2024
Life's Essential 8 and Poor Brain Health Outcomes in Middle-Aged Adults
Clocchiatti-Tuozzo S, Rivier C, Renedo D, Huo S, Hawkes M, de Havenon A, Schwamm L, Sheth K, Gill T, Falcone G. Life's Essential 8 and Poor Brain Health Outcomes in Middle-Aged Adults. Neurology 2024, 103: e209990. PMID: 39442069, PMCID: PMC11498939, DOI: 10.1212/wnl.0000000000209990.Peer-Reviewed Original ResearchConceptsLife's Essential 8Poor cardiovascular healthCardiovascular healthBrain healthLife's Essential 8 scoreUnadjusted riskEssential 8Determinants of cardiovascular healthUK Biobank (UKBCardiovascular health profileModifiable cardiovascular risk factorsBrain health outcomesRisk factorsComposite outcomePublic health constructsPopulation studiesMiddle-aged adultsCox modelLate-life depressionCox proportional hazards modelsBrain health benefitsMultivariate Cox modelCardiovascular risk factorsFollow-up timeAoU participantsIn-Hospital Delirium and Disability and Cognitive Impairment After COVID-19 Hospitalization
Kaushik R, McAvay G, Murphy T, Acampora D, Araujo K, Charpentier P, Chattopadhyay S, Geda M, Gill T, Kaminski T, Lee S, Li J, Cohen A, Hajduk A, Ferrante L. In-Hospital Delirium and Disability and Cognitive Impairment After COVID-19 Hospitalization. JAMA Network Open 2024, 7: e2419640. PMID: 38954414, PMCID: PMC11220565, DOI: 10.1001/jamanetworkopen.2024.19640.Peer-Reviewed Original ResearchConceptsIn-hospital deliriumChart-Based Delirium Identification InstrumentOlder adultsFunctional disabilityCOVID-19 hospitalizationCognitive impairmentCohort studyAssociated with increased functional disabilityHospitalized older adultsIncreased functional disabilityAssociation of deliriumPostdischarge follow-upRisk of deliriumTertiary care systemFollow-upPresence of cognitive impairmentProspective cohort studyLogistic regression modelsOlder survivorsCare systemIncreasing cognitive impairmentMain OutcomesCOVID-19Hospital dischargePrimary outcomeSocial Determinants of Health and Delivery of Rehabilitation to Older Adults During ICU Hospitalization
Jain S, Murphy T, Falvey J, Leo-Summers L, O’Leary J, Zang E, Gill T, Krumholz H, Ferrante L. Social Determinants of Health and Delivery of Rehabilitation to Older Adults During ICU Hospitalization. JAMA Network Open 2024, 7: e2410713. PMID: 38728030, PMCID: PMC11087837, DOI: 10.1001/jamanetworkopen.2024.10713.Peer-Reviewed Original ResearchConceptsSocial determinants of healthDeterminants of healthOccupational therapyPhysical therapyOlder adultsRural residentsIntensive care unit hospitalizationRehabilitation deliveryIntensive care unitSocial determinantsSocioeconomic disadvantageNational Health and Aging Trends StudyDelivery of physical therapyIllness hospitalizationFactors associated with lower oddsDelivery of rehabilitationIn-hospital rehabilitationMitigate functional declineMedicaid eligibilityBurden of disabilityHigh school educationDual MedicareTrends StudyMedicare claimsLength of stayAssociations of Social Support With Physical and Mental Health Symptom Burden After COVID-19 Hospitalization Among Older Adults
Lee S, McAvay G, Geda M, Chattopadhyay S, Acampora D, Araujo K, Charpentier P, Gill T, Hajduk A, Cohen A, Ferrante L. Associations of Social Support With Physical and Mental Health Symptom Burden After COVID-19 Hospitalization Among Older Adults. The Journals Of Gerontology Series A 2024, 79: glae092. PMID: 38558166, PMCID: PMC11059296, DOI: 10.1093/gerona/glae092.Peer-Reviewed Original ResearchConceptsLow social supportMental health symptomsSocial supportSymptom burdenHealth symptomsFollow-up assessmentCOVID-19 hospitalizationMedical Outcomes Study Social Support SurveyPhysical symptomsAssociation of social supportEdmonton Symptom Assessment SystemPatient Health Questionnaire-4Burden of physical symptomsMental health symptom burdenModified Edmonton Symptom Assessment SystemSocial Support SurveyParticipants' mean ageAssociated with higher burdenSupport SurveyOlder survivorsSymptom managementOlder AdultsMental healthHispanic ethnicityLongitudinal associationsNational Estimates of Short- and Longer-Term Hospital Readmissions After Major Surgery Among Community-Living Older Adults
