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PubMed2004

Educational disadvantage impairs functional recovery after hospitalization in older persons.

PURPOSE: To determine whether low educational level is associated with poor functional recovery after hospitalization in older adults. METHODS: We followed 862 patients (374 with low education, defined as <high school) for 6 months after hospitalization. Poor functional recovery was defined as an Activities of Daily Living score that was lower 6 months after hospitalization than 1 month before hospitalization. People who died were also considered to have poor recovery. RESULTS: Of the 862 participants, 351 (41%) experienced poor functional recovery: 124 died and 227 had declines in activities of daily living. There was a graded, statistically significant relation between level of education and poor functional recovery, regardless of impairment of activities of daily living at baseline. Poor functional recovery was more common in subjects with baseline impairment (50% [147/296]) than in those without baseline impairment (36% [204/566]). Independent predictors of poor functional recovery were low education, cognitive impairment, lack of social support, poor self-rated health, and high comorbidity. Sequential addition of demographic, economic, functional, psychosocial, and clinical factors to low education only modestly affected the association between low education and poor functional recovery. CONCLUSION: Educational disadvantage impairs functional recovery after hospitalization in older persons.

Activities of Daily Living↗
PubMed2000

Dobutamine- vs exercise-induced ST segment elevation early after Q wave myocardial infarction. Prediction of functional recovery after revascularization.

AIMS: The association between stress-induced ST elevation and functional recovery following revascularization after myocardial infarction remains unclear. We assessed the relative accuracy of dobutamine- and exercise-induced ST elevation in Q wave leads in predicting functional recovery following revascularization, and we investigated the relationship of ST elevation to different wall motion responses to dobutamine. METHODS AND RESULTS: Thirty-nine patients underwent dobutamine stress echo and exercise test 8+/-2 days after Q wave myocardial infarction. All patients underwent angiography and subsequent revascularization. Follow-up echocardiograms were obtained 7+/-4 weeks after revascularization. Functional recovery was assessed by the difference between the baseline and the follow-up asynergy index. Nineteen patients (48%) developed dobutamine- and exercise-induced ST elevation. There was significant agreement between the tests (k=0.58, P<0.001). We found a significant correlation between dobutamine and exercise-induced ST elevation with functional recovery following revascularization (r=0. 45, P<0.005 and r=0.7, P<0.001, respectively). The parameters with the highest predictive value for functional recovery were: (a) the biphasic response during dobutamine infusion, (b) the development of ST elevation in both tests, and (c) the development of exercise-induced ST elevation in more than three leads. CONCLUSION: There is a strong association between dobutamine- and exercise-induced ST elevation with functional recovery following revascularization. Exercise-induced ST elevation in more than three leads and a biphasic response during dobutamine infusion accurately predict functional recovery.

Angioplasty, Balloon, Coronary↗
PubMed1990

A single injection of a biodegradable microsphere formulation of the ACTH-(4-9) analogue ORG 2766 accelerates functional recovery after brain damage.

The functional recovery from impaired motor activity induced by 6-hydroxydopamine lesions in rat nucleus accumbens was accelerated by subcutaneous treatment with the ACTH-(4-9) analogue Met/O2/-Glu-His-Phe-D-Lys-Phe (ORG 2766). Treatment was effective after daily injections of ORG 2766 dissolved in saline during the first 6 days following the lesion (ED50: 28.5 ng kg-1 day-1) or after a single injection of the peptide in a biodegradable microsphere formulation administered after the lesion (ED50: 8.9 ng kg-1 day-1). This study shows that a single injection of a microsphere preparation can replace multiple injections with ORG 2766 in order to facilitate functional recovery after brain damage.

Adrenocorticotropic Hormone↗
PubMed1988

Repair of severed peripheral nerve: a superior anatomic and functional recovery with a new "reconnection" technique.

