SEARCH · PubMed Health

Results for “Physical Functional Performance”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 847 records · Page 47Linked to original sources

PubMed2003

Cognitive and psychological outcomes of exercise in a 1-year follow-up study of patients with chronic obstructive pulmonary disease.

This study evaluated outcomes of self-directed exercise activity on cognitive functioning and psychological well-being among 28 adults with chronic obstructive pulmonary disease (COPD). Participants had completed an intensive 10-week program of exercise training and were given an exercise prescription to follow. One year later, participants completed comprehensive assessments of physical, cognitive, and psychological functioning. At follow-up, 39% (n=11) had continued with a regular program of moderate intensity exercise. Repeated measures analysis of variance indicated that exercise adherent participants maintained gains they had achieved in the initial exercise intervention, but nonexercise participants experienced declines in functional capacity, cognitive performance, and psychological well-being. Continued exercise among patients with COPD is associated with maintenance of physical, cognitive, and psychological functioning.

Aged↗

PubMed2004

Baseline health-related quality-of-life data as prognostic factors in a phase III multicentre study of women with metastatic breast cancer.

The potential value of baseline health-related quality-of-life (HRQOL) and clinical factors in predicting prognosis was examined using data from an international randomised phase III trial which compared doxorubicin and paclitaxel with doxorubicin and cylophosphamide as first line chemotherapy in 275 women with metastatic breast cancer. The European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and the related breast module (QLQ-BR23) were used to assess baseline HRQOL data. The Cox proportional-hazards regression model was used for both univariate and multivariate analyses of survival. In the univariate analyses, performance status (P<0.001) and number of sites involved (P=0.001) were the most important clinical prognostic factors. The HRQOL variables at baseline most strongly associated with longer survival were better appetite, physical and role functioning, as well as less fatigue (P<0.001). The final multivariate model retained performance status (P<0.001) and appetite loss (P=0.005) as the variables best predicting survival. Substantial loss of appetite was the only independent HRQOL factor predicting poor survival and was strongly correlated (/r/>0.5) with fatigue, role and physical functioning. In addition to known clinical factors, appetite loss appears to be a significant prognostic factor for survival in women with metastatic breast cancer. However, the mechanism underlying this association remains to be precisely defined in future studies.

Adult↗

PubMed2005

Can elderly patients who have had a hip fracture perform moderate- to high-intensity exercise at home?

BACKGROUND AND PURPOSE: The majority of patients after a hip fracture do not return to prefracture functional status. Depression has been shown to affect recovery. Although exercise can reduce impairments, access issues limit elderly people from participating in facility-based programs. The primary purpose of this study was to determine the effects and feasibility of a home exercise program of moderate- or high-intensity exercise. A secondary purpose was to explore the relationship of depression and physical recovery. SUBJECTS: Thirty-three elderly people (24 women, 9 men; mean = 78.6 years of age, SD = 6.8, range = 64-89) who had completed a regimen of physical therapy following hip fracture participated in the study. Subjects were randomly assigned to a resistance training group, an aerobic training group, or a control group. METHODS: Subjects were tested before and upon completion of the exercise trial. Isometric lower-extremity force, 6-minute-walk distance, free gait speed, mental status, and physical function were measured. Each exercise session was supervised by a physical therapist, and subjects received 20 visits over 12 weeks. The control group received biweekly mailings. The resistance training group performed 3 sets of 8 repetitions at the 8-repetition maximum intensity using a portable progressive resistance exercise machine. The aerobic training group performed activities that increased heart rate 65% to 75% of their age-predicted maximum for 20 continuous minutes. RESULTS: Resistance and aerobic training were performed without apparent adverse effects, and adherence was 98%. All groups improved in distance walked, force produced, gait speed, and physical function. Isometric force improved to a greater extent in the intervention groups than in the control group. Depressive symptoms interacted with treatment group in explaining the outcomes of 6-minute-walk distance and gait speed. DISCUSSION AND CONCLUSION: High-intensity exercise performed in the home is feasible for people with hip fracture. Larger sample sizes may be necessary to determine whether the exercise regimen is effective in reducing impairments and improving function. Depression may play a role in the level of improvement attained.

Activities of Daily Living↗

PubMed1995

Muscle function and mobility biomechanics in the elderly: an overview of some recent research.

