Health-related quality of life and the ability to perform activities of daily living: a cross-sectional study on 1079 war veterans with ankle-foot disorders

Background:The ankle-foot injuries are among the war-related injuries that cause many serious secondary problems for a lifetime.This nationwide study aimed to assess health-related quality of life and the ability to perform activities of daily living in veterans with ankle-foot injuries due to the Iran-Iraq war.Methods:A total of 1079 veterans with ankle-foot injuries were enrolled in a cross-sectional study from 2014 to 2016.Demographic characteristics,including age,gender,marital status,disability percent,educational level,employment and additional injuries,were collected.The ability to perform daily activities was assessed using the Barthel activities of daily living(ADL)and Lawton instrumental activities of daily living(IADL)Indexes.Physical and mental health-related quality of life(HRQOL)data were measured via the SF-36 subscales.The data were compared with those of bilateral lower limb amputees(BLLAs)and of the general Iranian population.Statistical analyses,including Pearson’s correlation coefficient,one-sample t-test and analysis of variance(ANOVA),were performed using SPSS16.0.A multiple linear regression model was used to determine the contribution of independent variables to the Physical Component Summary(PCS)and Mental Component Summary(MCS).Results:The highest and lowest scores were observed for mental health(48.93±20.69)and bodily pain(28.16±21.74),respectively.The mean scores of veterans with ankle-foot injuries on the SF-36 were significantly lower on all eight measures than those of the general Iranian male population and of the bilateral lower limb amputees(P<0.001).The mean scores of ADLs and IADLs were 83.9±16.3 and 5.3±2.0,respectively.The higher dependency in ADLs(P<0.001)and IADLs(P<0.001),the higher disability rate(P<0.001)and additional injury(P<0.001)were significant determinants of the PCS.ADL(P<0.001)and IADL(P<0.001)limitations,additional injury(P<0.001),history of hospitalization in the year preceding the study(P=0.007)and employment(P=0.001)were reported as determinants of the MCS.Conclusion:The results strongly suggest that veterans with ankle-foot injuries suffer from critically poor healthrelated quality of life.The main predicting factors of HRQOL were the disability to perform ADLs/IADLs,suffering two or more injuries,a history of hospitalization in the year preceding the study and unemployment.

Relationship between activities of daily living and depression among older adults and the quality of life of family caregivers

Objective： The purposes of this study were to explore the associations of activities of daily living （ADL） and depression among older adults with family caregivers1 quality of life and provide evidence for improving family caregivers＇ quality of life.Methods： Older adults （n=395） and their family caregivers （n=395） were selected as participants. The ADL scale and Geriatric Depression Scale were used to assess ADL and depression among older adults, and the 36-Item Short Form Health Questionnaire （SF-36） was used to assess family caregivers1 quality of life. Descriptive statistics and multiple linear regression were used to analyze the data.Resslts： The older adults’ ADL and depression scores were 21 ±7 and 11 ±6, respectively. Approximately 69.9% of older adults had declining or severely impaired ADL, and 47.1% had mild or moderate-to-severe depression. Family caregivers＂ mean quality of life score was 529±100. There was a negative correlation of older adults＇ ADL and depression with caregivers＇ quality of life. The correlation coefficient between ADL and the SF-36 mental component summary score was stronger than it was with the SF-36 physical component summary score.Conclusions： The ADL and depression of older adults influenced family caregivers＇ quality of life. Psychological health deserves closer attention, especially that of caregivers of disabled older adults.

Botulinum toxin type A plus rehabilitative training for improving the motor function of the upper limbs and activities of daily life in patients with stroke and brain injury

