Cross-Cultural Adaptation and Psychometric Properties of the Chinese Version of the Knee Osteoarthritis Fears and Beliefs Questionnaire.

This study aimed to adapt and validate the Knee Osteoarthritis Fears and Beliefs Questionnaire (KOFBeQ) for Chinese patients, thereby advancing the understanding of fear-avoidance behaviors. Adopting a cross-sectional design, data were collected for 241 subjects (78.8% women; mean age 68.0 ± 7.8 years) across various healthcare settings in Hong Kong. Exploratory factor analysis resulted in an 11-item questionnaire with three distinct subscales, covering fears and beliefs related to physicians and disease (six items), daily living activities (three items), and sports and leisure activities (two items). The overall Cronbach's α coefficient was 0.86, indicating strong internal consistency. The questionnaire exhibited favorable convergent validity. Confirmatory factor analyses confirmed a good model fit. Test-retest reliability analysis indicated a high intraclass correlation coefficient of 0.93 (95% confidence interval: 0.88, 0.96), and a Bland-Altman plot revealed a slight bias in two measurements (0.97 [0.19]) without a systematic trend. The adapted Chinese version of the KOFBeQ demonstrated robust psychometric properties in terms of validity and reliability, providing an effective tool for surveying Chinese patients with knee osteoarthritis. These findings offer valuable insights for clinicians and patients, aiding in informed decision-making and improved rehabilitation strategies.

Role of exosomes and exosomal microRNA in muscle-Kidney crosstalk in chronic kidney disease.

Chronic kidney disease (CKD) is a progressive damage of kidneys that can no longer serve the blood-filtering function, and is a life-threatening condition. Skeletal muscle wasting is a common complication of CKD. Yet the relationship between kidney and skeletal muscle in CKD remains unclear. Exosomes, a type of small membrane-bound vesicles released from cells to the extracellular environment, have increasingly received attention due to their potential as mediators of crosstalk between kidneys and different organs, including skeletal muscle. This mini-review summarizes the recent findings that point to the role of exosomes in the cross-talk between kidney and skeletal muscle in CKD. Understanding of the contents and the mechanism of exosome release may prone exosomes be the potential therapeutic targets for CKD.

Indentation Stiffness Measurement by an Optical Coherence Tomography-Based Air-Jet Indentation System Can Reflect Type I Collagen Abundance and Organisation in Diabetic Wounds.

There is a lack of quantitative and non-invasive clinical biomechanical assessment tools for diabetic foot ulcers. Our previous study reported that the indentation stiffness measured by an optical coherence tomography-based air-jet indentation system in a non-contact and non-invasive manner may reflect the tensile properties of diabetic wounds. As the tensile properties are known to be contributed by type I collagen, this study was aimed to establish the correlations between the indentation stiffness, and type I collagen abundance and organisation, in order to further justify and characterise the in vivo indentation stiffness measurement in diabetic wounds. In a male streptozotocin-induced diabetic rat model, indentation stiffness, and type I collagen abundance and organisation of excisional wounds were quantified and examined using the optical coherence tomography-based air-jet indentation system and picrosirius red polarised light microscopy, respectively, on post-wounding days 3, 5, 7, 10, 14, and 21. The results showed significant negative correlations between indentation stiffness at the wound centre, and the collagen abundance and organisation. The correlations between the indentation stiffness, as well as collagen abundance and organisation of diabetic wounds suggest that the optical coherence tomography-based air-jet indentation system can potentially be used to quantitatively and non-invasively monitor diabetic wound healing in clinical settings, clinical research or preclinical research.

Effect of EMG-biofeedback robotic-assisted body weight supported treadmill training on walking ability and cardiopulmonary function on people with subacute spinal cord injuries - a randomized controlled trial.

