Burden of musculoskeletal disorders among registered nurses: evidence from the Thai nurse cohort study.

BACKGROUND: Musculoskeletal disorders (MSDs) are a major public health problem among registered nurses (RNs) in Thailand. Information on their burdens at a national level is limited. This study estimated the prevalence of MSDs among RNs using the 2009 Thai Nurse Cohort, a nationally representative sample of RNs in Thailand. METHODS: This study is part of the first wave survey of the Thai Nurse Cohort Study (TNCS) conducted in 2009. Members of the cohort consisted of 18,756 RNs across Thailand. A 13-page self-administered questionnaire was sent to participants where MSDs were measured by self-reported answers to questions related to experiencing MSDs during a previous year. However, 1070 RNs were excluded from this study since they were unemployed during a previous year, therefore the final sample size was 17,686 RNs. A 12-month prevalence of MSDs and its 95% confidence interval (95% CI) were estimated based on normal approximation to binomial distribution. Chi-square test for trend was used. RESULTS: Of the 17,686 RNs, 47.8% (95% CI: 47.0-48.5) reported having MSDs during the previous 12 months. The prevalence of MSDs significantly increased with age, body mass index, and working duration (all P < 0.001). Compared to the non-MSD group, RNs with MSDs had a higher proportion who perceived MSDs as a long-term, chronic medical condition (78.1% vs 20.7%; p < 0.001), being currently on medication (49.4% vs 14.7%; p < 0.001), using pain relief medication almost every day (9.0% vs 1.9%; p < 0.001), experiencing sickness absence (15.7% vs 1.1%; p < 0.001), seeking medical specialist consultations (odds ratio, OR 2.2; 95% CI: 2.0-2.3; p < 0.001), and seeking alternative medications (OR 2.5; 95% CI: 2.3-2.7; p < 0.001). CONCLUSIONS: Musculoskeletal disorders affected almost half of the RNs in Thailand annually. They placed a major healthcare burden and were a major cause of working days lost due to sick leaves, diminished productivity and quality of patient care. More attention should be paid to the prevention and effective management of MSDs in RNs in Thailand. Further study on ergonomics related to MSDs and its prevention are needed.

Diet, exercise, sleep, sexual activity, and perceived stress in people with epilepsy in NE Thailand.

The aim of this study was to find out how people with epilepsy in NE Thailand feel about their levels of stress, sleep, diet, exercise habits, and sex lives using a cross-sectional design. Two hundred and three people with epilepsy (PWE) were randomly recruited from a university epilepsy clinic in Khon Kaen and then completed an interview and a questionnaire. A total of 27.6% of the patients believed that diet had an influence on their epilepsy (of those who reported changes, 41.1% stopped consuming alcohol, while 32.1% stopped drinking caffeinated beverages). A total of 47.2% of the patients exercised at least three times per week, while 52.8% exercised two times or less a week. Daytime sleeping was prevalent, with 43.3% saying that they slept during the day frequently or every day. There were 44.3% of the patients who believed that their sex lives changed after the onset of epilepsy, with decreased sexual arousal being most commonly mentioned. A total of 76.4% of the patients said that they had medium or high levels of stress, and epilepsy was listed as the most common reason for their stress (50.2%). Focusing on the problem was the most common method to reduce stress (80.3%). The findings illuminate the need to increase attention towards improving and promoting self-management of epilepsy. As a whole, diet, exercise, sleep, stress reduction, and sex therapy can be valuable tools to improve the quality of life of people with epilepsy.

Functional assessments for predicting a risk of multiple falls in independent ambulatory patients with spinal cord injury.

BACKGROUND/OBJECTIVES: Many ambulatory patients with spinal cord injury (SCI) encountered multiple falls and serious consequences after falls, but there was no quantitative practical measure for early identification of individuals at a risk of multiple falls. This study compared the utility of the Berg Balance Scale, Timed "Up & Go" Test, 10-Meter Walk Test, Functional Reach Test (FRT), Step Test, and Five Times Sit-to-Stand Test to predict risk of multiple falls (fall ≥2 times) in these individuals. METHODS: Eighty-three independent ambulatory subjects with SCI were assessed for their functional abilities using the six tests. Then, their fall data were monitored prospectively every 2 weeks for 6 months in total. The first 25 subjects were also involved in the reliability tests. RESULTS: The FRT showed the best predictive ability for the risk of multiple falls (cut-off score ≥20 cm, sensitivity = 73%, specificity = 55%, area under the receiver characteristic curve = 0.64, and adjusted odd ratio = 3.18, P < 0.05), excellent inter-tester reliability, and good feasibility. CONCLUSIONS: The FRT may be used as a screening tool to predict risk of multiple falls in independent ambulatory individuals with SCI. However, with a moderate level of specificity, a further comprehensive test may be needed to clearly indicate individuals at a risk of falls. In addition, the findings suggest that a higher level of ability increases the risk of multiple falls. Thus, programs for functional integration in an actual environment may be needed to reduce the risk of falls for these individuals.

