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Critical Care Nursing Quarterly 2013
Topics: Cooperative Behavior; Critical Care Nursing; Early Ambulation; Humans; Mobility Limitation; Organizational Innovation
PubMed: 23221436
DOI: 10.1097/CNQ.0b013e3182750698 -
Otolaryngology--head and Neck Surgery :... Apr 2024To investigate the relationship between hearing difficulty and measures of mobility for US adults.
OBJECTIVE
To investigate the relationship between hearing difficulty and measures of mobility for US adults.
STUDY DESIGN
Cross-sectional study.
SETTING
2021 National Health Interview Survey.
METHODS
The survey asked US adults about hearing difficulty and mobility measures, including difficulty walking 100 yards, difficulty climbing 12 steps, and injury from falling within the past 3 months. Multivariable logistic regressions examined the associations between hearing and mobility outcomes, controlling for visual difficulty, medical comorbidities, and various demographic characteristics (age [18-39, 40-64, 65+], race/ethnicity, sex, socioeconomic status).
RESULTS
The 2021 NHIS surveyed 29,467 adults, representing 253 million people in weighted responses (52% female; mean age 48.3, standard deviation = 18.6). Controlling for covariates, hearing difficulty was associated with increased odds of difficulty walking 100 yards (odds ratio, OR = 1.47, P < .001), difficulty climbing stairs (OR = 1.62, P < .001), and injury from falling in the past 3 months (OR = 1.51, P < .001). There was a significant interaction between age and hearing difficulty for injurious falls; stratifying by age revealed that younger adults (ages 18-39) with hearing difficulty were more likely to report recent harmful falls than their normal hearing peers; this increased risk was greater in magnitude than that observed comparing older adults with and without hearing difficulty.
CONCLUSION
The hearing difficulty is associated with worsened mobility for US adults and may be a stronger independent predictor of injury from falls for younger adults as compared to older adults. These findings can inform interventions to reduce the burden of declining mobility in adults with hearing difficulty.
Topics: Humans; Female; Aged; Middle Aged; Male; Cross-Sectional Studies; Mobility Limitation; Surveys and Questionnaires; Hearing Loss; Hearing
PubMed: 38037415
DOI: 10.1002/ohn.593 -
Physical Medicine and Rehabilitation... Nov 2012Mobility-assistive technologies allow patients with neuromuscular disease to interact with peers and the community. In children, they also serve to facilitate... (Review)
Review
Mobility-assistive technologies allow patients with neuromuscular disease to interact with peers and the community. In children, they also serve to facilitate development. Lack of access to appropriate assistive technology, especially in regards to mobility, can have adverse developmental consequences. There are multiple options for mobility devices and methods for their control. These devices can be integrated with other electronics to facilitate the control of a variety of devices in the environment. The clinician should assess which devices are best based on the patient's, caregivers', and medical team's goals.
Topics: Communication Aids for Disabled; Equipment Design; Humans; Mobility Limitation; Neuromuscular Diseases; Patient Positioning; Posture; User-Computer Interface; Wheelchairs
PubMed: 23137743
DOI: 10.1016/j.pmr.2012.08.007 -
Journal of Vascular Surgery Apr 2024Among people with peripheral artery disease (PAD), perceived change in walking difficulty over time, compared with people without PAD, is unclear. Among people reporting...
OBJECTIVE
Among people with peripheral artery disease (PAD), perceived change in walking difficulty over time, compared with people without PAD, is unclear. Among people reporting no change in walking difficulty over time, differences in objectively measured change in walking performance between people with and without PAD are unknown.
METHODS
A total of 1289 participants were included. Eight hundred seventy-four participants with PAD (aged 71.1 ± 9.1 years) were identified from noninvasive vascular laboratories and 415 without PAD (aged 69.9 ± 7.6 years) were identified from people with normal vascular laboratory testing or general medical practices in Chicago. The Walking Impairment Questionnaire and 6-minute walk were completed at baseline and 1-year follow-up. The Walking Impairment Questionnaire assessed perceived difficulty walking due to symptoms in the calves or buttocks on a Likert scale (range, 0-4). Symptom change was determined by comparing difficulty reported at 1-year follow-up to difficulty reported at baseline.
RESULTS
At 1-year follow-up, 31.9% of participants with and 20.6% of participants without PAD reported walking difficulty that was improved (P < .01), whereas 41.2% vs 55%, respectively, reported walking difficulty that was unchanged (P < .01). Among all reporting no change in walking difficulty, participants with PAD declined in 6-minute walk, whereas participants without PAD improved (-10 vs +15 meters; mean difference, -25; 95% confidence interval, -38 to -13; P < .01).
CONCLUSIONS
Most people with PAD reported improvement or no change in walking difficulty from calf or buttock symptoms at one-year follow-up. Among all participants who perceived stable walking ability, those with PAD had significant greater declines in objectively measured walking performance, compared with people without PAD.
