Prediction of Changes in Functional Outcomes During the First Year After Inpatient Stroke Rehabilitation: A Longitudinal Study.

OBJECTIVE: To identify meaningful changes in patients in 3 functional domains (basic mobility [BM], daily activity [DA], and applied cognition [AC]) after discharge from inpatient stroke rehabilitation and to identify the predictors of 1-year functional improvement. DESIGN: A longitudinal, multicenter, prospective cohort study. SETTING: The acute care wards of 3 hospitals in the Greater Taipei area of Taiwan. PARTICIPANTS: Five hundred patients with stroke in acute care wards (mean age=60±12.2 years, 62% men, N=500). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE(S): The Mandarin version of the Activity Measure for Post-Acute Care (AM-PAC) short forms were assessed at discharge and 3-, 6-, and 12-month follow-up. The minimal detectable change (MDC) was used to categorize changes in the scores as improved and unimproved at the 4 time points. RESULTS: The mean scores of the AM-PAC BM and DA subscales substantially increased over the first 3 months after discharge (86% of participants exhibited improvement) and slightly increased during the subsequent 9 months (5∼26% of participants exhibited improvement). However, the mean score of the AC subscale decreased within the first 3 months and increased over the subsequent 9 months (22-23% of participants exhibited improvement). The BM, AC scores at discharge were the dominant predictors of subsequent functional improvement (P<.05). Patients with a higher functional stage at discharge were more likely to experience significant improvement. CONCLUSION: This study established the capacity of the AM-PAC to predict functional improvement in 3 domains during the early, middle, and late stages of recovery. The findings can assist clinicians in identifying patients at risk of unfavorable long-term functional recovery and providing such patients with tailored interventions during the early stage of rehabilitation.

Development of a Dyad-Focused Intervention for Stroke Survivors and Their Family Caregivers: A Feasibility Study.

IMPORTANCE: Transitioning from the hospital to the community poses significant challenges for stroke survivors and their caregivers. OBJECTIVE: To examine the feasibility and preliminary effects of a dyad-focused strategy training intervention. DESIGN: Single-arm trial with data collection at baseline, postintervention, and 3-mo follow-up. SETTING: Rehabilitation settings in Taiwan. PARTICIPANTS: Sixteen stroke survivor-caregiver dyads. INTERVENTIONS: Dyad-focused strategy training was provided to stroke survivor-caregiver dyads twice a week over 6 wk. The training included shared decision-making, goal setting, performance evaluation, strategy development and implementation, and therapeutic guided discovery. OUTCOMES AND MEASURES: Feasibility indicators were Goal Attainment Scaling, Dyadic Relationship Scale, Participation Measure-3 Domains, 4 Dimensions, Activity Measure for Post-Acute Care, Montreal Cognitive Assessment, Trail Making Test, Stroop Color and Word Test, Preparedness for Caregiving Scale, and Zarit Burden Interview. RESULTS: In total, 15 dyads completed all intervention sessions with full attendance. Both stroke survivors and their caregivers demonstrated high engagement and comprehension and reported moderate to high satisfaction with the intervention. From baseline to postintervention, the effects on goal attainment, frequency and perceived difficulty of community participation, executive function, mobility function, and caregiver preparedness were significant and positive. CONCLUSIONS AND RELEVANCE: Our study supports the feasibility and preliminary efficacy of dyad-focused strategy training for stroke survivor-caregiver dyads transitioning from the hospital to the community in Taiwan. Our preliminary evidence indicates that dyads who receive strategy training exhibit advancement toward their goals and experience considerable enhancements in their individual outcomes. Plain-Language Summary: This study addresses the scarcity of interventions catering to both stroke survivors and their caregivers. By demonstrating the feasibility of our dyad-focused intervention, the research offers preliminary evidence that supports the potential advantages of involving both stroke survivors and their caregivers in the intervention process.

Simulation-based holistic education in physiotherapy interns to increase empathy toward older adults and individuals with disabilities.