The relationships between the use of self-regulated learning strategies and depression among medical students: an accelerated prospective cohort study.

We conducted this study to determine the relationships between the use of self-regulated learning strategies (SRL) and depression scores among medical students. An accelerated prospective cohort study among 623 students at a public medical university in Vietnam was carried out during the academic year 2012-2013. The Depression, Anxiety and Stress Scales (21 items) was used to measure depression scores as the primary research outcome, and to measure anxiety and stress scores as the confounding variables. Fourteen SRL subscales including intrinsic/extrinsic goal orientation, task value, self-efficacy for learning, control of learning beliefs, rehearsal, elaboration, organization, critical thinking, meta-cognitive strategies, time and study environment, effort regulation, peer learning, and help seeking were measured using the Motivated Strategies for Learning Questionnaire. Data were collected at two points in time (once each semester). There were 744 responses at the first time (95.88%) and 623 at time two (drop-out rate of 16.26%). The generalized estimating equation was applied to identify any relationships between the use of each SRL subscale and depression scores at time 2, adjusting for the effects of depression at time 1, anxiety, stress, within cluster correlation, and potential demographic covariates. Separate multivariate GEE analysis indicated that all SRL subscales were significantly negatively associated with depression scores, except for extrinsic goal orientation and peer learning. Whereas full multivariate GEE analysis revealed that self-efficacyT1, help-seekingT1, time and study environmentT2 were found to be significantly negatively associated with depressionT2, adjusting for the effects of depressionT1, anxiety, stress, and demographic covariates. The results should be used to provide appropriate support for medical students to reduce depression.

Walking devices used by the elderly living in rural areas of Thailand.

BACKGROUND: The use of all types of external devices was previously investigated for elderly with and without orthopaedic problems of a developed country. This study describes the proportion, types and the reasons of using a walking device in elderly who live in many rural areas of Thailand. METHODS: Participants (n = 390) were interviewed using a questionnaire to ascertain their demographics, health status and types of walking device required for daily activities. RESULTS: Forty-one participants (11%) used a walking device, particularly when walking long distances due to a fear of falling, musculoskeletal pain, and impaired walking ability. The proportion of walking devices used dramatically increased in participants aged 75 years and over (six times of those aged 60-74 years). Most of the participants used a modified walking stick by their own determination (81%), while only 7% used one according to medical prescription. A significant increase in the need of a walking device was seen in participants aged 75 years and over (OR = 13.9; 95% CI 5.9-32.7; P < 0.001), with a medical problem (OR = 45.9; 95% CI 6.7-73.4; P < 0.001) and who required regular medication (OR = 12.7; 95% CI 5.0-33.6; P = 0.001). CONCLUSION: The findings emphasise the importance of a community health service to promote health status, particularly before 75 years of age.

Seizure-related vehicular crashes and falls with injuries for people with epilepsy (PWE) in northeastern Thailand.

This cross-sectional study aimed to determine the number and types of falls and vehicular crashes with injuries , as well as some specific behavioral associations in people with epilepsy (PWE) in northeastern Thailand. Two hundred and three patients with epilepsy were randomly recruited from the university epilepsy clinic in Khon Kaen, who then completed an interview and a questionnaire. It was found that 84.5% of the patients were operating a vehicle on a regular basis (more than 3days a week), and 21.6% of those had been in a vehicle crash. Additionally, 25.6% of the patients had been involved in falls with injuries. Forty-three percent of the respondents had been involved in either a vehicular crash or a fall with an injury, with 39.7% of the accidents resulting in moderate to severe injuries. Medication compliance was estimated at 66%, while 59.1% said that they had little or no control over their seizures, and more than half the patients did not feel confident about their ability to take care of themselves or to take their antiepileptic drugs (AEDs) properly. In a multivariate model, the following factors significantly increased the risk of being in either a vehicular crash or a fall with an injury: being single, attaining a secondary or higher education, exercising at least three times a week, napping every day or more frequently, and having poor seizure control. The results of this study suggest that patients' poor medication adherence and lack of confidence in managing their seizures may contribute to accidents. Patients with epilepsy should be counseled to seek less risky behaviors and try to attend classes that provide education on AED management.

