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Physical Therapy Jan 2022The purpose of this study was to provide contemporary estimates of the prevalence of lower extremity motor impairment and walking limitation after first-ever stroke and... (Observational Study)
Observational Study
OBJECTIVE
The purpose of this study was to provide contemporary estimates of the prevalence of lower extremity motor impairment and walking limitation after first-ever stroke and to characterize the predictive nature of early walking ability for being discharged home after acute hospitalization.
METHODS
In this cohort study, data were collected from a metropolitan acute care hospital in Canada at admission for 487 adults with first-ever acute ischemic or hemorrhagic stroke. Lower extremity motor impairment and walking limitation were measured using the National Institutes of Health Stroke Scale and AlphaFIM, respectively. Parallel multivariable logistic regression models were built to predict discharge home after acute hospitalization compared with further hospitalization.
RESULTS
For patients surviving a first-ever stroke, 44.1% presented with some degree of lower extremity motor impairment and 46.0% were unable to walk. In a multivariable model built around a binary classification of walking (Nagelkerke R2 = 0.41), those with any ability to walk at admission (with or without therapist assistance) had 9.48 times greater odds of being discharged home (odds ratio = 9.48, 95% CI = 6.11-14.92) than those who were unable. In a parallel multivariable model built around an ordinal classification of walking (Nagelkerke R2 = 0.49), patients had 2.07 times greater odds (odds ratio = 2.07, 95% CI = 1.82-2.38) of being discharged home for each increment on a 6-point walking scale (total dependence to complete independence) assessed at acute admission.
CONCLUSION
Approximately one-half of patients with first-ever stroke present with lower extremity weakness and walking limitation. Early walking ability is a significant predictor of returning home after acute hospitalization, independent of stroke severity. Discharge planning may be facilitated early after stroke with the familiar assessment of walking ability.
IMPACT
An early assessment of walking function within days of stroke admission can help to streamline discharge planning.
LAY SUMMARY
Nearly one-half of all individuals who experience a first-time stroke have walking difficulty when they arrive at the hospital. The severity of the walking limitation can predict whether a patient will eventually be discharged home or go on to further hospitalization.
Topics: Aged; Aged, 80 and over; Cohort Studies; Female; Gait Disorders, Neurologic; Hospitalization; Humans; Male; Middle Aged; Mobility Limitation; Patient Discharge; Predictive Value of Tests; Prevalence; Stroke Rehabilitation; Walking
PubMed: 34718796
DOI: 10.1093/ptj/pzab246 -
The Journals of Gerontology. Series A,... Mar 2019Traditional clinical care models focus on the measurement and normalization of individual organ systems and de-emphasize aspects of health related to the integration of... (Review)
Review
Traditional clinical care models focus on the measurement and normalization of individual organ systems and de-emphasize aspects of health related to the integration of physiologic systems. Measures of physical, cognitive and sensory, and psychosocial or emotional function predict important health outcomes like death and disability independently from the severity of a specific disease, cumulative co-morbidity, or disease severity measures. A growing number of clinical scientists in several subspecialties are exploring the utility of functional assessment to predict complication risk, indicate stress resistance, inform disease screening approaches and risk factor interpretation, and evaluate care. Because a substantial number of older adults in the community have some form of functional limitation, integrating functional assessment into clinical medicine could have a large impact. Although interest in functional implications for health and disease management is growing, the science underlying functional capacity, functional limitation, physical frailty, and functional metrics is often siloed among different clinicians and researchers, with fragmented concepts and methods. On August 25-26, 2016, participants at a trans-disciplinary workshop, supported by the National Institute on Aging and the John A. Hartford Foundation, explored what is known about the pathways, contributors, and correlates of physical, cognitive, and sensory functional measures across conditions and disease states; considered social determinants and health disparities; identified knowledge gaps, and suggested priorities for future research. This article summarizes those discussions.
Topics: Aging; Frailty; Humans; Mobility Limitation
PubMed: 29697758
DOI: 10.1093/gerona/gly093 -
Developmental Medicine and Child... Apr 2015The aim of this study was to critically synthesize qualitative evidence regarding the child and family experience of power mobility, and to examine how this evidence... (Review)
Review
AIM
The aim of this study was to critically synthesize qualitative evidence regarding the child and family experience of power mobility, and to examine how this evidence fits with current theoretical concepts.
