Search

Markus Wübbeler,1 Jochen René Thyrian,1 Bernhard Michalowsky,2 Johannes Hertel,2 Franziska Laporte Uribe,3 Karin Wolf-Ostermann,4 Susanne Schäfer-Walkmann,6 Wolfgang Hoffmann2,5 1Interventional Health Care Research Group, German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, 2German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Greifswald, Germany; 3Implementation and Dissemination Research Group, German Center for Neurodegenerative Diseases (DZNE), Witten, Germany; 4Department of Human and Health Science, University of Bremen, Bremen, Germany; 5Epidemiology of Health Care and Community Health, Institute for Community Medicine, Ernst-Moritz-Arndt-University Greifswald, Greifswald, Germany; 6Institute for Applied Social Sciences, Stuttgart, Germany Background: Nonpharmacological therapies and the provision of aids are described to be supportive in the treatment of persons with dementia (PWDs). These aim to maintain individuals' participation in daily activities as long as possible, to slow the progression of their disease, and to support their independent living at home. However, there is a lack of knowledge about the utilization of therapies and aids among community-dwelling PWDs.Objective: The aims of the study were a) to describe the utilization of nonpharmacological therapies and aids among community-dwelling PWDs and b) to analyze the factors associated with utilization.Method: As part of a cross-sectional study of n=560 caregivers of PWDs in dementia networks throughout Germany, we assessed sociodemographics, clinical variables, and the utilization of nonpharmacological therapies (physiotherapy [PT], occupational therapy [OT]), and aids (sensory, mobility, and others), using face-to-face interviews and questionnaires.Results: Approximately every fourth PWD received PT and every seventh PWD received OT. Sensory aids were utilized by 91.1%, personal hygiene aids by 77.2%, mobility aids by 58.6%, and medical aids by 57.7% of the sample. Regression analysis revealed that the utilization of PT and medical aids was associated with comorbidities (odds ratio [OR] 1.17 and OR 1.27, respectively) and that the utilization of OT and sensory aids was associated with age (OR 1.06 and OR 0.95, respectively).Conclusion: The utilization of nonpharmacological therapies and aids among community-dwelling people served by dementia networks is more frequent than that reported for people in other settings. This result indicates that PWDs in integrated care models such as dementia networks receive better health care. Keywords: aid, integrated care, collaborative care

The failure of 3D-printed Polylactide (PLA) specimens with circular holes was studied under tensile and cyclic loading, respectively, by an inserted pin. Experiments were conducted for the perforated PLA specimens with various print angles from 0° to 90°, as well as [0°/90°]s and [0°/±45°/90°]s. The hole locations varied along the specimens. The PLA specimens showed two different failure modes: one through the print lines and the other between the print lines. Different print angles resulted in different tensile failure stresses under pin loading. The cyclic tests of different print angles showed very similar S-N data as the applied stresses were normalized to their tensile failure stresses if the failure mode was through the print lines. On the other hand, cyclic failure between print lines showed distinctly separated S-N data, even with the normalized applied stresses. The tensile failure stresses, failure locations, and orientations were successfully predicted using the failure criterion that is based on both stress and stress gradient conditions. A proposed mathematical interpolation equation provided good estimations of the tensile failure stresses and S-N curves of specimens with different print angles once the failure stresses were known for the 0° to 90° specimens. [ABSTRACT FROM AUTHOR]

To assess the changes in patient strength and function from 4- to 6-month assessments following ACLR, determine relationships between changes in strength to changes in subjective function, and identify factors that predict patients that fail to increase in strength. Prospective, Cohort Study. Controlled Laboratory. Forty-seven patients(27 female, 24.3 ± 11.1 years) completed a battery of performance assessments at approximately 4- and 6-months following primary ACLR (4.03 ±0.49 and 6.46 ±0.68 months). Subjective scores and isokinetic knee flexor and extensor strength were compared across visits. Patients were categorized per their ability to increase in strength beyond a previously defined threshold(0.22 Nm/kg). Binary logistic regression models were used to determine predictors of patients that failed to meet strength changes. Patients demonstrated improvements in patient-reported outcomes and strength measures between visits(P 's < 0.05). Higher age (B = −0.073, P =.039), lower pre-injury activity levels (B = 0.61, P =.022), and higher limb symmetry indexes (B = −0.044, P =.05) at 4-months were predictors of patients that did not achieve improvements in quadriceps strength between assessments. From 4- to 6-months post-ACLR, increases in subjective function, strength and symmetry were observed. High quadriceps symmetry at interim assessments without consideration of the magnitude of strength values could overestimate recovery of quadriceps function. • Higher age, lower activity, and higher LSI were predictors of low strength gains. • Interim assessments can provide clinical timelines to achieve goals post-ACLR. • High quadriceps LSI without considering strength could overestimate patient recovery. [ABSTRACT FROM AUTHOR]

The purpose of this study was to formulate a predictive equation to discriminate males from females using static and dynamic lower extremity (LE) alignments. Twenty-four healthy adults volunteered to participate. Three-dimensional motion analysis was used to assess the kinematics of the right hip and knee during two functional tasks. Six measures of static LE alignment were also performed. Statistical comparisons were made between males and females for all variables. Static and dynamic variables that were significantly different by sex were entered into separate discriminant analyses for each task. The resulting equations were each able to correctly predict 87% of the subjects by sex. Fifty-eight percent and 55% of the variance was explained by sex for the vertical jump and plant & jump, respectively. The frontal plane hip angle was the best predictor of sex for both tasks. While there were statistically significant differences between the sexes for static measures of LE alignment, kinematic measures were better at discriminating between sexes. [ABSTRACT FROM AUTHOR]

