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.

Does adding transcutaneous electrical nerve stimulation to therapeutic ultrasound affect pain or function in people with osteoarthritis of the knee? A randomized controlled trial.

OBJECTIVE: To compare the efficacy of therapeutic ultrasound combined with transcutaneous electrical nerve stimulation versus therapeutic ultrasound alone for pain relief and functional improvement in patients with symptomatic knee osteoarthritis. DESIGN: Randomized controlled trial (blinded assessor). SETTING: Outpatient. PARTICIPANTS: A total of 148 ambulatory knee osteoarthritis patients (pain score ⩾ 5/10) were recruited as study participants. INTERVENTIONS: Ultrasound combined with transcutaneous electrical nerve stimulation (study group) or ultrasound (control group). Both groups received treatment in the supine position for 10 minutes per session, for 10 sessions within two weeks. MAIN OUTCOMES: Pain score and gait speed were measured after random allocation and on day 10. Adverse events, global assessment, and patient satisfaction were recorded after treatment. RESULTS: All baseline data were comparable between groups. The mean (SD) pain score at baseline and day 10 was 5.9 (1.3) and 2.7 (1.7) in the control group, and 5.8 (1.3) and 2.9 (1.7) in the study group, respectively. Gait speed at baseline and day 10 was 1.11 (0.30) and 1.23 (0.38) m/s in the control group, and 1.10 (0.36) and 1.17 (0.39) m/s in the study group, respectively. No difference was observed between groups for total pain score (0.28; 95% confidence interval (CI): -0.28, 0.84) or gait speed (-0.03; 95% CI: -0.13, 0.07). The results from intention-to-treat analysis were similar to those from per-protocol analysis. No difference was observed between groups for adverse events. Most participants reported satisfaction and improvement for the global assessment. CONCLUSION: Adding transcutaneous electrical nerve stimulation to ultrasound demonstrated no additional beneficial effect over ultrasound alone in patients with symptomatic knee osteoarthritis.

Creative art therapy to enhance rehabilitation for stroke patients: a randomized controlled trial.

OBJECTIVE: To examine the efficacy of creative art therapy plus conventional physical therapy, compared with physical therapy only, in increasing cognitive ability, physical functions, psychological status and quality of life of stroke patients. DESIGN: Randomized controlled trial with blinded assessor. SETTING: An in-patient setting PARTICIPANTS: One hundred and eighteen stroke patients aged ⩾50 years who could communicate verbally. INTERVENTIONS: All participants received conventional physical therapy five days per week. An intervention group received additional creative art therapy, twice a week for four weeks, in a rehabilitation ward. MAIN OUTCOMES: Cognitive function, anxiety and depression, physical performance and quality of life were measured with the Abbreviated Mental Test, the Hospital Anxiety and Depression Scale, the modified Barthel Index scale and the pictorial Thai Quality of Life questionnaire, respectively. RESULTS: Mean differences for the intervention group were significantly greater than the control group for depression (-4.5, 95% CI -6.5, -2.5, p< 0.001), physical functions (1.2, 95% CI 0.1, 2.3, p= 0.043) and quality of life (8.9, 95% CI 3.8, 13.8, p< 0.001).Compared with baseline measures, both groups experienced improved cognition, physical functions and quality of life and reduced anxiety and depression. Eighty-five percent of patients were satisfied with the creative art therapy and most reported improved concentration (68.5%), emotion (79.6%), self-confidence (72.2%) and motivation (74.1%). CONCLUSION: Creative art therapy combined with conventional physical therapy can significantly decrease depression, improve physical functions and increase quality of life compared with physical therapy alone.

Physical effects and cognitive function after exercising "Rue-si-dad-ton" (exercise using the posture of the hermit doing body contortion): a randomized controlled pilot trial.

BACKGROUND: This study aims to preliminarily evaluate effect on physical properties of shoulder joints and cognitive function after practicing Rue-si-dad-ton, a Thai traditional exercise using the postures of the hermit doing body contortion which still lacks systematically conducted evidence-based regarding its benefits. MATERIAL AND METHOD: Thirty-seven participants who have routinely worked on computer at least 3 hours per day were recruited and randomized into intervention (n = 19) or control group (n = 18). Physical effect on shoulder joints was evaluated by measuring shoulder range of motion (ROM) and evaluating shoulder function with the American Shoulder & Elbow Surgeons Standardized Shoulder Assessment Form. Cognitive function was determined by Verbal Fluency Test, Trail Maker B Test, and Digit Span Test. Both study groups were assessed by all tests at the beginning and at the end of study by blinded assessors. The intervention group performed 3 postures of Rue-si-dad-ton exercise (an hour per day for 4 days by a well-trained instructor) before thefinal measurement. RESULTS: Only left and right shoulder flexion of the intervention group (p-value = 0.006 and 0.010 respectively) showed significant increment compared with the control group using ANCOVA test with baseline adjusted as covariate. Other variables, including joint and cognitive function, indicated no significant changes between groups. No complications from exercise were found during the study CONCLUSION: Rue-si-dad-ton may safely help improve range of joint motion with potential benefit for joint and cognitive function. Additional extensive studies with adequate number of participants and longer period of exercise are warranted.

The efficacy of traditional Thai massage in decreasing spasticity in elderly stroke patients.

