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.

Investigating psychometric properties of the arm activity measure - Thai version (ArmA-TH) sub-scales using the Rasch model.

BACKGROUND: This study investigated the ArmA-TH sub-scale measurement properties based on item response theory using the Rasch model. METHODS: Patients with upper limb hemiplegia resulting from cerebrovascular and other brain disorders were asked to complete the ArmA-TH questionnaire. Rasch analysis was performed to test how well the ArmA-TH passive and active function sub-scales fit the Rasch model by investigating unidimensionality, response category functioning, reliability of person and item, and differential item functioning (DIF) for age, sex, and education. RESULTS: Participants had stroke or other acquired brain injury (n = 185), and the majority were men (126, 68.1 %), with a mean age of 55 (SD 22). Most patients (91, 49.2 %) had graduated from elementary/primary school. For the ArmA-TH passive function scale, all items had acceptable fit statistics. The scale's unidimensionality and local independence were supported. The reliability was acceptable. A disordered threshold was found for five items, and none indicated DIF. For the ArmA-TH active function scale, one item was misfit and three were locally dependent. The reliability was good. No items showed DIF. All items had disordered thresholds, and the data fitted the Rasch model better after rescoring. CONCLUSIONS: Both sub-scales of ArmA-TH fitted the Rasch model and were valid and reliable. The disordered thresholds should be further investigated.

The Effectiveness and Safety of Commonly Used Injectates for Ultrasound-Guided Hydrodissection Treatment of Peripheral Nerve Entrapment Syndromes: A Systematic Review.

Background: Peripheral nerve entrapment syndromes commonly result in pain, discomfort, and ensuing sensory and motor impairment. Many conservative measures have been proposed as treatment, local injection being one of those measures. Now with high-resolution ultrasound, anatomical details can be visualized allowing diagnosis and more accurate injection treatment. Ultrasound-guided injection technique using a range of injectates to mechanically release and decompress the entrapped nerves has therefore developed called hydrodissection or perineural injection therapy. Several different injectates from normal saline, local anesthetics, corticosteroids, 5% dextrose in water (D5W), and platelet-rich plasma (PRP) are available and present clinical challenges when selecting agents regarding effectiveness and safety. Aims: To systematically search and summarize the clinical evidence and mechanism of different commonly used injectates for ultrasound-guided hydrodissection entrapment neuropathy treatment. Methods: Four databases, including PubMed, EMBASE, Scopus, and Cochrane were systematically searched from the inception of the database up to August 22, 2020. Studies evaluating the effectiveness and safety of different commonly used injectates for ultrasound-guided hydrodissection entrapment neuropathy treatment were included. Injectate efficacy presents clinical effects on pain intensity, clinical symptoms/function, and physical performance, electrodiagnostic findings, and nerve cross-sectional areas. Safety outcomes and mechanism of action of each injectate were also described. Results: From ten ultrasound-guided hydrodissection studies, nine studies were conducted in carpal tunnel syndrome and one study was performed in ulnar neuropathy at the elbow. All studies compared different interventions with different comparisons. Injectates included normal saline, D5W, corticosteroids, local anesthetics, hyaluronidase, and PRP. Five studies investigated PRP or PRP plus splinting comparisons. Both D5W and PRP showed a consistently favorable outcome than those in the control group or corticosteroids. The improved outcomes were also observed in comparison groups using injections with normal saline, local anesthetics, or corticosteroids, or splinting. No serious adverse events were reported. Local steroid injection side effects were reported in only one study. Conclusion: Ultrasound-guided hydrodissection is a safe and effective treatment for peripheral nerve entrapment. Injectate selection should be considered based on the injectate mechanism, effectiveness, and safety profile.

Preliminary evaluation of the reliability, validity and feasibility of the arm activity measure - Thai version (ArmA-TH) in cerebrovascular patients with upper limb hemiplegia.

BACKGROUND: Upper limb hemiplegia following cerebrovascular diseases can result in significant functional limitation. To assess such functional disturbance requires a comprehensive, valid and reliable tool. The Arm Activity Measure (ArmA) is a comprehensive, valid and reliable self-report questionnaire to assess real-life function for upper limb hemiplegia. However, it has never been translated for use in different languages. The purpose of this study is to translate and cross-culturally adapt the Arm Activity Measure (ArmA) questionnaire into a Thai version and to evaluate content validity, internal consistency and feasibility. METHODS: The ArmA was translated and culturally adapted according to published cross-cultural adaptation guidelines resulting in the Thai version of ArmA (ArmA-TH). Forty Thai patients with upper limb hemiplegia resulting from cerebrovascular disorders participated in field-testing of the ArmA-TH. Its feasibility was evaluated. Content validity index for item (I-CVI) and score (S-CVI) were examined. Inter-rater reliability was evaluated by Gwet's AC2. Internal consistency was measured using Cronbach's alpha coefficient. RESULTS: Forty patients (29 males, 11 females) with upper limb spasticity due to stroke or TBI were included. The average age of patients was 54.5 years (SD 15.0). Twenty-seven patients (67.5%) completed the questionnaire within 5 min or less, average time taken was 4.45 (1.73) min. For both subscales, patients reported the ArmA-TH to be relevant (85%) and easy to use (67.5%). More than 80% of patients found the passive subscale useful, almost 80% found the active subscale useful. Overall S-CVI was 0.83, S-CVI for passive and active function subscale was 0.79 and 0.86 respectively. The inter-rater reliability coefficients for ArmA-TH was 0.81. Cronbach's alpha was 0.90 for the overall ArmA, 0.89 and 0.88 for the passive and active function subscales. CONCLUSIONS: The ArmA-TH was a feasible self-report questionnaire to assess hemiplegic upper limb function with good content validity, inter-rater reliability and internal consistency.

