Taxonomy and physical health inequalities in people with learning disabilities

The International Classification of Functioning, Disability and Health (ICF) is a taxonomic framework that provides a biopsychosocial understanding of intellectual disabilities (ID). It was hypothesised that the use of the ICF would help highlight physical health difficulties in people with ID and promote a wider, more holistic view of ID. There was an additional practical aim concerning widening competing categories of athletes with ID to include physical health. The study consisted of two stages. In Stage one the ICF-based questionnaire was developed with an expert panel. Stage two aimed to test this using a naturalistic, cross-sectional design, between three pre-existing groups: elite athletes competing through INAS; sub-elite athletes; and athletes with Down syndrome (DS). Seventy-seven athletes took part. The results suggested that a separate competing category for athletes with DS should be considered, as this group could currently be considered disadvantaged in terms of their physical health when compared to INAS athletes. It was hoped this research would inspire further debate on a taxonomy for intellectual disabilities and the potential advantages of this, particularly in helping to ensure physical health problems in this population are not overlooked

Sports classification and athletes with intellectual disabilities: Measuring health status using a questionnaire based on the international classification of functioning, disability and health

Most people with intellectual disabilities have comorbid health conditions, which will impact optimization of sporting performance. Classification is used in Paralympic events to ensure that those with similar levels of functional ability compete fairly against each other. An evidence-based approach needs to be developed for athletes with intellectual disabilities to be classified in relation to their overall functional capacity into competition groups of similar ability. This research builds on previous work using the taxonomy of The International Classification of Functioning, Disability and Health (ICF) to group athletes with intellectual disabilities into comparable competition groups as an approach to Paralympic classification. Three groups of athletes-Virtus, Special Olympics, and Down syndrome-are compared using the ICF questionnaire indicating functional health status in relation to sporting performance. The questionnaire was found to discriminate between athletes with Down syndrome and other athletes, and an approach to using a cutoff score to develop competition classes is explored

Effects of oral creatine supplementation on body composition and objective physical function in rheumatoid arthritis patients. A randomised controlled trial

Objective: Muscle wasting (‘rheumatoid cachexia’) is evident in most rheumatoid arthritis (RA) patients, including those with well-controlled disease, and contributes substantially to the reductions in strength and physical function that are characteristic of this disease. The aim of this randomized controlled trial was to investigate the efficacy of oral creatine (Cr) supplementation on improving muscle mass, strength and function in stable RA patients. Method: Forty RA patients were randomized to 12 weeks supplementation of Cr or placebo, in a double-blind fashion. Body composition (by whole-body dual-energy X-ray absorptiometry, DXA, and bioelectrical impedance spectroscopy, BIS), strength and objectively-assessed physical function measures were taken at baseline, week 12, and week 24 (i.e. after 12 weeks of treatment withdrawal). Data was analyzed by ANCOVA. Results: Cr supplementation increased appendicular lean mass (ALM; a surrogate DXA measure of muscle mass) by (mean±SE) 0.52±0.13kg (P=0.004 vs placebo), and total LM by 0.60±0.37kg (P=0.158 vs placebo). The increment in LM by DXA corresponded with the elevation in intracellular water (ICW) estimated by BIS (0.64±0.22 L, P=0.035 vs placebo). However, the observed increases in ALM, total LM and ICW were not accompanied by improvements in isometric knee extensor strength (P=0.408), hand-grip strength (P=0.833), or objectively assessed function (30s sit-to-stand, 50’ walk, 8’ up-&-go, estimated VO2max; P’s=0.335-0.764) Conclusion: Twelve weeks of Cr supplementation improved muscle mass, but not strength or objectively-measured physical function in RA patients. As no adverse treatment-related effects occurred, Cr supplementation appears to be a safe and acceptable adjunct treatment for attenuating muscle loss in RA patients. This treatment may be especially suitable for patients with severe rheumatoid cachexia

Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR):study protocol for a phase II randomised feasibility study of a multidisciplinary rehabilitation package following hip fracture [ ISRCTN22464643 ]

