third reported deterioration in balance, with associated difficulties with daily functioning. Factors associated with greater decline help identify those most at risk. Impact. Many people with PCC experience changes in mobility and balance, which can affect functional capacities and lead to physical therapist consultations. Further study should assess specific needs of these patients and determine effective physical therapist interventions to meet these needs. Lay Summary. Many persons with post-COVID-19 condition (PCC) experience symptoms resulting in functional problems, such as difficulties with personal care and performing usual activities. This study focused on difficulty in mobility and problems with balance. Almost half of persons with PCC in the study had declines in getting around and over a third had declines in balance. These problems were associated with older age and having other comorbid health conditions and were linked with decline in ability to perform personal care, carry out usual activities, and perceived global health status. [ABSTRACT FROM AUTHOR]

Objectives: This study investigated the association between living arrangements and healthrelated quality of life (HRQoL) in older people. Methods: A secondary analysis was conducted of 6,153 participants (aged ≥60 years) from the seventh Korean National Health and Nutrition Examination Survey (2016 to 2018). HRQoL was measured using the 3-level version of the EuroQol 5-dimensional questionnaire. The chi-square test, t-test, and multiple regression were used, applying sampling weights for the analysis. Results: The proportion of respondents living alone was 18.0%, with a higher prevalence among women and older age groups (p <0.001). The overall HRQoL was lower in groups living alone than in groups living with others (p <0.001). Older people living alone showed higher impairments in all dimensions of the 3-level version of the European Quality of Life 5-Dimensional Questionnaire (EQ-5D-3L) than those living with others, including mobility (p <0.001), self-care (p <0.001), usual activities (p <0.001), pain/discomfort (p <0.001), and depression/anxiety (p<0.001). Problems with mobility were most prevalent (42.8%), followed by pain/ discomfort (41.9%) in respondents living alone. Living alone was significantly associated with a lower HRQoL index score (b=-0.048, p<0.001) after adjusting for age, gender, education, exercise, perceived stress, and perceived health status. Conclusion: Living alone was negatively associated with HRQoL. Based on this study, future care planning for older people should consider their living arrangements. The need to strengthen and expand care programs targeting those living alone should also be addressed. [ABSTRACT FROM AUTHOR]

Objective: To analyze the factors associated with low functional mobility in older adults residing in Alcobaça, BA. Methods: This is an epidemiological survey with a cross‐sectional design, conducted in 2015 with 473 older adults (62.4% women; mean age 70.2 ± 8.2 years) from Alcobaça, BA. The interview script addressed sociodemographic characteristics, health, and behavioral aspects. Functional mobility was assessed using the Short Physical Performance Battery (≤6 points). Inferential analyses were conducted using the Mann–Whitney U test and Poisson regression (with robust variance and estimation of prevalence ratios and their respective 95.0% confidence intervals). Results: The prevalence of low functional mobility was 9.6%, with associated factors including the use of alcoholic beverages (PR = 1.7, 95% CI: 1.01–1.13) and the number of repetitions in elbow flexion (PR = 1.01, 95% CI: 1.01–1.05). Additionally, older adults with low mobility had lower height, thigh circumference, and lower performance in handgrip strength tests, elbow flexion, and flexibility. They also spent more time in sedentary behavior and less time in physical activity compared to older adults with preserved mobility (p < 0.05). Conclusion: Older adults with low mobility exhibit poorer values in anthropometric parameters, lower performance in motor tests, spend less time engaged in physical activities, and more time in sedentary behavior. [ABSTRACT FROM AUTHOR]

Purpose: This study investigates how access to assistive technologies affects employment and earnings among people with disabilities. Methods: We first document employment and earnings gaps associated with specific impairments and activity limitations using 2017–2021 American Community Survey and 2014 Survey of Income and Program Participation data. We then use accommodations data from the 2012, 2019, and 2021 Current Population Survey (CPS) Disability Supplements to examine employment and earnings growth for people with disabilities related both to any, and to technology-based, accommodations. We also provide short descriptions of three developing assistive technologies that assist people with upper body impairments, visual impairments, and anxiety conditions. Results: Almost all impairments and activity limitations are linked to lower employment and earnings, with especially low employment among people with mobility impairments and particularly low earnings among those with cognitive impairments. About one-tenth of workers with disabilities received any accommodations, and 3–4% received equipment-based accommodations in the 2012–2021 period; these figures increased slightly over the period. The occupations with the highest disability accommodations rates had greater disability employment growth from 2012 to 2021, but disability pay gaps did not decrease more in these occupations. The three developing assistive technologies we describe illustrate the potential to reduce the estimated employment and earnings deficits. Conclusion: Assistive technology accommodations have potential for improving employment outcomes for people with disabilities. [ABSTRACT FROM AUTHOR]