Ability of walking without a walking device in patients with spinal cord injury as determined using data from functional tests.

BACKGROUND/OBJECTIVES: More than half of independent ambulatory patients with spinal cord injury (SCI) need a walking device to promote levels of independence. However, long-lasting use of a walking device may introduce negative impacts for the patients. Using a standard objective test relating to the requirement of a walking device may offer a quantitative criterion to effectively monitor levels of independence of the patients. Therefore, this study investigated (1) ability of the three functional tests, including the five times sit-to-stand test (FTSST), timed up and go test (TUGT), and 10-meter walk test (10MWT) to determine the ability of walking without a walking device, and (2) the inter-tester reliability of the tests to assess functional ability in patients with SCI. METHODS: Sixty independent ambulatory patients with SCI, who walked with and without a walking device (30 subjects/group), were assessed cross-sectionally for their functional ability using the three tests. The first 20 subjects also participated in the inter-tester reliability test. RESULTS: The time required to complete the FTSST <14 seconds, the TUGT < 18 seconds, and the 10MWT < 6 seconds had good-to-excellent capability to determine the ability of walking without a walking device of subjects with SCI. These tests also showed excellent inter-tester reliability. CONCLUSIONS: Methods of clinical evaluation for walking are likely performed using qualitative observation, which makes the results difficult to compare among testers and test intervals. Findings of this study offer a quantitative target criterion or a clear level of ability that patients with SCI could possibly walk without a walking device, which would benefit monitoring process for the patients.

Discriminative ability of the three functional tests in independent ambulatory patients with spinal cord injury who walked with and without ambulatory assistive devices.

BACKGROUND/OBJECTIVES: Many persons with spinal cord injury (SCI) require an ambulatory assistive device (AAD). An effective monitoring method enables the use of an appropriate AAD and promotes levels of independence for patients. This study investigated the discriminative ability of the three-functional tools relating to walking ability, including the 10-meter walk test (10MWT), the five times sit-to-stand test (FTSST), and the timed up and go test (TUGT), in independent ambulatory persons with SCI who walked with walker, crutches, cane, and non-AAD. METHODS: Eighty-five persons with SCI who could perform sit-to-stand and walk independently at least 50 m were cross-sectionally assessed for their functional ability using the 10MWT, FTSST, and TUGT. RESULTS: The findings for persons not using AADs were significantly better than the other groups for every test (P < 0.001). In addition, persons who walked with cane were significantly different from those who used walkers (P < 0.001) but there were no significant differences between persons who used walker and crutches for every test (P > 0.05). CONCLUSION: The findings supported the discriminative validity of the tools, allowing them to indicate functional changes in persons with SCI who walk with different AADs. However, the non-significant differences between subjects who used a walker and crutches may relate to the method of subject arrangement and inclusion criteria that recruit subjects with rather good walking capability and lower limb function. The findings may also suggest the use of the sit-to-stand maneuver as a simple screening tool for walking advancement of walker users, pending further investigation.

Knowledge, attitudes, and care techniques of caregivers of PWE in northeastern Thailand.

Caregivers of persons with epilepsy (PWEs) in developing countries do not always have access to correct information related to the affliction of the patients they are entrusted to care for. Epilepsy can be difficult to manage for all those involved, whether it is a family member, the PWEs themselves, or the caregiver. Misconceptions are common about epilepsy, especially in undeveloped countries where a majority of the population have lower educational levels. This study aims to acquire baseline data about caregivers of PWEs related to their knowledge, attitudes, and methods of giving care to PWEs. A cross-sectional survey was administered to 83 PWE caregivers at a university epilepsy clinic in northeastern Thailand. The caregivers believed that knowledge about epilepsy was paramount; however, they felt that their own knowledge of the condition was insufficient. Educational level, relationship to the PWEs, and sex were correlated to various aspects related to epilepsy knowledge and attitudes in caregivers. A slight negative correlation was found between caregiver knowledge and attitudes toward epilepsy with Pearson's correlation coefficient (r=-0.38, P-value 0.001). Education and improved epilepsy information need to be provided to the caregivers of PWEs in northeastern Thailand.

