Publications by authors named "Shu-Chun Lee"

22 Publications

  • Page 1 of 1

Impacts of stroke and cognitive impairment on activities of daily living in the Taiwan longitudinal study on aging.

Sci Rep 2021 Jun 9;11(1):12199. Epub 2021 Jun 9.

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

Stroke and cognitive impairment are common in older population. They often occur together and their combined effects significantly increase disability in both basic (BADLs) and instrumental (IADLs) activities of daily living. We investigated the individual and combined impacts of stroke and cognitive impairment on BADLs and IADLs. A total of 3331 community-dwelling older adults were enrolled from the Taiwan longitudinal study on aging in 2011. Both BADLs and IADLs were analyzed. Combination of stroke and cognitive impairment increased severity of ADL disabilities, but similar prevalence, similar numbers of summed BADL and IADL tasks with disability, and similar levels of difficulty for each BADL and IADL task were found between the stroke group and cognitive impairment group. The former had more difficult in dressing while the latter had more difficult in using the telephone, transport, and managing finances. A hierarchy of ADLs was also observed in all groups. ADL skill training supplemented with cognitive and physical interventions should focus on secondary prevention of dementia and improve motor functional capacity to reduce loss of ADLs.
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http://dx.doi.org/10.1038/s41598-021-91838-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8190118PMC
June 2021

Turning difficulties after stroke and its relationship with trunk function.

Eur J Phys Rehabil Med 2021 May 27. Epub 2021 May 27.

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

Background: Turning difficulties has been reported in stroke patients, but most studies have indicated no differences in turning direction regarding turn time or steps. Recent evidence shows that turning difficulty may correlate with trunk control. Trunk flexibility and strength are considered essential to trunk control, but their association with turning performance has not been elucidated.

Aim: The study investigated the differences in turning direction in terms of turn duration and angular velocity and the relationship between turning performance and trunk function in patients with chronic stroke.

Design: Cross-sectional study.

Setting: Outpatient clinic at the Department of Physical Medicine and Rehabilitation.

Population: Chronic stroke patients.

Methods: Twenty-eight stroke patients were evaluated for turning performance and trunk function. Turn duration and angular velocity were assessed using three wearable sensors during 360° turning in place towards both sides. Trunk function, such as flexibility, strength, and control was measured using a tape measure, a microFET3 dynamometer, and the Trunk Impairment Scale.

Results: Stroke patients showed significantly longer turn durations (4.62 ± 2.08 vs 3.59 ± 1.93 s, p = 0.036) and lower angular velocity (118.67 ± 35.78 vs 135.26 ± 42.41 0/s, p = 0.009) during turning toward the paretic side than towards the nonparetic side. The turning parameters towards the paretic side associated with trunk flexion (r = -0.550, p = 0.003) and rotation (r = 0.409, p = 0.034), trunk flexor strength (r = -0.387, p = 0.046), dynamic sitting balance (r = -0.383, p = 0.049) and coordination of trunk movement (r = -0.494, p = 0.009). However, no relationship was observed between trunk function and turning towards the nonparetic side.

Conclusions: Stroke participants experienced greater difficulty turning towards the paretic side. Trunk flexibility, strength, and control may affect turning performance, especially when turning towards the paretic side, which could explain the occurrence of falls after a turn towards the paretic side.

Clinical Rehabilitation Impact: Stroke patients experience turning difficulties, particularly during turning towards the paretic side. Stroke patients with limited trunk function are more likely to experience turning dysfunction. Clinical therapists should develop effective strategies for enhancing turning ability through improvement of trunk flexibility, strength, and control for clinical rehabilitation practice.
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http://dx.doi.org/10.23736/S1973-9087.21.06841-6DOI Listing
May 2021

Turning assessment for discrimination of frailty syndrome among community-dwelling older adults.

Gait Posture 2021 May 6;86:327-333. Epub 2021 Apr 6.

School of Gerontology Health Management, College of Nursing, Taipei Medical University, 250 Wuxing Street, Xinyi District, Taipei, 11031, Taiwan. Electronic address:

Background: Frailty is a common geriatric syndrome and is characterized by decreased physiological reserve and increased vulnerability towards adverse health outcomes including falls. Turning is a challenging task and is reported to be one of the daily activities that leads to falling in older populations.

Research Question: Does 180° walking turns and 360° turning on the spot differ among frail, pre-frail, and non-frail older adults? Can 180° walking turns and 360° turning on the spot cutoffs discriminate older adults with frailty from those without?

Methods: A cross-sectional study was conducted on community-dwelling older adults aged over 65 years. Frailty was assessed using Fried's phenotype method, and turning tasks were measured by inertial sensors. The turn duration (s) and angular velocity (°/s) were recorded for analysis.

