Factors associated with frailty, pre-frailty, and each of Fried's criteria of frailty among older adult outpatients.

This study aims to investigate both the prevalence and associated factors of frailty, pre-frailty, and each criterion of frailty according to the Fried phenotype criteria among older adult outpatients receiving care from geriatric services. A cross-sectional study was conducted between 2020 and 2022 and included 335 older adults. Fried's criteria and a comprehensive geriatric assessment, including physical, clinical and mental health variables were investigated. More than half of participants presented frailty (11.6 %) and/or pre-frailty (43.3 %) according to Fried's criteria, with physical inactivity and low gait speed as the most prevalent criteria. Several factors demonstrated associations with the diagnosis of frailty/pre-frailty, including retirement status, marital status (unmarried), the use of walking aids, lower educational attainment, decreased functional status, and poor mental health. Furthermore, various factors were associated with each of Fried's criteria, highlighting that certain factors might align with a specific criterion without necessarily correlating with the diagnosis of frailty and pre-frailty.

Effects of a dual intervention (motor and virtual reality-based cognitive) on cognition in patients with mild cognitive impairment: a single-blind, randomized controlled trial.

BACKGROUND: The increase in cases of mild cognitive impairment (MCI) underlines the urgency of finding effective methods to slow its progression. Given the limited effectiveness of current pharmacological options to prevent or treat the early stages of this deterioration, non-pharmacological alternatives are especially relevant. OBJECTIVE: To assess the effectiveness of a cognitive-motor intervention based on immersive virtual reality (VR) that simulates an activity of daily living (ADL) on cognitive functions and its impact on depression and the ability to perform such activities in patients with MCI. METHODS: Thirty-four older adults (men, women) with MCI were randomized to the experimental group (n = 17; 75.41 ± 5.76) or control (n = 17; 77.35 ± 6.75) group. Both groups received motor training, through aerobic, balance and resistance activities in group. Subsequently, the experimental group received cognitive training based on VR, while the control group received traditional cognitive training. Cognitive functions, depression, and the ability to perform activities of daily living (ADLs) were assessed using the Spanish versions of the Montreal Cognitive Assessment (MoCA-S), the Short Geriatric Depression Scale (SGDS-S), and the of Instrumental Activities of Daily Living (IADL-S) before and after 6-week intervention (a total of twelve 40-minutes sessions). RESULTS: Between groups comparison did not reveal significant differences in either cognitive function or geriatric depression. The intragroup effect of cognitive function and geriatric depression was significant in both groups (p < 0.001), with large effect sizes. There was no statistically significant improvement in any of the groups when evaluating their performance in ADLs (control, p = 0.28; experimental, p = 0.46) as expected. The completion rate in the experimental group was higher (82.35%) compared to the control group (70.59%). Likewise, participants in the experimental group reached a higher level of difficulty in the application and needed less time to complete the task at each level. CONCLUSIONS: The application of a dual intervention, through motor training prior to a cognitive task based on Immersive VR was shown to be a beneficial non-pharmacological strategy to improve cognitive functions and reduce depression in patients with MCI. Similarly, the control group benefited from such dual intervention with statistically significant improvements. TRIAL REGISTRATION: ClinicalTrials.gov NCT06313931; https://clinicaltrials.gov/study/NCT06313931 .

Sedentary Behavior, Obesity, and Disabilities in Community-Dwelling Older Adults: Analysis of the Brazilian National Health Survey 2019.

Research suggests that sedentary behavior (SB) and obesity are associated with disabilities in basic activities (BADL) and instrumental (IADL) activities of daily living. However, there is a lack of studies investigating this association in community-dwelling older adults. Thus, the aim of this study was to investigate the association between different SB typologies, isolated and in conjunction with obesity, and their associations with BADL and IADL disabilities in community-dwelling Brazilian older adults. This was a cross-sectional study using data from older adults (≥60 years) who participated in the Brazilian National Health Survey (2019). The exposures were obesity (BMI > 27 kg/m2) and the amount of time spent daily on SB watching television (SB TV < 3 and ≥3 h/day) and engaging in leisure activities (SB leisure < 3 and ≥3 h/day), analyzed both separately and jointly. The outcomes were BADL and IADL disabilities. The main results showed that isolated SB TV ≥ 3 h/day (OR: 1.26; 95% CI: 1.14; 1.39) and SB TV ≥ 3 h/day combined with obesity (OR: 1.55; 95% CI: 1.37; 1.75) increased the odds of BADL and IADL disabilities. Obesity alone (OR: 1.21; 95% CI: 1.07; 1.36) increased only the odds of BADL disabilities. Moreover, SB leisure ≥ 3 h/day without obesity reduced the odds of IADL disabilities (OR: 0.56; 95% CI: 0.41; 0.76). Ideally, older adults should be encouraged to prevent obesity, reduce excessive periods spent in SB watching TV, and increase the daily periods spent in leisure activities, thus minimizing the likelihood of disabilities in functional activities.

Assessing Independence in Activities of Daily Living and Quality of Life in Patients with Dementia with Lewy Bodies.

