Improvement of Activities of Daily Living (ADL) for Patients Treated in Skilled Nursing Facilities (SNFs)

Background: Self-care tasks or activities of daily living (ADL)’s performance are often disrupted after an older adult sustains an injury or illness, which can be a determining factor for discharge placement after hospitalization, or it can determine the level of assistance required after discharge from a skilled nursing facility (SNF). We believe that comprehensive rehabilitation can improve a patient’s overall functioning during their short term stay in SNFs. The purpose of this study is to determine if an individual’s level of independence improved after admission to a skilled nursing facility and procurement of rehabilitation services. Methods: This study retrospectively reviewed 4612 nursing home patients in California who underwent rehabilitative services at skilled nursing facilities to determine how the patients responded to their environments, therapy interventions, and any other additional supportive measures. The records of patients who were admitted for short-term rehabilitation were reviewed in a blinded fashion, looking specifically at Section GG of the Minimum Data Set (MDS). Self-Care Section GG scores recorded by rehabilitative staff provide objective data and measure patients’ levels of assistance that were required. Each activity is scored from 1, being completely dependent, to 6, being entirely independent, with varying levels of assistance with scores in between. The admission scores versus the discharge scores can be compared to determine if a patient improved their level of functioning upon discharge. Results: Utilizing the Pearson’s correlation coefficient, a strong correlation of improvement in ADL performance on Section GG between the admission and discharge scores was identified, implying significant improvement in functional independence upon discharge. The average percent improvement for Managed Care patients was ~35.4% and ~39.4% for Medicare patients. Conclusions: The results support the benefits of rehabilitation services in skilled nursing facilities, and the data suggests that admission scores can be used as a predictive tool for functional outcomes.

Research on the Correlation between NSE Level and Activities of Daily Living in Parkinson’s Disease

Objective: To establish a prediction model of activities of daily living (ADL) as an auxiliary evaluation scheme of hospitalized Parkinson’s disease patients. Methods: The hospitalization data of Parkinson’s disease in patients in the Department of Neurology, Affiliated Brain Hospital of Guangzhou Medical University were collected. Firstly the NSE values and each BI item were analyzed by Pearson correlation analysis. Secondly, The NSE, Age, Body weight and Education level related to the total score of Barthel index were obtained by correlation analysis. At last, a multiple linear regression model was established with NSE, Age, Body weight and Education level as independent variables and BI as dependent variables. Results: A total of 95 patients with PD were enrolled in this study, including 53 males (55.8%) and 42 females (44.2%). The effects of the four independent variables incorporated in the model on the total score of Barthel index were statistically significant, as well as the regression model (F = 9.531, P Conclusion: The prediction model established in this research can effectively predict the activities of daily living of Parkinson’s patients and can be used as an auxiliary evaluation scheme of the hospitalized PD patients.

The Effect of Early versus Traditional Hospital Discharge on Activities of Daily Living for Women Undergoing Elective Cesarean Section. An Observational Cohort Study

Background: Cesarean section is one of the most common surgeries performed worldwide and its consequences and complications represent a major public health concern. The policy of enhanced recovery after surgery has been implemented after cesarean section to optimize perioperative care. Enhanced recovery also aims to reduce the length of hospital stay, which might imply substantial healthcare savings. Rising hospital costs are one of the factors in early discharge. Patients & Methods: This was a prospective cohort study. 158 patients met the inclusion criteria of the study, 81 patients were discharged after 48 hours and 77 patients were discharged after 24 hours. All patients received the same postoperative care and instructions. All the study participants received a phone call 1, 3, and 5 days after discharge to objectively assess the activities of daily living through Katz index of independence in activities of daily living. All patients were offered a postpartum visit 1 week after discharge during which the wound was assessed by the Southampton wound assessment scale. Moreover, other maternal complications such as mastitis, puerperal sepsis, or pyelonephritis were assessed and cases who were readmitted were documented. Initiation of successful breastfeeding and neonatal readmission were reported as well. Results: 158 patients met the inclusion/exclusion criteria of the study. There was no significant difference between the two arms of the study regarding baseline characteristics. Katz index of independence showed that the resumption of activities of daily living after CS was similar in both arms of the study on days 1, 3 and 5 after discharge. Time till the passage of flatus and stool after the cesarean section was significantly shorter among the early discharge arm (9.31 VS 14.68, p value < 0.001 & 13.25 VS 24.82, p value < 0.001 respectively). Maternal readmission was not significantly higher among the early discharge arm and at the 1-week postpartum visit, objective wound assessment by Southampton wound scoring assessment was made and there was no significant difference between the two arms of the study. Initiation of successful breastfeeding, and neonatal readmission were similar in both groups. Conclusion: The policy of early discharge can be adopted in low-risk cases scheduled for elective uncomplicated CS provided that the mother and the neonate are in good general condition and proper instructions regarding red flag manifestations are given.