BACKGROUND: Body weight supported treadmill training (BWSTT) is a frequently used approach for restoring the ability to walk after spinal cord injury (SCI). However, the duration of BWSTT is usually limited by fatigue of the therapists and patients. Robotic-assisted body weight supported treadmill training (RABWSTT) was developed to tackle the aforesaid limitation. Currently, limited randomized controlled trials are available to investigate its effectiveness, especially on cardiopulmonary function. The aim of this two-arm, parallel-group randomized controlled trial is to examine the feasibility of adapting an EMG-biofeedback system for assist-as-needed RABWSTT and its effects on walking and cardiopulmonary function in people with SCI. METHODS: Sixteen incomplete SCI subjects were recruited and randomly allocated into an intervention group or control group. The intervention group received 30 min of RABWSTT with EMG biofeedback system over the vastus lateralis muscle to enhance active participation. Dose equivalent passive lower limbs mobilization exercise was provided to subjects in the control group. RESULTS: Significant time-group interaction was found in the Walking Index for Spinal Cord Injury version II (WISCI II) (p = 0.020), Spinal Cord Independence Measure version III (SCIM III) mobility sub-score (p < 0.001), bilateral symmetry (p = 0.048), maximal oxygen consumption (p = 0.014) and peak expiratory flow rate (p = 0.048). Wilcoxon signed-rank test showed that the intervention group had significant improvement in the above-mentioned outcomes after the intervention except WISCI II, which also yielded marginal significance level. CONCLUSION: The present study demonstrated that the use of EMG-biofeedback RABWSTT enhanced the walking performance for SCI subjects and improve cardiopulmonary function. Positive outcomes reflect that RABSTT training may be able to enhance their physical fitness. TRIAL REGISTRATION: The study protocol was approved by the Research Ethics Committee (Kowloon Central/ Kowloon East), Hospital Authority on 6 December 2013, and the Human Subjects Ethics Sub-committee of The Hong Kong Polytechnic University on 15 May 2013, with reference numbers KC/KC-13-0181/ER-2 and HSEARS20130510002 respectively. The study was registered in ClinicalTrials.gov on 20 November 2013, with reference number NCT01989806 .).

Effects of pulsed electromagnetic fields on learning and memory abilities of STZ-induced dementia rats.

INTRODUCTION: Recent studies have shown that pulsed electromagnetic field (EMF) has therapeutic potential for dementia, but the associated neurobiological effects are unclear. This study aimed to determine the effects of pulsed EMF on Streptozotocin (STZ)-induced dementia rats. METHODS: Forty Sprague-Dawley rats were randomly allocated to one of the four groups: (i) control, (ii) normal saline injection (sham group), (iii) STZ injection (STZ group) and (iv) STZ injection with pulsed EMF exposure (PEMF, 10 mT at 20 Hz) (STZ + MF group). Morris water maze was used to assess the learning and memory abilities. Insulin growth factors 1 and 2 (IGF-1 and IGF-2) gene expression were determined by quantitative PCR. RESULTS: The results showed that the mean escape latency in STZ-induced dementia rats was reduced by 66% under the exposure of pulsed EMF. Compared with the STZ group, the swimming distance and the time for first crossing the platform decreased by 55 and 41.6% in STZ + MF group, respectively. Furthermore, the IGF-2 gene expression significantly increased compared to that of the STZ group. CONCLUSIONS: Our findings indicate that the pulsed EMF exposure can improve the ability of learning and memory in STZ-induced dementia rats and this effect may be related to the process of IGF signal transduction, suggesting a potential role for the pulsed EMF for the amelioration of cognition impairment.

Efficacy of Biophysical Energies on Healing of Diabetic Skin Wounds in Cell Studies and Animal Experimental Models: A Systematic Review.