The objective of this study was to use a quantitative functional and anatomic model to compare surgical repair of the rat sciatic nerve according to two techniques; standard epineurial repair and the recently reported "nerve reconnection technique" ("freeze-trim technique"). Functional recovery was evaluated using a functional index based on the measurements of the rats' footprints. Neuroanatomic experiments were conducted on the same animals to correlate functional recovery with regeneration of known motoneuron populations. The results of surgical repairs were also compared to those obtained from untreated sciatic nerve crush injuries. Functional recovery after epineurial repairs typically averaged 18%, whereas the mean recovery from the "nerve reconnection technique" was 71%. Crush injuries recovered to normal and reached a plateau much earlier than the surgical repairs. Retrograde horseradish peroxidase (HRP) labeling of motoneurons of the common peroneal nerve, a branch of the sciatic, revealed that there was a complex relationship between functional recovery and the number and distribution of motoneurons that regenerated axons distal to the repair site. The "nerve reconnection technique" greatly reduced the probability of axonal misdirection into the wrong distal branches at the repair site and brought an improvement of 300% to 400% in functional recovery over that found with epineurial repair. This technique of nerve repair may prove to be a valuable tool in reconstructive surgery.

Animals↗
PubMed1991

Putative neurotrophic factors and functional recovery from peripheral nerve damage in the rat.

1. In rats, recovery of sensory-motor function following a crush lesion of the sciatic or tibial nerve was monitored by measuring foot reflex withdrawal from a local noxious stimulation of the foot sole. 2. Putative neurotrophic compounds were tested on this functional recovery model: melanocortins (peptides derived from ACTH (corticotropin) and alpha-MSH (melanotropin], gangliosides and nimodipine were effective whereas isaxonine and TRH (thyrotropin releasing hormone) were not. 3. Structure-activity studies with melanocortins revealed a similar effectiveness of alpha-MSH, [N-Leu4, D-Phe7]-alpha-MSH, desacetyl-alpha-MSH and the ACTH analogue ORG 2766, questioning the validity of the previously suggested notion that the melanotrophic properties of these peptides are responsible for their neurotrophic effect. 4. As recovery of function after peripheral nerve damage follows a similar time course in hypophysectomized (five days post operation) and sham-operated rats, effective melanocortin therapy does not mimic an endogenous peptide signal in the repair process from pituitary origin. 5. Subcutaneous treatment with ORG 2766 (7.5 micrograms kg-1 48 h-1) facilitates recovery of function following peripheral nerve damage in young (6-7 weeks old), mature (5 month old) and old (20 month old) rats. 6. In view of the diversity in structure of the effective neurotrophic factors and the complexity of nerve repair, the present data support the notion that peripheral nerve repair may be facilitated by different humoral factors likely to be active on different aspects of the recovery process.

Adrenocorticotropic Hormone↗
PubMed1986

Continuous measurement of intramyocardial pH: correlation to functional recovery following normothermic and hypothermic global ischemia.

The continuous measurement of intramyocardial pH was used to follow the progression of ischemia and was correlated to the recovery of left ventricular function following normothermic (38 degrees C) and hypothermic (25 degrees C) global ischemia. New miniature myocardial transducers, which incorporate fiberoptic technology and dual pH- and temperature-sensing capability, were placed into the left ventricular free wall and septum of 52 sheep undergoing cardiopulmonary bypass. Left ventricular stroke work as a function of mean left atrial pressure curves were generated before and after cardiopulmonary bypass by volume loading with whole blood. Functional recovery was determined by the ratio of the integrals of the preischemic and postischemic function curves. Control sheep (N = 11) did not undergo ischemia. Three groups (N = 41) underwent aortic cross-clamping until pH reached 7.0, 6.8, or 6.6. The preischemic myocardial pH averaged 7.42 +/- 0.01. Following both normothermic and hypothermic global ischemia, no significant difference was demonstrated in recovery of function between control (pH 7.4) and pH 7.0 groups at either temperature. However, recovery of function of the pH 6.8 and pH 6.6 groups was significantly decreased (p less than 0.01) versus control and pH 7.0 groups at both temperatures. No significant difference in recovery of function was demonstrated at any pH level when normothermic versus hypothermic groups were compared. However, hypothermia provided increased time (p less than 0.001) before each level of function was reached with a slower rate of change of pH (p less than 0.01) compared with the corresponding same pH group in sheep undergoing normothermic (38 degrees C) cardiopulmonary bypass.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1996

Nitric oxide produced during ischemia improves functional recovery in the rabbit retina.

