Functional characteristics of female patients based on ambulatory ability 1 year after total knee arthroplasty.

BACKGROUND: Total knee arthroplasty (TKA) is commonly performed to reduce knee pain and improve physical function. Compared with the values for healthy, age-matched women, previous studies have reported large deficits in functional ability, such as muscle strength and ambulatory ability, in women 1 year post-TKA. Ambulatory ability is to move around, particularly by walking and is clinically assessed by the timed up and go test (TUG). AIM: This study aimed to clarify the characteristics of knee functions in female patients whose ambulatory ability recovered to a normal level at 1 year after TKA. METHODS: This cross-sectional study included 151 female patients who underwent TKA. The muscle strength of the lower extremity was measured, and the 2011 Knee Society Scoring (2011 KSS) system was used postoperatively. The TUG was conducted to assess ambulatory ability after TKA; then the patients were classified into the fast and slow ambulation groups based on previously reported gait-speed values of healthy female individuals. Then, we identified significant indicators of ambulatory ability at 1 year after TKA. RESULTS: Forty-nine percent of patients after TKA achieved the level of ambulatory ability of a healthy female. Logistic regression analysis identified that the non-operative side knee extensor strength and the functional activity score, as assessed by the 2011 KSS, were variables significantly associated with the mid-term ambulatory ability after TKA. CONCLUSION: Female patients with high non-operative knee extensor strength and a functional activity score at 1 year postoperatively can achieve better ambulatory ability than those of healthy, age-matched females.

Clinical prediction model for postoperative ambulatory ability outcomes in patients with trochanteric fractures.

INTRODUCTION: Regaining independent ambulatory ability is one of the primary goals of treatment in patients with trochanteric fractures. This study aimed to develop and evaluate the discriminative accuracy of a clinical prediction model for ambulatory ability outcomes 3 months after surgery for trochanteric fractures. METHODS: This retrospective cohort study included 346 patients treated with intramedullary nailing for trochanteric fractures who had independent ambulatory ability before their injury. Multiple regression models with preoperative and postoperative factors were used to predict ambulatory ability outcomes at 3 months. A clinical prediction model (CPM) was created based on a decision tree developed using a chi-square automatic interaction detector technique. RESULTS: Three months after surgery, 263 (76.0%) and 83 (24.0%) patients regained and lost independent ambulatory ability, respectively. Univariate analysis showed that the Barthel index (BI) total score at 2 weeks predicted the ambulatory ability outcome at 3 months with good discriminative accuracy (area under the receiver operating characteristic curve [AUROC]: 0.819; 95% confidence interval [CI]: [0.769, 0.868], cut-off value: 22.5; sensitivity: 69.5%; specificity: 82.3%). Multiple logistic regression analysis showed that preoperative factors (residence before injury, diagnosis of dementia, and serum albumin at admission) and postoperative factors (BI total score at 2 weeks) predicted ambulatory ability outcomes at 3 months (AUROC: 0.710; 95%CI: [0.636, 0.783]; sensitivity: 91.3%; specificity: 41.8%). The CPM with the BI total score at 2 weeks (≤10; 10<, ≤50; >50 points) and dementia status (present; absent) had a moderate discriminative accuracy (AUROC: 0.676; 95%CI: [0.600, 0.752]; sensitivity: 94.7%; specificity: 40.5%). CONCLUSIONS: We developed a CPM with moderate accuracy to predict ambulatory ability outcomes in patients 3 months after surgery for trochanteric fractures. Our results demonstrate the importance of the BI score measured soon after surgery and dementia status for the prediction of postoperative ambulation.

Prognostic Factors of Ambulatory Status for Patients with Metastatic Spinal Cord Compression: A Systematic Review and Meta-Analysis.

