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PubMedDate not supplied

Percutaneous vertebroplasty improves pain and physical functioning in elderly osteoporotic vertebral compression fracture patients.

BACKGROUND: Osteoporotic vertebral compression fractures are being recognized increasingly often in the elderly. They frequently cause severe and prolonged back pain and physical decline. Bed rest, narcotic analgesia, and external bracing were the only therapeutic modalities available in the past and had limited success. OBJECTIVE: The purpose of our study was to determine the efficacy of percutaneous vertebroplasty in treating osteoporotic vertebral compression fractures in the elderly. METHODS: Twenty-two vertebroplasties were performed in 16 elderly patients. Pain relief, medication requirements, and physical functioning were evaluated before and 24 h and 6 months after vertebroplasty. RESULTS: There was 81% improvement in pain intensity 24 h after operation, and 94% improvement was noted at the 6-month follow-up checkup. Physical functioning improved 69% 24 h after vertebroplasty and 63% 6 months later. Medication requirements also decreased in 75% of the patients. CONCLUSION: Percutaneous vertebroplasty for osteoporotic vertebral compression fractures is safe and effective and should not be withheld from the elderly.

Administration, Cutaneous↗

PubMedDate not supplied

Memory complaint, memory performance, and psychiatric diagnosis: a community study.

This study examined the prevalence of memory complaint and poor memory performance on brief screening measures within a community sample of 810 adults. All individuals received an extensive household interview and a clinical psychiatric evaluation. Overall, 22% indicated that they currently had trouble with their memory. This percentage increased with age, rising to 43% for those 65 to 74 years old, 51% for those 75 to 84 years old, and 88% for those 85 years of age and older; the percentage indicating memory problems decreased with educational attainment. The prevalence of poor memory performance was 11%, also increasing with less education and increased age, rising to 26% for those 65 to 74 years old and to 40% for those older then 75. Those who complained of memory trouble were twice as likely to show poor memory performance (29%) compared with those who did not complain (15%). Multivariate analysis found age, emotional distress, and physical illness to be independent predictors of memory complaint; age, functional disability, education, and physical illnesses proved to be independently associated with poor memory performance. A higher prevalence of complaints of memory trouble was found not only for those with affective disorders, as might be expected, but also among those with schizophrenic, cognitive, anxiety, and adjustment disorders. However, only individuals with cognitive disorders showed a higher prevalence of poor memory performance.

Adolescent↗

PubMed1996

Pain expectancies, pain, and functional self-efficacy expectancies as determinants of disability in patients with chronic low back disorders.

This study tested the relative predictive power of self-efficacy expectations of physical capabilities (functional self-efficacy [FSE]), expectations of pain, and expectations of reinjury on physical function in chronic back patients. Before behavioral assessment of function, 85 patients rated their abilities to perform essential job tasks (FSE) and the likelihood that their performances would be accompanied by pain and reinjury. Partial correlations revealed that FSE was significantly related to function when reinjury and pain were partialed out. Neither reinjury nor pain expectancies correlated significantly with function when FSE was partialed out. Further support for an FSE approach came from regression analyses that found pain intensity, gender, and FSE--not expected pain or reinjury--related consistently with physical performance. Thus, performance-specific cognitions may have greater explanatory power over disability than pain-specific ones.

Activities of Daily Living↗

PubMed2006

The efficacy of a medical virtual reality simulator for training phlebotomy.

OBJECTIVE: The present study compared the effectiveness of a virtual reality (VR) simulator for training phlebotomy with that of a more traditional approach using simulated limbs. BACKGROUND: Phlebotomy, or drawing blood, is one of the most common medical procedures; yet, there are no universal standards for training and assessing performance. The absence of any standards can lead to injuries and inaccurate test results if the procedure is improperly performed. METHOD: Twenty 3rd-year medical students were trained under one of the two methods and had their performance assessed with a 28-item checklist. RESULTS: The results showed that performance improvements were limited to those who trained with the simulated limbs, and a detailed comparison of the two systems revealed several functional and physical differences that may explain these findings. CONCLUSION: Participants trained with simulated limbs performed better than those trained with a VR simulator; however, the metrics recorded by the VR system may address some aspects of performance that could eventually prove beneficial. APPLICATION: The present study highlights the potential for medical simulators to improve patient safety by enabling trainees to practice procedures on devices instead of patients. Applications of this research include training, performance assessment, and design of simulator systems.

