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This retrospective cohort study examined the effects of undernutrition on swallowing function and activities of daily living in hospitalized patients. Data from the Japanese Sarcopenic Dysphagia Database were used, and hospitalized patients aged ≥20 years with dysphagia were included in the analysis. Participants were assigned to the undernutrition or normal nutritional status group based on the Global Leadership Initiative on Malnutrition criteria. The primary outcome was the Food Intake Level Scale change, and the secondary outcome was the Barthel Index change. Among 440 residents, 281 (64%) were classified under the undernutrition group. The undernutrition group had a significantly higher Food Intake Level Scale score at baseline and Food Intake Level Scale change (p = 0.001) than the normal nutritional status group. Undernutrition was independently associated with the Food Intake Level Scale change (B = −0.633, 95% confidence interval = −1.099 to −0.167) and the Barthel Index change (B = −8.414, 95% confidence interval = −13.089 to −3.739). This was defined as the period from the date of admission to the hospital until discharge or 3 months later. Overall, our findings indicate that undernutrition is associated with reduced improvement in swallowing function and the ability to perform activities of daily living.

Purpose Increasing life expectancy and rising populations create new challenges for science, economy, politics, society and each individual. The bio-functional status (BFS) as a theoretical model incorporates the International Classification of Functioning (ICF) and the concept of active and healthy ageing (AHA). This study addresses the question of which the strengths and resources have the greatest positive impact on bio-functional age (BFA) and might be influencable. Methods A monocenter, cross-sectional, observational, non-interventional trial was performed from 2012 to 2014 at Inselspital Bern to evaluate the BFS, a complex, generic, non-invasive, sex- and age-validated assessment tool. A standardized battery of assessments was performed on 464 females and 166 males, aged 18 to 65 years ( n  = 630). We aimed to statistically identify BFS items that might be influenceable to support healthy ageing and vitality. Results 341 participants of the original cohort were included. After carrying out regression analysis, 10 parameters ( T  = 8.992; p  < 0.001) remained as possible variables that can be influenced ( R 2  = 0.758). Of those identified parameters, one can be assigned to subcategory I of BFS (pulse performance index), two to II (tapping frequency part I and II), two to III (strategy building and verbal reaction time) and three to IV [sense of coherence, social potency, complaint questionnaire (BFB total)]. Age and sex, nevertheless, have an influence on the BFA and the BFA-Index. Conclusion The most promising approach to support vitality, is to support low social stress, high social integration, a good sense of coherence and maintaining a good mental and cognitive status.

Purpose To investigate the association of paraspinal muscle quantity and quality with functional status in patients with lumbar spinal stenosis (LSS) and explore whether degeneration of paraspinal muscle could predict patients’ functional recovery. Methods The data of 69 patients (26 males, 43 females; mean age 60.6 ± 9.4 years) with LSS was reviewed. The total cross-sectional area (tCSA), functional cross-sectional area (fCSA), and fatty infiltration (FI) of paraspinal muscle were measured. The Oswestry Disability Index (ODI) scores were used to reflect patients’ functional status. Correlations between measurements of paraspinal muscle and ODI scores were investigated by the Pearson correlation analysis. The multiple linear regression analysis was used to explore the correlation between change of ODI and other potential influence factors. Receiver operating characteristic curve was used to find out the most optimum cut-off value for predicting functional recovery. Results The pre-operation ODI was significantly associated with multifidus muscle (MF) fCSA ( r = − 0.304, p = 0.012), while the post-operation ODI was significantly correlated to MF FI ( r = 0.407, p < 0.01). Preoperative MF FI was an independent influence factor for change of ODI. The best cut-off value of preoperative MF FI to predict improvement of functional status (change of ODI > 50%) was 33%. Conclusion The preoperative degeneration of MF was significantly associated with patients’ functional status. Preoperative MF FI was a good predictor for assessing improvement of patients’ functional status. Evaluation of paraspinal muscle before operation could be helpful for surgeons to predict patients’ functional status and recovery.

