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3.
Vasc Health Risk Manag ; 17: 389-394, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34262283

RESUMO

Background: The World Health Organization (WHO) proposed the integrated care for older people (ICOPE) screening tool to identify functional impairment. We explore the association of geriatric functional impairment and hypertension, diabetes, dyslipidemia in the community-dwelling elderly. Methods: We enrolled individuals aged at least 65 with hypertension, diabetes, or dyslipidemia; or those aged at least 75 from May to July 2019. We applied ICOPE tools to evaluate six function assessments: cognitive decline, limited mobility, malnutrition, visual impairment, hearing loss, and depressive symptoms. Factors were analyzed using stepwise multivariable linear regression for ICOPE scores and logistic regression for geriatric functional impairment. All analyses were adjusted for age and glomerular filtration rate. Results: We enrolled 457 participants including 303 (66.3%) participants with hypertension, 296 (64.8%) diabetes, and 221 (48.4%) dyslipidemia. Seventy-eight (17.1%) participants have at least one geriatric functional impairment, including 41 (25.9%) participants aged ≥ 75 and 37 (12.4%) aged 65-74. The ICOPE score (0.4 ± 0.6) of participants aged at least 75 was higher than that (0.1 ± 0.4) of the participants aged 65-74 (p < 0.001). Dyslipidemia (p = 0.002) was positively associated with ICOPE score. Dyslipidemia (odds ratio: 2.15, 95% confidence interval: 1.27-3.70, p = 0.005), not hypertension (p = 0.3) and diabetes (p = 0.9), was associated with geriatric functional impairment. Visual impairment was the most common function impairment. Female was linked to limited mobility, renal function was associated with mobility (p < 0.001) and nutrition (p = 0.02). Conclusion: Dyslipidemia but not hypertension, diabetes is linked to geriatric functional impairment in community-dwelling elderly. Lower renal function is associated with decreased mobility and nutrition. More studies are needed to determine if treatment of dyslipidemia reduces geriatric functional impairment.


Assuntos
Dislipidemias/diagnóstico , Idoso Fragilizado , Fragilidade/diagnóstico , Avaliação Geriátrica , Vida Independente , Afeto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Cognição , Estudos Transversais , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/fisiopatologia , Diabetes Mellitus/psicologia , Dislipidemias/fisiopatologia , Dislipidemias/psicologia , Dislipidemias/terapia , Feminino , Fragilidade/fisiopatologia , Fragilidade/psicologia , Fragilidade/terapia , Estado Funcional , Taxa de Filtração Glomerular , Audição , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Hipertensão/psicologia , Rim/fisiopatologia , Masculino , Saúde Mental , Limitação da Mobilidade , Estado Nutricional , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores Sexuais , Visão Ocular
4.
Am J Phys Med Rehabil ; 100(9): 821-830, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34091465

RESUMO

OBJECTIVES: The aim of this study was to determine the impact of the COVID-19 pandemic on access to rehabilitation therapies and the impact of changes in therapy access on the physical and mental well-being of children with motor impairment and their caregivers. DESIGN: Caregivers of children younger than 18 yrs with childhood-onset motor impairment (primarily cerebral palsy) completed an anonymous survey through the online platform REDCap between May 5 and July 13, 2020. RESULTS: The survey was completed by 102 participants. Before the pandemic, 92 of 102 children (90%) were receiving one or more therapies; at the time surveyed, 55 children (54%) were receiving any therapies (P < 0.001). More than 40% of the sample reported increased child stress, decreased physical activity, and/or decline in mobility/movement. Participants who reported a decrease in number of therapies at the time surveyed more frequently reported lower satisfaction with treatment delivery (P < 0.001), a decline in child's mobility (P = 0.001), and increased caregiver stress (P = 0.004). Five qualitative themes were identified from open-ended question responses related to therapies and well-being. CONCLUSIONS: Access to pediatric rehabilitation therapies was disrupted during COVID-19. Disrupted access may be related to impact on physical and mental health. With the expansion of telehealth, caregiver and child feedback should be incorporated to optimize benefit.


