Effects of Walking-Only Intervention on Physical Function, Fall-Related Outcomes, and Health-Related Quality of Life in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis.

This study aimed to determine the effects of walking-only intervention (walking was the only exercise in which people participated) on physical function, fall-related outcomes, and health-related quality of life in community-dwelling older adults. We conducted a systematic search across five electronic databases, assessing risk of bias using Minds Manual for Guideline Development. Meta-analyses were performed, and pooled standardized mean differences were calculated. Nine studies (a total of 1,309 participants) were included, showing that walking-only interventions improved walking endurance (standardized mean difference: 1.11, 95% confidence interval: [0.08, 2.15]) and health-related quality of life (standardized mean difference: 0.71, 95% confidence interval: [0.18, 1.25]). However, there were no significant improvements in other outcomes. The certainty of the evidence based on the Grading of Recommendations, Assessment, Development, and Evaluation approach for all outcomes was graded as very low, primarily due to significant inconsistency and imprecision. Our results suggest that walking-only intervention can be effective for enhancing walking endurance and health-related quality of life for community-dwelling older adults. Further studies are required to investigate the effects of walking-only intervention. This need stems from the limited number of randomized controlled trials, heterogeneous intervention settings and results, and the very low certainty of the evidence.

Validity and reliability of the 2-min step test in individuals with stroke and lower-limb musculoskeletal disorders.

Introduction: We investigated the reliability and validity of the 2-min step test (2MST) for assessing the exercise endurance of individuals with stroke and lower-limb musculoskeletal disorders. Participants and methods: The participants were 39 individuals with stroke and 42 with lower-limb musculoskeletal disorders (mainly hip fractures) from the convalescent rehabilitation wards of four hospitals. The concurrent validity and congruence between the 2MST and the 6-min walk test (6MWT) and construct validity by hypotheses testing, including mobility and lower limb muscle strength, were also confirmed. A subset of participants (stroke-group, n = 15; musculoskeletal-group, n = 19) underwent a retest 2MST for our evaluation of relative and absolute reliability using the intraclass correlation coefficient (ICC1,1) and Bland-Altman plot. Results: Both groups showed a moderate correlation between the 2MST and 6MWT (ρ = 0.55-0.60), but the congruence was not sufficient. The 6MWT was correlated with mobility in both groups and with muscle strength in the stroke group, whereas the 2MST did not show a significant correlation with mobility. The relative reliability was excellent in both groups (ICC1,1 > 0.9). In terms of absolute reliability, the width of the limit of agreement was 18.8% for the stroke group and 15.4% for the musculoskeletal group, relative to their respective sample means of 2MST. A fixed bias was identified in the stroke group, in which step counts increased by 6.5 steps upon retesting. Discussion: Our analyses revealed that the 2MST is a valid and reliable tool for assessing the exercise endurance of individuals with stroke or lower-limb musculoskeletal disorders. However, it is necessary to validate the absolute reliability observed herein by using a larger sample size. In addition, when assessing the exercise endurance of individuals with stroke, it may be necessary to consider the potential bias of an increased step count during retesting.

Shared decision-making in physiotherapy: a cross-sectional study of patient involvement factors and issues in Japan.

BACKGROUND: Evidence-based medicine education has not focused on how clinicians involve patients in decision-making. Although shared decision-making (SDM) has been investigated to address this issue, there are insufficient data on SDM in physiotherapy. This study aimed to clarify the issues concerning patient involvement in Japan, and to examine whether SDM is related to perceptions of patient involvement in decision-making. METHODS: The study participants were recruited from among acute and sub-acute inpatients and community residents receiving physiotherapy outpatient care, day care, and/or home rehabilitation. The Control Preference Scale (CPS) was used to measure the patients' involvement in decision-making. The nine-item Shared Decision-Making Questionnaire (SDM-Q-9) was used to measure SDM. In analysis I, we calculated the weighted kappa coefficient to examine the congruence in the CPS between the patients' actual and preferred roles. In analysis II, we conducted a logistic regression analysis using two models to examine the factors of patient involvement. RESULTS: Analysis I included 277 patients. The patients' actual roles were as follows: most active (4.0%), active (10.8%), collaborative (24.6%), passive (35.0%), and most passive (25.6%). Their preferred roles were: most active (3.3%), active (18.4%), collaborative (39.4%), passive (24.5%), and most passive (14.4%). The congruence between actual and preferred roles by the kappa coefficient was 0.38. Analysis II included 218 patients. The factors for patient involvement were the clinical environment, the patient's preferred role, and the SDM-Q-9 score. CONCLUSIONS: The patients in Japan indicated a low level of decision-making involvement in physiotherapy. The patients wanted more active involvement than that required in the actual decision-making methods. The physiotherapist's practice of SDM was revealed as one of the factors related to perceptions of patient involvement in decision-making. Our results demonstrated the importance of using SDM for patient involvement in physiotherapy.

