Association between exercise and fear of falling in community-dwelling elderly Koreans: results of a cross-sectional public opinion survey.

OBJECTIVE: To investigate the association between habitual exercise and fear of falling in an older Korean population. DESIGN: Cross-sectional study conducted in a population-based sample of an urban city. SETTING: Urban city in South Korea. PARTICIPANTS: Randomly sampled older Korean people (N=828; aged ≥65y) living in a typical urban city located in South Korea. INTERVENTION: Standardized telephone interview. MAIN OUTCOME MEASURES: Data on exercise habits, history of falls during the previous year, and fear of falling were obtained using a random digit dialing telephone survey method. Multiple linear regression and multiple logistic regression analyses were used to examine the association between exercise habits and the fear of falling. RESULTS: The incidence of falls in the study cohort was 13%, and the prevalence of the fear of falling was 67.4% (47.6% in men and 80.8% in women). About 30% of those that expressed a fear of falling stated that this was the cause of their limited activity. Older men and women who exercised regularly showed a similar level of fear of falling, but they were less likely to experience fear-related activity restriction than nonexercisers. CONCLUSIONS: A regular exercise habit was found to be inversely associated with fear-related activity restriction regardless of fall experience among older Korean men and women.

The effect of mesenchymal stem cell transplantation on the recovery of bladder and hindlimb function after spinal cord contusion in rats.

BACKGROUND: Mesenchymal stem cells are widely used for transplantation into the injured spinal cord in vivo model and for safety, many human clinical trials are continuing to promote improvements of motor and sensory functions after spinal cord injury. Yet the exact mechanism for these improvements remains undefined. Neurogenic bladder following spinal cord injury is the main problem decreasing the quality of life for patients with spinal cord injury, but there are no clear data using stem cell transplantation for the improvement of neurogenic bladder for in vivo studies and the clinical setting.The purpose of this study was to delineate the effect of human mesenchymal stem cell (hMSCs) transplantation on the restoration of neurogenic bladder and impaired hindlimb function after spinal cord contusion of rats and the relationship between neurotrophic factors such as brain derived neurotrophic factor (BDNF) and neurotrophin-3 (NT-3) and bladder and hindlimb functions. RESULTS: Modified moderate contusion injury were performed on the thoracic spinal cord of Sprague-Dawley rats using MASCIS impactor and hMSCs, human fibroblasts or phosphate-buffered saline were transplanted into injured spinal cord 9 days after injury for hMSC and two control groups respectively. Ladder test showed more rapid restoration of hindlimb function in hMSC group than in control group, but Basso, Beattie, and Bresnahan score and coupling score were not different significantly among hMSC and two control groups. Neurogenic bladder was not improved in either group. ED1 positive macrophages were significantly reduced in hMSC group than in two control groups, but ELISA and RT-PCR studies revealed BDNF and NT-3 levels in spinal cord and bladder were not different among hMSC and two control groups regardless the experimental duration. CONCLUSION: hMSC transplantation was effective in reducing inflammatory reaction after spinal cord contusion of rats but not sufficient to recover locomotor and bladder dysfunction. BDNF and NT-3 levels in the spinal cord and bladder were not increased 28 and 56 days after hMSC transplantation.

Longitudinal change of treatment-related upper limb dysfunction and its impact on late dysfunction in breast cancer survivors: a prospective cohort study.

BACKGROUND AND OBJECTIVES: To investigate the prevalence of upper limb dysfunction (ULD) and subtypes after breast cancer surgery and to identify factors associated with late ULD. METHODS: Among 191 enrolled patients, 191 were evaluated at 3 months, 187 at 6 months, and 183 at 12 months after surgery. Pain, shoulder range of motion, muscle strength, and arm circumference were assessed. Based on symptoms and physical examinations, the types of ULD common after breast cancer treatment were diagnosed and categorized. RESULTS: The prevalence of ULD after surgery were 24.6%, 20.9%, and 26.8% at 3, 6, and 12 months, respectively. The most common types of ULD were pectoralis tightness at 3 and 6 months and lymphedema at 12 months. Patients with pectoralis tightness or lymphedema at 3 or 6 months showed a higher prevalence of rotator cuff disease at 12 months compared with those without early pectoralis tightness or lymphedema. CONCLUSIONS: The major post-operative ULD were pectoralis tightness at 3 and 6 months and lymphedema at 12 months. Late ULD such as rotator cuff disease were associated with pectoral tightness or lymphedema at earlier stages. Diagnosis and treatment of ULD should take place as soon as possible after surgery.

Cross-cultural adaptation and clinimetric property of Korean version of the Chronic Pain Coping Inventory-42 in patients with chronic low back pain.

