Effect of resistance exercises on function in older adults with osteoporosis or osteopenia: a systematic review. A randomized controlled trial of a health-promotion programme and its effect on ADL dependence and self-reported health problems for the elderly visually impaired The role of amputation as an outcome measure in cellular therapy for critical limb ischemia: implications for clinical trial design Development of a core outcome set for disease modification trials in mild to moderate dementia: a systematic review, patient and public consultation and consensus recommendations. Physiological Cost Index and Comfort Walking Speed in Two Level Lower Limb Amputees Having No Vascular Disease Functional electrical stimulation early after stroke improves lower limb motor function and ability in activities of daily living. How should we train the upper limbs? An Inventory to Assess Activities of Daily Living for Clinical Trials in Alzheimer's Disease Home-based multicomponent rehabilitation program for older persons after hip fracture: a randomized trial. Instrumental activities of daily living related to impairments and functional limitations in 70-year-olds and changes between 70 and 76 years of age. Costs of treating cardiovascular events in Germany: a systematic literature review Inpatient and outpatient costs in patients with coronary artery disease and mental disorders: a systematic review Tolerance of an Aquatic Power Training Program by Older Adults with Symptomatic Knee Osteoarthritis Efficacy of postural and neck-stabilization exercises for persons with acute whiplash-associated disorders: a systematic review. Physical exercise and the prevention of disability in activities of daily living in older persons with osteoarthritis. Platelet-rich plasma versus platelet-poor plasma in the management of chronic diabetic foot ulcers: a comparative study. Incidence and predictors of falls in the chinese elderly. Interventions to reduce dependency in personal activities of daily living in community-dwelling adults who use homecare services: protocol for a systematic review Reducing lower-extremity amputations due to diabetes. Application of the staged diabetes management approach in a primary care setting. Validity and Reliability of the Short Physical Performance Battery in Two Diverse Older Adult Populations in Quebec and Brazil Effects of physical activity on cancer survival: a systematic review. The lower-limb tasks questionnaire: an assessment of validity, reliability, responsiveness, and minimal important differences. A "client-centred activities of daily living" intervention for persons with stroke: One-year follow-up of a randomized controlled trial.
PURPOSE To examine the effect of resistance exercises on self-reported physical function and activities of daily living ( ADL ) in older adults with osteoporosis or osteopenia . METHODS A search of available literature was conducted using PubMed , CINAHL , SPORTD iscus , PEDro , ProQuest Nursing and Allied Health Source , and Cochrane Controlled Trials Register . Studies were included if they involved ( 1 ) r and omized controlled trials ; ( 2 ) participants with osteoporosis or osteopenia ; ( 3 ) resistance exercise as an intervention ;  and ( 4 ) self-report of physical function or ADL . Articles were independently review ed for quality by two authors using the Physiotherapy Evidence Data base ( PEDro ) scale . Cohen 's d effect size was calculated by dividing st and ardized mean differences by the st and ard deviation to determine treatment effect in terms of physical function or ADL . RESULTS Five full-text articles were selected for inclusion . PEDro scores ranged from 5 to 7 ( out of 10 ) . Effect size mean differences as a result of resistance intervention ranged from 0.08 to 1.74 , suggesting " trivial " to " large " effects on self-reported physical function and ADL . CONCLUSION RESULTS suggest that interventions using resistance training have a beneficial impact on the domains of physical function and ADL in participants with osteoporosis or osteopenia . More high- quality studies are needed to lend further validity to this supposition Background : Ageing with visual impairment is associated with a high degree of disability whereby age-related macular degeneration in particular causes dependence in activities of daily living ( ADL ) even at an early stage . Aims : To compare an activity-based , health-promotion programme with an individual programme , targeting the elderly with age-related macular degeneration concerning the effect on the development of dependence in ADL , general health , and self-reported health problems . Methods : A r and omized controlled study with a 28-month follow-up . A total of 229 persons were r and omized to the study and 131 ( 57 % ) were followed up ( individual intervention n=69 , health-promotion programme n=62 ) at 28-month . Results : The health-promotion group maintained their ADL level despite a significant decrease in visual acuity , while the individual intervention group increased its dependence in ADL . General health systematic ally dropped to a lower level in both groups , but participants from the health-promotion group reported fewer health problems . There were significantly fewer reports of tiredness and dizziness among the health-promotion participants . Conclusion : The health-promotion programme seems to have slowed down the disablement process among elderly with decreased vision by enabling them to maintain their ADL level and by reducing self-reported health problems for at least 28 months following intervention Background Autologous bone marrow-derived stem cells have been ascribed an important therapeutic role in No-Option Critical limb Ischemia ( NO-CLI ) . One primary endpoint for evaluating NO-CLI therapy is major amputation ( AMP ) , which is usually combined with mortality for AMP-free survival ( AFS ) . Only a trial which is double blinded can eliminate physician and patient bias as to the timing and reason for AMP . We examined factors influencing AMP in a prospect i ve double-blinded pilot RCT ( 2:1 therapy to control ) of 48 patients treated with site of service obtained bone marrow cells ( BMAC )  as well as a systematic review of the literature . Methods Cells were injected intramuscularly in the CLI limbs as either BMAC or placebo ( peripheral blood ) . Six month AMP rates were compared between the two arms . Both patient and treating team were blinded of the assignment in follow-up examinations . A search of the literature identified 9 NO-CLI trials , the control arms of which were used to determine 6 month AMP rates and the influence of tissue loss . Results Fifteen amputations occurred during the 6 month period , 86.7 % of these during the first 4 months . One amputation occurred in a Rutherford 4 patient . The difference in amputation rate between patients with rest pain ( 5.6 % ) and those with tissue loss ( 46.7 % ) , irrespective of treatment group , was significant ( p = 0.0029 ) . In patients with tissue loss , treatment with BMAC demonstrated a lower amputation rate than placebo ( 39.1 % vs. 71.4 % , p = 0.1337 ) . The Kaplan-Meier time to amputation was longer in the BMAC group than in the placebo group ( p = 0.067 ) . Projecting these results to a pivotal trial , a bootstrap simulation model showed significant difference in AFS between BMAC and placebo with a power of 95 % for a sample size of 210 patients . Meta- analysis of the literature confirmed a difference in amputation rate between patients with tissue loss and rest pain . Conclusions BMAC shows promise in improving AMP-free survival if the trends in this pilot study are vali date d in a larger pivotal trial . The difference in amp rate between Rutherford 4 & 5 patients suggests that these patients should be stratified in future RCTs BACKGROUND There is currently no disease-modifying treatment available to halt or delay the progression of the disease pathology in dementia . An agreed core set of the best-available and most appropriate outcomes for disease modification would facilitate the design of trials and ensure consistency across disease modification trials , as well as making results comparable and meta-analysable in future trials . OBJECTIVES To agree a set of core outcomes for disease modification trials for mild to moderate dementia with the UK dementia research community and patient and public involvement ( PPI ) . DATA SOURCES We included disease modification trials with quantitative outcomes of efficacy from ( 1 ) references from related systematic review s in workstream 1 ; ( 2 ) search es of the Cochrane Dementia and Cognitive Improvement Group study register , Cochrane Central Register of Controlled Trials , Cumulative Index to Nursing and Allied Health Literature , EMBASE , Latin American and Caribbean Health Sciences Literature and PsycINFO on 11 December 2015 , and clinical trial registries [ International St and ard R and omised Controlled Trial Number ( IS RCT N ) and clinical trials.gov ] on 22 and 29 January 2016 ; and ( 3 ) h and - search es of reference lists of relevant systematic review s from data base search es . REVIEW METHODS The project consisted of four workstreams . ( 1 ) We obtained related core outcome sets and work from co-applicants . ( 2 ) We systematic ally review ed published and ongoing disease modification trials to identify the outcomes used in different domains . We extracted outcomes used in each trial , recording how many used each outcome and with how many participants . We divided outcomes into the domains measured and search ed for validation data . ( 3 ) We consulted with PPI participants about recommended outcomes . ( 4 ) We presented all the synthesis ed information at a conference attended by the wider body of National Institute for Health Research ( NIHR ) dementia research ers to reach consensus on a core set of outcomes . RESULTS We included 149 papers from the 22,918 papers screened , referring to 125 individual trials . Eighty-one outcomes were used across trials , including 72 scales [ 31 cognitive , 12 activities of daily living ( ADLs ) , 10 global , 16 neuropsychiatric and three quality of life ] and nine biological techniques . We consulted with 18 people for PPI . The conference decided that only cognition and biological markers are core measures of disease modification . Cognition should be measured by the Mini Mental State Examination ( MMSE ) or the Alzheimer 's Disease Assessment Scale - Cognitive subscale ( ADAS-Cog ) , and brain changes through structural magnetic resonance imaging ( MRI ) in a subset of participants . All other domains are important but not core . We recommend using the Neuropsychiatric Inventory for neuropsychiatric symptoms : the Disability Assessment for Dementia for ADLs , the Dementia Quality of Life Measure for quality of life and the Clinical Dementia Rating scale to measure dementia globally . LIMITATIONS Most of the trials included participants with Alzheimer 's disease , so recommendations may not apply to other types of dementia . We did not conduct economic analyses . The PPI consultation was limited to members of the Alzheimer 's Society Research Network . CONCLUSIONS Cognitive outcomes and biological markers form the core outcome set for future disease modification trials , measured by the  MMSE or ADAS-Cog , and structural MRI in a subset of participants . FUTURE WORK We envisage that the core set may be superseded in the future , particularly for other types of dementia . There is a need to develop an algorithm to compare scores on the MMSE and ADAS-Cog . STUDY REGISTRATION The project was registered with Core Outcome Measures in Effectiveness Trials [ www.comet-initiative.org/ studies /details/819 ? result = true ( accessed 7 April 2016 ) ] . The systematic review protocol is registered as PROSPERO CRD42015027346 . FUNDING The National Institute for Health Research Health Technology Assessment programme Background : The Physiological Cost Index  ( PCI ) was introduced by MacGregor to estimate the energy cost in walking of healthy people , also it has been reported for persons with lower limb amputation , walking with prosthesis . Objective : To assess energy cost and walking speed in two level lower limb amputation : transfemoral and transtibial amputation  and to determine if the age and prosthetic walking supported with walking aids have impact on energy cost and walking speed . Methods : A prospect i ve cross sectional study was performed in two level lower limb amputees with no vascular disease who were rehabilitated at the Department of Prosthetics and Orthotics at the University Clinical Center of Kosovo . The  Physiological Cost Index ( PCI )  was assessed by five minutes of continuous indoor walking at Comfort Walking Speed ( CWS ) . Results : Eighty three lower limb amputees were recruited . It is shown relevant impact of level of amputation in PCI ( t=6.8 , p<0.001 ) and CWS ( T=487 , p<0.001 ) . The great influence of using crutches during prosthetic walking in  PCI  ( ANOVA F= 39.5 P < 0.001 ) and CWS ( ANOVA F=32.01 , P < 0.001 ) has been shown by One Way ANOVA test . The correlation coefficient ( R ) showed a significant correlation of age with PCI and CWS in both groups of amputation . Conclusions : Walking with transfemoral prosthesis or using walking aids during prosthetic ambulation is matched with higher cost of energy and slower walking speed . Advanced age was shown with high impact on PCI and CWS in both groups of amputees BACKGROUND Functional electrical stimulation ( FES ) to patients early after stroke has been proved to improve walking ability . The effects on abilities in activities of daily living ( ADL ) are not clear . OBJECTIVE To investigate the effectiveness of FES in improving lower limb function and ability in ADL of early stroke patients . METHODS Thirty-seven stroke patients were r and omly allocated to st and ard rehabilitation ( SR ) group ( n = 18 ) , and FES group with FES and SR ( n = 19 ) . SR included 60 minutes each for physiotherapy and occupational therapy . FES was delivered for 30 min to induce ankle dorsiflexion and eversion . Treatments were 5 days per week for 3 weeks . Evaluations including the composite spasticity scale ( CSS ) , lower-extremity subscale of Fugl-Myer Assessment ( FMA ) , postural assessment scale for stroke patients ( PASS ) , Berg Balance Scale ( BBS ) , and modified Barthel Index ( MBI ) assessed before treatment , after 2 and 3 week treatment respectively . RESULTS After 2 week treatment , FES group showed a significant reduction of CSS and improvements of FMA , MBI and PASS . After 3 week treatment , FES group showed a further reduction of CSS and also improvement of FMA , MBI and BBS as well . CONCLUSIONS FES on the paretic lower limbs early after stroke improved the mobility and ability in ADL The article by McKeough and colleagues in this issue of Chronic Respiratory Disease is the first study to compare different modes of upper extremity training in individuals with chronic obstructive pulmonary disease ( COPD ) . Limitations during exercise and daily activity in individuals with COPD are not limited to lower extremity activities such as walking or stair climbing ; most of the patients experience difficulty during activities that involve their arms due to the sensation of dyspnea and /or arm fatigue . Upper extremity training for patients with COPD is an important component of pulmonary rehabilitation ( PR ) , result ing in improvements in arm exercise capacity , arm function and muscle strength . However , there is limited evidence on what type of training should be performed . The study by McKeough and colleagues adds to the growing body of evidence in the area of upper extremity training in COPD and provides support for the inclusion of arm endurance and strength training as a part of PR . The study is a r and omized controlled trial ( RCT ) that aim ed to compare the effects of arm endurance training ; arm strength training , a combination of arm endurance and strength training ; and no arm training ( control group ) on endurance arm exercise capacity , functional arm exercise capacity and health-related quality of life ( HRQL ) in individuals with mild-tovery severe COPD . The authors found a significant improvement in arm endurance time ( arm endurance capacity ) between the endurance group and control group . There were nonsignificant trends in arm endurance time favoring the strength training and combined groups compared with the control group . In terms of symptoms , the authors demonstrated that the combined group had a significantly greater reduction in dyspnea and rate of perceived exertion at the end of the functional arm exercise test compared with the control and with each of the intervention groups . When the combined group was compared with the other two intervention groups , the improvement in HRQL ( measured using the St George ’s Respiratory Question naire ) exceeded the minimum clinical ly important difference of 4 units , although it did not reach statistical significance . Until the beginning of the century , several RCTs had been conducted to examine the effects of upper extremity training in