Results: In total, 109 participants were enrolled including 50 pre-frail and 12 frail individuals. Frail older adults took significantly longer and had slower angular velocities to complete the 180° and 360° turning than did either pre-frail (p = 0.002 and p < 0.001, respectively) or non-frail (p = 0.03 and p < 0.001, respectively) older adults. Cutoff times of 2.45 and 3.46 s were found to best discriminate frail people from those without frailty in both the 180° (sensitivity 83.3 %, specificity 71.1 %, area under the receiver operating characteristic curve (AUC) 0.796) and 360° (sensitivity 91.7 %, specificity 74.2 %, AUC 0.857) turn tasks.

Significance: Older individuals with frailty syndrome had difficulty turning as evidenced by a longer turning duration and a slower angular velocity. The turn duration could be a potential biomarker of frailty in older populations. Assessing the turning performance can facilitate early detection of the onset of frailty and inform early prevention and rehabilitation interventions in clinical practice.
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http://dx.doi.org/10.1016/j.gaitpost.2021.04.004DOI Listing
May 2021

Test-Retest Reliability and Minimal Detectable Change of the Comprehensive Occupational Therapy Evaluation Scale (COTES) in People With Schizophrenia.

Am J Occup Ther 2020 Sep/Oct;74(5):7405205110p1-7405205110p7

Fang-Yu Gu, MS, is Occupational Therapist, Department of Occupational Therapy, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.

Importance: A reliable observational measure is necessary to measure clients' behaviors as they participate in activities. The Comprehensive Occupational Therapy Evaluation Scale (COTES) is designed to measure strengths and difficulties in various behaviors that support occupational performance.

Objective: To examine the test-retest reliability of the COTES (overall score and scores on the General Behavior, Social Behavior, and Work Behavior subscales) and calculate the minimal detectable change (MDC) for people with schizophrenia.

Design: Prospective, observational study.

Setting: A psychiatric center.

Participants: COTES data for 118 people with schizophrenia were collected from occupational therapy records. Data from the initial and second COTES measurements were chosen for analysis.

Outcomes And Measures: Test-retest reliability of the overall scale and three subscales was evaluated using the intraclass correlation coefficient (ICC). The MDC was calculated on the basis of the standard error of measurement.

Results: ICCs for the overall scale and three subscales ranged from .91 to .97. The MDC values (MDC%) were 6.5 (10.5%) for the overall scale, 3.4 (13.5%) for the General Behavior subscale, 2.3 (15.2%) for the Social Behavior subscale, and 2.4 (11.0%) for the Work Behavior subscale.

Conclusion And Relevance: The COTES has good test-retest reliability. Clinicians and researchers can use the MDC values provided in this study to explain the implications of change scores for behaviors that affect occupational performance for people with schizophrenia.

What This Article Adds: The COTES has sound reliability and support for its use in determining whether people with schizophrenia make real improvements in behavior that affects occupational performance over time.
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http://dx.doi.org/10.5014/ajot.2020.040154DOI Listing
September 2020

Turning duration and steps predict future falls in poststroke hemiplegic individuals: A preliminary cohort study.

Top Stroke Rehabil 2021 01 12;28(1):33-41. Epub 2020 May 12.

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

: Turning was reported as one of the activities that most frequently leads to falling among stroke patients. This study investigated whether the duration and steps of a 180° turn while walking can distinguish retrospective fallers from non-fallers and predict future falls in a 1-year period in patients with poststroke hemiplegia. : Thirty stroke patients were recruited. They were instructed to get up from a chair, walk straight 3 m, turn around, and return to seated position to assess the 180° walking-turn task. Turning performance was measured by two inertial sensor units of Physilog. Turn duration and steps were recorded for analysis. The numbers of retrospective and prospective falls were also obtained. : No significant difference was observed between retrospective stroke fallers and non-fallers in turn duration and steps. Turn duration and steps were significantly greater in prospective stroke fallers than in non-fallers. The cutoff turn duration of 4 s (area under the curve 0.75, 95% CI: 0.56-0.93, sensitivity 67%, specificity 80%, =.04) and turn step of 7 steps (area under the curve 0.73, 95% CI: 0.51-0.94, sensitivity 56%, specificity 85%, =.05) were found to most accurately predict prospective stroke fallers from non-fallers. : Turn duration and steps were unable to discriminate between retrospective fallers and non-fallers but could predict prospective falls in patients with stroke. More than 4 s or 7 steps to complete a 180° turn while walking can be a predictor for patients with stroke at an increased risk of falling.
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http://dx.doi.org/10.1080/10749357.2020.1760644DOI Listing
January 2021

Validating the Capability for Measuring Age-Related Changes in Grip-Force Strength Using a Digital Hand-Held Dynamometer in Healthy Young and Elderly Adults.

