751
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Couturier E, Guillemin F, Mura M, Leon L, Virion JM, Letort MJ, De Valk H, Simon F, Vaillant V. Impaired quality of life after chikungunya virus infection: a 2-year follow-up study. Rheumatology (Oxford) 2012; 51:1315-22. [DOI: 10.1093/rheumatology/kes015] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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752
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Tikkanen P, Nykänen I, Lönnroos E, Sipilä S, Sulkava R, Hartikainen S. Physical activity at age of 20-64 years and mobility and muscle strength in old age: a community-based study. J Gerontol A Biol Sci Med Sci 2012; 67:905-10. [PMID: 22396477 DOI: 10.1093/gerona/gls005] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Physical activity in midlife has been related to lower mortality and better health in old age. The present study evaluated whether physical activity at age of 20-64 years was associated with mobility and muscle strength in old age. METHODS A random sample of 1,000 persons was extracted from all the ≥75-year-old people living in Kuopio, Finland, and 679 community-dwelling participants were included in the present analyses. Data on health status, ability to walk outside or 400 m, and physical activity level were obtained through structured interviews. Participants' walking speed, grip strength, and knee extension strength were measured by physiotherapists. Relationship between physical activity at age of 20-64 years and old-age mobility and strength was assessed using logistic regression and covariance analyses. RESULTS Of the 679 participants (mean age 80.8 years), 58.8% had been physically active at age of 20-64 years. Physical activity at that age was positively associated with ability to walk 400 m independently in old age (adjusted odds ratio 2.17, 95% confidence intervals: 1.25-3.77). Men who had been physically active at age of 20-64 years had greater walking speed (adjusted p = .01) and grip strength (adjusted p = .02) compared with physically inactive men. In women, the results did not differ statistically significantly. CONCLUSIONS Physical activity at age of 20-64 years was associated with better mobility in old age. It was also linked to better grip strength and walking speed in older men but not in women.
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Affiliation(s)
- Päivi Tikkanen
- Institute of Public Health and Clinical Nutrition, Department of Public Health, University of Eastern Finland, Kuopio, Finland.
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753
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Drageset J, Eide GE, Ranhoff AH. Mortality in nursing home residents without cognitive impairment and its relation to self-reported health-related quality of life, sociodemographic factors, illness variables and cancer diagnosis: a 5-year follow-up study. Qual Life Res 2012; 22:317-25. [DOI: 10.1007/s11136-012-0143-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2012] [Indexed: 10/28/2022]
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754
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Huntley AL, Johnson R, Purdy S, Valderas JM, Salisbury C. Measures of multimorbidity and morbidity burden for use in primary care and community settings: a systematic review and guide. Ann Fam Med 2012; 10:134-41. [PMID: 22412005 PMCID: PMC3315139 DOI: 10.1370/afm.1363] [Citation(s) in RCA: 419] [Impact Index Per Article: 34.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Many patients consulting in primary care have multiple conditions (multimorbidity). Aims of this review were to identify measures of multimorbidity and morbidity burden suitable for use in research in primary care and community populations, and to investigate their validity in relation to anticipated associations with patient characteristics, process measures, and health outcomes. METHODS Studies were identified using searches in MEDLINE and EMBASE from inception to December 2009 and bibliographies. RESULTS Included were 194 articles describing 17 different measures. Commonly used measures included disease counts (n = 98), Chronic Disease Score (CDS)/RxRisk (n = 17), Adjusted Clinical Groups (ACG) System (n = 25), the Charlson index (n = 38), the Cumulative Index Illness Rating Scale (CIRS; n = 10) and the Duke Severity of Illness Checklist (DUSOI; n = 6). Studies that compared measures suggest their predictive validity for the same outcome differs only slightly. Evidence is strongest for the ACG System, Charlson index, or disease counts in relation to care utilization; for the ACG System in relation to costs; for Charlson index in relation to mortality; and for disease counts or Charlson index in relation to quality of life. Simple counts of diseases or medications perform almost as well as complex measures in predicting most outcomes. Combining measures can improve validity. CONCLUSIONS The measures most commonly used in primary care and community settings are disease counts, Charlson index, ACG System, CIRS, CDS, and DUSOI. Different measures are most appropriate according to the outcome of interest. Choice of measure will also depend on the type of data available. More research is needed to directly compare performance of different measures.
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Affiliation(s)
- Alyson L Huntley
- Academic Unit of Primary Health Care, School of Social and Community Medicine, Bristol University, Bristol, England
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755
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Diederichs C, Bartels DB, Berger K. [Methodological challenges concerning the selection of diseases for a standardized multimorbidity index]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 54:972-8. [PMID: 21800246 DOI: 10.1007/s00103-011-1323-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Multimorbidity is defined as the coexistence of two or more chronic diseases. However, this complex health status, which primarily affects elderly, is still insufficiently understood. One reason is the underrepresentation of older, multimorbid people in studies. Another reason is that there is no agreement on the number and type of diseases, which have to be considered in the assessment of multimorbidity. Therefore, this article provides an overview on the status quo of research on multimorbidity indices and describes in detail, what kind of methodological challenges have to be faced regarding the development of a standardized index. Finally, recommendations are made for criteria, which can be used for the selection of diseases relevant for multimorbidity.
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Affiliation(s)
- C Diederichs
- Institut für Epidemiologie und Sozialmedizin, Westfälische Wilhelms-Universität Münster, Domagkstrasse 3, Münster, Germany.
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756
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Schüz B, Dräger D, Richter S, Kummer K, Kuhlmey A, Tesch-Römer C. [Autonomy despite multimorbidity in old age--the Berlin-based AMA research consortium]. Z Gerontol Geriatr 2012; 44 Suppl 2:9-26. [PMID: 22270971 DOI: 10.1007/s00391-011-0248-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The proportion of the population with multiple illnesses increases with age and growing numbers of people are now living to a very old age. Despite medical progress and improved living conditions, many old people have to deal with physical, psychological, and social impairments. It is a crucial challenge for health and social policy to support the elderly with health-related impairments in their desire to lead as independent a life as possible. Against this background the research consortium Autonomy Despite Multimorbidity in Old Age (AMA I) examined the extent to which the self-determined life style of multimorbid old and very old persons can be supported and maintained. In order to reflect the diversity of life worlds of the elderly, the study sample included participants who were not notably impaired in their everyday functioning, participants in need of nursing care and participants with cognitive impairments. Moreover, the sample comprised both older persons who were still living in their own homes and nursing home residents. The studies conducted within the AMA framework focused on the resources available to old persons living in different situations and on how these resources can be strengthened. This article presents findings from the first phase of funding of the AMA research consortium. In a second phase of funding (2011-2013, AMA II), sustainable practice-based interventions are being developed to mobilize resources which can help multimorbid older persons to maintain their autonomy and the practical viability of these interventions will be tested.
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Affiliation(s)
- B Schüz
- School of Psychology, University of Tasmania, Tasmania, Australia
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757
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Nadathur SG. Comorbidity indexes from administrative datasets: what is measured? AUST HEALTH REV 2012; 35:507-11. [PMID: 22126957 DOI: 10.1071/ah10933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Accepted: 01/13/2011] [Indexed: 11/23/2022]
Abstract
It is important to factor-in the characteristics of patients that may affect treatment, outcome and resource when making clinical and administrative decisions, plans or policies. For some two and half decades there have been efforts to construct and refine instruments that endeavour to capture the concept of comorbidity. This paper focuses on such comorbidity measures that are derived from diagnoses information recorded in administrative datasets. The pros and cons of the popular weighted Charlson and Charlson-based indexes are discussed. Means to improve the comorbidity indexes are considered including the very concept and definition of comorbidity.
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758
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Drageset J, Espehaug B, Kirkevold M. The impact of depression and sense of coherence on emotional and social loneliness among nursing home residents without cognitive impairment - a questionnaire survey. J Clin Nurs 2012; 21:965-74. [DOI: 10.1111/j.1365-2702.2011.03932.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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759
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Giesbrecht EM, Mortenson WB, Miller WC. Prevalence and facility level correlates of need for wheelchair seating assessment among long-term care residents. Gerontology 2012; 58:378-84. [PMID: 22222920 DOI: 10.1159/000334819] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 11/03/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Wheelchairs are frequently prescribed for residents with mobility impairments in long-term care. Many residents receive poorly fitting wheelchairs, compromising functional independence and mobility, and contributing to subsequent health issues such as pressure ulcers. The extent of this problem and the factors that predict poor fit are poorly understood; such evidence would contribute greatly to effective and efficient clinical practice in long-term care. OBJECTIVE To identify the prevalence of need for wheelchair seating intervention among residents in long-term care facilities in Vancouver and explore the relationship between the need for seating intervention and facility level factors. METHODS Logistic regression analysis using secondary data from a cross-sectional study exploring predictors of resident mobility. A total of 263 residents (183 females and 80 males) were randomly selected from 11 long-term care facilities in the Vancouver health region (mean age 84.2 ± 8.6 years). The Seating Identification Tool was used to establish subject need for wheelchair seating intervention. Individual item frequency was calculated. Six contextual variables were measured at each facility including occupational therapy staffing, funding source, policies regarding wheelchair-related equipment, and decision-making philosophy. RESULTS The overall prevalence rate of inappropriate seating was 58.6% (95% CI 52.6-64.5), ranging from 30.4 to 81.8% among the individual facilities. Discomfort, poor positioning and mobility, and skin integrity were the most common issues. Two facility level variables were significant predictors of need for seating assessment: ratio of occupational therapists per 100 residents [OR 0.11 (CI 0.04, 0.31)] and expectation that residents purchase wheelchair equipment beyond the basic level [OR 2.78 (1.11, 6.97)]. A negative association between facility prevalence rate and ratio of occupational therapists (r(p) = -0.684, CI -0.143 to -0.910) was found. CONCLUSION Prevalence of need for seating assessment in long-term care is high overall but it varies considerably between facilities. Increasing access to occupational therapy services appears to mediate this need.
