Transcranial direct current stimulation (tDCS) for neurological disability among subacute stroke survivors to improve multiple domains in health-related quality of life: Randomized controlled trial protocol.

OBJECTIVES: The primary goal of the current proposal is to fill the gaps in the literature by studying the effectiveness of transcranial direct current stimulation (tDCS) on lifestyle parameters, and physical, behavioral, and cognitive functions among stroke survivors, and understanding the factors that mediate the effects of various domains related to Health-related Quality of life (HRQoL) improvements. METHODS: Anticipated 64 volunteer subacute stroke survivors (>7 days to 3 months post stroke) aged 40-75 years with National Institutes of Health stroke scale (NIHSS) score of >10 and Mini-Mental State Examination (MMSE) score between 18 and 23 will be randomly assigned at a ratio of 1:1 to receive either: (1) 20 sessions of anodal tDCS or (2) sham tDCS in addition to conventional rehabilitation. Battery driven tDCS will be applied at 2 mA intensity to the dorsolateral prefrontal cortex and primary motor cortex for 20 minutes. The primary endpoints of study will be 36-Item Short Form Survey (SF-36) post intervention at 4 weeks. The secondary outcomes will include Stroke Specific Quality of Life Scale (SS_QOL), Montreal cognitive assessment (MCA), Beck Anxiety Inventory (BAI), Fugl-Meyer Assessment (FMA), 10 m walk test and Modified Barthel Activities of daily living (ADL) Index. At 0.05 level of significance, data normality, within group and between group actual differences will be analyzed with a moderate scope software. DISCUSSION: Our knowledge of this technique and its use is expanding daily as tDCS motor recovery studies-mostly single-center studies-in either single session or many sessions have been completed and shown positive results. The field is prepared for a multi-center, carefully planned, sham-controlled, double-blinded tDCS study to comprehensively examine its feasibility and effectiveness in enhancing outcomes in stroke population. CONCLUSION: The function of Transcranial Direct Current Stimulation in aiding stroke recuperation will be ascertained.

Multisite Pain and Intensity were Associated with History Fall among Older Adults: A Cross-Sectional Study.

Purpose: This study examined the independent associations among multisite pain, pain intensity, and the risk of falls, including a history of falls in the previous 12 months and frequent falls (≥ two falls vs one or two falls) among community-dwelling older adults. Methods: A cross-sectional design from Wave 2 of the National Social Life, Health, and Aging Project was used. Data on pain intensity and location (45 sites) over the past 4 weeks were collected. Multisite pain was categorized into four groups: none, one, two, and three or more sites. The main outcomes of falls were a history of falls and frequent falls. The covariates included age, sex, race, body mass index, education, medications, and comorbidities. Results: Among 3,196 participants in Wave 2, 2,697 were included because of missing key variables related to pain and fall history. The prevalence of falls and frequent falls were 30.3% (n = 817) and 12.6% (n = 339), respectively. Multisite pain at ≥ three sites (odds ratio (OR) 2.04, confidence interval (CI) [1.62, 2.57]; p < 0.001) and two sites (OR 1.72, 95% CI [1.30, 2.27]; p < 0.001) was significantly associated with an increased risk of falls. An increase in pain intensity was significantly associated with an increased risk of fall (OR 1.28, 95% CI [1.15, 1.44], p < 0.001), independent of multisite pain. Multisite pain at ≥3 sites (OR 2.19, 95% CI [1.56, 3.07], p < 0.001) and 2 sites (OR 1.54, 95% CI [1.01, 2.34], p = 0.045) was associated with an increased risk of frequent falls. An increase in pain intensity was associated with risk of frequent falls (OR 1.64, 95% CI [1.40, 1.91], p < 0.001), independent of multisite pain. Conclusion: Multisite pain and pain intensity were associated with a history of falls and frequent falls among older adults, emphasizing the need for routine pain evaluation to develop fall prevention strategies in this population.

Effects of trunk exercises using virtual reality technology on trunk performance and impairment post stroke: a systematic review and meta-analysis.

OBJECTIVE: To systematically explore the effects of trunk exercises using virtual reality technology compared to conventional exercises for trunk impairment in patients with subacute and chronic strokes. METHODS: A comprehensive search of literature published from inception until December 2022 was conducted using PubMed, Cochrane Library, Web of Science, Scopus, IEEE, and the Physiotherapy Evidence Database (PEDro). The inclusion criteria encompassed all randomized controlled trials (RCT) published in the English language involving adults who had had strokes and the evaluation of the effectiveness of virtual reality -based trunk exercises in reducing trunk impairment post stroke as measured by the trunk control test (TCT) and/or the trunk impairment scale (TIS) compared to conventional trunk exercises. RESULT: A total of 397 studies were retrieved, and six studies were included in the current analysis. A random-effects meta-analysis of six studies indicated that video games had a very large, significant effect (SMD = 1.11; 95%, P < 0.0001) on the delivery of trunk exercises to reduce trunk impairment post stroke at both the subacute and chronic stages. CONCLUSION: The study findings indicate that trunk exercises using virtual reality have a highly significant effect on reducing trunk impairment in patients with subacute and chronic stroke. Large RCTs are needed to study the effects of virtual reality trunk exercises on the acute, subacute, and chronic stages of stroke.

