[Association between working in small-scale cultivated land as a daily-life task and the physical and cognitive functions among elderly people in hilly and mountainous areas]

AIM

This study aimed to verify whether working in cultivated land as a daily-life task contributes to the maintenance and improvement of physical and cognitive functions.

METHODS

The participants were 91 elderly people of ≥65 years of age who owned cultivated land in the mountainous Koyadaira district in Tokushima Prefecture. Sex, age, body mass index (BMI), walking speed as a physical function, and the mini-mental status examination (MMSE) score as a cognitive function were measured and analyzed in addition to the total working hours per week (WH) in cultivated land.

RESULTS

The participants were 31 males and 60 females (mean age 78.5±6.6 years). The average values of the evaluated variables were as follows: WH, 18.0±13.2; BMI, 23.4±3.0 kg/m2; walking speed, 0.95±0.28 m/s; and MMSE score, 26.6±3.1 points. In addition, the Mann-Whitney U test and the Chi-square test showed no significant differences between sexes for each item. A logistic regression analysis showed that WH was significantly associated with MMSE (1, ≥28 points; 0, <28 points), and the odds ratio was 1.054 (p=0.010) in the model adjusted for age and BMI, while it was not significantly associated with walking speed (1, ≥1 m/s; 0, <1 m/s).

CONCLUSIONS

Working on small-scale cultivated land was significantly associated with the cognitive function but not the physical function. Routine work on small-scale cultivated land as a daily-life task would contribute to the suppression of cognitive decline in older people living in hilly and mountainous areas.

Effect of dietary diversity on incident of disability in community-dwelling older adults with sarcopenia: A 40-month follow-up longitudinal study

BACKGROUND

Sarcopenia is a clinical issue in older adults that leads to serious adverse health outcomes, including disability. The present study investigated whether dietary diversity affects the incidence of disability in older adults with sarcopenia.

METHOD

Participants were 759 Japanese older adults with sarcopenia (mean age 77.2 ± 6.0 years; 44.4 % men) who were aged ≥65 years at the time of the examination. Sarcopenia was diagnosed according to the recommendations of the European Working Group on Sarcopenia in Older People 2. Dietary diversity was assessed using a diet variety score. This diet variety score assessed the one-week consumption frequency of ten food groups, according to the following responses: "eat almost every day" (1 point), or "not eaten almost daily" (0 points). Older adults with a diet variety score of 3 or more points were defined as having high dietary diversity. Incident disability was certified by long-term care insurance (mean follow-up duration 32 months).

RESULTS

The cumulative disability incidence rates in the older adults with low dietary diversity and high dietary diversity were 23.3 % and 16.9 %, respectively. Cox proportional hazards regression analysis revealed high dietary diversity was associated with a lower risk of incident disability in older adults with sarcopenia (hazard ratio 0.66, 95 % confidence interval 0.47-0.92; p = 0.015), after adjusting for covariates.

CONCLUSIONS

This longitudinal study revealed that high dietary diversity is associated with a lower risk of incident disability among sarcopenic Japanese older adults.

Multicomponent and power training with elastic bands improve metabolic and inflammatory parameters, body composition and anthropometry, and physical function in older women with metabolic syndrome: A 20-week randomized, controlled trial

PURPOSE

This study aimed to explore the effects of 20 weeks of multicomponent or power training with elastic bands (EBs) on metabolic and inflammatory blood parameters, body composition, anthropometry, and physical function in older women with metabolic syndrome (MS).

METHODS

Ninety participants were randomly assigned to a multicomponent (MCG; n = 30), power (PG; n = 30), or a control group (CG; n = 30). The MCG performed balance, slow-speed strength, and aerobic training, twice per week. The PG completed a high-speed resistance training program twice per week, composed of three to four sets of ten repetitions of six overall body exercises at a perceived rating of effort for the first repetition of 3-4 on the OMNI-Resistance Exercise Scale EB. MS-related variables (glucose, triglycerides, and waist circumference) and cardiometabolic risk factors (high-density lipoprotein [HDL], glycosylated hemoglobin, total cholesterol, low-density lipoprotein cholesterol [LDL], C-reactive protein, and anthropometric profile) were assessed. Physical function was evaluated through balance, strength, and mobility tests.

RESULTS

An analysis of variance revealed that both training groups similarly improved most glycemic and lipidic profile parameters (p ≤ 0.006; d ≥ 0.46), body composition and anthropometry (p < 0.001; d ≥ 0.41), and physical function (p ≤ 0.005; d ≥ 0.69). Opposed to the PG, the MCG improved balance (p < 0.001; d = 0.96) and decreased the inflammatory status by downregulating C-reactive protein (p = 0.003; d = 0.47). On the other hand, the PG exhibited improvements in handgrip strength (p = 0.006; d = 0.48), while the MCG did not.

CONCLUSION

Therefore, multicomponent and power training with EBs are plausible strategies for improving the cardiometabolic health status and physical function in older women with MS.

Effects of comprehensive geriatric assessment-guided interventions on physical performance and quality of life in older patients with advanced cancer: A randomized controlled trial (PROGNOSIS-RCT)

INTRODUCTION

Older patients with frailty starting oncological treatment are at higher risk of experiencing declining physical performance, loss of independence, and quality of life (QoL). This study examines whether comprehensive geriatric assessment (CGA)-guided interventions added to standard oncological care can prevent declining physical performance and QoL in older patients with frailty initiating palliative treatment.

