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Results for “Physical Functional Performance”

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PubMed2000

Effects of angiotensin-converting enzyme inhibitors and digoxin on health outcomes of very old patients with heart failure. SAGE Study Group. Systematic Assessment of Geriatric drug use via Epidemiology.

BACKGROUND: Randomized trials have shown that angiotensin-converting enzyme (ACE) inhibitors reduce mortality and morbidity, and improve symptoms and exercise tolerance in selected patients with congestive heart failure (CHF). There is, however, no evidence on the effectiveness of ACE inhibitors in the typical, very old and frail patients with CHF. OBJECTIVE: To compare the effects of ACE inhibitors and digoxin on 1-year mortality, morbidity, and physical function among patients aged 85 years. METHODS: We conducted a retrospective cohort study using the SAGE database, a long-term care database linking patient information with drug utilization data. Among 64637 patients with CHF admitted to all nursing homes in 5 states between 1992 and 1995, we identified 19492 patients taking either an ACE inhibitor (n = 4911) or digoxin (n = 14890). Record of date of death was derived from Medicare enrollment files, and we used the part A Medicare files to identify hospital admissions and discharge diagnoses. As a measure of physical function, we used a scale for activities of daily living performance. The effect of ACE inhibitors was estimated using Cox proportional hazards models with digoxin users as the reference group. RESULTS: The overall mortality rate among ACE inhibitor recipients was more than 10% less than that of digoxin users (relative rate, 0.89; 95% confidence interval, 0.83-0.95). Mortality was equally reduced regardless of concomitant cardiovascular conditions and baseline physical function. Treatment with ACE inhibitors was associated with a tendency toward reduced hospital admissions that was more evident among patients with greater functional impairment. The adjusted relative rate for hospitalization for any reason was 0.96 (95% confidence interval, 0.91-1.01). The rate of functional decline was greatly reduced among ACE inhibitor recipients (relative rate, 0.74; 95% confidence interval, 0.69-0.80), and this effect was consistent and independent of background comorbidity and baseline physical function. CONCLUSIONS: These data suggest that survival and functional benefits of ACE inhibitor therapy extend to patients with CHF 85 years and older, and mostly women, both systematically underrepresented in randomized trials. Alternatively, digoxin has a detrimental effect in this population.

Activities of Daily Living↗

PubMed2001

Reliability and validity of the functional assessment of cancer therapy-ovarian.

PURPOSE: To report the reliability and validity of the Functional Assessment of Cancer Therapy-Ovarian (FACT-O) in a consecutive series of outpatients with epithelial ovarian cancer. PATIENTS AND METHODS: Two hundred thirty-two ovarian cancer patients attending an outpatient gynecologic oncology clinic completed questionnaires at baseline. The patients' FACT-O scores were compared with their performance status, disease stage, treatment status, and other factors hypothesized to be related to quality of life. Patients received a second questionnaire either one week after baseline to assess the instrument's test-retest reliability and/or two months after baseline to evaluate its sensitivity to change in performance status. RESULTS: Internal consistency and test-retest reliability of the FACT-O were adequate. Overall, the scales correlated with other measures as expected; all correlations were in the hypothesized direction. Patients with advanced disease, poor performance status, and who were receiving active treatment had lower scores on physical, functional, and ovarian cancer-specific scales. The total FACT-O and emotional well-being scores were lower for patients with poor performance status and patients in active treatment. The FACT-O total and all subscale scores except emotional well-being were sensitive to decreases in performance status. CONCLUSION: Overall, the FACT-O provides a reliable and valid assessment of the quality of life of women with ovarian cancer, and is appropriate as a brief quality of life assessment in clinical trials and descriptive studies.

Activities of Daily Living↗

PubMed1994

Measuring physical disablement: the contextual challenge.