Background Proximal femoral fracture is a common, major health problem in old age resulting in loss of functional independence and a high-cost burden on society, with estimated health and social care costs of £2.3 billion per year in the UK. Rehabilitation has the potential to maximise functional recovery and maintain independent living, but evidence of effectiveness is lacking. Usual rehabilitation care is delivered by a multi-disciplinary team in the hospital and in the community. An ‘enhanced rehabilitation’ intervention has been developed consisting of a workbook, goal-setting diary and extra therapy sessions, designed to improve self-efficacy and increase the amount and quality of the practice of physical exercise and activities of daily living. Methods/design This paper describes the design of a phase II study comprising an anonymous cohort of all proximal femoral fracture patients admitted to the three acute hospitals in Betsi Cadwaladr University Health Board over a 6-month period with a randomised feasibility study comparing the enhanced rehabilitation intervention with usual care. These will assess the feasibility of a future definitive randomised controlled trial and concurrent economic evaluation in terms of recruitment, retention, outcome measure completion, compliance with the intervention and fidelity of delivery, health service use data, willingness to be randomised and effect size for a future sample size calculation. Focus groups will provide qualitative data to contribute to the assessment of the acceptability of the intervention amongst patients, carers and rehabilitation professionals and the feasibility of delivering the planned intervention. The primary outcome measure is function assessed by the Barthel Index. Secondary outcomes measure the ability to perform activities of daily living, anxiety and depression, potential mediators of outcomes such as hip pain, self-efficacy and fear of falling, health utility, health service use, objectively assessed physical function and adverse events. Participants’ preference for rehabilitation services will be assessed in a discrete choice experiment. Discussion Phase II studies are an opportunity to not only assess the feasibility of trial methods but also to compare different methods of outcome measurement and novel methods of obtaining health service use data from routinely collected patient information. Trial registration Current Controlled Trials ISRCTN22464643, UKCRN16677

Tight control of disease activity fails to improve body composition or physical function in rheumatoid arthritis patients

Objective. RA typically features “rheumatoid cachexia” (loss of muscle mass (MM) and excessive fat mass (FM), especially trunk FM), which contributes to physical disability. Since rheumatoid cachexia is driven by inflammation, it would be anticipated that the success of tight control of disease activity, such as “treat-to-target” (T2T), in attenuating inflammation would benefit body composition and physical function. This cross-sectional study assessed the impact of T2T on body composition and objectively-assessed function in RA patients

An appraisal of rehabilitation regimes used for improving functional outcome after total hip replacement surgery

This study aimed to systematically review the literature with regards to studies of rehabilitation programmes that have tried to improve function after total hip replacement (THR) surgery. 15 randomised controlled trials were identified of which 11 were centre-based, 2 were home based and 2 were trials comparing home and centre based interventions. The use of a progressive resistance training (PRT) programme led to significant improvement in muscle strength and function if the intervention was carried out early (< 1 month following surgery) in a centre (6/11 centre-based studies used PRT), or late (> 1 month following surgery) in a home based setting (2/2 home based studies used PRT). In direct comparison, there was no difference in functional measures between home and centre based programmes (2 studies), with PRT not included in the regimes prescribed. A limitation of the majority of these intervention studies was the short period of follow up. Centre based program delivery is expensive as high costs are associated with supervision, facility provision, and transport of patients. Early interventions are important to counteract the deficit in muscle strength in the affected limb, as well as persistent atrophy that exists around the affected hip at 2 years post-operatively. Studies of early home-based regimes featuring PRT with long term follow up are needed to address the problems currently associated with rehabilitation following THR

Low level of physical activity in women with rheumatoid arthritis is associated with cardiovascular risk factors but not with body fat mass - a cross sectional study

<p>Abstract</p> <p>Background</p> <p>As many patients with rheumatoid arthritis (RA) have increased fat mass (FM) and increased frequency of cardiovascular diseases we evaluated if total physical activity (MET-hours) had impact on body composition and cardiovascular risk factors in women with RA.</p> <p>Methods</p> <p>Sixty-one out-ward RA women, 60.8 (57.3-64.4) years, answered a self-administered questionnaire, to estimate total daily physical activity during the previous year. Physical activity level was given as metabolic equivalents (MET) × h/day. Diet content was assessed by a food frequency questionnaire and body composition by whole-body dual-energy X-ray absorptiometry. Blood lipids and antibodies against phosphorylcholine (anti-PC) were determined.</p> <p>Results</p> <p>Forty-one percent of the women had BMI > 25, 6% were centrally obese and 80% had FM% > 30%. The median (IQR) total physical activity was 40.0 (37.4-47.7), i.e. the same activity level as healthy Swedish women in the same age. Total physical activity did not significantly correlate with disease activity, BMI or FM%. Disease activity, BMI and FM% did not differ between those in the lowest quartile of total physical activity and those in the highest quartile. However, the women in the lowest quartile of physical activity had lower HDL (p = 0.05), Apo A1 (p = 0.005) and atheroprotective natural anti-PC (p = 0.016) and higher levels of insulin (p = 0.05) and higher frequency of insulin resistance than those in the highest quartile. Women in the lowest quartile consumed larger quantities of saturated fatty acids than those in the highest quartile (p = 0.042), which was associated with high oxidized low-density lipoprotein (oxLDL).</p> <p>Conclusion</p> <p>This cross sectional study demonstrated that RA women with fairly low disease activity, good functional capacity, high FM and high frequency of central obesity had the same total physical activity level as healthy Swedish women in the same age. The amount of total physical activity was not associated with functional capacity or body composition. However, low total physical activity was associated with dyslipidemia, insulin resistance, low levels of atheroprotective anti-PC and consumption of saturated fatty acids, which is of interest in the context of increased frequency of cardiovascular disease in RA.</p