BACKGROUND:Botulinum toxin type A(BTX-A)is mostly to be used to treat various diseases of motor disorders,whereas its effect on muscle spasm after stroke and brain injury needs further observation.OBJECTIVE:To observe the effect of BTX-A plus rehabilitative training on treating muscle spasm after stroke and brain injury.DESIGN:A randomized controlled observation.SETTINGS:Department of Rehabilitation,Department of Neurology and Department of Neurosurgery,the Second Hospital of Hebei Medical University.PARTICIPANTS:Sixty inpatients with brain injury and stroke were selected from the Department of Rehabilitation,Department of Neurology and Department of Neurosurgery,the Second Hospital of Hebei Medical University from January 2001 to August 2006.They were all confirmed by CT and MRI,and had obvious increase of spastic muscle strength in upper limbs,their Ashworth grades were grade 2 or above.The patients were randomly divided into treatment group(n=30)and control group(n=30).METHODS:①Patients in the treatment group undertook comprehensive rehabilitative trainings,and they were administrated with domestic BTX-A,which was provided by Lanzhou Institute of Biological Products,Ministry of Health(S10970037),and the muscles of flexion spasm were selected for upper limbs,20-25 IU for each site.②Patients in the treatment group were assessed before injection and at 1 and 2 weeks,1 and 3 months after injection respectively,and those in the control group were assessed at corresponding time points.The recovery of muscle spasm was assessed by modified Ashworth scale(MAS,grade 0-Ⅳ;Grade 0 for without increase of muscle strength;GradeⅣfor rigidity at passive flexion and extension);The recovery of motor function of the upper limbs was evaluated with Fugl-Meyer Assessment(FMA,total score was 226 points,including 100 for exercise,14 for balance,24 for sense,44 for joint motion,44 for pain and 66 for upper limb);The ADL were evaluated with Barthel index,the total score was 100 points,60 for mild dysfunction,60-41 for moderate dysfunction,<40 for severe dysfunction).MAIN OUTCOME MEASURES:Changes of MAS grade,FMA scores and Barthel index before and after BTX-A injection.RESULTS:All the 60 patients with brain injury and stroke were involved in the analysis of results.①FMA scores of upper limbs:The FMA score in the treatment group at 2 weeks after treatment was higher than that before treatment[(14.98±10.14),(13.10±9.28)points,P<0.05],whereas there was no significant difference at corresponding time point in the control group.The FMA scores at 1 and 3 months in the treatment group[(23.36±10.69),(35.36±11.36)points]were higher than those in the control group[(20.55±10.22),(30.33±10.96)points,P<0.01].②MAS grades of upper limbs:There were obviously fewer cases of gradeⅢin MAS at 2 weeks after treatment than before treatment in the treatment group(0,9 cases,P<0.05),whereas there was no obvious difference in the control group.There were obviously fewer cases of gradeⅢin MAS at 2 weeks and 1 month after treatment in the treatment group(0,0 case)than the control group(5,2 cases,P<0.01).③Barthel index of upper limbs:The Barthel index at 2 weeks after treatment was higher than that before treatment in the treatment group[(30.36±22.25),(28.22±26.21)points,P<0.05],whereas there was no significant difference in the control group.The Barthel indexes at 1 and 3 months after treatment in the treatment group were obviously higher than those in the control group[(20.55±10.22),(30.33±10.96)points,P<0.01].CONCLUSION:BTX-A has obvious efficacy on decreasing muscle tension after stroke and brain injury,and relieving muscle spasm;Meanwhile,the combination with rehabilitative training can effectively ameliorate the motor function of upper limbs and ADL of the patients.

The Relationship among Chronic Disease, Feeling-for-Their-Age, Sleep Quality, Health-Related Quality of Life and Activities of Daily Living of Community-Dwelling Persons over 55 Years of Age

