Recovery of mobility function and life-space mobility after ischemic stroke: the MOBITEC-Stroke study protocol.

BACKGROUND: Stroke is a major cause of disability and stroke incidence increases with age. Stroke frequently results in permanent limitations of mobility, and, consequently, the need for the help of others in activities of daily living. In order to optimize rehabilitative efforts and their functional outcomes, detailed knowledge of the functional recovery process, regarding mobility, is needed. Objectives of the MOBITEC-Stroke study are: 1.) To characterize mobility, including lower extremity physical function (LEPF) and life space (the geospatial extent of all of a person's movements), and changes in mobility within the first year after stroke. 2.) To identify and characterize subgroups with different mobility trajectories. 3.) To evaluate whether changes in LEPF are associated with changes in life-space. 4.) To evaluate participants' reasons for going outdoors, transportation use, and assistance needed for outdoor movement. METHODS: Patients with incident first stroke who live in their own homes (target N = 59, based on sample size calculation) will be included in this cohort study. At 3, 6, 9, and 12 months after stroke a battery of mobility tests will be performed at the study centre, including laboratory-based tests of balance and strength, and quantitative gait analysis. Life-space assessment (including 1-week GPS measurements) will be performed in participants' real life. Semantic information on visited locations (reasons for going outdoors, transportation use, assistance needed) will be collected by using interactive digital maps. Linear mixed effects models will be used to model the trajectories of mobility measures for the total sample and for predefined subgroups. As an exploratory analysis, growth mixture models (GMMs) will be used to identify relevant subgroups with different trajectories. Linear mixed effect models will be used to test whether changes in LEPF parameters are associated with changes in life-space. Participants' motivation for going outdoors, transportation use, and assistance needed for outdoor mobility will be analysed descriptively. DISCUSSION: A comprehensive and detailed knowledge of recovery patterns will enable the planning of targeted and adaptively tailored rehabilitation measures. Information about patients' reasons for outdoor mobility will provide the opportunity to define individualized and patient-oriented rehabilitation goals. TRIAL REGISTRATION: ISRCTN85999967 (on 13 August 2020; retrospectively).

Prevalence and associated factors of pain in the Swiss spinal cord injury population.

STUDY DESIGN: Population-based, cross-sectional. OBJECTIVES: To determine pain prevalence and identify factors associated with chronic pain in individuals with spinal cord injury (SCI) living in Switzerland. SETTING: Swiss SCI Cohort Study (SwiSCI). METHODS: Pain characteristics were assessed using an adapted version of the International SCI Pain Basic Data Set, adding one item of the SCI Secondary Conditions Scale to address chronic pain. Pain prevalence was calculated using stratification over demographic, SCI-related and socioeconomic characteristics; odds ratios (adjusted for non-response) for determinants of severity of chronic pain were calculated using stereotype logistic regressions. RESULTS: Pain (in the past week) was reported by 68.9% and chronic pain by 73.5% (significant 36.9%) of all participants (N=1549; 28% female). Most frequently reported pain type was musculoskeletal (71.1%). Back/spine was the most frequently reported pain location (54.6%). Contrasting the 'significant' to the 'none/mild' category of chronic pain, adjusted odds ratios were 1.54 (95% CI: 1.18-2.01; P<0.01) for women (vs men); 6.64 (95% CI: 3.37-11.67; P<0.001) for the oldest age group 61+ (vs youngest (16-30)); 3.41 (95% CI: 2.07-5.62; P<0.001) in individuals reporting severe financial hardship (vs no financial hardship). Individuals reporting specific SCI-related health conditions were 1.41-2.92 (P<0.05) times more likely to report chronic pain as 'significant' rather than 'none/mild' compared with those without the respective condition. CONCLUSIONS: Pain is highly prevalent in individuals with SCI living in Switzerland. Considered at risk for chronic pain are women, older individuals and individuals with financial hardship and specific secondary health conditions. Longitudinal studies are necessary to identify predictors for the development of pain and its chronification.

Associations with being physically active and the achievement of WHO recommendations on physical activity in people with spinal cord injury.

