Reference Values and Cutoff Scores of the Spinal Cord Independence Measure III to Determine Independence for Wheelchair Users and Ambulatory Individuals With Spinal Cord Injury.

OBJECTIVE: To establish the reference values and optimal cutoff scores of the Spinal Cord Independence Measure Version III (SCIM III) to indicate independence of wheelchair users (WU) and ambulatory (AM) individuals with spinal cord injury (SCI). DESIGN: A cross-sectional study. SETTING: Tertiary rehabilitation center and communities. PARTICIPANTS: A total of 309 (168 WU and 141 AM) participants with SCI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE(S): SCIM III scores. RESULTS: Participants with greater levels of independence had significantly higher SCIM III scores, both total and subitem scores (P<.05). The SCIM III scores of ≥55 and ≥75 were optimal indicators of modified independence in WU and AM individuals, respectively (sensitivity and specificity >93%, AUC>.95). In addition, scores of 90 were proved to be excellent indicators for independence of AM individuals (sensitivity 94%, specificity 100%, AUC=.99). CONCLUSIONS: The present findings provide the reference values of SCIM III scores covering WU and AM individuals with SCI at various levels of independence as well as optimal cutoff scores to indicate independence of these individuals. These data can be used as standard criteria for data comparison with patients' ability, and target functional values for individuals with SCI in clinical-, community-, and home-based settings.

Reliability and concurrent validity of the Spinal Cord Independence Measure III among rehabilitation professionals.

STUDY DESIGN: A cross-sectional design. OBJECTIVES: To investigate rater reliability of the Spinal Cord Independence Measure or SCIM III among rehabilitation professionals, along with the concurrent validity of the tool as compared to standard measures covering wheelchair users (WU) and ambulatory (AM) individuals with spinal cord injury (SCI). SETTING: A tertiary rehabilitation center and communities. METHODS: Eighty-two participants with SCI (39 WU and 43 AM individuals) were assessed using SCIM III items. The data of first 30 participants were video recorded for rater reliability assessments by seven rehabilitation professionals, including nurses, occupational therapists, and physical therapists (one novice and one experienced rater for each professional). All participants were also assessed using standard measures to verify concurrent validity of SCIM III by an experienced rater. RESULTS: The SCIM III showed excellent intra-rater and inter-rater reliability among rehabilitation professionals when analyzed for overall items (intraclass correlation coefficient (ICC) >0.90) and separately for each subscale (kappa values >0.80). The total SCIM III of WU and the mobility scores of AM participants showed significant correlation with standard measures for muscle strength, limit of stability, balance control, functional endurance, and walking ability (rs = 0.343-0.779; p < 0.05). CONCLUSIONS: The present findings extend clinical benefit and confirm the use of SCIM III interchangeably among rehabilitation professionals after they have been adequately trained. The findings are important for community-based rehabilitation and home healthcare services, especially during the coronavirus (COVID-19) pandemic, when hospital beds and in-patient services are limited for individuals with SCI.

Spray drying of non-chemically prepared nanofibrillated cellulose: Improving water redispersibility of the dried product.

Despite increasing interest in using nanofibrillated cellulose (NFC) as food thickener and emulsifier, poor water redispersibility of dried NFC, which is form suitable for practical utilization, significantly limits such applications. Studies are lacking on preparation of dried NFC with superior redispersibility. The present study therefore proposed and examined strategies to improve water redispersibility of spray dried NFC via the use of selected co-carriers, i.e., gum Arabic with/without xanthan gum, carboxymethyl cellulose or pectin. Synergistic interactions between NFC and co-carriers, as confirmed by X-ray diffraction (XRD) patterns and Fourier transform infrared (FTIR) spectra, helped prevent NFC agglomeration during spray drying. All reconstituted spray-dried NFC/co-carriers suspensions exhibited shear-thinning and gel-like behaviors, thus supporting the use of such suspensions as thickener and emulsifier. Spray-dried NFC with 80% gum Arabic and 20% xanthan gum (SD-NFC/GA20XG) resulted in suspension with highest viscosity; the suspension also performed best at recovering viscous characteristics of NFC. Water thickened by SD-NFC/GA20XG had strongest shear-thinning behavior, indicating that SD-NFC/GA20XG suspension resulted in smoothest mouth feel and easiest swallowing. Such observations were supported by XRD patterns of SD-NFC/GA20XG, which suggested that its relative crystallinity was the lowest. Its FTIR spectra also showed the highest intensity of -OH bending and carbonyl bands, which are directly related to water adsorption capability of NFC. Use of reconstituted SD-NFC/GA20XG as emulsifier also resulted in highest stability for oil-in-water (O/W) Pickering emulsion during storage for up to 30 days.

