Phenotypic Classification and Functional Assessment in Knee Osteoarthritis Patients.

The purpose of our study was the phenotypic classification of patients with osteoarthritis of the knee (KOA) and the dynamic assessment of functional status, monitored both numerically and in conformity with the International Classification of Functioning, Disability, and Health (ICF-basic set, shortened form). We conducted a prospective study in the Department of Physical Medicine and Rehabilitation, Filantropia Hospital, Craiova, from June of 2022 to November of 2023. In total, 100 patients with KOA were enlisted. Using data from the literature, physiotherapeutic examination, and results from paraclinical examinations, we classified studied patients into the five phenotypic categories: chronic pain (F1), local pathology with predominance of inflammatory mechanisms (F2), local pathology with predominance of metabolic mechanisms of bone and cartilage structures (F3), metabolic disorders (F4) and comorbidities (F5)-primarily chronic venous insufficiency in the lower limbs. We analyzed the values of generic qualifiers (at two evaluation time points) for the most significant elements of the core ICF set, abbreviated form, used in OAG, across each of the five phenotypes. Phenotypes F4 and F5 showed significant improvements across all evaluated functions, indicating increased efficacy in patients with comorbidities and metabolic diseases. Reduction in pain sensation, improvement in joint and muscle mobility, as well as enhancements in functions related to walking, dressing, and hand use, reflect an overall improvement in the quality of life for these patients.

Functionally dependent status is an independent predictor for worse perioperative outcomes following craniotomy for aneurysmal subarachnoid hemorrhage.

Background: Aneurysmal subarachnoid hemorrhage (aSAH) is a medical emergency, and functional status is often a predictor of adverse outcomes perioperatively. Patients with different functional statuses may have different perioperative outcomes during surgery for aSAH. This study retrospectively examines the effect of functional status on specific perioperative outcomes in patients receiving craniotomy for aSAH. Methods: Patients with aSAH who underwent neurosurgery were identified using International Classification of Diseases (ICD) codes (ICD10, I60; ICD9, 430) in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2005 to 2021. Subjects were stratified into two study groups: functionally dependent and functionally independent, based on their documented functional status on NSQIP. Significant preoperative differences were present between groups so a multivariable regression was performed between functionally dependent and independent patients. The 30-day perioperative outcomes of the two groups were compared. Perioperative outcomes included death, major adverse cardiovascular events (MACEs), cardiac complications, stroke, wound complications, renal complications, sepsis, clot formation, pulmonary complications, return to the operating room, operation time >4 h, length of stay longer than 7 days, discharge not to home, and bleeding. Results: For aSAH patients receiving craniotomy repair, functionally dependent patients had significantly greater rates of MACE, cardiac complications, sepsis, pulmonary complications, and discharge not to home compared to functionally independent patients. Conclusion: This study shows specific perioperative variables influenced by dependent functional status when treating aSAH through craniotomy, thus leading to a more complicated postoperative course. Additional research is needed to confirm these findings among the specific variables that we analyzed.

Functional Impairments, Phenotypic Frailty and Sector-Specific Incremental Healthcare Costs in Older Adults.

BACKGROUND: This study quantifies incremental healthcare expenditures of functional impairments and phenotypic frailty in specific healthcare sectors. METHODS: Pooled 2023 analysis of 4 prospective cohort studies linked with Medicare claims including 4318 women and 3847 men attending an index examination (2002-2011). Annualized inpatient, skilled nursing facility (SNF), home healthcare (HHC) and outpatient costs (2023 dollars) ascertained for 36 months following index examination. Functional impairments (difficulty performing 4 activities of daily living) and frailty phenotype (operationalized using 5 components) derived from cohort data. Weighted multimorbidity index including demographics derived from claims. RESULTS: Mean age at index examination was 79.2 years. After accounting for multimorbidity and each other, average annualized incremental costs of 3-4 functional impairments versus no impairment in women (men) was $2838 ($5516) in inpatient, $1572 ($1446) in SNF and $1349 ($1060) in HHC sectors; average incremental costs of phenotypic frailty versus robust in women (men) was $4100 (not significant for men) in inpatient, $1579 ($1254) in SNF and $645 ($526) in HHC sectors. Incremental inpatient costs were primarily due to a higher hospitalization risk, while incremental SNF and HHC costs were related to both increased risks of utilization and higher costs among individuals with utilization. Neither geriatric domain was associated with outpatient costs. CONCLUSIONS: In this study of community-dwelling beneficiaries, functional impairments were independently associated with higher subsequent expenditures in inpatient, SNF and HHC sectors among both sexes. Phenotypic frailty was independently associated with higher subsequent inpatient costs in women, and higher SNF and HHC costs in both sexes.

