Validity of common physical function tests performed online for older adults

BACKGROUND

Objectively measured physical function tests are important predictors of institutionalization, disability, and premature mortality. Although physical function was usually assessed in person prior to the COVID-19 pandemic, there is a need to investigate whether physical function tests performed online are valid.

OBJECTIVE

The purpose of this study was to determine the validity of common physical function tests conducted online compared to in-person testing in older adults.

METHODS

Physical functions included gait speed, one leg stance balance, 30-second chair stands, and the 2-minute steps were tested online and in-person using a random order for community dwellers aged 65 years and above. Using an alpha two way mixed model, average intraclass correlation coefficients (ICC) were calculated between the two settings and one sample T-test performed on the difference between the results of each test between the two settings. Finally, Bland-Altman plots were created, and proportional biases tested via linear regressions.

RESULTS

Besides the one-leg stance balance with eyes closed, for which the ICC was 0.47 (0.23-0.74) the average ICC's were excellent ranging from 0.87 to 0.94. No proportional biases were observed based on Bland-Altman graphs.

CONCLUSION

For older adults living in the community, common physical function tests can be performed online.

Colonic oxygen microbubbles augment systemic oxygenation and CO2 removal in a porcine smoke inhalation model of severe hypoxia

Inhalation injury can lead to pulmonary complications resulting in the development of respiratory distress and severe hypoxia. Respiratory distress is one of the major causes of death in critically ill patients with a reported mortality rate of up to 45%. The present study focuses on the effect of oxygen microbubble (OMB) infusion via the colon in a porcine model of smoke inhalation-induced lung injury. Juvenile female Duroc pigs (n = 6 colonic OMB, n = 6 no treatment) ranging from 39 to 51 kg in weight were exposed to smoke under general anesthesia for 2 h. Animals developed severe hypoxia 48 h after smoke inhalation as reflected by reduction in SpO₂ to 66.3 ± 13.1% and PaO₂ to 45.3 ± 7.6 mmHg, as well as bilateral diffuse infiltrates demonstrated on chest X-ray. Colonic OMB infusion (75-100 mL/kg dose) resulted in significant improvements in systemic oxygenation as demonstrated by an increase in PaO₂ of 13.2 ± 4.7 mmHg and SpO₂ of 15.2 ± 10.0% out to 2.5 h, compared to no-treatment control animals that experienced a decline in PaO₂ of 8.2 ± 7.9 mmHg and SpO₂ of 12.9 ± 18.7% over the same timeframe. Likewise, colonic OMB decreased PaCO₂ and PmvCO₂ by 19.7 ± 7.6 mmHg and 7.6 ± 6.7 mmHg, respectively, compared to controls that experienced increases in PaCO₂ and PmvCO₂ of 17.9 ± 11.7 mmHg and 18.3 ± 11.2 mmHg. We conclude that colonic delivery of OMB therapy has potential to treat patients experiencing severe hypoxemic respiratory failure.

A novel large animal model of smoke inhalation-induced acute respiratory distress syndrome

Background

Acute respiratory distress syndrome (ARDS) is multifactorial and can result from sepsis, trauma, or pneumonia, amongst other primary pathologies. It is one of the major causes of death in critically ill patients with a reported mortality rate up to 45%. The present study focuses on the development of a large animal model of smoke inhalation-induced ARDS in an effort to provide the scientific community with a reliable, reproducible large animal model of isolated toxic inhalation injury-induced ARDS.

Methods

Animals (n = 21) were exposed to smoke under general anesthesia for 1 to 2 h (median smoke exposure = 0.5 to 1 L of oak wood smoke) after the ultrasound-guided placement of carotid, pulmonary, and femoral artery catheters. Peripheral oxygen saturation (SpO₂), vital signs, and ventilator parameters were monitored throughout the procedure. Chest x-ray, carotid, femoral and pulmonary artery blood samples were collected before, during, and after smoke exposure. Animals were euthanized and lung tissue collected for analysis 48 h after smoke inhalation.

Results

Animals developed ARDS 48 h after smoke inhalation as reflected by a decrease in SpO₂ by approximately 31%, PaO₂/FiO₂ ratio by approximately 208 (50%), and development of bilateral, diffuse infiltrates on chest x-ray. Study animals also demonstrated a significant increase in IL-6 level, lung tissue injury score and wet/dry ratio, as well as changes in other arterial blood gas (ABG) parameters.

Conclusions

This study reports, for the first time, a novel large animal model of isolated smoke inhalation-induced ARDS without confounding variables such as cutaneous burn injury. Use of this unique model may be of benefit in studying the pathophysiology of inhalation injury or for development of novel therapeutics.