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Stauffer SJ, Pohlig RT, Horne JR, Sarlo FB, Sions JM. Potentially inappropriate medication use among older adults with lower-limb loss. Geriatr Nurs 2024; 56:218-224. [PMID: 38367544 DOI: 10.1016/j.gerinurse.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE The aim of this study was to evaluate the prevalence of, and explore factors related to, prescription of potentially inappropriate medications (PIMs) among older adults with lower-limb loss (LLL). METHODS This was a secondary analysis of a cross-sectional dataset collected through an interdisciplinary limb loss clinic between September 2013 and November 2022. Self-report medication lists were reviewed during in-clinic face-to-face interviews and compared to the American Geriatrics Society Beers Criteria corresponding to the patient's evaluation year. RESULTS Of 82 participants (72.9 ± 6.6 years-old; 78.0 % male), n = 41 (50.0 %) reported using one or more PIM. PIM prescription was significantly associated with presence of phantom limb pain, history of upper gastrointestinal issues, and a greater number of medications. DISCUSSION Polypharmacy and PIM use are common among older adults with LLL. Greater attention should be paid to medications post-amputation, especially pain management medications, to minimize potential adverse side-effects.
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Affiliation(s)
- Samantha Jeanne Stauffer
- Delaware Limb Loss Studies, University of Delaware, Department of Physical Therapy, STAR Campus, 540 South College Ave, Suite 144A, Newark, DE, 19713, USA; Independence Prosthetics-Orthotics, Inc. 550 S. College Ave, Suite 111, Newark, DE, 19713, USA
| | - Ryan Todd Pohlig
- University of Delaware, Biostatistics Core, 100 Discovery Blvd, Newark, DE, 19713 USA; University of Delaware, Epidemiology Program, STAR Tower, Suite 614, Newark, DE, 19713, USA
| | - John Robert Horne
- Independence Prosthetics-Orthotics, Inc. 550 S. College Ave, Suite 111, Newark, DE, 19713, USA
| | | | - Jaclyn Megan Sions
- Delaware Limb Loss Studies, University of Delaware, Department of Physical Therapy, STAR Campus, 540 South College Ave, Suite 144A, Newark, DE, 19713, USA.
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Seth M, Horne JR, Pohlig RT, Sions JM. Pain, Balance-Confidence, Functional Mobility, and Reach Are Associated With Risk of Recurrent Falls Among Adults With Lower-Limb Amputation. Arch Rehabil Res Clin Transl 2023; 5:100309. [PMID: 38163037 PMCID: PMC10757173 DOI: 10.1016/j.arrct.2023.100309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Objective The study evaluated whether pain intensity and extent, balance-confidence, functional mobility, and balance (eg, functional reach) are potential risk factors for recurrent falls among adults with a lower-limb amputation. Design Cross-sectional study. Setting Research laboratory. Participants Eighty-three adults with unilateral lower-limb amputation that occurred >1 year prior (26 transfemoral- and 57 transtibial-level amputation; 44.6% women; 51.8% traumatic cause of amputation; N=83). Intervention Not applicable. Main Outcome Measures Participants reported on the number of falls in the past year, as well as pain intensity in the low back, residual, and sound limbs. Balance-confidence (per the Activities-Specific Balance-Confidence Scale [ABC]), functional mobility (per the Prosthetic Limb Users Survey of Mobility ([PLUS-M]), and balance (per the Functional Reach and modified Four Square Step Tests) were obtained. Results After considering non-modifiable covariates, greater extent of pain, less balance-confidence, worse self-reported mobility, and reduced prosthetic-side reach were factors associated with recurrent fall risk. Adults reporting pain in the low back and both lower-limbs had 6.5 times the odds of reporting recurrent falls as compared with peers without pain. A 1-point increase in ABC score or PLUS-M T score, or 1-cm increase in prosthetic-side reaching distance, was associated with a 7.3%, 9.4%, and 7.1% decrease in odds of reporting recurrent falls in the past year, respectively. Conclusions Of the 83 adults, 36% reported recurrent falls in the past year. Presence of pain in the low back and both lower-limbs, less balance-confidence, worse PLUS-M score, and less prosthetic-side reaching distance were identified as modifiable factors associated with an increased odd of recurrent falls.
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Affiliation(s)
- Mayank Seth
- Department of Physical Therapy, Delaware Limb Loss Studies, University of Delaware, Newark, DE
- Children's Specialized Hospital, Research Department, Union, NJ
| | | | - Ryan Todd Pohlig
- Biostatistics Core, University of Delaware, Newark, DE
- Epidemiology Program, University of Delaware, Newark, DE
| | - Jaclyn Megan Sions
- Department of Physical Therapy, Delaware Limb Loss Studies, University of Delaware, Newark, DE
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Sions JM, Seth M, Pohlig RT, Stauffer SJ, Horne JR, Sarlo FB. Key Modifiable Factors in Community Participation Among Adults With Lower Limb Amputation. Am J Phys Med Rehabil 2023; 102:803-809. [PMID: 36762830 DOI: 10.1097/phm.0000000000002209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
OBJECTIVE The aim of the study is to identify factors that may predict community participation among adults with lower limb amputation. DESIGN This study is a secondary analysis of a cross-sectional data set, including 126 community-dwelling adults, ≥1 yr after unilateral transfemoral- ( n = 44; mean age = 59 ± 14 yrs) or transtibial-level amputation ( n = 82; mean age = 59 ± 14 yrs) seen in an outpatient limb loss clinic. Participation was assessed with the Community Integration Questionnaire. Factors, that is, demographics, comorbidities, prosthesis use per the Houghton Scale, Socket Comfort Score, assistive device use, falls history, and activity level per General Practice Physical Activity Questionnaire were evaluated. Moreover, balance confidence per the Activities-Specific Balance Confidence Scale, mobility per the Locomotor Capabilities Index, fast and self-selected gait speed per 10-meter walk tests, and functional mobility via Timed Up and Go were also included. RESULTS Community participation was correlated with several factors ( P ≤ 0.050). Stepwise regression of correlated factors found absence of peripheral neuropathy and greater self-reported physical activity, balance confidence, and prosthesis use, as the strongest correlates, collectively explaining 50.1% of the variance in community participation post-lower limb amputation. CONCLUSIONS Findings identify key modifiable factors for consideration in future prospective research seeking to enhance community reintegration and participation among adults living with a unilateral transfemoral- or transtibial-level amputation.
