Systematic design of health monitoring systems centered on older adults and ADLs.

BACKGROUND: Older adults face unique health challenges as they age, including physical and mental health issues and mood disorders. Negative emotions and social isolation significantly impact mental and physical health. To support older adults and address these challenges, healthcare professionals can use Information and Communication Technologies (ICTs) such as health monitoring systems with multiple sensors. These systems include digital biomarkers and data analytics that can streamline the diagnosis process and help older adults to maintain their independence and quality of life. METHOD: A design research methodology is followed to define a conceptual model as the main artifact and basis for the systematic design of successful systems centered on older adults monitoring within the health domain. RESULTS: The results include a conceptual model focused on older adults' Activities of Daily Living (ADLs) and Health Status, considering various health dimensions, including social, emotional, physical, and cognitive dimensions. We also provide a detailed instantiation of the model in real use cases to validate the usefulness and feasibility of the proposal. In particular, the model has been used to develop two health systems intended to measure the degree of the elders' frailty and dependence with biomarkers and machine learning. CONCLUSIONS: The defined conceptual model can be the basis to develop health monitoring systems with multiple sensors and intelligence based on data analytics. This model offers a holistic approach to caring for and supporting older adults as they age, considering ADLs and various health dimensions. We have performed an experimental and qualitative validation of the proposal in the field of study. The conceptual model has been instantiated in two specific case uses, showing the provided abstraction level and the feasibility of the proposal to build reusable, extensible and adaptable health systems. The proposal can evolve by exploiting other scenarios and contexts.

Effects of Nature-Based Multisensory Stimulation on Pain Mechanisms in Women with Fibromyalgia Syndrome: A Randomized Double-Blind Placebo-Controlled Trial.

BACKGROUND: The term "nature-based sensory stimuli" refers to the sensory information produced by biotic and abiotic agents from natural environments. The literature has reported the beneficial effects of these agents on various pain dimensions in non-clinical populations. AIMS: To evaluate the potential analgesic effects of nature-based multisensory stimulation in women with fibromyalgia syndrome. METHODS: A randomized, double-blind, placebo-controlled, parallel-group trial with a 1:1 allocation ratio was conducted. Forty-two women with fibromyalgia syndrome interacted with either different plant species with flowers, stones, and soil organic matter or their synthetic imitations for 30 minutes. Outcome measurements were performed before and after the intervention, including clinical pain intensity using the Numeric Rating Scale, cold pain thresholds using the Cold Pressor Test, mechanical hyperalgesia and wind-up using a monofilament, and pressure pain thresholds using a pressure algometer. RESULTS: Analyses revealed group × time interactions for clinical pain intensity (F = 7.915, p = .008), cold-water immersion time (F = 7.271, p = .010), mechanical hyperalgesia (F = 4.701, p = .036), and pressure pain threshold (p ≤ .017). Between-group differences were found in clinical pain intensity (p = .012), cold pain thresholds (p = .002), and pressure pain thresholds (p < .05). The experimental group exhibited reduced clinical pain intensity (p = .001) and increased pressure pain thresholds (p ≤ .034). CONCLUSIONS: Women with fibromyalgia syndrome may benefit from multisensory stimulation using biotic and abiotic agents from natural environments for 30 minutes. Interacting with flowering plants and soil components appears to induce analgesic effects.

Impact of prolonged sitting interruption strategies on shear rate, flow-mediated dilation and blood flow in adults: A systematic review and meta-analysis of randomized cross-over trials.

