Is there any radiation-induced brachial plexopathy after hypofractionated postmastectomy radiotherapy with helical tomotherapy?

Introduction: Radiation-induced brachial plexopathy (RIBP) is one of the most concerning late radiation effects after hypofractionated postmastectomy radiotherapy (HF-PMRT) to the chest wall and regional lymph nodes. The purpose of this study was to investigate the RIBP events occurring in breast cancer patients after HF-PMRT using intensity-modulated radiation therapy (IMRT) by helical tomotherapy. Furthermore, the dosimetric parameters of the ipsilateral brachial plexus were reported. Materials and methods: Breast cancer patients who underwent HF-PMRT using the IMRT via HT at our institute were included. In the first cohort, subjective RIBP symptoms were measured using a QuickDASH questionnaire, whereas objective RIBP events were assessed using a comprehensive physical evaluation in the second cohort. The ipsilateral brachial plexus from all eligible patients' treatment plans was contoured, and the dosimetric parameters were explored. Results: From March 2014 to December 2022, 229 patients were enrolled; 107 and 72 individuals were in the first and second cohorts, respectively. The first cohort's median follow-up period was 27 months, and the second cohort was 31 months. In the first cohort, 80 patients (74.77%) had a normal function, 21 (19.63%) had a mild grade, and 6 (5.61%) had a moderate grade; no severe or very severe RIBP was observed. However, the comprehensive physical evaluation of the second cohort indicated no RIBP events. Dosimetric analysis revealed that the median maximum dose was 44.52, 44.52, and 44.60 Gy; the median mean dose was 33.00, 32.23, and 32.33 Gy; and the median dose at 0.03 cc was 44.33, 44.36, and 44.39 Gy for all patients, patients in the first and second cohort, respectively. Each dosimetric parameter was evaluated, and no statistically significant differences were detected. Conclusion: The absence of RIBP events supports the safety of employing HF-PMRT by HT for the chest wall and all regional lymph nodes. We propose that applying the ICRU Report 83 criteria for IMRT planning, which limit the maximum dose (107% of the prescribed dose) to less than 2% of the planning target volume and exclude the brachial plexus region from the maximal dose area, is a practical way to minimize the risk of RIBP from HF-PMRT.

Minimal clinically important difference (MCID) and minimal detectable change (MDC) of Spinal Cord Ability Ruler (SCAR).

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To find minimal clinically important difference (MCID) and minimal detectable change (MDC) of Spinal Cord Ability Ruler (SCAR) in Thai participants with spinal cord injury (SCI). SETTING: Rehabilitation ward at Maharaj Nakorn Chiang Mai Hospital. METHODS: Data of individuals with SCI who were not diagnosed with central cord syndrome and were admitted for the first time for rehabilitation were analyzed. Upper extremities motor score, self-care and mobility items of Spinal Cord Independence Measure version III were collected and used to calculate SCAR difference between data on date of admission and discharge. MCID and MDC were calculated by distribution-based method and categorized for each subgroup according to SCI characteristics. RESULTS: From data of 311 individuals, MCID of SCAR is approximately 4 for individual with tetraplegia AIS A, B, C; and individual with AIS D at any level, and 2 for individual with paraplegia AIS A, B, C. MDC of SCAR should be 1 for individual with tetraplegia AIS A, B, C; and individual with AIS D at any level and 0.5 for individual with paraplegia AIS A, B, C. CONCLUSION: This study provides MCID and MDC of SCAR in each subgroup. These values could be used as a benchmark for clinicians and researchers to determine whether participant has significant improvement or not after receiving an intervention.

Field testing and psychometric properties of Thai version of the Boston carpal tunnel questionnaire.

