Browsing by Subject "Mobility"
Now showing 1 - 10 of 13
Results Per Page
Sort Options
Item 12589 Two Systematic Reviews Of Treatment Efficacy On Patient Important Outcomes In Adult X-linked Hypophosphatemia(Oxford University Press, 2024-10-05) Ali, Dalal S.; Mirza, Reza; Alsarraf, Farah; Hussein, Salma; Appelman-Dijkstra, Natasha; Beck-Nielsen, Signe Sparre; Biosse-Duplan, Martin; Brandi, Maria Luisa; Chaussain, Catherine; Cohen-Solal, Martine; Crowley, Rachel K.; Dandurand, Karel; Florenzano, Pablo F.; Fukumoto, Seiji; Gagnon, Claudia; Goodyer, Paul; Grasemann, Corinna; Imel, Erik Allen; De Beur, Suzanne Marie Jan; Lewiecki, E. Michael; Morgante, Emmett; Ward, Leanne; Aziz Khan, Aliya; Guyatt, Gordon; Medicine, School of MedicineObjective: Our objective was to examine the highest certainty evidence addressing the management of X-linked hypophosphatemia in adults, aiming to inform treatment recommendations. Eligibility criteria: We searched Embase, MEDLINE, Web of Science, and Cochrane from inception to March 2023 and included RCTs and observational studies enrolling individuals ≥ 18 years diagnosed with XLH on clinical grounds or with a confirmed pathogenic variant in PHEX. Manuscripts evaluating the effectiveness of burosumab compared to either no treatment or conventional therapy (phosphate salts and active vitamin D) or evaluating conventional therapy compared to no treatment were selected. Methods: Two reviewers independently determined eligibility, conducted data extraction, and assessed the risk of bias (RoB). GRADE was used to assess certainty of evidence. Results: After removing duplicates from 7,043 citations, we assessed 254 full texts. Of those, one RCT proved eligible. The RCT of burosumab versus no treatment was at low RoB with certainty of evidence on individual outcomes ranging from high to very low. Burosumab probably improves pain inferred from fracture and pseudofracture healing (moderate certainty); however, burosumab probably has little or no impact on direct pain measures (moderate certainty). While burosumab may reduce the need for parathyroidectomy, indicated by lowered PTH levels (low certainty), it has little or no impact on fatigue (high certainty), stiffness (moderate certainty), and mobility (low certainty) over 24 weeks. Burosumab may also increase dental abscesses (low certainty). No formal comparisons of burosumab and conventional therapy exist; therefore, our low certainty evidence inferences regarding burosumab versus conventional therapy were based on indirect evidence from comparisons of burosumab versus no treatment and from conventional therapy versus no treatment. Observational studies proved at high RoB providing very low certainty of evidence regarding the impact of conventional therapy versus no treatment. This evidence pertained to the reduction in the risk of parathyroidectomy, as well as the reduction in the burden of symptoms caused by chronic hypophosphatemia. Conclusion: Burosumab when compared to no treatment may improve pain through fracture healing and may reduce the need for parathyroidectomy, but it could also increase the risk of dental abscess. However, when using direct measures of pain and function, burosumab demonstrated probably little or no impact on pain and stiffness, little or no impact on fatigue, and may have had little to no impact on mobility. Very low certainty exists regarding conventional therapy versus no treatment in adults. Overall, our review highlights the need for more data to better understand the long-term impact of burosumab and conventional therapy on patient-important outcomes.Item Adapting to CONNECT: modifying a nursing home-based team-building intervention to improve hospital care team interactions, functioning, and implementation readiness(BMC, 2022-07-29) Wang, Virginia; D’Adolf, Joshua; Decosimo, Kasey; Robinson, Katina; Choate, Ashley; Bruening, Rebecca; Sperber, Nina; Mahanna, Elizabeth; Van Houtven, Courtney H.; Allen, Kelli D.; Colón-Emeric, Cathleen; Damush, Teresa M.; Hastings, Susan N.; Medicine, School of MedicineBackground: Clinical interventions often need to be adapted from their original design when they are applied to new settings. There is a growing literature describing frameworks and approaches to deploying and documenting adaptations of evidence-based practices in healthcare. Still, intervention modifications are often limited in detail and justification, which may prevent rigorous evaluation of interventions and intervention adaptation effectiveness in new contexts. We describe our approach in a case study, combining two complementary intervention adaptation frameworks to modify CONNECT for Quality, a provider-facing team building and communication intervention designed to facilitate implementation of a new clinical program. Methods: This process of intervention adaptation involved the use of the Planned Adaptation Framework and the Framework for Reporting Adaptations and Modifications, for systematically identifying key drivers, core and non-core components of interventions for documenting planned and unplanned changes to intervention design. Results: The CONNECT intervention's original context and setting is first described and then compared with its new application. This lays the groundwork for the intentional modifications to