individuals with COPD . However , there were considerable variations in the exercise protocol s rendering it impossible to determine the optimal training regimen for these patients . Moreover , the impact of upper extremity training on other clinical outcomes besides arm exercise capacity was unclear as shown consistently by four systematic review s. More recently , four RCTs examining the effects of arm exercise training in individuals with COPD have been published . Holl and and colleagues compared the effects of unsupported upper limb endurance training with lower extremity training alone . The authors found that unsupported upper limb endurance training improved upper limb exercise capacity but had no additional effects on the symptoms or HRQL compared with lower extremity training alone . Costi and colleagues examined the effects of upper extremity resistance training in patients with COPD compared with st and ard PR . The authors demonstrated improvement in arm functional exercise capacity ( measured using the 6-minute pegboard and ring test ) and in performance during activities of daily living ( ADL ) measured by an ADL field test . In addition , the authors found a decrease in arm fatigue at the end of the ADL test in the intervention group . We developed a set of informant-based items describing performance of activities of daily living ( ADL ) by patients with Alzheimer 's disease ( AD ) to identify which ADL are useful for assessment of patients in clinical trials .  Evaluation of ADL is an important outcome measure in AD clinical trials . For clinical trial measurement , ADL should have broad applicability , good test-retest reliability , scaling to cover a range of performance , and sensitive to detect change in disease progression . A total of 45 ADL items developed from literature review and clinical experience were administered to informants of 242 AD patients and 64 elderly controls as part of the multicenter Alzheimer 's Disease Cooperative Study Instrument protocol . Half of the subjects were re-evaluated at 1 and 2 months and all at 6 and 12 months . Controls performed virtually all ADL items optimally at baseline and at 12 months . Among subjects with AD , 27 of the 45 ADL were widely applicable , i.e. , performed at baseline or premorbidly by > 90 % of subjects ; showed good test-retest reliability between baseline and 1 and 2 months ; correlated with MMSE scores of AD patients cross-sectionally ; and showed a decline in performance from baseline to 12 months in at least 20 % of AD patients . ADL could be identified that capture change in functional ability in patients across the entire range of the MMSE . The remaining 18 ADL included several that may be useful for trials that target specific population s , e.g. , women with AD . Because change on specific items depends on baseline MMSE , ADL evaluation should include items relevant to the severity of dementia of patients enrolled in a clinical trial OBJECTIVE To determine whether a home-based systematic multicomponent rehabilitation strategy leads to improved outcomes relative to usual care . DESIGN A r and omized controlled trial with 12 months of follow-up . SETTING General community ; 27 home care agencies . PARTICIPANTS Three hundred four nondemented persons at least 65 years of age who underwent surgical repair of a hip fracture at two hospitals in New Haven , CT , and returned home within 100 days . INTERVENTION Systematic multicomponent rehabilitation strategy addressing both modifiable physical impairments ( physical therapy ) and activities of daily living ( ADL ) disabilities ( functional therapy ) versus usual care . MAIN OUTCOME MEASURES A battery of self-report and performance-based measures of physical and social function . RESULTS There was no significant difference in the proportion of participants in the two groups who recovered to prefracture levels in self-care ADL at 6 months ( 71 % vs 75 % ) or 12 months ( 74 % in both groups ) or in home management ADL at 6 months ( 35 % vs 44 % ) or 12 months ( 44 % vs 48 % ) . There also was no difference between the two groups in social activity levels , two timed mobility tasks , balance , or lower extremity strength at either 6 or 12 months . Compared with participants who received usual care , those in the multicomponent rehabilitation program showed slightly greater upper extremity strength at 6 months ( p = .04 ) and a marginally better gait performance ( p = .08 ) . CONCLUSIONS The systematic multicomponent rehabilitation program was no more effective in promoting recovery than usual home-based rehabilitation . Compared with previous cohorts , however , participants r and omized to usual care in our study received more rehabilitative and home care services and experienced a higher rate of recovery . This finding is important given the current pressures to reduce home services . The challenge is to determine the composition and duration of rehabilitation and home services that will ensure optimal functional recovery most efficiently in older persons after hip fracture The aim of this study was to analyse in particular dependence in instrumental daily life activities ( I-ADLs ) and its association with physical impairments and functional limitations in the elderly . The study was based on cross-sectional data on 70-year-olds ( n = 602 ) and longitudinal data on subjects followed up to the age of 76 ( n = 371 ) . Persons dependent in ADL  had lower values in maximum walking speed , grip strength , knee extensor strength , stair climbing capacity and in forward reach , compared with those who were independent in ADL .  