scholarly journals Effects of a 16-week multimodal exercise program on activities of daily living in institutionalized individuals with dementia

Author(s):  
Jelena Bezold ◽  
Sandra Trautwein ◽  
Bettina Barisch-Fritz ◽  
Andrea Scharpf ◽  
Janina Krell-Roesch ◽  
...  

AbstractWe aimed to examine the effects of a 16-week multimodal exercise program (MEP) on activities of daily living (ADL) in individuals with dementia (IWD). Furthermore, we investigated the participants’ individual response to the MEP and whether baseline cognitive and motor performance explain ADL performance. We conducted a multicenter randomized controlled trial (RCT) involving 319 participants aged ≥ 65 years with mild to moderate dementia. ADL were assessed at baseline and after the 16-week intervention using the Barthel Index (BI), the Erlangen Test of Activities of Daily Living (E-ADL) and the 7‑item Physical Performance Test (PPT-7). We additionally assessed cognitive and motor performance using standardized and validated assessments. Intervention effects were examined through two-factor analysis of variance with repeated measurements applying a per protocol and an intention-to-treat analysis. We compared baseline cognitive and motor performance between positive-responders (positive-R), non-responders (non-R), and negative-responders (negative-R) and examined cognitive and motor performance as potential cofounders of ADL by conducting multiple regression analyses. There were no significant time×group effects on ADL. Between 20 and 32% of participants responded positively to the intervention, i.e., improved ADL performance from baseline to follow-up. Positive-R had worse baseline motor performance compared to non-R. Cognitive and motor performance explained up to 51.4% of variance in ADL. The MEP had no significant overall effect on ADL in IWD. This may be related to insufficient exercise intensity. However, our results indicate that the response to the MEP depends on individual prerequisites which should thus be considered in further research on individual exercise approaches.

2013 ◽  
Vol 118 (1) ◽  
pp. 94-103 ◽  
Author(s):  
Xiaowei Li ◽  
Zhaosheng Sun ◽  
Wangmiao Zhao ◽  
Jinrong Zhang ◽  
Jianchao Chen ◽  
...  

Object The authors evaluated the effects of acetylsalicylic acid (ASA) usage and transfusion of previously frozen apheresis platelets on postoperative hemorrhage, activities of daily living (ADL) score, and mortality rate in patients with acute hypertensive basal ganglia hemorrhage undergoing craniotomy. Methods This was a prospective, double-blind, parallel, randomized controlled trial in patients with acute hypertensive basal ganglia hemorrhage, who had either not received ASA therapy (control) or received ASA therapy. The patients who received ASA therapy were divided according to the results of a platelet aggregation test into ASA-resistant, ASA-semiresponsive, and ASA-sensitive groups. All patients required an emergency craniotomy for hematoma removal after hospitalization. The patients who were sensitive to ASA were randomized to receive one of the following transfusion regimens of previously frozen apheresis platelets: no transfusion, 1 therapeutic dose before surgery, or 2 therapeutic doses (1 before surgery and 1 after 24 hours of hospitalization). The postoperative hemorrhage rate and the average postoperative hemorrhage volume were recorded and the ADL scores and mortality rate were measured during a 6-month follow-up period. Results The rate of postoperative hemorrhage, average postoperative hemorrhage volume, and mortality rate were significantly higher in the ASA-sensitive patients who received ASA therapy compared with patients who did not receive ASA therapy (all p < 0.005). The ADL scores were grouped into different grades and the number of cases in the lower grades was higher and the overall scores were poorer in patients who received ASA therapy compared with those who did not (all p < 0.005). After transfusion of previously frozen apheresis platelets, the postoperative hemorrhage rate, average postoperative hemorrhage volume, and mortality rate of the ASA-sensitive patients were significantly lowered (all p < 0.005), and the ADL scores and their classification level were better than those of patients who did not undergo transfusion (all p < 0.005). Conclusions Transfusion of previously frozen apheresis platelets reduces the rate of postoperative hemorrhage, average postoperative hemorrhage volume, disability rate, and mortality rate in ASA-sensitive patients with acute hypertensive basal ganglia hemorrhage undergoing craniotomy.


1987 ◽  
Vol 50 (2) ◽  
pp. 60-62 ◽  
Author(s):  
D Corless ◽  
M Ellis ◽  
E Dawson ◽  
F Fraser ◽  
S Evans ◽  
...  

Selected activities of daily living were used to measure improvement in independence of long-stay elderly patients known to have low concentrations of plasma 25-hydroxyvitamin D. This was a double-blind random controlled trial lasting between 8 and 40 weeks. No significant changes were found in either group.