intervention design, which are developed before intervention delivery to participating providers. The unpredictable nature of implementation in real-world practice required unplanned adaptations, which were also considered and documented. Attendance and participation rates were examined and qualitative assessment of reported participant experience supported the feasibility and acceptability of adaptations of the original CONNECT intervention in a new clinical context. Conclusion: This approach may serve as a useful guide for intervention implementation efforts applied in diverse clinical contexts and subsequent evaluations of intervention effectiveness.Item Architecture for Mobile Heterogeneous Multi Domain Networks(Hindawi, 2010-04-01) Durresi, Arjan; Zhang, Ping; Durresi, Mimoza; Barolli, Leonard; Computer and Information Science, School of ScienceMulti domain networks can be used in several scenarios including military, enterprize networks, emergency networks and many other cases. In such networks, each domain might be under its own administration. Therefore, the cooperation among domains is conditioned by individual domain policies regarding sharing information, such as network topology, connectivity, mobility, security, various service availability and so on. We propose a new architecture for Heterogeneous Multi Domain (HMD) networks, in which one the operations are subject to specific domain policies. We propose a hierarchical architecture, with an infrastructure of gateways at highest-control level that enables policy based interconnection, mobility and other services among domains. Gateways are responsible for translation among different communication protocols, including routing, signalling, and security. Besides the architecture, we discuss in more details the mobility and adaptive capacity of services in HMD. We discuss the HMD scalability and other advantages compared to existing architectural and mobility solutions. Furthermore, we analyze the dynamic availability at the control level of the hierarchy.Item Correlates of Gait Speed Among Older Adults From 6 Countries: Findings From the COSMIC Collaboration(Oxford University Press, 2023) Sprague, Briana N.; Zhu, Xiaonan; Rosso, Andrea L.; Verghese, Joe; Delbaere, Kim; Lipnicki, Darren M.; Sachdev, Perminder S.; Ng, Tze Pin; Gwee, Xinyi; Yap, Keng Bee; Kim, Ki-Woong; Han, Ji Won; Oh, Dae Jong; Narazaki, Kenji; Chen, Tao; Chen, Sanmei; Brodaty, Henry; Numbers, Katya; Kochan, Nicole A.; Walker, Richard W.; Paddick, Stella-Maria; Gureje, Oye; Ojagbemi, Akin; Bello, Toyin; Rosano, Caterina; COSMIC Consortium; Medicine, School of MedicineBackground: Few studies have compared gait speed and its correlates among different ethnogeographic regions. The goals of this study were to describe usual and rapid gait speed, and identify their correlates across Australian, Asian, and African countries. Methods: We used data from 6 population-based cohorts of adults aged 65+ from 6 countries and 3 continents (N = 6 472), with samples ranging from 231 to 1 913. All cohorts are members of the Cohort Studies of Memory in an International Consortium collaboration. We investigated whether clinical (body mass index [BMI], hypertension, stroke, apolipoprotein status), psychological (cognition, mood, general health), and behavioral factors (smoking, drinking, physical activity) correlated with usual (N = 4 cohorts) and rapid gait speed (N = 3 cohorts) similarly across cohorts. Regression models were controlled for age, sex, and education, and were sex-stratified. Results: Age- and sex-standardized usual gait speed means ranged from 0.61 to 1.06 m/s and rapid gait speed means ranged from 1.16 to 1.64 m/s. Lower BMI and better cognitive function consistently correlated with faster gait speed in all cohorts. Less consistently, not having hypertension and greater physical activity engagement were associated with faster gait speed. Associations with mood, smoking, and drinking were largely nonsignificant. These patterns were not attenuated by demographics. There was limited evidence that the associations differed by sex, except physical activity, where the greater intensity was associated with usual gait among men but not women. Conclusions: This study is among the first to describe the usual and rapid gait speeds across older adults in Africa, Asia, and Australia.Item Development and feasibility testing of a new device for home-based leg heat therapy in patients with lower extremity peripheral artery disease(Elsevier, 2024-11-08) Ro, Bohyun; Spence, John P.; Spence, Paul A.; Buckley, Christian; Motaganahalli, Raghu L.; Roseguini, Bruno T.; Surgery, School of MedicinePeople with symptomatic lower extremity peripheral artery disease (PAD) suffer from severe leg pain, walking impairment, and reduced quality of life, but few effective treatments are available. Emerging evidence suggests that regular heat therapy (HT) may improve cardiovascular and physical function in patients with PAD. However, the lack of accessible, practical modalities for unsupervised HT, especially for elderly individuals, has hindered clinical implementation. The goals of this study were to design and assess the feasibility of a portable leg HT system for elderly patients with PAD. Building on a cryotherapy water-circulating device used in