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Affiliation(s)
- Edward M Giesbrecht
- Department of Occupational Therapy, University of Manitoba, Winnipeg, Canada.
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760
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Tremblay D, Charlebois K, Terret C, Joannette S, Latreille J. Integrated oncogeriatric approach: a systematic review of the literature using concept analysis. BMJ Open 2012; 2:bmjopen-2012-001483. [PMID: 23220777 PMCID: PMC3533132 DOI: 10.1136/bmjopen-2012-001483] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES The purpose of this study was to provide a more precise definition of an integrated oncogeriatric approach (IOGA) through concept analysis. DATA SOURCES The literature was reviewed from January 2005 to April 2011 integrating three broad terms: geriatric oncology, multidisciplinarity and integrated care delivery models. STUDY ELIGIBILITY CRITERIA Citation selection was based on: (1) elderly cancer patients as the study population; (2) disease management and (3) case studies, intervention studies, assessments, evaluations and studies. Inclusion and exclusion criteria were refined in the course of the literature search. INTERVENTIONS Initiatives in geriatric oncology that relate to oncology services, social support services and primary care services for elderly cancer patients. PARTICIPANTS Elderly cancer patients aged 70 years old or more. STUDY APPRAISAL AND SYNTHESIS METHODS Rodgers' concept analysis method was used for this study. The analysis was carried out according to thematic analysis based on the elements of the Chronic Care Model. RESULTS The search identified 618 citations. After in-depth appraisal of 327 potential citations, 62 articles that met our inclusion criteria were included in the analysis. Three IOGA main attributes were identified, which constitute IOGA's core aspects: geriatric assessment (GA), comorbidity burden and treatment outcomes. The IOGA concept comprises two broad antecedents: coordinated healthcare delivery and primary supportive care services. Regarding the consequents of an integrated approach in geriatric oncology, the studies reviewed remain inconclusive. CONCLUSIONS Our study highlights the pioneering character of the multidimensional IOGA concept, for which the relationship between clinical and organisational attributes, on the one hand, and contextual antecedents, on the other, is not well understood. We have yet to ascertain IOGA's consequents. IMPLICATIONS OF KEY FINDINGS: There is clearly a need for a whole-system approach to change that will provide direction for multilevel (clinical, organisational, strategic) interventions to support interdisciplinary practice, education and research.
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Affiliation(s)
- Dominique Tremblay
- Centre de recherche CSSS Champlain-Charles-Le Moyne, Université de Sherbrooke, École des Sciences infirmières, Longueuil, Québec, Canada
| | - Kathleen Charlebois
- Centre de recherche CSSS Champlain-Charles Le Moyne, Longueuil,Québec, Canada
| | - Catherine Terret
- Programme d'oncologie gériatrie, Département d'oncologie, Centre Leon-Bérard, Claude-Bernard Lyon-1 Université Lyon, Lyon, France
| | - Sonia Joannette
- Centre de recherche CSSS Champlain-Charles-Le Moyne, Université de Sherbrooke, Longueuil, Québec, Canada
| | - Jean Latreille
- Centre intégré de cancérologie de la Montérégie, Greenfield Park, Québec,Canada, Université de Sherbrooke, Faculté de médecine et des sciences de la santé, Longueuil. Québec, Canada
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761
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Schüz B, Wurm S, Warner LM, Ziegelmann JP. Self-efficacy and multiple illness representations in older adults: A multilevel approach. Psychol Health 2012; 27:13-29. [DOI: 10.1080/08870446.2010.541908] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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762
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Lowe CJM, Barker KL, Holder R, Sackley CM. Comparison of postdischarge physiotherapy versus usual care following primary total knee arthroplasty for osteoarthritis: an exploratory pilot randomized clinical trial. Clin Rehabil 2011; 26:629-41. [PMID: 22180446 DOI: 10.1177/0269215511427749] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To evaluate a pilot trial of a postdischarge physiotherapy intervention to improve patient function versus usual physiotherapy in patients undergoing total knee arthroplasty aiming to assess: recruitment rate, feasibility and acceptability of the intervention and control, suitability of outcomes, retention and adverse events and to inform sample size calculation for a definitive trial. Design: Exploratory pilot randomized controlled trial using independent assessment. Setting: Mixed urban and rural, UK. Participants: Patients undergoing primary, elective unilateral knee arthroplasty for osteoarthritis. Intervention: Two additional home physiotherapy visits of functional weight-bearing exercises, functional task-specific training versus treatment as usual. Main outcome: Oxford Knee Score at 12 months. Secondary outcomes: completion rates, adverse events, Knee Injury and Osteoarthritis Outcome Score, leg extensor power, timed 10-m walk, timed sit-to-stand, resource use diaries. Assessments completed at baseline (pre-operatively), 3, 6 and 12 months. Results: Of 181 eligible participants 107 (59.1%) were randomized over 13 months, one participant withdrew, no adverse events. Intervention group n = 56 (mean age 67.8), control group n = 51 (mean age 70.8). The difference in mean change of Oxford Knee Scores between groups (intervention – control) at 12 months was 0.2 (95% confidence interval (CI) –3.8, 4.2), P = 0.94. Patient diaries revealed non-trial additional physiotherapy requires improved measurement. Conclusions: Successful recruitment and retention rates were achieved. The intervention appeared feasible and acceptable but may be suboptimal in intensity given recent research. A sample size of 1271 participants would be required for a fully powered randomized controlled trial using the main outcome. However new outcomes, potentially of greater validity and responsiveness, require consideration.
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Affiliation(s)
- Catherine J Minns Lowe
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospital NHS Trust, Oxford, UK
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham UK
| | - Karen L Barker
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospital NHS Trust, Oxford, UK
- NIHR Musculoskeletal Biomedical Research Unit, NDORMS, University of Oxford, Oxford, UK
| | - Roger Holder
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham UK
| | - Catherine M Sackley
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham UK
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763
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Rosen CF, Mussani F, Chandran V, Eder L, Thavaneswaran A, Gladman DD. Patients with psoriatic arthritis have worse quality of life than those with psoriasis alone. Rheumatology (Oxford) 2011; 51:571-6. [PMID: 22157469 DOI: 10.1093/rheumatology/ker365] [Citation(s) in RCA: 150] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE PsA is an inflammatory arthritis present in ∼30% of people with psoriasis (PsC). Both conditions have a significant impact on quality of life (QoL). Our objective was to test the hypothesis that people with PsA have poorer QoL than patients with PsC because of the added burden of arthritis, age and comorbidities. METHODS Consecutive patients with PsA (CASPAR criteria) and PsC were approached to participate in this study. Patients with PsC were examined by a rheumatologist using a standardized protocol to exclude PsA. Patients completed the HAQ, Medical Outcome Study 36-item Short Form Health Survey, Dermatology Life Quality Index (DLQI), EuroQoL 5 domains (EQ-5D) and Fatigue Severity Scale (FSS). Mean scores were compared and multivariate analyses were conducted to compare the QoL measures between the two patient groups. RESULTS Two hundred and one patients with PsC and 201 patients with PsA were studied. A significant decrease in QoL for patients with PsA compared with those with PsC was identified by all questionnaires except for the DLQI. This skin-specific questionnaire revealed a lower QoL in patients with PsC. Multivariate analyses for each QoL measure confirmed the results of these analyses. After adjusting for age, sex, duration of PsC, comorbidities, DMARDs and biologic therapy, HAQ and DLQI were independently associated with PsA in a logistic regression. CONCLUSION Patients with PsA have a poorer QoL compared with those with PsC as measured by all questionnaires except the DLQI.