Validity and reliability of the block method for measuring thoracic hyperkyphosis.

OBJECTIVE: This study aimed to investigate the concurrent validity of the block method as compared with the gold standard (Cobb's method). An additional aim was to examine the intra- and inter-rater reliability of expert and novice assessors using the block method. METHODS: In a cross-sectional study, we enrolled 62 participants with hyperkyphosis aged ≥10 years, with hyperkyphosis defined as one or more blocks. The participants were stratified by age (<60 years and ≥60 years). To determine concurrent validity, and kyphosis was assessed in all the participants using the block method and Cobb's method. Finally, 15 participants were included in a reliability study. To determine intra- and inter-rater reliability, each participant was assessed twice, 7 days apart, by one expert and one novice using the block method. RESULTS: The concurrent validity of the block method and gold standard method showed moderate correlation (rs = 0.53, P < .001). However, after stratifying the participants by age (<60 years and ≥60 years), there was small to moderate correlation (rs = 0.42, P = .006, and rs = 0.64, P = .002, respectively). The intra- and inter-rater reliability of the expert and novice assessors was excellent (ICC3,1 = 0.82-0.97, P < .001). CONCLUSIONS: The findings showed small correlation in those <60 and moderate correlation in those ≥60 years, and reported excellent reliability. The block method can be used by novices with strong reliability. This method is a practical technique for early screening hyperkyphosis in the elderly.

Textural properties and muscle activities during mastication of normal and ultrasonically softened sticky rice aimed for consumers with swallowing disorder: A pilot study.

Ultrasonication was used to develop softer sticky rice for elder adults. Textural properties of original sticky rice (oSR) and ultrasonically modified sticky rice (mSR) were determined. In addition, jaw muscle activities during mastication of both oSR and mSR were investigated. Twenty-seven healthy elderly subjects, age 68.9 ± 7.6 years, were asked to masticate both types of sticky rice in random sequence for three times with a 5-min rest between each test. Activities of bilateral masseter and suprahyoid muscles were recorded. Root mean square (RMS) and mastication duration were analyzed. After mastication trials, subjects were asked to rate preference and softness of the samples. mSR exhibited significantly lower hardness than oSR, while cohesiveness and adhesiveness values of the two samples were not significantly different. Interestingly, all the muscle activities were not significantly different between masticating oSR and mSR, whereas the number of chewing cycles while chewing the mSR was larger. However, 92% of the subjects preferred mSR and felt that it was softer. mSR may therefore be regarded as having potential for elder people who have difficulty masticating hard solid foods based on its lower hardness and higher level of preference compared to oSR.

Swallowing Problems among Community-Dwelling Elderly in Northeastern Thailand.

INTRODUCTION/OBJECTIVES: Aging brings deterioration in many organs involving in swallowing, such as, oropharyngeal muscle weakness, decreased salivation, multiple teeth loss, decreased oral sensation, and delayed swallowing response. There are no official statistics and systematic records of swallowing problems in Thailand's healthy elder populations. Therefore, this study aimed to determine the prevalence of swallowing problems among a Thai healthy elder population. METHODS: A survey of 874 elders was conducted at Community Hospitals in region 7 of the Thai National Health Security Office from September to November 2019. All participants were interviewed using a questionnaire focused on, screening for swallowing problems using a 10-item Eating Assessment Tool (EAT-10) and questions about participants' physical and oral health behaviors. RESULTS: Sixty-six percent of the participants were women and 34% were males, with mean age 69.70 ± 6.79 years. Of these, 11.4% had swallowing problems. The most common swallowing problems were food sticking in the throat, effort on swallowing and choking. Age and having an underlying disease were found to be statistically significantly associated with dysphagia, whereas gender was not associated with dysphagia. CONCLUSIONS: The prevalence of swallowing problems among Thai healthy community-dwelling elders was assessed as about 11%. Early identification and early intervention for swallowing problem is necessary for promoting health and quality of life of our growing elderly population.