Performance of motor imitation in children with and without dyspraxia.

BACKGROUND: Motor imitation is truly essential for young children to learn new motor skills, social behavior and skilled acts or praxis. The present study aimed to investigate motor imitation ability between typically-developing children and dyspraxic children and to examine the development trends in both children groups. MATERIAL AND METHOD: The comparison ofmotor imitation was studied in 55 typically-developing children and 59 dyspraxic children aged 5 to 8 years. The Motor Imitation subtest consisted of two sections, imitation of postures and imitation of verbal instructions. Typically-developing children and dyspraxic children were examined for developmental trends. The independent samples t-test was used to analyze the differences between both groups. Two-way analysis of variance (ANOVA) was used to analyze inter-age differences for each age group. RESULTS: The results revealed significant differences between dyspraxic and typically-developing children. Both typically-developing and dyspraxic children demonstrated age trends. The older children scored higher than younger children. CONCLUSION: Imitation is a primary learning strategy of young children. It is essential that children with dyspraxia receive early detection and need effective intervention. Typically-developing children and dyspraxic children showed higher mean score on the Imitation of Posture section than the Verbal Instructions section. Motor imitation competency, therefore, changes and improves with age.

Factors associated with knowledge and attitudes in persons with epilepsy.

Treating persons with epilepsy (PWE) in developing countries may be different from elsewhere. Knowledge and attitudes of PWE are known to be associated with seizure control. This study aims to evaluate factors related with the knowledge and attitudes of PWE in northeastern Thailand. A cross-sectional survey using questionnaires and interviews was undertaken at the Khon Kaen University epilepsy clinic. The questionnaire comprised 22 questions (14 knowledge questions and 8 attitude questions). Two hundred three PWE participated in the study with a mean age of 36.5 years. Four factors were significantly associated with the knowledge about epilepsy, which included education level, age, epilepsy duration, and a history of experiencing antiepileptic medication side effects. In addition, there were four factors significantly associated with the attitudes about epilepsy, which included seizure control, education level, epilepsy duration, and marital status. There is a need to provide more education, preferably community based, to help PWE obtain more accurate information.

Prevalence of benzodiazepines misuse in Ubon Ratchathani province Thailand.

BACKGROUND: Benzodiazepines misuse, abuse, and dependence is becoming a new problem in medicine used in Thailand. OBJECTIVE: Study the prevalence of benzodiazepines use, misuse, abuse, and dependence in Ubon Ratchathani province Thailand. MATERIAL AND METHOD: A cross-sectional household survey was conducted between October 2008 and June 2009. The target population were the people age 15 and above. A sample size of 2280 was selected from three stage stratified random sampling. Benzodiazepines were identified with generic name and drug characteristics. The DSM-IV questionnaires were used to define misuse, abuse, and dependence. Dependence was interpreted with judgment of a psychiatric nurse. For statistical analyses, prevalence was estimated with weight adjustment, variances estimated by Teylor Series Linearization method, and interpreted with 95% CI. RESULTS: There were 46,805 current users [3.9% (95% CI: 2.2-6.4)], 26,404 misuser [2.2% (95% CI: 1.6-6.2)], 7203 abuser [0.6% (95% CI: 0.1-4.1)] and 2402 dependent [0.2% (95% CI: O. 1-9.2)]. When considering the group of current user, the results showed that 57.2% of this group misused, 16.6% abused and 5.9% were dependent. CONCLUSION: Prevalence of use was higher than previously reported in Thailand while more than half of the current users misused Surveillance ofmisuse should be done in the group of current user Medical professional should give recommendations to patients, focusing on harm of misuse. Furthermore, they should limit the amount of medicine when it is necessary to dispense.

Socioeconomic disparities and chronic respiratory diseases in Thailand: The National Socioeconomics Survey.

This study aimed to determine the association between socioeconomic determinants and Chronic Respiratory Diseases (CRDs) in Thailand. The data were used from the National Socioeconomics Survey (NSS), a cross-sectional study conducted by the National Statistical Office (NSO), in 2010 and 2012. The survey used stratified two-stage sampling to select a nationally representative sample to respond to a structured questionnaire. A total of 17,040 and 16,905 individuals in 2010 and 2012, respectively, were included in this analysis. Multiple logistic regressions were used to identify the association between socioeconomic factors while controlling for other covariates. The prevalence of CRDs was 3.81% and 2.79% in 2010 and 2012, respectively. The bivariate analysis indicated that gender, family size, geographic location, fuels used for cooking and smoking were significantly associated with CRDs in 2010, whereas education, family size, occupation, region, geographic location, and smoking were significantly associated with CRDs in 2012. Both in 2010 and 2012, the multiple logistic regression indicated that the odds of having CRDs were significantly higher among those who lived in urban areas, females, those aged ≥41-50 or ≥61 yr old, and smokers when controlling for other covariates. However, fuels used for cooking, wood and gas, are associated with CRDs in 2010.

