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Introducción. Los factores psicológicos preoperatorios pueden influir en los resultados de la rehabilitación de la artroplastia de cadera por artrosis. No existe consenso de cuáles serían estos factores, ni sobre en qué medidas de resultados influirían. Objetivo. Sintetizar la evidencia respecto a los factores psicológicos que pronostican los resultados de la artroplastía de cadera en términos de función física y dolor en individuos con artrosis de cadera. Métodos. Se efectuó una búsqueda en PUBMED, EMBASE, SCOPUS y CINAHL. Los términos incluyeron artroplastia de cadera, artrosis, factores psicológicos, función física y dolor. Se incorporaron estudios observacionales prospectivos. Los resultados se agruparon por factor psicológico en periodos menor a un año e igual o mayor a un año. Resultados. La búsqueda arrojó 895 artículos, dos cumplieron los criterios de elegibilidad. Los resultados descritos fueron: 1) un mayor nivel de expectativas preoperatorias genera un efecto positivo en la disminución de la intensidad de dolor y 2) tiene un efecto positivo en la función física, ambas a menos de un año, y 3) la depresión preoperatoria genera un efecto negativo en la disminución de intensidad de dolor a un año o más. Conclusiones. La presencia de depresión preoperatoria se asoció a una menor reducción de dolor, y las altas expectativas preoperatorias se asociaron con una mejor función física y una menor intensidad de dolor. Sin embargo, se hace necesaria la generación de nueva evidencia científica que profundice en la asociación factores psicológicos preoperatorios y dolor crónico en esta población.
Background. Preoperative psychological factors may influence the results of hip arthroplasty rehabilitation for osteoarthritis. There is no consensus on what these factors would be, nor on what outcome measures they would influence. Objetive. To review was to synthesize the evidence regarding psychological factors that predict hip arthroplasty outcomes in terms of physical function and pain in individuals with hip osteoarthritis. Methods. A search was carried out in PUBMED, EMBASE, SCOPUS and CINAHL. Terms included hip arthroplasty, osteoarthritis, psychological factors, physical function, and pain. Prospective observational studies were incorporated. The results were grouped by psychological factor in periods of less than one year and equal to or greater than one year. Results. The search yielded 895 articles, two met the eligibility criteria. The results described were: 1) a higher level of preoperative expectations generates a positive effect in the reduction of pain intensity and 2) has a positive effect on physical function, both at less than one year, and 3) preoperative depression generates a negative effect in the reduction of pain intensity at one year or more. Conclusions. The presence of preoperative depression was associated with less pain reduction, and high preoperative expectations were associated with better physical function and less pain intensity. However, it is necessary to generate new scientific evidence that deepens the association of preoperative psychological factors and chronic pain in this population.
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Background: Patients undergoing cardiac surgery can experience functional impairment. Objective: Assess the influence of Perme Score on the intensive care unit (ICU) length of stay in patients after cardiac surgery. As a secondary objective, investigate if preoperative variables can predict the patient's mobility status after surgery. Methods: A prospective observational study was conducted in ICU in a university hospital. The mobility status (Perme Score) was collected from the first postoperative day until ICU discharge. The preoperative assessment of respiratory muscle strength, pulmonary function, and handgrip strength were collected. Results: A total of 44 patients, mean age of 62.3 years, 28 men were included in the study. A high Perme Score on the second postoperative day among patients who underwent Coronary artery bypass grafting and the third postoperative day on three types of intervention (Coronary artery bypass grafting, valve replacement, or both simultaneously) was associated with shorter ICU length of stay). The preoperative pulmonary function was one of the main independent predictors of mobility status on the first three days of ICU stay, in addition to left ventricular ejection fraction and cardiopulmonary bypass time on the first day, age, and left ventricular ejection fraction on the second day and maximum expiratory pressure on third day Conclusion: An increase in mobility status (Perme Score), mainly on the third postoperative day, reduced the ICU stay, mainly influenced by preoperative pulmonary function.