Introduction: The Boston Carpal Tunnel Questionnaire (BCTQ) is a widely recommended patient-reported outcome measure to evaluate symptoms and functions in carpal tunnel syndrome (CTS) patients. We aimed to evaluate the translation and cross-cultural adaptation of the Thai version of the BCTQ (Thai BCTQ) and to investigate the psychometric properties including internal consistency, test-retest reliability, construct validity and responsiveness. Methods: The Thai BCTQ was field tested with 15 healthy volunteers and 15 CTS patients to evaluate the item-objective congruence of each item. Following that, one hundred and twenty-four CTS patients were included for psychometric evaluation in this study. Internal consistency was assessed using Cronbach's alpha. Test-retest reliability was examined using the intraclass correlation coefficient (ICC). To evaluate construct validity, Spearman's rank correlation of the symptom severity scale (Thai BCTQ -S), the functional status scale (Thai BCTQ -F) and the subscales of the Thai MHQ were analyzed. Responsiveness was determined using the standardized response mean (SRM). Results: Minor modification of the Thai version was made to better explain the term "tingling". The Thai BCTQ-S, Thai BCTQ-F and Thai BCTQ demonstrated adequate Cronbach's alpha values (0.91-0.94) and good test-retest reliability (ICC=0.89-0.98). Regarding related dimensions, a strong correlation (r=0.67, P<0.008) was found between the Thai BCTQ-F and the Function subscale of Thai MHQ as well as between Thai BCTQ-F and the Activities of Daily Living subscale of the Thai MHQ (r=0.75, P<0.008). In unrelated dimensions, there was a relatively weak correlation between the Thai BCTQ-S and the Aesthetics subscale of the Thai MHQ (r=0.32, P=0.0116). The SRM of the Thai BCTQ was 1.46, indicating large responsiveness. Discussion: The Thai BCTQ has adequate internal consistency in both the symptom and function scales as well as good construct validity and test-retest reliability indicating it is suitable for evaluating Thai CTS patients. This tool also has a high ability to detect clinically significant changes in symptoms and function over time after receiving conservative or surgical treatment.

Electromyography of the External Anal Sphincter during Micturition and Electrophysiological Bulbocavernosus Reflex in Healthy Spayed Female Canines.

This study aimed to find methods and interferences and illustrate the pattern of external anal sphincter (EAS) electromyography (EMG) during micturition and to determine reference intervals of electrophysiological bulbocavernosus reflex (EBCR) by using robust statistical methods in healthy spayed female canines. Ten healthy spayed female canines (no breed restriction) with a body weight of 11.3-18 kg were enrolled. EAS EMG during micturition and the EBCR test were performed under light general anesthesia. Altogether 25 out of 34 EAS EMG showed a similar pattern, including low-amplitude high-frequency bursting pattern before voiding, medium- or high-amplitude low-frequency bursting pattern at the beginning of voiding, oscillate medium- and/or high-amplitude low-frequency bursting with a low-amplitude high-frequency bursting pattern during voiding, and high-amplitude high-frequency bursting pattern at the end of voiding. An average of 100 consecutive stimulations of EBCR for one cycle were performed in each dog and another cycle was repeated to ensure reproducibility. The lower and upper limits of the reference interval of EBCR onset latency values and EBCR mean amplitude values were calculated using both standard and robust methods with untransformed and transformed Box-Cox data. The EBCR onset latency was between 13.85 and 27.44 milliseconds, whereas the EBCR mean baseline to peak amplitude was not transformed with Box-Cox transformation. All EBCR compound muscle action potentials started with a negative sharp wave, which tapers from the baseline in the upward direction, showing an upturned bell-shaped curve. In conclusion, this study was possibly the first to examine the method and provide the electrographic pattern of EAS EMG during micturition and reference intervals of EBCR onset latency in spayed female dogs, which may serve as baseline information to help veterinarians differentiate healthy from diseased dogs. Further studies should compare normal dogs and dogs with lower urinary tract abnormalities at different lesion locations.

Effects of urinary of organophosphate metabolites on nerve conduction and neurobehavioral performance among farmers in northern Thailand.

Farmers are regarded as a high-risk population for pesticide exposure because of the frequency of their occupational exposure to organophosphate (OP) pesticides. The purposes of this study were 1) to compare urinary OP metabolites, nerve conduction, and neurobehavioral (NB) performance between farmers and a control group, as well as between baseline measurement and after spraying OP pesticides; 2) to investigate the factors associated with increased urinary OP metabolites after spraying OP pesticides; and 3) to investigate the effects of OP metabolites on changes in nerve conduction and NB performance after spraying OP pesticides. This study was conducted with a sample size of 71 farmers and a control group of 26. The findings showed that after spraying OP pesticides total dialkylphosphate (DAP) levels were significantly higher than baseline levels. Multiple linear regression showed that increased urinary OP metabolites among farmers after spraying pesticides were negatively associated with wearing a mask when spraying OP pesticides and positively associated with the number of years of farm work and type of sprayer equipment. The results also showed a positive association between the increased urinary total diethylphosphate (DEP) levels and the decreased amplitude of motor nerve conduction. Furthermore, a positive correlation was observed between increased urinary total DEP and decreased right amplitude of sympathetic skin response (SSR). An increase in urinary total DMP was positively associated with a decrease in raw score and a standard score of visual-motor integration (VMI). Our findings provide evidence that exposure to OP pesticides can cause a deficit in nerve conduction and NB performance in farmers. These findings may contribute to the early detection of neurological disease and inform strategies to prevent damage to the peripheral and central nervous systems.

Ischemic preconditioning upregulates Mitofusin2 and preserves muscle strength in tourniquet-induced ischemia/reperfusion.

