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Locomotion prediction for human welfare has gained tremendous interest in the past few years. Multimodal locomotion prediction is composed of small activities of daily living and an efficient approach to providing support for healthcare, but the complexities of motion signals along with video processing make it challenging for researchers in terms of achieving a good accuracy rate. The multimodal internet of things (IoT)-based locomotion classification has helped in solving these challenges. In this paper, we proposed a novel multimodal IoT-based locomotion classification technique using three benchmarked datasets. These datasets contain at least three types of data, such as data from physical motion, ambient, and vision-based sensors. The raw data has been filtered through different techniques for each sensor type. Then, the ambient and physical motion-based sensor data have been windowed, and a skeleton model has been retrieved from the vision-based data. Further, the features have been extracted and optimized using state-of-the-art methodologies. Lastly, experiments performed verified that the proposed locomotion classification system is superior when compared to other conventional approaches, particularly when considering multimodal data. The novel multimodal IoT-based locomotion classification system has achieved an accuracy rate of 87.67% and 86.71% over the HWU-USP and Opportunity++ datasets, respectively. The mean accuracy rate of 87.0% is higher than the traditional methods proposed in the literature. [ABSTRACT FROM AUTHOR]

Locomotion prediction for human welfare has gained tremendous interest in the past few years. Multimodal locomotion prediction is composed of small activities of daily living and an efficient approach to providing support for healthcare, but the complexities of motion signals along with video processing make it challenging for researchers in terms of achieving a good accuracy rate. The multimodal internet of things (IoT)-based locomotion classification has helped in solving these challenges. In this paper, we proposed a novel multimodal IoT-based locomotion classification technique using three benchmarked datasets. These datasets contain at least three types of data, such as data from physical motion, ambient, and vision-based sensors. The raw data has been filtered through different techniques for each sensor type. Then, the ambient and physical motion-based sensor data have been windowed, and a skeleton model has been retrieved from the vision-based data. Further, the features have been extracted and optimized using state-of-the-art methodologies. Lastly, experiments performed verified that the proposed locomotion classification system is superior when compared to other conventional approaches, particularly when considering multimodal data. The novel multimodal IoT-based locomotion classification system has achieved an accuracy rate of 87.67% and 86.71% over the HWU-USP and Opportunity++ datasets, respectively. The mean accuracy rate of 87.0% is higher than the traditional methods proposed in the literature.

Introduction: Given the longevity noticed among older people in Ghana, and the potential occurrence of functional disability in later years of life, it has become essential to understand their care needs. This study examined the care needs in daily tasks and associated factors in Ghana, following the World Health Organisation International Classification of Functioning, Disability and Health framework., Materials and Methods: A cross-sectional survey was conducted among a sample of 400 older people from Komfo Anokye Teaching Hospital in Southern Ghana. Care need was assessed by one question; "Do you regularly need help with daily tasks because of long-term illness, disability, or frailty?" Multivariate logistic regression was used to test the association between care need and independent variables based on the WHO-ICF conceptual framework., Results: Majority of the sample (81%), particularly women (54%) reported needing care in daily tasks. Per the WHO-ICF conceptual framework, functional disability-activity variable, (OR = 1.07 95%CI: 1.05-1.09, p<0.001), and absence of government support-an environmental factor, (OR = 3.96 95%CI: 1.90-8.25, p<0.001) were associated with care need., Conclusions: The high prevalence of care needs among older people may offer an indication that majority of older people in Ghana could benefit from long-term care services. Functional disability and the absence of government support are the major issues that need to be prioritised in addressing the increased demand for care related to performing daily tasks among older people in Ghana., Competing Interests: The authors have declared that no competing interests exist.

Background: Besides cognitive and psychiatric abnormalities, motor symptoms are the most prominent in Huntington's disease. The manifest disease is preceded by a prodromal phase with subtle changes such as fine motor disturbances or concentration problems., Objective: Movement disorders show a high variation in their clinical manifestation depending on condition and external influences. Therefore, devices for continuous measurements, which patients use in their daily life and which can monitor motor abnormalities, in addition to the medical examination, might be useful. The aim of current scientific efforts is to find markers that reflect the prodromal phase in gene carriers. This is important for future interventional studies, as future therapies should be applied at the stage of neuronal dysfunction, i.e., before the clinical manifestation., Methods: We performed a software-supported, continuous monitoring of keyboard typing on the participants' own computer to evaluate this method as a tool to assess the motor phenotype in HD. We included 40 participants and obtained sufficient data from 25 participants, 12 of whom were manifest HD patients, 7 HD gene expansion carriers (HDGEC) and 6 healthy controls., Results: In a cross-sectional analysis we found statistically significant higher typing inconsistency in HD patients compared to controls. Typing inconsistency compared between HDGEC and healthy controls showed a trend to higher inconsistency levels in HDGEC. We found correlations between typing cadence and clinical scores: the UHDRS finger tapping item, the composite UHDRS and the CAP score., Conclusion: The typing cadence inconsistency is an appropriate marker to evaluate fine motor skills of HD patients and HDGEC and is correlated to established clinical measurements.

Objectives: The Medicare Health Outcome Survey (HOS) is the largest longitudinal survey of the U.S. community-dwelling elderly population. This study estimated total life expectancy, active life expectancy (ALE), and disability-free life expectancy (DFLE) by disability status among HOS participants., Methods: Data were from the Medicare HOS Cohort 15 (baseline 2012, follow-up 2014). We included respondents aged ≥ 65 years (n = 164,597). Participants' disability status was assessed based on the following six activities of daily living (ADL): bathing, dressing, eating, getting in or out of chairs, walking, and using the toilet. The multi-state models were used to estimate life expectancy, ALE, and DFLE by participants' baseline disability status and age., Results: Persons who had higher-level ADL limitations had a shorter life expectancy, ALE, and DFLE. Also persons with disability had greater expected life years with disability than those with no limitations and those with mild limitations. For example, among 65-year old respondents with no limitations, mild limitations, and disability, life expectancy was 19.9, 18.6, and 17.1 years, respectively; ALE was 14.0, 9.5, and 7.2 years, respectively; DFLE was 17.3, 15.2, and 11.4 years, respectively; and expected years with disability was 2.6, 3.4, and 5.7 years, respectively., Conclusions: This study demonstrated that greater levels of disability adversely impact life expectancy, ALE, DFLE, and expected number of years with a disability among U.S. older adults. Understanding levels of disability, and how these may change over time, would enhance health care quality and planning services related to home care and housing in this community-dwelling population., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: This study aims to understand breathing patterns during daily activities by developing a wearable respiratory and activity monitoring (WRAM) system., Methods: A novel multimodal fusion architecture is proposed to calculate the respiratory and exercise parameters and simultaneously identify human actions. A hybrid hierarchical classification (HHC) algorithm combining deep learning and threshold-based methods is presented to distinguish 15 complex activities for accuracy enhancement and fast computation. A series of signal processing algorithms are utilized and integrated to calculate breathing and motion indices. The designed wireless communication structure achieves the interactions among chest bands, mobile devices, and the data processing center., Results: The advantage of the proposed HHC method is evaluated by comparing the average accuracy (97.22%) and predictive time (0.0094 s) with machine learning and deep learning approaches. The nine breathing patterns during 15 activities were analyzed by investigating the data from 12 subjects. With 12 hours of naturalistic data collected from one participant, the WRAM system reports the breathing and exercise performance within the identified motions. The demonstration shows the ability of the WRAM system to monitor multiple users breathing and exercise status in real-time., Conclusion: The present system demonstrates the usefulness of the framework of breathing pattern monitoring during daily activities, which may be potentially used in healthcare., Significance: The proposed multimodal based WRAM system offers new insights into the breathing function of exercise in action and presents a novel approach for precision medicine and health state monitoring.

