Research Designs and Statistical Methods Trends in the Annals of Rehabilitation Medicine

OBJECTIVE: To investigate trends of the research designs and statistical methods in the Annals of Rehabilitation Medicine (ARM) published from 2005 to 2015 through a comparison of articles with the Archives of Physical Medicine and Rehabilitation (APMR). METHODS: The authors reviewed all articles published in ARM and APMR for the years 2005 and 2015 in order to determine their research designs as well as their statistical methods used in each article. RESULTS: In ARM, randomized controlled trials increased from 4.5% in 2005 to 6.5% in 2015. In APMR, randomized controlled trials increased from 8.1% in 2005 to 14.0% in 2015, meta-analyses increased to 5.3%, and systematic reviews increased to 6%. The number of studies using statistical methods increased in ARM from 1.9 to 2.6 per article and in APMR, from 2.7 to 3.1. Use of advanced methods in ARM also showed an increase from 2005 to 2015. CONCLUSION: This study concludes that there is a trend of increased awareness and attempts to use varied research approaches in ARM articles. There should also be more in-depth discussions and opportunities for researchers to share their experiences regarding statistical methods in the clinical field.

Erratum: A U-shaped Association between Body Mass Index and Psychological Distress on the Multiphasic Personality Inventory: Retrospective Cross-sectional Analysis of 19-year-old Men in Korea

One author's affiliation is misspelled in original article.

A U-shaped Association between Body Mass Index and Psychological Distress on the Multiphasic Personality Inventory: Retrospective Cross-sectional Analysis of 19-year-old Men in Korea

Objective personality tests, such as the Minnesota Multiphasic Personality Inventory (MMPI), might be more sensitive to reflect subclinical personality and be more state-dependent in an individual's lifetime, so they are good scales to predict the psychological distress regarding certain states. The aim of this study was to identify the specific pattern between body mass index (BMI) and psychological distress using the objective personality test. For this study, we investigated BMI and the Korean Military Multiphasic Personality Inventory (MPI). A retrospective cross-sectional study was conducted with 19-yr-old examinees who were admitted to the Military Manpower Administration in Korea from February 2007 to January 2010. Of 1,088,107 examinees, we enrolled 771,408 subjects who were psychologically apparent healthy possible-military-service groups. Afterwards, we reviewed and analyzed directly measured BMI and MPI results. In terms of the validity scales, the faking-good subscale showed an inverted U-shaped association, and faking-bad and infrequency subscales showed a U-shaped association with BMI groups. In terms of the neurosis scales, all clinical subscales (anxiety, depression, somatization, and personality disorder) also showed a U-shaped association with BMI groups. For the psychopath scales, the schizophrenia subscale showed a U-shaped association, and the paranoia subscale showed a near-positive correlation with BMI. In conclusion, a specific U-shaped pattern was observed between BMI and the MPI in 19-yr-old men in Korea. Underweight and obesity are related to psychological distress, so supportive advice and education are needed to them.

A Case of Cerebella Infarction Caused by Cervical Meningioma

Mechanisms and causes of cerebral infarction, usually two mechanisms, are identified: hemodynamics and thrombotic or thromboembolic causes. Compressive causes by tumor are not reported in the main etiological classifications as Trial of Org10172 in Acute Stroke Treatment (TOAST) classification and ASCO (atherosclerosis, small vessel disease, cardiac source, and other causes). However tumors found in these locations often involve an intracranial portion of the internal carotid artery (ICA) and may compromise cerebral blood flow. Cerebral infarction related to meningioma, the common extra-axial brain tumor in adults, has been rarely reported. We experienced an extremely rare case of cerebellar infarction resulting from direct compression of the vertebral artery by cervical meningioma. To the best of our knowledge, there are no documented cases of a meningioma causing stroke by vertebral artery occlusion. We report on a case of meningioma presenting with cerebellar infarction as a result of vertebral artery compression.