Assuntos
COVID-19 , Paralisia Cerebral/reabilitação , Acesso aos Serviços de Saúde/estatística & dados numéricos , Transtornos dos Movimentos/reabilitação , Quarentena/psicologia , Adolescente , Adulto , Fardo do Cuidador/epidemiologia , Cuidadores/psicologia , Paralisia Cerebral/psicologia , Criança , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Feminino , Humanos , Masculino , Limitação da Mobilidade , Transtornos dos Movimentos/psicologia , Pesquisa Qualitativa , SARS-CoV-2 , Estresse Psicológico/epidemiologia , Estresse Psicológico/etiologia , Inquéritos e Questionários
5.
Am Fam Physician ; 103(12): 737-744, 2021 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-34128609

RESUMO

Many individuals need a mobility assistive device as they age. These devices include canes, crutches, walkers, and wheelchairs. Clinicians should understand how to select the appropriate device and size for individual patients (or work with a physical therapist) and prescribe the device using the patient's health insurance plan. Canes can improve standing tolerance and gait by off-loading a weak or painful limb; however, they are the least stable of all assistive devices, and patients must have sufficient balance, upper body strength, and dexterity to use them safely. Older adults rarely use crutches because of the amount of upper body strength that is needed. Walkers provide a large base of support for patients who have poor balance or who have bilateral lower limb weakness and thus cannot always bear full weight on their legs. A two-wheel rolling walker is more functional and easier to maneuver than a standard walker with no wheels. A four-wheel rolling walker (rollator) can be used by higher-functioning individuals who do not need to fully off-load a lower limb and who need rest breaks for cardiopulmonary endurance reasons, but this is the least stable type of walker. Wheelchairs should be considered for patients who lack the lower body strength, balance, or endurance for ambulation. Proper sizing and patient education are essential to avoid skin breakdown. To use manual wheelchairs, patients must have sufficient upper body strength and coordination. Power chairs may be considered for patients who cannot operate a manual wheelchair or if they need the features of a power wheelchair.


Assuntos
Limitação da Mobilidade , Equipamentos de Autoajuda , Idoso , Bengala/classificação , Muletas/classificação , Feminino , Humanos , Masculino , Andadores/classificação
6.
Rev. Hosp. Ital. B. Aires (2004) ; 41(2): 52-60, jun. 2021. graf, tab
Artigo em Espanhol | LILACS | ID: biblio-1254374

RESUMO

Introducción: el Índice de Movilidad de De Morton® (en inglés De Morton Mobility Index: DEMMI®) es una escala, válida y fiable para evaluar la movilidad funcional del adulto mayor. Objetivo: validar una versión en español para pacientes hospitalizados en una sala general. Material y métodos: traducción y adaptación transcultural, evaluación de la fiabilidad interobservador y validación de criterio explorando la correlación entre los índices DEMMI y Barthel® al ingreso hospitalario y también entre la percepción subjetiva del cambio en la movilidad por parte del propio paciente y la del puntaje DEMMI, y además evaluando la asociación entre este y el grado de acompañamiento requerido en el egreso hospitalario (n = 87). Su consistencia interna fue evaluada mediante los coeficientes de Kuder y Richardson (KR) y de Cronbach (n = 104). Resultados: la correlación entre los puntajes DEMMI y Barthel fue buena (Spearman's Rho = 0,78: p ≤ 0,0001), mientras que la correlación entre la percepción del paciente respecto del cambio en su movilidad y la variación en el puntaje DEMMI fue moderada (Spearman's Rho = 0,50; p < 0,0001). Quienes fueron dados de alta con alto nivel de acompañamiento habían tenido al ingreso un puntaje DEMMI inferior (28,1; IC 95%, 24,9 a 31,3) al de quienes no lo requirieron (48; 44,4 a 53,0). La consistencia interna fue adecuada (KR = 0,827 y Cronbach = 0,745; Pearson's Rho = 0,7885; p < 0,00001). Conclusión: la consistencia interna y la fiabilidad interobservador de la versión en español del puntaje DEMMI son buenas, mientras que sus cambios tienen buena correlación con los percibidos por los propios pacientes. Consideramos que puede ser usado como un elemento más para estimar al momento del ingreso hospitalario, el grado de acompañamiento que requerirán al ser dados de alta. (AU)


