Psychometric Properties of the Barthel Index Used at Intensive Care Unit Discharge

Background The Barthel Index, originally developed and validated to assess activities of daily living in patients with neuromuscular disorders, is commonly used in research and clinical practice involving critically ill patients. Objectives To evaluate the internal consistency, reliability, measurement error, and construct validity of the Barthel Index used at intensive care unit discharge. Methods In this observational study, 2 physiotherapists measured the physical functioning of 122 patients at intensive care unit discharge, using the Barthel Index and other measurement instruments. Results The patients had a median (IQR) age of 56 (47-66) years, and 62 patients (51%) were male. The primary reason for intensive care unit admission was sepsis (28 patients [23%]), and 83 patients (68%) were receiving mechanical ventilation. The Cronbach α value indicating internal consistency was 0.81. For interrater reliability, the intraclass correlation coefficient for the total score was 0.98 (95% CI, 0.97-0.98; P < .001) and the κ statistic for the individual items was 0.54 to 0.94. The standard error of measurement was 7.22, the smallest detectable change was 20.01, and the 95% limits of agreement were –10.3 and 11.8. The Barthel Index showed moderate to high correlations with the other physical functioning measurement instruments (ρ = 0.57 to 0.88; P < .001 for all). Conclusion The Barthel Index is a reliable and valid instrument for assessing physical functioning at intensive care unit discharge.

Preventive effect of rehabilitation training therapy on muscle quality in patients with stroke: A retrospective study

A retrospective analysis was conducted in 45 patients with stroke. All patients received three weeks of rehabilitation training. Body composition was examined using Bio-impedance analysis methods before and after training. Barthel index was used to evaluate activities of daily living before and after the intervention. After rehabilitation training, total body water, muscle mass, protein content, inorganic salt content, and skeletal muscle content were increased while body fat content and body fat percentage were significantly decreased. Barthel Index scores showed that the ability of daily living was improved after rehabilitation. In conclusion, rehabilitation training therapy may have protective effects on sarcopenia in patients with stroke. Keywords: Stroke, sarcopenia, rehabilitation training

Association of anemia with rehabilitation outcomes for subacute geriatric rehabilitation patients in a secondary hospital in malaysia

Background: To evaluate the effects of anemia on rehabilitation outcomes for geriatric subjects in the Taiping Hospital subacute geriatric rehabilitation ward. Methods: This was a retrospective study with 126 subjects that compared the change in the modified Barthel Index score of anemic and non-anemic subjects. Results: In the study, 43.7% of subjects were anemic. Among anemic subjects, 45.5% were Malay, 38.2% were Chinese, 14.5% were Indian, and 1% were others. The median (Interquartile (IQR)) modified Barthel Index (MBI) on admission for anemic and non-anemic subjects was insignificantly different, at 47 (29, 63) and 36 (21, 59), respectively (P = 0.059). The median (IQR) of MBI improvement for non-anemic subjects was found to be significantly higher than for anemic subjects, which were 14 (5, 26) and 8 (1, 18; P = 0.021). Subjects with hemoglobin (hb) ≥ 9 g/dL were significantly associated with MBI improvement of more than 20, P = 0.009. Simple linear regression found that the P-values were not significant for albumin, creatinine, the Charlson comorbidity index, or the clinical frailty scale; hence, they were not significantly associated with rehabilitation outcome. Conclusions: The study suggested that non-anemic subjects showed significant MBI improvement. Our study also suggested that judicious practices to target a hb threshold of 9 g/dL might be able to improve a subject’s functional outcome. These results should encourage further research with a larger elderly population to provide insights and awareness for the need to treat anemia in rehabilitation subjects. Keywords: Geriatric, anemia, rehabilitation, modified barthel index

GAMBARAN TINGKAT KEMANDIRIAN LANSIA DALAM PEMENUHAN ACTIVITY OF DAILY LIVING (ADL) DI ROJINHOME THINSAGUNO IE ITOMAN OKINAWA JEPANG

