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Neuropsychology Review Dec 2019Rett syndrome is the second most common cause of intellectual disability in females worldwide. The severity of many individuals' impairment limits the effectiveness of...
Rett syndrome is the second most common cause of intellectual disability in females worldwide. The severity of many individuals' impairment limits the effectiveness of traditional assessment. However, clinician and parent reports of adaptive functioning may provide insight into these patients' abilities. This review aims to synthesize the current literature assessing adaptive functioning in Rett syndrome and evaluate existing measurement tools in this population. A search was conducted on PubMed using the search term "Rett syndrome." Studies that quantitatively assessed adaptive functioning outcomes in Rett syndrome with published and normed questionnaire measures were included. Twenty-three studies met inclusion criteria. Overall results indicate that the population of people with Rett syndrome is highly impaired, both in overall adaptive functioning as well as in specific subdomains (e.g., mobility, activities of daily living). Atypical Rett syndrome groups performed better on measures of adaptive functioning relative to patients with classic Rett syndrome. Our findings identified measurement weaknesses, as many of the studies found floor effects and therefore were unable to capture meaningful variability in outcomes. Individuals with Rett syndrome are highly reliant on caregivers due to disrupted adaptive functioning abilities. Optimizing measurement of adaptive skills in Rett syndrome will facilitate the quantification of meaningful change in skills and the identification of efficacious interventions aimed at improving outcomes and quality of life.
Topics: Activities of Daily Living; Adaptation, Psychological; Caregivers; Communication; Health Personnel; Humans; Psychological Tests; Rett Syndrome; Socialization
PubMed: 31748842
DOI: 10.1007/s11065-019-09420-9 -
Medicine Jul 2020To investigate the risk factors for postoperative venous thromboembolism (VTE) in patients undergoing spinal surgery. (Meta-Analysis)
Meta-Analysis
BACKGROUND
To investigate the risk factors for postoperative venous thromboembolism (VTE) in patients undergoing spinal surgery.
METHODS
Literature published in PubMed, Embase, the Cochrane Library, and Web of Science was systematically reviewed to assess risk factors for VTE following spinal surgery. The data analysis was conducted with STATA 12.0. Data were pooled using fixed-effects or random-effects models according to the heterogeneity among the included studies.
RESULTS
Twenty-six studies involving 3,216,187 patients were included in this meta-analysis, and the total incidence of VTE after spinal surgery was 0.35% (0.15-29.38%). The pooled analysis suggested that the incidence of VTE after spinal surgery was higher in such aspects as increasing age (weighted mean difference [WMD] 0.55 years, 95% confidence interval [CI] 0.33-0.78, P < .001), female sex (odds ratio [OR] 1.12, 95% CI 1.01-1.25; P = .034), diabetes (OR 1.34, 95% CI 1.29-1.44; P < .001), chronic kidney disease (OR = 8.31, 95% CI 1.98-34.93; P = .004), nonambulatory preoperative activity status (OR 3.67, 95% CI 2.75-4.83; P < .001), D-dimer level (WMD 1.023, 95% CI 0.162-1.884; P = .02), long duration of operation (WMD 0.73, 95% CI 0.21-1.24; P = .006), spine fusion (OR 1.54, 95% CI 1.31-1.82; P < .001), and blood transfusion (OR 2.31, 95% CI 1.73-3.07; P < .001), and the differences were statistically significant. However, there were no significant differences in body mass index, obesity, hypertension, coronary heart disease, spondylolisthesis, intraoperative blood loss, surgical procedures (anterior lumbar interbody fusion vs posterior intervertebral fusion /translaminar lumbar interbody fusion), or surgical site (lumbar vs thoracic) (all P > .05).
CONCLUSION
Based on our meta-analysis, we identified several important factors that increased the risk of VTE after spinal surgery. We hope our study provides assistance to spine surgeons so that they can adequately analyze and assess risk factors in patients and then develop preventive measures to reduce the incidence of VTE.
Topics: Age Factors; Blood Transfusion; Fibrin Fibrinogen Degradation Products; Humans; Mobility Limitation; Neurosurgical Procedures; Operative Time; Orthopedic Procedures; Postoperative Complications; Renal Insufficiency, Chronic; Risk Factors; Sex Factors; Spine; Venous Thromboembolism
PubMed: 32702835
DOI: 10.1097/MD.0000000000020954 -
PloS One 2019Systematic Review was used to evaluate the efficacy and safety of Dalfampridine (DAP) in the treatment of Mobility Disability (MS) in patients with Multiple Sclerosis. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Systematic Review was used to evaluate the efficacy and safety of Dalfampridine (DAP) in the treatment of Mobility Disability (MS) in patients with Multiple Sclerosis.