Background: Tourniquet-induced ischemia and reperfusion (I/R) has been related to postoperative muscle atrophy through mechanisms involving protein synthesis/breakdown, cellular metabolism, mitochondrial dysfunction, and apoptosis. Ischemic preconditioning (IPC) could protect skeletal muscle against I/R injury. This study aims to determine the underlying mechanisms of IPC and its effect on muscle strength after total knee arthroplasty (TKA). Methods: Twenty-four TKA patients were randomized to receive either sham IPC or IPC (3 cycles of 5-min ischemia followed by 5-min reperfusion). Vastus medialis muscle biopsies were collected at 30 â€‹min after tourniquet (TQ) inflation and the onset of reperfusion. Western blot analysis was performed in muscle protein for 4-HNE, SOD2, TNF-ɑ, IL-6, p-Drp1ser616, Drp1, Mfn1, Mfn2, Opa1, PGC-1ɑ, ETC complex I-V, cytochrome c, cleaved caspase-3, and caspase-3. Clinical outcomes including isokinetic muscle strength and quality of life were evaluated pre- and postoperatively. Results: IPC significantly increased Mfn2 (2.0 â€‹± â€‹0.2 vs 1.2 â€‹± â€‹0.1, p â€‹= â€‹0.001) and Opa1 (2.9 â€‹± â€‹0.3 vs 1.9 â€‹± â€‹0.2, p â€‹= â€‹0.005) proteins expression at the onset of reperfusion, compared to the ischemic phase. There were no differences in 4-HNE, SOD2, TNF-ɑ, IL-6, p-Drp1ser616/Drp1, Mfn1, PGC-1ɑ, ETC complex I-V, cytochrome c, and cleaved caspase-3/caspase-3 expression between the ischemic and reperfusion periods, or between the groups. Clinically, postoperative peak torque for knee extension significantly reduced in the sham IPC group (-16.6 [-29.5, -3.6] N.m, p â€‹= â€‹0.020), while that in the IPC group was preserved (-4.7 [-25.3, 16.0] N.m, p â€‹= â€‹0.617). Conclusion: In TKA with TQ application, IPC preserved postoperative quadriceps strength and prevented TQ-induced I/R injury partly by enhancing mitochondrial fusion proteins in the skeletal muscle. The translational potential of this article: Mitochondrial fusion is a potential underlying mechanism of IPC in preventing skeletal muscle I/R injury. IPC applied before TQ-induced I/R preserved postoperative quadriceps muscle strength after TKA.

The reliability of neurobehavioral tests in a thai adult population / A confiabilidade dos testes neurocomportamentais em uma população adulta tailandesa

ABSTRACT Early detection of decline in neurobehavioral (NB) performance requires reliable methods of testing. Although NB tests have been shown to be consistent and reliable in Western countries, there has been limited research in Asian populations. Objective: The purpose of this study was to investigate the test-retest reliability of NB tests in a Thai adult population and examine the impact of demographic data on NB tests. The aspects of the tests chosen were memory, attention, hand-eye coordination, motor speed, and dexterity. Methods: The three NB tests used were digit span, Purdue Pegboard, and visual-motor integration. All three were administered to a population of 30 Thai adults. Results: The outcomes of all Pearson's correlation coefficient tests (r) were positive and greater than 0.60, and subtest-retest reliability correlation coefficients ranged from 0.63 (p<0.001) to 0.81 (p<0.001). Interestingly, the outcomes of all of these tests were not affected by demographic data, with the exception of the Purdue Pegboard test, in which performance on the preferred hand and both hands assessment was weakly associated with age (β=-0.09, p<0.001 and β=-0.08, p<0.05, respectively). Conclusions: NB tests have adequate reliability and are useful for the evaluation of clinical memory, attention, hand-eye coordination, motor speed, and dexterity in Thai adults. These tests were not affected by demographic data. However, further studies to measure the validity of the digit span, Purdue Pegboard, and visual-motor integration tests are needed.

