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Chiropractic & Manual Therapies Jun 2024Prognostic research in low back pain (LBP) is essential for understanding and managing the condition. This study aimed to, (1) describe the proportions with...
BACKGROUND
Prognostic research in low back pain (LBP) is essential for understanding and managing the condition. This study aimed to, (1) describe the proportions with mild-moderate and severe pain and disability at baseline, 1-year and 4-year follow-up, and (2) investigate prognostic factors for improvement in pain and disability over 4 years in a cohort of secondary care LBP patients.
METHODS
This was a secondary analysis of a cohort of patients with LBP aged 18-40 years recruited from a non-surgical outpatient spine clinic between March 2011 and October 2013 (n = 1037). Questionnaires were collected at baseline, 1-year, and 4-year follow-up. Disability was assessed using the Roland Morris Disability Questionnaire (RMDQ 0-100) and pain intensity using the Numeric Rating Scale (NRS 0-10). 'Mild-moderate pain' was defined as NRS < 7 and 'severe pain' as NRS ≥ 7. Likewise, 'mild-moderate disability' was defined as RMDQ < 58.3, and 'severe disability' was RMDQ ≥ 58.3. In the prognostic analysis, improvement in pain and disability over 4 years was defined as meeting both criteria: decrease of ≥ 2 on the NRS and of ≥ 20.8 on the RMDQ. Sixteen candidate prognostic factors were assessed by multivariate logistic regression.
RESULTS
Among patients with information available at all three time points (n = 241), 54%/48% had persistent mild-moderate pain/disability, while only 7%/15% had persistent severe pain/disability. Of patients included in the multivariate prognostic analysis regarding improvement over 4 years (n = 498), 32% had improved in pain and disability after 4 years. Positive associations were found for pain intensity (OR 1.34 [95%CI: 1.17-1.54]), disability (OR 1.01 [1.00-1.02]), and regular employment or studying (OR 1.67 [1.06-2.64]), and negative associations for episode duration (OR 0.99 [0.99-1.00]) and risk of persistent pain (OR 0.58 [0.38-0.88]).
CONCLUSION
Patients with persistent LBP in secondary care had mostly mild-moderate pain and disability consistently at all three time points, with few having consistently severe symptoms over 4 years. Moreover, approximately half of the included patients improved in pain and disability. We found that pain intensity, disability, episode duration, regular employment or studying, and risk of persistent pain predicted a long-term improvement. However, the limited availability of complete follow-up data may affect generalisability.
Topics: Humans; Low Back Pain; Male; Female; Adult; Prognosis; Young Adult; Adolescent; Disability Evaluation; Pain Measurement; Surveys and Questionnaires; Disabled Persons; Cohort Studies
PubMed: 38918850
DOI: 10.1186/s12998-024-00546-z -
Scientific Reports Jun 2024This study aimed to develop a deep learning model to predict the risk stratification of all-cause death for older people with disability, providing guidance for...
This study aimed to develop a deep learning model to predict the risk stratification of all-cause death for older people with disability, providing guidance for long-term care plans. Based on the government-led long-term care insurance program in a pilot city of China from 2017 and followed up to 2021, the study included 42,353 disabled adults aged over 65, with 25,071 assigned to the training set and 17,282 to the validation set. The administrative data (including baseline characteristics, underlying medical conditions, and all-cause mortality) were collected to develop a deep learning model by least absolute shrinkage and selection operator. After a median follow-up time of 14 months, 17,565 (41.5%) deaths were recorded. Thirty predictors were identified and included in the final models for disability-related deaths. Physical disability (mobility, incontinence, feeding), adverse events (pressure ulcers and falls from bed), and cancer were related to poor prognosis. A total of 10,127, 25,140 and 7086 individuals were classified into low-, medium-, and high-risk groups, with actual risk probabilities of death of 9.5%, 45.8%, and 85.5%, respectively. This deep learning model could facilitate the prevention of risk factors and provide guidance for long-term care model planning based on risk stratification.
