El dolor de espalda es un motivo frecuente de asistencia sanitaria en los países occidentales. El presente estudio se dirigió a establecer la prevalencia del dolor de espalda en la población adulta ...de Cataluña, así como sus características, su vinculación a las variables sociodemográficas, la conducta terapéutica seguida y las consecuencias para quienes lo sufren.
Estudio descriptivo realizado en 1994 a partir de una muestra de 1.964 personas, representativa de la población mayor de 18 años y obtenida a partir del censo de 1991. Los datos se obtuvieron mediante una entrevista telefónica. Se determinó la prevalencia de dolor en general durante los últimos 6 meses. En aquellos entrevistados que refirieron haber sufrido dolor de espalda, se analizaron sus características, se investigó su relación con las variables sociodemográficas, y se determinaron las conductas terapéuticas empleadas para aliviarlo y las consecuencias personales, sociales y laborales.
El dolor de espalda presentó una elevada prevalencia (50,9%), apareció en todas las edades (media DE, 47,6 17 años), predominó en mujeres (60,7%), en trabajadores manuales (54,9%) y en personas con menos años de escolarización (71,1%). Era de larga evolución (el 69,2%, más de 3 años), frecuente (el 49,7%, más de la mitad de días), de duración variable (el 27,3%, más de 1 semana) e intensidad elevada (el 51,4%, intenso-insoportable). Las opciones terapéuticas más empleadas fueron la consulta médica (71,9%), terapias no convencionales (24,7%), fisioterapia (el 22,7%, sobre todo ejercicios físicos y electroterapia) y automedicación (14,6%). En general, la duración y el grado de alivio obtenido con los diversos tratamientos fue variable. El dolor de espalda limitó la actividad habitual (36,7%), obligó a guardar cama (22,7%), generó baja laboral (17%) y fue motivo de invalidez profesional (6,5%).
El dolor de espalda constituye una situación clínica de elevada frecuencia en la población catalana y un motivo muy importante de utilización de atención médica y de limitación de la actividad personal y profesional.
Back pain is a common symptom of health assistance in Western countries. The goal of the present survey was to establish the prevalence of back pain in the general population in Catalonia, as well as to establish its characteristics, its relationship to sociodemographic variables, the therapeutic behavior followed by those affected and the associated-impairment and disabilities for the sufferers.
The survey was a descriptive study including a sample of 1,964 people, obtained from the census (1991) and representative of the population older than 18 years. The study was done in 1994 and data were obtained by means of a telephone interview. The prevalence of pain in the last six months was determined. Among those suffering back pain, additional information was obtained concerning its characteristics, the relationship with socio-demographic variables, the therapeutic behaviors used by patients, and the personal, social and work impairment and disabilities.
Back pain was highly prevalent (50.9%), appeared in all ages (mean age of 47.6 years), was the highest in women (60.7%), in manual workers (54.9%) and in those less educated (71.1%). Back pain was long lasting (69.2% more than 3 years), frequent (49.7% more than the half of the days), and highly painful (severe-unbearable in 51.4%). The therapeutic behaviors most commonly used were the visit to the physician (71.9%), the use of alternative medical treatments (24.7%), physical therapy (22.7%, physical exercises and electrotherapy) and self-medication (14.6%, being acetylsalicylic acid the most employed). In general, the duration and degree of improvement was variable. Back pain limited the daily activities (36.7%) and forced to bed rest (22.7%). It was also a significant reason for time off work (17%) and disability pension (6.5%).
Back pain has a very high prevalence in the Catalonian population and is an important reason to seek medical attention. It greatly limits the daily personal and professional activities.
A multinational collaborative study on deaf children was carried out in 1977. The intention was to include all children aged 8 years with a hearing loss of 50 dB or worse, residing in the nine ...countries of the European Economic Community. Information was obtained on the prevalence of deafness, the distribution of mean hearing loss, aetiology and associated disabilities.