Topics: Humans; Leg; Mobility Limitation; Patient Reported Outcome Measures; Peripheral Arterial Disease; Walking; Middle Aged; Aged; Aged, 80 and over
PubMed: 38122859
DOI: 10.1016/j.jvs.2023.12.027 -
Physiotherapy Research International :... Jan 2018Since physical inactivity is the major risk factor for recurrent stroke, it is important to understand how level of disability impacts oxygen uptake by people after...
BACKGROUND AND PURPOSE
Since physical inactivity is the major risk factor for recurrent stroke, it is important to understand how level of disability impacts oxygen uptake by people after stroke. This study investigated the nature of the relationship between level of disability and oxygen cost in people with chronic stroke.
METHODS
Level of walking disability was measured as comfortable walking speed using the 10-m Walk Test reported in m/s with 55 ambulatory people 2 years after stroke. Oxygen cost was measured during 3 walking tasks: overground walking at comfortable speed, overground walking at fast speed, and stair walking at comfortable speed. Oxygen cost was calculated from oxygen uptake divided by distance covered during walking and reported in ml∙kg ∙m .
RESULTS
The relationship between level of walking disability and oxygen cost was curvilinear for all 3 walking tasks. One quadratic model accounted for 81% (95% CI [74, 88]) of the variance in oxygen cost during the 3 walking tasks: [Formula: see text] DISCUSSION: The oxygen cost of walking was related the level of walking disability in people with chronic stroke, such that the more disabled the individual, the higher the oxygen cost of walking; with oxygen cost rising sharply as disability became severe. An equation that relates oxygen cost during different walking tasks according to the level of walking disability allows clinicians to determine oxygen cost indirectly without the difficulty of measuring oxygen uptake directly.
Topics: Aged; Energy Metabolism; Female; Humans; Male; Middle Aged; Mobility Limitation; Oxygen; Oxygen Consumption; Stroke; Walk Test; Walking
PubMed: 28671315
DOI: 10.1002/pri.1688 -
Journal of Occupational Health Jul 2019
Topics: Aged; Aged, 80 and over; Aging; Disability Evaluation; Disabled Persons; Geriatric Assessment; Health Services for the Aged; Humans; Japan; Mobility Limitation
PubMed: 31290259
DOI: 10.1002/1348-9585.12071 -
Gait & Posture Jan 2021Persons with lower limb amputation often experience decreased physical capacity, difficulty walking, and increased fall risk. To either prevent or recover from a loss of...
BACKGROUND
Persons with lower limb amputation often experience decreased physical capacity, difficulty walking, and increased fall risk. To either prevent or recover from a loss of balance, one must effectively regulate their stepping movements. It is therefore critical to identify how well persons with amputation regulate stepping. Here, we used a multi-objective control framework based on Goal Equivalent Manifolds to identify how persons with transtibial amputation (TTA) regulate lateral stepping while walking without and with lateral perturbations.
RESEARCH QUESTION
When walking in destabilizing environments, do otherwise healthy persons with TTA exhibit greater difficulty regulating lateral stepping due to impaired control? Or do they instead continue to use similar strategies to regulate lateral stepping despite their amputation?
METHODS
Eight persons with unilateral TTA and thirteen able-bodied (AB) controls walked in a virtual environment under three conditions: no perturbations, laterally oscillating visual field, and laterally oscillating treadmill platform. We analyzed step-to-step time series of step widths and absolute lateral body positions. We computed means, standard deviations and Detrended Fluctuation Analysis scaling exponents for each time series and computed how much participants directly corrected step width and position deviations at each step. We compared our results to computational predictions to identify the underlying causes of our experimental findings.
RESULTS
All participants exhibited significantly increased variability, decreased scaling exponents, and tighter direct control when perturbed. Simulations from our stepping regulation models revealed that people responded to the increased variability produced by the imposed perturbations by tightening their control of both step width and lateral position. Participants with TTA exhibited only a few minor differences from AB in lateral stepping regulation, even when subjected to substantially destabilizing lateral perturbations.
SIGNIFICANCE
Since control of stepping is intrinsically multi-objective, developing effective interventions to reduce fall risk in persons with amputation will likely require strategies that adopt multi-objective approaches.
Topics: Adult; Amputation, Surgical; Female; Gait; Humans; Male; Mobility Limitation; Postural Balance; Walking; Young Adult
PubMed: 33099136
DOI: 10.1016/j.gaitpost.2020.09.031 -
Progress in Cardiovascular Diseases 2023Unhealthy lifestyles, such as maintenance of poor diets and physical inactivity, are a powerful driver of disease-producing risk factors and chronic illnesses. This has... (Review)
Review
Unhealthy lifestyles, such as maintenance of poor diets and physical inactivity, are a powerful driver of disease-producing risk factors and chronic illnesses. This has led to an increasing call to assess adverse lifestyle factors in healthcare settings. This approach could be aided by designating health-related lifestyle factors as "vital signs" that can be recorded during patient visits. Just such an approach has been used for assessing patients' smoking habits since the 1990s. In this review, we assess the rationale for addressing six other health-related lifestyle factors, beyond smoking, in patient care settings: physical activity (PA), sedentary behavior (SB), participation in muscle strengthening exercises, mobility limitations, diet, and sleep quality. For each domain, we evaluate the evidence that supports currently proposed ultra-short screening tools. Our analysis indicates strong medical evidence to support the use of one to two-item screening questions for assessing patients' PA, SB, muscle strengthening activities, and presence of "pre-clinical" mobility limitations. We also present a theoretical basis for measuring patients' diet quality through use of an ultrashort dietary screen, based on evaluation of healthy food intake (fruits/vegetables) and unhealthy food intake (high consumption of highly processed meats and/or consumption of sugary foods and beverages) and a proposed evaluation of sleep quality using a single-item screener. The result is a 10-item lifestyle questionnaire that is based on patient self-report. As such, this questionnaire has the potential to be employed as a practical tool for assessing health behaviors in clinical care settings without impairing the normal workflow of healthcare providers.
