Prevalence and Factors Associated with Fear of Falling in Community-Dwelling Thai Elderly.

BACKGROUND: Falls are common in older people. The fear of falling (FOF) can lead elderly persons to restrict their activities which reduces quality of life. We aimed to estimate the prevalence and factors associated with FOF in community-dwelling Thai elderly to improve screening, treatment and prevention policies and practices. OBJECTIVES: We aimed to estimate the prevalence and factors associated with FOF in suburban-dwelling Thai seniors. METHODS: Seniors aged 60-85 years old from 4 suburban communities near Bangkok, Thailand, were interviewed and examined. Questionnaires were used to collect data on the FOF, symptoms of depression, anxiety and balance tests. T tests, χ2 tests, and logistic regressions were used in statistical analysis. RESULTS: 210 subjects were enrolled. The mean age was 70.3, and 74.3% were female. Fifty-three (25.2%) reported a previous history of falls. The prevalence of FOF was 35.8% in the subjects with previous history of falls and 21.7% in subjects without previous history of falls. FOF was associated with female gender, age ≥80, living alone, impaired balance, and functional impairment but not with previous history of falls. CONCLUSION: FOF is associated with balance impairment, anxiety, depression, and functional impairment of daily routine activities.

Dyad Training Protocol on Learning of Bimanual Cup Stacking in Individuals with Stroke: Effects of Observation Duration.

OBJECTIVE: To examine the effects of dyad training protocol with different observation-durations on the learning of bimanual cup stacking in individuals with chronic stroke. MATERIAL AND METHOD: Participants (experimental and control groups) completed the task in pairs. On the first day (acquisition phase: AP), the experimental group observed their partner 6 minutes and alternately performed the task 6 minutesfor 4 sessions. The control group underwent 1 minute of observing alternated with 1 minute of performing the task for 24 sessions. On the following day (retention phase: RP), both groups performed the task individually first without feedback, followed by withfeedback. The dependent measures were movement time (MT), a measure of motor execution, and reaction time (RT), a measure of motor planning. RESULTS: In the AP both groups completed the task with decreased MT The experimental group showed significantly greater improvement of MT than the control group. As for RP, only the experimental group performed the task with less MT when compared with the last block of AP Additionally, this group significantly decreased MT when compared with the first block. Although, a similar pattern was observed of decreased RTfor both groups, in the RP the experiment group had shorter RT compared with that of the control group. CONCLUSION: For individuals with chronic stroke, compared with the 1-minute observation alternating with physical practice, the 6-minute duration resulted in greater persistent learning. Moreover the 6-minute duration greatly enhanced the planning of bimanual cup stacking.

Impaired Reach-to-Grasp Actions during Barrier Avoidance in Individuals with Parkinson's Disease.

OBJECTIVE: To determine the kinematics and coordination while performing reach-to-grasp (RTG) actions under barrier avoidance condition in individuals with Parkinson's disease (PD). MATERIAL AND METHOD: Right handed idiopathic PDs (Hoehn and Yahr stage 2-3) (n = 20) and age-matched controls (n = 10) without dementia and psychological impairment were recruited. They were asked to perform RTG "as soon as you see the light and as fast as you can" with their right hands under barrier condition. The RTG performance were assessed in three domains, planning, execution (or kinematics), and coordination. The planning was measured by reaction time. The kinematics variables were movement time, maximum velocity, time to maximum velocity, deceleration time, maximum aperture, time to maximum aperture, aperture closure time, and aperture closure distance. The coordination was assessed using a cross correlation analysis between transport velocity and aperture size, which consisted of maximal correlation coefficient (rmax) and associated time lag (Tmax). RESULTS: Compared to the controls, the PD group had delayed planning. In execution domain, they showed decreased maximum velocity, smaller amplitude of maximum aperture, and prolonged all raw times comparing to controls. When considering the coordination, they had only prolonged T. than controls. CONCLUSION: PD participants with mild to moderate impairment showedpoorer RTG planning, execution, and coordination during barrier avoidance when compared to age-matched controls.

Weight and body mass index in men and age and height in women relate to difficulty and ability in performing activities in community-living Thai elders.

