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Rahbek MA, Mikkelsen EE, Overgaard K, Vinge L, Andersen H, Dalgas U. Exercise in myasthenia gravis: A feasibility study of aerobic and resistance training. Muscle Nerve 2017; 56:700-709. [PMID: 28085204 DOI: 10.1002/mus.25552] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 12/21/2016] [Accepted: 12/28/2016] [Indexed: 12/11/2022]
Abstract
INTRODUCTION It has not been established whether progressive resistance training (PRT) and aerobic training (AT) are feasible and efficient in myasthenia gravis (MG). METHODS Fifteen subjects with generalized MG (Myasthenia Gravis Foundation of America (MGFA) clinical classification II-IV) were randomly assigned to 20 training sessions during 8 weeks of either PRT or AT. Feasibility was evaluated based on adherence, drop-out rate, adverse events, and Quantitative Myasthenia Gravis (QMG) score. RESULTS Twelve subjects (MGFA II, n = 11; MGFA III, n=1) completed the intervention with a mean adherence of 95 % ± 8. One dropout (PRT) could potentially be related to PRT. Both groups reported adverse events, including bulbar symptoms (n = 2) and increased fatigue (n = 3), but no change in QMG score was observed in either group. The PRT group showed increases in maximal strength and functional capacity. CONCLUSIONS Eight weeks of moderate to high intensity AT and PRT were feasible for most patients with mild MG. Maximal strength and functional capacity increased in the PRT group. Muscle Nerve 56: 700-709, 2017.
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Affiliation(s)
- Martin Amadeus Rahbek
- Section for Sport Science, Department of Public Health, Aarhus University, Denmark, Dalgas Avenue 4, 8000, Aarhus C, Denmark
| | - Erik Elgaard Mikkelsen
- Section for Sport Science, Department of Public Health, Aarhus University, Denmark, Dalgas Avenue 4, 8000, Aarhus C, Denmark
| | - Kristian Overgaard
- Section for Sport Science, Department of Public Health, Aarhus University, Denmark, Dalgas Avenue 4, 8000, Aarhus C, Denmark
| | - Lotte Vinge
- Department of Neurology, Aarhus University Hospital, Noerrebrogade, 44, 8000 Aarhus C, Denmark
| | - Henning Andersen
- Department of Neurology, Aarhus University Hospital, Noerrebrogade, 44, 8000 Aarhus C, Denmark
| | - Ulrik Dalgas
- Section for Sport Science, Department of Public Health, Aarhus University, Denmark, Dalgas Avenue 4, 8000, Aarhus C, Denmark
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Frost A, Svendsen ML, Rahbek J, Stapelfeldt CM, Nielsen CV, Lund T. Labour market participation and sick leave among patients diagnosed with myasthenia gravis in Denmark 1997-2011: a Danish nationwide cohort study. BMC Neurol 2016; 16:224. [PMID: 27855651 PMCID: PMC5114816 DOI: 10.1186/s12883-016-0757-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 11/13/2016] [Indexed: 11/10/2022] Open
Abstract
Background To examine labour market participation and long-term sick leave following a diagnosis with myasthenia gravis (MG) compared with the general Danish population and for specific subgroups of MG patients. Methods A nationwide matched cohort study from 1997 to 2011 using data from population-based medical and social registries. The study includes 330 MG patients aged 18 to 65 years old identified from hospital diagnoses and dispensed prescriptions, and twenty references from the Danish population matching each MG patient on age, gender, and profession. Main outcome measures are labour market participation (yes/no) and long-term sick leave ≥9 weeks (yes/no) with follow-up at 1- and 2 years after the time of MG diagnosis or match. Based on complete person-level information on all public transfer payments in Denmark, persons having no labour market participation are defined as individuals receiving social benefits for severely reduced workability, flexijob, and disability pension. Results MG is consistently associated with higher odds of having no labour market participation and long-term sick leave compared with the general Danish population (no labour market participation & ≥9 weeks sick leave at 2-year follow-up, adjusted OR (95% CI): 5.76 (4.13 to 8.04) & 8.60 (6.60 to 11.23)). Among MG patients, females and patients treated with both acetylcholinesterase inhibitors and immunosuppression have higher odds of lost labour market participation and long-term sick leave. Conclusions This study suggests that MG patients have almost 6 times higher odds of no labour market participation and almost 9 times higher odds of long-term sick leave 2 years after diagnosis compared with the general Danish population. In particular female MG patients and patients treated with both acetylcholinesterase and immunosuppression have high odds of a negative labour market outcome. Future research should focus on predictors in workplace and labour market policy of labour market participation among MG patients.