Very high dose phenobarbital for refractory status epilepticus.

BACKGROUND: Refractory status epilepticus (RSE), defined as status epilepticus that fails to respond to first, second and third-line therapy. The RSE is associated with high morbidity and mortality. Treatment guidelines of RSE give a spectrum of options, such as, continuous intravenous (i.v.) midazolam (MDL), or continuous i.v. propofol (PRO) as alternatives to phenobarbital (PB) or continuous i.v. pentobarbital (PTB). OBJECTIVE: To study the efficacy of very-high-dose phenobarbital (VHDPB) for treatment RSE. STUDY DESIGN: Retrospective study MATERIAL AND METHOD: The authors collected and analyzed data from adult patients who were diagnosed with RSE. RESULTS: The authors present 10 patients with RSE who were treated with VHDPB. All of them were generalized convulsive status epilepticus (GCSE). Ages ranged from 16-86 years old (mean.: 43 years). PB dosage ranged 40-140 mg/kg/day (mean: 70 mg/kg/day). The duration of status epilepticus (SE) varied widely, ranged 1-44 days (mean: 7 days). PB level ranged 35.29-218.34 ug/mL (mean 88.1 ug/mL). RSE was controlled by VHDPB 70%, 30% were not controlled. CONCLUSION: VHDPB were considered as alternative treatment for RSE.

Association between Socioeconomic Status and Diabetes Mellitus: The National Socioeconomics Survey, 2010 and 2012.

INTRODUCTION: The prevalence of Diabetes Mellitus (DM) is increasing, globally. However, studies on the association between Socioeconomic Status (SES) factors and DM have mostly been conducted in specific areas with rather small sample sizes or not with nationally representative samples. Their results have also been inconclusive regarding whether SES has any influence on DM or not. AIM: To determine the association between SES and DM in Thailand. MATERIALS AND METHODS: This study utilized the data from the National socioeconomics survey, a cross-sectional study conducted by the National Statistical Office (NSO) in 2010 and 2012. A total of 17,045 and 16,903 participants respectively who met the inclusion criteria were included in this study. The information was collected by face-to-face interview with structured questionnaires. Multilevel mixed-effects logistic regression analysis was performed to determine the potential socioeconomic factors associated with DM. RESULTS: The prevalence of DM was 3.70% (95% CI: 3.36 to 4.05) and 8.11% (95%CI: 6.25 to 9.74) in 2010 and 2012 respectively and the prevalence of DM in 2012 was 1.36 times (95% CI: 1.25 to 1.48) when compared with 2010. The multilevel mixed-effects logistic regression observed that odds of having DM were significantly higher among those who aged 55-64 years old in 2010 and 65 years old or greater in 2012 (ORadj = 18.13; 95%CI: 9.11 to 36.08, ORadj 31.69; 95%CI: 20.78 to 48.33, respectively), females (ORadj = 2.09; 95%CI: 1.66 to 2.62, ORadj = 1.77; 95%CI: 1.54 to 2.05, respectively), and had lower education attainment (ORadj = 5.87; 95%CI: 4.70 to 7.33, ORadj= 1.22; 95%CI: 1.04 to 1.45, respectively) were also found to be associated with DM . CONCLUSION: The study indicated that SES has been associated with DM. Those with female gender, old age and low educational attainment were vulnerable to DM.

Knowledge of epilepsy among teachers in Khon Kaen Province, Thailand.