Antecedentes: Los pacientes sometidos a cirugía cardiaca pueden experimentar deterioro funcional. Objetivo: Evaluar la influencia del Perme Score en la estancia hospitalaria en la unidad de cuidados intensivos (UCI) en pacientes postoperados de cirugía cardiaca. Como objetivo secundario fue investigar si las variables preoperatorias pueden predecir el estado de movilidad del paciente después de la cirugía. Métodos: Se realizó un estudio observacional prospectivo en la UCI de un hospital universitario. El estado de movilidad (Perme Score) se monitoreó desde el primer día postoperatorio, hasta el alta de la UCI. Se recolectó la evaluación preoperatoria de la fuerza de los músculos respiratorios, la función pulmonar y la fuerza de agarre. Resultados: Fueron incluidos en el estudio 44 pacientes, con edad media de 62.3 años y 28 hombres. Se obruvo una puntuación alta de Perme entre los pacientes que se sometieron a un injerto de derivación de la arteria coronaria a partir del segundo día posoperatorio y al tercer día posoperatorio en tres tipos de intervención (injerto de derivación de la arteria coronaria, reemplazo de válvula o ambos simultáneamente), se asoció con una estancia más corta en la UCI. La función pulmonar preoperatoria fue uno de los principales predictores independientes del estado de movilidad en los tres primeros días de estancia en la UCI, además de la fracción de eyección del ventrículo izquierdo y el tiempo de circulación extracorpórea al primer día, la edad y la fracción de eyección del ventrículo izquierdo al segundo día y presión espiratoria máxima al tercer día. Conclusión: Un aumento en el estado de movilidad (Perme Score), principalmente en el tercer día postoperatorio, redujo la estancia en la UCI, influenciado principalmente por la función pulmonar preoperatoria.
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Introdução e Objetivo: O impacto do câncer em pacientes com DAP sobre nível de atividade física diária, capacidade funcional, função cardiovascular e qualidade de vida ainda não é conhecido, sendo, portanto, o objetivo deste presente estudo. Métodos: Estudo transversal com 299 pacientes. Nível de Atividade física (acelerômetro), capacidade funcional (teste de caminhada de 6 minutos, Handgrip, Short Physical Performance Battery, Walking Impairment Questionnaire-WIQ e o Walking Estimated-Limitation Calculated by History), função cardiovascular (pressão arterial braquial, variabilidade da frequência cardíaca e rigidez arterial) e qualidade de vida (WHOQOL-bref) foram comparados entre os pacientes com DAP com e sem histórico de câncer. Resultados: Pacientes com DAP e câncer (N=27) apresentaram melhor desempenho no domínio da distância e da velocidade do WIQ (21±37 vs 14±26, p=0.036; 29±18 vs 22±15, p=0.022, respectivamente) comparado aos pacientes com DP sem câncer. Os outros parâmetros foram similares entre os grupos. Conclusão: Os pacientes com DAP e câncer apresentaram
Introduction and Objective: The impact of cancer in patients with PAD on the level of daily physical activity, functional capacity, cardiovascular function and quality of life is not yet known, thus being the objective of this present study. Methods: Cross-sectional study with 299 patients. Physical activity level (accelerometer), functional capacity (6-minute walk test, Handgrip, Short Physical Performance Battery, Walking Impairment Questionnaire-WIQ and the Walking Estimated-Limitation Calculated by History), cardiovascular function (brachial blood pressure, variability of heart rate and arterial stiffness) and quality of life (WHOQOL-bref) were compared between patients with PAD with and without a history of cancer. Results: Patients with PAD and cancer (N=27) performed better in the distance and speed domains of the WIQ (21±37 vs 14±26, p=0.036; 29±18 vs 22±15, p=0.022, respectively) compared to PD patients without cancer. The other parameters were similar between groups. Conclusion: Patients with PAD and cancer had better results for subjectively assessed functional capacity.
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Objective:To investigate the attribution therapy on self-efficacy and physical function among patients with rheumatoid arthritis, and provide reference for functional rehabilitation of patients.Methods:A total of 72 rheumatoid arthritis patients of Rheumatology Department of Henan Province Orthopaedic Hospital were divided into experimental group ( n=36) and control group ( n=36) by random digits table method. The control group received routine nursing, while experimental group implemented attribution therapy for 6 times. Before and after 3 months of intervention, the intervention effect was assessed by using Health Assessment Questionnaire (HAQ), Clinical Disease Activity Index (CDAI), morning stiffness time as well as Arthritis Self-efficacy Scale (ASES), respectively. Results:After intervention, the scores of HAQ, CDAI were 0.62 ± 0.23, 9.52 ± 3.15, morning stiffness time were (31.76 ± 5.80) minutes in the experimental group, significantly lower than those in the control group (0.91 ± 0.33, 12.41 ± 2.70) points and (35.91 ± 7.90) minutes. The differences were statistically significant ( t=4.09, 4.04, 2.46, all P<0.05). The scores of self-efficacy pain subscale, self-efficacy function subscale, self-efficacy other symptoms subscale and total ASES scores were 6.58 ± 1.20, 5.88 ± 1.36, 6.67 ± 1.90 and 6.30 ± 0.81, significantly higher than those in the control group (5.97 ± 0.76, 5.18 ± 1.24, 5.59 ± 1.73 and 5.59 ± 0.74), the differences were statistically significant ( t values were 2.21-3.77, P<0.05). Conclusions:Attribution therapy can effectively alleviate physical function and promote self-efficacy of patients with rheumatoid arthritis.
