Browsing by Subject "Physical Functional Performance"

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    ItemOpen Access
    Group-based Trajectory Modeling: A Novel Approach to Classifying Discriminative Functional Status Following Adult Spinal Deformity Surgery: Study of a 3-year Follow-up Group.
    (Spine, 2020-07) Yang, Jingyan; Lafage, Renaud; Gum, Jeffrey L; Shaffrey, Christopher I; Burton, Douglas; Kim, Han Jo; Ames, Christopher P; Mundis, Gregory; Hostin, Richard; Bess, Shay; Klineberg, Eric O; Smith, Justin S; Schwab, Frank; Lafage, Virginie; International Spine Study Group (ISSG)

    Study design

    Retrospective review of prospectively collected database.

    Objective

    To delineate and visualize trajectories of the functional status in surgically-treated adult spinal deformity (ASD) patients.

    Summary of background data

    Classifying long-term recovery following ASD surgery is not well defined.

    Methods

    One thousand one hundred seventy-one surgically-treated patients with a minimum of 3-year follow-up were included. The group-based trajectory modeling (GBTM) was used to identify distinct trajectories of functional status over time, measured by Oswestry Disability Index (ODI). Patient profiles were then compared according to the observed functional patterns.

    Results

    The GBTM identified four distinct functional patterns. The first group (10.0%) started with minimal disability (ODI: 15 ± 10) and ended up almost disability-free (low-low). The fourth group (21.5%) began with high ODI (66 ± 11) and improvement was minimal (high-high). Groups two (40.1%) and three (28.4%) had moderate disability (ODI: 39 ± 11 vs. 49 ± 11, P < 0.001) before surgery. Following surgery, marked improvement was seen in group two (median-low), but deterioration/no change was observed in group three (median-high). The low-low group primarily included adult idiopathic scoliosis, while the high-high group had the oldest and the most severe patients as compared with the rest of the groups. A subgroup analysis was performed between groups two and three with propensity score matching on age, body mass index, baseline physical component score (PCS), and severity of deformity. Notably, the baseline mental status of the median-high group was significantly worse than that of the median-low group, though the differences in demographics, surgery, and deformity no longer existed.

    Conclusions

    Patients with moderate-to-low disability are more likely to obtain better functional postoperative outcomes. Earlier surgical interventions should be considered to prevent progression of deformity, and to optimize favorable outcomes. Greatest improvement appears to occur in moderately disabled patients with good mental health. GBTM permits classification into distinct groups, which can help in surgical decision making and setting expectations regarding recovery.

    Level of evidence

    3.
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    ItemOpen Access
    Physical Performance Predictor Measures in Older Adults With Falls-Related Emergency Department Visits.
    (Journal of the American Medical Directors Association, 2019-06) Pua, Yong-Hao; Matchar, David B
    OBJECTIVES:Identifying strong predictors for falls and mobility limitations in older adults with a falls-related emergency department visit is crucial. This study aimed to compare, in this clinical population, the incremental predictive value of the Short Physical Performance Battery (SPPB) component tests for incident falls, injurious falls, and mobility limitations. DESIGN AND MEASURES:Prospective cohort study. SETTING AND PARTICIPANTS:A total of 323 community-dwelling older adults with a falls-related emergency department visit participated. Baseline physical performance was measured by the SPPB standing balance test, sit-to-stand test, and habitual gait speed test. Six-month prospective fall rate and self-reported mobility limitations at 6 months post baseline assessment were also measured. An injurious fall was defined as a fall for which the participant sought medical attention or that restricted his or her daily activities for at least 48 hours. RESULTS:In multivariable proportional odds analyses adjusted for demographics and clinical covariates, higher levels of full-tandem balance and sit-to-stand performance were significantly associated with fewer incident falls (P = .04 and .02, respectively) and lower odds of mobility limitations (P = .05 and .03, respectively) and marginally associated with lower odds of injurious falls (P = .06 and .07, respectively). Habitual gait speed was the weakest predictor of falls but the strongest predictor (odds ratio 0.24, 95% confidence interval 0.08-0.70; P < .001) of mobility limitations. CONCLUSIONS/IMPLICATIONS:In high-fall-risk older adults, the SPPB balance and sit-to-stand tests predicted falls whereas the SPPB gait speed test was adept at predicting mobility limitations. No one test is best across all situations, so the choice of test will depend on the goal of the assessment.
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    ItemOpen Access
    Physical Performance Tests Correlate With Patient-reported Outcomes After Periacetabular Osteotomy: A Prospective Study.
    (Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews, 2021-06) Scott, Elizabeth J; Willey, Michael C; Davison, John C; Westermann, Robert W; Paulson, Amanda C; Wilken, Jason M