Context: Dynamic malalignment (DM), abnormal muscle activation, and static malalignments all might lead to patellofemoral pain (PFP) but have not been examined using a multifactorial approach. Objective: To determine which measures of static malalignment, DM, and muscle-onset times best predict PFP. Design and Setting: Between-subjects, laboratory. Subjects: 2 groups (PFP and uninjured) of 16 subjects each. Interventions: EMG and 3-D kinematic data were recorded during a step-down. Five static-alignment assessments were performed. Measurements: Three discriminant analyses using injury as the grouping variable and static measures, joint angles, and EMG onsets as the predictor variables. A final combined discriminant analysis using the most predictive variables from each set. Results: The static-alignment discriminant function was most predictive (81.3% correct), followed by the kinematic (69%) and the EMG (67%) functions. The final discriminant function included iliotibial-band flexibility, navicular drop, pronation, knee flexion, hip adduction, gluteus medius, and vastus medialis obliquus onset time and correctly classified 92.3% of PFP subjects. Conclusions: PFP can most accurately be predicted when multiple measures of lower extremity function are considered together. [ABSTRACT FROM AUTHOR]

Context: The SMART[TM] software system offers low-cost kinematic analysis through digitization of video from a single camera. The reliability and validity of this product have not been reported. Objective: To assess the reliability and validity of the SMART software during a simple static task and dynamic task. Design: Test-retest to compare assumed neutral and goniometrically measured joint angles in the sagittal plane of the lower extremity. Setting: Research laboratory. Participants: 7 in a static task, 16 young, physically active in a dynamic task. Results: Measurement error of the SMART system ranged from 0.29 degrees +/- 1.98 degrees to 11.07 degrees +/- 1.77 degrees. The interrater reliability (ICC[2,1]) values ranged from .60 to .92 for the static task and from .76 to .89 for the dynamic task. Conclusions: Based on the results of both studies, the SMART system offers a low-cost alternative for reporting single-plane kinematics during an individual frame of video during static stances and slow dynamic tasks with strong reliability and reasonable validity. [ABSTRACT FROM AUTHOR]

Objective: To estimate intratester and intertester reliability and learning effects during the Star Excursion Balance Tests (SEBTs). Setting: A university athletic training research laboratory. Subjects: Sixteen healthy volunteers with no history of balance disorders or significant lower extremity joint pathology. Measurements: Length of excursion was measured manually for each trial. Results: ICCs for intratester reliability were .78-.96 on day 1 and .82-.96 on day 2. ICCs for intertester reliability were .35-.84 on day 1 and .81-.93 on day 2. Significant learning effects were identified for 4 of the 8 tests. Conclusions: Estimates of intratester and intertester reliability were high, but adequate practice trials should be performed before taking baseline measures. [ABSTRACT FROM AUTHOR]

Neuromuscular control is a complex entity composed of volitional muscle contractions, reflex responses, and pattern-generated movements. Postural awareness is an important element of neuromuscular control. Closed kinetic chain exercises are ideal for retraining reflex responses. [ABSTRACT FROM AUTHOR]

Objectives: Current research suggests that dementia care management (DCM) can decrease burden and associated health impairments of caregivers. The objective of this secondary analysis is to investigate the impact of DCM on multifaceted caregivers’ burden dimensions by differentiating between objective and subjective burden. Methods: A sample of n = 317 dyads of caregivers and community-dwelling people with dementia (PwD) participated in a general practitioner-based, cluster-randomized intervention trial (Identifier:NCT01401582) with two arms and comprehensive data assessment at baseline and 12-month follow-up. Data provided by the caregiver included an inventory with 88 items in 20 different dimensions. Results: Caregivers in the intervention ‘DCM’ group showed decreased caregiver burden, especially in caregivers’ objective burden due to caring (i.e. emotional support), caregivers’ subjective burden due to behavior change (i.e. cognition, aggression and resistance, depression, late symptoms) and caregivers’ subjective burden due to perceived conflicts between needs and responsibilities to care (i.e. financial losses) compared to caregivers in the control ‘care as usual’ group, which showed significant increased caregiver burden after 12 months. Conclusion: Our findings support evidence for the effectiveness of DCM to lower family dementia caregivers' burden in multifaceted dimensions. [ABSTRACT FROM AUTHOR]

Background: Older people have a higher risk of drug-related problems (DRPs). However, little is known about the prevalence of DRPs in community-dwelling people who screened positive for dementia. Our study aimed to determine (1) the prevalence and types of DRPs and (2) the socio-demographic and clinical variables associated with DRPs in people screened positive for dementia in primary care.Methods: The Dementia: life- and person-centered help in Mecklenburg-Western Pomerania (DelpHi-MV) study is a general practitioner (GP)-based cluster-randomized controlled intervention study to implement and evaluate an innovative concept of collaborative dementia care management in the primary care setting in Germany. Medication reviews of 446 study participants were conducted by pharmacists based on a comprehensive baseline assessment that included a computer-based home medication assessment. ClinicalTrials.gov Identifier: NCT01401582.Results: A total of 1,077 DRPs were documented. In 414 study participants (93%), at least one DRP was detected by a pharmacist. The most frequent DRPs were administration and compliance problems (60%), drug interactions (17%), and problems with inappropriate drug choice (15%). The number of DRPs was significantly associated with the total number of drugs taken and with a formal diagnosis of a mental or behavioral disorder.Conclusions: Degree of cognitive impairment (MMSE defined) and formal diagnosis of dementia were not risk factors for an increased number of DRPs. However, the total number of drug taken and the presence of a diagnosis of mental and behavioral disorders were associated with an increased total number of DRPs. [ABSTRACT FROM AUTHOR]