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This review aims to interpret the interventions to improve physical function for children and young people with cerebral palsy, thus providing relevant suggestions.Relevant literatures published before November 2018 were systematically searched in Cochrane library, CINAHL, and Embase MEDLINE using the Grading of Recommendations Assessment, Development and Evaluation method.Consult with international experts and patients to assess evidence and recommend it.Based on 3 systematic reviews, 30 randomized clinical trials, and 5 pre-and post-treatment studies, a total of 13 recommendations were given.The guidelines recommend that, in order to achieve functional stan-dards, intervention measures should include, patient-selected goals, full-task practice in real-life settings, support for family empowerment, and a team approach.The age, ability, and child/family preferences were all needed to be considered.In order to improve walking ability, ground walking and treadmill training can be carried out.Various methods can promote the realization of hand use goals hand use, including the two-hand exercise training, constraint-induced moverment therapy, goal-oriented training and cognitive therapy.In terms of patient self-care, the guideline proposed that, the combination of full-task practice and auxiliary equipment can improve the independence of self-care and reduce the burden of care givers.Leisure goals could be achieved by the combination of the practice of the entire task with strategies to address environmental, personal, and social barriers.The intervention of children and adolescents with cerebral palsy should take into consideration of patient selection and the goal of full-task practice.The child/family preference, age and ability should be considered when clinical workers selecting specific interventions.
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Many acute and subacute complications of coronavirus disease 2019 (COVID-19) have been reported. However, the recovery process in severely ill patients is not clear. Here, we report three patients with favorable physical function after severe COVID-19. All three patients were older than 65 years and had comorbidities such as diabetes mellitus, hypertension, and smoking habits. During respiratory failure, they received mechanical ventilation support for more than 4 days. Two patients had undergone tracheostomy, and one had undergone extracorporeal membrane oxygenation (ECMO). At the time of transfer to our hospital, they had lower-limb muscle weakness, respiratory distress on exertion, exercise-induced hypoxemia (EIH), and complications from immobility, such as peroneal nerve palsy. During rehabilitation, we monitored peripheral blood oxygen saturation, adjusted the workload, and administered temporary orthotic therapy. The patients improved within 150 days after the onset of the disease, and they were discharged home and were able to walk as a practical means of transportation. Even after severe COVID-19, the patients achieved good physical function. Interventions for EIH and complications due to immobility were additionally necessary. In the future, we must examine the relationship between improvements in physical function and rehabilitation.
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Resumo Avaliar e correlacionar o estado funcional (EF) e a força muscular (FM) em adultos jovens, adultos e idosos em Unidade de Terapia Intensiva (UTI). Coorte prospectiva com 48 pacientes avaliando EF por meio do Functional Status Score for the Intensive Care Unit (FSS-ICU) e FM pelo Medical Research Council Sum-Score (MRC-SS) e força de preensão palmar (FPP), no despertar e na alta da UTI. Dados analisados pelos testes Kruskall-Wallis, Qui-quadrado, Wilcoxon e Correlação de Sperman. Na comparação do despertar em relação à alta, o EF e o MRC-SS foram maiores na alta em todos os grupos, com menor ganho nos idosos. A FPP aumentou bilateralmente na alta, exceto no grupo de adultos, pois apresentavam valores maiores no despertar. Na comparação dos grupos, o FSS-ICU foi maior nos adultos no despertar e alta, e a FPP-D menor nos idosos. O EF apresentou forte associação com a FM em adultos jovens e adultos, pois ambos apresentam progressiva melhora durante a permanência na UTI. Os idosos apresentam menor ganho do estado funcional, além de apresentarem menor força muscular desde o despertar. Estas variáveis apresentam importante associação apenas nos adultos jovens e adultos, considerando a natureza multifatorial do processo de adoecimento e incapacidade nos idosos.
Abstract The aim of this study was to analyze and assess the association between functional status (FS) and muscle strength (MS) in young adults, adults and older adults in an intensive care unit (ICU). We conducted a prospective cohort study with 48 patients. FS was assessed using the Functional Status Score for the Intensive Care Unit (FSS-ICU) and MS was measured using the Medical Research Council Sum-Score (MRC-SS) and by testing handgrip strength (HS). The assessments were performed on awakening and ICU discharge. The data were analyzed using the Kruskall-Wallis, chi-squared, Wilcoxon and Spearman's correlation tests. FS and MRC-SS scores were higher on ICU discharge in all groups. Gains were lowest in the older adult group. HS was greater in both hands on ICU discharge in all groups except the adults. FSS-ICU on both awakening and ICU discharge was highest in the adults; HS-R was lowest in the older adults. There was a strong association between FS and MS in the young adults and adults. FS and MS showed progressive improvement during ICU stay. Gains in FS and MS on awakening and ICU discharge were lowest among the older adults. Important associations were found between these variables in all groups except the older adults. This can be explained by the multifactorial nature of illness and incapacity in this group.