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Affiliation(s)
- Asger Frost
- The National Rehabilitation Centre for Neuromuscular Disorders, Kongsvang Allé 23, DK-8000, Aarhus, Denmark
| | | | - Jes Rahbek
- The National Rehabilitation Centre for Neuromuscular Disorders, Kongsvang Allé 23, DK-8000, Aarhus, Denmark
| | | | - Claus Vinther Nielsen
- DEFACTUM and Section of Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, P.P. Oerums Gade 11, Building 1B, DK-8000, Aarhus C, Denmark
| | - Thomas Lund
- DEFACTUM, Olof Palmes Allé 15, DK-8200, Aarhus N, Denmark. .,Danish Ramazzini Centre, Department of Occupational Medicine, University Research Clinic, Regional Hospital West Jutland, Gl. Landevej 61, DK-7400, Herning, Denmark.
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Leonardi M, Covelli V, Giovannetti AM, Raggi A, Sattin D. ICF-DOC: the ICF dedicated checklist for evaluating functioning and disability in people with disorders of consciousness. Int J Rehabil Res 2015; 37:197-204. [PMID: 24463705 DOI: 10.1097/mrr.0000000000000051] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Clinicians need a comprehensive description of patients' functioning state to capture the complex interaction between symptoms and environmental factors, and to determine the actual level of functioning in patients in a vegetative state or a minimally conscious state. The aim of this study is to develop an International Classification of Functioning, Disability, and Health (ICF) checklist for patients with disorders of consciousness (DOC) so as to capture and describe, with a tailored list of categories, the most common health, disability, and functioning issues of adult patients with DOC. The WHO ICF checklist was used as a basis for collecting data. This was an observational, cross-sectional, multicenter study conducted in 69 Italian centers. Specific methodological procedures were used to identify the most appropriate categories for DOC patients to be added to or deleted from the ICF checklist so as to develop the ICF-DOC checklist. A total of 566 adult patients were enrolled: 398 in a vegetative state and 168 in a minimally conscious state. A total of 127 ICF categories reached the threshold of 20% concerning the presence of a problem: 37 categories from the body functions chapter, 13 from the body structures chapter, 46 from the activities and participations chapter, and 31 from the environmental factors chapter. ICF categories identified in this study can be useful guidelines for clinicians and researchers to collect data on functioning and disability of adult patients with DOC. The new ICF-DOC checklist allows monitoring of the effects of interventions on functional areas and possible changes in each patient in follow-up studies.