STUDY DESIGN: Secondary data analysis from the cross-sectional survey of the Swiss Spinal Cord Injury Cohort Study. OBJECTIVES: To explore associations with physical activity (PA) levels in people with spinal cord injury (SCI) with the specific aim to identify aspects that potentially explain being physically active (PHYS-ACT) and the achievement of the World Health Organization recommendations on PA. SETTING: Community sample (n=485). METHODS: Participants who completely answered four items of the Physical Activity Scale for Individuals with Physical Disabilities were included. Two outcome measures were defined: (1) being PHYS-ACT vs being completely inactive and (2) achieving WHO recommendations on PA (ACH-WHO-REC) (at least 2.5 h per week of at least moderate intensity) vs performing less. Independent variables were selected from the original questionnaire by applying the ICF framework. Multivariate logistic regression analyses were conducted. RESULTS: In the participants (aged 52.8±14.8; 73.6% male) older age decreased, but being a manual wheelchair user increased the odds of achieving both outcomes. Social support and self-efficacy increased the odds of being PHYS-ACT. Use of an intermittent catheter increased, whereas dependency in self-care mobility and coping with emotions decreased the odds for ACH-WHO-REC. Experiencing hindrances due to accessibility is associated with increased odds for ACH-WHO-REC. CONCLUSION: Being PHYS-ACT at all and achieving the WHO recommendations on PA are associated with different aspects. Applying the ICF framework contributes to a comprehensive understanding of PA behavior in people with SCI, which can tailor the development of interventions. Longitudinal studies should be initiated to test these associations for causal relationships.

Sports and brain morphology - a voxel-based morphometry study with endurance athletes and martial artists.

Physical exercises and motor skill learning have been shown to induce changes in regional brain morphology, this has been demonstrated for various activities and tasks. Also individuals with special skills show differences in regional brain morphology. This has been indicated for professional musicians, London taxi drivers, as well as for athletes like dancers, golfers and judokas. However little is known about whether sports with different metabolic profiles (aerobic vs. anaerobic) are associated with different patterns of altered brain morphology. In this cross-sectional study we investigated two groups of high-performance athletes, one group performing sports that are thought to be mainly aerobic, and one group performing sports known to have intermittent phases of anaerobic metabolism. Using high-resolution structural imaging and voxel-based morphometry (VBM), we investigated a group of 26 male athletes consisting of 13 martial artists and 13 endurance athletes as well as a group of non-exercising men (n=13). VBM analyses revealed higher gray matter (GM) volumes in the supplementary motor area/dorsal premotor cortex (BA 6) in both athlete groups as compared to the control group. In addition, endurance athletes showed significantly higher GM volume in the medial temporal lobe (MTL), specifically in the hippocampus and parahippocampal gyrus, which was not seen in the martial arts group. Our data suggest that high-performance sports are associated with changes in regional brain morphology in areas implicated in motor planning and motor learning. In addition high-level endurance sports seem to affect MTL structures, areas that have previously been shown to be modulated by aerobic exercise.

The prevalence of falls in adults aged 40 years or older in an urban, German population. Results from a telephone survey.

BACKGROUND: Single or frequent falls lead to increased morbidity due to fall-related injury, fear of falling, impairments in quality of life and loss of independence. To assess the impact of falls, prevalence data are essential. METHODS: In 2006, a telephone survey was performed in a random sample of 1270 inhabitants of the city of Herne, Germany, aged 40 years or older. Participants were asked about falls during the previous 4 weeks and 6 and 12 months, respectively. A fall was defined as an unexpected event in which the individual comes to rest on the ground, floor or a lower level. Participants were also asked about pain and whether or not a medical diagnosis of osteoporosis had ever been made. Standardized prevalences and odds ratios (OR) with 95 % confidence interval are reported. RESULTS: In total, 862 (67.9 %) adults participated. Participants were significantly older than non-participants and more often female than male. Prevalences standardized for the population of Herne for at least one fall within the previous 4 weeks or 12 months or two or more falls within 12 months, respectively, were 3.1 %, 12.1 %, and 4.5 %. Women were more often affected than men. A total of 2.3 % participants reported both at least one fall and a medical diagnosis of osteoporosis. The prevalence of falls increased with increasing age and was also related to musculoskeletal pain. CONCLUSIONS: Our estimates indicate that single and multiple falls affect a substantial proportion of adults in the urban population. Risk groups such as older adults and females with osteoporosis might represent a target group when considering measures for fall prevention.

An exercise programme for community-dwelling, mobility-restricted and chronically ill older adults with structured support by the general practitioner's practice (HOMEfit). From feasibility to evaluation.

Programmes containing health-enhancing physical exercise should be evaluated using standards that are just as rigorous as those required for drug development. In contrast to new medicines, exercise programmes are highly complex. This has to be taken into account when designing the research plan. In order to illustrate the development process of a "complex intervention", we use the example of an exercise programme for community-dwelling, mobility-restricted and chronically ill older adults. Based on a framework for evaluation of complex interventions (Medical Research Council [MRC], UK), a research plan was set up containing the phases: development, feasibility, evaluation, implementation. The development phase resulted in the design of a home-based exercise programme in which the target group is approached and supported via their general practitioner and an exercise therapist. A feasibility study was performed. Three quantitative criteria for feasibility (adoption, safety, continuing participation) were statistically confirmed which permitted the decision to proceed with the research plan. So far, the MRC framework has proved to be valuable for the development of the new programme.