Wang Y, Leo-Summers L, Vander Wyk B, Davis-Plourde K, Gill T, Becher R. National Estimates of Short- and Longer-Term Hospital Readmissions After Major Surgery Among Community-Living Older Adults. JAMA Network Open 2024, 7: e240028. PMID: 38416499, PMCID: PMC10902728, DOI: 10.1001/jamanetworkopen.2024.0028.Peer-Reviewed Original ResearchConceptsCenters for Medicare & Medicaid ServicesFee-for-serviceMedicare Advantage beneficiariesHospital readmissionUS residentsNational Health and Aging Trends Study dataCommunity-living older adultsProspective longitudinal cohort studyCommunity-living participantsRate of hospital readmissionLikelihood of hospital readmissionPopulation-based estimatesNationally representative estimatesSex-adjusted modelsCommunity-livingData linkageGeriatric conditionsMedicaid ServicesOlder personsOlder adultsMain OutcomesNational estimatesRepresentative estimatesData analysisCohort study
2023
Association of Poor Oral Health With Neuroimaging Markers of White Matter Injury in Middle-Aged Participants in the UK Biobank.
Rivier C, Renedo D, de Havenon A, Sunmonu N, Gill T, Payabvash S, Sheth K, Falcone G. Association of Poor Oral Health With Neuroimaging Markers of White Matter Injury in Middle-Aged Participants in the UK Biobank. Neurology 2023, 102: e208010. PMID: 38165331, PMCID: PMC10870735, DOI: 10.1212/wnl.0000000000208010.Peer-Reviewed Original ResearchConceptsPoor oral healthOral healthBrain healthRisk factorsNeuroimaging markerWMH volumeHealth profileMD scoreSelf-reported poor oral healthCross-sectional neuroimaging studiesFractional anisotropyWhite matter hyperintensity volumeModifiable risk factorsWhite matter injuryPresence of denturesMendelian randomizationMiddle-aged personsFA scoreMiddle-aged participantsLoose teethCardiovascular diseaseHyperintensity volumeBrain MRIModifiable processEarly interventionComparisons Between GPS-based and Self-reported Life-space Mobility in Older Adults.
Bai C, Zapata R, Karnati Y, Smail E, Hajduk A, Gill T, Ranka S, Manini T, Mardini M. Comparisons Between GPS-based and Self-reported Life-space Mobility in Older Adults. AMIA Annual Symposium Proceedings 2023, 2022: 212-220. PMID: 37128363.Peer-Reviewed Original ResearchDistressing symptoms after major surgery among community‐living older persons
Gill T, Han L, Murphy T, Feder S, Gahbauer E, Leo‐Summers L, Becher R. Distressing symptoms after major surgery among community‐living older persons. Journal Of The American Geriatrics Society 2023, 71: 2430-2440. PMID: 37010784, PMCID: PMC10524276, DOI: 10.1111/jgs.18357.Peer-Reviewed Original ResearchConceptsCommunity-living older personsMajor surgeryDistressing symptomsArea Deprivation IndexOlder personsSocioeconomic disadvantageCommunity-living personsTiming of surgeryProspective longitudinal studyYears of ageQuality of lifeSymptom burdenNonelective surgeryPresurgery valuesElective surgeryMultivariable analysisFunctional outcomeNonelective proceduresChronic conditionsSurgerySymptomsProportional increaseMedicaid eligibilityDeprivation indexMonthsA genome-wide association study of frailty identifies significant genetic correlation with neuropsychiatric, cardiovascular, and inflammation pathways
Ye Y, Noche R, Szejko N, Both C, Acosta J, Leasure A, Brown S, Sheth K, Gill T, Zhao H, Falcone G. A genome-wide association study of frailty identifies significant genetic correlation with neuropsychiatric, cardiovascular, and inflammation pathways. GeroScience 2023, 45: 2511-2523. PMID: 36928559, PMCID: PMC10651618, DOI: 10.1007/s11357-023-00771-z.Peer-Reviewed Original ResearchConceptsFried frailty scoreBiology of frailtyEuropean descent participantsOccurrence of frailtyGenome-wide association studiesMendelian randomization analysisFrailty scoreChronic painJoint disordersPolygenic risk scoresRespiratory diseaseInflammation pathwaysRisk scoreClinical phenotypeBrain tissueCausal associationFrailtyAge-related pathwaysRandomization analysisGenetic factorsAssociation studiesUK BiobankRetirement StudyPerson's vulnerabilitySignificant genetic correlationsFeasibility of a Smartwatch Platform to Assess Ecological Mobility: Real-Time Online Assessment and Mobility Monitor.