Many old adults have difficulty in performing activities of daily living, in maintenance of postural balance, and in recovering from impending falls. It is not yet fully clear to what extent these difficulties arise from age, or disease-related declines in muscle function. The strength requirements for the performance of many common physical tasks are not often large. When the time available to make an appropriate response is short, maximum joint torque strengths may not be as important a consideration as abilities to develop joint torques rapidly. Even old adults who are fit and healthy, compared to young adults, have substantially diminished abilities to do this. Recent findings suggest that the source of this decline, at least sometimes, lies in muscle physiology more so than in central processing delays. A considerable amount of research to explore the issues relevant to the relations among muscle function and mobility is currently underway, but much remains to be learned.

Accidental Falls↗

PubMed1998

Mapping of the central sulcus with functional MR: active versus passive activation tasks.

PURPOSE: Our purpose was to assess the pattern of functional MR activation obtained with a passive sensory versus an active sensorimotor hand stimulus paradigm. METHODS: Eight functional MR runs, four with an active sensorimotor (sponge-squeezing) task and four with a passive sensory (palm-finger brushing) reception, were acquired for each of 10 healthy volunteers. Activation maps were generated by thresholding cross-correlation maps. Regions of interests (ROIs) were drawn around the precentral and postcentral gyri on T1-weighted images according to established anatomic criteria, and the number of activated pixels inside the ROIs was ascertained. Displacement of the sensorimotor and sensory activation centroids within the ROIs from the central sulcus as well as from each other was measured. RESULTS: Active sensorimotor stimulation produced a significantly greater number of activation pixels than did passive sensory stimulation. Run-to-run variability was equivalent between sensorimotor and sensory activation tasks. On average, the sensorimotor and sensory activation centroids were located in the postcentral gyrus, and their spatial locations were not significantly different. CONCLUSION: Active and passive activation tasks produce largely equivalent results. Presurgical mapping of the sensorimotor area can be performed with functional MR imaging using a passive palm-finger brushing task in patients who are physically unable to perform active finger-tapping or hand-squeezing sensorimotor activation tasks.

Adult↗

PubMed2002

Supraphysiological doses of GH induce rapid changes in cardiac morphology and function.

GH is an agent widely used in sport to improve physical performance and has been proposed as adjunctive therapy in several clinical conditions. However, its short-term effects on the normal human heart are poorly understood. Sixty young normal volunteers (30 males and 30 females) were enrolled in a multicenter, double-blind, placebo-controlled study. All subjects were randomized to receive GH (0.03 or 0.06 mg/kg.d) or placebo. A complete Doppler-echocardiographic examination was performed at baseline and after 4 wk of treatment. Low-dose GH did not significantly affect echocardiographic parameters. In contrast, high-dose GH increased left ventricular mass index by 12% (P < 0.05). The type of growth response was concentric, because left ventricular wall thickness but not diameter increased, leading to a 10% increase of relative wall thickness. These structural changes were associated with functional changes, including a significant increase in cardiac index and a decrease in peripheral vascular resistance; diastolic function was not altered. Fractional shortening and systemic blood pressure were unchanged in the two treatment groups. In conclusion, administration of GH for 4 wk at doses that simulate GH abuse in sport caused a high cardiac output state associated with concentric left ventricular remodeling.

Adult↗

PubMedDate not supplied

Factors influencing survival in patients with hepatic metastases from adenocarcinoma of the colon or rectum.

The median survival of all patients with hepatic metastases from colorectal cancer referred to the Sidney Farber Cancer Institute during a five-year period was 12.5 months. Two major factors influenced survival. The first was extent of disease at presentation. The second was the histologic grade of the cancer. The median survival of patients presenting with the least disease, characterized by less than four liver nodules visible on liver scan (n = 38), normal liver size on physical examination (n = 60), normal liver function test results (n = 30), and normal performance status (n = 91), was between 18 and 24 months, regardless of treatment. The median survival of those few patients (n = 13) who had objective responses to a variety of treatments, most of whom also had minimal disease at presentation, was also 24 months. Patients whose tumors were poorly differentiated or who had abnormal performance status or weight loss of greater than 10 per cent at presentation survived only six months (median). Those with four or more liver nodules, hepatomegaly (greater than 16-cm vertical span on physical examination), or abnormal liver function test results, survived ten, eight, and 12 months (median), respectively. It is concluded that a significant group of patients survived longer than would have been predicted by earlier literature surveys after the diagnosis of colorectal cancer metastatic to the liver. It is suggested that future therapeutic trials, using survival as a measure of response of patients with liver metastases from colorectal cancer, must be prospectively controlled before selection factors can be differentiated from significant therapy effect.