Subject(s)
Humans , Aged , Young Adult , Hand Strength , Functional Status , Prospective Studies , Muscle Strength , Intensive Care UnitsABSTRACT
To evaluate the effectiveness of a 24-week nutritional supplementation program involving whey protein intake after resistance exercise in treatment of sarcopenia and quality of life (QOL) among older women with sarcopenia, we carried out a pilot study, randomized controlled trial among elderly individuals with sarcopenia, aged 65-years or older, who were allocated to three groups: exercise and whey protein supplementation (Ex+Whey) group, exercise (Ex) group, and whey protein supplementation (Whey) group. Sarcopenia was defined using the Asian Working Group for sarcopenia 2014 criteria, as follows: low hand-grip strength (<18.0 kg) or slow gait speed (<0.8m/sec), and low skeletal muscle mass index (SMI, <5.7kg/m2). A 24-week program of resistance exercise, carried out twice per week, was combined with whey protein supplementation, involving 11.0 g of protein and 2,300 mg of leucine. After the 24-week intervention period, the Ex+Whey group (n=20) showed a decrease in sarcopenia, lower SMI, lower grip strength, and increase in physical QOL score (sarcopenia; p=0.004, SMI and grip strength; p=0.008, QOL; p=0.027). After the 24-week intervention period, the Whey group (n=20) showed a decrease in sarcopenia and lower SMI (all p=0.017). The Ex-group (n=19) did not show a decrease in sarcopenia, lower SMI, and lower grip strength. These results suggest that resistance exercise and whey protein intake in older women with sarcopenia, on the multiple outcome measures such as improves lower SMI, lower grip strength, and physical QOL. However, there were no between-group differences in the change from the pre- to the post-intervention period at 24 weeks in the lower SMI and lower grip strength. In this study, the intervention effect of Ex+Whey could not be clearly shown in the outcome measures.
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The aim of this study was to examine the relationship between deep squatting or ROM of lower limbs, and physical function in typically developing children. 337 elementary school students were recruited for this study. The subjects were performed to squat with their heels down and then were divided into 2 groups: possible squatting and impossible squatting. ROM of lower limbs (hip flexion, knee flexion, and ankle dorsiflexion), circumference of leg, standing long jump, the five-repetition sit-to stand test (FTSST) and a standing test were analyzed. Unpaired t-test or Mann-Whitney U test was used for the two-group comparison. Logistic regression analysis was used to determine variables associated with squatting, and multiple regression analysis was used to determine variables associated with physical function. The rate of impossible squatting was 11.9%. The ROM of the lower limbs was significantly decreased in the impossible group. Multiple regression analysis showed that the ankle dorsiflexion ROM and BMI were correlated with squatting. In physical function, the FTSST and standing test were correlated with squatting. However, in the multiple regression analysis squatting did not significantly affect physical function. In this study, ROM of the ankle dorsiflexion and BMI affected the squatting. It was suggested that the squatting might be useful as a screening for ankle dorsiflexion ROM.
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Objective：To investigate the physical functions of peripheral arterial disease (PAD) patients undergoing endovascular treatment (EVT), and their association with physical activity before EVT.Methods：One hundred and one PAD patients underwent EVT. Physical functions were specified as grip strength, walking speed, and the weight ratio of knee extension isometric muscle strength (KEIS). We divided the patients into 3 groups, based on the amount of physical activity per week：(a) low activity (0 kcal/week：n＝52), (b) moderate activity (0 kcal to less than 500 kcal/week：n＝22), and (c) high activity (more than 500 kcal/week：n＝27). Physical activity data were collected using an international standardized physical activity questionnaire. A multivariate regression analysis (cumulative logit model) was used to evaluate the association between physical activity (low activity, moderate activity, high activity) and KEIS＜0.4 kgf/kg.Results：The averages of the physical functions were：grip strength (kg；Men 28.1, Women 16.6), walking speed (m/s；Men 1.10, Women 0.96), KEIS (kgf/kg；Men 0.42, Women 0.28). The prevalence of KEIS＜0.4 kgf/kg was 56.4％ (n＝57). KEIS＜0.4 kgf/kg was not significantly different between low and moderate activity groups (Odds：0.99, p＝0.98). However, KEIS＜0.4 kgf/kg was significantly different between low and high activity groups (Odds：5.02, p＝0.007).Conclusion：Physical functions were lower in PAD patients undergoing EVT than in healthy adults of the same age, and KEIS was related to physical activity before EVT.