RESUMO A detecção precoce do declínio no desempenho neurocomportamental (NC) requer métodos confiáveis de teste. Embora os testes NC tenham se mostrado consistentes e confiáveis em países ocidentais, as pesquisas em populações asiáticas ainda são limitadas. Objetivo: O objetivo deste estudo foi investigar a confiabilidade de teste-reteste dos testes NC em uma população adulta tailandesa e o impacto dos dados demográficos nos testes NC. Os aspectos dos testes escolhidos foram memória, atenção, coordenação óculo-manual, velocidade motora e destreza. Métodos: Os três testes RC utilizados foram o digit span, o Purdue Pegboard e a integração visomotora. Todos os três foram usados em uma população de 30 adultos tailandeses. Resultados: Os resultados de todos os testes de coeficiente de correlação de Pearson (r) foram positivos e superiores a 0,60, e os coeficientes de correlação de confiabilidade subteste-reteste variaram de 0,63 (p<0,001) a 0,81 (p<0,001). Curiosamente, os resultados de todos esses testes não foram afetados pelos dados demográficos, com exceção do teste Purdue Pegboard, no qual o desempenho na mão preferida e a avaliação de ambas as mãos foi fracamente associado à idade (β=-0,09, p<0,001 e β=-0,08, p<0,05, respectivamente). Conclusão: Os testes NC apresentam confiabilidade adequada e são úteis para avaliação da memória clínica, atenção, coordenação óculo-manual, velocidade motora e destreza em adultos tailandeses. Esses testes não foram afetados por dados demográficos. No entanto, são necessários mais estudos para medir a validade dos testes de digit span, Purdue Pegboard e IVM.

Estimation of diaphragm depth based on waist circumference in the Thai population.

INTRODUCTION/AIMS: There is a potential risk of causing a pneumothorax during needle electromyography of the diaphragm. The diaphragm depth can be estimated from body mass index (BMI), but this may not be practical in bedbound patients. The objectives of this study were to formulate correlation equations to estimate diaphragm depth based on waist circumference (WC) and determine their validity. METHODS: Personal data, weight, height, and WC were collected from healthy volunteers, and the diaphragm depth from the skin and diaphragm thickness of the participants were measured by ultrasonography. These data were used to formulate the equations for estimation of diaphragm depth based on WC, and the equations were validated by comparing the estimated diaphragm depths between BMI-based equations and WC-based equations. RESULTS: A total of 100 volunteers (48 men and 52 women) were recruited. The median age of the participants was 27 y (interquartile range, 26). The mean WC was 83.3 cm (SD, 7.8 cm). The diaphragm depth ranged between 1.0 and 2.7 cm. Equations for estimation of the diaphragm depth were created for each hemidiaphragm using data from 80 participants: left hemidiaphragm depth = (0.03 × WC) - 0.89 (r2  = 0.56); right hemidiaphragm depth = (0.03 × WC) - 0.94 (r2  = 0.55) with 10%-20% errors in 20 tested participants. The estimated diaphragm depths calculated from BMI and WC were comparable. DISCUSSION: The WC-based equation can be used in addition to palpation techniques for guiding needle EMG insertion when ultrasound guidance is not available.

Short incision versus minimally invasive surgery with tool-kit for carpal tunnel syndrome release: a prospective randomized control trial to evaluate the anterior wrist pain and time to return to work or activities.

TRIAL DESIGN: The prospective randomized controlled trial. BACKGROUND: This study compares outcomes in terms of early postoperative anterior wrist pain and time to return to work or activities of daily living of patients who underwent carpal tunnel syndrome (CTS) release with short incision and those who had minimally invasive surgery (MIS) with CTS kits. METHODS: A total of 24 patients diagnosed with primary CTS confirmed with electrodiagnosis at an academic university hospital were randomly assigned into one of two groups of 12 patients each: a short incision group and an MIS with tool-kit group using computer-generated block randomization (block of four). Sequentially numbered, opaque, sealed envelopes were used in the allocation concealment process. In the short incision group, skin was incised longitudinally from Kaplan's line to the area distal to transverse wrist crease (2.5-4.0 cm) while in the tool-kit group, an incision of less than 2.5 cm. was made using special MIS-CTS kits. Primary outcomes evaluated include visual analogue scale (VAS) measurement of pain intensity in the anterior carpal area both while at rest and while conducting daily activities at the 2nd week postoperatively as well as the time to return to activities of daily living and work. Improvement in the Michigan hand questionnaire (MHQ) score, a secondary outcome, was also measured at the 2nd week postoperatively. Patients, allocator and outcome assessor were blinded. RESULTS: Demographic data, including preoperative electrodiagnostic severity and occupation, were similar in the two groups. There were no significant differences in terms of VAS of the early postoperative anterior carpal area at rest (p > 0.99), while conducting daily activities (p = 0.89) and time to return to activities of daily living (p = 0.46) and work (p = 0.24). The MHQ score improvement at the 2nd week postoperatively showed no significant difference between the groups (p = 0.95). The MIS wound length in the tool-kit group was significantly shorter than in the short incision group (1.95 vs 2.92 cm, p < 0.01). CONCLUSIONS: There is no difference in early postoperative anterior wrist pain, time to return to work or to activities of daily living between the surgical techniques. Short incision is recommended for benefit in term of cost-effectiveness, while MIS with tool-kit could be preferred in patients who concerned in cosmetic appearance between the surgical techniques. TRIAL REGISTRATION: www. CLINICALTRIALS: in.th (TCTR20200530003). Registered 30 May 2020.