Japan’s aging population rate is increasing and healthy life expectancy has decreases by 10 years shorter than average life expectancy. The aim of this study is to determine the relationship among chronic disease, sleep quality, health-related quality of life (HRQOL), and activities of daily living in people over 55 years old who live in the community. Subjects were 161 persons aged 57 to 90 years who were treated with chronic disease in the outpatient department of the A hospital. Exclusion criteria included patients with dementia, cancer and severe heart disease. The survey evaluation questionnaires included the Pittsburgh Sleep Quality Index (PSQI), HRQOL by Short-Form 8 Health Survey (SF-8), and activities of daily living. Variables associated with quality of sleep, HRQOL in univariate analysis with p < 0.05 were entered into multivariate analysis using logistic regression with a stepwise forward selection procedure to determine independent variables and their association with major causes. The logistic regression analysis was done using SPSS software and the post-hoc power of the study was estimated using G*power. The level of significance was set at p < 0.05. The risk factor of poor sleep quality was because of history of cancer [odds ratio (OR): 3.53, 95% confidence interval (CI): 1.06 - 11.77], and insomnia (OR: 3.25, 95% CI: 1.55 - 6.79). The risk factors of poor physical HRQOL were motor disease (OR: 2.62, 95% CI: 1.36 - 5.07), respiratory disease (OR: 3.24, 95% CI: 1.27 - 8.26) and having pain (OR: 11.71, 95% CI: 5.35 - 25.66). In addition, anemia was found to be a risk factor of poor mental HRQOL (OR: 4.87, 95% CI: 1.11 - 21.33). The feeling-for-their-body-age (OR: 0.30, 95% CI: 0.15-0.59) was as “younger than actual age” and advanced the risk factor of poor sleep quality. In addition, feeling-for-their-age (OR: 0.44, 95% CI: 0.21 - 0.92) resulted in reduced risk factor of poor physical HRQOL. The risk factor of poor sleep quality was due to a patient with history of cancer. The factor for good sleep quality and the good factor for physical HRQOL were indications of feeling younger than the actual age.

Treatment of Elderly Bedridden Patients with Removable Dentures to Promote Their Daily Physical Activities: A Case-Control Study

Bedridden patients remain in bed for various reasons, such as chronic illness, old age, and disability, and they cannot perform self-care activities completely or partially. The provision of care for bedridden patients is a major issue in the aging population. Effective rehabilitation is associated with several factors such as cooperation between the patient and the medical staff, selection of effective facilities, and the financial burden. The objective of this study was to evaluate the effect on the activities of daily living (ADL) of occlusion restoration using removable dentures in bedridden older people. This case-control study comprised 32 bedridden older patients who were divided into two groups as follows: denture (n = 18) and no-denture (n = 14). No rehabilitation was provided to any of the patients. The patients were evaluated 3 months after placing the denture, and the ADLs were compared between the two groups. Of the 18 bedridden patients who received removable dentures, 55.6% demonstrated improvements in the ADLs, and the effects persisted for at least 3 months. No improvement in the ADL was observed in the no-denture group. The results of this study suggested that adequate occlusal support can improve the ADL of the elderly. Thus, it is important to take care of oral health early in life in order to maintain oral health, which could help prevent the decrease in the ADL during the later stages of life.

Patient Life Experience and Activity of Daily Living before and after Total Knee Arthroplasty

Background: As the population ageing, more patients suffer from joint disease. Joint replacement surgery performed in Taiwan is about 10,000 to 20,000 cases yearly. Aims: The purpose of this study is to realize Total Knee Arthroplasty (TKA) patients’ views about life experiences and difficulty in daily life before and after the surgery. Methods: In this study, in-depth interview with interview guideline was used to analyze patients’ experience by using a qualitative research method, and questionnaires were used to collect quantity data. Results: 1) A total of 20 participants were recruited. Average age was 75.15 (SD = 6.468). Eighteen of the participants were female and the other two were male. The majority of participants indicated that their home facilities were convenient or very convenient. 2) Motivations of the participants to undergo TKA were joint pain, limited joint range of motion, and weakness in legs. Participants’ expectations after surgery were no more pain and ease in walking, and able to manage daily life. 3) Depending on the time after surgery, joint pain and walking ability had improved to some extent. The joint range of motion increased, but kneeling remained difficult, and the participants’ mood and exercise capacity were improved. Conclusions: The finding can be as a reference for clinical practitioner to provide preoperative education for total knee arthroplasty patients.