Abstrak Activity of daily living (ADL) adalah aktivitas pokok bagi perawatan diri. Activity of daily living meliputi antara lain: ke toilet, makan, berpakaian (berdandan), mandi, dan berpindah tempat. Pengkajian ADL penting untuk mengetahui tingkat ketergantungan lansia dalam rangka menetapkan level bantuan bagi lansia tersebut dan untuk menyusun rencana perawatan jangka panjang. Tujuan dari penelitian ini adalah untuk mengetahui gambaran tingkat kemandirian lansia dalam pemenuhan ADL yang tinggal di rojinhome Thinsaguno Ie Itoman Okinawa Jepang. Jenis penelitian ini adalah deskriptif observasional. Sampel dalam penelitian ini adalah seluruh lansia di rojinhome Thinsaguno Ie Itoman Okinawa Jepang sejumlah 34 responden. Penentuan sampel menggunakan teknik total sampling. Alat ukur yang digunakan adalah lembar checklist Barthel Index. Penelitian ini menggunakan analisis data univariat yang ditampilkan dalam distribusi frekuensi. Hasil penelitian menunjukan rata-rata umur yaitu 83,23 tahun dan paling dominan pada rentang umur old (75-90 tahun) yaitu 70,6%. Jenis kelamin sebagian besar perempuan yaitu 64,7%, tingkat kemandirian sedang dalam ADL yaitu 38,2%. Tingkat kemandirian lansia berdasarkan umur paling dominan pada rentang umur old (75-90 tahun) dengan tingkat kemandirian sedang (29,4%). Tingkat kemandirian lansia berdasarkan jenis kelamin paling dominan pada jenis kelamin perempuan dengan ketergantungan sedang (23,5%). Kata kunci: lansia, activity of daily living, tingkat kemandiria Abstract Activity of daily living (ADL) is a staple activity for self-care. Activity of daily living includes, among others: toileting, eating, dressing, showering, and moving places. ADL assessment is important to determine the level of dependence of the elderly in order to determine the level of assistance for the elderly and to develop a long-term care plan. The purpose of this study was to describe the level of independence of the elderly in fulfilling the ADL at rojinhome of Thinsaguno Ie Itoman Okinawa, Japan. The type of this research is descriptive observational with cross sectional approach. The sample in this research were all 34 elderly people at rojinhome Thinsaguno Ie Itoman Okinawa Japan. Determination of the sample using total sampling technique. The measuring instrument used is the Barthel Index checklist sheet. This study uses univariate data analysis which is displayed in the frequency distribution. The results showed that the average age was 83.23 years and the most dominant in the old age range (75-90 years) was 70.6%. The gender of most of the women was 64.7%, the level of independence was moderate in ADL, namely 38.2%. The level of elderly independence based on age is the most dominant in the old age range (75-90 years) with a moderate level of independence (29.4%). The level of independence of the elderly based on sex was the most dominant in the female sex with moderate dependence (23.5%). Keywords: elderly, activity of daily living, level of independence

Respiratory rehabilitation for patients with COVID-19 infection and chronic respiratory failure: a real-life retrospective study by a Lombard network

The Lombardy region has been one of the areas most affected by the COVID-19 pandemic since the first months of 2020, providing real-life experiences in the acute phase. It is unclear how the respiratory rehabilitation network responded to this emergency. The aims of this retrospective study were: i) to analyze clinical, functional, and disability data at admission; ii) describe assessment tools and rehabilitative programs; iii) evaluate improvement after rehabilitation. The study was conducted on data collected from ten pulmonary rehabilitation centers in Lombardy, between the period of March 1st 2020 to March 1st 2021, in patients with respiratory failure recovering from COVID-19 both at admission and discharge. The study included demographics, comorbidities, nutritional status, risk of falls, disability status (Barthel index; Short Physical Performance Battery (SPPB); 6 minutes walking test (6MWT), symptoms (dyspnoea with Barthel Dyspnoea and MRC Dyspnoea Scale), length of stay, discharge destination, need for mechanical ventilation, respiratory function, assessment/outcomes indices, and prescribed rehabilitative programs. 413 patients were analyzed. Length of stay in acute and rehabilitative units was less than 30 days. Fifty % of patients used non-invasive ventilation during their stay. Functional status was mildly compromised for forced volumes and oxygenation, while severely compromised for diffusion capacity. Independency was low while physical performance status very low. At discharge, 318 (77%) patients were sent home, 83 (20.1%) were transferred to an acute unit and 12 (2.9%) passed away. Barthel Index and 6MWT were the most used, while MRC score was the least used outcome parameter. The 5 main rehabilitative activities were walking (90.8 %), transfer from bed to armchair (77.5%), limb mobilization in bed (76%), balance (71.2%), and cycle-ergometer or treadmill (43.1%). A huge difference was found in admission, discharge, and delta change among different rehabilitative centers. When available, all outcomes showed a significant improvement. With the limitation of a retrospective study with a clear amount of missing data, COVID-19 subjects admitted to rehabilitative centers presented a reduced physical performance, symptoms of dyspnoea, and severe disability. The 6MWT and Barthel index were the most used measurement.