Context is a fundamental consideration in physical therapy assessment and in the interpretation of physical disablement. Specification of context may include physical requirements of a task such as the demands for speed or a specific degree of accuracy, or the social context in which an activity is performed such as dressing for work versus dressing for leisure activities. Context also encompasses individual factors such as the importance of particular activities within the person's culture or value system, or the specific types of roles requiring physical functioning that a person resumes upon discharge from physical therapy. Data are presented to illustrate the differences in performance across related physical tasks and between self-care and mobility tasks in home and school settings in children with severe functional delays. These data highlight the potential impact of context on performance. Implications for future development of functional assessments are discussed, particularly in light of the importance of incorporating contextual information in the clinical interpretation of disablement outcomes for patient groups and individual patients.

Activities of Daily Living↗

PubMed2002

Falls and fear of falling: which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention.

OBJECTIVES: Previous cross-sectional studies have shown a correlation between falls and fear of falling, but it is unclear which comes first. Our objectives were to determine the temporal relationship between falls and fear of falling, and to see whether these two outcomes share predictors. DESIGN: A 20-month, population-based, prospective, observational study. SETTING: Salisbury, Maryland. Each evaluation consisted of a home-administered questionnaire, followed by a 4- to 5-hour clinic evaluation. PARTICIPANTS: The 2,212 participants in the Salisbury Eye Evaluation project who had baseline and 20-month follow-up clinic evaluations. At baseline, subjects were aged 65 to 84 and community dwelling and had a Mini-Mental State Examination score of 18 or higher. MEASUREMENTS: Demographics, visual function, comorbidities, neuropsychiatric status, medication use, and physical performance-based measures were assessed. Stepwise logistic regression analyses were performed to evaluate independent predictors of falls and fear of falling at the follow-up evaluation, first predicting incident outcomes and then predicting fall or fear-of-falling status at 20 months with baseline falling and fear of falling as predictors. RESULTS: Falls at baseline were an independent predictor of developing fear of falling 20 months later (odds ratio (OR) = 1.75; P <.0005), and fear of falling at baseline was a predictor of falling at 20 months (OR = 1.79; P <.0005). Women with a history of stroke were at risk of falls and fear of falling at follow-up. In addition, Parkinson's disease, comorbidity, and white race predicted falls, whereas General Health Questionnaire score, age, and taking four or more medications predicted fear of falling. CONCLUSION: Individuals who develop one of these outcomes are at risk for developing the other, with a resulting spiraling risk of falls, fear of falling, and functional decline. Because falls and fear of falling share predictors, individuals who are at a high risk of developing these endpoints can be identified.

Accidental Falls↗

PubMed2002

[Significance of physical activity for bone mass and fracture risk in patients with rheumatoid arthritis].

Subjects with rheumatoid arthritis (RA) have reduced bone mineral density (BMD) and at least a twofold increased risk of osteoporotic fractures. Several factors, including the inflammatory process itself, treatment with glucocorticoids, and physical inactivity have been suggested as being implicated in the aetiology. Only a few studies, however, have examined the value of physical activity for the maintenance of BMD in RA. Cross-sectional studies have shown associations between BMD and indirect measures of physical activity, such as muscle strength and a self-reported degree of physical activity and functional capacity. Only three randomised controlled trials have been performed and none of these were able to demonstrate that exercise had an effect on BMD. Whether physical activity is associated with a reduced risk of fracture has only been addressed in a few cross-sectional studies, which yielded conflicting results, and has not yet been examined in longitudinal trials. Consequently, there is no evidence that physical exercise reduces bone loss and risk of fracture in RA. It is well-known, however, that immobilisation leads to rapid bone loss and should therefore be avoided.

Arthritis, Rheumatoid↗

PubMed1998

Medical, morphological and functional aspects of Greek football referees.

