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PubMed2000

Outcome validation of the AO/OTA fracture classification system.

OBJECTIVES: To determine whether a greater severity of injury as documented by the AO/OTA code would correlate with poor scores of impairment, functional performance, and self-reported health status. DESIGN: Prospective, functional outcome. SETTING: Three Level One Trauma Centers. PATIENTS/PARTICIPANTS: Two hundred patients with unilateral and isolated lower extremity fractures. MAIN OUTCOME MEASUREMENTS: Six- and twelve-month SIP, AMA impairment, and functional performance measures of self-selected walking speed, stair climbing, heel raises, rising from a chair, balance work. RESULTS: At six months post injury, overall impairment was significantly (p < 0.05) higher for patients with Type C versus Type B fractures. A significant difference was found among the A, B, C types and the ROM impairment rating at six months (p = 0.004). Using the Scheffe method, the significant difference was determined to be between the B- and C-type fractures. Overall functional performance scores at six months were shown to have significant (p = 0.01) variation using an ANOVA with the significant variation being between the B and C type. At twelve months, the overall functional performance was significant (p = 0.05). CONCLUSION: Patients with C-type fractures had significantly worse functional performance and impairment compared with patients with B-type fractures but were not significantly different from patients with A-type fractures. AO/OTA code may not be a good predictor of six- and twelve-month functional performance and impairment for patients with isolated unilateral lower extremity fractures.

Analysis of Variance↗
PubMed2004

Weight loss intervention for obese older women: improvements in performance and function.

OBJECTIVES: To determine the feasibility of a 3-month weight loss program for obese older women with short-term laboratory, performance, functional, and life quality outcomes. RESEARCH METHODS AND PROCEDURES: This was a pre- and postintervention design. Community-dwelling women (n = 26) > or =60 years old with BMI > or =30 were enrolled in a 3-month weight loss program promoting prudent diet, behavior modification, and physical activity. The primary emphasis of the program was on health, function, and quality of life. The approach was specifically tailored to older subjects through use of large-font instructional materials, supplementation of calcium and vitamin D, and moderate weight loss and physical activity goals. An initial assessment by a bariatric physician was followed by eight visits with a dietitian and a follow-up physician visit. Measurements included anthropometrics, body composition, laboratories, pedometer, physical performance, Short-Form 36 Health Status Survey (SF-36), Life Space Assessment, and dietary assessment. RESULTS: Eighteen participants completed the program. There was a significant decrease in mean body weight (100 +/- 15 vs. 96 +/- 18 kg, p = 0.006), with a mean weight loss of 4.3 +/- 5.5 kg (range -15.5 to +7.20 kg). Significant improvements were observed for diastolic blood pressure, total cholesterol, triglycerides, physical performance, pedometer-measured step counts, and step climb and descent. Self-rated physical functioning (SF-36 subscore) and vitality (SF-36 subscore) were also significantly improved. DISCUSSION: It is feasible for self-selected obese older women to achieve a moderate weight loss and increase in physical activity resulting in short-term improvements in laboratory, physical performance, self-reported function, vitality, and life quality outcomes.

Aged↗
PubMed2007

Depression and apathy affect functioning in community active subjects with questionable dementia and mild Alzheimer's disease.

BACKGROUND: The relationships between apathy, depression and functional impairment in questionable dementia (QD) and Alzheimer's disease (AD) are complex. This study aimed to explore the interactions between severity of apathy, depression and functional performance; and to investigate the effects of apathy alone, depression alone and coexistence of apathy and depression on the functional performance in subjects with QD and AD. METHODS: One hundred ninety-five subjects with QD and 96 subjects with mild AD were recruited. Apathy and depression were rated using the Neuropsychiatric Inventory and functional disability was measured using the Disability Assessment for Dementia (DAD). RESULTS: Severity of apathy and depression symptoms were associated with poorer functional performance in QD and apathy was associated with poorer functional performance in AD. In QD, subjects with apathy, depression, or coexistence of apathy and depression had poorer functional performance than those with neither apathy nor depression. The coexistence of apathy and depression did not produce more severe functional disability than apathy alone or depression alone. In AD, subjects with apathy had poorer functional performance than those without apathy. Depression in the absence of apathy was not associated with more severe functional disability. CONCLUSION: Apathy and depression symptoms are common in the early course of AD. Apathy and depression had different effects on functional performances in the subjects with QD from those with AD.