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Affiliation(s)
- Matilde Leonardi
- Neurology Public Health and Disability Unit, Scientific Directorate, Neurological Institute C. Besta, IRCCS Foundation, Milan, Italy
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Barnett C, Bril V, Kapral M, Kulkarni A, Davis AM. A conceptual framework for evaluating impairments in myasthenia gravis. PLoS One 2014; 9:e98089. [PMID: 24844418 PMCID: PMC4028305 DOI: 10.1371/journal.pone.0098089] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 04/29/2014] [Indexed: 11/24/2022] Open
Abstract
Background Myasthenia gravis is characterized by weakness and fatigability of different muscle groups, including ocular, bulbar and the limbs. Therefore, a measure of disease severity at the impairment level in myasthenia needs to reflect all the relevant impairments, as well as their variations with activity and fatigue. We conducted a qualitative study of patients with myasthenia, to explore their experiences and related impairments, aimed at developing a conceptual framework of disease severity at the impairment level in myasthenia gravis. Methods Twenty patients representing the spectrum of disease participated in semi-structured interviews. Interviews were recorded and the transcripts were analyzed by content analysis using an inductive approach with line-by-line open coding. Themes were generated from these codes. Results Two main themes were identified: the severity of the impairments and fatigability (i.e., triggering or worsening of an impairment with activity). The impairments were further classified within body regions (ocular, bulbar and axial/limbs). Fatigability was described as a phenomenon affecting the whole body but also affecting specific impairments, and was associated with fluctuation of the symptoms. Patients were concerned that clinical examination at a single point in time might not reflect their true clinical state due to fatigability and fluctuations in severity. Conclusions This conceptual framework reflects the relevance of both severity and fatigability in understanding impairment-based disease severity in myasthenia. This framework could inform the development of impairment measures in myasthenia gravis.
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Affiliation(s)
- Carolina Barnett
- Division of Neurology - Department of Medicine, University of Toronto and University Health Network, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- * E-mail:
| | - Vera Bril
- Division of Neurology - Department of Medicine, University of Toronto and University Health Network, Toronto, Canada
| | - Moira Kapral
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Medicine, University of Toronto and University Health Network, Toronto, Canada
| | - Abhaya Kulkarni
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Neurosurgery, Hospital for Sick Children, Toronto, Canada
| | - Aileen M. Davis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, Toronto, Canada
- Department of Physical Therapy and Graduate Department of Rehabilitation Science, University of Toronto, Toronto, Canada
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Leonardi M, Martinuzzi A, Meucci P, Sala M, Russo E, Buffoni M, Raggi A. A population survey in Italy based on the ICF classification: recognizing persons with severe disability. ScientificWorldJournal 2012; 2012:189097. [PMID: 22454601 PMCID: PMC3290329 DOI: 10.1100/2012/189097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 12/08/2011] [Indexed: 11/23/2022] Open
Abstract
Aim of this paper is to describe functioning of subjects with "severe disability" collected with a protocol based on the International Classification of Functioning, Disability, and Health. It included sections on body functions and structures (BF and BS), activities and participation (A&P), and environmental factors (EF). In A&P, performance without personal support (WPS) was added to standard capacity and performance. Persons with severe disability were those reporting a number of very severe/complete problems in BF or in A&P-capacity superior to mean + 1SD. Correlations between BF and A&P and differences between capacity, performance-WPS, and performance were assessed with Spearman's coefficient. Out of 1051, 200 subjects were considered as severely disabled. Mild to moderate correlations between BF and A&P were reported (between 0.148 and 0.394 when the full range of impairments/limitations was taken into account; between 0.198 and 0.285 when only the severe impairments/limitations were taken into account); performance-WPS was less similar to performance than to capacity. Our approach enabled identifying subjects with "severe disability" and separating the effect of personal support from that of devices, policies, and service provision.