Family-based genome-wide association study of frontal θ oscillations identifies potassium channel gene KCNJ6.

Event-related oscillations (EROs) represent highly heritable neuroelectric correlates of cognitive processes that manifest deficits in alcoholics and in offspring at high risk to develop alcoholism. Theta ERO to targets in the visual oddball task has been shown to be an endophenotype for alcoholism. A family-based genome-wide association study was performed for the frontal theta ERO phenotype using 634 583 autosomal single nucleotide polymorphisms (SNPs) genotyped in 1560 family members from 117 families densely affected by alcohol use disorders, recruited in the Collaborative Study on the Genetics of Alcoholism. Genome-wide significant association was found with several SNPs on chromosome 21 in KCNJ6 (a potassium inward rectifier channel; KIR3.2/GIRK2), with the most significant SNP at P = 4.7 × 10(-10)). The same SNPs were also associated with EROs from central and parietal electrodes, but with less significance, suggesting that the association is frontally focused. One imputed synonymous SNP in exon four, highly correlated with our top three SNPs, was significantly associated with the frontal theta ERO phenotype. These results suggest KCNJ6 or its product GIRK2 account for some of the variations in frontal theta band oscillations. GIRK2 receptor activation contributes to slow inhibitory postsynaptic potentials that modulate neuronal excitability, and therefore influence neuronal networks.

[Measurement of physical activity in older adults. Correlation between the PRISCUS-PAQ and accelerometry]. / Messung körperlicher Aktivität bei älteren Erwachsenen. Übereinstimmung zwischen PRISCUS-PAQ und Akzelerometrie.

BACKGROUND: The German questionnaire PRISCUS-PAQ was developed to measure actual physical activity of older adults in a telephone interview. PRISCUS-PAQ consists of ten main questions to assess the time spend in domestic activities (e.g., housework, gardening), sporting activities (e.g., riding a bicycle), and inactivity (e.g., sedentary activity, sleeping during the day) during the prior week. By assessing the number of days for each activity and the mean duration of performing this activity, a total score can be calculated. The total score corresponds to the energy consumption for 1 week. The aim of this study is to estimate the correlation of the PRISCUS-PAQ total score and accelerometry as an objective measurement method for the assessment of physical activity. MATERIAL AND METHODS: A total of 114 participants (58% women) with a mean age of 76 years participated in the study. PRISCUS-PAQ was initially analyzed descriptively. To assess the validity of PRISCUS-PAQ, the correlation (correlation coefficient of Spearman) was calculated between the total score of the questionnaire PRISCUS-PAQ and the 95% trimmed sum of an accelerometer with a measurement period of 1 week. RESULTS: The correlation coefficient for the association of the PRISCUS-PAQ total score and the 95% trimmed sum of the acceleration values was r = 0.28 (95% confidence interval 0.10­0.44). Activities of daily life like cleaning and other domestic activities highly contributed to the weekly energy consumption of the participants. CONCLUSION: The association between the PRISCUS-PAQ questionnaire and accelerometry measured physical activity is comparable to other validated and established international questionnaires. The PRISCUS-PAQ is the first German questionnaire that allows the measurement of physical activity of older adults in a telephone interview.

[Injuries of the musculoskeletal system in German elite rowers]. / Beschwerden des Bewegungsapparats bei deutschen Hochleistungsruderern.

BACKGROUND: Elite rowers on national and international level are exposed to considerable impact on the musculoskeletal system. The aim of this study was to give an overview of the training load and the injuries of the musculoskeletal system in German elite rowers during the Olympic year. METHODS: A sample of 29 female rowers aged 22.2 ± 3.1 years and 38 male rowers aged 22.3 ± 3.1 years of German national team has been interviewed about training contents and training volume as well as about musculoskeletal injuries (current and over the past 12 months). Furthermore the athletes were asked to declare the supposed reason for the injuries. RESULTS: Rowers trained on average 22.8 ± 5.3 hours in 16.0 ± 4.6 training sessions per week. The most frequently reported injuries during the 12-month period were at the lumbar spine/buttock (50.0 % of interviewees), followed by the shoulder girdle (33.9 %), the forearm/hand (32.2 %), the cervical spine (31.6 %) and the thoracic spine (28.1 %). The most frequently reported reason for injuries was "overuse" in all regions. CONCLUSIONS: This study confirms a high prevalence of musculoskeletal injuries in German elite rowers and supports the demand for adequate preventive measures.