BACKGROUND: The proportion of older adults and individuals with disabilities in the general population increases each year. Thus, clinical clerkships designed for physiotherapy interns should provide more than simply knowledge and skills. For such interns to be able to handle the requirements of their future jobs, clerkships must enable them to develop empathy and positive attitudes toward patients. This study investigated the effect of simulation-based, holistic health-care education on physiotherapy interns' empathy, attitudes, and knowledge.  METHODS: A parallel-group design. Thirty physiotherapy interns from a medical institution were enrolled as participants, with experimental and control groups each comprising 15 participants. Both groups received standard clinical training. However, the experimental group received an additional 3.5 h of simulation-based holistic health-care education. The Jefferson Scale of Empathy, Kogan's Attitudes Toward Old People Scale, the Attitudes Towards the Elderly Scale, the Knowledge About Aging Scale, Knowledge of the Situation of Older People Scale, Perceptions of Working with Older People Scale, and Care Willingness Scale were used in a pretest and posttest. RESULTS: After the intervention period, we observed substantial between-group differences of 6.4 points on the Jefferson Scale of Empathy (p = 0.001), 7.7 points on Kogan's Attitudes Toward Old People Scale (p = 0.002), 3.5 points on the Attitudes Toward the Elderly Scale (p = 0.002), 2.5 points on Knowledge About Aging (p = 0.055), 4.5 points on the Knowledge of the Situation of Older People Scale (p < 0.001), and 2.1 points on Perceptions of Working with Older People Scale (p = 0.046). CONCLUSION: Simulation-based, holistic health-care education can significantly improve the empathy, knowledge, and attitudes of physiotherapy interns.

Effectiveness, Compliance, and Safety of Dextrose Prolotherapy for Knee Osteoarthritis: A Meta-Analysis and Metaregression of Randomized Controlled Trials.

OBJECTIVES: This study assessed the effectiveness, compliance, and safety of dextrose prolotherapy for patients with knee osteoarthritis. DATA SOURCES: PubMed, EMBASE, the Cochrane Library Database, and the Scopus database from their inception to December 31, 2021. METHODS: This study was conducted in accordance with the guidelines recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Randomized controlled trials regarding the effectiveness of dextrose prolotherapy in knee osteoarthritis were identified. The included trials were subjected to meta-analysis. Risk of bias was assessed using the Cochrane risk of bias tool. Subgroup and random-effects metaregression analyses were performed to explore any heterogeneity (I2) of treatment effects across studies. RESULTS: A total of 14 trials enrolling 978 patients were included in the meta-analysis. Compared with placebo injection and noninvasive control therapy, dextrose prolotherapy had favorable effects on pain, global function, and quality of life during the overall follow-up. Dextrose prolotherapy yielded greater reductions in pain score over each follow-up duration than did the placebo. Compared with other invasive therapies, dextrose prolotherapy generally achieved comparable effects on pain and functional outcomes for each follow-up duration.Subgroup results indicated that combined intra-articular and extra-articular injection techniques may have stronger effects on pain than a single intra-articular technique. CONCLUSIONS: Dextrose prolotherapy may have dose-dependent and time-dependent effects on pain reduction and function recovery, respectively, in patients with knee osteoarthritis. Due to remarkable heterogeneity and the risk of biases across the included trials, the study results should be cautiously interpreted.

Hybrid robot-assisted gait training for motor function in subacute stroke: a single-blind randomized controlled trial.

BACKGROUND: Robot-assisted gait training (RAGT) is a practical treatment that can complement conventional rehabilitation by providing high-intensity repetitive training for patients with stroke. RAGT systems are usually either of the end-effector or exoskeleton types. We developed a novel hybrid RAGT system that leverages the advantages of both types. OBJECTIVE: This single-blind randomized controlled trial evaluated the beneficial effects of the novel RAGT system both immediately after the intervention and at the 3-month follow-up in nonambulatory patients with subacute stroke. METHODS: We recruited 40 patients with subacute stroke who were equally randomized to receive conventional rehabilitation either alone or with the addition of 15 RAGT sessions. We assessed lower-extremity motor function, balance, and gait performance by using the following tools: active range of motion (AROM), manual muscle test (MMT), the Fugl-Meyer Assessment (FMA) lower-extremity subscale (FMA-LE) and total (FMA-total), Postural Assessment Scale for Stroke (PASS), Berg Balance Scale (BBS), Tinetti Performance-Oriented Mobility Assessment (POMA) balance and gait subscores, and the 3-m and 6-m walking speed and Timed Up and Go (TUG) tests. These measurements were performed before and after the intervention and at the 3-month follow-up. RESULTS: Both groups demonstrated significant within-group changes in the AROM, MMT, FMA-LE, FMA-total, PASS, BBS, POMA, TUG, and 3-m and 6-m walking speed tests before and after intervention and at the 3-month follow-up (p < 0.05). The RAGT group significantly outperformed the control group only in the FMA-LE (p = 0.014) and total (p = 0.002) assessments. CONCLUSION: Although the novel hybrid RAGT is effective, strong evidence supporting its clinical effectiveness relative to controls in those with substantial leg dysfunction after stroke remains elusive. Trial registration The study was registered with an International Standard Randomized Controlled Trial Number, ISRCTN, ISRCTN15088682. Registered retrospectively on September 16, 2016, at https://www.isrctn.com/ISRCTN15088682.

