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Núñez-Cortés R, López-Bueno L, Besoain-Saldaña Á, Cruz-Montecinos C, Solís-Navarro L, Suso-Martí L, López-Bueno R, Morral A, Calatayud J. Comorbidity burden and nutritional status are associated with short-term improvement in functional independence and pain intensity after hip fracture surgery in older adults with in-hospital rehabilitation. Geriatr Nurs 2024; 59:223-227. [PMID: 39053164 DOI: 10.1016/j.gerinurse.2024.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 06/24/2024] [Accepted: 07/13/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE Hip fracture is a common condition among older adults. The aim of this study was to explore the influence of nutritional status and comorbidity burden on changes in functionality, fall risk, and pain intensity one month after hip surgery in older adults with in-hospital rehabilitation. METHODS Thirty-six hip fracture patients (55.6% female) aged 65 years or older with indication for surgical resolution were recruited. The main outcomes were functional independence (Barthel Index), risk of falls (Downton Falls Risk Index) and pain intensity (Visual Analogue Scale), assessed preoperatively and one month after discharge. Covariates included age, sex, BMI, Charlson Comorbidity Index (CCI) and nutritional status (Mini Nutritional Assessment). For the inferential analysis, a one-way analysis of covariance (ANCOVA) was applied. RESULTS Significant improvements were observed in functional independence (11.0 points, 95% CI: 1.7 to 20.3), risk of falls (-2.8 points, 95% CI: -4.0 to -1.7) and pain intensity (-2.6 points, 95% CI: -3.4 to -1.9). Among the covariates, a significant interaction was found between the CCI and improvements in functional independence (F=7.03, p=0.010, η2p=0.093), while nutritional status showed a significant interaction with pain reduction (F=5.65, p=0.020, η2p=0.075). CONCLUSION A lower comorbidity burden was associated with greater postoperative functional independence, while better nutritional status was associated with a greater reduction in postoperative pain intensity.
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Affiliation(s)
- Rodrigo Núñez-Cortés
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Laura López-Bueno
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain.
| | - Álvaro Besoain-Saldaña
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Carlos Cruz-Montecinos
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Lilian Solís-Navarro
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Luis Suso-Martí
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Rubén López-Bueno
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain; Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain; National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Antoni Morral
- Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain; National Research Centre for the Working Environment, Copenhagen, Denmark
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Ashkenazy S, Ganz FD, Kuniavsky M, Jakobson L, Levy H, Avital IL, Kolpak O, Golan D, Rebecca ML, Itzhakov S, Suliman M, Lavy A, Biton C, Broyer C, Benbenishty J. Patient mobilization in the intensive care unit: Assessing practice behavior - A multi-center point prevalence study. Intensive Crit Care Nurs 2024; 80:103510. [PMID: 37599127 DOI: 10.1016/j.iccn.2023.103510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVES To describe intensive care unit mobility clinical practice behaviors and the factors associated with these behaviors that could explain the theory-practice gap. METHODOLOGY A multi-center, descriptive, retrospective, one-day point prevalence study. SETTING intensive care patients hospitalized for a minimum of 24 hours, in 20 Israeli Adult Intensive Care Units, from six medical centers. MAIN OUTCOME MEASURES Maximum patient mobility level during the 24 hours prior to the prevalence study collection day and 48 hours from patient admission; mobility clinical practice behaviors and their inhibiting factors. RESULTS The study included 210 patients from a relatively even distribution of admission diagnoses. About half (46%) were intubated and 31% were hemodynamically unstable. Position change was most frequently reported as the maximum mobility level. The use of intubation, ventilation, tracheostomy, and inotropes was positively correlated with the level of mobility. Charlson Comorbidity Index and body mass index were not related to the level of mobility. A multiple regression model including these variables found that only intubation was a significant predictor of mobility level (R2 = 0.52, p < 0.001). CONCLUSION There is a gap between clinical practice guidelines and actual intensive care mobility practice behaviors. The association between mobility level and common therapies suggests subjective norms or common practices that could serve as a barrier to guideline implementation and partially explain the gap between clinical practice guidelines and clinical practice behavior. IMPLICATIONS FOR CLINICAL PRACTICE Behaviors and their subjective norms can be barriers to the implementation of clinical practice guidelines. Promoting increased provider awareness and policies of proactive mobilization could potentially improve patient outcomes.