Gambaran Activity Daily Living Pada Pasien Pasca Stroke Non Hemoragic Setelah Pemberian Propioceptive Neuromuscular Facilitation : Literature Review

Stroke occurs when a blood vessel that carries oxygen and nutrients to the brain bursts or is blocked by a clot so that the brain does not get the blood it needs. Stroke affects physical limitations and disabilities in carrying out daily living activities. One of the rehabilitation interventions to increase daily living activities among them is propioceptive neuromuscular facilitation. Thisstudy aimed to describe the activity daily living in non-hemorrhagic post-stroke patients after propioceptive neuromuscular facilitation intervention. The selection of articles in the study usesthe PICO mnemonic. Searcharticles through the Indonesian Scientific Respirator Research, PubMed, GARUDA, and Google scholar with predetermined inclusion and exlusion criteria. The results show that propioceptive neuromuscular facilitation was proven in increase activity daily living in non-hemorrhagic post-stroke patients. The activity daily living was assessed using Barthel Index checklist. The average of Barthel Index before and after intervention were 42,493 and 75,372 respectively. The propioceptive neuromuscular facilitation has been shown to improve activity daily living in non-hemorrhagic post-stroke patients. Propioceptive neuromuscular facilitation can be a modality treatment to increase activity daily living in non-hemorrhagic post-stroke patients.Keywords: Activity Daily Living, Non-Hemorrhagic Post-Stroke, Propioceptive Neuromuscular Facilitation AbstrakStroke terjadi ketika pembuluh darah yang mengangkut oksigen dan nutrisi menuju otak pecah atau terblokir oleh bekuan sehingga otak tidak mendapat darah yang dibutuhkan. Kejadian stroke memunculkan gangguan keterbatasan fisik dan kecacatan dalam melakukan activity daily living. Peran fisioterapi pada penderita stroke yaitu tindakan rehabilitasi yang dapat meningkatkan ADL salah satuya adalah propioceptive neuromuscular facilitation. Penelitian ini bertujuan untuk mengetahui gambaran activity daily living pada pasien pasca stroke non hemoragic dengan pemberian propioceptive neuromuscular facilitation. Pemilihan artikel pada penelitian ini menggunakan mnemonic PICO. Penelusuran artikel melalui Neliti Respiratori Ilmiah Indonesia, PubMed, Garuda-Garba rujukan digital dan Google scholar dengan kriteria inklusi dan ekslusi yang telah ditentukan. Hasil literature review kelima artikel menunjukkan bahwa PNF terbukti meningkatkan ADL pada pasien pasca stroke non hemoragic dengan hasil rata-rata peningkatan sebesar 32.879 dengan menggunakan alat ukur indeks barthel sebelum intervensi 42.493 dan sesudah intervensi 75.372. Hasil literature review kelima artikel ini menunjukkan bahwa propioceptive neuromuscular facilitation terbukti dapat meningkatkan activity daily living pada pasien pasca stroke non hemoragic. Penetitian ini dapat digunakan sebagai dasar pengembangan praktisi fisioterapi pada masalah peningkatan activity daily living pada pasien pasca stroke non hemoragic dengan menggunakan latihan propioceptive neuromuscular facilitation.Kata Kunci: Activity Daily Living, Propioceptive Neuromuscular Facilitation, Pasca Stroke

Comparing the effectiveness of bimanual and unimanual mirror therapy in unilateral neglect after stroke: A pilot study

BACKGROUND: Unilateral neglect in stroke patients is a major obstacle to rehabilitation, which is a great challenge for therapists. OBJECTIVE: This study aimed to compare the effectiveness of bimanual mirror therapy (BMT) and unimanual mirror therapy (UMT), the two protocols of mirror therapy, for the reduction of the symptoms of unilateral neglect in stroke patients. METHODS: Twenty-eight individuals were randomly assigned to the UMT or BMT groups. Both groups received mirror therapy for 30 minutes per day, 5 days a week, for a period of 4 weeks. The Star Cancelation Test (SCT), Line Bisection Test (LBT), Picture Scanning test (PST), and Korean Catherine Bergego Scale (K-CBS) were used to measure the change in unilateral neglect, and the Korean version of the Modified Barthel Index (K-MBI) was used to evaluate activities of daily living (ADL). RESULTS: The results of SCT, LBT, PST, and K-CBS showed significant decreases in unilateral neglect in both groups (p < 0.05). K-MBI improved significantly in both groups (p < 0.05). There were significant differences between the two groups in the unilateral neglect tests (p < 0.05), but no significant difference in ADL evaluation (p > 0.05). CONCLUSIONS: Mirror therapy protocols can be applied to treat unilateral neglect in stroke patients. However, BMT may be more beneficial for reducing the symptoms of unilateral neglect.