Efficacy of Therapeutic Exercise on Activities of Daily Living and Cognitive Function Among Older Residents in Long-term Care Facilities: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

OBJECTIVES: This study aimed to systematically analyze the efficacy of therapeutic exercise on activities of daily living (ADL) and cognitive function among older residents in long-term care facilities. DATA SOURCES: PubMed, Cochrane Central of Register Trials, Physiotherapy Evidence Database, OTseeker, and Ichushi-Web were searched from inception until December 2018. STUDY SELECTION: Databases were searched to identify randomized controlled trials (RCTs) of therapeutic exercise for long-term care facility residents aged 60 years and older, focusing on ADL and cognitive function as outcomes. DATA EXTRACTION: Two independent reviewers extracted the key information from each eligible study. Two reviewers independently screened and assessed all studies for eligibility, extracting information on study participants, details of interventions, outcome characteristics, and significant outcomes. Any discrepancies were resolved by a third reviewer. DATA SYNTHESIS: A total of 11 RCTs with 1280 participants were eligible for analyses. Therapeutic exercise had a significant benefit on ADL (standard mean difference [SMD]=0. 22, 95% confidence interval [CI]: 0.02, 0.42, P=.03). Subgroup analyses indicated that interventions conducted ≥3 days per week [SMD=0.42, 95% CI 0.02, 0.82, P=.04] had a significant benefit on ADL. For cognitive function, group exercise and ≥3 days/week of intervention had a significant benefit (group exercise: mean difference [MD]=3.36, 95% CI 0.91, 5.80, P=.007; ≥3 days/week of intervention: MD=2.28, 95% CI 0.07, 4.49, P=.04). CONCLUSIONS: Therapeutic exercise conducted 3 or more days per week may be effective for improving ADL and cognitive function among older residents in long-term care facilities. This meta-analysis suggested that group exercise for cognitive functions was effective. However, the effective method of intervention delivery for ADL was unclear.

Low-intensity resistance training to improve knee extension strength in community-dwelling older adults: Systematic review and meta-analysis of randomized controlled studies.

AIM: The purpose of this systematic review and meta-analysis was to investigate the effects of low-intensity resistance training on knee extension strength with respect to intensity, frequency, duration and training site in community-dwelling older adults. METHODS: A literature search was conducted for articles published up to December 2018 on PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Physiotherapy Evidence Database (PEDro), OTseeker and Ichushi-Web. Randomized controlled trials involving resistance training with <60 % one repetition maximum (1RM) in community-dwelling older adults aged 60 years and older were eligible. RESULTS: In total, 7 studies involving 275 participants were included in the meta-analysis. The results showed significant improvements in knee extension strength with low-intensity resistance training [standardized mean difference (SMD) 0.62, 95 % confidence interval (CI) 0.32 to 0.91]. In subgroup analyses, significant improvements were observed in the group with intensity at 50-60 % 1RM (0.83, 0.46 to 1.19), but not in the group at 40 % or less 1RM (0.30, 95%CI: -0.08 to 0.68). Concerning frequency, there were significant improvements in knee strength for those receiving training three times (0.90, 0.52 to 1.27) and two times (0.36, 0.03 to 0.69) per week, with a significant difference between the groups (p = 0.04). CONCLUSIONS: Low-intensity resistance training should be considered as an effective intervention to improve knee extension strength in community-dwelling older adults. Older adults may show more improvement in knee extension strength if intensity of the training is set at 50-60 % 1RM and frequency of training is three times per week.

Kinematic Analyses Using Finger-Tapping Task for Patients After Surgery With Distal Radius Fracture at Acute Phase.

