The validity and reliability of the PHQ-9 in screening for post-stroke depression.

BACKGROUND: Depression affects about 30% of stroke survivors within 5 years. Timely diagnosis and management of post-stroke depression facilitate motor recovery and improve independence. The original version of the Patient Health Questionnaire-9 (PHQ-9) is recognized as a good screening tool for post-stroke depression. However, no validation studies have been undertaken for the use of the Thai PHQ-9 in screening for depression among Thai stroke patients. METHODS: The objectives were to determine the criterion validity and reliability of the Thai PHQ-9 in screening for post-stroke depression by comparing its results with those of a psychiatric interview as the gold standard. First-ever stroke patients aged ≥45 years with a stroke duration 2 weeks-2 years were administered the Thai PHQ-9. The gold standard was a psychiatric interview leading to a DSM-5 diagnosis of depressive disorder and adjustment disorder with a depressed mood. The summed-scored-based diagnosis of depression with the PHQ-9 was obtained. Validity and reliability analyses, and a receiver operating characteristic curve analysis, were performed. RESULTS: In all, 115 stroke patients with a mean age of 64 years (SD: 10 years) were enrolled. The mean PHQ-9 score was 5.2 (SD: 4.8). Using the DSM-5 criteria, 11 patients (9.6%) were diagnosed with depressive disorder, 12 patients (10.5%) were diagnosed with adjustment disorder with a depressed mood. Both disorders were combined as a group of post-stroke depression. The Thai PHQ-9 had satisfactory internal consistency (Cronbach's alpha: 0.78). The algorithm-based diagnosis of the Thai PHQ-9 had low sensitivity (0.52) but very high specificity (0.94) and positive likelihood ratio (9.6). Used as a summed-scored-based diagnosis, an optimal cut-off score of six revealed a sensitivity of 0.87, specificity of 0.75, positive predictive value of 0.46, negative predictive value of 0.95, and positive likelihood ratio of 3.5. The area under the curve was 0.87 (95% CI: 0.78-0.96). CONCLUSIONS: The Thai PHQ-9 has acceptable psychometric properties for detecting a mixture of major depression and adjustment disorder in post-stroke patients, with a recommended cut-off score of ≥6 for a Thai population.

Walking function at 1-year after stroke rehabilitation: a multicenter study.

OBJECTIVE: To study the mobility status of stroke patients at 1-year after discharge from inpatient stroke rehabilitation. The factors associated with walking ability at 1-year were also explored MATERIAL AND METHOD: A multicenter prospective study of 327 stroke patients from the Thai Stroke Rehabilitation Registry (TSRR) were followed-up at 1-year after discharge from inpatient rehabilitation. Based on the Modified Barthel Index, the stroke patients who had mobility score either 2 or 3 were classified as ambulators. The mobility status was reported as ambulator and non-ambulator. Multivariate analysis was performed to determine any factors associated with the walking ability at 1-year RESULTS: One hundred ninety two patients (58.7%) came for follow-up at 1-year Among these, 87 (45.3%), 86 (44.8%), and 19 (9.9%) of patients had mobility skills improved, sustained, and declined respectively. Eighty-five (44.3%) patients recovered their walking ability. The stroke patients who were able to walk increased from 131 (68.2%) at discharge to 151 (78.7%) at 1-year Meanwhile, 13 patients (6.8%) who could ambulate by walking at discharge became non-ambulators. The factors associated with the walking ability at 1-year were motor recovery of the affected leg at discharge, having no diabetes mellitus, being married, and able to change position from supine to sitting on admission. CONCLUSION: After being discharged from inpatient stroke rehabilitation, the walking ability had continued to improve. At one year 78% of stroke patients had ability to ambulate. Motor power of the affected leg at discharge, having no diabetes mellitus, married and able to change position from supine to sitting on admission were factors associated with walking ability at 1-year after discharged from inpatient stroke rehabilitation.

Comparative effectiveness of high-intensity laser therapy and ultrasound therapy for hemiplegic shoulder pain in stroke patients: a randomized controlled trial".

