Falls are common in patients presenting to a dizziness unit. Those with central syndromes are at risk of recurrent and injurious falling. Fall rates and fear of falling should be assessed in balance disorders and used to guide the regimen of rehabilitation therapy. The identification of risk factors would help provide protective measures to these groups of patients.
Background Frailty is expressed by a reduction in physical capacity, mobility, muscle strength, and endurance. (Pre-)frailty is present in up to 42% of the older surgical population, with an increased risk for peri- and postoperative complications. Consequently, these patients often suffer from a delayed or limited recovery, loss of autonomy and quality of life, and a decrease in functional and cognitive capacities. Since frailty is modifiable, prehabilitation may improve the physiological reserves of patients and reduce the care dependency 12 months after surgery. Methods Patients ≥ 70 years old scheduled for elective surgery or intervention will be recruited in this multicenter, randomized controlled study, with a target of 1400 participants with an allocation ratio of 1:1. The intervention consists of (1) a shared decision-making process with the patient, relatives, and an interdisciplinary and interprofessional team and (2) a 3-week multimodal, individualized prehabilitation program including exercise therapy, nutritional intervention, mobility or balance training, and psychosocial interventions and medical assessment. The frequency of the supervised prehabilitation is 5 times/week for 3 weeks. The primary endpoint is defined as the level of care dependency 12 months after surgery or intervention. Discussion Prehabilitation has been proven to be effective for different populations, including colorectal, transplant, and cardiac surgery patients. In contrast, evidence for prehabilitation in older, frail patients has not been clearly established. To the best of our knowledge, this is currently the largest prehabilitation study on older people with frailty undergoing general elective surgery. Trial registration ClinicalTrials.gov NCT04418271. Registered on 5 June 2020. Universal Trial Number (UTN): U1111-1253-4820
Disability is understood by the World Health Organization (WHO) as the outcome of the interaction between a health condition and personal and environmental factors. Comprehensive data about environmental factors is therefore essential to understand and influence disability. We aimed to identify which environmental factors have the highest impact on the performance of people with mild, moderate and severe difficulties in capacity, who are at risk of experiencing disability to different extents, using data from a pilot study of the WHO Model Disability Survey in Cambodia and random forest regression. Hindering or facilitating aspects of places to socialize in community activities, transportation and natural environment as well as use and need of personal assistance and use of medication on a regular basis were the most important environmental factors across groups. Hindering or facilitating aspects of the general environment were the most relevant in persons experiencing mild levels of difficulties in capacity, while social support, attitudes of others and use of medication on a regular basis were highly relevant for the performance of persons experiencing moderate to higher levels of difficulties in capacity. Additionally, we corroborate the high importance of the use and need of assistive devices for people with severe difficulties in capacity.
ZUSAMMENFASSUNGDie komplexe Symptomatik der Parkinsonerkrankung erfordert einen langfristigen, individuellen und umfassenden Therapieansatz. Spezialisierte Netzwerke sind eine Möglichkeit, diesem Bedarf zu begegnen. In Deutschland ist keine flächendeckende, netzwerkbasierte Versorgung Parkinsonerkrankter etabliert. Es fehlen in Netzwerken organisierte und in der Parkinsonbehandlung geschulte Physiotherapeuten. Die im Heilmittelkatalog geregelten, ambulanten Leistungen der Physiotherapie beruhen auf konzeptbasierten Therapieformen, die nicht den Inhalten der europäischen Physiotherapieleitlinie entsprechen. Im Modellvorhaben PaNTher – Parkinson Netzwerk Therapie erhalten Parkinsonpatienten im Großraum München die Möglichkeit einer spezialisierten, leitlinienbasierten Physiotherapie. Vorgestellt wird das Chronic Care Modell auf dessen Basis PaNTher darauf abzielt, die Versorgungsqualität zu verbessern. Stadien- bzw. symptomspezifische Therapieprogramme, ein strukturiertes Schulungsprogramm zur Steigerung der Expertise der Physiotherapeuten und eine sektorenübergreifende Zusammenarbeit zwischen kooperierenden Fachärzten, Therapeuten und dem Projektzentrum an der Parkinson-Fachklinik sind Komponenten des Programms. Teilnehmende Patienten werden im Selbstmanagement ihrer Erkrankung gestärkt. Die Wirksamkeit des Modellvorhabens PaNTher wird durch eine unabhängige, begleitende wissenschaftliche Evaluation untersucht.