We have systematically assessed published cell studies and animal experimental reports on the efficacy of selected biophysical energies (BPEs) in the treatment of diabetic foot ulcers. These BPEs include electrical stimulation (ES), pulsed electromagnetic field (PEMF), extracorporeal shockwave (ECSW), photo energies and ultrasound (US). Databases searched included CINAHL, MEDLINE and PubMed from 1966 to 2018. Studies reviewed include animal and cell studies on treatment with BPEs compared with sham, control or other BPEs. Information regarding the objective measures of tissue healing and data was extracted. Eighty-two studies were eventually selected for the critical appraisal: five on PEMF, four each on ES and ECSW, sixty-six for photo energies, and three about US. Based on the percentage of original wound size affected by the BPEs, both PEMF and low-level laser therapy (LLL) demonstrated a significant clinical benefit compared to the control or sham treatment, whereas the effect of US did not reveal a significance. Our results indicate potential benefits of selected BPEs in diabetic wound management. However, due to the heterogeneity of the current clinical trials, comprehensive studies using well-designed trials are warranted to confirm the results.

A Tailor-Made Exercise Program for Improving Balance and Mobility in Older Adults With Type 2 Diabetes.

Effectiveness of an exercise program designed for improving postural control and mobility in older adults with type 2 diabetes was investigated. Ninety-three adults 65 or older diagnosed with type 2 diabetes and able to walk unaided were recruited. The intervention group received exercise training focused on ankle strengthening and mobility twice per week for 10 weeks. The control group did not participate in any exercise program. After 10 weeks, the intervention group showed significantly greater improvement in the mean Sensory Organization Test composite score (4.4 vs. 0.3; p = 0.01) as well as visual ratio (0.1 vs. 0.002; p = 0.01) and vestibular ratio (0.1 vs. 0.003; p < 0.001) than the control group after adjusting for covariates. A greater trend of improvement in the Timed Up and Go and Single-Leg Stance Test was also found in the intervention group. Exercise training focusing on the ankle is effective in enhancing the postural stability of older adults with type 2 diabetes and can potentially be effective in improving single-leg standing balance and mobility. [Journal of Gerontological Nursing, 44(2), 41-48.].

Effects of pulsed electromagnetic fields on peripheral blood circulation in people with diabetes: A randomized controlled trial.

Cutaneous blood flow provides nourishment that plays an essential role in maintaining skin health. We examined the effects of pulsed electromagnetic fields (PEMFs) on cutaneous circulation of dorsal feet. Twenty-two patients with diabetes mellitus (DM) and 21 healthy control subjects were randomly allocated to receive either PEMFs or sham PEMFs (0.5 mT, 12 Hz, 30 min). Blood flow velocity and diameter of the small vein were examined by using ultrasound biomicroscopy; also, microcirculation at skin over the base of the 1st metatarsal bone (Flux1) and distal 1st phalange (Flux2) was measured by laser Doppler flowmetry before and after intervention. Results indicated that PEMFs produced significantly greater changes in blood flow velocity of the smallest observable vein than did sham PEMFs (both P < 0.05) in both types of subjects. However, no significant difference was found in changes of vein diameter, nor in Flux1 and Flux2, between PEMFs and sham PEMFs groups in subjects with or without DM. We hypothesized that PEMFs would increase blood flow velocity of the smallest observable vein in people with or without DM. Bioelectromagnetics. 37:290-297, 2016. © 2016 Wiley Periodicals, Inc.

Pulsed electromagnetic field (PEMF) promotes collagen fibre deposition associated with increased myofibroblast population in the early healing phase of diabetic wound.

The present study evaluated the effects of PEMF on collagen fibre deposition, collagen fibril alignment and collagen fibre orientation. The potential relationships between collagen fibre deposition and myofibroblast population in diabetic wound healing were also examined. Forty young male streptozotocin-induced diabetic Sprague-Dawley rats were randomly assigned to PEMF group or control group. 2 cm × 2 cm square wounds were made at their back. The PEMF group received daily exposure of PEMF to the wounds, while control group was handled in the same manner except that the PEMF device was not activated. Wound tissues harvested on post-wounding day 7, 10 and 14 were fixed, processed and sectioned. The abundance, fibril alignment and fibre orientation of type I collagen were quantified with picro-sirius polarization method and image analysis software (Nikon NIS Element AR). Myofibroblast population data were adopted from our previous study. Correlation between myofibroblast population and collagen fibre deposition was examined. There was significantly greater abundance of type I collagen fibre in the PEMF group than in the control on day 7 (P = .013), but not on day 10 or 14. No significant between-group differences were found in collagen fibril alignment and collagen fibre orientation at any measured time points. Positive correlation was found between collagen fibre deposition and myofibroblast population only on day 7 (r = .729, P = .007). In conclusion, PEMF can significantly increase collagen fibre in the early phase of diabetic wound healing, which is associated with the enhancement of myofibroblast population.

