The effect of different high-intensity interval training protocols on cardiometabolic and inflammatory markers in sedentary young women: A randomized controlled trial.

Few studies have reported the cardiovascular health effects of different high-intensity interval training (HIIT) protocols among sedentary young women. We investigated the impact of a traditional HIIT programme and a high-intensity circuit training (HICT) programme on lipid profiles and inflammatory cytokine levels in sedentary young women. Forty-two women were randomly assigned to HICT (body weight-based training), HIIT (cycling-based training), or control groups (n = 14 each). HICT and HIIT participants completed an 8-week training programme of three sessions per week. Total cholesterol (TC), triglyceride, high- and low-density lipoprotein, leptin, resistin, tumour necrosis factor-alpha (TNF-α), interleukin-8, and interferon-gamma levels were measured before and after the intervention. Post-intervention, TC and leptin were decreased in the HICT group. The HICT group also demonstrated increased lean mass, upper and lower limb strength, and balance, while the HIIT group displayed improved lower limb strength. Additionally, the control group showed significant increases in triglyceride levels, weight, body mass index, and fat mass. In conclusion, although both HICT and HIIT interventions showed improvements in cardiovascular health and physical fitness, participants in the HICT group experienced more health benefits.

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.].

Differences Between Students With Comorbid Intellectual Disability and Autism Spectrum Disorder and Those With Intellectual Disability Alone in the Recognition of and Reaction to Emotions.

This study investigates whether students with intellectual disability (ID) alone differ from students with combined individual disability and autism spectrum disorder (ASD) in their recognition of emotions. The ability to recognise emotions does not mean that students automatically know how to react to these emotions. Differences in performance on recognition and reaction tasks are examined. Participants were 20 primary 6 students who had ID with ASD and 20 primary 6 students who had ID without ASD from four special schools. The testing and training materials were adapted from a local teaching package. The results showed that both groups exhibited similar performance patterns in recognition tasks. Students with comorbid ASD exhibited inferior performance in tasks requiring reactions to complex emotions.

Effects of Functional Fascial Taping on pain and function in patients with non-specific low back pain: a pilot randomized controlled trial.

OBJECTIVES: To compare the short-term and medium-term effect of Functional Fascial Taping to placebo taping on pain and function in people with non-specific low back pain. DESIGN: A pilot randomized controlled trial with a 2-week intervention, and 2-, 6- and 12-week follow-up. SETTING: Individuals with non-specific low back pain recruited from local communities. PARTICIPANTS: Forty-three participants with non-specific low back pain for more than 6 weeks were randomized into either Functional Fascial Taping group (n = 21) or placebo group (n = 22). INTERVENTIONS: The intervention group was treated with Functional Fascial Taping while the control group was treated with placebo taping. Both groups received four treatments over 2 weeks. MAIN OUTCOME MEASURES: Worst and average pain and function were assessed at baseline, after the 2-week intervention, and at 6 and 12 weeks follow-up. RESULTS: The Functional Fascial Taping group demonstrated significantly greater reduction in worst pain compared to placebo group after the 2-week intervention (P = 0.02, effect size = 0.74; 95% confidence interval 0.11-1.34). A higher proportion of participants in Functional Fascial Taping group attained the minimal clinically important difference in worst pain (P = 0.007) and function (P = 0.007) than those in placebo group after the 2-week intervention. There were no significant differences in either group's disability rating or clinically important difference in average pain at any time. CONCLUSIONS: Functional Fascial Taping reduced worst pain in patients with non-acute non-specific low back pain during the treatment phase. No medium-term differences in pain or function were observed.

Effects of Transcranial Direct Current Stimulation Combined With Neuromuscular Electrical Stimulation on Upper Extremity Motor Function in Patients With Stroke.

OBJECTIVE: The aim of the study was to investigate the treatment effects of transcranial direct current stimulation combined with neuromuscular electrical stimulation on the motor function of upper extremity in persons with stroke. DESIGN: This study was a pilot double-blind randomized controlled trial. Twenty-six patients due to stroke onset of more than 6 mos were randomly allocated to three groups: transcranial direct current stimulation combined with neuromuscular electrical stimulation group, transcranial direct current stimulation group, or control group. In addition to conventional rehabilitation, all subjects received one of the three protocols in a total of 15 sessions for 3 wks. RESULTS: A significant difference among the three groups was found for the change scores of the Fugl-Meyer Assessment upper extremity subscale from pretreatment to 1-mo follow-up (P = 0.02), in favor of the transcranial direct current stimulation combined with neuromuscular electrical stimulation group. Moreover, the transcranial direct current stimulation combined with neuromuscular electrical stimulation group showed significant within-group improvement on the Fugl-Meyer Assessment upper extremity (from preintervention to postintervention, P = 0.01) and the Action Research Arm Test (from preintervention to postintervention and to 1-mo postintervention, P = 0.03 and P = 0.04, respectively). CONCLUSIONS: This preliminary study reveals that combining transcranial direct current stimulation and neuromuscular electrical stimulation with regular rehabilitation programs may enhance better upper extremity functional improvement than regular rehabilitation programs alone in patients with chronic stroke.