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764
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Fortin M, Steenbakkers K, Hudon C, Poitras ME, Almirall J, van den Akker M. The electronic Cumulative Illness Rating Scale: a reliable and valid tool to assess multi-morbidity in primary care. J Eval Clin Pract 2011; 17:1089-93. [PMID: 20586841 DOI: 10.1111/j.1365-2753.2010.01475.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES The presence of multiple concomitant diseases is an increasing health problem, and prompted by the limitations of the disease count, several indices measuring multi-morbidity or co-morbidity have been described to account for the overall burden of morbidity. The Cumulative Illness Rating Scale (CIRS) is one of those indices. We developed an electronic version of the CIRS (eCIRS) to take advantage of computerized data processing. The aim of this study was to evaluate the reliability and validity of the eCIRS scored in a primary care setting. METHODS Two nurses interviewed 48 adult patients recruited during consecutive consultation periods in a primary care setting and scored the eCIRS in a random order during two sessions of data collection (T1 and T2) 1 month apart. We measured intra- and inter-rater reliability [intra-class correlation coefficient (ICC)]. We also assessed concomitant validity [(Pearson's correlation (r)] using standard CIRS scored by the attending family doctors. RESULTS Intra-rater (ICC: 0.90 and 0.95) and inter-rater reliability (ICC: 0.86 and 0.91) were both excellent. No significant differences between the nurses' scores at T1 and T2 (P = 0.40 for nurse 1, P = 0.73 for nurse 2) were found. The eCIRSs scored by the nurses were highly correlated with the CIRSs scored by the doctors (r = 0.80 and 0.88). CONCLUSION Reliable and valid, the eCIRS completed during patient interviews with trained nurses can be used to quantify multi-morbidity in primary care, either for research or clinical use.
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Affiliation(s)
- Martin Fortin
- Department of Family Medicine, Sherbrooke University, Sherbrooke, Québec, Canada.
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765
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Denkinger MD, Lindemann U, Nicolai S, Igl W, Jamour M, Nikolaus T. Assessing Physical Activity in Inpatient Rehabilitation: Validity, Practicality, and Sensitivity to Change in the Physical Activity in Inpatient Rehabilitation Assessment. Arch Phys Med Rehabil 2011; 92:2012-7. [DOI: 10.1016/j.apmr.2011.06.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 06/24/2011] [Indexed: 11/25/2022]
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766
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Using intake and change in multiple psychosocial measures to predict functional status outcomes in people with lumbar spine syndromes: a preliminary analysis. Phys Ther 2011; 91:1812-25. [PMID: 22003164 DOI: 10.2522/ptj.20100377] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Managing patients with lumbar spine syndromes who are seeking outpatient physical therapy represents a complex problem where psychosocial constructs such as fear-avoidance beliefs regarding physical activities or work activities, somatization, and depressive symptoms may affect functional status (FS) outcomes. OBJECTIVE The purpose of this study was to determine whether intake or changes in fear-avoidance beliefs regarding physical or work activities, somatization, and depressive symptoms assessed simultaneously affect FS outcomes prediction. DESIGN This study was a secondary analysis of prospectively collected, longitudinal, observational cohort data. METHODS Data analyzed were from adult patients (n=323) with lumbar syndromes classified as elevated versus not elevated on single-item screening instruments for fear-avoidance beliefs regarding physical or work activities, somatization, and depressive symptoms at intake and discharge. Prediction of minimal clinically important difference in FS was assessed separately for intake and change from intake to discharge classifications using logistic regression models controlling for important variables. RESULTS Intake and change models were strong (McFadden rho-squared values=.31 and .49, respectively). Patients classified as not elevated in fear-avoidance beliefs regarding physical activities but elevated in fear-avoidance beliefs regarding work activities, somatization, and depressive symptoms at intake were 5 out of 100 times less likely to report clinically important outcomes compared with being elevated in each measure. Patients not elevated in fear-avoidance beliefs regarding work activities and somatization at intake and discharge were 8 to 14 times more likely to report clinically important outcomes compared with being elevated in each measure. LIMITATIONS Sample size was limited. Data analyses were retrospective with no control of missing data. CONCLUSIONS Combinations of multiple psychosocial constructs were important predictors of FS outcomes and may assist patient management by: (1) identifying patients with elevated psychosocial constructs at intake and (2) tracking change in psychosocial variables for improved outcomes prediction. This model may prove helpful for future clinical and research applications to determine optimal psychosocial screening methods.
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767
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Husted JA, Thavaneswaran A, Chandran V, Eder L, Rosen CF, Cook RJ, Gladman DD. Cardiovascular and other comorbidities in patients with psoriatic arthritis: A comparison with patients with psoriasis. Arthritis Care Res (Hoboken) 2011; 63:1729-35. [DOI: 10.1002/acr.20627] [Citation(s) in RCA: 174] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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768
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Stepnowsky CJ, Palau JJ, Zamora T, Ancoli-Israel S, Loredo JS. Fatigue in sleep apnea: the role of depressive symptoms and self-reported sleep quality. Sleep Med 2011; 12:832-7. [PMID: 22014844 DOI: 10.1016/j.sleep.2011.07.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 07/14/2011] [Accepted: 07/15/2011] [Indexed: 10/16/2022]
Abstract
UNLABELLED OBJECTIVES OR BACKGROUND: Obstructive Sleep Apnea (OSA) is characterized by partial or complete cessation of breath during sleep. OSA is associated with increased cardiovascular risk as well as psychosocial complications such as daytime somnolence, depression, and fatigue. The goal of the present study was to better understand fatigue in OSA by examining self-reported sleep quality, depressive symptoms, excessive daytime sleepiness, and OSA severity in a group of newly diagnosed OSA patients. METHODS Two hundred and forty newly diagnosed OSA patients enrolled in the study. Participants completed several questionnaires at baseline. RESULTS Depressive symptoms accounted for 15% of variance in fatigue beyond that of demographics and OSA severity (p<0.001). Self-reported sleep quality accounted for 11% of variance beyond that of depressive symptoms (p<0.001). The total model accounted for 48% of the variance in fatigue. Post hoc analysis found that the total model accounted for only 14% of the variance in sleepiness (as measured by the Epworth Sleepiness Scale). CONCLUSION The current study confirms the findings of previous OSA studies, which found depressive symptoms have a greater association with fatigue than OSA disease severity variables. This study extends those findings by showing that self-reported sleep quality is independently associated with fatigue, even after taking into account demographic, comorbid conditions, OSA disease severity, sleepiness, and depressive symptoms. The role of sleep quality as an independent contributor to daytime fatigue in OSA may be under appreciated. Sleep quality should be closely followed in the clinical management of OSA.
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Affiliation(s)
- Carl J Stepnowsky
- Health Services Research & Development, VA San Diego Healthcare System, San Diego, CA 92161, USA.
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769
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Sicras-Mainar A, Velasco-Velasco S, Navarro-Artieda R, Blanca Tamayo M, Aguado Jodar A, Ruíz Torrejón A, Prados-Torres A, Violan-Fors C. [Comparison of three methods for measuring multiple morbidity according to the use of health resources in primary healthcare]. Aten Primaria 2011; 44:348-57. [PMID: 22014855 DOI: 10.1016/j.aprim.2011.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 05/27/2011] [Accepted: 05/30/2011] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To compare three methods of measuring multiple morbidity according to the use of health resources (cost of care) in primary healthcare (PHC). DESIGN Retrospective study using computerized medical records. SETTING Thirteen PHC teams in Catalonia (Spain). PARTICIPANTS Assigned patients requiring care in 2008. MAIN MEASUREMENTS The socio-demographic variables were co-morbidity and costs. Methods of comparison were: a) Combined Comorbidity Index (CCI): an index itself was developed from the scores of acute and chronic episodes, b) Charlson Index (ChI), and c) Adjusted Clinical Groups case-mix: resource use bands (RUB). The cost model was constructed by differentiating between fixed (operational) and variable costs. STATISTICAL ANALYSIS 3 multiple lineal regression models were developed to assess the explanatory power of each measurement of co-morbidity which were compared from the determination coefficient (R(2)), p< .05. RESULTS The study included 227,235 patients. The mean unit of cost was €654.2. The CCI explained an R(2)=50.4%, the ChI an R(2)=29.2% and BUR an R(2)=39.7% of the variability of the cost. The behaviour of the ICC is acceptable, albeit with low scores (1 to 3 points), showing inconclusive results. CONCLUSIONS The CCI may be a simple method of predicting PHC costs in routine clinical practice. If confirmed, these results will allow improvements in the comparison of the case-mix.
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770
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Mariconda M, Galasso O, Costa GG, Recano P, Cerbasi S. Quality of life and functionality after total hip arthroplasty: a long-term follow-up study. BMC Musculoskelet Disord 2011; 12:222. [PMID: 21978244 PMCID: PMC3204273 DOI: 10.1186/1471-2474-12-222] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 10/06/2011] [Indexed: 12/13/2022] Open
Abstract
Background There is a lack of data on the long-term outcome of total hip arthroplasty procedures, as assessed by validated tools. Methods We conducted a follow-up study to evaluate the quality of life and functionality of 250 patients an average of 16 years (range: 11-23 years) after total hip arthroplasty using a validated assessment set including the SF-36 questionnaire, Harris Hip Score, WOMAC score, Functional Comorbidity Index, and a study specific questionnaire. Models of multiple stepwise linear and logistic regression analysis were constructed to evaluate the relationships between several explanatory variables and these functional outcomes. Results The SF-36 physical indexes of these patients compared negatively with the normative values but positively with the results obtained in untreated subjects with severe hip osteoarthritis. Similar results were detected for the Harris Hip Score and WOMAC score. There was a 96% rate of post-surgical satisfaction. Hip functionality and comorbidities were the most important determinants of physical measures on the SF-36. Conclusions Patients who had undergone total hip arthroplasty have impaired long-term self-reported physical quality of life and hip functionality but they still perform physically better than untreated patients with advanced hip osteoarthritis. However, the level of post-surgical satisfaction is high.