Among elderly populations over the world, a high percentage of individuals are affected by physical or mental diseases, greatly influencing their quality of life. As it is a known fact that they wish to remain in their own home for as long as possible, solutions must be designed to detect these diseases automatically, limiting the reliance on human resources. To this end, our team developed a sensors platform based on infrared proximity sensors to accurately recognize basic bathroom activities such as going to the toilet and showering. This article is based on the body of scientific literature which establish evidences that activities relative to corporal hygiene are strongly correlated to health status and can be important signs of the development of eventual disorders. The system is built to be simple, affordable and highly reliable. Our experiments have shown that it can yield an F-Score of 96.94%. Also, the durations collected by our kit are approximately 6 seconds apart from the real ones; those results confirm the reliability of our kit.

Background: Functional dependence is highly prevalent in maintenance hemodialysis (MHD) settings. Also, poor health-related quality of life (HRQoL) and high levels of depressive symptoms have been reported by MHD patients. We investigated associations between functional status and mental aspects of quality of life in Brazilian MHD patients., Methods: Cross sectional study of 235 patients enrolled in two of the four participating MHD clinics of the Prospective Study of the Prognosis of Chronic Hemodialysis Patients (PROHEMO) in Salvador, BA, Brazil. Data were collected from September 2016 to August 2017. The Katz's questionnaire was used for basic activities of daily living (ADL) and the Lawton-Brody's questionnaire for instrumental activities of daily living (IADL). ADL and IADL scores were combined to create 3 functional status groups: highly dependent (n = 47), moderately dependent (n = 109) and independent (n = 82). The validated Brazilian version of the Kidney Disease Quality of Life Short Form (KDQOL-SF) was used for scores of two distinct HRQoL measures, i.e., the mental component summary (MCS) and the 5-item mental health inventory (MHI-5). We used linear regression to estimate differences in scores with adjustment for possible confounders: months of dialysis, age, gender, other sociodemographic variables, body mass index, type of vascular access, dialysis dose by Kt/V, laboratory variables (albumin, blood hemoglobin, calcium, phosphorus, urea, creatinine and parathyroid hormone) and nine comorbid conditions., Results: Mean age was 51.2 ± 12.4 yr (median age = 51.0 yr), 59.1% were male, 93.2% were non-White. The prevalence of self-reported functional status differed by age: 54.4% for age < 45 yr, 67.8% for age 45-60 yr and 73.9% for age ≥ 60 yr. Using functionally independent as reference, lower scores were observed for highly dependent patients in MCS (difference: -4.69, 95% CI: -8.09, -0.29) and MHI-5 (difference: -5.97, 95% CI: -8.09, -1.29) patients. These differences changed slightly with extensive adjustments for covariates., Conclusions: Our results call attention to a high prevalence of functional dependence in younger and older MHD patients. The results suggest that the lower self-reported mental quality of life in functionally dependent MHD patients cannot be explained by differences in age and comorbidities.

Dementia contributes to the development of pressure injuries (PrIs)., Purpose: This study describes the real-time body positions of 2 nursing home (NH) residents, residing in the United States and living with dementia, to inform development of PrI prevention strategies tailored to individual risk profiles., Methods: As part of a larger study, eligible residents were fitted with a triaxial accelerometer sensor placed on the anterior chest to monitor body positions 24-hours daily through a 4-week monitoring period. The current study used an observational, prospective design during routine repositioning events for 2 residents. A convenience sample of 2 residents from a single NH wing who were considered moderately at risk for PrI development (Braden Scale score 13-14) with a Brief Interview for Mental Status score in the severely impaired range were selected based on nursing staff recommendation., Results: Sensor data showed that both residents, although "chairfast" according to the Braden Scale, spent <5% in an upright position and the great majority of time reclining at an angle <50%. One (1) resident demonstrated a persistent side preference., Conclusions: Wearable sensors are not a long-term solution for protecting those with dementia from PrI formation but do provide a crude picture of overall body positions throughout the 24-hour day that may inform individualized PrI prevention strategies. Studies including large samples of NH residents living with dementia are warranted.

Introduction: Sarcopenia is a geriatric syndrome characterised by progressive loss of skeletal muscle mass and function with risks of adverse outcomes and becomes more prevalent due to ageing population. Elastic-band exercise, vibration treatment and hydroxymethylbutyrate (HMB) supplementation were previously proven to have positive effects on the control of sarcopenia. The purpose of this study is to evaluate the effectiveness of elastic-band exercise or vibration treatment with HMB supplementation in managing sarcopenia. Our findings will provide a safe and efficient strategy to mitigate the progression of sarcopenia in older people and contribute to higher quality of life as well as improved long-term health outcomes of elderly people., Methods and Analysis: In this single-blinded, randomised controlled trial (RCT), subjects will be screened for sarcopenia based on the Asian Working Group for Sarcopenia (AWGS) definition and 144 sarcopenic subjects aged 65 or above will be recruited. This RCT will have three groups evaluated at two time points to measure changes over 3 months-the control and the groups with combined HMB supplement and elastic-band resistance exercise or vibration treatment. Changes in muscle strength in lower extremity will be the primary outcome. Muscle strength in the upper extremity, gait speed, muscle mass (based on AWGS definition), functional performance in terms of balancing ability and time-up-and-go test and quality of life will be taken as secondary outcomes. In addition, each participant's daily activity will be monitored by a wrist-worn activity tracker. Repeated-measures analysis of variance will be performed to compare within-subject changes between control and treatment groups at two time points of pretreatments and post-treatments., Ethics and Dissemination: The procedures have been approved by the Joint CUHK-NTEC Clinical Research Management Office (Ref. CREC 2018.602) and conformed to the Declaration of Helsinki. Results will be disseminated through peer-reviewed publications, conferences and workshops., Trial Registration Number: NCT04028206., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The recognition of activities of daily living (ADL) in smart environments is a well-known and an important research area, which presents the real-time state of humans in pervasive computing. The process of recognizing human activities generally involves deploying a set of obtrusive and unobtrusive sensors, pre-processing the raw data, and building classification models using machine learning (ML) algorithms. Integrating data from multiple sensors is a challenging task due to dynamic nature of data sources. This is further complicated due to semantic and syntactic differences in these data sources. These differences become even more complex if the data generated is imperfect, which ultimately has a direct impact on its usefulness in yielding an accurate classifier. In this study, we propose a semantic imputation framework to improve the quality of sensor data using ontology-based semantic similarity learning. This is achieved by identifying semantic correlations among sensor events through SPARQL queries, and by performing a time-series longitudinal imputation. Furthermore, we applied deep learning (DL) based artificial neural network (ANN) on public datasets to demonstrate the applicability and validity of the proposed approach. The results showed a higher accuracy with semantically imputed datasets using ANN. We also presented a detailed comparative analysis, comparing the results with the state-of-the-art from the literature. We found that our semantic imputed datasets improved the classification accuracy with 95.78% as a higher one thus proving the effectiveness and robustness of learned models.

In this study, we propose a novel, context-based, location-aware algorithm for identifying low-level micro-activities that can be used to derive complex activities of daily living (ADL) performed by home-care patients. This identification is achieved by gathering the location information of the target user by using a wearable beacon embedded with a magnetometer and inertial sensors. The shortcomings of beacon-signal stability and mismatch issues in magnetic-field sequences are overcome by adopting a hybrid, three-phase approach for deducing the locus of micro-activities and their associated zones in a smart home environment. The suggested approach is assessed in two different test environments, where the main intention is to map the location of a person performing an activity with pre-defined house landmarks and zones in the offline labeled database. In addition to the recognition of low-level activities, the proposed method also identifies the person's walking trajectory within the same zone or between different zones of the house. The experimental results demonstrate that it is possible to achieve centimeter-level accuracy for the recognition of micro-activities and to achieve the classification accuracy of 85% for trajectory prediction. These results are encouraging and imply that the collection of accurate low-level information for ADL recognition is possible using integration of inertial sensors, magnetic field and Bluetooth low energy (BLE) technologies from the wearable beacon without relying on other infrastructural sensors.