Background: Around 15% of the global population live with some form of disabilities and experience worse health outcomes, less participation in the community and are part of fewer activities outside the home. Outdoor mobility interventions aim to improve the ability to move, travel and orient outside the home and could influence the number of activities outside the home, participation and quality of life. However, outdoor mobility interventions may also lead to harm like falls or injuries or have unforeseen effects which could lead to mortality or hospitalization. Objectives: To assess the efficacy of interventions aiming to improve outdoor mobility for adults living with disabilities and to explore if the efficacy varies between different conditions and different intervention components. Search Methods: Standard, extensive Campbell search methods were used, including a total of 12 databases searched during January 2023, including trial registries. Selection Criteria: Only randomized controlled trials were included, focusing on people living with disabilities, comparing interventions to improve outdoor mobility to control interventions as well as comparing different types of interventions to improve outdoor mobility. Data Collection and Analysis: Standard methodological procedures expected by Campbell were used. The following important outcomes were 1. Activity outside the home; 2. Engagement in everyday life activities; 3. Participation; 4. Health‐related Quality of Life; 5. Major harms; 6. Minor harms. The impact of the interventions was evaluated in the shorter (≤6 months) and longer term (≥7 months) after starting the intervention. Results are presented using risk ratios (RR), risk difference (RD), and standardized mean differences (SMD), with the associated confidence intervals (CI). The risk of bias 2‐tool and the GRADE‐framework were used to assess the certainty of the evidence. Main Results: The screening comprised of 12.894 studies and included 22 studies involving 2.675 people living with disabilities and identified 12 ongoing studies. All reported outcomes except one (reported in one study, some concerns of bias) had overall high risk of bias. Thirteen studies were conducted in participants with disabilities due to stroke, five studies with older adults living with disabilities, two studies with wheelchair users, one study in participants with disabilities after a hip fracture, and one study in participants with cognitive impairments. Skill training interventions versus control interventions (16 studies) The evidence is very uncertain about the benefits and harms of skill training interventions versus control interventions not aimed to improve outdoor mobility among all people living with disabilities both in the shorter term (≤6 months) and longer term (≥7 months) for Activity outside the home; Participation; Health‐related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. Skill training interventions may improve engagement in everyday life activities among people with disabilities in the shorter term (RR: 1.46; 95% CI: 1.16 to 1.84; I2 = 7%; RD: 0.15; 95% CI: −0.02 to 0.32; I2 = 71%; 692 participants; three studies; low certainty evidence), but the evidence is very uncertain in the longer term, based on very low certainty evidence. Subgroup analysis of skill training interventions among people living with disabilities due to cognitive impairments suggests that such interventions may improve activity outside the home in the shorter term (SMD: 0.44; 95% CI: 0.07 to 0.81; I2 = NA; 118 participants; one study; low certainty evidence). Subgroup analysis of skill training interventions among people living with cognitive impairments suggests that such interventions may improve health‐related quality of life in the shorter term (SMD: 0.49; 95% CI: 0.12 to 0.88; I2 = NA; 118 participants; one study; low certainty evidence). Physical training interventions versus control interventions (five studies) The evidence is very uncertain about the benefits and harms of physical training interventions versus control interventions not aimed to improve outdoor mobility in the shorter term (≤6 months) and longer term (≥7 months) for: Engagement in everyday life activities; Participation; Health‐related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. Physical training interventions may improve activity outside the home in the shorter (SMD: 0.35; 95% CI: 0.08 to 0.61; I2 = NA; 228 participants; one study; low certainty evidence) and longer term (≥7 months) (SMD: 0.27; 95% CI: 0.00 to 0.54; I2 = NA; 216 participants; one study; low certainty evidence). Comparison of different outdoor mobility interventions (one study) The evidence is very uncertain about the benefits and harms of outdoor mobility interventions of different lengths in the shorter term (≤6 months) and longer term (≥7 months) for Activity outside the home; Engagement in everyday life activities; Participation; Health‐related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. No studies explored the efficacy of other types of interventions. Authors' Conclusions: Twenty‐two studies of interventions to improve outdoor mobility for people living with disabilities were identified, but the evidence still remains uncertain about most benefits and harms of these interventions, both in the short‐ and long term. This is primarily related to risk of bias, small underpowered studies and limited reporting of important outcomes for people living with disabilities. For people with disabilities, skill training interventions may improve engagement in everyday life in the short term, and improve activity outside the home and health‐related quality of life for people with cognitive impairments in the short term. Still, this is based on low certainty evidence from few studies and should be interpreted with caution. One study with low certainty evidence suggests that physical training interventions may improve activity outside the home in the short term. In addition, the effect sizes across all outcomes were considered small or trivial, and could be of limited relevance to people living with disabilities. The evidence is currently uncertain if there are interventions that can improve outdoor mobility for people with disabilities, and can improve other important outcomes, while avoiding harms. To guide decisions about the use of interventions to improve outdoor mobility, future studies should use more rigorous design and report important outcomes for people with disabilities to reduce the current uncertainty. [ABSTRACT FROM AUTHOR]

