Introduction: Delirium is a common complication in the intensive care unit. The attention of researchers has shifted from the treatment to the prevention of the syndrome necessitating the study of associated risk factors. Methods: In a multicenter study at one university hospital, two community hospitals and one private hospital, all consecutive newly admitted adult patients were screened and included when reaching a Glasgow Coma Scale greater than 10. Nurse researchers assessed the patients for delirium using the NEECHAM Confusion Scale. Risk factors covered four domains: patient characteristics, chronic pathology, acute illness and environmental factors. Odds ratios were calculated using univariate binary logistic regression. Results: A total population of 523 patients was screened for delirium. The studied factors showed some variability according to the participating hospitals. The overall delirium incidence was 30%. Age was not a significant risk factor. Intensive smoking (OR 2.04), daily use of more than three units of alcohol (OR 3.23), and living alone at home (OR 1.94), however, contributed to the development of delirium. In the domain of chronic pathology a pre-existing cognitive impairment was an important risk factor (OR 2.41). In the domain of factors related to acute illness the use of drains, tubes and catheters, acute illness scores, the use of psychoactive medication, a preceding period of sedation, coma or mechanical ventilation showed significant risk with odds ratios ranging from 1.04 to 13.66. Environmental risk factors were isolation (OR 2.89), the absence of visit (OR 3.73), the absence of visible daylight (OR 2.39), a transfer from another ward (OR 1.98), and the use of physical restraints (OR 33.84). Conclusions: This multicenter study indicated risk factors for delirium in the intensive care unit related to patient characteristics, chronic pathology, acute illness, and the environment. Particularly among those related to the acute illness and the environment, several factors are suitable for preventive action.
Objective: To evaluate trunk performance in non-acute and chronic stroke patients by means of the Trunk Control Test and Trunk Impairment Scale and to compare the Trunk Control Test with the Trunk Impairment Scale and its subscales in relation to balance, gait and functional ability after stroke. Subjects: Fifty-one stroke patients, attending a rehabilitation programme, participated in the study. Main measures: Subjects were evaluated with the Trunk Control Test, Trunk Impairment Scale, Tinetti balance and gait subscales, Functional Ambulation Category, 10-m walk test, Timed Up and Go Test and motor part of the Functional Independence Measure. Results: Participants obtained a median score of 61 out of 100 on the Trunk Control Test and 11 out of 23 for the Trunk Impairment Scale. Twelve participants (24%) obtained the maximum score on the Trunk Control Test; no subject reached the maximum score on the Trunk Impairment Scale. Measures of trunk performance were significantly related with values of balance, gait and functional ability. Multivariate linear regression analysis showed an additional, significant contribution of the dynamic sitting balance subscale of the Trunk Impairment Scale in addition to the Trunk Control Test total score for measures of gait and functional ability (model R2 = 0.55-0.62). Conclusions: This study clearly indicates that trunk performance is still impaired in non-acute and chronic stroke patients. When planning future follow-up studies, use of the Trunk Impairment Scale has the advantage that it has no ceiling effect.
1 February 2010 in Archives of Physical Medicine and Rehabilitation
The purpose of this study was to provide age specific normative data of clinical gait and balance tests and to determine to what extent gender contributes to differences in postural control. Standing balance and walking performance was tested in 318 asymptomatic adults. The logistic regression, using both 10- and 30-second time limits as a dichotomization point, revealed a significant age effect for standing on foam with eyes closed, tandem Romberg with eyes closed (TR-EC), and one leg stance (eyes open and closed). The actual effect of decline was different for each test. Both tandem gait and dynamic gait index showed a ceiling effect up to 60 years of age, with a rapid decline of performance for subjects in their seventies. Linear regression equations indicated that for both men and women, timed up and go test (TUG) times increased with age, but even older subjects should perform the TUG in 10 seconds or less. Women performed significantly poorer on the TUG and TR-EC (30-second time limit).
1 August 2010 in Archives of Physical Medicine and Rehabilitation
(1) Background: Marker-based 3D motion capture systems (MBS) are considered the gold standard in gait analysis. However, they have limitations for which markerless camera-based 3D motion capture systems (MCBS) could provide a solution. The aim of this systematic review and meta-analysis is to compare the accuracy, validity, and reliability of MCBS and MBS. (2) Methods: A total of 2047 papers were systematically searched according to PRISMA guidelines on 7 February 2024, in two different databases: Pubmed (1339) and WoS (708). The COSMIN-tool and EBRO guidelines were used to assess risk of bias and level of evidence. (3) Results: After full text screening, 22 papers were included. Spatiotemporal parameters showed overall good to excellent accuracy, validity, and reliability. For kinematic variables, hip and knee showed moderate to excellent agreement between the systems, while for the ankle joint, poor concurrent validity and reliability were measured. The accuracy and concurrent validity of walking speed were considered excellent in all cases, with only a small bias. The meta-analysis of the inter-rater reliability and concurrent validity of walking speed, step time, and step length resulted in a good-to-excellent intraclass correlation coefficient (ICC) (0.81; 0.98). (4) Discussion and conclusions: MCBS are comparable in terms of accuracy, concurrent validity, and reliability to MBS in spatiotemporal parameters. Additionally, kinematic parameters for hip and knee in the sagittal plane are considered most valid and reliable but lack valid and accurate measurement outcomes in transverse and frontal planes. Customization and standardization of methodological procedures are necessary for future research to adequately compare protocols in clinical settings, with more attention to patient populations.