Introduction: the De Morton Mobility Index (DEMMI) is a valid and reliable scale to evaluate the functional mobility of the elderly. Aim: validate a Spanish version for hospitalized patients in a general ward. Material and methods: translation and cross-cultural adaptation, evaluation of inter-observer reliability and criterion validation exploring the correlation between DEMMI and Barthel scores at hospital admission and also between the subjective perception of the change in mobility by the patient himself and that of DEMMI score, and also, evaluating the association between DEMMI and the degree of support required at hospital discharge (n = 87). Its internal consistency was evaluated using Kuder-Richardson (KR) and Cronbach (n = 104) coefficients. Results: correlation between DEMMI and Barthel scores was good (Spearman's Rho = 0.78: p < = 0.0001), while correlation between patient's perception of change in mobility and variation in DEMMI score was moderate (Spearman's Rho = 0.50; p < 0.0001). Those discharged with a high level of support had a lower DEMMI score upon admission (28.1; 95% CI 24.9 to 31.3) than those who didn´t require it (48; 44.4 to 53.0). Internal consistency was adequate (KR = 0.827 and Cronbach = 0.745; Pearson's Rho = 0.7885; p < 0.00001). Conclusion: internal consistency and interobserver reliability of the Spanish version of DEMMI score are good, while its changes correlate well with those perceived by the patients themselves. We consider that it can be used as another element to estimate at hospital admission, the degree of support they will require upon discharge. (AU)


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Avaliação Geriátrica/métodos , Avaliação de Resultados em Cuidados de Saúde/métodos , Alta do Paciente , Tradução , Atividades Cotidianas , Idoso Fragilizado , Limitação da Mobilidade , Hospitalização
7.
J Parkinsons Dis ; 11(3): 1057-1065, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33935103

RESUMO

BACKGROUND: Patients with Parkinson's disease (PD) are at higher risk of vaccine-preventable respiratory infections. However, advanced, homebound individuals may have less access to vaccinations. In light of COVID-19, understanding barriers to vaccination in PD may inform strategies to increase vaccine uptake. OBJECTIVE: To identify influenza and pneumococcal vaccination rates, including barriers and facilitators to vaccination, among homebound and ambulatory individuals with PD and related disorders. METHODS: Cross-sectional US-based study among individuals with PD, aged > 65 years, stratified as homebound or ambulatory. Participants completed semi-structured interviews on vaccination rates and barriers, and healthcare utilization. RESULTS: Among 143 participants, 9.8% had missed all influenza vaccinations in the past 5 years, and 32.2% lacked any pneumococcal vaccination, with no between-group differences. Homebound participants (n = 41) reported difficulty traveling to clinic (p < 0.01) as a vaccination barrier, and despite similar outpatient visit frequencies, had more frequent emergency department visits (31.7% vs. 9.8%, p < 0.01) and hospitalizations (14.6% vs. 2.9%, p = 0.03). Vaccine hesitancy was reported in 35% of participants, vaccine refusal in 19%, and 13.3% reported unvaccinated household members, with no between-group differences. Nearly 13% thought providers recommended against vaccines for PD patients, and 31.5% were unsure of vaccine recommendations in PD. CONCLUSION: Among a sample of homebound and ambulatory people with PD, many lack age-appropriate immunizations despite ample healthcare utilization. Many participants were unsure whether healthcare providers recommend vaccinations for people with PD. In light of COVID-19, neurologist reinforcement that vaccinations are indicated, safe, and recommended may be beneficial.


Assuntos
Utilização de Instalações e Serviços/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde/estatística & dados numéricos , Doença de Parkinson , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , COVID-19/prevenção & controle , Estudos Transversais , Feminino , Humanos , Vacinas contra Influenza , Masculino , Limitação da Mobilidade , Vacinas Pneumocócicas , Estados Unidos
9.
J Stroke Cerebrovasc Dis ; 30(8): 105868, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34029887

RESUMO

BACKGROUND AND PURPOSE: Physical environmental factors are generally likely to become barriers for discharge to home of wheelchair users, compared with non-wheelchair users. However, the importance of environmental factors has not been investigated adequately. Application of machine learning technology might efficiently identify the most influential factors, although it is not easy to interpret and integrate various information including individual and environmental factors in clinical stroke rehabilitation. This study aimed to identify the influential factors affecting home discharge in the stroke patients who use a wheelchair after discharge by using machine learning technology. METHODS: This study used the rehabilitation database of our facility, which includes all stroke patients admitted into the convalescence rehabilitation ward. The chi-squared automatic interaction detection (CHAID) algorithm was used to develop a model to classify wheelchair-using stroke patients discharged to home or not-to-home. RESULTS: Among the variables, including basic information, motor functional factor, activities of daily living ability factor, and environmental factors, the CHAID model identified house renovation and the existence of sloping roads around the house as the first and second discriminators for home discharge. CONCLUSIONS: Our present results could scientifically clarify that the clinician need to focus on the physical environmental factors for achieving home discharge in the patients who use a wheelchair after discharge.


