Publications by authors named "Li-Fong Lin"

38 Publications

Application of Artificial Intelligence in COVID-19 Pandemic: Bibliometric Analysis.

Healthcare (Basel) 2021 Apr 9;9(4). Epub 2021 Apr 9.

School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei 110, Taiwan.

The application of artificial intelligence (AI) to health has increased, including to COVID-19. This study aimed to provide a clear overview of COVID-19-related AI publication trends using longitudinal bibliometric analysis. A systematic literature search was conducted on the Web of Science for English language peer-reviewed articles related to AI application to COVID-19. A search strategy was developed to collect relevant articles and extracted bibliographic information (e.g., country, research area, sources, and author). VOSviewer (Leiden University) and Bibliometrix (R package) were used to visualize the co-occurrence networks of authors, sources, countries, institutions, global collaborations, citations, co-citations, and keywords. We included 729 research articles on the application of AI to COVID-19 published between 2020 and 2021. (33/729, 4.52%), (29/729, 3.97%), and (29/729, 3.97%) were the most common journals publishing these articles. The Republic of China (190/729, 26.06%), the USA (173/729, 23.73%), and India (92/729, 12.62%) were the most prolific countries of origin. The , , and were the most productive institutions. This is the first study to show a comprehensive picture of the global efforts to address COVID-19 using AI. The findings of this study also provide insights and research directions for academic researchers, policymakers, and healthcare practitioners who wish to collaborate in these domains in the future.
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http://dx.doi.org/10.3390/healthcare9040441DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8070493PMC
April 2021

Health Service Access among Indonesian Migrant Domestic Workers in Taiwan.

Int J Environ Res Public Health 2021 04 4;18(7). Epub 2021 Apr 4.

Master Program in Global Health & Development Department, College of Public Health, Taipei Medical University, Taipei City 110, Taiwan.

The number of migrant workers in Taiwan increases annually. The majority is from Indonesia and most of them are female caregivers. This study aims to determine the access to health services and the associated factors among Indonesian female domestic workers in Taiwan. In this cross-sectional study, data were collected from February to May 2019, using a structured questionnaire. Subsequently, multiple logistic regression was used to examine the association between socio-demographic factors and health service access. Two hundred and eighty-four domestic migrant workers were interviewed. Eighty-five percent of the respondents declared sickness at work, but only 48.8% seek health care services. Factors associated with health service access were marital status, income, and the availability of an attendant to accompany the migrant workers to the healthcare facilities. Language barrier and time flexibility were the main obstacles. Further research and an effective health service policy are needed for the domestic migrant workers to better access health care services.
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http://dx.doi.org/10.3390/ijerph18073759DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8038466PMC
April 2021

Assessment of knowledge, attitudes, and practices towards Zika virus among healthcare workers in St. Kitts.

BMC Infect Dis 2021 Mar 5;21(1):237. Epub 2021 Mar 5.

Global Health & Development Department, College of Public Health, Taipei Medical University, No. 172-1, Sec. 2, Keelung Rd, Daan District, Taipei City, 106, Taiwan.

Background: Healthcare workers are usually the first responders during outbreaks and are instrumental in educating the populace about the prevention of different diseases and illnesses. The aim of this study was to assess the association between healthcare workers' characteristics and knowledge, attitudes and practices toward Zika virus.

Methods: This was a cross-sectional study that collected data from healthcare workers at 3 medical facilities using a validated self-administered questionnaire between July 2017 - September 2017. Logistic regression models were used to examine the association between sociodemographic and knowledge, attitudes, and practices.

Results: A total of 190 healthcare workers were analyzed. Of these, 60, 72.6 and 64.7% had good knowledge, positive attitudes, and good practices toward Zika virus, respectively. Healthcare workers without a formal degree were less likely to have good knowledge of Zika virus (adjusted odds ratio (AOR) = 0:49; 95% confidence interval (CI) = 0.24-0.99) compared to those with a formal degree. Reduced odds for positive attitude towards Zika virus were observed in healthcare workers with low income as compared to those with high income (AOR = 0.31; 95% CI =0.13-0.75). Being younger than 40 years old was associated with poor Zika virus practices (AOR = 0:34; 95% CI = 0.15-0.79).

Conclusions: Significant association between healthcare workers' sociodemographic characteristics and Zika virus knowledge, attitudes and practices were observed. Public health interventions that seek to increase Zika virus awareness should aim to train healthcare workers who are younger, without formal degree and those earning low income.
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http://dx.doi.org/10.1186/s12879-021-05932-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7934413PMC
March 2021

Effects of progressive elastic band resistance exercise for aged osteosarcopenic adiposity women.

Exp Gerontol 2021 05 4;147:111272. Epub 2021 Feb 4.

Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan, Taiwan. Electronic address:

Purpose: Osteosarcopenic adiposity (OSA), which is described as the concurrent occurrence of osteopenia, sarcopenia, and adiposity, can lead to frailty and increase the risk of physical disability in elderly women. Progressive elastic band resistance exercise training (peRET) is considered a safe and feasible exercise intervention for elderly women with sarcopenic obesity. This study investigated the effects of elastic band resistance exercise on the physical capacity and body composition of elderly women with osteosarcopenic adiposity.

Method: A total of 15 and 12 women were randomly assigned to the experimental (12 weeks of resistance exercise) and control groups (no exercise intervention), respectively. Lean mass (measured using a dual-energy X-ray absorptiometer) and physical capacity assessments (such as timed up and go test and single leg stance tests) were conducted at baseline, 12 weeks (end of intervention), and 6 months after the intervention. Outcome differences within the study and control groups were analyzed using repeated-measures analysis of variance with a post-hoc test. The Mann-Whitney U test was used to examine differences between groups at different time points.

Results: After the intervention, no body composition changes in muscle mass and fat were observed between the study and control groups. Moreover, muscle mass and fat body composition did not significantly differ at different time points. The bone density was higher in the study group, with a higher T-score than their baseline values, but did not significantly differ compared with the control group. The study group exhibited more improved physical function than the control group, but the effect did not last after 6 months of follow-up.

Conclusions: A 12-week progressive elastic band resistance training program effectively increased the physical capacity and improved the bone density; however, without persistent training, the positive effect diminished at 6-month follow-up.
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http://dx.doi.org/10.1016/j.exger.2021.111272DOI Listing
May 2021

Balance and gait performance in older adults with early-stage cognitive impairment.

Eur J Phys Rehabil Med 2020 Dec 1. Epub 2020 Dec 1.

School of Gerontology Health Management College of Nursing, Taipei Medical University, Taipei, Taiwan -

Background: People with cognitive impairment are susceptible to fall. Previous studies regarding balance and gait enrolled patients with various severity of dementia. Quantification of the balance and gait performance of people with cognitive impairment may help identify their postural instability and fall risks.

Aim: We investigated the differences in balance and gait among older adults with preserved cognition, amnestic mild cognitive impairment, and mild dementia due to Alzheimer's disease.

