Background: The acute nature and complications of COVID-19, including fatigue and dyspnea, reduce the ability of the affected individuals to play individual and social roles and perform activities of daily living, and have adverse effects on the life quality and economic status of patients. Conducting pre-discharge rehabilitation programs following a home-based approach can be effective in reducing fatigue and dyspnea and improving the activities of daily living of COVID-19 patients. Objectives: This study aimed to investigate the effect of home-based pulmonary rehabilitation on fatigue, dyspnea, and activities of daily living of COVID-19 patients in the teaching hospitals of Zahedan University of Medical Sciences in 2020. Methods: The quasi-experimental study enrolled 60 patients with COVID-19 respiratory symptoms admitted to the COVID-19 intensive care units of teaching hospitals affiliated with Zahedan University of Medical Sciences in 2020. The patients who met the inclusion criteria were selected using convenience sampling and randomly divided into intervention and control groups with color cards. The instruments used to collect the data were the Fatigue Severity Scale (FSS), the Borg Dyspnea Scale, and the Barthel Index completed by the participants before, two weeks, and two months after the intervention. The rehabilitation training was provided to the patient and the primary caregiver in the intervention group in three 45-min sessions individually and using training videos during the hospital stay. After discharge, the patients were followed up in person or by phone for eight weeks to ensure the effectiveness of the rehabilitation program. The collected data were analyzed using SPSS-22 software through repeated measures analysis of variance (ANOVA), independent samples t-test, and chi-square test at a significance level of 0.05 (P < 0.05). Results: The repeated measures ANOVA showed that changes in the fatigue and dyspnea scores were significant over time (P < 0.001). Furthermore, the intervention effect was significant (P = 0.04), and more remarkable changes were observed in the intervention group than in the control group. Given the significance of the group-time interactive effect on the two given variables, the comparisons were made point by point and with Bonferroni correction again by time and group. There were significant differences in the mean fatigue scores in the second (P = 0.03) and third (P < 0.001) stages and the mean dyspnea scores (P < 0.001) between the two groups. The mean scores of activities of daily living two weeks and two months after the intervention were significantly different between the two groups, with higher scores in the intervention group than in the control group (P = 0.01). The repeated measures ANOVA confirmed a statistically significant difference between the two groups in terms of the effect of time (P < 0.001) and group (P = 0.03) on the patients’ activities of daily living. Conclusions: The study showed that home-based pulmonary rehabilitation measures were effective on fatigue, dyspnea, and activities of daily living of COVID-19 patients. Thus, this intervention approach by nurses for family participation can be practical for treating acute and chronic respiratory diseases.
Glioblastoma multiforme (GBM) is the most common and aggressive brain tumor. To identify the factors influencing the improvement of the activities of daily living (ADL) in newly diagnosed patients with GBM, we investigated the characteristics and variable factors and overall survival. A total of 105 patients with GBM were retrospectively analyzed and categorized into the following three groups according to the quartile of change of their Barthel index score from admission to discharge: deterioration (n = 25), no remarkable change (n = 55), and good recovery (n = 25). A statistical difference was observed in the pre-operative, intra-operative, post-operative, and rehabilitation-related factors between the deterioration and good recovery groups. Multiple regression analysis identified the following significant factors that may influence the improvement of ADL after surgery: the improvement of motor paralysis after surgery, mild fatigue during radio and chemotherapy, and length up to early walking training onset. The median overall survival was significantly different between the deterioration (10.6 months) and good recovery groups (18.9 months, p = 0.025). Our findings identified several factors that may be associated with post-operative functional improvement in patients with GBM. The inpatient rehabilitation during radio and chemotherapy may be encouraged without severe adverse events and can promote functional outcomes, which may contribute to the overall survival of newly diagnosed patients with GBM.
Methods to measure physical activity and sedentary behaviors typically quantify the amount of time devoted to these activities. Among patients with chronic diseases, these methods can provide interesting behavioral information, but generally do not capture detailed body motion and fine movement behaviors. Fine detection of motion may provide additional information about functional decline that is of clinical interest in chronic diseases. This perspective paper highlights the need for more developed and sophisticated tools to better identify and track the decomposition, structuration, and sequencing of the daily movements of humans. The primary goal is to provide a reliable and useful clinical diagnostic and predictive indicator of the stage and evolution of chronic diseases, in order to prevent related comorbidities and complications among patients.