Biomed Res Int 2020 20;2020:6936879. Epub 2020 Apr 20.

Master Program in Long-Term Care & School of Gerontology Health Management, College of Nursing, Taipei Medical University, 250 Wu-Xing Street, Taipei 11031, Taiwan.

Background: Grip-force performance can be affected by aging, and hand-grip weakness is associated with functional limitations of dasily living. However, using an appropriate digital hand-held dynamometer with continuous hand-grip force data collection shows age-related changes in the quality of hand-grip force control may provide more valuable information for clinical diagnoses rather than merely recording instantaneous maximal hand-grip force in frail elderly adults or people with a disability. Therefore, the purpose of this study was to indicate the construct validity of the digital MicroFET3 dynamometer with Jamar values for maximal grip-force assessments in elderly and young adults and confirmed age-related changes in the maximal and the quality of grip-force performance using the MicroFET3 dynamometer in elderly people.

Methods: Sixty-five healthy young (23.3 ± 4.5 years) and 50 elderly (69.5 ± 5.8 years) adults were recruited and asked to perform a validity test of the grip-force maximum voluntary contraction (MVC) using both the dominant and nondominant hands with a Jamar dynamometer and a MicroFET3 dynamometer.

Results: A strong correlation of maximal grip-force measurements was found between the MicroFET3 dynamometer and Jamar standard dynamometer for both hands in all participants ( < 0.05). Although, the results showed that a lower grip force was measured in both hands by the MicroFET3 dynamometer than with the Jamar dynamometer by 49.9%~57% ( < 0.05), but confidently conversion formulae were also developed to convert MicroFET3 dynamometer values to equivalent Jamar values for both hands. Both dynamometers indicated age-related declines in the maximum grip-force performance by 36.7%~44.3% ( < 0.05). We also found that the maximal hand-grip force values generated in both hand by the elderly adults were slower and more inconsistent than those of the young adults when using the MicroFET3 dynamometer.

Conclusions: This study demonstrated that the digital MicroFET3 dynamometer has good validity when used to measure the maximal grip force of both hands, and conversion formulae were also developed to convert MicroFET3 dynamometer force values to Jamar values in both hands. Comparing with the Jamar dynamometer for measuring grip force, the MicroFET3 dynamometer not only indicated age-related declines in the maximum grip-force performance but also showed slower and more inconsistent maximal hand-grip strength generation by the elderly.
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http://dx.doi.org/10.1155/2020/6936879DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7191369PMC
February 2021

Construct Validity and Reliability of the Comprehensive Occupational Therapy Evaluation Scale (COTES) in People With Schizophrenia.

Am J Occup Ther 2019 Nov/Dec;73(6):7306205060p1-7306205060p8

Ching-Lin Hsieh, PhD, is Professor, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan, and Adjunct Professor, Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taichung, Taiwan.

Objective: We evaluated the construct validity (i.e., unidimensionality and convergent validity) and Rasch reliability of the 20-item Comprehensive Occupational Therapy Evaluation Scale (COTES) in people with schizophrenia.

Method: Retrospective chart review was used to collect COTES data from 505 inpatients with schizophrenia. For construct validity, we first examined unidimensionality of each of the three COTES subscales using Rasch analysis. After unidimensionality was supported, we examined convergent validity using Pearson's r and Rasch reliability of the individual subscales.

Results: After deleting two misfitting items, the remaining items (i.e., the COTES-18) showed unidimensionality. Infit and outfit mean squares were 0.73-1.25. Moderate correlations were found among the three COTES-18 subscales (rs = .57-.71). The Rasch reliabilities of the three subscales were .83-.92.

Conclusion: The COTES-18 has sufficient construct validity and reliability to assess three specific dimensions of behavior affecting occupational performance in people with schizophrenia.
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http://dx.doi.org/10.5014/ajot.2019.026807DOI Listing
January 2020

Test-retest reliability of the Wisconsin Card Sorting Test in people with schizophrenia.

Disabil Rehabil 2021 Apr 30;43(7):996-1000. Epub 2019 Jul 30.

Department of Occupational Therapy, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan, ROC.

Purpose: The aim of this study was to examine the test-retest reliability of the Wisconsin Card Sorting Test in people with schizophrenia. In this study, minimal detectable change (MDC) was calculated and systematic measurement errors were evaluated.

Method: Sixty-three people with schizophrenia underwent the WCST twice with a two-week interval. Test-retest reliability was evaluated using intraclass correlation coefficient. Systematic measurement error was examined using paired -test and effect size (Cohen's ).

