Cost-effectiveness of the HiBalance training program for elderly with Parkinson’s disease: analysis of data from a randomized controlled trial

OBJECTIVE: To determine the cost-effectiveness of the HiBalance training program for managing Parkinson’s disease (PD)-related balance and gait disorders. DESIGN: Cost comparison design following the randomized controlled trial comparing a novel balance training intervention with care as usual. SUBJECTS: A total of 100 participants with mild–moderate PD were randomized to either the intervention (n = 51) or the control group (n = 49). INTERVENTION: A 10-week (three times per week), group-based, progressive balance training program, led by two physical therapists. MAIN OUTCOMES: All program costs were collected for both groups. Cost-utility was evaluated using quality-adjusted life years (QALYs) and cost-effectiveness measures were the Mini Balance Evaluation Systems Test (Mini-BESTest; assessing balance performance) and gait velocity. Incremental cost-effectiveness ratios were calculated and a probabilistic sensitivity analysis was conducted. RESULTS: The between-group difference in QALYs was 0.043 (95% confidence interval (CI): 0.011–0.075), favoring the intervention group. Between-group differences in balance performance and gait velocity were 2.16 points (95% CI: 1.19–3.13) and 8.2 cm/second (95% CI: 2.9–13.6), respectively, favoring the intervention group. The mean cost per participant in the intervention group was 16,222 SEK (€1649) compared to 2696 SEK (€274) for controls. The estimated incremental cost-effectiveness ratios were 314,558 SEK (€31,969) for an additional QALY, 6262 SEK (€631) for one point improvement in balance performance, and 1650 SEK (€166) for 1 cm/second increase in gait velocity. Sensitivity analyses indicated a high probability (85%) of program success. CONCLUSION: In terms of QALYs, the HiBalance program demonstrated a high probability of cost-effectiveness in the short-term perspective when considering the willingness-to-pay thresholds used in Europe

Mobile enterprise solutions in small business : Can a mobile IT-solution made for bigger companies be applied for smaller companies with employees that works in the field?

Sogeti har tillsammans med Lawson utvecklat en mobil lösning, kallad EASY, åt Toyota Material Handling Europe (TMHE) som deras 2000 servicetekniker använder. I denna rapport redovisas vilka behov mindre företag har kring mobila lösningar och om besparingar kan göras vid användning av ett mobilt system. Undersökningen fokuserar på företag som i dagsläget inte har en mobil lösning och med cirka 10-70 användare med arbetsuppgifter i fält. Rapporten diskuterar om EASY i modifierad form kan användas av mindre företag. Samt bland annat om mindre företag kan effektivisera sin verksamhet, öka kassaflödet, öka kvaliteten i arbetet och minska pappersarbetet genom att investera i en mobil lösning. Slutligen undersöks om det finns en marknad för mobila lösningar för mindre företag. Tre stycken intervjuer med mindre företag har genomförts för att undersöka hur de arbetar idag och om de kan vara i behov av ett mobilt system. Företagen har analyserats och beräkningar har gjorts för att se om det kan vara lönsamt för företagen att investera i en mobil lösning. Rapporten visar, efter att investeringskalkyler har gjorts med hjälp av nuvärdesmetoden, att det i dagsläget inte är lönsamt för de tre undersökta företagen att investera i en mobil lösning. För att det ska bli lönsamt krävs att utvecklingskostnaderna kan delas mellan två eller flera företag för att grundinvesteringen ska minska. För det minsta företaget av dem som undersökts, med sju anställda, blir det fortfarande inte lönsamt, för dem krävs att grundinvesteringen minskar ännu mer eller att inbetalningsöverskottet ökar.Sogeti has together with Lawson developed a mobile solution, called EASY, for Toyota Material Handling Europe (TMHE), which their 2000 service technicians are now using. This report investigates which needs smaller companies have of mobile solutions and if savings can be done by using a mobile solution. The investigation focuses on companies with around 10-70 employees who work in the field and who do not have a mobile solution today. The report discusses if EASY in modified form can be a solution for smaller companies: if smaller companies can be more effective, increase cash flow, increase quality in the work and decrease paperwork by investing in a mobile solution. Finally it investigates if there is a market for mobile solutions for smaller companies. Three interviews with smaller companies have been done to examine how they work today and if they can be in need of a mobile solution. The companies have been analyzed and calculations have been done to see if it can be profitable to the companies to invest in a mobile solution. This report shows, based on the performed net present value investment assessment that it is today not profitable for the companies to invest in a mobile solution. For this to change, the development cost needs to be shared between two or more companies to decrease the total investment cost. For the smallest of the examined companies with seven employees it is according to the calculations still not profitable to invest in a mobile system

Does fatigue in Parkinson’s disease impact one’s physical function in daily live?