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease that causes progressive autonomy loss and need for care. This does not only affect patients themselves, but also the patients’ informal caregivers (CGs) in their health, personal and professional lives. The big efforts of this multi-center study were not only to evaluate the caregivers’ burden and to identify its predictors, but it also should provide a specific understanding of the needs of ALS patients’ CGs and fill the gap of knowledge on their personal and work lives. Using standardized questionnaires, primary data from patients and their main informal CGs (n = 249) were collected. Patients’ functional status and disease severity were evaluated using the Barthel Index, the revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) and the King’s Stages for ALS. The caregivers’ burden was recorded by the Zarit Burden Interview (ZBI). Comorbid anxiety and depression of caregivers were assessed by the Hospital Anxiety and Depression Scale. Additionally, the EuroQol Five Dimension Five Level Scale evaluated their health-related quality of life. The caregivers’ burden was high (mean ZBI = 26/88, 0 = no burden, ≥24 = highly burdened) and correlated with patients’ functional status (rp = −0.555, p < 0.001, n = 242). It was influenced by the CGs’ own mental health issues due to caregiving (+11.36, 95% CI [6.84; 15.87], p < 0.001), patients’ wheelchair dependency (+9.30, 95% CI [5.94; 12.66], p < 0.001) and was interrelated with the CGs’ depression (rp = 0.627, p < 0.001, n = 234), anxiety (rp = 0.550, p < 0.001, n = 234), and poorer physical condition (rp = −0.362, p < 0.001, n = 237). Moreover, female CGs showed symptoms of anxiety more often, which also correlated with the patients’ impairment in daily routine (rs = −0.280, p < 0.001, n = 169). As increasing disease severity, along with decreasing autonomy, was the main predictor of caregiver burden and showed to create relevant (negative) implications on CGs’ lives, patient care and supportive therapies should address this issue. Moreover, in order to preserve the mental and physical health of the CGs, new concepts of care have to focus on both, on not only patients but also their CGs and gender-associated specific issues. As caregiving in ALS also significantly influences the socioeconomic status by restrictions in CGs’ work lives and income, and the main reported needs being lack of psychological support and a high bureaucracy, the situation of CGs needs more attention. Apart from their own multi-disciplinary medical and psychological care, more support in care and patient management issues is required.

BackgroundAdvancements in cancer treatment have resulted in longer survival but often at the expense of new therapy-associated morbidities. The aim of this study is to evaluate functional outcomes of hemato-oncology patients at PICU discharge, and to identify associated risk factors.MethodsA single-center retrospective observational study. All children (< 19 years) with a hemato-oncology diagnosis admitted to the Hong Kong Children’s Hospital PICU over a 2-year period were included. Functional status upon admission and discharge were compared. Univariable and multi-variable analyses were employed to identify risk factors associated with new morbidities.ResultsOut of 288 PICU admissions, there were 277 live discharges (mortality 4%), of which 52 (18.8%) developed new morbidities. Emergency admission, severity of illness at admission, organ dysfunction and support were associated with new morbidities (OR 1.08–11.96; p < 0.05). Adjusting for confounding factors, higher Pediatric Logistic Organ Dysfunction 2 score at admission was significantly associated with development of new morbidities (OR 1.34; 95% CI 1.18–1.54; p < 0.001).ConclusionCritically ill children with hemato-oncological diseases had a higher rate of developing new morbidities (18.8%) compared with the general PICU population (4–8%). This was associated with severity of illness at admission. Further work is warranted to understand the lasting effects of these new morbidities and mitigating interventions.