BACKGROUND: After a distal radius fracture (DRF), severe pain, disabilities, and pain-related psychological problems can arise and sometimes remain ~1 year later. DRF-related disabilities have been assessed with questionnaires but not by kinematic evaluations; the kinematic features of DRF patients are unknown. Here, we investigated the kinematic characteristics of DRF patients and explored the relationship between their clinical assessments and kinematic characteristics. METHODS: We analyzed 20 patients with DRFs after their surgeries. We recorded their finger-tapping using a magnetic sensor, and we calculated the velocity, magnitude, and movement-initiation hesitation. The patients' pain intensity and fear of movement were assessed by a visual analogue scale and the Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH). To investigate the features of the patients who achieved only slight improvement, we compared the kinematic characteristics of the DRF patients in 2 subgroups: the "good improvement group" and the "slight improvement group" based on a cutoff value of the DASH score (>40) at 1 month postsurgery. RESULTS: The DASH score at 30 days postsurgery was significantly correlated with hesitation at 1 day postsurgery (r = .66, P < .0071) and with velocity at 7 days (r = -.54, P < .0071). Our kinematic analyses revealed significant differences in velocity at 7 days postsurgery (P < .05) and in hesitation at 1 day postsurgery (P < .05) between the subgroups. CONCLUSIONS: Since assessments using range-of-motion measurements or a questionnaire are not sufficient to evaluate a patient's movement disorder, a kinematic analysis should be conducted for quantitative assessments.

Effect of neurocognitive rehabilitation on upper limb function in community-dwelling chronic stroke patients: A pilot study.

BACKGROUND: Although it has been reported that neurocognitive rehabilitation is effective for improving upper limb function in acute and subacute stroke patients, its effectiveness has not been clarified in community-dwelling chronic stroke patients. OBJECTIVE: To examine the effect of neurocognitive rehabilitation on upper limb function in community-dwelling chronic stroke patients. METHODS: Eight community-dwelling chronic stroke patients participated in the study. The mean period from the stroke onset to the start of the intervention was 425.3 days (approximately 14 months post-stroke). All patients received neurocognitive rehabilitation for 60 min, twice per week, for 3 months. Fugl-Meyer Assessments (FMA) were performed, and the amount of use (AOU) and quality of movement (QOM) of the Motor Activity Log (MAL) were measured before and after the intervention. We used the Wilcoxon signed-rank test to analyze the data. RESULTS: The total, shoulder/elbow/forearm, and wrist scores of the FMA, MAL-AOU, and MAL-QOM significantly improved after the intervention compared to those before the intervention. However, significant improvement was not observed in the hand score of the FMA. CONCLUSION: Neurocognitive rehabilitation could be effective for improving upper limb function in community-dwelling chronic stroke patients.

Characteristics of postural control during fixed light-touch and interpersonal light-touch contact and the involvement of interpersonal postural coordination.

Haptic feedback by light touch with a fingertip influences the postural control of the human body by postural orientation. Postural control might therefore differ depending on the characteristics of the contacting object. The main experimental targets of contact have been a fixed object (fixed light touch: FLT) and an individual (interpersonal light touch: ILT), but the postural control characteristics of FLT and ILT have not been directly compared within the same study. Nor has there been a study comparing frequency characteristics in these conditions. We hypothesized that (1) the frequency of postural sway would be higher in FLT and that no such change would be observed in ILT, and (2) the interpersonal postural coordination that is specific to ILT, i.e., sway that resembles the other person's sway, would be observed in the low-frequency component (≤0.4 Hz) rather than the high-frequency component (>0.4 Hz). We applied a closed-eyes tandem stance by adult subjects as the standard condition, and the center of pressure was measured when they performed four standing conditions: no-touch, FLT, stable ILT with a bipedal partner, and unstable ILT with a tandem partner. The results demonstrated that the FLT condition and both the stable and unstable ILT conditions also stabilized the posture, but the stability was superior in the FLT condition. Further, the difference in postural stability depending on the axis is not clear in any conditions for velocity, whereas for amplitude, stabilization by contact is more easily captured in the medio-lateral (ML) axis than in the anterior-posterior (AP) axis. The mean power frequency (MPF) in the FLT condition was higher than the no-touch condition, and the stable ILT condition in the ML axis and was higher than any other conditions in the AP axis. Moreover, the stable ILT condition in both axes was not significantly different from the no-touch condition. The unstable ILT condition in the AP axis was also not significantly different, though the ML axis was higher than the no-touch condition. The interpersonal postural coordination in both the stable and unstable ILT conditions was observed in the low-frequency component (except for the ML axis of the unstable ILT condition) and not in the high-frequency component. These results support our hypotheses and suggest that although FLT and ILT exert effects on reducing postural sway to some certain extent, in actuality, these conditions result in different postural controls in the frequency domain due to postural coordination based on the low-frequency component.

