Development of a Dyad-Focused Intervention for Stroke Survivors and Their Family Caregivers: A Feasibility Study.

IMPORTANCE: Transitioning from the hospital to the community poses significant challenges for stroke survivors and their caregivers. OBJECTIVE: To examine the feasibility and preliminary effects of a dyad-focused strategy training intervention. DESIGN: Single-arm trial with data collection at baseline, postintervention, and 3-mo follow-up. SETTING: Rehabilitation settings in Taiwan. PARTICIPANTS: Sixteen stroke survivor-caregiver dyads. INTERVENTIONS: Dyad-focused strategy training was provided to stroke survivor-caregiver dyads twice a week over 6 wk. The training included shared decision-making, goal setting, performance evaluation, strategy development and implementation, and therapeutic guided discovery. OUTCOMES AND MEASURES: Feasibility indicators were Goal Attainment Scaling, Dyadic Relationship Scale, Participation Measure-3 Domains, 4 Dimensions, Activity Measure for Post-Acute Care, Montreal Cognitive Assessment, Trail Making Test, Stroop Color and Word Test, Preparedness for Caregiving Scale, and Zarit Burden Interview. RESULTS: In total, 15 dyads completed all intervention sessions with full attendance. Both stroke survivors and their caregivers demonstrated high engagement and comprehension and reported moderate to high satisfaction with the intervention. From baseline to postintervention, the effects on goal attainment, frequency and perceived difficulty of community participation, executive function, mobility function, and caregiver preparedness were significant and positive. CONCLUSIONS AND RELEVANCE: Our study supports the feasibility and preliminary efficacy of dyad-focused strategy training for stroke survivor-caregiver dyads transitioning from the hospital to the community in Taiwan. Our preliminary evidence indicates that dyads who receive strategy training exhibit advancement toward their goals and experience considerable enhancements in their individual outcomes. Plain-Language Summary: This study addresses the scarcity of interventions catering to both stroke survivors and their caregivers. By demonstrating the feasibility of our dyad-focused intervention, the research offers preliminary evidence that supports the potential advantages of involving both stroke survivors and their caregivers in the intervention process.

Implementing strategy training in Taiwan: perspectives of individuals with Acquired brain injury.

PURPOSE: Strategy training is a rehabilitation intervention that aims to enhance problem-solving skills with respect to daily activity-related challenges and has achieved favorable results in Western countries. This study explored the perspectives of individuals with acquired brain injury (ABI) in Taiwan who received strategy training. MATERIALS AND METHODS: Semi-structured interviews with community-dwelling adults with ABI were conducted, and reflective memos made by research team members were recorded. Interviews and memos were analyzed through thematic analysis. RESULTS: This study included 55 participants. The analysis of the participants' interview responses and memos yielded nine themes under three categories: 1) expectations regarding strategy training, 2) perceived benefits of strategy training, and 3) barriers affecting the process and outcomes of strategy training. CONCLUSIONS: All the participants endorsed strategy training through different gains. Most participants' expectations before the intervention were uncertain. Including family members into the strategy training is of key importance for a successfulness of their goals. The participants' experiences about strategy training were affected by various barriers (i.e., health and medical problems, the physical environment, and natural events). Clinicians and researchers should consider these expectations, benefits, and barriers when studying and implementing strategy training in non-Western contexts.IMPLICATIONS FOR REHABILITATIONStrategy training provides clients the opportunity to actively engage in their own goal setting and decision making.Strategy training increases the client's confidence in their ability to participate in the community, communicate, and perform daily living and physical activities.Therapists should consider the health conditions and physical environment of clients when helping them set goals and before facilitating their engagement in the community.Taiwanese family members play a crucial role in supporting acquired brain injury survivors in strategy training.

Prediction of Changes in Functional Outcomes During the First Year After Inpatient Stroke Rehabilitation: A Longitudinal Study.

