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Background

People with intellectual disabilities are less physically active and suffer from ill-health more than the general population. Support staff play an important role in the person's life. This study aimed to explore the support staff's experiences regarding the feasibility of adapted web-based exercise for people with intellectual disabilities.

Method

Participants with intellectual disabilities living in community-based settings were recruited for a web-based exercise study. Eight semi-structured interviews were carried out with their support staff before and after the intervention period.

Results

The main theme, ‘Support staff are crucial for feasibility’ encompasses the importance of communication, structure, and motivation in improving physical activity for people with intellectual disabilities.

Conclusion

The experiences of support staff, indicate that a web-based exercise program is feasible for the target group, and one way to overcome challenges for PA, where the role of the staff is crucial.

A large international meta-analysis using primary data from 64 cohorts has quantified the increased risk of fracture associated with a previous history of fracture for future use in FRAX.IntroductionThe aim of this study was to quantify the fracture risk associated with a prior fracture on an international basis and to explore the relationship of this risk with age, sex, time since baseline and bone mineral density (BMD).MethodsWe studied 665,971 men and 1,438,535 women from 64 cohorts in 32 countries followed for a total of 19.5 million person-years. The effect of a prior history of fracture on the risk of any clinical fracture, any osteoporotic fracture, major osteoporotic fracture, and hip fracture alone was examined using an extended Poisson model in each cohort. Covariates examined were age, sex, BMD, and duration of follow-up. The results of the different studies were merged by using the weighted & beta;-coefficients.ResultsA previous fracture history, compared with individuals without a prior fracture, was associated with a significantly increased risk of any clinical fracture (hazard ratio, HR = 1.88; 95% CI = 1.72-2.07). The risk ratio was similar for the outcome of osteoporotic fracture (HR = 1.87; 95% CI = 1.69-2.07), major osteoporotic fracture (HR = 1.83; 95% CI = 1.63-2.06), or for hip fracture (HR = 1.82; 95% CI = 1.62-2.06). There was no significant difference in risk ratio between men and women. Subsequent fracture risk was marginally downward adjusted when account was taken of BMD. Low BMD explained a minority of the risk for any clinical fracture (14%), osteoporotic fracture (17%), and for hip fracture (33%). The risk ratio for all fracture outcomes related to prior fracture decreased significantly with adjustment for age and time since baseline examination.ConclusionA previous history of fracture confers an increased risk of fracture of substantial importance beyond that explained by BMD. The effect is similar in men and women. Its quantitation on an international basis permits the more accurate use of this risk factor in case finding strategies.

Background: Rehabilitation is suggested to improve outcomes following traumatic brain injury (TBI), however, the extent of access to rehabilitation among TBI patients remains unclear. Objective To examine the level of access to rehabilitation after TBI, and its association with health and sociodemographic factors.

Method: We conducted a longitudinal cohort study using Swedish nationwide healthcare and sociodemographic registers. We identified 15880 TBI patients >= 18years hospitalized >= 3days from 2008 to 2012 who were stratified into 3 severity groups; grade I (n=1366; most severe), grade II (n=5228), and grade III (n=9268; least severe). We examined registered contacts with specialized rehabilitation or geriatric care (for patients >= 65years) during the hospital stay, and/or within 1year post-discharge. We performed a generalized linear model analysis to estimate the risk ratio (RR) for receiving specialized rehabilitation or geriatric care after a TBI based on sociodemographic and health factors.

Results: Among TBI patients, 46/35% (grade I), 14/40% (grade II), and 5/18% (grade III) received specialized rehabilitation or geriatric care, respectively. Being currently employed or studying was positively associated (RR 1.7, 2.3), while living outside of a city area was negatively associated (RR 0.36, 0.79) with receiving specialized rehabilitation or geriatric care. Older age and a prior substance use disorder were negatively associated with receiving specialized rehabilitation (RR 0.51 and 0.81).

Conclusion: Our results suggest insufficient and unequal access to rehabilitation for TBI patients, highlighting the importance of organizing and standardizing post-TBI rehabilitation to meet the needs of patients, regardless of their age, socioeconomic status, or living area.