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@#Introduction: Cognitive decline and cognitive impairment among older adults is a rising public health concern because of its association with increased risk of dementia, disability and mortality. In Malaysia, early identification of cognitive impairment is uncommon due to lack of understanding of risk profile of the elderly population. The objective of this study was to determine factors associated with cognitive impairment among community-dwelling older adults. Methods: This cross-sectional study was conducted among 698 community-dwelling older adults aged 60 years old and above in Klang Valley, Malaysia by using multi-stage sampling to determine the risk factors and predictors of cognitive impairment from a multidimensional approach. Multivariate logistic regression analysis was performed to determine the relationship between socio-demographic characteristics, physical activity, physical functional status and cognitive impairment. Results: Increased of age (OR = 1.056), being female (OR = 2.219) and Indian (OR = 2.722) were the risk factors for cognitive impairment, while years of education (OR = 0.765), physically active (OR = 0.823) and better physical function (OR = 0.843) were significantly associated with decreased risk of cognitive impairment. Marital and nutritional status failed to predict the risk of cognitive impairment. Conclusion: Given the protective effects of physical activity and physical function on the cognitive decline at later age, relevant policymakers should formulate appropriate health education programmes to promote regular physical activity to improve physical and cognitive function among Malaysians across all ages.
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Objective To study the effect of cardiac autonomic nerve function on body function and weakness in elderly diabetic patients.Methods A total of 100 patients diagnosed as diabetic autonomic neuropathy in the endocrine ward of Dalian Friendship Hospital from August 2017 to August 2018 were enrolled.The demographics,clinical data,and Activities of Daily Living (ADL) scale of each patient were recorded,and the Instrument Activities of Daily Living (IADL) and the weak score were used to record heart rate variability in each patient.Aweak score of 5 was used as boundaries.Patients with weak score greater than or equal to 5 were divided into weak group,and those less than 5 were divided into non-weak groups.Each indicators were compared between the two groups.The statistically significant variables were used as covariates,and the weak scores were used as dependent variables to perform direct and indirect Logistic regression analysis of covariates and dependent variables and the receiver operation characteristic (ROC) curve.Results There were significant differences between the two groups in age,diabetes history,heart rate variability,standard deviation of NN intervals (SDNN),standard deviation of sinus RR interval every 5 min (SDANN),triangle index,ultralow frequency (ULF),very low frequency (VLF),activities of daily living (ADL),instrument activities of daily living (IADL) (t =13.45,U=1700,t =-17.52,t =-18.34,U =1204.00,U=3407.56,t=17.90,t =21.89,t=12.21,P＜ 0.05).Age,diabetes history,heart rate variability,SDNN,SDANN,triangle index,ULF,VLF,ADL,IADL were independent factors of weakness (B =1.14,0.98,-0.46,-0.45,-0.79,0.57,0.53,-0.67,-0.79,P ＜ 0.05).Age,history of diabetes,SDNN,SDANN,ULF,VLF could affect the weak score by indirectly affecting ADL/IADL (B =0.54/0.23,0.16/0.07,-0.34/-0.04,,-0.54/-0.03,0.99/0.21,0.47/0.22,P ＜0.05).SDNN,SDANN and ULF could significantly predict weakness,and the sensitivity values of the Yuedeng index maximum were 98ms,97ms and 236 ms2/Hz,respectively.Conclusions Week score needs to be assessed in patients with diabetic autonomic neuropathy who have a long history of diabetes,and a DANN greater than 98 ms,a SDANN greater than 97 ms,and a ULF greater than 236 ms2/Hz in the heart rate variability index.
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Objective：To investigate the physical functions of peripheral arterial disease (PAD）patients undergoing endovascular treatment (EVT), and their association with physical activity before EVT.Methods：One hundred and one PAD patients underwent EVT. Physical functions were specified as grip strength, walking speed, and the weight ratio of knee extension isometric muscle strength (KEIS). We divided the patients into 3 groups, based on the amount of physical activity per week：(a) low activity (0 kcal/week：n＝52), (b）moderate activity (0 kcal to less than 500 kcal/week：n＝22), and (c) high activity (more than 500 kcal/week：n＝27). Physical activity data were collected using an international standardized physical activity questionnaire. A multivariate regression analysis (cumulative logit model) was used to evaluate the association between physical activity (low activity, moderate activity, high activity) and KEIS＜0.4 kgf/kg.Results：The averages of the physical functions were：grip strength (kg；Men 28.1, Women 16.6), walking speed (m/s；Men 1.10, Women 0.96), KEIS (kgf/kg；Men 0.42, Women 0.28). The prevalence of KEIS＜0.4 kgf/kg was 56.4％ (n＝57). KEIS＜0.4 kgf/kg was not significantly different between low and moderate activity groups (Odds：0.99, p＝0.98). However, KEIS＜0.4 kgf/kg was significantly different between low and high activity groups (Odds：5.02, p＝0.007).Conclusion：Physical functions were lower in PAD patients undergoing EVT than in healthy adults of the same age, and KEIS was related to physical activity before EVT.