Objective: To investigate fatigue at baseline and 3.5 years later and its association with balance and gait over time.Background: In Parkinson’s disease (PD), fatigue is considered one of the most common and disabling nonmotor symptoms that may persist or even worsen over time. Fatigue in generally has been described as a significantly diminished energy level or an increased perception of effort disproportionate to attempted activities. Fatigue has been associated to several nonmotor symptoms (e.g., depression, apathy, anxiety, sleep disturbances) and negatively impact quality of life in cross-sectional PD-studies. However, few studies have investigated fatigue over time and its association with other physical symptoms.Method: A prospective cohort of 70 persons with mild to moderate PD was assessed at baseline and 3.5 years later. Mean (SD) age and PD duration at baseline were 66 (8.9) and 4 (4.0) years, respectively and median (q1-q3) “on” phase motor symptoms (Unified PD Rating Scale, UPDRS, part III) were 11 (7-18). Fatigue was investigated with The Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F, higher=better). Multiple linear regression analysis was performed with FACIT-F scores at baseline as dependent variable and a battery of clinical balance and gait tests targeting functional, reactive, and dynamic balance (Bergs Balance Scale vs Nutt Retropulsion Test vs Tandem gait, respectively), comfortable and fast gait speed and functional mobility (Timed up and go, TUG) as independent variables. The results were controlled for age and motor symptoms.Results: The median (q1-q3) FACIT-F scores at baseline (39 (30-36)) were significantly higher than corresponding value 3.5 years later (33.5 (22.5-41)). Significant association was found between FACIT-F scores at baseline and time needed to perform TUG 3.5 years later (B (95% CI); -0,568 (-0,925, -0.211), P=0.002)). These results suggest more than half a second longer time to perform the TUG for every point/score on the FACIT-F.Conclusion: Fatigue in people with PD seem to increase substantially over a relatively short time of 3.5 years. Fatigue also impacts functional mobility incorporating components of balance and gait ability in PD (gait speed, turning and sit-to-stand transfers). More longitudinal studies are needed to investigate long-term impact of fatigue on physical function in daily live

HiCommunication as a novel speech and communication treatment for Parkinson's disease: A feasibility study

Abstract Introduction Speech and communication problems are common in Parkinson's disease (PD) and can result in social withdrawal and reduced quality of life. Intervention may improve symptoms but transfer and maintenance remain challenging for many. Access to treatment may also be limited. Group intervention incorporating principles for experience‐dependent plasticity may address these challenges. The aim of this study was to develop and study feasibility aspects of a new intervention program for group training of speech and communication in people with PD. Materials & Methods Development and content of the program called HiCommunication is described. Core target areas are voice, articulation, word‐finding and memory. Five participants with mild‐moderate PD completed this feasibility trial. Attendance rate and possible adverse events as well as the participants' experiences were documented. A speech recording and dysarthria testing were completed to study feasibility of the assessment procedure and evaluate possible changes in voice sound level and intelligibility. Results Attendance rate was 89%. No adverse events occurred. Participants reported a positive experience and limited fatigue. Assessment was completed in approximately 30 min and was well tolerated. Four of five participants had an increased voice sound level during text‐reading postintervention and mean intelligibility improved. Conclusions Results indicate that HiCommunication is feasible for people with mild‐moderate PD. The program was appreciated and well tolerated. Positive outcomes regarding voice sound level and intelligibility were observed; however, the number of participants was very limited. The results motivate that effects of HiCommunication are further studied in a randomized controlled trial, which is ongoing

Medio-lateral stability during walking turns in older adults.