Activities of Daily Living↗
PubMed2004

Testing the functional status model in patients with chronic obstructive pulmonary disease.

BACKGROUND: Patients with chronic obstructive pulmonary disease usually experience gradual functional status degradation, especially dyspnoea, which may affect their daily activities and, eventually, quality of life. A full understanding of both their physiological and psychological functional status is therefore beneficial for effective treatment and helping patients regain or maintain control of their lives. METHOD: Based on a non-experimental research design, 138 patients to test a hypothesized model of functional status in patients with chronic obstructive pulmonary disease, using structural equation modelling, were recruited from a medical center. Data were collected using questionnaires, 6-minute walking distance measurement, and pulmonary function test results recorded in patients' medical records. The proposed functional status model incorporated the exogenous variables disease severity and dyspnoea, and the endogenous variables age, exercise tolerance, fatigue, depression, anxiety, health perception and functional performance. Structural equation modelling with the lisrel software was used to establish a functional status model with those exogenous and endogenous variables. RESULTS: The results indicated a good fit between the proposed functional status model and the data collected [chi(2) = 8.84, P = 0.64, chi(2)/d.f. = 0.80, Goodness of Fit Index (GFI) = 0.98, adjusted GFI (AGFI) = 0.95, root mean square residual (RMR) = 0.04, Critical N (CN) = 384.26]. Coefficients for paths in the functional status model all demonstrated statistical significance. CONCLUSION: The functional status model was shown to consist of functional performance, functional capacity and other concepts, including disease severity, dyspnoea, age, exercise tolerance, fatigue, depression, anxiety and health perception. These results can be used to develop a suitable functional status model for chronic obstructive pulmonary disease, and could act as a reference for formulating future strategies and intervention procedures for further development of functional status.

Activities of Daily Living↗
PubMed2004

The effect of self-reported and performance-based functional impairment on future hospital costs of community-dwelling older persons.

PURPOSE: We determined the prognostic value of self-reported and performance-based measurement of function, including functional transitions and combining different measurement approaches, on utilization. DESIGN AND METHODS: Our cohort study used the 6th, 7th, and 10th waves of three sites of the Established Populations for Epidemiologic Studies of the Elderly, linked to 1- and 4-year Medicare Part A hospital costs. We examined mean hospital expenditures based on (a) 1- and 4-year transitions in self-reported functional status; (b) 4-year transitions in performance-based functional status; (c) combined baseline self-reported and performance-based functional status; and (d) poorest self-reported and performance-based functional status during a 4-year period. RESULTS: Even modest declines in self-reported or performance-based functional status were associated with increased expenditures. When baseline self-reported and performance-based assessments were combined, mean 1- and 4-year adjusted costs were higher with progressively worse performance-based scores, even among those who were independent in self-reported function. When the poorest 4-year self-reported and performance-based functions were examined, self-reported functioning was the most important determinant of hospital costs, but within each self-reported functional level, poorer performance-based function was associated with progressively higher costs. IMPLICATIONS: The costs associated with even modest functional decline are high. Combining self-reported and performance-based measurements can provide more precise estimates of future hospital costs.