Prolonged sitting has been shown to affect endothelial function. Strategies that promote interruption of sitting have shown varying results on the shear rate (SR), flow-mediated dilation (FMD) and blood flow (BF). Thus, we conducted a systematic review and meta-analysis to 1) increase the existing knowledge of the impact of sitting interruption in the prevention of endothelial dysfunction in adults and 2) determine the effect of the sitting interruption strategies on SR, FMD, BF. Literature search was carried out through 7 databases. A random effects model was used to provide the overall mean difference with a 95%CI, and forest plots were generated for pooled estimates of each study outcome. Assessment of biases was performed using ROB2 and considerations for crossover trials. Prolonged sitting interruption strategies showed a significant effect in increasing SR (MD: 7.58 s-1; 95% CI: 3.00 to 12.17), FMD (MD: 1.74%; 95% CI: 0.55 to 2.93) and BF (MD: 12.08 ml/min; 95% CI: 7.61 to 16.55) when compared with the uninterrupted prolonged sitting condition. Prolonged sitting interruption strategies significantly increase SR, FMD and BF, therefore, they represent a considerable effective preventive method on endothelial dysfunction caused by acute exposure to uninterrupted prolonged sitting.

Effectiveness of a Functional Rehabilitation Program for Upper Limb Apraxia in Poststroke Patients: A Randomized Controlled Trial.

OBJECTIVE: To analyze the effectiveness of a home-based restorative and compensatory upper limb apraxia (ULA) rehabilitation program. DESIGN: Randomized controlled trial. SETTING: Neurology Unit of San Cecilio Hospital and 2 private and specialized health care centers. PARTICIPANTS: Community dwelling participants (N=38) between the ages of 25 and 95 years old (sex ratio, 1:1) with unilateral mild-to-moderate poststroke lesions (time of evolution since stroke, 12.03±8.98mo) and secondary ULA. INTERVENTIONS: Participants were randomly assigned to an 8-week combined ULA functional rehabilitation group (n=19) 3 days per week for 30 minutes or to a traditional health care education protocol group (n=19) once a month for 8 weeks. Both interventions were conducted at home. MAIN OUTCOME MEASURES: Sociodemographic and clinical data, Barthel Index (primary outcome), Lawton and Brody Scale, observation and scoring activities of daily living, the De Renzi tests for ideational and ideomotor apraxia and imitating gestures test, recognition of gestures, test for upper limb apraxia , and stroke-specific quality of life scale were assessed at 3 time points: baseline, posttreatment (8wk), and follow-up (8wk). RESULTS: There were statistically significant differences among the groups regarding ideomotor apraxia, imitating gestures, global recognition of gestures, intransitive gestures, and comprehension of gesture production (P<.05) in favor of the experimental group. However, no statistically significant differences were found between the groups regarding functionality or quality of life (P>.05). Regarding the within-group effect, statistically significant differences were found in all neuropsychological outcomes at posttreatment and follow-up (P<.05). CONCLUSION: A functional rehabilitation program was found to be superior to a traditional health care education program and resulted in improvements in neuropsychological functioning in ULA poststroke. Conventional education showed an insufficient effect on apraxia recovery. Further studies with larger sample sizes are needed to determine the effect of rehabilitation strategies on functionality and quality of life of poststroke ULA patients.

Psychometric properties of the Spanish version of the Sleep Hygiene Index.

The Sleep Hygiene Index (SHI) has shown adequate psychometric properties in samples from several countries but has not been validated in Spanish. The aims of the study were to translate the original (i.e., English) version of the SHI into Spanish and to evaluate the psychometric properties of this instrument (i.e., factor structure, internal consistency reliability, and concurrent, predictive, and discriminant validity) in Spanish adults. The overall sample, comprising 548 university students, was divided into two groups based on their self-reported insomnia symptoms (Insomnia Severity Index) because sleep hygiene has been shown to be closely related to insomnia. The Pittsburgh Sleep Quality Index and the Stanford Sleepiness Scale were used for testing concurrent validity. The Depression, Anxiety, and Stress Scale was used for testing predictive validity. Three items were dropped from the original SHI scale due to their low factor loadings. The principal component analysis revealed a four-factor solution for the SHI, accounting for 65.58% of the total variance in the overall sample, for 65.34% in the noninsomnia group, and for 63.50% in the insomnia group. Factor 1 comprised items regarding sleep-disrupting behaviors; Factor 2 comprised items regarding cognitive activation; Factor 3 comprised items about bedroom comfort; and Factor 4 comprised items on sleep/wake time. Omega coefficient indices for the SHI ranged from 0.751 to 0.878 in the overall sample, from 0.734 to 0.822 in the noninsomnia group, and from 0.724 to 0.835 in the insomnia group. The Spanish version of the SHI can be regarded as a reliable tool with adequate concurrent and predictive validity for assessing sleep hygiene in Spanish people with or without insomnia symptoms.