Multimodal prehabilitation to enhance functional capacity of patients with esophageal cancer during concurrent neoadjuvant chemotherapies-a randomized feasibility trial.

Esophageal adenocarcinoma continues to bear high morbidity and mortality. Prehabilitation, using exercise, nutrition, and psychosocial strategies to optimize patients prior to surgical resection, is largely underexplored in this malignancy, especially in patients undergoing neoadjuvant chemotherapy. Objectives of this study were (i) to determine feasibility of prehabilitation during treatment in patients with esophageal cancer and (ii) to establish differences between hospital and home-based exercise. Patients were recruited from August 2019 - February 2023 and blindly randomized to either supervised or homebased exercise, receiving identical nutritional and psychosocial support. The main outcome measures were recruitment, retention, and dropout rates. The secondary outcomes included cardiorespiratory fitness, functional capacity, and quality of life. Forty-four subjects were blindly randomized: 23 to supervised exercise and 21 to home-based exercise (72% recruitment rate). Overall compliance for the supervised group was 72%; home-based group was 77%. Baseline to pre-operative, both groups experienced significant increases in sit-to-stand, arm curls, and amount of weekly moderate-vigorous physical activity. The home-based group experienced an additional considerable decrease in up-and-go test times. Both groups maintained cardiorespiratory fitness and saw substantial increases in some quality-of-life scores. Multimodal prehabilitation is feasible for patients with esophageal cancer undergoing neoadjuvant chemotherapy. In both groups, patient fitness, which is relevant for this patient population given the anticipated decline in functional status during this period, was maintained. This study provides a foundation for future prehabilitation interventions in this patient population.

Predictors of functional status and disability among patients living with chronic kidney diseases at St Paul's hospital millennium medical college, Ethiopia: findings from a cross-sectional study.

BACKGROUND: The rise in risk factors like obesity, hypertension, and diabetes mellitus has partly led to the increase in the number of patients affected by chronic kidney disease, affecting an estimated 843 million people, which is nearly 10% of the general population worldwide in 2017. Patients with CKD have an increased risk of functional difficulties and disability. This study aimed to assess the level of functional status and disability and its associated factors among patients with chronic kidney attending Saint Paul Hospital, Millennium Medical College, Addis Ababa, Ethiopia. METHODS: An institution-based cross-sectional study was conducted with 302 enrolled study participants through systematic random sampling techniques. Face-to-face interviews and chart reviews were used to collect data using a semi-structured questionnaire adapted from works of literature. The Health Assessment Questionnaire Disability Index (HAQ-DI) was used to assess the functional status and disability of the participants. Data was entered into EPI info version 7 and exported to SPSS version 23 for analysis. Bivariate logistic regression analysis was employed with a p-value less than 0.25. Finally, those variables with a p-value less than 0.05 in multivariate analysis were taken as statistically significant. RESULTS: A total of 219 (72.5%) CKD patients had moderate to severe functional limitation and disability (HAQ-Di > 0.5-3). Age > 50 years [AOR = 1.65; 95% CI (1.23, 3.15)], being at stage 2 and 3 CKD [AOR = 4.05; 95% CI (1.82, 9.21), being at stage 4 and 5 CKD [AOR = 2.47; 95% CI (1.87, 4.72)], and having MSK manifestations [AOR = 2.97; 95% CI (1.61, 5.55)] were significantly associated with functional status and disability. CONCLUSION: The findings of this study suggest that CKD-associated functional disabilities are common. The advanced stage of CKD, higher age, and presence of musculoskeletal manifestations appear to be important variables predicting self-reported functional status. Healthcare professionals treating CKD shall be vigilant about the CKD-associated disability, the modifiable predictors, and interventions to limit the CKD-related disability.

