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PubMed2005

Performance measures were necessary to obtain a complete picture of osteoarthritic patients.

OBJECTIVES: Self-report questionnaires and performance measures represent two methods for assessing physical function. A recurring theme is that self-report measures are superior to performance measures. This study investigated the association between three performance test outcomes of four activities (pain, exertion, and time or distance; for self-paced walk, stair test, timed up-and-go, 6-minute walk) with self-reports of physical function (WOMAC Physical Function subscale and LEFS) and the association between the change scores of the performance tests and those of the self-report measures. STUDY DESIGN AND SETTING: Performance and self-report measures were administered three times (presurgery and at approximately 1 week and approximately 8 weeks post arthroplasty) to 85 patients who underwent total hip or knee arthroplasty. Components of the performance tests were pooled within each domain across the four measures. Multiple regression analyses were applied. Independent variables were performance tests components; dependent variables were self-report measures. Standardized regression coefficients described the cross-sectional and longitudinal associations. RESULTS: Pain was the principal determinant of WOMAC Physical Function subscale scores. Pain, exertion, and time or distance were strongly associated with the LEFS at the first, second, and third assessments, respectively. Change in pain was most strongly associated with change in self-reported physical function. CONCLUSION: Our findings caution against the isolated use of self-report assessments of physical function.

Aged↗

PubMed2004

Quality of life in spinal cord injured individuals and their caregivers during the initial 6 months following rehabilitation.

Addressing quality of life (QOL) issues in the spinal cord injured (SCI) population is imperative as the majority survive their initial injury and longevity now approaches that of the general population. The purpose of this mixed method, descriptive, longitudinal feasibility study was to describe and compare QOL in 10 adult SCI individuals and their family caregivers (FCs) during the initial 6 months following rehabilitation. Instruments used were the SF-36 and two horizontal visual analog scales, one for pain and one for QOL. Participants completed the instruments and a face-to-face in-depth interview at 1-, 3-, and 6-months following inpatient rehabilitation. SCI individuals reported low physical function, role physical (RP), and role emotional (RE) scores on the SF-36, while reporting high general health (GH), mental health and social functioning on the SF-36. FCs reported lower RP, GH and vitality scores, while reporting higher physical functioning and RE scores. On the visual analog scales, persons with SCI reported lower QOL while FCs reported more pain at 3 and 6 months. This study suggests that more work is needed to identify interventions which could enhance QOL during the transition from rehabilitation to home for SCI individuals and their FCs.

Adult↗

PubMed2004

Optimizing physical energy functions for protein folding.

We optimize a physical energy function for proteins with the use of the available structural database and perform three benchmark tests of the performance: (1) recognition of native structures in the background of predefined decoy sets of Levitt, (2) de novo structure prediction using fragment assembly sampling, and (3) molecular dynamics simulations. The energy parameter optimization is based on the energy landscape theory and uses a Monte Carlo search to find a set of parameters that seeks the largest ratio deltaE(s)/DeltaE for all proteins in a training set simultaneously. Here, deltaE(s) is the stability gap between the native and the average in the denatured states and DeltaE is the energy fluctuation among these states. Some of the energy parameters optimized are found to show significant correlation with experimentally observed quantities: (1) In the recognition test, the optimized function assigns the lowest energy to either the native or a near-native structure among many decoy structures for all the proteins studied. (2) Structure prediction with the fragment assembly sampling gives structure models with root mean square deviation less than 6 A in one of the top five cluster centers for five of six proteins studied. (3) Structure prediction using molecular dynamics simulation gives poorer performance, implying the importance of having a more precise description of local structures. The physical energy function solely inferred from a structural database neither utilizes sequence information from the family of the target nor the outcome of the secondary structure prediction but can produce the correct native fold for many small proteins.

Algorithms↗

PubMed2006

The influence of growth hormone status on physical impairments, functional limitations, and health-related quality of life in adults.