Adenocarcinoma↗

PubMed2001

The psychometric function: I. Fitting, sampling, and goodness of fit.

The psychometric function relates an observer's performance to an independent variable, usually some physical quantity of a stimulus in a psychophysical task. This paper, together with its companion paper (Wichmann & Hill, 2001), describes an integrated approach to (1) fitting psychometric functions, (2) assessing the goodness of fit, and (3) providing confidence intervals for the function's parameters and other estimates derived from them, for the purposes of hypothesis testing. The present paper deals with the first two topics, describing a constrained maximum-likelihood method of parameter estimation and developing several goodness-of-fit tests. Using Monte Carlo simulations, we deal with two specific difficulties that arise when fitting functions to psychophysical data. First, we note that human observers are prone to stimulus-independent errors (or lapses). We show that failure to account for this can lead to serious biases in estimates of the psychometric function's parameters and illustrate how the problem may be overcome. Second, we note that psychophysical data sets are usually rather small by the standards required by most of the commonly applied statistical tests. We demonstrate the potential errors of applying traditional chi2 methods to psychophysical data and advocate use of Monte Carlo resampling techniques that do not rely on asymptotic theory. We have made available the software to implement our methods.

Bias↗

PubMed1994

The Karnofsky Performance Status Scale re-examined: a cross-validation with the EORTC-C30.

A cross-validation of the Karnofsky Performance Status (KPS) and quality of life (QOL) as measured by item 30 of the quality of life questionnaire developed by the European Organization for Research and Treatment of Cancer Study Group (EORTC QLQ-C30) was conducted using ordered logit analysis and prospective data from a continuous sample of 139 lung cancer patients. The QOL is found to be a much broader concept than the KPS, since it likely captures not only physical functioning but also functioning in the non-physical dimensions of social, emotional, and possibly cognitive well-being as well as the level of distress in the physical dimensions of pain, breathing and fatigue. These results suggest that the palliative treatment of advanced cancer and the terminally ill should be guided by a broad concept of well-being that goes beyond one based only on physical functioning.

Humans↗

PubMed2005

Anabolic growth hormone action improves submaximal measures of physical performance in patients with HIV-associated wasting.

Growth hormone (GH) treatment reverses the muscle loss allegedly responsible for diminished aerobic capacity and increased fatigue in patients with HIV-associated wasting. This study examined whether submaximal measures of physical performance can be used as objective measures of the functional impact of GH treatment-induced anabolism. We randomized 27 HIV-positive men [mean (SD) age, 43.9 (7.2) yr; body mass, 71.9 (10.4) kg; BMI, 23.1 (2.8) kg/m2] with unintentional weight loss despite antiretroviral therapy to receive GH (6 mg) or placebo in a double-blinded, placebo-controlled, cross-over trial with a 3-mo washout. Lean body mass (LBM), maximum oxygen uptake (Vo2 peak), ventilatory threshold (VeT), 6-min walk test (6MWT) distance and work, profile of mood states (POMS) fatigue and vigor scores, and Nottingham health profile (NHP) energy and physical mobility scores were measured. LBM significantly increased after 3 mo of GH treatment vs. placebo (means +/- SE, 3.7 +/- 0.6 vs. 0.3 +/- 0.4 kg; P < 0.001). VeT significantly improved (17.6 +/- 3.7 vs. -5.9 +/- 2.5%; P < 0.001), but Vo2 peak did not change significantly. 6MWT distance improved (24.9 +/- 9.7 vs. 19.9 +/- 11.6 m; P > 0.05) and 6MWT work increased significantly more after 3 mo of GH treatment (33.3 +/- 8.8 vs. 16.5 +/- 7.5 kJ; P < 0.05). POMS scores of fatigue and vigor and the NHP score of energy improved, yet the changes were not statistically significant. GH treatment improved VeT linearly to the increase in LBM (r =0.43, P = 0.037) and 6MWT work (r = 0.51, P = 0.008), and the increase in 6MWT work correlated with increase in LBM (r = 0.45, P = 0.024). Improvement in 6MWT work above the median (27.3 kJ) showed a decrease in fatigue (r = -0.62, P = 0.024). We concluded that GH treatment-induced LBM gains in HIV-associated wasting were functionally relevant, as determined by effort-independent submaximal measures of cardiopulmonary exercise testing.