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Affiliation(s)
- Massimo Mariconda
- Department of Orthopaedic Surgery, Federico II University, Naples, Italy.
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771
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Taylor WJ, Brown M, William L, McPherson KM, Reed K, Dean SG, Weatherall M. A pilot cluster randomized controlled trial of structured goal-setting following stroke. Clin Rehabil 2011; 26:327-38. [DOI: 10.1177/0269215511419384] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To determine the feasibility, the cluster design effect and the variance and minimal clinical importance difference in the primary outcome in a pilot study of a structured approach to goal-setting. Design: A cluster randomized controlled trial. Setting: Inpatient rehabilitation facilities. Subjects: People who were admitted to inpatient rehabilitation following stroke who had sufficient cognition to engage in structured goal-setting and complete the primary outcome measure. Interventions: Structured goal elicitation using the Canadian Occupational Performance Measure. Main measures: Quality of life at 12 weeks using the Schedule for Individualised Quality of Life (SEIQOL-DW), Functional Independence Measure, Short Form 36 and Patient Perception of Rehabilitation (measuring satisfaction with rehabilitation). Assessors were blinded to the intervention. Results: Four rehabilitation services and 41 patients were randomized. We found high values of the intraclass correlation for the outcome measures (ranging from 0.03 to 0.40) and high variance of the SEIQOL-DW (SD 19.6) in relation to the minimally importance difference of 2.1, leading to impractically large sample size requirements for a cluster randomized design. Conclusions: A cluster randomized design is not a practical means of avoiding contamination effects in studies of inpatient rehabilitation goal-setting. Other techniques for coping with contamination effects are necessary.
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Affiliation(s)
- William J Taylor
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago Wellington, New Zealand
| | - Melanie Brown
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago Wellington, New Zealand
| | - Levack William
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago Wellington, New Zealand
| | | | - Kirk Reed
- Auckland University of Technology, Auckland, New Zealand
| | - Sarah G Dean
- Peninsula Medical College of Medicine and Dentistry, Exeter, UK
| | - Mark Weatherall
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago Wellington, New Zealand
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772
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Puts M, Monette J, Girre V, Wolfson C, Monette M, Batist G, Bergman H. A pilot study on frailty, health and functioning in older newly-diagnosed cancer patients, what have we learned? J Geriatr Oncol 2011. [DOI: 10.1016/j.jgo.2011.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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773
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Kho ME, Damluji A, Zanni JM, Needham DM. Feasibility and observed safety of interactive video games for physical rehabilitation in the intensive care unit: a case series. J Crit Care 2011; 27:219.e1-6. [PMID: 21944880 DOI: 10.1016/j.jcrc.2011.08.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Revised: 07/20/2011] [Accepted: 08/12/2011] [Indexed: 12/20/2022]
Abstract
BACKGROUND Early rehabilitation in the intensive care unit (ICU) improves patients' physical function. Despite reports of using commercially available interactive video game systems for rehabilitation, there are few data evaluating feasibility and safety as part of routine in-patient rehabilitation, particularly in the ICU. METHODS We conducted an observational study from September 1, 2009, to August 31, 2010, of adults admitted to a 16-bed medical ICU receiving video games as part of routine physical therapy (PT), evaluating use and indications and occurrence of 14 prospectively monitored safety events. RESULTS Of 410 patients receiving PT in the medical ICU, 22 (5% of all patients; male, 64%; median age, 52 years) had 42 PT treatments with video games (median [interquartile range] per patient, 1.0 [1.0-2.0]). Main indications for video game therapy included balance (52%) and endurance (45%), and the most common activities included boxing (38%), bowling (24%), and balance board (21%). Of 42 treatments, 69% occurred while standing and 45% while mechanically ventilated. During 35 hours of PT treatment, 0 safety events occurred (95% upper confidence limit for safety event rate, 8.4%). CONCLUSIONS Novel use of interactive video games as part of routine PT in critically ill patients is feasible and appears safe in our case series. Video game therapy may complement existing rehabilitation techniques for ICU patients.
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Affiliation(s)
- Michelle E Kho
- Department of Physical Medicine and Rehabilitation, Critical Care Physical Medicine and Rehabilitation Program, Johns Hopkins University, Baltimore, MD 21287, USA.
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774
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Taipale HT, Bell JS, Gnjidic D, Sulkava R, Hartikainen S. Muscle strength and sedative load in community-dwelling people aged 75 years and older: a population-based study. J Gerontol A Biol Sci Med Sci 2011; 66:1384-92. [PMID: 21934126 DOI: 10.1093/gerona/glr170] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Use of psychotropic and sedative drugs has been associated with impaired muscle strength. Muscle weakness predicts important outcomes for older people including functional disability and mortality. The objective of this study was to investigate if the use of drugs with sedative properties is associated with poorer muscle strength. METHODS Seven-hundred community-dwelling participants, aged 75 years and older, enrolled in the population-based Geriatric Multidisciplinary Strategy for the Good Care of the Elderly (GeMS) study in 2004 were included in the present analyses. Data on demographics, diagnostics, and drug use were collected during standardized interviews, conducted by trained nurses and verified through medical records. Physiotherapists conducted objective tests of handgrip strength, knee extension strength, and the five repeated chair stands test. Sedative load was calculated using a previously published model for each participant. RESULTS Twenty-one percent of the participants (n = 147) had a sedative load of 1-2 and 8% (n = 58) had a sedative load 3 or more. After adjusting for covariates, participants with sedative load more than 0 had poorer performance on grip strength (p = .009), knee extension strength (p = .02), and five chair stands (p = .003) than nonusers of drugs with sedative properties. Increasing sedative load was associated with poorer grip strength. CONCLUSIONS Use of drugs with sedative properties was associated with impaired muscle strength. Although we adjusted for diagnoses affecting physical function, the possibility of confounding by indication cannot be entirely excluded. Given that muscle strength is predictive of functional disability and mortality, further attention should be directed toward conducting regular reviews of drug therapy and reducing use of sedative drugs.
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Affiliation(s)
- Heidi T Taipale
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
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775
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Synergistic effect of social support and self-efficacy on physical exercise in older adults. J Aging Phys Act 2011; 19:249-61. [PMID: 21727305 DOI: 10.1123/japa.19.3.249] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of the current study was to examine whether the effects of social support on physical exercise in older adults depend on individual perceptions of self-efficacy. Three hundred nine older German adults (age 65-85) were assessed at 3 points in time (3 months apart). In hierarchical-regression analyses, support received from friends and exercise self-efficacy were specified as predictors of exercise frequency while baseline exercise, sex, age, and physical functioning were controlled for. Besides main effects of self-efficacy and social support, an interaction between social support and self-efficacy emerged. People with low self-efficacy were less likely to be active in spite of having social support. People with low support were less likely to be active even if they were high in self-efficacy. This points to the importance of both social support and self-efficacy and implies that these resources could be targets of interventions to increase older adults' exercise.
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776
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Tinetti ME, McAvay GJ, Chang SS, Newman AB, Fitzpatrick AL, Fried TR, Peduzzi PN. Contribution of multiple chronic conditions to universal health outcomes. J Am Geriatr Soc 2011; 59:1686-91. [PMID: 21883118 PMCID: PMC3622699 DOI: 10.1111/j.1532-5415.2011.03573.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the relative effect of five chronic conditions on four representative universal health outcomes. DESIGN Cross-sectional. SETTING Cardiovascular Health Study. PARTICIPANTS Five thousand two hundred and ninety-eight community-living participants aged 65 and older. MEASUREMENTS Multiple regression and Cox models were used to determine the effect of heart failure (HF), chronic obstructive pulmonary disease (COPD), osteoarthritis, depression, and cognitive impairment on self-rated health, 12 basic and instrumental activities of daily living (ADLs and IADLs), six-item symptom burden scale, and death. RESULTS Each condition adversely affected self-rated health (P < .001) and ADLs and IADLs (P < .001). For example, persons with HF performed 0.70 ± 0.08 fewer ADLs and IADLs than those without; persons with depression and persons with cognitive impairment performed 0.59 ± 0.04 and 0.58 ± 0.06 fewer activities, respectively, than those without these conditions. Depression, HF, COPD, and osteoarthritis were associated with 1.18 ± 0.04, 0.40 ± 0.08, 0.40 ± 0.05, and 0.57 ± 0.03 more symptoms, respectively, in individuals with these conditions than in those without. HF (hazard ratio (HR) = 2.84, 95% confidence interval (CI) = 1.97-4.10), COPD (2.62, 95% CI = 1.94-3.53), cognitive impairment (2.05, 95% CI = 1.47-2.85), and depression (1.47, 95% CI = 1.08-2.01) were each associated with death within 2 years. Several paired combinations of conditions had synergistic effects on ADLs and IADLs. For example, individuals with HF plus depression performed 2.0 fewer activities than persons with neither condition, versus the 1.3 fewer activities expected from adding the effects of the two conditions together. CONCLUSION Universal health outcomes may provide a common metric for measuring the effects of multiple conditions and their treatments. The varying effects of the conditions across universal outcomes could inform care priorities.