The availability of recombinant human GH and somatostatin analogs has resulted in widespread treatment for adults with GH deficiency (GHD) and those with GH excess (acromegaly). Despite being at opposite ends of the spectrum in terms of their GH/IGF-I axis, both of these populations experience overlapping somatic impairments. Adults with untreated GHD have low circulating levels of IGF-I that manifest as altered body composition with increased fat and reduced lean body and skeletal muscle mass. At the other end of the spectrum, adults with GH excess, who have elevated levels of IGF-I, also have altered body composition. Impairments that result from disorders of either GHD or GH excess are both associated with increased functional limitations, such as reduced ability to walk quickly for prolonged periods, and poorer health-related quality of life (HR-QoL). Adults with untreated GHD and GH excess both commonly complain of excessive fatigue that seems to be associated more with impaired aerobic than muscular performance. Several studies have documented that administration of GH or somatostatin analogs to adults with GHD or GH excess, respectively, ameliorates abnormal biochemical profile and the associated somatic impairments. However, whether these improvements translate into improved physical function in adults with GHD or GH excess remains largely unknown, and their impact on HR-QoL controversial. Review of placebo-controlled trials to date suggests that GH and somatostatin analogs have greater effects on gas exchange and aerobic performance than as anabolic agents on skeletal muscle mass and function. Future investigations should include dose-response studies to establish the optimal combination of pharmacological agents plus exercise required to improve not only biochemical markers but also physical function and HR-QoL in adults with GHD or GH excess.

Acromegaly↗

PubMed2001

Exercise dose-response effects on quality of life and independent living in older adults.

PURPOSE: The purpose of this study was to determine if exercise operates in a dose-response fashion to influence well-being and to postpone dependency. METHODS: A computer-assisted search was made by using the following key words: resistance training, strength training, function, exercise, elderly, quality of life, frailty, physical activity, independence, performance, aerobic training, mobility, well-being, and disability. Review articles and personal files were also used, and a critical review of research studies meeting the criteria described in the methods section of the article was conducted. RESULTS: In large sample correlational studies and prospective longitudinal studies, researchers consistently report that measures of physical function in old adults are related to feelings of well-being, and that old adults who are physically active also report higher levels of well-being and physical function, but the results of randomized intervention studies of aerobic and/or resistive strength training do not always support this relationship. Even if changes in well-being and physical function were reported, no evidence was found that levels of intensity operated in a dose-response fashion to influence these changes. Research design problems included ineffective aerobic or strength training treatments, widely varying participation and effort of the research participants, and both treatment and physical function tests that were not appropriate for the physical status of the participants. CONCLUSION: The most consistent results were that long-term physical activity is related to postponed disability and independent living in the oldest-old subjects. Even in individuals with chronic disease, systematic participation in physical activities enhances physical function.

Activities of Daily Living↗

PubMed2004

Patient quality of life during the 12 months following joint replacement surgery.

OBJECTIVE: To determine whether preoperative characteristics influence quality of life outcomes 1, 6, and 12 months after joint replacement surgery. METHODS: Patients (n = 222) with osteoarthritis undergoing primary joint replacement surgery at a university hospital between November 1990 and March 1993 were prospectively studied. Bodily pain and physical function were assessed preoperatively and at the 3 postoperative time points using the Medical Outcomes Study 36 Item Short Form Health Survey. RESULTS: Bodily pain and physical function improved after joint replacement. At 1 month after surgery, despite improvements in bodily pain, physical function deteriorated. Preoperative bodily pain and physical function, demographic characteristics, and social support were significant correlates of improvement in bodily pain and physical function. CONCLUSIONS: Patients experienced dramatic improvements in bodily pain and physical function after joint replacement. However, decline in physical function at 1 month implies significant need for prolonged informal or formal patient assistance with basic physical function after surgery. Greater preoperative social support was associated with improved bodily pain and physical function outcomes.

Activities of Daily Living↗

PubMedDate not supplied

The POSNA pediatric musculoskeletal functional health questionnaire: report on reliability, validity, and sensitivity to change. Pediatric Outcomes Instrument Development Group. Pediatric Orthopaedic Society of North America.