Smail E, Alpert J, Mardini M, Kaufmann C, Bai C, Gill T, Fillingim R, Cenko E, Zapata R, Karnati Y, Marsiske M, Ranka S, Manini T. Feasibility of a Smartwatch Platform to Assess Ecological Mobility: Real-Time Online Assessment and Mobility Monitor. The Journals Of Gerontology Series A 2023, 78: 821-830. PMID: 36744611, PMCID: PMC10172974, DOI: 10.1093/gerona/glad046.Peer-Reviewed Original Research
2022
Rationale, Design, and Characteristics of the VALIANT (COVID‐19 in Older Adults: A Longitudinal Assessment) Cohort
Cohen A, McAvay G, Geda M, Chattopadhyay S, Lee S, Acampora D, Araujo K, Charpentier P, Gill T, Hajduk A, Ferrante L. Rationale, Design, and Characteristics of the VALIANT (COVID‐19 in Older Adults: A Longitudinal Assessment) Cohort. Journal Of The American Geriatrics Society 2022, 71: 832-844. PMID: 36544250, PMCID: PMC9877652, DOI: 10.1111/jgs.18146.Peer-Reviewed Original ResearchConceptsPatient-centered outcomesCOVID-19 hospitalizationCognitive impairmentPhysical functionOlder COVID-19 survivorsCOVID-19-related symptomsCOVID-19Older adultsIntensive care unitCOVID-19 survivorsPersistent cognitive impairmentSix-month followMost older adultsThird of participantsElectronic health recordsStepdown unitAcute illnessBurdensome symptomsCare unitSupplemental oxygenMedian lengthProspective studyMean ageBlack raceBaseline interviewInsomnia with objective short sleep duration in community‐living older persons: A multifactorial geriatric health condition
Miner B, Doyle M, Knauert M, Yaggi H, Stone K, Ancoli‐Israel S, Cauley J, Redline S, Blackwell T, Gill T, Groups F. Insomnia with objective short sleep duration in community‐living older persons: A multifactorial geriatric health condition. Journal Of The American Geriatrics Society 2022, 71: 1198-1208. PMID: 36524599, PMCID: PMC10089942, DOI: 10.1111/jgs.18195.Peer-Reviewed Original ResearchConceptsShort sleep durationObjective short sleep durationCommunity-living older personsSleep durationOsteoporotic fracturesOlder menCommunity-living older menOlder personsMultiple predisposingHealth conditionsMen Sleep StudyModifiable risk factorsSeparate logistic regression modelsPoor sleep qualityHigh-risk phenotypeCross-sectional studyCross-sectional associationsMiddle-aged personsLogistic regression modelsClinical correlatesRisk factorsMultivariable modelSleep studiesSleep qualityOlder womenEffect of Structured, Moderate Exercise on Kidney Function Decline in Sedentary Older Adults
Shlipak M, Sheshadri A, Hsu F, Chen S, Jotwani V, Tranah G, Fielding R, Liu C, Ix J, Coca S, Pahor M, Guralnik J, Leeuwenburgh C, Caudle C, Crump L, Holmes L, Leeuwenburgh J, Lu C, Miller M, Espeland M, Ambrosius W, Applegate W, Beavers D, Byington R, Cook D, Furberg C, Harvin L, Henkin L, Hepler J, Hsu F, Lovato L, Roberson W, Rushing J, Rushing S, Stowe C, Walkup M, Hire D, Rejeski W, Katula J, Brubaker P, Mihalko S, Jennings J, Hadley E, Romashkan S, Patel K, Bonds D, McDermott M, Spring B, Hauser J, Kerwin D, Domanchuk K, Graff R, Rego A, Church T, Blair S, Myers V, Monce R, Britt N, Harris M, McGucken A, Rodarte R, Millet H, Tudor-Locke C, Butitta B, Donatto S, Cocreham S, King A, Castro C, Haskell W, Stafford R, Pruitt L, Berra K, Yank V, Fielding R, Nelson M, Folta S, Phillips E, Liu C, McDavitt E, Reid K, Kirn D, Pasha E, Kim W, Beard V, Tsiroyannis E, Hau C, Manini