Adult↗

PubMed2005

Physical function and health related quality of life: analysis of 2-year data from randomized, controlled studies of leflunomide, sulfasalazine, or methotrexate in patients with active rheumatoid arthritis.

OBJECTIVE: To determine whether improvements in physical function and health related quality of life (HRQOL) are sustained over 2 years of blinded treatment with leflunomide (LEF), methotrexate (MTX), or sulfasalazine (SSZ) in patients with active rheumatoid arthritis (RA). METHODS: Three phase III randomized, controlled trials compared LEF, MTX, and SSZ in patients with active RA. Improvements in physical function were assessed by Health Assessment Questionnaire Disability Index (HAQ-DI) and Modified Health Assessment Questionnaire (MHAQ); monthly MHAQ and mean HAQ scores were used to calculate American College of Rheumatology responses; HAQ-DI was assessed at baseline and 6-month intervals. In US301, the Medical Outcomes Study 36-Item Short-Form questionnaire (SF-36) assessed treatment-associated changes in HRQOL at baseline and 6-month intervals. RESULTS: Mean and median improvements in HAQ-DI after 12 and 24 months of active treatment in all phase III protocols significantly exceeded -0.22 or a minimum clinically important difference (MCID). These improvements closely reflected positive changes in SF-36 that met or exceeded MCID in all domains with LEF and MTX treatment. Problem Elicitation Technique Top 5 scores reflected improvements in performance of physical activities most important to patients. CONCLUSION: Improvements in physical function were sustained over 24 months of successful treatment with LEF, MTX, and SSZ, and reflected improvements in mental as well as physical domains of HRQOL.

Antirheumatic Agents↗

PubMed1993

Effect of antioxidant vitamin supplementation on muscle function after eccentric exercise.

This study investigated the effects of antioxidant vitamin supplementation upon muscle contractile function following eccentric exercise and was performed double blind. Twenty-four physically active young subjects ingested either placebo (400 mg; n = 8), vitamin E (400 mg; n = 8) or vitamin C (400 mg; n = 8) for 21 days prior to and for 7 days after performing 60 min of box-stepping exercise. Contractile function of the triceps surae was assessed by the measurement of maximal voluntary contraction (MVC) and the ratio of the force generated at 20 Hz and 50 Hz tetanic stimulation before and after eccentric exercise and for 7 days during recovery. Following eccentric exercise, MVC decreased to 75 (4)% [mean (SE); n = 24; P < 0.05] of the preexercise values and the 20/50 Hz ratio of tetanic tension from 0.76 (0.01) to 0.49 (0.03) [mean (SE); n = 24; P < 0.05). Compared to the placebo group no significant changes in MVC were observed immediately post-exercise, though recovery of MVC in the first 24 h post-exercise was greater in the group supplemented with vitamin C. The decrease in 20/50 Hz ratio of tetanic tension was significantly less (P < 0.05) post-exercise and in the initial phase of recovery in subjects supplemented with vitamin C but not with vitamin E. These data suggest that prior vitamin C supplementation may exert a protective effect against eccentric exercise-induced muscle damage.

Adolescent↗

PubMed1990

Physical and psychological capabilities during substitution therapy with recombinant growth hormone in adults with growth hormone deficiency.