Correction: Association between chronic pain and pre-frailty in Japanese community-dwelling older adults: A cross-sectional study.

[This corrects the article DOI: 10.1371/journal.pone.0236111.].

Using a postoperative pain trajectory to predict pain at 1 year after total knee arthroplasty.

BACKGROUND: The pain trajectory is an early detection/prediction method for chronic postsurgical pain (CPSP). It is unclear whether a pain trajectory can predict CPSP in patients who have undergone a total knee arthroplasty (TKA). Here we investigated (1) whether CPSP can be predicted in TKA patients, and (2) the values that can be used to predict CPSP. METHODS: We studied 211 postoperative TKA patients. We calculated the pain trajectory (pain curve slope and intercept) using the patients' self-reported pain intensity values at 1, 3, 5, and 7 days post-TKA. Using structural equation modeling (SEM), we performed a multiple regression analysis to investigate appropriate prediction models for the pain trajectory. Classification and regression tree (CHAID) methodology was used to calculate values to predict CPSP by a decision tree model. CPSP (dependent variable) was defined as >30 mm on a visual analog scale for pain intensity at 1 year post-TKA. The predictor variables were pain curve slope, intercept, age, sex, body mass index, and preoperative pain intensity. RESULTS: The pain trajectory was the best fit among the models to predict pain intensity at 1 year post-TKA. When the pain curve slope (pain trajectory) was greater than 2.8, the probability of CPSP at 1 year post-TKA was 33.3%. CONCLUSION: Our results suggest that the pain trajectory could be applied to post-TKA patients and used to calculate clinical values to predict CPSP. Our findings also indicate the possibility that patients with a positive pain curve slope in the first postoperative week may need early intervention to avoid CPSP.

Association between chronic pain and pre-frailty in Japanese community-dwelling older adults: A cross-sectional study.

A relationship between chronic pain and frailty has been reported. The early detection and prevention of frailty are recommended, in part because community-dwelling older adults in a pre-frailty state may return to a healthy state. The relationship between chronic pain and pre-frailty is not known. Toward the goal of promoting a reversible return to health from pre-frailty, we investigated the relationship between chronic pain and pre-frailty among community-dwelling older adults. We assessed the frailty and chronic pain of 107 older adults who were participating in community health checks. The status of physical frailty was based on the five components described by Fried (2001): muscle weakness shown by handgrip strength, slowness of gait speed, weight loss, low physical activity, and exhaustion. Chronic pain was assessed based on pain intensity, the Pain Catastrophizing Scale (PCS), the Japanese version of the Geriatric Depression Scale-15 (GDS-15), and the Central Sensitization Inventory (CSI). The prevalence of chronic pain with pre-frailty was 40.2%. A hierarchical analysis revealed that PCS-measured helplessness (odds ratio [OR]: 0.88) and the CSI (OR: 0.87) were significant factors associated with the presence of chronic pain with pre-frailty. The prevalence of chronic pain with pre-frailty was high, and chronic pain and pre-frailty were strongly related. New intervention or prevention programs that take into account both chronic pain and pre-frailty must be created as soon as possible.

Development of More Precise Measurement to Predict Pain 1 Month Postoperatively Based on Use of Acute Postoperative Pain Score in Patients With Distal Radial Fracture.

