Francesca Cecchi

Does the Clock Drawing Test Predict Cognitive Decline in Older Persons Independent of the Mini-Mental State Examination?

OBJECTIVE: To evaluate the value of the Clock Drawing Test (CDT) in predicting cognitive deterioration over a 4‐year period, independent of baseline cognitive status evaluated by the Mini‐Mental State Examination (MMSE).

Epidemiology of back pain in a representative cohort of italian persons 65 years of age and older : The InCHIANTI study

Study Design. Clinico-epidemiologic study in the Chianti area (Tuscany, Italy). Objectives. To describe prevalence and correlates of back pain in a representative sample of the population. Summary of Background Data. Back pain is common in old age and is related to functional limitations, but back pain characteristics and correlates in older adults, which may be targeted by specific interventions, are still underinvestigated. Methods. A total of 1,299 persons aged 65 or older were selected from the city registry of Greve in Chianti and Bagno a Ripoli; 1,008 (565 women; 443 men) were included in this analysis. Back pain in the past 12 months was ascertained using a questionnaire. Potential correlates of back pain were identified in age- and sex-adjusted regression analyses, and their independent association with back pain was tested in a multivariate model. Results. The prevalence of frequent back pain was 31.5%. Back pain was reported less often by men and the very old, was primarily located in the dorsolumbar and lumbar spine, was moderate in intensity and mainly elicited by carrying, lifting, and pushing heavy objects. Among participants who reported frequent back pain, 76.3% had no back pain-related impairments; 7.4% of the overall study population had back pain-related functional limitation. Back pain participants were significantly more likely to report difficulty in heavy household chores, carrying a shopping bag, cutting toenails, and using public transportation. Limited trunk extension, depression, low levels of prior-year physical activity, and hip, knee, and foot pain were independent correlates of back pain. Conclusions. Frequent back pain is highly prevalent in the older population and is often associated with conditions that are potentially reversible.

Spinal manipulation compared with back school and with individually delivered physiotherapy for the treatment of chronic low back pain: a randomized trial with one-year follow-up

Objective: To compare spinal manipulation, back school and individual physiotherapy in the treatment of chronic low back pain. Design: Randomized trial, 12-month follow-up. Setting: Outpatient rehabilitation department. Participants: 210 patients with chronic, non-specific low back pain, 140/210 women, age 59 ± 14 years. Interventions: Back school and individual physiotherapy scheduled 15 1-hour-sessions for 3 weeks. Back school included: group exercise, education/ ergonomics; individual physiotherapy: exercise, passive mobilization and soft-tissue treatment. Spinal manipulation, given according to Manual Medicine, scheduled 4 to 6 20’-sessions once-a-week. Outcome: Roland Morris Disability Questionnaire (scoring 0-24) and Pain Rating Scale (scoring 0-6) were assessed at baseline, discharge 3, 6, and 12 months. Results: 205 patients completed the study. At discharge, disability score decreased by 3.7 ± 4.1 for back school, 4.4 ± 3.7 for individual physiotherapy, 6.7 ± 3.9 for manipulation; pain score reduction was 0.9 ± 1.1, 1.1 ± 1.0, 1.0 ± 1.1, respectively. At 12 months, disability score reduction was 4.2 ± 4.8 for back school, 4.0 ± 5.1 for individual physiotherapy, 5.9 ± 4.6 for manipulation; pain score reduction was 0.7 ± 1.2, 0.4 ± 1.3, and 1.5 ± 1.1, respectively. Spinal manipulation was associated with higher functional improvement and long-term pain relief than back school or individual physiotherapy, but received more further treatment at follow-ups (P<0.001); pain recurrences and drug intake were also reduced compared to back school (P <0.05) or individual physiotherapy (P <0.001). Conclusions: Spinal manipulation provided better short and long-term functional improvement, and more pain relief in the follow-up than either back school or individual physiotherapy.