BACKGROUND: This study aimed to identify prognostic factors for functional outcome of metastatic spinal cord compression (MSCC). METHODS: All full texts in English regarding the prognostic factors for functional outcome of MSCC, published between January 2007 and October 2017, were identified using the electronic databases PubMed, Embase, and the Cochrane Library. An exploratory meta-analysis was also conducted when appropriate data were available. RESULTS: A total of 25 studies, involving 4897 patients, met the inclusion criteria. Overall, 69.7% of patients across all studies were able to walk postoperatively compared with 49.0% preoperatively. Moreover, 84.7% of the patients maintained ambulation after treatment. Motor function was significantly associated with ambulatory status before treatment, time of developing motor deficits, interval from symptom to surgery, and preoperative performance status. CONCLUSIONS: Ambulatory status before treatment, interval from symptom to treatment, and time of developing motor deficits can be considered as the most significant prognostic factors for posttreatment ambulatory status. Spinal metastasis should have a higher priority, and immediate intervention should be started before the development of irreversible neurologic deficits. Moreover, short-course radiotherapy might be a good option for patients with a limited life span. Consequently, the identified prognostic factors can be regarded as a preoperative assessment tool to predict neurologic outcome and guide clinical treatment for individual patients with MSCC. However, the retrospective nature of this study with low-quality evidence must be taken into account when interpreting these results, and further research is needed to identify prognostic factors.

Rapid Worsening of Symptoms and High Cell Proliferative Activity in Intra- and Extramedullary Spinal Hemangioblastoma: A Need for Earlier Surgery.

STUDY DESIGN: A retrospective analysis of a prospective database. OBJECTIVE: To compare preoperative symptoms, ambulatory ability, intraoperative spinal cord monitoring, and pathologic cell proliferation activity between intramedullary only and intramedullary plus extramedullary hemangioblastomas, with the goal of determining the optimal timing for surgery. METHODS: The subjects were 28 patients (intramedullary only in 23 cases [group I] and intramedullary plus extramedullary in 5 cases [group IE]) who underwent surgery for spinal hemangioblastoma. Preoperative symptoms, ambulatory ability on the McCormick scale, intraoperative spinal cord monitoring, and pathologic findings using Ki67 were compared between the groups. RESULTS: In group IE, preoperative motor paralysis was significantly higher (100 versus 26%, p < 0.005), the mean period from initial symptoms to motor paralysis was significantly shorter (3.5 versus 11.9 months, p < 0.05), and intraoperative spinal cord monitoring aggravation was higher (65 versus 6%, p < 0.05). All 5 patients without total resection in group I underwent reoperation. Ki67 activity was higher in group IE (15% versus 1%, p < 0.05). Preoperative ambulatory ability was significantly poorer in group IE (p < 0.05), but all cases in this group improved after surgery, and postoperative ambulatory ability did not differ significantly between the two groups. CONCLUSIONS: Intramedullary plus extramedullary spinal hemangioblastoma is characterized by rapid preoperative progression of symptoms over a short period, severe spinal cord damage including preoperative motor paralysis, and poor gait ability compared with an intramedullary tumor only. Earlier surgery with intraoperative spinal cord monitoring is recommended for total resection and good surgical outcome especially for an IE tumor compared with an intramedullary tumor.

Influence of postural intervention to ambulation of patients after video-assisted thoracoscope surgery / 现代临床护理

Objective To study the influence of postural intervention on ambulation of patients after video-assisted thoracoscope surgery? Methods One hundred and forty eight patients having undergone chest cardiac surgery were randomly divided into the control group(n = 75)and the observation group(n = 74)? The former received routine nursing intervention and the latter postural intervention besides routine nursing? The two groups were compared in terms of the time for ambulation and the ability in ambulation? Result The ambulation in the observation group was earlier than the control group and the ability in ambulation was better compared to the control group(both P < 0?05)? Conclusion The postural intervention after thoracic surgery is effective in pushing patient’s ambulation and improve their ability?

Comparison of activity level in daily life with heart rate: Application to elderly persons of different ambulatory abilities.