Effects of Hyperosmolar Dextrose Injection in Patients With Rotator Cuff Disease and Bursitis: A Randomized Controlled Trial.

OBJECTIVE: To determine whether dextrose prolotherapy offers clinical benefits in patients with shoulder pain and bursitis. DESIGN: Double-blinded, randomized controlled trial. SETTING: Outpatient rehabilitation department of a single medical center. PARTICIPANTS: Patients (N=50) who had received a diagnosis of shoulder pain and bursitis through clinical tests and ultrasound examination. INTERVENTIONS: Participants were randomly assigned to the 15% dextrose injection (D15W) group or the placebo group to receive either D15W or normal saline injection, respectively. All participants received ultrasound-guidance bursal injection every 2 weeks for a total of 3 injections. MAIN OUTCOME MEASURES: The primary outcome was maximal pain level while performing activities. The secondary outcomes included resting pain level, function and disability assessment results, and ultrasonographic parameters. Participants were followed up for 3 months after completion of the injection course. RESULTS: No significant differences in baseline characteristics were observed between the D15W and placebo groups. Significant time effects were observed for all outcome parameters (all P<.05); however, time × group effects were nonsignificant for all outcomes, except for tissue elasticity (P=.026). CONCLUSIONS: Supporting evidence is insufficient regarding the clinical benefits of 15% dextrose bursal injection administered through 3 sessions in patients with chronic shoulder pain and bursitis. The findings indicate that these injections may increase the tissue stiffness of the supraspinatus tendon, as indicated by elastography assessment results, but further research is required to determine the nature of such changes in elastography findings.

Effects of Robot-Assisted Rehabilitation on Hand Function of People With Stroke: A Randomized, Crossover-Controlled, Assessor-Blinded Study.

IMPORTANCE: The effects of robot-assisted task-oriented training with tangible objects among patients with stroke remain unknown. OBJECTIVE: To investigate the effects of robot-assisted therapy (RT) with a Gloreha device on sensorimotor and hand function and ability to perform activities of daily living (ADLs) among patients with stroke. DESIGN: Randomized, crossover-controlled, assessor-blinded study. SETTING: Rehabilitation clinic. PARTICIPANTS: Patients (N = 24) with moderate motor and sensory deficits. INTERVENTION: Patients participated in 12 RT sessions and 12 conventional therapy (CT) sessions, with order counterbalanced, for 6 wk, with a 1-mo washout period. OUTCOMES AND MEASURES: Performance was assessed four times: before and after RT and before and after CT. Outcomes were measured using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Box and Block Test, electromyography of the extensor digitorum communis (EDC) and brachioradialis, and a grip dynamometer for motor function; Semmes-Weinstein hand monofilament and the Revised Nottingham Sensory Assessment for sensory function; and the Modified Barthel Index (MBI) for ADL ability. RESULTS: RT resulted in significantly improved FMA-UE proximal (p = .038) and total (p = .046) and MBI (p = .030) scores. Participants' EDC muscles exhibited higher efficacy during the small-block grasping task of the Box and Block Test after RT than after CT (p = .050). CONCLUSIONS AND RELEVANCE: RT with the Gloreha device can facilitate whole-limb function, leading to beneficial effects on arm motor function, EDC muscle recruitment efficacy, and ADL ability for people with subacute and chronic stroke. WHAT THIS ARTICLE ADDS: The evidence suggests that a task-oriented approach combined with the Gloreha device can facilitate engagement in whole-limb active movement and efficiently promote functional recovery.

The effect of mechanical traction on low back pain in patients with herniated intervertebral disks: a systemic review and meta-analysis.