缺血性脑卒中康复结局ADL能力及其影响因素的Logistic回归分析

目的分析缺血性脑卒中患者康复结局ADL能力的影响因素,为临床康复和预后判断提供一些客观指标及最佳治疗方案,指导康复治疗工作。方法选取2012年10月-2014年10月治疗和康复出院的缺血性脑卒中患者178例,采用回顾性分析方法,将研究对象的康复结局影响因素分为Ⅰ类不可干预影响因素(性别、年龄、偏瘫侧、类型、病变部位、医疗费用来源、文化程度),Ⅱ类可干预影响因素(康复治疗开始时间、疗程、患者对脑卒中认识、康复的愿望或主动性、康复治疗方法是否规范),Ⅲ类并发症影响因素(肩手综合征、肩痛、肩关节半脱位、心理障碍、言语障碍、认知障碍、下肢深静脉血栓)和Ⅳ类基础疾病的控制质量影响因素(卒中史、高血压、高血脂、高血糖、肥胖)四个类别,使用改良的Barthel指数评分(MBI≥60,MBI<60),判断患者ADL独立程度,并逐项分类统计后,采用二分类的Logistic多因素回归分析。结果缺血性脑卒中患者康复结局的ADL能力MBI评分与病变的类型、部位、康复治疗开展持续时间、患者对康复的愿望或主动性等有关,并受患者的年龄、医保费用来源、并发症、基础疾病控制质量等因素影响。结论早期重视缺血性脑卒中康复结局影响的关键因素,可有效预防不良因素影响,并为患者提供最佳康复治疗方案,提高日常生活活动自理能力。

高压氧对颅脑损伤患者认知功能和ADL的影响

目的观察高压氧对颅脑损伤患者认知功能和日常生活活动能力(ADL)的影响。方法纳入40例颅脑损伤患者,随机分为高压氧治疗组和对照组,两组患者均接受常规治疗,治疗组在此基础上接受高压氧治疗。治疗后对两组患者进行认知功能简易精神状态检查(MMSE)评定和ADL Barthel指数评定和比较,并对MMSE与ADL进行相关性分析。结果高压氧治疗组患者MMSE评分和ADL评分都较对照组有明显改善,差异有统计学意义,并且ADL评分与MMSE评分高度相关。结论高压氧可以安全有效地改善颅脑损伤患者认知功能,并且在定向力、注意力和语言方面改善尤为显著,提高患者的ADL能力。

醒脑静联合纳洛酮对高血压脑出血患者GCS、ADL指标的影响

目的探讨醒脑静联合纳洛酮对高血压脑出血患者格拉哥斯评分法(GCS)、日常生活能力量表(ADL)的影响。方法选取2013年10月至2014年10月收治的60例高血压脑出血患者,按随机数字表法分为观察组和对照组,每组30例。观察组采取醒脑静联合纳洛酮进行治疗,对照组单独使用纳洛酮,观察2组患者治疗前后GCS及ADL指标的变化。结果观察组患者神经功能缺损情况显著少于对照组(P<0.05);观察组患者生活能力评分显著高于对照组(P<0.05);观察组患者治疗后血肿量显著少于对照组(P<0.05)。结论醒脑静联合纳洛酮对高血压脑出血患者进行治疗效果显著,有利于改善患者神经缺损功能评分及日常生活能力评分,降低患者死亡率。

早期康复对急性脑卒中患者ADL的影响

目的：探讨早期康复对急性脑卒中患者ＡＤＬ的影响。方法：采用以Ｂｏｂａｔｈ和Ｂｒｕｎｎｓｔｒｏｍ方法为主的现代康复治疗技术和传统按摩疗法，对急性脑卒中患者进行了临床对照性研究。结果：康复组ＡＤＬ基本自理的恢复率为６４．００％，对照组为２３．５３％，两组间的差异有显著性（Ｐ＜０．０５）。结论：早期康复可以明显降低急性脑卒中患者的功能残疾，提高其生存质量，在病后１个月内，ＢＩ评定在２５分以上的脑卒中患者经过早期康复治疗有可能达到ＡＤＬ的基本自理或自理。

社区脑卒中患者抑郁、ADL和生活质量的相关性研究

目的分析社区脑卒中患者生活质量现状,探讨社区脑卒中患者抑郁、日常生活活动能力与生活质量之间的关系。方法随机抽取郑州市5个社区的脑卒中患者146例,分别用抑郁自评量表(self-rating depression scale,SDS)、Barthel指数评定量表、简明健康状况问卷(short form 36,SF-36)测评脑卒中患者的抑郁水平、日常生活活动能力(activity of dailyliving,ADL)及生活质量。描述生活质量现状,分析抑郁、ADL与生活质量的相关性。结果社区脑卒中患者生活质量水平低于中国常模水平;抑郁与生活质量8个维度均呈负相关;ADL与生活质量除社会功能外的其余7个维度均呈正相关。结论脑卒中发病后生活质量显著下降,尤其是生理功能、职能及情感方面;脑卒中后抑郁发生、ADL水平下降都会影响患者生活质量。

