Does musculoskeletal function deteriorate in a predictable sequence in the elderly?

A variety of functions decline with aging, but whether losses occur in a predictable sequence is unknown. Improved understanding might facilitate the early detection and possible prevention of functional deterioration. We assessed self-reported difficulty with functional tasks in 288 community-dwelling elderly aged 65 to 97. We hypothesized that the ability to perform tasks involving strength, skill, and endurance (run errands, shop, yardwork or housework) would be lost first, followed by activities requiring less strength or mobility (rise from a chair with no hands, walk), followed by easier, but essential tasks (pick up clothes, rise from bed, lift a cup to the mouth). The patterns of decline were evaluated with Guttman scalograms. Picking up clothes and walking were reversed from the predicted order. Scale reliability was 0.92, indicating that functional decline is ordered; 75% of subjects fell into one of the modal sequence types. Analysis by self-reported presence of arthritis showed that 83% of nonarthritic subjects fit the predicted patterns (reliability = 0.95) versus 65% of arthritic subjects (reliability = 0.86), who tended to lose hand ability out of sequence. Sequential functional loss scales may tell more than the typical simple summation of functional loss, and may have predictive value to the clinician monitoring an elderly patient. If the sequence is accelerated or out of order, such as was seen in patients with arthritis, it may indicate the need for intervention. Examination of sequences of loss may help characterize adaptations to impairment and differences among subgroups.

Productivity analysis.

This paper discusses productivity analysis, a method used in the Department of Rehabilitation Services at the Brigham and Women's Hospital in Boston to measure the efficiency of occupational therapy services. Input and output information forms are displayed for a computerized program of productivity analysis. Input information includes time and nontime (modality) units and scheduled downtime. Output reports contain productivity analyses which allow the manager to monitor the ratio between actual hours worked by therapists and allocated hours per service. The data generated give weekly, monthly, and yearly feedback on performance by service and discipline. The objective information produced by these reports on service and department function contributes to management decisions on resource allocation and equipment requests.

A cost analysis and management reporting system in occupational therapy.

Productivity management through cost analysis is fundamental in today's health care. A description of a cost analysis and management reporting system based on relative value units is presented in this article along with a practical method of identifying variable, fixed, and total costs for occupational therapy. Occupational therapy management participation in the cost analysis process is also discussed.

Clinical exercise trial for stroke patients.

This investigation evaluated the effectiveness of the traditional and facilitation approaches to therapeutic exercise in stroke patients. A total of 42 adults (24 men and 18 women) with a mean age of 61.6 years (SD = 21) were selected from a larger population of hospitalized stroke victims. Stroke patients were classified by CT scan information and judged medically fit to participate in a nonrestrictive program by neurologic examinations and laboratory tests. The Barthel Index and the manual muscle test were administered at admission and discharge. Both facilitation and traditional exercise therapies improved functional and motor performance, but there were no significant differences between these approaches. The lack of differences between the facilitation and traditional exercise therapies may be due to heterogeneity of the stroke population, the small sample size, and the measurements used. The study demonstrates the need for a measurement instrument capable of reliably assessing the facilitation approach. Future investigations should incorporate lesion type, site, and side along with global measurements in evaluating differences among motor remediation approaches.

Objectively measuring physical ability in elderly persons: the Physical Capacity Evaluation.

The Physical Capacity Evaluation, a performance measure of functional capabilities comprised of 13 tasks simulating those used in activities of daily living, was tested on 289 community-dwelling elderly people and compared against a widely used self-report measure of function, the Health Assessment Questionnaire. Factor analysis identified one dominant component in each instrument. Internal consistency reliability (Cronbach's alpha) was .90 for both instruments. Global disability (Health Assessment Questionnaire) and function (Physical Capacity Evaluation) scores were correlated -.74. One-week retest reliabilities on 58 subjects were .94 for the Physical Capacity Evaluation and .95 for the Health Assessment Questionnaire. The Physical Capacity Evaluation is a valid and reliable measure of physical performance for use with elderly people.