Effect of TRP-Stimulating Compounds to Reduce Swallowing Response Time in the Elderly: A Systematic Review.

There is still controversy on evidence supporting compounds that stimulate the transient receptor potential cation channel (TRP) receptor, which can reduce the latency of swallowing reflex. This systematic review aims to evaluate the effectiveness of TRP-stimulating compounds to reduce swallowing reflex time in the elderly. We searched the following databases: PubMed, EMBASE, OVID, Central, Scopus, ISI, CINALH, LILACS, CRD database, and Open grey until June 1st, 2019. We included randomized controlled trials (RCTs) which compared swallowing time between TRP-stimulating compounds and placebo or no treatment in population aged more than 60 years old. We assessed bias using the Cochrane risk of bias tool. Three authors independently screened and selected studies. Quality assessment and data extraction were performed by two authors independently. Of 363 reviews, we included four RCTs. Two RCTs used black pepper, one RCT used capsaicinoids, and the other one used capsaicin ointment to stimulate the TRPV1 receptor. All of the studies were assessed at unclear bias except the study, which used capsaicin ointment with assessed as low risk of bias. Meta-analysis could not be done in this study due to the different baseline characteristics and definition of swallowing reflex time. This review demonstrates the potential effect of TRPV1-stimulating compounds to reduce swallowing response time in the elderly were remains unclear. Most studies had an unclear bias. Further larger and well-designed RCTs are needed to draw robust conclusions.

Effectiveness of Stroke Rehabilitation Compared between Intensive and Nonintensive Rehabilitation Protocol: A Multicenter Study.

BACKGROUND AND AIM: Stroke is one of the leading causes of death, physical disability, and economic burden. Nowadays, various types of rehabilitation are available. Rehabilitation centers in Thailand provide services in different ways, including starting time, duration, and frequency of each therapy. In addition, many rehabilitation wards have a standing policy to reduce length of stay (LOS) due to economic considerations. This study aimed to compare the effectiveness and efficiency between intensive and nonintensive rehabilitation protocol for stroke patients. METHODS: This prospective, multicenter cohort study was conducted among stroke patients who admitted to rehabilitation wards at 14 centers. All participants received either intensive or non-intensive rehabilitation program. Barthel Index (BI) at admission (BIad), BI at discharge (BIdc), and LOS were recorded. The effectiveness was difference in BIdc and BIad score (ΔBI), and the efficiency was ΔBI divided by LOS (ΔBI/LOS). RESULTS: Seven hundred and eighty stroke patients were included. Mean age was 61.9 ± 13.3 years, and 59.7% were male. The majority of patients (79.5%) were admitted for intensive rehabilitation. Effectiveness and efficiency were significantly higher in the intensive group than in the nonintensive group (4.5 ± 3.4 versus 2.6 ± 3.2 and .24 ± .30 versus .18 ± .33, respectively). LOS, intensive rehabilitation, and quality of life were significantly positively correlated with effectiveness; whereas, age, onset to admission interval (OAI), and BIad were significantly negatively correlated with the effectiveness of stroke rehabilitation. CONCLUSIONS: Stroke patients admitted for intensive rehabilitation had better effectiveness and efficiency than those admitted for non-intensive rehabilitation. Younger patients with shorter OAI, lower BIad, and longer LOS realized significantly enhanced effectiveness.

Five times sit-to-stand test for ambulatory individuals with spinal cord injury: a psychometric study on the effects of arm placements.

