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PubMed2003

[Specifying work and rest schedule for those using heavy individual means of respiratory system protection].

The authors present data concerning influence of gas-masks with higher respiratory resistance on functional state of subjects performing physical and operator tasks. Finding are that only individuals with high general capacity for work (PWC170 over 3.0 W/kg of body weight) could perform tasks in heavy gas-masks, therefore only for them the specification of work and rest schedule is possible. Real flow rates for inspiration and expiration under physical load in gas-mask occurred exceeding the value (30 l/min) that is accepted in national standards and servers for calculating the individual respiratory protective means resistance to air flow.

Adaptation, Physiological↗

PubMed2003

The long-term psychosocial effects of haematopoetic stem cell transplantation.

The purpose of this study was to identify long-term psychosocial effects of allogenic, syngenic and autologous haematopoetic stem cell transplantation (HSCT) on relevant parameters (physical performance, role and sexual functioning, intimate relationships, professional and social rehabilitation). A total of 163 patients, who had undergone an autologous (11.6%), syngenic (3.1%) or allogenic (85.3%) HSCT at the Department of Internal Medicine III, Ludwig-Maximilians-University, during a preceding 16-year period, were asked to complete the Herschbach Questionnaire on Stress in Cancer Patients in order to evaluate their current psychosocial distress status. An additional questionnaire for demographic data was used. Reduced quality of life as a result of HSCT is restored to its pre-HSCT level by most patients within 2 years after transplantation (no differences between groups transplanted 2-5, 6-9 or >10 years ago). The majority of patients had serious problems with "fitness" (24%), followed by problems with "pain" (17.2%) and "fear/emotional stress" (14.1%). Professional reintegration is an important factor in patients' well-being. However, 30.7% of these patients did not return to work at all. Unemployed patients had significantly higher scores for pain, anxiety, sleep disorders, depression, impairments in social functioning, partnership and family life. Only 9.8% of all patients took part in a psychotherapeutic programme and 39.3% in a rehabilitation programme. Identifying strategies for risk patients (e.g. lower education and married) need to be developed in order to optimize support for this group. Although some patients show a higher distress score in anxiety/fear and psychophysical performance, only 9.8% of all patients took advantage of available psychotherapy.

Adult↗

PubMed2005

[Effects of physical training of chronic cardiac insuffciency].

During the last ten years,the traditional dogma "physical rest" for patients with chronic cardiac insufficiency (CCI) has been increasingly abandoned. Studies on the effects of low intensity physical endurance training for patients with stable CCI showed the following effects after 12 months: Decrease in the heart size and a slight improvement in the EF, reduction of the systemic vascular resistance during rest and during stress through improvement of the endothelial function, increase in the physical performance by 12 to 26%, reduction of local inflammation and improvement of the oxidative metabolism in skeletal muscles, an end to muscle atrophy and reduction of the total mortality. Training programs for patients with chronic cardiac insufficiency today represent an established auxiliary therapy for CCI with prognostic relevance.

Exercise↗

PubMed1990

Factors in functional assessment.

UNLABELLED: The list of individualized needs of the wheelchair user as developed by the medical and personal profile assessment can be categorized under the general goals to be accomplished through the process of the wheelchair recommendation: MEDICAL PROFILE: MEDICAL HISTORY: (1) Compensate for loss or absence of function. (2) Promote good health through prevention of problems. Physical Assessment: (1) Maintain proper seating and posture of the individual in the wheelchair. (2) Correct or accommodate for deformity through positioning in the wheelchair. PERSONAL PROFILE: Social History/User Goals: (1) Minimize mobility limitations as they apply to educational, vocational, socialization, and recreational pursuits. (2) Minimize mobility limitations as they apply to communication. (3) Promote positive self-image. Functional Abilities: (1) Optimize physical performance of wheelchair user for: (a) wheelchair mobility, and (b) transfers. (2) Assist family or caretaker in performance of: (a) dependent mobility, and (b) handling. (3) Provide means of dependent, manual mobility. ENVIRONMENT: Minimize the impact of the environment on mobility in: (a) home, vocational/educational, community and recreational settings, and (b) transportation of the wheelchair.

Choice Behavior↗

PubMed1988

ADL-reduction and need for technical aids among 70-year-olds. From the population study of 70-year-olds in Göteborg.