To investigate functional outcomes in children who survived extracorporeal life support at 12 months follow-up post-discharge. Some patients who require extracorporeal life support acquire significant morbidity during their hospitalisation. The Functional Status Scale is a validated tool that allows quantification of paediatric function. A retrospective study that included children placed on extracorporeal life support at a quaternary children's hospital between March 2020 and October 2021 and had follow-up encounter within 12 months post-discharge. Forty-two patients met inclusion criteria: 33% female, 93% veno-arterial extracorporeal membrane oxygenation (VA ECMO), and 12% with single ventricle anatomy. Median age was 1.7 years (interquartile range 10 days-11.9 years). Median hospital stay was 51 days (interquartile range 34-91 days), and median extracorporeal life support duration was 94 hours (interquartile range 56-142 hours). The median Functional Status Scale at discharge was 8.0 (interquartile range 6.3-8.8). The mean change in Functional Status Scale from discharge to follow-up at 9 months (n = 37) was -0.8 [95% confidence interval (CI) -1.3 to -0.4, < 0.001] and at 12 months (n = 34) was -1 (95% confidence interval -1.5 to -0.4, < 0.001); the most improvement was in the feeding score. New morbidity (Functional Status Scale increase of ≥3) occurred in 10 children (24%) from admission to discharge. Children with new morbidity were more likely to be younger ( = 0.01), have an underlying genetic syndrome ( = 0.02), and demonstrate evidence of neurologic injury by electroencephalogram or imaging ( = 0.05). In survivors of extracorporeal life support, the Functional Status Scale improved from discharge to 12-month follow-up, with the most improvement demonstrated in the feeding score.

Most hospitalized COVID-19 pneumonia patients are older adults and/or have nutrition-related issues. Many are bedridden in intensive care units (ICU), a well-documented cause of malnutrition, muscle wasting, and functional impairment. Objectives: To assess the effectiveness of an intensive rehabilitation program over the nutritional/functional status of patients recovering from COVID-19 pneumonia. Post-COVID-19 pneumonia patients underwent a 30-day intensive interdisciplinary rehabilitation program including a personalized nutritional intervention designed to achieve a minimum intake of 30 kcal/kg/day and 1 g protein/kg/day. The nutritional and functional status was assessed in each patient at three different moments. Each assessment included Body Mass Index (BMI), Mid Upper Arm Circumference (MUAC), Mid Arm Muscle Circumference (MAMC), Tricipital Skinfold (TSF), Hand Grip Strength (HGS), and Mini Nutritional Assessment (MNA®). The study included 118 patients, with ages in the range 41–90 years old. BMI increased linearly over time (0.642 units, F-test = 26.458, p < 0.001). MUAC (0.322 units, F-test = 0.515, p = 0.474) and MAMC status (F-test = 1.089, p = 0.299) improved slightly, whereas TSF decreased (F-test = 1.885, p = 0.172), but all these arm anthropometry trends did not show significant variations, while HGS (4.131 units, F-test = 82.540, p < 0.001) and MNA® (1.483 units, F-test = 217.726, p < 0.001) reported a meaningful improvement. Post-COVID-19 pneumonia patients presented malnutrition and functional impairment. An interdisciplinary rehabilitation program, including personalized nutritional intervention, was effective for post-hospital COVID-19 pneumonia nutritional/functional rehabilitation.

Purpose The modified Rankin scale (mRS) is frequently used in the emergency setting to estimate pre-stroke functional status in stroke patients who are candidates to acute revascularization therapies (ps-mRS). We aimed to describe the agreement between pre-stroke mRS evaluated in the emergency department (ED-ps-mRS) and pre-stroke mRS evaluated comprehensively post-admission (PA-ps-mRS). Methods Retrospective study of consecutive ischemic stroke patients undergoing mechanical thrombectomy, with available ED-ps-mRS and PA-ps-mRS. ED-ps-mRS was evaluated by the treating neurologist and documented in the emergency stroke treatment protocol. PA-ps-mRS was retrospectively evaluated with information registered in the clinical record. Collection of baseline characteristics and 3‑month outcomes. Patients with ED-overestimated pre-stroke functional status (ED ps-mRS ≤ 2 and PA-ps-mRS ≥ 3) were compared to correct low and high ED-ps-mRS groups. Results We included 409 patients (median age 77 years, 50% female, median NIHSS 14). Concordance of dichotomized ED-ps-mRS and PA-ps-mRS (0–2 vs. 3–5) was found in 81.4% (Cohen’s kappa = 0.476, p  < 0.001). ED-overestimated pre-stroke functional status was found in 69 patients (17%). Patients with ED-overestimated pre-stroke functional status were older ( p  < 0.001), more frequently presented diabetes ( p  < 0.001), previous stroke ( p  = 0.014) and less frequently presented 3‑month functional independence ( p  < 0.001) compared to patients with correct low ED-ps-mRS. No differences in pre-stroke baseline characteristics between overestimated and correct high ED-ps-mRS was found. Conclusion Disagreement between dichotomized ED-ps-mRS and PA-ps-mRS (0–2 vs. 3–5) occurred in 1/5 of patients. Overestimation of pre-stroke functional status may falsely reduce the expected proportion of patients achieving favourable 3‑month functional outcomes.

