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European Spine Journal : Official... Jun 2024This study aimed to clarify the relation between global spinal alignment and the necessity of walking aid use in patients with adult spinal deformity (ASD) and to...
PURPOSE
This study aimed to clarify the relation between global spinal alignment and the necessity of walking aid use in patients with adult spinal deformity (ASD) and to investigate the impact of spinal fixation on mobility status after surgery.
METHODS
In total, 456 older patients with ASD who had multi-segment spinal fixation surgery and were registered in a multi-center database were investigated. Patients under 60 years of age and those unable to walk preoperatively were excluded. Patients were classified by their mobility status into the independent, cane, and walker groups. Comparison analysis was conducted using radiographic spinopelvic parameters and the previously reported global spine balance (GSB) classification. In addition, preoperative and 2 years postoperative mobility statuses were investigated.
RESULTS
Of 261 patients analyzed, 66 used walking aids (canes, 46; walkers, 20). Analysis of preoperative radiographical parameters showed increased pelvic incidence and pelvic incidence-lumbar lordosis mismatch in the walker group and increased sagittal vertebral axis in the cane and walker groups versus the independent group. Analysis of GSB classification showed a higher percentage of walker use in those with severe imbalance (grade 3) in the sagittal classification but not in the coronal classification. While postoperative radiographical improvements were noted, there was no significant difference in the use of walking aids before and 2 years after surgery (P = 0.085).
CONCLUSION
A significant correlation was found between "sagittal" spinal imbalance and increased reliance on walking aids, particularly walkers. However, the limitation of improvement in postoperative mobility status suggested that multiple factors influence the mobility ability of elderly patients with ASD.
PubMed: 38922414
DOI: 10.1007/s00586-024-08380-w -
Healthcare (Basel, Switzerland) Jun 2024With the advent of global aging, the health of the older population has become a critical public health challenge. The purpose of this study was to investigate the...
BACKGROUND
With the advent of global aging, the health of the older population has become a critical public health challenge. The purpose of this study was to investigate the effect of dual-tasking on gait performance in patients with sarcopenia.
METHODS
Thirty participants with sarcopenia (age: 70.73 ± 4.12 yr, MMSE score: 26.90 ± 3.00), including 14 males and 16 females, were selected according to the diagnostic criteria of the Asian Working Group on Sarcopenia. All participants were instructed to perform the gait test in three modes: single task (ST), cognitive-motor dual task (CMDT), and motor-motor dual task (MMDT). Statistical analyses were performed using one-way ANOVA to evaluate the effects of different task types on gait parameters of the participants.
RESULTS
(1) Compared with ST walking, gait frequency, step length, and step speed decreased, and the gait cycle and double-support phase increased in patients with sarcopenia during dual-task walking ( < 0.05); (2) Compared with ST walking, gait variability indices such as stride frequency, stride length, and support period significantly increased in patients with sarcopenia during dual-task walking ( < 0.05).
CONCLUSIONS
The increased difficulty in postural control caused by dual-task interference may reduce the safety of motor strategies in patients with sarcopenia and increase the risk of falls. Future studies should focus on the effects of exercise interventions on multitasking patterns in people with sarcopenia to promote balance function in these populations.
PubMed: 38921320
DOI: 10.3390/healthcare12121206 -
Diseases (Basel, Switzerland) Jun 2024Chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) frequently coexist, significantly impacting health-related quality of life (HRQoL). This...
Chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) frequently coexist, significantly impacting health-related quality of life (HRQoL). This study evaluated HRQoL in patients with CHF, COPD, or both, three months post-COVID-19 discharge using EQ-5D and KCCQ questionnaires to guide targeted healthcare interventions. We conducted a cross-sectional study at "Victor Babes" Hospital in Timisoara, enrolling 180 patients who had recovered from COVID-19 (60 in each group including CHF, COPD, and both conditions). HRQoL was assessed via EQ-5D and KCCQ. Significant disparities in HRQoL measures were noted across the groups. Patients with both CHF and COPD reported the worst outcomes, especially in terms of hospital stay lengths due to COVID-19 (11.63 days) and initial oxygen saturation levels (88.7%). HRQoL improvements from discharge to three months post-discharge were significant, with EQ-5D mobility scores improving notably across all groups (CHF and COPD: 2.87 to 2.34, = 0.010). KCCQ results reflected substantial enhancements in physical limitation (CHF and COPD: 38.94 to 58.54, = 0.001) and quality of life scores (CHF and COPD: 41.38 to 61.92, = 0.0031). Regression analysis revealed that dual diagnosis (CHF and COPD) significantly impacted usual activities and quality of life (β = -0.252, = 0.048; β = -0.448, = 0.017), whereas the initial severity of COVID-19 was a significant predictor of worse HRQoL outcomes (β = -0.298, = 0.037; β = -0.342, = 0.024). The presence of both CHF and COPD in patients recovering from COVID-19 was associated with more severe HRQoL impairment compared with either condition alone. These findings emphasize the need for specialized, comprehensive post-COVID-19 recovery programs that address the complex interplay among chronic conditions to optimize patient outcomes and enhance quality of life.