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Objective@#To study the effect of cardiac autonomic nerve function on body function and weakness in elderly diabetic patients.@*Methods@#A total of 100 patients diagnosed as diabetic autonomic neuropathy in the endocrine ward of Dalian Friendship Hospital from August 2017 to August 2018 were enrolled. The demographics, clinical data, and Activities of Daily Living (ADL) scale of each patient were recorded, and the Instrument Activities of Daily Living (IADL) and the weak score were used to record heart rate variability in each patient. Aweak score of 5 was used as boundaries. Patients with weak score greater than or equal to 5 were divided into weak group, and those less than 5 were divided into non-weak groups. Each indicators were compared between the two groups. The statistically significant variables were used as covariates, and the weak scores were used as dependent variables to perform direct and indirect Logistic regression analysis of covariates and dependent variables and the receiver operation characteristic (ROC) curve.@*Results@#There were significant differences between the two groups in age, diabetes history, heart rate variability, standard deviation of NN intervals (SDNN), standard deviation of sinus RR interval every 5 min (SDANN), triangle index, ultralow frequency (ULF), very low frequency (VLF), activities of daily living (ADL), instrument activities of daily living (IADL) (t=13.45, U=1700, t=-17.52, t=-18.34, U =1204.00, U=3407.56, t=17.90, t=21.89, t=12.21, P< 0.05). Age, diabetes history, heart rate variability, SDNN, SDANN, triangle index, ULF, VLF, ADL, IADL were independent factors of weakness (B=1.14, 0.98, - 0.46, -0.45, -0.79, 0.57, 0.53, -0.67, -0.79, P<0.05). Age, history of diabetes, SDNN, SDANN, ULF, VLF could affect the weak score by indirectly affecting ADL/IADL (B=0.54/0.23, 0.16/0.07, -0.34/-0.04,, -0.54/-0.03, 0.99/0.21, 0.47/0.22, P< 0.05). SDNN, SDANN and ULF could significantly predict weakness, and the sensitivity values of the Yuedeng index maximum were 98ms, 97ms and 236 ms2/Hz, respectively.@*Conclusions@#Week score needs to be assessed in patients with diabetic autonomic neuropathy who have a long history of diabetes, and a DANN greater than 98 ms, a SDANN greater than 97 ms, and a ULF greater than 236 ms2/Hz in the heart rate variability index.
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INTRODUÇÃO: Recentes evidências têm demonstrado resultados bastante promissores para o uso de estratégias não invasivas de neuromodulação na melhora de habilidades físicas ou esportivas. A estimulação elétrica periférica (EEP) e a estimulação transcraniana por corrente contínua (ETCC) são técnicas não invasivas e não farmacológicas bastante utilizadas para modular a excitabilidade neuronal de áreas cortico-motoras e estimular a recuperação funcional. No entanto, poucos estudos têm investigado o efeito dessas técnicas na melhora do desempenho muscular. OBJETIVO: Investigar o efeito da estimulação elétrica periférica sensorial (EEPs) seguida de estimulação elétrica periférica motora (EEPm) ou estimulação transcraniana por corrente contínua (ETCC) na força isométrica máxima dos extensores do joelho em indivíduos saudáveis. MÉTODO: 20 universitários saudáveis foram distribuídos aleatoriamente em dois blocos distintos de 10 participantes cada: Bloco n°1 EEPs real + EEPm real ou EEPs simulada + EEPm real e bloco n°2 EEPs real + ETCC real ou EEPs simulada + ETCC real em uma única sessão. A contração voluntária isométrica máxima (CVIM) dos extensores do joelho foi avaliada por meio da dinamometria manual antes, durante e 10 min pós-estimulação. RESULTADOS: A CVIM dos extensores do joelho aumentou significativamente 10 minutos pós-ETCC isolada (diferença média = 0,23 N/Kg; IC 95% = 0,01 a 0,44 N/Kg; p = 0,04). A ETCC isolada também apresentou maior proporção cumulativa de respondedores seguido de EEPs+ETCC. CONCLUSÃO: A estimulação transcraniana por corrente contínua induz a aumentos significativos na CVIM em indivíduos saudáveis. No entanto, a aplicação prévia de estimulação elétrica periférica sensorial não impulsiona os efeitos da estimulação elétrica periférica motora ou cerebral na CVIM.