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Affiliation(s)
- Mary E Tinetti
- Department of Medicine, School of MedicineSchool of Public Health, Yale University, New Haven, Connecticut 06520, USA.
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777
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Tinetti ME, McAvay G, Chang SS, Ning Y, Newman AB, Fitzpatrick A, Fried TR, Harris TB, Nevitt MC, Satterfield S, Yaffe K, Peduzzi P. Effect of chronic disease-related symptoms and impairments on universal health outcomes in older adults. J Am Geriatr Soc 2011; 59:1618-27. [PMID: 21883120 DOI: 10.1111/j.1532-5415.2011.03576.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the extent to which disease-related symptoms and impairments, which constitute measures of disease severity or targets of therapy, account for the associations between chronic diseases and universal health outcomes. DESIGN Cross-sectional. SETTING The Cardiovascular Health Study (CHS) and the Health, Aging and Body Composition Study (Health ABC). PARTICIPANTS Five thousand six hundred fifty-four CHS members and 2,706 Health ABC members. MEASUREMENTS Diseases included heart failure (HF), chronic obstructive pulmonary disease (COPD), osteoarthritis, and cognitive impairment. The universal health outcomes included self-rated health, basic and instrumental activities of daily living (ADLs and IADLs), and death. Disease-related symptoms and impairments included HF symptoms and ejection fraction (EF) for HF, Dyspnea Scale and forced expiratory volume in 1 second for COPD, joint pain for osteoarthritis, and executive function for cognitive impairment. RESULTS The diseases were associated with the universal health outcomes (P<.001) except osteoarthritis with death (both cohorts) and cognitive impairment with self-rated health (Health ABC). Symptoms and impairments accounted for 30% or more of each disease's effect on the universal health outcomes. In CHS, for example, HF was associated with one fewer (0.918) ADL and IADL performed without difficulty than no HF; HF symptoms accounted for 27% of this effect and EF for only 5%. The hazard ratio for death with HF was 6.5 (95% confidence interval=4.7-8.9) with EF accounting for 40% and HF symptoms for only 14%. CONCLUSION Disease-related symptoms and impairments accounted for much of the significant associations between the four chronic diseases and the universal health outcomes. Results support considering universal health outcomes as common metrics across diseases in clinical decision-making, perhaps by targeting the disease-related symptoms and impairments that contribute most strongly to the effect of the disease on the universal health outcomes.
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Affiliation(s)
- Mary E Tinetti
- Department of Medicine, School of Medicine, Yale University, New Haven, Connecticut 06520-8025, USA.
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778
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Mortenson WB, Miller WC, Backman CL, Oliffe JL. Predictors of mobility among wheelchair using residents in long-term care. Arch Phys Med Rehabil 2011; 92:1587-93. [PMID: 21840499 DOI: 10.1016/j.apmr.2011.03.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 01/05/2011] [Accepted: 03/30/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify predictors of mobility among long-term care residents who use wheelchairs as their main means of mobility. Based on the Matching Person to Technology Model, we hypothesized that wheelchair-related, personal, and environmental factors would be independent predictors of mobility. DESIGN Cross-sectional study. SETTING Eleven long-term residential care facilities in the lower mainland of British Columbia, Canada. PARTICIPANTS Residents (N=268): self-responding residents (n=149) and residents who required proxy respondents (n=119). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Mobility was measured using the Nursing Home Life-Space Diameter. Standardized measures of personal, wheelchair-related, and environmental factors were administered and sociodemographic data were collected as independent variables. RESULTS Independent mobility decreased as the distance from the resident's room increased: 63% of participants were independently mobile on their units, 40% were independently mobile off their units within the facilities, and 20% were independently mobile outdoors. For the total sample, the significant predictors of mobility, in descending order of importance, were: wheelchair skills (including the capacity to engage brakes and maneuver), functional independence in activities of daily living, having 4 or more visits per week from friends or family, and use of a power wheelchair. This regression model accounted for 48% of variance in mobility scores. CONCLUSIONS Limited independent mobility is a common problem among facility residents. Residents may benefit from interventions such as wheelchair skills training or provision of powered mobility, but the effectiveness of these interventions needs to be evaluated.
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Affiliation(s)
- W Ben Mortenson
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada.
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779
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Dinglas VD, Gellar J, Colantuoni E, Stan VA, Mendez-Tellez PA, Pronovost PJ, Needham DM. Does intensive care unit severity of illness influence recall of baseline physical function? J Crit Care 2011; 26:634.e1-7. [PMID: 21737233 DOI: 10.1016/j.jcrc.2011.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Revised: 04/19/2011] [Accepted: 05/09/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study is to evaluate if severity of illness in the intensive care unit influences patients' retrospective recall of their baseline physical function from before hospital admission. MATERIALS AND METHODS This is a prospective cohort study of 193 acute lung injury survivors who, before hospital discharge, retrospectively reported their prehospitalization physical function using the Short Form 36 quality of life survey. RESULTS Four measures were used to evaluate intensive care unit (ICU) severity of illness: (1) Acute Physiology and Chronic Health Evaluation II Acute Physiologic Score at ICU admission, (2) Lung Injury Score at acute lung injury diagnosis, (3) Sequential Organ Failure Assessment score at study enrollment, and (4) maximum daily Sequential Organ Failure Assessment score during the entire ICU stay. In multivariable linear regression analysis, no measure of severity of illness was associated with prehospitalization physical function. Education level significantly modified the relationship between ICU severity of illness and baseline physical function with lower educational attainment having a stronger association with baseline physical function. CONCLUSION Intensive care unit severity of illness was not associated with patients' retrospectively recalled baseline physical function. Patients with a lower level of education may be more influenced by ICU severity of illness, but the magnitude of this effect may not be clinically meaningful.
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Affiliation(s)
- Victor D Dinglas
- Outcomes After Critical Illness and Surgery Group, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
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780
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Total number and severity of comorbidities do not differ based on anatomical region of musculoskeletal pain. J Orthop Sports Phys Ther 2011; 41:477-85. [PMID: 21654099 DOI: 10.2519/jospt.2011.3686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Secondary analysis, cross-sectional study. OBJECTIVES To (1) compare differences in individual comorbidity rates among patients with cervical, lumbar, and extremity pain complaints and (2) compare rates based on total number and severity in these same patient groups. BACKGROUND Comorbidities can impact recovery, prognosis, and potentially hinder participation in rehabilitation. Few studies have compared comorbidity rates among patients with different anatomical region of pain, to determine whether specific screening is warranted in physical therapy settings. METHODS Included in the analyses were 2375 patients who reported complete demographic, clinical, and comorbidity information using Patient Inquiry software. Comorbidity data were collected from the Functional Comorbidity Index (18 items) and 6 additional comorbidities, to assess the presence of medical disease across multiple body systems. Comorbidities were further classified as "nonsevere" or "severe," based on inclusion in the Charlson Comorbidity Index. Chi-square analyses investigated differences in the rates of total number and severe comorbidities. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated on rates with statistically significant differences (P<.001), using the lumbar spine as the reference group. RESULTS Of the 24 comorbid conditions included in this analysis, 3 nonsevere medical conditions (degenerative disc disease, obesity, and headache) had different rates among anatomical region. A lower rate for degenerative disc disease was associated with the extremity conditions (χ2 = 66.3; OR = 0.40; 95% CI: 0.32, 0.50). Higher rate of headache (χ2 = 115.3; OR = 3.01; 95% CI: 2.45, 3.70) and lower rate of obesity (χ2 = 16.2; OR = 0.64; 95% CI: 0.51, 0.80) were associated with cervical conditions. There were no differences among the 3 anatomical regions for total number or severe comorbidities. CONCLUSION Focused screening for degenerative disc disease, obesity, and headache may be warranted. However, the same strategy was not supported for total number or severe comorbidities, at least when considering comparative rates from this cohort. Physical therapists should consider the potential influence of total number and severe comorbidities equally for all anatomical regions of musculoskeletal pain. LEVEL OF EVIDENCE Differential diagnosis/symptom prevalence, level 3b.
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781
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Health-specific optimism mediates between objective and perceived physical functioning in older adults. J Behav Med 2011; 35:400-6. [PMID: 21720826 DOI: 10.1007/s10865-011-9368-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 06/22/2011] [Indexed: 12/16/2022]
Abstract
Particularly in older adults, self-reports of physical health need not necessarily reflect their objective health status as they can be biased by optimism. In this study, we examine whether the effect of objective physical functioning on subjective physical functioning is modified by health-specific optimism and self-efficacy. A longitudinal study with three measurement points over 6 months and 309 older adults (aged 65-85) with multimorbidity was conducted. Subjective physical functioning was regressed on objective physical functioning, health-specific optimism and self-efficacy. Subjective physical functioning was predicted by both objective physical functioning and optimism as a mediator. Moreover, an interaction between optimism and self-efficacy was found: Optimism predicted subjective physical functioning only for individuals with low self-efficacy. Subjective physical functioning is as much based on objective physical functioning as it is on health-specific optimism. Older adults base their subjective physical functioning on objective indicators but also on optimism, when they are less self-efficacious.
