Clinical effects and mechanisms of a Chinese patent medicine, Tongxinluo capsule, as an adjuvant treatment in coronary heart disease.

Coronary heart disease (CHD) is the leading cause of death globally, posing a serious threat to human health. However, the current treatment approaches available for CHD fall short of the ideal results. Tongxinluo (TXL) is a traditional Chinese medicine (TCM) that has been employed in the clinical treatment of cardiovascular and cerebrovascular diseases (such as angina pectoris, stroke, etc.) in China for many years and holds great potential as a prospective treatment. TXL either as a standalone treatment or in combination with interventions recommended in CHD guidelines has been shown to be effective and well tolerated in clinical trials for CHD. Drawing on the evidence from clinical trials and experimental studies, this review will focus on the cardiovascular protective properties and related mechanisms of TXL. By searching 8 Chinese and English databases, more than 4000 articles were retrieved. These articles were categorized, then read, and finally written into this review. In this review, the pharmacological properties of TXL include regulation of blood lipids, improvement of endothelial function, anti-inflammatory, antioxidant, inhibition of apoptosis and regulation of autophagy, anti-fibrosis, promotion of angiogenesis, and modulation of exosome communication. The information provided in this review will help the reader to comprehend better the insights that TCM has developed over time in practice and provide new perspectives for the treatment of CHD.

Comparison of responsiveness of the Barthel Index and modified Barthel Index in patients with stroke.

PURPOSE: To compare the group- and individual-level responsiveness of the Barthel Index (BI) and modified BI (MBI) in patients with early subacute stroke. MATERIALS AND METHODS: The BI and MBI scores of 63, 63, and 55 patients were retrieved at 3 time points with a 3-weeks interval. The group-level responsiveness was examined using paired t-test and standardized response mean (SRM). The individual-level responsiveness was examined by the percentage of patients who achieved significant improvement exceeding the corresponding minimal detectable change. RESULTS: At the group level, the MBI showed significantly larger SRMs than did the BI in the 1st-2nd assessment (1.10 vs. 0.81 [95% CI of mean difference = 0.05-0.38]) and the 2nd-3rd assessment (0.94 vs. 0.72 [95% CI of mean difference = 0.04-0.41]). At the individual level, the MBI detected significantly more patients with significant improvement than the BI for the 1st-2nd assessments only (34.9 vs. 25.4% [95% CI of mean differences = 3.2-17.5]). CONCLUSIONS: The MBI has better responsiveness than the BI at both the group and individual levels in the patients with early subacute stroke. The MBI is recommended for clinical and research use as an outcome measure for patients with stroke.IMPLICATIONS FOR REHABILITATIONThe MBI is recommended for clinical and research applications because of its superior ability to detect subtle changes in ADL performance in patients with subacute stroke.The MBI and the BI have equal responsiveness for patients whose magnitude of improvement of ADL is substantial.

Predicting the handgrip strength across the age span: Cross-validating reference equations from the 2011 NIH toolbox norming study.

STUDY DESIGN: This is a cross-sectional observational study. BACKGROUND: Reference equations for describing hand-grip strength across the age span were derived from the 2011 NIH Toolbox norming study. PURPOSE: The purpose of this study was to cross-validate reference equations by evaluating its predicting power on a separate, independent data set from the 2011-2014 National Health and Nutrition Examination Survey (NHANES) study METHODS: Observed hand-grip strength data from 13,676 noninstitutionalized participants were obtained from the NHANES study. Best values (best from 3 trials) and the mean values (averaged from 3 trials) were determined for each hand. Using the age (yr), height (m), and weight (kg), we computed predicted grip strength values for dominant and nondominant hands using the reference equations. For validation, three predictability measures: the correlation coefficient, residuals, and accuracy, were used along with the Bland-Altman plot. RESULTS: The predicted values highly correlated with observed values (r = 0.90, ICC = 0.89). In predicting best values, means (SD) of residuals were 1.41 (5.57) and 1.03 (5.44) kg for dominant and nondominant hands, respectively. In predicting mean values, means (SD) of residuals were -0.23 (5.42) and -0.54 (5.31) kg for dominant and nondominant hands, respectively. Root mean square error ranged from 4.10 (female's nondominant mean values) to 6.74 (male's dominant best values). About 5.56% fell outside of the 95% confidence interval of the prediction. CONCLUSIONS: We acknowledged that the two studies' hand-grip protocols (NIH Toolbox, NHANES) were different. Results provided the preliminary predicting performance of the reference equations derived from the NIH Toolbox study.

[Therapeutic effect of auriculotherapy with miniature bian needle on anxiety in the patients after percutaneous coronary intervention].