MATERIALS AND METHODS

Patients aged ≥70 years, with a Geriatric-8 score of ≤14, initiating palliative oncological treatment were enrolled in an open label randomized controlled trial and randomized 1:1 to receive either CGA-guided interventions in addition to oncological standard care or oncological care alone. Baseline characteristics, physical performance measures, and QoL questionnaires were retrieved before group allocation. CGA was performed using a fixed set of domains and validated tests by a geriatrician-led team. The primary endpoint, physical performance, was measured by the 30-s chair stand test (30s-CST) at three months. Additional outcomes included 30s-CST at six months, handgrip strength test, and QoL. Outcomes were analyzed using linear mixed regression models. The trial was registered at clinicaltrials.org (NCT04686851).

RESULTS

From November 1, 2020 to May 31, 2022, 181 patients were included; 88 in the interventional arm and 93 in the control arm. Median age was 77 (interquartile range [IQR] 73-81) years, 69% were male, median Geriatric-8 score was 12 (IQR 10-13), 69% had a Performance Status of 0-1, and the median 30s-CST was 9 (IQR 5-11) repetitions. The between-group difference in 30s-CST at three months was 0.67 (95%CI: -0.94 - 2.29) and 1.57 (95%CI: -0.20 - 3.34) at six months, which were not statistically significant. Subgroup analysis including participants with a baseline Geriatric-8 of 12-14 found borderline significant between-group differences in 30s-CST scores at three and six months of 2.04 (95% confidence interval [CI]: -0.07 - 4.2, P = 0.06) and 2.25 (95%CI: 0.01-4.5, P = 0.05), respectively. No within-group or between-group differences in the summary score or the Elderly Functional Index score (measuring QoL) were found.

DISCUSSION

This study did not find significant between-group differences in the 30s-CST in older patients receiving palliative care. However, a tendency towards improved physical performance was seen in the least frail. These patients may represent a target group wherein CGA interventions provide particular benefit.

Nutrition Interventions on Muscle-Related Components of Sarcopenia in Females: A Systematic Review of Randomized Controlled Trials

Sarcopenia is a skeletal muscle disease categorized by low muscle strength, muscle quantity or quality, and physical performance. Sarcopenia etiology is multifaceted, and while resistance training is widely agreed upon for prevention and treatment, disease progression is also highly related to poor diet. The incidence of sarcopenia appears sex-specific and may be increased in females, which is problematic because dietary quality is often altered later in life, particularly after menopause. Identifying effective nutrition or supplementation interventions could be an important strategy to delay sarcopenia and related comorbidities in this vulnerable population. This systematic review examined randomized controlled trials (RCTs) of nutrition strategies on muscle-related components of sarcopenia in middle-aged and older females. A protocol was registered (PROSPERO CRD42022382943) and a systematic search of MEDLINE and CINAHL was undertaken. RCTs from 2013 to 2023 that assessed nutrition-only interventions on muscle mass, muscle strength, and physical function in female participants were included. Fourteen RCTs were included based on selection criteria. Study designs and interventions were heterogeneous in supplementation type and amount, age, and duration. Six RCTs reported beneficial effects of protein, Vitamin D, Vitamin D and Magnesium (Mg), and fish oil on muscle protein synthesis, muscle strength, and/or muscle function. Eight studies that examined various protein interventions, VitD alone, Mg alone, and dairy derivatives did not demonstrate any effect. Exercise appeared to modulate results in several studies. Nutrition interventions alone are likely to have a limited but positive effect on muscle-related components of sarcopenia in females. Current evidence suggests that a combination of dietary intervention and exercise is likely to be key to preventing and treating sarcopenia in middle aged and older females and there is a need for well-designed nutrition based studies in this population.

Longitudinal changes in cognitive and physical function and health-related quality of life in older adults with acute myeloid leukemia

INTRODUCTION

Many older adults with acute myeloid leukemia (AML) do not receive chemotherapy because of physicians' and patients' concern for toxicities and functional decline. This highlights the critical and urgent need to generate knowledge of functional changes following new treatments.

MATERIALS AND METHODS

As a part of a pragmatic single-center trial, 59 older adults ≥60 years with AML completed geriatric assessment and health-related quality of life measures before treatment and at one month and three months after chemotherapy initiation. Changes in scores of various geriatric assessment measures were computed by subtracting the baseline score from the one-month and three-month scores for each patient. Established cut-offs were used to determine a clinically meaningful change (improvement or worsening). This study provides results of descriptive exploratory analyses.

RESULTS

Patients experienced significant comorbidity burden and a high prevalence of functional impairments before treatment, with 56% of patients having ≥2 comorbid conditions, 69% having abnormal cognitive function (using Montreal Cognitive Assessment), 69% having impaired objective physical function (using Short Physical Performance Battery), and 64% having a positive depression screen (Patient Health Questionnaire-9). Patients (n = 53) received treatment with predominantly low-intensity chemotherapy; six patients received intensive chemotherapy. Among those who completed some or all of the three-month evaluation (N = 43), from baseline before treatment to three months later, cognitive function improved (38.7%) or remained stable (38.7%), objective physical function improved (51.6%) or remained stable (22.6%), and depression scores improved (9.4%) or remained stable (53.1%). Global health status score and role functioning moderately improved by a score of >16.