OBJECTIVES: Normal activity monitoring methods are mainly useful for relatively healthy and ablebodied people, but are not necessarily appropriate for elderly persons who may have difficulty in walking, or for the frail who may be bedridden. The purpose of this study was to examine 24-hour heart rate recording for the comparison of activity levels in daily life of elderly persons of different ambulatory abilities. METHODS: Forty-two elderly females (mean, 82.1 years old) volunteered to participate in this study. The subjects were divided into four groups on the basis of their ambulatory status, and their 24-hour heart rate recordings were compared with their results of activity assessments. RESULTS: The results of activity assessments showed a tendency to decrease as the ambulatory ability of the group decreased. The "total heart beats", calculated as the sum of all heart rates over 24 hours, were almost the same among the four groups, and therefore did not show a similar tendency. However, the "total excess-beats product (TEBP)" correlated with the results of activity assessments. TEBP was calculated as the sum of all differences in beats between each heart rate in 24 hours and the mean heart rate during sleeping at night. Therefore, TEBP may reflect a more active state than the bedridden state. CONCLUSIONS: These results suggest that comparison of activity levels in daily life using 24-hour heart rate recording might be possible by the calculation of TEBP, and that this method might be useful for the comparison of the activity levels of elderly persons of diffent ambulatory abilities.

Comparison of activity level in daily life with heart rate: Application to elderly persons of different ambulatory abilities

<p><b>OBJECTIVES</b>Normal activity monitoring methods are mainly useful for relatively healthy and ablebodied people, but are not necessarily appropriate for elderly persons who may have difficulty in walking, or for the frail who may be bedridden. The purpose of this study was to examine 24-hour heart rate recording for the comparison of activity levels in daily life of elderly persons of different ambulatory abilities.</p><p><b>METHODS</b>Forty-two elderly females (mean, 82.1 years old) volunteered to participate in this study. The subjects were divided into four groups on the basis of their ambulatory status, and their 24-hour heart rate recordings were compared with their results of activity assessments.</p><p><b>RESULTS</b>The results of activity assessments showed a tendency to decrease as the ambulatory ability of the group decreased. The "total heart beats", calculated as the sum of all heart rates over 24 hours, were almost the same among the four groups, and therefore did not show a similar tendency. However, the "total excess-beats product (TEBP)" correlated with the results of activity assessments. TEBP was calculated as the sum of all differences in beats between each heart rate in 24 hours and the mean heart rate during sleeping at night. Therefore, TEBP may reflect a more active state than the bedridden state.</p><p><b>CONCLUSIONS</b>These results suggest that comparison of activity levels in daily life using 24-hour heart rate recording might be possible by the calculation of TEBP, and that this method might be useful for the comparison of the activity levels of elderly persons of diffent ambulatory abilities.</p>

Comparison of Activity Level in Daily Life with Heart Rate: Application to Elderly Persons of Different Ambulatory Abilities

Objectives: Normal activity monitoring methods are mainly useful for relatively healthy and able-bodied people, but are not necessarily appropriate for elderly persons who may have difficulty in walking, or for the frail who may be bedridden. The purpose of this study was to examine 24-hour heart rate recording for the comparison of activity levels in daily life of elderly persons of different ambulatory abilities. Methods: Forty-two elderly females (mean, 82.1 years old) volunteered to participate in this study. The subjects were divided into four groups on the basis of their ambulatory status, and their 24-hour heart rate recordings were compared with their results of activity assessments. Results: The results of activity assessments showed a tendency to decrease as the ambulatory ability of the group decreased. The “total heart beats”, calculated as the sum of all heart rates over 24 hours, were almost the same among the four groups, and therefore did not show a similar tendency. However, the “total excess-beats product (TEBP)” correlated with the results of activity assessments. TEBP was calculated as the sum of all differences in beats between each heart rate in 24 hours and the mean heart rate during sleeping at night. Therefore, TEBP may reflect a more active state than the bedridden state. Conclusions: These results suggest that comparison of activity levels in daily life using 24-hour heart rate recording might be possible by the calculation of TEBP, and that this method might be useful for the comparison of the activity levels of elderly persons of diffent ambulatory abilities.