The goal of orthopaedic interventions is to improve the functional health of patients, particularly physical function. The American Academy of Orthopaedic Surgeons and the Pediatric Orthopaedic Society of North America (POSNA) commissioned a work group to construct functional health outcomes scales for children and adolescents, focusing on musculoskeletal health. The work group developed scales assessing upper extremity function, transfers and mobility, physical function and sports, comfort (pain free), happiness and satisfaction, and expectations for treatment. Parent and adolescent self-report forms were developed and tested on 470 subjects aged 2-18 years. The POSNA scales demonstrated good reliability, construct validity, sensitivity to change over a 9-month period, and ability to outperform a standard instrument, the Child Health Questionnaire physical functioning scale. They were useful for a wide variety of ages and diagnoses. They appear to be ideally suited for orthopaedic surgeons to assess the functional health and efficacy of treatment of their patients at baseline and follow-up.

Activities of Daily Living↗

PubMed2000

Social support and quality of life in patients with coronary artery disease.

The relationship between perceived social support and domain-specific health-related quality of life (HRQOL) was examined in a sample of cardiac catheterization patients after considering age, gender, race, education, and coronary artery disease (CAD) severity. Data was collected on 4,278 cardiac catheterization patients (63% males) and included 1,215 patients with non-significant CAD and 3,063 patients who had significant CAD ( > or = 75% stenosis of at least one major coronary artery). Among the patients with significant CAD, 2,721 were classified as low disease severity and 342 were considered high disease severity. Regression models indicated that a lack of social support was associated with significantly lower levels of HRQOL across all eight SF-36 HRQOL domains after considering disease severity and other demographic factors. The models also indicated that social support and other relevant variables interacted across various HRQOL domains. Physical function and physical role function were lower with age, whereas mental health, emotional role function, and vitality were higher with age. Females reported lower HRQOL than males across all domains. Minority patients reported lower levels of HRQOL than white patients across four domains. Increased disease severity was related to lower levels among four of the eight HRQOL domains. The observed interactions of social support with minority status, disease severity, and education suggest that a subset of individuals may suffer lower levels of HRQOL. These individuals may subsequently require the greatest degree of care and potentially benefit most from intervention.

Adult↗

PubMed1995

Health-related quality of life in patients with major depression who are treated with moclobemide.

A total of 651 depressed patients completed self-administered health-related quality-of-life (HRQOL) questionnaires during treatment with moclobemide in order to evaluate whether general and psychopathology-specific HRQOL questionnaires could detect changes in depressed patients receiving treatment. Patients were treated with moclobemide on an outpatient basis over an 8-week period; questionnaires were completed at weeks 0, 2, 4, and 8. At each assessment, patients completed one of two HRQOL questionnaires: namely, the General Health Questionnaire (GHQ), a psychopathology-specific HRQOL questionnaire, or the Short-Form 36 (SF-36), a general HRQOL instrument. Physicians were randomized to one of the two HRQOL questionnaires for all of their patients. Because the French version of the SF-36 was not available in the public domain, the patients of all Francophone physicians completed the GHQ, whereas the patients enrolled by Anglophone physicians completed either the SF-36 or the GHQ. The GHQ provides an overall score that measures the emotional dimensions of HRQOL, whereas the SF-36 provides scores in the following eight domains: physical functioning (PF), physical role functioning (PRF), emotional role functioning (ERF), social functioning (SF), bodily pain (BP), mental health (MH), vitality (VT), and general health perceptions (GHP). The GHQ and seven domains of the SF-36 detected a statistically significant linear trend (improvement) over time (p < 0.05). The change in the BP domain of the SF-36 was not statistically significant (p = 0.29).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2005

Physical and functional interaction of DNA methyltransferase 3A with Mbd3 and Brg1 in mouse lymphosarcoma cells.