DISCUSSION

An exploratory analysis of our phase 2 trial demonstrated improvement or stabilization of cognitive and physical function and depression score at three months in a high proportion of older survivors of AML, despite a high prevalence of frailty and significant comorbidity burden at baseline. These results demonstrate success of treatment in improving cognitive and physical function and depression score, and, if confirmed in larger studies, should encourage oncologists to offer chemotherapy to older adults with AML.

CLINICAL TRIAL REGISTRATION

The study is registered in the ClinicalTrials.gov ID: NCT03226418.

Effects of video game-based therapy in an adolescent with cerebral palsy: A case report

BACKGROUND

Herein, we report the case of a 13-year-old boy with spastic quadriplegia cerebral palsy (CP) at Gross Motor Function Classification System (GMFCS) level II, engaging in a 6-wk video game-based therapy (VBT) program. This study aimed to offer essential insights regarding VBT's impact on enhancing the physical function and improving the quality of life (QoL) of adolescents diagnosed with CP. This report provides a distinctive viewpoint that can inform and direct future clinical practices and research endeavors.

CASE SUMMARY

The boy presented with moderate mobility, balance, and overall well-being. He faced challenges with diminished lower limb strength, which affected his daily living and physical fitness capabilities. Our participant was diagnosed with spastic quadriplegic CP at GMFCS level II. He participated in a 6-wk program of VBT using a play station. This innovative approach incorporates warm-up exercises, interactive activities, and cool-down routines, targeting various movements, including single-leg stance, weight shifting, kicking, jumping, marching, and squatting. After VBT, the strength of the left hip extensor significantly increased from 199.3 N to 541.3 N. Distance covered as part of a 6-min walk test increased by 82 m. His Paediatric QoL Inventory score increased dramatically by 25.9%.

CONCLUSION

VBT is an innovative, individualized therapy that enhances physical function and QoL in CP, emphasizing its role in ambulatory patients.

Influence of changes in pelvic anteversion during gait on walking ability and physical function in patients with adult spinal deformity: A cross-sectional study

BACKGROUNDS

Evaluation of gait posture using a three-dimensional motion analysis system (3DMAS) revealed that elderly patients with adult spinal deformity (ASD) experience pelvic anteversion while walking. The purpose of this study was to investigate the influence of changes in pelvic anteversion during gait on walking ability and physical function in patients with ASD.

METHODS

Fifty-four patients with ASD aged 50 years or older who were admitted to our hospital between March 2016 and December 2021 were included in the study. The 6-min walking distance (6MWD) was used to evaluate walking ability, and trunk and hip extensor strength were measured to evaluate physical function in the subjects. The 3DMAS was used to measure the subject's changes in pelvic anteversion during gait. After measuring the changes in pelvic anteversion, the median value of the study subjects was calculated, according to which the subjects were divided into two groups (small anteversion [S] group, large anteversion [L] group). Walking ability and physical function were compared between the two groups.

RESULTS

The number of subjects in each group was 27. Comparisons of walking ability and physical function between the groups revealed significant differences in 6MWD (S group, 333.6 ± 111.2 m; L group, 238.0 ± 106.3 m) and hip extensor strength (S group, 15.8 ± 3.8 kgf; L group, 13.4 ± 4.4 kgf). No significant differences regarding trunk extensor strength were observed between the groups (S group, 15.2 ± 4.0 kgf; L group, 12.9 ± 4.8 kgf).

CONCLUSION

The results of the present study revealed that ASD patients with greater pelvic anteversion associated with walking have lower walking ability and physical function. These results suggest the importance of evaluating the posture of ASD patients not only by using radiographic findings but also by assessing movement, such as gait posture.

Do physical fitness and cognitive function mediate the relationship between basic activities of daily living and quality of life in older adults with dementia?

PURPOSE

Independence in activities of daily living (ADLs) is associated with quality of life (QoL) in individuals with dementia. However, the contribution of physical and cognitive functions to this relationship needs further examination. This study aims to examine the mediating effect of physical fitness and cognitive function in the relationship between independence in basic ADLs and QoL among older adults with dementia.

METHODS

This cross-sectional study included 107 older adults with dementia (74.8% women; age 78.21 ± 7.70 years). Independence in basic ADL and QoL were evaluated using the Barthel Index (BI) and QoL- Alzheimer's Disease Scale, respectively. The Alzheimer's Disease Assessment Scale-Cognitive Subscale and the Mini-Mental State Examination were applied to assess cognitive function. Physical fitness was evaluated using the 30-s chair stand, 2-min step and the Timed-Up and Go tests. A structural equation modelling (SEM) with bootstrapping estimation was conducted to determine the relationship between all variables.

RESULTS

Independence in basic ADL positively affected QoL and this association was mediated by physical fitness (β = 0.242, p = 0.011). No statistically significant results were observed when testing cognitive function as a mediator between BI and QoL (β = 0.009, p = 0.345).

CONCLUSIONS

Physical fitness (i.e., lower body strength, aerobic capacity, and mobility) plays a role in the relationship between basic ADL independence and QoL of older adults with dementia, reinforcing the need to improve and monitor these parameters throughout the disease progression. Future longitudinal studies should explore the temporal relationship between physical and cognitive function and its contribution to basic ADL independence and QoL.

