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At least 487 records · Page 27Linked to original sources
PubMed2003

Specific effects of balance and gait exercises on physical function among the frail elderly.

OBJECTIVE: To evaluate the specific effects of balance and gait exercises among frail elderly individuals. DESIGN: A randomized three-group parallel controlled study. SETTING: Geriatric health services facility in Japan. SUBJECTS: Thirty-four frail elderly subjects attending the care facility were randomized into a control group, an exercise group with emphasis on balance or an exercise group with emphasis on gait re-education. INTERVENTIONS: The two exercise groups received balance or gait exercise for 40 minutes, 2-3 times weekly, for 12 weeks. MAIN OUTCOME MEASURES: One Leg Standing Test, Functional Reach Test, Manual Perturbation Test, Functional Balance Scale, Performance-Oriented Mobility Assessment, Timed 'Up and Go' Test and Stair Climbing/Descending Test. These assessments were performed before and after 12-week intervention. RESULTS: Comparison of the performance before and after intervention demonstrated significant improvement in One Leg Standing Test, Functional Reach Test and Functional Balance Scale in the balance exercise group, and Functional Balance Scale, Timed 'Up and Go' Test and Stair Descending Test showed improvement in the gait exercise group. All test items showed no significant differences in the control groups. Among the three groups, the balance exercise group showed more significant improvement in Functional Balance Scale, and the gait exercise group showed more significant improvement in Performance-Oriented Mobility Assessment than the control group. The balance exercise group showed greater improvement in performance in Functional Reach Test than the gait exercise group. CONCLUSIONS: Balance exercises led to improvements in static balance function, and gait exercises resulted in improvements to dynamic balance and gait functions in the very frail elderly.

Aged↗
PubMed1994

Mortality and physical functioning in epidemiologic studies of three older populations.

Mortality experienced in the first three years of follow-up for three Established Populations for Epidemiologic Studies of the Elderly (EPESE) is examined in relation to the participants' self-reported functional ability. In East Boston, Massachusetts (N = 3,812), Iowa and Washington Counties, Iowa (N = 3,673), and New Haven, Connecticut (N = 2,812), noninstitutionalized persons aged 65 and older were asked a series of questions to determine their functional status. These measures, used in logistic regression analyses of the mortality data, showed that an increased number of reported disabilities significantly increased the risk of mortality over and above the effects of the age and sex of the participant, or the methodological differences among the sites. Disabilities in gross mobility (e.g., ability to walk a half mile, climb stairs, or perform heavy work around the house) were more strongly related to mortality than were measures of activities of daily living.

Aged↗
PubMed1999

Improvement of physical functioning of morbidly obese patients who have undergone a Lap-Band operation: one-year study.

BACKGROUND: The Netherlands has a population of 20,000 morbidly obese patients, an average of 350 of whom per year undergo a stomach reduction operation involving the surgical placement of a Lap-Band. The quality of life (OOL) of a sample of female patients who underwent this operation was studied in a 1-year postoperative study. METHODS: The Medical Outcome Study Short Form-36 (MOS SF-36) was used to assess 1-year postoperative quality of life among a sample of 39 female patients aged 19-53 years. QOL was measured at most 20 h preoperatively and 1 year postoperatively using a randomized pretest/posttest design. Statistical data, after transformation, were analyzed with SPSS Version 7.5 for Windows 95. RESULTS: The response rate of 92.9% of patients polled was good, in contrast to earlier findings with this measuring instrument. Mean body mass index (BMI) declined from 40.86 kg/m2 preoperatively to 33.14 kg/m2 1 year postoperatively. QOL improved on all scores in the MOS SF-36. Internal consistency of the scales used was high. CONCLUSIONS: The response rate to the MOS SF-36 questionnaire was high. The surgical placement of a Lap-Band resulted in a significant improvement of QOL (1 year postoperatively) on all scores used. The internal consistency of the scales used was high.

Adult↗
PubMed2003

[Health status, physical functioning, health services utilization, and expenditures on medicines among Brazilian elderly: a descriptive study using data from the National Household Survey].

The objective of this research was to describe health conditions and health services utilization among Brazilian seniors. The study was based on 28,943 adults > 60 years (99.9%) from an overall National Household Survey (PNAD 1998). The results show that prevalence rates for at least one chronic disease (69.0%), hypertension (43.9%), arthritis (37.5%), and inability to feed oneself/bathe/use the toilet (2.0%) are very similar to those observed in other populations. Physician visits and hospitalization patterns are within the variation reported by different countries. The low prevalence rates of older adults who had interrupted activities because of a health problem (13.9%) or had been bedridden (9.5%) in the previous 2 weeks or hospitalized in the previous year (13.6%) show that the vast majority are not subject to these events. Considering that 50% of this population live on less than or equal to one Brazilian monthly minimum wage, expenditures on medications consume approximately one-fourth (23%) of total income for half of the elderly population.

Aged↗
PubMed2004

Biological agents for rheumatoid arthritis: targeting both physical function and structural damage.

