Age and Sex Differences in Balance Outcomes among Individuals with Chronic Obstructive Pulmonary Disease (COPD) at Risk of Falls.

No previous research has examined age and sex differences in balance outcomes in individuals with chronic obstructive pulmonary disease (COPD) at risk of falls. A secondary analysis of baseline data from an ongoing trial of fall prevention in COPD was conducted. Age and sex differences were analyzed for the Berg Balance scale (BBS), Balance Evaluation System Test (BEST test) and Activities-specific Balance Confidence Scale (ABC). Overall, 223 individuals with COPD were included. Females had higher balance impairments than males [BBS: mean (SD) = 47 (8) vs. 49 (6) points; BEST test: 73 (16) vs. 80 (16) points], and a lower confidence to perform functional activities [ABC = 66 (21) vs. 77 (19)]. Compared to a younger age (50-65 years) group, age >65 years was moderately associated with poor balance control [BBS (r = - 0.37), BEST test (r = - 0.33)] and weakly with the ABC scale (r = - 0.13). After controlling for the effect of balance risk factors, age, baseline dyspnea index (BDI), and the 6-min walk test (6-MWT) explained 38% of the variability in the BBS; age, sex, BDI, and 6-MWT explained 40% of the variability in the BEST test; And BDI and the 6-MWT explained 44% of the variability in the ABC scale. This study highlights age and sex differences in balance outcomes among individuals with COPD at risk of falls. Recognition of these differences has implications for pulmonary rehabilitation and fall prevention in COPD, particularly among females and older adults.

Psychometric Properties of Patient-Reported Outcome Measures Assessing Self-Efficacy in Patients with Chronic Obstructive Pulmonary Disease (COPD): A Systematic Review.

This systematic review aimed to synthesize the evidence of the psychometric properties of self-efficacy patient-reported outcome measures (PROMs) in patients with chronic obstructive pulmonary disease (COPD). We conducted a systematic search of MEDLINE and other common databases from inception until September 2020. Studies that reported psychometric properties of self-efficacy outcome measures in COPD patients were included. We used the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) 2018 guidelines for data extraction and evidence synthesis. Eighteen studies that assessed nine self-efficacy PROMs were eligible for inclusion. The assessment of structural validity indicated sufficient results rating for the Exercise Self-Regulatory Efficacy Scale and the Self-Care-Self-Efficacy Scale, and insufficient rating for the COPD Self-Efficacy Scale and the Pulmonary Rehabilitation Adaptation Index for Self-Efficacy (PRAISE). Construct validity measures displayed sufficient results rating with correlations ranging from -0.48 to - 0.71 between self-efficacy PROMs and other PROMs such as St. George's Respiratory Questionnaire, Hospital Anxiety and Depression Scale and Chronic Respiratory Questionnaire. Internal consistency measures indicated sufficient rating for all self-efficacy PROMs with a Cronbach's alpha range of 0.71 - 0.98. Responsiveness was assessed for the PRAISE with an overall sufficient rating (effect sizes of 0.21 - 0.37). The evidence regarding the psychometric properties of self-efficacy PROMs in COPD is variable. The PRAISE is responsive to changes in self-efficacy in COPD patients attending a pulmonary rehabilitation program. When using self-efficacy PROMs in clinical practice or research, clinicians and researchers should consider the psychometric properties and choose the appropriate outcome measure based on the purpose.

Systematic review of psychometric properties and cross-cultural adaptation of the University of California and Los Angeles loneliness scale in adults.

This systematic review assessed the psychometric properties and the cross-cultural adaptation of the University of California and Los Angeles Loneliness scale (UCLA-LS) in adults. A systematic search of four electronic databases (PubMed, EMBASE, Scopus, and PsycINFO) was conducted from inception until March 2021. We followed the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines for data extraction and evidence synthesis. Eighty-one studies assessed the validity and reliability of the UCLA-LS, translated into many languages, and applied across several countries/societies. Three versions of the 20-item and nine short versions of the UCLA-LS with 3 to 20 questions were identified. High-quality evidence supported the internal structure of the UCLAs: 4, 6, 7 and 10, while low-to moderate-quality evidence supported the construct validity of the UCLAs: 3, 4, 6, 8, 16 and 20. Moderate-quality evidence supported the test-retest reliability of version 3 UCLA-20 with excellent interclass coefficients values of 0.76-0.93. The UCLAs: 4, 6, 7 and 10 had the most robust internal structure and may therefore be the most useful for informing clinicians and social psychologists engaged in assisting those with loneliness. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12144-021-02494-w.