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.

Effect of post-stroke sensory disorders on the recovery processes of motor function and activity of daily living A non-randomized synchronical controlled trial

BACKGROUND： In the rehabilitation of stroke patients, clinicians usually concentrate on motor problems, such as spasm of limbs and restriction of joint motion, while sensory and perceptive problems are almost always neglected, although they are just as important. One such area is the sensory disorder. OBJECTIVE： To evaluate the motor function and activities of daily living in stroke patients with and without sensory disorders after treatment of integrated western and Chinese medicine. DESIGN： A non-randomized synchronically controlled trial. SETTING： First Affiliated Hospital of Tianjin College of Traditional Chinese Medicine. PARTICIPANTS： Totally 500 stroke inpatients were selected from the Department of Acupuncture and Massage, the First Affiliated Hospital of Tianjin College of Traditional Chinese Medicine from January 2003 to December 2004. They all had suffered from stroke in the last 4 weeks and accompanied by sensory disorder of the ipsilateral limb to different severity. The patients were all accorded with the Diagnostic and Efficacy Evaluative Standards for Stroke （in trial） set by the Encephalopathy Emergency Assistant Group, the State Administration of Traditional Chinese Medicine in 1995, and they were diagnosed by imaging examination. The patients were stratified into sensory disorder group （n =220） and normal sense group （n =280）. Informed consent for the detected items and therapeutic program was obtained from the relatives of all the participants. The study was approved by the hospital ethical committee. METHODS： All the patients were treated with acupuncture of Xing Nao Kai Qiao for restoring consciousness and inducing resuscitation, assisted by traditional Chinese medicine and western medicine specific to corresponding symptoms. The therapeutic principles were restoring consciousness and inducing resuscitation, nourishing liver and kidney, and dredging meridian. In addition, the patients were given western medical treatments for decreasing intracranial pressure, thrombolysis, reducing blood viscosity, anticoagulation, anti-arteriosclerosis, ameliorating microcirculation, also administrated with activator for nerve cells. MAIN OUTCOME MEASURES： （1） The severity of motor function deficit was evaluated using clinical neurological deficit score for stroke patients set by the Fourth National Academic Meeting for Cerebrovascular Disease in 1995; （2） The activities of daily living was evaluated with Barthel Index, the higher the score, the better the independence, and the less the dependence. RESULTS： All the 500 stroke patients were involved in the final analysis of results. （1） The neurological deficit scores before treatment had no significant difference between the two groups （P 〉 0.05）, but the scores after treatment were significantly decreased as compared with those before treatment in both groups （t =6.59, 12.43, P 〈 0.01）. The neurological deficit score after treatment in the normal sense group was significantly lower than that in the sensory disorder group （t =1.63, P 〈 0.05）. （2） The scores of activities of daily living after treatment were significantly increased as compared with those before treatment in both groups （t =16.03, 25.10, P 〈 0.01）. The scores of activities of daily living in the normal sense group were higher than those in the sensory disorder group both before and after treatment （t =6.07, 14.26, P 〈 0.05）. CONCLUSION： Sensory disorders have obvious negative effects on the recovery of motor function and activities of daily living of stroke patients.