[Back pain, pain therapy and satisfaction with therapy--analyses in a cohort of elderly primary health care patients (getABI)]. / Rückenschmerz, Schmerztherapie und Therapiezufriedenhei--Analyse einer Kohorte älterer Hausarztpatienten (getABI).

INTRODUCTION: Back pain can affect quality of life and independence of elderly people. The goal of this study was to determine the prevalence of back pain in a cohort of elderly primary health care patients, as well as to analyse pain therapy and level of satisfaction with therapy. METHODS: In a monitored prospective cohort study (German epidemiological trial on ankle brachial index, getABI), 6 880 unselected patients aged 65 years and above have been followed up by 344 representative primary care physicians in Germany since October 2001. In the 5-year follow-up, 2 120 patients (median age 76; 70-94 years; 53.7% women) were interviewed by telephone about location and intensity of pain during the past 3 months, about impairment due to pain, about pain therapy and satisfaction with therapy. RESULTS: Of the 2 095 patients who answered the questions on pain, 803 (38.3%) had suffered from pain of the upper and/or lower back within the past 3 months. The prevalence of back pain was higher in female than in male patients (45.0% vs. 30.6%; p<0.05). In about half of the men and half of the women with back pain, the back was also the main pain region. This subsample (n=409) with the back as main pain region (BMP) was analysed in more detail. The mean "von Korff intensity score" (scale 0-100) was 46.5±19.9, the mean "von Korff impairment score" (scale 0-100) was 23.6±23.0. Women reported a higher mean intensity of back pain than men (48.8±20.0 vs. 42.4±19.3; p<0.05) and complained about a higher pain-related impairment (26.2±23.5 vs. 19.2±21.5; p<0.05). Of all BMP patients, 253 (61.9%) visited a physician (at least once) during the past 3 months due to pain. The treatments most frequently applied (multiple answers permitted) were: oral medication (62.5%), injections (38.6%), and physiotherapy (35.9%). Patients (n=224) were asked to rate the therapy on a scale from 1 to 6 (1 being the highest grade). The mean rating was 3.1±1.4. 36.8% were not satisfied with pain relief. 61.4% wished for a considerable improvement of their pain therapy. CONCLUSION: The prevalence of back pain in elderly people is high and leads to functional limitations. As a consequence of the rather low mean satisfaction with pain therapy, future studies on back pain therapy should include an assessment of patient preferences and satisfaction with therapy. It remains questionable, if the current medical care for elderly people with back pain complies with the latest guidelines that demand for multimodal therapy.

Prerequisites for a new health care model for elderly people with multimorbidity: the PRISCUS research consortium.

BACKGROUND: Multimorbidity, the concurrent manifestation or presence of multiple chronic conditions, poses huge challenges to affected patients, their relatives, physicians, and practitioners alike. The growing number of affected persons and the complexity of their needs places just as much of a burden on the health care system as does the plethora of often poorly coordinated interventions. The Chronic Care Model developed for different chronic diseases is suited for improving medical care. The PRISCUS research consortium was established to create the prerequisites for a new care model for multimorbid, elderly patients oriented along those lines. METHODS: The research consortium utilizes data gathered in a large-scale epidemiological study on peripheral arterial disease (getABI study) and from the Dortmund and Münster stroke registries, by extracting epidemiologic and health economic data, quality-of-life parameters, and data on the extent and quality of medication. Additional projects evaluate the implementation of a multidimensional geriatric assessment in primary care, the functional consequences of multimorbidity in stroke patients along with options for prevention and therapy afforded by physical activity. Systematic reviews of the literature are used to describe quality of life and patient preferences. Experts will work on an initial draft treatment standard for patients with multimorbidity and a list of potentially inappropriate medication for the elderly in Germany. CONCLUSION: The results of the PRISCUS research consortium will enable an epidemiologic characterization and description of consequences of multimorbidity, while illustrating new approaches towards prevention, diagnosis, and management of multimorbid patients. With this, some prerequisites for a new health care model for patients with multimorbidity comparable to the Chronic Care Model will be fulfilled.

[Prerequisites for a new health care model for elderly people with multiple morbidities: results and conclusions from 3 years of research in the PRISCUS consortium]. / Voraussetzungen für ein neues Versorgungsmodell für ältere Menschen mit Multimorbidität: Ergebnisse und Schlussfolgerungen aus 3-jähriger Forschung im PRISCUS-Verbund.