Does Functional Status Predict Worse 30-D Outcomes in Endovascular Repair of Abdominal Aortic Aneurysms? A Propensity-Score Matched Study From ACS-NSQIP Targeted Database From 2012 to 2022.

INTRODUCTION: In patients undergoing endovascular aneurysm repair (EVAR), existing studies have identified an association between dependent functional status (DFS) and poorer outcomes after EVAR. However, noted limitations, especially the lack of differentiation between ruptured and nonruptured abdominal aortic aneurysm (AAA), potentially affect the extrapolation of these findings to specific patient groups. Thus, this study aimed to evaluate the association between functional status and 30-d outcomes after EVAR in ruptured and nonruptured AAA patients separately. METHODS: Patients who underwent infrarenal EVAR were identified in the American College of Surgeons National Surgical Quality Improvement Program targeted database from 2012-2022. Patients with DFS and those with independent functional status (IFS) were stratified into the two study cohorts. In nonruptured AAA, a 1:1 propensity-score matching was used to address demographics, baseline characteristics, aneurysm diameter, distal extent of the aneurysm, anesthesia, and concomitant procedures between patients with DFS and IFS. The sample size for ruptured patients with AAA was too small for meaningful statistical analysis so only qualitative description was provided. Thirty-d postoperative mortality and morbidities of EVAR were assessed. RESULTS: For nonruptured cases, there were 380 (2.55%) DFS and 14,545 (97.45%) patients with IFS, where 453 patients with IFS were matched to the DFS cohort. For ruptured AAA, there were 17 (6.39%) DFS and 249 (93.61%) IFS. After matching, nonruptured DFS and patients with IFS had similar 30-d mortality rates (2.37% vs 2.11%, P = 1.00). However, patients with DFS had a higher risk of bleeding requiring transfusion (18.42% vs 11.84%, P = 0.01) and longer length of stay (median 3.00 [Q1 1.00, Q3 6.00] vs median 2.00 [Q1 1.00, Q3 4.00] d, P < 0.01). All other outcomes, including major adverse cardiovascular events, cardiac complications, stroke, pulmonary complications, renal complications, sepsis, venous thromboembolism, wound complications, lower extremity ischemia, ischemic colitis, postoperative ruptured aneurysm, unplanned reoperation, 30-d readmission, were not different between patients with DFS and IFS. Qualitatively, ruptured patients with DFS had higher crude rates of 30-d mortality and morbidities compared to patients with IFS. CONCLUSIONS: Contrary to previous literature, patients with DFS with nonruptured AAA undergoing EVAR were found to have largely comparable outcomes to patients with IFS, although extra attention should be paid to postoperative bleeding.

Functional Status and Quality of Life in Light-Chain Amyloidosis: Advanced Imaging, Longitudinal Changes, and Outcomes.

BACKGROUND: In light-chain (AL) amyloidosis, whether functional status and heart failure-related quality of life (HF-QOL) correlate with cardiomyopathy severity, improve with therapy, and are associated with major adverse cardiac events (MACE) beyond validated scores is not well-known. OBJECTIVES: The authors aimed to: 1) correlate functional status and HF-QOL with cardiomyopathy severity; 2) analyze their longitudinal changes; and 3) assess their independent associations with MACE. METHODS: This study included 106 participants with AL amyloidosis, with 81% having AL cardiomyopathy. Functional status was evaluated using the NYHA functional class, the Karnofsky scale, and the 6-minute walk distance (6MWD), and HF-QOL using the MLWHFQ (Minnesota Living with Heart Failure Questionnaire). Cardiomyopathy severity was assessed by cardiac 18F-florbetapir positron emission tomography/computed tomography, cardiac magnetic resonance, echocardiography, and serum cardiac biomarkers. MACE were defined as all-cause death, heart failure hospitalization, or cardiac transplantation. RESULTS: NYHA functional class, Karnofsky scale, 6MWD, and MLWHFQ were impaired substantially in participants with recently diagnosed AL cardiomyopathy (P < 0.001), and correlated with all markers of cardiomyopathy severity (P ≤ 0.010). NYHA functional class, 6MWD, and MLWHFQ improved at 12 months in participants with cardiomyopathy (P ≤ 0.013). All measures of functional status and HF-QOL were associated with MACE (P ≤ 0.017), independent of Mayo stage for 6MWD and MLWHFQ (P ≤ 0.006). CONCLUSIONS: Functional status and HF-QOL were associated with AL cardiomyopathy severity, improved on therapy within 12 months, and were associated with MACE, independently of Mayo stage for 6MWD and MLWHFQ. They may be validated further in addition to prognostic scores and as surrogate outcomes for future studies.