OBJECTIVE: The aim of the study was to investigate state of health, morphological and functional profile of football referees (Rs). EXPERIMENTAL DESIGN: A prevalence study. PARTICIPANTS: 188 Greek active male Rs of A, B, C and D football divisions have been evaluated. MEASURES: Standard clinical-instrumental and anthropometric methods were used. Appropriate functional tests were used for evaluation of visual performance, physical condition and mental ability. RESULTS: Mean age, height, weight, and BMI were 36.3 +/- 4.5 years, 177.4 +/- 5.7 cm, 81.6 +/- 7.8 kg, and 25.9 +/- 2.1 kg.m-2 respectively. 64% and 6% were overweight and obese respectively. In 27.2% resting blood pressure exceeded upper normal limits. Active (41.5%) and former smokers (17.0%) were identified. Visual acuity and colour discrimination were defective in 2.4% and 0.7% respectively. Stereo depth perception deficiently in 7.1%. Compared to international standards, Rs' mean scores in the 6 physical condition field tests were found satisfactory. All Rs were found efficient in the agility test, two-thirds in the maximal and prolonged speed tests and half of them in the endurance test. Relatively more Rs of A and B divisions were found fit as compared to Rs of C and D divisions. Average IQ score was 112.5 +/- 11.1, while about 90% and 34% of the Rs' IQ score was > or = 100 and > or = 120 respectively. CONCLUSIONS: Average male Greek football R is an apparently healthy, young to middle aged, rather overweight, and functionally efficient. The great majority of Rs of A and B divisions appear better trained and somewhat better functional than Rs of C and D divisions.

Adult↗

PubMed1990

Interval versus continuous exercise training after coronary bypass surgery: a comparison of training-induced acute reactions with respect to the effectiveness of the exercise methods.

In order to improve endurance by exercise on a bicycle ergometer, both the interval method (I) (exertion and recovery phases alternate each minute) and the continuous method (constant exertion) can be employed. We examined the effects of both methods on the following parameters: heart rate, blood pressure, rate-pressure product, glucose, lactate, and catecholamine levels, and physical performance. Two groups of nine male patients were trained daily on a bicycle ergometer for 3.5 weeks. These patients had undergone coronary bypass surgery 24 and/or 26 days before the training started. The training heart rate was set at 86% of the individual maximum heart rate. In the last week of training, the exercise intensity in both patient groups, following either I or C regimen, was 20:121 W and 83 W respectively. The exercise training lasted 20 minutes with the following findings: (1) there were no significant differences in blood pressure, rate-pressure product, rates of glucose and catecholamines, and (2) there was a significantly higher rate of lactate in the second ten minutes of the I training. Before and after the training period, the patients were subjected to a multistage bicycle ergometer exercise test (sitting). The following results obtained after the training favor the I method: (1) patients' physical performance increased (+0.63 vs. +0.26 W/kg; p less than 0.001); (2) heart rate was lower at rest (-9 vs. -4 beats/min; p less than 0.04) and at 75 W (-12 vs. -2 beats/min; p less than 0.02); (3) rate-pressure product was lower at rest (-1675 vs. -291; p less than 0.04) and at 75 W (-2810 vs. -735; p less than 0.05); (4) rate of lactate was lower at 75 W (-0.83 vs. -0.33 mmol/l; p less than 0.04); (5) catecholamines were not lowered by I or C training, and no differences between the two groups could be observed. Exercise training according to the I method involves both the aerobic and anaerobic capacity of the organism, whereas exercise training according to the C method involves only oxidative capacity. After coronary bypass surgery, the I method is better suited to increase physical performance and is more effective in economizing the cardiac function.

Adult↗

PubMed2001

Comparing outcomes of routine care for depression: the dilemma of case-mix adjustment.

The purpose of this study was to formulate and test two case-mix models for depression treatment that permit comparisons of patient outcomes across diverse clinical settings. It assessed demographics; eight, diagnostic-specific, case-mix variables; and clinical status at baseline and follow-up for 187 patients. Regressions were performed to test two models for four dependent variables including depression severity and diagnosis. Individual treatment settings were then ranked based on a comparison of actual versus predicted outcomes using regression coefficients and predictor variables. A model inclusive of baseline physical health status and depression severity predicted depression severity, mental health, and physical health functioning at follow-up. A simpler model performed well in predicting depression remission. This study identifies variables to be included in case-mix adjustment models and demonstrates statistical methods to control for differences across settings when comparing depression outcomes.