We examined the effect of modulating endogenous nitric oxide (NO) production on the recovery of neuronal function from temporary ischemia using a preparation in which blood flow is not a factor. Inhibition of nitric oxide synthase (NOS) during ischemia with L-NA (100 mumol-1) resulted in worse functional recovery compared to D-NA (100 mumol-1)-treated in control retinas (p < 0.01). In contrast, addition of L-Arg (1000 mumol-1) during ischemia, resulted in a concentration-dependent functional improvement (p < 0.05). These results show that inhibition of constitutive NOS is detrimental, whilst the enhancement of endogenous NO production improves the recovery of neuronal function during a period of temporary ischemia in the isolated retina, (an in vitro avascular model of the CNS). Thus, independent of its effects on the vasculature, NO production during temporary ischemia protects neurons from irreversible function damage.

Action Potentials↗
PubMed1997

A longitudinal examination of functional recovery among older people with subcapital hip fractures.

OBJECTIVE: Few studies have examined the time-dependent change in functional recovery along with the factors that affect the change among older hip fracture patients. The focus of this study is to examine the predictors of functional recovery in community-dwelling older people with subcapital fractures using longitudinal data analysis methods. DESIGN: A 1-year prospective study. Information was obtained through structured interviews following surgery and at 2, 6, and 12 months after hospital discharge and from medical chart review. SETTING AND PATIENTS: The sample consisted of 312 community-dwelling older adults, admitted to one of the seven Baltimore area hospitals with a subcapital fracture, who received either internal fixation or hemiarthroplasty. RESULTS: The longitudinal data analysis using mixed-effects regression indicates that time and prefracture physical activities of daily living (PADL) had a significant association with PADL functional recovery over the course of 1 year. Among those 85 years and older, those who were disoriented after surgery had poorer PADL functional recovery over time than those who were not disoriented. Also, recovery in instrumental activities of daily living (IADL) was associated significantly with time, prefracture IADL function, unsteady gait prefracture, hospital length of stay, and discharge to an institution. The type of surgical procedure performed was not associated significantly with either PADL or IADL functional recovery. CONCLUSIONS: The factors that are related to functional recovery in this study shed light on the complexity of the recovery process in hip fracture patients. The rate of recovery in postsurgical PADL and IADL function is not constant over time; postsurgical IADL function among disoriented patients (without dementia) continues to deteriorate over time compared with the nondisoriented group; this difference in trends of deterioration on IADL function is most profound in the oldest-old aged group, those 85 and older. The types of surgical procedure performed was not significantly associated with postsurgical functional recovery.

Activities of Daily Living↗
PubMed2005

Comparison of real-time contrast echocardiography and low-dose dobutamine stress echocardiography in predicting the left ventricular functional recovery in patients after acute myocardial infarction under different therapeutic intervention.

BACKGROUND: Early prediction of left ventricular (LV) functional recovery after acute myocardial infarction (AMI) remains challenging. This prospective study aims to compare real-time myocardial contrast echocardiography (MCE) with low-dose dobutamine stress echocardiography (LDDSE) in predicting the LV functional recovery in patients after AMI who underwent different therapeutic interventions. METHODS: Ninety-two patients with AMI were divided into 3 groups: primary coronary intervention group (n=34), thrombolysis group (n=30) and conservative therapy group (n=28). MCE was performed 2.3+/-0.7 days after chest pain onset. LDDSE was done within 2 days of MCE study. Follow-up echocardiography was performed 4 months later. RESULTS: Patients treated by primary coronary intervention or thrombolysis had significantly lower regional perfusion score (0.65+/-0.53 vs. 1.01+/-0.49, p=0.008; 0.78+/-0.55 vs. 1.01+/-0.49, p=0.03), better contractile reserve (regional dobutamine Deltawall motion score -1.12+/-0.39 vs. -0.80+/-0.43, p=0.01; -0.99+/-0.50 vs. -0.80+/-0.43, p=0.08) and LV function recovery (regional Deltawall motion score -1.67+/-0.53 vs. -1.02+/-0.46, p=0.003; -1.42+/-0.58 vs. -1.02+/-0.46, p=0.03) than those of conservative therapy group. MCE and LDDSE showed good concordance for predicting LV functional recovery (kappa=0.63, p<0.001). Perfusion score index had a good correlation with LV functional recovery (r=-0.75, p<0.001). CONCLUSIONS: This study demonstrates that perfusion score index obtained from real-time MCE is comparable to LDDSE in predicting the LV functional recovery even under different therapeutic interventions. Revascularization results in better preservation of myocardial microvascular integrity, regional contractile reserve and LV functional recovery.