Design: Prospective observational study.

Setting: Outpatient department of neurology or psychology.

Population: Older adults (aged ≥65 years) with independent gait were evaluated using the Mini-Mental State Examination and Clinical Dementia Rating scale. People with other neurological or musculoskeletal disorders were excluded.

Methods: Participants were classified into three groups: 30 healthy controls, 30 mild cognitive impairment and 30 mild dementia. Balance were evaluated through functional test (Berg Balance Scale, BBS) and laboratory test (posturography). Gait was assessed by wearable device. Muscle strength and mass were measured through grip force, calf circumstance, and body composition.

Results: The BBS (p = 0.04), posturography of fall risk index (FR, p = 0.01) and sensory integration indices in eyes open and firm surface (EOFIS, p = 0.009), eyes open and foam surface (EOFOS, p = 0.003) were substantially different among three groups. EOFIS and EOFOS indices of balance in mild dementia were significantly worse than in MCI. The gait speed (p = 0.04) and stride length (p = 0.04) were significantly different among three groups. The post-hoc analyses revealed that all above balance and gait indices in subjects with cognitive impairments were significantly worse than in healthy controls. The grip force, calf circumstance and body composition-muscle mass did not significantly differ among three groups.

Conclusions: It is a piece of evidence that cognitive dysfunction, even in early stage of memory decline, may have some bad impact on balance and gait regardless of the effect of musculoskeletal problems.

Clinical Rehabilitation Impact: Understanding the difference of specific indices of balance and gait among different severity of cognitive impairments and healthy controls could help to develop better balance-oriented rehabilitation programs in older adults at early-stage cognitive impairment.
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http://dx.doi.org/10.23736/S1973-9087.20.06550-8DOI Listing
December 2020

High-intensity functional exercise in older adults with dementia: A systematic review and meta-analysis.

Clin Rehabil 2021 Feb 11;35(2):169-181. Epub 2020 Oct 11.

School of Medicine, College of Medicine, Taipei Medical University, Taipei.

Objective: This study aimed to investigate the efficacy of high-intensity functional exercise among older adults with dementia.

Methods: In this systematic review and meta-analysis of randomized controlled trials, we collected articles published before August 2020 from PubMed, Embase, and the Cochrane Library to evaluate the effect of high-intensity functional exercise on older adults with dementia. Primary outcomes included improvements in balance function and gait performance (speed, cadence, and stride length). The secondary outcomes included lower limb strength, activities of daily living, psychiatric well-being, depression, and cognition. Furthermore, we performed subgroup analysis with two high-intensity functional exercise programs: the Umeå program and Hauer's program.

Results: We identified 15 articles describing six trials including older adults with dementia undergoing high-intensity functional exercise or control activity. The meta-analysis indicated that high-intensity functional exercise, both in Hauer's program and in the Umeå program, significantly improved balance function (pooled standardized mean difference 0.57, 95% confidence interval 0.31-0.83). Hauer's program significantly improved gait speed, cadence, stride length, and lower limb strength. Beneficial effects on speed, cadence, and lower limb strength were retained for several months. The Umeå program facilitated activities of daily living and psychiatric well-being, with effects on activities of daily living lasting several months. In the only eligible trial, no effects on cognition were observed. Adverse effects of high-intensity functional exercise were minimal to none.

Conclusions: High-intensity functional exercise is generally safe and is recommended for older individuals with mild or moderate dementia to provide benefits in motor performance and daily functioning.
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http://dx.doi.org/10.1177/0269215520961637DOI Listing
February 2021

Accuracy of the Critical Shoulder Angle for Predicting Rotator Cuff Tears in Patients With Nontraumatic Shoulder Pain.

Orthop J Sports Med 2020 May 15;8(5):2325967120918995. Epub 2020 May 15.

Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.

Background: The critical shoulder angle (CSA) is the angle between the superior and inferior bony margins of the glenoid and the most lateral border of the acromion. Although studies have reported that the CSA is associated with rotator cuff tears (RCTs), few studies have examined the accuracy of the CSA for predicting RCTs in patients with shoulder pain.

Purpose: To investigate the accuracy of the CSA for predicting RCTs among patients with nontraumatic shoulder pain.

Study Design: Cross-sectional study; Level of evidence, 3.

Methods: Data were retrospectively collected from 301 patients who had RCTs and underwent arthroscopic rotator cuff repair between January 2014 and December 2018 (RCT group). During that same period, we also included 300 patients with shoulder pain but without RCTs, confirmed through ultrasound (non-RCT group). Baseline demographic data, the CSA, and the acromion index (AI) were compared using an independent test. Categorical variables were analyzed using the chi-square test. Receiver operating characteristic (ROC) curve analysis was performed to investigate the accuracy of the CSA and AI for predicting RCTs, and the optimal cutoff point was determined using the Youden index. Multiple stepwise and binary logistic regressions were used to determine the predictors of RCTs.

Results: A total of 301 patients (123 males, 178 females) and 300 patients (116 males, 184 females) were included in the RCT and non-RCT groups, respectively. The RCT group had a higher CSA ( < .001) than the non-RCT group. The area under the ROC curve (AUC) was 70.5% ( < .001) for the CSA, but there was no significance for the AI, with an AUC of 47.7% for predicting RCTs in patients. Stepwise logistic regression revealed the CSA as an independent predictor of RCTs, with an adjusted odds ratio of 1.295 (95% CI, 1.019-1.571; = .006). For patients with a CSA greater than 37.52°, binary logistic regression revealed an adjusted odds ratio of 3.92 (95% CI, 2.79-5.51; < .001) for the presence of an RCT.

Conclusion: The CSA was an objective assessment tool to identify patients with shoulder pain who may have RCTs. Our study indicated that the CSA predicted RCTs more accurately than did the AI for patients with shoulder pain.
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http://dx.doi.org/10.1177/2325967120918995DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7232055PMC
May 2020

Efficacy of robot-assisted gait training in multiple sclerosis: A systematic review and meta-analysis.

Mult Scler Relat Disord 2020 Mar 3;41:102034. Epub 2020 Mar 3.

Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; Center for Evidence-Based Health Care, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan; Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan; Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan; Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Electronic address:

Background: Multiple sclerosis is a progressive disease responsible for gait disabilities and cognitive impairment, which affect functional performance. Robot-assisted gait training is an emerging training method to facilitate body-weight-supported treadmill training in many neurologic diseases. Through this study, we aimed to determine the efficacy of robot-assisted gait training in patients with multiple sclerosis.

Methods: We performed a systematic review and meta-analysis of randomized controlled trials evaluating the effect of robot-assisted gait training for multiple sclerosis. We searched PubMed, EMBASE, the Cochrane Library, and ClinicalTrials.gov registry for articles published before May 2019. The primary outcome was walking performance (gait parameters, balance, and ambulation capability). The secondary outcomes were changes in perceived fatigue, severity of spasticity, global mobility, physical and mental quality of life, severity of pain, activities of daily living, and treatment acceptance.