Development and pilot evaluation of the Cognition domain of the Hong Kong Comprehensive Assessment Scales for Toddlers.

Purpose: To describe the development of the Cognition domain of the Hong Kong Comprehensive Assessment Scales for Toddlers (HKCAS-T).Methods: Participants included 345 toddlers aged 18-41 months, with 258 recruited from Maternal and Child Health Centers (MCHCs) and 87 with cognitive delay recruited from Child Assessment Centers (CACs). They were individually administered the 83-item pilot version by medical practitioners or educational psychologists between 2017 and 2019 in MCHCs and CACs in Hong Kong.Results: Rasch analysis results supported the unidimensionality of the pilot version, after removing six items. Analysis of covariance results indicated that both the 83-item version and the 77-item version could differentiate between children of different age groups, and children with typical development from children with cognitive delay. Internal consistency and interrater reliability were 0.90 or above.Conclusions: The Cognition domain of the HKCAS-T is a promising developmental assessment tool for the assessment of toddlers. Cognition assessment, preschool, Chinese.

Are there any cross-ethnic differences in menstrual profiles? A pilot comparative study on Australian and Chinese women with primary dysmenorrhea.

AIM: To explore and compare the features of menstruation, perception and management of menstrual pain between two cohorts of Australian and Chinese women. METHODS: A pilot comparison study was carried out using modified valid menstrual questionnaires. The study included 120 Australian women and 122 Chinese women aged from 18 to 45 years with primary dysmenorrhea. RESULTS: Australian women rated menstrual pain as more intense than Chinese women (8.5 ± 1.5 on a 10-point pain scale vs 7.3 ± 1.8, P < 0.001), duration of pain was 36% longer (3.0 ± 2.5 vs 2.2 ± 0.9 days, P = 0.002) and menarche commenced earlier (12.7 ± 1.5 vs 14.2 ± 1.4 years, P < 0.001). The mean reported menstrual interval was also shorter (29.2 ± 5.3 vs 30.52 ± 3.7, P = 0.020) with heavier overall menstrual flow (P = 0.002) and fewer clots in menstrual blood (83% vs 95.8%, P = 0.001). There was no significant difference in duration of menstruation (5.2 ± 1.3 vs 5.4 ± 1.1 days; P = 0.180). Correlations were found between earlier menarche and increased intensity of menstrual pain (r = -0.16, P = 0.011), and between heavier menstrual flow and increased intensity of menstrual pain (r = 0.19, P = 0.003). CONCLUSION: Evidence from this pilot study suggested that the clinical menstrual presentations in the cohorts of Australian and Chinese women were different. Although the findings are preliminary, evaluating ethnic differences in menstruation and experimental menstrual pain models may not only provide some information about underlying mechanisms but may also predict or explain group differences.

Clinical pharmacy workload in medical and surgical patients: effect of patient partition, disease complexity and major disease category.

OBJECTIVES: The aim of this study was to measure the time spent providing clinical pharmacy services to individual patient episodes for general medical and surgical patients and to measure the effect of patient presentation and complexity on this workload. METHODS: We conducted a 5-month study at The Northern Hospital and Western Hospital in Melbourne, Australia, during 2006. Pharmacists recorded a defined range of activities that they provided for individual patients, including the actual times required for these tasks. A customised database, linked to the two hospitals' patient administration systems, stored these data according to the specific patient episode number. We then examined the influence of patient presentation and complexity on clinical pharmacy activities provided. KEY FINDINGS: During intervals when pharmacists recorded the time required to conduct activities, the average time required to perform the medication history and reconciliation exercise on 3052 occasions was 9.6 +/- 4.5 min. The 1844 interventions required an average of 5.9 +/- 3.0 min, clinical review of the patient's medical record required 5.5 +/- 2.7 min and medication order review required 3.5 +/- 1.3 min. For all of these activities, the time required was greater for medical patients than for surgical patients and greater for patients whose Diagnosis Related Group classification included a complication or co-morbidity. The average time required to perform all clinical pharmacy activities for 4625 completed patient episodes was 22.4 +/- 16.7 min and was again greater for medical patients and for patients with a complication or co-morbidity. CONCLUSIONS: The times required to perform a range of clinical pharmacy activities for individual patients was affected by whether the patients were medical or surgical patients. Furthermore, the existence of co-morbidities or complications affected these times. The methodology has potential application for other patient presentations and in other practice settings.