METHODS
Clinical randomized controlled studies about DAP and placebo in the treatment of Mobility Disability in patients with Multiple Sclerosis until March 2019 were explored by searching Embase, PubMed, Cochrane, Web of Knowledge, and ClinicalTrials.gov. Literature screening, data extraction, quality assessment, and statistical analysis were performed by using Stata 14.0.
RESULTS
10 papers were included in the meta-analysis, and the number of patients was 2100. In conclusion, the application of DAP in clinical can significantly improve the Mobility Disability of patients [OR = 2.73, 95%CI (1.66, 4.50), P<0.001, I2 = 74.1%] and boost the mobility speed of patients in Timing 24 Minute Walk Test (T24FW) [SMD = 3,08, 95%CI(1,58, 4.58), P<0.001, I2 = 98.7%]. There are no significant differences of the incidence of adverse events [RR = 1.06, 95%CI (0.99, 1.14), P = 0.928, I2 = 0.0%] and urinary tract infection [RR = 1.21, 95%CI(0.91, 1.60), P = 0.145, I2 = 37.2%] between the DAP test group (Doses≤10 mg) and the placebo control group, and the incidence of adverse events [RR = 1.14, 95%CI(1.02, 1.28), P = 0.793, I2 = 0.0%] and urinary tract infection[RR = 3.05, 95%CI(1.04, 8.99), P = 0.680, I2 = 0.0%] for the DAP test group (Doses>10 mg) is a litter higher than the placebo control group.
CONCLUSION
DAP can effectively improve Mobility Disability in patients with Multiple Sclerosis, which is safe and reliable in specific DAP usage doses.
Topics: 4-Aminopyridine; Disabled Persons; Humans; Immunosuppressive Agents; Mobility Limitation; Multiple Sclerosis; Multiple Sclerosis, Relapsing-Remitting; Range of Motion, Articular
PubMed: 31513613
DOI: 10.1371/journal.pone.0222288 -
Journal of Advanced Nursing Sep 2019To determine the impact of strategies to promote mobilization on physical function in hospitalized adults with medical conditions. (Comparative Study)
Comparative Study Meta-Analysis
AIM
To determine the impact of strategies to promote mobilization on physical function in hospitalized adults with medical conditions.
BACKGROUND
Slow progress is noted on the promotion of mobilization during hospitalization for adult patients admitted for medical conditions. This may reflect the limited evidence on the evaluation of the impact of progressive mobilization activities on clinical endpoints in adult patients throughout hospitalization.
DESIGN
A systematic review and meta-analysis of published randomized controlled trials in any language.
DATA RESOURCES
The literature search was performed in the MEDLINE, CINAHL online, HealthStar, EMBASE, the Cochrane Library Controlled Trials Registry and LILACS databases (January 2000-February 2017).
REVIEW METHODS
Two authors independently identified randomized trials meeting inclusion criteria, assessed their quality and extracted relevant data. Outcomes assessed were the changes in physical function evaluated by scales measuring either the aerobic (metres walked/second) or the balance domain (using the Time Up and Go test, in seconds), length of hospital stay (days), and adverse clinical events. We calculated pooled mean differences or Mantel-Haenszel odds ratios and 95% confidence intervals for continuous or dichotomous outcome data and obtained heterogeneity statistics across studies.
RESULTS
Thirteen studies, including in total 2,703 participants, met our eligibility criteria. Patients in the intervention group showed significant improvement in physical function (aerobic domain), reduced length of stay, and a reduction of pulmonary embolism.
CONCLUSION
Patients and health providers should consider a course of therapy that enhances the functional capacity of medical patients during hospitalization.
Topics: Adult; Aged; Aged, 80 and over; Exercise; Exercise Therapy; Female; Hospitalization; Humans; Male; Middle Aged; Mobility Limitation; Postural Balance; Practice Guidelines as Topic; Standard of Care
PubMed: 30672011
DOI: 10.1111/jan.13958 -
Clinical Rehabilitation Dec 2020To investigate the effects of the water-based exercise on balance, mobility, mobility and functional independence, functional performance, fear of falling and quality of... (Meta-Analysis)
Meta-Analysis
AIM
To investigate the effects of the water-based exercise on balance, mobility, mobility and functional independence, functional performance, fear of falling and quality of life in people with Parkinson's disease.
METHODS
We searched pubmed/MEDLINE, Cochrane Central Register of Controlled Trials, PEDro data base and SciELO to June 2020 for randomised controlled trials that investigated the effects of water-based exercise in people with Parkinson's disease. Two comparisons were made: water-based exercise versus usual care and water-based exercise versus land-exercise. The main outcomes were Balance, Confidence, Mobility, Unified Parkinson's Disease Rating Scale and quality of life. Mean differences (MD) with 95% confidence interval (CI) were calculated, and heterogeneity was assessed using the test.