PubMed: 38920556
DOI: 10.3390/diseases12060124 -
Journal of the American Society For... Jun 2024The sequencing of intact proteins within a mass spectrometer has many benefits but is frequently limited by the fact that tandem mass spectrometry (MS/MS) techniques...
The sequencing of intact proteins within a mass spectrometer has many benefits but is frequently limited by the fact that tandem mass spectrometry (MS/MS) techniques often generate poor sequence coverages when applied to protein ions. To overcome this limitation, exotic MS/MS techniques that rely on lasers and radical chemistry have been developed. These techniques generate high sequence coverages, but they require specialized instrumentation, create products through multiple dissociation mechanisms, and often require long acquisition times. Recently, we demonstrated that protein ions can be dissociated in a trapped ion mobility spectrometry (TIMS) device prior to mobility separation in a commercial timsTOF. All generated product ions were distributed throughout the mobility dimension, and this separation enabled deconvolution of complex tandem mass spectra and could enable facile pseudo-MS interrogation of generated product ions with the downstream quadrupole and collision cell. A second activation step improves sequence coverage because the most labile bonds have been depleted during the first dissociation and subsequent dissociation events are more evenly distributed throughout the product ion backbone. In this work, we explore the potential of this mobility-assisted pseudo-MS (MAP) method on a commercial timsTOF and timsTOF Pro 2. We demonstrate that while MAP only generates 92% of the sequence coverage of the most effective MS/MS technique, it accomplished this feat in 1.5 min and could be facilely integrated with liquid chromatographic separations.
PubMed: 38920020
DOI: 10.1021/jasms.4c00148 -
Quality of Life Research : An... Jun 2024Lower extremity physical function (LEPF) is a key component for mobility and is impacted in stroke-related disability. A reduction in LEPF can have a significant impact...
PURPOSE
Lower extremity physical function (LEPF) is a key component for mobility and is impacted in stroke-related disability. A reduction in LEPF can have a significant impact on an individual's Quality of Life (QoL). The aim of this study is to characterise the relationship between LEPF and QoL.
METHODS
The MOBITEC-Stroke Study is a longitudinal cohort-study including patients with their first occurrence of ischaemic stroke. Using a linear mixed-effects model, the relationship between LEPF (timed up-and-go performance (TUG); predictor) and QoL (Stroke Specific Quality of Life scale (SS-QoL); outcome) at 3 and 12 months post stroke was investigated and adjusted for sex, age, Instrumental Activities of Daily Living (IADL), fear of falling (Falls Efficacy Scale-International Version, FES-I), and stroke severity (National Institute of Stroke Severity scale, NIHSS), accounting for the repeated measurements.
RESULTS
Data of 51 patients (65 % males, 35% females) were analysed. The mean age was 71.1 (SD 10.4) years, median NIHSS score was 2.0. SS-QoL was 201.5 (SD 20.5) at 3 months and 204.2 (SD 17.4) at 12 months; the mean change was 2.7 (95% CI -2.4 to 7.7), p= 0.293. A positive association was found between baseline TUG performance (estimate log score -13.923; 95% CI -27.495 to -0.351; p=0.048) and change in SS-QoL score in multivariate regression analysis.
CONCLUSION
Higher LEPF (i.e better TUG performance) at baseline, was associated with an improvement in QoL from 3- to 12-months post stroke. These results highlight the critical role of physical function, particularly baseline LEPF, in influencing the QoL of stroke survivors.
PubMed: 38916661
DOI: 10.1007/s11136-024-03713-0 -
Journal of Neuroengineering and... Jun 2024Treadmill gait training has been shown to improve gait performance in People with Parkinson's Disease (PwPD), and in combination with Virtual Reality, it can be an...
BACKGROUND
Treadmill gait training has been shown to improve gait performance in People with Parkinson's Disease (PwPD), and in combination with Virtual Reality, it can be an effective tool for gait rehabilitation. The addition of gamification elements can create a more stimulating and adherent intervention. However, implementation of new technologies in healthcare can be challenging. This study aimed to develop and evaluate the feasibility of a treadmill rehabilitation program in a Gamified Virtual Reality Environment (GVRE) for PwPD.