In a double-blind cross-over study with recombinant methionyl growth hormone (GH) and placebo during 12 weeks, the effect of GH substitution therapy (0.5-06 IU.kg-1.week-1) on physical performance, muscle strength, bone mineral density, and mood and cognitive functions was investigated in 6 GH-deficient adults. During GH substitution serum concentrations of insulin-like growth factor-I and procollagen-III peptide increased in all 6 patients, whereas concentrations of serum urea decreased. Five of the patients identified the GH period and reported improved well-being with increased mental alertness and vitality and improved physical capacity and muscle strength. There was, however, no change of the isokinetic muscle strength during GH substitution therapy, and the working capacity on the bicycle ergometer was just slightly improved in some patients. The bone mineral density was low and unchanged in all patients. Mood and cognitive functions did not change during GH therapy. A reversible fluid retention was observed in one patient during the GH period. In conclusion, short-term GH substitution therapy to GH-deficient adults induced a subjective improvement of general well-being. Longer treatment periods will be necessary to establish the effect on physical capacity, muscle strength, bone mineral density, and mood and cognitive functions.

Adult↗

PubMed2002

Spiritual correlates of functional well-being in women with breast cancer.

Breast cancer is the most common cancer in women in the United States and constitutes a major source of medical and psychological morbidity. The psychosocial sequelae, while not always severe, can last up to a year after diagnosis. This may be a time when spiritual and social resources become important. It is known that practical and emotional support during treatment for breast cancer benefits the patient's mood and quality of life, but it is unclear as to how spirituality and spiritual well-being may benefit the patient. This study examined this question by exploring the relationships between spirituality, spiritual well-being, physical well-being, functional well-being, mood, and adjustment style in a sample of 191 women recently diagnosed with breast cancer or who had metastatic cancer. The women were asked to complete questionnaires pertaining to the above topics at enrollment to a group intervention study. Measures of spirituality, spiritual well-being, physical well-being, functional well-being, mood, and adjustment style taken at the same point in time were then correlated with each other. There were more significant correlations of spirituality and spiritual well-being with functional well-being than physical well-being, but items pertaining to meaning and peace tended to correlate significantly with physical well-being. Spirituality also correlated significantly with several coping styles, but not avoidance as has been previously suggested. Regression analyses were also performed to find the best combination of variables to predict physical and functional well-being. A combination of social well-being and several questions pertaining to peacefulness accounted for 18% of the variance in physical well-being. However, a combination of social well-being and the spiritual scales accounted for 46% of the variance in functional well-being. When the spiritual scales were examined alone, they accounted for 40% of the variance in functional well-being. The results of this study confirm the importance of spirituality and spiritual well-being in both physical and functional well-being. Asking patients about the role of spirituality in their lives may be a useful marker to predict patient's ability to cope with stress in their lives and of their quality of life.

Adaptation, Psychological↗

PubMed2007

Self-administered cognitive screening for a study of successful aging among community-dwelling seniors: a preliminary study.

BACKGROUND: Cognitive functioning is a central component of successful aging. Yet, there are few published instruments for brief and reliable self-administered cognitive assessment that could be used in large population-based studies of community-dwelling elderly people. OBJECTIVE: We examined the utility of a self-administered cognitive screening instrument in a group of community-dwelling older adults, and we evaluated correlations of the performance on this measure with demographic variables and specific indicators of self-rated successful aging. METHOD: We assessed 182 well-educated adults ages 58 to 99 with a modified version of a previously published cognitive screening instrument (Cognitive Assessment Screening Test--Revised; CAST-R), a measure of cognitive complaints (Cognitive Failures Questionnaire; CFQ), and a self-rating of successful aging. We used the SF-36 Physical and Mental Composite Scores as measures of physical and mental health-related functioning. RESULTS: As expected, most individuals performed well on the CAST-R; only 7% of participants fell below a previously established cut score for cognitive impairment. CAST-R scores were positively correlated with level of education, income, SF-36 Mental Composite Scores, and a self-rating of successful aging, and negatively correlated with chronological age. Scores on the CAST-R were not correlated with cognitive complaints (CFQ total score) or SF-36 Physical Composite Scores. CONCLUSIONS: A self-administered cognitive screening tool may be a useful, albeit limited, way of screening for cognitive disabilities among well-educated, community-dwelling older adults. Although preliminary, significant associations with several successful aging-related variables in expected directions represent the first step in establishing the validity of the CAST-R.