T, Anton S, Nayfield S, Buford T, Marsiske M, Sandesara B, Knaggs J, Lorow M, Marena W, Korytov I, Morris H, Fitch M, Singletary F, Causer J, Radcliff K, Newman A, Studenski S, Goodpaster B, Glynn N, Lopez O, Nadkarni N, Williams K, Newman M, Grove G, Bonk J, Rushing J, Kost P, Ives D, Kritchevsky S, Marsh A, Brinkley T, Demons J, Sink K, Kennedy K, Shertzer-Skinner R, Wrights A, Fries R, Barr D, Gill T, Axtell R, Kashaf S, de Rekeneire N, McGloin J, Wu K, Shepard D, Fennelly B, Iannone L, Mautner R, Sweeney Barnett T, Halpin S, Brennan M, Bugaj J, Zenoni M, Mignosa B, Williamson J, Hendrie H, Rapp S, Verghese J, Woolard N, Espeland M, Jennings J, Wilson V, Pepine C, Ariet M, Handberg E, Deluca D, Hill J, Szady A, Chupp G, Flynn G, Hankinson J, Vaz Fragoso C, Groessl E, Kaplan R. Effect of Structured, Moderate Exercise on Kidney Function Decline in Sedentary Older Adults. JAMA Internal Medicine 2022, 182: 650-659. PMID: 35499834, PMCID: PMC9062767, DOI: 10.1001/jamainternmed.2022.1449.Peer-Reviewed Original ResearchConceptsKidney function declineExercise interventionSedentary older adultsPhysical activityFunction declineOlder adultsClinical trialsHealth education control interventionModerate-intensity physical activityModerate-intensity exercise interventionAncillary analysisGlomerular filtration rateRandomized clinical trialsHigh physical activityModerate-intensity exerciseModerate-intensity activityCystatin C changesLifestyle interventionPrimary outcomeLarge trialsMean ageFiltration rateModerate exerciseOriginal trialMAIN OUTCOME
2021
Association Between Neighborhood Disadvantage and Functional Well-being in Community-Living Older Persons
Gill TM, Zang EX, Murphy TE, Leo-Summers L, Gahbauer EA, Festa N, Falvey JR, Han L. Association Between Neighborhood Disadvantage and Functional Well-being in Community-Living Older Persons. JAMA Internal Medicine 2021, 181: 1297-1304. PMID: 34424276, PMCID: PMC8383163, DOI: 10.1001/jamainternmed.2021.4260.Peer-Reviewed Original ResearchMeSH KeywordsActivities of Daily LivingAgedFemaleFunctional StatusHealthy Life ExpectancyHousing QualityHumansIndependent LivingLongitudinal StudiesMaleMental HealthNeighborhood CharacteristicsPrognosisPsychosocial FunctioningQuality of LifeSocial Determinants of HealthSocioeconomic FactorsUnited StatesConceptsProspective longitudinal cohort studyCommunity-living older personsAge 70 yearsActive life expectancyLongitudinal cohort studyOlder personsCohort studyPrognostic factorsLife expectancyArea deprivation index scoreCommunity-living personsPrecipitating Events ProjectDeprivation index scoreDisabled life expectancyAge 90 yearsArea Deprivation IndexPublic health initiativesPublic health interventionsNeighborhood disadvantageGreater percentageResource-poor environmentsIndividual-level socioeconomic characteristicsMean ageMAIN OUTCOMEDaily living
2020
Functional Effects of Intervening Illnesses and Injuries After Hospitalization for Major Surgery in Community-living Older Persons