Results: We identified 10 studies (9 different trials) that included patients with multiple sclerosis undergoing robot-assisted gait training or conventional walk training. The meta-analysis showed comparable effectiveness between robot-assisted gait training and conventional walking therapy in walking performance, quality of life, pain, or activities of daily living. The robot-assisted gait training was even statistically superior to conventional walking therapy in improving perceived fatigue (pooled SMD: 0.34, 95% CI: 0.02-0.67), spasticity (pooled SMD: 0.70, 95% CI: 0.08-1.33, I² = 53%), and global mobility (borderline) after the intervention.

Conclusion: Our results provide the most up-to-date evidence regarding the robot-assisted gait training on multiple sclerosis. In addition to the safety and good tolerance, its efficacy on multiple sclerosis is comparable to that of conventional walking training and is even superior in improving fatigue and spasticity.
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http://dx.doi.org/10.1016/j.msard.2020.102034DOI Listing
March 2020

Development of a comprehensive core set from the international classification of functioning, disability and health for return to work among patients with stroke through Delphi-based consensus.

Eur J Phys Rehabil Med 2020 Jun 23;56(3):257-264. Epub 2020 Jan 23.

Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan -

Background: Young patients with stroke are typically the economic support of their families and societies, and their return to work (RTW) is crucial to maintaining their quality of life. However, the identification of RTW-related factors of different aspects is complicated and a systematic analysis of these factors is lacking.

Aim: The aim of this study was to develop a core set from the International Classification of Functioning, Disability and Health (ICF) for return to work (RTW) among patients with stroke.

Design: Three-round Delphi-based consensus.

Setting: University-based hospital.

Population: Thirty experts in stroke-related domains from different institutions.

Methods: A five-point Likert Scale was used to rate the importance of each item. Consensus of ratings was analyzed using Spearman's rho and semi-interquartile range indices. The International Classification of Functioning, Disability and Health core set for return to work among patients with stroke was based on a high level of consensus and a mean score of ≥4.0 in the third round of the Delphi.

Results: The ICF core set comprised 58 categories distributed as follows: 16 body function, 30 activities and participation, 10 environmental factor, and 2 personal factors.

Conclusions: Our ICF core set for RTW among patients with stroke can inform effective rehabilitation strategies and goal setting for RTW among patients with stroke. However, further validation is warranted.

Clinical Rehabilitation Impact: ICF core set could provide information on rehabilitation strategies setting for RTW of stroke patients.
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http://dx.doi.org/10.23736/S1973-9087.20.05992-4DOI Listing
June 2020

Autoimmune Connective Tissue Diseases and the Risk of Rotator Cuff Repair Surgery: A Population-Based Retrospective Cohort Study.

BMJ Open 2019 02 25;9(2):e023848. Epub 2019 Feb 25.

Department of Mathematics, Soochow University, Taipei, Taiwan.

Objectives: Autoimmune connective tissue diseases (ACTDs) commonly involve the shoulder joint; however, clinical epidemiological studies investigating their association with tendons are scant. Rotator cuff (RC) tears can cause shoulder disability, and surgical intervention is usually required. The study investigated RC repair surgery risk in ACTD patients. The effect of anti-inflammatory medication on RC repair surgery risk was also investigated.

Methods: We conducted a retrospective cohort study with a 7-year longitudinal follow-up period. Patients with systemic lupus erythematosus, systemic sclerosis, sicca syndrome, dermatomyositis and polymyositis diagnoses between 2004 and 2008 were enrolled. The control cohort comprised age- and sex-matched controls. The HR and adjusted HR (aHR) were estimated for the risk of RC surgery between ACTD and control cohorts after adjustment for confounders. Furthermore, the effects of steroid and non-steroidal anti-inflammatory drug (NSAID) use on the HR and aHR of RC surgery risk were analysed.

Results: We enrolled 5019 ACTD patients and 25 095 controls in the ACTD and control cohorts, respectively. RC surgery incidence was 49 and 24 per 100 000 person-years in the ACTD and control cohorts, respectively. In the ACTD cohort, the crude HR for RC surgery was 2.08 (95% CI , 1.08 to 4.02, p<0.05), and the aHR was 1.97 (95% CI, 1.01 to 3.82, p<0.05). The ACTD patients who used NSAIDs had an aHR of 3.13 (95% CI, 1.21 to 8.07, p<0.05) compared with the controls, but the ACTD patients who used steroids did not have a significantly higher aHR than the controls.

Conclusions: ACTD patients had an increased risk of RC repair surgery. However, no difference was found in RC surgery risk when steroids were used compared with the control cohort. This could indicate that inflammation control may be a strategy for managing subsequent RC lesions.
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http://dx.doi.org/10.1136/bmjopen-2018-023848DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398915PMC
February 2019

The Use of Wearable Sensors for the Movement Assessment on Muscle Contraction Sequences in Post-Stroke Patients during Sit-to-Stand.

Sensors (Basel) 2019 Feb 6;19(3). Epub 2019 Feb 6.

Department of Neurosurgery, Tri-Service General Hospital, Taipei 11490, Taiwan.

Electromyography (EMG) sensors have been used to study the sequence of muscle contractions during sit-to-stand (STS) in post-stroke patients. However, the majority of the studies used wired sensors with a limited number of placements. Using the latest improved wearable technology with 16 sensors, the current study was a thorough investigation to evaluate the contraction sequences of eight key muscles on the trunk and bilateral limbs during STS in post-stroke patients, as it became feasible. Multiple wearable sensors for the detection of muscle contraction sequences showed that the post-stroke patients performed STS with abnormal firing sequences, not only in the primary mover on the sagittal plane during raising, but also in the tibialis anterior, which may affect anticipatory postural adjustment in the gluteus medius, which may affect balance control. The abnormal tibialis anterior contraction until the early ascending phase and the delayed firing of the gluteus muscles highlight the importance of whole-kinetic-chain monitoring of contraction sequences using wearable sensors. The findings can be helpful for the design of therapeutic exercises.
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http://dx.doi.org/10.3390/s19030657DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6387101PMC
February 2019

Chronic obstructive pulmonary disease with short-acting inhaled pharmacotherapy increases the risk of prostate cancer: A two-stage database approach.

PLoS One 2018 6;13(9):e0203377. Epub 2018 Sep 6.

Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.

Background: Patients with chronic obstructive pulmonary disease (COPD) are at a higher risk of many types of cancer. However, specific investigation of the risk of prostate cancer and the influence of COPD pharmacotherapy in patients with COPD is lacking. This study investigated the risk and influence of COPD pharmacotherapy on risk of prostate cancer in patients with COPD.