Six hundred and nineteen persons from the population study of 70-year-olds "The intervention study of the elderly in Göteborg" (IVEG) were examined. They were interviewed in their home environment concerning their ability to manage activities of daily living (ADL), and the definition "ADL-reduction" is based on seven of these ADL-measurements. One third of the 70-year-old population had reduced ADL-capability, some only slightly. Joint disorders, paresis and congestive heart failure were the most common problems among the ADL-reduced subjects. Forty-three per cent of the ADL-reduced subjects (19% of total) received help with their personal care and/or housekeeping. One third had technical aid, mostly quite simple and inexpensive. Half were provided with new technical aids. The need for technical aids and home help service was noted and intervention undertaken as and when necessary. The needs were correlated to physical activity and performance in functional tests. The results do not illustrate the occurrence of handicap but are aimed at illustrating the special needs that elderly people may have in their normal surroundings.

Activities of Daily Living↗

PubMedDate not supplied

No demonstrable effect of sobrerol as an expectorant in patients with stable chronic bronchial diseases.

A randomized double-blind cross-over study compared the clinical effectiveness of a 14-day treatment with 400 mg X day-1 of sobrerol and placebo in 23 patients with stable chronic bronchial disease. During the seven week trial, subjective symptoms and findings (cough frequency and severity, difficulty in raising sputum, dyspnoea) were recorded, pulmonary function tests performed and sputum physical characteristics (24-h sputum volume, purulence, cell concentration, protein, sputum dry weight and "apparent" viscosity) determined on a regular basis. Side-effects were closely monitored. Both subjective assessment of overall clinical efficacy as well as statistical analysis of the above mentioned factors failed to show any significant advantage of sobrerol to placebo--except for a transient decrease of the 24-h sputum volume. Sobrerol appears to be another example of an expectorant lacking evidence of clinical effectiveness in the management of chronic bronchial secretions.

Bronchial Diseases↗

PubMed1994

Geriatric functional assessment in acute care: a pilot project.

This experimental pilot project examined 33 acute care patients over age 70 to determine if length of stay, cost of stay, and functional decline during hospitalization could be reduced through early assessment. A gerontological clinical nurse specialist (GCNS), using three established instruments, scored all patients within 72 hours of admission to the study unit in relation to mental status, physical functioning, and ability to perform activities of daily living. The instruments included the (a) Mini-Mental State Exam (MMSE), (b) PULSES Profile, and (c) Katz Index of Activities of Daily Living (Katz ADL). The GCNS's assessments and recommendations for care were documented in patient charts. Subjects were randomly assigned to experimental or control groups. Those in the experimental group received GCNS monitoring, which included daily (except weekends) patient visits to assess newly developed problems, response to interventions, and follow-through on previous recommendations. Other patients received only the usual care. Subjects were retested prior to discharge. The differences between change scores from admission to discharge were not statistically significant. However, the GCNS observed several positive trends in medical and nursing staff practices in relation to increased staff awareness of geriatric care needs. Replication of this study using a larger sample of high-risk elderly patients is needed to further delineate the potential benefits of the unit-based model.

Activities of Daily Living↗

PubMed2006

Lifetime occupation and physical function: a prospective cohort study on persons aged 80 years and older living in a community.

BACKGROUND: Several studies have reported predictors for loss of mobility and impairments of physical performance among frail elderly people. AIM: To evaluate the relationship between lifetime occupation and physical function in persons aged 80 years or older. METHODS: Data are from baseline evaluation of 364 subjects enrolled in the ilSIRENTE study (a prospective cohort study performed in a mountain community in Central Italy). Physical performance was assessed using the physical performance battery score, which is based on three timed tests: 4-metre walking speed, balance, and chair stand tests. Muscle strength was measured by hand grip strength. Lifetime occupation was categorised as manual or non-manual work. RESULTS: Mean age of participants was 85.9 (SD 4.9) years. Of the total sample, 273 subjects (75%) had a history of manual work and 91 subjects (25%) a history of non-manual work. Manual workers had significant lower grip strength and physical performance battery score (indicating worse performance) than non-manual workers. After adjustment for potential confounders (including age, gender, education, depression, cognitive performance scale score, physical activity, number of diseases, hearing impairment, history of alcohol abuse, smoking habit, and haemoglobin level), manual workers had significantly worse physical function (hand grip strength: non-manual workers 32.5 kg, SE 1.4, manual workers 28.2 kg, SE 0.8; physical performance battery score: non-manual workers 7.1, SE 0.4, manual workers 6.1, SE 0.2). CONCLUSIONS: A history of manual work, especially when associated with high physical stress, is independently associated with low physical function and muscle strength in older persons.