The reliability and suitability of strength assessments in frail and pre-frail older adults: recommendations for strength testing in older populations

BACKGROUND

Lifelong strength is fundamental to physical function, health, and quality of life. Reliable appropriate strength assessment measures for older adults play an important role in effective evaluation of baseline ability and exercise prescription to counter disease and disuse. This study aimed to investigate the within-session reliability of maximal isometric knee extension and flexion, hip abduction and adduction, and handgrip strength measures in frail and pre-frail older adults.

METHOD

The study was conducted at a residential care home in Birmingham, UK. All care home residents aged ≥ 65 years; pre-frail or frail according to the Fried Frailty phenotype criteria; able to speak and read English; not currently involved in any other clinical trial; without severe sensory impairments; and with a predicted life expectancy greater than the trial length were eligible. Maximal isometric lower limb testing was performed using specialised resistance training equipment and a portable measurement device, and grip strength was assessed using a portable dynamometer. All eligible participants attended a single testing session and performed three trials per measure. Peak force measures were obtained for analysis. Within-session reliability for each measure was calculated from repeated-measures analysis of variance, intraclass correlation coefficients (ICC), and coefficients of variation (CV) with 95% confidence intervals.

RESULTS

Eleven frail and eleven pre-frail older adults participated in the study. Within-session absolute and relative measures were found to be reliable with the highest overall repeatability indicated between trial 2 and trial 3 for knee extension, hip abduction, and handgrip (CV ≤ 4.65%, ICC ≥ 0.96) with variation evident across all measures, except knee extension, from trial 1 to 2.

CONCLUSIONS

Overall, maximal isometric strength in frail and pre-frail older adults with no previous testing experience can be measured with good to high reliability within their first testing session. An initial two familiarisation trials followed by two measurement trials is recommended to achieve the highest level of overall repeatability.

TRIAL REGISTRATION

The trial was registered with ClinicalTrials.gov: NCT03141879 on 05/05/2017.

Epidemiology and Functional Impact of Early Peripheral Neuropathy Signs in Older Adults from a General Population

INTRODUCTION

Peripheral neuropathy (PN) becomes more common with increasing life expectancy, but general population prevalence estimates are lacking. We investigated an epidemiological distribution of signs of PN among 2,996 community-dwelling participants in Good Aging in Skåne Study, age 60-97, and their impact on physical and autonomic function.

METHODS

Signs of PN were measured with Utah Early Neuropathy Scale (UENS). Associations between UENS and physical tests, pain, and dysautonomic phenomena were calculated for each sex, adjusted for age, with estimated marginal means (EMM) and odds ratios (ORs) in four UENS quantiles (Q1-Q4).

RESULTS

Participants in Q4 had worse EMM for: time to complete Timed Up and Go test (Q4-Q1: male 10.8-9.6 s; female 11.7-10.2 s), 15 m Walk test (Q4-Q1: male 11.1-9.9 s; female 11.2-10.4 s), and fewer repetitions in Step test (Q4-Q1: male 15.2-17.0 steps; female 14.5-15.8 steps). Higher OR of failing one-leg balance 60 s test {male 2.5 (confidence interval [CI] 95%: 1.7-3.8); female 2.1 (1.1-3.2)}, Foam Pad Balance test (male 4.6 [CI 95%: 3.2-6.7]; female 1.8 [1.3-2.6]), and lower physical quality of life were seen in Q4 compared to Q1. Participants in Q4 had higher OR for walking aid usage, falls, fear of falling, pain, and urinary incontinence, while in males, higher OR for orthostatic intolerance, fecal incontinence, and constipation.

CONCLUSIONS

In a general population, 20-25% of older adults who have highest UENS scores, a sensitive measure of early PN, express slower gait, worse balance, lower quality of life, pain, falls and fear of falling, and autonomic symptoms.

Relating depression, anxiety, stress and loneliness to 5-year decline in physical function and frailty

OBJECTIVES

While depression has been associated with physical function decline and worsening frailty in older adults, the impact of other mental health symptoms on physical function and frailty is unknown. The study objective was to determine whether depression, perceived stress, loneliness, and anxiety symptoms affect 5-year physical function and frailty trajectories of older adults.

METHODS

The National Social Life, Health, and Aging Project (NSHAP) is a nationally-representative study of adults born between 1920 and 1947. The analysis included data collected in 2010-11 and 2015-16. Mental health symptoms were quantified using NSHAP's measures of anxiety (range:0-21), perceived stress (0-8), depression (0-22), and loneliness (0-6); higher scores indicated worse symptoms. We regressed 2015-16 3 m usual walk time, five-repeated chair stand time or an adapted frailty phenotype scale (0-4) separately on each 2010-11 mental health scale, adjusting for baseline physical function or frailty, demographics, and comorbidities.

RESULTS

In separate models, every one-point increase on the depression or perceived stress scales was associated with, respectively, a 0.06 s slower (95 % CI: 0.03, 0.10) or 0.09 s slower (95 % CI: 0.01, 0.16) 5-year walk time. Every one-point increase on the depression or perceived stress scales was associated with a 0.15 s slower (95 % CI: 0.06, 0.23) or 0.16 s slower (95 % CI: 0.02, 0.29) 5-year chair stand time. Every one-point increase on the depression scale predicted 0.06 higher log odds of having a worse frailty score 5 years later. Only depression's association with 3 m walk time and chair stands remained significant in models including all four mental health scales.

DISCUSSION

Older adults with more depression and to a lesser extent stress symptoms may experience faster physical function decline and worsening frailty. Future work exploring and addressing the mechanisms underlying these relationships are warranted.