Physical activity is essential for physical and mental health, and its absence is highly associated with severe health conditions and disorders. Therefore, tracking activities of daily living can help promote quality of life. Wearable sensors in this regard can provide a reliable and economical means of tracking such activities, and such sensors are readily available in smartphones and watches. This study is the first of its kind to develop a wearable sensor-based physical activity classification system using a special class of supervised machine learning approaches called boosting algorithms. The study presents the performance analysis of several boosting algorithms (extreme gradient boosting-XGB, light gradient boosting machine-LGBM, gradient boosting-GB, cat boosting-CB and AdaBoost) in a fair and unbiased performance way using uniform dataset, feature set, feature selection method, performance metric and cross-validation techniques. The study utilizes the Smartphone-based dataset of thirty individuals. The results showed that the proposed method could accurately classify the activities of daily living with very high performance (above 90%). These findings suggest the strength of the proposed system in classifying activity of daily living using only the smartphone sensor's data and can assist in reducing the physical inactivity patterns to promote a healthier lifestyle and wellbeing.

Aim: Computer-based virtual reality assessments of functional capacity have shown promise as a reliable and valid way to assess individuals with multi-episode schizophrenia. However, there has been little research utilizing this innovative approach with young patients who are in the early phase of schizophrenia., Methods: Outpatients in the early course of schizophrenia (n = 42) were compared to controls (n = 13) at cross-sectional study points. Patients were within 2 years of their first psychotic episode, were an average of 22.2 years old and had an average of 12.3 years of education. We used the Virtual Reality Functional Capacity Assessment Tool (VRFCAT) and the University of California, San Diego (UCSD) Performance-Based Skills Assessment-2 (UPSA-2) to assess functional capacity. The MATRICS Consensus Cognitive Battery (MCCB) and the Cognitive Assessment Interview (CAI) were the measures of cognitive functioning. The Global Functioning Scale: Role (GFS-R) and Social (GFS-S), and the Role Functioning Scale (RFS) were the measures of daily functioning., Results: Early course patients vs controls were slower (patient M = 830.41 seconds vs control M = 716.84 seconds; t = 3.0, P < .01) and committed more errors (patient M = 3.2 vs control M = 1.7 seconds, t = 2.9, P < .01) on the VRFCAT. Total time was significantly correlated with the UPSA (r = -0.66, P < .01), MCCB (r = -0.70, P < .01), CAI (r = -0.51, P < .01), and GFS role (r = -0.52, P <. 01) and social functioning (r = -0.43, P = .03)., Conclusions: We extend previous findings to patients with first-episode schizophrenia. Virtual-reality-based performance was correlated with a standard test of functional capacity, indicating VRFCAT validity. Furthermore, correlations with cognitive functioning and occupational/school and social functioning indicate promise as a co-primary measure to track changes in response to treatment., (© 2019 John Wiley & Sons Australia, Ltd.)

Introduction: Military personnel and civilian athletes are both at risk for mild traumatic brain injury. However, these groups are unique in their training and typical daily activities. A fundamental gap in the evaluation of military personnel following mild traumatic brain injury is the lack of military-specific normative reference data. This project aimed to determine if a separate normative sample should be used for military personnel on their performance of the Cleveland Clinic Concussion application and a recently developed dual-task module., Methods: Data were collected from healthy military personnel (n = 305) and civilians (n = 281) 18 to 30 years of age. Participants completed the following assessments: simple and choice reaction time, Trail Making tests A&B, processing speed test, single-task postural stability, single-task cognitive assessment, and dual-task assessment., Results: Civilian participants outperformed military service members on all cognitive tasks under single- and dual-task conditions (P ≤ 0.04). The military group outperformed civilians on all postural stability tasks under single- and dual-task conditions (P ≤ 0.01)., Conclusion: Differences in cognitive performance and postural stability measures may be influenced by demographic differences between military and civilian cohorts. Thus, military-specific normative datasets must be established to optimize clinical interpretation of Cleveland Clinic Concussion assessments., (© Association of Military Surgeons of the United States 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

BACKGROUND This study aimed to develop a risk prediction model for prolonged length of stay (LOS) in stroke patients in 50 inpatient rehabilitation centers in 20 provinces across mainland China based on the International Classification of Functioning, Disability, and Health (ICF) Generic Set case mix on admission. MATERIAL AND METHODS In this cohort study, 383 stroke patients were included from inpatient rehabilitation settings of 50 hospitals across mainland China. Independent predictors of prolonged LOS were identified using multivariate logistic regression analysis. A prediction model was established and then evaluated by receiver operating characteristic (ROC) curve analysis and the Hosmer-Lemeshow test. RESULTS Multivariate logistic regression analysis showed that the type of medical insurance and the performance of daily activities (ICF, d230) were associated with prolonged LOS (P<0.05). Age and mobility level measured by the ICF Generic Set demonstrated no significant predictive value. The prediction model showed acceptable discrimination shown by an area under the curve (AUC) of 0.699 (95% CI, 0.646-0.752) and calibration (χ²=11.66; P=0.308). CONCLUSIONS The risk prediction model for prolonged LOS in stroke patients in 50 rehabilitation centers in China, based on the ICF Generic Set, showed that the scores for the type of medical insurance and the performance of daily activities (ICF, d230) on admission were independent predictors of prolonged LOS. This prediction model may allow stakeholders to estimate the risk of prolonged LOS on admission quantitatively, facilitate the financial planning, treatment regimens during hospitalization, referral after discharge, and reimbursement.

Aim: Controlling epileptic seizures in elderly populations is widely considered to be relatively easy, but we hypothesized that the lifestyles of elderly individuals may affect the outcomes of epilepsy treatment. The purpose of this study was to review the activities of daily living (ADL) of elderly individuals with epilepsy and compare them with the outcomes of epilepsy treatment., Methods: Of the 177 patients ≥65 years old who were referred to our epilepsy centre, epilepsy was diagnosed in 84. ADL and treatment outcomes were then reviewed, with ADL classified into three levels: ADL I, without disability; ADL II, disabled only in some instrumental ADL; and ADL III, disabled in some basic ADL. Epilepsy syndromes and use of anti-seizure drugs were also evaluated., Results: Forty-five patients (53.6%) achieved freedom from seizures, 23 (27.4%) achieved ≥80% but <100% reduction in seizures, 5 (6%) achieved ≥50% but <80% reduction in seizures, and 11 (13.1%) achieved <50% reduction in seizures. Thirty-five patients (81.4%) with ADL I achieved freedom from seizures, compared with seven patients with ADL II (28.0%) and three patients with ADL III (19.0%). A significant difference was evident among the three groups (F = 6.145, P = 0.003)., Conclusions: ADL should be taken into account when an epilepsy treatment is being selected., (© 2019 Japanese Psychogeriatric Society.)

