Cross-functional team processes and patient functional improvement.

The Model of Human Occupation-Based Intervention for Patients with Stroke: A Randomised Trial

ObjectivesTo determine the relationship between long-term change in activities of daily living (ADL) and falls in the elderly and to identify characteristics of groups at risk for falls.MethodsThis was a 6-year, prospective cohort study using data from the Good Aging in Skåne study in southern Sweden, involving 1,540 elderly subjects, including the oldest-old (age, 60–93 years). The subjects were recruited from the general population. ADL was measured at a baseline and follow-up assessment, using Sonn and Åsberg’s revised scale and the ADL staircase. Falls were recorded in a period of 6 months before the follow-up assessment. The association between falls and change in ADL was calculated using adjusted, multiple logistic regression analysis and presented in odds ratios (ORs).ResultsThirteen percent of the study population reported one or several falls in the measured period. Over the course of 6 years, one in four participants changed their ADL status, and parts of this category had an increased risk for falls compared with those who stayed independent in ADL or who had no change in the ADL staircase. Groups with different characteristics had a prominent risk for falls: those with a reduction of two to eight steps in the ADL staircase (OR, 4.05; 95% confidence interval [CI], 1.62–10.11) and those becoming independent from dependency in instrumental ADL (OR, 4.13; 95% CI, 1.89–9.00). The former group had advanced age with a greater burden of cognitive impairment, gait disability, arrhythmia, and fall risk medications. The latter group had a higher prevalence of ischemic heart disease and low walking speed.ConclusionBoth deterioration and improvement in ADL over the course of 6 years increased the risk for falls in a general elderly population. Interventional efforts may require different strategies, as groups with different characteristics were at risk. Those at risk with improved ADL function may have a history of sufficient burden of comorbidity combined with obtained mobility for exposure to a fall event.

ABSTRACTPurpose: The purpose of this study is to describe improvement in activities of daily living (ADL) and gait speed, and associated factors in subjects receiving home-based rehabilitation after hospital admission for heart failure. Methods: A total of 1,055 patients (mean age 82 ± 8 years SD) receiving post-admission home care services for heart failure. Subjects were included if they were referred for home-care rehabilitation after inpatient admission with ICD-9 code indicating heart failure at inpatient discharge, primary home care, or co-morbid diagnosis on admission Outcome and Assessment Information Set version-C (OASIS-C). Change in total ADL score was described and adjusted for significant baseline factors/covariates using a generalized linear model. Factors predictive of exceeding the ADL score Minimal Detectable Change (MDC) were identified with multiple variable logistic regression. Results: Mean change in total ADL score from admission to discharge was 1.6 ± 1.2, the mean change for gait speed was 0.17 ± 0.21 m/s, and the minimum detectable change (MDC) (1.3) was exceeded by 57% of subjects. Improvement in mean ADL score was significantly predicted by age, baseline total ADL score, baseline gait speed score, cognitive-behavioral status, and living situation (R2 = 42%). Conclusions: Patients with heart failure receiving home-based rehabilitation services make significant improvements in ADL function and gait performance. Greater ADL improvements are associated with younger age, faster gait speed at baseline, and greater impairment of baseline ADL scores. Age, baseline gait speed, and ADL composite score are significantly related to making a change beyond measurement error in ADL change score.

Rannsökuð var þátttaka nemenda í kennslustundum í níu íslenskum framhaldsskólum og var markmið þríþætt. Í fyrsta lagi að greina hvernig þátttaka nemenda birtist í kennslustundum. Í öðru lagi að skoða hvort kennsluaðferðirnar í þeim kennslustundum þar sem þátttaka nemenda var til staðar væru kennarastýrðar eða nemendamiðaðar. Í þriðja lagi að skoða viðmót og athafnir kennara í kennslustundum þar sem nemendur tóku þátt. Unnið var úr 130 vettvangslýsingum á kennslustundum í níu framhaldsskólum sem safnað var á skólaárinu 2013–2014 og haustið 2014 í rannsóknarverkefninu Starfshættir í framhaldsskólum. Kennslustundir voru flokkaðar eftir því hvort þær náðu viðmiðum um þátttöku. Viðmiðið var að 75% af nemendunum tækju þátt í því sem kennarinn ætlaðist til af þeim í 75% af tímanum og náðu 83 kennslustundir þessu viðmiði. Algengustu birtingarmyndir þátttöku nemenda í kennslustundum voru að þeir unnu verkefni og spurðu kennara um námsefnið og komu þessar athafnir fram í meirihluta kennslustundanna. Í um helmingi stundanna kom einnig fram að nemendur sýndu athygli (fylgdust með) og ræddu um viðfangsefnið. Niðurstöður benda til þess að þátttaka nemenda í kennslustundum tengist ekki hvaða kennsluaðferðir eru notaðar, þar sem þátttökustundirnar skiptust frekar jafnt í nemendamiðaðar og kennarastýrðar kennslustundir. Flestar birtingarmyndir þátttöku nemenda komu tiltölulega jafnt fyrir í bæði kennarastýrðum og nemendamiðuðum kennslustundum en athöfnin að sýna athygli var algengari í kennarastýrðum kennslustundum og athafnirnar að leita og nota efnivið og hjálpast að við að leysa verkefni komu oftar fram í nemendamiðuðum kennslustundum. Flestar þátttökustundanna einkenndust af því að kennari sýndi jákvætt viðmót, hafði skapað hlýlegt andrúmsloft, hafði gefið skýr fyrirmæli um vinnu nemenda eða verið hvetjandi. Þannig virðast viðmót og athafnir kennara hafa haft jákvæð áhrif á þátttöku nemenda í kennslustundunum. Niðurstöðurnar undirstrika að mikilvægt er að gefa viðmóti og athöfnum kennara sérstakan gaum í samhengi við námslega skuldbindingu nemenda.

