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.

Effectiveness of a Soft Robotic Glove to Assist Hand Function in Stroke Patients: A Cross-Sectional Pilot Study.

Purpose: Stroke patients have difficulty performing tasks using their paretic hands. There are limited data on the effects of using a soft robotic glove to assist with hand function. The objective of this study was to investigate the effectiveness of a soft robotic glove in assisting hand function in stroke patients. Methods: This study was a cross-sectional pilot study. Twenty stroke patients with partial or complete hand weakness were recruited from a rehabilitation centre. The Box and Block Test (BBT) and the Action Research Arm Test (ARAT) were performed under two conditions: with and without use of the soft robotic glove. The order of the conditions was randomly assigned by a computer-generated program. Results: BBT scores increased 6.4 blocks when using the soft robotic glove (p < 0.001). ARAT grasp, grip, pinch, and overall scores increased by 27.08% (p < 0.01), 28.75% (p < 0.001), 15.89% (p < 0.01), and 21.15% (p < 0.001), respectively, using the glove versus not using the glove. Conclusions: The findings of this study suggest that using a soft robotic glove can assist a poststroke paretic hand in executing grasp, grip, and pinch.

Effects of Bilateral Transcutaneous Tibial Nerve Stimulation on Neurogenic Detrusor Overactivity in Spinal Cord Injury: A Urodynamic Study.

OBJECTIVE: To study the short-term effect of bilateral transcutaneous tibial nerve stimulation (TTNS) on urodynamic study (UDM) parameters in spinal cord injury (SCI) patients with neurogenic detrusor overactivity (NDO). DESIGN: Single-blinded sham-controlled study. SETTING: Rehabilitation center. PARTICIPANTS: SCI patients with NDO (N=17) were recruited. Fifteen patients (mean age, 40±18y) completed the study. Most of the patients had chronic incomplete SCI. INTERVENTIONS: UDM was performed 3 times. The first UDM was performed after taking anticholinergics for 1 hour to assess the effects of medication. After stopping anticholinergics for a 5 half-lives, the second UDM was performed immediately after a 20-minute sham TTNS (switch on for 30s at the beginning, switch off for 20min, and switch on for 30s before stopping). The third UDM was performed immediately after a 20-minute bilateral TTNS. MAIN OUTCOME MEASURES: Reflex volume (mL), cystometric capacity (mL), maximum pressure detrusor (mmH2O), and bladder compliance (mL/mmH2O). RESULTS: UDM tracings were interpreted by 2 blinded assessors. This study used per-protocol analysis and repeated measures Analysis of variance with Bonferroni post hoc analysis. When compared with sham stimulation, bilateral TTNS and anticholinergics produced greater increases in reflex volume (136.1±99.88, 212.2±112.82, and 226.3±111.52 mL; P<.001), cystometric capacity (218.3±137.66, 319.1±143.74, and 350.7±163.43 mL; P<.001), and compliance (5.8±6.81, 7.9±6.74, 9.7±8.12 mL/cmH2O; P=.02). No significant differences were found in reflex volume, cystometric capacity, or compliance between bilateral TTNS and anticholinergics (P>.05). The maximum pressure detrusor was not significantly different between groups (P>.05). CONCLUSION: Bilateral TTNS may be an effective short-term intervention to improve UDM parameters in SCI with NDO. Further study is necessary to determine the long-term effects and benefits of combined bilateral TTNS with anticholinergics.

Effectiveness of Conventional Swallowing Therapy in Acute Stroke Patients with Dysphagia.

BACKGROUND: Dysphagia is a common problem in acute stroke patient. Aspiration pneumonia increases in this group. Swallowing therapy is immediately conducted in a stable stroke patient. An effectiveness of our program has not been determined. OBJECTIVE: To determine an effectiveness of conventional swallowing therapy in acute stroke patients with dysphagia. METHODS: We retrospectively reviewed data from medical records of acute stroke patients with dysphagia who participated a swallowing therapy from January 2017 to June 2017. Fifty-seven acute stroke patients with dysphagia (26 males and 31 females) were participating in a conventional swallowing therapy (50 minutes a day for 3 days per week). A functional oral intake scale (FOIS) and swallow function scoring system (SFSS) were used to determine an effectiveness of the swallowing therapy. FOIS and SFSS scores before the first therapy session and after the last therapy session were compared using a paired t-test. RESULTS: The mean age of the patient was 69.5 ± 15.35 years. The period from stroke onset to the first swallowing therapy session was 7.5 ± 6.69 days. The number of therapy was 5.6 ± 2.83 sessions. Participants showed a significant improvement of the FOIS (mean score increased from 1.74 to 3.30 points, P = 0.001) and SFSS (mean score increased from 2.51 to 3.68 points, P = 0.001). Forty-two percent of patients with tube dependent change to total oral intake. CONCLUSION: Conventional swallowing therapy is an effective treatment in acute stroke with dysphagia.