Results: The values of intraclass correlation coefficient were >0.70, except for two indices ("nonperseverative errors" and "failure to maintain set" with intraclass correlation coefficient of 0.56 and 0.30, respectively). Seven indices showed nonsignificant differences between the two assessments ((62)= -0.84 to 1.38,  > 0.05) and negligible effect sizes ( = 0.03-0.13). The values of MDC with 95% certainty were 32.3, 42.0, 31.2, 36.9, 40.1, 3.3, and 3.8 for the "total number correct," "perseverative responses," "perseverative errors," "nonperseverative errors," "conceptual level responses," "number of categories completed," and "failure to maintain set" indices, respectively.

Conclusions: The WCST has acceptable test-retest reliability. Two indices ("nonperseverative errors" and "failure to maintain set") revealed lower levels of consistency in scores over repeated assessments. Clinicians and researchers should be cautious when using these two indices to interpret of the re-assessment results in people with schizophrenia.IMPLICATIONS FOR REHABILITATIONThe Wisconsin Card Sorting Test showed acceptable test-retest reliability in people with schizophrenia.Six indices of the Wisconsin Card Sorting Test revealed substantial random measurement errors, which should be used cautiously to interpret executive functions over repeated assessments.
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http://dx.doi.org/10.1080/09638288.2019.1647295DOI Listing
April 2021

Traditional-Chinese Dispositional Flow Scale-2 and Flow State Scale-2 in Taiwanese subjects with schizophrenia or schizoaffective disorder.

Psychiatry Res 2019 Apr 19;274:287-293. Epub 2018 Dec 19.

Occupational Therapy Department, Taipei City Hospital Songde Branch, Taipei, Taiwan (R.O.C.).

Introduction: The 36-item Dispositional Flow Scale-2 (DFS-2) and Flow State Scale-2 (FSS-2) were developed to assess flow experience in daily and specific activities. Although their validity and reliability had been examined in general populations and different cultures, little is known for schizophrenic subjects. Thus, this study aimed to validate Traditional-Chinese DFS-2 (TCDFS-2) and FSS-2 (TCFSS-2) in Taiwanese subjects with schizophrenia or schizoaffective disorder.

Methods: We recruited 229 adult participants from outpatient clinics, day care centers, and psychiatric rehabilitation centers in Taipei. They filled out 36-item TCDFS-2 and TCFSS-2 under guidance. The LISREL 9.30 software was used to conduct exploratory factor analysis for exploring measurement structures, and then confirmatory factor analysis for identifying factor models.

Results: The six first-order factor and one second-order factor measurement models were obtained for both 36-item TCDFS-2 (Chi-square statistic = 999.1, df = 545, p < 0.0001, Root Mean Square Error of Approximation [RMSEA] = 0.0603, and Comparative Fit Index [CFI] = 0.9213) and TCFSS-2 (Chi-square statistic = 987.9, df = 539, p < 0.0001, RMSEA = 0.0603, and CFI = 0.9213).

Conclusion: Our factor models differed remarkably from those of 36-item DFS-2 and FSS-2. Yet, they were barely acceptable to be used to measure flow experiences in schizophrenic subjects in clinical applications. Since the factor scores, measurement structures, or even definitions of flow experiences could differ substantially between healthy people and patients with mental illness, disease-specific instruments of flow experiences should be considered in the future.
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http://dx.doi.org/10.1016/j.psychres.2018.12.093DOI Listing
April 2019

Influence of aging and visual feedback on the stability of hand grip control in elderly adults.

Exp Gerontol 2019 05 26;119:74-81. Epub 2019 Jan 26.

Masters Program in Long-Term Care & School of Gerontology Health Management, College of Nursing, Taipei Medical University, 250 Wu-Xing Street, Taipei 110, Taiwan, ROC.

Aging causes a gradual decrease in maximal grip strength and leads many elderly people to have to rely on visual feedback to compensate for poorer muscle strength in performing daily activities and preventing accidents. Previous studies have investigated age and visual feedback-related changes in grip strength. However, little is known about methods of determining the quality and stability of hand grip strength control in the elderly, which is important for understanding their ability to generate grip force when handling objects with and without visual feedback in daily living. Therefore, the purpose of this study was to investigate the influence of aging and visual feedback on the stability of hand grip control in both hands in elderly adults. Forty-four healthy elderly persons (age 80.5 ± 4.53 years) and 36 young adults (age 32.69 ± 16.48 years) were recruited to execute grip force stability tasks using both hands at a 2 kg target force level. To perform the grip force stability task, the participants were asked to hold the dynamometer tightly in an attempt to achieve the target force level under visual and non-visual feedback conditions. Strength performances (grip force and coefficient of variation values) and stability of strength control (deviation error, variation error and force stability index values) for hand grip force stability tasks were calculated and analyzed. Compared with the visual feedback condition, the stability of grip force control in the hands of the young and elderly groups were significantly reduced in the non-visual feedback condition by 23.5%-57.1% (p < .05). The elderly group also showed significantly worse hand grip strength performances and stability of hand strength control than the young adult group (p < .05). Aging and non-visual feedback reduced the hand grip force output and stability of grip strength control of the hands. This may reveal the difficulty with manipulating hand-held objects in the absence of visual feedback while performing activities of daily living among the elderly.
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http://dx.doi.org/10.1016/j.exger.2019.01.024DOI Listing
May 2019

Predictive power of a single body temperature at different cutoff values for neonates in the nursery transferring to special care nursery.