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782
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Cook WL, Khan KM, Bech MH, Brasher PM, Brown RA, Bryan S, Donaldson MG, Guy P, Hanson HM, Leia C, Macri EM, Sims-Gould J, McKay HA, Ashe MC. Post-discharge management following hip fracture--get you back to B4: a parallel group, randomized controlled trial study protocol. BMC Geriatr 2011; 11:30. [PMID: 21651819 PMCID: PMC3132160 DOI: 10.1186/1471-2318-11-30] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Accepted: 06/09/2011] [Indexed: 11/10/2022] Open
Abstract
Background Fall-related hip fractures result in significant personal and societal consequences; importantly, up to half of older adults with hip fracture never regain their previous level of mobility. Strategies of follow-up care for older adults after fracture have improved investigation for osteoporosis; but managing bone health alone is not enough. Prevention of fractures requires management of both bone health and falls risk factors (including the contributing role of cognition, balance and continence) to improve outcomes. Methods/Design This is a parallel group, pragmatic randomized controlled trial to test the effectiveness of a post-fracture clinic compared with usual care on mobility for older adults following their hospitalization for hip fracture. Participants randomized to the intervention will attend a fracture follow-up clinic where a geriatrician and physiotherapist will assess and manage their mobility and other health issues. Depending on needs identified at the clinical assessment, participants may receive individualized and group-based outpatient physiotherapy, and a home exercise program. Our primary objective is to assess the effectiveness of a novel post-discharge fracture management strategy on the mobility of older adults after hip fracture. We will enrol 130 older adults (65 years+) who have sustained a hip fracture in the previous three months, and were admitted to hospital from home and are expected to be discharged home. We will exclude older adults who prior to the fracture were: unable to walk 10 meters; diagnosed with dementia and/or significant comorbidities that would preclude their participation in the clinical service. Eligible participants will be randomly assigned to the Intervention or Usual Care groups by remote allocation. Treatment allocation will be concealed; investigators, measurement team and primary data analysts will be blinded to group allocation. Our primary outcome is mobility, operationalized as the Short Physical Performance Battery at 12 months. Secondary outcomes include frailty, rehospitalizations, falls risk factors, quality of life, as well as physical activity and sedentary behaviour. We will conduct an economic evaluation to determine health related costs in the first year, and a process evaluation to ascertain the acceptance of the program by older adults, as well as clinicians and staff within the clinic. Trial registration number ClinicalTrials.gov: NCT01254942
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Affiliation(s)
- Wendy L Cook
- Centre for Hip Health and Mobility, Vancouver, Canada
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783
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Holden L, Scuffham PA, Hilton MF, Muspratt A, Ng SK, Whiteford HA. Patterns of multimorbidity in working Australians. Popul Health Metr 2011; 9:15. [PMID: 21635787 PMCID: PMC3123553 DOI: 10.1186/1478-7954-9-15] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 06/02/2011] [Indexed: 11/17/2022] Open
Abstract
Background Multimorbidity is becoming more prevalent. Previously-used methods of assessing multimorbidity relied on counting the number of health conditions, often in relation to an index condition (comorbidity), or grouping conditions based on body or organ systems. Recent refinements in statistical approaches have resulted in improved methods to capture patterns of multimorbidity, allowing for the identification of nonrandomly occurring clusters of multimorbid health conditions. This paper aims to identify nonrandom clusters of multimorbidity. Methods The Australian Work Outcomes Research Cost-benefit (WORC) study cross-sectional screening dataset (approximately 78,000 working Australians) was used to explore patterns of multimorbidity. Exploratory factor analysis was used to identify nonrandomly occurring clusters of multimorbid health conditions. Results Six clinically-meaningful groups of multimorbid health conditions were identified. These were: factor 1: arthritis, osteoporosis, other chronic pain, bladder problems, and irritable bowel; factor 2: asthma, chronic obstructive pulmonary disease, and allergies; factor 3: back/neck pain, migraine, other chronic pain, and arthritis; factor 4: high blood pressure, high cholesterol, obesity, diabetes, and fatigue; factor 5: cardiovascular disease, diabetes, fatigue, high blood pressure, high cholesterol, and arthritis; and factor 6: irritable bowel, ulcer, heartburn, and other chronic pain. These clusters do not fall neatly into organ or body systems, and some conditions appear in more than one cluster. Conclusions Considerably more research is needed with large population-based datasets and a comprehensive set of reliable health diagnoses to better understand the complex nature and composition of multimorbid health conditions.
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Affiliation(s)
- Libby Holden
- School of Medicine, Griffith University; University Drive Meadowbrook, Queensland 4131, Australia
| | - Paul A Scuffham
- School of Medicine, Griffith University; University Drive Meadowbrook, Queensland 4131, Australia
| | - Michael F Hilton
- Queensland Centre for Mental Health research, Queensland Health; Level 3 Dawson house, The Park, Wacol, Queensland 4076, Australia
| | - Alexander Muspratt
- University of Queensland, School of Population Health; Herston Road Herston, Queensland 4006, Australia
| | - Shu-Kay Ng
- School of Medicine, Griffith University; University Drive Meadowbrook, Queensland 4131, Australia
| | - Harvey A Whiteford
- Queensland Centre for Mental Health research, Queensland Health; Level 3 Dawson house, The Park, Wacol, Queensland 4076, Australia.,University of Queensland, School of Population Health; Herston Road Herston, Queensland 4006, Australia
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784
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Formica V, Del Monte G, Giacchetti I, Grenga I, Giaquinto S, Fini M, Roselli M. Rehabilitation in Neuro-Oncology: A Meta-Analysis of Published Data and a Mono-Institutional Experience. Integr Cancer Ther 2011; 10:119-126. [DOI: 10.1177/1534735410392575] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Background. Rehabilitation for cancer patients with central nervous system (CNS) involvement is rarely considered and data on its use are limited. The purpose of the present study is to collect all available published data on neuro-oncology rehabilitation and perform a meta-analysis where results were presented in a comparable manner. Moreover, the authors report results on cancer patients with neurological disabilities undergoing rehabilitation at their unit. Study design. A PubMed search was performed to identify studies regarding cancer patients with CNS involvement undergoing inpatient physical rehabilitation. Studies with a complete functional evaluation at admission and discharge were selected. As the most common evaluation scales were Functional Independence Measure (FIM) and Barthel Index (BI), only articles with complete FIM and/or BI data were selected for the meta-analysis. Moreover, 23 cancer patients suffering from diverse neurological disabilities underwent standard rehabilitation program between April 2005 and December 2007 at the San Raffaele Pisana Rehabilitation Center. Patient demographics and relevant clinical data were collected. Motricity Index, Trunk Control Test score, and BI were monitored during rehabilitation to assess patient progresses. BI results of patients in this study were included in the meta-analysis. Results. The meta-analysis included results of a total of 994 patients. A statistically significant ( P < .05) improvement of both BI and FIM scores was demonstrated after rehabilitation (standardized mean difference = 0.60 and 0.75, respectively). Functional status determined by either FIM or BI improved on average by 36%. Conclusion. Published data demonstrate that patients with brain tumors undergoing inpatient rehabilitation appear to make functional gains in line with those seen in similar patients with nonneoplastic conditions.
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Affiliation(s)
- Vincenzo Formica
- University of Rome, Rome, Italy, IRCCS San Raffaele Pisana, Rome, Italy,
| | | | | | | | | | | | - Mario Roselli
- University of Rome, Rome, Italy, IRCCS San Raffaele Pisana, Rome, Italy
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785
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Warner LM, Schüz B, Knittle K, Ziegelmann JP, Wurm S. Sources of Perceived Self-Efficacy as Predictors of Physical Activity in Older Adults. Appl Psychol Health Well Being 2011. [DOI: 10.1111/j.1758-0854.2011.01050.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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786
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Rationale and design of the chronic GVHD cohort study: improving outcomes assessment in chronic GVHD. Biol Blood Marrow Transplant 2011; 17:1114-20. [PMID: 21664473 DOI: 10.1016/j.bbmt.2011.05.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 05/05/2011] [Indexed: 01/08/2023]
Abstract
In 2005, the National Institutes of Health sponsored a Consensus Development Project on Criteria for Clinical Trials in chronic graft-versus-host (cGVHD) to achieve consensus about key elements of cGVHD research, including definitions for diagnosis, severity scoring, and response measures. To test these proposed definitions, a multicenter prospective cohort study of people with cGVHD is ongoing. This study will evaluate the performance of proposed prognostic factors, measures of disease activity, and surrogate endpoints for therapeutic response. Data are collected at 6-month intervals in a heterogeneous population of patients reflecting modern transplant techniques and posttransplantation clinical management (target enrollment 672 with cGVHD from 10 transplantation centers). This report describes the rationale, design, and methods of the cGVHD cohort study, and invites other investigators to collaborate with the Consortium to analyze data or specimens.