Walking speed in both women and men and sight impairment in men had the greatest influence on dependence in ADL . Possible critical levels for disability in ADL are discussed , as persons who developed dependence between 70 and 76 already had a lower capacity in walking speed and knee extensor strength at age 70 than persons who retained their independence in ADL Objective This study aims to systematic ally evaluate available evidence regarding direct medical costs of treating cardiovascular ( CV ) events in Germany after 2003 on an individual patient basis and from a payer perspective . The CV events of interest were myocardial infa rct ion ( MI ) , unstable angina , heart failure ( HF ) , stroke , and peripheral artery disease ( PAD ) . Method A systematic literature search was performed in the following data bases according to Preferred Reporting Items for Systematic Review s and Meta- Analysis ( PRISMA ) guidelines - Medline , Embase , Centre for Review s and Dissemination , TIBORDER , and German dissertation data base from January 2003 to October 2013 . Both observational studies and r and omized clinical trials were considered for the review . All values stated in € are inflation adjusted to 2014 € unless stated otherwise . Result This review included 13 articles . For newly occurred MI patients , the average hospitalization costs during the acute phase were reported to be between € 6790 and € 8918 per admission . In the first year after a MI event , direct medical costs were € 13,838–14,792 per patient . Direct medical costs of chronic HF patients were found to be between € 3417 and 5576 per patient per year . Treatment costs increase with disease progression . The average treatment costs  for hospitalized PAD in the acute phase were reported to be € 4963 per admission , € 2535 per patient during month 1–6 after the initial hospitalization , € 1601 in month 7–12 , and € 1390 in month 13–18 . For stroke of all types , total direct medical costs in the 1st year after an event were reported to be € 13,273 per patient . Total direct medical costs during the 1st year after an ischemic stroke event were € 17,399–21,954 per patient , € 6260 in month 13–18 , and € 6496 per year in the subsequent 4 years . Conclusion MI , unstable angina , HF , stroke and PAD have a high financial impact on the German health care system . Treatment costs of these diseases are mostly incurred during the acute phase of events and tend to decrease over time . Hospitalization and rehabilitation costs were two major cost drivers . Medication costs was one of the smallest cost component reported Background To systematic ally review in- and outpatient costs in patients with coronary artery disease ( CAD ) and comorbid mental disorders . Methods A comprehensive data base search was conducted for studies investigating persons with CAD and comorbid mental disorders ( Medline , EMBASE , PsycINFO , Psyndex , EconLit , IBSS ) . All studies were included which allowed a comparison of in- and outpatient health care costs ( assessed either monetarily or in terms of health care utilization ) of CAD patients with comorbid mental disorders ( mood , anxiety , alcohol , eating , somatoform and personality disorders ) and those without . R and om effects meta-analyses were conducted and results reported using forest plots . Results The literature search result ed in 7,275 potentially relevant studies , of which 52 met inclusion criteria . Hospital readmission rates were increased in CAD patients with any mental disorder ( pooled st and ardized mean difference ( SMD ) = 0.34 [ 0.17;0.51 ] ) . Results for depression , anxiety and posttraumatic stress disorder pointed in the same direction with heterogeneous SMDs on a primary study level ranging from −0.44 to 1.26 . Length of hospital stay was not increased in anxiety and any mental disorder , while studies on depression reported heterogeneous SMDs ranging from −0.08 to 0.82 . Most studies reported increased overall and outpatient costs for patients with comorbid mental disorders . Results for invasive procedures were non-significant respectively inconclusive . Conclusions Comorbid mental disorders in CAD patients are associated with an increased healthcare utilization in terms of higher hospital readmission rates and increased overall and outpatient health care costs . From a health care point of view , it is requisite to improve the diagnosis and treatment of comorbid mental disorders in patients with CAD to minimize incremental costs Objective . To determine the tolerance and feasibility of aquatic-based power training for improving lower limb muscle power , impairments , and mobility in adults with symptomatic knee OA . Participants . Twenty-nine adults , age 50 years and over , with symptomatic knee OA ( ACR clinical criteria ) and mobility limitation ( 400-meter walk time slower than median for sex and decade ) completed 45-minute aquatic power training sessions twice weekly for 6 weeks . Main Outcome Measurements . Prospect i ve outcomes included tolerance of the program , as well as change in stair climb power , 400-meter walk time , overall and knee-specific pain , activities of daily living ( ADL ) , quality of life ( QOL ) , and lower limb function at 6- and 12-week follow-up . Results . The training intensity required modification for 9 of the 29 participants .  