Purpose: Premorbid conditions affect prognosis of acutely-ill aged patients. Several lines of evidence suggest geriatric syndromes need to be assessed but little is known on their relative effect on the 30-day survival after ICU admission. The primary aim of this study was to describe the prevalence of frailty, cognition decline and activity of daily life in addition to the presence of comorbidity and polypharmacy and to assess their influence on 30-day survival., Methods: Prospective cohort study with 242 ICUs from 22 countries. Patients 80 years or above acutely admitted over a six months period to an ICU between May 2018 and May 2019 were included. In addition to common patients' characteristics and disease severity, we collected information on specific geriatric syndromes as potential predictive factors for 30-day survival, frailty (Clinical Frailty scale) with a CFS > 4 defining frail patients, cognitive impairment (informant questionnaire on cognitive decline in the elderly (IQCODE) with IQCODE ≥ 3.5 defining cognitive decline, and disability (measured the activity of daily life with the Katz index) with ADL ≤ 4 defining disability. A Principal Component Analysis to identify co-linearity between geriatric syndromes was performed and from this a multivariable model was built with all geriatric information or only one: CFS, IQCODE or ADL. Akaike's information criterion across imputations was used to evaluate the goodness of fit of our models., Results: We included 3920 patients with a median age of 84 years (IQR: 81-87), 53.3% males). 80% received at least one organ support. The median ICU length of stay was 3.88 days (IQR: 1.83-8). The ICU and 30-day survival were 72.5% and 61.2% respectively. The geriatric conditions were median (IQR): CFS: 4 (3-6); IQCODE: 3.19 (3-3.69); ADL: 6 (4-6); Comorbidity and Polypharmacy score (CPS): 10 (7-14). CFS, ADL and IQCODE were closely correlated. The multivariable analysis identified predictors of 1-month mortality (HR; 95% CI): Age (per 1 year increase): 1.02 (1.-1.03, p = 0.01), ICU admission diagnosis, sequential organ failure assessment score (SOFA) (per point): 1.15 (1.14-1.17, p < 0.0001) and CFS (per point): 1.1 (1.05-1.15, p < 0.001). CFS remained an independent factor after inclusion of life-sustaining treatment limitation in the model., Conclusion: We confirm that frailty assessment using the CFS is able to predict short-term mortality in elderly patients admitted to ICU. Other geriatric syndromes do not add improvement to the prediction model. Since CFS is easy to measure, it should be routinely collected for all elderly ICU patients in particular in connection to advance care plans, and should be used in decision making.

Purpose: Published results of quality of life (QoL) studies mostly concern whole brain radiotherapy for limited or multiple brain metastases. This prospective multicentre study was designed to compare the QoL of patients with limited (1-3) brain metastases treated with either whole brain (WBRT) or stereotactic radiotherapy (SRT)., Methods: From 01/2007-03/2011, 90 limited brain metastases patients who were previously untreated (n = 77) or had undergone primary surgery (n = 13) were recruited at 14 centres in Germany and Austria. QoL was measured with the EORTC-QLQ-C15-PAL and BN20 brain modules before the start of radiotherapy and after 3 months., Results: Fifty-two patients (58%) received WBRT and 38 (42%) received SRT. At 3 months, 67 patients (74%) were still living, and 92.6% of the 3‑month survivors completed the second set of questionnaires. Analysis of the QLQ-C15-PAL and BN20 scales revealed significant deterioration in patients treated with WBRT and SRT in physical function (p < 0.001 and p = 0.007), fatigue (p < 0.001 and p = 0.036), nausea (p = 0.003 and p = 0.002), appetite loss (p < 0.001 and p = 0.025), drowsiness (p < 0.001 and p = 0.011), hair loss (p = 0.019 and p = 0.023) and itchy skin (p = 0.030 and p = 0.018). Motor dysfunction (p < 0.001), communication deficits (p = 0.002) and leg weakness (p < 0.001) declined significantly only in patients treated with WBRT. Comparing the two radiotherapy techniques over time, the results showed significant differences in symptom scores for future uncertainty, fatigue and appetite loss., Conclusions: QoL data as an outcome of the paper should be considered in decision making on the irradiation technique in patients with small number of brain metastases. Larger studies are required to verify the results according to subgroups.

Chez les résidents en soins de longue durée (SLD), l'hospitalisation peut amener des complications telles que le déclin fonctionnel. L'objectif de notre étude était d'examiner l'association entre les données démographiques et de santé et le taux d'hospitalisation des résidents nouvellement admis en SLD. Nous avons mené une étude de cohorte rétrospective incluant tous les centres de SLD de six provinces et d'un territoire du Canada, à l'aide des données de la RAI-MDS 2.0 et de la Discharge Abstract Database. Nous avons inclus les résidents nouvellement admis ayant eu une évaluation entre le 1er janvier et le 31 décembre 2013 (n = 37 998). Les résidents de sexe masculin avec une santé plus instable et une déficience fonctionnelle de modérée à grave présentaient des taux d'hospitalisation plus élevés, tandis que les résidents avec une déficience cognitive de modérée à grave avaient des taux moindres. Les résultats de notre étude pourraient contribuer à l'identification des résidents nouvellement admis qui seraient plus à risque d'hospitalisation et à l'élaboration de stratégies préventives plus ciblées, incluant la réadaptation, la planification préalable de soins, les soins palliatifs et les services gériatriques spécialisés., Hospitalizations of long-term care (LTC) residents can result in adverse outcomes such as functional decline. The objective of our study was to investigate the association between demographic and health information and hospitalization rate for newly admitted LTC residents. We conducted a retrospective cohort study of all LTC homes in six provinces and one territory in Canada, using data from the Resident Assessment Instrument–Minimum Data Set (RAI-MDS) 2.0 and the Discharge Abstract Database. We included newly admitted residents with an assessment between January 1 and December 31, 2013 (n = 37,998). Residents who were male, had higher health instability, and had moderate or severe functional impairment had higher rates of hospitalization, whereas residents who had moderate or severe cognitive impairment had decreased rates. The results of our study can be used to identify newly admitted residents who may be at risk for hospitalization, and appropriately target preventative interventions, including rehabilitation, advance care planning, palliative care, and geriatric specialty services.

Background: There is a lack of occupation-focused instruments to assess Activities of Daily Living (ADL) that are intended for persons with mental disorders. The ADL Taxonomy is an instrument that is widely-used within clinical practice for persons with physical impairment. The aim of this study was to adapt the ADL Taxonomy for persons with mental disorders and evaluate its validity., Methods: An expert group of Occupational Therapists (OTs) from psychiatric care adapted the ADL Taxonomy to fit the client group, including creating three new items. OTs in psychiatric care collected client data and evaluated the instrument for usability. Rasch analysis was used to evaluate the contruct validity of 16 activities separately., Results: The OTs collected 123 assessments from clients with various mental disorders. Ten activities had excellent, and four had acceptable, psychometric properties with regard to item and person fit and unidimensionality. The activity managing the day/time gave complex results and would benefit from further development. The OTs found the test version intelligible, relevant and easy to use., Conclusions: The ADL Taxonomy for persons with mental disorders has 16 activities with three to six actions each, and is now ready for clinical use.

This study was conducted to investigate the effects of motor imagery (MI) and mirror therapy (MT) on upper extremity function according to the level of cognition in stroke patients. Twenty-four participants who were diagnosed with stroke were divided into a mild cognitive group (n = 12) and a severe cognitive group (n = 12). Then, the two groups were again divided into MI group (n = 6) and MT group (n = 6). The participants were evaluated for function of upper extremity using the Box and Block Test (BBT), the Jebsen-Taylor Hand Function Test (JTHFT), and Manual Function Test (MFT). There were significant differences between the two groups of cognitive function of mild level in the post-test of JTHFT (p < 0.05). In the MI group, significant differences were found in the pre- and post-test scores for all variance (p < 0.05). In the MT group, significant differences were found in the pre- and post-test scores for JTHFT and MFT (p < 0.05). There were significant differences between the two groups of cognitive function of severe level in the post-test of all variances (p < 0.05). Furthermore, in the MT group, significant differences were found in the pre- and post-test scores for all variances (P < 0.05). The results of this study suggest that applying MI to the mild cognitive group is effective and that applying MT to the severe cognitive group is effective.