The benefits of cataract surgery for patients aged ≥90 years in terms of improvements in activities of daily living (ADL) have been poorly evaluated using only limited data. Using a large nationwide administrative database of hospitalized patients, we investigated the improvement of ADL after cataract surgery in the very old (age of ≥90 years). We identified 84,747 patients with cataracts aged 80 to 89 years and 7,253 patients with cataracts aged ≥90 years who underwent cataract surgery in both eyes during hospitalization from April 2014 to March 2015. A retrospective matched-pair cohort study was performed to compare the proportion of patients with improved ADL after cataract surgery. We also compared the length of hospital stay between the two groups. Patients aged ≥90 years were more likely to be female and have a lower ADL score at admission. In the 1:4 matched-pair analysis with 7,253 versus 29,012 pairs, a lower proportion of patients aged ≥90 years had an improved ADL score (odds ratio, 0.33; 95% confidence interval, 0.29-0.36; P < 0.001) even after adjusting for other variables. Patients aged ≥90 years had a slightly shorter length of hospital stay than those aged 80 to 89 years (7.5 vs. 8.2 days, respectively; P < 0.001). In this large nationwide cohort of patients with cataracts, those aged ≥90 years showed significantly poorer improvement of ADL than did patients aged 80 to 89 years. Cataract surgery before the age of 90 years may be recommended for patients with cataracts.

Association of early-onset dementia with activities of daily living (ADL) in middle-aged adults with intellectual disabilities: The caregiver's perspective

Exergames can be an appealing strategy that is integrated into post-abdominal surgery rehabilitation. The aim of this study was to assess the effectiveness of exergame rehabilitation in improving independence in activities of daily living (ADLs) and patient balance after abdominal cancer surgery. A randomized control-group study was carried out in an oncological hospital in Portugal. Seventy postoperative patients were included, and data collection took place between January 2023 and May 2023. The patients were randomly assigned to either an exergame rehabilitation program (n = 35) or a traditional rehabilitation program (n = 35). The assessed outcomes were the Barthel and Berg scales, and data collection occurred at 3 different time points: admission, 48 hours postoperatively, and on the seventh day after surgery. At the third assessment, a statistically significant difference was observed between the 2 groups for both indicators, ADLs and balance. There was an improvement in ADLs and balance in the exergames group. By the seventh day after surgery, the intervention group showed improvement in balance and ADLs compared with the control group. The use of exergames can be a solution to the challenges of traditional rehabilitation methods after abdominal surgery for cancer for postoperative patients. This is the first study carried out in this specific population.

Impact of frailty on risk of long-term functional decline following vascular surgery