OBJECTIVE: To identify meaningful changes in patients in 3 functional domains (basic mobility [BM], daily activity [DA], and applied cognition [AC]) after discharge from inpatient stroke rehabilitation and to identify the predictors of 1-year functional improvement. DESIGN: A longitudinal, multicenter, prospective cohort study. SETTING: The acute care wards of 3 hospitals in the Greater Taipei area of Taiwan. PARTICIPANTS: Five hundred patients with stroke in acute care wards (mean age=60±12.2 years, 62% men, N=500). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE(S): The Mandarin version of the Activity Measure for Post-Acute Care (AM-PAC) short forms were assessed at discharge and 3-, 6-, and 12-month follow-up. The minimal detectable change (MDC) was used to categorize changes in the scores as improved and unimproved at the 4 time points. RESULTS: The mean scores of the AM-PAC BM and DA subscales substantially increased over the first 3 months after discharge (86% of participants exhibited improvement) and slightly increased during the subsequent 9 months (5∼26% of participants exhibited improvement). However, the mean score of the AC subscale decreased within the first 3 months and increased over the subsequent 9 months (22-23% of participants exhibited improvement). The BM, AC scores at discharge were the dominant predictors of subsequent functional improvement (P<.05). Patients with a higher functional stage at discharge were more likely to experience significant improvement. CONCLUSION: This study established the capacity of the AM-PAC to predict functional improvement in 3 domains during the early, middle, and late stages of recovery. The findings can assist clinicians in identifying patients at risk of unfavorable long-term functional recovery and providing such patients with tailored interventions during the early stage of rehabilitation.

A Descriptive Qualitative Study of Foreign Caregivers of Older Adult Stroke Survivors.

BACKGROUND AND OBJECTIVES: With a growing aging stroke population and the changing structure of the society, the demand for foreign caregivers has rapidly increased in Taiwan and many other developed countries. However, little is known regarding the perception, values, and abilities of foreign caregivers and how those may influence their quality of care. This study aimed to explore and describe the experiences of Indonesian foreign caregivers, the largest migrant working population in Taiwan, who reside with and provide support to older adults with stroke and their families. RESEARCH DESIGN AND METHODS: By adopting a descriptive qualitative approach, we conducted semistructured interviews with 22 Indonesian caregivers (mean age: 36 years) who were providing care to community-dwelling older stroke survivors (age ≥ 65 years) in Taiwan. Data were analyzed through thematic analysis. RESULTS: Six themes were constructed from the interviews: (a) foreign caregiver's background, (b) foreign caregiver's perception of the health and functional status of stroke survivors, (c) foreign caregiver's values and preferences, (d) consequences of caring for stroke survivors, (e) skills/abilities/knowledge of foreign caregivers to provide stroke survivors with required care, and (f) potential resources that foreign caregivers can use. DISCUSSION AND IMPLICATIONS: Foreign caregivers described the positive and negative aspects of caring for stroke survivors. Differences in language, religion, culture, values, and expectations between foreign caregivers and stroke survivors influence the caregiving experience. These findings can help Taiwan and other developed countries to better support foreign caregivers providing critical care to older adults with stroke and their families.

Predicting trends of community participation after hospital discharge for younger adults after stroke.

BACKGROUND: Community participation is an indicator of recovery for younger adults after stroke who generally have a greater need to return to society than do older adults. However, little is known about the trends of participation and their determinants in this population. OBJECTIVE: To explore the trends of community participation by younger (<65 years) adults with stroke in Taiwan after their hospital discharge and to identify predictors of these trends. METHODS: This longitudinal, multicenter, prospective cohort study enrolled 570 relatively young adults (aged 20-65 years) with stroke. Participants were assessed at hospital discharge and at 3-, 6-, and 12-month follow-up. The primary outcome measure was the Participation Measure-3 Domains, 4 Dimensions (PM-3D4D). Sociodemographic and stroke-related variables were derived by using standardized instruments and questionnaires. Mixed models were used to derive the trends of each participation domain and to identify predictors. RESULTS: PM-3D4D score changes showed a positive trend from discharge to 1-year follow-up (particularly in social and community subscales); however, the improvement was mild and mainly occurred in the first 3 months. Sociodemographic factors, such as income and education levels, and stroke-related variables, such as stroke severity, comorbidity, and physical function, significantly predicted changes in PM-3D4D scores over time. Physical function demonstrated the strongest prediction ability for all participation domains and dimensions. CONCLUSION: Multiple sociodemographic and stroke-related variables, particularly physical function, predicted improvement in community participation by younger adults after stroke. These findings may help clinicians identify younger adults at risk of unfavorable long-term participation outcomes after stroke.