Pain Intensity, Pressure Pain Hypersensitivity, Central Sensitization, and Pain Catastrophizing Related to Vascular Alterations in Raynaud's Phenomenon: A Preliminary Case-Control Study.

OBJECTIVE: To evaluate pain intensity, widespread pressure pain, central sensitization (CS), and catastrophizing between subjects with primary and secondary Raynaud's phenomenon (RP) and healthy controls and to compare the relationships between vascular impairment and pain perception. METHODS: A preliminary case-control study was performed with a total sample of 57 participants (37 with RP). Sociodemographic data, clinical/vascular data, and pain variables (pain intensity, pressure pain sensitivity, pain magnitude and threshold, CS, and catastrophizing) were registered. Results were analyzed by analysis of covariance and Pearson correlation. RESULTS: Participants with RP had a lower basal temperature (more vasoconstriction) in their hands (P ≤ 0.012), higher pain intensity (P ≤ 0.001), higher electrical pain magnitude (P < 0.001), and lower pressure pain (P ≤ 0.05) and electrical pain (P < 0.001) thresholds in comparison with healthy controls. Secondary RP participants showed a significantly higher level of CS compared with controls and primary RP participants (P = 0.001). Catastrophizing was higher in the primary and secondary RP (P ≤ 0.001) groups than in controls. No correlations were observed between severity of vasoconstriction and pain variables. CONCLUSIONS: RP participants showed bilateral hypersensitivity to pressure pain. However, the severity of vascular alterations seems not to be related to central pain experiences. Additional mechanisms such as catastrophizing may influence pain in RP; nevertheless, central sensitization only appears to be involved in the secondary form of RP.

The Effect of Proprioceptive Exercises on Balance and Physical Function in Institutionalized Older Adults: A Randomized Controlled Trial.

OBJECTIVES: To evaluate the efficacy of a proprioceptive exercise program on functional mobility, musculoskeletal endurance, dynamic and static balance, gait, and risk of falls in institutionalized older adults. DESIGN: Randomized, single-blind, controlled trial. SETTING: A Spanish nursing home in the autonomous community of Extremadura, Spain. PARTICIPANTS: An initial sample was created by recruiting 148 older adult volunteers. The final sample (N=42) was randomly divided into 2 groups. INTERVENTIONS: Both the control and experimental group received physical therapy treatment based on a combination of adapted exercises and other physical therapy techniques (physical therapy intervention program) for a period of 12 weeks. This program consisted of 45 minutes (group intervention) plus 100 minutes (individual intervention) a week, for a total of 36 sessions (29 hours). The experimental group received a proprioceptive training program during the same intervention period, which was conducted twice weekly (24 sessions), with each session lasting 55 minutes. MAIN OUTCOME MEASURES: Timed Up and Go (TUG), Cooper, Tinetti, 1-leg stance, and the Morse Fall Scale (MFS). RESULTS: Analysis of variance showed a time × group interaction in TUG score (F=10.41, P=.002), Cooper test (F=5.94, P=.019), Tinetti score (F=6.41, P=.015), and MFS scores (F=5.24, P=.028). Differences between groups were achieved for TUG scores (d=0.76), Tinetti scores (d=1.12), 1-leg stance test scores (d=0.77), and MFS scale scores (d=0.85). In the experimental group, within-group analyses showed pre- to post-treatment differences for TUG scores (d=0.72), Cooper test scores in meters (d=0.18), Tinetti scores (d=0.60), 1-leg stance scores (d=0.55), and MFS scores (d=0.42). CONCLUSIONS: A proprioceptive exercise program demonstrated significant improvements compared with the control group in areas such as functional mobility, musculoskeletal endurance, balance, gait, and risk of falls in institutionalized older adults. This study may help to enhance our understanding of the impact of a specific protocol for a proprioceptive rehabilitation program.