Methods: This retrospective cohort study used data from Taiwan's Longitudinal Health Insurance Database 2005 (LHID2005). The study cohort comprised COPD patients who received treatment between 2004 and 2008, and who were identified from the LHID2005. The control cohort comprised patients without COPD and was matched to the study cohort by age and sex. Two-stage propensity score calibration with the National Health Interview Survey 2005 was performed to obtain the missing confounders of smoking, alcohol drinking, and body mass index in the LHID. The hazard ratio (HR) and adjusted HR were estimated. Moreover, the influence of inhaled medications and other related medication on the risk of prostate cancer was analyzed by Cox proportional hazard regression.

Results: The COPD cohort comprised 12,774 patients, and the control cohort comprised 38,322 patients (1:3). The incidence of prostate cancer was 633 per 100,000 person-years in the COPD cohort and 361 per 100,000 person-years in the control cohort. The propensity score calibration-adjusted HR was 1.62 (95% CI, 1.40-1.87, p < 0.001) in the COPD cohort. Further analysis revealed that the adjusted HR for the risk of prostate cancer was 1.61 (95% CI, 1.19-2.16, p = 0.002) in patients with COPD who used short-acting muscarinic antagonists (SAMAs) and 1.89 (95% CI, 1.40-2.54, p < 0.001) in patients with COPD who used short-acting beta-agonists (SABAs). COPD patients had lower risk of prostate cancer when using statin (HR = 0.63, 95% CI, 0.45-0.89, p = 0.010) or aspirin (HR = 0.55, 95% CI, 0.35-0.85, p = 0.008).

Conclusion: Patients with COPD are at a higher risk of prostate cancer, particularly those using SAMAs or SABAs. This finding suggests that inflammation control may be an effective strategy for decreasing the risk of prostate cancer.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0203377PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6126830PMC
February 2019

Simultaneous stimulation in bilateral leg motor areas with intermittent theta burst stimulation to improve functional performance after stroke: a feasibility pilot study.

Eur J Phys Rehabil Med 2019 Apr 27;55(2):162-168. Epub 2018 Aug 27.

Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan -

Background: Intermittent theta burst stimulation (iTBS) was widely used in stroke rehabilitation and was more efficient than repetitive transcranial magnetic stimulation in terms of inducing larger motor evoked potential and producing longer effects. To our knowledge, the outcomes are not available combining rehabilitation and iTBS for improving motor function of lower extremities in patients with stroke.

Aim: To evaluate the feasibility and effectiveness of intermittent theta burst stimulation aiming to stimulate bilateral leg motor cortex and promote functional improvements.

Design: A single blind, randomized controlled pilot study.

Setting: Rehabilitation ward.

Population: Twenty patients with chronic stroke finally enrolled for analyzed.

Methods: Participants were randomized into two groups to receive 10 sessions of iTBS group and sham group over a 5-week period. The iTBS was delivered over the midline of skull to stimulate bilateral leg motor cortex. The outcome measures included balance, mobility, and leg motor functions were measured before and after interventions.

Results: Within-group differences were significant in the Berg Balance Scale for both groups (Z=-2.442, P=0.015 in iTBS group; Z=-2.094, P=0.036 in sham group), in the Fugl-Meyer Assessment (Z=-2.264, P=0.024) and Overall Stability Index of Biodex Balance System of iTBS group (Z=-2.124, P=0.034). However, no significant between-group differences were found.

Conclusions: There was no powerful evidence to support the effectiveness of iTBS group better than sham control group. Some essential technical issues should be considered for future studies applying iTBS to stimulate bilateral leg motor cortex.

Clinical Rehabilitation Impact: iTBS combined with stroke rehabilitation are probably expected to be useful to promote brain plasticity and functional performance but some technical issues should be carefully considered.
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http://dx.doi.org/10.23736/S1973-9087.18.05245-0DOI Listing
April 2019

Kinesio taping reduces elbow pain during resisted wrist extension in patients with chronic lateral epicondylitis: a randomized, double-blinded, cross-over study.

BMC Musculoskelet Disord 2018 Jun 19;19(1):193. Epub 2018 Jun 19.

Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, No.111, Hsing-Long Road, Section 3, Taipei, 116, Taiwan.

Background: Lateral epicondylitis is frequently seen in racquet sport players and the treatments are usually symptomatic rather than curative. Taping therapy is cheap and easy to apply in the sport field. In this study we valued the effectiveness of Kinesio taping (KT) on immediate pain control for patients with chronic lateral epicondylitis.

Methods: We conducted a randomized, double-blinded, cross-over study with 15 patients with chronic lateral epicondylitis. All participants received two taping sessions in a random order with a 3-day interval in between: one with KT and the other with sham taping (ST). Pain perceived during resisted wrist extension and at rest using numeric rating scale (NRS), the pain-free grip strength, and the pressure pain threshold, were measured before and 15 min after the tape was applied.

Results: A significant reduction of 2.1 ± 1.6 (Z = - 3.081, P = 0.002) and 0.7 ± 0.8 (Z = - 2.428, P = 0.015) was found on a NRS with KT and ST, respectively, indicating that both taping sessions produced immediate pain relief for resisted wrist extension. Both taping sessions significantly improved the pain-free grip strength with increases of 3.31 ± 5.05 (Z = - 2.615, P = 0.009) and 2.43 ± 3.31 (Z = - 2.783, P = 0.005) kg found with KT and ST, respectively. Compared with ST, KT exhibited superiority in controlling pain experienced during resisted wrist extension (Z = - 2.168, P = 0.030).

Conclusions: Taping produced unneglectable placebo effects on pain relief and painf-free grip strength for patients with lateral epicondylitis, and KT seemed to have additional effects on controlling pain that was elicited by resisted wrist extension.

Trial Registration: ISRCTN13618356 (retrospectively registered on 13/02/2017).
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http://dx.doi.org/10.1186/s12891-018-2118-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6010177PMC
June 2018

Association of physical capacity with heart rate variability based on a short-duration measurement of resting pulse rate in older adults with obesity.

PLoS One 2017 21;12(12):e0189150. Epub 2017 Dec 21.

Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.

Background: Obesity can limit physical capacity and lower physical activity levels in elderly people. Low physical activity levels may be mediated by autonomic dysfunction with decreased heart rate variability (HRV). However, the relationship between autonomic dysfunction and low physical capability remains unclear. This cross-sectional study investigated the association of low physical capability with HRV in older adults with obesity.

Materials And Methods: We recruited 231 old man and 210 old women with a mean (range) age of 65.5 (51-78) and 62.9 (52-76) years, respectively. Physical capability was measured using mobility tasks, including functional reach, single-leg stance (SLS), gait speed (GS), timed up and go, and timed chair rise (TCR), and the scores on these tasks were merged and transformed into a global physical capability score (GPCS). HRV was measured using a 7-min resting pulse-based technique, and the time- and frequency-domain indices of HRV were obtained including standard deviation of normal-to-normal intervals (SDNN), root mean square of successive differences at rest (rMSSD), and high-frequency (HF) power. All HRV indices were natural log (ln) transformed for analysis. Participants were divided into high, moderate, and low physical-capability groups according to their physical performance. Multivariate analysis of covariance was performed to test differences in HRV indices among physical-capability groups with participants' characteristics serving as covariates. A stepwise regression model was established to identify the determinants of HRV indices. We used hierarchical regression analysis to identify the association of the GPCS with HRV indices.

