Background LSVT-BIG® is an intensively delivered, amplitude-oriented exercise therapy reported to improve mobility in individuals with Parkinson’s disease (PD). However, questions remain surrounding the efficacy of LSVT-BIG® when compared with similar exercise therapies. Instrumented clinical tests using body-worn sensors can provide a means to objectively monitor patient progression with therapy by quantifying features of motor function, yet research exploring the feasibility of this approach has been limited to date. The aim of this study was to use accelerometer-instrumented clinical tests to quantify features of gait, balance and fine motor control in individuals with PD, in order to examine motor function during and following LSVT-BIG® therapy. Methods Twelve individuals with PD undergoing LSVT-BIG® therapy, eight non-exercising PD controls and 14 healthy controls were recruited to participate in the study. Functional mobility was examined using features derived from accelerometry recorded during five instrumented clinical tests: 10 m walk, Timed-Up-and-Go, Sit-to-Stand, quiet stance, and finger tapping. PD subjects undergoing therapy were assessed before, each week during, and up to 13 weeks following LSVT-BIG®. Results Accelerometry data captured significant improvements in 10 m walk and Timed-Up-and-Go times with LSVT-BIG® ( p < 0.001), accompanied by increased stride length. Temporal features of the gait cycle were significantly lower following therapy, though no change was observed with measures of asymmetry or stride variance. The total number of Sit-to-Stand transitions significantly increased with LSVT-BIG® ( p < 0.001), corresponding to a significant reduction of time spent in each phase of the Sit-to-Stand cycle. No change in measures related to postural or fine motor control was observed with LSVT-BIG®. PD subjects undergoing LSVT-BIG® showed significant improvements in 10 m walk ( p < 0.001) and Timed-Up-and-Go times ( p = 0.004) over a four-week period when compared to non-exercising PD controls, who showed no week-to-week improvement in any task examined. Conclusions This study demonstrates the potential for wearable sensors to objectively quantify changes in motor function in response to therapeutic exercise interventions in PD. The observed improvements in accelerometer-derived features provide support for instrumenting gait and sit-to-stand tasks, and demonstrate a rescaling of the speed-amplitude relationship during gait in PD following LSVT-BIG®.
Frailty is the age-accelerated decline across multiple organ Background systems which leads to vulnerability to poor resolution of homeostasis after a stressor event. This loss of reserve means that a minor illness can result in a disproportionate loss of functional ability. Improving acute care for frail older patients is now a national priority and an important aspect of the National Programme for Older People in Ireland. Evidence suggests that an interdisciplinary approach incorporating rapid comprehensive geriatric assessment and early intervention by an interdisciplinary team can reduces susceptibility to hospitalisation related functional decline. The aim of the Systematic Approach to Improving Care for Frail Older Patients (SAFE) is to develop and explore the process of implementing a model of excellence in the delivery of patient-centred integrated care within the context of frail older people's acute admissions.: The SAFE study will employ a mixed methodology approach, Methods including a rapid realist review of the current literature alongside a review of baseline data for older people attending the emergency department. Semi-structured interviews will be undertaken to document the current pathway. The intervention processes and outcomes will be jointly co-designed by a patient and public involvement (PPI) group together with the interdisciplinary healthcare professionals from hospital, community and rehabilitation settings. Successive rounds of Plan-Do-Study-Act cycles will then be undertaken to test and refine the pathway for full implementation.: This research project will result in a plan for implementing an Discussion integrated, patient-centred pathway for acute care of the frail older people which has been tested in the Irish setting. During the process of development, HRB Open Research(0) Comments which has been tested in the Irish setting. During the process of development, each element of the new pathway will be tested in turn to ensure that patient centred outcomes are being realised. This will ensure the resulting model of care is ready for implementation in the context of the Irish health service.
Frailty is the age-accelerated decline across multiple organ Background systems which leads to vulnerability to poor resolution of homeostasis after a stressor event. This loss of reserve means that a minor illness can result in a disproportionate loss of functional ability. Improving acute care for frail older patients is now a national priority and an important aspect of the National Programme for Older People in Ireland. Evidence suggests that an interdisciplinary approach incorporating rapid comprehensive geriatric assessment and early intervention by an interdisciplinary team can reduces susceptibility to hospitalisation related functional decline. The aim of the Systematic Approach to Improving Care for Frail Older Patients (SAFE) is to develop and explore the process of implementing a model of excellence in the delivery of patient-centred integrated care within the context of frail older people's acute admissions.: The SAFE study will employ a mixed methodology approach, Methods including a rapid realist review of the current literature alongside a review of baseline data for older people attending the emergency department. Semi-structured interviews will be undertaken to document the current pathway. The intervention processes and outcomes will be jointly co-designed by a patient and public involvement (PPI) group together with the interdisciplinary healthcare professionals from hospital, community and rehabilitation settings. Successive rounds of Plan-Do-Study-Act cycles will then be undertaken to test and refine the pathway for full implementation.: This research project will result in a plan for implementing an Discussion This research project will result in a plan for implementing an Discussion integrated, patient-centred pathway for acute care of the frail older people which has been tested in the Irish setting. During the process of development, each element of the new pathway will be tested in turn to ensure that patient centred outcomes are being realised. This will ensure the resulting model of care is ready for implementation in the context of the Irish health service.
The concept of frailty, is associated with key clinical syndromes including loss of mobility, falls, confusion, incontinence, and polypharmacy. Frail elderly patients are particularly vulnerable to adverse effects of hospitalisation, including deconditioning, immobility, and loss of independence. [i] [ii] [iii] Within St Vincent's University (SVUH) hospital data analysis from the Special Delivery Unit for the period from January to August 2014 conducted on a sample of 382,334 attendances shows that more than one-third of attendances at ED during this period were in the 65+ age cohort, with 12.37% aged 75+. [iv] This from a population of over 65s that account for 11.67% of the total population, indicating a disproportionate level of use of ED by the older population. [v] This raises concern about whether services will be able to cope with rapidly increasing demand. Recently attention has focused on identifying the best pathways for treating frail elderly patients identified as a priority of the national program for older persons and the emergency department task force to develop pathways and processes aimed at improving care in this age group.[vi] [vii].As a response the HRB funded SAFE project is project focused upon co-designing a systematic Approach to improving care for Frail Elderly patients within SVUH. This poster will present the findings of work stream one of the project that commenced in November 2016. In particular, findings from the rapid realist review [viii] of the evidence and results of a scoping of existing care pathways for frail older persons in SVUH will be presented. A range of ethnographic qualitative data collection methods will inform the development of a map of current care pathways, including the challenges and bottlenecks that cause delays and dissatisfaction and/or pose a risk to the quality and timeliness of patient care. The analysis presented will increase our understanding of the advantages and problems with the current
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