Limitations in activities of daily living increase the risk of stroke in older Chinese adults:a population-based longitudinal study

It remains unclear whether limitations in activities of daily living(ADL) increase the risk of stroke in older Chinese adults.This longitudinal study used data from the Chinese Longitudinal Healthy Longevity Survey to investigate the effects of limitations in ADL on the incidence of stroke in older adults.Between 2002 and 2011,46,728 participants from 22 provinces in China were included in this study.Of participants,11,241 developed limitations in ADL at baseline.A 3-year follow-up was performed to determine the incidence of stroke.During the 3-year follow-up,929 participants(8.26%) and 2434 participants(6.86%) experienced stroke in the ADL limitations group and non-ADL limitations group,respectively.Logistic regression was used to analyze the effect of ADL limitations on the risk of stroke.The results showed that after adjusting for the confounding factors gender,age,weight,hypertension,diabetes,heart disease,natural teeth,hearing impairment,visual impairment,smoking,alcohol abuse,exercise,ethnicity,literacy,residential area,and poverty,the ADL limitations group had a 77% higher risk of developing stroke than the non-ADL limitations group.After propensity score matching,the ADL limitations group still had a 33% higher risk of developing stroke than the non-ADL limitations group(OR = 1.326,95% CI:1.174–1.497).These findings suggest that limitations in ADL are a stroke risk factor.

Factors associated with activities of daily living among the disabled elders with stroke

Objective:To determine the factors associated with activities of daily living(ADL)among the disabled elders post-stroke.Methods:A total of 158 patients were chosen from community health service stations in eighteen regions of Tianjin city by convenience sampling from March to November in 2013.The Barthel Index(BI)and the short-formmini-nutritional assessment(MNA-SF)were used to evaluate the ADL,the nutritional status respectively.Statistical analysis was performed using independent sample t-test,one-way ANOVA,Pearson correlation and multiple linear regression analysis.Barthel ADL index was the main outcome.Results:The mean score of ADL was 50.50±27.125.The multiple linear regression showed that the factors which had significant impact on ADL were stroke frequency,types of stroke,nutritional status,financial status,and age.Conclusions:Disabled elders with recurrent strokes,hemorrhagic stroke,dependent financial resources,older age,worse nutritional status and living with family had poorer strokerelated outcome.Healthcare providers can discover the high-risk groups of disability and implement individualized preventive interventions in accordance with the related factors.

Effect of Activities of Daily Living on Self-Care Agency in Individuals with Type 2 Diabetes

Diabetes mellitus continues to be a global health problem with increasing importance across the world by affecting the activities of daily living and self-care ability of patients due to its incidence and troubles caused by it. The present study aims at determining the effect of activities of daily living of patients with type 2 diabetes mellitus on their self-care agency. Methods: The population of this descriptive study consisted of patients with type 2 diabetes mellitus who were being treated at the internal medicine clinic of a provincial state hospital between July 2014 and November 2015 and its sample consisted of 150 diabetic patients who volunteered to take part in the study and who were open to communication. A personal information form, the Activities of Daily Living (ADL) Scale, the Instrumental Activities of Daily Living (IADL) Scale and the Self-Care Ability Scale (CAS) were used as data collecting tools. The data were analyzed using descriptive statistics (numbers, percentages, mean, standard deviation, mean rank and frequencies), the Shapiro-Wilk, Kruskal-Wallis Variance Analysis, Mann-Whitney U test and Cronbach’s alpha formula and correlation analysis. Results: Approximately 97.3% of the patients with type 2 diabetes stated that they were independent in ADL and 75.3% of them in IADL. The patients’ mean self-care ability score was found to be 83.85 ± 17.87 ADL and IADL were found to be affected by age, marital status, education, duration of disease, willingness to receive further education, and presence of another disease besides diabetes. There was a significant correlation between the self-care agency score and marital status, education, duration of disease, willingness to receive further education, presence of another disease besides diabetes, regular checking of blood sugar and compliance with diet. A significant positive correlation was found between the patients’ activities of daily living and their self-care agency. Conclusion: The patients’ activities of daily living were found to affect their self-care agency. The personal and disease-related characteristics of patients should be identified so that their self-care behaviors can be increased.