Background: This study determined the incidence of hospitalization-associated disability (HAD) and its characteristics in older patients with heart failure in Japan.Methods and Results: Ninety-six ...institutions participated in this nationwide multicenter registry study (J-Proof HF). From December 2020 to March 2022, consecutive heart failure patients aged ≥65 years who were prescribed physical rehabilitation during hospitalization were enrolled. Of the 9,403 patients enrolled (median age 83.0 years, 50.9% male), 3,488 (37.1%) had HAD. Compared with the non-HAD group, the HAD group was older and had higher rates of hypertension, chronic kidney disease, and cerebrovascular disease comorbidity. The HAD group also had a significantly lower Barthel Index score and a significantly higher Kihon checklist score before admission. Of the 9,403 patients, 2,158 (23.0%) had a preadmission Barthel Index score of <85 points. Binomial logistic analysis revealed that age and preadmission Kihon checklist score were associated with HAD in patients with a preadmission Barthel Index score of ≥85, compared with New York Heart Association functional classification and preadmission cognitive decline in those with a Barthel Index score <85.Conclusions: This nationwide registry survey found that 37.1% of older patients with HF had HAD and that these patients are indicated for convalescent rehabilitation. Further widespread implementation of rehabilitation for older patients with heart failure is expected in Japan.
Background: We investigated the components of frailty associated with hospitalization-associated disability (HAD) after cardiac surgery.Methods and Results: This retrospective, observational study ...evaluated 1,446 older patients after elective cardiac surgery at the Sakakibara Heart Institute. We examined the association between HAD and 7 domains of frailty assessed by the Kihon Checklist. HAD was defined as a decline in the ability to perform activities of daily living (ADL) between admission and discharge, as assessed by the Barthel Index. Logistic regression and decision tree analysis were used to identify associations between the number and type of frailty components and HAD. Of the 1,446 patients, 190 were excluded, and 90 (7%) developed HAD. An increase in the number of frailty components was a risk factor for HAD (odds ratio: 1.88, 95% confidence interval: 1.62–2.17). Decision tree analysis identified physical functional decline, depression, and cognitive dysfunction as factors associated with HAD. The incidence of HAD was highest in cases of physical functional decline (21%) and lowest for cases in which the 3 aforementioned factors were absent (2.8%).Conclusions: An increased number of frailty factors increased the risk of HAD and the findings also reaffirmed the importance of a comprehensive assessment to evaluate the risk of HAD, including evaluation of physical function, cognitive function, and depression.
Introduction
Older adults with cognitive impairment, including those with Alzheimer's disease and related dementias, are particularly at risk for hospitalization and hospital‐associated disability. ...Understanding of key risk factors for hospital‐associated disability is limited. Sarcopenia, age‐related declines in muscle mass and strength, is common in older adults with cognitive impairment and may be an important risk factor for hospital‐associated disability.
Methods
Using data from the Health ABC Study, we examined associations of pre‐hospitalization appendicular lean mass (ALM) and grip strength with the development of a new activity of daily living (ADL) disability at the next annual assessment after hospitalization.
Results
Grip strength, but not ALM, was negatively associated with increased risk of hospital‐associated ADL disability, and this association was greater among those with cognitive impairment compared to those without.
Discussion
Lower grip strength may be an important risk factor for hospital‐associated ADL disability in older adults, particularly those with cognitive impairment.
Aims
To investigate the change and associated factors of care needs within 6 months post‐discharge in older people with hospital‐associated disability, and the relationship between time‐varying care ...needs and physical function.
Background
Older people with hospital‐associated disability will have various care needs post‐discharge. Understanding their care needs will help to improve their health. However, studies on this population are still limited.
Design
A longitudinal study.
Methods
The older people who met the inclusion and exclusion criteria were selected in 2 tertiary hospitals in Zhejiang Province, China. The questionnaire survey method was used to collect data about socio‐demographic characteristics, physical function and care needs. The data of 375 older people who completed follow‐up were analysed using logistic regression analysis, generalised estimating equations and generalised additive mixed model. We followed STROBE checklist for reporting the study.
Results
The care needs of the older people with hospital‐associated disability declined unevenly, it decreased rapidly in the first three months, and then flattening out. The percentage of people with care needs in each dimension decreased over time, but daily care and rehabilitation needs were consistently more important. Socio‐demographic factors and physical function had different effects on need at different time points, the physical function was the main factor among them. There were non‐linear relationships between the physical function and different care needs with different inflection points.
Conclusion
This research revealed change patterns of the care needs of older people with hospital‐associated disability post‐discharge and the non‐linear relationship between physical function and care needs. These findings may help healthcare professionals and caregivers to provide accurate care.