The Effect of Massage Force on Relieving Nonspecific Low Back Pain: A Randomized Controlled Trial.

OBJECTIVE: To investigate the effect of force applied during massage on relieving nonspecific low back pain (LBP). METHODS: This single-blinded, randomized controlled trial enrolled 56 female patients with nonspecific LBP at a single medical center. For each participant, the therapist performed a 30 min massage session (20 min general massage and 10 min focal massage) using a special instrument with a force sensor inserted, for a total of six sessions in 3 weeks. During the 10 min focal massage, HF and LF groups received high force (HF, ≥2 kg) and low force (LF, ≤1 kg) massage, respectively. The primary outcome was pain intensity (i.e., visual analog scale (VAS), 0-10), and secondary outcomes comprised pain pressure threshold, trunk mobility, LBP-associated disability, and quality of life. RESULTS: No significant between-group differences were observed in baseline characteristics. The HF group exhibited significantly lower VAS than did the LF group, with a mean difference of -1.33 points (95% CI: -2.17 to -0.5) at the end of the intervention, but no significant difference was noted at the end of the follow-up. A significant time effect (p < 0.05) was detected in all secondary outcomes except the pain pressure threshold and trunk mobility. A significant time × group interaction (p < 0.05) was found only for the VAS and pain pressure threshold. CONCLUSIONS: Compared with LF massage, HF massage exerted superior effects on pain relief in female patients with nonspecific LBP at the end of intervention. Applying different levels of force showed no effects on LBP-associated disabilities and quality of life.

How does culture influence the implementation of strategy training in stroke rehabilitation? A rapid ethnographic study of therapist perspectives in Taiwan and the United States.

PURPOSE: Strategy training is a promising stroke rehabilitation intervention commonly delivered in Western countries. We examined the perspectives of rehabilitation therapists who have delivered strategy training in Taiwan and the United States to understand the influence of culture on strategy training implementation. MATERIALS AND METHODS: In this rapid ethnographic study, the maximum variation sampling approach was used to recruit seven therapists in Taiwan and seven therapists in the United States with experience delivering strategy training. Data was collected from multiple sources, including interviews, study documents, therapist notes, and reflective memos. Interviews with the recruited therapists in Taiwan and the United States were conducted in Mandarin and English, respectively. Data were analyzed using a constant comparative approach. RESULTS: The following two themes were generated: (1) differences between conventional rehabilitation and strategy training, namely that conventional rehabilitation is therapist-directed and emphasizes impairment reduction, whereas strategy training empowers clients and focuses on real-life generalization, and (2) challenges in implementing strategy training in practice, including difficulty in achieving client buy-in and disengagement. CONCLUSIONS: Therapists from both countries shared similar perspectives on the perceived advantages of strategy training, such as enhancing client empowerment and engagement, and the generalization of strategies. Family involvement was more prominently discussed by therapists in Taiwan than by those in the United States.IMPLICATIONS FOR REHABILITATIONStrategy training differs from conventional rehabilitation in its emphasis on clients' life participation and empowerment, generalization of strategies, and enhancement of their engagement, confidence, and problem-solving skills.Therapists may face challenges related to client buy-in and disengagement as well as difficulties in establishing a therapeutic rapport at the beginning of strategy training because clients have different expectations from those of conventional rehabilitation.Cultural differences in norms and expectations and the clinical experiences of therapists may influence the delivery of strategy training to clients.Family support may influence the success of strategy training.Thoughtful conversations to reach a mutual understanding regarding the expectations of strategy training among clients, family, and rehabilitation practitioners are necessary prior to implementing strategy training.

Recovery after stroke: perspectives of young stroke survivors in Taiwan.