Activities of Daily Living↗

PubMed2001

The impact of physical function and pain on work status at 1-year follow-up in patients with back pain.

STUDY DESIGN: A randomized, controlled trial. OBJECTIVE: To examine the impact of physical function and pain on work status in patients who are long-term sick-listed because of back pain. SUMMARY OF BACKGROUND DATA: Sickness benefit is granted to a person who is incapable of working because of reduced functioning. Improved physical function and decrease of pain may be important in considering return to work. METHODS: Physical performance (five activities), disability, and pain (self-reported questionnaires) were assessed at baseline and at the 1-year follow-up evaluation in 117 patients randomized to an intervention group (n = 81) and a control group (n = 36). RESULTS: At the 1-year follow-up evaluation, 50% had returned to work. Statistically significant improvements were demonstrated from baseline to follow-up evaluation in returners to work: in the intervention group on all tests and in the control group on all except two performance tests. Improvement measures discriminated between returners and nonreturners to work in the intervention group on all physical tests and a pain test and in the control group on three physical tests and a pain test. In the intervention group, odds ratios for not having returned to work were high when test measures at follow-up indicated markedly impaired physical function and high pain; in the control group, this appeared in high pain. CONCLUSIONS: Return to work was related to physical function and pain. More importance seemed to be attributed to physical performance in the intervention group than in the controls as a basis for returning patients to work.

Adult↗

PubMed1992

The association of pain with physical activities in chronic low back pain.

Most patients with chronic low back pain associate strenuous physical activities with increased pain. This association can cause avoidance of those activities believed to cause intolerable discomfort. This study explored the relationship of performance of physical activities with self-reported pain measures in 40 consecutive patients with disabling low back pain (mean duration 17 months) during a functional restoration rehabilitation program (mean treatment period 7 weeks). Evaluations were performed at initial presentation and at program completion. Measures included quantification of performance on eight physical tests assessing flexibility, lifting capacity and endurance. Before physical testing patients were asked to complete a pain analog scale, a quantified pain drawing, and a rating of the pain anticipated to result from the performance of each physical test. Results showed that pain measures did not generally correlate with measured physical performance. At completion of treatment, significant improvement in performance on all physical tests was found, but these were not associated with consistent changes in pain measures. These results demonstrate that subjects with chronic low back pain can increase their physical performance abilities within their same pain experiences. Medical recommendations for subjects' involvement in physical activities should not be based solely on the reported association of pain with those activities.

Adult↗

PubMed2003

Fear of pain, physical performance, and attentional processes in patients with fibromyalgia.

Patients with fibromyalgia often present with increased levels of disability and physical functioning, for which the determinants are still unclear. In patients with other musculoskeletal pain syndromes, such as chronic low back pain, physical performance and disability levels are shown to be strongly associated with pain-related fear, and even stronger than pain severity. The present study was aimed at examining the role of pain-related fear and attentional processes on tolerance for physical activity in fibromyalgia patients. High and low fearful fibromyalgia patients (N=81) were requested to perform a physical task, a cognitive (reaction time) task, and a dual task in which the physical and cognitive tasks were combined. It was hypothesized that high fearful patients would terminate the physical performance task sooner than low fearful patients, and would show a greater disruption on the cognitive task. In addition, it was expected that when distracted in the dual task, high fearful patients would show improved performance on the physical task after a fear reduction instruction. The results showed that pain itself was a greater predictor of activity tolerance than pain-related fear, but that pain-related fear was the stronger predictor of reaction times on the cognitive task. Also, all groups showed equal improvement in physical performance in the dual task. The findings suggest that baseline pain acts as an occasion setter which determines the level of physical activity the patient is willing to perform, regardless of pain increase and threat-reducing instructions.