From Chronic Low Back Pain to Disability, a Multifactorial Mediated Pathway: The InCHIANTI Study

Study Design. Clinicoepidemiologic study in the Chianti area (Tuscany, Italy). Objective. To evaluate whether performance measures of lower extremity function confounds the association of low back pain (LBP) with self-report disability in specific basic and instrumental activities of daily living (IADLs). Summary of Background Data. LBP is high prevalent in older population and has a negative impact on functional status. Studies on the pathway leading from LBP to disability are limited and often the role played by important confounders is not considered. Methods. A total of 956 InCHIANTI study participants aged 65 and older able to complete performance-based tests of lower extremity function were included in this analysis. LBP was defined as a self-report of back pain “quite often-almost every day” in the past 12 months. Lower extremity function was evaluated administering the Short Physical Performance Battery. In addition, participants were asked to walk on a 7-m course and collect an object from the ground. Depressive symptoms (CES-D score), trunk flexion–extension range of motion, and hip–knee–foot pain were also considered in the pathway from LBP to disability. Results. Compared with participants who did not report LBP, those with LBP were more likely to report difficulty in performing most activities of daily living. LBP was also associated with disability in the activities of bathing, doing the laundry, performing heavy household chores, cutting toenails, shopping, and carrying a shopping bag. The association between LBP and disability in selected ADLs and IADLs was no longer statistical significant, after adjustment for performance in lower extremity function, with exception of the activity of “carrying a shopping bag”. Conclusion. The cross-sectional association between LBP and self-reported disability, in specific tasks is modulated by performance measures. Specific performance-based tests that explore the functional consequences of LBP may help design specific interventions of disability prevention and treatment in patients with LBP.

Measures of Physical Performance Capture the Excess Disability Associated With Hip Pain or Knee Pain in Older Persons

BACKGROUNDnHip pain (HP) and knee pain (KP) may specifically affect function and performance; few studies investigate the functional impact of HP or KP in the same population.nnnMETHODSnPopulation-based sample of older individuals living in the Chianti area (Tuscany, Italy) (1998-2000); 1006 persons (564 women and 442 men) were included in this analysis; 11.9% reported HP and 22.4% reported KP in the past 4 weeks. Self-reported disability and lower extremity performance, measured by 400-m walk test and by the short physical performance battery (SPPB, including standing balance, chair raising, and 4-m walk test), were compared in participants reporting HP or KP versus those free of these conditions; the relationship of HP or KP with performance and self-reported disability was studied, adjusting for age, sex, hip or knee flexibility, muscle strength, multiple joint pain, major medical conditions, and depression.nnnRESULTSnParticipants reporting HP were more likely to report disability in shopping, cutting toenails, carrying a shopping bag, and using public transportation; those with KP reported more disability in cutting toenails and carrying a shopping bag. Participants reporting HP or KP had significantly lower SPPB scores. Adjusting by SPPB, pain no longer predicted self-reported disability, except for HP-carrying a shopping bag.nnnCONCLUSIONSnIn our cohort of older persons, those with HP reported disability in a wider range of activities than those with KP. Physical performance measured by SPPB was impaired in both conditions. Reduced lower extremity performance captures the excess disability associated with either HP or KP.

Higher circulating levels of uric acid are prospectively associated with better muscle function in older persons.

BACKGROUNDnPrevious studies have shown that oxidative protein damage is independently associated with low grip strength and that dietary intake and circulating levels of antioxidant vitamins are positive predictors of muscle strength among older persons. Since uric acid (UA), has strong antioxidant properties, we tested the hypothesis that UA levels is cross-sectionaly associated with muscle strength and protective against the decline of strength over the aging process.nnnSUBJECTS AND METHODSn789 InCHIANTI Study participants underwent baseline serum UA, handgrip and knee extension torque measurements. Of these, 497 participants (226 men and 271 women, mean age 76.0+/-5.4 years) also had follow-up strength measures. Lifestyle, comorbidities, nutritional profile, inflammatory markers and other laboratory measures were considered as potential confounders.nnnRESULTSnFollow-up strength measures significantly increased across baseline UA tertiles. After adjusting for potential confounders and analogous baseline strength measures, higher baseline UA levels still remained significantly associated with higher follow-up strength measures.nnnCONCLUSIONSnOur findings suggest that higher levels of UA might represent a protective reaction aimed at counteracting the excessive production of free radicals that cause muscle protein damage and eventually contribute to the decline of muscle mass and strength.

One-year adherence to exercise in elderly patients receiving postacute inpatient rehabilitation after cardiac surgery.