PURPOSE: To learn about the experiences of stroke recovery among young stroke survivors in Taiwan and to elucidate the beliefs, goals, and facilitators of and barriers to their recovery. METHODS: A qualitative approach was used for data collection, and data were obtained from five focus groups consisting of stroke survivors aged 20-64 years (n = 25). Data were transcribed verbatim and analyzed thematically by two independent coders using NVivo version 10. RESULTS: "Returning to prestroke status" was a common belief of recovery for stroke survivors; their goals of recovery changed overtime from regaining physical functions, independent living, and participating in work and leisure activities to maintaining functions or returning to normality. Their perceived personal and environmental facilitators of recovery included positive attitude, family and friends, and rehabilitation, whereas barriers to recovery included psychological factors, social stigma, and physical environment. CONCLUSION: These findings provide useful insights for rehabilitation clinicians to develop culturally tailored interventions to improve poststroke recovery outcomes in young stroke survivors.Implications for rehabilitationRehabilitation clinicians should understand stroke survivors' beliefs and goals of recovery to provide tailored services.Optimizing the goal-setting process and patient-provider communication may help clinicians and survivors examine and adjust their expectations toward recovery during rehabilitation.Interventions will be needed to address personal and environmental supports and barriers, such as motivation, psychological factors, social support, and the physical environment to help survivors achieve their recovery goals.

Sports injuries and risk factors for table tennis among nonprofessional collegiate athletes: A cross-sectional study.

ABSTRACT: Despite the increasing popularity of table tennis worldwide, few studies have focused on table tennis injuries.This study aimed to investigate the injury profiles, including the injury rate, types, locations, and risk factors, among nonprofessional collegiate table tennis athletes in Taiwan.We performed an online investigation among collegiate table tennis athletes of the nonprofessional category in the 2019 National Intercollegiate Athletic Games in Taiwan. Participants provided general information, and data on the characteristics of their play style, training, and injuries were collected. We then categorized these participants into injured and noninjured groups. Injuries were classified as mild, moderate, and severe, based on the time loss in playing table tennis. The risk factors for table tennis-related sports injuries were then identified through between-group comparisons.In total, 150 participants responded to the questionnaire. The average participant age was 21.3 years. Gender differences existed in age categories, forehand rubber, backhand style of play, and average days of training per week. Over the 6 months before the study, 76 of 150 participants experienced at least one injury. The handedness for play was associated with the occurrence of injury. Factors associated with injury severity included using rubber other than inverted rubber for the forehand and not qualifying for the national round of the team category of the National Intercollegiate Athletic Games.With a considerably high injury rate among nonprofessional collegiate athletes, further studies are required on table tennis-related injuries. Playing styles such as handedness and type of rubber used might be associated with the injury. The lower limb was the most common site of injury. These results may provide insights into trainers and coaches for further measures on injury prevention.

Effects of Hyperosmolar Dextrose Injection in Patients With Rotator Cuff Disease and Bursitis: A Randomized Controlled Trial.

OBJECTIVE: To determine whether dextrose prolotherapy offers clinical benefits in patients with shoulder pain and bursitis. DESIGN: Double-blinded, randomized controlled trial. SETTING: Outpatient rehabilitation department of a single medical center. PARTICIPANTS: Patients (N=50) who had received a diagnosis of shoulder pain and bursitis through clinical tests and ultrasound examination. INTERVENTIONS: Participants were randomly assigned to the 15% dextrose injection (D15W) group or the placebo group to receive either D15W or normal saline injection, respectively. All participants received ultrasound-guidance bursal injection every 2 weeks for a total of 3 injections. MAIN OUTCOME MEASURES: The primary outcome was maximal pain level while performing activities. The secondary outcomes included resting pain level, function and disability assessment results, and ultrasonographic parameters. Participants were followed up for 3 months after completion of the injection course. RESULTS: No significant differences in baseline characteristics were observed between the D15W and placebo groups. Significant time effects were observed for all outcome parameters (all P<.05); however, time × group effects were nonsignificant for all outcomes, except for tissue elasticity (P=.026). CONCLUSIONS: Supporting evidence is insufficient regarding the clinical benefits of 15% dextrose bursal injection administered through 3 sessions in patients with chronic shoulder pain and bursitis. The findings indicate that these injections may increase the tissue stiffness of the supraspinatus tendon, as indicated by elastography assessment results, but further research is required to determine the nature of such changes in elastography findings.