sports recovery, we developed a new prototype system consisting of a single-touch controller unit integrating a heater, water pump, and air pump, and leg sleeves with inner-layer water-circulating pads and an outer layer of inflatable bladders. The system was designed to ensure efficient heat transfer through gentle pneumatic inflation, adapting to varying limb dimensions. Safety features included temperature sensors with auto shut-off and a built-in timer. The prototype's feasibility and safety were evaluated in a single-arm pilot trial with six symptomatic patients with PAD, who were asked to apply the therapy daily for 90 minutes for 12 weeks. Primary outcomes included completion rates, safety, and device usability. Secondary outcomes were changes in blood pressure, 6-minute walk distance, calf strength, sit-to-stand performance, and quality of life. Participants underwent a 90-minute supervised treatment session with the prototype HT units to assess the acute physiological responses before starting the 12-week intervention. Leg HT gradually increased leg skin temperature from 33.8 ± 0.8°C to 38.7 ± 0.7°C at 90 minutes and reduced arterial blood pressure, with mean reductions of 13 mm Hg in systolic and 12 mm Hg in diastolic blood pressure after treatment. All participants completed the 12-week program without serious adverse events, indicating that leg HT is safe and well-tolerated. The 6-minute walk distance improved by an average of 32 m, coupled with increased calf muscle strength and reduced time for the sit-to-stand test. Improvements were also observed in self-reported walking speed and quality of life. This study represents the first step in developing a portable leg heating system for elderly patients with PAD, demonstrating that home-based leg HT is feasible and safe. However, further engineering refinements are needed to enhance portability, simplify application, and encourage long-term adherence. Developing methods to track compliance with the treatment regimen will be crucial for the success of this unsupervised, home-based therapy.Item Hospital-associated functional status decline in pulmonary patients(2017-06-26) Shay, Amy Cornett; Fulton, Janet; Von Ah, Diane; Otte, Julie Elam; Warden, Stuart J.; O'Malley, PatriciaChronic obstructive pulmonary disease (COPD) is a significant worldwide cause of chronic illness and mortality and one of the most common admitting diagnoses in the United States. Persons with COPD are at increased risk for deconditioning during hospitalization, which can lead to decreased functional status at discharge. Disease-related factors and elements of the hospital environment make older adults with COPD vulnerable to hospital-associated functional status decline. The purpose of this dissertation was to identify activity factors that contribute to hospital-associated functional status decline in older adults with COPD by promoting functioning during hospitalization. This predictive correlational study is a secondary analysis of a pre-existing dataset. Patients with COPD were pulled from the larger parent study sample for comparison with patients without COPD. The convenience sample consisted of 111 patients with COPD and 190 patients without COPD. Subjects were 46.5% male, 53.5% female, and a mean age of 66 years. All subjects were patients admitted to a pulmonary unit and received an intervention protocol designed to address mobility barriers related to COPD and hospitalization. Statistical analysis explored the number, type, and timing of activity events in relation to the selected functional status outcomes of discharge disposition, length of hospital stay, and 30-day readmission rates for hospitalized older adults with COPD. Multivariate and bivariate analyses results indicated ambulation to the bathroom, ambulation outside the patient room, and number of days to first out-of-bed activity were significant predictors (p < 0.05) of patient discharge to home; days to first activity and ambulation were significant predictors (p < 0.05) of reduced length of stay; none of the variables were predictive of 30-day readmission. Patients with COPD experienced longer lengths of stay and more non-weight bearing activity than patients without COPD in this sample. These findings provide a foundation for future research to explore hospital environmental factors influencing mobility, determine optimal modes of activity during hospitalization, and examine potential cost savings associated with promotion of early mobility. Findings help explain the effects of physical activity during hospitalization and may aid development of nursing interventions to prevent or alleviate functional status decline in this vulnerable population.Item Impacts of state COVID-19 reopening policy on human mobility and mixing behavior(Wiley, 2021) Nguyen, Thuy D.; Gupta, Sumedha; Andersen, Martin S.; Bento, Ana I.; Simon, Kosali I.; Wing, Coady; Economics, School of Liberal ArtsThis study quantifies the effect of the 2020 state COVID economic activity reopening policies on daily mobility and mixing behavior, adding to the economic literature on individual responses to public health policy that addresses public contagion risks. We harness cellular device signal data and the timing of reopening plans to provide an assessment of the extent to