Knowledge of performance in activities of daily living and quality of life is important for management decisions and research endpoints. The use of harmonized scales is essential for objective assessment of both caregivers and patients with dementia with Lewy bodies. Functionality and quality of life are more impaired in dementia with Lewy bodies than in Alzheimer's disease, mostly due to higher prevalence of behavioral symptoms and motor manifestations in dementia with Lewy bodies. More longitudinal studies are required to assess if causality mediates the associations of clinical features with functional independence and worsened quality of life in these patients.

Impact of disabilities in activities of daily living on opioid use for chronic pain in older adults: an exploratory secondary analysis from ELSI-Brazil.

OBJECTIVES: Problematic use of opioids by older adults is associated with adverse effects and has become a public health crisis worldwide. Ageing-related disabilities in activities of daily living (ADL) could promote unnecessary use of opioids in this population. This study evaluates the association between ADL disability and opioid consumption in Brazilian older adults. STUDY DESIGN: Study design- cross-sectional secondary data analysis of the second wave of the Brazil Longitudinal Study of Ageing (ELSI-Brazil). METHODS: Data from the second wave of the Brazil Longitudinal Study of Ageing (ELSI-Brazil) were used. Older adults with chronic pain were included. ADL disability was measured using the Katz Index. The primary outcome was opioid consumption for chronic pain. The primary association was explored using logistic regression models adjusting for predetermined confounders. Sensitivity analyses evaluating model performance were done by calibrating and validating the model using randomly split equal sets. RESULTS: In those who reported presence of chronic pain (n = 2865), the prevalence of opioid use was 29% (95% CI:23.1%-35.6%). In adjusted models, participants with moderate and severe ADL disability had 1.6 (95% CI:1.13-2.32; P = 0.009) and 3.8 (95% CI: 1.80-7.90; P < 0.001) times higher odds of opioid consumption compared to no disability, respectively. Being female, alcohol consumption, higher pain intensity, history of dementia, fractures, and presence of ≥2 comorbidities were significantly associated with increased opioid use (P < 0.05). CONCLUSION: Nearly one-third of the Brazilian elderly population experiencing chronic pain reported using opioids. The functional decline during the process of ageing appears to be a risk factor for pain intolerance and opioid use. Multidisciplinary approaches to detect early ADL disabilities and improve mobility and access to assistive technologies need to be established to prevent opioid overuse and addiction in elderly populations.

Evaluación de la capacidad funcional en actividades básicas de la vida diaria de adultos mayores residentes en hogares de Asunción, Paraguay

Introducción: El envejecimiento poblacional y el aumento de enfermedades crónicas han incrementado la prevalencia de discapacidad en adultos mayores. Evaluar la capacidad funcional en actividades básicas de la vida diaria (ABVD) es esencial para mantener la independencia y calidad de vida. Este estudio se enfocó en evaluar la capacidad funcional de adultos mayores en ABVD en el ámbito familiar de Asunción en el año 2023. Materiales y métodos: Se realizó un estudio observacional, descriptivo, de corte transversal, en noviembre del 2023, con 91 adultos mayores (≥65 años) de Asunción, en hogares familiares. Se aplicaron encuestas mediante Google Formulario y se utilizó el Índice de Barthel para medir la capacidad funcional. El muestreo fue no probabilístico por bola de nieve. Se empleó estadística descriptiva e inferencial, con un nivel de significancia de p≤0,05. Se respetaron los aspectos éticos de la investigación. Resultados: Participaron 91 adultos mayores, con una edad promedio de 79 años±8,2. El 62,6% fueron mujeres y 41,8% del grupo de edad de 75 a 84 años. Según el Índice de Barthel, el 59,3% necesita ayuda para cortar alimentos y el 34,1% depende de otra persona para la higiene personal. El 28,6% tiene incontinencia en deposiciones y el 30,8% en micción. La puntuación promedio del Índice de Barthel fue 68,5±33,9, indicando dependencia leve en el 61,5% de los participantes. El 77% de los adultos mayores reciben cuidados de un familiar. Conclusión: Un alto porcentaje de los adultos mayores mostró algún grado de dependencia, especialmente en actividades de alimentación e higiene. La edad avanzada y el sexo femenino se asociaron con mayores niveles de dependencia. La mayoría de los adultos mayores dependieron de familiares para su cuidado, destacando la necesidad de fortalecer las redes de apoyo y capacitar a los cuidadores informales.

Introduction: Population aging and the increase in chronic diseases have raised the prevalence of disability in older adults. Evaluating functional capacity in basic activities of daily living (BADL) is essential to maintaining independence and quality of life. This study focused on evaluating the functional capacity of older adults in BADL within the family setting of Asunción in 2023. Material and methods: An observational, descriptive, cross-sectional study was conducted in November 2023, with 91 older adults (≥65 years) from Asunción, in family homes. Surveys were administered via Google Forms, and the Barthel Index was used to measure functional capacity. The sampling was non-probabilistic snowball sampling. Descriptive and inferential statistics were employed, with a significance level of p≤0.05. Ethical aspects of the research were respected. Results: Ninety-one older adults participated, with an average age of 79 years±8.2. Of these, 62.6% were women and 41.8% were in the age group of 75 to 84 years. According to the Barthel Index, 59.3% needed help cutting food, and 34.1% depended on another person for personal hygiene. Additionally, 28.6% had bowel incontinence, and 30.8% had urinary incontinence. The average Barthel Index score was 68.5±3.9, indicating mild dependence in 61.5% of participants. Furthermore, 77% of older adults received care from a family member. Conclusion: A high percentage of older adults showed some degree of dependence, especially in activities related to feeding and hygiene. Advanced age and female sex were associated with higher levels of dependence. Most older adults relied on family members for care, highlighting the need to strengthen support networks and train informal caregivers.