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Affiliation(s)
- Shelly Ashkenazy
- Hadassah-Hebrew University Medical Center, Jerusalem, Israel, Kiryat Hadassah, POB 12000, Jerusalem 91120, Israel.
| | - Freda DeKeyser Ganz
- Jerusalem College of Technology, Hadassah Hebrew University School of Nursing, Jerusalem College of Technology, 11 Beit Hadfus, Jerusalem 9548311, Israel.
| | - Michael Kuniavsky
- Quality and Safety Division, Israel Ministry of Health - 39 Yirmeyahu Street, Jerusalem 9101002, Israel; Shamir (Assaf HaRofeh) Medical Center, Beer-Jaacov 7030000, Israel; Tel Aviv-Jaffa Academic College, Rabenu Yeruham St., P.O.B 840, Yaffo 6818211, Israel.
| | - Levana Jakobson
- Nahariya Galilee Medical Center, Nahariya cabri-89, Nahariya 22100001 Israel.
| | - Hadassa Levy
- Rambam Health Care Campus, P.O.B. 9602, Haifa 3109601, Haifa, Israel.
| | - Iris Levdov Avital
- Israel Poison Information Center, Rambam Health Care Campus, Ministry of Health, Haaliya Hashniya 8 Bat Galim, POB 9602, Haifa 3109601, Israel.
| | - Orly Kolpak
- Nahariya Galilee Medical Center, Nahariya cabri-89, Nahariya 22100001 Israel.
| | - Dorit Golan
- Rambam Health Care Campus, Bat Galim POB 9602, Haifa 3109601, Israel.
| | - Mor Levy Rebecca
- Sheba Medical Center, Derech Sheba 2, Tel Hashomer, Ramat Gan, Israel.
| | - Shiran Itzhakov
- Sheba Medical Center, Derech Sheba 2, Tel Hashomer, Ramat Gan, Israel.
| | - Moriya Suliman
- Sheba Medical Center, Derech Sheba 2, Tel Hashomer, Ramat Gan, Israel.
| | - Alinoy Lavy
- Shamir (Assaf HaRofeh) Medical Center, Tel Aviv University, Zerifin 70300, Israel.
| | - Chen Biton
- Shamir (Assaf HaRofeh) Medical Center, Tel Aviv University, Zerifin 70300, Israel.
| | - Chaya Broyer
- Shaare Zedek Medical Center, 12 Bait St., Jerusalem, Israel.
| | - Julie Benbenishty
- Hadassah Hebrew University Faculty of Medicine School of Nursing, Jerusalem, Israel; Kiryat Hadassah, POB 12000, Jerusalem 91120, Israel.
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3
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Falsetti L, Zaccone V, Santoro L, Santini S, Guerrieri E, Giuliani L, Viticchi G, Cataldi S, Gasbarrini A, Landi F, Santoliquido A, Moroncini G. The Relationship between Post-COVID Syndrome and the Burden of Comorbidities Assessed Using the Charlson Comorbidity Index. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1583. [PMID: 37763702 PMCID: PMC10533175 DOI: 10.3390/medicina59091583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/22/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023]
Abstract
Introduction: The post-COVID-19 syndrome is a clinical entity characterized by the manifestation of signs and symptoms that develop after the acute phase of COVID-19, which persist for a duration of more than 12 weeks and are not explained by any alternative diagnosis. It has been observed that individuals with pre-existing chronic diseases, including cardiovascular and pulmonary diseases, are at a greater risk of developing post-COVID-19 syndrome. The Charlson Comorbidity Index (CCI) is a useful tool employed to evaluate the burden of comorbidities and predict the prognosis of patients with post-COVID-19 syndrome. The present study aims to assess whether the burden of comorbidities, evaluated using the CCI, correlates with post-COVID-19 syndrome. Materials and Methods: Between 21 April 2020 and 15 May 2023, we enrolled all consecutive outpatients with previous COVID-19 admissions to a post-acute day-hospital service three months after a negative SARS-CoV-2 molecular test. We assessed age, sex, BMI, acute COVID-19 and post-COVID-19 signs, and symptoms and calculated CCI according to its current definition. Post-COVID-19 syndrome was defined as the persistence of at least one sign or symptom lasting more than 12 weeks after COVID-19 resolution and not explained by an alternative diagnosis. The relationship between post-COVID-19 and CCI was explored first with the chi-squared test, then with different binary logistic regression models. We considered significant values of p lower than 0.05. Results: We obtained a cohort of 3636 patients and observed a significant association between the number of post-COVID-19 symptoms and CCI. Patients developing post-COVID-19 were more commonly affected by a greater burden of comorbidities. Patients with at least one CCI point had an increased risk of post-COVID-19 syndrome (OR:2.961; 95%CI: 2.269-3.863; p < 0.0001), which increased further for CCI ≥ 4 (OR:6.062; 95%CI: 3.163-11.618; p < 0.0001). Conclusions: Patients affected by post-COVID-19 show a greater clinical complexity and a larger burden of comorbidities, synthesized by a higher CCI; moreover, a higher CCI seems to correlate with an increasing post-COVID-19 risk, being the presence of ≥1 or ≥4 CCI points associated with a 3-fold and 6-fold increased risk of post-COVID-19 syndrome, respectively.