BackgroundThe studio di intervento nel decadimento vascolare lieve (IDEALE study) was an open multicenter Italian study, the aim of which was to assess the effectiveness and safety of oral citicoline in elderly people with mild vascular cognitive impairment.MethodsThe study was performed in 349 patients. The active or citicoline group was composed of 265 patients and included 122 men and 143 women of mean age 79.9 ± 7.8 years selected from six Italian regions. Inclusion criteria were age ≥ 65 years, Mini-Mental State Examination (MMSE) score ≥ 21, subjective memory complaints but no evidence of deficits on MMSE, and evidence of vascular lesions on neuroradiology. Those with probable Alzheimer’s disease were excluded. The control group consisted of 84 patients, including 36 men and 48 women of mean age 78.9 ± 7.01 (range 67–90) years. Patients included in the study underwent brain computed tomography or magnetic resonance imaging, and plasma dosage of vitamin B12, folate, and thyroid hormones. Functional dependence was investigated by scores on the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scales, mood was assessed by the Geriatric Depression Scale (GDS), and behavioral disorders using the Neuropsychiatric Inventory scale. Comorbidity was assessed using the Cumulative Illness Rating Scale. An assessment was made at baseline (T0), after 3 months (T1), and after 9 months (T2, ie, 6 months after T1). The main outcomes were an improvement in MMSE, ADL, and IADL scores in the study group compared with the control group. Side effects were also investigated. The study group was administered oral citicoline 500 mg twice a day throughout the study.ResultsMMSE scores remained unchanged over time (22.4 ± 4 at T0; 22.7 ± 4 at T1; 22.9 ± 4 at T2), whereas a significant difference was found between the study and control groups, both in T1 and in T2. No differences were found in ADL and IADL scores between the two groups. A slight but not statistically significant difference was found in GDS score between the study and control groups (P = 0.06). No adverse events were recorded.Conclusion:In this study, citicoline was effective and well tolerated in patients with mild vascular cognitive impairment. Citicoline activates biosynthesis of phospholipids in neuronal membranes, increases brain metabolism as well as norepinephrine and dopamine levels in the central nervous system, and has neuroprotective effects during hypoxia and ischemia. Therefore, citicoline may be recommended for patients with mild vascular cognitive impairment.

Introduction: The impact of several dementia syndromes on activities of daily living (ADLs) has been well documented, but no study has yet investigated functional ability in posterior cortical atrophy (PCA). The primarily visual nature of deficits in this condition is likely to have a pronounced impact on ADLs. Objective: The aim of this study was to profile functional change in PCA and identify predictors of change. Method: Twenty-nine PCA patients and 25 patients with typical Alzheimer’s disease (AD) and their caregivers were included in this cross-sectional study. ADLs were assessed using the Disability Assessment for Dementia (DAD), administered to caregivers, assessing basic ADLs (e.g., eating, dressing) and instrumental ADLs (e.g., managing finances, meal preparation). The predictive utility of cognitive domains (Addenbrooke’s Cognitive Examination), behavioural impairment (Cambridge Behavioural Inventory-Revised) and demographic variables on ADL ability was also examined. Results: PCA patients showed significantly reduced total ADL scores compared to AD patients (medium effect size, d = –0.7; p < 0.05), with significantly more impairment on basic ADLs (large effect size, d = –0.8; p < 0.05) but similar impairment on instrumental ADLs (medium effect size, d = –0.5; p > 0.05). A model combining patient mood, disinhibition, apathy, symptom duration, and memory and attention/orientation scores explained the variance of scores in functional decline (61.2%), but the key factor predicting ADL scores was attention/orientation (p = 0.048). Conclusion: This study shows the profound impact of PCA on ADLs and factors underpinning patients’ disability. Attention/orientation deficits were found to correlate and contribute to variance in ADL scores. Future work to develop tailored interventions to manage ADL impairment in PCA should take these findings into account.

This study examined the relationship of perceived safety and confidence in local law enforcement and government to changes in daily life activities during the Washington, DC, sniper attacks. Participants were 1238 residents from the Washington, DC metropolitan area who were assessed using an Internet survey that included items related to safety at work, at home, and in general, confidence in law enforcement/government, and changes in routine daily life activities. A majority of participants (52%, n = 640) reported changing their daily life activities, with approximately one-third identifying changes related to being in large places and getting gas. Perceived safety was associated with confidence in local law enforcement/government. After adjusting for demographics, lower feelings of safety and less confidence in law enforcement/government were related to a higher likelihood of altered daily activities. Confidence in local law enforcement/government modified the association of safety with changes in daily activities. Among participants with high safety, less confidence in local law enforcement/government was associated with greater changes in daily life activities. Serial shooting events affect feelings of safety and disrupt routine life activities. Focus on enhancing experiences of safety and confidence in local law enforcement and government may decrease the life disruption associated with terrorist shootings.