Adult↗

PubMed1992

Factors influencing hand/eye synchronicity in the computer age.

In using a computer, the relation of vision to hand/finger actuated keyboard usage in performing fine motor-coordinated functions is influenced by the physical location, size, and collective placement of the keys. Traditional nonprehensile flat/rectangular keyboard applications usually require a high and nearly constant level of visual attention. Biometrically shaped keyboards would allow for prehensile hand-posturing, thus affording better tactile familiarity with the keys, requiring less intense and less constant level of visual attention to the task, and providing a greater measure of freedom from having to visualize the key(s). Workpace and related physiological changes, aging, onset of monocularization (intermittent lapsing of binocularity for near vision) that accompanies presbyopia, tool colors, and background contrast are factors affecting constancy of visual attention to task performance. Capitas extension, excessive excyclotorsion, and repetitive strain injuries (such as carpal tunnel syndrome) are common and debilitating concomitants to computer usage. These problems can be remedied by improved keyboard design. The salutary role of mnemonics in minimizing visual dependency is discussed.

Accommodation, Ocular↗

PubMed1997

Relationship between functional exercise capacity and general quality of life in nonsurgical patients with lower-extremity peripheral arterial disease.

The purpose of this study was to examine the relationship between functional exercise capacity and general quality of life in patients with lower-extremity peripheral arterial disease (PAD) whose conditions are managed without surgical intervention and to establish new ways of measuring functional exercise capacity and general quality of life in this population. This descriptive survey examined 29 nonsurgical patients with lower-extremity PAD. Functional exercise capacity was measured with the 6-minute walk test. Quality of life was measured with the Medical Outcomes Study Short Form 36 (SF-36). All participants were either present or former smokers. Age ranged from 42 to 81 (M = 65). Walk test performance improved significantly from appointment 1 to appointment 2 (p = 0.01) but not from appointment 2 to appointment 3 (p = 0.9). All participants were able to finish all three walk tests for a total of 87 tests; however, in 30% (n = 26) of tests breaks were required because of leg pain. No one reported angina, and no syncope was observed. The SF-36 revealed significantly lower scores on the physical dimension scales and physical component summary (PCS) score in study participants as compared with a general population. Three physical dimension scales correlated significantly with walk test performance, as did the PCS score (r = 0.57, p = 0.001). In conclusion, functional exercise capacity correlated significantly with physical domains of general quality of life, whereas mental domains were unaffected. The 6-minute walk test was a safe, reliable measure of functional exercise capacity in the nonsurgical PAD population. By improving functional exercise capacity, physical abilities may improve. Thus the 6-minute walk test and SF-36 provide additional methods for objective measurement of the therapeutic impact of the nonsurgical management of PAD.

Activities of Daily Living↗

PubMed2000

Human factors impact on risk analysis of complex systems.

This paper discusses the methods and techniques that are applied for including human factors considerations into risk analysis of modern plants. The application of new control design principles and the extensive use of automation have strongly modified the role of operators, who have progressively become supervisors of automatically performed procedures and decision makers in a context of shared management processes. This implies that cognitive functions and organisational factors affect risk analysis much more than behavioural and physical performances. Another crucial issue of human reliability assessment concerns the dynamic nature of human-machine interaction. This feature covers a wide spectrum of real situations, but demands quite complex and extensive data. These considerations favour the development of new and evolutionary techniques which must be confronted with the requirements and needs of different types of risk analysis be carried out for different objectives, such as quantitative risk analysis, safety management, accident investigation, risk-based decision making and risk-based regulations. Advantages and areas of application of different techniques are briefly discussed, without attempting to develop a detailed comparison.

Cognition↗

PubMed2003

Can older cancer patients tolerate chemotherapy? A prospective pilot study.