OBJECTIVE: To observe the effect of auriculotherapy with miniature bian needle on anxious emotion, the condition of angina pectoris attack and sleep quality in the patients with anxiety after percutaneous coronary intervention (post-PCI). METHODS: A total of 74 eligible patients of post-PCI combined with anxious depression were randomized into an auriculotherapy group (37 cases, 2 cases dropped out) and a control group (37 cases, 3 cases dropped out). In the auriculotherapy group, on the base of the conventional secondary prevention medication for coronary heart disease (CHD), auriculotherapy with miniature bian needle was supplemented. In the control group, a proper physical exercise was combined on the base of the secondary prevention medication for CHD. The duration of treatment was 4 weeks in two groups. Separately, the score of Hamilton anxiety scale (HAMA), the score Seattle angina questionnaire (SAQ) and the score of Pittsburgh sleep quality index (PSQI) were assessed in the patients of the two groups before and after treatment. RESULTS: After treatment, the score of HAMA, the score of each item of SAQ and PSQI score were all improved significantly as compared with those before treatment respectively in both the auriculotherapy group and the control group (P<0.001, P<0.05). After treatment, HAMA score, PSQI score and the scores of physical limitation (PL), anginal stability (AS), anginal frequency (AF) and treatment satisfaction (TS) in SAQ in the auriculotherapy group were all better than those in the control group (P<0.001, P<0.05). The total effective rate was 91.43% (32/35) in the auriculotherapy group, obviously higher than 58.82% (20/34) in the control group (P<0.001). CONCLUSION: Auriculotherapy with miniature bian needle effectively relieves anxious emotions and the condition of angina pectrois attack and improves sleep quality in the post-PCI patients with anxiety.

Psychometric evaluation of the disabilities of the arm, shoulder and hand (DASH) in patients with orthopedic shoulder impairments seeking outpatient rehabilitation.

STUDY DESIGN: This is a cross-sectional, observational study. INTRODUCTION: The disability of the arm, shoulder and hand (DASH) questionnaire is an upper-extremity specific outcome measure commonly used in routine clinical care and clinical trials. PURPOSE OF THE STUDY: Our purposes were to: (1) examine the psychometric properties of the DASH questionnaire using factor analysis, one- and two-parameter item response theory models, and (2) develop a functional staging map illustrating the relationships between the item difficulty hierarchy of the DASH items and the patient's DASH total score. METHODS: Data from 2724 patients with orthopedic shoulder impairments seeking outpatient physical therapy in 79 clinics in the US were analyzed. RESULTS: Factor analysis supported a general factor, explaining 62.2% of the total variance. The coverage of DASH items was suitable for patients with shoulder impairments with no ceiling or floor effect. Endorsed items representing the most difficult items were related to feeling less capable, executing recreational activities with force or impact, and performing recreational activities in which you move your arm freely. Items with higher discriminating abilities were those related to do heavy household chores, garden/yard work, and change a light bulb overhead. With a separation index equaled to 4.94, the DASH can differentiate persons into at least 6 statistically distinct person strata. None of the DASH items exhibited differential item functioning by gender or symptom acuity, except two items by age group. DISCUSSION: Besides a total (summed) final score obtained from a specific measure, the keyform and functional staging plots/maps can be used to assist clinicians in clinical interpretation of the scores. CONCLUSIONS: Results supported the clinical usage of the DASH questionnaire in patients with orthopedic shoulder impairments seeking outpatient rehabilitation.

Validity of the Sock Test for Sitting Balance: A Functional Sitting Balance Assessment.

There is a relationship between sitting balance and self-care functioning, but no occupation-based sitting balance assessment. The objective of this study was to determine whether the Sock Test for Sitting Balance (STSB) is a valid balance assessment for use by therapists in acute care. Results of the STSB were compared with those of the Adapted Functional Reach (AFR), the Functional Independence Measure (FIM™) chair transfer, and the Kansas University Sitting Balance Scale (KUSBS), in both hospitalized and healthy participants. There is a significant relationship between STSB results and AFR results for all participants (rs = -.382, p = .012). Relationships between STSB results and score on the FIM™ Chair Transfer subscale (p = .001), and score on the KUSBS (p = .003) are significant. The STSB can differentiate between a hospitalized population and healthy population (p = .017). Criterion and known-groups validity are demonstrated, but should be confirmed with further testing.

Persons With Dementia and Their Caregivers' Perceptions About Occupational Therapy and Telehealth: A Qualitative Descriptive Study.

Occupational therapy (OT) services provided in the home to a person with dementia can decrease caregiver burden by targeting home modifications, functional performance, and safety. One method to deliver these services is through telehealth. The use of telehealth is expanding rapidly, but there is a current lack of evidence to support the use of telehealth to deliver OT services to persons with dementia. The purpose of this study was to identify the perceptions of persons with dementia and their caregivers about the use of telehealth to receive OT services. A qualitative descriptive design was used. Results provided themes in three domains: dementia journey, skills for technology use, and perceptions of OT. Each participant identified a unique journey through awareness, challenges, and adaptive strategies as they adjusted to a life with dementia. The skills for technology focused on current usage and perceptions about technology. Participants had limited knowledge of OT but did appreciate the role it has in dementia care. The themes identified in the study provide support for further exploration of the use of telehealth in OT for persons with dementia and their caregivers.

Effectiveness of Interventions Within the Scope of Occupational Therapy Practice to Improve Motor Function of People With Traumatic Brain Injury: A Systematic Review.