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Affiliation(s)
- Lorenzo Falsetti
- Clinica Medica, Department of Clinical and Molecular Sciences, Marche Polytechnic University, 60126 Ancona, Italy; (L.F.); (G.M.)
| | - Vincenzo Zaccone
- Internal and Subintensive Medicine, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy;
| | - Luca Santoro
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Silvia Santini
- Emergency Medicine Residency Program, Marche Polytechnic University, 60126 Ancona, Italy; (S.S.); (E.G.); (L.G.)
| | - Emanuele Guerrieri
- Emergency Medicine Residency Program, Marche Polytechnic University, 60126 Ancona, Italy; (S.S.); (E.G.); (L.G.)
| | - Luca Giuliani
- Emergency Medicine Residency Program, Marche Polytechnic University, 60126 Ancona, Italy; (S.S.); (E.G.); (L.G.)
| | - Giovanna Viticchi
- Clinica Neurologica, Department of Medical and Surgical Sciences, Marche Polytechnic University, 60126 Ancona, Italy;
| | - Serena Cataldi
- Department of Pediatrics, Marche Polytechnic University, 60126 Ancona, Italy;
| | - Antonio Gasbarrini
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Francesco Landi
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
- Geriatrics Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Angelo Santoliquido
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Gianluca Moroncini
- Clinica Medica, Department of Clinical and Molecular Sciences, Marche Polytechnic University, 60126 Ancona, Italy; (L.F.); (G.M.)
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Larrateguy S, Vinagre J, Londero F, Dabin J, Ricciardi E, Jeanpaul S, Torres-Castro R, Núñez-Cortés R, Sánchez-Ramírez D, Gimeno-Santos E, Blanco I. Clinical Variables Related to Functional Capacity and Exertional Desaturation in Patients with COVID-19. Biomedicines 2023; 11:2051. [PMID: 37509690 PMCID: PMC10377716 DOI: 10.3390/biomedicines11072051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/01/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Impaired functional capacity is one of the most commonly reported consequences among post-COVID-19 patients. This study aimed to analyse the clinical variables related to functional capacity and exertional desaturation in post-COVID-19 patients at the time of hospital discharge. A cross-sectional study was conducted on patients recovering from COVID-19 pneumonia. The main outcomes measures were functional capacity, assessed using the 1 min sit-to-stand test (1 min STST), and exertional desaturation, defined as a drop of ≥4% in the arterial oxygen saturation. Factors used to characterise the participant outcomes included the use of a high-flow nasal cannula (HFNC), prolonged hospitalisation, occurrence of pulmonary embolism during hospitalisation, and underlying comorbidities. A total of 381 participants (mean age = 53.7 ± 13.2 years, 65.6% men) were included. Participants completed a mean of 16.9 ± 6.2 repetitions in the 1 min STST. Exertional desaturation was observed in 51% of the patients. Higher odds of exertional desaturation were found in the participants who used a HFNC (OR = 3.6; 95%CI: 1.6 to 7.8), were admitted in the hospital >10 days (OR = 4.2; 95%CI: 2.6 to 6.8), and had a pulmonary embolism (OR = 3.5; 95%CI: 2.2. to 5.3). Use of a HFNC (β = -3.4; 95%CI: -5.3 to -1.44), a hospital stay >10 days (β = -2.2; 95%CI: -3.4 to -0.9), and a history of pulmonary embolism (β = -1.4; 95%CI: -2.6 to -0.2) were also negatively associated with the 1 min STST. Most post-COVID-19 patients exhibited reduced functional capacity at the time of hospital discharge, and approximately half had exertional desaturation after the 1 min STST. The use of a HFNC, prolonged hospitalisation and pulmonary embolism were the main clinical variables associated with worse a 1 min STST performance and a higher likelihood of exertional desaturation.