Lower limb muscle power , ADL , QOL , and overall pain were improved immediately and 6 weeks following completion ( all P < 0.05 ) . However , 400-meter walk times , and lower limb function did not differ from baseline . Conclusions . A 6-week aquatic rehabilitation program appears to be well tolerated by adults with symptomatic knee OA with mobility limitations and may result in improved lower limb muscle power , symptoms , ADL , and QOL . However , this intervention may have insufficient specificity or intensity for improving physical function PURPOSE We systematic ally review ed r and omized and quasi-r and omized clinical trials in the literature to assess the efficacy of neck stabilization and postural exercises on pain , neck range of motion , and time off work in adults with acute whiplash-associated disorders . METHODS Electronic data bases , reference lists of relevant Cochrane review s , reference lists of studies selected for inclusion , and tables of contents of relevant journals were systematic ally search ed for r and omized and quasi-r and omized controlled trials . Two independent review ers selected studies for inclusion , assessed method ological quality , and extracted data . Because of the heterogeneity of the interventions , a qualitative synthesis was performed using " levels of evidence " as recommended by van Tulder et al. RESULTS Eight studies representing five clinical trials were selected for inclusion . Two trials were grade d as high quality , two as moderate quality , and one as low quality . Many of these studies had mixed results , demonstrating significant differences on some outcome measures but not on others . CONCLUSIONS There is moderate evidence to support the use of postural exercises for decreasing pain and time off work in the treatment of patients with acute whiplash-associated disorders . However , no evidence exists to support the use of postural exercises for increasing neck range of motion . There is conflicting evidence in support of neck stabilization exercises in the treatment of patients with acute whiplash-associated disorders BACKGROUND The prevention of disability in activities of daily living ( ADL ) may prolong older persons ' autonomy ( older persons are defined in this study as those aged > or = 60 years ) . However , proved preventive strategies for ADL disability are lacking . A sedentary lifestyle is an important cause of disability . This study examines whether an exercise program can prevent ADL disability . METHODS A 2-center , r and omized , single-blind , controlled trial was conducted in which participants were assigned to an aerobic exercise program , a resistance exercise program , or an attention control group .  Of the 439 community-dwelling persons aged 60 years or older with knee osteoarthritis originally recruited , the 250 participants initially free of ADL disability were used for this study .  Incident ADL disability , defined as developing difficulty in transferring from a bed to a chair , eating , dressing , using the toilet , or bathing , was assessed quarterly during 18 months of follow-up . RESULTS The cumulative incidence of ADL disability was lower in the exercise groups ( 37.1 % ) than in the attention control group ( 52.5 % ) ( P = .02 ) . After adjustment for demographics and baseline physical function , the relative risk of incident ADL disability for assignment to exercise was 0.57 ( 95 % confidence interval , 0.38 - 0.85 ; P = .006 ) . Both exercise programs prevented ADL disability ; the relative risks were 0.60 ( 95 % confidence interval , 0.38 - 0.97 ; P = .04 ) for resistance exercise and 0.53 ( 95 % confidence interval , 0.33 - 0.85 ; P = .009 ) for aerobic exercise . The lowest ADL disability risks were found for participants with the highest compliance to exercise . CONCLUSIONS Aerobic and resistance exercise may reduce the incidence of ADL disability in older persons with knee osteoarthritis .  Exercise may be an effective strategy for preventing ADL disability and , consequently , may prolong older persons ' autonomy Non healing diabetic foot ulcers and the result ing potential amputations present significant costs to the health care system and reduce patient quality of life . The goal of diabetic foot ulcer treatment is to obtain wound closure as expeditiously as possible . The use of platelet-rich plasma ( PRP ) to enhance wound healing has increased dramatically over the last decade . However , controversies exist in the literature regarding the added benefit of this procedure . The aim of this study is to investigate the efficiency of platelet releasate on the healing of chronic diabetic ulcers in comparison with platelet-poor plasma ( PPP ) . This study included 24 patients with chronic diabetic ulcers . They were systematic ally r and omised into two groups : PRP group ( n = 12 ) and PPP group ( n = 12 ) . The results showed that healing in PRP group was significantly faster ( P < 0·005 ) . PRP enhances healing of chronic diabetic foot ulcers INTRODUCTION This is the first prospect i ve longitudinal study carried out in a Chinese elderly population with the objective of identifying the incidence and predictors of falls . MATERIAL S AND METHODS This is a population -based cohort study in Hong Kong with 1517 ambulatory elderly Chinese recruited using a multi-stage sampling method . Baseline data on demographic , comorbid diseases , drugs , Activities of Daily Living ( ADL ) [ Barthel Index and Lawton 's Instrumental Activities of Daily Living ( IADL ) ] , Geriatric Depression Scale ( GDS-15 ) , cognitive assessment by the Abbreviated Mental Test ( AMT ) , fear of falling , self-perceived mobility problem , h and grip strength , lower limb power , balance and gait tests were performed . Every subject was followed up for 1 year . RESULTS Four hundred and one falls occurred in 294 fallers ( 19.3 % ) over 1 year of follow-up . The prevalence of falls and recurrent falls were 19.3 % and 4.75 % , respectively . The incidences of falls ( i.e. , the fall events ) were 220 , 324 and 270 per 1000 person-years for men , women and both gender , respectively . The independent predictors of falls were previous history of falls , advancing age , Parkinson 's disease , knee