Validation of the Thai version of the Spinal Cord Independence Measure Self-Report (SCIM-SR-Thai).

STUDY DESIGN: Cross-sectional validation study OBJECTIVES: To cross-culturally translate and evaluate the psychometric properties of the Thai version of the Spinal Cord Independence Measure Self-Report (SCIM-SR-Thai) in Thai people with spinal cord injury (SCI) SETTING: Rehabilitation Ward at Maharaj Nakorn Chiang Mai Hospital METHODS: A cross-cultural forward and backward translation of the English version SCIM-SR into Thai was performed following the standard guideline. Sixty-one participants completed the SCIM-SR-Thai. On the same day, the rehabilitation medicine resident administered the Spinal Cord Independence Measure III (SCIM III) by observation. The Cronbach's alpha, Pearson's correlation coefficients and intraclass correlation coefficients (ICC) were used to assess internal consistency and concurrent validity, respectively. The Bland-Altman analysis and regression analysis evaluated the differences in scores between instruments. To explore the construct validity, confirmatory factor analysis (CFA) was conducted. RESULTS: The SCIM-SR-Thai provided excellent internal consistency (Cronbach's alpha ≥ 0.96). The Pearson's correlation coefficients and ICC revealed strong correlation with values of 0.93, 0.94, 0.95, and 0.97 in respiration and sphincter management, self-care, mobility, and total score, respectively. The regression analysis demonstrated that onset of injury of less than one year might be a possible predictor of the difference between the scores. CFA showed that the three-factor-model had an acceptable fit to the data but the unidimensional model fit the data better. CONCLUSIONS: The SCIM-SR-Thai had excellent internal consistency and good validity for evaluating functional independence in Thai people with SCI. Persons with recent onset of injury might have limited ability for self-assessment of their functions.

Differences in Knowledge, Awareness, Practice, and Health Symptoms in Farmers Who Applied Organophosphates and Pyrethroids on Farms.

OBJECTIVE: This cross-sectional study aimed to examine farmers' knowledge, awareness, practices regarding pesticide use, and prevalence of health symptoms related to pesticides exposure among farmers who applied organophosphates (OP) and pyrethroids (PY). METHODS: Data regarding demographic variables and health symptoms pertinent to pesticide use was collected from 67 farmers who applied OP and 50 farmers who applied PY using interviews from January to March 2021. RESULTS: The farmers who applied OP had lower knowledge, awareness, and prevention practices regarding pesticide use than those who applied PY. After adjustment of covariate variables, the farmers who applied OP had a significantly higher prevalence of respiratory conditions (OR = 8.29 for chest pain, OR = 6.98 for chest tightness, OR = 27.54 for dry throat, and OR = 5.91 for cough), neurological symptoms (OR = 10.62 for fatigue and OR = 6.76 for paresthesia), and neurobehavioral symptoms (OR = 13.84 for poor concentration, OR = 3.75 for short term memory, and OR = 8.99 for insomnia) related to pesticide exposure than those who applied PY. CONCLUSION: Our findings suggest that OP had a more adverse effect on human health than PY, resulting in a higher prevalence of pesticide-related symptoms. The outcomes of this study have the benefit of providing vital information for all stakeholders with regard to the implementation of safe practices in the utilization of personal protective equipment (PPE) and pesticide use in a health intervention and health promotion program.

CoenzymeQ10 and Ischemic Preconditioning Potentially Prevent Tourniquet-Induced Ischemia/Reperfusion in Knee Arthroplasty, but Combined Pretreatment Possibly Neutralizes Their Beneficial Effects.

Tourniquet (TQ) use during total knee arthroplasty (TKA) induces ischemia/reperfusion (I/R) injury, resulting in mitochondrial dysfunction. This study aims to determine the effects of coenzyme Q10 (CoQ10) and ischemic preconditioning (IPC), either alone or in combination, on I/R-induced mitochondrial respiration alteration in peripheral blood mononuclear cells (PBMCs) and pain following TKA. Forty-four patients were allocated into four groups: control, CoQ10, IPC, and CoQ10 + IPC. CoQ10 dose was 300 mg/day for 28 days. IPC protocol was three cycles of 5/5-min I/R time. Mitochondrial oxygen consumption rates (OCRs) of PBMCs were measured seven times, at baseline and during ischemic/reperfusion phases, with XFe 96 extracellular flux analyzer. Postoperative pain was assessed for 48 h. CoQ10 improved baseline mitochondrial uncoupling state; however, changes in OCRs during the early phase of I/R were not significantly different from the placebo. Compared to ischemic data, IPC transiently increased basal OCR and ATP production at 2 h after reperfusion. Clinically, CoQ10 significantly decreased pain scores and morphine requirements at 24 h. CoQ10 + IPC abolished analgesic effect of CoQ10 and mitochondrial protection of IPC. In TKA with TQ, IPC enhanced mitochondrial function by a transient increase in basal and ATP-linked respiration, and CoQ10 provides postoperative analgesic effect. Surprisingly, CoQ10 + IPC interferes with beneficial effects of each intervention.