Necessity to Develop a Tool to Evaluate Activity of Daily Living for Electric Powered Indoor/Outdoor Chair Users

OBJECTIVE: To evaluate changes in activity of daily living before and after provision of electric-powered indoor/outdoor chair (EPIOC), discuss problems of current activities of daily living (ADL) evaluating tools for EPIOC users, and provide preliminary data to develop ADL evaluation tool for EPIOC user. METHODS: A total of 70 users who were prescribed EPIOC and had been using for more than 1 year were recruited in this study. Before and after provision of EPIOC, MBI and FIM scores were measured and a questionnaire consisting of six categories (general socioeconomic states, currently using state, whether EPIOC was helpful for social participation and occupational chances, psychiatric influences, self-reported degrees of independency, and barriers of using EPIOC) was used. RESULTS: No difference in MBI scores before and after provision of EPIOC was observed. However, the wheelchair ambulation category showed a significant difference. While motor FIM was not significantly different from MBI, FIM score were significantly (p<0.05) higher than MBI. For questions regarding social participation frequency, helpfulness of EPIOC on confidence, refreshing patients' emotions and self-reported degrees of independence, all of them showed positive responses. Especially, EPIOC users' self-reported degree of independency showed favorable results. There was discrepancy in MBI or FIM measured by physicians. CONCLUSION: Our study showed that there was a gap between the existing ADL evaluation tool and the ADL level that EPIOC users were actually feeling. Thus, it is necessary to develop an evaluation tool specifically for EPIOC.

Central Hyperthermia Treated With Baclofen for Patient With Pontine Hemorrhage

Central hyperthermia is a very rare disease; however, once it happens, it is associated with a poor prognosis and high mortality for patients with severe brainstem strokes. Following a pontine hemorrhage, a 46-years-old female developed prolonged hyperthermia. Work-ups to the fever gave no significant clues for the origin of fever, and hyperthermia did not respond to any empirical antibiotics or antipyretic agents. The patient's body temperature still fluctuated in a range of 37.5degrees C to 39.2degrees C. Considering the lesion of hemorrhage, we suspected central hyperthermia rather than infectious diseases. We started with baclofen administration at a dose of 30 mg/day. The body temperature changed to a range of 36.6degrees C to 38.2degrees C. We raised the dose of baclofen to 60 mg/day. The patient's body temperature finally dropped to a normal range. Central hyperthermia, caused by failures of thermoregulatory pathways in brainstem, following the pontine hemorrhage rarely occurs. Baclofen can be used to treat suspected central hyperthermia in a patient with pontine hemorrhage.

Central Hyperthermia Treated With Baclofen for Patient With Pontine Hemorrhage

Central hyperthermia is a very rare disease; however, once it happens, it is associated with a poor prognosis and high mortality for patients with severe brainstem strokes. Following a pontine hemorrhage, a 46-years-old female developed prolonged hyperthermia. Work-ups to the fever gave no significant clues for the origin of fever, and hyperthermia did not respond to any empirical antibiotics or antipyretic agents. The patient's body temperature still fluctuated in a range of 37.5degrees C to 39.2degrees C. Considering the lesion of hemorrhage, we suspected central hyperthermia rather than infectious diseases. We started with baclofen administration at a dose of 30 mg/day. The body temperature changed to a range of 36.6degrees C to 38.2degrees C. We raised the dose of baclofen to 60 mg/day. The patient's body temperature finally dropped to a normal range. Central hyperthermia, caused by failures of thermoregulatory pathways in brainstem, following the pontine hemorrhage rarely occurs. Baclofen can be used to treat suspected central hyperthermia in a patient with pontine hemorrhage.

Analysis of Publication Status of Abstracts Presented at the Annual Meeting of the Korean Academy of Rehabilitation Medicine

OBJECTIVE: To analyze publication rate, time to publication and the characteristics of the abstracts presented at the annual Korean Academy of Rehabilitation Medicine (KARM) meetings. METHODS: A total of 1,027 abstracts presented at the 2008 and 2009 annual KARM meetings were enrolled in the database and searched for their subsequent citation in PubMed, KoreaMed, and Google Scholar. RESULTS: The data analysis revealed that 317 (30.87%) abstracts, were published as full-length journal articles and publication rates by subject were not significantly different. The mean time to publication was 17.17+/-10.48 months, and the journals written in English (20.39+/-10.20) required a longer duration than those written in Korean (11.94+/-8.44) with statistical significance (p<0.001). There was no statistical difference (p=0.284) in the duration between domestic (17.61+/-10.37) and foreign (16.48+/-10.51) of the 220 domestic journal articles, 190 (86.76%) were published in the Annals of Rehabilitation Medicine and the 97 articles published in foreign journals were scattered over 60 different journals. CONCLUSION: The publication rate of abstracts presented at the 2008 and 2009 annual KARM meetings was 30.87% and the mean time to publication was 17.17+/-10.48 months.