Purpose: The aim of this study was to investigate how health-related quality of life (HRQoL) and functional shoulder range of motion are affected among patients with diabetes with shoulder problems, treated with a specific physiotherapy programme. A further aim was to investigate how health-related quality of life, functional shoulder range of motion, pain intensity, and shoulder function correlate within the group of patients after the treatment period.

Method: A pre–post treatment design was applied for a study group of ten patients with type 1 diabetes and shoulder problems. The physiotherapy treatment consisted of exercises promoting enhanced microcirculation in the shoulder tissues, optimal shoulder co-ordination,  and muscle relaxation. The Short Form-36 (SF-36), shoulder range of motion measures, the Shoulder Rating Scale – Swedish version, and pain intensity measures were used. The results regarding SF-36 were compared with the results of a control group of patients having either type 1 or type 2 diabetes and shoulder problems that did not receive any specific physiotherapy treatment.

Results: As a potential result of physiotherapy training, a significant change towards higher scores was observed in the physical component summary (PCS) measure of SF-36. There was a significant improvement regarding PCS in the study group as compared with the control group. There were negative correlations between the four aspects of pain intensity and PCS and Shoulder Rating Scale – Swedish version, respectively, but a positive correlation between PCS and Shoulder Rating Scale – Swedish version. “Handraising” and “hand-behind-back” were significantly improved, and proved to be positively correlated with Shoulder Rating Scale – Swedish version.

Conclusions: The results of this study indicate that patients with type 1 diabetes and shoulder problems,treated with a specific physiotherapy programme, may improve with respect to physical aspects of healthrelated quality of life, and partially regain their range of motion in the shoulder joint. Based on these results, the associated treatment protocol may be recommended for physiotherapy treatment in such patients.

Background: Limited research has explored balance problems as a prospective risk factor for cardiovascular disease (CVD). This study aimed to characterize the association between balance measures and the risk of incident CVD in a population of 70-year-olds.

Methods and Results: From 2012 to 2022 a cohort of 4927 older individuals who were CVD free underwent balance assessments using a balance board. Measurements included lateral and anterior-posterior sway, along with a safety limit of stability in a subcohort (N=2782). Time to first hospitalization for CVD, encompassing stroke, myocardial infarction, or angina pectoris was the primary outcome. Multivariable regression models assessed associations between balance parameters and CVD risk. Over a mean follow-up of 4.9 years, 320 individuals were hospitalized for CVD. In a balance test with eyes open, increased lateral sway at baseline was associated with a higher risk of CVD (hazard ratio [HR], 1.014 [95% CI, 1.004-1.025], P=0.005, per mm increased sway), after adjustment for traditional risk factors for CVD. Similarly, individuals with CVD during follow-up exhibited higher lateral sway with eyes closed at baseline (HR, 1.015 [95% CI, 1.005-1.025], P=0.002, per mm increased sway), after multivariable adjustment. The 4 strongest independent predictors of CVD included lateral sway and were associated with a population attributable fraction of 61% (95% CI, 54-68).

Conclusions: In community-dwelling 70-year-olds, impaired lateral balance was an independent predictor of later CVD, after adjustment for traditional risk factors. This may suggest that position balance could be used as an early risk marker for underlying atherosclerotic disease.