Results: In both men and women, the low physical-capability group exhibited significantly increased heart rate (P <0.05) and decreased HRV in terms of a decreased ln[SDNN] (P <0.001), ln[rMSSD] (P <0.05) and ln[HF] (P <0.05), compared with the high physical-capability group. GS positively predicted ln[SDNN], whereas SLS, GS, and TCR were determinants of ln[HF], regardless of gender. The GPCS in older men and women independently accounted for 29.9% (P <0.001) and 23.7% (P <0.001), respectively, in variance in ln[SDNN].

Conclusions: A low physical-capability level is an independent determinant of decreased HRV in older adults with obesity.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0189150PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5739389PMC
January 2018

Priming With 1-Hz Repetitive Transcranial Magnetic Stimulation Over Contralesional Leg Motor Cortex Does Not Increase the Rate of Regaining Ambulation Within 3 Months of Stroke: A Randomized Controlled Trial.

Am J Phys Med Rehabil 2018 05;97(5):339-345

From the Neuroscience Research Center and Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan (Y-ZH); Institute of Cognitive Neuroscience, College of Health Sciences and Technology, National Central University, Taoyuan, Taiwan (Y-ZH); Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan (L-FL, T-HL); Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan (K-HC, Y-NL); Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan (K-HC, Y-NL); and Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan (C-JH).

Background: The potential benefits of repetitive transcranial magnetic stimulation (rTMS), applied either alone or as a combination treatment, on recovery of lower limbs after stroke have been insufficiently studied.

Objective: The aim of the study was to evaluate the effect of priming with 1-Hz repetitive transcranial magnetic stimulation over contralesional leg motor area with a double-cone coil before physical therapy on regaining ambulation.

Methods: Thirty-eight subacute stroke patients with significant leg disabilities were randomly assigned into the experimental group or control group to receive a 15-min real or sham 1-Hz repetitive transcranial magnetic stimulation, respectively, over the contralesional motor cortex representing the quadriceps muscle followed by 45-min physical therapy for 15 sessions for 3 wks. Functional measures, motor evoked potentials, and quality of life were assessed.

Results: There was no significant difference between experimental group and control group regarding the recovery in ambulation, balance, motor functions, and activity of daily living. No significant difference was found in other functional measures and the quality of life. Only the control group displayed significantly increased cortical excitability of the contralesional hemisphere after the intervention.

Conclusions: The present study found that insufficient evidence that contralesional priming with 1-Hz repetitive transcranial magnetic stimulation improves ambulatory and other motor functions among patients with a severe leg dysfunction in subacute stroke.
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http://dx.doi.org/10.1097/PHM.0000000000000850DOI Listing
May 2018

A novel Robotic Gait Training System (RGTS) may facilitate functional recovery after stroke: A feasibility and safety study.

NeuroRehabilitation 2017 ;41(2):453-461

Department of Physical Medicine and Rehabilitation, Wan Fang Medical Center, Taipei Medical University, Taipei City, Taiwan (ROC).

Background: Robot-assisted gait training has been introduced as a practical treatment adjunctive to traditional stroke rehabilitation to provide high-intensity repetitive training. The design of robots is usually based on either the end-effector and exoskeleton method. The novel Robot Gait Training System (RGTS), a hybrid mixed type of end-effector and exoskeleton, tries to combine advantages from both methods.

Objective: This preliminary study was conducted to report whether this novel system is feasible and safe when applied to non-ambulatory subacute patients with stroke.

Methods: Six patients with stroke participated in this study and received 15 daily RGTS sessions. The outcome measures included the lower extremity subscale of the Fugl-Meyer Assessment (FMA-LE), Postural Assessment Scale for Stroke (PASS), Berg Balance Scale (BBS), and Barthel Index (BI). These measurements were performed at the pretest and posttest.

Results: The RGTS demonstrated significant after-before changes in the FMA-LE, PASS, BBS and BI (p < 0.05), which indicated improvements substantially across the neurological status, balance, and activities of daily living after intervention.

Conclusions: This study demonstrated that the novel RGTS designed was practical, safe, and suitable to use in substantial leg dysfunction with stroke.
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http://dx.doi.org/10.3233/NRE-162137DOI Listing
May 2018

Evaluating the European Health Literacy Survey Questionnaire in Patients with Stroke: A Latent Trait Analysis Using Rasch Modeling.

Patient 2018 02;11(1):83-96

School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.

Background: The effective self-management and treatment of long-term disability after stroke depends greatly on the health literacy of patients. The European Health Literacy Survey Questionnaire (HLS-EU-Q) is a comprehensive and theory-based measure that captures multiple self-perceived competencies of health literacy and covers a diverse range of health contexts. However, there is no psychometric evidence on the HLS-EU-Q in the stroke population.

Objective: The aim of this study was to examine the validity of the HLS-EU-Q in patients with stroke using Rasch analysis.

Methods: We compared the model deviance among the one-domain, three-domain, four-domain, and 12-domain structures using likelihood ratio tests to determine the dimensionality of the HLS-EU-Q. Thereafter, we examined the unidimensionality of each domain, local independence, item fit, response categories, and differential item functioning (DIF) for the best fitting structure.

Results: A total of 311 patients with stroke participated in this study. Rasch analysis revealed that the 12-domain HLS-EU-Q demonstrated the best data-model fit. The original 4-point scales showed disordering, which can be corrected by rescaling them as 3-point scales with the two middle categories collapsed. All 47 items in the rescaled HLS-EU-Q fit the 12-domain Rasch model, demonstrated local independence, assessed the 12 unidimensional domains respectively, and had invariant difficulties between different age or education groups of the patients with stroke.

Conclusion: We recommend using the 12-domain scores of the rescaled HLS-EU-Q to comprehensively and accurately capture the competencies to access, understand, appraise, and apply health information within the three health contexts of healthcare, disease prevention, and health promotion for patients with stroke.
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http://dx.doi.org/10.1007/s40271-017-0267-3DOI Listing
February 2018

Feasibility and efficacy of wearable devices for upper limb rehabilitation in patients with chronic stroke: a randomized controlled pilot study.

Eur J Phys Rehabil Med 2018 Jun 19;54(3):388-396. Epub 2017 Jun 19.

Department of Electronic and Computer Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan -

Background: Wearable devices based on inertial measurement units through wireless sensor networks have many applications such as real-time motion monitoring and functional outcome assessment of stroke rehabilitation. However, additional investigations are warranted to validate their clinical value, particularly in detecting the synergy patterns of movements after stroke.