2022 ◽  
Vol 76 (1) ◽  
Author(s):  
Adam R. Kinney ◽  
James E. Graham ◽  
Rayyan Bukhari ◽  
Amanda Hoffman ◽  
Matt P. Malcolm

Importance: Hospitalized patients who have difficulty performing activities of daily living (ADLs) benefit from occupational therapy services; however, disparities in access to such services are understudied. Objective: To investigate whether need (i.e., limited ADL performance) predicts acute care occupational therapy utilization and whether this relationship differs across sociodemographic factors and insurance type. Design: A secondary analysis of electronic health records data. Logistic regression models were specified to determine whether ADL performance predicted use of occupational therapy treatment. Interactions were included to investigate whether the relationship between ADL performance and occupational therapy utilization varied across sociodemographic factors (e.g., age) and insurance type. Participants: A total of 56,022 adults admitted to five regional hospitals between 2014 and 2018 who received an occupational therapy evaluation. Intervention: None. Outcomes and Measures: Occupational therapy service utilization, Activity Measure for Post-Acute Care “6-Clicks” measure of daily activity. Results: Forty-four percent of the patients evaluated for occupational therapy received treatment. Patients with lower ADL performance were more likely to receive occupational therapy treatment; however, interaction terms indicated that, among patients with low ADL performance, those who were younger, were White and non-Hispanic, had significant others, and had private insurance (vs. public) were more likely to receive treatment. These differences were smaller among patients with greater ADL performance. Conclusions and Relevance: Greater need was positively associated with receiving occupational therapy services, but this relationship was moderated by age, minoritized status, significant other status, and insurance type. The findings provide direction for exploring determinants of disparities in occupational therapy utilization. What This Article Adds: Acute care occupational therapy utilization is driven partly by patient need, but potential disparities in access to beneficial services may exist across sociodemographic characteristics and insurance type. Identifying potential determinants of disparities in acute care occupational therapy utilization is the first step in developing strategies to reduce barriers for those in need.


2014 ◽  
Vol 26 (8) ◽  
pp. 1283-1293 ◽  
Author(s):  
Clarissa M. Giebel ◽  
Caroline Sutcliffe ◽  
Minna Stolt ◽  
Staffan Karlsson ◽  
Anna Renom-Guiteras ◽  
...  

ABSTRACTBackground:Performing basic activities of daily living (ADLs) is one of the major difficulties encountered in dementia, which can have considerable negative impacts on the quality of life (QoL) of people with dementia (PwD). However, the extent to which basic ADL performance deteriorates across mild, moderate, and severe dementia is little examined and its impact, together with depression and neuropsychiatric behavior, upon QoL, is of considerable relevance across European countries.Methods:Data were drawn from people living in the community who were participants in a large-scale European study on transition from community living to care homes of PwD. PwD completed measures on cognitive functioning and QoL, and informal carers reported upon QoL, depressive symptomatology, psychopathology, and functional ability of the PwD.Results:ADL performance deteriorated differently for each activity. In particular, toileting, transfer, and feeding remained relatively intact throughout, whereas performance on bathing and dressing deteriorated to a greater extent from mild to severe dementia. It appears that continence was not affected by the stage of dementia with similar levels of impairment. Basic ADL performance impacted to different degrees on QoL across dementia stages and countries.Conclusions:Interventions aimed at maintaining independence or QoL need to target different ADLs across different dementia stages and perhaps also tailor interventions to the context of different countries. Findings contribute to the development of non-pharmaceutical interventions and governmental pledges to promote independence in dementia.


2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Marcia Belas dos Santos ◽  
Clarissa Barros de Oliveira ◽  
Arly dos Santos ◽  
Cristhiane Garabello Pires ◽  
Viviana Dylewski ◽  
...  

Objectives. To assess the influence of RAGT on balance, coordination, and functional independence in activities of daily living of chronic stroke survivors with ataxia at least one year of injury.Methods. It was a randomized controlled trial.The patients were allocated to either therapist-assisted gait training (TAGT) or robotic-assisted gait training (RAGT). Both groups received 3 weekly sessions of physiotherapy with an estimated duration of 60 minutes each and prescribed home exercises. The following outcome measures were evaluated prior to and after the completion of the 5-month protocol treatment: BBS, TUG test, FIM, and SARA. For intragroup comparisons, the Wilcoxon test was used, and the Mann–Whitney test was used for between-group comparison.Results. Nineteen stroke survivors with ataxia sequel after one year of injury were recruited. Both groups showed statistically significant improvement (P<0.05) in balance, functional independencein, and general ataxia symptoms. There were no statistically significant differences (P<0.05) for between-group comparisons both at baseline and after completion of the protocol.Conclusions. Chronic stroke patients with ataxia had significant improvements in balance and independence in activities of daily living after RAGT along with conventional therapy and home exercises. This trial was registered with trial registration number39862414.6.0000.5505.


1995 ◽  
Vol 3 (1) ◽  
pp. 39-53 ◽  
Author(s):  
Hee Sik Kim ◽  
Kiyoji Tanaka

The purpose of this study was to assess the extent to which a battery of 24 activities of daily living (ADL) performance tasks could be used to determine functional age in a sample of older women. The subjects were 253 older adult Korean women, aged 60 to 91 years. All subjects completed a comprehensive battery of 24 performance tests related to common activities of daily living. Correlations between the measures were computed, and principal component analysis was applied to the 24 × 24 correlation matrix. A principal component score was computed for each subject and was found to decrease significantly with advancing age. Multiple regression analysis revealed that out of the initial 24 variables, 5 variables accounted for 81% of the variability. An equation was developed to determine ADL age; the equation was considered useful for the assessment of daily living activities of older adult Korean women.


2013 ◽  
Vol 14 (2) ◽  
pp. 259-266 ◽  
Author(s):  
Carla Manuela Crispim Nascimento ◽  
Carlos Ayan ◽  
Jose Maria Cancela ◽  
Lilian Teresa Bucken Gobbi ◽  
Sebastião Gobbi ◽  
...  

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