Background. Hip fractures among older adults are a major public health concern worldwide. This study investigated the potential clinical factors that predict postoperative 1-year activities of daily living (ADL), quality of life (QoL), and mortality in Taiwanese older adults following hip fracture. Methods. This is a prospective cohort study enrolling older adults (≥60 years) who had undergone hip fracture surgery in a single medical center. The comprehensive clinical history of each patient was examined. QoL, ADL, and mortality events were recorded consecutively at 3, 6, and 12 months after operation. The multiple logistic regression model and the generalized estimating equation (GEE) were adopted to identify contributing factors for mortality and postoperative ADL and QoL prognosis, respectively. Results. Among 377 participants with hip fracture, 48 died within 1 year of the index operation. ADL and QoL considerably decreased at 3 months following hip surgery. Old age, high Charlson Comorbidity Index, and American Society of Anesthesiologists grading were crucial predictors for mortality at the 1-year follow-up. The generalized estimating equation analysis indicated that the length of postoperative follow-up time, serum albumin level, patient cognitive status, and handgrip strength were considerably associated with QoL and ADL recovery prognosis in the Taiwanese older adults following hip fracture. Conclusions. Hip fractures have long-lasting effects on the older adults. Our data imply several prognosis predicting parameters that may assist clinicians in accounting for an individual’s personalized risks in order to improve functional outcomes and reduce mortality.
Background: The cognitive and neuropsychiatric deficits present in patients with behavioral variant frontotemporal dementia (bvFTD) are associated with loss of functionality in the activities of daily living (ADLs). The main purpose of this study was to examine and explore the association between the cognitive and neuropsychiatric features that might prompt functional impairment of basic, instrumental, and advanced ADL domains in patients with bvFTD.Methods: A retrospective cross-sectional study was conducted with 27 patients with bvFTD in its early stage (<2 years of evolution) and 32 healthy control subjects. A neuropsychological assessment was carried out wherein measures of cognitive function and neuropsychiatric symptoms were obtained. The informant-report Technology–Activities of Daily Living Questionnaire was used to assess the percentage of functional impairment in the different ADL domains. To identify the best determinants, three separate multiple regression analyses were performed, considering each functional impairment as the dependent variable and executive function, emotion recognition, disinhibition, and apathy as independent variables.Results: For the basic ADLs, a model that explains 28.2% of the variability was found, in which the presence of apathy (β = 0.33, p = 0.02) and disinhibition (β = 0.29, p = 0.04) were significant factors. Concerning instrumental ADLs, the model produced accounted for 63.7% of the functional variability, with the presence of apathy (β = 0.71, p < 0.001), deficits in executive function (β = −0.36, p = 0.002), and lack of emotion recognition (β = 0.28, p = 0.017) as the main contributors. Finally, in terms of advanced ADLs, the model found explained 52.6% of the variance, wherein only the presence of apathy acted as a significant factor (β = 0.59, p < 0.001).Conclusions: The results of this study show the prominent and transverse effect of apathy in the loss of functionality throughout all the ADL domains. Apart from that, this is the first study that shows that the factors associated with loss of functionality differ according to the functional domain in patients with bvFTD in its early stage. Finally, no other study has analyzed the impact of the lack of emotion recognition in the functionality of ADLs. These results could guide the planning of tailored interventions that might enhance everyday activities and the improvement of quality of life.
The objective is to investigate the mediating roles of living alone and personal network in the relationship between physical frailty and activities of daily living (ADL) limitations among older adults. 2271 individuals were classified as vulnerable (pre-frail or frail) or robust. Mediating variables were living alone and personal network. Katz Index and Lawton-Brody scale were used to assess ADL. Mediating effects were analyzed with beta coefficients from linear regression models using the bootstrapping method. Mediation analysis showed significant mediating effects of living alone (β = .011; 95% CI = .004; .018) and personal network (β = .005; 95% CI = .001; .010) on the relationship between physical frailty and basic ADL limitations. Mediation effects of living alone and personal network on the relationship between physical frailty and instrumental ADL limitations were β = −.074 (95% CI=−.101; −.046) and β = −.044 (95% CI = −.076; −.020), respectively. Physically vulnerable older adults who lived alone or had poor personal network were more dependent on basic and instrumental ADL.
Current evidence on the association between Mediterranean diet (MeDi) intake and activities of daily living (ADL) is limited and inconsistent in older adults.
This study included 1696 participants aged ≥ 65 years in the Washington Heights-Inwood Community Aging Project (WHICAP) study. The MeDi score was calculated based on data collected from the Willett’s semi-quantitative food frequency questionnaire. The multivariable-adjusted Cox regression model was applied to examine the association of MeDi score with risks of disability in basic (BADL) and instrumental ADL (IADL), as well as the overall ADL (B-IADL).
832 participants with incident ADL disability were identified over a median follow-up of 5.39 years. The continuous MeDi score was significantly associated with decreased risk of disability in B-IADL (hazard ratio [HR] = 0.95, 95% confidence interval [CI] = 0.91 to 0.99, p = 0.018) in a model adjusted for age, sex, race/ethnicity, educational level, and dietary calories intake but was no longer significant after additionally adjusted for multiple comorbidities and physical activities (0.97 [0.93, 1.01], p = 0.121). The continuous MeDi score was significantly associated with decreased risk of disability in B-IADL (0.92 [0.85, 1.00], p = 0.043) and BADL (0.90 [0.82, 0.99], p = 0.030) in non-Hispanic Whites, but not in non-Hispanic Blacks and Hispanics (p > 0.05 for all).
Higher MeDi score was associated with decreased risk of ADL disability, particularly in non-Hispanic Whites.