Topics: Humans; Delivery of Health Care; Diet; Feeding Behavior; Life Style; Mobility Limitation; Vital Signs
PubMed: 36848965
DOI: 10.1016/j.pcad.2023.02.002 -
Journal of Clinical Epidemiology Nov 2021This study examines hierarchical patterns of progression in activities of daily living (ADL) disabilities among older adults in low- and middle-income countries. (Comparative Study)
Comparative Study
OBJECTIVE
This study examines hierarchical patterns of progression in activities of daily living (ADL) disabilities among older adults in low- and middle-income countries.
STUDY DESIGN AND SETTING
Data from WHO's SAGE survey (2007-2010) on adults aged 60 and above in China, India, Russia, Ghana, Mexico, and South Africa, were analyzed. We used factor analysis and Rasch modelling to develop ADL hierarchies for cross-national comparisons.
RESULTS
Data fitted the Rasch model well and Cronbach's α were 0.80-0.87 across countries. Based on scaled logit scores, "walking" was the most difficult item for older adults in five of the six countries. Older persons in developing countries also found "transferring" to/from beds challenging. "Eating" and "dressing" ranked lower in the hierarchies, thus perceived as easier than other activities. Sequences were most compact for China, Mexico, and India, implying that older adults in these countries who have difficulty "walking" are at high risk of developing the rest of the disabilities.
CONCLUSION
This is the first study that used Rasch analysis to demonstrate that functional loss sequences in various developing countries share certain broad similarities. Interventions targeted at improving walking and transferring activities can help offset certain deficits in independent functioning for community-dwelling elderly in these countries.
Topics: Activities of Daily Living; Aged; Aged, 80 and over; Aging; China; Cross-Sectional Studies; Developing Countries; Disabled Persons; Factor Analysis, Statistical; Female; Ghana; Humans; India; Male; Mexico; Middle Aged; Mobility Limitation; Russia; South Africa; Surveys and Questionnaires; Walking
PubMed: 34363969
DOI: 10.1016/j.jclinepi.2021.07.020 -
Journal of the American Geriatrics... Aug 2008To identify clinical measures that aid detection of impending severe mobility difficulty in older women.
OBJECTIVES
To identify clinical measures that aid detection of impending severe mobility difficulty in older women.
DESIGN
Cross-sectional and longitudinal cohort study.
SETTING
Urban community in Baltimore, Maryland.
PARTICIPANTS
One thousand two community-dwelling, moderate to severely disabled women aged 65 and older in the Women's Health and Aging Study I.
MEASUREMENTS
Self-report and performance measures representing six domains necessary for mobility: central and peripheral nervous systems, muscles, bones and joints, perception, and energy. Severe mobility difficulty was defined as usual gait of 0.5 m/s or less, any reported difficulty walking across a small room, or dependence on a walking aid during a 4-m walking test.
RESULTS
Four hundred sixty-seven out of 984 (47%) had severe mobility difficulty at baseline, and 104/474 (22%) developed it within 12 months. Baseline mobility difficulty was correlated with poor vision, knee pain, feelings of helplessness, inability to stand with feet side by side for 10 seconds, difficulty keeping balance while dressing or walking, inability to rise from a chair five times, and cognitive impairment. Of these, knee pain (odds ratio (OR)=1.74, 95% confidence interval (CI)=1.05-2.89), helplessness (OR=1.87, 95% CI=1.10-3.24), poor vision (OR=2.03, 95% CI=1.06-3.89), inability to rise from a chair five times (OR=2.50, 95% CI=1.15-5.41), and cognitive impairment (OR=4.75, 95% CI=1.67-13.48) predicted incident severe mobility difficulty within 12 months, independent of age.
CONCLUSION
Five simple measures may aid identification of disabled older women at high risk of severe mobility difficulty. Further studies should determine generalizability to men and higher-functioning individuals.
Topics: Activities of Daily Living; Aged; Aged, 80 and over; Baltimore; Chronic Disease; Cohort Studies; Comorbidity; Cross-Sectional Studies; Disability Evaluation; Female; Frail Elderly; Geriatric Assessment; Humans; Longitudinal Studies; Mass Screening; Mental Status Schedule; Mobility Limitation; Risk Factors
PubMed: 18808598
DOI: 10.1111/j.1532-5415.2008.01819.x