The reliability of neurobehavioral tests in a thai adult population.

Early detection of decline in neurobehavioral (NB) performance requires reliable methods of testing. Although NB tests have been shown to be consistent and reliable in Western countries, there has been limited research in Asian populations. Objective: The purpose of this study was to investigate the test-retest reliability of NB tests in a Thai adult population and examine the impact of demographic data on NB tests. The aspects of the tests chosen were memory, attention, hand-eye coordination, motor speed, and dexterity. Methods: The three NB tests used were digit span, Purdue Pegboard, and visual-motor integration. All three were administered to a population of 30 Thai adults. Results: The outcomes of all Pearson's correlation coefficient tests (r) were positive and greater than 0.60, and subtest-retest reliability correlation coefficients ranged from 0.63 (p<0.001) to 0.81 (p<0.001). Interestingly, the outcomes of all of these tests were not affected by demographic data, with the exception of the Purdue Pegboard test, in which performance on the preferred hand and both hands assessment was weakly associated with age (ß=-0.09, p<0.001 and ß=-0.08, p<0.05, respectively). Conclusions: NB tests have adequate reliability and are useful for the evaluation of clinical memory, attention, hand-eye coordination, motor speed, and dexterity in Thai adults. These tests were not affected by demographic data. However, further studies to measure the validity of the digit span, Purdue Pegboard, and visual-motor integration tests are needed.

A detecção precoce do declínio no desempenho neurocomportamental (NC) requer métodos confiáveis de teste. Embora os testes NC tenham se mostrado consistentes e confiáveis em países ocidentais, as pesquisas em populações asiáticas ainda são limitadas. Objetivo: O objetivo deste estudo foi investigar a confiabilidade de teste-reteste dos testes NC em uma população adulta tailandesa e o impacto dos dados demográficos nos testes NC. Os aspectos dos testes escolhidos foram memória, atenção, coordenação óculo-manual, velocidade motora e destreza. Métodos: Os três testes RC utilizados foram o digit span, o Purdue Pegboard e a integração visomotora. Todos os três foram usados em uma população de 30 adultos tailandeses. Resultados: Os resultados de todos os testes de coeficiente de correlação de Pearson (r) foram positivos e superiores a 0,60, e os coeficientes de correlação de confiabilidade subteste-reteste variaram de 0,63 (p<0,001) a 0,81 (p<0,001). Curiosamente, os resultados de todos esses testes não foram afetados pelos dados demográficos, com exceção do teste Purdue Pegboard, no qual o desempenho na mão preferida e a avaliação de ambas as mãos foi fracamente associado à idade (ß=-0,09, p<0,001 e ß=-0,08, p<0,05, respectivamente). Conclusão: Os testes NC apresentam confiabilidade adequada e são úteis para avaliação da memória clínica, atenção, coordenação óculo-manual, velocidade motora e destreza em adultos tailandeses. Esses testes não foram afetados por dados demográficos. No entanto, são necessários mais estudos para medir a validade dos testes de digit span, Purdue Pegboard e IVM.

Cross­cultural adaptation, construct validity, reliability, and responsiveness of the Thai version of the Patient-Rated Wrist/Hand Evaluation (Thai PRWHE).

PURPOSE: To translate the Patient-Rated Wrist/Hand Evaluation (PRWHE) which is widely used as the evaluation in healthcare and research system in wrist/hand disorder patients into Thai (Thai PRWHE) and to examine its psychometric properties. METHODS: The PRWHE was translated to Thai, including cross-cultural adaptations, following standard guidelines. Psychometric properties were evaluated with 292 wrist/hand musculoskeletal disorder patients. Internal consistency was assessed using Cronbach's alpha. Intraclass correlation coefficient (ICC) was used to determine test-retest reliability over a 7-day interval. Construct validity was evaluated using two methods: Spearman's rank correlation of related and unrelated subscales and confirmatory factor analysis (CFA). Responsiveness was analyzed using the standardized response mean (SRM). RESULTS: All subscales had high Cronbach's alpha (0.91-0.96). Evaluation of the Pain subscale found good correlations with the Thai PRWHE and the Thai version of disabilities of the arm, shoulder, and hand (Thai DASH) questionnaire (r = 0.55, P < 0.0001) in related dimensions. Unrelated dimensions, the Total Function subscale of the Thai PRWHE, and the Mobility subscale of the Thai EQ-5D-5L had a weak correlation (r = 0.09, P < 0.12). Comparison of the one-factor solution and the bifactor model found the first-order three-factor solution fitted the data better than other models. The test-retest reliability with 61 patients in each subscale revealed excellent reliability (ICC = 0.94-0.96). In the assessment of responsiveness, the SRM with 54 patients was large (0.94). CONCLUSIONS: The Thai PRWHE has excellent internal consistency in all modules and good construct validity and reliability for Thai patients and provides a large standardized response mean after treatment.