BACKGROUND: To the authors' knowledge, few data currently are available regarding the tolerance to chemotherapy in older cancer patients. This prospective pilot study evaluated the changes in functional, mental, nutritional, and comorbid status, as well as the quality of life (QOL), in geriatric oncology patients receiving chemotherapy. METHODS: Sixty patients age > or = 70 years who were undergoing cancer chemotherapy were recruited in a university-based comprehensive cancer center. Changes in physical function were measured by the Eastern Cooperative Oncology Group performance status (ECOG PS) and Instrumental Activities of Daily Living (IADLs), mental health changes were measured by the Mini-Mental State Examination and the Geriatric Depression Scale (GDS), comorbidity was measured by Charlson's index and the Cumulative Illness Rating Scale-Geriatric, nutrition was measured by the Mini-Nutritional Assessment, and QOL was measured by the Functional Assessment of Cancer Therapy-General (FACT-G). Changes were assessed at baseline and at the end of treatment (EOT). Grade 4 hematologic and Grade 3-4 nonhematologic toxicities were recorded. RESULTS: Thirty-seven patients (63%) completed both assessments. Older cancer patients demonstrated a significant decline in measurements of physical function after receiving chemotherapy, as indicated by changes in scores on the IADL (P = 0.04) and on the physical (P = 0.01) and functional (P = 0.03) subscales of the FACT-G. They also displayed worse scores on the GDS administered postchemotherapy (P < 0.01). Patients who experienced severe chemotoxicity had more significant declines in ECOG PS (P = 0.03), IADL (P = 0.03), and GDS (P = 0.04), and more gain in the social well-being subscale (P = 0.02) of the FACT-G, than those who did not experience severe chemotoxicity. However, changes in most scores were small in magnitude clinically. No significant change was found between baseline and EOT in nutrition, comorbidity, and other aspects of the FACT-G. CONCLUSIONS: Older cancer patients undergoing chemotherapy may experience toxicity but generally can tolerate it with limited impact on independence, comorbidity, and QOL levels. It is important to recognize and monitor these changes during geriatric oncology treatment.

Activities of Daily Living↗

PubMed1993

Social functioning and general well-being in patients treated with clean intermittent catheterization.

Social role function, health perceptions and general well-being were studied longitudinally over 1 yr in 149 males and 153 females performing clean intermittent catheterization (CIC). The evaluation included urological assessments and self-rating instruments (Revised Physical Battery, General Health Questionnaire--28 items, State Anxiety Inventory and CIC Pain and Discomfort Scale). Twenty-six percent reported major improvement in their overall quality of life, while 7% reported a wish to be dead and away from it all. Females with infranuclear lesions and detrusor myopathies scored higher on unpleasant health perceptions, state anxiety and physical discomfort by performing CIC than males. In males, the social role function 1 yr later was predicted by initial anxiety and urinary tract infections, whereas in females by initial anxiety only. Discomfort by CIC was predicted by initial infection in males, and by none or moderate medical comorbidity, initial depression and infection in females.

Adaptation, Psychological↗

PubMed2005

A randomized phase II trial of capecitabine and two different schedules of irinotecan in first-line treatment of metastatic colorectal cancer: efficacy, quality-of-life and toxicity.

BACKGROUND: To determine the efficacy, impact on quality-of-life (QoL) and tolerability of two different irinotecan administration schedules in combination with capecitabine as first-line treatment of metastatic colorectal cancer. PATIENTS AND METHODS: We carried out a randomized phase II trial to select one of the following treatment regimens for further investigation: weekly irinotecan at a dose of 70 mg/m(2) days 1, 8, 15, 22, 29 (arm A) or 3-weekly irinotecan at a dose of 300/240 mg/m(2) day 1 and days 22 (arm B) in combination with capecitabine 1000 mg/m(2) twice daily days 1-14 and days 22-35 every 6 weeks. RESULTS: Seventy-five patients with good performance status entered the trial. The two arms were well balanced for relevant patient and disease characteristics. The most frequent toxic effects were grade 3/4 diarrhea (arm A: 34%, B: 19%), grade 3/4 neutropenia (A: 5%, B: 19%) and grade 2/3 alopecia (A: 26%, B: 65%). Other grade 3/4 toxic effects were rare (<5%). Response rates were 34% [95% confidence interval (CI) 20% to 51%] in arm A and 35% (95% CI: 20% to 53%) in arm B. Median time to progression was 6.9 (4.6-10.1) and 9.2 (7.9-11.5) months and median overall survival was 17.4 (12.6-23.0+) and 24.7 (16.3-26.4+) months. Patients with an objective tumor response reported better physical well-being (P < 0.01), mood (P < 0.05), functional performance (P < 0.05) and less effort to cope (P < 0.05) compared with the non-responders and stable disease patients. CONCLUSIONS: The primary end point of this study was the objective response rate and based on the statistical design of the trial, the 3-weekly irinotecan schedule was selected over weekly irinotecan administration. The 3-weekly irinotecan schedule also seemed advantageous in terms of grade 3/4 diarrhea, time to progression, overall survival and patient convenience, but the study was not designed to detect differences in these parameters. In addition, tumor response was shown to have a beneficial effect on QoL indicators.