METHOD
Electronic database/hand searches were undertaken in September 2012 and updated in February 2014. The searches were restricted to qualitative studies published in English before February 2014 that included at least one child under the age of 19 with a disability and described an outcome related to the use of power mobility. Inclusion criteria were set a priori. Two reviewers independently screened titles, abstracts, and full-text articles and extracted data. McMaster qualitative review forms were used for quality appraisal.
RESULTS
Of 259 titles, 21 met inclusion criteria. From 143 codes, 15 second-order themes were developed using constant comparison and analysis. Three overarching themes emerged: power mobility experience promotes developmental change and independent mobility; power mobility enhances social relationships and engagement in meaningful life experiences; and power mobility access and use is influenced by factors in the physical, social, and attitudinal environment.
INTERPRETATION
This qualitative research provides rich and rigorous evidence supporting the benefits of power mobility for children and families. Numerous factors, which warrant careful consideration, influence power mobility access and use.
Topics: Child; Disabled Children; Electrical Equipment and Supplies; Family; Humans; Mobility Limitation; Wheelchairs
PubMed: 25403793
DOI: 10.1111/dmcn.12633 -
International Journal of Environmental... Aug 2016The aim of this review is to evaluate the health and social effects of accessible home environments for people with functional limitations, in order to provide evidence... (Review)
Review
The aim of this review is to evaluate the health and social effects of accessible home environments for people with functional limitations, in order to provide evidence to promote well-informed decision making for policy guideline development and choices about public health interventions. MEDLINE and nine other electronic databases were searched between December 2014 and January 2015, for articles published since 2004. All study types were included in this review. Two reviewers independently screened 12,544 record titles or titles and abstracts based on our pre-defined eligibility criteria. We identified 94 articles as potentially eligible; and assessed their full text. Included studies were critically appraised using the Mixed Method Appraisal Tool, version 2011. Fourteen studies were included in the review. We did not identify any meta-analysis or systematic review directly relevant to the question for this systematic review. A narrative approach was used to synthesise the findings of the included studies due to methodological and statistical heterogeneity. Results suggest that certain interventions to enhance the accessibility of homes can have positive health and social effects. Home environments that lack accessibility modifications appropriate to the needs of their users are likely to result in people with physical impairments becoming disabled at home.
Topics: Architectural Accessibility; Housing; Humans; Mobility Limitation
PubMed: 27548194
DOI: 10.3390/ijerph13080826 -
The Netherlands Journal of Medicine Sep 2014
Topics: Aged; Arterial Occlusive Diseases; Brain Ischemia; Dizziness; Dysarthria; Female; Giant Cell Arteritis; Humans; Magnetic Resonance Imaging; Mobility Limitation; Vertebral Artery
PubMed: 25178774
DOI: No ID Found -
The Journals of Gerontology. Series A,... Nov 2022It is important to understand the factors associated with life-space mobility so that mobility disability can be prevented/treated. The purpose of this study was to... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
It is important to understand the factors associated with life-space mobility so that mobility disability can be prevented/treated. The purpose of this study was to identify the association between mobility determinants and life space among older adults.
METHODS
This study was a cross-sectional analysis of 249 community-dwelling older adults (mean age = 77.4 years, 65.5% female, 88% White), who were recruited for a randomized, controlled, clinical intervention trial. Associations between cognitive, physical, psychosocial, financial, and environmental mobility determinants and the life-space assessment (LSA) at baseline were determined using Spearman's correlation coefficients and one-way analysis of variance. Multivariate analysis was performed using multivariable linear regression models.
RESULTS
The mean LSA score for the sample was 75.3 (SD = 17.8). Personal factors (age, gender, education, comorbidities), cognitive (Trail Making Test A and B), physical (gait speed, lower extremity power, 6-Minute Walk Test, Figure of 8 Walk Test, tandem stance, energy cost of walking, and Late-Life Function and Disability Function Scale), psychosocial (Modified Gait Efficacy Scale), and financial (neighborhood socioeconomic status) domains of mobility were significantly associated with LSA score. In the final regression model, age (β = -0.43), lower extremity power (β = 0.03), gait efficacy (β = 0.19), and energy cost of walking (β = -57.41) were associated with life space (R2 = 0.238).