OBJECTIVE: To evaluate the effectiveness of traction in improving low back pain, functional outcome, and disk morphology in patients with herniated intervertebral disks. DATA SOURCE: PubMed, Scopus, Embase, and the Cochrane Library were searched from the earliest record to July 2019. REVIEW METHODS: We included randomized control trials which (1) involved adult patients with low back pain associated with herniated disk confirmed by magnetic resonance imaging or computed tomography, (2) compared lumbar traction to sham or no traction, and (3) provided quantitative measurements of pain and function before and after intervention. Methodological quality was assessed using the physiotherapy evidence database (PEDro) scale and Cochrane risk of bias assessment. RESULTS: Initial searches for literature yielded 3015 non-duplicated records. After exclusion based on the title, abstract, and full-text review, 7 articles involving 403 participants were included for quantitative analysis. Compared with the control group, the participants in the traction group showed significantly greater improvements in pain and function in the short term, with standard mean differences of 0.44 (95% confidence interval (CI): 0.11-0.77) and 0.42 (95% CI: 0.08-0.76), respectively. The standard mean differences were not significant to support the long-term effects on pain and function, nor the effects on herniated disk size. CONCLUSION: Compared with sham or no traction, lumbar traction exhibited significantly more pain reduction and functional improvements in the short term, but not in the long term. There is insufficient evidence to support the effect of lumbar traction on herniated disk size reduction.

Effects of interactive video-game-based exercise on balance in older adults with mild-to-moderate Parkinson's disease.

BACKGROUND: This study aimed to evaluate the effectiveness of a customized interactive video game-based (IVGB) training on balance in older adults with mild-to-moderate Parkinson's disease (PD). METHODS: In this 12-week crossover trial, PD patients ≥65 years of age were randomly divided into Group A (a 6-week intervention phase followed by a 6-week control phase) and Group B (a 6-week control phase followed by a 6-week intervention phase). Participants received IVGB exercise training during the intervention phase and no exercise during the control phase. Functional outcomes were measured using behavioral evaluation scales and questionnaires at baseline, week 6 and week 12. RESULTS: Twenty-four PD patients were included in this study, and were evenly divided into two groups. After Bonferroni adjustment, the changes in Modified Falls Efficacy Scale (MFES) and two subscales of Multi-Directional Reach Test were significantly different between two groups in the first 6-week period. In addition, the changes in Berg Balance Scale, MFES, and two subscales of Maximum Step Length were significantly different between two groups in the second 6-week period. Compared to controls, 6-week IVGB exercise intervention significantly improved different but overlapping functional outcomes in two groups of PD patients. CONCLUSIONS: The customized IVGB exercise training improves balance, postural stability and confidence in preventing falls in older adults with mild-to-moderate PD. However, this IVGB exercise doesn't have a significant impact on quality of life. TRIAL REGISTRATION: ClinicalTrials.gov. NCT03689764 . Registered 27 September 2018, retrospectively registered.

Adapting Strategy Training for Adults With Acquired Brain Injury: A Feasibility Study in a Chinese Population.

IMPORTANCE: Before introducing strategy training into a cross-cultural (Chinese) context, it is necessary to evaluate its feasibility. OBJECTIVE: To examine the feasibility of applying strategy training to improve participation outcomes of rehabilitation patients in Taiwan and evaluate the potential intervention effects. DESIGN: A single-group, repeated-measures study. SETTING: Rehabilitation outpatient settings. PARTICIPANTS: A convenience sample of adults (N = 20) with a primary diagnosis of acquired brain injury (ABI) and with cognitive impairment received the intervention and were assessed before and after it. INTERVENTION: The participation-focused strategy training intervention, a modified version of the strategy training intervention, was provided to participants in 1-2 sessions weekly for a total of 10-20 intervention sessions. OUTCOMES AND MEASURES: Feasibility indicators, Participation Measure-3 Domains, 4 Dimensions (PM-3D4D), and Canadian Occupational Performance Measure (COPM). RESULTS: Eighteen participants completed 100% of the scheduled intervention sessions. Participants had very good engagement in the intervention sessions with sufficient comprehension. Participants reported moderate to high satisfaction. Positive score changes were observed for the PM-3D4D (d = 0.46-1.25) and COPM scales (d = 1.82 and 2.12). CONCLUSIONS AND RELEVANCE: This study demonstrated the feasibility of delivering participation-focused strategy training in Taiwan to people with cognitive impairment after ABI. The preliminary evidence also showed that participants who received the strategy training intervention had positive changes in participation outcomes and in performance of their self-identified goals. On the basis of this study's findings, a larger clinical trial is warranted to evaluate the efficacy of the strategy training intervention. WHAT THIS ARTICLE ADDS: Participation-focused strategy training is feasible and acceptable for Taiwanese community-dwelling adults with cognitive impairment after ABI. However, because strategy training is quite different from traditional rehabilitation delivered in Taiwan, additional instructions and discussion among the therapist, client, and caregiver may be needed before the intervention is provided.