Upper limb kinematic assessments provide quantifiable information on qualitative movement behavior and limitations after stroke. A comprehensive characterization of spatiotemporal kinematics of stroke subjects during upper limb daily living activities is lacking. Herein, kinematic expressions were investigated with respect to different movement types and impairment levels for the entire task as well as for motion subphases.
Chronic stroke subjects with upper limb movement impairments and healthy subjects performed a set of daily living activities including gesture and grasp movements. Kinematic measures of trunk displacement, shoulder flexion/extension, shoulder abduction/adduction, elbow flexion/extension, forearm pronation/supination, wrist flexion/extension, movement time, hand peak velocity, number of velocity peaks (NVP), and spectral arc length (SPARC) were extracted for the whole movement as well as the subphases of reaching distally and proximally. The effects of the factors gesture versus grasp movements, and the impairment level on the kinematics of the whole task were tested. Similarities considering the metrics expressions and relations were investigated for the subphases of reaching proximally and distally between tasks and subgroups.
Data of 26 stroke and 5 healthy subjects were included. Gesture and grasp movements were differently expressed across subjects. Gestures were performed with larger shoulder motions besides higher peak velocity. Grasp movements were expressed by larger trunk, forearm, and wrist motions. Trunk displacement, movement time, and NVP increased and shoulder flexion/extension decreased significantly with increased impairment level. Across tasks, phases of reaching distally were comparable in terms of trunk displacement, shoulder motions and peak velocity, while reaching proximally showed comparable expressions in trunk motions. Consistent metric relations during reaching distally were found between shoulder flexion/extension, elbow flexion/extension, peak velocity, and between movement time, NVP, and SPARC. Reaching proximally revealed reproducible correlations between forearm pronation/supination and wrist flexion/extension, movement time and NVP.
Spatiotemporal differences between gestures versus grasp movements and between different impairment levels were confirmed. The consistencies of metric expressions during movement subphases across tasks can be useful for linking kinematic assessment standards and daily living measures in future research and performing task and study comparisons.
Trial registration: ClinicalTrials.gov Identifier NCT03135093. Registered 26 April 2017, https://clinicaltrials.gov/ct2/show/NCT03135093.
Early identification of mild cognitive impairment (MCI) in Parkinson’s disease (PD) patients can lessen emotional and physical complications. In this study, a cognitive functional (CF) feature using cognitive and daily living items of the Unified Parkinson’s Disease Rating Scale served to define PD patients as suspected or not for MCI. The study aimed to compare objective handwriting performance measures with the perceived general functional abilities (PGF) of both groups, analyze correlations between handwriting performance measures and PGF for each group, and find out whether participants’ general functional abilities, depression levels, and digitized handwriting measures predicted this CF feature. Seventy-eight participants diagnosed with PD by a neurologist (25 suspected for MCI based on the CF feature) completed the PGF as part of the Daily Living Questionnaire and wrote on a digitizer-affixed paper in the Computerized Penmanship Handwriting Evaluation Test. Results indicated significant group differences in PGF scores and handwriting stroke width, and significant medium correlations between PGF score, pen-stroke width, and the CF feature. Regression analyses indicated that PGF scores and mean stroke width accounted for 28% of the CF feature variance above age. Nuances of perceived daily functional abilities validated by objective measures may contribute to the early identification of suspected PD-MCI.
Background. Contralaterally controlled neuromuscular electrical stimulation (CCNMES) is a novel electrical stimulation treatment for stroke; however, reports on the efficacy of CCNMES on lower extremity function after stroke are scarce. Objective. To compare the effects of CCNMES versus NMES on lower extremity function and activities of daily living (ADL) in subacute stroke patients. Methods. Forty-four patients with a history of subacute stroke were randomly assigned to a CCNMES group and a NMES group (
per group). Twenty-one patients in each group completed the study per protocol, with one subject lost in follow-up in each group. The CCNMES group received CCNMES to the tibialis anterior (TA) and the peroneus longus and brevis muscles to induce ankle dorsiflexion motion, whereas the NMES group received NMES. The stimulus current was a biphasic waveform with a pulse duration of 200 μs and a frequency of 60 Hz. Patients in both groups underwent five 15 min sessions of electrical stimulation per week for three weeks. Indicators of motor function and ADL were measured pre- and posttreatment, including the Fugl–Meyer assessment of the lower extremity (FMA-LE) and modified Barthel index (MBI). Surface electromyography (sEMG) assessments included average electromyography (aEMG), integrated electromyography (iEMG), and root mean square (RMS) of the paretic TA muscle. Results. Values for the FMA-LE, MBI, aEMG, iEMG, and RMS of the affected TA muscle were significantly increased in both groups after treatment (
). Patients in the CCNMES group showed significant improvements in all the measurements compared with the NMES group after treatment. Within-group differences in all post- and pretreatment indicators were significantly greater in the CCNMES group than in the NMES group (
). Conclusion. CCNMES improved motor function and ADL ability to a greater extent than the conventional NMES in subacute stroke patients.