[Treatment response and complications of older patients with ANCA(antineutrophil cytoplasmatic antibody)-associated vasculitis]

BACKGROUND

ANCA (antineutrophil cytoplasmatic antibody)-associated vasculitis (AAV) mainly affects elderley people but adjusted therapy concepts for this patient group are lacking.

AIM

The aim of this study was therefore to analyze differences in course and outcome of patients with AAV with respect to age.

MATERIALS AND METHODS

62 patients were analyzed for treatment response, of whom 53 (85%) experienced adverse events (AE and SAE) that could be evaluated. Older (> 65 yrs.) versus younger (< 65 yrs.) patients were compared. Treatment response was assessed at 6 months, complications were assessed over 18 months.

RESULTS

Treatment response was not seen to differ by age groups. In multiple logistic regression, pulmonary involvement (OR = 6,9; CI = 1,7-27,8, p < 0,01) and ΔGFR [ml/min] (OR = 0,93; CI = 0,89-0,97, p < 0,01) were predictors of SAE. 14 patients had more than 1 SAE. Again, pulmonary involvement (28,2% vs. 78,6%, p < 0,01) was a risk factor and older patients (78,6% vs. 43,6%, p = 0,025) were more frequently affected. Patients with multiple SAEs received glucocorticoids of more than 5 mg/d for longer periods of time (171 ± 65 days vs. 120 ± 70 days, p = 0,03).

DISCUSSION

No differences were found between older and younger patients with regard to treatment response. Multiple SAEs occurred more frequently in elderly patients. There was a correlation between pulmonary manifestation and duration of glucocorticoid therapy with a complicated course. The most frequent SAEs were infections requiring hospitalisation.

CONCLUSION

Therapy for elderly patients should be individualized with the goal of a fast reduction of glucocorticoids. Special monitoring is indicated for elderly patients, especially those with pulmonary involvement.

The combined deleterious effects of multiple sclerosis and ageing on neuromuscular function

BACKGROUND

The prevalence of older (>60 years) people with multiple sclerosis (pwMS) is increasing. This introduces numerous challenges, as both MS and ageing independently contribute to the deterioration of neuromuscular function.

AIM

The aim was to compare the neuromuscular function in pwMS and healthy controls (HC) across three age groups: young, middle-aged, and old.

METHODS

Using a cross-sectional study design, the maximal muscle strength (Fmax) and rate of force development (RFD) of the knee extensors (KE) and plantar flexors (PF) were assessed using an isokinetic dynamometer. In addition, voluntary activation (VA) and resting twitch (RT) were measured using the interpolated twitch technique.

RESULTS

The Fmax, RFD, and VA of the KE were reduced in pwMS compared to HC across age groups. In pwMS, reductions were observed in PF Fmax, RFD, and RT, predominantly in the middle-aged and old age groups. Reductions increased with age in KE for both groups (except for VA) but in PF only for pwMS. The "trajectory" differed between pwMS and HC, as pwMS showed reductions from young to middle age, while HC showed reductions from middle to old age in KE.

CONCLUSION

The combined negative effects of MS and ageing on neuromuscular function were especially present in the PF but also substantial in the KE. RFD showed large deficits for pwMS compared to HC across age groups. The findings can partly be explained by a reduction in VA and RT, but further investigations of neural regulation are needed to explain large RFD deficits.

Nutritional strategies to optimise musculoskeletal health for fall and fracture prevention: Looking beyond calcium, vitamin D and protein

Falls and osteoporotic fractures are a major public health problem, particularly among older adults. A third of individuals aged 65 years and over fall at least once each year, with up to 20 % of these resulting in serious injury, including fracture. In conjunction with regular exercise, the importance of diet for musculoskeletal health has largely focused upon calcium, vitamin D, and protein, particularly in the context of preventing falls and fractures. Whilst there is evidence for the benefits of these nutrients for musculoskeletal health, other aspects of the diet remain largely underexplored. For example, vegetables are rich sources of macro- and micronutrients that are essential for muscle function and bone health, which are key factors in the prevention of falls and fractures. Recent work has highlighted the importance of nutrients such as vegetable-derived nitrate and vitamin K1 in optimising muscle strength, physical function, and bone quality. In the context of dietary patterns, vegan/plant-based diets have recently gained popularity due to perceived health benefits, animal welfare, or to tackle climate change. The elimination and/or substitution of animal-based products for plant foods (without careful planning and/or expert dietary guidance) could, however, have long-term negative musculoskeletal consequences; a trend uncovered by recent evidence. Within the overarching theme of nutrition for fall and fracture prevention in older populations, the aim of this review is to (i) summarise the current evidence for calcium, vitamin D and protein; (ii) describe the importance of vegetables and selected nutrients, such as nitrate and vitamin K1, for muscle function and bone structural integrity; and (iii) highlight current evidence around different dietary patterns (e.g., plant-based, diet quality, data driven approaches) and their impact on musculoskeletal health.

Relationship of Age And Mobility Levels During Physical Rehabilitation With Clinical Outcomes in Critical Illness

Objective

To determine whether age, mobility level, and change in mobility level across the first 3 physical rehabilitation sessions associate with clinical outcomes of patients who are critically ill.

Design

Retrospective, observational cohort study.

Setting

Medical Intensive Care Unit (MICU).