BACKGROUND: Hemiplegic shoulder pain (HSP) is a prevalent clinical manifestation following stroke, often causing considerable discomfort and disability. Various therapeutic approaches have been developed to address HSP. OBJECTIVES: This study aimed to compare the effectiveness of HILT versus US therapy in alleviating HSP in stroke patients. METHODS: A double-blind randomized controlled trial enrolled stroke patients with HSP within one year post-onset. Participants were randomly assigned to HILT (with sham US) or US therapy (with sham HILT). Both groups received 10-minute sessions of their assigned therapy modality along with daily shoulder range of motion (ROM) exercises 5 times per week over two consecutive weeks. Pain reduction was the primary outcome, with shoulder ROM as secondary outcomes. RESULTS: Thirty patients (11 women, 19 men; mean age: 60.80 ± 11.51 years) were included. After the two-week intervention, significant improvements were observed in pain reduction at rest and during motion in the HILT group, and in pain reduction during motion and shoulder internal rotation in the US group compared to pre-treatment values within each group. However, there was no significant difference between the HILT and US therapy groups in any evaluated parameter. CONCLUSIONS: Comparable efficacy was found between HILT and US therapy in reducing pain and improving shoulder ROM for HSP in stroke patients. Both modalities, when combined with shoulder ROM exercises, offer viable options for managing HSP in this population. Further research with larger sample sizes is needed to validate these findings and explore long-term outcomes.

A systematic review of major evaluation metrics for simulator-based automatic assessment of driving after stroke.

Background: Simulator-based driving assessments (SA) have recently been used and studied for various purposes, particularly for post-stroke patients. Automating such assessment has potential benefits especially on reducing financial cost and time. Nevertheless, there currently exists no clear guideline on assessment techniques and metrics available for SA for post-stroke patients. Therefore, this systematic review is conducted to explore such techniques and establish guidelines for evaluation metrics. Objective: This review aims to find: (a) major evaluation metrics for automatic SA in post-stroke patients and (b) assessment inputs and techniques for such evaluation metrics. Methods: The study follows the PRISMA guideline. Systematic searches were performed on PubMed, Web of Science, ScienceDirect, ACM Digital Library, and IEEE Xplore Digital Library for articles published from January 1, 2010, to December 31, 2023. This review targeted journal articles written in English about automatic performance assessment of simulator-based driving by post-stroke patients. A narrative synthesis was provided for the included studies. Results: The review included six articles with a total of 239 participants. Across all of the included studies, we discovered 49 distinct assessment inputs. Threshold-based, machine-learning-based, and driving simulator calculation approaches are three primary types of assessment techniques and evaluation metrics identified in the review. Discussion: Most studies incorporated more than one type of input, indicating the importance of a comprehensive evaluation of driving abilities. Threshold-based techniques and metrics were the most commonly used in all studies, likely due to their simplicity. An existing relevant review also highlighted the limited number of studies in this area, underscoring the need for further research to establish the validity and effectiveness of simulator-based automatic assessment of driving (SAAD). Conclusions: More studies should be conducted on various aspects of SAAD to explore and validate this type of assessment.

Epidemiology of urinary tract infection among spinal cord injured patients in rehabilitation ward at Siriraj Hospital.

BACKGROUND AND OBJECTIVE: A prophylactic antibiotic in retrograde investigations (Ix) such as an urodynamic study was suggested by the European Association of Urology in order to prevent urinary tract infection (UTI) in the neurogenic bladder However finding an appropriate antibiotic is questionable since bacterial types and their sensitivities are variable in different settings. Therefore, the present study was aimed to find out the epidemiology of UTI in spinal cord injured (SCI) patients within the rehabilitation ward at Siriraj Hospital. MATERIAL AND METHOD: A retrospective chart review of 100 SCI patients admitted to the rehabilitation ward between 2006 and 2010 was done. Symptomatic UTI events, urine cultures, and sensitivities (C/S) were reviewed Demographic data and possible UTI-associated factors were collected and examined the association with the occurrence of UTI RESULTS: There were 64 males and 36 females with a mean age of 42.9 (SD 15.8) years. Most of them (77%) were injured at cervical and thoracic spinal cords. Forty-five patients had 57 UTI episodes. Escherichia coli was the most common isolated pathogen (50%), followed by Pseudomonas aeruginosa (17.3%), and Enterococcus faecalis (7.7%). The top three most sensitive antibiotics were imipenem, amikacin, and piperacillin/tazobactam. Unfortunately, gentamicin, ceftriaxone, and ciprofloxacin, which were frequently used as a prophylactic antibiotic, had the efficacy for only 51.9%, 38.5%, and 28.8% ofpathogens respectively. The mean length ofstay ofpatients with UTI was far greater than non-UTI patients, 45.5 (SD 24.4) versus 30.4 (SD 14.8) days (p = 0.001). Vesicoureteric reflux (VUR) (OR 21.2, 95% CI2.1 to 214.2) and increased intravesical pressure at storage phase (OR 1.1, 95% CI 1.004-1.113) were significant riSk factors for post investigation UTI. CONCLUSION: UTI was commonly observed in SCI patients within the rehabilitation ward The most common uropathogen was Escherichia coli. Therefore, a prophylactic antibiotic such as amikacin should be prescribed in patients with VUR and increased intravesical pressure at storage phase.