Dnmt3a and Dnmt3b are de novo DNA methyltransferases that also act as transcriptional repressors independent of methyltransferase activity. To elucidate the underlying mechanism of transcriptional repression, Dnmt3a was purified from mouse lymphosarcoma cells (P1798) by extensive fractionation on five different chromatographic matrices followed by glycerol density gradient centrifugation. Liquid chromatography electrospray tandem mass spectrometry analysis of Dnmt3a-associated polypeptides identified the methyl CpG binding protein Mbd3, histone deacetylase 1(Hdac1), and components of Brg1 complex (Brg1, Baf155, and Baf57) in the purified preparation. Association of Dnmt3a with Mbd3 and Brg1 was confirmed by coimmunoprecipitation and coimmunolocalization studies. Glutathione S-transferase pulldown assay showed that the NH2-terminal ATRX homology domain of Dnmt3a interacts with the methyl CpG binding domain of Mbd3 and with both bromo and ATPase domains of Brg1. Chromatin immunoprecipitation assay revealed that all three proteins are associated with transcriptionally silent methylated metallothionein (MT-I) promoter in the mouse lymphosarcoma cells. To understand the functional significance of their association with the promoter, their role on the MT-I promoter activity was analyzed by transient transfection assay. The results showed that Mbd3 and Dnmt3a specifically inhibited the methylated promoter, and the catalytic activity of Dnmt3a was dispensable for the suppression. In contrast, the wild-type but not the ATPase-inactive mutant of Brg1 suppressed MT-I promoter irrespective of its methylation status, implicating involvement of ATP-dependent chromatin remodeling in the process. Coexpression of two of the three interacting proteins at a time augmented their repressor function. This study shows physical and functional interaction of Dnmt3a with components of nucleosome remodeling machinery.

Animals↗

PubMed2005

Health status rated with the Medical Outcomes Study 36-Item Short-Form Health Survey after spinal cord injury.

OBJECTIVE: To describe the health status of Australians with spinal cord injury (SCI). DESIGN: Survey. SETTING: Australian population-based sample. PARTICIPANTS: Participants (N=305) with SCI at recruitment to a randomized trial. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) health questionnaire. RESULTS: Compared with the general population, our sample reported significantly lower scores in 6 SF-36 domains (physical function, role-physical, bodily pain, general health, social function, vitality) and the physical component summary (PCS) score, but unexpectedly higher mental component summary (MCS) scores (difference in mean MCS scores, 4.6; 95% confidence interval [CI], 2.4-6.8). Compared with people with tetraplegia, those with paraplegia had better physical function and PCS scores (difference, 21; 95% CI, 17-24; difference, 3; 95% CI, 1-5, respectively), and worse bodily pain scores (difference, 9; 95% CI, 2-15). Recent urinary infections were associated with worse general health, vitality, mental health, and MCS scores. Receiving family or external physical care was associated with worse physical function and PCS scores, but better mental health and MCS scores. Older age at injury was associated with lower bodily pain and PCS scores. CONCLUSIONS: Using the SF-36, Australians with SCI rate their physical (not mental) health status as worse than the general population.

Adolescent↗

PubMed2006

Postoperative physical training following colorectal surgery: a randomised, placebo-controlled study.

BACKGROUND AND AIMS: Major surgery is often followed by fatigue and reduced physical function. We wished to study if postoperative physical training reduced fatigue and improved physical function. MATERIAL AND METHODS: Randomised, placebo-controlled, single-blinded study. Participants were unselected patients > or = 60 years undergoing elective colorectal surgery without disseminated cancer or inflammatory bowel disease. Group A trained muscular strength and work capacity. Group B performed relaxation exercises and received hot wrappings and massage. Main outcome measures were: fatigue (visual analogue scale), muscular strength, walking speed, physical performance test, and physical function questions (SF-36). RESULTS: Preoperatively the two groups were similar except that A was more fatigued than B. By postoperative day seven fatigue had increased compared to preoperatively, more in B than A, but by day 30 and 90 there were no significant differences between groups. All indices of physical function decreased postoperative day seven and were at the preoperative level day 90 with no significant differences between groups in change in function. Day seven the change in knee extension strength tended to be lower in B than A but by day 30 changes were similar in both groups. CONCLUSION: Postoperative training did not improve physical function, but reduced fatigue in hospital.

Aged↗

PubMed1999

Mental, physical and functional status in primary care attenders.