RESULTS
Fifteen randomised controlled trials were found (435 people). Compared to usual care, water-based exercise resulted in improvement in balance MD (9.1, 95% CI: 6.5, 11.8, = 45). Water-based exercise resulted in improvement in balance MD (3.1, 95% CI: 1.2, 5.0, = 179), mobility MD (-2.2, 95% CI: -3.3, -1.0, = 197) and quality of life MD (-5.5, 95% CI: -11, -0.07, = 98) compared to land-based exercise, but without significant difference in functional performance MD (0.01, 95% CI: -2.6 to 2.7, = 69). Land-based exercise resulted in improvement in fear of falling MD (-3.5, 95% CI: -5.6, -1.3, = 58) compared to water-based exercise.
CONCLUSION
Water-based exercise was more efficient than land-based exercise and/or usual care in improving balance, mobility and quality of life in people with Parkinson's disease.
Topics: Accidental Falls; Exercise Therapy; Humans; Mobility Limitation; Parkinson Disease; Physical Functional Performance; Postural Balance; Quality of Life; Water
PubMed: 32715810
DOI: 10.1177/0269215520943660 -
Physical Therapy Aug 2020People with stroke cite mobility deficits as one of the most burdensome limitations. National and international stroke guidelines recommend physical therapy based on...
People with stroke cite mobility deficits as one of the most burdensome limitations. National and international stroke guidelines recommend physical therapy based on task-oriented practice, with high numbers of repetitions to improve mobility. In the outpatient setting in Germany and Austria, these principles have not yet been established. The purpose of this study was to identify an evidence-based intervention that could help reduce this research-practice gap. A stepwise approach proposed by Voigt-Radloff and colleagues and Cochrane Germany was used. First, the specific health service problem in the German and Austrian physical therapy outpatient context was identified. Second, a promising intervention was identified using a systematic search in the Cochrane Library and by grading the quality of the evidence using the Grading of Recommendations Assessment, Development and Evaluation. Finally, the transferability of the promising intervention into the local context was evaluated using predefined questions from the Cochrane guide and reports from health insurances, professional organizations, and national stroke guidelines. Task-oriented circuit training reviewed by English and colleagues was chosen. The review showed clinically important improvements in walking distance and speed. The quality of the evidence was graded high for these 2 outcomes. We identified contextual challenges for implementation at the setting level (eg, insufficient reimbursement for group therapy by insurance companies), the participant and therapist level (eg, unknown motivation for group therapy due to the established 1:1 patient-therapist ratio), and the outcome measure level (eg, lack of standardized, cross-culturally translated manuals). Although task-oriented circuit training is scientifically well established, barriers to implementation into routine care in Germany and Austria can be expected. In a next step, research using knowledge translation methodology will focus on the detailed evaluation of barriers and facilitators with relevant stakeholders.
Topics: Ambulatory Care; Austria; Circuit-Based Exercise; Germany; Health Facility Size; Humans; Mobility Limitation; Outcome Assessment, Health Care; Patient Selection; Research Design; Stroke; Stroke Rehabilitation; Walk Test; Walking Speed
PubMed: 32266383
DOI: 10.1093/ptj/pzaa053 -
Disability and Rehabilitation Jun 2020The prevalence of mobility disability reaches up to 20.5% among older adults. Mobility is a key factor of participation, thus rehabilitation interventions often aim to...
The prevalence of mobility disability reaches up to 20.5% among older adults. Mobility is a key factor of participation, thus rehabilitation interventions often aim to improve mobility and participation. Peer-based approaches to intervention delivery have become increasingly common. This study aims to identify peer-based rehabilitation interventions and summarize their influence on mobility and participation among individuals with mobility disabilities. A systematic review was conducted using CINALH, EMBASE, MEDLINE, and PsycINFO. Articles that evaluated peer-based rehabilitation interventions for individuals with a mobility disability and assessed mobility or participation, as defined in the International Classification of Functioning, Disability and Health framework, were included. Study quality was assessed using the Physical Therapy Evidence Database and the Quality Assessment Tool for Before-After Studies With No Control Group. Thirteen peer-based studies were identified. Six peer-led studies evaluated participation and two evaluated mobility. Seven professional-led studies evaluated participation and six evaluated mobility. Randomized controlled trials had fair to high quality. The quality of pre-post studies ranged from poor to good. Peer-based interventions should not be overlooked as a potential intervention strategy, but further research is needed to establish their influence on mobility and participation.Implications for rehabilitationPeers offer a unique model of intervention that could support clinicians in their effort to improve mobility and participation outcomes for individuals with disabilities.There are currently two main models of peer-based interventions in rehabilitation: professional-led (peers assist professionals to facilitate the intervention) and peer-led interventions (peers facilitate the intervention).Both professional-led and peer-led models of intervention could be helpful in facilitating participation and in increasing mobility.