OBJECTIVE: To compare difficulty between male and female community-living elderly in performing activities (DDA), ability in performing living activities (ADA) and balance, and to explore associations among them related to age, weight, height and body mass index (BMI). MATERIAL AND METHOD: In all, 1,964 participants (646 men, 1,318 women) aged 60 or over reported their age, weight, height, DDA, ADA, and performed the Berg balance scale (BBS). Male and female elderly were divided into low and high BBS groups (BBS cutoff point score: male = 26,female = 28.5). The Mann-Whitney U test was conducted to compare age, weight, height, BMI, DDA, ADA and the BBS. Associations among them were tested using Spearman's rank correlation. RESULTS: A low BBS score represented high risk of falling and vice versa for a high BBS score. No difference in DDA, ADA, and BBS was found associated with sex. Weight and BMI correlated to DDA, ADA, and BBS in elderly men with high fall risk, while age and height was related to DDA and ADA, respectively in elderly women with low fall risk. CONCLUSION: Male and female community-dwelling Thai elders were similar in ability in performing activities and balance. Weight and BMI was important among elderly men, whereas age and height was significant among women.

Impact on participation and autonomy questionnaire: psychometric properties of the thai version.

[Purpose] The present study aimed to cross-culturally translate and evaluate the reliability and validity of the Thai version of the Impact on Participation and Autonomy (IPA) in persons with spinal cord injury (SCI). [Subjects] One hundred and thirty-nine persons with SCI who lived in the community were recruited for this study. [Methods] The IPA was translated following the guideline for cross-cultural adaptation of self-report measures. The reliability and validity was examined in 139 persons with SCI. For the test-retest reliability, 30 participants completed the Thai version of the IPA twice with a 2-week interval. [Results] The translated questionnaire and its items had moderate to good reliability, with the ICC(3,1) ranging from 0.76 to 0.93. The internal consistency for all domains was high, with Cronbach's alpha ranging from 0.86 to 0.90. The convergent validity, discriminant validity, and construct validity were supported. [Conclusion] The Thai version of the IPA is a reliable and valid instrument for assessing the level of community participation in Thai persons with spinal cord injury.

Translation and Cross-Cultural Adaptation of Nepali Version of the Montreal Cognitive Assessment.

BACKGROUND: Montreal Cognitive Assessment is widely used in stroke to detect cognitive impairment. The superiority of it over other outcome measures has been well established. It has been cross-culturally translated and has shown excellent psychometric properties. To assess the intervention effect on cognition of Nepalese individuals with stroke using the Montreal Cognitive Assessment, an adapted Nepali version is required as the Nepalese cultural context and language are completely different than the original was developed. Thus, the objective of this study is to translate and cross-culturally adapt Montreal Cognitive Assessment in the Nepali language and see its test-retest reliability and internal consistency. METHODS: After translating and cross-culturally adapting the Montreal Cognitive Assessment into Nepali using Beaton guidelines. Its Nepali version was administered to 28 individuals with stroke twice keeping the interval of two weeks. Test-retest reliability and internal consistency were assessed using the Intraclass correlation coefficient and Cronbach's alpha. RESULTS: The Montreal Cognitive Assessment was translated into Nepali with significant cultural adaptations and the Nepali version demonstrated excellent psychometric properties as hypothesized. The test-retest reliability and internal Consistency were excellent. The Intraclass correlation coefficient of the total score was 0.990 and Cronbach's alpha value was 0.994 for total scores. CONCLUSIONS: The Nepali version of Montreal Cognitive Assessment is reliable to use as a diagnostic tool for detecting cognitive impairment in patients with stroke. It is comprehensive, easy to administer and culturally appropriate.

Effects of repetitive transcranial magnetic stimulation combined with action-observation-execution on social interaction and communication in autism spectrum disorder: Feasibility study.