Background Frailty is accompanied with a reduced physical capacity, mobility, muscle strength and endurance. (Pre-)Frailty is present in an older surgical population in up to 50% with an increased risk for peri- and post-surgical complications. Consequently, these patients often suffer from a delayed or diminished recovery, loss of autonomy and quality of life, as well as a decrease of functional and cognitive capacity. As frailty is modifiable, we hypothesize that prehabilitation is able to improve the physiological reserves of surgical patients ≥ 70 years old and reduce the care dependency 12 months postoperatively. Methods Patients ≥ 70 years old scheduled for elective surgery or intervention will be investigated in this multicentre, randomized controlled study. We aim at including 1400 participants in our study with an allocation ratio of 1:1. The intervention consists of (1) a shared decision-making process with an interdisciplinary and interprofessional shared decision making conference as well as (2) a 3-week multimodal prehabilitation program including exercise therapy, nutritional intervention, mobility and balance training as well as psychosocial interventions and medical assessment. Frequency of the prehabilitation is 5 times / week for 3 weeks. The primary endpoint is defined as level of care dependency 12 months after surgery or intervention. Discussion Prehabilitation has been proven to be effective for different patient populations, including colorectal, transplant, and cardiac surgery, among other. In contrast, evidence for prehabilition in older, frail patients is not established yet. To the best of our knowledge, this is the largest study on prehabilitation for older people with frailty in a general elective surgery patient cohort. Trial registration: Clinical Trials. NCT04418271. Registered 5 June 2020, https://clinicaltrials.gov/ct2/show/NCT04418271), Universal Trial Number (UTN): U1111-1253-4820
Zusammenfassung Ziel der Studie Seit Beginn der aktuellen COVID-19 Pandemie sind Übersichtskarten zur räumlichen Darstellung des Infektionsgeschehens von großem öffentlichen Interesse. Aus methodischer und risikokommunikativer Sicht sind diese Darstellungen nicht unproblematisch, da zufällige Schwankungen oder Extremwerte auftreten und tatsächliche regionale Verteilungsmuster überdeckt sein können. Ein potentieller Lösungsansatz, um diesen Herausforderungen zu begegnen, besteht in Glättungen durch Bayesianische Verfahren. Ziel dieser Arbeit ist es, anhand von räumlich geglätteten Übersichtskarten die Veränderungen der Inzidenzverhältnisse im zeitlichen Verlauf in den Landkreisen und kreisfreien Städten in Bayern zu untersuchen. Methodik Die Daten zu SARS-CoV-2 wurden vom Bayerischen Landesamt für Gesundheit und Lebensmittelsicherheit am 29.10.2021 und 17.02.2022 zur Verfügung gestellt. Die demographischen Daten pro Kreis sind dem Statistischen Bericht des Bayerischen Landesamtes für Statistik für das Jahr 2019 entnommen. Betrachtet wurden vier Altersgruppen pro Geschlecht (<18, 18–29, 30–64,>64 Jahre) aufgeteilt in 16 Zeiträume (28.01.2020 bis 31.12.2021). Die Karten basieren auf standardisierten Inzidenzraten, die räumlich durch Bayesianische hierarchische Modelle geglättet wurden. Ergebnisse Das Standardisierte Inzidenzverhältnis (SIR) variierte deutlich zwischen den Kreisen. Variationen traten für jeden Zeitraum auf, wobei sich über den zeitlichen Verlauf sich ändernde regionale Verteilungsmuster zeigten. Schlussfolgerung Geglättete Gesundheitskarten eignen sich, um Veränderungen der Inzidenzverhältnisse im zeitlichen Verlauf bei COVID-19 in Bayern darzustellen und bieten gegenüber traditionellen Karten den Vorteil, dass sie realitätsnähere Schätzungen liefern, da sie Nachbarschaftsbeziehungen als erklärenden Faktor einbeziehen. Der methodische Ansatz kann als erster Schritt gesehen werden, um wichtige Erklärungsansätze für die beobachtete Heterogenität zu identifizieren, und eine verbesserte Risikokommunikation zu unterstützen.
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