extension power and gait speed . The independent predictors of recurrent falls were previous history of falls , self-perceived mobility problem , the knee extension strength and the Total Mobility Score of the Tinetti Balance and Gait Evaluation . CONCLUSIONS The incidence of falls in the Chinese elderly was 270 per 1000 person-years . History of falls , old age , Parkinson 's disease , decreased lower limb power and impairment in balance and gait function were important independent predictors of falls or recurrent falls in the Chinese elderly . Effective fall prevention programmes targeted at improving these risk factors for falls should be developed for the Chinese elderly in Hong Kong and Asia Background There is a growing dem and for services whereby individuals receive assistance from care workers for personal care within the home . This has led to the development of re-ablement or restorative homecare services that provide time-limited input aim ed at reducing dependency in personal activities of daily living , and preventing or delaying the need for further homecare support . However , little is currently known about how such interventions are configured , or how they may affect individuals ’ ability to carry out personal care independently . Methods / Design We will seek to identify studies that compare an intervention design ed to reduce dependency in personal activities of daily living with routine input or usual care as the control . We will include r and omised controlled trials , nonr and omised controlled trials , and controlled before and after studies . We will also include interrupted time series studies .We shall search electronic data bases in addition to search ing for ongoing and unpublished studies , and where appropriate will contact key authors . Two review ers will independently screen articles for inclusion ; will assess risk of bias using quality assessment tools ; and will carry out data extraction using pre-prepared forms . Any disagreements , at any stage , will be resolved by discussion and the involvement of a third review er if needed . We will produce a narrative summary of the results . A meta- analysis will be conducted if sufficient data are available of appropriate quality and comparability . Discussion The findings from this review will inform future practice within homecare re-ablement services ; will inform policy decisions about the structure , organisation and content of such services ; and will identify areas where further research is warranted . Systematic review registration This review protocol has been registered on the PROSPERO data base ( CRD42013004163 ) BACKGROUND While lower-extremity amputation ( LEA ) is a frequent complication of diabetes , effective strategies for the prevention of LEA in primary care setting s have not been extensively studied . METHODS This prospect i ve study of American Indians with diabetes in a rural primary care clinic was divided into three periods : the st and ard care period ( 1986 to 1989 ) , during which patients received foot care at the discretion of the primary care provider ; the public health period ( 1990 to 1993 ) , during which patients  were screened for foot problems and high-risk individuals received foot care education and protective footwear ; and the Staged Diabetes Management ( SDM ) period ( 1994 to 1996 ) , during which comprehensive guidelines for diabetic foot management were adapted by the primary care clinicians to their practice s and were systematic ally implemented . RESULTS A total of 639 individuals contributed 4322 diabetic person-years during the three periods of observation . Patient sex distribution , mean age , and mean duration of diabetes were similar i the three periods . The average annual LEA incidence was 29/1000 diabetic person-years for the st and ard care period ( n = 42 ) , 21/1000 for the public health period ( n = 33 ) , and 15/1000 for the SDM period ( n = 20 ) , an overall 48 % reduction ( P = .016 ) . Overall , the incidence of a first amputation declined from 21/1000 to 6/1000 ( P < .0001 ) . CONCLUSIONS The customization and systematic implementation of practice guidelines by local primary care providers was associated with improved diabetic foot care outcomes . SDM has relevance to primary care organizations seeking to improve outcomes for patients with diabetes Objectives : To assess the validity and reliability of the Short Physical Performance Battery ( SPPB ) in adults 65 to 74 years old , capable in all basic activities of daily living ( ADL ) , in Quebec and Brazil . Methods : Participants were recruited in St. Bruno ( Quebec ) by local advertisements ( n = 60 ) and in Santa Cruz ( Brazil ) by r and om sampling ( n = 64 ) . The SPPB includes tests of gait , balance , and lower-limb strength . Disability status was categorized as intact mobility , limited mobility , and difficulty in any of ADL . Results : There was a grade d decrease in mean SPPB scores with increasing limitation of lower limbs , disability , and poor health . Using the test – retest reliability the authors evaluated the intraclass correlation coefficient , which was high in both sample s : .89 ( 95 % CI : 0.83 , 0.93 ) in St. Bruno and .83 in Santa Cruz ( 95 % CI : 0.73 , 0.89 ) . Discussion : This study provides evidence for the validity and reliability of SPPB in diverse population PURPOSE Physical activity ( PA ) has been suggested to help increase the survival of individuals with cancer . The objective of this review was to systematic ally evaluate and summarize the available evidence investigating the effect of PA on the survival of individuals with cancer . METHODS Electronic data bases ( CINAHL , EMBASE , and MEDLINE ) were systematic ally search ed for r and