BACKGROUND: A method for modeling the acute pain trajectory using the simple linear fit of an individual's pain intensity scores after surgery was developed and affords more precise measurement than conventional pain assessment. However, the method has the disadvantage of using only the slope without considering the intercept. The purpose of this study was to verify our modification of the pain trajectory model including slope and intercept and to identify clusters. METHODS: The pain intensity was measured in 60 patients after surgery, and we calculated their pain trajectories. The pain trajectory normally resolves in intensity over a period of days, and the linear fit of an individual patient's pain intensity score defines the trajectory. In this simple linear model (x axis, days; y axis, pain intensity), each patient's trajectory has the slope and the intercept. A multiple regression analysis model known as structural equation modeling was used to predict postoperative pain at 30 days after surgery. Finally, we performed hierarchical cluster analysis using the pain trajectory. RESULTS: The slope and intercept model was the best fit among the models. Based on cluster analysis results, we created 4 pain trajectory groups (slope and intercept). CONCLUSION: Our results suggest that the pain trajectory using the slope and intercept is quite useful for predicting postoperative pain at 30 days after surgery. Additionally, patients were classified into 4 groups using the slope and intercept. By considering both the slope and intercept, clinicians may be able to detect the risk for prolonged pain earlier than other methods.

Motor-imagery ability and function of hemiplegic upper limb in stroke patients.

Objectives: We quantitatively examined the motor-imagery ability in stroke patients using a bimanual circle-line coordination task (BCT) and clarified the relationship between motor-imagery ability and motor function of hemiplegic upper limbs and the level of use of paralyzed limbs. Methods: We enrolled 31 stroke patients. Tasks included unimanual-line (U-L)-drawing straight lines on the nonparalyzed side; bimanual circle-line (B-CL)-drawing straight lines with the nonparalyzed limb while drawing circles with the paralyzed limb; and imagery circle-line (I-CL)-drawing straight lines on the nonparalyzed side during imagery drawing on the paralyzed side, using a tablet personal computer. We calculated the ovalization index (OI) and motor-imagery ability (image OI). We used the Fugl-Meyer motor assessment (FMA), amount of use (AOU), and quality of motion (QOM) of the motor activity log (MAL) as the three variables for cluster analysis and performed mediation analysis. Results: Clusters 1 (FMA <26 points) and 2 (FMA ≥26 points) were formed. In cluster 2, we found significant associations between image OI and FMA, AOU, and QOM. When AOU and QOM were mediated between image OI and FMA, we observed no significant direct association between image OI and FMA, and a significant indirect effect of AOU and QOM. Interpretation: In stroke patients with moderate-to-mild movement disorder, image OI directly affects AOU of hemiplegic upper limbs and their QOM in daily life and indirectly influences the motor functions via those parameters.

Association between Unintentional Interpersonal Postural Coordination Produced by Interpersonal Light Touch and the Intensity of Social Relationship.

Interpersonal postural coordination (IPC) produced by interpersonal light touch (ILT), whereby time-series variations in the postural sway between two people unintentionally resemble each other, may be a possible social interaction. From a sociopsychological standpoint, close mutual behavioral coordination is recognized as "social glue," which represents the closeness of relationships and contributes to the building of a good rapport. Therefore, we hypothesized that if IPC functions as social glue, then IPC produced by ILT also represents a social relationship. Participants were dyadic pairs with a preexisting social relationship (acquaintance, friend, or best-friend), and we assessed the closeness between the partners. Postural sway in two quiet standing conditions-no touch (NT) and ILT (a mutual light touch with <1 N) condition-was concurrently measured with the side-by-side standing position, and the association of IPC with intradyadic closeness (rapport) was analyzed using hierarchical linear modeling. The results showed that unintentional IPC was higher in both axes of the ILT condition than in NT condition. Additionally, IPC in the mediolateral axis (the partner side) of the ILT condition was positively correlated with intradyadic closeness, whereas that in the anteroposterior axis (the non-partner side) showed a negative association. As expected, IPC represented intradyadic closeness (rapport). Results indicate that, in unintentional IPC produced by ILT, the priority of processing sensory feedback for postural control, which is received from the individual and a partner, is modulated depending on the rapport in interactional coupled feedback loops between the two individuals (i.e., good rapport increases the degree of taking in feedback from a partner). Thus, unintentional IPC produced by ILT functions as social glue, and it provides an understanding of the sociopsychological aspect in the human-to-human postural coordination mechanism.

Effects of illusory kinesthesia by tendon vibratory stimulation on the postoperative neural activities of distal radius fracture patients.