Assuntos
Técnicas de Apoio para a Decisão , Planejamento Ambiental , Habitação , Aprendizado de Máquina , Limitação da Mobilidade , Alta do Paciente , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/terapia , Cadeiras de Rodas , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisão Clínica , Bases de Dados Factuais , Avaliação da Deficiência , Feminino , Humanos , Masculino , Equipamentos de Autoajuda , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento
10.
Fisioter. Bras ; 22(2): 120-131, Maio 25, 2021.
Artigo em Português | LILACS | ID: biblio-1284085

RESUMO

Introdução: A imobilidade no leito de pacientes em unidades de terapia intensiva (UTI) favorece o maior tempo de permanência na unidade. Objetivos: Comparar a funcionalidade na admissão e na alta da UTI segundo a especialidade médica e correlacionar a funcionalidade na alta com o tempo de internação na UTI. Métodos: Estudo exploratório, longitudinal, realizado na UTI Geral de um hospital escola. Os pacientes foram divididos em grupos de acordo com a especialidade de internação: neurologia, pneumologia, gastroenterologia, politrauma e outros. O estado funcional prévio à internação foi obtido por meio da medida de independência funcional (MIF). Na alta foi aplicada a escala de mobilidade funcional em UTI (EMU). Resultados: Amostra de 174 pacientes, 53% do sexo masculino. O grupo politrauma apresentou idade significativamente menor que os outros grupos (p < 0,0001). O tempo médio de internação para os grupos neurologia e pneumologia apresentou correlação inversamente proporcional com p = 0 ,02 / r = -0,5 e p = 0,009 / r = - 0,4 respectivamente. Não houve diferença significativa entre as médias da MIF na admissão (p = 0,11) e da EMU na alta (p = 0,24) entre as especialidades médicas em que os pacientes foram admitidos. Conclusão: Quanto maior o tempo de internação na UTI, menor a funcionalidade na alta em pacientes neurológicos e pneumopatas. (AU)


Introduction: Patients on bed rest in intensive care units (ICU) prolong length of stay in the unit. Objectives: To compare ICU admission and discharge functionality according to medical specialty, and to correlate ICU discharge functionality with ICU length of stay. Methods: Longitudinal exploratory study, performed at the General ICU of a teaching hospital. The patients were divided into groups according to the hospitalization specialty: neurology, pneumology, gastroenterology, polytrauma and others. The functional status prior to hospitalization was obtained through the functional independence measure (FIM). At discharge, the ICU functional mobility scale (FMS) was applied. Results: A sample of 174 patients, 53% male. The polytrauma group was significantly younger than the other groups (p < 0.0001). The mean length of stay for the neurology and pneumology groups was inversely proportional to p = 0.02 / r = -0.5 and p = 0.009 / r = -0.4, respectively. There was no significant difference between the mean FIM at admission (p = 0.11) and FMS at discharge (p = 0.24) between the medical specialties at which patients were admitted. Conclusion: The longer the patient stays in the IC, the lower functionality at discharge in neurological and lung disease patients. (AU)


Assuntos
Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Alta do Paciente , Modalidades de Fisioterapia , Limitação da Mobilidade
11.
J Neuroeng Rehabil ; 18(1): 56, 2021 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-33789693

RESUMO

BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular disorders leading to balance difficulties and increased fall risks. This study aims to investigate the walking stability of BPPV patients in clinical settings and propose a machine-learning-based classification method for determining the severity of gait disturbances of BPPV. METHODS: Twenty-seven BPPV outpatients and twenty-seven healthy subjects completed level walking trials at self-preferred speed in clinical settings while wearing two accelerometers on the head and lower trunk, respectively. Temporo-spatial variables and six walking stability related variables [root mean square (RMS), harmonic ratio (HR), gait variability, step/stride regularity, and gait symmetry] derived from the acceleration signals were analyzed. A support vector machine model (SVM) based on the gait variables of BPPV patients were developed to differentiate patients from healthy controls and classify the handicapping effects of dizziness imposed by BPPV. RESULTS: The results showed that BPPV patients employed a conservative gait and significantly reduced walking stability compared to the healthy controls. Significant different mediolateral HR at the lower trunk and anteroposterior step regularity at the head were found in BPPV patients among mild, moderate, and severe DHI (dizziness handicap inventory) subgroups. SVM classification achieved promising accuracies with area under the curve (AUC) of 0.78, 0.83, 0.85 and 0.96 respectively for differentiating patients from healthy controls and classifying the three stages of DHI subgroups. Study results suggest that the proposed gait analysis that is based on the coupling of wearable accelerometers and machine learning provides an objective approach for assessing gait disturbances and handicapping effects of dizziness imposed by BPPV.