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Affiliation(s)
- Santiago Larrateguy
- Servicio de Kinesiología y Fisioterapia, Hospital de la Baxada “Dra. Teresa Ratto”, Paraná 3100, Argentina; (S.L.); (J.V.); (F.L.); (J.D.); (E.R.); (S.J.)
- Facultad de Ciencias de la Salud, Universidad Adventista del Plata, Libertador San Martin 3103, Argentina
| | - Julian Vinagre
- Servicio de Kinesiología y Fisioterapia, Hospital de la Baxada “Dra. Teresa Ratto”, Paraná 3100, Argentina; (S.L.); (J.V.); (F.L.); (J.D.); (E.R.); (S.J.)
| | - Federico Londero
- Servicio de Kinesiología y Fisioterapia, Hospital de la Baxada “Dra. Teresa Ratto”, Paraná 3100, Argentina; (S.L.); (J.V.); (F.L.); (J.D.); (E.R.); (S.J.)
| | - Johana Dabin
- Servicio de Kinesiología y Fisioterapia, Hospital de la Baxada “Dra. Teresa Ratto”, Paraná 3100, Argentina; (S.L.); (J.V.); (F.L.); (J.D.); (E.R.); (S.J.)
| | - Evangelina Ricciardi
- Servicio de Kinesiología y Fisioterapia, Hospital de la Baxada “Dra. Teresa Ratto”, Paraná 3100, Argentina; (S.L.); (J.V.); (F.L.); (J.D.); (E.R.); (S.J.)
| | - Santiago Jeanpaul
- Servicio de Kinesiología y Fisioterapia, Hospital de la Baxada “Dra. Teresa Ratto”, Paraná 3100, Argentina; (S.L.); (J.V.); (F.L.); (J.D.); (E.R.); (S.J.)
| | - Rodrigo Torres-Castro
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8380453, Chile; (R.T.-C.); (R.N.-C.)
- Department of Pulmonary Medicine, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain;
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Rodrigo Núñez-Cortés
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8380453, Chile; (R.T.-C.); (R.N.-C.)
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46003 Valencia, Spain
| | - Diana Sánchez-Ramírez
- Department of Respiratory Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, MB R3T 2N2, Canada;
| | - Elena Gimeno-Santos
- Department of Pulmonary Medicine, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain;
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Biomedical Research Networking Center on Respiratory Diseases (CIBERES), 30627 Madrid, Spain
- Barcelona Institute for Global Health (ISGlobal), 08036 Barcelona, Spain
| | - Isabel Blanco
- Department of Pulmonary Medicine, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain;
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Biomedical Research Networking Center on Respiratory Diseases (CIBERES), 30627 Madrid, Spain
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Torres-Castro R, Núñez-Cortés R, Larrateguy S, Alsina-Restoy X, Barberà JA, Gimeno-Santos E, García AR, Sibila O, Blanco I. Assessment of Exercise Capacity in Post-COVID-19 Patients: How Is the Appropriate Test Chosen? Life (Basel) 2023; 13:life13030621. [PMID: 36983777 PMCID: PMC10054514 DOI: 10.3390/life13030621] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/10/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
There is a wide range of sequelae affecting COVID-19 survivors, including impaired physical capacity. These sequelae can affect the quality of life and return to work of the active population. Therefore, one of the pillars of following-up is the evaluation of physical capacity, which can be assessed with field tests (such as the six-minute walk test, the one-minute standing test, the Chester step test, and the shuttle walking test) or laboratory tests (such as the cardiopulmonary exercise test). These tests can be performed in different contexts and have amply demonstrated their usefulness in the assessment of physical capacity both in post-COVID-19 patients and in other chronic respiratory, metabolic, cardiologic, or neurologic diseases. However, when traditional tests cannot be performed, physical function can be a good substitute, especially for assessing the effects of an intervention. For example, the Short Physical Performance Battery assessment and the Timed Up and Go assessment are widely accepted in older adults. Thus, the test should be chosen according to the characteristics of each subject.