Self-Efficacy, Pain Intensity, Rheumatic Disease Duration, and Hand Functional Disability on Activities of Daily Living.

BACKGROUND: Knowledge regarding the possible influence of self-efficacy, pain intensity and disease duration on hand functional disability could promote new intervention strategies for activities of daily living (ADLs) in patients with rheumatic disease (RD). These approaches could prevent the health problems and socioeconomic costs associated with these diseases. OBJECTIVE: The aims of this study were to evaluate if there are differences between the levels of perceived self-efficacy, pain intensity and disease duration among people with RD and non-RD diseases, and to analyze if hand functional disability in ADLs is related to self-efficacy, pain intensity and disease duration in a sample of patients with RD. METHODS: A multicenter, observational, cross-sectional study was conducted on a total sample of 335 participants over 50 years old (176 patients with RD and 159 individuals with non-RD). The Duruöz Hand Index, the General Perceived Self-Efficacy Scale, the Rheumatic Diseases Self-Efficacy Scale (RDS-ES), the Visual Analog Scale (VAS), and the mean time of evolution in years of the disease (disease duration) were used to analyze the possible relationships surrounding hand functional disability in ADLs. RESULTS: The comparison analysis showed significant differences between the RD/non-RD sample for the General Perceived Self-Efficacy Scale, RDS-ES, and VAS scores (p < .001). The multiple regression results showed that age, General Perceived Self-Efficacy Scale scores, RDS-ES scores, VAS scores, and disease duration (or a combination of some of them) explained the variability of hand functional disability in almost 68% of kitchen tasks, 44% of dressing tasks, 46% of hygiene and other tasks, and 47% of office tasks. DISCUSSION: Our study shows that general and domain-specific self-efficacy, pain intensity, and disease duration are predictors of the dimensions of hand functional disability in patients with RD. Early evaluation of these components with an interdisciplinary approach would help to manage hand disability properly.

A Microservices e-Health System for Ecological Frailty Assessment Using Wearables.

The population in developed countries is aging and this fact results in high elderly health costs, as well as a decrease in the number of active working members to support these costs. This could lead to a collapse of the current systems. One of the first insights of the decline in elderly people is frailty, which could be decelerated if it is detected at an early stage. Nowadays, health professionals measure frailty manually through questionnaires and tests of strength or gait focused on the physical dimension. Sensors are increasingly used to measure and monitor different e-health indicators while the user is performing Basic Activities of Daily Life (BADL). In this paper, we present a system based on microservices architecture, which collects sensory data while the older adults perform Instrumental ADLs (IADLs) in combination with BADLs. IADLs involve physical dimension, but also cognitive and social dimensions. With the sensory data we built a machine learning model to assess frailty status which outperforms the previous works that only used BADLs. Our model is accurate, ecological, non-intrusive, flexible and can help health professionals to automatically detect frailty.

Effect of adding interferential current stimulation to exercise on outcomes in primary care patients with chronic neck pain: a randomized controlled trial.