Driving scenarios and environmental settings in simulator-based driving assessment systems for stroke: a systematic review.

BACKGROUND: Driving simulators are effective tools to evaluate the driving abilities of patients with stroke. They can introduce various driving scenarios which will greatly benefit both the assessors and drivers. However, there is still no guidelines by which driving scenarios should be introduced in the driving assessment. OBJECTIVES: We conducted a systematic review to examine the utilization of driving scenarios and environments in the simulator-based driving assessment for patients with stroke. METHODS: A systematic review was conducted following PRISMA. We searched PubMed, Web of Science, ScienceDirect, ACM Digital Library, and IEEE Xplore Digital Library databases in January and June 2022 to identify eligible articles published since 2010. RESULTS: Our searches identified 1,614 articles. We included 12 studies that applied driving simulators to assess the driving performance of patients with stroke. The driving scenarios were categorized into three categories - vehicle controls scenarios, hazard perception scenarios, and trajectory planning scenarios - based on a certain set of driving abilities. The most common driving scenarios are simple navigation (n = 8) and emergency stop (n = 8). The most frequently used driving area is urban (n = 9), and a variety of roads and traffic conditions were found in the included studies. Only 2 studies applied weather conditions, such as the clear and sunny condition or the windy condition. CONCLUSION: It is recommended for future research to consider covering scenarios from the aforementioned three categories and further investigate the benefits of introducing complex weather conditions and localized traffic conditions in the driving assessment.

Summary of the Thai Osteoporosis Foundation (TOPF) Clinical Practice Guideline on the diagnosis and management of osteoporosis 2021.

Objectives: The Thai Osteoporosis Foundation (TOPF) is an academic organization that consists of a multidisciplinary group of healthcare professionals managing osteoporosis. The first clinical practice guideline for diagnosing and managing osteoporosis in Thailand was published by the TOPF in 2010, then updated in 2016 and 2021. This paper presents important updates of the guideline for the diagnosis and management of osteoporosis in Thailand. Methods: A panel of experts in the field of osteoporosis was recruited by the TOPF to review and update the TOPF position statement from 2016. Evidence was searched using the MEDLINE database through PubMed. Primary writers submitted their first drafts, which were reviewed, discussed, and integrated into the final document. Recommendations are based on reviews of the clinical evidence and experts' opinions. The recommendations are classified using the Grading of Recommendations, Assessment, Development, and Evaluation classification system. Results: The updated guideline comprises 90 recommendations divided into 12 main topics. This paper summarizes the recommendations focused on 4 main topics: the diagnosis and evaluation of osteoporosis, fracture risk assessment and indications for bone mineral density measurement, fracture risk categorization, management according to fracture risk, and pharmacological management of osteoporosis. Conclusions: This updated clinical practice guideline is a practical tool to assist healthcare professionals in diagnosing, evaluating, and managing osteoporosis in Thailand.

The impact of physical medicine and rehabilitation consultation on clinical outcomes in the surgical intensive care unit: A prospective observational cohort study.