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Affiliation(s)
- Jaclyn Megan Sions
- From the Delaware Limb Loss Studies, Department of Physical Therapy, University of Delaware, Newark, Delaware (JMS, MS, SJS); University of Delaware, Biostatistics Core, Newark, Delaware (RTP); Independence Prosthetics-Orthotics, Inc, Newark, Delaware (SJS, JRH); and Christiana Spine Center, Newark, Delaware (FBS)
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Beisheim-Ryan EH, Hicks GE, Pohlig RT, Medina J, Sions JM. Body image and perception among adults with and without phantom limb pain. PM R 2023; 15:278-290. [PMID: 34914201 PMCID: PMC10211469 DOI: 10.1002/pmrj.12750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/28/2021] [Accepted: 12/02/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Following lower-limb amputation, phantom limb pain (i.e., pain perceived as coming from the amputated portion of the limb) is common. Phantom limb pain may be associated with impaired body image and perception, which may be targets for rehabilitative intervention. OBJECTIVE To compare measures of body image and perception between adults with and without phantom limb pain post amputation and evaluate associations between measures of body image and perception and phantom limb pain. DESIGN Survey. SETTING Online, remote assessment. PARTICIPANTS Seventy-two adults ≥1 year post unilateral lower-limb loss (n = 42 with phantom limb pain, n = 30 without phantom limb pain or pain in the remaining portion of the limb). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Self-reported outcome measures assessing body image (i.e., Amputee Body Image Scale-Revised), perceptual disturbances associated with the phantom limb (i.e., a modified Bath Complex Regional Pain Syndrome Body Perception Disturbance Scale), and prosthesis satisfaction (i.e., Trinity Amputation and Prosthesis Experience Scale) were administered; participants with phantom limb pain reported pain interference via the Brief Pain Inventory-Short Form. Between-group comparisons of self-reported outcome measure scores were conducted using Mann Whitney U or chi-square tests, as appropriate (a = .05). RESULTS Compared to peers without phantom limb pain, adults with phantom limb pain reported more negative body image; increased phantom limb ownership, attention, and awareness; and reduced prosthesis satisfaction and embodiment (U = 175.50-364.00, p < .001 to .034). Disturbances in phantom limb perception (i.e., size, weight, pressure, temperature) were similar between groups (p = .086 to >.999). More negative body image was associated with increased phantom limb pain interference (τb = .25, p = .026). CONCLUSIONS Adults with phantom limb pain demonstrate more negative body image and hypervigilance of the phantom limb as compared to peers with nonpainful phantom sensations. Mind-body treatments that target impaired body image and perception may be critical interventions for adults with phantom limb pain.
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Affiliation(s)
- Emma Haldane Beisheim-Ryan
- University of Delaware Department of Physical Therapy, 540 South College Avenue, Newark, DE, 19713, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, CO, USA
| | - Gregory Evan Hicks
- University of Delaware Department of Physical Therapy, 540 South College Avenue, Newark, DE, 19713, USA
| | - Ryan Todd Pohlig
- University of Delaware Biostatistics Core, 102B STAR Tower, Newark, DE, 19713, USA
| | - Jared Medina
- University of Delaware Department of Psychological and Brain Sciences, 105 The Green, Room 108, Newark, DE, 19716, USA
| | - Jaclyn Megan Sions
- University of Delaware Department of Physical Therapy, 540 South College Avenue, Newark, DE, 19713, USA
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Beisheim-Ryan EH, Pohlig RT, Hicks GE, Horne JR, Sions JM. Post-amputation pain: Comparing pain presentations between adults with and without increased amputated-region sensitivity. Pain Pract 2023; 23:155-166. [PMID: 36250812 PMCID: PMC9905279 DOI: 10.1111/papr.13172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 09/27/2022] [Accepted: 10/11/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Among adults with persistent post-amputation pain, increased amputated-region pain sensitivity may reflect peripheral sensitization or indicate underlying central sensitization. To determine whether underlying central sensitization may contribute to increased pain sensitivity in this population, this study compared clinical signs and symptoms associated with central sensitization between adults with post-amputation pain who demonstrate or lack increased amputated-region sensitivity (as compared to reference data). DESIGN Cross-sectional. SUBJECTS Ninety-nine adults (60 with a unilateral, transtibial amputation and post-amputation pain, 39 pain-free controls with intact limbs). METHODS Participants underwent pain-pressure threshold testing of amputated-region and secondary (non-amputated region) sites and completed outcome measures assessing central sensitization symptoms (Patient-Reported Outcomes Measurement Information System® pain intensity and interference domains, Central Sensitization Inventory). Among the full sample, the presence and frequency of specific central sensitization symptoms were evaluated. Participants with post-amputation pain were then grouped based on whether normalized, amputated-region pain-pressure thresholds fell below (i.e., sensitive) or above (i.e., non-sensitive) the 25th percentile of sex-specific reference data. Between-group differences in normalized secondary-site sensitivity were evaluated using a multivariate analysis of variance; central sensitization symptom scores were compared using a Kruskal-Wallis test. RESULTS Noteworthy symptoms associated with central sensitization (e.g., fatigue, sleep disturbance, cognitive difficulty) were reported by 33%-62% of participants. Secondary-site pain sensitivity was greater among individuals with increased amputated-region sensitivity (n = 24) compared to peers without increased amputated-region sensitivity ([n = 36], mean difference > 1.33 standard deviation [SD], p < 0.001). Central sensitization symptom scores, however, were similar between groups (p > 0.187). CONCLUSIONS Participants with increased amputated-region sensitivity demonstrate generalized, secondary-site pain hypersensitivity, potentially indicating underlying central sensitization. Central sensitization symptom scores, however, were similar between groups, suggesting differences in physiological pain sensitivity may not manifest in subjective post-amputation pain descriptions.