Effect of six-month standardized tertiary rehabilitation program on the activities of daily living in stroke patients with hemiplegia

BACKGROUND： At present, there are many studies on the rehabilitation therapy of stroke patients with hemiplegia, but there is deficiency of corresponding standardized rehabilitation program. OBJECTIVE： To explore the effects of standardized tertiary rehabilitation on the activities of daily living in stroke patients with hemiplegia within 6 months after attack. DESIGN： A clinical observation. SETTING： Department of Rehabilitation Medicine, Huashan Hospital of Fudan University. PARTICIPANTS： Eighty-two outpatients and inpatients with acute stroke were selected from the Department of Neurology, Shanghai Huashan Hosptial from January 1999 to June 2003, including 49 males and 33 females, 40 - 80 years of age, with a mean age of （65 ±11） years old. Inclusive criteria： According to the diagnostic standards for cerebrovascular diseases set by Fourth National Academic Meeting for Cerebrovascular Disease in 1995, the patients were diagnosed as new attack of cerebral infarction or cerebral hemorrhage, and confirmed by CT or MRI to be initial patients; They should be accorded with the following conditions, including within 1 week after stabilization of life signs, Glasgow coma score 〉 8 points, 40 - 80 years of age, with disturbance of limb function. Informed consents were obtained from all the patients or their relatives. Exclusive criteria： Patients were excluded due to active liver disease, liver and kidney malfunction, congestive heart failure, malignant tumor, history of dementia, failure in respiratory function, tetraplegia; cerebral infarction or cerebral hemorrhage for more than 3 weeks; unable to be followed up due to in other cities and provinces; psychiatric history; deafness and muteness. According to the will of the patients or their relatives, the patients who accepted the standardized rehabilitation program were enrolled as the treatment group （n =42）, and the others as the control group （n =40）. Approval was obtained from the ethical committee of the hospital. METHODS： All the patients were given routine therapies of internal medicine after admission. According to the conditions of Brunnstom recovery 6-phase evaluation, the patients in the treatment group were trained with the pre-designed comprehensive standardized rehabilitation program for corresponding period. At early period （within about 1 month after attack）, the patients received rehabilitative interventions in the Department of Emergency or Department of Neurology, once a day, 45 minutes for each time, 5 times a week; At middle period （about 1 - 3 months after attack）, the patients received rehabilitative interventions in the rehabilitation ward or center, once to twice a day, 30 - 45 minutes for each time, 4 - 5 days a week; At late period （about 3 - 6 months after attack）, the patients received rehabilitative intervention mainly assisted by rehabilitation physician in the community, relatives and volunteers, 3 - 4 times a week, and they were followed in the house or outpatient department once every two weeks. MAIN OUTCOME MEASURES： The patients were evaluated blindly by the same rehabilitation physician using scale of modified Barthel index at admission and 1, 3 and 6 months after attack respectively. RESULTS： Totally 82 patients with acute stroke were enrolled, and 3 cases in the treatment group missed, including 2 cases died at 1 month after admission, and 1 case refused the follow up l0 days later, all the others were involved in the analysis of results. The scores of modified Barthel index at corresponding time points after admission in the treatment group were all obviously higher than those in the control group （P 〈 0,01）, and the score differences were also obviously higher than those in the control group （P 〈 0,01）. The activities of daily living at admission and 1, 3 and 6 months after admission in the treatment group were 22,50%, 46.43%, 75,95% and 89,52% of that of normal people respectively, and those in the control group were 17.09%, 25,77%, 43,38% and 55,00% respectively, The activities of daily Diving at admission and 1, 3 and 6 months in the treatment group were 131.66%, 180.17%, 175.08% and 162.76% of those in the controlgroup. As compared with at admission, the percentage of the score difference to the total score at the ends of the 1^st, 3^rd and 6^th months were 23.93%, 53.45% and 67.02% in the treatment group, while 8.67%, 25.36% and 36.98% in the control group. CONCLUSION： Standardized tertiary rehabilitation can obviously promote the activities of daily living in stroke patients with hemiplegia.