Objective: to evaluate, in emergency hospital service and at home, the functional independence of elderly people who fell., Method: longitudinal study with 151 elderly. Functional Independence Measure (FIM) was used. Statistical tests were performed with univariate and bivariate analysis., Results: mean of total FIM value in the hospital was 70.4; and at home 84.3 (p <0.001). Independence was lower in the motor domain, in "self-care", "mobility" and "locomotion" dimensions, in the two evaluations (p <0.001). Dependence reduced from 97.3% elderly in the hospital to 82.8% at home (p <0.001). There was a negative correlation between total FIM and age, number of medications, number of diseases and hospitalization time in both evaluations. Femoral and hip fractures were associated with lower total FIM values (p <0.001)., Conclusion: the elderly had less independence in the hospital compared to at home, with greater impairment in the motor domain and "self-care", "mobility" and "locomotion" dimensions, in the two moments evaluated.

Purpose: In acute ischemic stroke, infarct location and volume have, separately, been used to determine long-term outcomes after stroke. Little information exists on the combination of these imaging characteristics on rehabilitation outcomes. We evaluated the association between infarct lesion location volume with the Functional Independence Measure (FIM) measure during inpatient rehabilitation facility (IRF) in ischemic stroke patients., Methods: Between 2012 and 2014, we prospectively enrolled consecutive acute ischemic stroke patients admitted from a Comprehensive Stroke Center and followed to an IRF in Chicago, Illinois. We adjudicated infarct volumes in specific lesion locations using a validated brain atlas. Volumes were calculated using an automated pipeline. FIM measure was extracted from IRF charts. We analyzed the association between acute infarct characteristics and functional measures using adjusted Spearman's correlation., Results: Among 162 stroke patients (mean age 67.6 years, 48.1% male, 58.6% Caucasian), the median FIM at IRF was 52 (IQR 36-62). In an adjusted analysis, infarct volumes in the left basal ganglia (r s  = - 0.45, p = 0.02) and left frontal lobe (r s  = - 0.38, p = 0.04) were negatively correlated with FIM scores., Conclusions: There is an association between specific infarct lesion location volume and subsequent FIM scores assessed at IRF. Our findings suggest that imaging during index stroke hospitalization could be used to predict outcomes assessed during IRF.

Purpose: The aim of the study was to examine the characteristics of wandering associated with preserved versus worsened activities of daily living (ADL) function., Design: Longitudinal prospective design. Twenty-two cognitively impaired residents of an assisted living facility with over 450 observations were followed up to 8 months., Methods: Hierarchical linear modeling techniques examine how wandering activity (episodes, distance traveled, gait speed), measured by a real-time locating system, may affect ADL (the Barthel index, the Functional Independence Measure [FIM])., Findings: Wandering episodes were associated with increased ADL (B = 0.11, p ≤ .05, FIM); wandering distance (B = -4.52, p ≤ .05, the Barthel index; B = -2.14, p ≤ .05, FIM) was associated with decreased ADL., Conclusion: Walking an average of 0.81 miles per week with 18 or fewer wandering episodes is associated with decreased ability to perform ADL., Clinical Relevance: Tailored protocols that allow productive wandering with ongoing assessment for fatigue/other physiological needs to appropriately limit distance walked within wandering episodes are needed for this population.

Our aim was to clarify the nutritional status and energy intake needed for activities of daily living (ADL) improvement among convalescent stroke patients. This retrospective cohort study of stroke patients used data from the Japan Rehabilitation Nutrition Database. Mean energy intake per ideal body weight was 26 kcal/kg/day at 1 week after hospitalization. Patients were divided into two groups according to energy intake: ≥26 kcal/kg/day (high) and <26 kcal/kg/day (low). ADL was evaluated using Functional Independence Measure (FIM), and nutritional status was evaluated using the mini nutritional assessment short form score. We created an inverse probability weighted (IPW) model using propensity scoring to control and adjust for patient characteristics and confounders at the time of admission. The analysis included 290 patients aged 78.1 ± 7.8 years. There were 165 patients with high energy intake and 125 patients with low energy intake. FIM score was significantly higher in the high group compared with the low group (median 113 vs 71, P <0.001). FIM efficiency was also higher in the high group (median 0.31 vs 0.22, P <0.001). FIM efficiency was significantly higher in the high energy intake group than in the low energy intake group after adjustment by IPW (median 0.31 vs 0.25, P = 0.011). Nutritional status improvement was also higher in the high energy intake group after adjustment by IPW (60.6% vs 45.2%, P <0.001). High energy intake was associated with higher FIM efficiency and nutritional status improvement at discharge among convalescent stroke patients.

Objective: The purpose of this scoping review was to identify predictors of community integration for adults with traumatic brain injury., Data Sources: We searched the PubMed and PsycINFO databases and reviewed references of included studies. We selected studies exploring multiple components of community integration, including instrumental activities of daily living, leisure activities, and social activities. A total of 53 studies were included., Data Extraction: We extracted data on sample size and sample characteristics (stage of injury and recovery, severity) and examined predictor variables, outcome measures for community integration, and significant findings, reported as correlations., Data Synthesis: We found that the predictors of community integration fell into 4 categories: demographics, injury characteristics, disability and impairments, and environmental factors. There was large variability in reported relationships for demographics (r = 0.01-0.43), injury characteristics (r = 0.01-0.58), disability/functional impairments (r = 0.003-0.98) and environmental factors (r = 0.11-0.58). Cognition, disability, mobility/physical functioning, mood, social support, and length of posttraumatic amnesia had the strongest relationships with community integration outcomes., Conclusions: Strategies for the management of cognitive, physical, and emotional functioning, and building and training a strong support system, may facilitate community integration outcomes. Additional work is warranted to further explore the discrepancies found among studies.

Background: There is growing international interest in maximising the functional ability of older people., Objective: The aim of this article is to discuss 'reablement' and 'restorative care' in the context of providing a function-focused approach in primary care to address the needs of older people with functional decline., Discussion: Loss of functional ability can profoundly affect an older person and is often what prompts them to seek healthcare. The emergence of reablement and restorative care is a welcome development in policy. Reablement and restorative care are discussed in relation to current Australian Government-funded programs. These programs increase the availability of multidisciplinary services in community settings and support general practitioners (GPs) to take a comprehensive, 'function-focused' approach to the management of functional decline. GPs are important to identify and refer older people likely to benefit, and they play an essential part in effective program delivery.

Purpose: The purpose of this study was to develop and compare 3 predictive models for pressure injury (PI) occurrence in surgical patients., Design: Retrospective case-control study., Subjects and Setting: Data on PI risk assessment and preanesthesia evaluation records from 400 patients (80 patients who developed PIs after surgery and 320 patients who did not) in a South Korean acute care setting who underwent surgery between January 2015 and May 2016 were extracted from the electronic health record., Methods: Three models were developed with items from the Braden Scale (model 1), the Scott Triggers tool (model 2), and the Scott Triggers tool in addition to type of anesthesia, laboratory test results, and comorbid conditions (model 3) using logistic regression to analyze items (factors) in each model. Predictive performance indices, which included sensitivity, specificity, positive predictive value, negative predictive value, area under the receiver operating characteristics curve, and Akaike information criterion, were compared among the 3 models., Results: Findings showed there were no significant factors in model 1, the estimated surgery time and serum albumin level were significant in model 2, and the estimated surgery time, serum albumin level, and brain disease were significant in model 3. The model performance evaluation revealed that model 2 was the best fitting model, demonstrating the highest sensitivity (84.4%), highest negative predictive value (94.6%), and lowest Akaike information criterion (302.03)., Conclusions: The Scott Triggers tool in model 2, which consists of simple items that are easy to extract from preanesthesia evaluation records, was the best fitting model. We recommend the Scott Triggers tool be used to predict the development of PIs in surgical patients in acute care settings.