Association of physical symptoms with accelerometer-measured movement behaviors and functional capacity in individuals with Long COVID.

Long COVID has been linked to a decline in physical activity and functional capacity. However, it remains unclear which physical symptoms are associated with specific aspects of movement behaviors and functional capacity. We aimed to investigate the associations of fatigue, dyspnea, post-exertional malaise, myalgia, and the co-occurrence of symptoms with movement behaviors and functional capacity in individuals with Long COVID. A cross-sectional multicenter study was conducted. Questionnaires were used to assess fatigue, dyspnea, post-exertional malaise, and myalgia. Accelerometry was employed to assess sedentary time, steps per day, light physical activity, and moderate-to-vigorous physical activity. The six-minute walk test, 30-s chair stand test, and timed up and go were used to assess functional capacity. One hundred and two community-dwelling individuals who had been living with Long COVID for 15 ± 10 months participated in the study. Fatigue, post-exertional malaise, and the co-occurrence of physical symptoms showed a negative association with step count, while post-exertional malaise was also negatively associated with moderate-to-vigorous physical activity. Dyspnea showed a negative association with the functional score, including all tests. Our findings suggest that fatigue, post-exertional malaise, and the co-occurrence of physical symptoms are negatively associated with physical activity, while dyspnea is negatively associated with functional capacity in individuals with Long COVID.

A Cross-Sectional Study Assessing the Functional Status in Children With Juvenile Idiopathic Arthritis and Its Correlation With Their Quality of Life and Burden on Caregivers.

Background Juvenile idiopathic arthritis (JIA) is a common rheumatic disease in children, significantly impacting their functional status and quality of life (QoL), as well as imposing a burden on caregivers. This study aims to assess the functional status of children with JIA, their QoL, and the associated caregiver burden while exploring the correlations between these factors. Methodology A prospective, cross-sectional, observational study was conducted over 18 months. A total of 33 children diagnosed with JIA were evaluated using the Childhood Health Assessment Questionnaire (CHAQ), and Euro Quality of Life-5 Dimension-Youth (EQ-5D-Y). Caregiver burden was assessed using the Family Burden Interview Schedule (FBIS). Data were analyzed using descriptive statistics, regression analysis, and Spearman's rank correlation. Results A total of 33 consecutive children with JIA were prospectively enrolled. The mean age was 10.1 ± 3.7 years, with a male predominance (63.6%, n = 21). Enthesitis-related arthritis was the most common subtype (42%, n = 14). The CHAQ scores indicated moderate disability, with profound impacts on walking and arising. Most children reported "some problems" in all EQ-5D-Y domains, with a mean health status visual analog scale score of 60.97 ± 23.43. The mean FBIS score was 9.64 ± 5.78, indicating a moderate caregiver burden. The majority of caregivers reported moderate financial, family routine, and family leisure disruptions. Significant correlations were found between CHAQ and EQ-5D-Y scores in several domains (p ≤ 0.040), as well as between specific CHAQ domains and FBIS scores (p ≤ 0.037). Conclusions Children with JIA experience significant functional limitations and reduced QoL, which also impacts their caregivers. Early rehabilitation and comprehensive care strategies are crucial for improving functional outcomes and QoL, as well as alleviating caregiver burden.