OBJECTIVE: To evaluate the effect of adding interferential current stimulation to exercise on pain, disability, psychological status and range of motion in patients with neck pain. DESIGN: A single-blinded randomized controlled trial. SETTING: Primary care physiotherapy units. SUBJECTS: A total of 84 patients diagnosed with non-specific mechanical neck pain. This sample was divided into two groups randomly: experimental (n = 42) versus control group (n = 42). INTERVENTIONS: Patients in both groups had a supervised therapeutic exercise programme, with the experimental group having additional interferential current stimulation treatment. MAIN MEASURES: The main measures used were intensity of neck pain according to the Visual Analogue Scale; the degree of disability according to the Neck Disability Index and the CORE Outcome Measure; anxiety and depression levels according to the Goldberg scale; apprehension as measured by the Personal Psychological Apprehension scale; and the range of motion of the cervical spine. The sample was evaluated at baseline and posttreatment (10 sessions/two weeks). RESULTS: Statistically significant differences between groups at posttreatment were observed for Visual Analogue Scale (2.73 ± 1.24 vs 4.99 ± 1.56), Neck Disability Index scores (10.60 ± 4.77 vs 18.45 ± 9.04), CORE Outcome Measure scores (19.18 ± 9.99 vs 35.12 ± 13.36), Goldberg total score (6.17 ± 4.27 vs 7.90 ± 4.87), Goldberg Anxiety subscale, Personal Psychological Apprehension Scale scores (28.17 ± 9.61 vs 26.29 ± 11.14) and active and passive right rotation. CONCLUSIONS: Adding interferential current stimulation to exercise resulted in better immediate outcome across a range of measures.

Association between perceived level of stress, clinical characteristics and psychopathological symptoms in women with systemic lupus erythematosus.

OBJECTIVES: To evaluate psychopathological status and stress level from a sample with SLE; compare mental functioning and stress levels between women with SLE and healthy women; determine whether disease duration, disease activity, cumulative organ damage and stress have an influence on psychopathological symptoms in SLE patients; and evaluate whether perception of stress is related to SLE severity. METHODS: We conducted a cross-sectional study of 425 participants; 202 women with SLE, with an average age (SD) of 36.61 (10.15), and 223 healthy women, with age-matched controls. The assessment included the clinical characteristics (disease duration, SLE activity, cumulative organ damage, pharmacotherapy), the Symptom Checklist-90-Revised (SCL-90-R) and the Perceived Stress Scale. Descriptive, comparative, univariate and multivariate analysis were performed. RESULTS: SLE patients showed psychopathological alterations in the somatisation, obsessive-compulsive and positive discomfort subscales of SCL-90-R. Women with SLE reported significantly higher scores on the psychopathological dimensions and perceived stress compared to healthy women, except for paranoid ideation. Disease duration, SLE activity, cumulative organ damage, and perceived stress were shown to be significant predictors of psychopathological manifestations, explaining a range, between 20 and 43%, of variance across SCL-90-R dimensions. Moreover, perceived stress was related to SLE activity, after controlling for psychopathological dimensions. CONCLUSIONS: The psychopathological manifestations in SLE appeared to be influenced by perceived stress, disease duration, disease activity and cumulative organ damage. In turn, perceived stress was associated with disease severity. This knowledge may contribute to a more comprehensive perspective of these manifestations in the SLE population in the clinical setting.

Inpatient dependency in activities of daily living predicts informal caregiver strain: A cross-sectional study.

AIMS AND OBJECTIVES: To investigate what factors influence caregiver strain in informal caregivers just before inpatients are discharged. BACKGROUND: Previous research has investigated the risk factors related to the burden on caregivers in different clinical contexts. However, the findings from studies analysing these factors just before inpatients are discharged are uncertain. DESIGN: A cross-sectional study design. METHODS: The study involved 100 inpatients and 100 informal caregivers from seven different hospital units. Sociodemographic, clinical, functional and cognitive factors of inpatients-caregivers, and caregiver strains were recorded. Descriptive, bivariate correlation and multiple regression analyses were performed. RESULTS: Caregivers of inpatients at risk of ulcers had significantly higher scores of strain. Dependency in activities of daily living scores and cognitive status scores were statistically inversely proportional to caregiver strain. Almost 27% of total variance of caregiver strain was due to dependency in activities of daily living. CONCLUSIONS: Caregiver strain was mainly associated with those situations in which the hospitalised patients presented the risk of ulcers, dependency and cognitive disorders, with dependency in activities of daily living being the factor that most influenced informal caregiver strain. RELEVANCE TO CLINICAL PRACTICE: Dependency in activities of daily living, among other risk factors, should be evaluated at an early stage, monitored and controlled by hospital nursing staff. These strategies could protect and promote the well-being and quality of life of informal caregivers during patient hospitalisation and after discharge.