Activities of daily living and lesion position among multiple sclerosis patients by Bayes network

Magnetic resonance imaging is a highly sensitive approach for diagnosis of multiple sclerosis, and T2-weighted images can reveal lesions in the cerebral white matter, gray matter, and spinal cord. However, the lesions have a poor correlation with measurable clinical disability. In this study, we performed a large-scale epidemiological survey of 238 patients with multiple sclerosis in eleven districts by network member hospitals in Shanghai, China within 1 year. The involved patients were scanned for position and size of lesions by MRI. Results showed that lesions in the cerebrum, spina cord, or supratentorial position had an impact on the activities of daily living in multiple sclerosis patients, as assessed by the Bayes network. On the other hand, brainstem lesions were very unlikely to influence the activities of daily living, and were not associated with the position of lesion, patient＇s gender, and patient＇s living place.

Negative Association of Domestic Activity and Active Commuting with Metabolic Syndrome in a Chinese Population Aged 35-64 Years

Objective To understand the associations of physical activity domains with metabolic syndrome among a middle-aged Chinese population. Methods In all, 3326 professional adults aged 35-64 years from Beijing and Zhejiang province were recruited with a cluster random sampling method. The Global Physical Activity Questionnaire was modified, and the recommended Asia-Pacific cut-offs of waist circumstance were introduced into the criteria for metabolic syndrome from the Adult Treatment Panel III. A binary logistic regression model was applied to examine the association of all physical activity domains with the risk of the syndrome. Results Participants who engaged in domestic activity for 〉1176 MET-min/week had a 41.6% less chance of having metabolic syndrome [odds ratio （OR）, 0.584; 95% confidence interval （CI）, 0.480-0.710] than those without this activity. In adjusted models, adults who actively commuted for 〉33 MET-rain/week but 〈52g MET-min/week had a 25% less chance of having the syndrome （OR, 0.750; 95% CI, 0.582-0.966） than those who did not. No interaction was detected between the two domains of activity and the syndrome. Conclusion This study highlighted the independently negative association of traffic and house activity with the prevalence of the syndrome in this sample with a generally low level of moderate activity.

Relationship between fall risks and activities of daily living in older individuals

Objective:To investigate the relationship between fall risks and maintaining activities of daily living in individuals aged 65 and over.Methods:This study is cross-sectional.It was conducted with 233 individuals who were aged 65 and over in Family Health Centers located in the eastern part of Turkey between February and June 2018.Results:The mean older individuals’DENN Fall Risks Assessment Scale score was 11.73±7.13,and 62.2%of the participants were in the high-risk group.Barthel Index of Activities of Daily Living(ADL)mean score was 68.03±25.36,and 45.1%of the participants were in the moderately dependent group.There was a statistically significant,negative correlationship between Barthel Index of ADL score and age and DENN Fall Risks Assessment Scale score.In addition,there was a statistically significant,positive relationship between the DENN Fall Risks Assessment Scale score and age(p<0.01).Conclusions:This study found that level of dependency and fall risks increased with the increase in age.Effective global and multidisciplinary interventions are needed to decrease older individuals’dependency levels and fall risks today when the number of older individuals is increasing.

The Association between Activity of Daily Living and the Combination of Alzheimer’s Disease and Cataract in Elderly Requiring Nursing Care

Some clinical and epidemiological studies have suggested that Alzheimer’s Disease (AD) and cataract, may share common pathogenetic mechanisms, subsequently a positive association between the prevalence of AD and cataract, although other studies found no significant relationship between dementia and visual impairment including cataract in the elderly. Little is known about the association between Activity of Daily Living (ADL) and the combination of AD and cataract. To examine the association between ADL and the combination of AD and cataract, we performed a national survey in nursing care institutions in Japan, examining the decreased ADL in elderly with and without AD and cataract for 453 elderly aged 85.0 ± 8.13 years. The proportion, 43.5% of AD in subjects without cataract was significantly higher than that, 23.5% with cataract. Almost all ADL in AD with cataract was significantly lower than that without cataract, although all ADL in cataract patients receiving surgery in AD was significantly (all p < 0.002) higher than that in cataract patients without surgery in AD, as was confirmed by the multiple regression analysis incorporating into the relevant factors as independent variables. These results showed that ADL scores including cognitive functions decreased by cataract were increased by the surgery in the patients with AD. A significantly negative association between AD and cataract seen in our data, which was inconsistent with the previous result, might lead to the necessities of the clinical diagnosis for slight severity of cataract for patients with AD.