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Affiliation(s)
- Emma Haldane Beisheim-Ryan
- University of Delaware Department of Physical Therapy, 540 South College Avenue, Newark, DE, 19713, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, 1700 N Wheeling Street, Aurora, CO, 80045, USA
| | - Ryan Todd Pohlig
- University of Delaware Biostatistics Core, 102B STAR Tower, Newark, DE, 19713, USA
| | - Gregory Evan Hicks
- University of Delaware Department of Physical Therapy, 540 South College Avenue, Newark, DE, 19713, USA
| | - John Robert Horne
- Independence Prosthetics-Orthotics, Inc., 550 South College Avenue, Suite 111, Newark, DE, 19713, USA
| | - Jaclyn Megan Sions
- University of Delaware Department of Physical Therapy, 540 South College Avenue, Newark, DE, 19713, USA
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Stauffer SJ, Seth M, Pohlig RT, Beisheim-Ryan EH, Horne JR, Smith SC, Sarlo FB, Sions JM. Risk Factors for Underreporting of Life-Limiting Comorbidity Among Adults With Lower-Limb Loss. Inquiry 2023; 60:469580231205083. [PMID: 37837278 PMCID: PMC10576913 DOI: 10.1177/00469580231205083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/29/2023] [Accepted: 09/05/2023] [Indexed: 10/15/2023]
Abstract
Peripheral neuropathy (PN) and peripheral arterial disease (PAD) are life-limiting comorbidities among adults with lower-limb loss that may not be adequately addressed in current care models. The objective of this study was to evaluate underreporting of PN and PAD among adults with lower-limb loss. We conducted a secondary analysis of a cross-sectional dataset of community-dwelling adults with unilateral lower-limb loss seen in an outpatient Limb Loss Clinic (n = 196; mean age = 56.7 ± 14.4 years; 73.5% male). Individuals participated in standardized clinical examinations including Semmes-Weinstein monofilament testing to assess for PN and pedal pulse palpation to assess for PAD. Bivariate regression was performed to identify key variables for subsequent stepwise logistic regression to discern risk factors. Clinical examination results indicated 16.8% (n = 33) of participants had suspected PN alone, 15.8% (n = 31) had suspected PAD alone, and 23.0% (n = 45) had suspected PN and PAD. More than half of participants with clinical examination findings of PN or PAD failed to self-report the condition (57.7% and 86.8%, respectively). Among adults with lower-limb loss with suspected PN, participants with dysvascular amputations were at lower risk of underreporting (odds ratio [OR] = 0.2, 95% CI: 0.1-0.6). For those with suspected PAD, those who reported more medication prescriptions were at lower risk of underreporting (OR = 0.8, 95% CI: 0.7-1.0). Adults with lower-limb loss underreport PN and PAD per a medical history checklist, which may indicate underdiagnosis or lack of patient awareness. Routine assessment is highly recommended in this population and may be especially critical among individuals with non-dysvascular etiology.