ABSTRACT: The impact of a physical medicine and rehabilitation (PM&R) consultation on clinical outcomes in critically ill surgical patients remains unclear. The aim of this study is to examine whether the patients who received PM&R consultation will demonstrate better clinical outcomes in terms of the differences in clinical outcomes including muscle mass and strength, intensive care unit (ICU) length of stay (LOS) and functional outcomes between the PM&R consultation and no PM&R consultation and between early PM&R consultation and late PM&R consultation in critically ill surgical patients.A prospective observational cohort study was undergone in 65-year-old or older patients who were admitted > 24 hours in the surgical intensive care unit (SICU) in a tertiary care hospital. Data collection included patients' characteristic, muscle mass and muscle strength, and clinical outcomes.Ninety surgical patients were enrolled and PM&R was consulted in 37 patients (36.7%). There was no significant difference in muscle mass and function between consulted and no consulted groups. PM&R consulted group showed worse in clinical outcomes including functional outcomes at hospital discharge, longer duration of mechanical ventilation, ICU, and hospital LOS as compared with no PM&R consulted group. The median time of rehabilitation consultation was 6 days and there were no significant differences in clinical outcomes between early (≤ 6 days) and late (> 6 days) consultation.PM&R consultation did not improve muscle mass, functional outcomes at hospital discharge, and ICU LOS in critically ill surgical patients. The key to success might include the PM&R consultation with both intensified physical therapy and early start of mobilization or the rigid mobilization protocol.

Change in quality of life of disabled patients after intensive inpatient rehabilitation at Siriraj Hospital.

OBJECTIVE: To compare the quality of life (QOL) before and after intensive rehabilitation of disabled patients and to examine the factors associated with the change in QOL. MATERIAL AND METHOD: A retrospective chart review of 200 disabled patients who were admitted for intensive rehabilitation between 2006 and 2009. The Thai abbreviated version of World Health Organization quality of life (WHOQOL-BREF-THAI) was used to assess QOL. Demographic data, physical and psychosocial status, Modified Barthel ADL Index (BAI) were collected and analyzed for the association with WHOQOL-BREF-THAI score changes. RESULTS: One hundred seventeen (58.5%) males and 83 (41.5%) females with mean age 55.6 (SD 17.9) years old participated in this study. Various principal diagnoses were included; 112 (56%) stroke, 54 (27%) spinal cord injury and 34 (17%) other diagnoses. After the intensive rehabilitation, quality of life perception was improved in 164 (82%) disabled patients. There was significant difference in mean WHOQOL-BREF-THAI scores on admission and at discharge which were 81.3 (SD 11.2) and 85.5 (SD 11.0) respectively with the p-value < 0.001. The mean changed score was 4.2 (SD 8.0). However, four domains of QOL were improved except the social domain. The factors associated with the disabled patients who were non-improved in WHOQOL-BREF-THAI score after rehabilitation were having non-familial caregiver (OR 5.8, 95% CI 2.1 to 16.0) and joint stiffness (OR 4.1, 95% CI 1.7 to 9.9). CONCLUSION: Intensive inpatient rehabilitation can significantly improve quality of life in the disabled patients with various primary diagnoses. Having joint stiffness prior to rehabilitation and non-availability of familial members for taking care are the factors associated with the poor outcome in QOL perception.

Quality of life among the traumatic spinal cord injured patients.

OBJECTIVES: To study the quality of life among the traumatic spinal cord injured patients and to identify the factors related with the quality of life in the good level of such patients. MATERIAL AND METHOD: The traumatic SCI patients who had been treated in the Department of Rehabilitation Medicine, Siriraj Hospital, Bangkok, Thailand from January 2003 until August 2009 were interviewed for the demographic data. The injury related data were obtained from the medical records. The WHOQOL-BREF-Thai was used to acquire the QOL score, which would be interpreted as poor fair, and good QOL level according to the questionnaire. The Center for Epidemiologic Studies Depression scale and the modified Barthel Index (BI) were used to assess depression, and functional disability respectively. The median split method was used to divide the participants into two groups as good and poor QOL groups. The Chi-square and Independent Sample t-test were performed to determine the difference between these two groups and multivariate logistic regression was used to analyze the factors associated with the good QOL. P-value < 0.05 was accepted as statistical significance. RESULTS: Sixty-seven patients (49 males and 18 females) with a mean age 36.54 +/- 11.46 years old participated the present study. They suffered from traffic accident 67.2%, gunshot 16.4%, fall from a height 11.9%, and others 4.5%. The injury levels were cervical 31.3%, thoracic 50.7%, and lumbosacral 18%. Most of them (60.6%) had incomplete lesion. Eighteen patients (26.1%) reported depression. The mean BI score was 69.71 +/- 29.42. Three (4.5%), forty-nine (73.1%), and fifteen (22.4%) participants reported their QOL score in the range of poor, fair and good levels respectively. Using the median split method, participants with a score over 82 were classified as having good QOL groups and the rest were classified as having poor QOL group. When considering the score in each domain of the WHOQOL questionnaire, the differences between the good and poor QOL groups had statistical significance. The sufficient income (OR 13.67, 95% CI: 3.1-60.22, p = 0.001), having no depression (OR 7.6, 95% CI: 1.17-49.22, p = 0.033), and being employed (OR 6.88, 95% CI: 1.44-32.94, p = 0.016) were significantly related with the good QOL. CONCLUSION: Most of the SCI patients determined their QOL as fair level. Sufficient income, having no depression, and being employed were associated with the good QOL.