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787
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Drageset J, Eide GE, Ranhoff AH. Depression is associated with poor functioning in activities of daily living among nursing home residents without cognitive impairment. J Clin Nurs 2011; 20:3111-8. [DOI: 10.1111/j.1365-2702.2010.03663.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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788
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Wilson NM, Hilmer SN, March LM, Cameron ID, Lord SR, Seibel MJ, Mason RS, Chen JS, Cumming RG, Sambrook PN. Associations between drug burden index and falls in older people in residential aged care. J Am Geriatr Soc 2011; 59:875-80. [PMID: 21539525 DOI: 10.1111/j.1532-5415.2011.03386.x] [Citation(s) in RCA: 163] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the association between the Drug Burden Index (DBI), a measure of a person's total exposure to anticholinergic and sedative medications that includes principles of dose-response and maximal effect and is associated with impaired physical function in community-dwelling older people, and falls in residents of residential aged care facilities (RACFs). DESIGN Data were drawn from participants in a randomized controlled trial that investigated falls and fractures. SETTING RACFs in Sydney, Australia. PARTICIPANTS Study participants (N=602; 70.9% female) were recruited from 51 RACFs. Mean age was 85.7 ± 6.4, and mean DBI was 0.60 ± 0.66. MEASUREMENTS Medication history was obtained on each participant. Drugs were classified as anticholinergic or sedative and a DBI was calculated. Falls were measured over a 12-month period. Comorbidity, cognitive impairment (Mini-Mental State Examination) and depression (Geriatric Depression Scale) were determined. RESULTS There were 998 falls in 330 individuals during a follow-up period of 574.2 person-years, equating to an average rate of 1.74 falls per person-year. The univariate negative binomial regression model for falls showed incidence rate ratios of 1.69 (95% confidence interval (CI)=1.22-2.34) for low DBI (<1) and 2.11 (95% CI=1.47-3.04) for high DBI (≥1) when compared with those who had a DBI of 0. After adjusting for age, sex, history of falling, cognitive impairment, depression, use of a walking aid, comorbidities, polypharmacy, and incontinence, incident rate ratios of 1.61 (95% CI=1.17-2.23) for low DBI and 1.90 (95% CI=1.30-2.78) for high DBI were obtained. CONCLUSION DBI is significantly and independently associated with falls in older people living in RACFs. Interventional studies designed for this population are needed to determine whether reducing DBI, through dose reduction or cessation of anticholinergic and sedative drugs, can prevent falls.
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Affiliation(s)
- Nicholas M Wilson
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, Royal North Shore Hospital, Sydney, New South Wales, Australia.
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789
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Davis JC, Marra CA, Liu-Ambrose TY. Falls-related self-efficacy is independently associated with quality-adjusted life years in older women. Age Ageing 2011; 40:340-6. [PMID: 21436152 DOI: 10.1093/ageing/afr019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND falls-related self-efficacy is associated with falls, falls-related injury and subsequent functional decline which may lead to poor health-related quality-of-life (HRQL). To our knowledge, no previous studies have examined the independent contribution of falls-related self-efficacy to HRQL. Our primary objective was to determine whether falls-related self-efficacy is independently associated HRQL, measured by quality-adjusted life years (QALYs), in older women after accounting for known covariates. METHOD we conducted a secondary analysis of 135 community-dwelling older women aged 65-75 years who participated in a 12-month randomised controlled trial of resistance training. We assessed falls-related self-efficacy using the Activities-specific Balance Confidence Scale and QALYs calculated from the EuroQol EQ-5D (EQ-5D). RESULTS our multivariate linear regression model demonstrated that falls-related self-efficacy as assessed using the Activities-specific Balance Confidence Scale was independently associated with QALYs after accounting for age, group, education, functional co-morbidity index, general mobility, global cognition and physiological falls risk. The final model explained 52% of the variation in QALYs. The ABC Scale accounted for 5% of the total variance in the final model. CONCLUSIONS although falls-related self-efficacy was independently associated with QALYs after controlling for a number of known variables, there may well be other factors not investigated, such as risk taking behaviour and psychological measures, which could account for some of the association. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00426881.
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Affiliation(s)
- Jennifer C Davis
- Centre for Clinical Epidemiology and Evaluation, University of British Columbia, Vancouver, BC, Canada
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790
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Drageset J, Kirkevold M, Espehaug B. Loneliness and social support among nursing home residents without cognitive impairment: A questionnaire survey. Int J Nurs Stud 2011; 48:611-9. [DOI: 10.1016/j.ijnurstu.2010.09.008] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Revised: 09/08/2010] [Accepted: 09/11/2010] [Indexed: 10/19/2022]
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791
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Effect of fear-avoidance beliefs of physical activities on a model that predicts risk-adjusted functional status outcomes in patients treated for a lumbar spine dysfunction. J Orthop Sports Phys Ther 2011; 41:336-45. [PMID: 21471649 DOI: 10.2519/jospt.2011.3534] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Retrospective analysis of a prospective, longitudinal cohort study of 30 858 patients being treated for a lumbar spine dysfunction in outpatient physical therapy. OBJECTIVES To determine effect of adding a single-item screening variable classifying patients with elevated versus not-elevated scores of fear-avoidance beliefs of physical activities at intake, on a model predicting risk-adjusted functional status (FS) outcomes. BACKGROUND Outcomes must be risk-adjusted before making meaningful interpretations. Elevated fear-avoidance beliefs scores have been predictive of poor outcomes. But the importance of elevated fear-avoidance scores in a multivariable model predicting FS outcomes needs further study. METHODS Using retrospective analyses, predictive ability (R2) of multivariable linear regression models of discharge FS with and without classification by elevated versus not-elevated fear-avoidance scores were compared, while controlling for intake FS, age, symptom acuity, surgical history, gender, number of comorbidities, and payer. Percent variance controlled and beta coefficients (95% confidence intervals) of each variable in both models were compared. A split-half design was used for model cross-validation. Predictive ratios (predicted FS, divided by actual discharge FS) were assessed. RESULTS Adding fear-avoidance beliefs classification to the discharge FS model improved (P<.001) model predictive ability but only slightly (R2 without, and with, fear-avoidance classification, 0.2997 and 0.3010, respectively). Variables impacted models similarly (95% confidence intervals not different). Fear-avoidance classification added 0.2% data variance control to the existing model. Cross-validation was supported. Predictive ratios were 1.09 and 1.10, without and with fear-avoidance, respectively. CONCLUSION Although screening for elevated fear-avoidance beliefs of physical activities significantly improves the FS outcomes predictive model, the amount of additional meaningful interpretation of FS outcomes was minimal. Exploration of other clinically relevant variables designed to improve outcomes prediction is warranted. LEVEL OF EVIDENCE Prognosis, level 2c.
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792
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Changes in functional status in older newly-diagnosed cancer patients during cancer treatment: A six-month follow-up period. Results of a prospective pilot study. J Geriatr Oncol 2011. [DOI: 10.1016/j.jgo.2010.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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793
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Heyland DK, Muscedere J, Drover J, Jiang X, Day AG. Persistent organ dysfunction plus death: a novel, composite outcome measure for critical care trials. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:R98. [PMID: 21418560 PMCID: PMC3219367 DOI: 10.1186/cc10110] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 10/28/2010] [Accepted: 03/18/2011] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Due to resource limitations, few critical care interventions have been rigorously evaluated with adequately powered randomized clinical trials (RCTs). There is a need to improve the efficiency of RCTs in critical care so that more definitive high quality RCTs can be completed with the available resources. The objective of this study was to validate and demonstrate the utility of a novel composite outcome measure, persistent organ dysfunction (POD) plus death, for clinical trials of critically ill patients. METHODS We performed a secondary analysis of a dataset from a prospective randomized trial involving 38 intensive care units (ICUs) in Canada, Europe, and the United States. We define POD as the persistence of organ dysfunction requiring supportive technologies during the convalescent phase of critical illness and it is present when a patient has an ongoing requirement for vasopressors, dialysis, or mechanical ventilation at the outcome assessments time points. In 600 patients enrolled in a randomized trial of nutrition therapy and followed prospectively for six months, we evaluated the prevalence of POD and its association with outcome. RESULTS At 28 days, 2.3% of patients had circulatory failure, 13.7% had renal failure, 8.7% had respiratory failure, and 27.2% had died, for an overall prevalence of POD + death = 46.0%. Of survivors at Day 28, those with POD, compared to those without POD, had a higher mortality rate in the six-month follow-up period, had longer ICU and hospital stays, and a reduced quality of life at three months. Given these rates of POD + death and using a two-sided Chi-squared test at alpha = 0.05, we would require 616 patients per arm to detect a 25% relative risk reduction (RRR) in mortality, but only 286 per arm to detect the same RRR in POD + mortality. CONCLUSIONS POD + death may be a valid composite outcome measure and compared to mortality endpoints, may reduce the sample size requirements of clinical trials of critically ill patients. Further validation in larger clinical trials is required.