Topics: Humans; Deep Learning; Female; Male; Aged; China; Long-Term Care; Prospective Studies; Aged, 80 and over; Cause of Death; Disabled Persons; Risk Assessment; Mortality; Risk Factors; Prognosis
PubMed: 38918463
DOI: 10.1038/s41598-024-65601-4 -
Oncology and Therapy Jun 2024Chronic graft-versus-host disease (GVHD) following hematopoietic stem cell transplantation (HSCT) is associated with poor health-related quality of life (HRQoL) and...
INTRODUCTION
Chronic graft-versus-host disease (GVHD) following hematopoietic stem cell transplantation (HSCT) is associated with poor health-related quality of life (HRQoL) and functional status. However, few studies have evaluated chronic GVHD-related disability and specific activity limitations from a patient perspective. The objective of this analysis was to assess physical, cognitive, and work disability, and describe factors predictive of disability in patients with chronic GVHD in the potentially employable general workforce.
METHODS
The cross-sectional, online, Living With Chronic GVHD Patient Survey was administered in 2020 to adult US patients who reported an active chronic GVHD diagnosis (i.e., within the previous 5 years) following HSCT. Data included demographics, diagnosis, work status, chronic GVHD symptoms per the Lee Symptom Scale (LSS), and effects on daily living activities. Descriptive and correlational analyses informed composite disability definitions: (1) severe cognitive disability, (2) severe physical disability, and (3) work disability.
RESULTS
Of 137 respondents with GVHD included in this analysis, 47.0% reported severe cognitive disability, and approximately two-thirds each reported severe physical disability (67.4%) and work disability (62.8%). Chronic GVHD severity/duration, symptoms (Lee Symptom Scale), and number of transplant specialists consulted were associated with all types of disability (univariable analyses). Severe cognitive disability was associated with the number of transplant specialists consulted, severe physical disability with female sex, and work disability with nonwhite race.
CONCLUSIONS
In this analysis, we found that the presence of specific symptoms and the number of transplant specialists consulted were associated with all types of severe disability; female sex was predictive of severe physical disability and nonwhite race of work disability. These findings add to the understanding of chronic GVHD-associated disability, suggest a need for improved social support for patients, and highlight potential indicators for those most in need.
PubMed: 38918341
DOI: 10.1007/s40487-024-00288-1 -
PloS One 2024Factors associated with upper limb prosthesis adoption are not well understood. In this study, we explored how prosthesis usability experience relates to the extent of...
Factors associated with upper limb prosthesis adoption are not well understood. In this study, we explored how prosthesis usability experience relates to the extent of prosthesis adoption through the development of a structural equation model (SEM). First, items related to prosthesis usability were developed and refined using cognitive testing and pilot testing and employed in a survey of 402 prosthesis users (mean age 61.7 (sd 14.4), 77.1% Veterans). The SEM examined two unidimensional latent constructs: Prosthesis Usability Experience and Prosthesis Adoption-and each had multiple measured indicators. SEMs tested direct as well as moderating and mediating effects between the latent constructs and covariates related to demographics and prosthesis type. SEM found a significant positive association between Prosthesis Usability Experience and Extent of Prosthesis Adoption. Several covariates had direct effects on prosthesis adoption: 1) Extent of Prosthesis Adoption was lower for those with transhumeral and shoulder amputation, and higher for those with bilateral amputation, compared to the reference group with unilateral transradial amputation and 2) Myoelectric multiple degree of freedom (multi-DOF) prosthesis use was associated with lower Extent of Prosthesis Adoption, compared to body-powered prosthesis use. Myoelectric multi-DOF use also modified the effect of Prosthesis Usability Experience on Extent of Prosthesis Adoption. For those with bilateral ULA, the strength of the relationship between Prosthesis Usability Experience and Extent of Prosthesis Adoption was reduced. Findings suggest that in order to increase prosthesis adoption, prosthetics developers and rehabilitation providers should focus on implementing strategies to improve prosthesis usability experience. New Prosthesis Usability Experience measures could be used to identify persons at greater risk for poor prosthesis adoption and target interventions to increase prosthesis use.