A Brief Clinical Assessment of Cognitive Deficit with Impaired Daily Living Functioning in Parkinson’s Patients with and without Dementia

Cognitive decline in Parkinson’s disease (PD) is defined as dementia which affects activities of daily living (ADL) function. Dementia is one of the recognized issues in the treatment of Parkinson’s disease patients (PDP) as it is becoming a major contributor to morbidity. The objective of our study was to evaluate the cognitive decline in Parkinson’s disease patients (PDP) and the influence of cognition on daily living function deterioration in cognitively impaired and cognitively unimpaired PDP. Cognitively impaired PDP (n = 24), and cognitively unimpaired PDP (n = 16) were administered MoCA and MMSE performance based tests for cognitive measurements and Alzheimer’s Disease Cooperative Study Activities of Daily Living Inventory (ADCS-ADL) to determine everyday functioning. The significances of MoCA and MMSE among cognitively impaired PDP and cognitively unimpaired PDP in univariant analysis were P < 0.001 and P < 0.05. In partial correlation, MoCA was strongly related to ADL function as compare to MMSE (r = 0.623, P = 0.001). Cognitively impaired PDP showed significantly lower score on visuo-construction and attention. Among all variables of MoCA domains, attention is strongly associated with instrumental activity daily living (IADL) scores (logistic regression coefficient = 0.672, P = 0.01). These results suggest that dementia affects daily living performances especially the IADL tasks like attention and execution. Therefore, the assessment of complex daily activities particularly IADL is probably useful for the diagnosis of early stage cognitive impairment in PDP. Further MMSE test is less sensitive than MoCA for detecting significant cognitive decline in PDP and impaired attention is an important determinant of ADL functions in cognitively impaired PDP.

Application of a hospital–community–family trinity rehabilitation nursing model combined with motor imagery therapy in patients with cerebral infarction

BACKGROUND Rehabilitation nursing is considered an indispensable part of the cerebral infarction treatment system.The hospital–community–family trinity rehabilitation nursing model can provide continuous nursing services across hospitals,communities,and families for patients.AIM To explore the application of a hospital–community–family rehabilitation nursing model combined with motor imagery therapy in patients with cerebral infarction.METHODS From January 2021 to December 2021,88 patients with cerebral infarction were divided into a study(n=44)and a control(n=44)group using a simple random number table.The control group received routine nursing and motor imagery therapy.The study group was given hospital–community–family trinity rehabilitation nursing based on the control group.Motor function(FMA),balance ability(BBS),activities of daily living(BI),quality of life(SS-QOL),activation status of the contralateral primary sensorimotor cortical area to the affected side,and nursing satisfaction were evaluated before and after intervention in both groups.RESULTS Before intervention,FMA and BBS were similar(P>0.05).After 6 months’intervention,FMA and BBS were significantly higher in the study than in the control group(both P<0.05).Before intervention,BI and SS-QOL scores were not different between the study and control group(P>0.05).However,after 6months’intervention,BI and SS-QOL were higher in the study than in the control group(P<0.05).Before intervention,activation frequency and volume were similar between the study and the control group(P>0.05).After 6 months’intervention,the activation frequency and volume were higher in the study than in the control group(P<0.05).The reliability,empathy,reactivity,assurance,and tangibles scores for quality of nursing service were higher in the study than in the control group(P<0.05).CONCLUSION Combining a hospital–community–family trinity rehabilitation nursing model and motor imagery therapy enhances the motor function and balance ability of patients with cerebral infarction,improving their quality of life.