There is growing evidence on the prevalence and impact of loneliness, particularly among older people. However, much less is known about the personal origins of loneliness and how it persists, or not, over an individual's life course. This study aimed to increase understanding of the personal experiences of loneliness among older adults across the life course. Central to this study was giving voice to the participants and allowing them to define loneliness, what it meant to them, and how it affected them throughout their lives. This qualitative study employed 18 life story interviews with older adults attending a mental health service. We explored their personal experiences of loneliness and the situations and factors associated with loneliness across the life course. We identified three distinct typologies of loneliness: those who experienced (1) chronic loneliness since childhood, (2) chronic loneliness after a life-changing event in midlife, and (3) loneliness which remained situational/transitional, never becoming chronic. This study found the seeds of chronic life course loneliness are often determined in childhood. Early detection and intervention may prevent situational loneliness from becoming chronic. More research is needed from a life course approach to help understand and address the causes and consequences of loneliness. [ABSTRACT FROM AUTHOR]

Objective: Hard-to-heal (chronic) wounds are common in patients with diabetes and are associated with a decrease in quality of life (QoL). Pathogenic bacteria often colonise hard-to-heal wounds and hinder the healing process which poses a high risk for (systemic) infections. In this study, we aim to prove that probiotics are capable of displacing human pathogenic bacteria, ameliorating inflammation and positively influencing the microenvironment/microbiome of skin and mucosa. Method: In this pilot study, patients with diabetes and hard-to-heal wounds with a duration of 2–120 months received an oral multispecies probiotic daily for six months. Changes in oral, stool and wound microbiome were investigated, and the effects of the probiotic intervention on wound healing, periodontitis and wound-specific quality of life (Wound-QOL-17) were analysed throughout the course of this clinical study. Results: In total, seven of the 20 patients included were unable to complete the study. After six months of oral probiotic intake supplementation in five out of the remaining 13 patients, the wounds had healed completely. Most patients reported an improvement in wound-specific QoL, with particular positive effects on pain and mobility. Microbiome analysis revealed a reduction in Staphylococcus aureus and Pseudomonas aeruginosa, and Staphylococcus epidermis in healed wounds. Conclusion: This findings of this study provide evidence for the beneficial effects of the oral application of a multispecies probiotic over six months in patients with diabetes and hard-to-heal wounds on wound closure, wound microbial pattern, QoL, and on dental health. A randomised, placebo-controlled, double-blinded clinical trial is required to verify the results. [ABSTRACT FROM AUTHOR]

Introduction: Manual wheelchairs (MWC) users have limited mobility during winter months as they encounter many environmental barriers that restrict their community participation. This paper outlines the creation and standardization of an outdoor environment designed to simulate the real-life conditions and obstacles experienced by MWC users in winter. Methods and results: This study consisted of four phases. In Phase 1, researchers used a qualitative ethnographic approach to document the specific challenges and adaptive strategies used by MWC users in winter conditions. In Phase 2, key informants with expertise in MWC winter mobility were invited to co-design the Standardized Navigation Of Winter Mobility & Accessibility Network (SNOWMAN) course. Participants reviewed draft design solutions and offered their input and suggestions to expand upon the initial design. A second co-design workshop included additional key informants, including service providers, policymakers, and professionals with expertise in landscape architecture and engineering, to validate the design solution. The workshops resulted in a detailed illustration of the SNOWMAN course, including five sections: platforms with side slopes, a miniature ice rink, curbs and curb cuts, a path with uneven winter surfaces, and modular ramps at various slopes. Phases 3 and 4 marked the conclusion of the study and involved fabrication of the SNOWMAN course and establishment of a standardized protocol for course setup and maintenance. Discussion: The project aimed to offer several additional potential benefits, supported by the various stakeholders across the study phases, that extend beyond creation of a controlled and safe environment for wheelchair users to develop their winter mobility skills. Practicing wheelchair skills in this area may assist wheelchair users in gaining confidence which may ultimately translate to increased participation in the community. [ABSTRACT FROM AUTHOR]