Medicine (Baltimore) 2018 Oct;97(42):e12619

Department of Pediatric Emergency Medicine, Children's Hospital, China Medical University.

The aim of this study was to identify the clinical parameters indicative of serious etiology of neonatal hyperthermia and to determine the appropriate cutoff value of body temperature (BT) for predicting the need to transfer the newborn to the special care (SC) nursery.The nursery records of newborns diagnosed with hyperthermia between 2007 and 2013 were retrospectively reviewed. The clinical characteristics of newborns with hyperthermia remained in the nursery were compared with those transferred to the SC nursery. In addition, the receiver operating characteristic analysis was used to determine the appropriate cutoff BT for predicting further septic workup in the SC nursery.Among the 92 newborns with hyperthermia evaluated, 30 (32.6%) were transferred to the SC nursery and 62 (67.4%) remained in the nursery. Clinical characteristics associated with transfer to the SC nursery included the highest BT, BT at first measurement during hyperthermia, frequency of hyperthermia, duration of hyperthermia, irritable crying, decreased appetite, poor activity, vomiting with abdominal distension, tachypnea, and tachycardia (all P < .05). BT for predicting the need for transferring newborns with hyperthermia to the SC nursery had an area under the curve of 0.976 (P < .001). A BT of 38 °C was determined as the optimal cutoff value for predicting the need to monitoring for suspicious clinical symptoms (sensitivity (Sn), 93%; specificity (Sp), 87%). Furthermore, BT≥38.2 °C (Sn, 70%; Sp 100%) and BT≤37.8 °C (Sn, 100%; Sp, 61%) respectively were determined as the cutoff values for transferring newborns to the SC nursery or allowing them to remain in the regular nursery.Our results suggest a BT of 38 °C represents the optimal cutoff indicating newborns for close monitoring for suspicious clinical presentations including irritable crying, decreased appetite, poor activity, vomiting with abdominal distension, tachypnea, and tachycardia. Newborns with BT < 37.8 °C may remain in the nursery but should be transferred to the SC nursery for septic workup and empiric antibiotics if the BT is above 38.2 °C.
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http://dx.doi.org/10.1097/MD.0000000000012619DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6211842PMC
October 2018

Minimal Detectable Change on the Lawton Instrumental Activities of Daily Living Scale in Community-Dwelling Patients With Schizophrenia.

Am J Occup Ther 2018 Sep/Oct;72(5):7205195020p1-7205195020p7

Ching-Lin Hsieh, PhD, OTR, is Professor, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Adjunct Occupational Therapist, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan; and Adjunct Professor, Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taichung, Taiwan.

The main purpose of this study was to estimate the minimal detectable change (MDC) on the Lawton Instrumental Activities of Daily Living (LIADL) scale in community-dwelling patients with schizophrenia. Fifty-seven patients completed the LIADL assessment twice, about 14 days apart. Two scoring methods (dichotomous and polytomous) were used to record the patients' performance on the LIADL scale. The MDCs of the LIADL scale were 1.5 (dichotomous) and 4.4 (polytomous) points. The MDC percentages were 22.0% (dichotomous) and 22.5% (polytomous), both of which are within acceptable measurement errors. The test-retest reliabilities of the LIADL scale were both acceptable with two different scoring methods (dichotomous = .75; polytomous = .76). Users can choose the scoring method according to their individual needs.
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http://dx.doi.org/10.5014/ajot.2018.026898DOI Listing
November 2018

Corrigendum to "Minimal detectable change of the Personal and Social Performance scale in individuals with schizophrenia" [Psychiatry Research 246 (2016) 725-729].

Psychiatry Res 2018 02 5;260:508. Epub 2018 Feb 5.

School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.

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http://dx.doi.org/10.1016/j.psychres.2018.01.019DOI Listing
February 2018

Responsiveness of the Personal and Social Performance scale in patients with schizophrenia.

Psychiatry Res 2018 02 27;260:338-342. Epub 2017 Nov 27.

School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan; Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taiwan.