Meta-analyzability Concerns in Meta-analyses.

Many studies to date have conducted a meta-analysis on a mix of effectiveness and superiority studies. This methodological flaw will lead to difficulties in interpreting the results. We addressed this issue in this article, illustrated our point with a simulated experiment, and re-analyzed a recent meta-analysis study based on the effectiveness-superiority dichotomy to provide a real-world correlate of our point of view.

Effectiveness and Superiority of Rehabilitative Treatments in Enhancing Motor Recovery Within 6 Months Poststroke: A Systemic Review.

OBJECTIVE: To investigate the effects of various rehabilitative interventions aimed at enhancing poststroke motor recovery by assessing their effectiveness when compared with no treatment or placebo and their superiority when compared with conventional training program (CTP). DATA SOURCE: A literature search was based on 19 Cochrane reviews and 26 other reviews. We also updated the searches in PubMed up to September 30, 2017. STUDY SELECTION: Randomized controlled trials associated with 18 experimented training programs (ETP) were included if they evaluated the effects of the programs on either upper extremity (UE) or lower extremity (LE) motor recovery among adults within 6 months poststroke; included ≥10 participants in each arm; and had an intervention duration of ≥10 consecutive weekdays. DATA EXTRACTION: Four reviewers evaluated the eligibility and quality of literature. Methodological quality was assessed using the PEDro scale. DATA SYNTHESIS: Among the 178 included studies, 129 including 7450 participants were analyzed in this meta-analysis. Six ETPs were significantly effective in enhancing UE motor recovery, with the standard mean differences (SMDs) and 95% confidence intervals outlined as follow: constraint-induced movement therapy (0.82, 0.45-1.19), electrostimulation (ES)-motor (0.42, 0.22-0.63), mirror therapy (0.71, 0.22-1.20), mixed approach (0.21, 0.01-0.41), robot-assisted training (0.51, 0.22-0.80), and task-oriented training (0.57, 0.16-0.99). Six ETPs were significantly effective in enhancing LE motor recovery: body-weight-supported treadmill training (0.27, 0.01-0.52), caregiver-mediated training (0.64, 0.20-1.08), ES-motor (0.55, 0.27-0.83), mixed approach (0.35, 0.15-0.54), mirror therapy (0.56, 0.13-1.00), and virtual reality (0.60, 0.15-1.05). However, compared with CTPs, almost none of the ETPs exhibited significant SMDs for superiority. CONCLUSIONS: Certain experimented interventions were effective in enhancing poststroke motor recovery, but little evidence supported the superiority of experimented interventions over conventional rehabilitation.

Non-elastic taping, but not elastic taping, provides benefits for patients with knee osteoarthritis: systemic review and meta-analysis.

OBJECTIVE: To determine whether therapeutic taping, which includes elastic (Kinesio tape) and non-elastic (Leukotape) taping, is superior to control taping in improving pain and functions for patients with knee arthritis. To understand whether both elastic and non-elastic taping are beneficial. METHODS: We searched the PubMed and Scopus databases from their earliest record to 31 May 2017 for randomized controlled and cross-over studies that used taping to treat knee osteoarthritis. We extracted the mean differences and SD between baseline and posttreatment for selected outcomes measured in the experimental and control groups for subsequent meta-analyses. RESULTS: In total, 11 studies were included in the review. Of which, five Leukotaping and five Kinesio taping studies involving 379 participants were used in the meta-analysis. PEDro scores of the Leukotaping and Kinesio taping studies were 4.2 and 7.8, respectively. Overall, therapeutic taping exhibited significantly greater pain reduction than control taping with a significant weighted mean difference of 12.8 mm on a 0- to 100-mm visual analogue scale. Compared to control taping, Leukotaping produced a significant weighted mean difference of 11.6 mm regarding pain with a large effect size of 0.89 and I2 = 0%, while Kinesio taping produced a non-significant weighted mean difference of 12.1 mm and I2 = 93%. Leukotaping also exhibited a large and significant standard mean difference of 0.82, while Kinesio taping exhibited a non-significant standard mean difference of 1.34 regarding climbing stairs and stepping. CONCLUSION: Therapeutic taping seemed to be superior to control taping in pain control for knee osteoarthritis. Non-elastic taping, but not elastic taping, provides benefits in pain reduction and functional performance.