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Affiliation(s)
- Daren K Heyland
- Department of Medicine, Queen's University, 76 Stuart Street, Kingston, ON K7L 2V7, Canada.
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794
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Warner LM, Ziegelmann JP, Schüz B, Wurm S, Tesch-Römer C, Schwarzer R. Maintaining autonomy despite multimorbidity: self-efficacy and the two faces of social support. Eur J Ageing 2011; 8:3-12. [PMID: 28798638 PMCID: PMC5547307 DOI: 10.1007/s10433-011-0176-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Multimorbidity-the co-occurrence of multiple illnesses-is a frequent condition in older adults and poses serious threats to autonomy. In order to identify resources for autonomy despite multimorbidity, our longitudinal study tested main and interaction effects of personal and social resources (self-efficacy and social support) on maintaining autonomy. Three hundred and nine individuals (aged 65-85 years) with multiple illnesses completed measures of self-efficacy beliefs, received instrumental social support and perceptions of autonomy. Data were analyzed using structural equation modeling. Cross-sectionally, individuals with lower perceptions of autonomy received more support from their networks. Longitudinally, the relation of received support with autonomy was moderated by self-efficacy: Simple slopes analyses showed that social support compensated for lower levels of self-efficacy, whereas in individuals with higher self-efficacy the resources interfered. Receiving social support bolstered autonomy in lower self-efficacious individuals, but in highly self-efficacious individuals support threatened autonomy. This has implications for both theory and practice, as it suggests differential effects of social resources depending on personal resources.
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Affiliation(s)
- Lisa M. Warner
- Department of Psychology, Health Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
- German Centre of Gerontology, Berlin, Germany
| | - Jochen P. Ziegelmann
- Department of Psychology, Health Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
- German Centre of Gerontology, Berlin, Germany
| | | | | | | | - Ralf Schwarzer
- Department of Psychology, Health Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
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795
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ICF participation restriction is common in frail, community-dwelling older people: an observational cross-sectional study. Physiotherapy 2011; 97:26-32. [DOI: 10.1016/j.physio.2010.06.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2010] [Accepted: 06/28/2010] [Indexed: 11/19/2022]
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796
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Dubois MF, Dubuc N, Kröger E, Girard R, Hébert R. Assessing comorbidity in older adults using prescription claims data. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2011. [DOI: 10.1111/j.1759-8893.2010.00030.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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797
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Medication beliefs predict medication adherence in older adults with multiple illnesses. J Psychosom Res 2011; 70:179-87. [PMID: 21262421 DOI: 10.1016/j.jpsychores.2010.07.014] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 07/20/2010] [Accepted: 07/27/2010] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To examine factors preventing medication nonadherence in community-dwelling older adults with multiple illnesses (multimorbidity). Nonadherence threatens successful treatment of multimorbidity. Adherence problems can be intentional (e.g., deliberately choosing not to take medicines or to change medication dosage) or unintentional (e.g., forgetting to take medication) and might depend on a range of factors. This study focused in particular on the role of changes in beliefs about medication to explain changes in adherence. METHODS Longitudinal study with N = 309 individuals aged 65-85 years with two or more diseases at three measurement points over six months. Medication adherence and beliefs about medicines were assessed by questionnaire. Hierarchical weighted least squares regression analyses were used to predict individual intentional and unintentional nonadherence. RESULTS Changes in intentional nonadherence were predicted by changes in specific necessity beliefs (B = -.19, P<.01), after controlling for sociodemographic factors, health status and number of prescribed medicines. Changes in unintentional nonadherence were predicted by changes in general overuse beliefs (B = .26, P<.01), controlling for the same covariates. CONCLUSION Beliefs about medication affect both intentional and unintentional adherence to medication in multimorbid older adults. This points to the importance of addressing medication beliefs in patient education to improve adherence.
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798
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Determining whether women with osteopenic bone mineral density have low, moderate, or high clinical fracture risk. Menopause 2011; 17:1010-6. [PMID: 20555289 DOI: 10.1097/gme.0b013e3181da4b7d] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Most low-trauma fractures occur among women with osteopenic bone mineral density (BMD), a population considered to have moderate absolute fracture risk. Our purpose was to refine the fracture risk prediction in women with osteopenic BMD to determine the subgroups at lowest and highest risk. METHODS We included 2,588 women aged 50 to 90 years with osteopenic BMD (femoral neck BMD between -1 and -2.5) participating in the Canadian Multicentre Osteoporosis Study, an ongoing prospective cohort study of randomly selected Canadians. Baseline variables, in addition to known risk factors, age, and BMD, were considered for inclusion in a model for the prediction of 5-year absolute risk of low-trauma fracture. Models were derived using logistic regression and assessed by the Bayesian Information Criterion. RESULTS We found an increased fracture risk among those with lower BMD (odds ratio [OR], 1.53; 95% CI, 1.06-2.21) for each decrease in femoral neck T score (eg, from -1 to -2), those with prior low-trauma fracture (OR, 2.06; 95% CI, 1.46-2.92), those with self-reported worse general health (OR, 1.35; 95% CI, 1.15-1.59) for each lower category (categories: excellent, very good, good, fair, poor), and those with height loss (OR, 1.44; 95% CI, 1.16-1.90) for each 5-cm difference between current and maximal height. The new model had yielded a better risk stratification than did a model with World Health Organization risk factors. CONCLUSIONS Including risk factors such as general health and height loss can be used to provide a highly effective assessment of fracture risk among women with osteopenic BMD.
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799
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Styron JF, Barsoum WK, Smyth KA, Singer ME. Preoperative predictors of returning to work following primary total knee arthroplasty. J Bone Joint Surg Am 2011; 93:2-10. [PMID: 21209263 DOI: 10.2106/jbjs.i.01317] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is little in the literature to guide clinicians in advising patients regarding their return to work following a primary total knee arthroplasty. In this study, we aimed to identify which factors are important in estimating a patient's time to return to work following primary total knee arthroplasty, how long patients can anticipate being off from work, and the types of jobs to which patients are able to return following primary total knee arthroplasty. METHODS A prospective cohort study was performed in which patients scheduled for a primary total knee arthroplasty completed a validated questionnaire preoperatively and at four to six weeks, three months, and six months postoperatively. The questionnaire assessed the patient's occupational physical demands, ability to perform job responsibilities, physical status, and motivation to return to work as well as factors that may impact his or her recovery and other workplace characteristics. Two survival analysis models were constructed to evaluate the time to return to work either at least part-time or full-time. Acceleration factors were calculated to indicate the relative percentage of time until the patient returned to work. RESULTS The median time to return to work was 8.9 weeks. Patients who reported a sense of urgency about returning to work were found to return in half the time taken by other employees (acceleration factor = 0.468; p < 0.001). Other preoperative factors associated with a faster return to work included being female (acceleration factor = 0.783), self-employment (acceleration factor = 0.792), higher mental health scores (acceleration factor = 0.891), higher physical function scores (acceleration factor = 0.809), higher Functional Comorbidity Index scores (acceleration factor = 0.914), and a handicap accessible workplace (acceleration factor = 0.736). A slower return to work was associated with having less pain preoperatively (acceleration factor = 1.132), having a more physically demanding job (acceleration factor = 1.116), and receiving Workers' Compensation (acceleration factor = 4.360). CONCLUSIONS Although the physical demands of a patient's job have a moderate influence on the patient's ability to return to work following a primary total knee arthroplasty, the patient's characteristics, particularly motivation, play a more important role.
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Affiliation(s)
- Joseph F Styron
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, OH 44106-4945, USA.
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800
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Eisner MD, Blanc PD, Omachi TA, Yelin EH, Sidney S, Katz PP, Ackerson LM, Sanchez G, Tolstykh I, Iribarren C. Socioeconomic status, race and COPD health outcomes. J Epidemiol Community Health 2011; 65:26-34. [PMID: 19854747 PMCID: PMC3017471 DOI: 10.1136/jech.2009.089722] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Although chronic obstructive pulmonary disease (COPD) is a common cause of death and disability, little is known about the effects of socioeconomic status (SES) and race-ethnicity on health outcomes. METHODS The aim of this study is to determine the independent impacts of SES and race-ethnicity on COPD severity status, functional limitations and acute exacerbations of COPD among patients with access to healthcare. Data were used from the Function, Living, Outcomes and Work cohort study of 1202 Kaiser Permanente Northern California Medical Care Plan members with COPD. RESULTS Lower educational attainment and household income were consistently related to greater disease severity, poorer lung function and greater physical functional limitations in cross-sectional analysis. Black race was associated with greater COPD severity, but these differences were no longer apparent after controlling for SES variables and other covariates (comorbidities, smoking, body mass index and occupational exposures). Lower education and lower income were independently related to a greater prospective risk of acute COPD exacerbation (HR 1.5; 95% CI 1.01 to 2.1; and HR 2.1; 95% CI 1.4 to 3.4, respectively). CONCLUSION Low SES is a risk factor for a broad array of adverse COPD health outcomes. Clinicians and disease management programs should consider SES as a key patient-level marker of risk for poor outcomes.
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Affiliation(s)
- M D Eisner
- Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143-0111, USA.
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