Pulsed electromagnetic field therapy promotes healing and microcirculation of chronic diabetic foot ulcers: a pilot study.

OBJECTIVE: To examine the effects of pulsed electromagnetic field (PEMF) therapy on promoting the healing and microcirculation of chronic diabetic foot ulcers. DESIGN: A randomized, double-blind, placebo-controlled clinical trial on a homogenous subset of chronic diabetic foot ulcers. SETTING: Hospital and university. PATIENTS: Thirteen subjects (7 in the PEMF group and 6 in the control group) diagnosed with type 2 diabetes and had unsatisfactory healing of ulcer(s) in the preceding 4 weeks were recruited. INTERVENTIONS: Subjects were randomly allocated to receive either active PEMF therapy (duration: 60 minutes; frequency: 12 Hz; intensity: 12 Gauss) or nonactive PEMF for 14 sessions within 3 weeks. MAIN OUTCOME MEASURES: Assessment on wound closure, wound depth, and microcirculation were performed at the baseline, end of the treatment period, and 1-month follow-up. MAIN RESULTS: By the end of the treatment period, there was an 18% decrease in wound size in the active PEMF group as compared with a 10% decrease in the control group. The PEMF group demonstrated significant cumulative increase in cutaneous capillary blood velocity (by 28%) and 14% increase in capillary diameter. In contrast, the control group showed a decrease in both capillary blood velocity and diameter. CONCLUSION: In this study, PEMF therapy seemed to accelerate wound healing and improve microcirculation.

An innovative ultrasound foot scanner system for measuring the change in biomechanical properties of plantar tissue from sitting to standing.

The present study investigated the reliability of an innovative ultrasound foot scanner system in assessing the thickness and stiffness of plantar soft tissue and the comparison of stiffness and thickness in sitting and standing. Fifteen young healthy individuals were examined. The target sites on the foot sole for investigation included the heel pad, the fifth metatarsal head, the second metatarsal head, the first metatarsal head, and the pulp of the hallux. The test (day 1) and retest (day 2) were performed 1 week apart at the exact time with humidity and temperature of the assessment room under control. The thickness and stiffness of the plantar soft tissue obtained in sitting and standing positions on day 1 were used for comparison. The results showed significant test-retest reliability [intraclass correlation coefficient(3,2)>0.90, P<0.001] at all five sites in both sitting and standing positions. When changing from sitting to standing, the plantar soft tissue became significantly thinner (with decrease ranging from 10 to 14% at various sites) and stiffer (with increase ranging from 123 to 164% at various sites, all P<0.05). The present innovative system is a reliable device for the measurement of the thickness and stiffness of plantar soft tissue in either the sitting or the standing position. The change in positions from sitting to standing resulted in a significant thinning and stiffening of plantar soft tissues. This system could be a potential clinical device to monitor the biomechanical properties of plantar tissue in the elderly or in patients with diseases such as diabetes to estimate the risk of developing foot ulcer or other foot complications.

The association between physical characteristics of the ankle joint and the mobility performance in elderly people with type 2 diabetes mellitus.

