An enhanced functional ability questionnaire(faVIQ) to measure the impact of rehabilitation services on the visually impaired

AIM: To develop a short,enhanced functional ability Quality of Vision(faVIQ) instrument based on previous questionnaires employing comprehensive modern statistical techniques to ensure the use of an appropriate response scale,items and scoring of the visual related difficulties experienced by patients with visual impairment. · METHODS: Items in current quality-of-life questionnaires for the visually impaired were refined by a multi-professional group and visually impaired focus groups. The resulting 76 items were completed by 293 visually impaired patients with stable vision on two occasions separated by a month. The faVIQ scores of 75 patients with no ocular pathology were compared to 75 age and gender matched patients with visual impairment. ·RESULTS: Rasch analysis reduced the faVIQ items to 27. Correlation to standard visual metrics was moderate(r =0.32-0.46) and to the NEI-VFQ was 0.48. The faVIQ was able to clearly discriminate between age and gender matched populations with no ocular pathology and visual impairment with an index of 0.983 and 95% sensitivity and 95% specificity using a cut off of 29.·CONCLUSION: The faVIQ allows sensitive assessment of quality-of-life in the visually impaired and should support studies which evaluate the effectiveness of low vision rehabilitation services.

Stroke Patients’ Reintegration into Normal Living Post-Discharge from Inpatient Rehabilitation: An Integrative Review

Background: Stroke rehabilitation professionals have historically focused rehabilitation on physical functions and overlooked the concept of community reintegration after discharge from inpatient rehabilitation. The lack of focus on psychosocial functions post-stroke may lead to lower levels of satisfaction during community reintegration. Methods: This integrative review synthesized findings from research literature on stroke patients’ reintegration into the community after inpatient rehabilitation to address three research questions: a) What specific physical and psychosocial functions have been identified as predictors of successful reintegration into normal living after stroke?, b) How do physical and psychosocial functions promote successful reintegration into normal living after stroke?, and c) What factors have been identified that hinder stroke patients’ reintegration into normal living after stroke? Results: A systematic search of literature identified sixteen studies that provided significant context for the research questions. What physical and psychosocial functions of stroke patients included, for example, improved mobility, independence in daily activities, reduced disability, psychological well-being, self-efficacy, social support, and personal relationships. How physical and psychosocial functions promote reintegration included, for example, disability management, emotional well-being, self-care independence, sense of purpose, and employment influence. Factors that hinder stroke patients’ reintegration consisted of longer stride time, impaired balance/mobility, activities limitation, severe stroke, presence of comorbidity, depressive symptoms, speech and language challenges, inadequate self-efficacy, fear of falling, older age, low educational level, lack of social support, and social isolation. Conclusion: Successful community reintegration after stroke requires a shift of focus from rehabilitation interventions that target physical functions to include interventions that address psychosocial functions.

Improvement of learning and memory abilities and motor function in rats with cerebral infarction by intracerebral transplantation of neuron-like cells derived from bone marrow stromal cells

BACKGROUND： Transplantation of fetal cell suspension or blocks of fetal tissue can ameliorate the nerve function after the injury or disease in the central nervous system, and it has been used to treat neurodegenerative disorders induced by Parkinson disease. OBJECTIVE： To observe the effects of the transplantation of neuron-like cells derived from bone marrow stromal cells （rMSCs） into the brain in restoring the dysfunctions of muscle strength and balance as well as learning and memory in rat models of cerebral infarction. DESIGN ： A randomized controlled experiment.SETTING ： Department of Pathophysiology, Zhongshan Medical College of Sun Yat-sen University.MATERIALS ： Twenty-four male SD rats （3-4 weeks of age, weighing 200-220 g） were used in this study （Certification number：2001A027）. METHODS： The experiments were carried out in Zhongshan Medical College of Sun Yat-sen University between December 2003 and December 2004. ① Twenty-four male SD rats randomized into three groups with 8 rats in each： experimental group, control group and sham-operated group. Rats in the experiment al group and control group were induced into models of middle cerebral artery occlusion （MCAO）. After in vitro cultured, purified and identified with digestion, the Fischer344 rMSCs were induced to differentiate by tanshinone IIA, which was locally injected into the striate cortex （18 area） of rats in the experimental group, and the rats in the control group were injected by L-DMEM basic culture media （without serum） of the same volume to the corresponding brain area. In the sham-operated group, only muscle and vessel of neck were separated. ② At 2 and 8 weeks after the transplantation, the rats were given the screen test, prehensile-traction test, balance beam test and Morris water-maze test. ③ The survival and distribution of the induced cells in corresponding brain area were observed with Nissl stained with toluidine blue and hematoxylin and eosin （HE） staining in the groups.MAIN OUTCOME MEASURES ： ① Results of the behavioral tests （time of the Morris water-maze test screen test, prehensile-traction test, balance beam test）; ② Survival and distribution of the induced cells.RESULTS： All the 24 rats were involved in the analysis of results. ① Two weeks after transplantation, rats with neuron-like cells grafts in the experimental group had significant improvement on their general muscle strength than those in the control group [screen test： （9.4±1.7）, （4.7±1.0） s, P 〈 0.01]; forelimb muscle strength [prehensile-traction test： （7.6±1.4）, （5.2±1.2） s, P 〈 0.01], ability to keep balance [balance beam test： （7.9±0.74）, （6.1±0.91） s, P 〈 0.01] and abilities of learning and memory [latency to find the platform： （35.8±5.9）, （117.5±11.6） s, P 〈 0.01; distance： （623.1±43.4）, （1 902.3±98.6） cm, P 〈 0.01] as compared with those in the control group. The functional performances in the experimental group at 8 weeks were better than those at two weeks, which were still obviously different from those in the sham-operated group （P 〈 0.05）. ② The HE and Nissl stained brain tissue section showed that there was nerve cell proliferation at the infarcted cortex in the experiment group, the density was higher than that in the control group, plenty of aggregative or scattered cells could be observed at the site where needle was inserted for transplantation, the cells migrated directively towards the area around them, the cerebral vascular walls were wrapped by plenty of cells; In the control group, most of the cortices were destroyed, karyopyknosis and necrosis of neurons were observed, normal nervous tissue structure disappeared induced by edema, only some nerve fibers and glial cells remained.CONCLUSION： The rMSCs transplantation can obviously enhance the motor function and the abilities of learning and memory in rat models of cerebral infarction.