Long-term outcomes of patients affected by Guillain-Barré syndrome in Colombia after the Zika virus epidemic.

BACKGROUND: Guillain-Barré Syndrome (GBS) can lead to significant functional impairments, yet little is understood about the recovery phase and long-term consequences for patients in low- and medium-income countries. OBJECTIVE: To evaluate the functional status and identify factors influencing outcomes among patients with GBS in Colombia. METHODS: Telephone interviews were conducted with GBS patients enrolled in the Neuroviruses Emerging in the Americas Study between 2016 and 2020. The investigation encompassed access to health services and functional status assessments, utilizing the modified Rankin Scale (mRS), GBS Disability Score (GDS), Barthel Index (BI), and International Classification of Functioning (ICF). Univariate analysis, principal component analysis, linear discriminant analysis, and linear regression were employed to explore factors influencing functional status. RESULTS: Forty-five patients (mean age = 50[±22] years) with a median time from diagnosis of 28 months (IQR = 9-34) were included. Notably, 22% and 16% of patients did not receive rehabilitation services during the acute episode and post-discharge, respectively. Most patients demonstrated independence in basic daily activities (median BI = 100, IQR = 77.5-100), improvement in disability as the median mRS at follow-up was lower than at onset (1 [IQR = 0-3] vs. 4.5 [IQR = 4-5], p < 0.001), and most were able to walk without assistance (median GDS = 2, IQR = 0-2). A shorter period from disease onset to interview was associated with worse mRS (p = 0.015) and ICF (p = 0.019). Negative outcomes on GDS and ICF were linked to low socioeconomic status, ICF to the severity of weakness at onset, and BI to an older age. CONCLUSIONS: This study underscores that the functional recovery of GBS patients in Colombia is influenced not only by the natural course of the disease but also by socioeconomic factors, emphasizing the crucial role of social determinants of health.

Londrina Activities of Daily Living Protocol: validity, reliability, minimal detectable change, and standard error of measurement in adults with asthma.

INTRODUCTION: Asthma symptoms are dyspnea, chronic cough, wheezing, chest tightness, or chest discomfort, which can directly limit the activities of daily living (ADL), which is frequently reported by adults with asthma. Evaluating ADL with a reliable protocol at the usual speed is necessary. OBJECTIVES: To investigate the validity, reliability, minimal detectable change (MDC), and standard error of measurement (SEM) of the Londrina ADL Protocol (LAP) for adults with asthma. METHODS: Adults with asthma were evaluated with the LAP test. Spearman's correlation coefficient was used to verify validity with the 6-min walk test (6MWT), Glittre-ADL test, and London Chest Activity of Daily Living (LCADL). To test the reliability, the test was reapplied in at least 30 min; the Wilcoxon test and Intraclass Correlation Coefficient (ICC), SEM, MDC, and learning effect were performed. RESULTS: Fifty-three individuals were included (26% men, 43 ± 15 years, BMI 28 ± 8 kg/m2, FEV1 70 ± 24%predicted). For convergent validity, the LAP test was correlated with the 6MWT, Glittre-ADL, and LCADL scale (r = -0.49, 0.71, and 0.30, respectively; p < 0.03). There was a difference in test-retest (p < 0.0001) and reliability analysis shows ICC3 of 0.94, SEM of 14.88 s (22%), and MDC of 41.23 s (15%). Furthermore, the individuals performed the second test with -23 ± 19 (7.9%) s. CONCLUSION: The LAP test is valid and reliable for assessing limitations during ADL in adults with asthma. Considerable learning effect was observed, therefore, the best of two measures may avoid underestimation.

Social rhythm and implications on functionality of patients after stroke.

The study aimed to assess the regularity, intensity, frequency, and period of activities comprising social rhythm and associate them with the functionality of stroke patients. The sample consisted of 73 patients (41 men and 32 women) with a mean age of 60 years (±10). Social rhythm was assessed by Social Rhythm Metric (SRM) and Activity Level Index (ALI). The functionality was evaluated using the International Classification of Functioning, Disability, and Health (ICF). Data were analyzed using Student's t-test, ANOVA, and Chi-square test. The mean SRM was 5.1 ± 0.9, and ALI was 58.3 ± 14.9. Notably, 40% of the patients exhibited both low regularity and low intensity of activities. Six SRM activities, performed with low frequency (going outside, starting work, exercising, snacking, watching other TV programs, and going home), exhibited a tendency to have periods that deviated from the expected 24-hour daily cycle. ICF domains most associated with SRM were: d2-General tasks and demands, d3-Communication, d4-Mobility, d5-Self care, d8-Major life areas, and d9-Community, social and civic life. The results indicated changes in social rhythm with implications for patient functionality. Screening for disruptions in social rhythm could be part of the functional assessment during the rehabilitation process for post-stroke patients.