Preservice teachers' neuroscience literacy and perceptions of neuroscience in education: Implications for teacher education.

BACKGROUND: Owing to the prevalence of neuromyths in education, there has been a call for more teacher training in neuroscience. However, neuroscience is rarely featured in teacher education. This study investigated the neuroscience literacy and perceptions of neuroscience in education among preservice teachers in order to inform future development of initial teacher education. METHOD: Neuroscience literacy of 968 preservice teachers and their perceptions towards applying neuroscience in education were examined using survey items adapted from studies addressing similar constructs. Rasch item response theory and classical test theory techniques were employed for data analysis. RESULTS: Most of the preservice teachers had limited brain knowledge and subscribed to many common neuromyths but were positive towards applying neuroscience in education. General brain knowledge was the only predictor for ability to identify neuromyths (ß = .564). CONCLUSION: Neuroscience knowledge can help safeguard preservice teachers against neuromyths. Neuroscience training deserves a place in teacher education.

Immediate effects of noxious and innocuous thermal stimulation on brain activation in patients with stroke.

Case-control studies have shown that noxious thermal stimulation (TS) can improve arm function in patients with stroke. However, the neural mechanisms underlying this improvement are largely unknown. We explored functional neural activation due to noxious and innocuous TS intervention applied to the paretic arm of patients with stroke. Sixteen participants with unilateral cortical infarctions were allocated to one of two groups: noxious TS (8 patients; temperature combination: hot pain 46°C to 47°C, cold pain 7°C-8°C) or innocuous TS (n = 8; temperature combination: hot 40°C-41°C, cold 20°C-21°C). All subjects underwent fMRI scanning before and after 30 min TS intervention and performed a finger tapping task with the affected hand. Immediate brain activation effects were assessed according to thermal type (noxious vs. innocuous TS) and time (pre-TS vs post-TS). Regions activated by noxious TS relative to innocuous TS (P < .05, adjusted for multiple comparisons) were related to motor performance and sensory function in the bilateral primary somatosensory cortices, anterior cingulate cortex, insula, thalamus, hippocampus and unilateral primary motor cortex, secondary somatosensory cortex at the contralateral side of lesion, and unilateral supplementary motor area at the ipsilateral side of lesion. Greater activation responses were observed in the side contralateral to the lesion, suggesting a significant intervention effect. Our preliminary findings suggest that noxious TS may induce neuroplastic changes unconstrained to the local area.Trial registration: NCT01418404.

The efficacy of acupoint stimulation for the management of therapy-related adverse events in patients with breast cancer: a systematic review.

The aim of the present study was to scrutinize the evidence on the use of acupoint stimulation for managing therapy-related adverse events in breast cancer. A comprehensive search was conducted on eight English and Chinese databases to identify clinical trials designed to examine the efficacy of acupressure, acupuncture, or acupoint stimulation (APS) for the management of adverse events due to treatments of breast cancer. Methodological quality of the trials was assessed using a modified Jadad scale. Using pre-determined keywords, 843 possibly relevant titles were identified. Eventually 26 papers, 18 in English and eight in Chinese, satisfied the inclusion criteria and entered the quality assessment stage. The 26 articles were published between 1999 and 2008. They assessed the application of acupoint stimulation on six disparate conditions related to anticancer therapies including vasomotor syndrome, chemotherapy-induced nausea and vomiting, lymphedema, post-operation pain, aromatase inhibitors-related joint pain and leukopenia. Modalities of acupoint stimulation used included traditional acupuncture, acupressure, electroacupuncture, and the use of magnetic device on acupuncture points. Overall, 23 trials (88%) reported positive outcomes on at least one of the conditions examined. However, only nine trials (35%) were of high quality; they had a modified Jadad score of 3 or above. Three high quality trials revealed that acupoint stimulation on P6 (NeiGuang) was beneficial to chemotherapy-induced nausea and vomiting. For other adverse events, the quality of many of the trials identified was poor; no conclusive remarks can be made. Very few minor adverse events were observed, and only in five trials. APS, in particular acupressure on the P6 acupoint, appears beneficial in the management of chemotherapy-induced nausea and vomiting, especially in the acute phase. More well-designed trials using rigorous methodology are required to evaluate the effectiveness of acupoint stimulation interventions on managing other distress symptoms.