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Affiliation(s)
- Samantha Jeanne Stauffer
- University of Delaware, Newark, DE, USA
- Independence Prosthetics-Orthotics, Inc., Newark, DE, USA
| | - Mayank Seth
- University of Delaware, Newark, DE, USA
- Children’s Specialized Hospital, Union, NJ, USA
| | | | - Emma Haldane Beisheim-Ryan
- University of Delaware, Newark, DE, USA
- Defense Health Agency, Falls Church, VA, USA
- Naval Medical Center San Diego, San Diego, CA, USA
| | | | - Sarah Carolyn Smith
- University of Delaware, Newark, DE, USA
- University of Maryland, Baltimore, MD, USA
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Sions JM, Beisheim-Ryan EH, Pohlig RT, Seth M. Adults with unilateral lower-limb amputation: greater spatial extent of pain is associated with worse adjustment, greater activity restrictions, and less prosthesis satisfaction. Scand J Pain 2022; 22:578-586. [PMID: 35107232 PMCID: PMC9262753 DOI: 10.1515/sjpain-2021-0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 01/11/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study's primary purpose was to determine if the extent of bodily pain, as evaluated with pain body diagrams, is associated with prosthetic-related activity restrictions, adjustment, and satisfaction among adults with a major unilateral lower-limb amputation. A secondary objective was to evaluate between-days, test-retest reliability for pain body diagrams among adults with lower-limb amputation. METHODS Adults with a lower-limb amputation that occurred ≥1 year prior participated in an online, cross-sectional research study. Outcome measures included pain body diagrams and the Trinity Amputation and Prosthesis Experience Scales-Revised, which evaluates post-amputation activity restrictions, psychosocial adjustment, and prosthesis satisfaction. Linear regression modeling was used to evaluate associations between the number of painful body regions and prosthetic outcomes, after considering covariates (alpha ≤ 0.010). A subset of participants recompleted pain body diagrams to evaluate between-days, test-retest reliability. RESULTS Data from 74 participants (n = 32 female; n = 42 transtibial-level; n = 27 traumatic etiology) were available. Beyond covariates (i.e., age, sex, amputation level), the total number of painful body regions was significantly associated with all Trinity Amputation and Prosthesis Experience Scales-Revised subscales (p < 0.001-0.006), with the exception of Social Adjustment (p = 0.764). The total number of painful body regions explained 14.5, 11.8, 11.6, and 7.4% of the variance in Functional Satisfaction with the Prosthesis, Adjustment to Limitation, General Adjustment, and Activity Restriction, respectively. In a subset (n = 54), test-retest reliability for total number of painful body regions per body diagrams was good [intraclass correlation coefficient (ICC)3,1 = 0.84]. CONCLUSIONS A greater number of painful body regions is associated with greater activity restriction, worse adjustment, and lower prosthesis satisfaction, supporting the need to enhance post-amputation pain management and both amputated- and secondary-site pain prevention. ETHICAL COMMITTEE NUMBER IRB #1611862.
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Affiliation(s)
- Jaclyn Megan Sions
- University of Delaware, Department of Physical Therapy, 540
South College Avenue, Suite 210JJ, Newark, DE, 19713, USA
| | - Emma Haldane Beisheim-Ryan
- University of Delaware, Department of Physical Therapy, 540
South College Avenue, Suite 144A, Newark, DE, 19713, USA
- VA Eastern Colorado Geriatric Research, Education, and
Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, CO, 80045, USA
| | - Ryan Todd Pohlig
- University of Delaware, Biostatistics Core, 102B STAR
Tower, Newark, DE, 19713, USA
| | - Mayank Seth
- University of Delaware, Department of Physical Therapy, 540
South College Avenue, Suite 144A, Newark, DE, 19713, USA
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Seth M, Pohlig RT, Hicks GE, Sions JM. Clinical mobility metrics estimate and characterize physical activity following lower-limb amputation. BMC Sports Sci Med Rehabil 2022; 14:124. [PMID: 35799260 PMCID: PMC9264684 DOI: 10.1186/s13102-022-00518-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/01/2022] [Indexed: 12/04/2022]
Abstract
Background Regular physical activity following a lower-limb amputation is essential for maintaining health and a high quality of life. Most adults with a lower-limb amputation, however, participate in insufficient daily physical activity, and thus, are predisposed to poor health outcomes. Estimating physical activity after lower-limb amputation via common mobility metrics may aid in clinical decisions regarding treatment prioritization and prosthesis prescription. The objectives of this study were (a) to examine associations between daily physical activity and patient-reported and performance-based mobility metrics among adults with lower-limb amputation, and (b) to determine whether patient-reported and performance-based mobility metrics can distinguish between physical activity status [i.e., sedentary (< 5000 steps/day) or non-sedentary (≥ 5000 steps/day)] of adults with lower-limb amputation. Methods A cross-sectional study involving 35 adults with a unilateral transtibial (N = 23; 63.0 ± 10.4 years) or transfemoral amputation (N = 12; 58.8 ± 9.5 years) was conducted. Participants completed patient-reported (Prosthesis Evaluation Questionnaire-Mobility Subscale) and performance-based mobility metrics (L-Test, 10-m Walk Test, 6-min Walk Test). Physical activity, i.e., average steps/day, was measured with an accelerometer. Results Patient-reported and performance-based mobility metrics were associated with daily physical activity (p < 0.050). Prosthesis Evaluation Questionnaire-Mobility Subscale scores, L-Test time, 10-m Walk Test speed and 6-min Walk Test distance independently explained 11.3%, 31.8%, 37.6% and 30.7% of the total variance in physical activity. Receiver operating characteristic curves revealed patient-reported and performance-based mobility metrics significantly distinguish between physical activity status, i.e., sedentary (< 5000 steps/day) versus non-sedentary (≥ 5000 steps/day). Preliminary cut-points for mobility metrics to classify physical activity status were determined. Conclusions Following a lower-limb amputation, patient-reported and performance-based mobility metrics may estimate daily physical activity, thereby aiding clinical decisions regarding treatment prioritization as well as prosthesis selection.
