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Aging and Disease Aug 2016The objective of this study is to systematically review the relationship between lower-extremity peripheral nerve function and mobility in older adults. The National... (Review)
Review
The objective of this study is to systematically review the relationship between lower-extremity peripheral nerve function and mobility in older adults. The National Library of Medicine (PubMed) was searched on March 23, 2015 with no limits on publication dates. One reviewer selected original research studies of older adults (≥65 years) that assessed the relationship between lower-extremity peripheral nerve function and mobility-related outcomes. Participants, study design and methods of assessing peripheral nerve impairment were evaluated and results were reported and synthesized. Eight articles were identified, including 6 cross-sectional and 2 longitudinal studies. These articles investigated 6 elderly cohorts (4 from the U.S. and 2 from Italy): 3 community-dwelling (including 1 with only disabled women and 1 without mobility limitations at baseline), 1 with both community-dwelling and institutionalized residents, 1 from a range of residential locations, and 1 of patients with peripheral arterial disease. Mean ages ranged from 71-82 years. Nerve function was assessed by vibration threshold (n=2); sensory measures and clinical signs and symptoms of neuropathy (n=2); motor nerve conduction (n=1); and a combination of both sensory measures and motor nerve conduction (n=3). Each study found that worse peripheral nerve function was related to poor mobility, although relationships varied based on the nerve function measure and mobility domain assessed. Six studies found that the association between nerve function and mobility persisted despite adjustment for diabetes. Evidence suggests that peripheral nerve function impairment at various levels of severity is related to poor mobility independent of diabetes. Relationships varied depending on peripheral nerve measure, which may be particularly important when investigating specific biological mechanisms. Future research needs to identify risk factors for peripheral nerve decline beyond diabetes, especially those common in late-life and modifiable. Interventions to preserve nerve function should be investigated with regard to their effect on postponing or preventing disability in older adults.
PubMed: 27493833
DOI: 10.14336/AD.2015.1127 -
Muscle & Nerve Mar 2017No treatments for axonal peripheral neuropathy are approved by the United States Food and Drug Administration (FDA). Although patient- and clinician-reported outcomes... (Review)
Review
INTRODUCTION
No treatments for axonal peripheral neuropathy are approved by the United States Food and Drug Administration (FDA). Although patient- and clinician-reported outcomes are central to evaluating neuropathy symptoms, they can be difficult to assess accurately. The inability to identify efficacious treatments for peripheral neuropathies could be due to invalid or inadequate outcome measures.
METHODS
This systematic review examined the content validity of symptom-based measures of diabetic peripheral neuropathy, HIV neuropathy, and chemotherapy-induced peripheral neuropathy.
RESULTS
Use of all FDA-recommended methods to establish content validity was only reported for 2 of 18 measures. Multiple sensory and motor symptoms were included in measures for all 3 conditions; these included numbness, tingling, pain, allodynia, difficulty walking, and cramping. Autonomic symptoms were less frequently included.
CONCLUSIONS
Given significant overlap in symptoms between neuropathy etiologies, a measure with content validity for multiple neuropathies with supplemental disease-specific modules could be of great value in the development of disease-modifying treatments for peripheral neuropathies. Muscle Nerve 55: 366-372, 2017.
Topics: Diabetic Neuropathies; HIV Infections; Humans; Peripheral Nervous System Diseases
PubMed: 27447116
DOI: 10.1002/mus.25264 -
Journal of the Formosan Medical... Sep 2016A systematic assessment of literature was done to estimate the impact of pruritus on health-related quality of life among patients with cholestatic liver disease (CLD).... (Review)
Review
A systematic assessment of literature was done to estimate the impact of pruritus on health-related quality of life among patients with cholestatic liver disease (CLD). All the articles were reviewed manually for study design, population, outcomes, and study quality. A qualitative approach was used to analyze and extract data from included studies. A total of eight studies were retrieved, of which one was a cohort study and the other seven were cross-sectional studies. Overall, it appears that the incidence of pruritus was a common complication reported by most of the studies. Among patients with CLD incidence of pruritus was 29%. Pruritus was found to have a substantial impact on patients' health-related quality of life. Greater health-related quality of life impairment was observed with increased severity of pruritus. Pruritus was found to have a significant association (p<0.05) in quality-of-life instrument domains such as role limitation-physical, role limitation-emotional, bodily pain, vitality, energy, and physical mobility. Evidence suggests that pruritus has a substantial impact on health-related quality of life among patients with CLD. More research is required to support the evidence.
