Walking meditation versus balance training for improving balance abilities among older adults with history of fall: A randomized controlled trial.

OBJECTIVE: To investigate improvement in balance abilities compared between walking meditation and balance training among older adults with history of fall. INTERVENTIONS: Walking meditation or mindfulness meditation whilst standing and moving (n = 35) or balance training (n = 33) 20-30 min/day, 5-7 days/week for 24 weeks was performed at home. MAIN OUTCOMES: The primary outcomes were dynamic balance abilities as assessed by Timed Up and Go test (TUGT), and static balance as assessed by Functional Reach Test (FRT) and Single Leg Stance Test (SLST). The secondary outcomes were quality of life as measured by the EuroQOL 5-dimensions 5-levels (EQ-5D-5L), and mental health as evaluated by the Thai Geriatric Mental Health Assessment Tool-15 (TGMHA-15). All outcomes were assessed at baseline, 6 months, and 9 months. Self-reported compliance, adverse events, and patient satisfaction were recorded at 6 and 9 months. RESULTS: The mean age was 69 years (range: 60-85). No significant difference was observed between groups for the 3 primary outcome measures. The mean difference (95% confidence interval) between groups was -0.48 (-1.40, 0.44) for TUGT, -1.11 (-3.66, 1.45) for FRT, and 0.82 (-5.03, 6.67) for SLST. The EQ-5D-5L and TGMHA-15 also showed no significant difference between groups. Most participants were in good compliance with the exercise protocol (48.3-68.0%), and no serious adverse events were reported. CONCLUSION: Our results showed walking meditation to be comparable to balance training for improving balance abilities in older adults with history of fall. Walking meditation may be considered an alternative treatment for improving balance abilities in this patient population.

Depression after stroke at 12-month follow-up: a multicenter study.

PURPOSE: To study the prevalence of depression at 12 months after stroke and to analyze factors associated with depression. METHODS: This prospective cross-sectional study was conducted among nine tertiary hospitals in Thailand. Stroke patients from the Thai Stroke Rehabilitation Registry who were admitted in inpatient rehabilitation wards were recruited for evaluation at the 12-month follow-up time point. Hospital Anxiety and Depression Scale (HADS) was used to evaluate depression in stroke. A score of ≥11 was considered as having depression. Univariate and multivariate analysis was used to investigate factors related with depression in stroke. RESULTS: Two hundred stroke patients with a mean age of 62.1±12.5 years were recruited. Approximately 60% were male. The number of stroke patients with depression at the 12-month follow-up was 42 (21.0%, 95%CI 15.9%-27.2%). Mean HADS score at 12-month follow-up was not significantly different from those at discharge. However, 28 (16.5%) stroke patients who did not have depression at discharge developed depression during the 12-month period. From multivariate analysis, complications and urinary incontinence were found to be significantly associated with depression after stroke with adjusted odds ratio of 3.65 (95%CI 1.11-12.06) and 4.82 (95%CI 1.74-13.38), respectively. CONCLUSION: Depression is a common complication after stroke. This study found one-fifth of stroke survivors developed depression at the 12-month follow-up. Complications at discharge and urinary incontinence were significantly correlated with depression in multivariate analysis. Further study concerning interventions in decreasing depression should be performed in order to improve the quality of life of those stroke patients.

The prevalence of sarcopenia and related factors in a community-dwelling elders Thai population.

BACKGROUND: Sarcopenia is one of common problems among elderly worldwide. OBJECTIVES: Sarcopenia is one of common problems among elderly worldwide. To determine the prevalence of sarcopenia and related factors in community-dwelling elders Thai population. METHODS: This cross-sectional study was performed in 243 subjects aged over 60 years. All participants were evaluated for handgrip strength by dynamometer and for gait speed by walking a 6-m distance. The muscle mass for subjects who had abnormal grip strength and/or gait speed was evaluated by bioimpedance analysis (BIA). The prevalence of sarcopenia was calculated and factors related to sarcopenia were also analyzed. RESULTS: The mean age was 69.7 ± 6.9 years with three-fourths female participants. Approximate 60% of subjects were overweight. There were 74 participants (30.5%, (95% CI: 25.0%-36.5%)) with abnormal grip strength; gait speed and muscle mass. Males had more prevalence than females (33.9% vs. 29.3% respectively). There is higher prevalence with increasing age among both genders (17.9%, 41.4% and 80.0% in young old, middle old, and the very old groups respectively in male; and 11.5%, 49.1%, and 65.0% in female). After using multivariate analysis, age, body mass index (BMI), and quadriceps strengths were significantly related to sarcopenia with the adjusted odds ratio of 15.47 (95% CI: 4.93, 48.54), 12.84 (95% CI: 3.85, 42.82) and 3.77 (95% CI: 1.70, 8.37) respectively. CONCLUSIONS: Thirty percent of the community-based elderly experienced sarcopenia. As the prevalence is high, the screening for sarcopenia should be performed in community-dwelling elders especially older age, underweight subjects and lower quadriceps strength.

Efficacy and safety of mirtazapine in fibromyalgia syndrome patients: a randomized placebo-controlled pilot study.

BACKGROUND: Data from an open-label trial suggest that mirtazapine might prove useful in treatment of fibromyalgia syndrome (FMS). OBJECTIVE: To obtain preliminary efficacy data of mirtazapine for estimation of sample size requirements for a Phase 2 clinical trial in FMS. METHODS: This 13-week randomized controlled trial compared the effects of mirtazapine 15 mg/day, mirtazapine 30 mg/day, and placebo in 40 patients with FMS. The primary outcomes were change in Pain Visual Analog Scale (PVAS) and proportion of pain responders (≥30% PVAS reduction). Secondary outcomes included scores from the Jenkins Sleep Scale (JSS), Patient Global Impression of Change (PGIC), Fibromyalgia Impact Questionnaire (FIQ), Hamilton Depression Rating Scale (HAM-D), Patient Global Assessment, and self-reported adverse events. RESULTS: Significant within-group PVAS reductions from baseline were observed in all 3 groups, with the greatest improvement in the mirtazapine 30-mg group (p < 0.005); between-group difference was not significant. The proportion of pain responders did not meet significance criteria (66.67% for mirtazapine 30 mg, 50% for mirtazapine 15 mg, 41.67% for placebo). Significant within-group improvement in JSS scores was seen for mirtazapine 30 mg (p < 0.01) and mirtazapine 15 mg (p < 0.05). Between-group comparison achieved significance for JSS item 3, waking several times per night (p < 0.05). On the PGIC, 72.73% felt better with both mirtazapine dosages compared with 50% for placebo. Within-group FIQ responses indicated improvement in only mirtazapine-treated groups, whereas within-group improvement for HAM-D and Patient Global Assessment was observed in all groups. Based on our findings, the sample size requirement (80% power, 5% type I error) should be 83 per group to detect PVAS change difference between mirtazapine 30 mg and placebo. Common mirtazapine-related adverse events were increased appetite and weight gain. CONCLUSIONS: Patients with FMS taking mirtazapine exhibited within-group significant improvement in most of the measured outcomes. Between-group analysis was predictably compromised by the small sample size. Mirtazapine was well tolerated. Further study with a larger sample size is likely to be useful.