INTRODUCTION: Recent evidence has shown very promising results for the use of noninvasive neuromodulation strategies in improving physical strength or sports skills. Peripheral electrical stimulation (PES) and transcranial direct current stimulation (tDCS) are non-invasive and non-pharmacological techniques widely used to modulate neuronal excitability of corticomotor areas and to induce functional improvements. However, few studies have investigated the effect of these techniques on improving muscle performance. OBJECTIVE: To investigate the effect of sensory peripheral electrical stimulation (PESs) followed by motor peripheral electrical stimulation (PESm) or transcranial direct current stimulation (tDCS) on the maximal isometric force production of the knee extensors in healthy individuals. METHODS: Twenty healthy university students were randomly assigned to two distinct blocks with 10 participants in each block: 1) block n°1 PESs + PESm or sham PESs + PESm, 2) block n°2 PESs + tDCS or sham PESs + tDCS (each in a single session). The maximum voluntary isometric contraction (MVIC) of the knee extensors was evaluated by manual dynamometry pre-, during and 10 min post-stimulation. RESULTS: MVIC of the knee extensors was significantly increased 10 min post-tDCS alone (mean difference = 0.23 N/kg, 95% CI = 0.01 to 0.44 N/kg, p = 0.04). Isolated tDCS also had a higher cumulative proportion of responders, followed by PESs + tDCS. CONCLUSIONS: Transcranial direct current stimulation induces a significant increase in MVIC in healthy subjects. However, prior application of peripheral electrical stimulation does not compound the effects of peripheral electrical motor or cerebral stimulation.
Subject(s)
Physical Functional Performance , Electric Stimulation , Transcranial Direct Current StimulationABSTRACT
ABSTRACT: Aerobic capacity declines significantly throughout life, beginning at the age of 30 years and accelerating from 60 years, where a decline of 17% per decade is expected thereafter. Objective: To investigate the association between aerobic capacity and a diagnosis of mild cognitive impairment (MCI), mild AD or moderate AD in older adults, considering the risk classification of functional loss of the Step test. Methods: In this cross-sectional study, 93 patients (age >60 years) were evaluated (Healthy=36; MCI=18, AD=39). The step test was used to assess aerobic capacity, while overall cognitive status was measured using the MMSE. The groups were divided according to the risk classifications of functional loss into below or above the standard cut-off point for aerobic capacity. Results: Subjects in the functional loss risk group were approximately ten to fourteen times more likely to be diagnosed with mild (OR:10.7; p=0.001) or moderate (OR.=14.7; p=0.002) AD than their fitter counterparts. Low aerobic fitness was also associated with the MCI condition (OR=4.5; p=0.05), but only after controlling for educational level, age and sex. In the overall sample (N=93), there was an association between aerobic capacity and MMSE performance (R2=0.35; p<0.001) after controlling for confounding variables. Conclusion: low aerobic capacity was associated with cognitive decline, and older adults at risk of functional loss on the STEP test had greater chance of being diagnosed with MCI or AD after controlling for age, sex and education.
RESUMO: A capacidade aeróbica diminui significativamente ao longo da vida, começando com a idade de 30 anos e acelerando a partir dos 60 anos, onde se prevê um declínio de 17% por década. Objetivo: Investigar a associação entre a capacidade aeróbica medida e o risco de desenvolvimento de comprometimento cognitivo leve (CCL), DA leve e moderado em idosos, considerando as classificações de risco de perda funcional para o teste do STEP. Métodos: Nesse estudo de corte-transversal, foram avaliados 93 idosos (>60 anos) (saudáveis=36; CCL=18, DA=39). Para acessar a capacidade aeróbica foi utilizado o teste de STEP e o estado cognitivo global foi medido através do MEEM. Os grupos foram divididos em relação às classificações de risco de perda funcional em abaixo ou acima do ponto de corte padronizado para idosos. Resultados: Idosos incluídos no grupo de risco de perda funcional tinham aproximadamente dez a catorze vezes mais chances de serem diagnosticados com DA leve (O.R:10.7; p=0.001) e moderado (O.R.=14.7; p=0.002), do que os seus pares mais bem condicionados. Menores níveis de capacidade aeróbica também foram associados com o diagnostico de CCL (O.R=4.5; p=0.05), entretanto apenas após controle por idade, escolaridade e sexo. Na amostra total (N=93) houve uma associação entre a capacidade aeróbica e o MEEM (R2=0.35; p<0.001) depois de controlado pelas variáveis confundidoras. Conclusão: Idosos que se encontram dentro da classificação de risco de perda funcional medida através do teste de STEP possuem maiores chances de desenvolverem CCL, Alzheimer leve e moderado mesmo após controle por idade, sexo e escolaridade.