Previous studies showed that older adults with diabetes have a worse mobility performance as compared with those without diabetes. Studies also demonstrated that older adults with diabetes have weakened ankle muscle strength, reduced joint range in ankle dorsiflexion and worsened ankle joint proprioception as compared with control population. The purpose of the present study was to examine the relationship between the physical characteristics of the ankle joint and the mobility performance in older adults with type 2 diabetes. Older adults with type 2 diabetes (n=85) were recruited, and Timed Up and Go test (TUG) for mobility assessment was performed. Active ankle joint repositioning test was used for assessing the ankle joint proprioception sense; peak torque of ankle dorsiflexors and plantar flexors were tested by using a Cybex Norm dynamometer, and weight-bearing lunge test (WBLT) was used for assessing the stiffness of ankle dorsiflexion. Our results showed that age, body mass index (BMI), normalized peak torque of plantar flexors and dorsiflexors, active ankle joint repositioning test errors and the WBLT distance were significantly correlated with the TUG (all p<0.001). These ankle characteristics, together with the demographic data of the subjects, contributed 59.9% of the variance in the TUG by multiple regression analysis. Body mass, ankle plantar flexors strength and ankle joint proprioception are important factors contributing to the physical mobility of the older adults with type 2 diabetes.

Pulsed electromagnetic fields (PEMF) promote early wound healing and myofibroblast proliferation in diabetic rats.

Reduced collagen deposition possibly leads to slow recovery of tensile strength in the healing process of diabetic cutaneous wounds. Myofibroblasts are transiently present during wound healing and play a key role in wound closure and collagen synthesis. Pulsed electromagnetic fields (PEMF) have been shown to enhance the tensile strength of diabetic wounds. In this study, we examined the effect of PEMF on wound closure and the presence of myofibroblasts in Sprague-Dawley rats after diabetic induction using streptozotocin. A full-thickness square-shaped dermal wound (2 cm × 2 cm) was excised aseptically on the shaved dorsum. The rats were randomly divided into PEMF-treated (5 mT, 25 Hz, 1 h daily) and control groups. The results indicated that there were no significant differences between the groups in blood glucose level and body weight. However, PEMF treatment significantly enhanced wound closure (days 10 and 14 post-wounding) and re-epithelialization (day 10 post-wounding), although these improvements were no longer observed at later stages of the wound healing process. Using immunohistochemistry against α-smooth muscle actin (α-SMA), we demonstrated that significantly more myofibroblasts were detected on days 7 and 10 post-wounding in the PEMF group when compared to the control group. We hypothesized that PEMF would increase the myofibroblast population, contributing to wound closure during diabetic wound healing.

The potential influence of diabetic history on peripheral blood flow in superficial skin.

Vascular complication occurrence increases with the duration of diabetes. The present study compared the peripheral blood flow in superficial skin among subjects with a short or long history of diabetes as compared to a healthy control group. Thirty-two subjects with type 2 diabetes were recruited and stratified into a group of those with a short history of diabetes (i.e., shorter than or equal to ten years) and a group of those with a long history of diabetes (i.e., over ten years). Thirty-eight healthy age-matched volunteers were recruited as the control. The blood flow velocity of the superficial small veins in the skin over the base of the 1st metatarsal bone was measured by ultrasound biomicroscopy. The blood flow (flux) of the cutaneous microcirculation over the base of the 1st metatarsal bone (Flux1) and over the distal 1st phalanges bone (Flux2) was measured by Laser Doppler Flowmetry. One-way analysis of variance was used to analyze the differences between the three groups. No significant between-group difference was found in any outcome (all P>0.05). However, the group with a long history of diabetes tended to have a more reduced blood flow than did the healthy control group. A difference was found between the diabetes group and the healthy control in any outcomes. A trend of hemodynamic changes in the three groups was observed, but the difference did not reach significance. Ten years seems to be the time when angiopathy becomes noticeable among people with diabetes.

A multidisciplinary rehabilitation programme for patients with chronic low back pain: a prospective study.