Impact of Functional Status at the Time of Transplant on Short-Term Pediatric Lung Transplant Outcomes in the USA.

PURPOSE: Poor functional status is associated with pediatric lung transplant (LTx) waitlist mortality. We investigate how pre-transplant functional status affects post-LTx survival. METHODS: A retrospective analysis was performed using The United Network for Organ Sharing (UNOS) Registry data. Pediatric first-time lung transplant candidates between ages 1 and 18 years with reported Lansky Play-Performance Scores (LPPS) at the time of waitlist and/or transplant were included from 2005 and 2021. Functional status by the LPPS scores is defined as severe limitation for LPPS score 10-40, mild limitation for LPPS score 50-70, and normal activity for LPPS score 80-100. Univariate analyses, multivariable Cox regression, and Kaplan-Meier plots were used to assess the impact of functional status on 1-year post-LTx survival. RESULTS: There were 913 and 610 patients at the time of LTx listing and transplant with LPPS scores, respectively. Poor functional status as determined by the LPPS score at the time of LTx, but not at the time of waitlist, was associated with worse 1-year post-LTx outcome (p value 0.0025 vs. 0.071). Multivariable survival analysis using Cox proportional hazards regression identified that a severely limited functional status at the time of LTx was the most profound risk factor for worse 1-year post-LTx survival outcomes when compared to a normal functional status (HR 2.16; 95% CI 1.15-4.07, p value 0.017). CONCLUSIONS: Children with severely limited functional status at the time of LTx have worse 1-year post-LTx outcome. It is important to develop strategies to optimize the functional status of children for improved post-LTx outcomes.

Paediatric survivors of extracorporeal life support functional outcomes at one-year follow-up.

OBJECTIVE: To investigate functional outcomes in children who survived extracorporeal life support at 12 months follow-up post-discharge. BACKGROUND: Some patients who require extracorporeal life support acquire significant morbidity during their hospitalisation. The Functional Status Scale is a validated tool that allows quantification of paediatric function. METHODS: A retrospective study that included children placed on extracorporeal life support at a quaternary children's hospital between March 2020 and October 2021 and had follow-up encounter within 12 months post-discharge. RESULTS: Forty-two patients met inclusion criteria: 33% female, 93% veno-arterial extracorporeal membrane oxygenation (VA ECMO), and 12% with single ventricle anatomy. Median age was 1.7 years (interquartile range 10 days-11.9 years). Median hospital stay was 51 days (interquartile range 34-91 days), and median extracorporeal life support duration was 94 hours (interquartile range 56-142 hours). The median Functional Status Scale at discharge was 8.0 (interquartile range 6.3-8.8). The mean change in Functional Status Scale from discharge to follow-up at 9 months (n = 37) was -0.8 [95% confidence interval (CI) -1.3 to -0.4, p < 0.001] and at 12 months (n = 34) was -1 (95% confidence interval -1.5 to -0.4, p < 0.001); the most improvement was in the feeding score. New morbidity (Functional Status Scale increase of ≥3) occurred in 10 children (24%) from admission to discharge. Children with new morbidity were more likely to be younger (p = 0.01), have an underlying genetic syndrome (p = 0.02), and demonstrate evidence of neurologic injury by electroencephalogram or imaging (p = 0.05). CONCLUSIONS: In survivors of extracorporeal life support, the Functional Status Scale improved from discharge to 12-month follow-up, with the most improvement demonstrated in the feeding score.

Chest wall resection and reconstruction for primary chest wall sarcomas: analysis of survival, predictors of outcome and long-term functional status.