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.

Prognostic predictors for ambulation in children with cerebral palsy: a systematic review and meta-analysis of observational studies.

PURPOSE: The purpose of this study is to investigate the prognostic predictors for ambulation in children with cerebral palsy using meta-analysis of observational studies. METHOD: Electronic searches were conducted in PubMed, SCOPUS, CINAHL, ProQuest, Ovid, Wiley InterScience, and ScienceDirect databases from their start dates to December 2015. RESULTS: Of the 1123 identified articles, 12 met the inclusion criteria for qualitative synthesis, eight of which were deemed appropriate for meta-analysis. Qualitative synthesis found that the type of cerebral palsy, early motor milestones, primitive reflexes and postural reactions, absence of visual impairment, absence of intellectual disability, absence of epilepsy or seizure, and ability to feed self were indicated as potential predictors for ambulation. Meta-analysis detected four significant prognostic predictors for ambulation: sitting independently at 2 years, absence of visual impairment, absence of intellectual disability, and absence of epilepsy or seizure. CONCLUSION: These prognostic predictors should be taken into consideration in therapeutic plans and rehabilitation goals, especially sitting independently before the age of 2 years. Implications for rehabilitation The meta-analysis supports strong evidence that sitting independently at 2 years of age, absence of visual impairment, absence of intellectual disability, and absence of epilepsy or seizure are positive predictors for ambulation in children with cerebral palsy. The therapeutic plans and rehabilitation goals should be considered cautiously for these predictors, especially sitting independently before the age of two years.

Influence of Rehabilitation Medicine Residency Training in Performing Chemodenervation in Children with Cerebral Palsy in Thailand.

Background: Chemodenervation (CD) involves injecting drugs such as phenol, botulinum toxin, or alcohol to reduce muscle spasticity. However, they interfere with daily activities of children with cerebral palsy (CP). Rehabilitation residency training in Thailand currently requires performing a minimum of five CD procedures. However, the effect of this policy on post-training practice is unknown. Objective: To explore the influence of CD training during residency on post-training clinical practice and their current use of it in treating CP patients. Material and Method: The questionnaires were sent to 431 Thai physiatrists nationwide by both electronic and postal mails. The responses were collected within a three-month period. Results: Of 116 (27%) respondents with usable questionnaires, 85 (73%) were trained during their residency to perform CD and 46 (40%) performed it in their practice. Those trained to perform CD were more likely in their subsequent practice to do so (p = 0.0140), and younger age was associated with performing it (p = 0.0055). The number of CD procedures performed during residency correlated directly with reported confidence in performing the procedure in later practice (p<0.0001). The most common reasons for not performing CD were few CP cases in their care, and unavailable equipment or injection agent. Conclusion: Although only a cross-sectional study, the findings suggest that increasing the number of CD procedures required in rehabilitation residency may increase the use of CD to benefit CP patients in future clinical practice.

Multiple Neuromas Cause Painful "Jumping Stump" in a Transfemoral Amputee: A Case Report.

Painful "jumping stump" is an uncommon but very disturbing complication postamputation. This condition is one of the movement disorder entities resulting from peripheral nerve pathology, often known as "peripherally induced movement disorders." Previously case reports have been written about painful and nonpainful incidence of "jumping stump"; however, only the earliest "jumping stump" article in 1852 suspected that neuromas might influence the involuntary movement. In this study, we describe a 38-year-old man with bilateral transfemoral amputee who suffered from painful "jumping stump" with multiple neuromas confirmed by imaging. He was treated successfully by ultrasound-guided phenol injection into the sciatic neuroma stalks. The pathophysiology of jumping stump and its possible association with neuroma are briefly discussed.

Derivation of an Ambulatory Prognostic Score Chart for Thai Children with Cerebral Palsy Aged 2 to 18.