Direct anterior approach vs Hardinge in obese and nonobese osteoarthritic patients:A randomized controlled trial

BACKGROUND The increased prevalence of obesity has resulted in orthopedic surgeons being likely to face many patients with a high body mass index(BMI)who warrant total hip arthroplasties(THAs)over the coming years.Studies'findings considered the postoperative clinical,and functional outcomes in these patients are controversial,and selecting the most appropriate surgical approach remains debatable.AIM To compare pain-levels,functionality,and quality-of-life in obese and nonobese osteoarthritic patients who have undergone primary total hip arthroplasty through either direct-anterior-approach(DAA)or Hardinge-approach.METHODS One hundred and twenty participants(>50 years)were divided into four groups according to the surgical approach(DAA or Hardinge)and patients'BMI(nonobese<30 kg/m^(2)vs obese≥30 kg/m^(2)).Outcomes were measured preoperatively and postoperatively(6^(th)and 12^(th)week).Pain was measured with Face Pain Scale-Revised(FPS-R).Functionality was measured with Timed Up&Go(TUG)test and Modified Harris Hip Score-Greek version(MHHS-Gr).Quality-of-life was evaluated with the 12-item-International Hip Outcome Tool-Greek version(iHOT12-Gr)(Clinical Trial Identifier:ISRCTN15066737).RESULTS DAA vs Hardinge:(week 6)DAA-patients showed 12.2% less pain,more functionality(14.8% shorter TUG-performance time,21.5% higher MHHS-Gr),and 38.16% better quality-of-life(iHOT12-Gr)compared to Hardinge-patients(all P values<0.001).These differences were further increased on week 12(all P values≤0.05).DAA-obese vs Hardinge-obese:(week 6)DAA-obese patients had less pain,shorter TUG-performance time,better MHHS-Gr and iHOT12-Gr scores than Hardinge-obese(all P values<0.01).(Week 12)Only the TUG-performance time of DAA-obese was significantly shortened(22.57%,P<0.001).DAAnonobese vs DAA-obese:no statistically significant differences were observed comparing the 6th and 12th weeks'outcomes.CONCLUSION DAA-groups reported less pain,more functionality and better quality-of-life,compared to the Hardinge-groups.The DAA benefited obese and nonobese patients,similarly yet faster,suggesting that it should be the more preferred choice for obese patients,instead of Hardinge.However,more comparative studies with more extended follow-up periods are needed to confirm our results and better evaluate all patients'long-term outcomes.

Physical activity,fitness and all-cause mortality:An 18-year follow-up among old people

Background：Little is known about change in physical activity（PA） and its relationship to all-cause mortality among old people.There is even less information about the association between PA,fitness and all-cause mortality among people aged 80 years and above.The objective is to investigate persistence and change in PA over 5 years as a predictor of all-cause mortality,and fitnes as a mediator of this association,among people aged 80 and 85 years at the beginning of an 18-year mortality follow-up period.Methods：Using Evergreen Project data（started in 1989）,4 study groups were formed according to self-reported changes in PA level,over a 5-year period（starting in 1989–1990 and ending in 1994–1995）：remained active（RA,control group）,changed to inactive（CI）,remained inactive（RI）,and changed to active（CA）.Mortality was followed up over the 18-year period（1994–2012）.Cox models with different covariates such as age,sex,use of alcohol,smoking,chronic diseases,and a 10 m walking test were used to analyze the association between change in PA level and mortality.Results：Compared to RA,those who decreased their PA level（CI） between baseline and follow-up had higher all-cause mortality（hazard ratio（HR=2.09;95%CI：1.63–2.69） when adjusted for age,gender,and chronic diseases.RI showed the highest all-cause mortality（HR = 2.16;95%CI：1.59–2.93）.In CA,when compared against RA,the risk of all-cause mortality was not statistically significan（HR=1.51;95%CI：0.95–2.38）.In comparison with RA,when walking speed over 10 m was added as a covariate,all-cause mortality risk was almost statistically significan only in CI（HR=1.37;95%CI：1.00–1.87）.Conclusion：Persistence and change in PA level was associated with mortality.This association was largely explained by fitnes status.Randomized controlled studies are needed to test whether maintaining or increasing PA level could lengthen the life of old people.