Ultrasound-Guided Physiological Saline Injection for Patients with Myofascial Pain.

BACKGROUND: Based on the histological confirmation of the presence of nerve structure in the fascia, hence, myofascial pain was treated by the mechanism referred to as interfascial block. To date, the studies of physiological saline for treating patients with myofascial pain has been limited. Ultrasound (US) guided with physiological saline injection (PSI) technique has been routinely practiced among patients with myofascial pain in outpatient service at the Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital. The main objective of this present study is to find the overview data including the percentage of patients responding, acceptable pain period, and adverse events. MATERIALS AND METHODS: Electronic medical reports among 142 patients receiving US-guided PSI from August 1, 2016, to November 20, 2017, at the Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, were retrospectively reviewed by the first author. Procedures were performed by the last author. The analysis was independently performed by the first author. RESULTS: One hundred and forty-two patients with complete medical records were compatible with analysis. The average age of patients was 55 years. Most of the patients were female (68.3%). Most of the patients (76.8%) had chronic suffering from myofascial pain. Approximately half of the patients (56.4%) are currently received pain-relieving medications. Upper trapezius muscle (19.5%) was the most common muscle receiving the procedure, followed by multifidus (10.0%) and quadratus lumborum (9.5%). Most of the patients (86.8%) received the procedure one muscle. Approximately 30% of the patients were able to stop pain-relieving medications after the procedure. The median of acceptable pain period was 63 days. The percentage of patients having an acceptable pain period >3 months was 43.9%. No major adverse events were demonstrated. CONCLUSION: US-guided PSI technique demonstrated pain reduction in 72.8% of the analyzed patients, with an acceptable pain period of 63 days. No major adverse events were demonstrated among all the patients. This technique should be considered as another invasive procedure for eradication myofascial trigger point.

Bone turnover increases during supervised treadmill walking in Thai postmenopausal women.

INTRODUCTION: Treadmill walking is a cheap and attainable form of exercise, which carries a low injury risk and confers other health benefit. The aim of this study is to investigate the effects of 3-month treadmill walking on biochemical bone markers in Thai postmenopausal women. MATERIAL AND METHODS: Thai postmenopausal women participated in a 3-month supervised treadmill walking program. The program consisted of treadmill walking, the intensity of which was 55-70% of maximal heart rate, with duration of 30 min per day, at a frequency of 3 days a week. Crosslinked C-terminal telopeptides of type I collagen (CTX-I) and N-terminal propeptides of type I procollagen (PINP) level were measured at baseline and at 1 week after 3-month training. RESULTS: Eighteen women completed the training program. The average age of patients was 59.39 ± 4.18 years. The average period after menopause was 9.28 ± 6.52 years. CTX-I and PINP levels at baseline were 0.43 ± 0.14 and 52.15 ± 13.43 ng/ml. CTX-I and PINP levels after 3-month training were 0.80 ± 0.26 and 66.77 ± 22.82 ng/ml. Bone resorption and formation markers were significantly increased after treadmill walking (p < 0.01). CONCLUSION: Bone turnover increases after 3-month supervised treadmill walking in Thai postmenopausal women.

Validation study of the Thai ID Pain Scale.

OBJECTIVE: To translate the ID Pain scale into Thai and validate this scale. MATERIAL AND METHOD: The 6-item ID Pain scale was translated into Thai. The final version was tested in 100 patients. Sensitivity, specificity, and predictive validity were calculated. RESULTS: Twenty-four patients were neuropathic, 49 were nociceptive and 27 were mixed pain. Forty-six patients have chronic pain. Seventy-five were female. Sensitivity and specificity for diagnosis of neuropathic pain were 83% and 80%. The predictive validity using area under the ROC curve of the neuropathic, mixed and nociceptive pain groups were 0.890 (95% CI 0.824-0.955), 0.587 (95% CI 0.464-0.709) and 0.147 (95% CI 0.071-0.224), respectively. CONCLUSION: The Thai ID Pain scale is brief convenient to complete and had good predictive validity for screening of neuropathic pain. Prediction validity of mixed pain is moderate and of nociceptive pain is low.