Activities of Daily Living↗
PubMed2006

Gender differences in the performance of activities of daily living among patients with chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) limits the ability to perform activities of daily living (ADL). The Pulmonary Functional Status and Dyspnoea Questionnaire (PFSDQ) measures general dyspnoea, dyspnoea during ADL (dyspnoea score) and loss of functional performance (activity score) for a large number of activities commonly performed by adults. The questionnaire is only validated for male patients. The aim of our study was therefore to validate the PFSDQ for women with COPD. We then wanted to investigate possible gender differences in responses to the PFSDQ and whether associations between the PFSDQ and pulmonary function, exercise capacity, health related quality of life (HRQoL) and general quality of life (QoL) were influenced by gender. This cross-sectional, observational study included 110 COPD patients. Sixty-five men and 45 women, referred to pulmonary rehabilitation participated. Pulmonary function and six-minute walking distance (6MWD) were measured. Patients completed PFSDQ, St George's Respiratory Questionnaire (SGRQ, HRQoL) and Perceived Quality of Life Scale (PQoL, QoL). No gender differences were found in pulmonary function (% of predicted), 6MWD, SGRQ or PQoL. Most items in the PFSDQ were found relevant by both women and men. Activity Scores were only different for men and women for items concerning home management; women had changed their functional performance the most, particularly for the heaviest chores. No gender differences were found in dyspnoea scores. Moderate correlations were found between PFSDQ and 6MWD, SGRQ and PQoL. Multiple linear regression analyses showed that these relations were not influenced by gender. We consider PFSDQ as applicable to women as to men as a comprehensive measure of functional performance and dyspnoea. The questionnaire gives information complementary to measures of exercise capacity, HRQOL and QOL. The larger loss of functional performance in home management among women should be taken into account in the treatment of COPD patients.

Activities of Daily Living↗
PubMed1985

Effects of mitral valve surgery on static lung function and exercise performance.

Lung function at rest was assessed in 50 patients before and six months after mitral valve surgery. There were small increases in spirometric volumes (FEV1 and vital capacity) with decreases in total lung capacity and residual volume, but no change in carbon monoxide transfer factor or transfer coefficient (KCO). Progressive exercise tests performed before and after operation in 19 of the patients confirmed an improved exercise capacity after surgery. The patients with the greatest symptomatic improvement in breathlessness were also those who achieved the greatest increase in maximum work load and the greatest decrease in ventilation for a given oxygen consumption. Depression of the ST segment of the electrocardiogram and frequent ventricular ectopic beats on exercise remained common after surgery and may have been due to digoxin treatment.

Adult↗
PubMed2003

Two years later: a prospective long-term follow-up of a training intervention in geriatric patients with a history of severe falls.

OBJECTIVE: To study the long-term outcome of a physical training regimen of ambulant postward rehabilitation in community-dwelling geriatric patients with a history of injurious falls. DESIGN: Prospective 2-year follow-up of a randomized placebo-controlled intervention trial. SETTING: Postward rehabilitation in a geriatric hospital in Germany. PARTICIPANTS: Fifty-seven geriatric patients (mean age, 84.3+/-4.4 y) with a history of severe falls. INTERVENTION: Ambulatory training of strength, functional performance, and balance 3 times a week for 3 months for 31 patients versus placebo activities for 26 patients. MAIN OUTCOME MEASURES: Strength, functional performance, fall-related psychologic parameters, and physical activity assessed by standardized protocols 2 years after the training intervention, compared with baseline results. RESULTS: Motor performance decreased substantially in both groups. As patients in the intervention group declined from significantly improved motor performance levels achieved in the initial training intervention, differences between the groups were still significant in most functional performances 2 years later. Functional decline was greater in persons who were institutionalized or being cared for by family members. Physical activity, which increased during the exercise intervention, returned to low baseline levels. CONCLUSIONS: Improved functional performance in the training group did not lead to an increased level of physical activity after training, which might have preserved the functional improvements. In mobility-restricted, frail, geriatric patients such as our study population, training programs should continue to keep patients active and to prevent the decline in strength and functional performance that precedes loss of autonomy.

Accidental Falls↗
PubMed1986

Binocular vs. monocular task performance.