Background: Most parents want to know that their children with cerebral palsy will be able to walk. A simple tool to predict ambulatory status and one uses The Gross Motor Function Classification System is still lacking. Objective: To develop a simple prognostic score chart for predicting ambulatory status in Thai children with cerebral palsy. Material and Method: Four hundred seventy one children with cerebral palsy aged 2 to 18 registered and treated at six special schools or hospitals for children with physical disability between 2008 and 2013 were recruited. Baseline characteristics and clinical histories of children with cerebral palsy were collected from medical and physical therapy records. Ambulatory status was classified as three ordinal scales by The Gross Motor Function Classification System - Expanded and Revised version. Results: Multivariable ordinal continuation ratio logistic regression analysis identified age, type of cerebral palsy, sitting independently at the age of two, and eating independently as significant predictors of ambulation. These items were combined into a clinical prediction score: non-ambulation (scores <7), assisted ambulation (scores 7 to 8), and independent ambulation (scores >8). Conclusion: The prognostic tool has high discriminative values of ambulatory status among children with cerebral palsy. However, the validation of this tool needs to be tested in other subjects before clinical practice application.

Prognostic Predictors for Ambulation in Thai Children With Cerebral Palsy Aged 2 to 18 Years.

The objectives of this study were to determine prognostic predictors for ambulation among Thai children with cerebral palsy and identify their ambulatory status. A retrospective cohort study was performed at 6 special schools or hospitals for children with physical disabilities. The prognostic predictors for ambulation were analyzed by multivariable ordinal continuation ratio logistic regression. The 533 participants aged 2 to 18 years were divided into 3 groups: 186 with independent ambulation (Gross Motor Function Classification System [GMFCS I-II]), 71 with assisted ambulation (Gross Motor Function Classification System III), and 276 with nonambulation (Gross Motor Function Classification System IV-V). The significant positive predictors for ambulation were type of cerebral palsy (spastic diplegia, spastic hemiplegia, dyskinesia, ataxia, hypotonia, and mixed type), sitting independently at age 2 years, and eating independently. These predictors were used to develop clinical scoring for predicting the future ability to walk among Thai children with cerebral palsy.

Efficacy and safety of Curcuma domestica extracts compared with ibuprofen in patients with knee osteoarthritis: a multicenter study.

OBJECTIVE: To determine the efficacy and safety of Curcuma domestica extracts in pain reduction and functional improvement. METHODS: 367 primary knee osteoarthritis patients with a pain score of 5 or higher were randomized to receive ibuprofen 1,200 mg/day or C. domestica extracts 1,500 mg/day for 4 weeks. The main outcomes were Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total, WOMAC pain, WOMAC stiffness, and WOMAC function scores. Adverse events (AEs) were also recorded. RESULTS: 185 and 182 patients were randomly assigned into C. domestica extracts and ibuprofen groups, respectively. The baseline characteristics were no different between groups. The mean of all WOMAC scores at weeks 0, 2, and 4 showed significant improvement when compared with the baseline in both groups. After using the noninferiority test, the mean difference (95% confidence interval) of WOMAC total, WOMAC pain, and WOMAC function scores at week 4 adjusted by values at week 0 of C. domestica extracts were noninferior to those for the ibuprofen group (P=0.010, P=0.018, and P=0.010, respectively), except for the WOMAC stiffness subscale, which showed a trend toward significance (P=0.060). The number of patients who developed AEs was no different between groups. However, the number of events of abdominal pain/discomfort was significantly higher in the ibuprofen group than that in the C. domestica extracts group (P=0.046). Most subjects (96%-97%) were satisfied with the treatment, and two-thirds rated themselves as improved in a global assessment. CONCLUSION: C. domestica extracts are as effective as ibuprofen for the treatment of knee osteoarthritis. The side effect profile was similar but with fewer gastrointestinal AE reports in the C. domestica extracts group.

The cross-cultural adaptation of the DASH questionnaire in Thai (DASH-TH).

STUDY DESIGN: Clinical measurement. INTRODUCTION: Currently there are no self-report questionnaires in Thai to evaluate disability levels in patients suffering from upper extremity musculoskeletal disorders. PURPOSE OF THE STUDY: To translate and cross-cultural adaptation the disabilities of the arm, shoulder and hand (DASH) questionnaire to Thai version and to evaluate content validity, construct validity and internal consistency of the questionnaire. METHODS: The DASH-TH was produced by following cross-cultural adaptation guidelines stated by the Institute for Work and Health (IWH). Forty Thai patients with arm, shoulder or hand problems participated in field testing of the questionnaire. Content validity was determined by obtaining the item-objective congruence (IOC) value for each questionnaire item. Correlation between the DASH-TH score and numeric rating scale was used to assess construct validity. Internal consistency of DASH-TH was measured using Cronbach's alpha coefficient. RESULTS: Forty patients (14 males, 26 females) with arm, shoulder or hand problems enrolled in the present study. The average age of patients was 44.8 years. The index of item-objective congruence (IOC) of each item ranged from 0.7 to 1.0. The Cronbach's alpha coefficient of the questionnaire was 0.938. There was no correlation between DASH-TH score and numeric rating scale. CONCLUSION: The DASH-TH has high content validity and internal consistency. LEVEL OF EVIDENCE: N/A.