Severe rigid hip flexion-abduction contracture in cerebral palsy: a case report and review of the literature.

INTRODUCTION: severe, rigid hip abduction deformity in individuals with cerebral palsy (CP) is an exceptionally uncommon condition. This posture hinders the positioning in the wheelchair and the completion of basic activities of daily living (ADL). Addressing such severe deformities can be quite challenging. MATERIAL AND METHODS: a 14-year-old male, with spastic-dystonic quadriplegic CP, developed rigid and severe flexion-abduction contractures in both hips, characterized by 90 degrees of flexion and 100 degrees of abduction. These contractures severely impeded his ability to comfortably use a wheelchair and even pass through doorways. Performing basic ADLs became a significant challenge for both the patient and his caregivers. RESULTS: the treatment approach involved a two-stage surgical procedure, one for each hip, with a two-month interval between them. An extensive release of the fascia latae, gluteus maximus, external rotators, and hip flexors; in combination with a proximal femur osteotomy were performed. To maintain the corrections achieved, long-leg casts connected with two bars were employed, followed by orthotic support and physiotherapy. Following the procedure, lower limb adduction was achieved, and the patient and caregivers were highly satisfied, as ADLs and basic caregiving had been greatly facilitated. CONCLUSIONS: while the available literature on the management of severe rigid abduction hip contractures in non-ambulatory CP patients is limited, and treatment options are often complex, the present case underscores the effectiveness of a comprehensive approach involving soft tissue release and bone surgery. Achieving a more favorable wheelchair positioning and facilitating basic ADLs and care represents a significant success for patients and families.

INTRODUCCIÓN: la deformidad severa y rígida en abducción de cadera en individuos con parálisis cerebral (PC) es una condición infrecuente. Esta postura dificulta el posicionamiento en la silla de ruedas y la realización de actividades básicas de la vida diaria (AVD). El tratamiento de estas deformidades tan severas puede ser todo un reto. MATERIAL Y MÉTODOS: varón de 14 años, con PC tetrapléjica espástica-distónica, que desarrolló contracturas rígidas y severas de flexión-abducción en ambas caderas, caracterizadas por 90 grados de flexión y 100 grados de abducción. Estas contracturas impedían gravemente su capacidad para utilizar cómodamente una silla de ruedas e incluso pasar por las puertas. La realización de actividades básicas de la vida diaria se convirtió en un reto importante tanto para el paciente como para sus cuidadores. RESULTADOS: el tratamiento consistió en una intervención quirúrgica en dos fases, una para cada cadera, con un intervalo de dos meses entre ellas. Se realizó una amplia liberación de la fascia lata, el glúteo mayor, los rotadores externos y los flexores de la cadera; en combinación con una osteotomía proximal del fémur. Para mantener las correcciones conseguidas, se emplearon escayolas de pierna larga conectadas con dos barras, seguidas de soporte ortésico y fisioterapia. Tras la intervención, se consiguió la aducción de los miembros inferiores y el paciente y los cuidadores se mostraron muy satisfechos, ya que se habían facilitado en gran medida las AVD y los cuidados básicos. CONCLUSIONES: aunque la bibliografía disponible sobre el tratamiento de las contracturas rígidas graves de la cadera en abducción en pacientes no deambulantes con PC es limitada, y las opciones de tratamiento suelen ser complejas, el presente caso subraya la eficacia de un enfoque integral que incluye la liberación de los tejidos blandos y la cirugía ósea. Conseguir una posición más favorable en la silla de ruedas y facilitar las AVD básicas y los cuidados representa un éxito significativo para los pacientes y sus familias.

Association between vitamin D insufficiency and depressive symptoms, and functional disability in community-dwelling Brazilian older adults: results from ELSI-Brazil study.

Low serum 25(OH)D levels (< 30 nmol/L) have been associated with increased depressive symptom scores over time, and it is believed that functionality may play a mediating role in the relationship between 25(OH)D and depressive symptoms. To comprehend the association between these factors could have significant implications for public health policy. The aim of this study was to verify the association between simultaneous vitamin D insufficiency and depressive symptoms, and functional disability in community-dwelling older adults. This was a cross-sectional study with data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), collected between 2015 and 2016. The outcomes were functional disability assessed through basic activities of daily living (ADL) and instrumental activities of daily living (IADL). The exposures were vitamin D insufficiency (< 30 nmol/L) and depressive symptoms (≥ 4 points in 8-item version of the Center for Epidemiological Studies-Depression). Crude and adjusted Poisson regression was performed to estimate associations. A total of 1781 community-dwelling older adults included in this study, 14.6% had disability in ADL and 47.9% in IADL; 59.7% had vitamin D insufficient levels, and 33.2% depressive symptoms. The concomitant presence of vitamin D insufficient and depressive symptoms increased the prevalence of ADL by 2.20 (95% CI: 1.25; 3.86) and IADL by 1.54 (95% CI: 1.24; 1.91), respectively. Therefore, preventive strategies to keep older adults physically and socially active, with a good level of vitamin D, are essential to avoid depression and functional disability.