Topics: Aged; Humans; Disabled Persons; Physical Therapy Modalities; Peer Influence; Mobility Limitation; Patient Participation
PubMed: 30696298
DOI: 10.1080/09638288.2018.1537380 -
Journal of Aging and Physical Activity Feb 2021Dual-task (DT) consists of the performance of two tasks simultaneously. An index of DT difficulty has been linked to decreased postural control. Because a wide range of... (Meta-Analysis)
Meta-Analysis
Dual-task (DT) consists of the performance of two tasks simultaneously. An index of DT difficulty has been linked to decreased postural control. Because a wide range of DT is employed, this study aimed to evaluate its effects in static balance in older adults. PubMed, Web of Science, and Scopus were screened, and the secondary tasks were grouped as manual, reaction time, discrimination and decision making, mental tracking, verbal fluency, working memory, or "other" tasks. A total of 66 studies have been included. The meta-analysis was conducted on 28 effects and showed a significant mean effect size of d = 0.24 (p = .02, SE = 0.10; confidence interval [0.04, 0.44]), indicating a worsening in stability during DT. In conclusion, postural control was worsened by the Stroop test and the arithmetic tasks improved it. The results do not underpin any conclusive statement on the impact of DT, and a standard operating procedure was created.
Topics: Accidental Falls; Aged; Aged, 80 and over; Cognition; Female; Gait; Humans; Male; Postural Balance; Reaction Time; Task Performance and Analysis; Walking
PubMed: 32788414
DOI: 10.1123/japa.2019-0474 -
Journal of Parkinson's Disease 2020Parkinson's disease (PD) is a neurological condition characterized by the development of daily disabling symptoms. Although the architecture and design of a PD patient's...
BACKGROUND
Parkinson's disease (PD) is a neurological condition characterized by the development of daily disabling symptoms. Although the architecture and design of a PD patient's environment can hinder or facilitate full participation in daily activities, their putative role in the management of these patients has received little attention to date.
OBJECTIVE
We conducted a systematic review to evaluate the evidence of architectural and design features in the management of people with PD.
METHODS
An electronic database search of observational and experimental studies was conducted in MEDLINE and Embase from inception to May 2020, with two independent reviewers identifying the studies. Falls, fear of falling, postural instability, gait impairment/disability, and functional mobility were our outcomes of interest.
RESULTS
Thirty-six studies were included, among which nineteen were observational and seventeen were experimental studies (overall participants = 2,965). Pavement characteristics, notably unstable surfaces and level differences, were found to be a major cause of falling. Ground-based obstacles and confined/narrowed spaces were found to disturb gait, increase postural instability, and decrease functional mobility. Housing type did not appear to increase risk of falling, nor to significantly explain concerns about falling.
CONCLUSION
Findings suggest a need to adjust architectural features of the surrounding space to ensure appropriate care and provide a safe environment to PD patients. More evidence about the impact of such modifications on PD outcomes is needed.
Topics: Accidental Falls; Architecture; Built Environment; Gait; Humans; Mobility Limitation; Parkinson Disease; Postural Balance
PubMed: 32804100
DOI: 10.3233/JPD-202035 -
Japan Journal of Nursing Science : JJNS Oct 2020The hospital length of stay for orthopedic surgery has been decreasing during the last couple of decades. Therefore, this study was performed to explore the...
AIM
The hospital length of stay for orthopedic surgery has been decreasing during the last couple of decades. Therefore, this study was performed to explore the postoperative experiences of adult/older patients (age ≥20 years) with osteoarthritis who underwent total hip or knee arthroplasty, focusing on the first 6 weeks following discharge.
METHODS
A systematic literature search on qualitative studies was conducted using six databases, such as Medline, CINAHL and Mednar. Verbatim interview data and themes or subthemes related to the patients' experience after discharge were extracted. Content analysis was used to code interview data. Codes similar in meaning were grouped, and subcategories were formed. These subcategories were then grouped into categories.
RESULTS
Sixteen qualitative studies with 253 participants were analyzed. In total, 136 codes were generated and formed 29 subcategories. Six categories were generated: (a) postoperative pain and medication; (b) difficulty in performing activities of daily living; (c) appreciation for support and difficulties associated with receiving support; (d) variability in recovery process and information-seeking; (e) lack of patient-centered care; and (f) transportation problems and social isolation.
CONCLUSION
Our review suggests that prospective patients and their caregivers need individually tailored presurgical education and advanced planning for postsurgical reduced mobility.
Topics: Activities of Daily Living; Adult; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Hospitals; Humans; Length of Stay; Mobility Limitation; Patient Education as Topic; Preoperative Period; Prospective Studies
PubMed: 32830912
DOI: 10.1111/jjns.12361