OBJECTIVE: To investigate the feasibility of a combined high-frequency rTMS (HF-rTMS) with action observation and execution (AOE) on social interaction and communication in children with Autistic Spectrum Disorder (ASD). MATERIALS AND METHODS: Fifteen children underwent 10 sessions of 5-Hz HF-rTMS on the right inferior frontal gyrus combined with AOE. An experimental group received the real HF-rTMS while the control group received the sham one. For the AOE protocol, they were instructed to watch and imitate a video showing the procedure, including reaching and grasping tasks, gustatory tasks, and facial expressions. Their behavioural outcomes were evaluated using the Vineland Adaptive Behaviour Scale (VABS) and electroencephalograms (EEGs) recorded at three time points: baseline, immediately after each treatment, and at the 1-week follow-up after the 10th treatment. RESULTS: There were increased VABS subitem scores in the experimental group, including the receptive, expressive, domestic, and community scores but no such increase was observed in the control group. For the EEG, the beta rhythm at C3 and C4 increased in the experimental group. Additionally, positive correlations were observed between changes in the scores for the expressive subitem and changes in the beta rhythm on the C4 electrode at baseline and immediately after treatment in the experimental group. The control group showed no significant differences in any items for both observation and imitation times. CONCLUSION: Ten sessions of HF-rTMS combined with AOE could improve both the subitems of communication and daily living skills domain in children aged 7-12 years with ASD. Although it is still inconclusive, this behavioural improvement may be partly attributable to increased cortical activity, as evidenced by beta rhythms.

Minimal detectable changes of the Berg Balance Scale, Fugl-Meyer Assessment Scale, Timed "Up & Go" Test, gait speeds, and 2-minute walk test in individuals with chronic stroke with different degrees of ankle plantarflexor tone.

OBJECTIVE: To determine test-retest reliability and absolute and relative minimal detectable changes at the 95% confidence level (MDC(95)) of measures to detect postural balance and lower limb movements in individuals with chronic stroke who were able to walk and had differences in ankle plantarflexor tone. DESIGN: Test-retest study. Data were collected on 2 occasions, about 6 days apart. SETTING: Outpatient physical therapy clinics. PARTICIPANTS: Volunteers (N=61) with chronic stroke who were able to walk and had differences in ankle plantarflexor tone: no increase in ankle plantarflexor tone (n=12), a slight increase in ankle plantarflexor tone (n=32), and a marked increase in ankle plantarflexor tone (n=17). INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Reliability and absolute and relative MDC(95) of the Berg Balance Scale (BBS), the lower limb subscale of Fugl-Meyer Assessment (FMA-LE), the Timed "Up & Go" test (TUG), the comfortable gait speed (CGS), the fast gait speed (FGS), and the 2-minute walk test (2MWT). RESULTS: Excellent reliability of the BBS, FMA-LE, TUG, CGS, FGS, and 2MWT for all the participants combined and for the subgroups was shown. All the participants combined showed the absolute and relative MDC(95) in the BBS of 5 points and 10%, FMA-LE of 4 points and 16%, TUG of 8 seconds and 28%, CGS of 0.2m/s and 34%, FGS of 0.1m/s and 21%, and 2MWT of 13m and 23%. The absolute and relative MDC(95) of the subgroups were varied based on ankle plantarflexor tone. CONCLUSIONS: The BBS, FMA-LE, TUG, CGS, FGS, and 2MWT are reliable measures to detect postural balance and lower limb movements in individuals with chronic stroke who have differences in ankle plantarflexor tone. The absolute and relative MDC(95) of each measure are dissimilar in those with differences in ankle plantarflexor tone. The relative MDC(95) seems more useful than the absolute MDC(95) because the relative value can be used for a single individual.

Randomized controlled trial of home rehabilitation for patients with ischemic stroke: impact upon disability and elderly depression.