Background Low bone density and osteoporosis are indications for bone-specific fi c treatment. However, given the limited availability of bone density data in clinical practice and the fact that most patients with hip fracture do not have osteoporosis, accurate prediction of hip fracture risk in the absence of bone density data would be crucial. Methods This development and validation study included the entire Swedish population aged 50 years or older in 2005 (N = 3,340,977) and was conducted by cross-linking data from nationwide registers. Potential predictive variables included diagnoses, prescription medications, familial factors, frailty-related factors, and socioeconomic factors. The primary endpoint was the 5-year risk of hip fracture. Fracture prediction algorithms were developed and validated using multivariable models. Model performance and validation was also examined in a sub cohort restricted to 504,431 individuals with non-Swedish background. Findings During a total follow-up of 15.2 million person-years, 87,089 individuals suffered a hip fracture within 5 years. In the fi nal prediction model, 19 variables were associated with a population attributable fraction of 93.9% (95% CI, 93.7-94.1) - 94.1) in women and 92.7% (95% CI, 92.2-93.0) - 93.0) in men. The strongest predictor, besides old age, was the use of homemaker service, with a 5-year risk of hip fracture of 7.8% in women and 4.7% in men. The diagnoses most strongly predicting the 5-year risk of hip fracture was Parkinson's ' s disease (6.8% in women, 4.6% in men) and dementia (6.1% in women, 3.6% in men). Validation of the prediction model suggested that the optimal threshold for treatment with bone-specific fi c agents was an estimated 5-year hip fracture risk of 3%. Assuming a threshold of 3% and a 30% relative risk reduction from bone-specific fi c treatment, the number needed to treat to prevent one hip fracture was estimated to 36 in women and 52 in men. Similar results were obtained in the sub cohort with non-Swedish background. Interpretation A clinical prediction model developed and validated in the total Swedish population could predict the risk of hip fractures with high precision even in absence of data on bone density. The model was associated with a population attributable fraction for hip fracture of more than 90%, and the strongest predictor besides old age was the use of homemaker service, which likely reflect fl ect frailty. Based on the model, individuals with an estimated 5-year risk of hip fracture of at least 3% could be considered for bone-specific fi c treatment. Funding None. Copyright (c) 2024 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). 2024;77: Published https://doi.org/10. 1016/j.eclinm.2024. 102877

Objective To describe the clinical features and progression of patients with respiratory onset amyotrophic lateral sclerosis (ALS).

Methods: We analyzed the clinical features, including respiratory tests, functional score, noninvasive ventilation (NIV) time and survival of ALS patients with respiratory-onset in our database consisting of 1688 patients. In a subset of 625 ALS patients we analyzed the spreading pattern to other bodily regions.

Results: We included 1579 patients with ALS. Sixty-three patients (4%) presented respiratory-onset (79.4% men, mean onset-age 67.7 +/- 8.9yrs). All had predominant LMN involvement, and significant weight loss (>10%) was identified in 38.9%. The respiratory tests were abnormal in these respiratory-onset patients (p < 0.001). ALSFRS-R respiratory subscore was lower in this population (p < 0.001). NIV was adapted in 84.1%, sooner than in the larger group of ALS patients (p < 0.001), and survival from disease onset was shorter (p < 0.001). Respiratory-onset was a predictor of time to NIV (X-2=42.0, p < 0.001) and of survival (X-2=7.1, p = 0.008). The spreading pattern was studied in 18 patients with isolated respiratory-onset. The progression interval to the 2nd region was 4.7 +/- 5.7mo and to a 3rd region 6.1 +/- 8.7mo. Different patterns of spread had no impact on survival.

Conclusions: This phenotype is typically seen in emaciated older men with predominant lower motor neuron involvement, and is associated with diaphragm paresis and central respiratory involvement. NIV adaptation is rapid but total survival is shorter than in the other patients. Spreading pattern did not affect time to NIV adaptation or total survival, as NIV support is a modifying treatment in the course of ALS.

Background and purpose Respiratory insufficiency and its complications are the main cause of death in amyotrophic lateral sclerosis (ALS). Respiratory symptoms are scored in questions Q10 (dyspnoea) and Q11 (orthopnoea) of the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R). The association of respiratory test alterations with respiratory symptoms is unclear. Methods Patients with ALS and progressive muscular atrophy were included. We retrospectively recorded demographic data, ALSFRS-R, forced vital capacity (FVC), maximal inspiratory (MIP) and expiratory (MEP) pressures, mouth occlusion pressure at 100 ms, nocturnal oximetry (SpO(2)mean), arterial blood gases, and phrenic nerve amplitude (PhrenAmpl). Three groups were categorized: G1, normal Q10 and Q11; G2, abnormal Q10; and G3, abnormal Q10 and Q11 or only abnormal Q11. A binary logistic regression model explored independent predictors. Results We included 276 patients (153 men, onset age = 62.6 +/- 11.0 years, disease duration = 13.0 +/- 9.6 months, spinal onset in 182) with mean survival of 40.1 +/- 26.0 months. Gender, onset region, and disease duration were similar in G1 (n = 149), G2 (n = 78), and G3 (n = 49). Time to noninvasive ventilation (NIV) was shorter in G3 (p < 0.001), but survival was similar. ALSFRS-R subscores were significantly different (G1>G2>G3, p < 0.001), except for lower limb subscore (p = 0.077). G2 and G3 patients were older than G1 (p < 0.001), and had lower FVC, MIP, MEP, PhrenAmpl, and SpO(2)mean. Independent predictors for G2 were MIP and SpO(2)mean; for G3, the only independent predictor was PhrenAmpl. Conclusions These three distinct ALS phenotypic respiratory categories represent progressive stages of ventilatory dysfunction, supporting ALSFRS-R clinical relevance. Orthopnoea is a severe symptom that should prompt NIV, phrenic nerve response being an independent predictor. Early NIV promotes similar survival for G2 and G3.