Subject(s)
Humans , Aged , Aged, 80 and over , Cognitive Dysfunction , Alzheimer Disease , Motor ActivityABSTRACT
Objective To explore the relationship between nutrition status and activity of daily livingof elders in nursing homes and the mediating effect of physical activity. Methods From Apr to Sep in 2016,320 elders in nursing homes were selected and were surveyed using the standardized tools. The mediating effects were analyzed with PROCESS. Results The scores of elders′ nutrition status, physical function and activities of daily living were (11.88±2.27), (3.61±3.51), (79.13±26.00) points, respectively. And there were 66.9％ elders suffering from activities of living life impaired. The nutrition status were significantly positive correlated with physical function and activities of daily living of elders, and the physical function were significantly positive correlated with activities of daily living of elders. The physical function partly mediated the association between nutrition status and activities of daily living, and the effect was reached to 39.1％. Conclusions The elders′activities of daily life was poor in nursing home in China. The physical function partly mediated the association between nutrition status and activities of daily living. The related departments could combine the long time and short time plans targeting at improving of nutrition status and physical function respectively, to enhance the outcomes of elders in nursing homes.
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@#n this review weaimed to determine the prevalence of urinary incontinence (UI)and its association with declined cognitive and physical function among community dwelling older adults. Literature review was performed using multiple online databases includingMEDLINE, Science Direct andWiley Online Library from June 2000 to April 2017. Hand searching ofbibliographies of relevant studies was also carried out. The studies included ofthose conducted from within the last 17years; assessed and compared according to population characteristics, definition of urinary incontinence, prevalence and its association with cognitive and physical functionaldecline. Nine studies met the eligibility criteria of this review. Prevalence rates of UI among community dwelling older adults ranged from10% to 53% (median 32%).Physical functionaldecline in termsof mobility, locomotion and activities of daily living interruptions werefound to be correlated with UI. Although limited, the existing evidence also showed an association between declined cognitive function and UI.
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OBJECTIVE@#To identify and synthesize the most recent available evidence of effectiveness of acupuncture on pain, physical function and health-related quality of life (HRQoL) in patients with rheumatoid arthritis (RA).@*METHODS@#A comprehensive search of 12 Western and Chinese databases was undertaken from their inception up to end of 2016. Randomized controlled trials (RCTs), concerning patients with RA treated with needle acupuncture, written in English, Portuguese, German or Chinese were included. Primary outcomes included pain, physical function and HRQoL. Secondary outcomes included morning stiffness, functional impairment, number of tender and swollen joints and serum concentrations of inflamatory markers. Methodological quality was assessed by three independent reviewers using the standardized critical appraisal instrument from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument.@*RESULTS@#Twenty-two studies met the inclusion criteria. Of those, 9 studies were excluded after assessment of their methodological quality. The remaining 13 original RCTs included 974 patients. Ten of these studies published in China, showed favorable statistical significant effects of acupuncture in relieving symptoms of RA compared with controls.@*CONCLUSIONS@#Evidence suggests that acupuncture interventions may have a positive effect in pain relief, physical function and HRQoL in RA patients. However, due to the heterogeneity and methodologic limitations of the studies included in this systematic review, evidence is not strong enough to produce a best practice guideline.
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PURPOSE: The purpose of this study was to systematically review the instruments utilized to assess physical impairment in post-intensive care syndrome (PICS) of intensive care unit (ICU) survivors.METHOD: Online databases searched were MEDLINE, Cochrane, CINAHL, and Embase. Studies that met the following criteria were included: 1) the study population exclusively had experience with ICU admission; 2) the study assessed pulmonary, neuromuscular, and physical functions; and 3) the study was published in English language journals after 2007.RESULTS: A total of 56 instruments (2 pulmonary, 25 neuromuscular, 29 physical function) from 94 studies were reviewed. They were classified into self-report, observation, and measurement according to the type of assessment. No instrument measured all 3 areas of physical impairment. Five instruments were originally developed for the ICU patients. The most frequently applied instruments were the Medical Research Council and the 36-item Short Form Survey (physical component summary), which were used in 23 studies each. Only 13.8% of reviewed studies reported the reliability or validity of the instruments.CONCLUSION: Our results suggest that the appropriateness of instruments assessing physical impairment in PICS cannot be guaranteed. Despite the multidimensional concept of physical disabilities, most studies measured only one area, and studies that reported psychometric properties were limited. Accordingly, we propose to develop a unique and multifaceted instrument for ICU survivors.