INTRODUCTION: Epileptic patients face social stigmatization due to negative attitudes and incorrect knowledge on epilepsy. OBJECTIVES: To evaluate knowledge of epilepsy among teachers in Khon Kaen province. MATERIAL AND METHOD: A self-administered questionnaire distributed to 102 teachers who attended the training lectures on epilepsy. The number of correct responses for each item were collected. The statistical analysis included the percentage of correct response and the means of the total scores. RESULTS: Most (78.4%) respondents understood that a seizure is an abnormal electrical discharge in the brain, while 54.9% thought it included a form of abnormal movement and 1% demonic possession. The generalized tonic-clonic seizure (GTCs) was the type of seizure with which most respondents were familiar (90.2%), while 23.5% had knowledge of absence seizures. The respondents identified the following as causes for epilepsy: 1) head injury (84%); 2) genetic disease (74.5%); 3) high fever (68%); and, 4) brain tumor (57%). A small minority associated epilepsy with eating pork (11%) and even fewer (2%) with a non-organic/non-physical cause. Only 16% of respondents thought epilepsy was incurable, and a quarter (27%) of the teachers thought epileptics required anti-epileptic drugs (AEDs) life long, while 20 and 9 percent believed patients would take AEDs for 3-6 months and only for episodes, respectively. About 57% of the teachers thought epileptics needed AEDs for 2-5 years. Most (77-79%) respondents thought epileptics were prohibited from using machinery or driving, and 63% thought alcohol would be prohibited. Almost two-thirds of the teachers (64%) thought they should try to place an object between the teeth of a person having an episode in order to prevent a biting injury to the tongue and 27% would restrain the person and perform chest compressions (CPR). The average total score for correct answers on the questionnaire was about 60% (29.26/50). Respondents generally understood that epilepsy is controllable (82%) and were able to identify a seizure (78.4%). The lowest scores were found in the section on identifying the types of seizures (37.8%). CONCLUSION: Teachers' knowledge of epilepsy was incomplete; thus, an epilepsy education campaign is needed and should emphasize the types of seizures, the causes of epilepsy, and management.

Medical complications and falls in patients with spinal cord injury during the immediate phase after completing a rehabilitation program.

BACKGROUND/OBJECTIVES: Complications and falls are crucial problems in patients with spinal cord injury (SCI). However, existing evidence on complications comes from data from hospital records over a long period of time, and falls were mostly reported retrospectively in patients with incomplete SCI. This study prospectively explored the occurrence of complications and falls, and associated factors in patients with SCI during the 6 months after discharge. METHODS: One hundred subjects with SCI (50 wheelchair-bound (WB) and 50 ambulatory (AM) subjects) from a tertiary rehabilitation center completed the study. Every month, subjects were monitored for data on medical complications and falls. Descriptive information is provided for each group. RESULTS: Every WB subject had complications and 14 subjects were re-hospitalized. The most frequent complications found in these subjects were neurogenic pain (36 subjects), urinary tract infection (UTI) (25 subjects), and pressure ulcers (21 subjects). In AM subjects, 38 subjects (76%) experienced complications and 3 subjects needed re-hospitalization. The most frequent complications included neurogenic pain (35 subjects) and UTI (11 subjects). Eighteen WB subjects (36%) and 27 AM subjects (54%) experienced falls. WB subjects had significantly increased odds for incidence of UTI and pressure ulcers, whereas AM subjects had significantly greater odds for falls (P < 0.05). CONCLUSION: A number of subjects with SCI experienced complications and falls after completing a rehabilitation program. The findings add to our knowledge about complications and falls after SCI, and confirm the importance of effective strategies to minimize the occurrence of complications and falls in these individuals.

Changes of functional ability in patients with spinal cord injury with and without falls during 6 months after discharge.

BACKGROUND: Ambulatory patients with spinal cord injury (SCI) encounter a high risk of falls. However, most of the fall data in the literature were subjectively reported, without evidence to confirm the functional ability of those with and without falls. OBJECTIVES: The purpose of this study was to prospectively evaluate changes in functional ability relating to falls in participants with SCI who fell and those who did not fall during the 6-month period after discharge. DESIGN: A 6-month prospective design was used in the study. METHOD: Fifty independent ambulatory participants with SCI were assessed for their functional ability using the Timed "Up & Go" Test, 10-Meter Walk Test, Berg Balance Scale, and Six-Minute Walk Test (6MWT) prior to discharge and 6 months afterward. After discharge, the participants' fall data were monitored monthly to categorize them into faller (≥1 fall in 6 months) and nonfaller (no fall) groups. RESULTS: Twenty-seven participants (54%) fell, and their baseline functional abilities were obviously lower than those who did not fall. After 6 months, the functional ability of these participants showed significant improvement for every test, whereas those who did not fall demonstrated a significant improvement only for the 6MWT. After adjusting for the baseline data, the functional ability at 6 months showed no significant differences between the groups. LIMITATIONS: The study did not monitor physical activities of the participants during the follow-up period. The findings on fear of falling were subjectively reported by the participants. CONCLUSIONS: Participants with SCI are commonly characterized as being active and enthusiastic, which may drive their physical activities. However, sensorimotor impairments following SCI hinder their ability to move safely, particularly in those with more functional deterioration. Therefore, greater functional improvement is accompanied by a higher risk of falls. Because falls can induce serious consequences, rehabilitation professionals may need to seek strategies to improve safety issues during movement for these patients, particularly in their own environments.

