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Journal of Foot and Ankle Research May 2020It is estimated that 2% of the global childhood population is living with some form of mobility impairment. Although footwear interventions are proposed to aid...
BACKGROUND
It is estimated that 2% of the global childhood population is living with some form of mobility impairment. Although footwear interventions are proposed to aid ambulation, there appears to be a paucity in the understanding of the effects of therapeutic footwear. This review aims to explore the effectiveness of footwear as an intervention for mobility impairment in children.
METHODS
A systematic search of MEDLINE, CINAHL, PubMed, SPORTdiscus and Scopus databases were performed. Studies which focused on children with some form of mobility impairment, age of 9 months to 18 years, therapeutic footwear that allowed walking, and outcome measures that had explored biomechanical or skeletal geometry or psychosocial aspects were included in this review. Modified Downs and Black quality assessment index of randomised and non-randomised studies were used to assess the methodologies of included papers.
RESULTS
Out of 5003 articles sourced, 13 met the inclusion criteria for this review. These were grouped into two titled "corrective and "functional" based on the types of footwear used for intervention. Studies within the corrective footwear group included participants aged 11 months to 5 years with moderate congenital talipes equino varus or mobile pes planus. While using skeletal geometry as an outcome, there was a limited fair quality (level II) evidence that corrective footwear has no significant effect on the development of pes planus but may assist in the reduction of deformity in congenital talipes equino varus. The functional footwear group included participants aged 3 to 17 years, predominantly with mobile pes planus or cerebral palsy. Based on biomechanical measures as an outcome, there was a limited fair quality (level III) evidence that functional footwear alters biomechanical parameters in mobile pes planus (spatiotemporal) and cerebral palsy (spatiotemporal, kinematic). Although psychosocial outcomes were considered within two studies, the analysis was limited.
CONCLUSION
Only a limited number of studies have explored the effects of therapeutic footwear and only in a narrow range of mobility impairments. Further high-quality research is required to improve the evidence base for the effectiveness of therapeutic footwear. This should include a wide range of mobility impairments and should focus both on physical and psychosocial outcomes.
Topics: Adolescent; Biomechanical Phenomena; Child; Child, Preschool; Female; Foot Orthoses; Humans; Infant; Male; Mobility Limitation; Shoes; Treatment Outcome
PubMed: 32404124
DOI: 10.1186/s13047-020-00390-3 -
Disability and Health Journal Jul 2020Women with disabilities experience significant health disparities. A barrier to progress in addressing these disparities is the lack of population-based data on their...
BACKGROUND
Women with disabilities experience significant health disparities. A barrier to progress in addressing these disparities is the lack of population-based data on their health outcomes, which are needed to plan health care delivery systems. Administrative health data are increasingly being used to measure the health of entire populations, but these data may only capture impairment and not activity and participation restrictions.
OBJECTIVE
We conducted a systematic review to identify and appraise existing literature on the development and validation of algorithms to identify reproductive-aged women with physical and sensory disabilities in administrative health data.
METHODS
We searched Medline, EMBASE, CINAHL, PsycINFO, and Scopus from inception to April 2019 for studies of the development and/or validation of algorithms using diagnostic, procedural, or prescription codes to identify physical and sensory disabilities in administrative health data. Study and algorithm characteristics were extracted and quality was assessed using standardized instruments.
RESULTS
Of 14,073 articles initially identified, we reviewed 6 articles representing 2 unique algorithms. One algorithm aimed to correlate diagnoses, procedure codes, and prescriptions with ability to access routine care as an indicator of functional limitation. The other algorithm used diagnostic and procedure codes to identify use of mobility-assistive devices to measure functional limitation. Only one algorithm was validated against self-reported disability.
CONCLUSIONS
Our findings underscore the need to strengthen current methods to identify disability in administrative health data, including linkage with other sources of information on functional limitations, so that population-based data can be used to optimize health care for women with disabilities.
Topics: Adult; Algorithms; Disabled Persons; Female; Health Status; Healthcare Disparities; Humans; Movement Disorders; Self Report; Sensation Disorders; United States
PubMed: 32139320
DOI: 10.1016/j.dhjo.2020.100909 -
BMJ Open Feb 2020To evaluate the effectiveness of rehabilitation interventions on physical function and immobility-related complications in severe stroke.
OBJECTIVE
To evaluate the effectiveness of rehabilitation interventions on physical function and immobility-related complications in severe stroke.
DESIGN
Systematic review of electronic databases (Medline, Excerpta Medica database, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Physiotherapy Evidence Database, Database of Research in Stroke, Cochrane Central Register of Controlled Trials) searched between January 1987 and November 2018.
METHODS
The Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement guided the review. Randomised controlled trials comparing the effect of one type of rehabilitation intervention to another intervention, usual care or no intervention on physical function and immobility-related complications for patients with severe stroke were included. Studies that recruited participants with all levels of stroke severity were included only if subgroup analysis based on stroke severity was performed. Two reviewers screened search results, selected studies using predefined selection criteria, extracted data and assessed risk of bias for selected studies using piloted proformas. Marked heterogeneity prevented meta-analysis and a descriptive review was performed. The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess evidence strength.