Enhancing community participation for stroke survivors with cognitive impairment: study protocol for a randomised controlled trial in Taiwan.

INTRODUCTION: Stroke can lead to life-long disability and constitutes a huge financial burden on the family and society. Stroke survivors with cognitive impairment often experience considerable challenges in the process of recovery and returning to society. Interventions that effectively help individuals resume essential daily activities and return to active participation in their communities are lacking. This study examines the efficacy of a newly-developed intervention programme, the Optimising Participation after Stroke through Strategy-training (OPASS) programme, for improving community participation among stroke survivors with cognitive impairment. METHODS AND ANALYSIS: A single-blind, parallel-group randomised controlled trial with allocation concealment and assessor blinding will be implemented to assess the efficacy of the OPASS programme. An expected 210 adults with cognitive impairment following stroke will be randomly assigned to either the experimental intervention (OPASS) group or the attention control group. In addition to their usual rehabilitation, both groups will receive 45 min sessions, twice weekly for a total of 12-15 sessions. The primary outcome is change in participation performance, which will be measured using the participation measure-three domains, four dimensions scale. Additional measures include the Activity Measure for Post-Acute Care generic outpatient short forms, Montreal Cognitive Assessment, Stroop Test, Trail Making Test and General Self-Efficacy Scale. These scales will be administered at baseline, post-intervention, 3-month follow-up, 6-month follow-up and 12-month follow-up. Their results will be analysed using multiple linear regression models and mixed-effects regression models. Further assessment of feasibility and acceptability of the intervention will be conducted through structured interviews with participants, caregivers and therapists. These interviews will be transcribed and thematically analysed. ETHICS AND DISSEMINATION: Ethics approval was obtained from the Ethics Committee of Taipei Medical University (approval number: N201804055). The findings will be disseminated through presentations at scientific conferences and through publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT03792061; pre-results.

Predicting admission to post-acute inpatient rehabilitation in patients with acute stroke.

OBJECTIVE: To identify predictors of admission to post-acute inpatient rehabilitation settings follow-ing acute care for stroke survivors in Taiwan. DESIGN: Prospective observation study. PARTICIPANTS: Stroke survivors (n = 558) admitted to acute care wards for inpatient rehabilitation (62% male; mean age 60.0 ± 12.2 years). METHODS: The primary outcome was whether survivors were admitted to post-acute inpatient rehabilitation settings after discharge from acute care wards. Logistic regression model was adopted to examine the predictors of admission to post-acute inpatient rehabilitation. A receiver operating characteristic curve was drawn to compute the ability of the predictors to discriminate the outcome. RESULTS: Multivariate analysis results indicated Activity Measure Post-Acute Care "6-Clicks" Basic Mobility score to be the only significant predictor of admission to post-acute inpatient rehabilitation (odds ratio = 0.44, 95% confidence interval: 0.34-0.56). Receiver operating characteristic curve analysis results indicated that the cut-off point for Basic Mobility was 13 (standardized score: 33.99). This yielded a sensitivity value of 0.98 and a specificity value of 0.96 for determining the admission to post-acute inpatient rehabilitation. CONCLUSION: Activity Measure Post-Acute Care "6-Clicks" Basic Mobility subscale scores at admission for acute care can predict admission to post-acute inpatient rehabilitation for stroke survivors in Taiwan. This tool can aid clinicians in formulating adequate discharge plans at an early stage, and thus improve the quality of care.

Experiences with making difficult decisions of the family caregivers of patients on prolonged mechanical ventilation: a qualitative study.