CONCLUSIONS
Younger age, greater lower extremity power, more confidence in walking, and lower energy cost of walking were associated with greater life space. Clinicians treating individuals with mobility disability should consider personal, physical, and psychosocial factors when assessing barriers to life-space mobility.
Topics: Humans; Female; Aged; Male; Mobility Limitation; Activities of Daily Living; Cross-Sectional Studies; Walking; Gait
PubMed: 34529773
DOI: 10.1093/gerona/glab268 -
Current Heart Failure Reports Oct 2022Right ventricular (RV) failure is increasingly recognized as a major cause of morbidity and mortality. When RV failure is refractory to medical therapy, escalation to... (Review)
Review
PURPOSE OF REVIEW
Right ventricular (RV) failure is increasingly recognized as a major cause of morbidity and mortality. When RV failure is refractory to medical therapy, escalation to right-sided mechanical circulatory support (MCS) should be considered. In this review, we begin by recapitulating the hemodynamics of RV failure, then we delve into current and future right-sided MCS devices and describe their hemodynamic profiles.
RECENT FINDINGS
The field of temporary right-sided MCS continues to expand, with evolving strategies and new devices actively under development. All right-sided MCS devices bypass the RV, with each bypass configuration conferring a unique hemodynamic profile. Devices that aspirate blood directly from the RV, as opposed to the RA or the IVC, have more favorable hemodynamics and more effective RV unloading. There has been a growing interest in single-access MCS devices which do not restrict patient mobility. Additionally, a first-of-its-kind percutaneous, pulsatile, right-sided MCS device (PERKAT RV) is currently undergoing investigation in humans. Prompt recognition of refractory RV failure and deployment of right-sided MCS can improve outcomes. The field of right-sided MCS is rapidly evolving, with ongoing efforts dedicated towards developing novel temporary devices that are single access, allow for patient mobility, and directly unload the RV, as well as more durable devices.
Topics: Heart Failure; Heart-Assist Devices; Hemodynamics; Humans; Mobility Limitation; Treatment Outcome; Ventricular Dysfunction, Right
PubMed: 35994222
DOI: 10.1007/s11897-022-00562-1 -
Journal of Rehabilitation Research and... 2008Stroke survivors are at high risk for falls in all poststroke stages. Falls may have severe consequences, both physically and psychosocially. Individuals with stroke... (Review)
Review
Stroke survivors are at high risk for falls in all poststroke stages. Falls may have severe consequences, both physically and psychosocially. Individuals with stroke have an increased risk for hip fractures, and after such a fracture, they less often regain independent mobility. In addition, fear of falling is a common consequence of falls, which may lead to decreased physical activity, social deprivation and, eventually, loss of independence. Important risk factors for falls are balance and gait deficits. Stroke-related balance deficits comprise reduced postural stability during quiet standing and delayed and less coordinated responses to both self-induced and external balance perturbations. Gait deficits include reduced propulsion at push-off, decreased hip and knee flexion during the swing phase, and reduced stability during the stance phase. Interventions addressing these deficits can be expected to prevent falls more successfully. Preliminary evidence shows that task-specific exercise programs targeting balance and gait deficits can indeed reduce the number of falls in individuals with stroke. Technological advances in assistive devices are another promising area. More research is needed, however, to provide conclusive evidence of the efficacy of these interventions regarding the prevention of falls in individuals with stroke.
Topics: Accidental Falls; Activities of Daily Living; Aged; Aged, 80 and over; Gait Disorders, Neurologic; Humans; Mobility Limitation; Postural Balance; Stroke Rehabilitation
PubMed: 19235120
DOI: No ID Found -
The American Journal of Managed Care Jul 2020To develop an easy-to-interpret, patient-reported Functional Limitations Index (FLI) that can be used to assess and monitor the full spectrum of functioning in a... (Observational Study)
Observational Study
OBJECTIVES
To develop an easy-to-interpret, patient-reported Functional Limitations Index (FLI) that can be used to assess and monitor the full spectrum of functioning in a community-dwelling population.