Aged↗
PubMed1988

The boxers' fracture: a prospective study of functional recovery.

The rate of functional recovery following fracture of the fifth metacarpal neck is reported. The recovery of power grip and finger grip strength is complete in most patients by two months. The functional outcome is not significantly related to the degree of angulation at the fracture site.

Adolescent↗
PubMed2005

Measurement of functional recovery in individuals with acute anterior cruciate ligament rupture.

OBJECTIVES: To measure functional recovery following acute anterior cruciate ligament (ACL) rupture using a simple and reliable clinical movement analysis system. Clinic based methods that simultaneously quantify different aspects of movement over a range of activities and model functional recovery will help guide rehabilitation. METHODS: A longitudinal study was used to measure gait variables at initial physiotherapy attendance and then at monthly intervals using a digital camcorder and computer for quantitative analysis. Jogging and distance hopping were added during recovery. A sample of 63 ACL deficient subjects entered the study and 48 subjects were measured at least three times. To determine the pattern of recovery, repeated measurements were analysed using a least square fit of the data. RESULTS: Gait variables took between 95 and 130 days post injury to reach the control mean and stabilise shortly after this. Hopping distance for the injured leg took 62 days to recover to within normal limits and 5 months post injury to reach the control mean. Jogging was already within the control limits at 30 days post injury and demonstrated little change with recovery. CONCLUSIONS: Functional recovery of multiple variables has been modelled. In the early phase of post injury, gait velocity seems to be the most useful variable to measure improvement. Recovery of more challenging activities appears to take an average of 5 months. Therefore, patients may need to be monitored in physiotherapy until this time and advised not to return to sport until sufficient recovery is demonstrated on activities such as distance hopping.

Adult↗
PubMed2006

Fear of falling more important than pain and depression for functional recovery after surgery for hip fracture in older people.

BACKGROUND: Depression and cognitive functioning have a negative impact on functional recovery after hip fracture surgery in older people, and the same has been suggested for pain and fear of falling. These variables, however, have never been studied together, nor has the timing of psychiatric assessment been taken into account. METHOD: Two parallel, randomized controlled trials were undertaken aiming to prevent and treat depression after hip fracture surgery in older people. Multiple logistic regression analyses corrected for age and pre-morbid level of functioning were performed to evaluate the effect of depressive symptoms (15-item Geriatric Depression Scale, GDS), pain (Wong-Baker pain scale), cognitive functioning (Mini-mental State Examination, MMSE) and fear of falling (Modified Falls Efficacy Scale, MFES) within 2 weeks after surgery and 6 weeks later on functional recovery at 6 months. Main outcome measures were performance-based measures (up-and-go test, gait test, functional reach) and the self-report Sickness Impact Profile (SIP) questionnaire to assess the impact of the hip fracture on activities of daily living (ADL). RESULTS: Two hundred and ninety-one patients participated and outcome measures for 187 (64%) patients were available at 6 months. All mental health variables interfered with functional recovery. However, in the final multivariate model, cognitive functioning and fear of falling assessed 6 weeks after surgery consistently predicted functional recovery, whereas pain and depressive symptoms were no longer significant. CONCLUSION: Fear of falling and cognitive functioning may be more important than pain and depression to predict functional recovery after hip fracture surgery. Rehabilitation strategies should take this into account.

Accidental Falls↗
PubMed1999

The systematic assessment of short-term functional recovery after major joint arthroplasty.