Assuntos
Vertigem Posicional Paroxística Benigna/fisiopatologia , Tontura , Marcha , Caminhada , Acelerometria , Adulto , Idoso , Área Sob a Curva , Vertigem Posicional Paroxística Benigna/diagnóstico , Feminino , Humanos , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Exame Físico/métodos , Índice de Gravidade de Doença , Dispositivos Eletrônicos Vestíveis
12.
J Sports Sci ; 39(sup1): 109-115, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33902397

RESUMO

Adapted sailing is a Paralympic sport in which sailors with different types of disabilities can compete in the same event. According to 2.4mR Class, eligible impairments include limb deficiency and vision impairment. However, it is still unknown the variables that determine performance. Thus, the objectives of this study were: (i) to identify the variables that determine the sailing performance, (ii) to analyse the influence of the type of impairment on sailing performance, and (iii) analyse the influence of the wind force on sailing performance. Thirty-three elite sailors with disabilities participated and were divided into three groups according to the type of impairment: affectation of upper, lower, or upper and lower limbs. Participants were evaluated during three 2.4mR class World Cups and the following variables were assessed: velocity made good, distance and manoeuvres in upwind-downwind courses and type of impairment. Those sailors with better performance travelled a shorter distance during downwind sailing. The results showed that performance was not affected by which category the sailor was placed according to the type of impairment. The sailors with a lesser disability perform better when the wind is medium and high.


Assuntos
Desempenho Atlético , Paratletas , Esportes para Pessoas com Deficiência , Esportes Aquáticos , Vento , Adulto , Idoso , Feminino , Humanos , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Paratletas/classificação , Navios/classificação , Estatísticas não Paramétricas , Extremidade Superior , Transtornos da Visão , Adulto Jovem
13.
Exp Gerontol ; 150: 111343, 2021 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-33848565

RESUMO

BACKGROUND: In older adults, increases in physical activity may prevent decline in lower-extremity function, but whether the benefit differs according to metabolic syndrome (MetS) status is uncertain. We aim to investigate whether structured physical activity is associated with less decline in lower-extremity function among older adults with versus without MetS. METHODS: We used data from the multicenter Lifestyle Interventions and Independence for Elders (LIFE) study to analyze 1535 sedentary functionally-vulnerable women and men, aged 70 to 89 years old, assessed every 6 months (February 2010-December 2013) for an average of 2.7 years. Participants were randomized to a structured, moderate-intensity physical activity intervention (PA; n = 766) or health education program (HE; n = 769). MetS was defined according to the 2009 multi-agency harmonized criteria. Lower-extremity function was assessed by 400-m walking speed and the Short Physical Performance Battery (SPPB) score. RESULTS: 763 (49.7%) participants met criteria for MetS at baseline. Relative to HE, PA was associated with faster 400-m walking speed among participants with MetS (P < 0.001) but not among those without MetS (P = 0.91), although the test for statistical interaction was marginally non-significant (P = 0.07). In contrast, no benefit of PA versus HE was observed on the SPPB score in either MetS subgroup. CONCLUSIONS: Among older adults at high risk for mobility disability, moderate-intensity physical activity conveys significant benefits in 400-m walking speed but not SPPB in those with, but not without, MetS. The LIFE physical activity program may be an effective strategy for maintaining or improving walking speed among vulnerable older adults with MetS. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01072500.