Effectiveness of Transcutaneous Electrical Nerve Stimulation Energy in Older Adults: A Pilot Clinical Trial.

OBJECTIVE: To evaluate the effectiveness of a transcutaneous electric nerve stimulation (TENS) device typically used for pain suppression (analgesia) during pressure injury (PI) healing, peripheral vascularization, and secondary pain in older adults with chronic PIs and cognitive impairment. DESIGN AND SETTING: This pilot clinical trial followed patients from 6 nursing homes. PATIENTS AND INTERVENTION: Twenty-two patients with PIs in the distal third of their lower limbs (7 men, 15 women) were included in this study. The control group completed standard wound care (SWC), whereas the experimental group received SWC and TENS. A total of 20 sessions were conducted for each group over 2 months, 3 times a week. MAIN OUTCOME MEASURE: PI area, PI healing rate, blood flow, skin temperature, oxygen saturation, and level of pain at baseline and posttreatment. MAIN RESULTS: Significant improvements were achieved in PI area (mean difference, 0.92; 95% confidence interval [CI], 0.15-1.67; P =.024), healing rate (3; 95% CI, 1-4.99; P =.009), skin temperature (1.82; 95% CI, 0.35-3.28; P =.021), and pain (1.44; 95% CI, 0.49-2.39; P =.008) in the experimental group, whereas none of the variables revealed a significant change in the control group. CONCLUSIONS: The effect of local and spinal TENS combined with the SWC for PI produced a significant improvement in size, healing, skin temperature, and pain levels.

Association between burnout and cortisol secretion, perceived stress, and psychopathology in palliative care unit health professionals.

ABSTRACTObjective:A high incidence of burnout has been reported in health professionals working in palliative care units. Our present study aims to determine whether there are differences in the secretion of salivary cortisol between palliative care unit health professionals with and without burnout, and to elucidate whether there is a relationship between burnout syndrome and perceived stress and psychopathological status in this population. METHOD: A total of 69 health professionals who met the inclusion criteria participated in our study, including physicians, nurses, and nursing assistants. Some 58 were women (M = 29.65 years, SD = 8.64) and 11 men (M = 35.67 years, SD = 11.90). The level of daily cortisol was registered in six measurements taken over the course of a workday. Burnout syndrome was evaluated with the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), the level of perceived stress was measured using the Perceived Stress Scale, and psychopathological status was gauged using the SCL-90-R Symptoms Inventory. RESULTS: There were statistically significant differences in secretion of cortisol in professionals with high scores on a single subscale of the MBI-HSS [F(3.5) = 2.48, p < 0.03]. This effect was observed 15-30 minutes after waking up (p < 0.01) and at bedtime (p < 0.06). Moreover, the professionals with burnout showed higher scores on the psychopathology and stress subscales than professionals without it. SIGNIFICANCE OF RESULTS: A higher score in any dimension of the burnout syndrome in palliative care unit health professionals seems to be related to several physiological and psychological parameters. These findings may be relevant for further development of our understanding of the relationship between levels of burnout and cortisol secretion in the health workers in these units.

Effectiveness of a fine motor skills rehabilitation program on upper limb disability, manual dexterity, pinch strength, range of fingers motion, performance in activities of daily living, functional independency, and general self-efficacy in hand osteoarthritis: A randomized clinical trial.