Despite extensive information about long-term recovery from major joint arthroplasty, little attention has been given to the measurement of functional recovery in the immediate postoperative period. Therefore assumptions about the importance of physical therapy during this period remain untested. We devised a way of recording functional recovery before discharge, based primarily on the achievement of objective milestones. This was incorporated into routine physiotherapy practice and applied to sequential patients undergoing elective hip (n = 163) or knee (n = 66) replacement. Six months later, we followed up 160 patients, of whom 145 completed questionnaires to assess subjective physical and emotional state and functional recovery. The method was sensitive to known influences on pace of recovery, including type of arthroplasty (hip vs knee) and surgeons' differing requirements for mobilization. In addition, we were able to confirm and quantify sources of variation in functional recovery which previously were suspected but unconfirmed: in particular, the timing of early mobilization. Outcome at 6 months was unrelated to objective functional recovery in hospital, although fatigue and wellbeing at this time were predicted by physiotherapists' subjective assessment of patients' motivation before discharge. The findings can be used to inform patients and as a source of comparison data for the assessment of functional recovery in other centres. More importantly, the procedure reported may be applied to quantify functional recovery in routine practice and thereby expose variability in recovery to scientific scrutiny.

Aged↗
PubMed2006

Exercise enhances axonal growth and functional recovery in the regenerating spinal cord.

We investigated whether enhancing locomotory activity could accelerate the axonal growth underlying the significant recovery of function after a complete spinal transection in the eel, Anguilla. Eels with low spinal transections (at about 60% body length) were kept in holding tanks, where they were inactive, or made to swim continually against a water current at about one body length/s. Their locomotion was periodically assessed by measuring tail beat frequencies at different swimming speeds. Axonal growth was determined from anterograde labeling with 1,1'-diotadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate, inserted postmortem into the spinal cord, just rostral to the transection. Twenty days after surgery, there were significantly more labeled growth cones more than 2 mm caudal from the transection in the exercised fish (74.6+/-2.3%; cf. 34.5+/-1.1%). This difference was still observed at 40 days (57.9+/-1.6% cf. 42.1+/-2% >2 mm), but the regenerated axons were of similar maximum lengths by 120 days (9.8+/-0.3 cf. 7.7+/-2.8 mm). After surgery, each eel undulated its whole body faster at any given swimming speed, thus changing the linear relationship between tail beat frequency and forward speed established before transection. The slope increased by up to 112.5+/-27.4% over the first 8 days post-surgery in inactive animals, while a smaller rise (45.6+/-10.5%) was observed in exercised fish during this period. Thereafter, the slope progressively declined to pre-surgery levels in both groups of animals, but the recovery occurred within 20+/-4 days in exercised eels, as opposed to 40+/-5 days in inactive fish. The locomotory performance of sham-operated fish was unaffected by 10 days of continual locomotion and remained similar to that of naïve eels, pre-transection. These data show that elevated locomotory activity enhances axonal growth and accelerates recovery of locomotory function.

Anguilla↗
PubMed1997

An assessment of dobutamine echocardiography and end-diastolic wall thickness for predicting post-revascularization functional recovery in patients with chronic coronary artery disease.

AIMS: This study investigated the functional outcome of wall-thinned, akinetic myocardium after revascularization and evaluated the accuracy of dobutamine echocardiography in predicting post-revascularization functional recovery with the assessment of end-diastolic wall thickness in chronic ischaemic patients. METHODS AND RESULTS: Fifty-three patients underwent dobutamine echocardiography before coronary revascularization. End-diastolic wall thickness was also evaluated before and after revascularization. The sensitivity and specificity of dobutamine echocardiography to predict postrevascularization functional recovery were 69% and 100% in 58 akinetic/dyskinetic segments, and 86% and 57% in 96 hypokinetic segments. Of 19 akinetic/dyskinetic segments with a preserved end-diastolic wall thickness, 17 (89%) showed functional recovery after revascularization, and dobutamine detected 14 (83%) of these 17 segments. Of 39 akinetic/dyskinetic segments with a thinned end-diastolic wall thickness, 15 (38%) achieved functional recovery, whereas dobutamine echocardiography detected recovery in only eight (53%). Further, of these 15 viable, Wall-thinned segments, 12 (80%) showed an increased end-diastolic wall thickness after revascularization (mean +/- SD were from 5.6 +/- 0.7 mm at baseline to 7.4 +/- 1.3 mm and 9.7 +/- 1.4 mm after 1 week and after 3 months, respectively), and only 5 (42%) of these responded to dobutamine. CONCLUSION: Dobutamine echocardiography showed a lessened sensitivity to predict post-revascularization functional recovery in akinetic/dyskinetic segments with a thinned end-diastolic wall thickness that subsequently increased in size.