A Case of Right Middle Cerebral Artery Infarction Presenting as Thunderclap Headache

Thunderclap headache refers to a sudden and severe headache that comes unexpectedly, reminding one of a clap of thunder. The initial description of this type of headache was in association with an unruptured intracranial aneurysm. It is known to be a presenting feature of subarachnoid hemorrhage, unruptured intracranial aneurysm, cerebral venous thrombosis, cervical artery dissection, spontaneous intracranial hypotension, pituitary apoplexy, retroclival hematoma, and hypertensive reversible posterior leukoencephalopathy. A formula for diagnostic assessment of thunderclap headache, such as brain computed tomographic scan and spinal tap, should be established. We experienced a case of cerebral infarction presented with thunderclap headache, diagnosed using diffusion weighted magnetic resonance imaging. We suggest that, even when these patients have shown non-specific findings on neurological examination, brain computed tomography, and cerebrospinal fluid analysis, diffusion MRI should be considered for differential diagnosis of thunderclap headache in emergency medical services.

Therapeutic Effects of Mechanical Horseback Riding on Gait and Balance Ability in Stroke Patients

OBJECTIVE: To investigate the therapeutic effects of mechanical horseback riding for gait and balance parameters in post-stroke patients. METHOD: This study was a non randomized prospective positive-controlled trial over a 12 week period. From May 2011 to October 2011, 37 stroke patients were recruited from our outpatient clinic and divided into two groups. The control group received the conventional physiotherapy while the intervention group received the conventional physiotherapy along with mechanical horseback riding therapy for 12 weeks. Outcome measurements of gait included the Functional Ambulation Category (FAC) and gait part of the Performance Oriented Mobility Assessment (G-POMA) while those of balance included the Berg Balance Scale (BBS) and the balance part of the Performance Oriented Mobility Assessment (B-POMA). These measurements were taken before and after treatment. RESULTS: There were no significant differences in the baseline characteristics and initial values between the two groups. When comparing baseline and 12 weeks post treatment in each group, the intervention group showed significant improvement on BBS (39.9+/-5.7 --> 45.7+/-4.8, p=0.001) and B-POMA (10.4+/-2.6 --> 12.6+/-2.1, p=0.001), but significant improvement on gait parameters. When comparing the groups, the dynamic balance category of BBS in post treatment showed significant difference (p=0.02). CONCLUSION: This study suggests that mechanical horseback riding therapy may be an effective treatment tool for enhancing balance in adults with stroke.

Usefulness of Transcranial Magnetic Stimulation in Diagnosis of Acute Bell's Palsy

OBJECTIVE: To investigate the diagnostic significance of transcranial magnetic stimulation (TMS) compared with electroneurography (ENoG) in very early period of Bell's palsy. METHOD: Thirty-six Bell's palsy patients within four days of disease onset were recruited and disease severity was assessed using the House-Brackmann grading system on the first visit, on the second visit (14 days later) and one year later. TMS at the labyrinthine segment was performed only on the first visit, while ENoG was done on the first and second visit. RESULTS: The amplitude ratio of magnetically evoked muscle responses between the affected side and the healthy side was correlated significantly with the clinical course and the final outcome which were documented using the House-Brackmann grade, whereas ENoG was not on the first visit. On the other hand, ENoG on the second visit was correlated significantly with the final outcome. CONCLUSION: In the early period of Bell's palsy, magnetically evoked muscle responses by TMS reflect neural insult more accurately than ENoG. TMS could be a useful measuring tool for the diagnosis and prognosis of Bell's palsy in the acute stage.

Spontaneous Bilateral Achilles Tendon Rupture after Local Steroid Injection for Carpal Tunnel Syndrome in a Diabetic Patient: A case report

Achilles tendon injuries are one of the most common tendon injuries in the lower extremities, but spontaneous bilateral achilles tendon rupture without any external force is extremely rare. We present a case of a patient who had spontaneous bilateral achilles tendon rupture related to multiple steroid injections for carpal tunnel syndrome in diabetes. According to this case, we suggest that we should take special precaution to use steroid to the diabetes though it is not applied to the achilles tendon directly.