Background: Falls remain a major issue in inpatient rehabilitation. Decreased scores on the Functional Independence Measure (FIM), given to every patient, have been shown to predict falls risk., Purpose: The aim of the study was to extend previous research using FIM to predict falls by using only subscales assessed earliest during admissions to indicate high risk of falls., Design: Retrospective cohort study., Methods: Two consecutive samples of patients (n1 = 1,553, n2 = 12,301) admitted to a rehabilitation hospital over 9-month and 5-year periods, respectively, were used to evaluate the predictive utility of using only a small number of FIM subscales. Subscales were selected from those assessed earliest and were related to previously published research on falls risk factors. The metric was developed using a historical data set and was validated with a second, separate group of patients. Receiver operating characteristic curves were used to evaluate predictive utility., Findings: The combination of Toileting and Expression subscales yielded a comparable area under the curve to the full FIM, and both were greater than the existing method of falls risk assessment. Likelihood of falling was strongly linearly related to score on the Toileting/Expression metric., Conclusions: The sum of two FIM subscales can be used to predict which patients may fall during their stay in a rehabilitation hospital., Clinical Relevance: The FIM scores are assessed early during a patient's stay, are required for all Medicare patients, and may be useful for simple, rapid, and accurate assignment of falls risk.

Rehabilitation aims to optimize functioning of persons experiencing functioning limitations. As such the comparative evaluation of rehabilitation interventions relies on the analysis of the differences between the change in patient functioning after a specific rehabilitation intervention versus the change following another intervention. A robust health information reference system that can facilitate the comparative evaluation of changes in functioning in rehabilitation studies and the standardized reporting of rehabilitation interventions is the International Classification of Functioning, Disability and Health (ICF). The objective of this paper is to present recommendations that Cochrane Rehabilitation could adopt for using the ICF in rehabilitation studies by: 1) defining the functioning categories to be included in a rehabilitation study; 2) specifying selected functioning categories and selecting suitable data collection instruments; 3) examining aspects of functioning that have been documented in a study; 4) reporting functioning data collected with various data collection instruments; and 5) communicating results in an accessible, meaningful and easily understandable way. The authors provide examples of concrete studies that underscore these recommendations, whereby also emphasizing the need for future research on the implementation of specific recommendations, e.g. in meta-analysis in systematic literature reviews. Furthermore, the paper outlines how the ICF can complement or be integrated in established Cochrane and rehabilitation research structures and methods, e.g. use of standard mean difference to compare cross-study data collected using different measures, in developing core outcome sets for rehabilitation, and the use of the PICO model.

Background: Women, especially those with low-socio-economic status and financial deprivation, are found to be affected by mental illnesses disproportionately. We compared the clinical, functioning and cognitive characteristics between the financially deprived women with first-episode psychosis and their non-deprived women counterparts., Method: A cross-sectional analysis of consecutively recruited first-episode psychosis women patients was conducted. A total of 93 financially deprived women patients and 105 non-deprived women patients aged 25 to 55 years were compared in terms of demographic, premorbid and help-seeking characteristics, baseline clinical characteristics, baseline functioning and baseline cognitive functioning., Results: Financially deprived women were older (P = .005), had received less education (P = .001), more likely to live alone (P < .001) and with a higher proportion of immigrants (P = .001). Whereas there was no significant difference found in duration of untreated psychosis, deprived women had more severe depressive symptoms (P = .021) and more severe negative symptoms, in terms of avolition-apathy (P = .003) and anhedonia-asociality (P = .008). They also perform worse in social and occupational functioning (P = .002) and a range of cognitive abilities., Conclusions: Nearly half of the adult female patients with first-episode psychosis in Hong Kong encountered persistent financially difficulties. The fact that they suffer from more severe symptoms and worsened functioning and cognitive abilities at an early stage of illness shows that this subgroup of patients warrant assistance and attention., (© 2018 John Wiley & Sons Australia, Ltd.)

Background and Objective : Medication non-adherence is a preventable reason for treatment failure, poor blood pressure control among hypertensive patients and the geriatric population owing to poor physical activity is more vulnerable strata. The objective of this study is to investigate medication adherence and its associated factors among Pakistani geriatric hypertensive patients. Methods : A cross-sectional survey-based study was conducted at the out-patient department of the cardiac center from May 2018 to August 2018. A universal sampling technique was used to approach patients and 262 eligible consented patients were interviewed to collect information about socio-demographics, health, and disease-related characteristics using a structured questionnaire. The Morisky Levine Green test was used for the assessment of medication adherence. The Barthel index and single item literacy screener (SILS) was used to measure performance in activities of daily living and health literacy respectively. Chi-square tests and multivariate binary logistic regression analysis were performed to find factors by using SPSS version 20. Results: Of the total 262 participants, about 38.9% ( n = 102) were scored 4 and considered adherent while 61.1% ( n = 160) were considered as non-adherent. In logistic regression analysis, self-reported moderate (OR = 3.538, p = 0.009) and good subjective health (OR = 4.249, p = 0.008), adequate health literacy (OR = 3.369, p < 0.001) and independence in performing activities of daily living (OR = 2.968, p = 0.002) were found to be independent predictors of medication adherence among older hypertensive patients. Conclusion : Medication adherence among the older hypertensive population in Pakistan is alarmingly low. This clearly requires patient-centered interventions to overcome barriers and educating them about the importance of adherence., Competing Interests: The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Understanding the factors affecting activities of daily living (ADL) is important in Alzheimer's disease (AD), because decline in ADL contributes to many poor health outcomes. Existing studies often investigate the factors in isolation without a theoretical framework. The purpose of the present study was to provide preliminary results on how cognition, physical performance, and behavioral and psychological symptoms of dementia mediate the relationship of aerobic fitness and ADL in AD. A cross-sectional analysis was used (n = 28: average age 78 [8] years, education 16 (3) years, Mini-Mental State Examination scores 20 [4]). The results showed that aerobic fitness is not linked to ADL directly, and its association with ADL was mediated by physical performance and global cognition. Our findings provide preliminary support for aerobic fitness as a potential therapeutic target, as enhanced aerobic fitness could simultaneously modify other factors affecting ADL. Nurses are in a unique position for coordinating exercise safety assessment and prescription and educating older adults with AD about exercise participation., (© 2018 John Wiley & Sons Australia, Ltd.)

Aim: To clarify the concept of mild cognitive impairment (MCI) and identify its attributes to enhance understanding of its implications for nursing practice and research., Background: MCI is a concept that has evolved, thus clarification of this concept is essential for the advancement of nursing science., Design: Walker and Avant's eight steps of concept analysis strategy was used., Data Source: Manuals of mental disorders and databases such as PubMed, Springer, PsychINFO, Cumulative Index to Nursing and Allied Health Literature, and Education Resources Information Center (ERIC) from 1982 to 2018., Review Methods: A literature search was conducted using keywords such as "mild," "cognitive," "impairment," and "deterioration.", Results: The concept of MCI is defined as the transitional state between cognitive state normal for age and the early manifestation of dementia states. It is characterized by the presence of objective and subjective evidence of impairment in one or multiple cognitive domains, independence in daily activities, can be reversible, and is a risk factor for dementia., Conclusions: Clarification of MCI serves as a framework for identification, treatment, and interventions that may support healthy aging in older adults., (© 2018 Wiley Periodicals, Inc.)