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Affiliation(s)
- Mayank Seth
- Delaware Limb Loss Studies, Department of Physical Therapy, University of Delaware, 540 South College Avenue, Suite 210JJ, Newark, DE, 19713, USA
| | | | - Gregory Evan Hicks
- Delaware Spine Studies, Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Jaclyn Megan Sions
- Delaware Limb Loss Studies, Department of Physical Therapy, University of Delaware, 540 South College Avenue, Suite 210JJ, Newark, DE, 19713, USA. .,Delaware Spine Studies, Department of Physical Therapy, University of Delaware, Newark, DE, USA.
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Sions JM, Donohoe M, Beisheim-Ryan EH, Pohlig RT, Shank TM, Nichols LR. Characterizing Pain Among Adolescents and Young Adults With Arthrogryposis Multiplex Congenita. Pediatr Phys Ther 2022; 34:288-295. [PMID: 35639545 PMCID: PMC9250615 DOI: 10.1097/pep.0000000000000913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Primary study objectives were to ( a ) characterize pain and explore differences between adolescents and adults with arthrogryposis multiplex congenita (AMC) and ( b ) evaluate associations between pain-related outcomes and mobility. METHODS People who can walk and with AMC completed pain-related questionnaires. RESULTS Sixty-three participants (28 adolescents and 35 young adults) were recruited. Pain was reported in the past week by 81% of participants; intensity ratings were similar between age groups. Per the McGill Pain Questionnaire, pain severity was significantly lower among adolescents. Adults had a greater number of painful regions compared with adolescents. Greater 7-day average pain intensity, McGill Pain Questionnaire scores, and number of painful regions were associated with reduced functional mobility. CONCLUSIONS As most adolescents and young adults with AMC have at least mild pain, and pain is associated with mobility, future longitudinal investigations of pain and its functional consequences are warranted.
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Affiliation(s)
- Jaclyn Megan Sions
- Department of Physical Therapy (Drs Sions and Beisheim-Ryan and Ms Shank), University of Delaware, Newark, Delaware; Therapeutic and Rehabilitative Services Department (Dr Donohoe) and Orthopedics Department (Dr Nichols), Nemours Alfred I. duPont Hospital for Children, Wilmington, Delaware; VA Eastern Colorado Geriatric Research, Education, and Clinical Center (Dr Beisheim-Ryan), VA Eastern Colorado Health Care System, Aurora, Colorado; Biostatistics Core (Dr Pohlig), University of Delaware, Newark, Delaware
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Sions JM, Donohoe M, Beisheim-Ryan EH, Pohlig RT, Shank TM, Nichols LR. Test–retest reliability for performance-based outcome measures among individuals with arthrogryposis multiplex congenita. BMC Musculoskelet Disord 2022; 23:121. [PMID: 35123456 PMCID: PMC8818254 DOI: 10.1186/s12891-022-05070-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 01/27/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Most individuals with arthrogryposis multiplex congenita, a rare condition characterized by joint contractures in ≥ 2 body regions, have foot and ankle involvement leading to compromised gait and balance. The purpose of this study was to establish between-days, test–retest reliability for performance-based outcome measures evaluating gait and balance, i.e., the 10-m Walk Test, Figure-of-8 Walk Test, 360-degree Turn Test, and modified Four Square Step Test, among adolescents and adults with arthrogryposis multiplex congenita.
Methods
This reliability study included ambulatory participants, aged 10 to 50 years, with a medical diagnosis of arthrogryposis multiplex congenita. Participants completed performance-based measures, in a randomized order, on two separate occasions. Intraclass correlation coefficients with 95% confidence intervals and minimal detectable changes at the 90% and 95% confidence level were calculated.
Results
Participants included 38 community-ambulators with a median of 13 out of 14 upper and lower joint regions affected. Intraclass correlation coefficient point estimates and 95% confidence intervals ranged from .85-.97 and .70-.98, respectively. Minimal detectable changes were 10 to 39% of sample means and were largest for the modified Four Square Step Test.
Conclusions
Among individuals with arthrogryposis, gait speed per the 10-m Walk Test, as well as non-linear walking and dynamic balance assessment per the Figure-of-8 Walk and 360 Degree Turn Tests, have adequate test–retest reliability enabling evaluation of individual patient changes. Changes in groups of ambulatory individuals with arthrogryposis multiplex congenita may be reliably evaluated with all of the studied outcome measures.
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Abstract
OBJECTIVE The aim of this study was to evaluate associations between time since amputation (TSAmp) and mobility outcomes of adults with lower-limb amputation. DESIGN A secondary analysis of a cross-sectional dataset, including 109 community-dwelling adults, 1 yr or more after unilateral transfemoral (n = 39; mean age, 54 ± 15 yrs) or transtibial (n = 70; mean age = 58 ± 14 yrs) amputation, was conducted. Participants attended standardized clinical evaluations and completed mobility-related outcome measures: Prosthesis Evaluation Questionnaire-Mobility Subscale, timed up and go, 10-m walk test, and 6-min walk test. RESULTS After controlling for age, sex, amputation level, and etiology, TSAmp was significantly associated with each mobility outcome. Prosthesis Evaluation Questionnaire-Mobility Subscale and TSAmp were linearly associated, with TSAmp explaining 10.6% of the overall variance. Timed up and go test time and TSAmp were linearly associated, with TSAmp and an interaction term (LevelxTSAmp) explaining 8.4% of the overall variance; 10-m walk test speed and 6-min walk test distance had nonlinear associations with TSAmp, with TSAmp and nonlinear terms (TSAmp2) explaining 12.1% and 13.2% of the overall variance, respectively. CONCLUSIONS Based on the findings, longer TSAmp may be associated with better Prosthesis Evaluation Questionnaire-Mobility Subscale score and timed up and go test time, whereas longer TSAmp may be associated with better or worse 10-m walk test speed and 6-min walk test distance depending upon time elapsed since lower-limb amputation. Estimations of postamputation mobility among adults with lower-limb amputation should consider TSAmp.