Adult↗

PubMed1975

[Effects of rapeseed oil on production of corticosterone by rats subjected to stresses (physical effort, cold].

Investigations were carried out on male Wistar rats from an own animal farm of the Institute of Food and Nutrition. The animals were kept on two types of diet containing 50 p. 100 of calories from rapeseed or sunflower oil. The investigations on the effect of rapeseed oil on functional changes of rat adrenals in animals exposed to graded physical exercise were performed on 40 rats aged 3.5 months at the beginning of the experiment. The animals were divided into two groups and were given during 6 weeks diets containing rapeseed or sunflower oil. Then, each group was divided into two subgroups. Administering further these diets one subgroup was left without physical exercise during 7 days, the 2nd group was exposed to graded physical exercise during 45 min. daily during 7 days. Physical exercise was graded by means of special rotating drums driven electrically and provided with running-tracks. Each rat had a daily run of 630 m., and during 7 days this distance was 4 410 m. The investigations on the effect of rapeseed oil on functional changes of rat adrenals in animals exposed to low temperature were performed on 40 rats aged 3.5 months at the beginning of experiment. After 6 weeks on diets each of the two groups was divided into two subgroups. Administering further the same diets one group was left in the laboratory and the other subgroup was placed for 2 weeks in a room at 4 degrees C. After the experiment the animals were decapitated and their adrenals and plasma were taken for corticosterone determinations by the fluorimetric method. Differences were demonstrated in the effects of rapeseed oil and sunflower oil during these stresses. During graded physical exercise the corticosterone level in the adrenals of rats kept on diet with rapeseed oil was unchanged, while it rose significantly in the group receiving sunflower oil. In the plasma the corticosterone level increased during physical exercise in both groups, but in the group receiving rapeseed oil this increase was lower. During exposure to low temperature the adrenal corticosterone level decreased in the group receiving rapeseed oil and was unchanged in the group on sunflower oil. In the plasma the corticosterone level increased on exposure to low temperature in both groups but less in the group receiving rapeseed oil as compared with the group on sunflower oil.

Adrenal Glands↗

PubMed2000

Employment and social issues in adults with cerebral palsy.

OBJECTIVE: To assess the social and employment status of adults with cerebral palsy. DESIGN: Detailed medical history, physical examination, and functional rating in the PULTIBEC system were performed on all study participants; they also responded to a standardized social adaptation questionnaire. SETTING: Outpatient clinic. SUBJECTS: Volunteer participants (n = 101), all with cerebral palsy, between the ages of 27 and 74 years, living independently in the community. RESULTS: More than 80% wished that their physician knew more about cerebral palsy. The majority (84%) felt their parents overprotected them in childhood. More than 90% desired more sexual education. More than half (67%) lived independently, 34% with and 33% without attendant. Of the 53% who were competitively employed, 22% earned an income high enough that advancement would cause financial loss through termination of disability benefits. Speech deficits severely compromised functional verbal communication in 50%. Type of employment correlated more with adequate cognition than with physical or communicative impairments. CONCLUSIONS: Compared with earlier studies, the present study showed more adults with cerebral palsy achieving competitive employment and independent living, despite moderate to severe physical disability. Advances in rehabilitation technology, better home support services, and legal mandates in education and environmental access may have facilitated positive change for persons with cerebral palsy. Further studies are encouraged with emphasis on longitudinal designs.

Activities of Daily Living↗