After traumatic brain injury (TBI), many people experience significant motor function impairments. To help occupational therapy practitioners make informed decisions in choosing treatment strategies to improve clients' motor function, we undertook a systematic review and synthesized applicable findings of intervention studies. Of 2,306 articles identified in the literature search, we reviewed 47 full-text articles, of which 16 met approved criteria. We found moderate evidence that various exercise programs increase motor function and limited evidence that people with TBI can benefit from rehabilitation and computer-based programs. We offer implications for practice, education, and research.

Showering habits: time, steps, and products used after brain injury.

OBJECTIVE: This pilot study describes the showering habits of people with brain injury (BI) compared with those of people without BI (WBI). METHOD: The showering habits of 10 people with BI and 10 people WBI were measured and compared. A videotaped session recorded and documented the shower routine. RESULTS: The BI group spent longer time showering, used more steps, and used fewer products than the WBI group. A moderately significant relationship was found between time and age (r = .46, p = .041). Similarly, we found significant correlations between number of steps and number of products used (r = .64, p = .002) and between the number of products used and education (r = .47, p = .044). CONCLUSION: Results suggest that people with BI have showering habits that differ from those WBI. Correlations, regardless of group, showed that older people showered longer, and people with more education used more showering products.

Race/ethnicity and outcomes following inpatient rehabilitation for hip fracture.

BACKGROUND: Hip fracture results in severe and often permanent reductions in overall health and quality of life for many older adults. As the U.S. population grows older and more diverse, there is an increasing need to assess and improve outcomes across racial/ethnic cohorts of older hip fracture patients. METHODS: We examined data from 42,479 patients receiving inpatient rehabilitation for hip fracture who were discharged in 2003 from 825 facilities across the United States. Outcomes of interest included length of stay, discharge setting, and functional status at discharge and 3- to 6-month follow-up. RESULTS: Mean age was 80.2 (standard deviation [SD] = 8.0) years. A majority of the sample was non-Hispanic white (91%), followed by non-Hispanic black (4%), Hispanic (4%), and Asian (1%). After controlling for sociodemographic factors and case severity, significant (p <.05) differences between the non-Hispanic white and minority groups were observed for predicted lengths of stay in days (Asian: 1.1; 95% confidence interval [CI], 0.5-1.7; non-Hispanic black: 0.8; 95% CI, 0.6-1.1), odds of home discharge (Asian: 2.1; 95% CI, 1.6-2.8; non-Hispanic black: 2.0; 95% CI, 1.8-2.3; Hispanic: 1.9; 95% CI, 1.6-2.2), lower discharge Functional Independence Measure (FIM) ratings (non-Hispanic black: 3.6; 95% CI, 3.0-4.2; Hispanic: 1.6; 95% CI, 0.9-2.2 points lower), and lower follow-up FIM ratings (Hispanic: 4.4; 95% CI, 2.8-5.9). CONCLUSIONS: Race/ethnicity differences in outcomes were present in a national sample of hip fracture patients following inpatient rehabilitation. Recognizing these differences is the first step toward identifying and understanding potential mechanisms underlying the relationship between race/ethnicity and outcomes. These mechanisms may then be addressed to improve hip fracture care for all patients.

Ethnic differences in discharge destination among older patients with traumatic brain injury.

UNLABELLED: Ethnic differences in discharge destination among older patients with traumatic brain injury. OBJECTIVE: To estimate the association between ethnicity and discharge destination in older patients with traumatic brain injury (TBI). DESIGN: A retrospective analysis. SETTING: Nationally representative sample of older patients from the Uniform Data System for Medical Rehabilitation in 2002 and 2003. PARTICIPANTS: Patients (N=9240) aged 65 years or older who received inpatient rehabilitation services for TBI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Discharge destination (home, assisted living facility, institution) and ethnicity (white, black, Hispanic). RESULTS: Multinomial logit models showed that older Hispanics (odds ratio [OR]=2.24; 95% confidence interval [CI], 1.66-3.02) and older blacks (OR=2; 95% CI, 1.55-2.59) with TBI were significantly more likely to be discharged home than older whites with TBI, after adjusting for relevant risk factors. Older blacks were also 78% less likely (OR=.22; 95% CI, .08-.60) to be discharged to an assisted living facility than whites after adjusting for relevant risk factors. CONCLUSIONS: Our findings indicate that older minority patients with TBI were significantly more likely to be discharged home than white patients with TBI. Studies are needed to investigate underlying factors associated with this ethnic difference.

Becoming "at home" in assisted living residences: exploring place integration processes.

OBJECTIVES: This study explores the roles of place attachment, nonfamily social involvement, place valuation, and individual characteristics in the process of becoming at home in assisted living residences. METHODS: Purposive sampling and cross-sectional data by means of a questionnaire completed by current assisted living residents in four states (N = 297) were used to estimate a structural equation model to explain becoming at home. RESULTS: Place attachment to town and community is a necessary but not sufficient explainer of older adults' process of becoming at home. Nonfamily social involvement plays a pivotal role through which place attachment works to explain becoming at home. Both place valuation and nonfamily social involvement exhibit direct positive effects on the outcome. DISCUSSION: Findings support a transactional interpretation of assisted living as home. The relationship between place attachment to one's community and full integration into assisted living is more complex than currently acknowledged.