Rheumatoid arthritis (RA) is a chronic progressive inflammatory disease of multifactorial aetiology. The pivotal role of proinflammatory cytokines in the pathogenesis and perpetuation of synovitis has been demonstrated in basic research since the late 1980s and in clinical research since the early 1990s. Biological agents are monoclonal antibodies or recombinant forms of natural inhibitory molecules which selectively interact with molecules or cell receptors affecting immune or inflammatory processes. In RA, etanercept, infliximab and adalimumab are currently available to target tumour necrosis factor (TNF) and an interleukin (IL)-1 receptor antagonist is available to target IL-1 activity. Trials have shown benefits as monotherapy, although the best results for disease control are seen when biological agents are coadministered with methotrexate. The use of these agents in clinical trials and in practice has resulted in dramatic improvements in RA disease control, and delay and prevention of radiographic damage. The remarkable benefits to patients in well-being, quality of life and function, and the speed of onset of action are reminiscent of the early days of corticosteroid use. Ten years after the first clinical trials of anti-TNF therapies, the adverse effect profile is evolving and includes, for anti-TNF therapy, an increased risk of infections associated with immune suppression, injection and infusion reactions, and a risk of drug induced autoimmune syndromes such as systemic lupus erythematosus. Where these drugs are affordable, the prognosis of individuals for control of severe RA is better than ever before. This manuscript summarises the clinical trial results and post-marketing information regarding the biological agents currently in use for RA.

Antibodies, Monoclonal↗
PubMed2000

Independent effects of peripheral nerve dysfunction on lower-extremity physical function in old age: the Women's Health and Aging Study.

OBJECTIVE: To determine the role of peripheral nerve dysfunction (PND) in the disablement pathway. RESEARCH DESIGN AND METHODS: Vibration perception threshold (VPT) was measured in 894 women aged > or = 65 years, and those with normal peripheral nerve function and with mild, moderate, and severe PND were identified. Lower-extremity impairments included quadriceps strength (kilograms) and three progressively difficult balance tasks (able/unable). Functional limitations included rising from a chair (able/unable) and usual pace and fast-paced walking speeds (meters/second). Level of PND was related to impairments and functional limitations in linear and logistic regression models that controlled for potentially confounding factors, including reported diabetes. RESULTS: Level of PND was associated with impaired balance (adjusted odds ratios: 2.21, 1.95, and 3.02 for mild, moderate, and severe PND, respectively, relative to normal, P < 0.05). PND was also associated with decrements in both usual and fast-paced walking speeds (-0.08, -0.08, and -0.15 m/s for usual pace and -0.13, -0.12, and -0.24 m/s for fast-paced walking speed for women with mild, moderate, and severe PND, respectively; P < 0.01 for all). Reported diabetes was not associated with these outcomes in the presence of PND. Some, but not all, of the association between PND and functional limitations was explained by the relationship between PND and impairments. CONCLUSIONS: PND is significantly associated with both lower-extremity impairments and functional limitations in older women, and PND appears to have independent effects on functional limitations. The independent effect of diabetes on these outcomes may be limited when PND is considered. Further research is needed to determine if PND is causally related to disability in old age.

Aged↗
PubMed1999

[Functional physical complaints. Guideline for diagnosis and treatment of somatoform disorders].

Although physical symptoms are the main reason why people go to the doctor, in many cases no unequivocal underlying organic disturbances are to be found, not even during subsequent visits to the doctor (Kroenke & Mangelsdorff, 1989). Frequently, the patient's previous history contains pointers for other physical complaints that also had no unequivocal organic etiology. This group of patients, who often present their problem in a very complaining fashion, are considered by many physicians to be difficult, bothersome, and ungrateful. Until quite recently it was assumed that the chances of successful treatment in these patients were poor. Accordingly, an American standard textbook of psychiatry recommends, as the main aim of the treatment, avoiding iatrogenic harm (Barsky, 1988). The present article wishes to make it clear that such a pessimistic assessment of the therapeutic outcome is no longer warranted. A positive effect can now be achieved with ambulatory psychotherapeutic measures both in the offices of general practitioners or internists, and in hospitals offering integrative-psychosomatic treatment on an inpatient basis.

Diagnosis, Differential↗
PubMed2001

[Diagnosis and treatment of somatoform disorders (functional physical complaints)].

In modern classification systems, unexplained physical symptoms without an organic origin are labelled "somatoform disorders". This syndrome is very frequent and causes a lot of treatment costs as well as indirect costs (such as workers' compensation and others). In the past, effective treatment strategies were lacking. However, consideration of modern scientific results has made it possible to develop treatment approaches which find the acceptance of the patients and which are highly effective. A hierarchical approach is presented suggesting the following steps: a) Primary care: The consideration of management rules in primary care can prevent the chronicity of somatoform symptoms. b) Brief psychological and psychopharmacological treatments: Modern cognitive-behavioural approaches can help to cope with the symptoms and to improve the subjective well-being. First results for pharmacological treatments are encouraging. c) Integrative inpatient treatment including intense psychotherapeutic and psychosomatic ingredients. Experts' judgements of course and prognosis in somatoform disorders should consider the following features: Duration and multiplicity of the complaints; comorbidity with other psychiatric and physical disorders; disability in different areas of life such as at work, family, leisure time; individual coping strategies; treatment approaches in the past.

Combined Modality Therapy↗
PubMed2003

Developing an initial physical function item bank from existing sources.

The objective of this article is to illustrate incremental item banking using health-related quality of life data collected from two samples of patients receiving cancer treatment. The kinds of decisions one faces in establishing an item bank for computerized adaptive testing are also illustrated. Pre-calibration procedures include: identifying common items across databases; creating a new database with data from each pool; reverse-scoring "negative" items; identifying rating scales used in items; identifying pivot points in each rating scale; pivot anchoring items at comparable rating scale categories; and identifying items in each instrument that measure the construct of interest. A series of calibrations were conducted in which a small proportion of new items were added to the common core and misfitting items were identified and deleted until an initial item bank has been developed.

Adaptation, Psychological↗