STUDY DESIGN
Observational design using nationally representative survey data.
METHODS
We used self-rated health as a criterion for empirically assigning weights to 5 National Health Interview Survey items assessing difficulty with seeing, hearing, walking, cognition, and self-care. In addition to succinctly summarizing cumulative limitations, we addressed 2 main questions: (1) Which limitations have stronger associations with self-rated health? and (2) How does severity (from 0, no difficulty, to 3, unable to do) relate to self-rated health? We generated a respondent-level summary score based on a model predicting self-rated health from the 5 linearly scored (0-3) items and used splines to account for nonlinear severity-self-rated health associations.
RESULTS
The strongest association of specific functional limitations with self-rated health involved mobility; the weakest associations involved sensory limitations. The association of severity with self-rated health was nonlinear and largest moving from no difficulty to somewhat difficult. Nationally, 5% of noninstitutionalized adults were considered most limited, 8% somewhat limited, and 87% least limited. Great mobility limitations (defined as a lot of difficulty or unable to do) most distinguished limitation groups (present in 0% of least limited, 25% of somewhat limited, and 70% of most limited).
CONCLUSIONS
The FLI is an easy-to-administer, easy-to-interpret, and valid summary measure of disability that health plans and health care organizations can use for quality-of-care monitoring across a variety of settings to improve care for patients with disabilities.
Topics: Activities of Daily Living; Aged; Aged, 80 and over; Cognition; Communication; Disabled Persons; Female; Functional Status; Hearing; Humans; Male; Middle Aged; Mobility Limitation; Self Care; Self Report; Severity of Illness Index; Socioeconomic Factors; Surveys and Questionnaires; Vision, Ocular
PubMed: 32672921
DOI: 10.37765/ajmc.2020.43765 -
Journal of Foot and Ankle Research 2019Reports suggest that children with mobility impairment represent a significant proportion of the population living with a disability. Footwear is considered to be the... (Review)
Review
BACKGROUND
Reports suggest that children with mobility impairment represent a significant proportion of the population living with a disability. Footwear is considered to be the key extrinsic factor affecting children's gait and footwear modifications have been historically postulated to assist with locomotory difficulty. Although therapeutic footwear has been considered within the literature, there is a lack of consistency on terminology and paucity on the overall understanding. A scoping review was performed to chart the key concepts in children's footwear and to establish the range of studies that considered therapeutic footwear.
METHODS
A systematic search of MEDLINE, CINAHL, PubMed, SPORTdiscus, and Scopus electronic databases was performed using MeSH headings and free text terms in relation to children's footwear. All studies that used footwear as an intervention in children aged 9 months to 18 years with the outcome measures including design, fit, and the effects on development and health were included. Studies were charted by textual narrative synthesis into research groupings dependent on the topics discussed and the methods used in the studies.
RESULTS
The search yielded a total of 5006 articles with 287 of these articles meeting the inclusion criteria. Two overarching areas of research were identified; articles that discussed footwear design and those that discussed the effects of footwear. Eight further general groupings were charted and apportioned between the overarching areas and therapeutic footwear was charted into three subgroupings (corrective, accommodative and functional).
CONCLUSION
Children's footwear has become an increasing area of research in the past decade with a shift towards more empirical research, with most of the included articles examining biomechanical and anthropometric aspects. However, children's therapeutic footwear has not shared the same recent impetus with no focused review and limited research exploring its effects. Empirical research in this area is limited and there is ambiguity in the terminology used to describe therapeutic footwear. Based on the findings of this review the authors suggest the term children's therapeutic footwear be used as the standard definition for footwear that is designed specifically with the purpose to support or alleviate mobility impairment in childhood; with subgroupings of corrective, accommodative and functional dependent on the intended therapeutic role.
Topics: Biomechanical Phenomena; Child; Developmental Disabilities; Disabled Children; Equipment Design; Foot Orthoses; Gait; Gait Disorders, Neurologic; Humans; Mobility Limitation; Shoes
PubMed: 31061678
DOI: 10.1186/s13047-019-0336-z