Medical complications during inpatient stroke rehabilitation in Thailand: a prospective study.

OBJECTIVE: To identify the incidence and risk factors of medical complications during inpatient stroke rehabilitation. MATERIAL AND METHOD: Stroke patients (n = 118) admitted to the Thai Red Cross Rehabilitation Center between August 2006 and January 2007 were prospectively evaluated throughout inpatient rehabilitation to identify incidence of complications. RESULTS: Eighty-three patients (70.3%) experienced at least one complication. The common complications were post-stroke depression (56.6%), musculoskeletal pain (28%), urinary tract infection (UTI) (17.8%), and complex regional pain syndrome (CRPS) type I (15.3%). Others were pneumonia (4.2%), cardiovascular complications (4.2%), falls (4.2%), upper GI bleeding (3.2%), seizure (2.5%), and pressure ulcer (1.7%). Fourteen patients (11.8%) were referred to the acute care hospital because of severe medical complications. History of myocardial infarction, low admission Barthel ADL Index, urinary incontinence, indwelling catheterization, and dysphagia were risk factors of complications (p < 0.05). There were no specific risk factors of post-stroke depression. The risk factor of UTI was indwelling catheterization (RR 78.86, p < 0.001), CRPS type I was limited shoulder range of motion (RR 3.13, p = 0.035), pneumonia was aspiration (RR 145.33, p < 0.001), and cardiovascular complication was history of myocardial infarction (RR 7.70, p = 0.037). CONCLUSION: The incidence of medical complication is 70.3%. Post-stroke depression, musculoskeletal pain, UTI and CRPS type I are the common complications. The risk factors of complications are low admission BAI, history of myocardial infarction, urinary incontinence, indwelling catheterization, and dysphagia. Awareness and screening of risk factors should be implemented to lower the incidence.

Do Heberden and Bouchard nodes affect finger dexterity in elderly?

Elderly often have Heberden nodes (HN) and Bouchard nodes (BN) that may affect finger dexterity. The aim of this cross-sectional study was to assess an effect of HN and BN on finger dexterity of the elderly. The nine-hole peg test was used for dexterity measurement in 200 elderly with HN and/or BN. Mean age was 68.6 +/- 5.39 years. Average performance of each hand was compared between elderly with or without nodes. HN and BN were found in 75 right hands (37.5%) and 73 left hands (36.5%). Nodes were found in females more often than males (p < 0.001). Average right hand dexterity in elderly with and without nodes was 21.6 +/- 3.16 and 21.4 +/- 3.16 s. Average left hand dexterity in elderly with and without nodes was 23.3 +/- 3.13 and 23.3 +/- 3.67 s. There was no significant difference between elderly with or without nodes (p >/= 0.05). In conclusion, HN and BN in elderly hands do not affect finger dexterity. Therapist may use the same training program to prevent deterioration of finger dexterity in elderly with or without nodes.

Increased pinch strength in acute and subacute stroke patients after simultaneous median and ulnar sensory stimulation.

BACKGROUND: Peripheral nerve stimulation may induce cortical adaptations as it improves pinch strength in chronic stroke patients immediately after stimulation. OBJECTIVE: Test the effects of peripheral sensory stimulation on pinch strength in patients with acute and subacute stroke. METHODS: Stroke patients (N = 20) who had onset less than 6 months previously and could voluntarily pinch the thumb to the index finger participated in a randomized, single-blinded, controlled study. Ten patients received 2 hours of simultaneous electrical stimulation over the median and ulnar nerves at the wrist to the level of appreciating paresthesias (peripheral sensory stimulation group). Ten control patients received stimulation to the level of perception (sham-control group). Pinch strength of the thumb pad to tip and to lateral side of the index finger of the paretic hand and the Action Research Arm test were tested before and immediately after the stimulation. RESULTS: Lateral and tip pinch strength were significantly increased in both groups (P < .05). Mean +/- SD of increased lateral pinch strength of peripheral sensory stimulation and sham-control groups were 1.24 +/- 0.54 pounds and 0.20 +/- 0.28 pounds, respectively. Mean +/- SD of increased tip pinch strength of peripheral sensory stimulation and sham-control groups were 1.00 +/- 0.72 pounds and 0.37 +/- 0.36 pounds, respectively. Increase pinch strength of the peripheral sensory stimulation group was greater than the sham-control group, with significant difference (P < .05). The Action Research Arm test was not significantly changed after stimulation in both groups (P > .05). CONCLUSION: Peripheral sensory stimulation of the paretic hand may increase pinch strength of acute and subacute stroke patients immediately after stimulation.