BACKGROUND: Patients with major stroke are often left with disability and may have depression and dementia during the recovery phase. Rehabilitation programmes have been shown to improve short-term physical outcome, but their long-term effectiveness and impact on dementia and depression are uncertain. METHODS: We performed a 6-month randomized controlled trial of a home rehabilitation programme and compared it with the standard care patients with recent ischemic stroke receive. The intervention group received home-based physical therapy once a month for 6 months, along with educational support, counselling and audiovisual materials. The control group received rehabilitation as prescribed by a physician and educational materials upon discharge from hospital. The primary measurement was a change in Barthel Index. Secondary measurements were the Hospital Anxiety and Depression Scale (HADS) and Thai Mini-Mental State Examination. RESULTS: Of the 68 screened patients, 60 patients were enrolled. At baseline, there was no significant difference in patient characteristics between the two groups. Over 2 years, the mean Barthel Index and Hospital Anxiety and Depression Scale were significantly improved in the intervention group compared to the control group (Barthel Index mean: from 31.7 ± 5.9 to 97.2 ± 2.8 vs from 33.2 ± 4.8 to 76.4 ± 9.4, P < 0.001; Hospital Anxiety and Depression Scale mean: from 16.1 ± 7.6 to 9.1 ± 0.3 vs 16.4 ± 4.9 to 9.1 ± 0.3, P= 0.003). Depression was strongly associated with being dependent on others. However, the Thai Mini-Mental State Examination in both groups did not significantly differ (Thai Mini-Mental State Examination mean: from 24.4 ± 2.0 to 24.6 vs 23.8 ± 1.9 to 24.1 ± 0.3, P= 0.068). There was no significant interaction between baseline characteristics and treatment outcome. CONCLUSIONS: At 2 years follow-up, it was evident that a 6-month home rehabilitation programme after ischemic stroke improved functional outcome and reduced incidence of depression, but not dementia.

Muscle Microcirculatory Responses to Incremental Exercises Are Correlated with Peak Oxygen Uptake in Individuals With and Without Type 2 Diabetes Mellitus.

Background: The role of impaired oxygen extraction on peak oxygen uptake (V̇O2peak) has been extensively studied using noninvasive and indirect methods in both diabetic patients and healthy participants. Methods: A total of 22 participants with type 2 diabetes mellitus [T2DM; median (range) age: 60 (47-70) years] and 22 controls [58 (52-69) years] with no history of diabetes were recruited (reference no. 201812135RINB). Subjects performed an exhaustive incremental exercise and were evaluated using a gas analyzer and near-infrared spectroscopy (NIRS) to determine V̇O2peak and changes in muscle oxygenation (SmO2) in the vastus lateralis, respectively. Measurements were taken at rest, warm-up, a period during exercise when SmO2 reached a minimum saturation plateau, and recovery. The microcirculatory responses of the vastus lateralis muscle during incremental exercise in patients with T2DM were compared with those in control individuals, and the correlation between changes in SmO2 and V̇O2peak was estimated. Results: The diabetic group demonstrated lower V̇O2peak, peak workload, peak heart rate, peak minute ventilation (all P < 0.05), and lower SmO2 during the rest, warm-up, and recovery phases (all P < 0.05) compared with the control group. A correlation was observed between the change in SmO2 between the warm-up and plateau value and the V̇O2peak (r = 0.608, P = 0.006). Conclusions: The results obtained in this study using NIRS support the feasibility of directly measuring changes in muscle SmO2 magnitudes to estimate the contributions of peripheral active muscle to systemic O2 uptake (V̇O2) during incremental exercise.

Cost-effectiveness analysis of home rehabilitation programs for Thai stroke patients.

BACKGROUND: The individual home rehabilitation program for ischemic stroke patients was conducted in a Thai healthcare setting. The program demonstrated that it was statistically significantly more effective than the conventional method. However for policy makers to adopt this program, the question of cost-effectiveness must be answered. OBJECTIVE: To compare the costs and effects of a home rehabilitation program versus conventional hospital care for ischemic stroke patients in Thailand. MATERIAL AND METHOD: Cost-effectiveness analysis was conducted alongside a clinical trial. An open-label randomized control trial was conducted to explore the efficacy of a home rehabilitation program for acute stroke care for three months after hospital discharge. The Barthel Index and Modified Rankin Scale were used to evaluate the outcome measures. Success was defined as improvement by at least one level of the outcome scales. An incremental cost-effectiveness ratio, including sensitivity analysis, was presented. RESULTS: Fifty-eight patients were included in the study. Patients were randomly assigned to the study and control groups (28 and 30, respectively). The cost and number of successful cases in the study group were higher than those of the control group. The incremental cost-effectiveness ratio (ICER) was lowest--13,644 Thai Baht (THB)--regarding the Modified Rankin Scale measurement. For patients achieving mild disability and no disability based on the Barthel Index, the ICERs were 14,212 THB and 24,364 THB, respectively. Sensitivity analyses regarding variations in number of patients and cost of home visits demonstrated more cost-effectiveness than the base case. CONCLUSION: Providing a home rehabilitation program with higher cost resulted in a greater number of patients avoiding disability than via conventional hospital care. The hospital had to pay approximately 24,000 THB for each additional disability-avoided patient when switching from conventional hospital care to a home rehabilitation program. This was assumed to be cost-effective when compared to per capita gross domestic product.