To determine whether Residential Immersive Life Skills programs (RILS) result in reliable change in autonomy and self-efficacy of youth with disabilities and whether gains persist over time. Sex differences and program response patterns were also examined. Autonomy from the ARC's Self-Determination Scale and self-efficacy from the General Self-Efficacy Scale were completed by participants at baseline, post-intervention, 3-month, and at 12-month follow-ups. Reliable change index was calculated and examined over time. Autonomy improved significantly following the completion of RILS program and gains persisted and increased at 12-month follow-up. Participants who reliably improved in autonomy (program-responders) also improved in self-efficacy. The program-responders began the program with significantly lower autonomy and self-efficacy scores at baseline and differed in personal factor relative to those who did not experience increased autonomy post-program (non-responders). There were sex differences in program response with more male participants responding to the program. RILS programs can result in sustained improvements in autonomy and self-efficacy. Urgency for change and personal needs/priorities may contribute to growth experiences. We recommend including a social connectedness module that formally facilitates friendships and social development to better meet the social needs of all youth, especially females with disabilities. Youth's autonomy improves following participation in Residential Immersive Life Skills programs. Over time, improvements in youth autonomy may lead to improvements in self-efficacy. It is important to measure gains over time as beneficial change increase over time. More male participants may experience outcome change in autonomy than female participants. Urgency for change and personal needs/priorities may contribute to growth experiences. [ABSTRACT FROM AUTHOR]

Introduction: Walking in complex environments increases the cognitive demand of locomotor control; however, our understanding of the neural mechanisms contributing to walking on uneven terrain is limited. We used a novel method for altering terrain unevenness on a treadmill to investigate the association between terrain unevenness and cortical activity in the prefrontal cortex, a region known to be involved in various cognitive functions. Methods: Prefrontal cortical activity was measured with functional near infrared spectroscopy while participants walked on a novel custom-made terrain treadmill surface across four different terrains: flat, low, medium, and high levels of unevenness. The assessments were conducted in younger adults, older adults with better mobility function and older adults with worse mobility function. Mobility function was assessed using the Short Physical Performance Battery. The primary hypothesis was that increasing the unevenness of the terrain would result in greater prefrontal cortical activation in all groups. Secondary hypotheses were that heightened prefrontal cortical activation would be observed in the older groups relative to the younger group, and that prefrontal cortical activation would plateau at higher levels of terrain unevenness for the older adults with worse mobility function, as predicted by the Compensation Related Utilization of Neural Circuits Hypothesis. Results: The results revealed a significant main effect of terrain, indicating a significant increase in prefrontal cortical activation with increasing terrain unevenness during walking in all groups. A significant main effect of group revealed that prefrontal cortical activation was higher in older adults with better mobility function compared to younger adults and older adults with worse mobility function in all pooled terrains, but there was no significant difference in prefrontal cortical activation between older adults with worse mobility function and younger adults. Contrary to our hypothesis, the older group with better mobility function displayed a sustained increase in activation but the other groups did not, suggestive of neural compensation. Additional findings were that task-related increases in prefrontal cortical activation during walking were lateralized to the right hemisphere in older adults with better mobility function but were bilateral in older adults with worse mobility function and younger adults. Discussion: These findings support that compared to walking on a flat surface, walking on uneven terrain surfaces increases demand on cognitive control resources as measured by prefrontal cortical activation. [ABSTRACT FROM AUTHOR]

Incontinence-associated dermatitis (IAD) is a skin inflammation caused by contact with urine or faeces or both. It has a negative effect on the patient's quality of life and is indicative of the care provided. However, globally there is a lack of empirical data on the prevalence of IAD. Aim: To identify, for the first time, the proportion of older adults in extended care settings in Ireland affected by IAD. Design: Cross-sectional, multisite, point prevalence survey, across three community extended care settings for older people in Ireland. Methods: Two clinical nurse specialists, using the Scottish Excoriation and Moisture Related Skin Damage Tool, identified the presence of IAD through clinical observation and visual skin inspection. IAD prevalence was calculated for the total population and incontinent population sets using percentages and confidence intervals (CI). Results: The prevalence of incontinence was 86.4% (n=165), a significantly higher proportion were female (P=0.003). The point prevalence of IAD across the total population and incontinent population was 11.5% (22/191; 95% CI, 7.4–19.9%) and 13.3% (22/164; 95% CI, 8.5–19.5%), respectively. Being incontinent was associated with being female, more dependent (Barthel), having possible cognitive impairment, poorer mobility (Braden and Waterlow) and a high risk of pressure ulcers (Waterlow). A logistic regression analysis found no predictor variables for IAD among the variables that met the cut-off point for this analysis. Conclusions: The study provides the first point prevalence empirical data on the occurrence of IAD in Ireland. It can inform decision-making on future planning and budgeting of new quality improvement projects and act as a benchmark for ongoing auditing of IAD. [ABSTRACT FROM AUTHOR]