Kinesio taping reduces elbow pain during resisted wrist extension in patients with chronic lateral epicondylitis: a randomized, double-blinded, cross-over study.

BACKGROUND: Lateral epicondylitis is frequently seen in racquet sport players and the treatments are usually symptomatic rather than curative. Taping therapy is cheap and easy to apply in the sport field. In this study we valued the effectiveness of Kinesio taping (KT) on immediate pain control for patients with chronic lateral epicondylitis. METHODS: We conducted a randomized, double-blinded, cross-over study with 15 patients with chronic lateral epicondylitis. All participants received two taping sessions in a random order with a 3-day interval in between: one with KT and the other with sham taping (ST). Pain perceived during resisted wrist extension and at rest using numeric rating scale (NRS), the pain-free grip strength, and the pressure pain threshold, were measured before and 15 min after the tape was applied. RESULTS: A significant reduction of 2.1 ± 1.6 (Z = - 3.081, P = 0.002) and 0.7 ± 0.8 (Z = - 2.428, P = 0.015) was found on a NRS with KT and ST, respectively, indicating that both taping sessions produced immediate pain relief for resisted wrist extension. Both taping sessions significantly improved the pain-free grip strength with increases of 3.31 ± 5.05 (Z = - 2.615, P = 0.009) and 2.43 ± 3.31 (Z = - 2.783, P = 0.005) kg found with KT and ST, respectively. Compared with ST, KT exhibited superiority in controlling pain experienced during resisted wrist extension (Z = - 2.168, P = 0.030). CONCLUSIONS: Taping produced unneglectable placebo effects on pain relief and painf-free grip strength for patients with lateral epicondylitis, and KT seemed to have additional effects on controlling pain that was elicited by resisted wrist extension. TRIAL REGISTRATION: ISRCTN13618356 (retrospectively registered on 13/02/2017).

Association Between Manual Loading and Newly Developed Carpal Tunnel Syndrome in Subjects With Physical Disabilities: A Follow-Up Study.

OBJECTIVE: To identify the association between body composition and newly developed carpal tunnel syndrome (CTS) and to search for the best probabilistic cutoff value of associated factors to predict subjects with physical disabilities developing new CTS. DESIGN: Longitudinal. SETTING: University-affiliated medical center. PARTICIPANTS: Subjects with physical disabilities (N=47; mean age ± SD, 42.1±7.7y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Median and ulnar sensory nerve conduction velocity (SNCV) were measured at the initial and follow-up tests (interval >2y). Total and regional body composition were measured with dual-energy x-ray absorptiometry at the initial test. Leg lean tissue percentage was calculated to delineate each participant's manual loading degree during locomotion. Leg lean tissue percentage is the lean tissue mass of both legs divided by body weight. RESULTS: Based on median SNCV changes, we divided all participants into 3 groups: subjects with bilateral CTS (median SNCV value <45m/s plus a normative ulnar SNCV value >37.8m/s) in the initial test (n=10), subjects with newly developed CTS in the follow-up test (n=8), and subjects without additional CTS in the follow-up test (n=27). Eight of 35 subjects not having bilateral CTS initially developed new CTS (8.8% per year; mean follow-up period, 2.6y). Leg lean tissue percentage was associated with the probability of newly developed CTS (adjusted odds ratio, .64; P<.05). Subjects with a leg lean tissue percentage >12% were less likely to have developed new CTS at the follow-up test (sensitivity, .75; specificity, .85; area under the curve, .88; P<.005). CONCLUSIONS: Leg lean tissue percentage may be useful for early identification of developing new CTS in subjects with physical disabilities. Therefore, a preventive program for those subjects at risk can start early.