Effectiveness of Nonsurgical Interventions for Managing Adhesive Capsulitis in Patients With Diabetes: A Systematic Review.

OBJECTIVE: This systematic review evaluated the effectiveness of nonsurgical interventions for managing adhesive capsulitis (AC) in patients with diabetes on pain, function, and range of motion. DATA SOURCES: MEDLINE and other databases were searched for studies published in the last 20 years. STUDY SELECTION: Randomized controlled trials (RCTs) that assessed AC in people with diabetes and implemented 1 or a combination of physiotherapeutic interventions, corticosteroids, and manipulation under anesthesia (MUA) were eligible for inclusion. DATA EXTRACTION: The Cochrane Risk of Bias was used by 2 independent raters who met to achieve consensus. The quality of trials was assessed using Grading of Recommendations, Assessment, Development and Evaluations. Data extracted from the eligible studies included study design, participant characteristics and duration of symptoms, type of intervention, outcome measures, follow-up intervals, and research findings. DATA SYNTHESIS: Because of the lack of similar interventions, a narrative synthesis was conducted, and meta-analyses were not performed. The effect sizes or between-group differences of the interventions were reported. A total of 8 RCTs met the inclusion criteria: 4 addressed physiotherapeutic interventions, 3 corticosteroid injections, and 1 MUA. The effect sizes for physiotherapeutic interventions were 0.8-2.0, 0.9-2.0, and 1.0 for ROM, function, and pain, respectively, with the largest effect size (2.0) being reported for joint mobilization plus exercises. The effect sizes for corticosteroids were 0.2-0.5 and 0.1 for ROM and pain. The between-group improvement for MUA was 5.6 points on Constant Shoulder Score. CONCLUSION: Low-quality evidence suggests large effects of joint mobilization plus exercises on AC in people with diabetes, although confidence in this conclusion is limited due to the high risk of bias. Even weaker support was available for corticosteroid and MUA. Future high-quality RCTs are needed to determine the best intervention for managing AC in patients with diabetes.

The effect of diabetes on functional outcomes among individuals with distal radial fractures.

STUDY DESIGN: Prospective cohort study. INTRODUCTION: Diabetes is reported to adversely affect outcomes; however, its effect on distal radial fractures (DRF) is not well examined. PURPOSE OF THE STUDY: This study investigated the effect of diabetes on pain, hand function, physical health status, grip strength, and wrist and forearm range of motion among patients with DRF. METHODS: A total of 479 patients with DRF were classified into patients with and without diabetes based on self-report. Patient-Rated Wrist Evaluation assessed pain and hand function. The Short Form-12 assessed physical health status. Both questionnaires examined DRF recovery at baseline, 3 month, and 1 year. RESULTS: There was a significant improvement in Patient-Rated Wrist Evaluation scores over time (69 [19] to 25 [22]; 76 [15] to 20 [20] for patients with and without diabetes respectively, P < .01) with a significant interaction between time and diabetes (P < .01), indicating that patients with diabetes recovered more slowly than the rest of the cohort. There was an improvement over time on physical status (36 [12] to 45 [12]; 39 [9] to 50 [9], P < .01), grip strength (16 [7] to 24 [10]; 15 [9] to 24 [10], P < .01), and range of motion (flexion [42 {14} to 49 {15}; 43 {15} to 54 {14}, P < .01], extension [45 {11} to 52 {11}; 46 {13} to 53 {12}, P < .01], pronation [73 {10} to 77 {9}; 73 {11} to 78 {9}, P < .01], and supination [58 {17} to 65 {14}; 61 {17} to 70 {12}, P < .01]) for patients with and without diabetes, respectively. Patients with diabetes did not differ significantly in these secondary outcomes compared to the rest of the cohort. DISCUSSION AND CONCLUSION: Although individuals with diabetes had good outcomes, their recovery was slower than the rest of the cohort. This may be due to the adverse effect of hyperglycemia on bone tissues and small blood vessels. Future studies are required to assess how severity and duration of diabetes affect outcomes after DRF.

The effects of diurnal Ramadan fasting on energy expenditure and substrate oxidation in healthy men.