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Affiliation(s)
- Mayank Seth
- Delaware Limb Loss Studies, University of Delaware, Department of Physical Therapy, Newark, Delaware, USA
| | - Emma Haldane Beisheim
- Delaware Limb Loss Studies, University of Delaware, Department of Physical Therapy, Newark, Delaware, USA
| | - Ryan Todd Pohlig
- University of Delaware, Biostatistics Core Facility, Newark, Delaware, USA
| | | | | | - Jaclyn Megan Sions
- Delaware Limb Loss Studies, University of Delaware, Department of Physical Therapy, Newark, Delaware, USA
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Beisheim-Ryan EH, Pohlig RT, Hicks GE, Horne JR, Medina J, Sions JM. Mechanical Pain Sensitivity in Postamputation Pain. Clin J Pain 2021; 38:23-31. [PMID: 34620753 PMCID: PMC8639794 DOI: 10.1097/ajp.0000000000000989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 09/28/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Postamputation, clinical markers of pain-related peripheral and central nervous system hypersensitivity remain understudied. This study aimed to identify whether adults with postamputation pain demonstrate greater pain sensitivity in primary (ie, amputated region) and secondary (ie, nonamputated region) sites, as compared with pain-free peers and controls with intact limbs. METHODS Ninety-four participants postunilateral, transtibial amputation (59 with pain, 35 pain-free) and 39 controls underwent pain-pressure threshold (PPT) testing at 10 sites. Pain-pressure thresholds were normalized to sex-specific control data using Z score conversions. Normalized primary-site and secondary-site PPTs were compared between groups using multivariate analysis of variance (P<0.050). RESULTS Compared with pain-free peers, adults with postamputation pain demonstrated reduced normalized PPTs across primary and secondary sites (mean difference=0.61-0.74, P=0.001 to 0.007). Compared with controls, adults with postamputation pain demonstrated reduced normalized PPTs (mean difference=0.52, P=0.026) only at primary sites. DISCUSSION Adults with postamputation pain demonstrate greater amputated region pain sensitivity as compared with pain-free peers or controls with intact limbs, indicating peripheral sensitization persists even after limb healing. Secondary-site pain sensitivity was similar between controls and adults with postamputation pain, suggesting central nervous system hypersensitivity may not be ubiquitous with postamputation pain. Studies are needed to investigate mechanisms underlying pain sensitivity differences between adults with and without postamputation pain.
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Affiliation(s)
| | - Ryan Todd Pohlig
- University of Delaware Biostatistics Core, 102B STAR Tower,
Newark, DE, 19713, USA
| | - Gregory Evan Hicks
- University of Delaware Department of Physical Therapy, 540
South College Avenue, Newark, DE, 19713, USA
| | - John Robert Horne
- Independence Prosthetics-Orthotics, Inc., 550 South College
Avenue, Suite 111, Newark, DE, 19713, USA
| | - Jared Medina
- University of Delaware Department of Psychological and
Brain Sciences, 105 The Green, Room 108, Newark, DE, 19716, USA
| | - Jaclyn Megan Sions
- University of Delaware Department of Physical Therapy, 540
South College Avenue, Newark, DE, 19713, USA
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Beisheim EH, Seth M, Horne JR, Hicks GE, Pohlig RT, Sions JM. Sex-specific Differences in Multisite Pain Presentation among Adults with Lower-Limb Loss. Pain Pract 2020; 21:419-427. [PMID: 33251680 DOI: 10.1111/papr.12969] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/05/2020] [Accepted: 11/23/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Multisite pain remains significantly understudied following lower-limb loss (LLL), especially among females. This study aimed to explore sex-specific differences in the presentation of multisite pain post LLL. Hypotheses were multisite pain would be more prevalent among females post LLL as compared with males, and female sex would be significantly associated with multisite pain prevalence. METHODS In this cross-sectional study, participants answered standardized questions regarding the presence of amputation-specific (ie, phantom-limb, residual-limb) and secondary (ie, contralateral-limb, low-back) pain. Multisite pain was defined as pain in ≥ 2 locations. Sex-specific differences in pain prevalence were evaluated using chi-square tests (P ≤ 0.050). Using logistic regression, the association between sex and multisite pain was examined after controlling for covariates (age, body mass index, time since amputation, amputation etiology and level). RESULTS The sample included 303 adults (33% females) ≥ 1 year post unilateral LLL. More females than males reported pain in the residual limb (53.0% vs. 38.4%), low back (56.0% vs. 39.9%), contralateral knee (37.0% vs. 24.1%), and contralateral hip (25.0% vs. 12.3%; P < 0.050). More females than males were classified as having multisite pain (72.0% vs. 54.7%; P = 0.004). While patterns of multisite pain were similar (ie, pain affected both amputation-specific and secondary sites) between sexes, being female was independently associated with higher odds of having multisite pain (odds ratio: 2.40, 95% confidence interval: 1.40 to 4.12). DISCUSSION Female sex appears to be associated with multisite pain ≥ 1 year after LLL. Future work is needed to identify mechanisms underlying sex-specific differences in pain presentation and evaluate the impact of sex on pain-related outcomes post amputation.