Dorsal root avulsion injuries lead to loss of sensation and to reorganization of blood vessels (BVs) in the injured area. The inability of injured sensory axons to re-enter the spinal cord results in permanent loss of sensation, and often also leads to the development of neuropathic pain. Approaches that restore connection between peripheral sensory axons and their CNS targets are thus urgently need. Previous research has shown that sensory axons from peripherally grafted human sensory neurons are able to enter the spinal cord by growing along BVs which penetrate the CNS from the spinal cord surface. In this study we analysed the distribution of BVs after avulsion injury and how their pattern is affected by implantation at the injury site of boundary cap neural crest stem cells (bNCSCs), a transient cluster of cells, which are located at the boundary between the spinal cord and peripheral nervous system and assist the growth of sensory axons from periphery into the spinal cord during development. The superficial dorsal spinal cord vasculature was examined using intravital microscopy and intravascular BV labelling. bNCSC transplantation increased vascular volume in a non-dose responsive manner, whereas dorsal root avulsion alone did not decrease the vascular volume. To determine whether bNCSC are endowed with angiogenic properties we prepared 3D printed scaffolds, containing bNCSCs together with rings prepared from mouse aorta. We show that bNCSC do induce migration and assembly of endothelial cells in this system. These findings suggest that bNCSC transplant can promote vascularization in vivo and contribute to BV formation in 3D printed scaffolds.

Summary

The relationship between self-reported falls and fracture risk was estimated in an international meta-analysis of individual-level data from 46 prospective cohorts. Previous falls were associated with an increased fracture risk in women and men and should be considered as an additional risk factor in the FRAX® algorithm.

Introduction

Previous falls are a well-documented risk factor for subsequent fracture but have not yet been incorporated into the FRAX algorithm. The aim of this study was to evaluate, in an international meta-analysis, the association between previous falls and subsequent fracture risk and its relation to sex, age, duration of follow-up, and bone mineral density (BMD).

Methods

The resource comprised 906,359 women and men (66.9% female) from 46 prospective cohorts. Previous falls were uniformly defined as any fall occurring during the previous year in 43 cohorts; the remaining three cohorts had a different question construct. The association between previous falls and fracture risk (any clinical fracture, osteoporotic fracture, major osteoporotic fracture, and hip fracture) was examined using an extension of the Poisson regression model in each cohort and each sex, followed by random-effects meta-analyses of the weighted beta coefficients.

Results

Falls in the past year were reported in 21.4% of individuals. During a follow-up of 9,102,207 person-years, 87,352 fractures occurred of which 19,509 were hip fractures. A previous fall was associated with a significantly increased risk of any clinical fracture both in women (hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.33–1.51) and men (HR 1.53, 95% CI 1.41–1.67). The HRs were of similar magnitude for osteoporotic, major osteoporotic fracture, and hip fracture. Sex significantly modified the association between previous fall and fracture risk, with predictive values being higher in men than in women (e.g., for major osteoporotic fracture, HR 1.53 (95% CI 1.27–1.84) in men vs. HR 1.32 (95% CI 1.20–1.45) in women, P for interaction = 0.013). The HRs associated with previous falls decreased with age in women and with duration of follow-up in men and women for most fracture outcomes. There was no evidence of an interaction between falls and BMD for fracture risk. Subsequent risk for a major osteoporotic fracture increased with each additional previous fall in women and men.

Conclusions

A previous self-reported fall confers an increased risk of fracture that is largely independent of BMD. Previous falls should be considered as an additional risk factor in future iterations of FRAX to improve fracture risk prediction.