BACKGROUND: Family caregivers of patients on prolonged mechanical ventilation (PMV) may encounter challenges concerning medical decision-making besides witnessing patient suffering. Palliative care (PC) should be a good support for both patients and caregivers; however, for PMV families, PC is not always a choice through long companion time. This qualitative study clarifies family caregivers' burden of assisting patients on PMV and evaluates the need for PC information and support. METHODS: Interviews were caregivers of patients on ventilator support for more than 60 days in five hospitals of the Taipei City Hospital System. Based on phenomenology, this study was conducted by using a semistructured questionnaire comprising three questions: (I) what was the most crucial moment of deciding to intubate? (II) how would you describe the quality of life of your ventilator-dependent family member? (III) what type of assistance do you expect from the PC team for your ventilator-dependent family member? RESULTS: Twenty-one caregivers of patients on PMV in five hospitals of the Taipei City Hospital System agreed to participate in face-to-face interviews. The identified themes, including stressful decision-making, companion pain/discomfort, and unwillingness to accept PC, elucidated the difficulties experienced by caregivers when providing care. CONCLUSIONS: Understanding family caregivers' experiences can enable physicians to improve communication with them, encourage the PC team to support them during surrogate decision-making for patients on PMV during critical moments, and enhance the overall PC service.

Validation of the Mandarin Version of the Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" Among Patients in Acute Rehabilitation.

IMPORTANCE: A standardized functional measure that can be used across rehabilitation care settings in Taiwan is urgently needed. OBJECTIVE: To generate a Mandarin version of the Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" for patients in acute care. DESIGN: Mixed-methods study with a cross-sectional design. SETTING: Acute care wards of three teaching hospitals in Taiwan. PARTICIPANTS: A sample of 231 neurological patients in acute care (62.3% female; mean age = 63.2 yr, standard deviation = 14.6). OUTCOMES AND MEASURES: The 6-Clicks consist of three subscales: Basic Mobility, Daily Activity, and Applied Cognition. They were translated into Mandarin, and their internal consistency, test-retest reliability, interrater reliability, and convergent validity were tested. RESULTS: All subscales of the Mandarin version of the 6-Clicks showed good internal consistency (α = .97-.98). Test-retest and interrater reliabilities were excellent for all subscales (intraclass correlation coefficients >.8). Convergent validity was supported by strong correlations of the Basic Mobility and Daily Activity subscales with the Barthel Index (r = .73 and .72, respectively) and between the Applied Cognition subscale and the Montreal Cognitive Assessment (r = .82). CONCLUSION: Our results provide psychometric evidence supporting the use of the Mandarin version of the 6-Clicks in acute care settings in Taiwan. WHAT THIS ARTICLE ADDS: This study confirms the appropriateness of the use of the Mandarin version of the AM-PAC "6-Clicks" with patients in acute rehabilitation, making it a valuable addition to validated measures available for use by occupational therapists in Taiwan.

Adapting Strategy Training for Adults With Acquired Brain Injury: A Feasibility Study in a Chinese Population.

IMPORTANCE: Before introducing strategy training into a cross-cultural (Chinese) context, it is necessary to evaluate its feasibility. OBJECTIVE: To examine the feasibility of applying strategy training to improve participation outcomes of rehabilitation patients in Taiwan and evaluate the potential intervention effects. DESIGN: A single-group, repeated-measures study. SETTING: Rehabilitation outpatient settings. PARTICIPANTS: A convenience sample of adults (N = 20) with a primary diagnosis of acquired brain injury (ABI) and with cognitive impairment received the intervention and were assessed before and after it. INTERVENTION: The participation-focused strategy training intervention, a modified version of the strategy training intervention, was provided to participants in 1-2 sessions weekly for a total of 10-20 intervention sessions. OUTCOMES AND MEASURES: Feasibility indicators, Participation Measure-3 Domains, 4 Dimensions (PM-3D4D), and Canadian Occupational Performance Measure (COPM). RESULTS: Eighteen participants completed 100% of the scheduled intervention sessions. Participants had very good engagement in the intervention sessions with sufficient comprehension. Participants reported moderate to high satisfaction. Positive score changes were observed for the PM-3D4D (d = 0.46-1.25) and COPM scales (d = 1.82 and 2.12). CONCLUSIONS AND RELEVANCE: This study demonstrated the feasibility of delivering participation-focused strategy training in Taiwan to people with cognitive impairment after ABI. The preliminary evidence also showed that participants who received the strategy training intervention had positive changes in participation outcomes and in performance of their self-identified goals. On the basis of this study's findings, a larger clinical trial is warranted to evaluate the efficacy of the strategy training intervention. WHAT THIS ARTICLE ADDS: Participation-focused strategy training is feasible and acceptable for Taiwanese community-dwelling adults with cognitive impairment after ABI. However, because strategy training is quite different from traditional rehabilitation delivered in Taiwan, additional instructions and discussion among the therapist, client, and caregiver may be needed before the intervention is provided.