Gill TM, Han L, Gahbauer EA, Leo-Summers L, Murphy TE, Becher RD. Functional Effects of Intervening Illnesses and Injuries After Hospitalization for Major Surgery in Community-living Older Persons. Annals Of Surgery 2020, 273: 834-841. PMID: 33074902, PMCID: PMC8370041, DOI: 10.1097/sla.0000000000004438.Peer-Reviewed Original ResearchConceptsMajor surgeryED visitsRestricted activityFunctional statusFunctional declineOlder personsCommunity-living older personsAdjusted hazard ratioAdverse functional outcomesCommunity-living personsEmergency department visitsTraditional risk factorsCorresponding odds ratiosFunctional effectsIllness/injuryHazard ratioDepartment visitsFunctional recoveryFunctional outcomeRisk factorsOdds ratioHospitalizationSurgeryInjuryVisitsA Randomized Trial of a Multifactorial Strategy to Prevent Serious Fall Injuries
Bhasin S, Gill TM, Reuben DB, Latham NK, Ganz DA, Greene EJ, Dziura J, Basaria S, Gurwitz JH, Dykes PC, McMahon S, Storer TW, Gazarian P, Miller ME, Travison TG, Esserman D, Carnie MB, Goehring L, Fagan M, Greenspan SL, Alexander N, Wiggins J, Ko F, Siu AL, Volpi E, Wu AW, Rich J, Waring SC, Wallace RB, Casteel C, Resnick NM, Magaziner J, Charpentier P, Lu C, Araujo K, Rajeevan H, Meng C, Allore H, Brawley BF, Eder R, McGloin JM, Skokos EA, Duncan PW, Baker D, Boult C, Correa-de-Araujo R, Peduzzi P. A Randomized Trial of a Multifactorial Strategy to Prevent Serious Fall Injuries. New England Journal Of Medicine 2020, 383: 129-140. PMID: 32640131, PMCID: PMC7421468, DOI: 10.1056/nejmoa2002183.Peer-Reviewed Original ResearchConceptsSerious fall injuriesFall injuriesIntervention groupControl groupUsual careMultifactorial interventionRate of hospitalizationPrimary care practicesCluster-randomized trialCommunity-dwelling adultsFirst-event analysisYears of ageHealth care systemRate of fallElectronic health recordsBaseline characteristicsPrimary outcomeRandomized trialsMean ageEfficacy trialsIndividualized planCare practicesInjuryMultifactorial strategyEvent ratesCohort Profile: The Precipitating Events Project (PEP Study)
Gill T, Han L, Gahbauer EA, Leo-Summers L, Murphy TE. Cohort Profile: The Precipitating Events Project (PEP Study). The Journal Of Nutrition Health & Aging 2020, 24: 438-444. PMID: 32242212, PMCID: PMC7322244, DOI: 10.1007/s12603-020-1341-4.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsConceptsPrecipitating Events ProjectPEP studyComprehensive home-based assessmentsEpidemiology of disabilityAge 70 yearsHealth care utilizationGreater New HavenLarge health planParticipant-level dataHome-based assessmentEnd of lifeCare utilizationDeath certificatesMedicare claimsDepressive symptomsOngoing longitudinal studyDisabling processEligible membersOlder personsHealth plansLongitudinal studyMethodologic researchCompletion ratesOriginal reportQualified investigators
2019
Impact of Baseline Fatigue on a Physical Activity Intervention to Prevent Mobility Disability
Glynn N, Gmelin T, Santanasto A, Lovato L, Lange‐Maia B, Nicklas B, Fielding R, Manini T, Myers V, Rekeneire N, Spring B, Pahor M, King A, Rejeski W, Newman A, Pahor M, Guralnik J, Anton S, Buford T, Leeuwenburgh C, Nayfield S, Manini T, Caudle C, Crump L, Holmes L, Lee J, Lu C, Miller M, Espeland M, Ambrosius W, Applegate W, Beavers D, Byington R, Cook D, Furberg C, Harvin L, Henkin L, Hepler J, Hsu F, Joyce K, Lovato L, Pierce J, Roberson W, Robertson J, Rushing J, Rushing S, Stowe C, Walkup M, Hire D, Rejeski W, Katula J, Brubaker P, Mihalko S, Jennings J, Chen S, Pierce J, Chen H, Hadley E, Romashkan S, Patel K, Bethesda, Bonds D, McDermott M, Spring B, Hauser J, Kerwin D, Domanchuk K, Graff R, Rego A, Church T, Blair S, Myers V, Monce R, Britt N, Harris