The study aimed to examine the effects of diurnal Ramadan fasting (RF) on substrate oxidation, energy production, blood lipids and glucose as well as body composition. Nine healthy Muslim men (fasting (FAST) group) and eight healthy non-practicing men (control (CNT) group) were assessed pre- and post-RF. FAST were additionally assessed at days 10, 20 and 30 of RF in the morning and evening. Body composition was determined by hydrodensitometry, substrate oxidation and energy production by indirect calorimetry, blood metabolic profile by biochemical analyses and energy balance by activity tracker recordings and food log analyses. A significant group×time interaction revealed that chronic RF reduced body mass and adiposity in FAST, without changing lean mass, whereas CNT subjects remained unchanged. In parallel to these findings, a significant main diurnal effect (morning v. evening) of RF on substrate oxidation (a shift towards lipid oxidation) and blood metabolic profile (a decrease in glucose and an increase in total cholesterol and TAG levels, respectively) was observed, which did not vary over the course of the Ramadan. In conclusion, although RF induces diurnal metabolic adjustments (morning v. evening), no carryover effect was observed throughout RF despite the extended daily fasting period (18·0 (sd 0·3) h) and changes in body composition.

Effectiveness of surgical and non-surgical interventions for managing diabetic shoulder pain: a systematic review.

PURPOSE: This systematic review evaluated and compared the effectiveness of non-surgical and surgical interventions for managing shoulder pain in patients with diabetes. METHODS: PubMed, Scopus, CINAHL, EMBASE, Sport Discus, and Cochrane library were searched for studies published in the last 20 years. Randomized clinical trials (RCTs) and cohort studies that assessed shoulder pain in patients with diabetes and implemented one or a combination of non-surgical and surgical interventions were eligible for inclusion. The quality of the included studies was assessed using the Structured Effectiveness Quality Evaluation Scale (SEQES) tool. Data extracted from the eligible studies included study design, patient characteristics, duration of symptoms, type of interventions, outcome measures used to assess pain, follow-up intervals, and research findings. RESULTS: A narrative synthesis with effect sizes (ES) or between-group differences was conducted. A total of 25 (14 non-surgical and 11 surgical) studies met the inclusion criteria. Six studies addressed physiotherapeutic interventions (three RCTs and three cohorts - ES = 0.07-1.3), three studies assessed the effect of steroid injections (two RCTs and one cohort - ES = 0.2-0.4), two cohorts addressed arthrographic capsular distension (between-group difference of 1.1 on Visual Analogue Scale), two cohorts addressed MUA, and one RCT addressed suprascapular nerve block (ES = 1-6). For the surgical studies, six cohorts addressed arthroscopic capsular release (ES = 0.2), three cohorts addressed arthroscopic rotator cuff repair (ES = 0.05-0.5), and one cohort addressed arthroplasty (ES = 0.3). CONCLUSION: Moderate- to very-low-quality evidence suggests large effects of physiotherapy modalities plus exercise and suprascapular nerve block, and trivial to small effects for surgical interventions for improving shoulder pain in patients with diabetes. Future well-designed studies are needed to provide accurate estimates of the true effects of these interventions on improving shoulder pain in patients with diabetes.Implications For RehabilitationShoulder pain may lead to disability in patients with diabetes.We recommend the use of physiotherapy interventions to reduce shoulder pain.Corticosteroid injections are recommended for short-term shoulder pain relief.

Multiple propane gas burn rates procedure to determine accuracy and linearity of indirect calorimetry systems: an experimental assessment of a method.

Objective: Indirect calorimetry (IC) systems measure the fractions of expired carbon dioxide (FeCO2), and oxygen (FeO2) recorded at the mouth to estimate whole-body energy production. The fundamental principle of IC relates to the catabolism of high-energy substrates such as carbohydrates and lipids to meet the body's energy needs through the oxidative process, which are reflected in the measured oxygen uptake rates (V̇O2) and carbon dioxide production rates (V̇CO2). Accordingly, it is important to know the accuracy and validity of V̇O2and V̇CO2 measurements when estimating energy production and substrate partitioning for research and clinical purposes. Although several techniques are readily available to assess the accuracy of IC systems at a single point for V̇CO2 and V̇O2, the validity of such procedures is limited when used in testing protocols that incorporate a wide range of energy production (e.g., basal metabolic rate and maximal exercise testing). Accordingly, we built an apparatus that allowed us to manipulate propane burn rates in such a way as to assess the linearity of IC systems. This technical report aimed to assess the accuracy and linearity of three IC systems using our in-house built validation procedure. Approach: A series of trials at different propane burn rates (PBR) (i.e., 200, 300, 400, 500, and 600 mL min-1) were run on three IC systems: Sable, Moxus, and Oxycon Pro. The experimental values for V̇O2 and V̇CO2 measured on the three IC systems were compared to theoretical stoichiometry values. Results: A linear relationship was observed between increasing PBR and measured values for V̇O2and V̇CO2 (99.6%, 99.2%, 94.8% for the Sable, Moxus, and Jaeger IC systems, respectively). In terms of system error, the Jaeger system had significantly (p < 0.001) greater V̇O2(mean difference (M) = -0.057, standard error (SE) = 0.004), and V̇CO2(M = -0.048, SE = 0.002) error compared to either the Sable (V̇O2, M = 0.044, SE = 0.004; V̇CO2, M = 0.024, SE = 0.002) or the Moxus (V̇O2, M = 0.046, SE = 0.004; V̇CO2, M = 0.025, SE = 0.002) IC systems. There were no significant differences between the Sable or Moxus IC systems. Conclusion: The multiple PBR approach permitted the assessment of linearity of IC systems in addition to determining the accuracy of fractions of expired gases.