Clinical Implications of Oral Assessment In Elderly Patients With Acute Heart Failure: A Single-Center, Retrospective Study

Background: Oral health problems are common and are associated with various geriatric conditions in older adults. The importance of oral health has not been fully highlighted in the assessment and management of patients with heart failure. Here, we investigated the clinical implications of oral assessment in elderly patients with acute heart failure.Methods: We evaluated oral health using the revised oral assessment guide in 77 patients aged 65 years or older who were admitted to hospital for acute heart failure. Poor oral health was defined as a revised oral assessment guide score ≥ 9.Results: Poor oral health was identified in 66.2% of the patients. Patients with poor oral health had high prevalence of decreased physical function, undernutrition, and cognitive impairment. A reduction in the Barthel Index, as an indicator of activities of daily living during hospitalization, was significant in the enrolled patients. The Barthel Index decreased more in patients with poor oral health than those with normal oral health. Furthermore, the revised oral assessment guide score on admission was found to be the only independent predictor of changes in the Barthel Index during hospitalization in the multivariate regression analyses. Conclusions: Oral assessment using the revised oral assessment guide during hospitalization could provide useful information for the management of elderly heart failure patients.Trail registration: Patients were retrospectively registered.

Beckeninsuffizienzfrakturen bei einer älteren Patientin mit Osteopetrose

Zusammenfassung Einleitung Bei der Osteopetrose handelt es sich um eine seltene hereditäre Knochenerkrankung, bei der es durch eine Störung des Knorpel-Knochenstoffwechsels zu einer pathologischen Anhäufung der Knochenmatrix mit Sklerosierung des Markraums und konsekutiver Verdrängung des blutbildenden Knochenmarks kommt. Bei der autosomal-dominant vererbten Osteopetrose Typ 2 (ADOII) handelt es sich um eine langsam verlaufende Form, die mit einer erhöhten Frakturgefährdung einhergeht. Fallbeschreibung und Ergebnisse Wir berichten über eine 80-jährige Patientin mit akut aufgetretenen, immobilisierenden lumbosakralen Schmerzen ohne vorangegangenes Trauma. Anamnestisch ergab sich kein Anhalt für das Vorliegen eines Malignoms, eine Osteoporose war nicht bekannt. Laborchemisch fand sich ein Vitamin D Mangel und eine erhöhte alkalische Phosphatase, der Calciumwert lag im Normbereich, eine Anämie oder Thrombozytopenie waren nicht nachweisbar. Die Sonographie des Abdomens war bis auf eine leichte Splenomegalie unauffällig. Zur weiteren Abklärung der Schmerzen erfolgten konventionelle Röntgenaufnahmen, ein CT sowie ein MRT der LWS und des Beckens. Des Weiteren erfolgten a.p. Röntgenaufnahmen der rechten Hüfte und Schulter. In der LWS zeigte sich eine charakteristische 3-Schichtung der Wirbelkörper mit Mehrsklerosierung der Grund- und Deckplatten, die sogenannten Sandwichwirbel, ohne Anhalt für eine Fraktur. In den Beckenaufnahmen zeigte sich eine ausgeprägte Dichtezunahme mit diffusen, inhomogenen Sklerosierungen sowie abgelaufenen Frakturen im vorderen Beckenring. Ein „Knochen im Knochen“ – Bild fand sich im Caput humeri und Caput femoris. Als schmerzursächlich fanden sich eine beidseitige komplexe Fraktur des Os sacrum sowie Frakturen im vorderen Beckenring in den CT-Schnittbildern. In der zusätzlich durchgeführten Knochenmineralgehaltsbestimmung mittels spinaler QCT und CTXA der Hüften fand sich ein stark erhöhter Knochenmineralgehalt. Die Patientin wurde schmerztherapeutisch eingestellt, schmerzadaptiert mobilisiert und physiotherapeutisch behandelt. Hierunter fand sich eine deutliche Schmerzreduktion von initial VAS 8 auf VAS 3. Mit einer Verbesserung des Barthel-Index von 35 auf 75 Punkte konnte die Patientin nach 3-wöchiger multimodaler Komplextherapie in die häusliche Umgebung entlassen werden. Der bestehende Vitamin D Mangel wurde auf > 30 ng/ml substituiert. Diskussion Passend zu einer ADOII fand sich bei unserer Patientin eine deutlich erhöhte Knochenmasse und -dichte mit inhomogenen knöchernen Sklerosierungen. Die Beckeninsuffizienzfrakturen waren Ausdruck des erhöhten Frakturrisikos einer ADOII und ursächlich für die immobilisierenden Schmerzen. Da es unter konservativer Therapie zu einer deutlichen Schmerzreduktion kam, und die Patientin mobilisiert werden konnte, wurde von einer interventionellen oder osteosynthetischen Versorgung der Frakturen abgesehen.