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Chronic obstructive pulmonary disease (COPD) is a common progressive disease, which is the third leading cause of death among older adults in the United States. Over 80% of patients with COPD have at least one comorbid chronic condition, and 25% are frail. Adverse outcome prediction using function measures reflective of total burden of COPD patients is important because it identifies vulnerable patients and helps to enhance bronchodilator therapies and specialized COPD treatment strategies including pharmacotherapy, rehabilitation, exercise programs, and measures to consolidate care in this complex population. COPD diagnosis, prognosis, and pharmacologic and non-pharmacologic treatment are assessed using spirometry, with low forced expiratory volume in one second (FEV1) predicting worse health outcomes. While FEV1 is related to mortality, it is not sensitive in “adverse outcome prediction” to identify vulnerable patients.Assessment of functional capacity (reflective of the geriatric syndromes of dynapenia and clinical frailty), in combination with pulmonary function testing (PFT) can help to predict COPD health outcomes. The 6-minute walk distance (6MWD) test is commonly used to assess functional capacity in COPD patients and has been shown to predict mortality better than PFTs. While the 6MWD has good reliability and validity, it is time-consuming, burdensome in clinical settings, or simply not feasible for some patients, especially elders with mobility impairments. For these reasons, an alternative objective, quick, and simple approach for assessing functional capacity in COPD would be beneficial to risk stratify, predict outcomes, and direct appropriate care. Previously, we developed an upper extremity function (UEF) test for frailty assessment, and we developed a frailty index based on the kinematic information that we obtain from the arm motion. Our previous investigations showed a correlation between the UEF frailty index and COPD 12 adverse outcomes. However

Progressive collapsing foot deformity (PCFD), initially known as adult acquired flatfoot deformity (AAFD), is a common degenerative disorder in which certain soft tissue stabilizers in the foot degenerate, resulting in ankle and foot pain. As the structures supporting the foot degenerate, a complex three‐dimensional deformity develops at multiple locations in the foot, including hindfoot valgus, midfoot planus (arch collapse), and forefoot abduction. Patients with longstanding PCFD often develop osteoarthritis of the midfoot or hindfoot joints leading to a fixed deformity and some even develop ankle arthritis. It was initially thought that dysfunction of the posterior tibial tendon (PTT) leads to the PCFD. However, later studies revealed that the degeneration of the arch and hindfoot supporting ligaments also plays a significant role. Despite the importance of ligaments in PCFD, the kinematic and kinetic effects of ligament degeneration and tears on each component of the deformity has not been well characterized. Moreover, the impact of individual ligament tears on changes in joint contact mechanics and the development of osteoarthritis has not been investigated. An improved understanding of the contribution of each of the ligaments to the deformity could be used to determine potential targets for early surgical interventions through ligament reconstruction that could prevent the progression of deformity and the development of arthrosis. Thus, the purpose of this Ph.D. study was to create and validate a computational model of the foot constructed from CT scan images in order to evaluate the impact of ligament failure on the development of PCFD and joint degeneration.