Driving scenarios and environmental settings in simulator-based driving assessment systems for stroke: a systematic review.

BACKGROUND: Driving simulators are effective tools to evaluate the driving abilities of patients with stroke. They can introduce various driving scenarios which will greatly benefit both the assessors and drivers. However, there is still no guidelines by which driving scenarios should be introduced in the driving assessment. OBJECTIVES: We conducted a systematic review to examine the utilization of driving scenarios and environments in the simulator-based driving assessment for patients with stroke. METHODS: A systematic review was conducted following PRISMA. We searched PubMed, Web of Science, ScienceDirect, ACM Digital Library, and IEEE Xplore Digital Library databases in January and June 2022 to identify eligible articles published since 2010. RESULTS: Our searches identified 1,614 articles. We included 12 studies that applied driving simulators to assess the driving performance of patients with stroke. The driving scenarios were categorized into three categories - vehicle controls scenarios, hazard perception scenarios, and trajectory planning scenarios - based on a certain set of driving abilities. The most common driving scenarios are simple navigation (n = 8) and emergency stop (n = 8). The most frequently used driving area is urban (n = 9), and a variety of roads and traffic conditions were found in the included studies. Only 2 studies applied weather conditions, such as the clear and sunny condition or the windy condition. CONCLUSION: It is recommended for future research to consider covering scenarios from the aforementioned three categories and further investigate the benefits of introducing complex weather conditions and localized traffic conditions in the driving assessment.

Change in quality of life of disabled patients after intensive inpatient rehabilitation at Siriraj Hospital.

OBJECTIVE: To compare the quality of life (QOL) before and after intensive rehabilitation of disabled patients and to examine the factors associated with the change in QOL. MATERIAL AND METHOD: A retrospective chart review of 200 disabled patients who were admitted for intensive rehabilitation between 2006 and 2009. The Thai abbreviated version of World Health Organization quality of life (WHOQOL-BREF-THAI) was used to assess QOL. Demographic data, physical and psychosocial status, Modified Barthel ADL Index (BAI) were collected and analyzed for the association with WHOQOL-BREF-THAI score changes. RESULTS: One hundred seventeen (58.5%) males and 83 (41.5%) females with mean age 55.6 (SD 17.9) years old participated in this study. Various principal diagnoses were included; 112 (56%) stroke, 54 (27%) spinal cord injury and 34 (17%) other diagnoses. After the intensive rehabilitation, quality of life perception was improved in 164 (82%) disabled patients. There was significant difference in mean WHOQOL-BREF-THAI scores on admission and at discharge which were 81.3 (SD 11.2) and 85.5 (SD 11.0) respectively with the p-value < 0.001. The mean changed score was 4.2 (SD 8.0). However, four domains of QOL were improved except the social domain. The factors associated with the disabled patients who were non-improved in WHOQOL-BREF-THAI score after rehabilitation were having non-familial caregiver (OR 5.8, 95% CI 2.1 to 16.0) and joint stiffness (OR 4.1, 95% CI 1.7 to 9.9). CONCLUSION: Intensive inpatient rehabilitation can significantly improve quality of life in the disabled patients with various primary diagnoses. Having joint stiffness prior to rehabilitation and non-availability of familial members for taking care are the factors associated with the poor outcome in QOL perception.

Quality of life among the traumatic spinal cord injured patients.

OBJECTIVES: To study the quality of life among the traumatic spinal cord injured patients and to identify the factors related with the quality of life in the good level of such patients. MATERIAL AND METHOD: The traumatic SCI patients who had been treated in the Department of Rehabilitation Medicine, Siriraj Hospital, Bangkok, Thailand from January 2003 until August 2009 were interviewed for the demographic data. The injury related data were obtained from the medical records. The WHOQOL-BREF-Thai was used to acquire the QOL score, which would be interpreted as poor fair, and good QOL level according to the questionnaire. The Center for Epidemiologic Studies Depression scale and the modified Barthel Index (BI) were used to assess depression, and functional disability respectively. The median split method was used to divide the participants into two groups as good and poor QOL groups. The Chi-square and Independent Sample t-test were performed to determine the difference between these two groups and multivariate logistic regression was used to analyze the factors associated with the good QOL. P-value < 0.05 was accepted as statistical significance. RESULTS: Sixty-seven patients (49 males and 18 females) with a mean age 36.54 +/- 11.46 years old participated the present study. They suffered from traffic accident 67.2%, gunshot 16.4%, fall from a height 11.9%, and others 4.5%. The injury levels were cervical 31.3%, thoracic 50.7%, and lumbosacral 18%. Most of them (60.6%) had incomplete lesion. Eighteen patients (26.1%) reported depression. The mean BI score was 69.71 +/- 29.42. Three (4.5%), forty-nine (73.1%), and fifteen (22.4%) participants reported their QOL score in the range of poor, fair and good levels respectively. Using the median split method, participants with a score over 82 were classified as having good QOL groups and the rest were classified as having poor QOL group. When considering the score in each domain of the WHOQOL questionnaire, the differences between the good and poor QOL groups had statistical significance. The sufficient income (OR 13.67, 95% CI: 3.1-60.22, p = 0.001), having no depression (OR 7.6, 95% CI: 1.17-49.22, p = 0.033), and being employed (OR 6.88, 95% CI: 1.44-32.94, p = 0.016) were significantly related with the good QOL. CONCLUSION: Most of the SCI patients determined their QOL as fair level. Sufficient income, having no depression, and being employed were associated with the good QOL.