OBJECTIVES: We aimed to analyze survival, predictors of outcome and the long-term functional status of patients with a diagnosis of primary chest wall sarcoma who undergo chest wall resection and reconstruction (CWRR). METHODS: We analysed a prospectively maintained database, including all patients operated on between 2008-2021. The primary outcome measures were overall and disease-free survival and analyses were employed to determine the risk factors for poor survival and recurrence. RESULTS: One hundred and thirty-nine patients included, 55% were male. The majority (96%) had an R0 resection and 75.1% had no post-operative complications up to 30 days post procedure; median length of hospital stay was 7 (6-10) days. Median overall and disease-free survival (DFS) was 58.8 and 53.6 months respectively. For those alive, at long-term follow-up, 80% had a Medical Research Council (MRC) dyspnoea score of 0 and Karnofsky index >80%. Survival and mortality rates were better in chondrosarcomas compared to non-chondromatous sarcomas (p<0.05). Previous history of radiotherapy, previous history of cancer, the type of sarcoma (Ewing's or soft tissue), the need for adjuvant treatment and tumour grade were significant predictors of mortality and recurrence on univariate testing. Extended resection, a higher number of ribs removed, and the incidence of post-operative complications were significantly associated with a worse post-operative MRC score. CONCLUSIONS: Careful patient selection and multi-disciplinary decision-making is crucial. This leads to clear resection margins, good overall and disease-free survival and good functional outcomes.

Pulmonary Rehabilitation Program Is an Effective Treatment Approach for Post-COVID-19 Syndrome Patients.

Background/Objectives: Patients with post-COVID-2019 syndrome may have reduced functional capacity and physical activity levels. The pulmonary rehabilitation program (PRP)-an exercise training program-is designed to restore these functions and has been shown to improve dyspnea, exercise capacity, and other measures in these patients. This study aimed to analyze the effects of the RP on post-COVID-19 syndrome patients with respect to objective and subjective functional capacity, balance, and musculoskeletal strength. Methods: A prospective interventional trial was conducted before and after this phase. Patients were referred to the hospital with a confirmed diagnosis of SARS-CoV-2 and subsequently directed to the RP. These patients underwent an 8-week pulmonary rehabilitation program (45-min sessions 3 times/week). Each session consisted of stationary cycle-ergometer and resistance musculoskeletal exercises tailored to individuals' performance. They were evaluated pre- and post-PRP using the maximal handgrip strength (HGS) test, timed up-and-go test, 6-min walk test and its derived variables, and Duke Activity Status Index questionnaire. Results: From 142 hospitalized patients admitted with a diagnosis of SARS-CoV-2 infection, 60 completed the program, with an attendance rate of 85%. Nineteen patients were categorized as severe/critical, with a significantly higher hospital stay, compared to mild/moderate patients, and there were no differences in terms of sex distribution, age, or BMI between groups. Compared to the pre-PRP evaluation, both groups showed significant (p < 0.001) improvements in TUG, HGS, DASI D6MWT, 6MWS, and DSP variables after the PRP conduction. In addition, the groups exhibited similar improvement patterns following PRP (intragroup analysis), with no intergroup differences. Conclusions: RPs promote both objective and subjective functional capacity in patients with post-COVID-19 syndrome, with no difference in improvement regardless of the severity of the initial infection.

Target Heart Rate Formulas for Exercise Stress Testing: What Is the Evidence?

Exercise stress testing (EST) is commonly used to evaluate chest pain, with some labs using 85% of age-predicted maximum heart rate (APMHR) as an endpoint for EST. The APMHR is often calculated using the formula 220-age. However, the accuracy of this formula and 85% APMHR as an endpoint may be questioned. Moreover, failing to reach 85% APMHR (known as chronotropic insufficiency) may also indicate poor cardiovascular prognosis, but measurements, such as percentage heart rate reserve (%HRR), maximum rate pressure product (MRPP), and the maximum metabolic equivalent of tasks (METs) reached during EST may provide better prediction of cardiovascular outcomes than not reaching 85% of APMHR. There is a need to incorporate comprehensive measurements to improve the diagnostic and prognostic capabilities of EST.

Measuring Cognition in Clinical Trials in Parkinson's Disease, Dementia with Lewy Bodies, and Related Disorders: Roundtable Proceedings and Roadmap for Research.