Aim: The aim of this study was to explore the feasibility and efficacy of wearable devices for upper limb rehabilitation in patients with chronic stroke and to compare the intervention effects (e.g., neurological recovery, active range of motion, and deviation angle) with those in a control group.

Design: A single-blind, randomized-controlled pilot study.

Setting: Rehabilitation ward.

Methods: A total of 18 patients with chronic stroke were randomly distributed into a device group and control group. Both groups received conventional rehabilitation; nevertheless, the device group was additionally subjected to 15 daily sessions at least three times a week for 5 weeks. The outcome measures included the upper extremity subscores of the Fugl-Meyer assessment, active range of motion, and deviation angle. These measurements were performed pre- and post-treatment.

Results: All five Fugl-Meyer assessment subscores improved in both the device and control groups after intervention; in particular, the "shoulder/elbow/forearm" subscore (P=0.02, 0.03) and "total score" (P=0.03, 0.03) substantially improved. The active range of motion of shoulder flexion and abduction substantially improved at pre-post treatment in both the device (P=0.02, 0.03) and control (P=0.02, 0.03) groups. The deviation angle of shoulder external rotation during shoulder abduction substantially improved in the device group (P=0.02), but not in the control group.

Conclusions: The designed wearable devices are practical and efficient for use in chronic patients with stroke.

Clinical Rehabilitation Impact: Wearable devices are expected to be useful for future internet-of-things rehabilitation clinical trials at home and in long-term care institutions.
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http://dx.doi.org/10.23736/S1973-9087.17.04691-3DOI Listing
June 2018

Effects of elastic resistance exercise on body composition and physical capacity in older women with sarcopenic obesity: A CONSORT-compliant prospective randomized controlled trial.

Medicine (Baltimore) 2017 Jun;96(23):e7115

School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University Department of Physical Medicine and Rehabilitation Department of Radiology, Shuang Ho Hospital Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan.

Background: Sarcopenia is associated with loss of muscle mass and an increased risk of physical disability in elderly people. However, the prevalence of sarcopenia has increased in obese elderly populations. The purpose of this study was to identify the clinical efficacy of elastic resistance exercise training (RET) in patients with sarcopenic obesity.

Methods: This study was conducted at the rehabilitation center of a university-based teaching hospital and was designed as a prospective and randomized controlled trial with an intention-to-treat analysis. A total of 46 women aged 67.3 (5.2) years were randomly assigned to an experimental group (EG) and control group (CG). The EG underwent elastic RET for 12 weeks, and the CG received no RET intervention. All outcome measures were assessed at the baseline and posttest, including body composition measured using dual-energy X-ray absorptiometry, muscle quality (MQ) defined as a ratio of muscular strength to muscle mass, and physical capacity assessed using functional mobility tests. One-way analysis of covariance and Pearson correlation were used to compare outcomes between the 2 groups and to identify the relationship between changes in body composition and physical outcomes, respectively. A chi-square test was performed to identify differences in qualitative data between the 2 groups.

Results: At the posttest, a significant between-group difference was observed in fat-free mass, MQ, and physical capacity (all P < .05); and a significant correlation was found between leg-lean-mass change and gait speed (r = 0.36; P < .05). After 12 weeks of elastic RET intervention, the EG had significantly fewer patients exhibiting sarcopenia (P < .05) and experiencing physical difficulty (P < .001) than the CG.

Conclusion: The present data suggest that elastic resistance exercise exerted benefits on the body composition, MQ, and physical function in patients with sarcopenic obesity. Regular exercise incorporating elastic RET should be used to attenuate muscle mass loss and prevent physical difficulty in obese older adults with sarcopenia on reconditioning therapy.

Trial Registration: Chinese Clinical Trial Registry, ChiCTR-IPR-15006069.
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http://dx.doi.org/10.1097/MD.0000000000007115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466239PMC
June 2017

Gout Can Increase the Risk of Receiving Rotator Cuff Tear Repair Surgery.

Am J Sports Med 2017 Aug 9;45(10):2355-2363. Epub 2017 May 9.

Department of Mathematics, Soochow University, Taipei, Taiwan.

Background: Gout commonly involves joint inflammation, and clinical epidemiological studies on involved tendons are scant. Rotator cuff tears are the most common cause of shoulder disability, and surgery is one of the choices often adopted to regain previous function.

Purpose: To investigate the risk of receiving rotator cuff repair surgery among patients with gout and to analyze possible risk factors to design an effective prevention strategy.

Study Design: Cohort study; Level of evidence, 3.

Methods: The authors studied a 7-year longitudinal follow-up of patients from the Taiwan Longitudinal Health Insurance Database 2005 (LHID2005). This included a cohort of patients who received a diagnosis of gout during 2004-2008 (gout cohort) and a cohort matched by propensity scores (control cohort). A 2-stage approach that used the National Health Interview Survey 2005 was used to obtain missing confounding variables from the LHID2005. The crude hazard ratio (HR) and adjusted HR were estimated between the gout and control cohorts.

Results: The gout and control cohorts comprised 32,723 patients with gout and 65,446 people matched at a ratio of 1:2. The incidence of rotator cuff repair was 31 and 18 per 100,000 person-years in the gout and control cohorts, respectively. The crude HR for rotator cuff repair in the gout cohort was 1.73 (95% confidence interval [CI], 1.23-2.44; P < .01) during the 7-year follow-up period. After adjustment for covariates by use of the 2-stage approach, the propensity score calibration-adjusted HR was 1.60 (95% CI, 1.12-2.29; P < .01) in the gout cohort. Further analysis revealed that the adjusted HR was 1.73 (95% CI, 1.20-2.50; P < .001) among patients with gout who did not take hypouricemic medication and 2.70 (95% CI, 1.31-5.59; P < .01) for patients with gout aged 50 years or younger.

Conclusion: Patients with gout, particularly those aged 50 years or younger and without hypouricemic medication control, are at a relatively higher risk of receiving rotator cuff repair surgery. Strict control of uric acid levels with hypouricemic medication may effectively reduce the risk of rotator cuff repair.
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http://dx.doi.org/10.1177/0363546517704843DOI Listing
August 2017

Effects of Kinesio taping for stroke patients with hemiplegic shoulder pain: A double-blind, randomized, placebo-controlled study.

J Rehabil Med 2017 Mar;49(3):208-215

Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, , Taiwan ROC.

Objective: To investigate the effects of Kinesio taping for stroke patients with hemiplegic shoulder pain.

Design: Double-blind, placebo-controlled clinical trial.

Subjects: Twenty-one stroke patients with hemiplegic shoulder pain within 6 months of stroke onset in the rehabilitation ward of a medical university hospital in Taiwan.

Methods: A 3-week intervention involving a conventional rehabilitation protocol and therapeutic Kinesio taping was conducted with an experimental group of 11 stroke patients. A control group of 10 stroke patients underwent an identical conventional rehabilitation programme and sham Kinesio taping on the hemiplegic shoulder. Numerical rating scale scores, Shoulder Pain and Disability Index, ultrasound findings and pain-free passive range of motion of the affected shoulder, were evaluated before and after the intervention. Mann-Whitney test was used to compare within-group continuous variables before and after the intervention. Wilcoxon signed-rank test was used to analyse the differences and changes in values between study and control groups.