Development and evaluation of a tablet-based participation measure for older adults in rehabilitation settings.

Purpose: To develop a tablet-based participation measure and to evaluate its reliability and acceptability to an older Chinese population in rehabilitation settings.Method: A multidimensional, self-reported participation measure, the Participation Measure-3 Domains, 4 Dimensions (PM-3D4D), was programed into mobile application software and presented on tablet computers. To explore the reliability of the tablet-based PM-3D4D, 80 adults in rehabilitation outpatient settings aged ≥65 years completed the tablet and the paper versions of the measure at baseline and at 1-week follow-up. Intraclass correlation coefficients were calculated for concordance and test-retest reliability. Participants' acceptability toward the two versions of the measure was described.Results: The tablet-based PM-3D4D showed good to excellent test-retest reliability (Intraclass correlation coefficients = 0.79 ∼ 0.96) and high concordance with the paper-form (Intraclass correlation coefficients = 0.74-1.00). Approximately, 44% participants reported preference for the tablet-based measure, and 20% reported preference for the paper-form measure. Many participants found the tablet-based measure user-friendly, convenient, and environmentally-friendly.Conclusions: Findings of this study provide supportive evidence for administering the tablet-based PM-3D4D to an older Chinese population in rehabilitation settings and suggest a promising measurement methodology for future clinical practice.Implications for rehabilitationThe developed tablet-based participation measure, the Participation Measure-3 Domains, 4 Dimensions (PM-3D4D), fills a critical void for an efficient and reliable rehabilitation outcome measure tailored to the needs of older adults in rehabilitation settings.The tablet-based PM-3D4D is a reliable outcome measure.Most of the older adults in rehabilitation settings preferred to use the tablet-based participation measure than the paper-form measure; and very few of them reported difficulty with using the tablet-version measure.A high concordance was found between data collected by the tablet version PM-3D4D and data collected by the paper version PM-3D4D.

Responsiveness and Predictive Validity of the Participation Measure-3 Domains, 4 Dimensions in Survivors of Stroke.

OBJECTIVES: To examine the responsiveness and predictive validity of the Participation Measure-3 Domains, 4 Dimensions (PM-3D4D) in people receiving outpatient rehabilitation following stroke. DESIGN: Prospective cohort observational study. SETTING: Outpatient rehabilitation settings. PARTICIPANTS: Volunteer patients (N=269) with stroke (mean age ± SD [y], 55.36±12.46; 70.26% male). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The PM-3D4D was designed to measure 3 domains (Productivity, Social, and Community) and 4 dimensions (Diversity, Frequency, Desire for change, and Difficulty) of participation in individuals with rehabilitation needs. All participants completed the PM-3D4D, the Participation Assessment with Recombined Tools-Objective (PART-O), the Participation Measure for Post-Acute Care (PM-PAC), and the EuroQol-5-Dimension (EQ-5D) at the baseline assessment and again following 3 months of outpatient rehabilitation. RESULTS: Significant mean changes in scores were observed for most of the PM-3D4D subscales, with the largest score change observed in the Difficulty subscale (standardized response mean=0.57∼0.88). The minimal detectable change and meaningful clinically important differences were calculated for each subscale. The Frequency and Difficulty dimensions of the PM-3D4D demonstrated significantly greater responsiveness than the PART-O and PM-PAC, respectively. The baseline PM-3D4D scores, except for Desire for change subscales, were significantly correlated with the PART-O, PM-PAC, and EQ-5D scores after 3 months of rehabilitation. CONCLUSIONS: This study provides evidence supporting the responsiveness and predictive validity of the PM-3D4D in survivors of stroke. Among all subscales of the PM-3D4D, the Difficulty dimensional scale demonstrated the greatest responsiveness. The Desire for change dimension of the PM-3D4D showed less responsiveness, and we recommend that it be used as a goal-setting tool rather than an outcome measure. The PM-3D4D can potentially be used to predict participation outcomes and the health-related quality of life following rehabilitation interventions.