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Affiliation(s)
- Rodrigo Torres-Castro
- Department of Pulmonary Medicine, Hospital Clínic—Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8380453, Chile
| | - Rodrigo Núñez-Cortés
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8380453, Chile
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46003 Valencia, Spain
| | - Santiago Larrateguy
- Servicio de Kinesiología y Fisioterapia, Hospital de la Baxada “Dra. Teresa Ratto”, Paraná 3100, Argentina
- Facultad de Ciencias de la Salud, Universidad Adventista del Plata, Libertador San Martin 3103, Argentina
| | - Xavier Alsina-Restoy
- Department of Pulmonary Medicine, Hospital Clínic—Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Joan Albert Barberà
- Department of Pulmonary Medicine, Hospital Clínic—Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 30627 Madrid, Spain
| | - Elena Gimeno-Santos
- Department of Pulmonary Medicine, Hospital Clínic—Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 30627 Madrid, Spain
- Barcelona Institute for Global Health (ISGlobal), 08036 Barcelona, Spain
- Correspondence:
| | - Agustin Roberto García
- Department of Pulmonary Medicine, Hospital Clínic—Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 30627 Madrid, Spain
| | - Oriol Sibila
- Department of Pulmonary Medicine, Hospital Clínic—Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Isabel Blanco
- Department of Pulmonary Medicine, Hospital Clínic—Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 30627 Madrid, Spain
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Alemi F, Avramovic S, Schwartz M. Predicting 6-month mortality of patients from their medical history: Comparison of multimorbidity index to Deyo-Charlson index. Medicine (Baltimore) 2023; 102:e32687. [PMID: 36749236 PMCID: PMC9901984 DOI: 10.1097/md.0000000000032687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
While every disease could affect a patient's prognosis, published studies continue to use indices that include a selective list of diseases to predict prognosis, which may limit its accuracy. This paper compares 6-month mortality predicted by a multimorbidity index (MMI) that relies on all diagnoses to the Deyo version of the Charlson index (DCI), a popular index that utilizes a selective set of diagnoses. In this retrospective cohort study, we used data from the Veterans Administration Diabetes Risk national cohort that included 6,082,018 diabetes-free veterans receiving primary care from January 1, 2008 to December 31, 2016. For the MMI, 7805 diagnoses were assigned into 19 body systems, using the likelihood that the disease will increase risk of mortality. The DCI used 17 categories of diseases, classified by clinicians as severe diseases. In predicting 6-month mortality, the cross-validated area under the receiver operating curve for the MMI was 0.828 (95% confidence interval of 0.826-0.829) and for the DCI was 0.749 (95% confidence interval of 0.748-0.750). Using all available diagnoses (MMI) led to a large improvement in accuracy of predicting prognosis of patients than using a selected list of diagnosis (DCI).
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Affiliation(s)
- Farrokh Alemi
- Department of Health Administration and Policy, George Mason University, Fairfax, VA
- * Correspondence: Farrokh Alemi, George Mason University, Health Administration and Policy Department, University Ave, Fairfax, VA 22030-4444 (e-mail: )
| | - Sanja Avramovic
- Department of Health Administration and Policy, George Mason University, Fairfax, VA
| | - Mark Schwartz
- Department of Population Health, NYU Grossman School of Medicine, NY
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Núñez-Cortés R, Flor-Rufino C, Martínez-Arnau FM, Arnal-Gómez A, Espinoza-Bravo C, Hernández-Guillén D, Cortés-Amador S. Feasibility of the 30 s Sit-to-Stand Test in the Telehealth Setting and Its Relationship to Persistent Symptoms in Non-Hospitalized Patients with Long COVID. Diagnostics (Basel) 2022; 13:24. [PMID: 36611316 PMCID: PMC9818883 DOI: 10.3390/diagnostics13010024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/17/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022] Open
Abstract
Fatigue, dyspnea and pain are the main limitations of patients with long COVID. The aim of this study was to determine the feasibility of the 30 s sit-to-stand (30s-STS) test in the telehealth setting and its relationship to persistent symptoms in a sample of non-hospitalized patients with long COVID. A cross-sectional study was conducted in community patients with long COVID. Data collection and assessments were performed by videoconference and consisted of the fatigue assessment scale (FAS), London activity of daily living scale (LCADL), post-COVID-19 functional status (PCFS) and European quality of life questionnaire (EQ-5D-5L), including the pain/discomfort dimension. The 30s-STS test was performed using a standardized protocol adapted for remote use, and the modified Borg scale (0−10) was used to assess dyspnea and lower limb fatigue immediately after the test. The feasibility of the 30s-STS test was assessed by the proportion of eligible participants who were able to complete the test. Safety was assessed by the number of adverse events that occurred during the test. Seventy-nine participants were included (median age: 44 years, 86.1% women). Performance in the 30s-STS test was 11.5 ± 3.2 repetitions with 60.8% of the sample below reference values. All eligible participants were able to complete the test. No adverse events were reported during the evaluation. Participants with lower 30s-STS performance had more fatigue and dyspnea, worse quality of life, more severe pain/discomfort, and worse functional status (p < 0.05). A significant correlation was obtained between LCADL and dyspnea, reported on the Borg scale (0−10) post 30s-STS (r = 0.71; p < 0.001). In conclusion, the 30s-STS test proved to be a feasible test to implement in the telehealth setting and is related to fatigue, dyspnea, quality of life and pain in non-hospitalized patients with long COVID. Clinicians may use this test when assessment of the physical sequelae of COVID-19 in the face-to-face setting is not possible.