OBJECTIVE: The purpose of the present study was to analyze the association, in primary care attenders, between psychiatric disorders, medical comorbidity, and impairment in mental and physical function status. METHODS: The study had a two-stage design. The GHQ-12 was used to screen 1647 patients, and 323 of them were then interviewed using the CIDI-PHC to obtain ICD-10 diagnoses. Severity of mental illness was assessed using the Hamilton scales for anxiety and depression. The DUSOI was used to evaluate the severity of physical illness. The MOS SF-36 was used to assess health related quality of life. RESULTS: The estimated prevalence of ICD-10 psychiatric disorders and subthreshold disorders was 12.4 percent and 18 percent respectively. The most common psychiatric disorders were generalized anxiety, major depression, and neurasthenia. The severity of physical illness did not vary across diagnostic status categories. Significant impairment, both in physical and mental functioning was seen in patients suffering from ICD-10 full-fledged and subthreshold disorders. Severity of impairment increased from sub-threshold cases to full-fledged cases, and among the latter according to the severity of depressive and anxious symptoms, assessed using Hamilton scales. The most frequent psychiatric disorders were associated with significant worsening in health related quality of life, with relevant differences between psychiatric diagnoses regarding the domains affected. Impairment associated with mental disorders was greater than that associated with physical illness. CONCLUSIONS: The results of the present study confirm that ICD-10 psychiatric disorders are common in general practice and are associated with relevant impairment in physical and mental functional status. Psychiatric morbidity is not related to severity of physical illness rated by general practitioner.

Adult↗

PubMed2005

Association of cognitive status with functional limitation and disability in older adults.

BACKGROUND AND AIMS: Although cognitive status is known to be associated with physical function in older people, the role it plays in the disability process is not well established. This study aimed at determining whether cognitive ability predicts functional limitations, as well as disability, and whether it is associated with the rate of change in physical functions. METHODS: A community-based longitudinal study was conducted, involving 977 older persons aged 65 and older living in an urban community. Physical functions were assessed by tests scoring functional limitations (upper and lower body) and disability (activities of daily living). Cognitive function was evaluated using the Mini-Mental State Examination. Linear regression analyses with generalized estimating equations modeled the two physical function scores separately, as functions of cognitive status and time, in a one-year follow-up, controlling for sociodemographic and health-related characteristics. RESULTS: Cognitive status independently predicted functional limitations as well as disability in older people. In addition, the strength of the association of cognitive status with physical functions increased over time, as revealed by the significant interaction between cognitive ability and time. Cognitive status influenced the rate of change in disability scores, more among women and in those aged 75 or older. The relationship was unaffected by baseline physical functional status, but was significant only among those with no cognitive impairment at baseline. CONCLUSIONS: Cognitive status appears to be a useful indicator of the disablement process in older people. It may play an important role in the development of disability, implying that strategies for early intervention to prevent the progression of disability may need to take cognitive functions into account. The increasing strength of the relationship between cognitive and physical functions over time further attests to its value in monitoring functional change.

Activities of Daily Living↗

PubMed2005

Sex differences in stroke recovery.