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Affiliation(s)
| | - Mayank Seth
- Department of Physical Therapy, University of Delaware, Newark, Delaware, U.S.A
| | | | - Gregory Evan Hicks
- Department of Physical Therapy, University of Delaware, Newark, Delaware, U.S.A
| | - Ryan Todd Pohlig
- University of Delaware Biostatistics Core Facility, Newark, Delaware, U.S.A
| | - Jaclyn Megan Sions
- Department of Physical Therapy, University of Delaware, Newark, Delaware, U.S.A
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Megan Sions J, Angelica Rodriguez C, Todd Pohlig R, Evan Hicks G, Charles Coyle P. Epidural Fat and Its Association with Pain, Physical Function, and Disability Among Older Adults with Low Back Pain and Controls. Pain Med 2019; 19:1944-1951. [PMID: 29024961 DOI: 10.1093/pm/pnx163] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objective To examine epidural fat and its relationship to pain, physical function, and disability among older adults with chronic low back pain, chronic low back pain plus leg pain, and controls. Design Cross-sectional, comparative study. Setting Standardized examinations were conducted in a research laboratory, and magnetic resonance images were obtained. Subjects A total of 93 adults age 60 to 85 years (24 with chronic back pain, 25 with chronic back pain plus leg pain, and 44 controls). Methods Reliability for assessment of epidural fat diameter, averaged across spinal levels, was established (intraclass correlation coefficient = 0.95). Linear regression was used to explore how epidural fat diameter related to self-reported (Short Form-36 Health Survey: physical component summary score) and performance-based (stair climb performance) measures of physical function among adults with chronic back pain with and without leg pain, as compared with controls, while controlling for age, sex, and body mass index. Associations between epidural fat and pain intensity and low back pain-related disability were also explored (P ≤ 0.050). Results Epidural fat helped explain self-reported function (P < 0.001); adults with axial low back pain (LBP) may have a relationship between epidural fat and self-report function that is different from controls (P = 0.015). Relationships between epidural fat and stair performance were significantly different from controls for those with LBP (P = 0.000) but not for those with LBP plus leg pain (P = 0.366). Relationships between epidural fat and pain intensity and/or disability were not found. Conclusions Increased epidural fat may help explain better function among older adults with chronic axial back pain, but not among those who also report leg pain.
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Affiliation(s)
| | | | - Ryan Todd Pohlig
- Dean's Office, College of Health Sciences, University of Delaware, Newark, Delaware, USA
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Sions JM, Crippen DC, Hicks GE, Alroumi AM, Manal TJ, Pohlig RT. Exploring Neuromuscular Electrical Stimulation Intensity Effects on Multifidus Muscle Activity in Adults With Chronic Low Back Pain: An Ultrasound Imaging-Informed Investigation. Clin Med Insights Arthritis Musculoskelet Disord 2019; 12:1179544119849570. [PMID: 31205429 PMCID: PMC6535907 DOI: 10.1177/1179544119849570] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 04/17/2019] [Indexed: 11/17/2022]
Abstract
Study design: Cross-sectional study. Background: Neuromuscular electrical stimulation (NMES) is an effective tool for stimulating multifidus muscle contractions. Ultrasound imaging (USI) is valid and reliable for quantifying multifidus activity represented by percent thickness change from a resting to contracted state. Thus, USI may be used to help determine optimal NMES intensity. Objectives: To explore NMES intensity effects on multifidus thickening in adults with chronic low back pain (CLBP). Methods: Sixty patients with CLBP participated. L4/5 multifidus ultrasound images were obtained and percent thickness change from a resting to a contracted state was determined at baseline with a limb lift and during NMES application. During NMES, the examiner recorded the intensity, in milliampere, when the multifidus first started to thicken as observed with USI. The examiner also recorded the NMES intensity that resulted in no further multifidus thickening (ie, high-tolerance group) or, in cases where maximal thickening was not observed, the NMES intensity of the submaximal contraction (ie, low-tolerance group). Differences between participants with high versus low NMES tolerance were evaluated. Results: During NMES, the multifidus began thickening at a higher intensity for the high-tolerance group (n = 39), that is, 34 mA, compared with the low-tolerance group (n = 21), that is, 32 mA (P = .001). A greater mean intensity in the high-tolerance group, that is, 62 mA, as compared to 45 mA in the low-tolerance group, resulted in a larger percent thickness change, that is, 30.89% compared to 20.60%, respectively (P < .001). Conclusions: Results provide clinicians with NMES intensity targets to facilitate multifidus muscle thickening, which provides insight into muscle activity.