Introduction: Occupational therapy (OT) is defined as the promotion of client health and well-being through a client-centred practice. However, there is a tendency to rely on the therapist's experiences and values, and there is a difference between the client's and therapist's perceptions regarding the current activity that the client is engaged in. In previous studies that have applied 'flow', activities supported by OT in elderly people were analysed, indicating a difference in recognition. Therefore, we thought that more effective OT could be implemented by adjusting the challenge-skill (ACS) balance, and we invented a novel process termed as ACS balance for OT. The purpose of this study is to verify the effect of ACS-OT on clients in the recovery rehabilitation unit and to prepare a protocol for randomised controlled trial (RCT) implementation., Method and Analysis: This single-blind RCT will recruit 80 clients aged 50-99 years admitted to the recovery rehabilitation unit who meet eligibility criteria. Clients will be randomly allocated to receive ACS-OT or standard OT. Both interventions will be performed during the clients' residence at the unit. The primary outcome measure will be subjective quality of life and will be measured at entry into (pre) and at discharge from (post) the unit and at 3 months afterwards (follow-up). Outcomes will be analysed using a linear mixed model fitted with a maximum likelihood estimation., Ethics and Dissemination: This protocol has been approved by the ethics review committee of the Tokyo Metropolitan University (No.17020). Results of this trial will be submitted for publication in a peer-reviewed journal., Trial Registration Number: UMIN-CTR number, UMIN000029505; Pre-results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Wernicke-Korsakoff syndrome is a type of brain disorder caused by the lack of thiamine, most commonly because of chronic alcohol misuse. It consists of two separate conditions including Wernicke's encephalopathy and Korsakoff syndrome. Various levels of cognitive impairments are associated with the severity of the syndrome. Although the effectiveness of thiamine replacement in the early phases of the syndrome is proven, the efficacy of subsequent treatments, which mainly include rehabilitation protocols after the development of Korsakoff syndrome, is not clear. This is the first report showing the positive effects of physical rehabilitation in a 48-year-old male patient with Wernicke-Korsakoff syndrome.

Since the clinical recognition of endovascular therapy (EVT) for stroke treatment is recent (2015), some organizational issues, such as the "drip and ship (DS) versus mothership (MS)" access to EVT remain unanswered. There is growing pressure to guarantee immediate access to EVT with limited human resources and infrastructures. As results from prospective studies are missing, a review of the existing literature dealing with clinical retrospective studies was carried out. Most of the studies did not report a significant difference with respect to the adverse effects for patients treated by EVT according to the organizational paradigm of care. Several studies did not report a significant difference concerning the 3 months functional outcomes regarding the organizational paradigm. Only two studies built theoretical models of the best outcomes and observed a superiority of the DS only if the door to needle time was less than 30 min. Waiting for the results of ongoing randomized controlled trials, this review of articles presenting patients treated with either MS or DS provides an overview but does not emphasize a superiority of a given paradigm; however, it highlights the inequalities of access to EVT according to the organization of care in different areas.

Introduction: Patients with chronic obstructive pulmonary disease (COPD) who have a clinical indication for beta-blocker therapy, are often not prescribed such medication, despite evidence suggesting that beta-blockers are not associated with adverse respiratory outcomes. The primary objective of this systematic review and meta-analysis is to examine the class effect of beta-blocker use in patients with COPD. We will focus on a broad range of endpoints including, clinical, safety, and patient-centric outcomes such as health related quality of life (HRQoL) and functional capacity. A secondary objective is to explore potential within-class variation in the effects of beta-blockers among patients with COPD, and rank individual agents according to their relative benefit(s)., Methods and Analysis: MEDLINE, Embase, The Cochrane Library and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases will be systematically searched, from inception to present, to identify randomised controlled trials (RCTs) and other prospective and interventional studies of beta-blocker use in patients with COPD which report on the outcomes of interest. Relative treatment effects with respect to mortality, COPD exacerbations, all-cause hospitalisation, lung function, HRQoL and exercise capacity will be summarised by meta-analysis. Individual treatments (agents) will be compared in a Bayesian network meta-analysis including RCT and observational data, if feasible., Ethics and Dissemination: The results of the study will be submitted for publication in a peer-reviewed journal. Only previously published aggregate data will be used for the purpose of this review., Prospero Registration Number: CRD42018098983., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Falls in older people are a major challenge to public health. A wearable fall detector can detect falls automatically based on kinematic information of the human body, allowing help to arrive sooner. To date, most studies have focused on the accuracy of an offline algorithm to distinguish real-world or simulated falls from activities of daily living, while neglecting the false alarm rate and battery life of a real device. To address these two important metrics, which significantly influence user compliance, this paper proposes a low-power fall detector using triaxial accelerometry and barometric pressure sensing. This fall detector minimizes power consumption using both hardware- and firmware-based techniques. Additionally, the fall detection algorithm used in this device is optimized to achieve a balance between sensitivity and false alarm rate, while minimizing the power consumption due to algorithm execution. The fall detector achieved a high sensitivity (91%) with a low false alarm rate (0.1149 alarms per hour), and a commercially-viable battery life (1125 days).

Background: Identifying the objective and subjective aspects of the quality of life (QoL) of institutionalized cognitively impaired older adults (CIOAs) is a challenge. However, it can reveal which aspects of their care require improvement., Aim: The aim of this study was to identify the core aspects of the QoL of CIOAs living in a nursing home (NH) by involving informal and professional caregivers (PCs)., Methods: Our sequential, mixed methods study exploring the QoL of CIOAs was based on Lodgson et al's (2002) quantitative quality of life-Alzheimer's disease (QoL-AD) questionnaire. Subsequently, a qualitative phase study analyzed perceptions and impressions of QoL using interviews of CIOAs and their most significant informal caregivers (SICs) and PCs., Results: Fifteen CIOAs, 12 SICs, and 2 PCs were recruited. Two-thirds of the older adults were females, overall average age was 86 years (SD=6.1), and all had a severe clinical dementia rating (CDR=3). A high level of comorbidity (measured using the Cumulative Illness Rating Scale for Geriatrics) was significantly associated with a lower QoL-AD score ( P =0.046). Higher numbers of visits by SICs or family members had a positive effect on QoL-AD scores ( P =0.036). No significant differences were found in overall QoL-AD scores as rated by CIOAs, SICs, and PCs ( P =0.080). Combining quantitative and qualitative data analyses revealed four significant themes influencing the QoL of CIOAs: 1) human dignity and acceptance; 2) development and existence; 3) functionality and health; and 4) recognizability and safety., Conclusion: Sequentially using mixed methods proved an appropriate way to examine the QoL of severe CIOAs living in an NH, and these results were compared with the perceptions of informal and PCs. The factors optimizing overall health were visits by SICs and family members, and the major aspect that increases the QoL was freedom of movement inside and outside the NH., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Introduction: In the geriatric population, independent mobility is a key factor in determining readiness for discharge following acute hospitalization. The Cumulated Ambulation Score (CAS) is a potentially valuable score that allows day-to-day measurements of basic mobility. The CAS was developed and validated in older patients with hip fracture as an early postoperative predictor of short-term outcome, but it is also used to assess geriatric in-patients with acute medical illness. Despite the fast-accumulating literature on the CAS, to date no systematic review synthesizing its psychometric properties has been published. Therefore, we aimed to provide a comprehensive review of the psychometric properties of the CAS, summarizing the present evidence on this measure as a basis for further research to investigate its applicability across a wider range of functional abilities and care settings., Evidence Acquisition: A literature search was conducted on research articles published between 2006 and June 2016 in journals indexed by MEDLINE and Scopus databases using as a search item "Cumulated Ambulation Score"[All Fields], and selecting studies that presented a psychometric analysis of the scale. Of 49 studies identified, 17 examined the psychometric properties of the CAS., Evidence Synthesis: Most papers dealt with patients after hip fracture surgery, and only 4 studies assessed the CAS psychometric characteristics also in geriatric in-patients with acute medical illness. Two versions of CAS (CAS1 and the more detailed CAS2 version) and two different methods to calculate the total score (1-day and 3-day CAS) were used in the selected papers. Most of the papers assessed reliability and validity, using different statistics, and only one showed evidence of sensitivity to change of the score., Conclusions: This systematic review shows international interest of researchers in the CAS, despite the short time frame since its first publication in 2006. The results support the reliability, validity, and sensitivity to change of the tool. Since different versions of CAS are available and two scores are commonly used, we suggest that clinicians and researchers in the future choose the more detailed CAS2 version, already used by the large majority of studies, and report whether they used the 1- or 3-day score.