Promoción de la salud y obesidad infantil en el cotidiano de los escolares y familias / Health promotion and child obesity in the daily life of school children and families / Promoção da saúde e obesidade infantil no cotidiano de escolares e famílias

ResumenObjetivos: comprender el cotidiano de familiar de niños y niñas de enseñanza prebásica y básica en una escuela del sector Barranco Amarillo, región de Magallanes y Antártica Chilena; conocer la experiencia de cuidados relacionados con la prevención de la obesidad infantil y la promoción de la salud de sus familias. Método: estudio cualitativo, descriptivo-exploratorio, basado en la sociología comprensiva y del cotidiano de Michel Maffesoli, con la participación de doce familias. Resultados: las familias tienen conocimientos sobre una buena salud, tratando de comer de forma sana, pero les resulta difícil aplicarlos porque no encuentran una rutina apropiada, por el mayor costo de los alimentos saludables, el sedentarismo y la preferencia por comidas rápidas, entre otros. Conclusión: es preciso instaurar estrategias de intervención en la prevención de la obesidad infantil, teniendo como foco la promoción de la salud para una vida digna y saludable.

AbstractObjectives: to understand the daily life of families of boys and girls in pre-school and basic education in a school in the Barranco Amarillo sector, Magallanes and Chilean Antarctic Region; to know the experience of care related to the prevention of childhood obesity and the promotion of the health of their families. Method: qualitative, descriptive-exploratory study, based on the Comprehensive and Daily Sociology of Michel Maffesoli, with the participation of twelve families. Results: families have knowledge about good health, trying to eat healthy, but it is difficult for them to apply them because they do not find an appropriate routine, due to the higher cost of healthy foods, sedentary lifestyle, and the preference for fast foods, among others. Conclusion: it is necessary to establish intervention strategies in the prevention of childhood obesity, focusing on health promotion, for a dignified and healthy life

ResumoObjetivos: compreender o cotidiano das famílias de meninos e meninas na educação pré-escolar e básica em uma escola do setor Barranco Amarillo, Magalhães e Região Antártica Chilena; conhecer a experiência de cuidados relacionados à prevenção da obesidade infantil e à promoção da saúde de seus familiares. Método: estudo qualitativo, descritivo-exploratório, baseado na Sociologia Compreensiva e Cotidiana de Michel Maffesoli, com a participação de 12 famílias. Resultados: as famílias têm conhecimento sobre a boa saúde, procurando se alimentar de forma saudável, mas têm dificuldade em aplicá-los por não encontrarem uma rotina adequada devido ao maior custo dos alimentos saudáveis, sedentarismo e preferência por fast foods, entre outros. Conclusão:é necessário estabelecer estratégias de intervenção na prevenção da obesidade infantil, com foco na promoção da saúde para uma vida digna e saudável.

A Multidimensional, Person-Centered Framework for Functional Assessment in Dementia: Insights from the 'What', 'How', 'To Whom', and 'How Much' Questions.

Dementia is a syndrome characterized by cognitive and neuropsychiatric symptoms associated with progressive functional decline (FD). FD is a core diagnostic criterion for dementia, setting the threshold between its prodromal stages and the full-blown disease. The operationalization of FD continues to generate a great deal of controversy. For instance, the threshold of FD for the diagnosis of dementia varies across diagnostic criteria, supporting the need for standardization of this construct. Moreover, there is a need to reconsider how we are measuring FD to set boundaries between normal aging, mild cognitive impairment, and dementia. In this paper, we propose a multidimensional framework that addresses outstanding issues in the assessment of FD: i) What activities of daily living (ADLs) are necessary to sustain an independent living in aging? ii) How to assess FD in individuals with suspected neurocognitive disorders? iii) To whom is the assessment directed? and iv) How much does FD differentiate healthy aging from mild and major neurocognitive disorders? Importantly, the To Whom Question introduces a person-centered approach that regards patients and caregivers as active agents in the assessment process of FD. Thus, once impaired ADLs have been identified, patients can indicate how significant such impairments are for them in daily life. We envisage that this new framework will guide future strategies to enhance functional assessment and treatment of patients with dementia and their caregivers.

Semi-supervised ensemble learning for human activity recognition in casas Kyoto dataset.