STUDY DESIGN: Validation of a translated, culturally adapted questionnaire. OBJECTIVE: We developed a Korean version of the Chronic Pain Coping Inventory-42 (CPCI-42) by performing a cross-cultural adaptation, and evaluated its reliability and validity. SUMMARY OF BACKGROUND DATA: The CPCI is widely used and validated instruments for measuring coping strategies in chronic pain. However, no validated and culturally adapted version was available in Asian countries. METHODS: We assessed 142 patients with chronic low back pain using the CPCI-42 and measures of physical disability, pain, and quality of life. Results for 93 of the 142 patients exhibited test-retest reliability. The interval time of collecting retest data varied from 2 weeks to 1 month. Criterion validity was evaluated using correlations between the CPCI-42 and the Oswestry Disability Index, the Brief Pain Inventory, and the Short Form 36-item Health Survey (version 2.0). Construct validity was computed using exploratory factor analysis. RESULTS: The Korean version of the CPCI-42 had a high internal consistency (Cronbach's alpha >0.70) with the exception of results for task persistence and relaxation. Illness-focused coping (guarding, resting, asking for assistance) and other-focused coping (seeking social support) were most significantly correlated with Oswestry Disability Index, Brief Pain Inventory, and Short Form 36-item Health Survey, respectively. Outcomes for task persistence were contrary to other subscales in wellness-focused coping. Construct validity by factor analysis produced similar results to the original CPCI subscale. However, several factors showed cross-loading in 8 factor solutions. CONCLUSION: Despite linguistic and cultural differences, the Korean version of the CPCI-42 is overall a meaningful tool, and produces results sufficiently similar to the original CPCI-42.

The effect of back school integrated with core strengthening in patients with chronic low-back pain.

OBJECTIVE: To assess the effect of back school integrated with core-strengthening exercises on back-specific disability and pain-coping strategies and to examine how reactions to pain affect the outcomes of back school in patients with chronic low back pain. DESIGN: A single-center prospective trial was conducted with 142 participants with chronic low-back pain (38 men and 104 women) who completed a back school program at the spine center of a university hospital. The subjects participated in a 4-wk program integrated with core-strengthening exercises. Back-specific disabilities were measured as a primary outcome before and after the program. Secondary outcomes were pain, Chronic Pain Coping Inventory, general health status assessed by the SF-36, and quantitative functional evaluations of factors, such as trunk muscle strength, endurance, and the back performance scale. A subgroup of 28 subjects (12 men and 16 women) of the total sample of 142 subjects was used to analyze the longitudinal association between coping strategies and the primary outcome in a long-term follow-up study. These participants were divided into three groups (much improved, slightly improved, and unimproved) based on changes in back-specific disability scores. RESULTS: Participants improved significantly in terms of back-specific disability, pain, general health, and quantitative functional tests according to the short-term evaluation. They used more relaxation and exercise/stretching techniques as coping strategies. Of the groups participating in the longer-term follow-up (T3), the much-improved group showed significant improvement between T1 (before back school) and T2 (after back school) in scores for relaxation (1.6 +/- 1.0 vs. 2.6 +/- 1.1), task persistence (2.9 +/- 1.2 vs. 3.7 +/- 1.2), and exercise (3.3 +/- 1.1 vs. 5.2 +/- 1.9), but the coping strategies of those in the slightly improved and unimproved groups did not change significantly at T2. CONCLUSIONS: Our back school program may help patients with chronic low back pain reduce back-specific disability and pain and develop wellness-focused coping strategies such as exercise and stretching.

Discrepancies between balance confidence and physical performance among community-dwelling Korean elders: a population-based study.

BACKGROUND: This study investigates discrepancies between the confidence expressed by Korean elders in their balance and their actual physical performances according to sex and age. It also attempts to identify the factors responsible for such gaps or discrepancies. METHODS: The Korean Longitudinal Study on Health and Aging (KLoSHA) was designed as a population-based prospective cohort study on the health and aging of Korean adults aged 65 years and over. We evaluated 1000 of 1118 randomly selected subjects in terms of activities-specific balance confidence (ABC) and performance in regard to balance and gait (POMA). Activities of daily living (ADL) and instrumental activities of daily living (IADL) were assessed to measure disability. Pain-related dysfunctions, depression and cognitive functions were assessed. Next, we assessed the relationship between balance confidence and physical performance and functioning by sex and age. RESULTS: The balance confidence of elderly women was lower than that of elderly men, although the physical performances of men and women under the age of 80 were similar. Women showed increased functional disability related to lower extremity pain and closely associated with balance confidence. However, psychological variables such as depression and cognitive functioning did not affect balance confidence. CONCLUSION: We found a discrepancy between balance confidence and physical performance according to sex and age among Koreans elders. Low balance confidence among women elders was correlated with pain-related dysfunctions other than those reflected in POMA scores. Therefore, enhancing confidence and controlling pain as a means of preventing disability should be emphasized when developing models for maintaining and promoting health in elders.