which human mobility and physical proximity in the United States respond to the reversal of state closure policies. We observe substantial increases in mixing activities, 13.56% at 4 days and 48.65% at 4 weeks, following reopening events. Echoing a theme from the literature on the 2020 closures, mobility outside the home increased on average prior to these state actions. Furthermore, the largest increases in mobility occurred in states that were early adopters of closure measures and hard-hit by the pandemic, suggesting that psychological fatigue is an important barrier to implementation of closure policies extending for prolonged periods of time.Item Impacts of State Reopening Policy on Human Mobility(National Bureau of Economic Research, 2020-05) Nguyen, Thuy D.; Gupta, Sumedha; Andersen, Martin; Bento, Ana; Simon, Kosali I.; Wing, Coady; O’Neill School of Public and Environmental Affairs, IU & IUPUIThis study quantifies the effect of state reopening policies on daily mobility, travel, and mixing behavior during the COVID-19 pandemic. We harness cell device signal data to examine the effects of the timing and pace of reopening plans in different states. We quantify the increase in mobility patterns during the reopening phase by a broad range of cell-device-based metrics. Soon (four days) after reopening, we observe a 6% to 8% mobility increase. In addition, we find that temperature and precipitation are strongly associated with increased mobility across counties. The mobility measures that reflect visits to a greater variety of locations responds the most to reopening policies, while total time in vs. outside the house remains unchanged. The largest increases in mobility occur in states that were late adopters of closure measures, suggesting that closure policies may have represented more of a binding constraint in those states. Together, these four observations provide an assessment of the extent to which people in the U.S. are resuming movement and physical proximity as the COVID-19 pandemic continues.Item Life-course and population health perspectives to fill gaps in migrant health research(FrancoAngeli, 2020) Ahonen, Emily Q.; Fujishiro, Kaori; Environmental Health Science, School of Public HealthThis article highlights categories and dichotomies used in the study of the health of migrants, including migrant motivation, migrant type, pre- and post-migration time periods, and health as biomedically or socially determined. The authors suggest that the full spectrum of migrants and migration be considered more thoroughly in order to improve our understanding of migrant health. This paper challenges simple conceptions of migration, mobility, and migrant experience. To fill gaps in knowledge left by these conceptions, researchers must recognize the decisions migrants make as a process which plays out both over time (in migrant life-courses) and also across personal, national, and international contexts which connect the individual to larger structures and phenomena. The authors argue that, in this reality, research questions related to migrant health are best addressed using life-course perspectives which recognize health as a continuum of socially-constructed statuses.Item Relative leg press strength relates to activity energy expenditure in older women: Implications for exercise prescription(Elsevier, 2022-11) Carter, Stephen J.; Singh, Harshvardan; Nabhan, Dustin C.; Long, Emily B.; Hunter, Gary R.; Exercise & Kinesiology, School of Health and Human SciencesLimited work has evaluated how leg press strength (LPS), relative to body mass (i.e., rLPS), affects heart rate (HR) responses during activities of daily living. Such information would prove useful by informing a specific level of rLPS needed to promote independent mobility and physical activity. Secondary analyses were performed on baseline measures of 76 untrained older (65 ± 4 y) women. After familiarization, one-repetition maximum leg press was converted to rLPS by dividing the external load lifted (kg) by body mass (BM). Participants were stratified according to percentile of age-group norms of rLPS: ≤50 % (low, ≤0.99 kg/BM, n = 15), 51–89 % (middle, 1.0–1.31 kg/BM, n = 31), and ≥90 % (high, ≥1.32 kg/BM, n = 30). HR was measured at rest and during laboratory-based tasks including fixed-speed (0.89 m·s−1) non-graded treadmill walking, graded (2.5 %) treadmill walking, and stair stepping. Maximal oxygen uptake (V̇O2max) was measured via indirect calorimetry. Doubly labeled water was used to quantify activity energy expenditure (AEE) over a 14-d period. Relative LPS per group were: 0.85 ± 0.12 (low), 1.16 ± 0.09 (middle), and 1.55 ± 0.25 (high) (p < 0.001). Significant between-group differences in HR emerged during both walking tasks and stair stepping – with the high rLPS group having the lowest HR. AEE between-group comparisons did not yield statistical significance (p = 0.084), however, rLPS correlated with AEE (r = 0.234, p = 0.042) and V̇O2max (r = 0.430, p < 0.001). Such findings suggest a higher rLPS attenuates HR for weight-bearing activities while also demonstrating a significant, albeit modest, positive link to AEE among older women. This information may be especially relevant for informing thresholds of rLPS linked to mobility and functional independence in older women.