Results: There was no statistical difference in demographic variables between the 2 groups. Both groups showed improvement in passive range of motion of the shoulder, (mean numerical rating scale 2.36 (standard deviation (SD) 1.03)), and mean Shoulder Pain and Disability Index (16.64 (SD 2.62)) after the intervention (p < 0.001); however, no significant between-group differences were observed in the numerical rating scale score, pain-free passive ROM, and ultrasound findings for the shoulder after 3 weeks of treatment. Concerning the variables changes, the therapeutic Kinesio taping group showed more improvement in the numerical rating scale (p = 0.008), shoulder flexion (p = 0.008), external rotation (p = 0.006), internal rotation (p = 0.040), and Shoulder Pain and Disability Index (p < 0.001) than the sham Kinesio taping group.

Conclusion: Stroke patients with hemiplegic shoulder pain can experience greater reductions in Shoulder Pain and Disability Index, pain, and improvement in shoulder flexion, external, and internal rotation after 3 weeks of Kinesio taping intervention compared with sham Kinesio taping. Kinesio taping may be an alternative treatment option for stroke patients with hemiplegic shoulder pain.
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http://dx.doi.org/10.2340/16501977-2197DOI Listing
March 2017

Body composition influenced by progressive elastic band resistance exercise of sarcopenic obesity elderly women: a pilot randomized controlled trial.

Eur J Phys Rehabil Med 2017 Aug 12;53(4):556-563. Epub 2017 Jan 12.

Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan -

Background: Sarcopenia involves age-related decreases in muscle strength and muscle mass, leading to frailty and disability in elderly people. When combined with obesity, it is defined as sarcopenic obesity (SO), which can result in more functional limitations and metabolic disorders than either disorder alone.

Aim: The aim of this study was to investigate body composition changes after elastic band resistance training in elderly women with SO.

Design: Randomized single-blinded (assessor blinded) controlled pilot trial.

Setting: Academic medical center.

Population: Thirty-five elderly (>60 years old) women with SO.

Methods: This pilot randomized controlled trial focused on elderly women with SO. The study group underwent progressive elastic band resistance training for 12 weeks (3 times per week). The control group received only a 40-minute lesson about the exercise concept. Dual-energy X-ray absorptiometry was performed before and after intervention to evaluate body composition. Mann-Whitney U and Wilcoxon signed rank tests were used to analyze the differences within and between these groups.

Results: In total, 35 elderly women with SO were enrolled and divided into study (N.=18) and control groups (N.=17). No difference was observed in age, biochemical parameters, or Body Mass Index between both groups. After the intervention, the fat proportion of body composition in the right upper extremity (P=0.03), left upper extremity (P=0.04), total fat (P=0.035), and fat percentage (P=0.012) had decreased, and bone mineral density (BMD) (P=0.026), T-score (P=0.028), and Z-score (P=0.021) had increased in the study group. Besides, statistical difference was observed in outcome measurements of right upper extremity (P=0.013), total fat (P=0.023), and fat percentage (P=0.012) between the groups.

Conclusions: Our study demonstrated that progressive elastic band resistance exercise can reduce fat mass and increase BMD in elderly women with SO, and that this exercise program is feasible for this demographic. Additional studies with larger sample sizes and longer intervention periods should be conducted.

Clinical Rehabilitation Impact: Twelve weeks of progressive elastic band resistance exercise program is safe and effective for SO elder women.
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http://dx.doi.org/10.23736/S1973-9087.17.04443-4DOI Listing
August 2017

Effects of Linearly Polarized Near-Infrared Irradiation Near the Stellate Ganglion Region on Pain and Heart Rate Variability in Patients with Neuropathic Pain.

Pain Med 2017 03;18(3):488-503

Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.

Background: Neuropathic pain associated with sympathetic overactivity can be effectively relieved by light irradiating the region near stellate ganglion (SGI), applied as an alternative to a conventional sympathetic blockade. The clinical effect of SGI on heart rate variability (HRV) and its association with pain outcomes require investigation.

Objective: This study attempted to identify the effects of SGI on pain outcomes and HRV indices and to determine the association between pain and HRV outcomes.

Design: A prospective double-blind, randomized study.

Setting: An outpatient pain medicine clinic.

Subjects And Methods: A total of 44 patients were enrolled and randomized into the experimental group ( n = 22) and control group ( n = 22). The experimental group received 12 sessions (twice weekly) of standard SGI, whereas the control group received the same protocol with sham irradiation. Pain and HRV were measured before and after each irradiation session. All outcome measures used in the first- and second-half treatment courses were analyzed.

Results: Pain and HRV outcome measures of the experimental group significantly improved after SGI when compared with the control group in both courses. Considering time and frequency domains, the changes in HRV in the second-half treatment course exceeded those in the first-half treatment course. Pain was significantly associated with postirradiated HRV indices ( P < 0.001).

Conclusions: Twelve sessions of SGI exerted time-dependent positive effects on pain and sympathovagal imbalance. HRV outcomes, including time and frequency domains, were an independent indicator of the clinical efficiency of SGI for treating pain in patients with neuropathic pain.
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http://dx.doi.org/10.1093/pm/pnw145DOI Listing
March 2017

Association between psychiatric disorders and osteoarthritis: a nationwide longitudinal population-based study.

Medicine (Baltimore) 2016 Jun;95(26):e4016

aDepartment of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University bDepartment of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei cDepartment of Physical Medicine and Rehabilitation, Changhua Christian Hospital, Changhua dInstitute of Gerontology and Health Management, Taipei Medical University eGraduate Institute of Injury Prevention, Taipei Medical University fDepartment of Mathematics, Soochow University gEvidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.

Although the association between depressive disorders and osteoarthritis (OA) has been studied, the association of other psychiatric disorders with OA remains unclear. Here, we investigated whether psychiatric disorders are risk factors for OA.The data were obtained from the Longitudinal Health Insurance Database 2005 of Taiwan. We collected the ambulatory care claim records of patients who were diagnosed with psychiatric disorders according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes between January 1, 2004 and December 31, 2008. The prevalence and adjusted hazard ratios (HRs) of osteoarthritis among patients with psychiatric disorders and the control cohort were estimated.Of 74,393 patients with psychiatric disorders, 16,261 developed OA during the 7-year follow-up period. The crude HR for OA was 1.44 (95% confidence interval [CI], 1.39-1.49), which was higher than that of the control cohort. The adjusted HR for OA was 1.42 (95% CI, 1.39-1.42) among patients with psychiatric disorders during the 7-year follow-up period. Further analysis revealed that affective psychoses, neurotic illnesses or personality disorders, alcohol and drug dependence or abuse, and other mental disorders were risk factors for OA.This large-scale longitudinal population-based study revealed that affective psychoses, personality disorders, and alcohol and drug dependence or abuse are risk factors for OA.
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http://dx.doi.org/10.1097/MD.0000000000004016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4937933PMC
June 2016

Postural Assessment Scale for Stroke Patients Scores as a predictor of stroke patient ambulation at discharge from the rehabilitation ward.