STUDY DESIGN: A psychometric study. OBJECTIVES: To investigate the reliability and the concurrent validity of the five times sit-to-stand test (FTSST) during various arm placement conditions in ambulatory participants with spinal cord injury (SCI). In addition, the difficulty of the FTSST during various arm placement conditions was compared using the number, characteristics, and physical ability of those who could complete the conditions. SETTING: Rehabilitation centers and communities in Thailand. METHODS: Eighty-two participants were assessed for their physical ability and ability to complete the FTSST in four arm placement conditions, namely, arms on a walking device, arms on knees, arms free by sides, and arms crossed over the chest, according to their ability and in random order. RESULTS: The outcomes for all the FTSST conditions had excellent rater and test-retest reliability with a modest to strong correlation with their physical ability (ρ = -0.39 to -0.72), and it is especially high for the condition with arms by sides. All participants could complete the conditions with arms on a walking device, and two-thirds of them could execute the other conditions. The physical ability of these individuals was significantly better, with the number of those with mild lesion severity being greater than those who could execute the FTSST with arms on a walking device (p <0.01). CONCLUSIONS: Arm placements affected the psychometric properties and the ability to complete the FTSST of the participants. The current findings recommend the FTSST for ambulatory individuals with SCI using arms free by sides.

Texture Modification Technologies and Their Opportunities for the Production of Dysphagia Foods: A Review.

Dysphagia or swallowing difficulty is a common morbidity experienced by those who have suffered a stroke or those undergone such treatments as head and neck surgeries. Dysphagic patients require special foods that are easier to swallow. Various technologies, including high-pressure processing, high-hydrodynamic pressure processing, pulsed electric field treatment, plasma processing, ultrasound-assisted processing, and irradiation have been applied to modify food texture to make it more suitable for such patients. This review surveys the applications of these technologies for food texture modification of products made of meat, rice, starch, and carbohydrates, as well as fruits and vegetables. The review also attempts to categorize, via the use of such key characteristics as hardness and viscosity, texture-modified foods into various dysphagia diet levels. Current and future trends of dysphagia food production, including the use of three-dimensional food printing to reduce the design and fabrication time, to enhance the sensory characteristics, as well as to create visually attractive foods, are also mentioned.

Is the occiput-wall distance valid and reliable to determine the presence of thoracic hyperkyphosis?

BACKGROUND: Hyperkyphosis may be frequently found nowadays due to the change in current lifestyles of sustained flexion postures and age-related system decline. The occiput-wall distance (OWD) is a practical measure that is commonly used to screen and monitor thoracic hyperkyphosis in epidemiologic studies. However, there was no clear evidence to support the clinical utility of the tool as compared to the data from direct standard measures. OBJECTIVES: To investigate psychometric properties-including validity, reliability, and appropriate cut-off point-of the OWD to determine the presence of thoracic hyperkyphosis, as compared to a standard Cobb's method. DESIGN: Observational study. METHODS: This study was conducted in ninety-nine participants, aged 10 years and above who had different degrees of thoracic hyperkyphosis from several communities. All participants were assessed for their severity of thoracic hyperkyphosis using the OWD, and 14 participants were involved in a reliability study. Within 7 days later, all participants were at a hospital to complete a radiographic examination. RESULTS: Outcomes from OWD had good concurrent validity with the Cobb angles (r = 0.683, P < 0.001) and excellent rater reliability when assessed by well-trained health professionals (ICCs > 0.9, P < 0.001). The OWD of at least 6.5 cm had the best diagnostic properties to determine the presence of thoracic hyperkyphosis (sensitivity = 71.4%, specificity = 76.6%, and area under the curve = 0.846). CONCLUSION: The findings support validity and reliability of OWD, and offer a clear cut-off point to determine the presence of thoracic hyperkyphosis for clinical utility in various settings.

Evaluation of Pharyngoesophageal Segment Using 320-Row Area Detector Computed Tomography.

OBJECTIVES:: The aim of this study was to determine the shape and area of the pharyngoesophageal segment (PES) during swallowing using 320-row area detector computed tomography, which can acquire a volume data set covering a 16-cm area in a single rotation. METHODS:: Twenty healthy subjects were scanned during swallowing 3, 10, and 20 mL of honey-thick barium (5% w/v). PES was identified using cross-sectional images of 0.5-mm slice thickness, and the area in each section was measured. RESULTS:: The PES opening area and the anteroposterior and lateral diameters of the PES were volume dependent. However, there was no statistical difference in anteroposterior and lateral diameters between 3- and 10-mL bolus swallowing. CONCLUSIONS:: Three hundred twenty-row area detector computed tomography provided new information about PES. This technique will facilitate further understanding of the mechanisms of PES opening and swallowing physiology.