The responsiveness (ability to detect change) of the Personal and Social Performance scale (PSP) is largely unknown, limiting its use as an outcome measure. The purpose of this study was to examine both internal and external responsiveness of the PSP in patients with schizophrenia in the acute phase. Eighty patients were administered the PSP and the Clinical Global Impression-Severity scale (CGI-S) at admission and at discharge. We used the standardized effect size, the standardized response mean, and paired t-test for examining internal responsiveness. We examined the correlations between the changes in scores of the PSP and those of the CGI-S using Pearson's r for validating the external responsiveness. The results showed that the standardized effect sizes and standardized response means of the PSP were 0.74-1.74 and 0.68-1.72, respectively. The paired t-tests showed statistically significant difference (p<0.001). Moderate to good correlations (r=0.35-0.74) were found among the changes of the PSP with those of the CGI-S. The PSP showed substantial internal responsiveness and sufficient external responsiveness in patients with schizophrenia receiving treatment in the acute phase. The PSP appears useful as an outcome measure for detecting changes of social functioning over time.
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http://dx.doi.org/10.1016/j.psychres.2017.11.053DOI Listing
February 2018

Comparison of construct validity of two short forms of Stroke-Specific Quality of Life scale.

PLoS One 2017 6;12(12):e0188478. Epub 2017 Dec 6.

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

Background: No studies have compared the 2-factor structures of Wong's and Post's versions of the short-form Stroke-Specific Quality of Life (i.e., 12-item SSQOL) scale. This study compared the construct validity of 2 short-forms of the 12-item-SSQOL (not the 12-domain-SSQOL).

Methods: Data were obtained from a previous validation study of the original 49-item SSQOL in 263 patients. Construct validity was tested by confirmatory factor analysis (CFA) to examine whether the two-factor structure, including psychosocial and physical domains, was supported in both versions. The CFA tested the data-model fit by indices: chi-square χ2/df ratio, root mean square error of approximation (RMSEA), comparative fit index (CFI), nonnormative fit index (NNFI), standard root mean square residual (SRMR), and parsimony normed fit index (PNFI). Item factor loadings (cutoffs: .50) were examined. Model fit was compared using Akaike information criterion (AIC) and consistent AIC (i.e., CAIC) values.

Results: All model fit indices for Post's version fell within expected ranges: χ2/df ratio = 2.02, RMSEA = 0.05, CFI = 0.97, NNFI = 0.97, SRMR = 0.06, and PNFI = 0.76. In the psychosocial domain, the item factor loadings ranged from 0.46 to 0.63. In the physical domain, all items (except the language and vision items) had acceptable factor loadings (0.68 to 0.88). However, in Wong's version, none of the model indices met the criteria for good fit. In model fit comparisons, Post's version had smaller AIC and CAIC values than did Wong's version.

Conclusions: All fit indices supported Post's version, but not Wong's version. The construct validity of Post's version with a 2-factor structure was confirmed, and this version of the 12-item SSQOL is recommended.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0188478PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5718408PMC
December 2017

Factor Structure of the Quality of Life Scale for Mental Disorders in Patients With Schizophrenia.

J Nurs Res 2018 Jun;26(3):185-190

PhD, OTD, Assistant Professor, Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan, ROC.

Background: The Quality of Life for Mental Disorders (QOLMD) scale was designed to measure health-related quality of life (HRQOL) in patients with mental illness, especially schizophrenia. The QOLMD contains 45 items, which are divided into eight domains. However, the factor structure of the QOLMD has not been evaluated, which restricts the interpretations of the results of this scale.

Purpose: The purpose of this study was to evaluate the factor structures (i.e., unidimensionality, eight-factor structure, and second-order model) of the QOLMD in patients with schizophrenia.

Methods: Two hundred thirty-eight outpatients with schizophrenia participated. We first conducted confirmatory factor analysis to evaluate the unidimensionality of each domain. After the unidimensionality of the eight individual domains was supported, we examined the eight-factor structure and second-order model.

Results: The results of unidimensionality showed sufficient model fit in all of the domains with the exception of the autonomy domain. A good model fit was confirmed for the autonomy domain after deleting two of the original items. The eight-factor structure for the 43-item QOLMD showed an acceptable model fit, although the second-order model showed poor model fit.

Conclusions/implications For Practice: Our results supported the unidimensionality and eight-factor structure of the 43-item QOLMD. The sum score for each of the domains may be used to reflect its domain-specific function. We recommend using the 43-item QOLMD to capture the multiple domains of HRQOL. However, the second-order model showed an unsatisfactory model fit. Furthermore, caution is advised when interpreting overall HRQOL using the total score for the eight domains.
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http://dx.doi.org/10.1097/jnr.0000000000000236DOI Listing
June 2018

A Reliable and Valid Assessment of Sustained Attention for Patients With Schizophrenia: The Computerized Digit Vigilance Test.