Topics: Cholestasis; Humans; Liver Diseases; Pruritus; Quality of Life; Severity of Illness Index; Surveys and Questionnaires
PubMed: 27431691
DOI: 10.1016/j.jfma.2016.05.006 -
Medical Care Research and Review : MCRR Aug 2017Our review establishes the empirical evidence for patient mobility for elective secondary care services in countries that allow patients to choose their health care... (Review)
Review
Our review establishes the empirical evidence for patient mobility for elective secondary care services in countries that allow patients to choose their health care provider. PubMed and Embase were searched for relevant articles between 1990 and 2015. Of 5,994 titles/abstracts reviewed, 26 studies were included. The studies used three main methodological models to establish mobility. Variation in the extent of patient mobility was observed across the studies. Mobility was positively associated with lower waiting times, indicators of better service quality, and access to advanced technology. It was negatively associated with advanced age or lower socioeconomic backgrounds. From a policy perspective we demonstrate that a significant proportion of patients are prepared to travel beyond their nearest provider for elective services. As a consequence, some providers are likely to be "winners" and others "losers," which could result in overall decreased provider capacity or inefficient utilization of existing services. Equity also remains a key concern.
Topics: Choice Behavior; Delivery of Health Care; Health Personnel; Health Policy; Health Services; Humans; Mobility Limitation; Quality of Health Care; Waiting Lists
PubMed: 27357394
DOI: 10.1177/1077558716654631 -
Clinical Journal of the American... Sep 2016Older patients reaching ESRD have a higher risk of adverse health outcomes. We aimed to determine the association of functional and cognitive impairment and frailty with... (Review)
Review
BACKGROUND AND OBJECTIVES
Older patients reaching ESRD have a higher risk of adverse health outcomes. We aimed to determine the association of functional and cognitive impairment and frailty with adverse health outcomes in patients reaching ESRD. Understanding these associations could ultimately lead to prediction models to guide tailored treatment decisions or preventive interventions.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS
We searched MEDLINE, Embase, Web of Science, CENTRAL, CINAHL, PsycINFO, and COCHRANE for original studies published until February 8, 2016 reporting on the association of functional or cognitive impairment or frailty with adverse health outcome after follow-up in patients reaching ESRD either with or without RRT.
RESULTS
Of 7451 identified citations, we included 30 articles that reported on 35 associations. Mean age was >60 years old in 73% of the studies, and geriatric conditions were highly prevalent. Twenty-four studies (80%) reported on functional impairment, seven (23%) reported on cognitive impairment, and four (13%) reported on frailty. Mortality was the main outcome measure in 29 studies (97%), and one study assessed functional status trajectory. In 34 of 35 (97%) associations reported, functional or cognitive impairment or frailty was significantly and independently associated with adverse health outcomes. The majority of studies (83%) were conducted in selected patient populations, mainly patients on incident dialysis.
CONCLUSIONS
Functional and cognitive impairment and frailty in patients reaching ESRD are highly prevalent and strongly and independently associated with adverse health outcomes, and they may, therefore, be useful for risk stratification. More research into their prognostic value is needed.