The effects of surface neuromuscular electrical stimulation on post-stroke dysphagia: a systemic review and meta-analysis.

OBJECTIVE: In this study, we intended to evaluate whether swallow treatment with neuromuscular electrical stimulation is superior to that without neuromuscular electrical stimulation, and whether neuromuscular electrical stimulation alone is superior to swallow therapy. METHODS: We searched the PubMed and Scopus databases from their earliest record to 31 December 2014 for randomized and quasi-randomized controlled trials that used neuromuscular electrical stimulation to treat post-stroke dysphagia. The Jadad scale was used to assess the quality of the included studies. We extracted the mean differences and standard deviation (SD) between baseline and posttreatment or posttreatment mean and SD for selected outcomes measured in the experimental and control groups for subsequent meta-analyses. RESULTS: Eight studies were identified. For the comparison "swallow treatment with neuromuscular electrical stimulation vs. swallow treatment without neuromuscular electrical stimulation," we found a significant standardized mean difference (SMD) of 1.27 (95% confidence interval (CI) = 0.51-2.02, P = 0.001) with significant heterogeneity (I(2) = 85%). The meta-analysis for the comparison of neuromuscular electrical stimulation alone and swallow therapy demonstrated a non-significant SMD of 0.25 (95% CI = -0.16-0.65, P = 0.23) without significant heterogeneity (I(2) = 16%). CONCLUSION: Swallow treatment with neuromuscular electrical stimulation seems to be more effective than that without neuromuscular electrical stimulation for post-stroke dysphagia in the short term considering the limited number of studies available. Evidence was insufficient to indicate that neuromuscular electrical stimulation alone was superior to swallow therapy.

Using surface electromyography to guide the activation during motor-evoked potential measurement: An activation control method for follow-up studies.

OBJECTIVE: This study evaluated the reliability and validity of a convenient method that uses the real-time feedback surface electromyography (sEMG) to control muscle activation while measuring the MEP recorded from the quadriceps muscle in patients with stroke. METHODS: It measured the MEP parameters as well as the clinical assessment at initial test. Participants were directed to adjust their quadriceps contraction to extend the knee isometrically and maintain the EMG amplitude at 0.2 mV. MEPs were measured 2 weeks after the initial test again to assess the reliability of this measurement. RESULTS: A good test-re-test reliability was demonstrated with an intra-class correlation coefficient (ICC) > 0.8 for the motor threshold and a moderate reliability (ICC > 0.6) for the MEP latency and MEP amplitude, for both paretic and non-paretic legs. Patients with present MEPs had significantly higher scores in muscle power, the Fugl-Meyer assessment, the balance sub-scale of performance-oriented mobility assessment and the Barthel index; and lower NIHSS scores than those of patients with absent MEPs (all p < 0.05). CONCLUSION: The sEMG-guided low level muscle activation is suitable for MEP assessment in patients with leg weakness after a stroke and may be used for long-term follow-up studies.

Environmental effects on WHODAS 2.0 among patients with stroke with a focus on ICF category e120.

PURPOSE: To explore the environmental effects on the disabilities of people post stroke and to search for the best probabilistic cut-off value of the WHO Disability Assessment Schedule second edition (WHODAS 2.0) scores to predict people post stroke experiencing an access barrier to the International Classification of Functioning, Disability and Health category e120 products and technology for personal indoor and outdoor mobility and transportation (PMT). METHOD: We analyzed data of 162 younger (aged 18-64 years) and 202 older (aged ≥65 years) people post stroke from the databank of persons with disability between June 1, 2011 and February 29, 2012. All participants rated each WHODAS 2.0 item with environmental intervention (performance score) and without any intervention (capacity score). We used the paired capacity-performance score difference to assess the whole environmental effects on the participants' disability, evaluated each participant's access barrier to PMT (negative PMT), and used a receiver-operating characteristic curve to predict patients having a negative PMT. RESULTS: The whole environment acted as a barrier on mobility and self-care in >10 % of older people post stroke. Older patients having a summary index performance score of ≥78.8 points and younger patients having an index of ≥56.0 points were likely to experience a negative PMT. Older patients who have an access to PMT were possible to improve their daily activities performance, and younger patients could report less disability. CONCLUSIONS: An environmental support to improve the PMT accessibility is important for people post stroke to reduce their disability.