Topics: Humans; Artificial Limbs; Male; Female; Middle Aged; Upper Extremity; Aged; Latent Class Analysis; Prosthesis Design; Amputation, Surgical; Amputees; Adult; Surveys and Questionnaires
PubMed: 38917074
DOI: 10.1371/journal.pone.0299155 -
Assistive Technology : the Official... Jul 2024
Topics: Self-Help Devices; Humans; Disabled Persons
PubMed: 38913944
DOI: 10.1080/10400435.2024.2367394 -
Applied Neuropsychology. Adult Jun 2024The evaluation of Activities of Daily Living (ADL) has become a critical issue in neuropsychology, but existing instruments for evaluating ADL have some limitations.... (Review)
Review
The evaluation of Activities of Daily Living (ADL) has become a critical issue in neuropsychology, but existing instruments for evaluating ADL have some limitations. This work aims to propose a new instrument to evaluate ADL, the ADL Inventory (ADLI), for which we present preliminary data. The ADLI was developed based on a comprehensive model of the stages of test development and following a combined framework of the World Health Organization's International Classification of Functioning, Disability, and Health and the American Occupational Therapy Association models. Besides sociodemographic information, ADLI includes 144 items, organized into four sections: (a) basic ADL; (b) IADL; (c) advanced ADL; and (d) factors influencing functionality. The main characteristics of ADLI are: having self- and informant-report forms; including items focused on different sensory and neurocognitive functions; individualizing the progression along items considering the person's functionality; considering the impact of several factors on functionality; and using a large response scale. Preliminary data of predictive and convergent validity for ADLI are presented. The preliminary study comprised 15 older adults. The Addenbrooke's Cognitive Examination - III, the Barthel Index, and the Instrumental Activities of Daily Living (IADL) Scale were applied to determine the predictive and convergent validity of ADLI.
PubMed: 38913789
DOI: 10.1080/23279095.2024.2367741 -
Rehabilitation Psychology Jun 2024To examine the association of changes in homebound status (i.e., never/rarely leaving the home) with life satisfaction in the first 10 years after traumatic brain injury...
PURPOSE/OBJECTIVE
To examine the association of changes in homebound status (i.e., never/rarely leaving the home) with life satisfaction in the first 10 years after traumatic brain injury (TBI).
RESEARCH METHOD/DESIGN
We analyzed data from 2,294 individuals with moderate-to-severe TBI from the TBI Model Systems National Database using a longitudinal multilevel model with time-varying predictors to account for within-person changes over time as well as between-person differences. We measured homebound status (defined as leaving the home ≤ 2 days/week) and life satisfaction (defined as the total score on the Satisfaction With Life Scale) at 1, 2, 5, and 10 years post-TBI. We adjusted the models for demographic and injury-related covariates and used inverse probability weighting to account for selection bias.
RESULTS
Forty-five (2%) individuals were homebound at all follow-up visits, 523 (22.8%) were homebound at least one follow-up visit, and 1,726 (75.2%) were never homebound. Individuals with TBI who were consistently homebound had > 1 lower life satisfaction compared to those who were never homebound, β = -8.07, 95% confidence interval (CI) = [-9.39, -6.76], < .001. Individuals who became homebound experienced a significant, but modest, decline in life satisfaction (β = -2.13, 95% CI = [-2.66, -1.61], < .001).