    Introduction

    Individuals with hip dysplasia report significant functional disability that improves with periacetabular osteotomy (PAO). Four physical performance measures (PPMs) have been recently validated for use with nonarthritic hip conditions; however, their ability to detect functional improvement and correlate with improvements in popular hip-specific patient-reported outcome (PRO) instruments after PAO is unknown. The purpose of this study was to evaluate the responsiveness of four PPMs up to 1 year after PAO, compare PPMs with established PRO measures at these time points, and report the acceptability and utility of PPMs for assessing outcomes after PAO.

    Methods

    Twenty-two participants aged 15 to 39 years completed the timed stair ascent (TSA), sit-to-stand five times (STS5), self-selected walking speed, four-square-step test, and seven hip-specific PRO measures before surgery and at approximately 6 months and 1 year after PAO. They completed questions regarding acceptability and utility of both types of testing. Wilcoxon rank sum test and unpaired Student t-tests were used to assess differences between time points; Spearman correlation and generalized linear modeling were used to determine the relationship between PPMs and PRO measures.

    Results

    Six months after PAO, participants showed significant improvements on all seven PRO instruments (P < 0.001) and on the STS5 (P = 0.01). At one year, these improvements were maintained and TSA also improved (P = 0.03). Improvement in other PPMs did not reach significance (P = 0.07 and 0.08). The STS5 test demonstrated moderate to strong correlation (|r| = 0.43 to 0.76, P < 0.05) with all PRO measures, and the TSA test demonstrated moderate to strong correlation with almost all measures (|r| = 0.43 to 0.58, P < 0.05). Correlations strengthened on subanalysis of participants with unilateral disease (n = 11) (|r| = 0.56 to 0.94, P < 0.05). All participants (100%) found PPM testing acceptable despite disability; 25% preferred PPMs to PRO measures, whereas 75% of participants found them equal in usefulness.

    Discussion

    The STS5 and TSA tests demonstrated moderate to very strong correlation with PRO measures at six and 12 months after PAO for dysplasia. These tests could be used as a functional outcome to supplement PRO instruments after PAO.
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    ItemOpen Access
    The Role of Prefracture Health Status in Physical and Mental Function After Hip Fracture Surgery.
    (Journal of the American Medical Directors Association, 2018-11) Lim, Ka Keat; Yeo, William; Koh, Joyce SB; Tan, Chuen Seng; Chong, Hwei Chi; Zhang, Karen; Østbye, Truls; Howe, Tet Sen; Matchar, David Bruce

    Objectives

    To examine the associations of 3 measures of prefracture health status (physical function, mental function, and comorbidity count) with trajectories of physical and mental function at 1.5, 3, 6, and 12 months after hip fracture surgery.

    Design

    Single-center observational study.

    Setting

    Singapore General Hospital (an acute hospital).

    Participants

    Patients aged ≥60 years who underwent first hip fracture surgery between June 2011 and July 2016 (N = 928).

    Intervention

    None.

    Measurements

    We used data collected prospectively from the hospital's hip fracture registry. We used the Short Form-36 (SF-36) Physical Component Summary (PCS) and Mental Component Summary (MCS) as indicators of physical and mental function, respectively, collected at admission and at 1.5, 3, 6, and 12 months after hip fracture surgery. Comorbidity count at admission was the sum from a list of 10 common diseases associated with poorer physical function.

    Results

    Prefracture physical function and prefracture mental function demonstrated time-varying associations (interaction P < .001 and P = .001, respectively) with postfracture physical function; the associations were small initially but increased in strength up to 6 months and stabilized thereafter. In contrast, the strength of the association between comorbidity count and postfracture physical function were time-invariant (-0.52, P = .027). The strength of the associations between all 3 measures of prefracture health status and postfracture mental function were also constant over time (0.09, P = .004, for physical function; 0.38, P < .001, for mental function; -0.70, P = .034, for comorbidity count).

    Conclusions/implications

    The time-varying associations between prefracture health status and postfracture physical function suggest that even for patients with good prefracture health status, initial recovery may be slow. Our findings can be useful to clinicians and therapists in their prognostic evaluations and in management of patients' expectation for recovery.