M, McGucken A, Rodarte R, Millet H, Tudor‐Locke C, Butitta B, Donatto S, Cocreham S, King A, Castro C, Haskell W, Stafford R, Pruitt L, Yank V, Berra K, Bell C, Thiessen R, Youngman K, Virgen S, Maldonado E, Tarin K, Klaftenegger H, Prosak C, Campero I, Garcia D, Soto J, Chio L, Hoskins D, Fielding R, Nelson M, Folta S, Phillips E, Liu C, McDavitt E, Reid K, Kirn D, Pasha E, Kim W, Krol J, Beard V, Tsiroyannis E, Hau C, Manini T, Pahor M, Anton S, Buford T, Marsiske M, Nayfield S, Sandesara B, Black M, Burk W, Hoover B, Knaggs J, Marena W, Korytov I, Curtis S, Lorow M, Goswami C, Lewis M, Kamen M, Bitz J, Stanton B, Hicks T, Gay C, Xie C, Morris H, Singletary F, Causer J, Yonce S, Radcliff K, Smith M, Scott J, Rodriguez M, Fitch M, Dunn M, Schllesinger J, Newman A, Studenski S, Goodpaster B, Lopez O, Glynn N, Nadkarni N, Ives D, Newman M, Grove G, Williams K, Bonk J, Rush J, Kost P, Vincent P, Gerger A, Romeo J, Monheim L, Kritchevsky S, Marsh A, Brinkley T, Demons J, Sink K, Kennedy K, Shertzer‐Skinner R, Wrights A, Fries R, Barr D, Gill T, Axtell R, Kashaf S, Rekeneire N, McGloin J, Mautner R, Huie‐White S, Bianco L, Zocher J, Wu K, Shepard D, Fennelly B, Castro R, Halpin S, Brennan M, Barnett T, Iannone L, Zenoni M, Bugaj J, Bailey C, Charpentier P, Hawthorne‐Jones G, Mignosa B, Lewis L, Williamson J, Sink K, Hendrie H, Rapp S, Verghese J, Woolard N, Espeland M, Jennings J, Wilson V, Pepine C, Ariet M, Handberg E, Deluca D, Hill J, Szady A, Chupp G, Flynn G, Gill T, Hankinson J, Vaz Fragoso C, Groessl E, Kaplan R. Impact of Baseline Fatigue on a Physical Activity Intervention to Prevent Mobility Disability. Journal Of The American Geriatrics Society 2019, 68: 619-624. PMID: 31867713, PMCID: PMC8061638, DOI: 10.1111/jgs.16274.Peer-Reviewed Original ResearchConceptsPersistent major mobility disabilityMajor mobility disabilityStructured PA interventionPhysical activity interventionsBaseline fatiguePA interventionsMobility disabilityActivity interventionsRisk of MMDHealth educationIncident major mobility disabilityModerate-intensity PA interventionHigher baseline fatigueProportional hazards modelSelf-reported fatigueYears of ageLifestyle interventionProspective cohortElders StudyHazards modelLower riskStudy participantsMore fatigueLess fatiguePast weekShort-Term Disability Fluctuations in Late Life
Stolz E, Gill T, Mayerl H, Freidl W. Short-Term Disability Fluctuations in Late Life. The Journals Of Gerontology Series B 2019, 74: e135-e140. PMID: 31298701, PMCID: PMC6777769, DOI: 10.1093/geronb/gbz089.Peer-Reviewed Original Research
2018
Functional Trajectories Before and After Major Surgery in Older Adults
Stabenau HF, Becher RD, Gahbauer EA, Leo-Summers L, Allore HG, Gill TM. Functional Trajectories Before and After Major Surgery in Older Adults. Annals Of Surgery 2018, 268: 911-917. PMID: 29356710, PMCID: PMC6521949, DOI: 10.1097/sla.0000000000002659.Peer-Reviewed Original ResearchConceptsMajor surgeryNonelective surgeryFunctional trajectoriesSevere disabilityOlder adultsCourse of disabilityFirst major surgeryPersons 70 yearsProspective cohort studyCohort studyFunctional prognosisModerate disabilityPartial improvementSurgeryPremorbid functionOlder personsStudy periodAnalytic sampleLittle improvementRapid improvementTrajectory groupsMild disabilityMost participantsDisabilityGradual improvement