Prevalence and risk factors for falls among community-dwelling adults in Riyadh area.

Objectives: This study aimed to assess fall prevalence, identify related risk factors, and establish cut-off scores for fall risk measures among community-dwelling adults in Riyadh region of Saudi Arabia. Methods: A cross-sectional study was conducted in community, Riyadh city, Saudi Arabia. A sample of 276 Saudi citizens aged ≥40 years who were able to read and write in Arabic. Fall history and number of falls in the past 12 months were determined via self-reports. Variables assessed included demographic information, self-reported chronic diseases, depressive symptoms, and back pain severity. Results: Participants were classified as either fallers (n = 28, 10.14%) or non-fallers. Fallers were more likely to have arthritis (odds ratio [OR]: 7.60, p = 0.001), back pain (OR: 5.22, p = 0.002), and higher depressive symptom scores (OR: 1.09, p = 0.013) than non-fallers. The number of reported falls was significantly associated with an elevated body mass index (incidence rate ratio [IRR]: 1.09, p = 0.045), arthritis (IRR: 8.74, p < 0.001), back pain (IRR: 4.08, p = 0.005), neurological diseases (IRR: 13.75, p < 0.007), and depressive symptoms (IRR: 1.08, p = 0.005). Cut-off scores predictive of falls associated with back pain and depressive symptoms were 1.5 (sensitivity: 0.61; specificity: 0.79; area under the curve [AUC]: 0.70) and 11.5 score (sensitivity: 0.57; specificity: 0.76; AUC: 0.66), respectively. Conclusions: The prevalence of falls was relatively low among the individuals considered in this study. Chronic conditions, back pain severity, and depressive symptoms were determined to be associated with falls among community-dwelling individuals in Saudi Arabia.

Parental knowledge of children's motor development: A cross-sectional study in Saudi Arabia.

BACKGROUND: This study was undertaken to explore parental knowledge of normal motor development. In addition, the association between parental knowledge and characteristics was investigated. METHODS: A cross-sectional design was adopted for this study. An online survey was used to administer a four-part questionnaire designed for this study. The first part of the questionnaire focused on demographic information, such as age, age at birth of first child, and educational level. The second part consisted of questions about birth-related information sources, and the third part included questions about normal motor development. The fourth part was directed to participants who had children with DDs. The data were analysed descriptively and reported using absolute and relative frequencies. Linear regression was used to investigate the association between parental knowledge level and gender, age, education, age at first birth, number of children, and self-rated knowledge level. RESULTS: A total of 4081 participants responded to the survey. Most participants were found to have low levels of parental knowledge, as 88.87% answered ≤ 50% of the developmental milestone questions correctly. Being a female and having a university education were significantly associated with high knowledge levels (p < 0.001 for both variables). Further, undergoing an awareness programme about normal child development was significantly associated with high knowledge levels (p = 0.02). No association was found between the factors of age, age at first birth, number of children, and knowledge rating and the level of parental knowledge about normal physical development. CONCLUSION(S): There is a lack of appropriate knowledge about normal motor development among parents in Saudi Arabia, which raises serious concerns about children's health in the country. IMPLICATIONS: Effective health education programmes on normal developmental milestones should be implemented by the Ministry of Health to improve the developmental outcomes of children in Saudi Arabia.

Osteoarthritis and Diabetes: Where Are We and Where Should We Go?

Diabetes mellitus (DM) and osteoarthritis (OA) are chronic noncommunicable diseases that affect millions of people worldwide. OA and DM are prevalent worldwide and associated with chronic pain and disability. Evidence suggests that DM and OA coexist within the same population. The coexistence of DM in patients with OA has been linked to the development and progression of the disease. Furthermore, DM is associated with a greater degree of osteoarthritic pain. Numerous risk factors are common to both DM and OA. Age, sex, race, and metabolic diseases (e.g., obesity, hypertension, and dyslipidemia) have been identified as risk factors. These risk factors (demographics and metabolic disorder) are associated with DM or OA. Other possible factors may include sleep disorders and depression. Medications for metabolic syndromes might be related to the incidence and progression of OA, with conflicting results. Given the growing body of evidence indicating a relationship between DM and OA, it is vital to analyze, interpret, and integrate these findings. Therefore, the purpose of this review was to evaluate the evidence on the prevalence, relationship, pain, and risk factors of both DM and OA. The research was limited to knee, hip, and hand OA.

Validity and reliability of sensor system to measure trunk range of motion during Streamlined Wolf Motor Function Test in chronic stroke and aged-matched healthy participants.