Health related quality of life among the Thai people with unilateral lower limb amputation.

OBJECTIVE: To study the health related quality of life (HRQOL) among Thai unilateral lower limb amputees and determine the factors associated with a good HRQOL. MATERIAL AND METHOD: A postal survey with the WHOQOL-BREF-Thai questionnaire (26 items) to 1300 people with LLA who received a lower limb prostheses from Siriraj Hospital, Prapokklao Hospital, and Ratchaburi Hospital between 2001 and 2005 was conducted. Descriptive statistics were used to report the level of HRQOL. Chi-Square, independent Sample t-test and multivariate analysis by stepwise logistic regression were used to determine the factors associated with a good QOL. RESULTS: Three hundred and nine questionnaires were completed from the 321 returned questionnaires (response rate 24.7%). Among these, 278 people were with unilateral LLA. They were 221 males and 57 females with mean age 46.9 +/- 13.9 years old. The number of people with LLA who had poor, fair and good QOL were 14 (5%), 241 (86.7%), and 23 (8.3%), respectively. Demographically, the people with LLA who had long duration of amputation (p = 0.001), higher education (p = 0.005), and had been employed after amputation (p < 0.001) had significantly better HRQOL. The amputees who had good wearing comfort (p = 0.04) after wearing the prostheses, had no phantom pain (p = 0.02), used no gait aids (p = 0.01), and had no body image anxiety (p = 0.01) had significantly better HRQOL. The factors associated with the good HRQOL were higher education (OR 3.2), having been employed after amputation (OR 2.1), and having good prosthetic wearing comfort (OR 1.3). CONCLUSION: Thai people with unilateral LLA reported primarily fair HRQOL. Having higher education, having been employed after amputation, and having good prosthetic wearing comfort were associated with the good HRQL.

Prevalence and management of poststroke spasticity in Thai stroke patients: a multicenter study.

OBJECTIVES: To study the prevalence, associated factors and management of poststroke spasticity in two muscle groups namely elbow flexor and knee flexor. MATERIAL AND METHOD: The Thai stroke rehabilitation registry (TSRR) was conducted among 9 rehabilitation centers. All subjects received the conventional rehabilitation program until they reached their rehabilitation goals or discharge criteria. The Brunnstrom motor recovery stage, Barthel Index, Thai Mental State Examination, Modified Ashworth Scale (MAS), and WHOQOL-BREF-Thai (26 items) questionnaires were used to assess the motor recovery, functional disability, cognition, spasticity and quality of life on admission respectively. The management of spasticity was also recorded. RESULTS: There were 327 patients with a mean age of 62.2-years-old participating in the study. The prevalence of poststroke spasticity was 41.6%. Among these the prevalences of spasticity of both elbow and knee flexors was 31.2% and of either elbow or knee flexor were 4.9% and 5.5% respectively. Spasticity with MAS grade 1 was found in the majority. The patients with spasticity had a significantly longer time to rehabilitation admission interval after the stroke (p = 0.049), had the Brunnstrom motor recovery stages of arm (p < 0.001), hand (p = 0.003) and leg (p < 0.001) significantly lower than the no spasticity group. The factor associated with spasticity was Brunnstrom motor recovery stage 2 and 3 of the arm with the odds ratio being 6.1 (95% CI = 2.5-14.9) and 3.5 respectively (95% CI = 1.3-9.2). Management of spasticity was demonstrated in 83 patients (25.4%). Therapeutic exercise, oral antispastic medication and assistive device were the first three managements frequently prescribed respectively. CONCLUSION: Spasticity was a common complication after stroke. Although the prevalence was quite high, spasticity with MAS grade 1 was found in the majority of cases. The associated factor was the Brunnstrom motor recovery stage of the arm. Therapeutic exercise was the mainstay of the management.

Knowledge and practice of physical exercise among the inhabitants of Bangkok.

OBJECTIVE: To study the knowledge and practice of physical exercise among the inhabitants of Bangkok. The factors correlated with knowledge and the practice of physical exercise, were also explored. MATERIAL AND METHOD: A self-administered questionnaire was designed to survey 1200 inhabitants in Bangkok and the vicinity aged more than 18 years old. RESULTS: One thousand one hundred and seven people aged ranging from 18-81 years old completed the questionnaires (response rate 92.25%). Six hundred and forty people (58.4%) exercised regularly. The exercise was performed 1-2 days per week with varied duration. They performed exercises alone, in their homes, in the evening. They did not report any expenditure on the exercises. Common types of exercise reported were walking, jogging, attending an aerobic exercise class, using an exercise machine, and callisthenic exercise. Two hundred and seven people (18.9%) did not perform exercise at all because of the lack of time. The factors correlated with regular exercise were the increasing age, the high level of education, the amount of free time per day, and the enjoyment of exercise. With relation to knowledge of exercise, most people lacked knowledge of the benefits of exercise rather than how to do exercise and when to stop exercising. People who had a higher educational level than secondary school and a high income, practiced exercise everyday. They acquired their knowledge of exercise from attending an exercise course. CONCLUSION: People living in Bangkok usually performed regular exercises of 1-2 days per week with varied duration. The majority lacked knowledge of the benefits of exercise. Educational level of the samples was the only factor correlated with both regular exercise and knowledge of exercise.