Aged, 80 and over↗

PubMed2005

Testosterone, dehydroepiandrosterone, and physical performance in older men: results from the Massachusetts Male Aging Study.

OBJECTIVE: This manuscript examines the relationships of total testosterone (T), bioavailable T, dehydroepiandrosterone (DHEA), and DHEA sulfate (DHEAS) to measures of physical performance in a large, population-based, random sample of men. METHODS: In the most recent wave of the Massachusetts Male Aging Study, measures of strength and physical performance [seven-item physical performance test (PPT), timed chair stand test, and grip strength] were made in 684 men, aged 55-85 yr. Complete hormone data were also obtained. Initial graphical exploration of performance outcomes as a function of hormone levels showed linear increases in physical performance up to certain threshold hormone concentrations, beyond which the associations were diminished. Regression models were used to estimate threshold locations and standardized regression coefficients quantifying the association between hormones and strength. RESULTS: All hormones exhibited significant age-adjusted positive association with PPT score below, but not necessarily above, the thresholds. DHEA was positively associated with chair stand score below, but was not above the threshold. None of the hormones studied was significantly associated with grip strength. CONCLUSION: Up to certain critical concentrations, elevated levels of TT, total T, bioavailable T, DHEA, and DHEA sulfate are associated with increased physical performance, as indicated by the PPT. However, levels beyond those critical concentrations, as might be achieved through exogenous supplementation, do not appear to confer any additional benefit. In general, hormone concentrations do not appear to be meaningfully associated with grip strength or chair stand scores.

Adult↗

PubMed1988

Contraindications to physical training in patients with impaired ventricular function.

Exercise performance in patients with impaired ventricular function does not correlate well with the severity of dysfunction. Patients with ventricular dysfunction can achieve a fairly high work capacity, and the physiological variables respond in a similar way, regardless of whether or not the patients do or do not have impaired function. Furthermore, patients with pump dysfunction can benefit from a supervised physical training programme by improving their functional capacity and thus, their quality of life. The absolute contraindications for exercise therapy in this group of patients with coronary artery disease should therefore be identical to those who have normal ventricular function. In our opinion, special attention should be exercised in patients who have chronotropic incompetence, lack of an elevation or decrease in blood pressure during exercise performance and in those whose stroke volume is not elevated during even low to moderate work-loads. Recommendations as to the implication of exercise therapy as a therapeutic modality in patients with ventricular impairment must be accepted with caution. The reason for this is that our observations are based on historical, anecdotal trials, most of which included only a modest number of patients. Future research and a prolonged follow-up is needed in order to obtain both a more exact analysis and eventually scientifically based evidence on the benefits and hazards involved.

Coronary Disease↗

PubMed2003

Anemia and decline in physical performance among older persons.

PURPOSE: Anemia is prevalent in old age and is potentially modifiable, but its effects on physical function have not been determined. We examined whether anemia in older persons increases the risk of subsequent decline in physical function, as measured by objective performance-based tests. METHODS: Participants in this 4-year prospective cohort study included 1146 participants, aged 71 years or older, living in Iowa and Washington counties, Iowa. Anemia was defined according to World Health Organization (WHO) criteria as a hemoglobin concentration below 12 g/dL in women and below 13 g/dL in men. An assessment of standing balance, a timed 2.4-m walk, and a timed test of five chair rises were used to assess physical performance; these were combined into a 0 (poor) to 12 (excellent) summary scale. RESULTS: After adjustment for baseline performance score, health status, and demographic characteristics, anemia was associated with greater mean decline in physical performance over 4 years; the adjusted mean decline was 2.3 (95% confidence interval [CI]: 1.7 to 2.8) in subjects with anemia and 1.4 (95% CI: 1.2 to 1.5) in those without anemia (P = 0.003). The association between anemia and greater physical decline was also present in participants who were free of diseases associated with anemia (cancer, infectious disease, and renal failure), and after adjustment for serum cholesterol, iron, and albumin levels. Persons with borderline anemia, a hemoglobin concentration within 1 g/dL above the WHO criteria, also showed greater mean physical decline (1.8; 95% CI: 1.5 to 2.2) than did those with higher hemoglobin concentrations (P = 0.02). CONCLUSION: This study suggests that anemia in old age is an independent risk factor for decline in physical performance.