Topics: Activities of Daily Living; Cognitive Dysfunction; Frailty; Health Status; Humans; Karnofsky Performance Status; Kidney Failure, Chronic; Mobility Limitation
PubMed: 27342598
DOI: 10.2215/CJN.13611215 -
Clinical Journal of the American... Jul 2016With aging of the general population, patients who enter dialysis therapy will more frequently have geriatric impairments and a considerable comorbidity burden. The most... (Review)
Review
BACKGROUND AND OBJECTIVES
With aging of the general population, patients who enter dialysis therapy will more frequently have geriatric impairments and a considerable comorbidity burden. The most vulnerable among these patients might benefit from conservative therapy. Whether assessment of geriatric impairments would contribute to the decision-making process of dialysis initiation is unknown.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS
A systematic Medline and Embase search was performed on December 1, 2015 to identify studies assessing the association between risk of mortality or hospitalization and one or more geriatric impairments at the start of dialysis therapy, including impairment of cognitive function, mood, performance status or (instrumental) activities of daily living, mobility (including falls), social environment, or nutritional status.
RESULTS
Twenty-seven studies were identified that assessed one or more geriatric impairments with respect to prognosis. The quality of most studies was moderate. Only seven studies carried out an analysis of elderly patients (≥70 years old). Malnutrition and frailty were systematically assessed, and their relation with mortality was clear. In addition, cognitive impairment and functional outcomes at the initiation of dialysis were related to an increased mortality in most studies. However, not all studies applied systematic assessment tools, thereby potentially missing relevant impairment. None of the studies applied a geriatric assessment across multiple domains.
CONCLUSIONS
Geriatric impairment across multiple domains at dialysis initiation is related to poor outcome. However, information in the elderly is sparse, and a systematic approach of multiple domains with respect to poor outcome has not been performed. Because a geriatric assessment has proved useful in predicting outcome in other medical fields, its potential role in the ESRD population should be the subject of future research.
Topics: Activities of Daily Living; Aged; Cognitive Dysfunction; Geriatric Assessment; Health Status; Hospitalization; Humans; Kidney Failure, Chronic; Mobility Limitation; Mood Disorders; Nutritional Status; Renal Dialysis; Social Environment
PubMed: 27117581
DOI: 10.2215/CJN.06660615 -
Journal of Geriatric Physical Therapy... 2018Participation in regular physical activity is associated with better physical function in older people (>65 years); however, older people are the least active of all age... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND PURPOSE
Participation in regular physical activity is associated with better physical function in older people (>65 years); however, older people are the least active of all age groups. Exercise-based active video games (AVGs) offer an alternative to traditional exercise programs aimed at maintaining or enhancing physical performance measures in older people. This review systematically evaluated whether AVGs could improve measures of physical performance in older people. Secondary measures of safety, game appeal, and usability were also considered.
METHODS
Electronic databases were searched for randomized controlled trials published up to April 2015. Included were trials with 2 or more arms that evaluated the effect of AVGs on outcome measures of physical performance in older people.
RESULTS
Eighteen randomized controlled trials (n = 765) were included. Most trials limited inclusion to healthy community-dwelling older people. With the exception of 1 trial, all AVG programs were supervised. Using meta-analyses, AVGs were found to be more effective than conventional exercise (mean difference [MD], 4.33; 95% confidence intervals [CIs], 2.93-5.73) or no intervention (MD, 0.73; 95% CI, 0.17-1.29) for improving Berg Balance scores in community-dwelling older people. Active video games were also more effective than control for improving 30-second sit-to-stand scores (MD, 3.99; 95% CI, 1.92-6.05). No significant differences in Timed Up and Go scores were found when AVGs were compared with no intervention or with conventional exercise.
CONCLUSIONS
Active video games can improve measures of mobility and balance in older people when used either on their own or as part of an exercise program. It is not yet clear whether AVGs are equally suitable for older people with significant cognitive impairments or balance or mobility limitations. Given the positive findings to date, consideration could be given to further development of age-appropriate AVGs for use by older people with balance or mobility limitations.