Clinical value of ankle flexion and extension exercises combined with a psychological intervention in knee osteoarthritis

BACKGROUND Considering the limited effectiveness of clinical interventions for knee osteoarthritis(KOA),it is necessary to continue to explore appropriate and effective treatment strategies to improve the condition of KOA patients.AIM To clarify the influence of ankle flexion and extension exercises combined with a psychological intervention on the psychological status and activities of daily living(ADLs)of patients with KOA.METHODS The research participants were 116 KOA patients admitted to The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine between May 2019 and May 2022,including 54 patients receiving routine treatment,care and psychological intervention(control group)and 62 patients additionally treated with ankle flexion and extension exercises(research group).The two groups were comparatively analyzed in terms of psychological status(Self-rating Anxiety/Depression Scale,SDS/SAS),ADLs,knee joint function(Lysholm Knee Scoring Scale),pain(Visual Analog Scale,VAS),fatigue(Multidimensional Fatigue Inventory,MFI),and quality of life(QoL;Short-Form 36 Item Health Survey,SF-36).RESULTS After evaluation,it was found that the postinterventional SDS,SAS,VAS,and MFI scores in the research group were significantly reduced compared with the baseline(before the intervention)values and those of the control group,while the postinterventional Lysholm,ADL and SF-36 scores were markedly elevated.CONCLUSION Therefore,ankle flexion and extension exercises are highly effective in easing negative psychological status,enhancing ADLs,daily living ability,knee joint function and QoL,and relieving pain and fatigue in KOA patients,thus warranting clinical promotion.

Arabic Version of the Modified Constant Murley Score

Objectives: “Patient-reported outcome measures” has been used extensively, and it has shown the diseases’ impact on patient quality of life and has enabled the clinician to evaluate the clinical care efficacy. In the literature, there are more than 34 shoulder function assessment scoring instruments;the Modified Constant Murley Score (M-CMS) is one of the most popular scores. Although, the M-CMS had been translated and culturally adapted to Danish, Brazilian and Turkish versions, there is no Arabic version found in the literature. We aim to translate and culturally adapt M-CMS into the Arabic language. Method: The M-CMS was translated using previously published guidelines. The translation and cultural adaptation were done in five stages, initial translation by two bilingual translators then a synthesis of the translations after that, back translation by two native English speakers. Then an expert committee meeting approved the pre-final Arabic version. Finally, a pilot test was conducted on 41 patients to ensure its validity. Results: The M-CMS was successfully translated from the original English version to the Arabic version;no difficulties in the translation process were faced. Conclusion: A validated Arabic version of the M-CMS was produced and ready to be used for functional assessment of different shoulder pathologies in Arabic-speaking countries. Future study is needed for translation and cultural adaptation of the English standardized test protocol to assure the reproducibility of the Arabic version of the M-CMS.

The association between frailty of older stroke patients during hospitalization and one-year all-cause mortality:A multicenter survey in China

Objective:Frailty is a common geriatric syndrome defined as multiple deficits,impairing the capacity to figure out insult.Previous studies have reported a significant association between frailty and mortality in stroke patients.This study aimed to explore the association between frailty and mortality among older Chinese stroke patients.Methods:This study was a secondary analysis of a multicenter prospective cohort study conducted in older Chinese inpatients from October 2018 to February 2020,and patients with a primary diagnosis of stroke including hemorrhage and ischemia,were included in our study.Frailty of older inpatients with stroke from six hospitals was measured by the FRAIL scale,and a one-year follow-up was performed by well-trained nurses of these hospitals via telephone.Multivariable logistic regression was used to detect the association between frailty and one-year mortality.Results:A total of 530 stroke patients with an average age of 72.94(SD¼5.79)years were included in the present study.There were 37(7.0%)hemorrhagic strokes and 493(93.0%)ischemic strokes,with 228(43.0%)females in this population.The prevalence of frailty was 22.5%.In the logistic regression model with adjustment for age,sex,instrumental activities of daily living(IADL),basic activities of daily living(ADL),education,history of falls,BMI,smoking,alcohol consumption,low handgrip strength,type of stroke and polypharmacy,stroke patients with frailty had an increased risk of one-year mortality compared to those without frailty(OR¼3.38,95%CI:1.22e9.37,P¼0.019).Conclusion:Our study indicated that frailty was an independent risk factor for one-year all-cause mor-tality among older stroke patients in China.Frailty may be an essential factor for clinicians to consider before making a comprehensive treatment,and corresponding mixed interventions,including exercise training and nutritional programs,need to be conducted among older stroke patients.