J Rehabil Med 2016 Mar;48(3):259-64

Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.

Objective: The Postural Assessment Scale for Stroke Patients (PASS) is used to assess static and dynamic balance of stroke patients. PASS has demonstrated good measurement properties for reliability and validity, but its predictive effect for ambulation in stroke patients has not been investigated. The aim of this study was to investigate the predictive value of PASS for ambulation in patients with stroke after inpatient rehabilitation.

Methods: In this retrospective study, a total of 341 stroke patients were recruited from a rehabilitation ward of a medical university hospital. Patients were assessed at baseline using PASS and observation of rolling ability, and divided into 2 groups at discharge: independently ambulatory (n = 246) and non-ambulatory (n = 95). Receiver operating characteristic curve and adjusted bivariate logistic regression was applied to analyse the predictive value of baseline PASS scores, variables of demographic data, and rolling ability at admission to inpatient rehabilitation.

Results: For all stroke patients, mean admission to the rehabilitation ward was 34.40 days after stroke and mean length of hospitalization 18.12 days. The receiver operating characteristic curve was obtained with a cut-off score of 3.5 points for static PASS, 8.5 points for dynamic PASS, and 12.5 points for total PASS, demonstrating the highest percentage of accurately predicted ability of independently walking at discharge. Adjusted bivariate logistic regression found rolling ability, static PASS and dynamic PASS to be predictors for ambulation of stroke patients at discharge.

Conclusion: Initial static PASS score, dynamic PASS score and rolling can be predictors for independent ambulation of stroke patients after a course of inpatient rehabilitation.
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http://dx.doi.org/10.2340/16501977-2046DOI Listing
March 2016

Using surface electromyography to guide the activation during motor-evoked potential measurement: An activation control method for follow-up studies.

Brain Inj 2015 23;29(13-14):1661-6. Epub 2015 Sep 23.

g Graduate Institute of Injury Prevention and Control, Taipei Medical University , Taipei , Taiwan , and.

Objective: This study evaluated the reliability and validity of a convenient method that uses the real-time feedback surface electromyography (sEMG) to control muscle activation while measuring the MEP recorded from the quadriceps muscle in patients with stroke.

Methods: It measured the MEP parameters as well as the clinical assessment at initial test. Participants were directed to adjust their quadriceps contraction to extend the knee isometrically and maintain the EMG amplitude at 0.2 mV. MEPs were measured 2 weeks after the initial test again to assess the reliability of this measurement.

Results: A good test-re-test reliability was demonstrated with an intra-class correlation coefficient (ICC) > 0.8 for the motor threshold and a moderate reliability (ICC > 0.6) for the MEP latency and MEP amplitude, for both paretic and non-paretic legs. Patients with present MEPs had significantly higher scores in muscle power, the Fugl-Meyer assessment, the balance sub-scale of performance-oriented mobility assessment and the Barthel index; and lower NIHSS scores than those of patients with absent MEPs (all p < 0.05).

Conclusion: The sEMG-guided low level muscle activation is suitable for MEP assessment in patients with leg weakness after a stroke and may be used for long-term follow-up studies.
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http://dx.doi.org/10.3109/02699052.2015.1075150DOI Listing
October 2016

Continuous passive motion and its effects on knee flexion after total knee arthroplasty in patients with knee osteoarthritis.

Knee Surg Sports Traumatol Arthrosc 2016 Aug 19;24(8):2578-86. Epub 2015 Aug 19.

Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.

Purpose: This study evaluated the effects of continuous passive motion (CPM) on accelerated flexion after total knee arthroplasty (TKA) and whether CPM application measures (i.e. initial angle and daily increment) are associated with functional outcomes.

Methods: A retrospective investigation was conducted at the rehabilitation centre of a university-based teaching hospital. Patients who received CPM therapy immediately after TKA surgery were categorized into rapid-, normal-, and slow-progress groups according to their response to CPM during their acute inpatient stay. Knee pain, passive knee flexion, and knee function-measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)-were assessed preoperatively at discharge and at 3- and 6-month outpatient follow-up visits.

Results: A total of 354 patients were followed for 6 months after inpatient-stay discharge. The patients in the rapid-progress group (n = 119) exhibited significantly greater knee flexions than those in the slow-progress group did (n = 103) at the 3-month follow-up [mean difference (MD) = 10.3°, 95 % confidence interval (CI) 4.3°-16.3°, p < 0.001] and 6-month follow-up (MD = 10.9°, 95 % CI 6.3°-15.6°, p < 0.001). Significant WOMAC score differences between the rapid- and slow-progress groups were observed at the 3-month follow-up (MD = 7.2, 95 % CI 5.4-9.1, p < 0.001) and 6-month follow-up (MD = 16.1, 95 % CI 13.4-18.7, p < 0.001). CPM initial angles and rapid progress significantly predicted short- and long-term outcomes in knee flexion and WOMAC scores (p < 0.001).

Conclusion: When CPM is used, early application with initial high flexion and rapid progress benefits knee function up to 6 months after TKA.

Level Of Evidence: II.
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http://dx.doi.org/10.1007/s00167-015-3754-xDOI Listing
August 2016

Stroke rehabilitation and risk of mortality: a population-based cohort study stratified by age and gender.

J Stroke Cerebrovasc Dis 2015 Jun 30;24(6):1414-22. Epub 2015 Mar 30.

Graduate Institute of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan. Electronic address:

Background: To determine the survival of patients with stroke for up to 10 years after a first-time stroke and to investigate whether stroke rehabilitation within the first 3 months reduced long-term mortality in these patients.

Methods: We used the medical claims data for a random sample of 1 million insured Taiwanese registered in the year 2000. A total of 7767 patients admitted for a first-time stroke between 2000 and 2005; 1285 (16.7%) received rehabilitation within the first 3 months after stroke admission. The other 83.3% of patients served as a comparison cohort. A Cox proportional hazards model was used to estimate the relative risk of mortality in relation to the rehabilitation intervention.

Results: In all, 181 patients with rehabilitation and 1123 controls died, representing respective mortality rates of 25.0 and 32.7 per 1000 person-years. Rehabilitation was significantly associated with a lower risk of mortality (hazard ratio .68, 95% confidence interval .58-.79). Such a beneficial effect tended to be more obvious as the frequency of rehabilitation increased (P for the trend <.0001) and was more evident in female patients.

Conclusions: Stroke rehabilitation initiated in the first 3 months after a stroke admission may significantly reduce the risk of mortality for 10 years after the stroke.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2015.03.006DOI Listing
June 2015