Health related quality of life among the Thai people with unilateral lower limb amputation.

OBJECTIVE: To study the health related quality of life (HRQOL) among Thai unilateral lower limb amputees and determine the factors associated with a good HRQOL. MATERIAL AND METHOD: A postal survey with the WHOQOL-BREF-Thai questionnaire (26 items) to 1300 people with LLA who received a lower limb prostheses from Siriraj Hospital, Prapokklao Hospital, and Ratchaburi Hospital between 2001 and 2005 was conducted. Descriptive statistics were used to report the level of HRQOL. Chi-Square, independent Sample t-test and multivariate analysis by stepwise logistic regression were used to determine the factors associated with a good QOL. RESULTS: Three hundred and nine questionnaires were completed from the 321 returned questionnaires (response rate 24.7%). Among these, 278 people were with unilateral LLA. They were 221 males and 57 females with mean age 46.9 +/- 13.9 years old. The number of people with LLA who had poor, fair and good QOL were 14 (5%), 241 (86.7%), and 23 (8.3%), respectively. Demographically, the people with LLA who had long duration of amputation (p = 0.001), higher education (p = 0.005), and had been employed after amputation (p < 0.001) had significantly better HRQOL. The amputees who had good wearing comfort (p = 0.04) after wearing the prostheses, had no phantom pain (p = 0.02), used no gait aids (p = 0.01), and had no body image anxiety (p = 0.01) had significantly better HRQOL. The factors associated with the good HRQOL were higher education (OR 3.2), having been employed after amputation (OR 2.1), and having good prosthetic wearing comfort (OR 1.3). CONCLUSION: Thai people with unilateral LLA reported primarily fair HRQOL. Having higher education, having been employed after amputation, and having good prosthetic wearing comfort were associated with the good HRQL.

Prevalence and associated factors of musculoskeletal pain among the dental personnel in a dental school.

OBJECTIVE: To study the prevalence and associated factors of musculoskeletal (MS) pain among the dental personnel. In addition, impacts and treatment of MS pain were reported. MATERIAL AND METHOD: Random sampling of 390 participants from the name lists of dental personnel working in each department. Self-administered questionnaires were equally distributed to three groups of dental personnel namely clinical instructors, postgraduate students, and dental assistants. The present study was conducted as a survey in the Faculty of Dentistry, Mahidol University, Bangkok between December 2008 and January 2009. RESULTS: Three hundred and ninety questionnaires were delivered and 164 questionnaires were returned (response rate 42.5%). The participants with MS pain were 32 clinical instructors (20.3%), 52 postgraduate students (32.9%), and 74 dental assistants (46.8%). Their mean age was 33.0 +/- 9.1 years old. The MS pain found respectively was shoulder pain 72.2% (n = 114), neckpain 70.3% (n = 111), and low backpain 50.6% (n = 80). The participants with shoulder and neckpain were combined and defined as cervicobrachial pain. The associated factor of cervicobrachial pain was working status. Being a clinical instructor and postgraduate student were associated with cervicobrachial pain with OR being 4.7 [1.3, 7.1] and 4.6 [1.6, 13.4], respectively. The impacts of MS pain among the dental personnel included usage of pain relieving medication (34.8%), seeking medical evaluation (32.3%), reduction in working hours (27.2%), difficulty sleeping (22.8%), and work absence (10.8%), respectively. The treatments of MS pain utilized to alleviate those impacts were Thai traditional massage (51.9%), medication (28.5%), physical therapy (15.8%), acupuncture (7.6%), and alternative medicine (4.4%), respectively. CONCLUSION: Cervicobrachial pain was the most prevalent MS pain among the dental personnel and working status was associated with their MS pain problems. The impact of MS pain was predominantly usage of pain relieving medication. Thai traditional massage was the most utilized treatment.