STUDY DESIGN: A randomized clinical trial. INTRODUCTION: Rehabilitation treatments for improving fine motor skills (FMS) in hand osteoarthritis (HOA) have not been well explored yet. PURPOSE OF THE STUDY: To assess the effectiveness of a rehabilitation program on upper limb disability, independence of activities of daily living (ADLs), fine motor abilities, functional independency, and general self-efficacy in older adults with HOA. METHODS: About 45 adults (74-86 years) with HOA were assigned to an experimental group for completing an FMS intervention or a control group receiving conventional occupational therapy. Both interventions were performed 3 times/wk, 45 minutes each session, during 8 weeks. Upper limb disability, performance in ADLs, pinch strength, manual dexterity, range of fingers motion, functional independency, and general self-efficacy were assessed at baseline, immediately after treatment, and after 2 months of follow-up. RESULTS: FMS group showed significant improvements with a small effect size on manual dexterity (P ≤ .034; d ≥ 0.48) and a moderate-high effect on range of index (P ≤ .018; d ≥ 0.58) and thumb (P ≤ .027; d ≥ 0.39) motion. The control group showed a significant worse range of motion over time in some joints at the index (P ≤ .037; d ≥ 0.36) finger and thumb (P ≤ .017; d ≥ 0.55). CONCLUSIONS: A rehabilitation intervention for FMS may improve manual dexterity and range of fingers motion in HOA, but its effects on upper limb disability, performance in ADLs, pinch strength, functionality, and self-efficacy remain uncertain. Specific interventions of the hand are needed to prevent a worsening in range of finger motion. LEVEL OF EVIDENCE: 1b.

Influence of upper limb disability, manual dexterity and fine motor skill on general self-efficacy in institutionalized elderly with osteoarthritis.

STUDY DESIGN: Descriptive, cross-sectional. INTRODUCTION: The impact of upper limb (UL) disability, dexterity and fine motor skill on self-efficacy in older adults with osteoarthritis (OA) is not well known yet. PURPOSES OF THE STUDY: To evaluate the self-efficacy and its relationship with UL function/disability in institutionalized OA. METHODS: Institutionalized adults (n = 45) over the age of 65 years with OA were evaluated in a single session, to determine pinch strength, active range of motion of the hand and UL disability and functionality. They were classified as self-efficacious or not based on their general self-efficacy level. The influence on self-efficacy on upper limb function was statistically analyzed using bivariate and multivariate regression analyses. RESULTS: Self-effective older adults showed significantly lower scores in disability and higher scores in pinch strength, dexterity and motion of thumb than those who were classified as non-self-effective. Self-efficacy was associated with pinch strength (p ≤ 0.038), disability (p < 0.001) and dexterity (p ≤ 0.048). Multiple regression analyses showed that disability explained almost 40% of the variability of self-efficacy. CONCLUSIONS: Older adults classified as non-self-effective have higher UL disability and less pinch strength, manual dexterity and thumb motion than those who are self-effective, suggesting a relationship between impairment and perceived ability.

Attentional Resources and Independence in Basic and Instrumental Activities of Daily Living in Individuals with Intellectual Disabilities.

The relationship between attentional resources and functionality in individuals with intellectual disabilities (IDs) is clinically relevant. This study aimed to examine the possible relationship between the degree of ID and attentional resources, and to evaluate whether attentional resources predict the performance of basic and instrumental activities of daily living (ADL) in individuals with mild and moderate ID. This study, which employed a descriptive, cross-sectional, observational design, was conducted between July 2019 and May 2020. The sample consisted of 166 individuals divided into three groups: moderate ID, mild ID, and those without ID. These groups were compared for attentional functions (p < 0.001), obtaining an effect size ranging from medium to large. The results indicated that 40% of the variance in basic ADL performance was explained by the age of the participants, degree of disability, and sustained attention in individuals with ID. Additionally, 64% of the variance in instrumental ADL performance was explained by sustained, divided, and executive attention. Therefore, attentional resources appear to be associated with the performance of basic and instrumental ADL in individuals with mild and moderate ID.

Effect of Exercise Prior to Sedentary Behavior on Vascular Health Parameters: A Systematic Review and Meta-Analysis of Crossover Trials.