Activation of motor-related regions with illusory kinesthesia had been suspected to contribute toward pain alleviation. We used electroencephalography (EEG) to assess the sensorimotor cortex activation during illusory kinesthesia by vibratory tendon stimulation in patients who were in pain. We investigated the relationship between the sensorimotor cortex and postoperative pain to clarify the analgesia mechanism. Patients who had undergone distal radius fracture surgery were studied. A hand massager provided the vibration stimulus for the illusory kinesthesia on the extensor digitorum muscle at the nonaffected hand's wrist joint on 7 consecutive days starting 1 day after surgery. The main outcomes were pain intensity and EEG activity. EEG activity was recorded during illusory kinesthesia. We also analyzed the high α rhythm (10-12 Hz) event-related desynchronization/event-related synchronization. The pain intensity was reduced. Attenuation of the high α wave was observed in the bilateral sensorimotor cortex (C3ch, C4ch) areas during illusory kinesthesia. A significant negative correlation was also observed in the C3 and the C4 of event-related desynchronization/event-related synchronization% values and the variation of pain amelioration at rest. Activation of the sensorimotor cortex by illusory kinesthesia might have influenced parts of the descending pain-inhibitory system. The postoperative pain in the patients might have been alleviated by the descending pain-inhibitory system.

The influence of trait anxiety and illusory kinesthesia on pain threshold.

[Purpose] It has also been reported that decreased activity in the reward pathway causes a decrease in brain activity in the descending pain control system in people with high trait anxiety. Activation of this system is dependent on both the reward pathway and motor areas. Recently, studies have also shown that motor areas are activated by illusory kinesthesia. It was aimed to explore whether anxiety trait modulates the influence of illusory kinesthesia on pain threshold. [Subjects and Methods] The pain threshold and trait anxiety at rest before vibratory tendon stimulation (the task) were measured. After the task, the pain threshold, the illusory kinesthesia angle, and the intensity of illusory kinesthesia for patients with and without illusory kinesthesia were measured. A total of 35 healthy right-handed students participated, among whom 22 and 13 were included in the illusion and no-illusion groups, respectively. [Results] There was a significant increase in the pain threshold after task completion in both groups; however, there was no statistically significant difference between the two groups. Correlational analysis revealed that State-Trait Anxiety Inventory-trait score correlated negatively with the pain threshold in the no-illusion group, but there was no correlation in the illusion group. [Conclusion] The pain threshold improved regardless of the size of trait anxiety in the illusion group, but did not improve merely through sensory input by vibratory stimulation in the no-illusion group. Thus, illusory kinesthesia has effect of increasing the pain threshold.

Effect of illusory kinesthesia on hand function in patients with distal radius fractures: a quasi-randomized controlled study.

OBJECTIVES: We investigated the effects of the illusion of motion through tendon vibration on hand function in patients with distal radius fractures. SETTING: Kawachi General Hospital, Japan. SUBJECTS: A total of 22 patients with distal radius fractures were divided into either an illusory kinesthesia group ( n = 11) or a control group ( n = 11). INTERVENTION: We performed the intervention for seven consecutive days after surgery. Evaluations were performed at one day, seven days, one month, and two months postsurgery. MAIN MEASURES: Data were collected on pain at rest and pain during movement. The Patient-Rated Wrist Evaluation and Pain Catastrophizing Scale were also used. RESULTS: The illusory kinesthesia group showed significantly better scores on Patient-Rated Wrist Evaluation ( p < 0.01) compared with the control group at seven days, one month, and two months postsurgery. The mean (SD) of the Patient-Rated Wrist Evaluation total score was 97.6 (2.2) at one day postsurgery and 9.1 (5.3) at seven days postsurgery in the illusory kinesthesia group, while the Patient-Rated Wrist Evaluation total score was 96.3 (4.4) at one day postsurgery and 20.1 (17.0) at seven days postsurgery in the control group. CONCLUSION: Our results indicate that illusory kinesthesia is an effective postsurgery management strategy not only for pain alleviation, but also hand function in patients with distal radius fractures. Furthermore, the significant improvements persisted for up to two months after intervention in the illusory kinesthesia group, but not in the control group. In addition, patients in the kinesthetic illusions group showed increased use of the affected limb in daily living.

Short-term effects of goal-setting focusing on the life goal concept on subjective well-being and treatment engagement in subacute inpatients: a quasi-randomized controlled trial.