Reliability of the international spinal cord injury urodynamic basic data set version 1.0.

STUDY DESIGN: A cross-sectional study. OBJECTIVE: To assess interrater and intrarater reliability of the International Spinal Cord Injury (SCI) Urodynamic Basic Data Set (UBS) version 1.0. SETTING: Urodynamic clinic at Maharaj Nakorn Chiang Mai Hospital. METHODS: Two raters independently analyzed urodynamic tracings from 50 patients and completed the UBS twice, each test 1 month apart. The interrater and intrarater reliability of this data set were analyzed using Kappa, Weighted Kappa, and the Intraclass correlation coefficient (ICC). RESULTS: Of the 50 patients, 72% were male. The mean (SD) age was 48.2 (16.6) years. The median time (IQR) since the injury was 27 months (0-101 months). The interrater reliability of the items of UBS were substantial to almost perfect (0.78-0.99). The intrarater reliability of the first rater was fair to almost perfect (0.37-1.00). The intrarater reliability of the second rater was moderate to almost perfect (0.51-1.00). Relatively low interrater and intrarater reliability were observed in bladder compliance and urethral function items. CONCLUSION: The first version of UBS has acceptable interrater and intrarater reliability on most items. Although bladder compliance and urethral function have problematic interrater and intrarater reliability, they have been adjusted in the second version. Due to its simplicity and reliability, UBS is clinically useful for urodynamic assessment in people with SCI.

A Thai version of the Michigan hand questionnaire (Thai MHQ): an investigation of the psychometric properties.

BACKGROUND: The Michigan Hand Questionnaire (MHQ) is widely used to assess the hand/wrist conditions. We translated the original version into Thai (Thai MHQ) and evaluated its psychometric properties. METHODS: After receiving permission, the original MHQ was translated and cross-culturally adapted to Thai following standard guidelines. Two hundred and seventeen patients who had hand/wrist injuries or disorders were included in the study. Internal consistency was evaluated using Cronbach's alpha. Test-retest reliability was analyzed using the intraclass correlation coefficient (ICC). Spearman's rank correlation among the subscales of Thai MHQ, Thai DASH and Thai EQ-5D-5L and also confirmatory factor analysis (CFA) were used to explore construct validity. The standardized response mean (SRM) was used to evaluate the responsiveness of the Thai MHQ. RESULTS: All subscales showed an acceptable Cronbach's alpha (0.79-0.98). The test-retest reliability of each subscale was good (ICC = 0.83-0.95). In related dimensions, strong correlation was demonstrated between the Activities of daily living subscale of the Thai MHQ and the Common activities subscale in the Thai DASH (r = 0.77, P < 0.0001). For unrelated dimensions, a weak correlation was found between the Aesthetics subscale in the Thai MHQ and the Mobility subscale in the Thai EQ-5D-5L (r = - 0.13, P = 0.05). The Thai MHQ had strong correlation with Thai DASH (r = - 0.79, P < 0.0001) and Thai EQ-5D-5L (r = 0.63, P < 0.0001). CFA showed that the 6-factor model demonstrated an acceptable fit to the data. The SRM of the Thai MHQ was 0.78, indicating relatively large responsiveness. The MIC of Thai MHQ using distribution methods (SEM) was 5.2. CONCLUSIONS: The Thai MHQ provides adequate internal consistency in all subscales as well as good construct validity and reliability for Thai patients and a relatively large standardized response mean at 2 months after treatment.

The reliability and validity of the International Spinal Cord Injury Quality of Life Basic Data set in people with spinal cord injuries from a middle-income country: a psychometric study of the Thai version.