Caregiver burden and needs of dementia caregivers in Thailand: a cross-sectional study.

OBJECTIVE: To identify the burdens of Thai dementia caregivers and to determine the services that could support them in this function. MATERIAL AND METHOD: The authors surveyed 88 dementia caregivers attending "Caregiver Day". The questionnaire contained Caregiver Burden Inventory. The answers range from "not at all descriptive" (zero) to "very descriptive" (4). The authors also explored baseline characteristics of caregivers and care recipients as well as caregiver's needs of a supporting system. RESULTS: There was an 82% response rate. Responses in time-dependence burden distributed almost equally in the five possible scales. In developmental and physical burden, caregivers rate scores mainly from 0-2. The scores in social and emotional burden ranged mainly between 0-1. Dependency in basic activities of daily living correlated with higher caregiver burden (odd ratio 7.48, 95% confidence interval 1.42-39.53, p = 0.02), while sex and kinship did not. The top three caregiver's needs were 1) caregiver education and training, 2) telephone line provided for caregiver consultation and 3) special system in a hospital provided for dementia patients to have rapid access to see a doctor. CONCLUSION: Caring for dementia patients can lead to high caregiver burden, particularly those caring for dependent patients. Physical and developmental burdens are affected more than social and emotional burdens. Culture, relationship quality and resources (coping, outlook on life and social support) might be contributing factors of this difference.

Prevalence and management of poststroke spasticity in Thai stroke patients: a multicenter study.

OBJECTIVES: To study the prevalence, associated factors and management of poststroke spasticity in two muscle groups namely elbow flexor and knee flexor. MATERIAL AND METHOD: The Thai stroke rehabilitation registry (TSRR) was conducted among 9 rehabilitation centers. All subjects received the conventional rehabilitation program until they reached their rehabilitation goals or discharge criteria. The Brunnstrom motor recovery stage, Barthel Index, Thai Mental State Examination, Modified Ashworth Scale (MAS), and WHOQOL-BREF-Thai (26 items) questionnaires were used to assess the motor recovery, functional disability, cognition, spasticity and quality of life on admission respectively. The management of spasticity was also recorded. RESULTS: There were 327 patients with a mean age of 62.2-years-old participating in the study. The prevalence of poststroke spasticity was 41.6%. Among these the prevalences of spasticity of both elbow and knee flexors was 31.2% and of either elbow or knee flexor were 4.9% and 5.5% respectively. Spasticity with MAS grade 1 was found in the majority. The patients with spasticity had a significantly longer time to rehabilitation admission interval after the stroke (p = 0.049), had the Brunnstrom motor recovery stages of arm (p < 0.001), hand (p = 0.003) and leg (p < 0.001) significantly lower than the no spasticity group. The factor associated with spasticity was Brunnstrom motor recovery stage 2 and 3 of the arm with the odds ratio being 6.1 (95% CI = 2.5-14.9) and 3.5 respectively (95% CI = 1.3-9.2). Management of spasticity was demonstrated in 83 patients (25.4%). Therapeutic exercise, oral antispastic medication and assistive device were the first three managements frequently prescribed respectively. CONCLUSION: Spasticity was a common complication after stroke. Although the prevalence was quite high, spasticity with MAS grade 1 was found in the majority of cases. The associated factor was the Brunnstrom motor recovery stage of the arm. Therapeutic exercise was the mainstay of the management.

Factors associated with vocational reintegration among the Thai lower limb amputees.