Emerging research suggests that Parkinson's disease (PD) and dementia with Lewy bodies (DLB) share underlying pathology and may represent a single, biologically defined disease spectrum. Cognitive changes are among the most worrisome symptoms for patients with PD, and are the core feature of DLB. While the cognitive changes experienced by individuals with PD and mild cognitive impairment share some clinical characteristics with patients who have undiagnosed or prodromal DLB, these changes are distinct from other types of dementias, such as Alzheimer's disease. To spur the adaptation of existing cognition-focused measures and the development of new ones to underlie clinical trial endpoints in PD and DLB, the PD/DLB Cognition Roundtable was held on January 10 and 11, 2024, in Washington, D.C. The roundtable brought together representatives from academia and industry, as well as with representatives of regulatory agencies, community partners, patient advocates, and research funders, to build consensus and collaborate on the outcome assessment and trial design methods that will support the development of new treatments for early or mild cognitive changes in disorders on the PD/DLB spectrum. The authors of this document summarize the roundtable, discussing the state of the field for clinical trial design and cognition measures in PD and DLB, promising avenues of research, and perspectives of regulatory agencies.

Projections of Disability in the Department of Defense Workforce Through 2031: Estimating Future Assistive Technology Requirements for Department of Defense Civilian Employees and Service Members.

The Department of Defense (DoD) requires both current and projected estimates of the size of its workforce population with specific categories of disabilities. These estimates support the requirements under the Rehabilitation Act of 1973 as well as the goals outlined in multiple executive orders, including Executive Order 14035, directing DoD to hire employees with disabilities and provide them with reasonable accommodations. These estimates are necessary to determine the assistive technology (AT) required and its anticipated costs through 2031. AT also furthers DoD's goals in aiding the recovery and retention of injured service members, as well as the broader DoD and U.S. Department of Veteran Affairs (VA) community in aiding in the post-service employment of service members who are medically separating. Thus, the authors seek to estimate the potential demand for AT from these groups. The authors give projections of the DoD civilian employee population-and of injured and wounded service members-with specific disabilities categorized by DoD's centralized AT procurer (hearing, vision, cognitive, and dexterity disabilities), as well as the potential anticipated requests for AT by these populations and their costs between 2021 and 2031.

Functional resilience and overall survival in adults treated for advanced non-small-cell lung cancer.

PURPOSE: As more treatments emerge for advanced, stage IV non-small-cell lung cancer (NSCLC), oncologists have difficulty predicting functional resiliency versus functional decline throughout cancer treatment. Our study evaluates functional resilience among patients with advanced NSCLC. METHODS: Functional status was evaluated through 12 months of follow-up based on disability score using the modified EQ-5D-5L (mEQ-5D-5L) survey. Participants were classified into 4 groups: functional maintenance, decline, resilient, or variable. Characteristics of 207 participants with newly diagnosed NSCLC included demographics, comorbidities, baseline Eastern Cooperative Oncology Group (ECOG) performance status (PS), mEQ-5D-5L scores, psychological symptoms, and lung cancer-specific symptoms. Treatment toxicity and grade were recorded. Resilience was defined as improvement from baseline disability scores. A 1-point increase in functional status score represents a 0.5 standard deviation change on the mEQ-5D-5L. Differences between the 4 groups were determined through Fisher's exact test or ANOVA. Kaplan-Meier curves describe overall survival (baseline through 18 months) stratified by baseline mEQ-5D-5L scores. RESULTS: Among participants, 42.0 % maintained functional status, 37.7 % experienced functional decline, 10.6 % were resilient, and 9.7 % had variable functional status. Participants with the best baseline function (score of 0) had the longest overall survival and participants with the worst baseline function (score of 5 + ) had the shortest overall survival. Among the healthiest patients, early score increases indicated shorter overall survival. Baseline ECOG PS was not associated with overall survival (p = 0.47). CONCLUSION: Baseline functional status may help better predict functional resiliency and overall survival than ECOG PS among patients receiving treatment for advanced NSCLC.

Exercise as a modality to improve heart transplantation-related functional impairments: An article review.