-The automatic identification of human physical activities, commonly referred to as Human Activity Recognition (HAR), has garnered significant interest and application across various sectors, including entertainment, sports, and notably health. Within the realm of health, a myriad of applications exists, contingent upon the nature of experimentation, the activities under scrutiny, and the methodology employed for data and information acquisition. This diversity opens doors to multifaceted applications, including support for the well-being and safeguarding of elderly individuals afflicted with neurodegenerative diseases, especially in the context of smart homes. Within the existing literature, a multitude of datasets from both indoor and outdoor environments have surfaced, significantly contributing to the activity identification processes. One prominent dataset, the CASAS project developed by Washington State University (WSU) University, encompasses experiments conducted in indoor settings. This dataset facilitates the identification of a range of activities, such as cleaning, cooking, eating, washing hands, and even making phone calls. This article introduces a model founded on the principles of Semi-supervised Ensemble Learning, enabling the harnessing of the potential inherent in distance-based clustering analysis. This technique aids in the identification of distinct clusters, each encapsulating unique activity characteristics. These clusters serve as pivotal inputs for the subsequent classification process, which leverages supervised techniques. The outcomes of this approach exhibit great promise, as evidenced by the quality metrics' analysis, showcasing favorable results compared to the existing state-of-the-art methods. This integrated framework not only contributes to the field of HAR but also holds immense potential for enhancing the capabilities of smart homes and related applications.

Occupational complexity of paid work and housework, and its impact on the cognitive performance in community dwelling older adults, preliminary results.

Work and activity could be an important source of cognitive enrichment. Activities that are more challenging concerning the cognitive functions that are put into practice are associated with lower risk of cognitive decline in old age. Objective: The present study aimed to assess the impact of occupational complexity and household tasks in three cognitive domains (verbal episodic memory, language, and executive functions) in older adults residing within the community. Methods: A trail analysis was executed, using the structural equations procedure in 120 participants assessed with main lifetime occupational activity and household tasks questionnaire, as well as a neuropsychological assessment battery for memory, language, and executive functions. Results: The regression weights analysis indicated that complexity in household chores showed moderate effects on executive functions (ß=0.19; p=0.027) and that occupational complexity of paid work showed effects on memory (ß=0.26; p=0.008), language (ß=0.38; p<0.001), and executive functions (ß=0.55; p<0.001). Conclusion: Paid work promotes cognitive reserve, contrary to household activities which seem to have a moderate impact on cognition. Differences in activity complexity not only impact people´s economic and social status and possibilities but can also determine different courses of aging and cognitive risk.

Trabalho e atividade podem ser importantes fontes de enriquecimento cognitivo. Atividades que são mais desafiadoras quanto às funções cognitivas postas em prática se associam a menor risco de declínio cognitivo em idade avançada. Objetivo: O objetivo do presente estudo é avaliar o impacto da complexidade ocupacional e das tarefas domésticas em três domínio cognitivos (memória episódica verbal, linguagem e funções executivas) em idosos residentes na comunidade. Métodos: Foi realizada uma análise de trilha com o uso de procedimento de equações estruturais em 120 participantes, avaliados por meio de: questionário das principais atividades ocupacionais e tarefas domésticas da vida, bem como bateria de avaliação neuropsicológica para memória, linguagem e funções executivas. Resultados: A análise dos pesos de regressou mostrou que a complexidade nas tarefas domésticas apresenta efeitos moderados nas funções executivas (ß=0,19; p=0,027) e que a complexidade ocupacional do trabalho remunerado teve efeitos sobre a memória (ß=0,26; p=0,008), linguagem (ß=0,38; p<0,001) e funções executivas (ß=0,55; p<0,001). Conclusão: O trabalho remunerado promove a reserva cognitiva, em contraste com as atividades domésticas, que parecem ter impacto moderado na cognição. As diferenças na complexidade das atividades não apenas impactam o status econômico e social e as possibilidades das pessoas, mas também podem determinar diferentes cursos de envelhecimento e risco cognitivo.

Comparison of the clinical effectiveness of Class IV Laser therapy and therapeutic ultrasound in patients with chronic neck pain: a randomized controlled trial / Comparação da eficácia clínica da terapia a laser Classe IV e do ultrassom terapêutico em pacientes com dor cervical crônica: um estudo controlado e randomizado

INTRODUCTION: Chronic neck pain (CNP) is a common musculoskeletal problem that affects a large proportion of the population and lasts longer than three months. It has a high cost in terms of life, disability, and healthcare. Several modalities have effectively provided immediate and long-term relief for CNP; however, the comparative clinical effectiveness of these modalities is limited. OBJECTIVES: The study aimed to determine the clinical effectiveness of Class IV Laser therapy and Therapeutic Ultrasound (TUS) in patients with CNP. METHODS AND MATERIALS: Forty-four patients with CNP of both genders were recruited from an age range of 20­45 years from the Department of Musculoskeletal Physiotherapy of Maharishi Markandeshwar Institute of Physiotherapy, MM(DU), Ambala, India. They were divided into two groups at random: the LASER group A (n = 22) and the TUS group B (n = 22). The intervention duration was 2 weeks with 6 treatment sessions. Pre- and post-treatment outcome measures were assessed with the Visual Analog Scale (VAS), Algometer, Goniometer, and Neck Disability Index (NDI) questionnaires at baseline and after 2 weeks of intervention. The LASER group received a target dose of 10 joules per cm2 at a power of 10 watts, with a continuous dosage frequency. The TUS group underwent a continuous mode ultrasound (3 MHz, 1 W/cm2) for 6 minutes. The Shapiro-Wilk test was used to assess the normality of the data. For parametric and non-parametric data analysis within the group, the paired t-test and Wilcoxon signed rank were used. The independente t-test and Mann-U Whitney test were used for the group comparison of parametric and non-parametric data, respectively. RESULTS: In both groups, there was a significant improvement in all the outcome measures (p<0.001). There was a statistically significant difference between the two interventions in VAS, Pain Pressure Threshold (PPT), and NDI (p<0.05). CONCLUSION: Class IV Laser therapy is clinically more effective than therapeutic ultrasound in treating patients with chronic neck pain.