WHODAS 2.0 Can Predict Institutionalization among Patients with Traumatic Brain Injury.

Patients with traumatic brain injury (TBI) often present with disabilities associated with a high burden of care for caregivers or family members at home. When family members cannot afford to care for patients with TBI, they are often required to find them residence in long-term care institutions. To date, there are no quantitative assessment tools developed to predict institutionalization. Therefore, this study analyzed the accuracy of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) for predicting the institutionalization of patients with TBI. We designed a cross-sectional study using a nationwide disability database. We analyzed the data of 8630 patients with TBI with injury for more than six months from the Taiwan Data Bank of Persons with Disability during July 2012-October 2018. The demographic data and WHODAS 2.0 standardized scores of patients with TBI who resided in community and long-term care institutions were analyzed. Receiver operating characteristic curve (ROC) analysis was performed to investigate the predictive accuracy of WHODAS 2.0 for being institutionalized, and the optimal cut-off point was determined using the Youden index. Binary logistic regression was employed to determine the predictors of the participants being institutionalized. The WHODAS 2.0 scores in each domain were lower in the community group than in the institutionalized group. ROC analysis revealed the highest accuracy for the summary scores of WHODAS 2.0 (area under the curve = 0.769). Binary logistic regression revealed that age, gender, work status, urbanization level, socioeconomic status, severity of impairment, and WHODAS 2.0 domain scores were factors associated with the institutionalization status of patients with TBI. Our results suggest that WHODAS 2.0 may be a feasible assessment tool for predicting the institutionalization of patients with TBI.

Perceptions and attitudes towards the implementation of a disability evaluation system based on the international classification of functioning, disability, and health among people with disabilities in Taiwan.

PURPOSE: To explore the perceptions and attitudes among people with disabilities towards the newly implemented International Classification of Functioning, Disability and Health-based disability evaluation system (the new system) in Taiwan. METHOD: Using a self-administered questionnaire, we conducted a nationwide survey. The questionnaire focused on the domains of quality, satisfaction, and revision of the new system. In total, 1073 persons (age, ≥18 years) with disabilities or their primary caregivers, who experienced both the old and the new system, responded to the questionnaire. RESULTS: Most participants were satisfied with the new system overall (58.7%) and the subscale of quality of structure (91.3%) and quality of outcome (63.6%). However, only 20.5% of the participants were favourable to the quality of process. The probability of being satisfied with the system overall was low for the quality of process subscale (adjusted odds ratio range, 0.3 ∼ 0.4) and its item of long interval (0.2 ∼ 0.6). Contrariwise, the probability was high for the other subscales (3.9 ∼ 13.7) and the item of identifying needs (21.9 ∼ 23.4). CONCLUSIONS: Persons with disabilities and their primary caregivers have positive attitudes towards the new system. It is important to simplify the assessment tools and procedures to improve the system's quality of process and facilitate its usability. IMPLICATIONS FOR REHABILITATION Persons with disabilities have positive attitudes towards the newly implemented International Classification of Functioning, Disability, and Health-based disability evaluation system in Taiwan. The system that provides comprehensive information about functioning and disability of persons with disabilities is able to capture the difficulties and needs of those individuals in their daily lives. The system hence helps people to mitigate the effects of disability and guide rehabilitation. The assessment items and processes of the system, however, were perceived to be complicated, time-consuming, and inconvenient. Simplifying the assessment items and processes, such as developing a short form version of the assessment tool and increasing the service time, may facilitate the usability of the system.