Heart transplantation (HT), the treatment choice of advanced heart failure patients, is proven effective in increasing the survival and functional status of the recipients. However, compared to normal controls, functional status is lower in HT recipients. Exercise given in cardiac rehabilitation has been shown to improve exercise capacity as measured with peak oxygen uptake (VO2 peak) and muscle strength after completion of the program and cessation of exercise results in loss of exercise benefits. Several factors related to cardiac denervation and the use of immunosuppressive agents in HT recipients result in functional impairments including cardiovascular, pulmonary, exercise capacity, psychological, and quality of life (QoL) problems. High-intensity interval training (HIIT) is the most common type of exercise used in HT recipients and given as a hospital-based program. Improvement of functional impairments was found to have occurred due to primarily musculoskeletal adaptations through improvement of muscle structure and aerobic capacity and cardiovascular adaptations. In general, exercise given after transplantation improved VO2 peak significantly and improvement was better in the HIIT group compared to moderate intensity continuous training or no-exercise groups. Improvement of QoL was ascribed to improvement of exercise capacity, symptoms, pulmonary function, physical capacity improvement, anxiety, and depression.

Recipient functional status impacts on short and long-term intestinal transplant outcomes in United States adults.

BACKGROUND: Recipient functional status prior to transplantation has been found to impact post-transplant outcomes in heart, liver and kidney transplants. However, information on how functional status, before and after transplant impacts post-transplant survival outcomes is lacking. AIM: To investigate the impact of recipient functional status on short and long term intestinal transplant outcomes in United States adults. METHODS: We conducted a retrospective cohort study on 1254 adults who underwent first-time intestinal transplantation from 2005 to 2022. The primary outcome was mortality. Using the Karnofsky Performance Status, functional impairment was categorized as severe, moderate and normal. Analyses were conducted using Kaplan-Meier curves and multivariable Cox regression. RESULTS: The median age was 41 years, majority (53.4%) were women. Severe impairment was present in 28.3% of recipients. The median survival time was 906.6 days. The median survival time was 1331 and 560 days for patients with normal and severe functional impairment respectively. Recipients with severe impairment had a 56% higher risk of mortality at one year [Hazard ratio (HR) = 1.56; 95%CI: 1.23-1.98; P < 0.001] and 58% at five years (HR = 1.58; 95%CI: 1.24-2.00; P < 0.001) compared to patients with no functional impairment. Recipients with worse functional status after transplant also had poor survival outcomes. CONCLUSION: Pre- and post-transplant recipient functional status is an important prognostic indicator for short- and long-term intestinal transplant outcomes.

Sex-Specific Functional Status Decline and Outcomes in Mild-to-Moderate Aortic Stenosis: Results From the PROGRESSA Study.

Background: Little is known about the effect of sex on functional status decline in aortic valve stenosis (AS) patients. Objectives: The purpose of this study was to examine the changes in functional status according to sex in patients with mild-to-moderate AS and its association with the composite of death or aortic valve replacement (AVR). Methods: We included patients with mild-to-moderate AS prospectively recruited in the PROGRESSA (Metabolic Determinants of the Progression of Aortic Stenosis) study (NCT01679431). Functional status was assessed using the New York Heart Association classification and the Duke Activity Status Index (DASI). Results: A total of 244 patients (mean age 64 ± 14 years, 29% women) were included. The mean follow-up was 4.3 ± 2.4 years. Women with intermediate-to-fast AS progression rate (median change in peak aortic jet velocity ≥0.11 m/s/year) had significantly faster decline in DASI score compared to men with similar progression rate (P < 0.05). In linear mixed analysis adjusted for several clinical and echocardiographic factors, female sex and change in peak aortic jet velocity remained strongly associated with the worsening of New York Heart Association class and the decline of DASI score (all, P < 0.001). The composite of death or AVR occurred in 115 patients (16 deaths and 99 AVRs). In multivariable Cox regression analyses, functional status decline during follow-up remained significantly associated with the composite of death or AVR (HR: 2.13; 95% CI: 1.22-3.73; P = 0.008). Conclusions: In patients with mild-to-moderate AS at baseline, intermediate-to-fast progression rate of AS was associated with a more rapid decline of functional status during follow-up, particularly in women. Functional status decline during follow-up was strongly associated with the incidence of death or AVR, with comparable effect in both women and men.