METHODS
The GVRE was developed following a user-centered design approach, involving both PwPD and physiotherapists in the development and evaluation of the intervention. The intervention consisted of a walking simulation in three different environments (countryside, city, and park), which had a progressive increase in difficulty. To test its feasibility, three sessions were carried out with four PwPD and four physiotherapists. To assess the usability, the System Usability Scale (SUS), Assistive Technology Usability Questionnaire for people with Neurological diseases (NATU Quest) and Simulator Sickness Questionnaire (SSQ) were used. To assess the intervention's acceptability, feedback and in-game performance was collected from participants.
RESULTS
Results showed the feasibility of the intervention, with a SUS score of 74.82 ± 12.62, and a NATU Quest score of 4.49 ± 0.62, and positive acceptability feedback. Participants showed clear preferences for naturalistic environments, and gamification elements were seen as positive. Difficulty settings worked as intended, but lowered enjoyment of the experience in some cases.
CONCLUSIONS
This intervention was successfully shown as a feasible option for the training of gait under Dual Task conditions for PwPD. It offers a safe and replicable environment in which complex situations can be trained. However, further iterations of the intervention need to be improved in order to guarantee accurate tracking and a more realistic training progression.
TRIAL REGISTRATION NUMBER
NCT05243394-01/20/2022.
Topics: Humans; Parkinson Disease; Feasibility Studies; Male; Virtual Reality; Aged; Female; Middle Aged; Gait Disorders, Neurologic; Video Games; Exercise Therapy; Gait
PubMed: 38915103
DOI: 10.1186/s12984-024-01399-6 -
IEEE Transactions on Image Processing :... Jun 2024Freezing of gait (FoG) is a common disabling symptom of Parkinson's disease (PD). It is clinically characterized by sudden and transient walking interruptions for...
Freezing of gait (FoG) is a common disabling symptom of Parkinson's disease (PD). It is clinically characterized by sudden and transient walking interruptions for specific human body parts, and it presents the localization in time and space. Due to the difficulty in extracting global fine-grained features from lengthy videos, developing an automated five-point FoG scoring system is quite challenging. Therefore, we propose a novel video-based automated five-classification FoG assessment method with a causality-enhanced multiple-instance-learning graph convolutional network (GCN). This method involves developing a temporal segmentation GCN to segment each video into three motion stages for stage-level feature modeling, followed by a multiple-instance-learning framework to divide each stage into short clips for instance-level feature extraction. Subsequently, an uncertainty-driven multiple-instance-learning GCN is developed to capture spatial and temporal fine-grained features through GCN scheme and uncertainty learning, respectively, for acquiring global representations. Finally, a causality-enhanced graph generation strategy is proposed to exploit causal inference for mining and enhancing human structures causally related to clinical assessment, thereby extracting spatial causal features. Extensive experimental results demonstrate the excellent performance of the proposed method on five-classification FoG assessment with an accuracy of 62.72% and an acceptable accuracy of 91.32%, which is confirmed by independent testing. Additionally, it enables temporal and spatial localization of FoG events to a certain extent, facilitating reasonable clinical interpretations. In conclusion, our method provides a valuable tool for automated FoG assessment in PD, and the proposed causality-related component exhibits promising potential for extension to other general and medical fine-grained action recognition tasks.
PubMed: 38913508
DOI: 10.1109/TIP.2024.3416052 -
Journal of Vascular Surgery May 2024Supervised exercise therapy (SET) provides clinical benefit for patients suffering from intermittent claudication and has been widely recommended as first-line therapy...
OBJECTIVE
Supervised exercise therapy (SET) provides clinical benefit for patients suffering from intermittent claudication and has been widely recommended as first-line therapy before endovascular or surgical intervention. However, published rates of SET program completion range from 5% to 55%, with historic completion of 54% at our own institution. As such, we sought to identify if targeted patient-supportive interventions improve SET completion rates while still maintaining efficacious SET programming.
METHODS
Patients who were diagnosed with intermittent claudication, as defined by ankle-brachial index (ABI) <0.9 without rest pain, were offered enrollment in a prospective quality improvement protocol for our 12-week SET for peripheral artery disease program. Program completion was defined as ≥24 of 36 offered sessions over 12 weeks. A three-pronged approach was utilized to improve completion during the study, including financial incentives up to $180, scheduled coaching with our advanced practitioner staff, and informational materials on the importance of SET programming and lifestyle modification. Patient-reported improvements in walking symptoms were tracked via regularly administered questionnaires. Functional measures of SET programming including total walking duration and distance, metabolic equivalent of task, and ABIs; vascular intervention within 12-months after enrollment was also collected and compared using univariate paired analysis.