Application of PRECEDE-PROCEED Planning Model in Transforming the Clinical Decision Making Behavior of Physical Therapists in Myanmar.

Introduction: Physical therapists in Myanmar use a prescriptive model of Clinical Decision Making (CDM). Improving CDM effectiveness is one essential factor in professionalizing practice and enhancing patient outcomes. This study assesses the changes in CDM skills and behaviors using the PRECEDE-PROCEED planning Model (PPM). Methods: In the PRECEDE planning phases, we investigated the current clinical decision making knowledge, and process, clinical practice culture, and contributing factors of CDM among Myanmar physical therapists. A qualitative approach consisted of 18 in-depth interviews and one focus group discussion was used. In the PROCEED evaluation and implementation phases, we developed and presented the CDM educational book at CDM workshop, which was a 4-day intensive program in Yangon, Myanmar with 34 participants. The participant's CDM knowledge and processes were assessed before and after the educational program to explore the potential impact on implementing CDM which can ultimately improve patient care in the health settings of Myanmar. Results: In the PRECEDE phases, we explored the predisposing and reinforcing factors of Myanmar physical therapists' CDM. We found that CDM models and deliberative decision making process that is used internationally were not followed by Myanmar physical therapists who followed the physician's prescriptions. Teaching and learning emphasize a stimulus-response-repeat-outcome cycle without internal processing or application to clinical situations. Using the PROCEED model components, we developed a 14 chapters CDM workbook and a 4-day workshop as a behavioral change intervention. Participants' prior technical CDM behavior was transformed into professional CDM behavior that included an understanding of clinical practice models and improvement in the cognitive process of CDM processes. The workbook coupled with the intensive active-learning, hands-on workshop of examination and intervention procedures were effective in improving CDM. Discussion: The application of PPM provided a through understandings of current CDM process of Myanmar therapists and aided in the development of the tailored CDM educational program to improve participants' CDM. Using the PPM model for developing a set of Physical Therapy educational content and curriculum was new. The application of PPM was beneficial to use accepted clinical practice models, standardized tests and measures, set goals and clinical outcomes, reassessed to determine change and implement evidence-based practice.

Enhanced Upper Extremity Functions with a Single Session of Action-Observation-Execution and Accelerated Skill Acquisition Program in Subacute Stroke.

BACKGROUND: Action-observation-execution (AOE) primes physical training. We examined the immediate effect of AOE with accelerated skill acquisition program (ASAP) on dexterity in subacute stroke. METHODS: Twelve individuals from 1 to 6 months after stroke were allocated into two groups by matching age and side of stroke. After AOE of 30 minutes, the experimental group received ASAP for 60 minutes whereas the control group received dose-equivalent usual care. The movement time (MT) and functional ability (FA) of hand items of the Wolf motor function test (WMFT), hand functions and global recovery of stroke impact scale (SIS), and intrinsic motivation items of stroke rehabilitation motivation scale were assessed at baseline, after training, and during one-week follow-up. Data were analyzed within and between the groups. RESULTS: AOE significantly decreased MT of flipping cards of WMFT and hand functions of SIS. Total MT was markedly reduced. AOE with ASAP demonstrated significant group-by-time interactions on MT of lifting pencil of WMFT, total MT, and global recovery. Grip strength, FA, and hand functions were significantly improved only in the experimental group. Both groups improved motivation significantly. CONCLUSIONS: The AOE with ASAP enhanced dexterity, which persisted for at least a week. This intervention might improve dexterity in subacute stroke. TRIAL REGISTRATION NUMBER: This trial is registered with TCTR20161007001.