张力平衡针法对脑卒中痉挛瘫痪患者ADL和生存质量的影响

目的:探讨张力平衡针法对脑卒中痉挛瘫痪的改善及对患者ADL和生存质量的影响。方法:选择脑卒中痉挛瘫痪患者106例,随机分为2组。张力组54例,采用张力平衡针法,上肢取屈肌侧极泉、尺泽、大陵,伸肌侧肩髃、天井及阳池穴;下肢伸肌侧血海、梁丘、照海,屈肌侧髀关、曲泉、解溪及申脉穴。传统组52例,采用传统针刺方法治疗。治疗前后采用Barthel指数(BI)及生活质量指数(QLI)评定患者的ADL及生活质量。结果:经过30 d的治疗,2组患者BI及QLI评分与治疗前比较均有明显提高(P<0.05,0.01);与传统组比较,张力组提高更显著(P<0.05,0.01)。结论:张力平衡针法能有效缓解脑卒中痉挛瘫痪状态,促进ADL及生存质量的提高。

初发脑卒中早期ADL与身体心理变量相关性研究

目的探讨初发脑卒中患者恢复早期日常生活活动能力 (ADL)与其身体心理变量之间的关系。方法评定 48例初发脑卒中患者在急性期和恢复早期的ADL、运动功能、神经功能缺损程度、认知水平和抑郁水平 ,分析ADL与各变量间的相关性。结果脑卒中患者恢复期ADL与其急性期的运动功能、神经功能缺损程度、认知水平有非常高度显著相关性 (P <0 .0 0 1) ,同时 ,也与患者的病灶数目、偏瘫严重程度和受教育程度有显著相关性 (P <0 .0 5 )。结论脑卒中患者急性期的运动功能、神经功能缺损程度和认知水平对患者早期ADL有重要的预测价值 ,患者的病灶数目。

脑瘫儿童ADL分级社区康复管理对患儿疗效及生存质量的影响

目的探讨脑瘫儿童日常生活活动能力(ADL)分级社区康复管理对患儿疗效及生存质量的影响。方法选择2015年1月至2016年3月期间从我院出院后在社区康复的脑瘫患儿96例为研究对象,根据随机数字表法分为两组,每组48例,对照组予社区常规康复训练,观察组则根据ADL分级采取针对性的康复训练,疗程10周。比较干预前后两组患儿粗大运动功能测试量表(GMFM-66)及儿童生存质量普适性核心量表(Peds QL)评分的变化。结果干预后,观察组与对照组患儿的GMFM-66评分分别为(50.23±13.31)分、(43.58±11.65)分,较治疗的(30.18±7.82)分、(29.07±8.04)分有明显上升,且观察组明显高于对照组,差异均有统计学意义(P<0.05);观察组患儿的Peds QL评分在生理、情感、社交及总分分别为(35.32±8.24)分、(68.78±16.45)分、(36.31±7.82)分、(48.18±10.38)分,对照组分别为(30.46±7.38)分、(60.37±14.63)分、(31.08±5.90)分、(43.48±9.87)分,均较干预前的(23.17±5.39)分、(57.64±14.17)分、(22.24±5.13)分、(38.27±8.57)分和(22.34±4.98)分、(56.28±12.47)分、(23.29±4.97)分、(37.29±8.96)分显著提高,且观察组均高于对照组,差异均有统计学意义(P<0.05)。结论脑瘫儿童ADL分级社区康复管理可以明显提高康复效果,改善患儿的生存质量。

