Publications by authors named "Wen-Hsuan Hou"

83 Publications

Conducting a Scoping Review in Physical Medicine and Rehabilitation.

Am J Phys Med Rehabil 2021 Apr 8. Epub 2021 Apr 8.

Department of Communication Sciences and Disorders, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, USA; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, VA, USA Health Sciences Library, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, USA Department of Communication Sciences and Disorders, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, USA Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan Department of Physical Medicine & Rehabilitation, Center of Evidence-based Medicine, Department of Education, Taipei Medical University Hospital, Taipei, Taiwan Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.

Abstract: In the field of Physical Medicine and Rehabilitation (PM&R), there is a continuous need to conduct literature search in advancing evidence-based practice. In addition to the traditional meta-analysis (MA) approach, many clinicians have turned their attention to systematic reviews (SyR) and scoping reviews (ScR) for research evidence to support clinical practice. In this article, the authors aim to (1) compare the similarities, differences, pros, and cons between a scoping review (ScR), a systematic review (SyR), and a meta-analysis (MA); (2) summarize the fundamental stages in conducting a scoping review (ScR). Examples of recently published articles relevant to PM&R are presented to illustrate the concept and value of scoping reviews (ScR).
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http://dx.doi.org/10.1097/PHM.0000000000001763DOI Listing
April 2021

Effectiveness of shared decision-making intervention in patients with lumbar degenerative diseases: A randomized controlled trial.

Patient Educ Couns 2021 Mar 10. Epub 2021 Mar 10.

Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.

Objective: To evaluate the efficacy of shared decision-making (SDM) intervention among patients with lumbar degenerative diseases (LDDs) in terms of decision self-efficacy, control preferences, SDM process, decision satisfaction, and conflict.

Methods: A total of 130 outpatients with LDDs recruited from orthopedic or rehabilitation clinics were randomly assigned to the SDM intervention (n = 67) or comparison (n = 63) groups. Patients in the intervention group received decision aids (DAs) with decision coaching and those in controlled group received standard educational materials from a health educator. The primary outcome was decision self-efficacy, and secondary outcomes were control preference, SDM process, conflict, and satisfaction.

Results: The SDM intervention significantly improved decision self-efficacy (mean difference [MD] = 7.1, 95% confidence interval [CI]: 1.7-12.5, partial η = 0.05) and reduced conflict (MD = -7.0, 95% CI: -12.2 to -1.9, partial η = 0.06), especially in patients without family involvement, compared with the health education group. However, no significant between-group differences were observed in other outcomes.

Conclusion: SDM intervention improved SDM self-efficacy and reduced conflict in patients with LDDs.

Practice Implications: Clinicians can integrate DAs and decision coaching in SDM conversations. SDM intervention seems to engage patients in decision-making, especially those without family involvement.
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http://dx.doi.org/10.1016/j.pec.2021.03.002DOI Listing
March 2021

Association between trajectory of severe hypoglycemia and dementia in patients with type 2 diabetes: A population-based study.

J Epidemiol 2021 Mar 6. Epub 2021 Mar 6.

School of Gerontology Health Management & Master Program in Long-Term Care, College of Nursing, Taipei Medical University.

Background: To investigate associations between exposure to various trajectories of severe hypoglycemic events and risk of dementia in patients with type 2 diabetes.

Methods: In 2002-2003, 677618 patients in Taiwan were newly diagnosed as having type 2 diabetes. Among them, 35720 (5.3%) experienced severe hypoglycemic events during the 3-year baseline period following diagnosis. All patients were followed from the first day after baseline period to the date of dementia diagnosis, death, or the end of 2011. A group-based trajectory model was used to classify individuals with severe hypoglycemic events during the baseline period. Cox proportional hazard models with the competing risk method were used to relate dementia risk to various severe hypoglycemia trajectories.

Results: After a median follow-up 6.70 and 6.10 years for patients with and without severe hypoglycemia at baseline, respectively, 1952 (5.5%) individuals with severe hypoglycemia and 23492 (3.7%) without developed dementia during follow-up, for incidence rates of 109.80 and 61.88 per 10000 person-years, respectively. Four groups of severe hypoglycemia trajectory were identified with a proportion of 18.06%, 33.19%, 43.25%, and 5.50%, respectively for Groups 1 to 4. Groups 3 (early manifestation but with later decrease) and 4 (early and sustained manifestation) were associated with a significantly increased risk of dementia diagnosis, with a covariate-adjusted subdistribution hazard ratio of 1.22 (95% confidence interval, 1.14-1.31) and 1.25 (95% confidence interval, 1.02-1.54), respectively.

Conclusions: Our analysis highlighted that early manifestation of severe hypoglycemic events may contribute more than does late manifestation to the risk of dementia among individuals newly diagnosed as having type 2 diabetes.
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http://dx.doi.org/10.2188/jea.JE20200518DOI Listing
March 2021

Peak expiratory flow rate and sarcopenia risk in older Indonesian people: A nationwide survey.

PLoS One 2021 9;16(2):e0246179. Epub 2021 Feb 9.

School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.

Reduced peak expiratory flow is a common physiological change in older individuals and age is an important predictor for sarcopenia. We analyzed nationwide survey data to determine the relationship between peak expiratory flow rate and sarcopenia in older Indonesians. Community-dwelling Indonesian individuals aged ≥60 years (n = 2422; mean age = 67.21 y) from the fifth-wave data of the Indonesian Family Life Survey was selected. Sarcopenia was diagnosed based on handgrip strength, gait speed, and appendicular skeletal muscle mass measurements. Peak expiratory flow rates (PEFRs) were categorized according to their percentage of predicted flow rates as <50%, 50% to 80%, and >80%. Confounders previously determined to be associated with sarcopenia occurrence were included. Sarcopenia prevalence was 50.25%. After adjustment for confounders, PEFRs of <50% and 50% to 80% were associated with an increased sarcopenia risk (odds ratio = 5.22 and 1.88, respectively) compared with PEFRs of >80%. Poor lung function was independently associated with sarcopenia occurrence. Future studies should explore the usefulness of PEFR as a risk factor of sarcopenia.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246179PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7872226PMC
February 2021

Effects of laser therapy on rheumatoid arthritis: A systematic review and meta-analysis.