Validity of the Activities-specific Balance Confidence Scale in individuals with chronic obstructive pulmonary disease.

BACKGROUND: Limited research assessed the validity of the Activities-specific Balance Confidence, ABC) Scale in individuals with chronic obstructive pulmonary disease, COPD) at risk of falls. We report on the scale's construct and criterion validity. METHODS: Construct validity was established by assessing known groups, convergent, and divergent validity. A receiver operating characteristic, (ROC) curve and logistic regression examined the criterion validity of the scale. RESULTS: In 223 individuals with COPD, the ABC Scale significantly, (p < 0.001) discriminated between groups, with lower scores for females [Mean difference (MD) = 10%], rollator use [MD = 13%], and fallers [MD = 12%], and had a strong association [r = 0.58, p < 0.001] with Berg Balance Scale. The scale distinguished fallers from non-fallers with a cutoff value of 58% [Area Under the Curve = 0.64, 95% CI = 0.57-0.72, p < 0.001] and significantly identified fall status [B, SE = -0.03, 0.01, p < 0.001] with an odds ratio of 0.97 [95%CI = 0.96-0.99]. The sensitivity, specificity, and test accuracy were: 61, 58, and 60%, respectively. CONCLUSION: The ABC Scale showed evidence for known groups, convergent, and divergent validity and can assist in identifying fall status in individuals with COPD.

Predictors of Clinical Benefits and One-Year Functional Outcomes Following Shoulder Arthroplasty.

Background: Shoulder arthroplasty has been shown to improve function in patients with advanced shoulder disease. However, the response to surgery and final outcomes are not easily predictable. This study assessed the effect of residual pain, age, sex, diabetes, hypertension, and depression on changes and status at one-year following arthroplasty with respect to shoulder function and overall physical and mental health status. Methods: A retrospective analysis of a prospective cohort of 140 patients tested preoperatively and one-year following shoulder arthroplasty was conducted at our tertiary hospital. Pearson's correlations and multiple regression analysis were performed to test the impact of predictors on shoulder pain and function assessed using the American Shoulder and Elbow Surgery (ASES) questionnaire, and on physical and mental health assessed using the Short Form-12. Results: Pain and female sex were significant predictors of poorer function at one-year (R = .56, p = .001); and with other predictors, they explained 32% of the variability in function. The explained variability of changes in function scores was 15% with pain being the only significant predictor. Physical health was lower in older patients (r = -.31, p < .05) and was less predictable for physical health change scores (12%) and the physical status at one-year (14%). Conclusions: Residual pain is associated with poorer function status and less clinical benefits. Female sex is not associated with less change in function which suggests that men and women get equal benefit from the surgery. Advanced age relates to poorer physical health and to a lesser extent physical change over the year.Level of Evidence: III.

Accuracy of the vivofit activity tracker.

The purpose of this study was to examine the accuracy of the vivofit activity tracker in assessing energy expenditure and step count. Thirteen participants wore the vivofit activity tracker for five days. Participants were required to independently perform 1 h of self-selected activity each day of the study. On day four, participants came to the lab to undergo BMR and a treadmill-walking task (TWT). On day five, participants completed 1 h of office-type activities. BMR values estimated by the vivofit were not significantly different from the values measured through indirect calorimetry (IC). The vivofit significantly underestimated EE for treadmill walking, but responded to the differences in the inclination. Vivofit underestimated step count for level walking but provided an accurate estimate for incline walking. There was a strong correlation between EE and the exercise intensity. The vivofit activity tracker is on par with similar devices and can be used to track physical activity.