Adult↗
PubMed2004

Markers of myocardial reperfusion as predictors of left ventricular function recovery in acute myocardial infarction treated with primary angioplasty.

BACKGROUND: Myocardial blush grade (MBG), corrected TIMI frame count (cTFC), and ST-segment reduction are indices of myocardial reperfusion. HYPOTHESIS: We evaluated their predictive value for left ventricular (LV) function recovery by gated single-photon emission computed tomography (SPECT) after acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention (PCI). METHODS: In 40 patients with AMI, gated SPECT was performed at admission and repeated 7 and 30 days after PCI. Left ventricular function recovery was defined as an increase > or = 10 points in SPECT LV ejection fraction from baseline to 1 month. The MBG, cTFC, and ST-segment elevation index 1 h after PCI were determined to evaluate reperfusion. RESULTS: Twenty-four patients (Group 1) had LV function recovery and 16 (Group 2) did not. A significant correlation was found between LV function recovery and MBG (r = 0.66; p = 0.0001), and ST-segment elevation index at 1 h (r = -0.55; p = 0.0001), but not with cTFC. Univariate predictors of LV function recovery were MBG (p = 0.0003) and ST-segment elevation index 1 h after intervention (p = 0.0026), but not cTFC. In a multivariate analysis, MBG was the only predictor of LV function recovery. Myocardial blush grade > or = 2 and ST-segment elevation index reduction had the same accuracy (88%) for predicting LV function recovery. Lower accuracy (75%) was shown by fast cTFC (< 23 frames). Myocardial blush grade > or = 2 showed the better negative likelihood ratio, and ST-segment elevation index reduction had the higher positive likelihood ratio in predicting LV function recovery. CONCLUSIONS: Myocardial blush grade was the best parameter for prediction of LV function recovery: MBG > or = 2 and ST-segment elevation index reduction showed good accuracy in predicting LV function recovery. The cTFC failed to be a significant predictor.

Aged↗
PubMed2004

[Functional recovery and return to work in the young patient after a stroke].

INTRODUCTION: There are few works that study the functional recovery of young patients after suffering cerebrovascular disease (CVD) and even fewer works that study work reincorporation. Our aim is to evaluate these two aspects in the middle term in the young adults who have suffered a stroke and also to establish the factors that can influence a better prognosis. PATIENTS AND METHODS: Our work is a cross-sectional descriptive study of 111 patients aged between 15 and 55 years who have been discharged from our Hospital with a CVD diagnosis during the years 1999-2000. We have collected the following data from the clinical records: age, gender, type, location and reason for the CVD, vascular risk factors, complications in the process, with or without rehabilitation treatment and treatment description. By means of telephone interview, we obtained functional recovery with the Barthel Index (BI) and Modified Rankin Scale (MRS) as well as study level, marital status and pre and poststroke labor situation, loss of friends, loss of recreational activities and finally, sequels after the discharge. RESULTS: Functional recovery for daily activities (IB >or= 90) was good in 78 % of the patients, this being 72.1 % if we assess their global handicap (MRS <or= 2). Almost 80 % of the patients were working before the stroke, however, this decreased to only 50.2 % after the stroke. We have observed better functional recovery and return to work in ischemic stroke and in patients without vascular risk factors, in both cases without statistical significance (SS). We discovered an inverse relationship between age and functional recovery, measured by IB and a direct relationship with MRS, both of them with SS. We have also found SS between IB and the MRS and in those patients who returned to work compared to those who remained in an invalid situation. A total of 22.5 % of the patients reported loss of friends after the stroke, and there was SS in those who presented worst functional recovery. Finally, 57 % left previous recreational activities, there being no change in the marital status in most of the cases. CONCLUSIONS: Three quarter of cases achieved good functional recovery with reincorporation to work in half of the patients. Sociofamiliar integration was acceptable. As predictors of a good prognosis, we found subarachnoid hemorrhage, absence of vascular risk factors and low age when the stroke occurred.

Adolescent↗