Sedentary lifestyle as a risk factor for low back pain: a systematic review.

OBJECTIVES: To review systematically studies examining the association between sedentary lifestyle and low back pain (LBP) using a comprehensive definition of sedentary behaviour including prolonged sitting both at work and during leisure time. METHODS: Journal articles published between 1998 and 2006 were obtained by searching computerized bibliographical databases. Quality assessment of studies employing a cohort or case-control design was performed to assess the strength of the evidence. RESULTS: Using pre-determined keywords, we identified 1,778 titles of which 1,391 were considered irrelevant. Then, 20 of the remaining 387 publications were scrutinized for full review after an examination of all the 387 abstracts. Finally, 15 studies (10 prospective cohorts and 5 case-controls) were included in the methodological quality assessment, of which 8 (6 cohorts and 2 case-controls; 53%) were classified as high-quality studies. One high-quality cohort study reported a positive association, between LBP and sitting at work only; all other studies reported no significant associations. Hence, there was limited evidence to demonstrate that sedentary behaviour is a risk factor for developing LBP. CONCLUSIONS: The present review confirms that sedentary lifestyle by itself is not associated with LBP.

The association of levels of physical activity with metabolic syndrome in rural Australian adults.

BACKGROUND: Physical activity (PA) reduces risk factors related to metabolic syndrome. Rurality influences the way people incorporate physical activity into daily life. The aim of this study is to determine the association of PA level with metabolic syndrome in a rural Australian population. The influence of adiposity on these associations is also investigated. METHODS: Three cross-sectional population health surveys were conducted in south-east Australia during 2004-2006 using a random population sample (n = 1563, participation rate 49%) aged 25-74 years. PA was assessed via a self-administered questionnaire, and components of the metabolic syndrome via anthropometric measurements taken by specially trained nurses and laboratory tests. RESULTS: Approximately one-fifth of participants were inactive in leisure-time and over one-third had metabolic syndrome (men 39%, women 33%; p = 0.022). There was an inverse association between level of PA and metabolic syndrome (p < 0.001). Men who were inactive in leisure-time were more than twice as likely and women more than three times as likely to have metabolic syndrome compared with those having high PA. Body mass index (BMI) is a mediating factor in the association between level of PA and metabolic syndrome. CONCLUSION: Some PA is better than none if adults, particularly women, are to reduce their risk of metabolic syndrome and associated vascular diseases. Specialised interventions that take rurality into consideration are recommended for adults who are inactive.

Do physical disabilities affect self-perceived quality of life in adolescents?

PURPOSE: We examined to what extent physical disabilities (PD) affect self-perceived quality of life (QOL) among adolescents. METHOD: A survey was conducted on 157 adolescents (aged 15.6 +/- 1.6 years) with PD, who were attending high schools in Taiwan; 855 students (15.3 +/- 1.6 years) from the same geographic regions and without a disability were recruited as controls. The Student Version of the Comprehensive Quality of Life Scale (COMQOL-S) was used to assess their subjective and objective well-being. RESULTS: No significant differences in overall objective QOL score were found between the two groups but the PD group was poorer in health and material well-being. Adolescents with PD scored significantly higher in overall subjective QOL and all the seven domains examined. Stratified analysis showed that older students and female students with PD had lower life satisfaction in some domains. There were no significant differences in overall objective (62.1 +/- 8.3 vs. 60.9 +/- 6.4; p = 0.55) or subjective (72.3 +/- 12.6 vs. 74.4 +/- 13.6; p = 0.15) QOL between students in mainstream and special schools. CONCLUSIONS: With national health care and educational coverage, the QOL of adolescents with PD in Taiwan do not seem to be affected by the disabilities, regardless of whether they are in mainstream or special schools. However, the negative effect of PD on QOL becomes a concern with increasing age; females with PD also appear to have a lower subjective QOL in health and emotion.

Effects of the hybrid of neuromuscular electrical stimulation and noxious thermal stimulation on upper extremity motor recovery in patients with stroke: a randomized controlled trial.