BACKGROUND: Vocational reintegration is an important goal in the rehabilitation process. The amputees had to take time to adjust themselves to their new condition after lower limb amputation and that might have an impact on their vocation. As yet, there has been no information regarding vocational reintegration among the lower limb amputees in Thailand. OBJECTIVES: To study the rate of vocational reintegration, factors associated with vocational reintegration among the lower limb amputees. MATERIAL AND METHOD: The postal survey with the questionnaires to 1,300 amputees who received the lower limb prostheses between 2001 and 2005 was conducted. The participants were divided into two groups namely the employed and unemployed groups. The Chi-Square and the Independent Sample T Test were used to compare the difference between the two groups. The multiple variables analysis by stepwise logistic regression was used to determine the associated factors. RESULTS: Three hundred and nine questionnaires were completed among 321 returned questionnaires (response rate 24.7%). Two hundred and forty seven males and 62 females with age ranging from 18-82 years old participated. The rate of vocational reintegration was 66.7%. Demographically, the employed group had less diabetes mellitus (p = 0.001), higher educational level (p = 0.004), were younger at the time of amputation (p < 0.001) and etiologies of amputation were blast injury from mines and congenital problems (p = 0.005). Prosthetic use and problems: the employed group used no gait aids (p < 0.001), had satisfactory to good wearing comfort (p = 0.005), wore prostheses longer hours per day (p < 0.001). The factors associated with vocational reintegration were etiologies of amputation from the blast injury from mines and congenital problems (OR 3.3), educational level from secondary school (OR 2.3), at least satisfactory to good wearing comfort (OR 1.16), and younger at the time of amputation (OR 0.97) respectively. CONCLUSION: This information can assist the rehabilitation personnel to encourage the vocational reintegration among the Thai lower limb amputees.

Anxiety and depressive symptoms after stroke in 9 rehabilitation centers.

OBJECTIVE: Determine the occurrence of anxiety and depressive symptoms in rehabilitation phase and identify the associated factors that include impact on functional outcome and quality of life in stroke patients. DESIGN: Prospective analytical study. MATERIAL AND METHOD: Two hundred fifty one stroke patients from nine rehabilitation centers admitted between March and December 2006 were enrolled into the present study. Anxiety and depressive symptoms were evaluated in stroke patients using the Hospital Anxiety and Depressive Scales (HADS) twice, on admission and at discharge to rehabilitation program. Factors associated with anxiety and depressive symptoms were identified using univariate and multiple logistic regression analyses. Functional ability and quality of life using Barthel ADL Index (BI) and WHOQOL-BREF questionnaires respectively were recorded and analyzed. RESULTS: Two hundred fifty one patients were assessed for anxiety and depressive symptoms using HADS. It was found that 25.5% of the patients suffered from anxiety symptoms, 37.8% from depressive symptoms, and 17.5% from both. Anxiety symptoms were associated with depressive symptoms (OR 5.49, 95%CI 2.89-10.43) and negatively associated with dyslipidemia (OR 0.48, 95%CI 0.25-0.94). Depressive symptoms were related to anxiety symptoms (OR 5.88, 95%CI 3.15-10.99) and female gender (OR 1.81, 95%CI 1.04-3.16). Patients with anxiety and depressive symptoms had lower functional ability and quality of life than patients without symptoms on admission and at discharge. After the rehabilitation program, patients without anxiety symptoms showed improvement in functional outcome and QOL. However, patients with or without depression symptoms have improvement in functional outcome after rehabilitation. However patients without depressive symptoms showed more items improvement in QOL than patients with depression. CONCLUSION: Symptoms of anxiety and depression are common after stroke. They are correlated with each other. Female gender also related to depressive symptoms. Patients with anxiety and depressive symptoms have lower functional ability and quality of life than those without symptoms.

An epidemiologic study of the Thai Stroke Rehabilitation Registry (TSRR): a multi-center study.

OBJECTIVE: To perform the registry of stroke patients receiving the in-patient comprehensive rehabilitation program at main tertiary hospitals from March to December 2006. MATERIAL AND METHOD: Demographic data including medical history and pathology of stroke were recorded. All subjects received a comprehensive rehabilitation program until they reached their rehabilitation goals or discharge criteria. RESULTS: Three hundred twenty seven patients met the inclusion criteria. The mean age was 62 +/- 12 years, and 59% were males. Most of the patients were married (73.1%), lived in an urban area (62.1%), and had an education level of primary school or lower (58.7%). The median duration from onset to admission for rehabilitation was 24 days. The major medical history was hypertension (74.9%), followed by dyslipidemia (54.4%), diabetes mellitus (26.6%), and ischemic heart disease (18.0%). Fifty-one (15.6%) patients had a history of previous stroke. Cerebral infarction was found in 71.9%, including thrombosis (45.3%), lacuna infarction (15.3%), and emboli (8.0%) and 28.1% had hemorrhagic stroke. On admission, more than half (51.8%) had cognitive impairment and one-third (31.5%) had bowel-bladder problems. Almost all of the patients (99.4%) had family support. Either their spouse or siblings had undertaken the main caregiver role (46.5% and 40.4% respectively). However, more than 80% of the patients were discharged to their own homes or immediate family's house. CONCLUSION: This was the first multi-center registry of inpatient stroke rehabilitation in Thailand. It presented the epidemiologic aspects in order to become national data of stroke patients receiving medical rehabilitation services.