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Affiliation(s)
- Matilde Leonardi
- Neurology, Public Health and Disability Unit-Scientific Directorate, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milano, Italy
| | - Andrea Martinuzzi
- IRCCS E. Medea Scientific Institute, Conegliano-Pieve di Soligo Research Centre, Via Costa Alta 37, 31015 Conegliano, Italy
| | - Paolo Meucci
- Neurology, Public Health and Disability Unit-Scientific Directorate, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milano, Italy
| | - Marina Sala
- Neurology, Public Health and Disability Unit-Scientific Directorate, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milano, Italy
| | - Emanuela Russo
- IRCCS E. Medea Scientific Institute, Conegliano-Pieve di Soligo Research Centre, Via Costa Alta 37, 31015 Conegliano, Italy
| | - Mara Buffoni
- IRCCS E. Medea Scientific Institute, Conegliano-Pieve di Soligo Research Centre, Via Costa Alta 37, 31015 Conegliano, Italy
| | - Alberto Raggi
- Neurology, Public Health and Disability Unit-Scientific Directorate, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milano, Italy
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Reinhardt JD, Miller J, Stucki G, Sykes C, Gray DB. Measuring impact of environmental factors on human functioning and disability: a review of various scientific approaches. Disabil Rehabil 2011; 33:2151-65. [PMID: 21548824 DOI: 10.3109/09638288.2011.573053] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The objective of this paper is to present a framework for systematically describing different approaches to measure environmental factors (EF) and to discuss some strengths and weaknesses of these approaches. METHODS Identification of suitable criteria for ordering measurements of EF was based on an analysis of existing reviews, a qualitative literature review and feedback from experts. Items of selected EF measures were linked to the International Classification of Functioning, Disability and Health. RESULTS Experimental and observational designs for the study of EF are distinguished and illustrated with examples. Approaches to study EF are differentiated into those directly measuring an environmental interaction with function and those relying on an independent assessment of environmental features. By applying these criteria, a three-dimensional matrix framework for measurement of EF in observational studies is developed. CONCLUSION The acknowledgement of different measurement approaches to the scientific study of EF is one pathway towards an increased understanding of the connection between environments and functioning. Many different measures may be used to approximate the realities of disabling or enabling environments. This review provides an initial framework for improving our fundamental comprehension of the complexity of the measurement of EF in the context of human health and disability.
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Affiliation(s)
- Jan D Reinhardt
- Swiss Paraplegic Research, Guido A. ZächStr. 4, Nottwil, 6207, Switzerland.
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Cerniauskaite M, Quintas R, Boldt C, Raggi A, Cieza A, Bickenbach JE, Leonardi M. Systematic literature review on ICF from 2001 to 2009: its use, implementation and operationalisation. Disabil Rehabil 2010; 33:281-309. [PMID: 21073361 DOI: 10.3109/09638288.2010.529235] [Citation(s) in RCA: 162] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE To present a systematic literature review on the state of the art of the utilisation of the International Classification of Functioning, Disability and Health (ICF) since its release in 2001. METHOD The search was conducted through EMBASE, MEDLINE and PsychInfo covering the period between 2001 and December 2009. Papers were included if ICF was mentioned in title or abstract. Papers focussing on the ICF-CY and clinical research on children and youth only were excluded. Papers were assigned to six different groups covering the wide scenario of ICF application. RESULTS A total of 672 papers, coming from 34 countries and 211 different journals, were included in the analysis. The majority of publications (30.8%) were conceptual papers or papers reporting clinical and rehabilitation studies (25.9%). One-third of the papers were published in 2008 and 2009. CONCLUSIONS The ICF contributed to the development of research on functioning and on disability in clinical, rehabilitation as well as in several other contexts, such as disability eligibility and employment. Diffusion of ICF research and use in a great variety of fields and scientific journals is a proof that a cultural change and a new conceptualisation of functioning and disability is happening.
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Affiliation(s)
- Milda Cerniauskaite
- Neurology, Public Health and Disability Unit-Scientific Directorate, Neurological Institute C. Besta IRCCS Foundation, Milan, Italy
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Ptyushkin P, Vidmar G, Burger H, Marincek C. Use of the International Classification of Functioning, Disability and Health (ICF) in patients with traumatic brain injury. Brain Inj 2010; 24:1519-27. [DOI: 10.3109/02699052.2010.523054] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Disability and functional profiles of patients with migraine measured with ICF classification. Int J Rehabil Res 2010; 33:225-31. [DOI: 10.1097/mrr.0b013e3283375e53] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Rauch A, Bickenbach J, Reinhardt J, Geyh S, Stucki G. The Utility of the ICF to Identify and Evaluate Problems and Needs in Participation in Spinal Cord Injury Rehabilitation. Top Spinal Cord Inj Rehabil 2010. [DOI: 10.1310/sci1504-72] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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