Effects of Anodal Transcranial Direct Current Stimulation With Overground Gait Training on Lower Limb Performance in Individuals With Incomplete Spinal Cord Injury.

OBJECTIVE: To determine the effects of anodal transcranial direct current stimulation (tDCS) combined with overground gait training on gait performance, dynamic balance, sit-to-stand performance, and quality of life in individuals with incomplete spinal cord injuries (iSCI). DESIGN: Double-blind sham-controlled trial with a matched-pair design. SETTING: Sirindhorn National Medical Rehabilitation Institute, Thailand. PARTICIPANTS: Individuals with iSCI (n=34) were allocated to the anodal or sham groups. INTERVENTION: Anodal tDCS was administered over the M1 lower-limb motor area at an intensity of 2 mA for 20 min in the anodal group, while the sham group received a 30-s stimulation. Both groups received 40 min of overground gait training after tDCS for 5 consecutive daily sessions. MAIN OUTCOME MEASURES: The 10-meter walk test (10MWT) was the primary outcome, while spatiotemporal gait parameters, the timed Up and Go test, Five-Time Sit-to-Stand Test, and World Health Organization Quality of Life-BREF were secondary outcomes. Outcomes were assessed at baseline, post-intervention, and at 1-month (1M) and 2-month (2M) follow-ups. RESULT: Improvements in walking speed measured using the 10MWT were observed in both groups. However, the anodal group showed a greater improvement than the sham group. For fast speed, the mean between-group differences were 0.10 m/s, 95% CI (0.02 to 0.17) (post-intervention), 0.11 m/s, (0.03 to 0.19) (1M), and 0.11 m/s, (0.03 to 0.20) (2M), while for self-selected speed, the median differences were 0.10 m/s, 95% CI (0.06 to 0.14) (post-intervention) and 0.09 m/s, (0.01 to 0.19) (2M). The anodal group also had a greater stride length difference post-intervention (median difference: 0.07 m, 95% CI (0.01 to 0.14)). No significant between-group differences were found for other outcomes. CONCLUSION: Five-session of anodal tDCS with gait training slightly improved walking speed, sustained for 2 months post-intervention. However, effect on spatiotemporal gait parameters was limited and dynamic balance, functional tasks (ie, sit-to-stand), and quality of life were unaffected compared with overground gait training.

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.

The simplified Chinese version of the Knee Injury and Osteoarthritis Outcomes Score (KOOS) in individuals with knee osteoarthritis for mainland China: the study of reliability and validity.

BACKGROUND: The Knee Injury and Osteoarthritis Outcomes Score (KOOS) is a free clinical tool commonly used to evaluate the symptoms and functional status of patients with knee injury. For people who speak Chinese, the Hong Kong Chinese and Singapore Chinese versions are preferred. However, variations in the Chinese language and culture are influenced by the country's geography. KOOS for Mainland China has not been reported. Therefore, the current study was to cross-culturally translate the original English version into a simplified Chinese version and to investigate its psychometric properties. METHODS: The simplified Chinese KOOS was obtained through forward-backward translation according to appropriate guidelines. A total of 158 individuals with knee osteoarthritis (KOA) were recruited from 13 hospitals in China to examine the psychometric properties. The test-retest questionnaire was performed at an interval of 5-7 days. Test-retest reliability and internal consistency were evaluated using the intraclass correlation coefficient (ICC) and Cronbach's alpha, respectively. The data of the first test were used to analyse the construct validity of the simplified Chinese KOOS and Chinese SF-36 through convergent and discriminant validity using Spearman's correlation coefficient. RESULTS: Cross-cultural translation exhibited minor cultural differences, and the questionnaire was well understood by the patients. The data from 128 patients, used for the test-retest reliability study, showed good to excellent reliability, with an ICC of 0.808-0.976 for all KOOS subscales. The Cronbach's alpha for all subscales ranged from 0.757 to 0.970, indicating acceptable internal consistency. There was a low-to-high correlation between the five domains of the simplified Chinese version of the KOOS and all domains of the SF-36 in construct validity. CONCLUSION: The simplified Chinese KOOS demonstrated acceptable reliability and validity. In clinical practice and research, this version can help provide valuable information on health-related quality of life for Chinese individuals with KOA in mainland China.

Reliability of the Nepali Version of the Spinal Cord Independence Measure Self-Report.

A self-report measure is considered a practical alternative tool for longitudinal monitoring and for community models of disability. Spinal Cord Independence Measure Self-Report (SCIM-SR) was developed to measure the functional independence of the spinal cord injury (SCI) population. For the application of this questionnaire in Nepali setting, the cross-cultural adaptation and reliability of the Nepali version of the SCIM-SR were also warranted. The aim of the study was to cross-culturally adapt the Nepali version of the SCIM-SR and determine its reliability. The English version of the SCIM-SR was translated into the Nepali language with cross-cultural adaptations following the Beaton guidelines. A total of 45 community-dwelling individuals with SCI administered the Nepali version of the SCIM-SR two times, with an interval of one week. The intraclass correlation coefficient (ICC) and Cronbach's alpha (α) were used to assess the test-retest reliability and internal consistency, respectively. Cross-cultural equivalence was achieved between the English version and the Nepali version of the SCIM-SR. The test-retest reliability was excellent, with ICCs for the total score 0.968 (95% confidence interval 0.941-0.982), self-care subscale 0.964 (0.934-0.980), respiration and sphincter management subscale 0.941 (0.893-0.968), and mobility subscale 0.966 (0.938-0.981). The internal consistency reached an acceptable range for the total score and most of the subscales except for those of respiration and sphincter management. Cronbach's α coefficients for the total score, self-care subscale, respiration and sphincter management subscale, and mobility subscale were 0.801, 0.959, 0.506, and 0.838, respectively. The Nepali version of the SCIM-SR was cross-culturally adapted and can be used as a reliable self-report instrument to assess functional independence among the community-dwelling SCI population in Nepal.

Predictors of Community Participation Among Individuals With First Stroke: A Thailand Study.

OBJECTIVE: To describe perceived participation among persons with first stroke and to identify the predictors based on the International Classification of Functioning, Disability and Health (ICF) concept of participation after stroke. METHODS: A total of 121 participants completed 4 questionnaires: the Impact on Participation and Autonomy (IPA), Personal Resource Questionnaire (PRQ2000), Hospital Anxiety and Depression Scale (HADS), and personal history. They were evaluated for their balance, motor function, functional and walking ability. RESULTS: The majority of participants perceived participation restriction in family role as poor to very poor. The best predictors of participation included social support, walking and balance, functional ability, number of secondary health problems and affected side, account for 66.6% of the variances in participation. CONCLUSION: The study highlights the importance of social support, walking and balance performance, functional ability in daily living, and number of secondary health problems after stroke. These factors that facilitate participation after stroke should be addressed by health personnel during rehabilitation.

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.