Purpose: Although radiotherapy can be administered with a relatively low therapeutic burden, many elderly patients do not complete radiotherapy. In order to predict intolerance during radiotherapy, this study retrospectively analyzed the frequency of and risk factors for radiotherapy interruption among geriatric patients., Methods: From September 2009 to December 2016, 353 patients aged ≥70 years received definitive radiotherapy with a conventionally fractionated schedule. "Total interruption" included completion of ≤90% of a planned radiotherapy, temporary discontinuation, and treatment-related mortality within 2 months. "Early-phase incompletion" and "mid-phase incompletion" represented completion of ≤50 and ≤80% of a planned radiotherapy, respectively., Results: The median age of patients was 74 years. Early- and mid-phase incompletions and total interruption occurred in 4.2, 9.3, and 19.3% of patients, respectively. Total interruption occurred frequently in cancers involving the thorax (27.4%), head and neck (23.1%), abdomen (20.0%), pelvis (17.4%), and breast/extremity (8.1%). The Eastern Cooperative Oncology Group (ECOG) performance score (P = 0.004 and 0.002), serum albumin level (P = 0.016 and 0.002), and the expected 5‑year survival (P = 0.033 and 0.034) were significant factors for mid-phase incompletion and total interruption. Age ≥ 75 years (P = 0.008), concurrent chemotherapy (P = 0.017), and the extent of radiation field (P = 0.027) were factors associated with total interruption., Conclusion: Overall, 19.3% of the elderly patients showed treatment intolerance during conventional radiotherapy. Serum albumin level and ECOG performance score should be considered as surrogate markers for radiotherapy interruption prior to the decision regarding definite conventional radiotherapy.

The authors analyzed the association between the standard deviation or the coefficient of variation in the glucose value, strong independent indexes for determining glycemic variability, and the prognosis of intracerebral hemorrhage. They found that glycemic variability may be associated with a poor outcome in intracerebral hemorrhage.

Background: Hand-arm vibration syndrome (HAVS) is a chronic occupational disease affecting workers exposed to hand-transmitted vibration. However, limited information exists on task-related disability experienced by workers with HAVS., Aims: This study was conducted to characterize the impact of HAVS on task-related disability and daily life activities., Methods: A retrospective chart review was undertaken of difficulty in carrying out activities reported by workers with HAVS who had been assessed in an Occupational Medicine clinic in 2015. Prior to their clinical assessment, the workers had been asked to complete an open-ended questionnaire regarding activities they were having difficulty performing in the domains of personal care, household activities and recreational activities or hobbies., Results: Data from 107 workers diagnosed with HAVS were obtained through the retrospective chart review. The activities most affected included: getting dressed (n = 72), lawn maintenance (n = 61), fishing (including ice fishing) (n = 56), snow removal (n = 36), washing the car (n = 26) and doing the dishes (n = 25)., Conclusions: These findings reported in an open-ended fashion by workers with HAVS provide a better understanding of the impact of HAVS on specific activities of daily living in comparison to highly structured questionnaires lacking any open-ended responses. Understanding the implications of HAVS on activities of daily living will contribute to the provision of patient-centred care, by enabling health care providers to effectively support HAVS patients, based on workers' actual experiences of functional limitations.

Importance: Body mass index (BMI) shows a U-shaped association with impaired physical functioning among adults; the association is reduced or eliminated with aging., Objective: To examine whether BMI is associated with subsequent disability in activities of daily living (ADL) in Chinese adults age 80 years or older., Design, Setting, and Participants: Data were obtained on 16 022 adults age 80 years or older who were able to perform ADL independently at baseline from the Chinese Longitudinal Healthy Longevity Study, a community-based prospective cohort study conducted in 23 provinces of China. The study was initiated in 1998, with follow-up and recruitment of new participants in 2000, 2002, 2005, 2008, 2011, and 2014., Main Outcomes and Measures: Disability in ADL was defined as dependence in eating, toileting, bathing, dressing, indoor activities, and/or continence., Results: Among the 16 022 participants, 45.2% were men and 54.8% were women, with a mean (SD) age of 92.2 (7.2) years and a mean (SD) BMI (calculated as weight in kilograms divided by height in meters squared) of 19.3 (3.8). During 70 606 person-years of follow-up, 8113 participants with disability in ADL were identified. Cox proportional hazards regression models with penalized splines showed that BMI was linearly associated with disability in ADL: each 1-kg/m2 increase in BMI corresponded to a 4.5% decrease in the risk of disability in ADL. In comparison with individuals in the fourth quintile for BMI, the adjusted hazard ratio for disability in ADL was 1.38 (95% CI, 1.29-1.48) in the first quintile, 1.37 (95% CI, 1.28-1.47) in the second quintile, 1.11 (95% CI, 1.04-1.19) in the third quintile, and 0.85 (95% CI, 0.79-0.91) in the fifth quintile (P < .001 for trend). When BMI was categorized by Chinese guidelines, the underweight group (BMI <18.5) showed significantly increased risk of disability in ADL (hazard ratio, 1.34; 95% CI, 1.28-1.41) and the overweight or obese group (BMI ≥24.0) showed significantly decreased risk of disability in ADL (hazard ratio, 0.84; 95% CI, 0.78-0.91) compared with the normal weight group (BMI 18.5 to <24.0) (P < .001 for trend)., Conclusions and Relevance: Higher BMI was associated with a lower risk of disability in ADL among Chinese adults age 80 years or older, which suggests that current recommendations for BMI may need to be revisited. More attention should be paid on underweight, rather than overweight or obesity, for the prevention of disability in ADL after age 80 years.

The Physical Examination of an 'Uncooperative' Elderly Patient Abstract. The physical examination of uncooperative elderly patients regularly presents physicians in the private practice, in the hospital or nursing home with great challenges. The lack of cooperation itself can be an important indication of an underlying medical problem. Important elements to improve the patient's cooperation include ensuring basic needs, sufficient time and patience, adequate communication and good cooperation with relatives and other healthcare professionals. Targeted clinical observation as well as thinking in geriatric syndromes and unmet needs can help to raise physical findings despite limited cooperation. Pathological findings are indicators of impaired organ and functional systems and must be supplemented by a detailed examination.

Objective: This systematic review evaluates the evidence for the effectiveness of interventions within the scope of occupational therapy to improve and maintain performance and participation for people with serious mental illness. Areas included in this review are activities of daily living, instrumental activities of daily living, leisure, social participation, and rest and sleep., Method: Databases searched included MEDLINE, PsycINFO, CINAHL, OTseeker, and the Cochrane Database of Systematic Reviews. Reviewers read and assessed citations, abstracts, and full-text articles for inclusion and analysis., Results: Sixty-one articles were selected for inclusion. The review yielded strong evidence for psychoeducation and occupation- and cognitive-based interventions, moderate evidence for skills-based interventions, and limited evidence for technology-supported interventions., Conclusion: Results of this review support use of evidence-based practice within the scope of occupational therapy, inclusion of occupational therapy practitioners as mental health service providers, and continued research., (Copyright © 2018 by the American Occupational Therapy Association, Inc.)