BACKGROUND: The concurrent presence or manifestation of multiple chronic conditions, i.e. multimorbidity, poses a challenge to affected patients and their relatives, physicians, and practitioners, and to the health care system in general. Aiming to improve medical care for different chronic diseases, the Chronic Care Model also appears to be suited for multimorbidity. The established research consortium PRISCUS is trying to create some of the prerequisites for a new care model for multimorbid, elderly patients oriented along the lines of the Chronic Care Model. METHODS AND RESULTS: Four out of seven subprojects of the research consortium provide an overview of some of their findings. Topics in a sports medicine subproject were the assessment of physical activity by means of a newly developed questionnaire and the development and feasibility testing of an exercise program for elderly people with chronic conditions and mobility impairment. Partners from family medicine implemented geriatric assessment in a primary care setting and evaluated its consequences. In a pharmacological subproject, potentially inappropriate medication as well as drug-drug interactions and dosing errors were addressed. The health economic subproject investigated quality of life impairment due to multiple chronic diseases and the effects of multimorbidity on costs. CONCLUSIONS: The results of the PRISCUS research consortium allow a better description of consequences of multimorbidity and illustrate at least some new approaches towards prevention, diagnosis, and treatment of patients suffering from multimorbidity. Ongoing projects will test the efficacy of a physical activity program and a new complex intervention to reduce potentially inappropriate medication in the elderly. With this, the research consortium will create some prerequisites for a new health care model for patients with multimorbidity comparable to the Chronic Care Model.

[Reliability of the PRISCUS-PAQ. Questionnaire to assess physical activity of persons aged 70 years and older]. / Reliabilität des PRISCUS-PAQ. Fragebogen zur Erfassung körperlicher Aktivität von Personen im Alter von 70 Jahren und älter.

A questionnaire (Q) to measure physical activity (PA) of persons ≥70 years for epidemiological research is lacking. The aim was to develop the PRISCUS-PAQ and test the reliability in community-dwelling people (≥70 years). Validated PA questionnaires were translated and adapted to design the PRISCUS-PAQ. Its test-retest reliability for 91 randomly selected people (36% men) aged 70-98 (76±5) years ranged from 0.47 (walking) to 0.82 (riding a bicycle). The overall activity score was 0.59 as determined by the intraclass correlation coefficient (ICC). Recording of general activities, e.g., housework (ICC=0.59), was in general less reliable than athletic activities, e.g., gymnastics (ICC=0.76). The PRISCUS-PAQ, which is a short instrument with acceptable reliability to collect the physical activity of the elderly in a telephone interview, will be used to collect data in a large cohort of older people in the German research consortium PRISCUS.

Voxel-based morphometry reveals an association between aerobic capacity and grey matter density in the right anterior insula.

This study investigated the effects of aerobic capacity on brain structure and memory performance. A sample of 33 healthy young subjects completed (i) assessment of aerobic capacity based on blood-lactate concentration, (ii) structural magnetic resonance imaging (MRI) scanning and analysis of grey matter density using voxel-based morphometry (VBM) and (iii) a range of memory tests. Memory performance was not significantly associated with aerobic capacity. After adjusting for effects of age, gender and total intracranial volume, cortical grey matter density in the right anterior insula was strongly correlated with aerobic capacity. These findings are in line with studies implicating the insula in the cortical control of cardiovascular processes during both exercise and autonomic arousal. Interindividual differences in aerobic capacity are thus reflected in structural differences in brain regions involved in cardiovascular control, resembling structural changes associated with certain cognitive or motor skills.

[Computed tomographic appearance of pulmonary mucormycosis]. / Computertomographisches Erscheinungsbild der pulmonalen Mukormykose.

AIM: Analysis of the morphological characteristics of pulmonary mucormycosis using computed tomography (CT). MATERIAL AND METHODS: Prospective analysis of CT studies in 9 patients out of 19 patients with proven pulmonary mucormycosis. RESULTS: Pulmonary mucormycosis was most frequently found in the upper lobe bilaterally (51% of all nodules). In 22% of the manifestations, the morphological criterion of a "bird's nest" could be verified in CT, in 37% central necrotic areas were detected. In 37% an open bronchus was diagnosed, in 6% we observed bronchiectases. 43% of all nodules presented with a halo sign. In three patients we found pleural effusions, enlarged mediastinal lymph nodes were diagnosed in one patient. CONCLUSION: Computed tomography allows an improved diagnosis and therapeutic follow-up in patients suffering from pulmonary mucormycosis.