Background and Aims Long COVID (LC) is a condition characterized by the persistence of physical or psychological symptoms after acute SARS‐CoV‐2 infection. While its pathophysiology remains unclear, it is essential to identify acute‐phase risk factors associated with its development. This study aimed to investigate the association between symptoms during acute COVID‐19 and the risk of developing LC, and to evaluate the impact of LC on functional status in a nonhospitalized population. Methods A retrospective observational case‐control study was conducted between May 2022 and March 2024 including 434 participants with confirmed SARS‐CoV‐2 infection. Participants were classified as cases (those with LC; n = 226) or controls (those without LC; n = 208). Data were collected using a structured electronic form, including self‐reported sociodemographic, clinical, and lifestyle information. Severity and number of acute symptoms were recorded. Functional status was assessed using the Post‐COVID functional status (PCFS) Scale. Logistic and linear regression analyses were performed to explore associations, adjusted for potential confounders. Results Severe acute COVID‐19 (defined as pneumonia or hospitalization) was associated with a significantly increased risk of LC (adjusted OR = 7.22; 95% CI: 2.79–18.70). Additionally, each additional symptom during the acute phase increased the odds of LC by 52% (adjusted OR = 1.52; 95% CI: 1.35–1.77). Dyspnea and chest pain were the symptoms most strongly associated with LC. Conclusion The severity and symptom burden of acute COVID‐19 are strongly associated with the development of LC and with long‐term functional impairment. These findings highlight the importance of early identification and follow‐up in patients with severe initial COVID‐19 symptoms.

Previous studies have reported a close relationship between nutritional and functional domains, but evidence in long-term care residents is still limited. We evaluated the relationship between nutritional risk and functional status and the association of these two domains with mortality in newly institutionalised elderly. In the present multi-centric prospective cohort study, involving 346 long-term care resident elderly, nutritional risk and functional status were determined upon admission by the Geriatric Nutritional Risk Index (GNRI) and the Barthel Index (BI), respectively. The prevalence of high (GNRI < 92) and low (GNRI 92–98) nutritional risk were 36·1 and 30·6 %, respectively. At multivariable linear regression, functional status was independently associated with age (P= 0·045), arm muscle area (P= 0·048), the number of co-morbidities (P= 0·027) and mainly with the GNRI (P< 0·001). During a median follow-up of 4·7 years (25th–75th percentile 3·7–6·2), 230 (66·5 %) subjects died. In the risk analysis, based on the variables collected at baseline, both high (hazard ratio (HR) 1·86, 95 % CI 1·32, 2·63; P< 0·001) and low nutritional risk (HR 1·52, 95 % CI 1·08, 2·14; P= 0·016) were associated with all-cause mortality. Participants at high nutritional risk (GNRI < 92) also showed an increased rate of cardiovascular mortality (HR 1·93, 95 % CI 1·28, 2·91; P< 0·001). No association with outcome was found for the BI. Upon admission, nutritional risk was an independent predictor of functional status and mortality in institutionalised elderly. Present data support the concept that the nutritional domain is more relevant than functional status to the outcome of newly institutionalised elderly.