Relevance to clinical practice
The findings can be used to identify effective approaches to address the care needs of older people with hospital‐associated disability based on the time of discharge, in conjunction with age, education, and especially physical function, which will promote the justify allocation of nursing resources.
What does this paper contribute to the wider global clinical community?
•Acute hospitalisation has some potential negative health consequences in older adults, notably loss of functional independence and physical performance.•In-hospital supervised exercise interventions ...are safe and effective to improve––or attenuate the decline of––functional independence and physical performance in acutely hospitalised older adults.•No clear benefits of in-hospital supervised exercise interventions are found for other clinical endpoints including the length of stay or the incidence of readmission or mortality.•These results support the routine implementation of exercise interventions (15–30 minutes per session, 5–7 days per week) during the acute hospitalisation of older patients.
Acute hospitalisation can have adverse effects in older adults, notably functional decline. We aimed to summarize evidence on the effects of exercise interventions in acutely hospitalised older adults.
Relevant articles were systematically searched (PubMed, Web of Science, Rehabilitation & Sports Medicine Source, and EMBASE) until 19th March 2020. Randomized controlled trials (RCTs) of in-hospital exercise interventions versus usual care conducted in older adults (>60yrs) hospitalised for an acute medical condition were included. Methodological quality of the studies was assessed with the PEDro scale. Primary outcomes included functional independence and physical performance. Intervention effects were also assessed for other major outcomes (length of hospital stay, incidence of readmission, and mortality). A meta-analysis was conducted when ≥3 studies analysed the same outcome.
Fifteen studies from 12 RCTs (n = 1748) were included. Methodological quality of the studies was overall high. None of the studies reported any adverse event related to the intervention. Exercise interventions improved functional independence at discharge (standardized mean difference SMD = 0.64, 95% confidence interval = 0.19–1.08) and 1–3 months post-discharge (SMD = 0.29, 95%CI = 0.13–0.43), as well as physical performance (SMD = 0.57, 95%CI = 0.18–0.95). No between-group differences were found for length of hospital stay or risk of readmission or mortality (all p > 0.05).
In-hospital supervised exercise interventions seem overall safe and effective for improving – or attenuating the decline of – functional independence and physical performance in acutely hospitalised older adults. The clinical relevance of these findings remains to be confirmed in future research.
Daily health management and exercise are important for staying healthy and avoiding the need for long-term care. However, it is not easy to maintain regular exercise. Therefore, exercise needs to be ...done efficiently. In recent years, due to the aging population and increasing severity of illness, older patients often experience a significant decline in physical function, even with minimal rest, which often interferes with their daily life after discharge from the hospital. Frailty not only affects ADLs, but also strongly influences prognosis, including the development of atherosclerotic disease and rehospitalization. This perspective is a summary of the 51st Metropolitan Public Lecture held on June 17, 2023, and discusses exercise-based rehabilitation programs that can be delivered at home to prevent physical frailty and avoid hospitalization-related disability.
Background: We investigated the components of frailty associated with hospitalization-associated disability (HAD) after cardiac surgery.Methods and Results: This retrospective, observational study ...evaluated 1,446 older patients after elective cardiac surgery at the Sakakibara Heart Institute. We examined the association between HAD and 7 domains of frailty assessed by the Kihon Checklist. HAD was defined as a decline in the ability to perform activities of daily living (ADL) between admission and discharge, as assessed by the Barthel Index. Logistic regression and decision tree analysis were used to identify associations between the number and type of frailty components and HAD. Of the 1,446 patients, 190 were excluded, and 90 (7%) developed HAD. An increase in the number of frailty components was a risk factor for HAD (odds ratio: 1.88, 95% confidence interval: 1.62–2.17). Decision tree analysis identified physical functional decline, depression, and cognitive dysfunction as factors associated with HAD. The incidence of HAD was highest in cases of physical functional decline (21%) and lowest for cases in which the 3 aforementioned factors were absent (2.8%).Conclusions: An increased number of frailty factors increased the risk of HAD and the findings also reaffirmed the importance of a comprehensive assessment to evaluate the risk of HAD, including evaluation of physical function, cognitive function, and depression.
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