OBJECTIVE: To investigate the short-term effects of the life goal concept on subjective well-being and treatment engagement, and to determine the sample size required for a larger trial. DESIGN: A quasi-randomized controlled trial that was not blinded. SETTING: A subacute rehabilitation ward. SUBJECTS: A total of 66 patients were randomized to a goal-setting intervention group with the life goal concept (Life Goal), a standard rehabilitation group with no goal-setting intervention (Control 1), or a goal-setting intervention group without the life goal concept (Control 2). INTERVENTIONS: The goal-setting intervention in the Life Goal and Control 2 was Goal Attainment Scaling. The Life Goal patients were assessed in terms of their life goals, and the hierarchy of goals was explained. The intervention duration was four weeks. MAIN MEASURES: Patients were assessed pre- and post-intervention. The outcome measures were the Hospital Anxiety and Depression Scale, 12-item General Health Questionnaire, Pittsburgh Rehabilitation Participation Scale, and Functional Independence Measure. RESULTS: Of the 296 potential participants, 66 were enrolled; Life Goal (n = 22), Control 1 (n = 22) and Control 2 (n = 22). Anxiety was significantly lower in the Life Goal (4.1 ±3.0) than in Control 1 (6.7 ±3.4), but treatment engagement was significantly higher in the Life Goal (5.3 ±0.4) compared with both the Control 1 (4.8 ±0.6) and Control 2 (4.9 ±0.5). CONCLUSIONS: The life goal concept had a short-term effect on treatment engagement. A sample of 31 patients per group would be required for a fully powered clinical trial.

Cathodal transcranial direct current stimulation of the posterior parietal cortex reduces steady-state postural stability during the effect of light touch.

Touching a stable object with a fingertip using slight force (<1 N) stabilizes standing posture independent of mechanical support, which is referred to as the effect of light touch (LT). In the neural mechanism of the effect of LT, the specific contribution of the cortical brain activity toward the effect of LT remains undefined, particularly the contribution toward steady-state postural sway. The aim of the present study was to investigate the cortical region responsible for the reduction of postural sway in response to the effect of LT. Active LT was applied with the right fingertip and transcranial direct current stimulation (sham or cathodal) was applied to the left primary sensorimotor cortex or the left posterior parietal cortex in the two groups. The experiments were conducted using a single-blind sham-controlled crossover design. Steady-state postural sway was compared with the factors of transcranial direct current stimulation (sham or cathodal) and time (pre or post). In the results, the effect of LT reduced postural stability in the mediolateral direction after cathodal transcranial direct current stimulation of the left posterior parietal cortex. No effect was observed after stimulation of the left primary sensorimotor cortex. This indicates that the left posterior parietal cortex is partly responsible for the effect of LT when touching a fixed point with the right fingertip during suprapostural tasks, where posture is adjusted according to the precision requirements. Cortical processing of sensory integration for voluntary postural orientation in response to touch occurs in the posterior parietal cortex.

EEG frequency analysis of cortical brain activities induced by effect of light touch.

In human postural control, touching a fingertip to a stable object with a slight force (<1 N) reduces postural sway independent of mechanical support, which is referred to as the effect of light touch (LT effect). The LT effect is achieved by the spatial orientation according to haptic feedback acquired from an external spatial reference. However, the neural mechanism of the LT effect is incompletely understood. Therefore, the purpose of this study was to employ EEG frequency analysis to investigate the cortical brain activity associated with the LT effect when attentional focus was strictly controlled with the eyes closed during standing (i.e., control, fixed-point touch, sway-referenced touch, and only fingertip attention). We used EEG to measure low-alpha (about 8-10 Hz) and high-alpha rhythm (about 10-12 Hz) task-related power decrease/increase (TRPD/TRPI). The LT effect was apparent only when the subject acquired the stable external spatial reference (i.e., fixed-point touch). Furthermore, the LT-specific effect increased the high-alpha TRPD of two electrodes (C3, P3), which were mainly projected from cortical brain activities of the left primary sensorimotor cortex area and left posterior parietal cortex area. Furthermore, there was a negative correlation between the LT effect and increased TRPD of C3. In contrast, the LT effect correlated positively with increased TRPD of P3. These results suggest that central and parietal high-alpha TRPD of the contralateral hemisphere reflects the sensorimotor information processing and sensory integration for the LT effect. These novel findings reveal a partial contribution of a cortical neural mechanism for the LT effect.