Arch Clin Neuropsychol 2018 Mar;33(2):227-237

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

Objective: The purposes of this study were to examine the test-retest reliability, concurrent validity, and ecological validity of the Computerized Digit Vigilance Test (C-DVT) in patients with schizophrenia.

Method: Each participant was assessed four times, with 1-week intervals. In each assessment, the participants completed both the C-DVT and the original DVT. The participants were also assessed using the Lawton Instrumental Activities of Daily Living Scale (LIADL) and the Personal and Social Performance Scale (PSP).

Results: Forty-nine participants were recruited in this study. The results showed that the test-retest agreement of the C-DVT was good-to-excellent (intraclass correlation coefficient = 0.71-0.89). The random measurement errors of the C-DVT were acceptable (percentages of minimal detectable change = 12.9%-24.1%). The practice effect of the C-DVT reached a plateau after three assessments (effect size <0.20). The concurrent validity of the C-DVT was good (r = .75-.79 with DVT) when we controlled for the randomized administration order of the two tests. The ecological validity of the C-DVT was good (r = -.44 with the LIADL; r = -.45 with the PSP).

Conclusions: The C-DVT had acceptable test-retest reliability, sound concurrent validity, and sound ecological validity in patients with schizophrenia. These findings indicate that the C-DVT has the potential to be a reliable and valid test of sustained attention in patients with schizophrenia.
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http://dx.doi.org/10.1093/arclin/acx064DOI Listing
March 2018

Relationship of visual dependence to age, balance, attention, and vertigo.

Authors:
Shu-Chun Lee

J Phys Ther Sci 2017 Aug 10;29(8):1318-1322. Epub 2017 Aug 10.

Department of Physical Therapy, Shu-Zen College of Medicine and Management, Taiwan.

[Purpose] The aim of this study was to investigate the relationship of increased visual dependence to age, balance, attention, and vertigo. [Subjects and Methods] Twelve younger, 12 visually independent (VI) older and 12 visually dependent (VD) older adults were assessed for levels of visual dependence using Subjective Visual Vertical (SVV) tilt values, balance ability using the Clinical Test of Sensory Integration for Balance (CTSIB), and attentional requirements through the dual-task paradigm and experience of vertigo by completing the Situational Vertigo Questionnaire (SVQ). [Results] VD older adults had higher SVV tilt values, greater postural sway in a scenario where visual and proprioceptive inputs were simultaneously altered, similar dual-task cost and lower SVQ scores compared with younger and VI older adults. No difference was observed between the latter two. [Conclusion] Visual dependence may not necessarily increase with age but affect balance in a sensory condition involving visual-proprioceptive conflict. There is a non-significant trend for elevated visual dependence with increased attentional demands. Greater visual dependence is not accompanied by more frequent symptoms of vertigo in visually complex environments.
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http://dx.doi.org/10.1589/jpts.29.1318DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574361PMC
August 2017

Minimal detectable change of the Personal and Social Performance scale in individuals with schizophrenia.

Psychiatry Res 2016 Dec 29;246:725-729. Epub 2016 Oct 29.

School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan. Electronic address:

The minimal detectable change (MDC) of the Personal and Social Performance scale (PSP) has not yet been investigated, limiting its utility in data interpretation. The purpose of this study was to determine the MDCs of the PSP administered by the same rater or different raters in individuals with schizophrenia. Participants with schizophrenia were recruited from two psychiatric community rehabilitation centers to complete the PSP assessments twice, 2 weeks apart, by the same rater or 2 different raters. MDC values were calculated from the coefficients of intra- and inter-rater reliability (i.e., intraclass correlation coefficients). Forty patients (mean age 36.9 years, SD 9.7) from one center participated in the intra-rater reliability study. Another 40 patients (mean age 44.3 years, SD 11.1) from the other center participated in the inter-rater study. The MDCs (MDC%) of the PSP were 10.7 (17.1%) for the same rater and 16.2 (24.1%) for different raters. The MDCs of the PSP appeared appropriate for clinical trials aiming to determine whether a real change in social functioning has occurred in people with schizophrenia.
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http://dx.doi.org/10.1016/j.psychres.2016.10.058DOI Listing
December 2016

Intrarater and Interrater Reliability of the Hierarchical Balance Short Forms in Patients With Stroke.

Arch Phys Med Rehabil 2016 12 25;97(12):2137-2145.e2. Epub 2016 Jul 25.

School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan. Electronic address:

Objective: To examine the intrarater and interrater reliability of a quick balance measure, the Hierarchical Balance Short Forms (HBSF), in outpatients with stroke receiving rehabilitation.