Participants

Hospitalized adults (n = 132) who received 3 or more, consecutive rehabilitation sessions in the MICU.

Interventions

Not applicable.

Measurements and Main Results

Sample included 132 patients with 60 (45%) classified as younger (18-59 years) and 72 (55%) as older (60+ years). The most common diagnosis was sepsis/septicemia (32.6%). Older relative to younger patients had a significantly slower rate of improvement in ICU Mobility Scale (IMS) scores across rehabilitation sessions (mean slope coefficient 0.3 vs 0.6 points, P<.001), were less likely to be discharged to home (30.6% vs 55.0%, P=.005), and were more likely to die within 12 months (41.7% vs 25.0%, P=.046). Covariate-adjusted models indicated greater early improvement in IMS scores were associated with discharge home (P=.005). Longer time to first rehabilitation session, lower initial IMS scores, and slower improvement in IMS scores were associated with increased ICU days (all P<.03).

Conclusion

Older age and not achieving the mobility milestone of sitting at edge of bed or limited progression of mobility across sessions is associated with poor patient outcomes. Our findings suggest that age and mobility level contribute to outcome prognostication, and can aide in clinical phenotyping and rehabilitative service allocation.

Effectiveness of percutaneous balloon compression (PBC) in improving physical function and quality of life in trigeminal neuralgia: a retrospective study

OBJECTIVE

To evaluate the effectiveness of percutaneous balloon compression (PBC) in treating trigeminal neuralgia (TN) and determine improvements in quality of life (QoL) and daily functional status.

METHODS

Data from primary TN (pTN) patients treated with PBC from December 2018 to April 2021 were retrospectively analyzed. Short-Form 36 (SF-36) Health Survey and Functional Independence Measure (FIM) assessments were used to evaluate patients' QoL and physical function every 6 months after surgery, and facial pain was evaluated every 3 to 6 months post-surgery.

RESULTS

A total of 80 pTN patients were enrolled for analysis. The Barrow Neurological Institute (BNI) scores of I-II were achieved in 67 (83.8%) patients immediately after the surgery. The estimated rates of BNI I-II pain relief at one, two, and three years were 94.2%, 87.6%, and 83.2%, respectively. All aspects of the SF-36 questionnaire were significantly improved after the PBC, especially in terms of role physical (RP), bodily pain (BP), and social functioning (SF). Patients' functional outcomes measured by FIM at the 6-month follow-up examination were 108.6 ± 9.9, which was significantly improved compared with the pretreatment scores (90.8 ± 12.7). There was no difference between the severity of facial numbness in FIM and any item of the SF-36 except RP (P = 0.004) at 6 months after surgery. There was also no difference in SF-36 and FIM between patients with or without facial hyperalgesia.

CONCLUSIONS

PBC can produce long-term and stable pain relief and significantly improve the patient's QoL and physical function. However, further well-designed, high-level, evidence-based studies are needed to precisely assess the efficacy of PBC for pTN patients.

Decrements in Both Physical and Cognitive Function Are Associated With a Higher Symptom Burden in Oncology Patients

OBJECTIVES

Physical and cognitive function are two of the most important patient-reported outcomes. In oncology patients receiving chemotherapy (N = 1331), purposes were to identify subgroups of patients with distinct joint physical and cognitive function profiles and evaluate for differences in demographic and clinical characteristics, severity of common symptoms, and quality of life outcomes.

DATA SOURCES

Measures of physical and cognitive functions were obtained six times over two cycles of chemotherapy. All of the other measures were done prior to the second or third cycle of chemotherapy. Latent profile analysis was done to identify the distinct joint physical and cognitive function profiles. Differences among the profiles were evaluated using parametric and nonparametric tests.

CONCLUSION

Five distinct profiles were identified (ie, Very Low Physical and Low Cognitive Function [18.4%; Both Low], Low Physical and High Cognitive Function [19.8%], Moderate Physical and Low Cognitive Function [26.7%], Changing Physical and Cognitive Function [5.4%], and Normal Physical and Cognitive Function [29.7%]). Patients in the Both Low class had the highest symptom burden and the poorest quality of life. Over 70% of the sample had moderate to severe decrements in one or both of these extremely important patient outcomes.

IMPLICATIONS FOR NURSING PRACTICE

Clinicians need to assess for both physical and cognitive function using simple subjective and objective measures.

Effects of correcting metabolic acidosis on muscle mass and functionality in chronic kidney disease: a systematic review and meta-analysis

Metabolic acidosis unfavourably influences the nutritional status of patients with non-dialysis dependent chronic kidney disease (CKD) including the loss of muscle mass and functionality, but the benefits of correction are uncertain. We investigated the effects of correcting metabolic acidosis on nutritional status in patients with CKD in a systematic review and meta-analysis. A search was conducted in MEDLINE and the Cochrane Library from inception to June 2023. Study selection, bias assessment, and data extraction were independently performed by two reviewers. The Cochrane risk of bias tool was used to assess the quality of individual studies. We applied random effects meta-analysis to obtain pooled standardized mean difference (SMD) and 95% confidence intervals (CIs). We retrieved data from 12 intervention studies including 1995 patients, with a mean age of 63.7 ± 11.7 years, a mean estimated glomerular filtration rate of 29.8 ± 8.8 mL/min per 1.73 m2 , and 58% were male. Eleven studies performed an intervention with oral sodium bicarbonate compared with either placebo or with standard care and one study compared veverimer, an oral HCl-binding polymer, with placebo. The mean change in serum bicarbonate was +3.6 mEq/L in the intervention group and +0.4 mEq/L in the control group. Correcting metabolic acidosis significantly improved muscle mass assessed by mid-arm muscle circumference (SMD 0.35 [95% CI 0.16 to 0.54], P < 0.001) and functionality assessed with the sit-to-stand test (SMD -0.31 [95% CI -0.52 to 0.11], P = 0.003). We found no statistically significant effects on dietary protein intake, handgrip strength, serum albumin and prealbumin concentrations, and blood urea nitrogen. Correcting metabolic acidosis in patients with CKD improves muscle mass and physical function. Correction of metabolic acidosis should be considered as part of the nutritional care for patients with CKD.