RESULTS
In total, seventy-three patients were enrolled in SET for peripheral artery disease programming over the study period. Utilizing our three-pronged coaching approach, 56 patients completed SET programming, increasing our SET completion rate to 76.7% over a 2-year study period. Compared with pre-SET baseline, patients who completed SET noted less pain, aching, cramps in calves when walking (P = .004), and less difficulty walking 1 block (P = .038). Additionally, patients significantly increased their metabolic equivalent of task (3.1 vs 2.6; P < .001), total walking duration (30 mins vs 13.5 mins; P < .001), and total walking distance (0.7 vs 0.3 miles; P < .001) from their pre-SET baseline. There were no changes in participant ABIs from enrollment to completion in participants. Patients who completed SET programming also delayed vascular intervention compared with those who did not complete SET or declined participation (213.5 vs 122.5 days from enrollment; P = .041).
CONCLUSIONS
Targeted incentives, including cost-coverage vouchers and personalized coaching with instructional materials, successfully improved patient completion of a prescribed SET program. Patients who completed SET programming reported subjective improvement in walking symptoms and objective walking benefits. In addition, these patients had delayed time to vascular intervention, supporting current vascular guidelines advocating for effective SET therapy prior to offering vascular intervention for intermittent claudication.
PubMed: 38912995
DOI: 10.1016/j.jvs.2024.04.055 -
The Journal of Clinical and Aesthetic... Jun 2024Atopic dermatitis (AD) is an inflammatory skin condition affecting both mental and physical health. Although research has shown reduced physical activity levels among...
Association Between Atopic Dermatitis and Impaired Mobility among Adults in the United States: Findings from the 2001-2006 National Health and Nutrition Examination Survey.
OBJECTIVE
Atopic dermatitis (AD) is an inflammatory skin condition affecting both mental and physical health. Although research has shown reduced physical activity levels among patients with AD, there is a scarcity of studies examining baseline mobility, which refers to the standard level of functional ambulation or movement capability. We analyzed the relationship between AD and baseline mobility among U.S. adults ages 20 to 59, utilizing the National Health and Nutrition Examination Survey (NHANES).
METHODS
We merged three, 2-year cycles of NHANEs data (2001-2006). Patients were categorized as having "impaired mobility" by the following question: "Because of a health problem, do you have difficulty walking without using any special equipment?" Multivariable logistic regression analyses were performed using STATA/SE 18.0.
RESULTS
Our analysis included 6,540 participants. The prevalence of impaired mobility was 7.1 percent among patients with AD and 3.9 percent among those without AD. This difference was statistically significant among patients aged 20 to 59 after adjusting for potential confounding variables (adjusted odds ratio [AOR], 1.65; 95% CI, 1.19-3.25; =0.010). Subgroup analysis showed increased rates of impaired mobility among males with AD (AOR, 2.55; 95% CI, 1.21-5.40; =0.016), and among adults aged 40 to 59 (AOR, 1.94; 95% CI, 1.03-3.68; =0.042).
LIMITATIONS
Limitations to our study include lack of specificity in the survey questionnaire, self-reporting bias, and an age limit of 59 years old.
CONCLUSION
Our study demonstrated a statistically significant elevation in impaired mobility among individuals with AD compared to those without AD. This underscores the importance of comprehensive care for AD patients.
PubMed: 38912191
DOI: No ID Found -
SAGE Open Medicine 2024Ambulatory mobility aids are several devices the elderly may use in order to improve their walking pattern, balance, or safety while mobilizing independently.
INTRODUCTION
Ambulatory mobility aids are several devices the elderly may use in order to improve their walking pattern, balance, or safety while mobilizing independently.
OBJECTIVES
To assess the effect of ambulatory mobility aid devices on cardiovascular parameters, walking speed, perceived exertion, and balance of older adult men.
METHODS
A sample of 156 old men was studied. Data were obtained through measurement of the participants' walking speed (distance covered/second), cardiovascular parameters (blood pressure), perceived exertion (difficulty or ease in breathing), and balance (ease in standing) after walking with and without the selected walking aid devices. Analysis was done to compare the effect of the walking aid devices on the selected dependent variables.
RESULTS
Results showed ambulation with mobility aid devices resulted in increase in the heart rate and blood pressure with the greatest increase observed when walking with Zimmer frame. Ambulation with mobility aid devices resulted in decrease of the walking speed of the participants when compared to ambulation without devices. Perceived exertion of participants after using Zimmer frame and walking cane was within 4.06 ± 1.35 and 3.98 ± 1.26, respectively, as opposed to 3.08 ± 0.73 after ambulation without aid. Use of Zimmer frame provided enough balance for participants.
CONCLUSION
Ambulatory mobility devices caused difference in cardiovascular parameters when compared to ambulation at rest and without aid. It was recommended that selection of ambulatory mobility aid devices should depend on objective mobility assessments and periodical re-evaluation to ensure that it suits a person's functional requirements and physical capabilities.
PubMed: 38911443
DOI: 10.1177/20503121241262250