Topics: Aged; Exercise; Female; Humans; Independent Living; Male; Mobility Limitation; Physical Functional Performance; Postural Balance; Randomized Controlled Trials as Topic; Video Games
PubMed: 26974212
DOI: 10.1519/JPT.0000000000000078 -
Revista Espanola de Salud Publica 2015People over 65 are the ones who have higher levels of functional limitations. There are many instruments to measure mobility in this age range that causes a lack of... (Review)
Review
BACKGROUND
People over 65 are the ones who have higher levels of functional limitations. There are many instruments to measure mobility in this age range that causes a lack of international consensus on what are the most suitable for this purpose. The aim is to analyze and identify which instruments provide greater data reliability and validity in measuring mobility in elderly people.
METHODS
Systematic review of the instruments used to measure mobility in people over 65 years published between 2001-2013, conducted in PubMed and Science Direct.
RESULTS
The 34 items selected instruments were grouped into 4 categories: doubly labeled water (DLW), motion detectors, objective measures of mobility and questionnaires. We identified, 23 are questionnaires, 4 accelerometers, 3 to objective measures of mobility and 2 both pedometers as DLW. The other 2 to combined analysis of different instruments.
CONCLUSIONS
We conclude that assessing objective and subjective data obtains the most accurate measures of mobility. To obtain objective data, objective measures of mobility will be opposed to pedometers and accelerometers, while questionnaires were selected for subjective data due to its ease of use and sociodemographic data that provides. Among these instruments, the Short Physical Performance Battery (SPPB) and Minnesota Leisure Time are the most appropriate instruments to estimate the mobility of the elderly in Spain.
Topics: Accelerometry; Aged; Aged, 80 and over; Disability Evaluation; Geriatric Assessment; Humans; Mobility Limitation; Reproducibility of Results; Surveys and Questionnaires
PubMed: 26786303
DOI: 10.4321/S1135-57272015000600003 -
The Cochrane Database of Systematic... Nov 2015Cerebral palsy is a disorder of movement and posture arising from a non-progressive lesion in the developing brain. Spasticity, a disorder of increased muscle tone, is... (Review)
Review
BACKGROUND
Cerebral palsy is a disorder of movement and posture arising from a non-progressive lesion in the developing brain. Spasticity, a disorder of increased muscle tone, is the most common motor difficulty and is associated with activity limitation to varying degrees in mobility and self care.Oral baclofen, a gamma-aminobutyric acid (GABA) agonist, has been used in oral form to treat spasticity for some time, but it has a variable effect on spasticity and the dose is limited by the unwanted effect of excessive sedation. Intrathecal baclofen produces higher local concentrations in cerebrospinal fluid at a fraction of the equivalent oral dose and avoids this excessive sedation.
OBJECTIVES
To determine whether intrathecal baclofen is an effective treatment for spasticity in children with cerebral palsy.
SEARCH METHODS
We searched the CENTRAL, MEDLINE, EMBASE and CINAHL databases, handsearched recent conference proceedings, and communicated with researchers in the field and pharmaceutical and drug delivery system companies.
SELECTION CRITERIA
We included studies which compared the effect of intrathecal baclofen treatment on spasticity, gross motor function or other areas of function with controls.
DATA COLLECTION AND ANALYSIS
Two authors selected studies, two authors extracted data and two authors assessed the methodological quality of included studies.
MAIN RESULTS
Six studies met the inclusion criteria. The data obtained were unsuitable for the conduct of a meta-analysis; we have completed a qualitative summary.All studies were found to have high or unclear risk of bias in some aspects of their methodology.Five of the six studies reported data collected in the randomised controlled phase of the study. A sixth study did not report sufficient results to determine the effect of intrathecal baclofen versus placebo. Of these five studies, four were conducted using lumbar puncture or other short-term means of delivering intrathecal baclofen. One study assessed the effectiveness of implantable intrathecal baclofen pumps over six months.The four short-term studies demonstrated that intrathecal baclofen therapy reduces spasticity in children with cerebral palsy. However, two of these studies utilised inappropriate techniques for statistical analysis of results. The single longer-term study demonstrated minimal reduction in spasticity with the use of intrathecal baclofen therapy.One of the short-term studies and the longer term study showed improvement in comfort and ease of care. The longer term study found a small improvement in gross motor function and also in some domains of health-related quality of life.Some caution is required in interpreting the findings of the all the studies in the review due to methodological issues. In particular, there was a high risk of bias in the methodology of the longer term study due to the lack of placebo use in the control group and the absence of blinding to the intervention after randomisation for both participants and investigators.