Loss of Muscle Mass and Strength After Hip Fracture: an Intervention Target for Nutrition Supplementation

PURPOSEOF REVIEW

To summarize what is known about the deleterious effect of hip fracture on muscle mass and strength as well as the scientific evidence for post-surgical nutrition supplementation to maintain muscle and improve function.

RECENT FINDINGS

This review provides a discussion of the relationship between muscle mass, strength, and physical function following hip fracture, briefly describes the approaches to measuring lean mass, discusses prevalence of sarcopenia and malnutrition among older men and women with hip fracture, and reviews the effects of essential amino acids on muscle. Loss of muscle mass and strength following hip fracture is substantial with consequences for recovery of functional independence. EAA-based nutrition supplementation, which directly effects muscle, has potential to improve outcomes.

Longitudinal Associations Between Higher Self-Reported Energy, Gait Speed, and Cognition in Older Adults With Fatigue

BACKGROUND

Older adults reporting higher energy levels have better physical function. It is not known if these associations persist among older adults reporting fatigue or if higher energy is associated with cognitive function. We examined longitudinal associations between self-reported energy, gait speed, and cognition, stratified by fatigue, in 2 613 participants (aged 74.6 ± 2.87 years) in the Health, Aging and Body Composition Study.

METHODS

Self-reported energy (0-10, dichotomized at median) and fatigue (present/absent) were measured at baseline. Usual and rapid-paced gait speed (m/s), modified Mini-Mental State Examination (3MS), and Digit Symbol Substitution Test (DSST) were measured at baseline and annually over 8 years. Linear mixed effect models compared changes in gait speed, 3MS, and DSST between higher and lower energy groups within fatigue strata.

RESULTS

At baseline, 724 participants (27%) were fatigued; 240 (33%) coreported higher energy (9% of total). The remaining 1 889 participants were fatigue-free (73%); 1 221 (65%) coreported higher energy (47% of total). Those with fatigue and higher energy had average rapid gait declines of 0.007 m/s per year (p = .04) after adjustment for demographics, comorbidities, depressive symptoms, and exercise. DSST declines were found among only fatigue-free participants (β = 0.17, p = .01). No statistically significant associations with energy were found for fatigue-free participants, or for usual gait or 3MS.

CONCLUSIONS

Asking about older adults' energy levels as well as fatigue may identify a subgroup of older adults protected against physical and cognitive decline, even among those with fatigue.

Efficacy of pulsed electromagnetic field therapy on pain and physical function in patients with non-specific low back pain: a systematic review

INTRODUCTION

Non-specific low back pain is a common and clinically significant condition with substantial socioeconomic implications. Pulsed electromagnetic field (PEMF) therapy has shown benefits in pain reduction and improvement of physical function in patients with pain-associated disorders like osteoarthritis. However, studies had heterogeneous settings. The aim of this study was to assess the effects of PEMF on pain and function on patients with non-specific low back pain.

METHODS

A systematic literature search of randomized controlled trials in PubMed, MEDLINE, EMBASE, Cochrane Library, and PEDro was performed (from inception until 15/5/2023). Outcome measures assessed pain and function.

RESULTS

Nine randomized controlled trials with 420 participants (n = 420) were included. The studies compared PEMF vs. placebo-PEMF, PEMF and conventional physical therapy vs. conventional physical therapy alone, PEMF and conventional physical therapy vs. placebo-PEMF and conventional physical therapy, PEMF vs. high-intensity laser therapy (HILT) vs. conventional physical therapy, and osteopathic manipulative treatment (OMT) and PEMF vs. PEMF alone vs. placebo-PEMF vs. OMT alone. Five of the nine included studies showed statistically significant pain reduction and improvement in physical function in comparison to their control groups (p < 0.05). There was substantial heterogeneity among the groups of the study, with a wide range of duration (10-30 min), treatments per week (2-7/week), applied frequencies (3-50 Hz), and intensities (2mT-150mT). No serious adverse event had been reported in any study. The included studies showed solid methodological quality, with an overall score of 7.2 points according to the PEDro scale.

CONCLUSION

PEMF therapy seems to be a safe and beneficial treatment option for non-specific low back pain, particularly if used as an addition to conventional physical therapy modalities. Future research should focus on standardized settings including assessment methods, treatment regimens, frequencies, and intensities.

Effects of whole-body vibration therapy on pain, functionality, postural stability, and proprioception in patients with subacute and chronic non-specific low back pain: a systematic review

INTRODUCTION

Non-specific low back pain (NLBP) is a common and clinically significant condition with substantial socioeconomic implications. Whole-body vibration therapy (WBVT) has shown effectiveness in improving pain and sensorimotor function (e.g., in osteoporosis) in previous studies. However, studies had heterogeneous settings. The aim of this study was to assess the effects of WBVT on pain, function, proprioception, and postural stability in patients with subacute and chronic NLBP.