INTRODUÇÃO: A dor cervical crônica (DCC) é um problema musculoesquelético comum que afeta uma grande proporção da população e dura mais de três meses. Ela tem um alto custo em termos de vida, incapacidade e assistência médica. Várias modalidades têm proporcionado alívio imediato e de longo prazo para a dor cervical crônica; entretanto, a eficácia clínica comparativa dessas modalidades é limitada. OBJETIVOS: O objetivo do estudo foi determinar a eficácia clínica da terapia a laser de classe IV e do ultrassom terapêutico (UST) em pacientes com DCC. MÉTODOS E MATERIAIS: Quarenta e quatro pacientes com DCC de ambos os sexos, em uma faixa etária de 20 a 45 anos, foram recrutados do Departamento de fisioterapia musculoesquelética do Instituto de Fisioterapia Maharishi Markandeshwar, MM (DU), Ambala, Índia. Eles foram divididos em dois grupos de forma aleatória: o grupo LASER A (n = 22) e o grupo UST B (n = 22). A duração da intervenção foi de 2 semanas com 6 sessões de tratamento. As medidas de resultado pré e pós-tratamento foram avaliadas com os questionários Escala Visual Analógica (EVA), Algometer, Goniometer e Índice de Incapacidade do Pescoço (IIP) na linha de base e após 2 semanas de intervenção. O grupo LASER recebeu dose alvo de 10 joules por cm2 na potência de 10 watts, com frequência de dosagem contínua. O grupo UST foi submetido a ultrassom em modo contínuo (3 MHz, 1 W/cm2) por 6 minutos. O teste de Shapiro-Wilk foi utilizado para avaliar a normalidade dos dados. Para análise dos dados paramétricos e não paramétricos dentro do grupo, foram utilizados o teste t pareado e o posto sinalizado de Wilcoxon. O teste t independente e o teste Mann-U Whitney foram utilizados para comparação de grupos para dados paramétricos e não paramétricos, respectivamente. RESULTADOS: Em ambos os grupos, houve uma melhora significativa em todas as medidas de resultado (p<0,001). Houve uma diferença estatisticamente significativa entre as duas intervenções na EVA, Limiar de pressão de dor (PPT) e IIP (p<0,05). CONCLUSÕES: A terapia a laser de classe IV é clinicamente mais eficaz do que o ultrassom terapêutico no tratamento de pacientes com dor cervical crônica.

Longitudinal associations between stroke-related neurologic deficits and course of basic activities of daily living up to six months after stroke.

PURPOSE: To investigate the course of basic activities of daily living (ADL) from admission up to six months after the stroke and the longitudinal associations between stroke-related neurological deficits at admission to the stroke unit and course of basic ADL. MATERIALS AND METHODS: 180 individuals with a first-ever stroke were assessed at admission to the stroke unit and at follow-ups of three and six months. Stroke-related neurological deficits were assessed at admission with the National Institutes of Stroke Scale (NIHSS). Independence in basic ADL was assessed at admission and three and six months after the stroke by the Modified Barthel Index (MBI). Generalized Estimating Equations (GEE) were performed. RESULTS: Dependence in basic ADL reduced overtime, with most changes occurring over the first three months. Individuals, who had moderate/severe stroke-related neurological deficits (NIHSS ≥6) at admission, had higher chances of becoming more dependent in activities related to feeding (OR:1.27;95%CI = 1.03-1.55;p = 0.021), bathing (OR:1.30;95%CI = 1.11-1.50;p = 0.0005), dressing (OR:1.19;95%CI = 1.04-1.36;p = 0.010), transfers (OR:1.24;95%CI = 1.05-1.46;p = 0.0072), stair climbing (OR:1.46;95%CI = 1.27-1.66;p < 0.0001), and ambulation (OR:1.21;95%CI = 1.02-1.43;p < 0.0001). CONCLUSIONS: Decreases in dependence in basic ADL occurred mainly over three months after the stroke and showed different patterns for specific ADL. Baseline moderate/severe stroke-related neurological deficits were associated with poor functional status in basic ADL over the follow-up period.

Stroke survivors experience dependence in basic activities of daily living (ADL) which is reduced over six months after the stroke and showed different individual variability in patterns of recovery.Patients with moderate/severe stroke-related neurological deficits had higher chances of becoming dependent in activities related to feeding, bathing, dressing, transfers, stair climbing, and ambulation.Rehabilitation professionals should consider assessing stroke-related neurologic deficits within the first hours after stroke, with particular attention to individuals with moderate/severe impairments.

Is prehospital physical performance a predictor of functional capacity decline at discharge in hospitalized Brazilian older adults?