OBJECTIVE: To investigate the validity and reliability of using the Valedo® system to measure trunk Range of Motion (ROM) during performance of the streamlined Wolf Motor Function Test (SWMFT). METHODS: Twenty chronic strokes and 20 age-matched healthy participants performed SWMFT while wearing Valedo® sensors on their trunks to capture trunk movements. A paired sample T-test was used to examine the validity of the system in distinguishing between the healthy and stroke group, and between the affected and unaffected sides in the stroke group. Interclass correlation coefficients were used to assess the inter-rater and intra-rater reliability (between-days) with 95% CI. RESULTS: The Valedo® system was able to distinguish between stroke and healthy participants; stroke participants employed greater trunk range of movements than the healthy controls in all tasks (p < .01). Furthermore, the Valedo® system enabled differentiation between affected and unaffected hands of people within the stroke group. The reliability for the stroke group was good to excellent with intrarater reliability (ICC = 0.71-0.92) and interrater reliability (ICC = 0.63-0.95). CONCLUSIONS: The Valedo system demonstrates an acceptable level of validity and reliability for measuring trunk ROM during the Streamlined Wolf Motor Function Test (SWMFT). Future studies with a larger sample size, different levels of upper limb impairment are warranted.

Instrumented trunk impairment scale (iTIS): A reliable measure of trunk impairment in the stroke population.

BACKGROUND: The Trunk Impairment Scale (TIS) is recommended for use in clinical research to assess trunk impairment post-stroke. However, it is observer dependent and does not consider the quality of trunk movement. To address these challenges, this study proposes an instrumented TIS (iTIS). OBJECTIVE: This study aims to investigate the intra-rater and inter-rater reliability of the iTIS in chronic stroke patients. METHOD: Trunk impairment was assessed in 20 patients with stroke using the iTIS Valedo system; three sensors were fixed to the skin on the sternum, L1 and S1 levels. Interclass correlation coefficients were used to assess the inter-rater and intra-rater reliability (between days) with 95% CI. RESULTS: Reliability for the dynamic subscale parameters was good to excellent (intra-rater ICC = 0.60-0.95; inter-rater ICC = 0.59-0.93); however, reliability for the coordination parameters was poor to good (intra-rater ICC = 0.05-0.72) and poor to excellent (inter-rater ICC = 0.04-0.78). CONCLUSION: The iTIS demonstrates an acceptable level of reliability for dynamic subscale measurement in research and clinical practice. Further studies could use larger sample sizes and improve the iTIS methodology by employing additional sensors on the limbs to detect compensatory movements.

Concurrent Validity of a Novel Wireless Inertial Measurement System for Assessing Trunk Impairment in People with Stroke.

Background: The Trunk Impairment Scale (TIS) is recommended for clinical research use to assess trunk impairment post-stroke. However, it is observer-dependent and neglects the quality of trunk movements. This study proposes an instrumented TIS (iTIS) using the Valedo system, comprising portable inertial sensors, as an objective measure of trunk impairment post-stroke. Objective: This study investigates the concurrent and discriminant ability of the iTIS in chronic stroke participants. Method: Forty participants (20 with chronic stroke, 20 healthy, age-matched) were assessed using the TIS and iTIS simultaneously. A Spearman rank correlation coefficient was used to examine concurrent validity. A ROC curve was used to determine whether the iTIS could distinguish between stroke participants with and without trunk impairment. Results: A moderate relationship was found between the observed iTIS parameters and the clinical scores, supporting the concurrent validity of the iTIS. The small sample size meant definitive conclusions could not be drawn about the parameter differences between stroke groups (participants scoring zero and one on the clinical TIS) and the parameter cut-off points. Conclusion: The iTIS can detect small changes in trunk ROM that cannot be observed clinically. The iTIS has important implications for objective assessments of trunk impairment in clinical practice.

Do trunk exercises improve trunk and upper extremity performance, post stroke? A systematic review and meta-analysis.

BACKGROUND: Post-stroke trunk control is reported to be associated with trunk performance and recovery of the upper limb, but the evidence for the influence of trunk exercise on both of these is unclear. OBJECTIVE: To evaluate the effect of trunk exercises on trunk performance post-stroke, and to determine if these exercises result in improved upper limb function. METHODS: A comprehensive search of the literature published between January 1990 and February 2017 was conducted using the following electronic databases; AMED, CINAHL, Cochrane Library, EMBASE, MEDLINE, PsychInfo and SPORTDiscus. Only randomized, controlled trials, published in English, evaluating the effect of trunk exercises on trunk performance and/or upper limb function post-stroke, were included. RESULTS: A total of 17 studies involving 599 participants were analysed. Meta-analysis showed that trunk exercises had a large significant effect on trunk performance post-stroke. This effect varied from very large for acute stroke to medium for subacute and chronic stroke. None of the included studies had measured the effect of trunk exercise on upper limb impairment or functional activity. CONCLUSIONS: Trunk exercises improve trunk performance for people with acute, subacute and chronic strokes. As yet there is no evidence to support the effect of trunk exercise on upper limb function.