Age Distribution↗

PubMed1991

Functional outcomes of children with sickle-cell disease affected by stroke.

The nature and degree of functional recovery after stroke in children with sickle-cell disease (SCD) has not been extensively investigated. The purpose of this study was to evaluate retrospectively the functional status of 14 SCD children who had had strokes and to compare them with age-matched and gender-matched SCD children who had not had strokes. By doing so, we would be able to quantify the eventual physical and cognitive functional outcomes of survivors of stroke secondary to SCD and assess the impact of stroke on these patients. These children (five boys and nine girls) with SCD and stroke(s) were 11.6 +/- 4.3 years of age (range five to 18 years). They experienced one to three strokes at a mean age of 6.1 +/- 5.2 years (range one to 17 years). A series of tests were administered to these subjects to evaluate physical and psychosocial functions. These tests were performed at least one year after the latest stroke. This study showed that all of the SCD-stroke children were physically independent. Only a few had impairments of hand functions and mild difficulties in self-care activities. However, most of these children demonstrated intellectual deficits ranging from borderline to moderate mental retardation, reduced language functions ranging from low normal to retarded range, and problems in adjustment. Intelligence quotient of the children with SCD-stroke(s) was significantly lower than those of age-matched and gender-matched nonstroke SCD children, suggesting that stroke caused an adverse effect on the cognitive functioning of these children. The results indicate that in the SCD-stroke children psychosocial deficits outweighed physical disabilities.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗

PubMed2006

Performance measures provide assessments of pain and function in people with advanced osteoarthritis of the hip or knee.

BACKGROUND AND PURPOSE: Pain and physical function are core outcome measures for people with osteoarthritis, and self-report questionnaires have been the preferred assessment method. There is evidence suggesting that self-reports of physical function represent what people experience when performing activities rather than their ability to perform activities. The purpose of this study was to examine the factorial validity of performance-specific assessments of pain and function. SUBJECTS: The sample consisted of 177 participants who had osteoarthritis of the hip (n=81) or knee (n=96) and who were awaiting total joint arthroplasty. METHODS: Through a cross-sectional design, participants performed 4 performance activities (self-paced walk test, stair test, Timed "Up & Go" Test, and Six-Minute Walk Test). OUTCOMES: were time or distance (function) and pain ratings obtained immediately after each activity. The authors conceptualized 2 correlated factors, with pain items loading uniquely on 1 factor and functional items loading on the second factor, and uncorrelated error terms. Confirmatory factor analysis was applied. RESULTS: Initial analysis yielded results consistent with the conceptualized model in this study with the exception of a nonzero correlation between the stair pain and function error terms. Dropping the stair test provided results consistent with the conceptualized model. DISCUSSION AND CONCLUSION: Given the limitations of self-report alone as a method of obtaining reasonably distinct assessments of pain and function, the extent to which performance-specific assessments could accomplish this goal was examined in this study. It was found that collectively the walk test, Timed "Up & Go" Test, and Six-Minute Walk Test yielded 2 factors consistent with the health concepts of pain and function. The authors believe that the application of these tests may provide clinicians and clinical researchers with more distinct impressions of pain and function that complement information from self-report measures.

Aged↗

PubMedDate not supplied

Fat mass rather than muscle strength is the major determinant of physical function and disability in postmenopausal women younger than 75 years of age.