Reliability of novice physiotherapists for measuring Cobb angle using a digital method.

BACKGROUND: The Cobb's method is the most accurate and reliable method for kyphosis measurement. Conventionally, a sagittal Cobb angle was commonly derived from a lateral plain film. With computer technology, a digital method is widely used in common clinical settings, but the existing reliability data involved only experienced raters. OBJECTIVES: To assess the interrater and intrarater reliability of a digital Cobb's method using novice physiotherapists. METHODS: Fifteen participants, with an occiput wall distance of more than 0 cm, were interviewed and assessed for their demographics. Then they were filmed for lateral spinal radiography over the area of thoracic spine in a standing position, and the Cobb angle was analyzed by four raters, including an expert physician and three novice physiotherapists, using a SurgimapSpine programme. RESULTS: The average Cobb angles among the four raters showed no significant difference (p = 0.984). Outcomes of their measurements had excellent intrarater and interrater reliability [intraclass correlation coefficient (ICC3,3) = 0.995-0.997] with a small range of standard errors of the measurement (<1°). CONCLUSION: A digital Cobb's method had excellent reliability when used by a novice health professional rater. The findings confirm the ease of using this method to detect and monitor kyphosis in general hospitals, clinics, or research facilities.

Swallowing Problem in Patients with Stroke: Multi-Center Study in Thailand.

Background: Swallowing problems are a common symptom in patients suffering from stroke. The severity of swallowing problems associate with age, stroke types, and brain lesion. Early recognition of the problem can prevent complications such as aspiration pneumonia, and malnutrition. Objective: To report the prevalence and the long-term outcome of dysphagia in patients with stroke. Material and Method: Data of patients with stroke admitted at nine rehabilitation wards/centers in Thailand were extracted from the Thai Stroke Rehabilitation Registry (TSRR) I and II (1-year follow-up). Results: Of 327 stroke patients [mean age 62 (SD 12) years and male: female = 193:134], 49 (15%) had swallowing dysfunction at admission. Dysphagic patients had significantly more cognitive impairment (TMSE score <24) than non-dysphagic group (p = 0.01). There was no significant difference in age, gender, onset-admission interval, type of stroke, and modified Barthel Index score (mBI) between the two groups. Moreover, there was no relationship between dysphagia and poor functional outcome (mBI ≤12). One year after discharge, only 214 (65.4%) patients returned for follow-up and seven patients (3.27%) had swallowing problem. Conclusion: After a stroke attack, about 15% of patients had swallowing dysfunction. Those with cognitive impairment at admission were more prone to swallowing functions impairment.

The efficacy of topical 0.1% adapalene gel for use in the treatment of childhood acanthosis nigricans: a pilot study.

AIMS: To assess the degree of improvement of neck hyperpigmentation in childhood acanthosis nigricans (AN) after treatment with topical 0.1% adapalene gel and the assessment of localized tissue tolerance to the gel. SUBJECTS AND METHODS: A split comparison study of the hyperpigmentation on the neck was conducted in patients diagnosed with childhood AN. Patients were treated with topical 0.1% adapalene gel for a period of 4 weeks. The skin color of their neck was evaluated at baseline, 2 weeks and 4 weeks using a skin color chart. Skin color ratio (the skin on their necks compared with the skin on their backs) was calculated for all subjects. The investigator's global evaluation (IGE) scale and the parent's global evaluation (PGE) scale were used to assess the efficacy of the patients' treatment at the end of the 4(th) week. RESULTS: The mean skin color ratio of therapeutic side was significantly decreased from the baseline scores, at weeks 2 and 4, respectively (30.1%, 18.3%, and 12.9%, P < 0.001), with marked skin improvement at 60.7% ± 28.5%. The percentage of changes of skin color ratio was consistent with the efficacy evaluations as performed by the IGE and PGE scales. Treatment-related cutaneous irritation was minimal, predominantly in the first 2 weeks of treatment and was shown to be well-tolerated at week 4 following a modification of the treatment regimen. CONCLUSIONS: The study has shown the efficacy of topical 0.1% adapalene gel in the treatment of AN, specifically, in regards to the skin darkening with minimal cutaneous irritation.