Assuntos
Síndrome Metabólica , Idoso , Idoso de 80 Anos ou mais , Exercício Físico , Terapia por Exercício , Feminino , Humanos , Extremidade Inferior , Masculino , Síndrome Metabólica/terapia , Limitação da Mobilidade , Comportamento Sedentário
14.
BMC Geriatr ; 21(1): 221, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33794786

RESUMO

BACKGROUND: People with Parkinson's disease (PD) have described their walking difficulties as linked to activity avoidance, social isolation, reduced independence and quality of life. There is a knowledge gap regarding predictive factors of perceived walking difficulties in people with PD. Such knowledge could be useful when designing intervention studies. This study aimed to investigate how perceived walking difficulties evolve over a 3-year period in people with PD. A specific aim was to identify predictive factors of perceived walking difficulties. METHODS: One hundred forty-eight people with PD (mean age 67.9 years) completed the Generic Walk-12 (Walk-12G) questionnaire (which assesses perceived walking difficulties) at both baseline and the 3-year follow-up. Paired samples t-test was used for comparing baseline and follow-up mean scores. Multivariable linear regression analyses were used to identify predictive factors of perceived walking difficulties. RESULTS: Perceived walking difficulties increased after 3 years: mean Walk-12G score 14.8 versus 18.7, p < 0.001. Concerns about falling was the strongest predictor (ß = 0.445) of perceived walking difficulties, followed by perceived balance problems while dual tasking (ß = 0.268) and pain (ß = 0.153). Perceived balance problems while dual tasking was the strongest predictor (ß = 0.180) of a change in perceived walking difficulties, followed by global cognitive functioning (ß = - 0.107). CONCLUSIONS: Perceived walking difficulties increase over time in people with PD. Both personal factors (i.e. concerns about falling) and motor aspects (i.e. balance problems while dual tasking) seem to have a predictive role. Importantly, our study indicates that also non-motor symptoms (e.g. pain and cognitive functioning) seem to be of importance for future perceived walking difficulties. Future intervention studies that address these factors need to confirm their preventative effect on perceived walking difficulties.


Assuntos
Doença de Parkinson , Caminhada , Acidentes por Quedas , Idoso , Humanos , Limitação da Mobilidade , Doença de Parkinson/diagnóstico , Qualidade de Vida
15.
BMC Geriatr ; 21(1): 228, 2021 04 07.
Artigo em Inglês | MEDLINE | ID: mdl-33827438

RESUMO

BACKGROUND: Based on a conceptual framework, Kuspinar and colleagues analysed life-space mobility in community-dwelling older adults. However, a number of earlier mobility studies that used the same framework remained undiscussed. This correspondence article addresses similarities and differences between these studies, as well as highlight issues that need to be addressed to improve our understanding of mobility determinants in older adults. FINDINGS: Despite differences in methodological approach as well as in detailed results, the studies share one important outcome: regardless of the specific choice of potential mobility determinants, only a low to moderate proportion of mobility could be explained. CONCLUSIONS: Our present understanding of the determinants of mobility in community-dwelling older adults is limited. A consistent terminology that takes into account the different aspects of mobility; the use of objective methods to assess real-life mobility; and monitoring changes in real-life mobility in response to interventions will contribute to furthering our understanding of mobility determinants.


Assuntos
Vida Independente , Limitação da Mobilidade , Idoso , Humanos
16.
J Stroke Cerebrovasc Dis ; 30(7): 105807, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33895428

RESUMO

BACKGROUND: Robot-assisted gait training has been confirmed to have beneficial effect on the rehabilitation of stroke patients. An exoskeleton robot, named BEAR-H1, is designed to help stroke patients with walking disabilities. METHODS: 17 subjects in experimental group and 15 subjects in control group completed the study. The experimental group received 30 minutes of BEAR-H1 assisted gait training(BAGT), and the control group received 30 minutes of conventional training, 5 times/week for 4weeks. All subjects were evaluated with 6-minute walk test (6MWT), Fugl-Meyer Assessment for lower extremity (FMA-LE), Functional Ambulatory Classification (FAC), Modified Ashworth Scale (MAS), and gait analysis at baseline and after 4 weeks intervention. RESULTS: The improvements of 6MWT, FMA-LE, gait speed, cadence, step length and cycle duration in BAGT group were more noticeable than in the control group. However, there was no difference in the assessment of MAS between two groups. CONCLUSIONS: Our results showed that BAGT is an effective intervention to improve the motor and walking ability during 4 weeks training for subacute stroke patients.