Academic Medical Centers↗

PubMed2004

Concordance of proxy-perceived change and measured change in multiple domains of function in older persons.

OBJECTIVES: To compare proxy perceptions about change over 6 months in physical, instrumental, affective, and cognitive functioning of older persons with computed change in patient self-report and performance and patient's own perceptions about change. DESIGN: Prospective study. SETTING: Recovery from hip fracture that occurred in community-dwelling persons in Baltimore, Maryland, in 1990-91. The recovery from the sixth to the 12th month postfracture was observed. PARTICIPANTS: One hundred forty-one hip fracture patients aged 65 and older and a self-designated proxy for each. MEASUREMENTS: For specific tasks of physical and instrumental functioning, proxy perception of change over the previous 6 months asked in the 12th month postfracture was compared with change in criterion measures (subject self-report and observed performance) from the sixth to the 12th month postfracture. For global change over the previous 6 months in each area of functioning, proxy perception was compared with the subject's own perception in the 12th month postfracture. RESULTS: Agreement between proxy perceptions of change and change in criterion measures was poor. There was a general pattern for proxies to overstate improvement and understate deterioration in comparison with change observed in criterion measures for specific tasks of physical and instrumental functioning. Proxies' global perceptions reported subjects improving less and deteriorating more than patients' own perceptions. CONCLUSION: Proxy perceptions about task-specific and global changes in subjects' functional health over a short period of time are systematically different from patient report and observed performance.

Activities of Daily Living↗

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↗

PubMed1999

Outcome of functional electrical stimulation in the rehabilitation of a child with C-5 tetraplegia.

Hand function was provided for a six-year-old child with C-5 American Spinal Injuries Association (ASIA) classification-A tetraplegia through a percutaneous intramuscular (i.m.) functional electrical stimulation (FES) system. In conjunction with implantation of 10 percutaneous i.m. electrodes for provision of grasp and release of her right hand, reconstructive surgery was performed to provide upper extremity positioning to optimize hand use. The subject participated in FES training over a nine-week period for approximately five hours weekly, with an additional five hours each week dedicated to exercise and conditioning of her arm muscles. Physical and functional assessments included range of motion (ROM), manual muscle testing (MMT), activities of daily living (ADL) abilities and the Canadian Occupational Performance Measure (COPM), used to evaluate the effect of stimulated hand function and surgical reconstruction on functional ability. These were conducted prior to FES and surgery and repeated after rehabilitation training. With rehabilitation and training, the child was able to control her FES system. Physical assessments revealed increased strength of both shoulders and more useful range of arm movement. Functional assessments show that the FES system enabled her to perform age-appropriate ADL that previously were achievable only with physical assistance. Her overall level of independence in ADL ability increased, as did self-rated levels of satisfaction and performance on chosen activities. Positive gains demonstrated here suggest the need for further studies of FES systems in young children with SCI.

Activities of Daily Living↗

PubMed1998

Enhanced endothelium-dependent vasodilatation in human skin vasculature induced by physical conditioning.

Functional alterations to the endothelial cells of the vascular system may contribute to the improved circulatory performance induced by physical conditioning. We evaluated microvascular reactivity to iontophoretic application of acetylcholine (ACh) and sodium nitroprusside (SNP) through the skin and blood perfusion measurements in the same area using laser Doppler flowmetry. Whereas ACh acts on smooth muscle cells of the vascular system via the production of vasodilator substances from the endothelium, SNP is an endothelium-independent vasodilator acting on vascular smooth muscle cells directly. The study was performed using two groups of subjects with different levels of aerobic endurance, long distance runners competing at national level (n = 9) and controls (n = 9). The subjects were tested for 40 min on a treadmill before and after an exercise test at 80% of their maximal oxygen uptake. During stimulation by ACh cutaneous perfusion increased to a higher level in the athletes than in the controls (overall P<0.05), whereas an acute period of exercise abolished this difference (overall P>0.6). There was no significant difference between the athletes and the controls with respect to the SNP-induced increase in cutaneous perfusion either before (P>0.9) or after (P>0.9) exercise. The higher cutaneous perfusion responses to stimulation with ACh in the athletes than in the controls may support the hypothesis that regular exercise modifies the responsiveness of the cutaneous endothelium. The difference in ACh-induced perfusion and in unstimulated forearm perfusion between the two groups was present only at rest. This finding indicated that mechanisms were introduced during exercise, which compensated for the lower endothelial sensitivity to stimulation in the controls at rest.