Electrodiagnosis and recovery of facial paralysis at King Chulalongkorn Memorial Hospital.

OBJECTIVE: To study electrodiagnostic findings and recovery patterns of patients with facial nerve paralysis. MATERIAL AND METHOD: Seventy-six medical records of patients who had a facial paralysis and had their electrodiagnosis performed in a 2-year period were reviewed. Patients were invited for re-evaluation. The patients would be evaluated according to House-Brackmann Facial Nerve Grading Scale (HBFNGS), residual impairment, disability, emotional and social consequences. RESULTS: Complete data were obtained from 50 patients whose mean age was 47.0 +/- 17.9 years. Seventy-two percent were diagnosed as Bell's palsy. There was significant correlation between %CMAP amplitude and HBFNGS (grade I-VI) at r = 0.5; p < 0.01. All cases of Bell's palsy with CMAP amplitude > or = 70% of normal side regained full recovery. Patients with CMAP amplitude > or = 30% had good recovery. Bell's palsy with CMAP amplitude < 10% and with other causes had poor outcome. Nine patients had synkinesis. Most of them were of traumatic cause and had severe nerve degeneration. No evidence showed that electrical stimulation was a factor inducing synkinesis. CONCLUSION: Percent CMAP amplitude could moderately predict the outcome of Bell's palsy better than other causes of facial palsy. The paralysis from traumatic cause with low %CMAP amplitude had more chance to develop synkinesis.

Cross-cultural adaptation to the Thai language of the neuropathic pain diagnostic questionnaire (DN4).

OBJECTIVE: To cross-culturally adapt the neuropathic pain diagnostic questionnaire (DN4) to Thai language MATERIAL AND METHOD: Phase 1: Forward and backward translation followed by assessment of semantic equivalence. Phase 2: Testing of the questionnaire in 30 neuropathic pain patients who were seen and diagnosed by experts, followed by modifications to produce a final version. RESULTS: All the Thai translated pain descriptors except 'tingling' got high percentages of understanding among neuropathic pain patients in the first round of testing. After some adaptation of the Thai word for 'tingling' had been made, the new translated word was retested, and all subjects doing the retest understood the word very well. CONCLUSION: The Thai DN4 questionnaire was systematically translated and validated. This offers a simple Thai neuropathic pain diagnostic tool for clinical use.

Thai Short-form McGill Pain Questionnaire.

OBJECTIVE: To validate the Thai Short-Form McGill Pain Questionnaire (Th-SFMPQ). MATERIAL AND METHOD: A postal survey to find the most corresponding terms to those used in the original English short-form McGill Pain Questionnaire had been performed The Thai version was created and validated. Sixty patients who had either musculoskeletal or neuropathic pain were assessed by two interviewers with this Th-SFMPQ. RESULTS: Forty four women and sixteen men participated in this study. Average age was 44.3 +/- 12.8 years and 80% of them had musculoskeletal pain. Means of sensory score was 8.98, affective score was 5.73, total score was 14.71, total count was 7.33, Present Pain Intensity (PPI) was 3.21 and Visual Analog Scale (VAS) was 53.61. Cronbach's a value was 0.7881 and inter-rater validity value of PPI was more than 0.7. The correlation coefficient was quite high (r > 0.8) for all scales. Regarding content validity, three pain descriptors (ie. stabbing, gnawing, and splitting) did not meet 33% in Melzack's criteria. CONCLUSION: The Th-SFMPQ has good internal consistency and inter-rater validity. Three uncommon descriptors should be substituted by other words or discarded in later version.

Falls among stroke patients in Thai Red Cross rehabilitation center.