Correlation between skin color evaluation by skin color scale chart and narrowband reflectance spectrophotometer.

CONTEXT: Various methods are available for the evaluation of skin color. A skin color scale chart is a convenient and inexpensive tool. However, the correlation between a skin color scale chart and objective measurement has not been evaluated. AIMS: To assess the correlation between skin color evaluation done by a skin color scale chart (Felix von Luschan skin color chart) and a narrowband reflectance spectrophotometer (Mexameter MX18). MATERIALS AND METHODS: The participants were evaluated for skin color by using the Felix von Luschan skin color chart (range 1-36) and a narrowband reflectance spectrophotometer (Mexameter MX18) in which the results of the measurements were expressed as Erythema (E) and Melanin (M) indices. Skin color was measured on four different anatomical skin sites from each participant on the medial aspect of the volar and the dorsal regions of both forearms. RESULTS: A total of 208 records from 52 participants were established. The majority of participants (19.2%) were rated with the skin color scale at the number 16 (range 14-33). The mean M plus E, M, and E indices were 498.9 ± 143.9, 230.4 ± 74.4, and 268.5 ± 73.2, respectively. The correlation coefficient between the number on the skin color scale and each index: M plus E, M, and E indices were 0.90, 0.90, and 0.86, respectively, with a statistical significance of P < 0.001. CONCLUSIONS: Skin color evaluation using a skin color scale chart has shown a high correlation with skin color evaluation done by the narrowband reflectance spectrophotometer.

The effect of bolus viscosity on laryngeal closure in swallowing: kinematic analysis using 320-row area detector CT.

The present study examined the effect of bolus viscosity on the onset of laryngeal closure (relative to hyoid elevation), the duration of laryngeal closure, and other key events of swallowing in ten healthy volunteers. All volunteers underwent 320-row area detector computed tomography swallow studies while swallowing 10 ml of honey-thick barium (5 % v/w) and thin barium (5 % v/w) in a 45° reclining position. Three-dimensional images of both consistencies were created in 29 phases at an interval of 0.10 s (100 ms) over a 2.90-s duration. The timing of the motions of the hyoid bone, soft palate, and epiglottis; the opening and closing of the laryngeal vestibule, true vocal cords (TVC), and pharyngoesophageal segment; and the bolus movement were measured and compared between the two consistencies. The result showed differing patterns of bolus movement for thin and thick liquids. With thin liquids, the bolus reached the hypopharynx earlier and stayed in the hypopharynx longer than with thick liquids. Among events of laryngeal closure, only the timing of TVC closure differed significantly between the two consistencies. With thin liquids, TVC closure started earlier and lasted longer than with thick liquids. This TVC movement could reflect a response to the faster flow of thin liquids. The results suggest that bolus viscosity alters the temporal characteristics of swallowing, especially closure of the TVC.

Relationship between the ability to change from a supine to a sitting position at admission and mobility outcomes after stroke rehabilitation.

BACKGROUND: Regarding observations, stroke patients able to change their basic body position from supine to sitting at admission usually could walk by the end of rehabilitation. However, there was not yet supported by any research evidence. OBJECTIVE: To study the relationship between the patient's ability at admission to change basic body position from a supine to a sitting position and the mobility outcome after stroke rehabilitation. MATERIAL AND METHOD: Data were gathered and analyzed from the case record forms (including the Barthel ADL Index assessment sheets) of 327 stroke patients in nine tertiary in-patient rehabilitation settings in Thailand between March and December 2006. RESULTS: On admission, 58.7% of the patients were able to change their basic position from supine to sitting. At the end of rehabilitation, the group which was able to sit had a higher mobility sub-score (OR = 6.15; 95% CI 3.24 -11.67) and total Barthel ADL index score (OR = 9.64; 95% CI 5.74-16.18) than the group which was unable to sit. CONCLUSION: The ability at admission to change from a supine to a sitting position was significantly related to a better mobility outcome after stroke rehabilitation.