BACKGROUND: Sedentary behavior has been shown to negatively affect parameters of endothelial function and central hemodynamics, both of which are closely associated with vascular health. Exercise prior to sedentary behavior has demonstrated potential as a preventive strategy to mitigate these detrimental effects. To evaluate the impact of exercise prior to sedentary behavior on vascular health parameters in the adult population, a systematic review and meta-analysis were conducted, synthesizing the available body of knowledge. METHODS: A literature search was carried out in 6 databases. For each outcome, standard error and mean difference or standardized mean difference were calculated, as appropriate. An analysis was performed using a random effects model with a 95% confidence interval, using the inverse variance statistical method. Risk of bias assessment was performed using ROB2 and considerations for crossover trials. The quality of evidence was assessed using the GRADE system. RESULTS: Exercise performed prior to prolonged sedentary behavior resulted in increased flow-mediated vasodilation at the first and third hours of sedentary time, compared with the control condition of sedentary behavior without prior exercise [MD: 1.51% (95% CI: 0.57 to 2.45) and MD: 1.36% (95% CI: 0.56 to 2.16), respectively]. Moreover, prior exercise led to increased shear rate at the first and third hours of sedentary time [MD: 7.70 s^-1 (95% CI: 0.79 to 14.61) and MD: 5.21 s^-1 (95% CI: 1.77 to 8.43), respectively]. Furthermore, it increased blood flow at the third hour [SMD: 0.40 (95%CI: 0.07 to 0.72)], compared with the control condition of prolonged sedentary behavior without prior exercise. Regarding hemodynamic parameters, exercise prior to prolonged sedentary behavior decreased mean arterial pressure during the first and third hours of sedentary behavior [MD: -1.94 mmHg (95% CI: -2.77 to -1.11) and MD: -1.90 mmHg (95% CI: -3.27 to -0.53), respectively], and an increase in heart rate during the first hour [MD: 4.38 beats per minute (95%CI: 2.78 to 5.98)] compared with the control condition of prolonged sedentary behavior without prior exercise. CONCLUSIONS: The findings of this research suggest that prior exercise may prevent the impairment of vascular health parameters caused by sedentary behavior. However, the quality of the evidence was estimated as moderate. Therefore, further experimental studies and high-quality clinical trials are needed in this field to strengthen the results and conclusions drawn. PROSPERO REGISTRATION NUMBER: CRD42023393686.

A semi-automatic mHealth system using wearable devices for identifying pain-related parameters in elderly individuals.

BACKGROUND: Mobile health systems integrating wearable devices are emerging as promising tools for registering pain-related factors. However, their application in populations with chronic conditions has been underexplored. OBJECTIVE: To design a semi-automatic mobile health system with wearable devices for evaluating the potential predictive relationship of pain qualities and thresholds with heart rate variability, skin conductance, perceived stress, and stress vulnerability in individuals with preclinical chronic pain conditions such as suspected rheumatic disease. METHODS: A multicenter, observational, cross-sectional study was conducted with 67 elderly participants. Predicted variables were pain qualities and pain thresholds, assessed with the McGill Pain Questionnaire and a pressure algometer, respectively. Predictor variables were heart rate variability, skin conductance, perceived stress, and stress vulnerability. Multiple linear regression analyses were conducted to examine the influence of the predictor variables on the pain dimensions. RESULTS: The multiple linear regression analysis revealed that the predictor variables significantly accounted for 27% of the variability in the affective domain, 14% in the miscellaneous domain, 15% in the total pain rating index, 10% in the number of words chosen, 14% in the present pain intensity, and 16% in the Visual Analog Scale scores. CONCLUSION: The study found significant predictive values of heart rate variability, skin conductance, perceived stress, and stress vulnerability in relation to pain qualities and thresholds in the elderly population with suspected rheumatic disease. The comprehensive integration of physiological and psychological stress measures into pain assessment of elderly individuals with preclinical chronic pain conditions could be promising for developing new preventive strategies.