Assuntos
Exoesqueleto Energizado , Marcha , Extremidade Inferior/inervação , Atividade Motora , Robótica/instrumentação , Reabilitação do Acidente Vascular Cerebral/instrumentação , Acidente Vascular Cerebral/terapia , Adulto , China , Feminino , Estado Funcional , Análise da Marcha , Humanos , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Estudos Prospectivos , Recuperação de Função Fisiológica , Método Simples-Cego , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Teste de Caminhada
17.
PLoS One ; 16(4): e0250180, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33882081

RESUMO

INTRODUCTION: The Coronavirus Disease 2019 (COVID-19) outbreak is evolving rapidly worldwide. Data on the mobility level of patients with COVID-19 in the intensive care unit (ICU) are needed. OBJECTIVE: To describe the mobility level of patients with COVID-19 admitted to the ICU and to address factors associated with mobility level at the time of ICU discharge. METHODS: Single center, retrospective cohort study. Consecutive patients admitted to the ICU with confirmed COVID-19 infection were analyzed. The mobility status was assessed by the Perme Score at admission and discharge from ICU with higher scores indicating higher mobility level. The Perme Mobility Index (PMI) was calculated [PMI = ΔPerme Score (ICU discharge-ICU admission)/ICU length of stay]. Based on the PMI, patients were divided into two groups: "Improved" (PMI > 0) and "Not improved" (PMI ≤ 0). RESULTS: A total of 136 patients were included in this analysis. The hospital mortality rate was 16.2%. The Perme Score improved significantly when comparing ICU discharge with ICU admission [20.0 (7-28) points versus 7.0 (0-16) points; P < 0.001]. A total of 88 patients (64.7%) improved their mobility level during ICU stay, and the median PMI of these patients was 1.5 (0.6-3.4). Patients in the improved group had a lower duration of mechanical ventilation [10 (5-14) days versus 15 (8-24) days; P = 0.021], lower hospital length of stay [25 (12-37) days versus 30 (11-48) days; P < 0.001], and lower ICU and hospital mortality rate. Independent predictors for mobility level were lower age, lower Charlson Comorbidity Index, and not having received renal replacement therapy. CONCLUSION: Patients' mobility level was low at ICU admission; however, most patients improved their mobility level during ICU stay. Risk factors associated with the mobility level were age, comorbidities, and use of renal replacement therapy.


Assuntos
COVID-19/fisiopatologia , Limitação da Mobilidade , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , COVID-19/epidemiologia , COVID-19/terapia , Estudos de Coortes , Cuidados Críticos , Feminino , Mortalidade Hospitalar , Hospitalização , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Respiração Artificial , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2/isolamento & purificação , Resultado do Tratamento
18.
Lancet Neurol ; 20(5): 362-372, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33770527

RESUMO

BACKGROUND: The European Friedreich's Ataxia Consortium for Translational Studies (EFACTS) investigates the natural history of Friedreich's ataxia. We aimed to assess progression characteristics and to identify patient groups with differential progression rates based on longitudinal 4-year data to inform upcoming clinical trials in Friedreich's ataxia. METHODS: EFACTS is a prospective, observational cohort study based on an ongoing and open-ended registry. Patients with genetically confirmed Friedreich's ataxia were seen annually at 11 clinical centres in seven European countries (Austria, Belgium, France, Germany, Italy, Spain, and the UK). Data from baseline to 4-year follow-up were included in the current analysis. Our primary endpoints were the Scale for the Assessment and Rating of Ataxia (SARA) and the activities of daily living (ADL). Linear mixed-effect models were used to analyse annual disease progression for the entire cohort and subgroups defined by age of onset and ambulatory abilities. Power calculations were done for potential trial designs. This study is registered with ClinicalTrials.gov, NCT02069509. FINDINGS: Between Sept 15, 2010, and Nov 20, 2018, of 914 individuals assessed for eligibility, 602 patients were included. Of these, 552 (92%) patients contributed data with at least one follow-up visit. Annual progression rate for SARA was 0·82 points (SE 0·05) in the overall cohort, and higher in patients who were ambulatory (1·12 [0·07]) than non-ambulatory (0·50 [0·07]). ADL worsened by 0·93 (SE 0·05) points per year in the entire cohort, with similar progression rates in patients who were ambulatory (0·94 [0·07]) and non-ambulatory (0·91 [0·08]). Although both SARA and ADL showed slightly greater worsening in patients with typical onset (symptom onset at ≤24 years) than those with late onset (symptom onset ≥25 years), differences in progression slopes were not significant. For a 2-year parallel-group trial, 230 (115 per group) patients would be required to detect a 50% reduction in SARA progression at 80% power: 118 (59 per group) if only individuals who are ambulatory are included. With ADL as the primary outcome, 190 (95 per group) patients with Friedreich's ataxia would be needed, and fewer patients would be required if only individuals with early-onset are included. INTERPRETATION: Our findings for stage-dependent progression rates have important implications for clinicians and researchers, as they provide reliable outcome measures to monitor disease progression, and enable tailored sample size calculation to guide upcoming clinical trial designs in Friedreich's ataxia. FUNDING: European Commission, Voyager Therapeutics, and EuroAtaxia.