METHODS

A systematic literature search was conducted in the scientific databases PubMed, EMBASE, and PEDro (from inception until 17.05.2023). Only prospective controlled and uncontrolled studies were included. Outcome measures assessed were pain intensity, function (activities of daily living and physical function), proprioception, and postural stability.

RESULTS

A total of 12 original articles (n = 821) were included in the analysis. Ten of the studies were randomized controlled trials, one study had a crossover design, and one study had a one-group pre-post study design. The studies compared WBVT vs. no intervention, WBVT vs. basic physical therapy, WBVT vs. core stabilization exercises with and without respiratory resistance, WBVT vs. lumbar extension exercises, and WBVT vs. whole body electromyostimulation training. The treatment approaches varied in terms of duration (2-18 weeks), frequency (2-3 times per week, two applications with a 2-week break), vibration frequency (5-30 Hz), type of exercises (WBVT with or without static or dynamic exercises), and vibration direction (horizontal and vertical). Significant pain reduction was observed in all 10 studies that investigated pain levels. Significant improvement in daily activity function was reported in five of the six studies that investigated daily function, while improvement in physical function was observed in all four studies that investigated physical function. Improvement in proprioception was reported in all three studies that investigated proprioception, and significant improvement in postural stability was observed in four out of six studies that investigated postural stability. No adverse events or side effects related to WBVT were reported.

CONCLUSION

The majority of the included studies demonstrated significant pain reduction, improvement in physical and daily functioning, and enhanced proprioception. Improvement in postural stability was less consistent. WBVT appears to be a safe and effective treatment modality for subacute and chronic NLBP when used within a multimodal approach. Future research should focus on standardized settings including assessment methods, treatment regimens, frequencies, and intensities.

Investigation of factors associated with static and dynamic balance in early-stage lung cancer survivors

PURPOSE

Balance impairment and falls are common among patients after cancer treatment. This study aimed to compare static and dynamic balance functions in lung cancer survivors (LCS) and healthy controls and to investigate the factors related to balance in LCS.

METHODS

Cross-sectional data were collected from lung cancer patients whose treatment had been completed within the previous 3 months (n = 60) and age and gender-matched healthy controls (n = 60). Clinical characteristics and history of falls were recorded. Pulmonary function tests and measurements of respiratory muscle strength were performed. Dynamic and static balance, fear of falling, knee-extension strength, physical activity level, dyspnea, comorbidity, and quality of life (QoL) were assessed using the Time Up and Go Test, Single Leg Standing Test, the Fall Efficacy Scale-International, hand-held dynamometer, the International Physical Activity Questionnaire, the Modified Medical Research Dyspnea Scale, the Charlson Comorbidity Index, and the European Organization for Research and Treatment of Cancer QoL Scale.

RESULTS

LCS reported a higher fall rate and exhibited lower dynamic balance compared to controls (p < 0.05). The number of chemotherapy cycles, number of falls in the past year, fear of falling, perceived dyspnea, forced expiratory volume in 1 s (%), maximal inspiratory pressure (%), knee-extension strength, physical activity score, and QoL score related to physical function were correlated with balance function in LCS (p < 0.05).

CONCLUSION

LCS had a higher risk of falls and lower dynamic balance function which might be related to various clinical and physical parameters.

IMPLICATIONS FOR CANCER SURVIVORS

Identifying factors related to balance should be considered within the scope of fall prevention approaches for these patients.

Instruments to assess post-intensive care syndrome assessment: a scoping review and modified Delphi method study

BACKGROUND

The assessment of post-intensive care syndrome (PICS) is challenging due to the numerous types of instruments. We herein attempted to identify and propose recommendations for instruments to assess PICS in intensive care unit (ICU) survivors.

METHODS

We conducted a scoping review to identify PICS follow-up studies at and after hospital discharge between 2014 and 2022. Assessment instruments used more than two times were included in the modified Delphi consensus process. A modified Delphi meeting was conducted three times by the PICS committee of the Japanese Society of Intensive Care Medicine, and each score was rated as not important (score: 1-3), important, but not critical (4-6), and critical (7-9). We included instruments with ≥ 70% of respondents rating critical and ≤ 15% of respondents rating not important.

RESULTS

In total, 6972 records were identified in this scoping review, and 754 studies were included in the analysis. After data extraction, 107 PICS assessment instruments were identified. The modified Delphi meeting reached 20 PICS assessment instrument recommendations: (1) in the physical domain: the 6-min walk test, MRC score, and grip strength, (2) in cognition: MoCA, MMSE, and SMQ, (3) in mental health: HADS, IES-R, and PHQ-9, (4) in the activities of daily living: the Barthel Index, IADL, and FIM, (5) in quality of life: SF-36, SF-12, EQ-5D-5L, 3L, and VAS (6), in sleep and pain: PSQI and Brief Pain Inventory, respectively, and (7) in the PICS-family domain: SF-36, HADS, and IES-R.

CONCLUSION

Based on a scoping review and the modified Delphi method, 20 PICS assessment instruments are recommended to assess physical, cognitive, mental health, activities of daily living, quality of life, sleep, and pain in ICU survivors and their families.