Acetylcholine↗

PubMed1996

Functional status in patients with chronic fatigue syndrome, other fatiguing illnesses, and healthy individuals.

BACKGROUND: Chronic fatigue syndrome (CFS) is a condition that may be associated with substantial disability. The Medical Outcomes Study Short-Form General Health Survey (SF-36) is an instrument that has been widely used in outpatient populations to determine functional status. Our objectives were to describe the usefulness of the SF-36 in CFS patients and to determine if subscale scores could distinguish patients with CFS from subjects with unexplained chronic fatigue (CF), major depression (MD), or acute infectious mononucleosis (AIM), and from healthy control subjects (HC). An additional goal was to ascertain if subscale scores correlated with the signs and symptoms of CFS or the presence of psychiatric disorders and fibromyalgia. DESIGN: Prospectively collected case series. SETTING: Patients with CFS and CF were seen in a university-based referral clinic and had undergone a complete medical and psychiatric evaluation. Other study subjects were recruited from the community to participate in research studies. PARTICIPANTS: The study included 185 patients with CFS, 246 with CF, 111 with AIM, and 25 with MD. There were 99 HC subjects. MEASURES: The SF-36 and a structured psychiatric interview were used. The SF-36 contains 8 subscales: physical, emotional, social, and role functioning, body pain, mental health, vitality, and general health- and a structured psychiatric interview. RESULTS: Performance characteristics (internal reliability coefficients, convergent validity) of the SF-36 were excellent. A strikingly consistent pattern was found for the physical functioning, role functioning, social functioning, general health, and body pain subscales, with the lowest scores in CFS patients, intermediate scores in AIM patients, and the highest scores in the HC subjects. The CFS patients had significantly lower scores than patients with CF alone on the physical functioning (P < or = 0.01), role functioning (P < or = 0.01), and body pain (P < or = 0.001) subscales. The emotional functioning and mental health scores were worst among those with MD. The presence of fibromyalgia, being unemployed, and increasing fatigue severity all were associated with additional functional limitations across multiple functional domains, with increasing fatigue appearing to have the greatest effect. CONCLUSIONS: The SF-36 is useful in assessing functional status in patients with fatiguing illnesses. Patients with CFS and CF have marked impairment of their functional status. The severity and pattern of impairment as documented by the SF-36 distinguishes patients with CFS and CF from those with MD and AIM, and from HC, but does not discriminate between CF and CFS.

Adult↗

PubMed1975

Guidelines for the functioning of a helping service.

The purpose and the operation of an effective helping service are defined along the principles developed by R. R. Carkhuff. A functional operationalism directly linking each aspect of a helping service to the objective of servicing the needs of those people for whom the service exists is developed. The personal fitness of the staff as defined by their effectiveness at living is identified as the critical variable determining service effectiveness. The level of staff performance on the operational indices of physical, emotional, and intellectual functioning including, specifically, the interpersonal dimensions of empathy, respect, genuineness, concreteness, confrontation, and immediacy is designated as the operational basis for the organizational decisions of hiring, firing, promotion, and role assignment. Systematic programs designed to meet specific client needs serve to complete staff and service effectiveness.

Counseling↗

PubMed2000

An application of generalizability theory to study a physical performance measure in Parkinson's disease.