Adult↗

PubMed2001

Measuring higher level physical function in well-functioning older adults: expanding familiar approaches in the Health ABC study.

BACKGROUND: To evaluate development and progression of functional limitation and retain comparability with established approaches, we raised the measurement ceiling of commonly used self-report and performance-based measures of function. This study evaluated the utility and concurrent validity of these expanded measures. METHODS: The study population consisted of 3075 black and white men and women aged 70 to 79 years, with no reported mobility limitations or disability, participating in the Health, Aging, and Body Composition, or Health ABC study. Self-report measures were expanded by ascertaining ease of performance and including more demanding levels of some tasks. A single foot stand and narrow walk supplemented an established performance battery. For walking endurance, we developed the Long Distance Corridor Walk (LDCW), which includes distance covered in 2 minutes and the time to walk 400 m. RESULTS: The expanded self-report items identified one half of the men and one third of the women as exceptionally well functioning and 10% to 13% of men and 21% to 36% of women with lower capacity. The supplemented and rescored performance battery discriminated function over the full range. The LDCW further differentiated walking capacity at the high end and also identified a subgroup with limitations. The self-report and performance measures were significantly, but weakly, correlated (0.13-0.35) and were independent predictors of walking endurance. CONCLUSIONS: Well-functioning persons in their 70s exhibit a broad range of functional capacity readily ascertained by expanded self-report and performance tests. Significant associations among these measures support their concurrent validity, but generally weak correlations indicate they tap different, but important, dimensions of physical function.

Aged↗

PubMed2006

Quantifying physical activity in daily life with questionnaires and motion sensors in COPD.

Accurate assessment of the amount and intensity of physical activity in daily life is considered very important due to the close relationship between physical activity level, health, disability and mortality. For this reason, assessment of physical activity in daily life has gained interest in recent years, especially in sedentary populations, such as patients with chronic obstructive pulmonary disease (COPD). The present article aims to compare and discuss the two kinds of instruments more commonly used to quantify the amount of physical activity performed by COPD patients in daily life: subjective methods (questionnaires, diaries) and motion sensors (electronic or mechanical methods). Their characteristics are summarised and evidence of their validity, reliability and sensitivity is discussed, when available. Subjective methods have practical value mainly in providing the patients' view on their performance in activities of daily living and functional status. However, care must be taken when using subjective methods to accurately quantify the amount of daily physical activity performed. More accurate information is likely to be available with motion sensors rather than questionnaires. The selection of which motion sensor to use for quantification of physical activity in daily life should depend mainly on the purpose of its use.

Diagnostic Techniques, Respiratory System↗

PubMed1995

Sleep deprivation: effects on work capacity, self-paced walking, contractile properties and perceived exertion.

The primary purpose of this study was to examine the effect of a 48-hour period of sleep deprivation on the performance of selected physical work tasks [30-45% of maximum oxygen consumption (VO2max)]. In addition, this study assessed the effect of continual performance of physical work during sleep deprivation on standardized physiological and psychological test scores. Nineteen male subjects performed six different physical tasks, designed to involve all major muscle groups, during a 48-hour period of sleep deprivation. Fourteen subjects served as sleep-deprivation controls. Performance on all physical work tasks decreased significantly. Neither sleep deprivation (SD) or sleep deprivation in conjunction with continuous physical work (SDW) had any effect on muscle contractile properties, anaerobic power measures or resting blood glucose and lactate concentrations. Only SD subjects demonstrated a decline in cardiorespiratory function. Self-selected walking pace decreased and perceived exertion increased significantly in the SDW group. Positive and negative mood scores were adversely affected in both groups, the total change being greatest in SD subjects. The results indicate that performance of physical work tasks requiring 30-45% VO2max declines significantly over a 48-hour period of sleep deprivation. However, maximal physiological function is not unduly compromised by either the work tasks in conjunction with sleep deprivation or by sleep deprivation alone.