脑卒中患者早期强化躯干训练对后期ADL的影响

目的探求早期躯干训练对后期脑卒中患者ADL的影响方法以FIM〔1评分为标准我们把160例患者随机分为2组,每组80例。第1组随机进行康复训练;第2组进行强化躯干训练。3～6个月后进行对比。结果 2组躯干的控制能力均有所提高。强化组比第一组提高明显(FIM)。结论早期躯干功能的强化训练有助于躯干控制能力的提高。躯干功能的提高有助于患者在FIM评分中的自理活动、转移、括约肌的控制等方面的提高。因此早期强化躯干训练对脑卒中患者后期的自理有着重要的意义。

清脑益元汤对缺血性中风患者的疗效及Barthel指数、ADL评分的变化研究

目的:研究清脑益元汤对缺血性中风患者的疗效及Barthel指数、日常生活活动能力(ADL)评分的变化。方法:选取我院2016年1月-2018年12月收治的缺血性中风患者90例,分为两组。对照组给予积极控制脑水肿、血压、血糖、抗血小板聚集、调节血脂治疗等常规治疗,观察组在对照组基础上给予清脑益元汤,分析两组患者治疗后的临床疗效。结果:两组治疗前中医证候积分组间比较,差异不具有统计学意义(P>0.05)。观察组治疗后中医证候积分(5.42±1.14)分低于对照组(P<0.05)。两组治疗前血清胶质纤维酸性蛋白(GFAP)、神经肽Y(NPY)、神经元特异性烯醇化酶(NSE)水平组间比较,差异不具有统计学意义(P>0.05)。观察组治疗后GFAP、NPY、NSE水平低于对照组(P<0.05)。两组治疗前美国国立卫生研究院卒中量表(NIHSS)、Barthel指数、ADL评分组间比较,差异不具有统计学意义(P>0.05)。观察组治疗后Barthel指数(68.23±11.74)分、ADL评分(83.12±7.54)分高于对照组,NIHSS评分(3.76±0.91)分低于对照组(P<0.05)。结论:清脑益元汤可降低缺血性中风患者GFAP、NPY、NSE的表达水平,改善神经功能,提高日常生活活动能力。

偏瘫患者上肢功能康复疗效与ADL相关性研究

目的探讨偏瘫患者上肢运动功能康复疗效与日常生活活动能力 (ADL)之间的相关性。方法 61例偏瘫患者接受作业疗法治疗 ,治疗前后评定患者上肢Brunnstrom分级、手实用性判定及Barthel指数 (BI)。结果训练前后上肢和手的功能及手的实用性判定的功能均有非常高度显著性差异 (P <0 0 0 1) ,上肢、手指功能 ,手的实用性判定与ADL存在不同程度的相关性 (r =0 5 3 0 -0 693 ,P <0 0 1)。结论上肢和手功能与ADL正相关。Brunnstom分级太粗可能是影响上肢功能等与ADL相关性的原因之一。

西安市老年人ADL及其影响因素调查研究

目的 探讨西安市老年人日常生活活动能力(ADL)受损情况及其主要影响因素,方法 通过分层整群抽样.对1 811名≥60岁老年人进行横断面调查。结果 老年人进食、入厕、起居活动、外出步行、听讲、交谈、看书报受损率分别为3.9％、3.3％、2.0％、12.8％、15.8％、10.4％、33.0％。年龄、患病、体育锻炼、婚姻状况是影响ADL的主要因素.而性别、吸烟对ADL的影响不显著。结论 高龄、患有多种疾病、不注意锻练、丧偶或独居者是老年人群中的高危人群.是社区保健的重点.

ADL评估量表在老年病房实施基础护理中的应用

目的:探讨ADL评估量表在老年病房实施基础护理中的应用效果。方法:按入院时间先后顺序,将2013年9月~11月入住老年病房的80例患者设为对照组,2013年12月~2014年2月入科的86例患者设为观察组。对照组入院时按常规护理评估,根据医嘱实施分级基础护理和生活护理;观察组在常规护理的基础上加上ADL评估,按照ADL评估结果实施分级护理。结果:观察组的基础护理合格率及患者满意度显著高于对照组,差异均有统计学意义(P<0.05)。结论:在老年病房中应用ADL评估量表实施基础护理,可提高护理服务质量和护理满意度,ADL评估量表可以作为患者对基础护理需求的依据。