PURPOSE: To study the efficacy of traditional Thai massage (TTM) versus conventional physical therapy (PT) programs in treating muscle spasticity, functional ability, anxiety, depression, and quality of life (QoL) in Thai stroke patients. METHODS: This randomized controlled trial with a blinded assessor was carried out at the Department of Rehabilitation Medicine, Siriraj Hospital (Bangkok, Thailand). The study included 50 stroke (onset ≥ 3 months) outpatients experiencing spasticity at the elbow or knee muscles at a grade of ≥ 1+ on the modified Ashworth Scale who were ≥ 50 years old and able to communicate. The subjects were randomly allocated to the treatment group receiving TTM (24 subjects) or the control group receiving the PT program (26 subjects). Both groups received treatment (either TTM or PT) twice a week for 6 weeks. Spasticity grade, functional ability, anxiety, depression, and QoL were measured at Week 0 and Week 6. RESULTS: At Week 6, the percentage of patients whose modified Ashworth Scale score had decreased by at least one grade was not statistically significant between the two groups. Both TTM and PT groups experienced a significant increase in functional ability and QoL, but no difference was found between the groups. Anxiety and depression scores showed a decreasing trend in the TTM group. CONCLUSION: This preliminary report showed no evidence that TTM differed from the PT program in decreasing spasticity. However, both interventions may relieve spasticity, increase functional ability, and improve QoL after 6 weeks. Only TTM can decrease anxiety and depression scores. Further studies with adequate sample size are necessary.

Efficacy and safety of Curcuma domestica extracts compared with ibuprofen in patients with knee osteoarthritis: a multicenter study.

OBJECTIVE: To determine the efficacy and safety of Curcuma domestica extracts in pain reduction and functional improvement. METHODS: 367 primary knee osteoarthritis patients with a pain score of 5 or higher were randomized to receive ibuprofen 1,200 mg/day or C. domestica extracts 1,500 mg/day for 4 weeks. The main outcomes were Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total, WOMAC pain, WOMAC stiffness, and WOMAC function scores. Adverse events (AEs) were also recorded. RESULTS: 185 and 182 patients were randomly assigned into C. domestica extracts and ibuprofen groups, respectively. The baseline characteristics were no different between groups. The mean of all WOMAC scores at weeks 0, 2, and 4 showed significant improvement when compared with the baseline in both groups. After using the noninferiority test, the mean difference (95% confidence interval) of WOMAC total, WOMAC pain, and WOMAC function scores at week 4 adjusted by values at week 0 of C. domestica extracts were noninferior to those for the ibuprofen group (P=0.010, P=0.018, and P=0.010, respectively), except for the WOMAC stiffness subscale, which showed a trend toward significance (P=0.060). The number of patients who developed AEs was no different between groups. However, the number of events of abdominal pain/discomfort was significantly higher in the ibuprofen group than that in the C. domestica extracts group (P=0.046). Most subjects (96%-97%) were satisfied with the treatment, and two-thirds rated themselves as improved in a global assessment. CONCLUSION: C. domestica extracts are as effective as ibuprofen for the treatment of knee osteoarthritis. The side effect profile was similar but with fewer gastrointestinal AE reports in the C. domestica extracts group.

Efficacy and safety of Derris scandens Benth extracts in patients with knee osteoarthritis.

OBJECTIVES: The objectives of this study were to determine the efficacy and safety of Derris scandens Benth extracts in pain reduction and functional improvement in patients with knee osteoarthritis (OA). DESIGN: This was a prospective, randomized, controlled trial, single-blinded (assessor). SETTINGS: The study was conducted at the Rehabilitation Medicine Department, Siriraj Hospital. SUBJECTS: One hundred and seven (107) patients with primary OA knee who had pain score of ≥ 5 were recruited. INTERVENTIONS: Patients were randomized to receive naproxen 500 mg/day or Derris 800 mg/day for 4 weeks. OUTCOME MEASUREMENTS: Western Ontario McMaster Osteoarthritis Index (WOMAC) scores and 6-minute walking distance were the outcome measurements. RESULTS: Fifty-five (55) and 52 patients were randomized to Derris and naproxen groups, respectively. The mean differences of all WOMAC scores between 2 groups at week 4 adjusted by week 0 were within ± 1 point. The mean scores of the aforementioned outcomes at weeks 0, 2, and 4 were significantly improved compared to the baseline values. There was no difference of WOMAC scores between groups. The gastrointestinal irritation and dyspepsia were observed more often in the naproxen than in the Derris group. CONCLUSIONS: Derris scandens Benth extracts were efficacious and safe for the treatment of knee OA.

Efficacy and safety of Curcuma domestica extracts in patients with knee osteoarthritis.

OBJECTIVE: The objective of this study was to determine the efficacy and safety of Curcuma domestica extracts in pain reduction and functional improvement in patients with knee osteoarthritis. STUDY DESIGN AND SETTING: The design and setting were a randomized controlled study at a university hospital in Bangkok, Thailand. METHODS: One-hundred and seven (107) patients with primary knee osteoarthritis (OA) with pain score of > or =5 were randomized to receive ibuprofen 800 mg per day or C. domestica extracts 2 g per day for 6 weeks. The main outcomes were improvement in pain on level walking, pain on stairs, and functions of knee assessed by time spent during 100-m walk and going up and down a flight of stairs. The adverse events were also recorded. RESULTS: Fifty-two (52) and 55 patients were randomized to C. domestica extracts and ibuprofen groups, respectively. Baseline characteristics of the patients in both groups were not different. The mean scores of the aforementioned outcomes at weeks 0, 2, 4, and 6 were significantly improved when compared with the baseline values in both groups. There was no difference in those parameters between the patients receiving ibuprofen and C. domestica extracts, except pain on stairs (p = 0.016). No significant difference of adverse events between both groups was found (33.3% versus 44.2%, p = 0.36 in C. domestica extracts and ibuprofen groups, respectively). CONCLUSIONS: C. domestica extracts seem to be similarly efficacious and safe as ibuprofen for the treatment of knee OA.