Assuntos
Atividades Cotidianas , Progressão da Doença , Ataxia de Friedreich/complicações , Ataxia de Friedreich/fisiopatologia , Adulto , Estudos de Coortes , Europa (Continente) , Feminino , Ataxia de Friedreich/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Sistema de Registros , Fatores de Tempo , Adulto Jovem
19.
Rev Recent Clin Trials ; 16(3): 316-321, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33726657

RESUMO

BACKGROUND AND OBJECTIVE: We aimed to examine the differences in life-space mobility and quality of life (QoL) of patients with cardiovascular disease (CVD) between the pre- and postnationwide state of emergency initiated by the Coronavirus disease 2019 (COVID-19) pandemic in Japan and to show the factors associated with the decrease in life-space mobility and QoL in these patients. METHODS: We undertook a longitudinal study of 20 out of 51 consecutive CVD patients with coronary artery disease (CAD) who met the study criteria. We used the Life-Space Assessment (LSA) tool to evaluate Life-space mobility and assessed QoL with the five-level EuroQoL five-dimensional questionnaire (EQ-5D-5L) in Japanese. RESULTS: The LSA scores and EQ-5D-5L QoL score decreased significantly from the pre- to postnationwide state of emergency in Japan (p < 0.01). ΔLSA was significantly positively associated with body mass index and significantly negatively associated with knee extensor muscle strength and pre-LSA score (p < 0.05). There were no significant relationships between ΔLSA and ΔEQ- 5D-5L QoL scores and between ΔEQ-5D-5L QoL scores and patient characteristics. CONCLUSION: The policies promoted to address the state of emergency in Japan might affect life-space mobility and QoL of CAD patients. Moreover, CAD patients in Japan who were not obese and maintained their physical function and activity tended to refrain from activity during the period between the pre- and post-nationwide state of emergency. Clarification of the effects of the COVID-19 pandemic on the relationship between living space motility and QoL in CAD patients will require further study.


Assuntos
COVID-19/epidemiologia , Doenças Cardiovasculares/epidemiologia , Índice de Massa Corporal , Política de Saúde , Humanos , Japão/epidemiologia , Estudos Longitudinais , Limitação da Mobilidade , Força Muscular , Pandemias , Qualidade de Vida
20.
Brain Behav ; 11(5): e02092, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33650788

RESUMO

OBJECTIVES: The objective of this study was to investigate the role of mobility limitations and vitality, as well as additional factors such as comorbidities, to predict post-stroke pain. MATERIALS & METHODS: This study included cross-sectional data from 214 participants living in varied settings in different parts of Sweden. Participants were asked to complete the Stroke Impact Scale, Medical Outcomes Study Short Form 36, and Self-administered Comorbidity Questionnaire to evaluate mobility, vitality, comorbidities, and pain. Descriptive statistics were used for demographic and clinical characteristics. Binary logistic regression analysis was performed to predict the pain domain score on Medical Outcomes Study Short Form 36. RESULTS: The mean age of all participants in the sample was 66 years (SD 14); 43.4% of the study population were women. After analyses, "standing without losing balance and vitality'' were found to be significant predictors in the model which explained the pain score on Medical Outcomes Study Short Form 36. CONCLUSIONS: In conclusion, the results suggest that restrictions in mobility and low vitality have an important role on the occurrence of post-stroke pain. Having post-stroke pain could be due to not able to stand without losing balance and low vitality. Thus, rehabilitation professionals may consider the importance of these factors, especially mobility restrictions, in preventing post-stroke pain.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Atividades Cotidianas , Idoso , Estudos Transversais , Feminino , Humanos , Limitação da Mobilidade , Dor/etiologia , Acidente Vascular Cerebral/complicações , Suécia/epidemiologia
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