BACKGROUND: Neuromuscular electrical stimulation (NMES) and noxious thermal stimulation (NTS) have been developed and incorporated in stroke rehabilitation. OBJECTIVE: This study aimed to compare the effects of NMES, NTS, and the hybrid of NMES and NTS ("Hybrid") on motor recovery of upper extremity (UE) for patients with stroke. METHODS: We conducted a prospective, single-blind randomized controlled trial with concealed allocation. Forty-three patients with chronic stroke (onset >6 months) were randomly assigned to three groups (NMES, NTS, and "Hybrid"). In addition to conventional rehabilitation, participants received 30 min of NMES or 30 min of NTS or 15 min of NTS followed by 15 min of NMES. The treatment period was 8 weeks, 3 days/week, 30 min/time. The UE subscale of Fugl-Meyer assessment (UE-FMA, the primary outcome), Motricity index, modified Ashworth scale, and Barthel index were administered by a blinded assessor at baseline, posttreatment, and one-month follow-up. RESULTS: Most of the participants had mild-to-moderate disability in activity of daily living. No significant differences in the outcome measures at posttreatment and one-month follow-up were found among the NMES group (n = 13), NTS group (n = 13), and the hybrid of NMES and NTS group (n = 17). However, significant score changes in UE-FMA (p < 0.025) from baseline to posttreatment and one-month follow-up were found for the "Hybrid" group. CONCLUSIONS: This study reveals that the hybrid of NMES and NTS therapy appears to be beneficial to UE recovery after stroke but is not superior to NMES or NTS alone.

The relative and absolute reliability of two balance performance measures in chronic stroke patients.

PURPOSE: To examine the relative reliability and absolute reliability of the Berg Balance Scale (BBS) and the Postural Assessment Scale for Stroke Patients (PASS) in chronic stroke patients. METHOD: A total of 52 mild to moderate stroke patients, who had a stroke more than 6 months previously, participated in the study. Both balance measures were administered twice, seven days apart, to the patients. A relative reliability index (intra-class correlation coefficient, ICC2,1) was used to examine the level of agreement between test and retest. Absolute reliability indices, including the Bland and Altman method, the standard error of measurement (SEM), and the smallest real differences (SRD), were used to define the extent to which a balance score varies on test-retest measurements. RESULTS: Test-retest agreements were high (ICC2,1: BBS = 0.98; PASS = 0.97), indicating excellent agreement from a relative perspective. The SEM of the BBS and PASS, representing the smallest change threshold that indicates a real improvement for a group of individuals, were 2.4 and 1.1, respectively. The SRD of the BBS and PASS were 6.7 and 3.2, respectively, exhibiting the smallest change threshold that indicates a real improvement for a single individual. CONCLUSIONS: The test-retest agreements of the BBS and PASS were high in mild to moderate chronic stroke patients. The thresholds of both measures to detect real change are acceptable in research and clinical settings.

The effect of rigid taping with tension on mechanical displacement of the skin and change in pain perception.

OBJECTIVES: To investigate the effect of rigid taping that induces mechanical displacement of the skin on pain perception. DESIGN: Single group experiment design with repeated measures. METHODS: Twenty-three active healthy volunteers (12 men and 11 women) participated in the study. All participants received three different taping procedures: no tape, taping with tension, and taping without tension. The order of three taping conditions was randomised. Skin displacement was measured during taping with tension. A pressure algometer was used to measure the level of pain perception once before taping, and again after each taping condition, in one testing session. The participants were blind to the values of their pressure pain threshold (PPT) during the experimental period. RESULTS: The mean±SD skin displacement in the condition of taping with tension was 2.58±0.49cm. There were significant differences in PPT between taping with tension and taping without tension (mean difference (mean diff)±standard error (SE) 36.43±4.22kPa, p=0.000) and no tape (mean diff±SE 44.31±3.13kPa, p=0.000). No significant difference in PPT between no tape and taping without tension was found (mean diff±SE 7.88±2.83kPa, p=0.067). CONCLUSIONS: Taping with tension increases the threshold of pressure pain perception. Therefore, stretch and compression caused by rigid taping with tension could disturb the nociceptive signal transmission and alter pain perception.

Thoracic kyphosis affects spinal loads and trunk muscle force.