RESULTS
28 studies (n=2677, mean age 72.7 years, 49.3% males) were included in the review. 24 studies were rated low or very low quality due to high risk of bias and small sample sizes. There was high-quality evidence that very early mobilisation (ie, mobilisation with 24 hours poststroke) and occupational therapy in care homes were no more effective than usual care. There was moderate quality evidence supporting short-term benefits of wrist and finger neuromuscular electrical stimulation in improving wrist extensor and grip strength, additional upper limb training on improving upper limb function and additional lower limb training on improving upper limb function, independence in activities of daily living, gait speed and gait independence.
CONCLUSIONS
There is a paucity of high-quality evidence to support the use of rehabilitation interventions to improve physical function and reduce immobility-related complications after severe stroke. Future research investigating more commonly used rehabilitation interventions, particularly to reduce poststroke complications, is required.
PROSPERO REGISTRATION NUMBER
CRD42017077737.
Topics: Activities of Daily Living; Aged; Early Ambulation; Female; Gait; Humans; Male; Mobility Limitation; Stroke Rehabilitation; Walking Speed
PubMed: 32029489
DOI: 10.1136/bmjopen-2019-033642 -
Annals of Physical and Rehabilitation... Mar 2020Lower-limb functional capacity is impaired in most people with multiple sclerosis (PwMS). Reductions in lower-extremity muscle mechanical function (e.g., muscle...
BACKGROUND
Lower-limb functional capacity is impaired in most people with multiple sclerosis (PwMS). Reductions in lower-extremity muscle mechanical function (e.g., muscle strength) appear to have critical implications for lower-limb functional capacity. However, no review has summarized the current knowledge about the importance of muscle strength for functional tasks in PwMS. Expanding the current knowledge would advance the design of both clinical and research interventions aiming to improve functional capacity in PwMS.
OBJECTIVES
(1) To identify studies that measured lower-extremity muscle mechanical function and lower-limb functional capacity outcomes in PwMS, and (2) to map associations between muscle strength and functional capacity.
METHODS
This review was based on a literature search (databases: PubMed, Embase). Included studies had to report data on lower-extremity muscle mechanical function and lower-limb functional capacity outcomes in PwMS. The associations between muscle strength and functional capacity were analyzed by using the reported correlation coefficients (R) recalculated to the determination coefficient R. Randomized trials and observational studies were included.
RESULTS
A total of 59 articles were reviewed; 17 (773 participants) reported associations between muscle strength and functional capacity. Lower-extremity muscle mechanical function explained a significant part of the variance in most lower-limb functional capacity tests (approximately 20-30%). This was particularly evident in muscle strength from the weakest leg. Muscle strength was predominantly tested on knee extensors and knee flexors by using isokinetic dynamometry during maximal isometric (0°/s) and dynamic (30-60°/s) contractions. Walking tests such as the timed 25-Foot Walk Test and 10-Min, 2-Min and 6-Min Walk Test were the most frequently performed functional capacity tests.
CONCLUSIONS
In PwMS, muscle strength of particularly the weakest limb explains 20% to 30% of the variance across a number of lower-limb functional capacity tests. Thus, exercise programs should focus on increasing lower-extremity muscle mechanical function in PwMS and minimizing strength asymmetry between limbs.
Topics: Biomechanical Phenomena; Humans; Isometric Contraction; Leg; Mobility Limitation; Multiple Sclerosis; Muscle Strength; Muscle Strength Dynamometer; Muscle, Skeletal; Walking
PubMed: 31816449
DOI: 10.1016/j.rehab.2019.11.005 -
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 Vascular Surgery Jan 2020Frailty has been associated with postoperative complications and mortality across surgical specialties, including vascular surgery. However, the influence of frailty on...
BACKGROUND
Frailty has been associated with postoperative complications and mortality across surgical specialties, including vascular surgery. However, the influence of frailty on postoperative functional outcomes is unclear. We sought to determine the influence of frailty on functional outcomes after open or endovascular vascular procedures in patients with peripheral arterial disease.
METHODS
This systematic review was conducted according to the PRISMA guidelines. Eligible articles were identified through database searches of Pubmed and EMBASE in April 2017. Studies reporting on frailty and functional outcomes after vascular interventions for peripheral artery disease (PAD) were included. Outcomes of interest were dependency in activities of daily living (ADL), dependent mobility, discharge destination, disability-free survival, and quality of life. Individual studies were assessed for quality and risk of bias using the Quality in Prognosis Studies tool.
RESULTS
Eight studies met the eligibility criteria and were included. The risk of bias was low in two studies, intermediate in three studies, and high in three studies. Methods for frailty assessment were different for each study. Frailty was a predictor for discharge to a higher level of care, dependent mobility, and dependency in ADL after vascular procedures for PAD. Both frailty models and individual frailty characteristics seem to be associated with these adverse functional outcomes.
CONCLUSIONS
Despite a limited amount of literature and an overall intermediate quality of the included studies, this systematic review shows an association between frailty and adverse functional outcomes after peripheral arterial procedures for PAD, including discharge to a care facility, dependent mobility, and a decline in ADL functioning.
Topics: Activities of Daily Living; Age Factors; Aged; Aged, 80 and over; Comorbidity; Endovascular Procedures; Female; Frail Elderly; Frailty; Health Status; Humans; Male; Middle Aged; Mobility Limitation; Patient Discharge; Peripheral Arterial Disease; Polypharmacy; Quality of Life; Recovery of Function; Risk Assessment; Risk Factors; Treatment Outcome; Vascular Surgical Procedures
PubMed: 31331651
DOI: 10.1016/j.jvs.2018.12.060