Clinicians and researchers frequently quantify impairments and functional ability to monitor patient's symptoms and progress. For some patients, such as those with Parkinson's disease (PD), symptoms can fluctuate from day to day, making reliable measurement difficult. Multiple measures then may be required to obtain reliable data. Decisions must be made, balancing the optimum measurement schedule to obtain "good reliability" against burden to the patient. This investigation demonstrates the use of Generalizability Theory in determining the testing schedule when designing an experiment involving patients with known fluctuations of symptoms. In this investigation we use "Functional Axial Rotation" (FAR), a measure of spinal flexibility, to illustrate the use of Generalizability Theory for designing an experiment using participants who have PD. Measurements of FAR were taken on 13 participants, aged 60 or older, who were in early and mid-stages of PD. Three measurements were obtained on each of two consecutive days, and repeated on two consecutive days a week later, giving a total of 12 measures of FAR for each individual. Four sources of variation (subject, week, day and trial) were employed to estimate the reliability of FAR under several designs. Assuming different schedules of measures across weeks, days and trials, the estimated reliability of FAR for four measurements is in the range of 0.75 to 0.83, and for eight measurements in the range of 0.82 to 0.86. We discuss the use of this type of analysis in the determination of the optimum measurement design for experiments involving subjects with known fluctuations.

Analysis of Variance↗

PubMed1981

[Variations in body weight as a function of age and smoking in physical workers].

The body weight of 181 men performing physical work at an industrial plant was observed for a long time. The rate of excessive body weight was about 20% and varied with age and smoking. In those with excessive body weight during 5 years a significantly higher rate of circulatory system diseases was found. The relative risk of circulatory system diseases was twice higher in those with excessive body weight, as compared to those with low body weight.

Adult↗

PubMed2002

A preliminary study on the reliability of physical performance measures in older day-care center clients with dementia.

BACKGROUND: Decline in physical functional ability is an intrinsic component of the dementia syndrome. Reductions in muscle mass and strength represent a major factor in the loss of functional ability Although resistance exercise has been studied as a method for maintaining/recovering function in populations of frail older adults, people with dementia have been systematically excluded because of uncertainty about the reliability of outcome measurements. OBJECTIVE: The purpose of this study was to determine the test-retest reliability of a battery of established performance-based measures of strength and function among subjects with dementia. SETTING: A hospital-affiliated adult day-care facility. SUBJECTS: Twelve of 28 older subjects with dementia of various etiologies were available for two assessments prior to implementation of a resistance-exercise intervention. METHODS: Subjects underwent an assessment of lower extremity strength and physical function consisting of two recorded trials of bilateral isometric strength of the knee extensor, hip flexor, and dorsiflexor muscles, as well as hand grip strength; repeated chair stands, evaluation of usual- and maximal safe-gait speed over a 6-m course, and the Timed-Up-and-Go Test. The entire assessment was repeated approximately 1 week later. An average of the trials for each measurement was computed for each of the two assessment periods, and intraclass correlation coefficients (ICCs) for these paired measurements were estimated using STATA. RESULTS: ICCs ranged from .56 for left iliopsoas to .77 for left dorsiflexors among the strength measures whereas measures of function ranged from .80 for number of steps in usual gait to .95 for time of fast gait. CONCLUSIONS: Performance-based measures of strength and function can be reliably assessed in older people with dementia, although measures of function appear to be more reliable than measures of strength.

Activities of Daily Living↗

PubMedDate not supplied

Prostate cancer and health-related quality of life: a review of the literature.

With the established effectiveness of diverse treatments for prostate cancer, identification of the physical and psychosocial consequences of the disease and various treatments becomes critical. We review the literature on the effects of prostate cancer and its treatment on health-related quality of life (HRQoL). Studies show that prostate cancer and its treatment affect both disease-specific HRQoL (i.e. urinary, sexual, and bowel function) as well as general HRQoL (i.e. energy/vitality, performance in physical and social roles). Yet, these effects appear to differ across stage of disease and type of treatment. We outline evidence from three sources: (1) studies that compare men with the disease with an age-matched sample of men without the disease, (2) studies that assess men with the disease across time, and (3) cross-sectional studies that highlight predictors of HRQoL. Future research directions are discussed.

Aged↗