Design: A repeated-assessments design (1wk apart) was used to examine the intrarater and interrater reliability of the HBSF. The HBSF was administered by a single rater in the intrarater reliability study and by 2 raters in the interrater reliability study. The raters had sufficient working experience in stroke rehabilitation.

Setting: Seven teaching hospitals.

Participants: Two independent groups of outpatients (N=106; each group, n=53) with stroke in chronic stages and in stable medical condition were recruited.

Interventions: Not applicable.

Main Outcome Measure: HBSF.

Results: For the intrarater reliability study, the values of the intraclass correlation coefficient (ICC), minimal detectable change (MDC), and percentage of minimal detectable change (MDC%) were .95, 1.02, and 16.3%, respectively, for the HBSF. The 95% limits of agreement (LOA) of the HBSF ranged from -.69 to 1.19. For the interrater reliability study, the values of the ICC, MDC, and MDC% were .91, 1.22, and 18.3%, respectively, for the HBSF. The 95% LOA of the HBSF ranged from -1.01 to 1.35.

Conclusions: Our results suggest that the HBSF has satisfactory intrarater and interrater reliability for assessing balance function in outpatients with stroke. The MDC values of the HBSF are useful for both researchers and clinicians to determine whether the change in balance function of an individual patient is real when administered by an individual rater or by different raters.
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http://dx.doi.org/10.1016/j.apmr.2016.07.003DOI Listing
December 2016

Development of a Performance-Based Measure of Executive Functions in Patients with Schizophrenia.

PLoS One 2015 12;10(11):e0142790. Epub 2015 Nov 12.

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

A performance-based measure for assessing executive functions (EF) is useful to understand patients' real life performance of EF. This study aimed to develop a performance-based measure of executive functions (PEF) based on the Lezak model and to examine psychometric properties (i.e., unidimensionality and reliability) of the PEF using Rasch analysis in patients with schizophrenia. We developed the PEF in three phases: (1) designing the preliminary version of PEF; (2) consultation with experts, cognitive interviews with patients, and pilot tests on patients to revise the preliminary PEF; (3) establishment of the final version of the PEF and examination of unidimensionality and Rasch reliability. Two hundred patients were assessed using the revised PEF. After deleting items which did not satisfy the Rasch model's expectations, the final version of the PEF contained 1 practice item and 13 test items for assessing the four domains of EF (i.e., volition, planning, purposive action, and effective performance). For unidimensional and multidimensional Rasch analyses, the 4 domains showed good reliability (i.e., 0.77-0.85 and 0.87-0.90, respectively). Our results showed that the PEF had satisfactory unidimensionality and Rasch reliability. Therefore, clinicians and researchers could use the PEF to assess the four domains of EF in patients with schizophrenia.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0142790PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4642955PMC
July 2016

Construct Validity of the Chinese Version of the Activities of Daily Living Rating Scale III in Patients with Schizophrenia.

PLoS One 2015 29;10(6):e0130702. Epub 2015 Jun 29.

School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.

Background: The Chinese version of the Activities of Daily Living Rating Scale III (ADLRS-III), which has 10 domains, is commonly used for assessing activities of daily living (ADL) in patients with schizophrenia. However, construct validity (i.e., unidimensionality) for each domain of the ADLRS-III is unknown, limiting the explanations of the test results.

Purpose: This main purpose of this study was to examine unidimensionality of each domain in the ADLRS-III. We also examined internal consistency and ceiling/floor effects in patients with schizophrenia.

Methods: From occupational therapy records, we obtained 304 self-report data of the ADLRS-III. Confirmatory factor analysis (CFA) was conducted to examine the 10 one-factor structures. If a domain showed an insufficient model fit, exploratory factor analysis (EFA) was performed to investigate the factor structure and choose one factor representing the original construct. Internal consistency was examined using Cronbach's alpha (α). Ceiling and floor effects were determined by the percentage of patients with the maximum and minimum scores in each domain, respectively.

Results: CFA analyses showed that 4 domains (i.e., leisure, picture recognition, literacy ability, communication tools use) had sufficient model fits. These 4 domains had acceptable internal consistency (α = 0.79-0.87) and no ceiling/floor effects, except the leisure domain which had a ceiling effect. The other 6 domains showed insufficient model fits. The EFA results showed that these 6 domains were two-factor structures.

Conclusion: The results supported unidimensional constructs of the leisure, picture recognition, literacy ability, and communication tool uses domains. The sum scores of these 4 domains can be used to represent their respective domain-specific functions. Regarding the 6 domains with insufficient model fits, we have explained the two factors of each domain and chosen one factor to represent its original construct. Future users may use the items from the chosen factors to assess domain-specific functions in patients with schizophrenia.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0130702PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4488143PMC
March 2016