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Affiliation(s)
- Rodrigo Núñez-Cortés
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8240000, Chile
| | - Cristina Flor-Rufino
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Francisco Miguel Martínez-Arnau
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Anna Arnal-Gómez
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | | | - David Hernández-Guillén
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Group of Physiotherapy in the Aging Process: Social and Health Care Strategies (PT_AGE), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Sara Cortés-Amador
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
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Núñez-Cortés R, Cruz-Montecinos C, Martinez-Arnau F, Torres-Castro R, Zamora-Risco E, Pérez-Alenda S, Andersen LL, Calatayud J, Arana E. 30 s sit-to-stand power is positively associated with chest muscle thickness in COVID-19 survivors. Chron Respir Dis 2022; 19:14799731221114263. [PMID: 35957593 PMCID: PMC9379968 DOI: 10.1177/14799731221114263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction After hospitalization, early detection of musculoskeletal sequelae might help
healthcare professionals to improve and individualize treatment,
accelerating recovery after COVID-19. The objective was to determine the
association between the 30s sit-to-stand muscle power (30s-STS) and
cross-sectional area of the chest muscles (pectoralis) in COVID-19
survivors. Method This cross-sectional study collected routine data from COVID-19 survivors
one month after hospitalization: 1) a chest computed tomography (CT) scan
and 2) a functional capacity test (30s-STS). The pectoralis muscle area
(PMA) was measured from axial CT images. For each gender, patients were
categorized into tertiles based on PMA. The 30s-STS was performed to
determine the leg extension power. The allometric and relative STS power
were calculated as absolute 30s-STS power normalized to height squared and
body mass. The two-way ANOVA was used to compare the gender-stratified
tertiles of 30s-STS power variants. Results Fifty-eight COVID-19 survivors were included (mean age 61.2 ± 12.9 years,
30/28 (51.7%/48.3%) men/women). The two-way ANOVA showed significant
differences between the PMA tertiles in absolute STS power
(p = .002) and allometric STS power (p
= .001). There were no significant gender x PMA tertile interactions (all
variables p > .05). The high tertile of PMA showed a
higher allometric STS power compared to the low and middle tertile,
p = .002 and p = .004, respectively.
Absolute STS power and allometric STS power had a moderate correlation with
the PMA, r = 0.519 (p < .001) and r = 0.458
(p < .001) respectively. Conclusion The 30s-STS power is associated with pectoralis muscle thickness in both male
and female COVID-19 survivors. Thus, this test may indicate global
muscle-wasting and may be used as a screening tool for lower extremity
functional capacity in the early stages of rehabilitation planning in
COVID-19 survivors.
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Affiliation(s)
- Rodrigo Núñez-Cortés
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), 16781University of Valencia, Valencia, Spain.,Department of Physical Therapy, Faculty of Medicine, 14655University of Chile, Santiago, Chile.,Day Hospital Unit, Hospital Clínico Florida, Santiago, Chile
| | - Carlos Cruz-Montecinos
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), 16781University of Valencia, Valencia, Spain.,Department of Physical Therapy, Faculty of Medicine, 14655University of Chile, Santiago, Chile.,Section of Research, Innovation and Development in Kinesiology, Kinesiology Unit, San José Hospital, Santiago, Chile
| | - Francisco Martinez-Arnau
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), 16781University of Valencia, Valencia, Spain
| | - Rodrigo Torres-Castro
- Department of Physical Therapy, Faculty of Medicine, 14655University of Chile, Santiago, Chile.,International Physiotherapy Research Network (PhysioEvidence), Barcelona, Spain
| | | | - Sofía Pérez-Alenda
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), 16781University of Valencia, Valencia, Spain
| | - Lars L Andersen
- 2686National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Joaquín Calatayud
- 2686National Research Centre for the Working Environment, Copenhagen, Denmark.,Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, 16781University of Valencia, Valencia, Spain
| | - Estanislao Arana
- Department of Radiology, 16829Fundación Instituto Valenciano de Oncología, Valencia, Spain
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