Functional advantages of binocularity were investigated by having 13 subjects perform a group of occupational-type tasks under monocular and binocular conditions. Significant binocular advantages ranging from 29.5% (pointers in straws) to 3.7% (reading speed) were measured. Tasks with many disparity cues showed the greatest binocular advantage. This shows that patients with normal binocular vision use binocular cues, most likely stereopsis, to enhance performance. In a second experiment, three subjects with normal binocular vision underwent monocular occlusion for 5 days to investigate whether monocular skills improved to compensate for the loss of binocular vision. During that period binocular performance was consistently better than monocular performance, and both monocular and binocular performance improved, even though the subjects were only gaining monocular experience. Although the 5 day occlusion period does not simulate the long-term denial of normal binocularity that strabismics or monocular patients experience, it shows that binocular superiority remains after short-term loss of binocularity.

Functional Laterality↗
PubMed2005

Sleep and quality of life in stable heart failure.

BACKGROUND: Functional performance and mental health are significant quality of life concerns for heart failure (HF) patients. Poor sleep also appears to be common. We examined the extent to which sleep was associated with functional performance and mental health among persons who had stable systolic HF. METHODS AND RESULTS: Sixty-one patients with stable systolic HF wore wrist actigraphs to record nocturnal sleep and daily activity for 3 days while living at home, performed 6-minute walks (6MWT), and completed the Pittsburgh Sleep Quality Index and the Medical Outcomes Study SF-36 questionnaire. Self-reported sleep quality and actigraph-recorded wake time and wake bout time explained 9% to 20% of the variance in the functional performance variables (daytime activity level, 6MWT, self-reported physical function), and mental health, after controlling for age, gender, comorbidity, and New York Heart Association class. Time in bed was negatively associated with functional performance. There were no statistically significant relationships between sleep duration and functional performance. CONCLUSIONS: Self-reported sleep quality and sleep continuity (sleep that is undisturbed by nocturnal awakenings) are associated with functional performance and mental health in stable systolic HF patients. Effective treatment of sleep problems may contribute to improvement in quality of life.

Adult↗
PubMed2004

Effects of cognitive-communication stimulation for Alzheimer's disease patients treated with donepezil.

This randomized study evaluated the combined effect of a cognitive-communication program plus an acetylcholinesterase inhibitor (donepezil; donepezil-plus-stimulation group; n = 26), as compared with donepezil alone (donepezil-only group; n = 28) in 54 patients with mild to moderate Alzheimer's disease (AD; Mini-Mental Status Examination score of 12- 28) ranging in age from 54 to 91 years. It was hypothesized that cognitive-communication stimulation in combination with donepezil would positively affect the following: (a) relevance of discourse, (b) performance of functional abilities, (c) emotional symptoms, (d) quality of life, and (e) overall global function, as measured by caregiver and participant report and standardized measures. Cognitive-communication, neuropsychiatric, functional performance, and quality of life evaluations were conducted at baseline and Month 4, the month after the 2-month active stimulation period. Follow-up evaluations were performed at Months 8 and 12. The stimulation program consisted of 12 hr of intervention over an 8-week period and involved participant-led discussions requiring homework, interactive sessions about AD, and discussions using salient life stories. Additive effects of active stimulation with donepezil were examined in 2 ways: (1) comparing mean group performance over time and (2) evaluating change scores from baseline. A Group x Time interaction was found for the donepezil-plus-stimulation group in the emotional symptoms of apathy and irritability as compared with the donepezil-only group. Evaluation of change scores from baseline to 12 months revealed a positive effect for the donepezil-plus-stimulation group on discourse and functional abilities with a trend on apathy, irritability, and patient-reported quality of life. In sum, the research revealed benefits to the donepezil-plus-stimulation group in the areas of discourse abilities, functional abilities, emotional symptoms, and overall global performance. This study adds to growing evidence that active cognitive stimulation may slow the rate of verbal and functional decline and decrease negative emotional symptoms in AD when combined with acetylcholinesterase inhibitors, indicating a need to advance research in the area of cognitive treatments. The fact that AD is a progressive brain disease should not preclude ameliorative treatment.