Preliminary validity and reliability of a Thai Berlin questionnaire in stroke patients.

BACKGROUND: Obstructive sleep apnea (OSA) is a major risk factor for stroke. The Berlin Questionnaire (BQ) has been shown to be a valid tool to screen for OSA. The literature has limited data on using the BQ in stroke patients; particularly in Thailand and other developing countries. Here, we aimed to develop a Thai-language Berlin Questionnaire (Thai BQ) and to preliminarily assess construct validity, test-retest reliability and the agreement of the Thai BQ with the Thai Epworth Sleepiness Scale (Thai ESS), another screening tool for OSA. METHODS: A hospital-based cross-sectional study was performed from January to July, 2011. One hundred first-ever stroke patients, including acute and chronic cases, and their caregivers were enrolled. The Thai BQ was developed using the forward-backward translation method. Evaluation of construct validity was done by factor analysis. Internal consistency of the Thai BQ and the Thai ESS were evaluated using Cronbach's alpha coefficient. Test-retest reliability and the agreement of the Thai BQ and the Thai ESS were evaluated using Cohen's kappa coefficient. RESULTS: Factor analysis identified 4 main factors: Factor 1-Snoring behaviour; Factor 2-Sleepiness during driving; Factor 3-Daytime fatigue; and Factor 4-Hypertension or obesity. Cronbach's alpha coefficient was 0.77 (95% confidence interval (CI) = 0.69-0.83) and Cohen's kappa coefficient was 0.86 (95% CI = 0.74-0.98) in the Thai BQ. Cronbach's alpha coefficient was 0.59 (95% CI = 0.45-0.70) and the Cohen's kappa coefficient was 0.81 (95% CI = 0.60-1.00) in the Thai ESS. The agreement between the Thai ESS and the Thai BQ was fair. CONCLUSIONS: The Thai BQ is a valid and reliable tool to screen for OSA in stroke patients. As factor analysis revealed 4 factors in contrast to the 3 factors in the original BQ, further modification of the Thai BQ is required.

Incidence and factors associated with falls in independent ambulatory individuals with spinal cord injury: a 6-month prospective study.

BACKGROUND: Sensorimotor impairments following spinal cord injury (SCI) affect mobility and subsequently increase the risk of falls to patients. However, most of the fall data for these patients were retrospectively gathered. OBJECTIVES: This study prospectively assessed falls and intrinsic factors associated with falls in 89 independent ambulatory individuals with SCI over the course of 6 months. In addition, functional ability between participants who did and did not fall was compared. METHODS: Participants were interviewed and assessed for their baseline data and functional ability using the Timed "Up & Go" Test and the Six-Minute Walk Test. Then they were interviewed by telephone to complete a self-report questionnaire once per week to gather fall data for 6 months. A stepwise multiple logistic regression was utilized to determine the effects of demographics and SCI characteristics on occurrence of falls. The functional data between participants who fell and those who did not fall were compared using the Mann-Whitney U test. RESULTS: Thirty-five participants (39%) experienced at least 1 fall during 6 months (range=1-11). Two participants required medical attention due to patellar and sternum fractures after falling. Participants with an educational level of high school graduate or greater, an American Spinal Injury Association Impairment Scale C (AIS-C) classification, and a fear of falling (FOF) significantly increased their risk of falls approximately 4 times more than those who graduated primary education, had an AIS-D classification, and did not have FOF. Moreover, the functional abilities of participants who fell were significantly poorer than those who did not fall. LIMITATIONS: The sample size was calculated based on the primary objective (incidence of falls), which may not be sufficient to clearly indicate factors associated with falls for the participants. CONCLUSIONS: More than one third of the independent ambulatory participants with SCI experienced at least 1 fall during the 6-month period of the study. The findings suggest the importance of functional improvement on the reduction of fall risk in these individuals.