Adult↗

PubMed2006

Local cold acclimation during exercise and its effect on neuromuscular function of the hand.

Most acclimation research is performed on resting individuals, whereas in real life, cold exposure is often accompanied by physical activity. We examined the effects of 2 weeks of repeated cold exposure of the hand with or without an elevated core temperature from exercise on neuromuscular function of the first dorsal interosseus (FDI) muscle and manual performance of the hand. The experimental group (4 female, 6 male; age, 25.1 +/- 6.9 y) cooled their hands in 8 degrees C water for 30 min daily while cycling (50% of heart rate reserve); the control group (4 female, 4 male; age, 25.1 +/- 5.7 y) remained still. Manual function testing consisted of tactile sensitivity, grip strength, manual dexterity, and evoked twitch force in a custom-made myograph. Thermal sensation, skin temperature of index finger (Tif) and hand (Tfdi), as well as rectal temperature (Tre), were recorded daily. Tre increased significantly during bicycling, by 0.6 +/- 0.2 degrees C. Minimal Tif and Tfdi of the groups combined increased significantly during exposure days from 8.7 +/- 0.7 degrees C and 12.4 +/- 2.8 degrees C to 10.1 +/- 1.3 degrees C and 15.0 +/- 3.0 degrees C, respectively (p=0.04), with no significant difference between groups. Thermal ratings improved significantly on exposure days. Manual function was impaired with cooling, but with no significant difference between groups or across time. Deterioration of twitch characteristics with cooling did not change with repeated cold exposure. Although the increasing core temperature during cold water immersion changed the acute temperature response and thermal ratings, it had no effect on local cold acclimation or manual function.

Acclimatization↗

PubMed2006

Contribution of physical fitness component to health status in middle-aged and elderly males.

This study determined the physical fitness component that contributes to improving and maintaining health status for each age group as well as quantifying the degree of the relationship between health status and physical fitness in middle-aged and elderly males. The participants were 995 males aged 30 to 69 years. Ten physical fitness tests and medical checkups were performed. The participants were divided into a healthy group and an unhealthy group according to health status. Multiple discriminant analysis was applied to the multivariate data. Correct discriminant probabilities of the multiple discriminant function to discriminate the healthy and unhealthy groups for males ranged from 67.0% to 75.1%. These findings suggest that there is a relatively high relationship between the health status and physical fitness level for middle-aged and elderly males. With each individual's discriminant score calculated using the multiple discriminant function as the index of the degree of health, the Pearson's correlation coefficient of the discriminant score and the performance in each physical fitness test were calculated. The age change between 30 and 69 years old was classified into five patterns according to the contribution. The result of this study is considered to be useful as objective data to prepare an exercise program considering the contribution of the physical fitness component of health status.

Adult↗

PubMed2004

Minimizing variations in functionality of whey protein concentrates from different sources.

Enhancement in processing technology has improved the nutritional and functional properties of whey protein concentrates by increasing the content and quality of the protein, leading to their increased use in different food products. The extent of heat treatment affects the quality of the whey protein concentrate, and wide variation in product quality exists due to the various means of manufacture and from the whey product history from farm to factory. The study was carried out with 6 commercial whey protein concentrates with 80% protein (WPC80) to determine variations in physical properties, particle size and density, and functional properties--solubility, gel strength, foam volume, and stability. Significant differences were observed among all the products for every property compared. Particulate size was the most important determinant of functional characteristics. Larger particulate WPC80 had significantly higher fat content and were less soluble with poor foam stability; but narrowing the particle size distribution through sieving, minimized variations. We determined that sieving all products within the particle size distribution range of 100 to 150 microns minimized variation in physical composition, making functionality uniform. WPC80 from different manufacturers can be made to perform uniformly within a narrow functionality range by reducing the particle size distribution through sieving.

Chemical Phenomena↗