Activities of Daily Living↗
PubMed2003

Changes in function and disability after resistance training: does velocity matter?: a pilot study.

OBJECTIVE: To compare the effects of high- and low-velocity resistance training on functional performance and disability outcomes in physically limited older women. DESIGN: A total of 16 wk of high-velocity resistance training or traditional low-velocity resistance training consisting of knee extension and leg press exercises was performed three times per week by 30 women with self-reported disability to compare their effect on functional performance and disability. Tests of dynamic balance, stair-climb time, chair-rise time, and gait velocity were used to assess changes in functional performance. Changes in disability were assessed using the Medical Outcomes Study Short Form. RESULTS: Dynamic balance and stair-climb time improved 8% and 10%, respectively, with training. Self-reported disability, physical functioning, role physical, and mental health improved 11, 9, and 5% with training, respectively. There were no significant differences between high- and low-velocity training groups. CONCLUSIONS: High- and low-velocity training achieved similar improvements in functional performance and disability. Improvements in functional performance and disability were modest compared with robust increases in strength and power. Specific modes of training or behavioral strategies may be necessary to optimize improvements in these outcomes.

Aged↗
PubMed1990

Ethanol effects on delayed spatial matching as modeled by a negative exponential forgetting function.

Performance on delayed matching-to-position as a function of ethanol was investigated in rats and dose effects assessed by fitting an exponential decay model of forgetting to signal detection sensitivity scores. Three ethanol doses (0.25, 0.50, and 0.75 g/kg) and one isovolume saline control were examined. For further comparison, one dose of chlordiazepoxide (CDP; 5 mg/kg) and its saline control were also given. Forgetting functions were reasonably well described by the decay model under all treatment conditions. In addition, the functions's decay constant (-b) proved to be differentially sensitive to both drug and dose effects. Reduced decay estimates were obtained following the two lowest ethanol doses, the reduction being statistically significant for the 0.25 g/kg dose. In contrast, the function estimate of initial sensitivity, the intercept parameter (SI0), was not significantly affected by ethanol. Consistent with the low-dose ethanol effects, CDP significantly decreased the value of the decay parameter while leaving the intercept parameter unaffected. But unlike ethanol, the variance accounted for by the model for the individual data was less following CDP administration. Drug effects were interpreted using the exponential decay model of forgetting, and the results suggest independent discriminative control over SI0 and b. The significant effect of the low-dose sedative-hypnotics upon b, with no attendant effects upon SI0, is suggested to result from enhanced, spontaneous, delay interval mediation.

Animals↗
PubMed2002

Spinal performance and functional impairment in postmenopausal women with osteoporosis and osteopenia without vertebral fracture.

Previous studies have paid much attention to the impact on functional impairment or quality of life from vertebral fractures secondary to osteoporosis, but little research has addressed the function of osteoporotic women without fractures. The purposes of this study were: (1) to describe spinal performance and functional impairment in postmenopausal women with osteoporosis and osteopenia without vertebral fracture, and (2) to investigate the relationship between them. Thirty postmenopausal women diagnosed as having osteoporosis or osteopenia were recruited who fulfilled the following criteria: (1) menopause for at least 6 months; (2) no vertebral fracture; (3) no medication that would interfere with calcium intake. Measurements included assessment of functional impairment and spinal performance including trunk extension/flexion isokinetic strength, spinal range of motion (ROM) and movement velocity in three planes (sagittal, frontal and transverse). The results showed that spinal ROM and velocity were significantly reduced in the osteoporosis group compared with the osteopenia group ( p<0.05), but no significant difference in trunk strength was shown. Functional impairment level showed a slight difference between the two groups ( p = 0.042). There was a significant correlation between spinal ROM and motion velocity with bone mineral density; however, functional impairment correlated with motion velocity only in the transverse plane (trunk rotation) ( p<0.05). Spinal strength did not show any correlation with other parameters. It was concluded that spinal motion performance declined and functional impairment increased in relation to the severity of bone mineral loss in postmenopausal women without vertebral fracture, but their physical performance was not correlated with functional impairments.