Background: Approximately 10% of patients with diabetes present with neuropathic complications at the time of diagnosis. Evaluating activities of daily living (ADLs) is an important indicator of overall functional performance. In individuals with diabetic neuropathy, ADL levels often decline due to neurological impairment. Objectives: The present study aimed to examine the relationship between ADLs and biochemical markers in newly diagnosed patients with type 2 diabetes mellitus (T2DM). Methods: This prospective observational study included 100 patients with T2DM selected using simple random sampling. Serum levels of total cholesterol, triglycerides, and glycated hemoglobin (HbA1c) were measured at baseline and six months after treatment initiation. Data were collected using a two-part questionnaire assessing demographic characteristics, biochemical parameters, and the standardized Barthel Index for ADLs. Statistical analysis was performed using SPSS v25 with a significance level of P &lt; 0.05. Statistical modeling was based on correlation analysis between biochemical factors and ADL scores. Results: The mean age of participants was 58.5 ± 8 years. Among them 42% were male, and 62% reported a family history of diabetes. During the study, the mean blood biochemical factors decreased; HbA1c decreased from 8.10 to 7.73, triglyceride from 187.12 to 142.03, and cholesterol from 182.09 to 150.70. The amount of ADLs increased from 18.30 to 18.46 six months after diagnosis and treatment of the participants. A significant correlation was found between HbA1c level and ADL score (P &lt; 0.001), whereas correlations between ADL score and cholesterol or triglyceride levels were not significant (P = 0.186 and P = 0.206, respectively). Conclusions: Improved glycemic control, as reflected by lower HbA1c levels, is associated with better functional performance in patients with T2DM. Maintaining optimal HbA1c may help reduce neuropathic complications and enhance ADLs in this population.

This service evaluation examined the impact of offloader knee bracing for unicompartmental osteoarthritis (OA) on pain, quality of life (QoL) and activities of daily living (ADL). The retrospective service evaluation was completed at two NHS community primary care clinics offering offloader knee bracing services. Between 2015 and 2023 patients prescribed offloader knee braces with unicompartmental osteoarthritis were invited to complete a Knee injury and Osteoarthritis Outcome Score (KOOS) at baseline, one, six and 12months and at two and three years. KOOS data were analysed to assess the change in ADL, Pain and QoL domains from baseline to one, six and twelve months and up to three years using a paired t-test. Demographic data collected included age, sex, and type of OA. Two hundred and forty-three patients were issued an offloader knee brace. There were statistically significant differences in pain and ADL for both braces at one and six months (p<0.05). Participants issued with an ÖSSUR brace demonstrated statistically significant changes in pain and ADL for up to two years (p=0.0101; p=0.0153) and QoL up to one year (p=0.0011). There was no statistically significant difference in either brace at three years. The ÖSSUR brace demonstrated a minimal clinically significant difference at one month for all domains, at one year for pain and ADL and two and three years for pain, ADL and QoL. Results indicate that offloader knee bracing for unicompartmental knee OA could reduce patients' pain, ADL and QoL in the long term.

Twenty-two patients with thalamic haemorrhage were examined to investigate the relationship between motor and cognitive function, and activities of daily living (ADL). Patients with unilateral spatial neglect had lower ADL scores on admission than patients without unilateral spatial neglect (Mean: 17.0 and 24.6, respectively; F= 4.38, df = 1, p < 0.05). Unilateral spatial neglect related to feeding, bowel control and transfer in Barthel index on admission. Patients with aphasia on admission had lower ADL at discharge than patients without aphasia on admission (Mean: 57.0 and 84.7, respectively; F= 7.70, df = 1, p ⁢ 0.05). Aphasia related to the bathing, toilet, stair climbing, dressing, and ambulation in Barthel index on discharge. There was a significant difference between the severity of paresis in upper and lower limb on admission and ADL at discharge. The two-way repeated measures ANOVA showed a significant difference between severity of paresis in lower limb and ADL improvement. It can be suggested that the most important predictor of outcome was paresis in lower limb, and not aphasia or unilateral spatial neglect.

Due to the use of multiple drugs and prevalence of diminished cognitive function, community-dwelling elderly individuals are more likely to have drug-related issues. We examined changes in quality of life (QOL) and activities of daily living (ADL) 3 months and 6 months after reducing drug use of dementia patients who had newly begun community-dwelling care. Prescription drug use was reduced in the intervention group, whereas the non-intervention group continued their regimen or began using additional drugs. QOL and ADL were assessed with the Japanese version of the EQ-5D and the Barthel Index, respectively. Subjects were 32 individuals aged ≥65 years who had begun community-dwelling between March and July 2014 and had received approval for long-term care insurance. On average, the intervention group (n = 19) stopped using 2.6 prescription drugs. After 6 months, the differences in the QOL and ADL scores in the intervention group were -0.03 ± 0.29 and 6.32 ± 18.6, respectively, while the differences in the QOL and ADL scores in the non-intervention group (n = 13) were -0.13 ± 0.29 and -2.69 ± 23.7, respectively. In the intervention group, ADL scores were significantly increased by 14.0 ± 11.1 6 months after reduced benzodiazepine use. QOL was maintained with reduced drug use, while ADL score was slightly increased. In addition, the reduction of benzodiazepine use significantly increased ADL. In order to reduce polypharmacy among community-dwelling elderly patients, it is necessary to create an opportunity for pharmacists to re-examine their prescriptions.