Predicting community participation after spinal cord injury in Thailand.

OBJECTIVE: To identify the predictors of community participation after spinal cord injury. DESIGN: Cross-sectional design. METHODS: A total of 139 persons with spinal cord injury living in the community completed 4 instruments: the Impact on Participation and Autonomy (IPA-Thai version), the Craig Hospital Inventory of Environmental Factors (CHIEF-SF-Thai version), the Personal Resource Questionnaire (PRQ2000-Thai version), and a personal history questionnaire. Functional performance was assessed using the Functional Independence Measure (FIM) motor subscale. RESULTS: Participants comprised 79% males. Fifty-one percent of variance in community participation was explained by social support, functional performance, age, and age at time of injury. CONCLUSION: Key predictors of community participation were the availability of social support and the individual's functional performance. These predictors should be emphasized when developing interventions in rehabilitation and community settings.

Effectiveness of home rehabilitation program for ischemic stroke upon disability and quality of life: a randomized controlled trial.

BACKGROUND: To develop and examine the effectiveness of individual 6-month home rehabilitation program in ischemic stroke patients upon disability and quality of life at 2 years. METHODS: This is a prospective randomized controlled trial (RCT) in 60 patients with recent ischemic stroke. They were randomly assigned to receive either home rehabilitation program once a month for 6 months with audiovisual materials (intervention group) or usual care (control group). We collected outcome data after discharge from the hospital until 2 years. The Barthel index (BI), the modified Rankin Scale (mRS) and utility index (EQ-5D) were measured for function, disability and quality of life respectively. RESULTS: At 2 years, the BI was significantly improved in the intervention group more than the control group: 97.2±2.8 vs. 76.4±9.4, p<0.001. The good outcome, defined as BI 95-100, or mRS 0 or 1. For BI, there were 29 patients (96.7%) in intervention group vs 12 patients (42.9%) in usual care group (95% CI, 42.0, 85.0, p=0.03). For mRS, there were 28 patients (93.3%) in intervention group vs 9 patients (32.1%) in usual care group (95% CI, 38.2, 87.0, p=0.02). Number needed to treat for good outcome in mRS was 2.0 (95% CI: 1.0, 1.3). The mean (SD) of utility index in intervention group and control group were 0.9±0.02 and 0.7±0.04 respectively (p=0.03). There was no significant interaction in baseline characteristics and treatment outcome. CONCLUSIONS: Early home rehabilitation program in the first 6 months period after ischemic stroke leads to more rapid improvement in function, reducing disability and increase quality of life than usual care.

Effectiveness of home rehabilitation for ischemic stroke.

The objective of this study was to develop and examine the effectiveness of an individual home rehabilitation program for patients with ischemic stroke. This was a randomized controlled trial in 60 patients with recent middle cerebral artery infarction. After hospital discharge for acute stroke care, they were randomly assigned to receive either a home rehabilitation program for three months (intervention group) or usual care (control group). We collected outcome data over three months after their discharge from the hospital. The Barthel Index (BI), the Modified Rankin Scale (MRS), the health-related quality-of-life index (EQ-5D), the Hospital Anxiety and Depression score (HADs), and the Thai Mental State Examination (TMSE) were used to analyze the outcomes. In the intervention group, all outcomes were significantly better (p<0.05) than in the control group, except in the case of TMSE. A favorable outcome, which was defined as minimal or no disability as measured by BI (score 95-100), was achieved by 93.33% of patients in the intervention group, and 90% had favorable scores (0 or 1) on the MRS. This showed a benefit in reducing disability, with two being the number of patients considered as needed-to-treat (NNT) (95% CI, 1.0-1.2). All dimensions of EQ-5D in the intervention group were significantly better for quality of life and generic health status than in the control group (p=0.001). Depression was found in one patient (3.33%) in the intervention group and in two patients (6.67%) in the control group. Dementia was found in three patients (10%) in the intervention group and in four patients (13.33%) in the control group. We concluded that an early home rehabilitation program for patients with ischemic stroke in the first three-month period provides significantly better outcomes in improving function, reducing disability, increasing quality of life, and reducing depression than a program of usual care does.