Knowledge and practice of physical exercise among the inhabitants of Bangkok.

OBJECTIVE: To study the knowledge and practice of physical exercise among the inhabitants of Bangkok. The factors correlated with knowledge and the practice of physical exercise, were also explored. MATERIAL AND METHOD: A self-administered questionnaire was designed to survey 1200 inhabitants in Bangkok and the vicinity aged more than 18 years old. RESULTS: One thousand one hundred and seven people aged ranging from 18-81 years old completed the questionnaires (response rate 92.25%). Six hundred and forty people (58.4%) exercised regularly. The exercise was performed 1-2 days per week with varied duration. They performed exercises alone, in their homes, in the evening. They did not report any expenditure on the exercises. Common types of exercise reported were walking, jogging, attending an aerobic exercise class, using an exercise machine, and callisthenic exercise. Two hundred and seven people (18.9%) did not perform exercise at all because of the lack of time. The factors correlated with regular exercise were the increasing age, the high level of education, the amount of free time per day, and the enjoyment of exercise. With relation to knowledge of exercise, most people lacked knowledge of the benefits of exercise rather than how to do exercise and when to stop exercising. People who had a higher educational level than secondary school and a high income, practiced exercise everyday. They acquired their knowledge of exercise from attending an exercise course. CONCLUSION: People living in Bangkok usually performed regular exercises of 1-2 days per week with varied duration. The majority lacked knowledge of the benefits of exercise. Educational level of the samples was the only factor correlated with both regular exercise and knowledge of exercise.

Efficacy of shoulder slings in shoulder subluxation of stroke patients.

OBJECTIVE: To assess the efficacy of the two types of shoulder slings in reducing shoulder subluxation in acute stroke patients. MATERIAL AND METHOD: Twenty-one acute stroke patients with shoulder subluxation were assessed for the subluxation distance before and after wearing the slings by physical examination and radiological measurement. The comparison by radiological measurement was performed by two radiologists who were blinded to each other as well as to the types of sling used. RESULTS: The mean difference of subluxation distance on the affected side after wearing the slings number 1 and 2 were 0.48 mm and 1.14 mm respectively on physical examination and 2.09 mm and 1.14 mm respectively on radiological assessment. There was no statistically significant difference of subluxation distance on either physical examination or radiological assessment (p > 0.05). CONCLUSION: There was no difference in efficacy of shoulder slings in reducing shoulder subluxation in acute stroke patients.

Efficacy and safety of Curcuma domestica extracts compared with ibuprofen in patients with knee osteoarthritis: a multicenter study.

OBJECTIVE: To determine the efficacy and safety of Curcuma domestica extracts in pain reduction and functional improvement. METHODS: 367 primary knee osteoarthritis patients with a pain score of 5 or higher were randomized to receive ibuprofen 1,200 mg/day or C. domestica extracts 1,500 mg/day for 4 weeks. The main outcomes were Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total, WOMAC pain, WOMAC stiffness, and WOMAC function scores. Adverse events (AEs) were also recorded. RESULTS: 185 and 182 patients were randomly assigned into C. domestica extracts and ibuprofen groups, respectively. The baseline characteristics were no different between groups. The mean of all WOMAC scores at weeks 0, 2, and 4 showed significant improvement when compared with the baseline in both groups. After using the noninferiority test, the mean difference (95% confidence interval) of WOMAC total, WOMAC pain, and WOMAC function scores at week 4 adjusted by values at week 0 of C. domestica extracts were noninferior to those for the ibuprofen group (P=0.010, P=0.018, and P=0.010, respectively), except for the WOMAC stiffness subscale, which showed a trend toward significance (P=0.060). The number of patients who developed AEs was no different between groups. However, the number of events of abdominal pain/discomfort was significantly higher in the ibuprofen group than that in the C. domestica extracts group (P=0.046). Most subjects (96%-97%) were satisfied with the treatment, and two-thirds rated themselves as improved in a global assessment. CONCLUSION: C. domestica extracts are as effective as ibuprofen for the treatment of knee osteoarthritis. The side effect profile was similar but with fewer gastrointestinal AE reports in the C. domestica extracts group.