OBJECTIVE: To determine the incidence and risk factors of falls among stroke patients. MATERIAL AND METHOD: A prospective cohort study was designed to study the stroke patients who were admitted to the Thai Red Cross Rehabilitation Center from February 2004 to July 2005. Related variables offaller and non-faller groups were compared. RESULTS: Of 151 patients, 24 (15.9%) experienced at least one fall. The incidence rate was 3.44/1000 patients/ day. Most of the falls (71.4%) occurred during the daytime, in the bathroom (37.1%), and by the bedside (22.9%). Falls frequently occurred while transferring (22.9%) and walking (20%). Barthel ADL Index (BAI) score was the variable that significantly differentiated the fallers from the non-fallers (p = 0.013). Patients with BAI score of > or = 12 had 3 times more risk to fall. CONCLUSION: About 16% of stroke patients fell during rehabilitation. More attention should be paid during the transfer and ambulation. Furthermore, a safety area should be provided in every bathroom and by the bedside.

Botulinum toxin type A injections for treating neurogenic detrusor overactivity combined with low-compliance bladder in patients with spinal cord lesions.

OBJECTIVE: To evaluate botulinum toxin type A (BTX-A) for treating neurogenic detrusor overactivity in patients with spinal cord lesions, including those with abnormally low bladder compliance. DESIGN: Nonrandomized, before-after trial (9-mo follow-up). SETTING: Hospitalized care. PARTICIPANTS: Ten patients with high detrusor contraction pressure and/or poor response to oxyphencyclimine with incontinence selected as a consecutive sample. INTERVENTION: BTX-A (Botox; 300U) was injected into the detrusor muscle. MAIN OUTCOME MEASURES: Urinary continence, functional bladder capacity, bladder compliance, detrusor contraction pressure, and volume at first reflex voiding. Measurements were taken before and 6, 16, and 36 weeks posttreatment. RESULTS: Six weeks after treatment, complete continence was restored in 7 patients without oxyphencyclimine. Mean functional bladder capacity (P=.008), compliance (P=.012), and reflex volume (P=.045) significantly increased, whereas maximal detrusor contraction pressure significantly decreased (P<.001). Urodynamic variables remained significantly improved at 16 weeks, but values were returning toward baseline levels by 36 weeks. The procedure was generally uneventful, without any serious side effects. CONCLUSIONS: BTX-A injections are an effective, well-tolerated treatment for neurogenic detrusor overactivity in patients with spinal cord lesions, even in patients with abnormally low bladder compliance. Patients may require repeat injections after 16 weeks to remain continent.

Effects of shoe lift on weight bearing in stroke patients.

OBJECTIVES: To determine the effect of shoe lift, cueing and cueing with shoe lift on weight bearing in paretic leg of stroke hemiparetic patients and compare the effect between each condition. DESIGN: Cross-sectional experimental study. SETTING: Department of Rehabilitation Medicine and Department of Ear Nose and Throat, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University. SUBJECT: Ten hemiparetic patients as a result of unilateral stroke. MATERIAL AND METHOD: Weight symmetry of each patient was measured by posturography during quiet stance and in conditions of compelled weight shift. Each patient was started with quiet standing, standing with shoe lift under the sound leg; cueing and cueing with shoe lift under the sound leg respectively. Weight symmetry scores were recorded for comparing the weight distribution between each foot. RESULTS: There were 10 hemiparetic patients. Seven were male. The average age was 53.4 +/- 8.45 years. There were 5 right hemiparesis and 5 left hemiparesis. The average onset was 12.3 +/- 15.73 months. In the right hemiparetic patients, weight bearing in the paretic leg was significantly improved when cueing with shoe lift compared with quiet standing and with shoe lift (Backward p = 0.012, Forward p = 0.011 and Backward p = 0.001, Forward p = 0.036 respectively). In the left hemiparetic patients, weight bearing in the paretic leg was significantly improved when cueing compared with quiet standing (Backward p = 0.046), and when using the shoe lift (Backward p = 0.016). Cueing with shoe lift could significantly improve weight bearing in the paretic leg when compared with shoe lift alone (Backward p = 0.015). Shoe lift alone could improve weight bearing in the paretic leg of the right and left hemiparetic patients but was not statistically significant (p > 0.05). CONCLUSION: Cueing with shoe lift under the sound leg can significantly improve weight bearing of the paretic leg of the right and left stroke hemiparetic patients.