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Affiliation(s)
- Jaclyn Megan Sions
- Delaware Spine Studies, Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - DeJ'a Chyanna Crippen
- Delaware Spine Studies, Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Gregory Evan Hicks
- Delaware Spine Studies, Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Abdulmohsen Meshari Alroumi
- Delaware Spine Studies, Department of Physical Therapy, University of Delaware, Newark, DE, USA.,Biomechanics and Movement Science Program, Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Tara Jo Manal
- Delaware Physical Therapy Clinic, Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Ryan Todd Pohlig
- Dean's Office, College of Health Sciences, University of Delaware, Newark, DE, USA
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Sions JM, Manal TJ, Horne JR, Sarlo FB, Pohlig RT. Balance-confidence is associated with community participation, perceived physical mobility, and performance-based function among individuals with a unilateral amputation. Physiother Theory Pract 2018; 36:607-614. [PMID: 29952694 DOI: 10.1080/09593985.2018.1490939] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To explore relationships between balance-confidence and: 1) community participation; 2) self-perceived mobility; and 3) performance-based physical function among individuals with a lower-limb amputation using a prosthetic. Design: Retrospective, cross-sectional study. Setting: Outpatient, multidisciplinary amputee clinic. Participants: Patients (n = 45) using a prosthesis, aged ≥ 18 years, with a unilateral transfemoral or transtibial amputation of ≥1 year, were included. Methods: Participants completed the following self-report measures: Activities-Specific Balance Confidence Scale (ABC); Community Integration Questionnaire (CIQ); Locomotor Capabilities Index (LCI); and two performance-based measures (i.e. Timed Up and Go and 6 Minute Walk Test). Linear regression modeling was used to explore relationships between balance-confidence (i.e. ABC) and self-report (i.e. CIQ and LCI) and performance-based measures (p ≤ 0.0125). Results: After controlling for potential covariates (i.e. age, sex, and body mass index), balance-confidence explained 47.4% of the variance in CIQ (p = 0.000), 53.0% of the variance in LCI (p = 0.000), 20.3% of the variance in Timed Up and Go (p = 0.001), and 18.2% of the variance in 6 Minute Walk Test (p = 0.001). Conclusion: Lower balance-confidence is associated with less community participation, lower self-perceived mobility, and poorer performance among patients with a unilateral lower-limb amputation.
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Affiliation(s)
- Jaclyn Megan Sions
- Department of Physical Therapy, University of Delaware , Newark, DE, USA
| | - Tara Jo Manal
- Delaware Physical Therapy Clinic, University of Delaware , Newark, DE, USA
| | | | - Frank Bernard Sarlo
- Physical Medicine and Rehabilitation, Christiana Health Care System , Newark, DE, USA
| | - Ryan Todd Pohlig
- College of Health Sciences, University of Delaware , Newark, DE, USA
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Fanelli Kuczmarski M, Pohlig RT, Stave Shupe E, Zonderman AB, Evans MK. Dietary Protein Intake and Overall Diet Quality Are Associated with Handgrip Strength in African American and White Adults. J Nutr Health Aging 2018; 22:700-709. [PMID: 29806859 PMCID: PMC5984956 DOI: 10.1007/s12603-018-1006-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/08/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine the association of handgrip strength (HS) with protein intake, diet quality, and nutritional and cardiovascular biomarkers in African American and White adults. DESIGN Cross-sectional wave 3 (2009-2013) of the cohort Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. PARTICIPANTS Socioeconomically diverse urban population of 2,468 persons aged 33 to 71 years. MEASUREMENTS Socio-demographic correlates, dietary intakes and biomarkers, HS, physical performance measures were collected. HS was measured using a dynamometer with the dominant hand. Functional measures included chair, tandem, and single leg stands. Two 24-hour recalls were collected using the US Department of Agriculture Automated Multiple Pass Method. The total protein intake and diet quality, evaluated by adherence to the DASH eating plan and Healthy Eating Index-2010, were calculated. Biomarkers included nutritional anemia, and serum levels of albumin, cholesterol, magnesium, and glucose. RESULTS The mean ±SE age of the sample was 52.3±0.2 years. Approximately 61% were African American and 57% were women. The mean ±SE HS of women was 29.1±0.2kg and for men was 45.9±0.4 kg. Protein, gm, per kg body weight for the women was 0.94±0.02 compared to 1.16 ±0.02 for men. After adjusting for socio-demographic factors, hypertension, and diabetes, HS/BMI ratio was significantly associated with protein intake per kg body weight (p<0.001) and diet quality, assessed by either the DASH adherence (p=0.009) or Health Eating Index-2010 (p=0.031) scores. For both men and women, participants in the upper tertile of HS maintained a single leg and tandem stances longer and completed 5 and 10 chair stands in shorter time compared to individuals in the lower HS tertile. Of the nutritional status indicators, the percent of men in the upper HS tertile with low serum magnesium and albumin, was significantly lower than those in the lower HS tertile [magnesium,7.4% vs 16.1%; albumin, 0.4% vs 4.5%]. The only difference observed for women was a lower percent of diabetes (14.4% for the upper HS tertile compared to 20.5% for the lower HS tertile. CONCLUSIONS The findings confirm the role of protein and a healthful diet in the maintenance of muscle strength. In this community sample, HS was significantly associated with other physical performance measures but did not appear to be strongly associated with indicators of nutritional risk. These findings support the use of HS as a proxy for functional status and indicate the need for research to explore its role as a predictor of nutritional risk.
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Affiliation(s)
- M Fanelli Kuczmarski
- Marie Fanelli Kuczmarskia, University of Delaware, Department of Behavioral Health and Nutrition, 206C McDowell Hall, Newark, DE 19716, United States, , Ph: +1-302-831-8765; Fax: +1-302-831-4261,
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