STUDY DESIGN: A cross-sectional study. OBJECTIVES: To examine psychometric properties, including internal consistency, construct validity, and test-retest reliability, of the Thai version of the International Spinal Cord Injury (ISCI) Quality of Life Basic Data Set (QoL-BDS). SETTING: Outpatient rehabilitation clinic, urodynamic clinic, and rehabilitation ward at Maharaj Nakorn Chiang Mai Hospital. METHODS: Participants were assigned to complete two assessment tools, the Thai version of QoL-BDS which consisted of three single items on satisfaction with life as a whole, physical health and psychological health, and the Thai version of the World Health Organization Quality of Life instrument (WHOQOL-BREF) completed by face to face interview. After 2 weeks, the participants were evaluated the QoL-BDS again via telephone interviewing to assess test-retest reliability. RESULTS: One hundred and thirty people with spinal cord injury (SCI) were included in the study. Of all participants, 103 people had a traumatic SCI. The mean (SD) age was 43.0 (13.1) years and the median (IQR) time after SCI was 7.5 (1-14) years. The Thai version of QoL-BDS had good internal consistency (Cronbach's alpha = 0.89), fair to good construct validity (Spearman's rank correlation coefficient of 0.43-0.57, p < 0.01) and good to excellent test-retest reliability (Intraclass correlation coefficient of 0.73-0.86). CONCLUSIONS: The Thai version of QoL-BDS had acceptable psychometric properties. As it is concise, QoL-BDS should be encouraged in healthcare providers to investigate QoL in people with SCI, especially in middle-income countries.

Double Motor Nerve Transfer for All Finger Flexion in Cervical Spinal Cord Injury: An Anatomical Study and a Clinical Report.

PURPOSE: To explore the feasibility of restoring all finger flexion after a cervical spinal cord injury. METHODS: Double nerve transfer was conducted in 22 cadaver upper extremities. Donor nerves were the brachialis branch of the musculocutaneous nerve and the extensor carpi radialis brevis (ECRB) branches of the radial nerve. Recipient nerves were the anterior interosseous nerve (AIN) and the flexor digitorum profundus (FDP) branch of ulnar nerve (ulnar-FDP). Nerve transfers were evaluated on 3 parameters: surgical feasibility, donor-to-recipient axon count ratio, and distance from the coaptation site to the muscle entry of recipient nerve. A complete C6 spinal cord injury reconstruction was accomplished in a patient using a double nerve transfer of ECRB to ulnar-FDP and brachialis to AIN. RESULTS: In the cadaver study, nerve transfers from ECRB to AIN, brachialis to AIN, and ECRB to ulnar-FDP were all feasible. The transfer from the brachialis to ulnar-FDP was not possible. Mean myelinated axon counts of AIN, brachialis, ulnar-FDP, and ECRB were 2,903 ± 1049, 1,497 ± 606, 753 ± 364, and 567 ± 175, respectively. The donor-to-recipient axon count ratios of ECRB to AIN, brachialis to AIN, and ECRB to ulnar-FDP were 0.24 ± 0.15, 0.55 ± 0.38, and 0.98 ± 0.60, respectively. The distance from coaptation of the ECRB to the ulnar-FDP muscle entry was shorter than for the other nerve transfers (54 ± 14.29 mm). At 18 months, there was restoration of flexion in all fingers and functional improvement from double nerve transfer of the brachialis to the AIN and the ECRB to the ulnar-FDP. CONCLUSIONS: Restoration of all finger flexion may be feasible by the ECRB to ulnar-FDP and brachialis to AIN double nerve transfer. CLINICAL RELEVANCE: Double nerve transfer can be used in C6-C7 spinal cord injury and patients with lower arm-type brachial plexus injury who have no finger flexion but have good brachialis and ECRB.

Construct validity, test-retest reliability and internal consistency of the Thai version of the disabilities of the arm, shoulder and hand questionnaire (DASH-TH) in patients with carpal tunnel syndrome.

OBJECTIVE: This study evaluated additional psychometric properties of the Thai version of the disabilities of the arm, shoulder and hand questionnaire (DASH-TH) which included, test-retest reliability, construct validity, internal consistency of in patients with carpal tunnel syndrome. As for determining construct validity, the Thai EuroQOL questionnaire (EQ-5D-5L) was also administered in order to examine convergent and divergent validity. RESULTS: Fifty patients completed both questionnaires. The DASH-TH showed excellent test-retest reliability (intraclass correlation coefficient = 0.811) and internal consistency (Cronbach's alpha = 0.911). The exploratory factor analysis yielded a six-factor solution while the confirmatory factor analysis denoted that the hypothesized model adequately fit the data with a comparative fit index of 0.967 and a Tucker-Lewis index of 0.964. The related subscales between the DASH-TH and the Thai EQ-5D-5L were significantly correlated, indicating the DASH-TH's convergent and discriminant validity. The DASH-TH demonstrated good reliability, internal consistency construct validity, and multidimensionality, in assessing the upper extremity function in carpal tunnel syndrome patients.