AUTHORS' CONCLUSIONS
There is some limited short-term evidence that intrathecal baclofen is an effective therapy for reducing spasticity in children with cerebral palsy. The effect of intrathecal baclofen on long-term spasticity outcomes is less certain.The validity of the evidence for the effectiveness of intrathecal baclofen in treating spasticity in children with cerebral palsy from the studies in the review is constrained by the small sample sizes of the studies and methodological issues in some studies.Spasticity is a impairment in the domain of body structure and function. Consideration must also be given to the broader context in determining whether intrathecal baclofen therapy is effective. The aim of therapy may be, for example, to improve gross motor function, to increase participation at a social role level, to improve comfort, to improve the ease of care by others or to improve the overall quality of life of the individual. Intrathecal baclofen may improve gross motor function in children with cerebral palsy, but more reliable evidence is needed to determine this.There is some evidence that intrathecal baclofen improves ease of care and the comfort and quality of life of the individuals receiving it, but again small sample sizes and methodological issues in the studies mean that these results should be interpreted with caution.Further evidence of the effectiveness of intrathecal baclofen for treating spasticity, increasing gross motor function and improving comfort, ease of care and quality of life is needed from other investigators in order to validate these results.The short duration of the controlled studies included in this review did not allow for the exploration of questions regarding whether the subsequent need for orthopaedic surgery in children receiving intrathecal baclofen therapy is altered, or the safety and the economic implications of intrathecal baclofen treatment when long-term therapy is administered via an implanted device. Controlled studies are not the most appropriate study design to address these questions, cohort studies may be more appropriate.
Topics: Adolescent; Baclofen; Cerebral Palsy; Child; Child, Preschool; Humans; Injections, Spinal; Muscle Relaxants, Central; Muscle Spasticity; Randomized Controlled Trials as Topic; Young Adult
PubMed: 26563961
DOI: 10.1002/14651858.CD004552.pub2 -
Sports Medicine (Auckland, N.Z.) Dec 2015Resistance training (RT) is an intervention frequently used to improve muscle strength and morphology in old age. However, evidence-based, dose-response relationships... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Resistance training (RT) is an intervention frequently used to improve muscle strength and morphology in old age. However, evidence-based, dose-response relationships regarding specific RT variables (e.g., training period, frequency, intensity, volume) are unclear in healthy old adults.
OBJECTIVES
The aims of this systematic review and meta-analysis were to determine the general effects of RT on measures of muscle strength and morphology and to provide dose-response relationships of RT variables through an analysis of randomized controlled trials (RCTs) that could improve muscle strength and morphology in healthy old adults.
DATA SOURCES
A computerized, systematic literature search was performed in the electronic databases PubMed, Web of Science, and The Cochrane Library from January 1984 up to June 2015 to identify all RCTs related to RT in healthy old adults.
STUDY ELIGIBILITY CRITERIA
The initial search identified 506 studies, with a final yield of 25 studies. Only RCTs that examined the effects of RT in adults with a mean age of 65 and older were included. The 25 studies quantified at least one measure of muscle strength or morphology and sufficiently described training variables (e.g., training period, frequency, volume, intensity).