BACKGROUND AND PURPOSE: Patients with increased thoracic curvature often come to physical therapists for management of spinal pain and disorders. Although treatment approaches are aimed at normalizing or minimizing progression of kyphosis, the biomechanical rationales remain unsubstantiated. SUBJECTS: Forty-four subjects (mean age [+/-SD]=62.3+/-7.1 years) were dichotomized into high kyphosis and low kyphosis groups. METHODS: Lateral standing radiographs and photographs were captured and then digitized. These data were input into biomechanical models to estimate net segmental loading from T2-L5 as well as trunk muscle forces. RESULTS: The high kyphosis group demonstrated significantly greater normalized flexion moments and net compression and shear forces. Trunk muscle forces also were significantly greater in the high kyphosis group. A strong relationship existed between thoracic curvature and net segmental loads (r =.85-.93) and between thoracic curvature and muscle forces (r =.70-.82). DISCUSSION AND CONCLUSION: This study provides biomechanical evidence that increases in thoracic kyphosis are associated with significantly higher multisegmental spinal loads and trunk muscle forces in upright stance. These factors are likely to accelerate degenerative processes in spinal motion segments and contribute to the development of dysfunction and pain.

Regulation of metabolic transcriptional co-activators and transcription factors with acute exercise.

Endurance exercise improves insulin sensitivity and increases fat oxidation, which are partly facilitated by the induction of metabolic transcription factors. Next to exercise, increased levels of FFA's also increase the gene expression of transcription factors, hence making it difficult to discern the effects from contractile signals produced during exercise, from those produced by increased circulatory FFA's. We aimed to investigate, in human skeletal muscle, whether acute exercise affects gene expression of metabolic transcriptional co-activators and transcription factors, including PGC-1alpha, PRC, PPARalpha, beta/delta, and gamma and RXR, SREBP-1c and FKHR, and to discern the effect of exercise per se from those of elevated levels of FFA. Two hours of endurance exercise was performed either in the fasted state, or following carbohydrate ingestion prior to and during exercise, thereby blunting the fasting-induced increase in FA availability and oxidation. Of the genes measured, PGC-1alpha and PRC mRNA increased immediately after, while PPARbeta/delta and FKHR mRNA increased 1-4 h after exercise, irrespective of the increases in FFA's. Our results suggest that the induction in vivo of metabolic transcription factors implicated in mitochondrial biogenesis are under the control of inherent signals, (PGC-1alpha, PRC), while those implicated in substrate selection are under the control of associated signals (PPARbeta/delta, FKHR) stimulated from the contracting skeletal muscle that are independent of circulating FFA levels.

A simplified stroke rehabilitation assessment of movement instrument.

BACKGROUND AND PURPOSE: An efficient, reliable, and valid instrument for assessing motor function in patients with stroke is needed by both clinicians and researchers. To improve administration efficiency, we applied the multidimensional Rasch model to the 30-item, 3-subscale Stroke Rehabilitation Assessment of Movement (STREAM) instrument to produce a concise, reliable, and valid instrument (simplified STREAM [S-STREAM]) for measuring motor function in patients with stroke. SUBJECTS AND METHODS: The STREAM (consisting of 3 subscales: upper-limb movements, lower-limb movements, and mobility) was administered to 351 subjects with first stroke occurrence and a median time after stroke of 12.5 months. The unidimensionality of each subscale of the STREAM first was verified with unidimensional Rasch analysis. Each subscale of the STREAM then was simplified by deleting redundant items on the basis of expert opinion and the results of the Rasch analysis. The Rasch reliability of the S-STREAM and the concurrent validity of the S-STREAM with the STREAM were examined with multidimensional Rasch analysis and the intraclass correlation coefficient (ICC), respectively. RESULTS: After deleting the items that did not fit the Rasch model, we found that the 8-item upper-limb movement subscale, the 9-item lower-limb movement subscale, and the 10-item mobility subscale assessed single, unidimensional upper-limb movements, lower-limb movements, and mobility, respectively. We selected 5 items from each subscale to construct the S-STREAM and found that the reliability of each subscale of the resulting simplified instrument was high (Rasch reliability coefficients of > or =.91). The agreement between the subscale scores (Rasch estimates) of the S-STREAM and those of the STREAM was excellent (ICC of > or =.99, with a lower limit for the 95% confidence interval of > or =.985), indicating good concurrent validity of the S-STREAM with the STREAM. DISCUSSION AND CONCLUSION: The S-STREAM demonstrates high Rasch reliability, unidimensionality, and concurrent validity with the STREAM in patients with stroke. Furthermore, the S-STREAM is efficient to administer, as it consists of only half the number of items in the original STREAM. Additional studies to examine other psychometric properties (eg, predictive validity and responsiveness) of the S-STREAM or its psychometric properties in various recovery stages after stroke are needed to further establish its utility in both clinical and research settings.