Aged↗
PubMed2005

Differences among outcome measures in occupational low back pain.

The rate of recurrence in low back pain patients has been reported as high as 70%; therefore, it is believed that researchers have a poor understanding of low back pain recovery. To enhance our understanding of recovery, a large cross-sectional study was conducted to compare outcome measures of return to work, impairment of activities of daily living, pain symptoms, and functional performance probability. A total of 208 workers were examined. The percentage of workers recovered based on return to work criteria was 99% compared to 25% for impairment of activities of daily living, 17% for symptoms, and 12.5% for functional performance probability. Single functional performance measures of range of motion, velocity, and acceleration had recovery rates of 59, 13, and 10%, respectively. It appears that all these criteria are measuring very different parameters of low back pain recovery. The residual loss in functional performance may indicate a decreased tolerance to physical demand providing potential insight for why recurrent low back pain rates are high.

Activities of Daily Living↗
PubMed1995

Use of mathematical models for predicting the metabolic effect of large-scale enzyme activity alterations. Application to enzyme deficiencies of red blood cells.

There are numerous examples showing that the metabolism of cells can be severely impaired if the activity of only one of the participating enzymes undergoes large-scale alterations, resulting, for example, from spontaneous mutations (inherited or acquired enzymopathies), the administration of toxic drugs or self-inactivation of enzymes during cell aging. However, a quantitative relationship between the degree of enzyme deficiency and the extent of metabolic dysfunction is very difficult to establish by experimental means. An alternative is to tackle this problem by mathematical modelling. Our approach is based on a comprehensive mathematical model of the energy and redox metabolism for human erythrocytes. We calculate stationary states of the cell metabolism, varying the activity of each of the participating enzymes by several orders of magnitude. The metabolic states are then evaluated in terms of a performance function which relates the metabolic variables to the overall functional fitness of the cell. The performance function for the erythrocyte takes into account the homeostasis of three essential metabolic variables: the energetic state (ATP), the reductive capacity (reduced glutathione), and the osmotic state. Based on the behaviour of the performance function at varying enzyme activities, we estimate those ranges of enzyme activities, in which the metabolic alterations should be either tolerable, associated with non-chronic or chronic diseases, or lethal. For most enzymopathies, the experimental and clinical observations can be satisfactorily rationalized by the computational results. Moreover, a surprisingly high correlation is found between the range of the activity range where disease is predicted by the model and the observed number of diseased probands. Another objective of our study was to contribute to the theory of metabolic control. The well-elaborated concept of the metabolic control theory is restricted to (infinitely) small activity alterations. In order to quantify the metabolic effect of finite (large-scale) changes in the activity of an enzyme, we propose, as a control measure, the effective activity E alpha, defined as the relative activity of an enzyme (with respect to the activity in a reference state) required to bring about a change in the stationary value of a metabolic variable by the (finite) factor alpha. We demonstrate that none of the existing extrapolation methods using the conventional control coefficient is capable to provide reliable predictions of the effective activities for all enzymes of erythrocyte metabolism.

Adenosine Triphosphate↗
PubMed1986

Functional vision in patients with neovascular maculopathy and poor visual acuity.

Central visual function is characteristically reported as Snellen acuity at distance and near. We performed functional tests in a group of patients with visual acuity of 20/100 or worse due to macular disease to determine whether there was a relationship between Snellen acuity and functional performance among these patients with poor visual acuity. Our tests of functional performance included currency discrimination, color recognition, reading a clock, and reading large print. Our results suggest that there is a correlation between Snellen acuity and functional vision, even among patients with poor visual acuity. Hence, therapeutic efforts to keep patients' visual acuity at 20/200 rather than 20/400, for example, appears to be justifiable in that better acuity levels seem to be associated with improved functional performance.

Aging↗