CONCLUSIONS/IMPLICATIONS
Our results indicate that being homebound and becoming homebound are associated with decreased life satisfaction. Homeboundness is a potentially modifiable target to improve life satisfaction, and elucidation of contributing factors to homebound status will help develop interventions to ameliorate post-TBI homeboundness. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
PubMed: 38913739
DOI: 10.1037/rep0000567 -
Journal of Deaf Studies and Deaf... Jun 2024
Topics: Humans; Child; Deafness; Sign Language; Persons With Hearing Impairments; Language; Education of Hearing Disabled; Comprehension
PubMed: 38913495
DOI: 10.1093/deafed/enae016 -
Scientific Reports Jun 2024Intoeing in children is a common parental concern, but our understanding of the impact of foot progression angle (FPA) in these children leaves remains limited. This...
Intoeing in children is a common parental concern, but our understanding of the impact of foot progression angle (FPA) in these children leaves remains limited. This study examines the relationship between FPA and plantar loading pattern, as well as gait symmetry in children with intoeing. The sample included 30 children with intoeing caused by internal tibial torsion, uniformly divided into three groups: unilateral intoeing, bilateral mild intoeing, and bilateral mild-moderate intoeing. The relationship between FPA and plantar loading pattern, and gait symmetry within and among groups were assessed using dynamic pedobarographic and spatiotemporal data. Results indicated a significant correlation between FPA and peak pressure, maximum force, and plantar impulse in the medial and central forefoot, and also the medial and lateral heel zones for both bilateral intoeing groups. Significant differences were observed only in subdivided stance phase, including loading response, single support, and pre-swing phases, between the unilateral intoeing and bilateral mild intoeing groups. These findings suggest that FPA significantly affects the forefoot and heel zones, potentially increasing the load on the support structures and leading to transverse arch deformation. While children with intoeing demonstrate a dynamic self-adjustment capability to maintain gait symmetry, this ability begins to falter as intoeing becomes more pronounced.
Topics: Humans; Child; Gait; Female; Male; Foot; Weight-Bearing; Biomechanical Phenomena
PubMed: 38909161
DOI: 10.1038/s41598-024-65422-5 -
BMC Geriatrics Jun 2024Increase in functional disability in aging societies is an international medical and public health issue. Masticatory function may be a potential risk factor for... (Observational Study)
Observational Study
BACKGROUND
Increase in functional disability in aging societies is an international medical and public health issue. Masticatory function may be a potential risk factor for functional disability, but the role of frailty in the association has not been clarified.
METHODS
Forty thousand five hundred sixty-two community-dwelling older adults aged 65 years and over who were insured by public health insurance as of April 2018 were followed up for a median of 3.0 years. Masticatory function was categorized as good, moderate, or poor based on a self-reported questionnaire. The development of functional disability was defined as a new certification of the need for long-term care. A Cox proportional hazards model was used to calculate hazard ratios (HRs) and their 95% confidence intervals (CIs).
RESULTS
During the follow-up period, 1,397 individuals experienced functional disability. After adjusting for age, sex, comorbidities, medical history, and lifestyle behaviors, the HR for incident functional disability was significantly higher in the moderate and poor groups compared to the good group (moderate, HR 1.21 [95% CI, 1.07-1.37]; poor, HR 1.64 [95% CI, 1.03-2.62]). However, after additional adjustment for frailty-related factors-namely, underweight, regular exercise, and gait speed-the association was attenuated in both the moderate group (HR 1.06 [95% CI, 0.94-1.21]) and the poor group (HR 1.51 [95% CI, 0.94-2.41]).
CONCLUSIONS
Masticatory dysfunction was significantly associated with incident functional disability in a community-dwelling older Japanese population. Our findings suggest that masticatory dysfunction may be a surrogate of frailty rather than a direct cause of functional disability.
Topics: Humans; Aged; Male; Female; Frailty; Mastication; Aged, 80 and over; Independent Living; Frail Elderly; Disabled Persons; Disability Evaluation; Risk Factors; Geriatric Assessment; Japan
PubMed: 38907214
DOI: 10.1186/s12877-024-05131-w