Intervention effect of neuromuscular electrical stimulation on ICU acquired weakness: A meta-analysis

Objective:The early use of neuromuscular electrical stimulation(NMES)to prevent intensive care unit-acquired weakness(ICU-AW)in critical patients is still a controversial topic.We conducted a systematic review to clarify the effectiveness of NMES in preventing ICU-AW.Methods:The Cochrane Library,PubMed,EMBASE,MEDUNE,Web of Science,Ovid,CNKI,Wanfang,VIP,China Biology Medicine disc(CBMdisc)and other databases were searched for randomized controlled trials on the influence of NMES on ICU-AW.The studies were selected according to the inclusion and exclusion criteria.After data and quality were evaluated,a meta-analysis was performed by RevMan 5.3 software.Results:A total of 11 randomized controlled trials with 576 patients were included.The meta-analysis results showed that NMES can improve muscle strength[MD=1.78,95%CI(0.44,3.12,P=0.009);shorten the mechanical ventilation(MV)time[SMD=-0.65,95%CI(-1.03,-0.27,P=0.001],ICU length of stay[MD=-3.41,95%CI(-4.58,-4.24),P<0.001],and total length of stay[MD=-3.97,95%CI(-6.89,-1.06,P=0.008];improve the ability of patients to perform activities of daily living[SMD=0.9,95%CI(0.45,1.35),P=0.001];and increase walking distance[MD=239.03,95%CI(179.22298.85),P<0.001].However,there is no evidence indicating that NMES can improve the functional status of ICU patients during hospitalization,promote the early awakening of patients or reduce mortality(P>0.05).Conclusion:Early implementation of the NMES intervention in ICU patients can prevent ICU-AW and improve their quality of life by enhancing their muscle strength and shortening the MV duration,length of stay in the ICU and total length of stay in the hospital.

Xingnao Kaiqiao needling method for acute ischemic stroke： a meta-analysis of safety and efficacy

OBJECTIVE： To evaluate the effectiveness and safety of the Xingnao Kaiqiao needling method for treating acute ischemic stroke.DATA SOURCES： We retrieved relevant randomized controlled trials involving Xingnao Kaiqiao acupuncture for treatment of acute ischemic stroke. The China National Knowledge Infrastructure, Weipu Information Resources System, Wanfang Medical Data System, Chinese Biomedical Literature Database, Cochrane Library, and Pub Med were searched from June 2006 to March 2016.DATA SELECTION： We analyzed randomized and semi-randomized clinical controlled trials that compared Xingnao Kaiqiao acupuncture with various control treatments, such as conventional drugs or other acupuncture therapies, for treatment of acute ischemic stroke. The quality of articles was evaluated according to the Cochrane Handbook for Systematic Reviews of Interventions（Version 5.1）, and the study was carried out using Cochrane system assessment methods. Rev Man 5.2 was used for the meta-analysis of the included studies.OUTCOME MEASURES： The mortality rate, disability rate, activities of daily living（Barthel Index）, and clinical efficacy were observed.RESULTS： Twelve studies met the inclusion criteria for this review. The meta-analysis showed that between Xingnao Kaiqiao acupuncture and the control treatment, Xingnao Kaiqiao acupuncture reduced the disability rate [risk ratio（RR） = 0.51, 95% confidence interval（CI） = 0.27-0.98, z = 2.03, P 〈 0.05], elevated the activities of daily living（weighted mean difference = 12.23, 95% CI： 3.66-20.08, z = 2.80, P 〈 0.005）, and had greater clinical efficacy（RR = 1.61, 95% CI： 1.23-2.09, z = 3.53, P 〈 0.0004）. However, there was no significant difference in mortality rate（RR = 0.61, 95% CI： 0.15-2.45, z = 0.70, P 〉 0.05）. CONCLUSION： The Xingnao Kaiqiao needling method is effective and safe for acute ischemic stroke. However, there was selective bias in this study, and the likelihood of measurement bias is high. Thus, more high-quality randomized controlled trials are needed to provide reliable evidence of the efficacy and safety of Xingnao Kaiqiao acupuncture in the treatment of acute ischemic stroke.