INTRODUCTION:Medio-lateral stability during walking turns relies on the interaction between precise weight shifts of the body and changes in base of support by regulating step width. Although older adults and clinical populations often slow down while turning in order to compensate for balance impairments, little is known about the influence of walking speed on stability during turning. OBJECTIVE:To compare medio-lateral stability between walking turns and straight walking and to investigate whether walking speed affects medio-lateral stability during turning in healthy older adults. METHODS:Nineteen older adults walked straight or walked and turned 180° to the right and left at their comfortable speed and at a slow pace. The walking direction was visually cued before they started to walk (preplanned) or while walking straight (unplanned). As a proxy for medio-lateral stability, we calculated the absolute difference between pelvis lateral displacement and the lateral edge of the base of support during straight walking and turning. RESULTS:Overall, irrespective of turning condition, medio-lateral stability was enhanced during turning as the pelvis was further away from the boundary of the base of support resulting in a greater margin of stability compared to straight walking. Turning at a slow pace hampered medio-lateral stability as demonstrated by pelvis lateral displacement closer to the boundaries of the base of support resulting in reduced margins of stability. The reduction in stability was caused by a narrower step width during slow walking whereas pelvis lateral displacement was unaffected by turning speed. CONCLUSION:In older adults, medio-lateral stability was augmented during turning compared to straight walking, whereas turning at a slow pace hampered medio-lateral stability. These findings provide insights into the postural strategies used by older adults in order to adapt to the postural challenges of turning and straight walking

Barns förståelse för mätning av längd : En systematisk litteraturstudie

Denna systematiska litteraturstudie behandlar barns förmåga att inte bara utföra utan faktiskt förstå vad mätning av längd innebär. Syftet är att redogöra för vilka aspekter som enligt tidigare forskning visat sig väsentliga för att möjliggöra denna typ av förståelse. Detta har gjorts med hjälp av data i form av artiklar och avhandlingar som systematiskt samlats in och analyserats. Det som i den utvalda litteraturen lyfts som mest väsentligt är de kognitiva egenskaperna transitivitet och iteration, att dessa egenskaper utvecklas är en förutsättning för att barn ska förstå mätning av längd. Barn behöver ha förståelse för att samma enhet krävs för att mätning ska kunna utföras och vid jämförelser kan ett tredje objekt användas. Studien belyser dessutom hur undervisning kan utformas så gynnsamt som möjligt i förhållande till barns förståelse av mätning. Detta görs förslagsvis med hjälp av kommunikation och uppgifter kopplade till elevers vardag, men även genom att ta reda på vilken nivå eleverna befinner sig på

Striatal hand deformities in Parkinson's disease - hand surgical perspectives

BackgroundThe knowledge about striatal hand deformities (SHD) in Parkinson’s disease (PD), has recently increased but need more attention due to their early impact on dexterity. The focus of clinical studies has been on the staging of SHD severity and neurological features. However, a hand surgical perspective has not been considered.ObjectivesOur purpose was to examine SHD in patients with PD using hand surgical assessmentmethods and the recommended staging of SHD.MethodsIn this observational study, a specialist in neurological physiotherapy examined 100 consecutive PD patients and identified 35 with suspected SHD, who were thenexamined by two hand surgeons. Their hands were clinically evaluated for severity of SHD, according to a previous proposed staging, focusing on metacarpophalangeal (MCP) joint flexion, presence of intrinsic and extrinsic tightness, as well as other hand deformities.ResultsThree kinds of deformities were identified among 35 included patients: surgicaldiagnoses unrelated to PD (n=5), SHD (n=23), and PD related hand deformities with increased extrinsic tightness (n=10); three of these 10 patients had also contralateral SHD, thus are included in SHD group. In addition to previously described MCP joint flexion, swan neck deformity and z-thumb deformity, we found in most hands finger “clefting”, abduction of the little finger and/or an increased intrinsic tightness, indicating pathology of intrinsic muscles of the hand involved in SHD.ConclusionsSHD diagnosed with a modified staging method, including features of intrinsic andextrinsic hand deformities, should be considered in PD to implement early and more accurate treatmen