STUDY APPRAISAL AND SYNTHESIS METHODS
We quantified the overall effects of RT on measures of muscle strength and morphology by computing weighted between-subject standardized mean differences (SMDbs) between intervention and control groups. We analyzed the data for the main outcomes of one-repetition maximum (1RM), maximum voluntary contraction under isometric conditions (MVC), and muscle morphology (i.e., cross-sectional area or volume or thickness of muscles) and assessed the methodological study quality by Physiotherapy Evidence Database (PEDro) scale. Heterogeneity between studies was assessed using I2 and χ2 statistics. A random effects meta-regression was calculated to explain the influence of key training variables on the effectiveness of RT in terms of muscle strength and morphology. For meta-regression, training variables were divided into the following subcategories: volume, intensity, and rest. In addition to meta-regression, dose-response relationships were calculated independently for single training variables (e.g., training frequency).
RESULTS
RT improved muscle strength substantially (mean SMDbs = 1.57; 25 studies), but had small effects on measures of muscle morphology (mean SMDbs = 0.42; nine studies). Specifically, RT produced large effects in both 1RM of upper (mean SMDbs = 1.61; 11 studies) and lower (mean SMDbs = 1.76; 19 studies) extremities and a medium effect in MVC of lower (mean SMDbs = 0.76; four studies) extremities. Results of the meta-regression revealed that the variables "training period" (p = 0.04) and "intensity" (p < 0.01) as well as "total time under tension" (p < 0.01) had significant effects on muscle strength, with the largest effect sizes for the longest training periods (mean SMDbs = 2.34; 50-53 weeks), intensities of 70-79% of the 1RM (mean SMDbs = 1.89), and total time under tension of 6.0 s (mean SMDbs = 3.61). A tendency towards significance was found for rest in between sets (p = 0.06), with 60 s showing the largest effect on muscle strength (mean SMDbs = 4.68; two studies). We also determined the independent effects of the remaining training variables on muscle strength. The following independently computed training variables are most effective in improving measures of muscle strength: a training frequency of two sessions per week (mean SMDbs = 2.13), a training volume of two to three sets per exercise (mean SMDbs = 2.99), seven to nine repetitions per set (mean SMDbs = 1.98), and a rest of 4.0 s between repetitions (SMDbs = 3.72). With regard to measures of muscle morphology, the small number of identified studies allowed us to calculate meta-regression for the subcategory training volume only. No single training volume variable significantly predicted RT effects on measures of muscle morphology. Additional training variables were independently computed to detect the largest effect for the single training variable. A training period of 50-53 weeks, a training frequency of three sessions per week, a training volume of two to three sets per exercise, seven to nine repetitions per set, a training intensity from 51 to 69% of the 1RM, a total time under tension of 6.0 s, a rest of 120 s between sets, and a rest of 2.5 s between repetitions turned out to be most effective.
LIMITATIONS
The current results must be interpreted with caution because of the poor overall methodological study quality (mean PEDro score 4.6 points) and the considerable large heterogeneity (I2) = 80%, χ2 = 163.1, df = 32, p < 0.01) for muscle strength. In terms of muscle morphology, our search identified nine studies only, which is why we consider our findings preliminary. While we were able to determine a dose-response relationship based on specific individual training variables with respect to muscle strength and morphology, it was not possible to ascertain any potential interactions between these variables. We recognize the limitation that the results may not represent one general dose-response relationship.
CONCLUSIONS
This systematic literature review and meta-analysis confirmed the effectiveness of RT on specific measures of upper and lower extremity muscle strength and muscle morphology in healthy old adults. In addition, we were able to extract dose-response relationships for key training variables (i.e., volume, intensity, rest), informing clinicians and practitioners to design effective RTs for muscle strength and morphology. Training period, intensity, time under tension, and rest in between sets play an important role in improving muscle strength and morphology and should be implemented in exercise training programs targeting healthy old adults. Still, further research is needed to reveal optimal dose-response relationships following RT in healthy as well as mobility limited and/or frail old adults.
Topics: Aged; Aged, 80 and over; Humans; Muscle Strength; Muscle, Skeletal; Resistance Training; Time Factors
PubMed: 26420238
DOI: 10.1007/s40279-015-0385-9