OBJECTIVE: Few studies have investigated the relationships between body composition, functional ability, and age-related disability in postmenopausal women. We investigated the relative role of fat mass, lean mass, and muscle strength in the development of disability in a group of healthy postmenopausal women younger than 75 years. DESIGN: We performed a cross-sectional study among 396 independently living women aged 56-73 years, randomly selected between 8 and 30 years after menopause. Lean mass and fat mass were assessed by dual-energy x-ray absorptiometry. Muscle strength (grip and leg extensors) was assessed using dynamometry. Functional ability was estimated by Physical Performance Score, physical activity during the preceding year, and impairment in activities of daily living. RESULTS: Of the participants, 43.7 % were overweight (25 > or = BMI < 30 kg/m2), and 17.7% were obese (BM I > or = 30 kg/m2). Higher muscle strength was observed with increasing lean body mass, and participants with higher muscle strength scored better in the physical performance score and activities of daily living. Higher fat mass was significantly associated with a lower physical performance score, lower physical activity, and a higher frequency of disability. Increasing fat mass was associated with increasing lean mass and decreasing lean/fat ratio. The increase in lean mass and muscle strength associated with higher fat mass was mainly localized in the legs. CONCLUSIONS: Our results support the role of fat mass as the primary risk marker for disability, which might later accelerate by the age-related decrease in lean mass and the development of sarcopenia after the age of 75 years.

Absorptiometry, Photon↗

PubMed1995

The structure underlying physical performance measures for older adults in the community.

A 6-item physical performance test assessing hand strength/speed, mobility, and balance was administered to 678 elderly people from a Japanese community (age 65-89). A second-order covariance structure model applied to the data revealed that three factors in observed variables (Hand Power, Walking, and Balance) had loadings more than 0.8 on a single higher-order factor, Basic Motor Ability (BMA). The BMA score, or "Physical Performance Age (PPA)", of the individual was calculated on the basis of this model as a unidimensional summary score of physical performances. The PPA predicted the self-reported levels of competence and physical activity with greater accuracy than age alone. The PPA also differentiated those at the high end of the functional spectrum, and thereby not identifiable by use of ordinary self-reported functional measures. The results suggest that a short physical performance battery assessing physical functioning is useful in community-based studies of aging.

Aged↗

PubMed1998

Comparing generic and disease-specific measures of physical and role functioning: results from the Veterans Health Study.

OBJECTIVES: This study compared the performance of generic measures of Medical Outcome Study Short Form 36-Item Health Survey physical functioning and role limitations with disease-specific measures of physical functioning and role limitations using specific disease attributions for chronic lung disease, chronic low back pain, and osteoarthritis of the knee. METHODS: Data were analyzed from the Veterans Health Study among patients receiving Veteran's Administration ambulatory care. Patients identified as having one of the three study conditions were included in the study (n = 932). RESULTS: The study revealed that the generic physical functioning and role limitations scales had higher correlations with other generic SF-36 scales, whereas disease-specific attribution measures had larger R2 values in explaining variability in symptom-based disease severity and larger t statistic values in discriminating the impacts of patients taking medications and having surgery. CONCLUSIONS: The generic measures of physical functioning and role limitations were more applicable in assessing a broad array of health-related quality-of-life issues, whereas disease-specific measures of physical functioning and role limitations were more useful in evaluating clinical management and limitations associated with specific disease conditions. The results of the study suggest that the use of disease-specific attribution assessments was more cost-efficient than the development of new disease-specific instruments. Disease-specific attribution could be used to complement generic measures in assessing patient outcomes.

Activities of Daily Living↗

PubMed1978

A study of former patients placed in private proprietary homes.

The authors report on a study of 1999 residents of 26 private proprietary homes for adults in the metropolitan New York City area; 76 per cent of the residents were former psychiatric inpatients. The former patients were compared with the other residents in areas of physical and psychiatric functioning and social performance; the former patients showed more dysfunction due to psychological problems than the other residents, who tended to be older and suffer from physical problems. The former patients were also categorized into three groups according to whether their needs were considered greater than, less than, or consistent with the level of services provided in the homes; the results suggest that a substantial proportion of former patients may be more appropriately placed in other facilities.

Aged↗

PubMed1975

The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance.

A system for evaluation of motor function, balance, some sensation qualities and joint function in hemiplegic patients is described in detail. The system applies a cumulative numerical score. A series of hemiplegic patients has been followed from within one week post-stroke and throughout one year. When initially nearly flaccid hemiparalysis prevails, the motor recovery, if any occur, follows a definable course. The findings in this study substantiate the validity of ontogenetic principles as applicable to the assessment of motor behaviour in hemiplegic patients, and foocus the importance of early therapeutic measures against contractures.

Ankle↗