Prevalence of incontinence in patients after stroke during rehabilitation: a multi-centre study.

OBJECTIVE: To report the prevalence and degree of isolated urinary and faecal incontinence and double incontinence (i.e. both urinary and faecal incontinence) in patients after stroke during post-acute rehabilitation and the factors related to incontinence. DESIGN: A multi-centre prospective study. METHODS: Data were extracted from the Thai Stroke Rehabilitation Registry. A total of 185 patients admitted within 4 weeks post-stroke were recruited. Based on the Barthel Index of Activities of Daily Living, the prevalence and degree of isolated urinary incontinence or faecal incontinence, and double incontinence were reported. Multivariate analysis was performed to identify any factors related to incontinence. RESULTS: The admission prevalence for isolated urinary incontinence was 12.4%, for isolated faecal incontinence 7.6% and for double incontinence 33%. At discharge, the prevalence had decreased, to 8.1% for isolated urinary incontinence, 4.9 % for isolated faecal incontinence and 15.1% for double incontinence. Cognitive (adjusted odds ratio (OR) 3.63; 95% confidence interval (CI) 1.71-7.70) and leg muscle functions impairments (adjusted OR 2.79; 95% CI 1.29-6.07) were significantly related to urinary incontinence; whereas, age (adjusted OR 1.98; 95% CI 1.07-3.67) was related to faecal incontinence at admission. CONCLUSION: Double incontinence was more prevalent than isolated incontinence in patients after stroke during post-acute rehabilitation. The decrease in prevalence at discharge reflected a recovery of bladder and bowel control. Age, cognitive and leg motor function impairments were related to incontinence.

Aerobic capacity of fifth-year medical students at Chiang Mai University.

OBJECTIVE: To study the level of aerobic capacity using maximal oxygen consumption (VO2max) in the fifth-year medical students at Chiang Mai University. MATERIAL AND METHOD: This was a retrospective study in which data were collected from the database of the fifth-year medical students who attended the rehabilitation medicine course at Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University between January 2003 and December 2004. The level of aerobic capacity was evaluated by maximal oxygen consumption (VO2max), which was calculated using sub-maximal exercise test on a bicycle ergometer (Astrand-Rhyming test). RESULTS: During two-year period, 226 medical students performed 226 Astrand-Rhyming submaximal cycle ergometer tests. The mean age was 22.3 +/- 0.7 years (range 21-26 years) and average body weight was 56.8 +/- 11.9 kg (range 30-125 kg). The number of male and female students was comparable (male 44.7% and female 55.3%). Average VO2max of the students was 38.1 +/- 8.6 ml/kg/min (range 18.5-76.7 ml/kg/min) and there was no statistical significance between sex (VO2max of male = 38.4 +/- 7.6 and female = 37.9 +/- 9.4 ml/kg/min, p 0.636). When standard VO2max value of Thai people was compared, 39.4% was categorized in low health fitness group, 40.7% was in health fitness group, and only 19.9% was in high health fitness group. However, 65% of the fifth-year medical students exercised 0-1 sessions per week (group 1), 24.3% exercised 2-4 sessions per week (group 2) and only 10. 7% exercised >4 sessions per week or everyday (group 3). Mean VO2max in group 2 (40.3 +/- 9.1 ml/kg/min) and 3 (43.2 +/- 8.4 ml/kg/min) are more than group 1 (36.5 +/- 8.4 ml/kg/min) significantly (p < 0.001 and p < 0.001 respectively) but there was no significant difference between group 2 and 3 (p = 0.16). The two most popular exercises were jogging and aerobic dance, 48.7% and 31.9% respectively. There was no significant difference of VO2max between methods ofexercise (p = 0.132) and between the single and combination of exercises (38.9 +/- 9.3 and 37.9 +/- 7.4 ml/kg/min respectively, p = 0.4). CONCLUSION: VO2max in most of the medical students was in poor to average range when compared to the standard value of Thai population. This information should prompt medical educators to address this problem, consider promoting exercise and corporate physical fitness into the medical school curriculum.