BACKGROUND: Hospitalization contributes to functional decline in older adults. OBJECTIVE: To assess the relationship between physical performance on admission and functional capacity and functional capacity decline at discharge, and to investigate tools capable of predicting this decline. METHODS: Prospective longitudinal study with 75 older adults admitted to a public hospital between July 2021 and February 2022. The independent variable was physical performance evaluated on admission by handgrip strength (HGS) and the Short Physical Performance Battery (SPPB). The dependent variables were functional capacity for basic activities of daily living (BADLs) and instrumental activities of daily living (IADLs) and their decline between admission and discharge. Statistical analyses were performed using linear and logistic regression and ROC curves. RESULTS: The median time between admission and participant assessment was 1 day (IQR=1-2 days). Median hospitalization time was 18 days (IQR= 7.5-30 days). Functional capacity for BADLs and IADLs declined in 39% and 79% of the participants, respectively. Performance in HGS and the SPPB at baseline, in adjusted models, explained 29.3 to 35.3% of functional capacity at discharge. One additional point in the SPPB decreased the risk of functional capacity decline for BADLs by 20.9% (OR=0.79, 95% CI: 0.68, 0.91). The AUC values for the SPPB (AUC=0.67) and HGS (AUC=0.65) were significant in identifying functional decline for BADLs, but not IADLs. CONCLUSION: In Brazilian older adults, physical performance on admission was related to functional capacity and its decline at discharge. Physical performance on admission is predictive of functional decline at discharge.

Grade-4/5 motor activity log-Brazil for post-stroke individuals with a severely impaired upper limb: a validity, reliability and measurement error study.

PURPOSE: This study examined the clinimetrics of the Brazilian-Portuguese translation of the Grade-4/5 Motor Activity Log (MAL 4/5), which assesses everyday use of the more affected upper-limb (UL) in stroke survivors with moderate/severe or severe motor impairment. MATERIALS AND METHODS: The translated MAL 4/5 was administered to 47 stroke survivors with moderate/severe or severe UL motor impairment. Accelerometers were worn on participants' wrists for five days on average prior to the first assessment. Test-retest and inter-rater reliabilities were assessed using the intraclass correlation coefficient (ICC), internal consistency using Cronbach's α, and construct validity was tested with correlations with the accelerometry. The measurement error (SEM) and the minimal detectable change (MDC) were calculated. RESULTS: MAL4/5-Brazil's test-retest reliability (AOU: ICC = 0.84; QOU: ICC = 0.90), inter-rater reliability (AOU: ICC = 0.83; QOU: ICC = 0.91), internal consistency (Cronbach's α = 0.91 and 0.95 for AOU and QOU scales, respectively), the SEM and MDC were 0.3 and 0.8 points for the AOU subscale and 0.2 and 0.5 points for the QOU subscale, respectively. The construct validity (AOU scale: r = 0.67; QOU scale: r = 0.76) was high. CONCLUSION: Grade-4/5 Motor Activity Log-Brazil is a reliable and valid instrument for assessing the more-affected UL use of stroke patients with moderate/severe or severe UL motor impairments.

Reliability and concurrent validity of the Grade-4/5 MAL-Brazil were established in adults with hemiparesis moderate/severe or severe upper extremity post Stroke.The minimum detectable change for the Grade-4/5 MAL-Brazil was 0.8 points for the Amount of Use scale and 0.5 points for the Quality of Use scale.Data from the accelerometry supports the construct validity of this instrument.The assessment can now be used clinically and for research in adults with impairment upper extremity moderate/severe or severe post Stroke.

Decreased functional mobility in individuals with mild to moderate expanded disability status from relapsing multiple sclerosis: Analysis of the Glittre-ADL test.

INTRODUCTION: Multiple sclerosis (MS) is a chronic inflammatory and autoimmune disease that significantly limits an individual's activities of daily living (ADLs) and negatively affects their social participation as it progresses. The impact of activities and participation must be continuously assessed, and the Glittre-ADL is a validated test for MS to assess functional capacity in tasks similar to ADLs. OBJECTIVE: To evaluate whether the Glittre-ADL test is a valid method for assessing functional mobility in individuals with MS and moderate disability or those who use assistive devices. METHODS: This cross-sectional study enrolled 30 individuals in two groups: 1) MS group (n = 15); and 2) healthy control group (n = 15). The MS group underwent three functional mobility tests: 1) Glittre-ADL; 2) Timed 25-Foot Walk (T25FWT); and 3) Timed Up and Go (TUG) while the healthy group underwent only the Glittre-ADL test. RESULTS: An association was found between the Glittre-ADL time and T25FWT (r = 0.78, p < .001) and TUG (r = 0.56, p = .030) times. In the MS group, statistically significant differences were found in time (F = 2.88, p = .038) and speed (F = 5.17, p = .024) between laps. A statistically significant difference was observed between the total time in the MS and control groups (Area Under Curve - AUC: 0.982, p < .0001). A total time > 46.0s represents the reduction of functional performance during ADLs in individuals with MS (sensitivity: 93.3%; specificity: 92.2%). CONCLUSION: The Glittre-ADL test is a valid tool for assessing functional mobility in individuals with MS and mild to moderate disability (EDSS score ≤ 6.5).