omized controlled trials and cohort studies . Selected studies were assessed by two independent investigators for method ological quality , using the PEDro scale . RESULTS Ten prospect i ve cohort studies met the inclusion criteria . Quality - assessment scores averaged 5/10 on the PEDro scale , with two articles obtaining a score of 6/10 . The majority of studies found that individuals participating in higher levels of physical activity had a reduced risk of cancer-related mortality . This trend was observed specifically for breast , colon , and colorectal cancers . On average , it appears that engaging in higher levels of metabolic equivalent hours per week may help to improve survival rates among individuals diagnosed with cancer . CONCLUSION Patients diagnosed with cancer demonstrated a trend toward increased survival with greater levels of PA . However , because only prospect i ve cohort studies were included in the study , the conclusions drawn should be regarded with caution OBJECTIVES To develop a question naire that focuses only on physical tasks related to lower-limb function and , within that question naire , to explore the psychometric properties of a series of questions that are related specifically to activities of daily living ( ADLs ) and a series of activities more often associated with recreation . DESIGN Inception cohort . SETTING Private practice . PARTICIPANTS Data were primarily from patients who had experienced a lower-limb injury that would typically involve rehabilitation up to 6 weeks . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Through 5 studies , the following psychometric qualities were evaluated : content and factor validity , construct and concurrent validity , test-retest reliability ( intraclass correlation coefficient [ ICC ] , typical error ) , responsiveness ( effect size , st and ardized response mean , Guyatt 's responsiveness statistic ) , and the minimum important difference ( distribution , anchor-based approaches ) . RESULTS Factor analysis supported the theoretical perspective that ADLs and recreational activities can be treated as different domains within the construct of function . Internal consistency was high ( Cronbach alpha : ADLs , .91 ; recreational activities , .95 ) and the 2 domains explained a moderate level of the response variance ( 61 % ) . In the ADL domain , 7 tasks had greater than 80 % of participants regarding them as having some importance . For recreational activities , 6 tasks had 79 % or more of participants regarding them as having some importance . Both domains were moderately correlated to actual performance of tasks ( r = .62 , r = .72 ) , and to other question naires used for lower-limb injuries ( r range , .51-.86 ) . The floor and ceiling effects of the domains followed an expected pattern that could be related to the loading forces experienced on the injured limb during activities . The reliability of the 2 domains was high ( ICCs > .95 ) , and the Bl and -Altman plots showed that the distribution of error across the range of scores was r and om with low bias scores ( < 1.0 point ) . Typical error scores were 2 points for each domain . All measures of responsiveness were high ( 1.2 - 6.7 ) . Measures of the minimal important difference varied ( 3 - 10 points ) according to the method ologic approach used . CONCLUSIONS The question naire possesses good factor structure and composition , relates well with other measures of function , differentiates patients with regard to certain characteristics or processes known to occur after injury , shows high levels of reliability and responsiveness , and shows evidence of good minimal important difference scores . The findings support the use of the question naire in both clinical scenarios and in research OBJECTIVE To compare changes regarding perceived participation , independence in activities of daily living ( ADL ) and life satisfaction between 3 , 6 and 12 months after inclusion in a study of a client-centred ADL intervention and usual ADL intervention after stroke . DESIGN A multicentre r and omized controlled trial . METHODS Sixteen rehabilitation units were r and omly assigned to provide client-centred ADL intervention or usual ADL intervention .  Eligible participants were persons ≤ 3 months after stroke who had been treated in a stroke unit , were dependent in two ADL domains , had not been diagnosed with dementia , and were able to underst and instructions . Data collection was performed by blinded assessors . The primary outcome , perceived participation , was assessed with the Stroke Impact Scale 3.0 , domain 8 . The secondary outcomes , participation , independence in ADL , and life satisfaction , were assessed with vali date d instruments . For statistical power , 280 participants were required . Statistical analyses were performed on an intention-to-treat basis . RESULTS There were no differences between the groups regarding changes in perceived participation , independence in ADL , or life satisfaction during the first 12 months . There was a trend towards a clinical ly meaningful positive change in perceived participation that favoured client-centred ADL intervention . CONCLUSION Further research is required to underst and the benefits of client-centred interventions
During walking , oxygen consumption ( ml O2/kg/min ) and heart rate ( beats/min ) increased with a higher walking speed and a more proximal amputation .
During walking , oxygen consumption ( ml O2/kg/min ) and heart rate ( beats/min ) increased with a higher walking speed and a more proximal amputation .
OBJECTIVE To systematic ally review the literature on the metabolic costs of activities of daily living ( ADL ) in persons with a lower limb amputation ( LLA ) .