INTRODUCTION: This study examined differences between men and women in the ability to perform basic activities of daily living, instrumental activities of daily living, and higher physical functioning after stroke. The objective of the study was to determine whether sex differences in stroke recovery can be explained by depressive status beyond older age, stroke severity, prestroke physical functioning, and other medical comorbidities. METHODS: A total of 459 stroke patients were recruited from acute and subacute facilities in an urban midwestern community. These patients were followed prospectively from stroke onset until 6 months poststroke. All study participants were assessed using standardized stroke outcome measures, including the National Institutes of Health Stroke Scale, the Barthel Activities of Daily Living Index, the Lawton Instrumental Activities of Daily Living scale, and the SF-36 Health Survey physical functioning scale. The Geriatric Depression Scale was used to assess depressive status. Each outcome was measured at baseline (within 2 weeks of stroke onset), as well as 1, 3, and 6 months poststroke. Prestroke physical functioning, stroke characteristics, and comorbidities were also assessed at baseline. RESULTS: Female patients in the study were older than male patients, with a mean age of 71 years for women vs 69 years for men. Female patients reported lower prestroke physical functioning than their male counterparts. Six months after stroke, women in the study were less likely than the men to achieve a score of > or = 95 on the Barthel Activities of Daily Living Index (hazards ratio [HR] = 0.68; 95% confidence interval [CI], 0.52-0.90), carry out eight of nine instrumental activities of daily living without assistance (HR = 0.46; 95% CI, 0.30-0.68), and score > or = 90 on the SF-36 Health Survey physical functioning scale (HR = 0.54; 95% CI, 0.28-1.01). When age, prestroke physical functioning, stroke severity, and depressive status at baseline were controlled in the analysis, women in the study continued to be less likely (HR = 0.51; 95% CI, 0.32-0.79) than men in the study to be able to carry out eight of nine instrumental activities of daily living completely without assistance, but there were no observed sex differences in achievement of independence in basic activities of daily living or higher physical functioning. CONCLUSION: Prestroke physical functioning and depressive symptoms are important factors in the investigation of sex differences in stroke recovery. Lower recovery of activities of daily living and physical functioning in women after stroke may be due to multifactorial effects of older age, poor physical function prior to stroke onset, and depressive status after stroke.

Activities of Daily Living↗

PubMed2003

Delaying decline in pulmonary function with physical activity: a 25-year follow-up.

The importance of physical activity for health is well recognized, but little is known about the influence of physical activity on pulmonary function. We have examined whether physical activity could slow down the decline in pulmonary function among the southwestern rural Finnish cohort of the Seven Countries Study. Physical activity was estimated by kilometers walked, cycled, and skied daily. We had complete data for 429 men for 10 years, 275 men for 20 years, and 186 men for 25 years. During the first 10 years, the decline in FEV was 9.8 ml/year less among men in the highest tertile of baseline physical activity than in men in the lowest tertile. According to the mean physical activity over either 20 or 25 years, men in the highest tertile also lost less pulmonary function (p = 0.009 and p = 0.043, respectively). A similar beneficial effect was observed in all smoking categories. In mortality analysis, continued high physical activity and an increase in activity to high level were associated with lower mortality. In conclusion, results indicated that physical activity is associated with a slower decline in pulmonary function and with lower mortality, and thus, middle-aged and older people should be encouraged to enjoy exercise.

Adult↗

PubMed1998

Early referral and outcome in rheumatoid arthritis.

In a cross-sectional study of 200 outpatients with rheumatoid arthritis (RA) we tested the hypothesis that early specialist referral within one year of disease onset reduces subsequent functional disability. Early referral was defined as being seen in a specialist unit within one year of the onset of symptoms. Functional outcome was measured using the physical functional section of the full test (NHP) and (HAQ). Additional information was collected on other factors likely to influence disability including age, sex, pain scores, and rheumatoid factor positivity. The difference in average HAQ and NHP physical function scores between late and early referrals was 0.34 and 11.0 respectively (p< 0.01 in both cases) using unequal-variance t-test. After adjusting for the other risk factors, multiple regression analysis showed late referral patients had greater NHP physical function scores than early-referred patients by approximately 8 points and there was a similar trend with HAQ. We conclude that early referral for specialist advice is associated with improved health status, with reduced physical function scores on the NHP.

Aged↗

PubMed2004

Physical activity intervention for older adults with intellectual disability: report on a pilot project.

A 12-week pilot project on physical activity was introduced in a day habilitation setting to a group of 12 older adults with intellectual disability and a variety of physical and behavioral conditions. Our purpose was to determine whether (a) this intervention would positively impact physical function in this population, (b) consumers would choose to participate in physical activity sessions, and (c) day habilitation staff could sustain this program beyond the intervention period. Findings indicate that 92% of participants experienced improvement in at least one domain of physical function, physical activity sessions remained a popular activity choice for consumers, and many participants sustained functional gains 1 year after habilitation staff assumed responsibility for sessions.

Adult↗