PURPOSE: To examine the effectiveness of a multidisciplinary rehabilitation programme for patients with chronic low back pain in Hong Kong, and to identify factors associated with work resumption. METHODS: 57 men and 8 women aged 20 to 56 (mean, 39) years who had a more than 3-month history of low back pain and were unresponsive to more than 6 months of conventional treatment participated in a 14-week multidisciplinary rehabilitation programme involving physical conditioning, work conditioning, and work readiness. Training protocols entailed flexibility and endurance training, hydrotherapy, weight lifting, and work stimulation. Patients were assessed at baseline (week 1), week 7, week 14, and month 6 with regard to the intensity of low back pain, self-perceived disability, range of lumbar motion, isoinertial performance of the trunk muscles, and depression level. Patient demographics that influenced work resumption were identified using a prediction model. Patients who did and did not return to work were compared. RESULTS: Of the 54 patients who completed all follow-up assessments, 28 returned to work and 26 did not. The latter was significantly older (37 vs. 42 years, p=0.038) and absent from work longer (11 vs. 22 months, p=0.029) than the former. The rehabilitation programme helped patients regain physical function and the ability to work. Patients who returned to work showed greater improvement in self-perceived disability and physical function. CONCLUSION: This rehabilitation programme facilitated regain of physical functioning and the ability to return to work. The pre-programme employment status, duration of absence from work, and patient age were the most important predictors for work resumption.

The effect of aging on the biomechanical properties of plantar soft tissues.

BACKGROUND: Foot problems are common in elderly people and stiffened plantar soft tissues may lead to ulceration in people with Diabetes Mellitus. It is unclear how the biomechanical properties of plantar soft tissues change with advancing age. Therefore, this study examined the age-related differences in the biomechanical properties of plantar soft tissues. METHODS: Sixty healthy volunteers without foot problems, aged from 41 to 83 years, were examined using tissue ultrasound palpation system. The thickness and stiffness of the plantar soft tissues under the big toe, first metatarsal head, third metatarsal head, fifth metatarsal head, and heel were measured. The load-deformation curve of the plantar soft tissues was plotted. The correlation between age and biomechanical properties was examined and comparisons were made between four age groups. FINDINGS: The mean stiffness of the plantar soft tissues at big toe, first metatarsal head, third metatarsal head, fifth metatarsal head, and the heel significantly increased with age (P<0.001). The plantar soft tissues at the heel were the thickest (P<0.001), with the plantar soft tissue tending to be increasingly thicker with age, although there was no statistical significance. Strong positive correlations between age and stiffness of the plantar soft tissues were found at the big toe (r=0.608), first metatarsal head (r=0.549), third metatarsal head (r=0.657), fifth metatarsal head (r=0.633), and heel (r=0.584) (all P<0.001). INTERPRETATION: The loss of compliance in the plantar soft tissues may be one of the factors responsible for the higher incidence of foot problems in elderly individuals.

The use of auricular examination for screening hepatic disorders.

Researches on auricular acupuncture (AA) have examined mainly its treatment effects. This study aimed to investigate the accuracy and precision of using auricular examination (AE) as a complementary diagnostic tool for screening hepatic disorders. Twenty patients suffering from liver dysfunction and 25 controls aged 18-60 years were recruited from an acute hospital. Participants were examined using three AE methods including visual inspection, electrical skin resistance measurement, and tenderness testing on the liver AA zone of both ears. Significant differences were found in visual inspection and electrical skin resistance on the AA zones between the two groups. Patients suffering from liver dysfunction tended to have at least one abnormality in skin color, appearance, presence of papules, abundance of capillary and desquamation on the ear (Relative Risk-Right ear: RR = 2.9, 95% confidence interval (CI) 1.4, 6.2; Left: RR = 1.8, 95% CI, 1.01, 3.1). The sensitivity for visual inspection was 0.7 for both ears; specificity was 0.76 for the (R) and 0.6 for the (L) ear. The mean difference in electrical skin resistance was 4.3 MOmega (95% CI, 1.7, 6.9) for the (L) ear; 4.5 MOmega (95% CI, 1.5, 7.6) for the (R) ear. Our results suggest that malfunction of the liver appeared to be reflected by the presence of morphological changes on the liver AA zone. Visual inspection and electrical skin resistance on the liver AA zone are potentially sensitive to screen hepatic disorders.