Macchi C, Polcaro P, Cecchi F, Zipoli R, Sofi F, Romanelli A, Pepi L, Sibilio M, Lipoma M, Petrilli M, Molino-Lova R: One-year adherence to exercise in elderly patients receiving postacute inpatient rehabilitation after cardiac surgery. Objective: Promoting an active lifestyle through an appropriate physical exercise prescription is one of the major targets of cardiac rehabilitation. However, information on the effectiveness of cardiac rehabilitation in promoting lifestyle changes in elderly patients is still scant. Design: In 131 patients over the age of 65 yrs (86 men, and 45 women, mean age 75 yrs ± 6 SD) who have attended postacute inpatient cardiac rehabilitation after cardiac surgery, we tested the 1-yr adherence to the physical exercise prescription received at the end of the cardiac rehabilitation by using a questionnaire on physical activity and the 6-min walk test. Results: All of the 36 patients who reported an active lifestyle and 49 of the 95 patients who reported a sedentary lifestyle in the year preceding the cardiac operation reported at least 1 hr/day on 5 days each week of light regular physical activity in the year after the cardiac rehabilitation. Further, the distance walked at the follow-up 6-min walk test was significantly related to the physical activity score gathered from the questionnaire. Conclusions: Our data show that 65% of the elderly patients who have attended postacute inpatient cardiac rehabilitation after cardiac surgery are still capable of recovering or even increasing their regular physical activity and of maintaining these favorable lifestyle changes at least for 1 yr.

Effects of a structured physical activity intervention on measures of physical performance in frail elderly patients after cardiac rehabilitation: a pilot study with 1-year follow-up

The objective of this prospective randomized controlled study was to compare the long-term effects of a structured physical activity intervention with those of aerobic exercises alone, in a cohort of elderly patients who had undergone elective cardiac surgery, and who were classified as frail at the end of rehabilitation based on their Short Physical Performance Battery (SPPB) score. At the end of rehabilitation, 140 frail elderly patients were randomly allocated either to the intervention group (IG) or to the control group (CG). CG participants received the usual aerobic exercise prescription, while IG participants were also taught additional exercises for strength, flexibility, balance and coordination. The improvement in SPPB score after 1xa0year was the outcome of the study. IG showed a significant improvement in SPPB score (9.0xa0±xa01.1 vs. 7.7xa0±xa01.4, pxa0<xa00.001), while no significant change was found in CG (7.7xa0±xa01.6 vs. 7.6xa0±xa01.5, pxa0=xa00.252). IG also showed a significantly higher proportion of participants who improved their SPPB score of at least 1 point (70 vs. 37%, pxa0<xa00.001). In conclusions, our structured physical activity intervention significantly improves the SPPB score in frail elderly patients who have undergone elective cardiac surgery. An intervention that improves the SPPB score might delay the occurrence of mobility disability.

Postacute rehabilitation after coronary surgery: The effect of preoperative physical activity on the incidence of paroxysmal atrial fibrillation

Objective: Postoperative atrial fibrillation (AF) is a frequent complication after cardiac surgery. AF may also occur after hospital discharge during postacute rehabilitation. Several studies have addressed the AF that occurs in the hospital after surgery, and predictors have already been identified. Postoperative AF that occurs after hospital discharge has not been investigated thoroughly, and predictors are still unknown. In this study, we hypothesized that moderate-intensity physical activity in the year before surgery might favorably affect the incidence of AF during postacute rehabilitation. Design: We tested our hypothesis in a cohort of 158 older patients admitted to a medical rehabilitation facility for postacute inpatient rehabilitation after coronary surgery and continuously monitored by telemetry for the duration of the rehabilitation. Results: Independent of potential confounders, patients who reported low-intensity physical activity in the year before surgery showed a significantly higher incidence of AF during postacute rehabilitation when compared with those who reported moderate-intensity physical activity (32.1% vs. 8.1%; P = 0.029). Other independent predictors of AF during postacute rehabilitation were the occurrence of AF during the patients stay in hospital, larger left atrial volume, and lower left atrial emptying fraction. Conclusions: These findings confirm our hypothesis that physical activity in the year before surgery affects the incidence of postoperative AF during postacute rehabilitation. The results also provide information regarding possible predictors that may assist in identifying patients who could benefit from preventive treatments.

Item re-scaling of an Italian version of the sickness impact profile: effect of age and profession of the observers.

An Italian version of the Sickness Impact Profile (SIP) obtained by professional and nonprofessional translators was checked for cross-cultural equivalence using a back-translation method followed by two scaling studies. The first scaling study involved 30 health professionals who ranked the items within each category for severity of dysfunction. By comparing Italian and US average ranks, 14 highly discordant items were identified. A revised translation was evaluated in a new study involving 120 observers stratified by age (< 65 versus > or = 65 years) and profession (health versus non health professionals) into 4 groups of the same size. The Italian and American item rank orders were almost equivalent, independently of the age and profession of the observers (93% of the ranks showing differences < 2), suggesting that this Italian version of SIP is cross-culturally unbiased. However, older age was associated with higher variability in the rank orders, and some caution is required for use in the geriatric population.