Am J Phys Med Rehabil 2021 Feb 1. Epub 2021 Feb 1.

Department of General Medicine, Cathy General Hospital, Taipei, Taiwan Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan Department of Physical Medicine & Rehabilitation, Center of Evidence-based Medicine, Department of Education, Taipei Medical University Hospital, Taipei, Taiwan Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.

Objective: To examine the effects of laser therapy on rheumatoid arthritis.

Design: A search of controlled trials was conducted in different medical electronic databases. The primary outcome was immediate pain relief after treatment. Secondary outcomes were level of functional disability, morning stiffness duration, and 3-month follow-up for pain.

Results: Ten trials met the inclusion criteria. Rheumatoid arthritis treatment with laser therapy significantly improved immediate pain relief [standardized mean difference (SMD), -0.839; 95% confidence interval (CI), -1.336, -0.343] and overall functional score (SMD, -0.309; 95% CI, -0.587, -0.031). There was no significant improvement in morning stiffness duration (SMD, -0.519; 95% CI, -1.176, 0.138) and 3-month follow-up for pain (SMD, -1.125; 95% CI, -2.311, 0.061). There was no publication bias (Egger's regression, p=0.277). However, heterogeneity was noted despite the removal of an outlier (Q=18.646; I2=57.096). Results of subgroup analyses suggested that high-intensity laser therapy and nerve irradiation is better suited for immediate pain relief. Meta-regression analyses showed no significant linear relationship between the treatment effect with laser wavelength or number of treatment sessions.

Conclusions: Laser therapies provide significant immediate pain relief and improve function for rheumatoid arthritis patients, but without significant improvement in morning stiffness duration and 3-month follow-up for pain.Systematic review registration number: CRD42020192906.
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http://dx.doi.org/10.1097/PHM.0000000000001711DOI Listing
February 2021

Mechanisms and Effects of Health Coaching in Patients With Early-Stage Chronic Kidney Disease: A Randomized Controlled Trial.

J Nurs Scholarsh 2021 03 4;53(2):154-160. Epub 2021 Jan 4.

Professor, School of Nursing, College of Nursing, Department of Nursing and Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Sleep Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan, ROC.

Purpose: To examine the effects of health coaching on self-management and quality of life (QOL) in patients with chronic kidney disease (CKD) and to evaluate whether self-efficacy and patient activation mediate the effect of health coaching on self-management and QOL.

Design And Methods: A single-center, parallel-group, randomized controlled trial. A total of 108 patients with stages 1 to 3a CKD participated in the study. Participants were randomly assigned to a health-coaching intervention group or a usual care control group. Participants' QOL (World Health Organization Quality of Life Scale), self-management (CKD Self-Management instrument), patient activation (Patient Activation Measure), and self-efficacy (CKD Self-Efficacy instrument) were measured at baseline, immediately after, and 6 weeks after the intervention.

Findings: Health coaching improved QOL, self-management, patient activation, and self-efficacy at postintervention and at 12 weeks' follow-up. Health coaching had a significant indirect effect on QOL through improvements in patient activation. Health coaching exerted a significant indirect effect on self-management through improvements in self-efficacy and patient activation.

Conclusions: The findings demonstrated that health coaching can effectively improve QOL and self-management. A health-coaching intervention can raise self-efficacy and activation levels through which self-management and QOL further improve.

Clinical Relevance: Health-coaching strategies can be used to assist patients with early-stage CKD in reaching their health goals and becoming activated in self-management of their diseases.
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http://dx.doi.org/10.1111/jnu.12623DOI Listing
March 2021

Improving the utility of the European Health Literacy Survey Questionnaire: a computerized adaptive test for patients with stroke.

Disabil Rehabil 2020 Dec 12:1-10. Epub 2020 Dec 12.

Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taichung, Taiwan.

Purpose: Health literacy among patients is crucial for effective stroke management. The European Health Literacy Survey Questionnaire is a theory-based measure that comprehensively captures 12 domains of health literacy. We aimed to develop a computerized adaptive test of the European Health Literacy Survey Questionnaire to efficiently assess health literacy among patients with stroke.

Materials And Methods: The European Health Literacy Survey Questionnaire data of 311 patients and item parameters were retrieved from a Rasch validation study. Real data simulations were performed to develop a computerized adaptive test of the European Health Literacy Survey Questionnaire and explore its efficiency and reliability.

Results: The computerized adaptive test of the European Health Literacy Survey Questionnaire displayed suitable reliability in all 12 domains (0.72-0.84) with a mean test length of 17 items (36.2% of the 47-item European Health Literacy Survey Questionnaire).

Conclusions: Our findings indicate that the computerized adaptive test of the European Health Literacy Survey Questionnaire, which assesses 12 domains of health literacy among patients with stroke in a timely and precise fashion, is efficient and reliable.Implications for rehabilitationThe computerized adaptive test of the European Health Literacy Survey Questionnaire assesses the subjective fit of personal health literacy competencies to environmental demands, providing insight into patient strengths and weaknesses when dealing with health tasks and interacting with health systems.The computerized adaptive test of the European Health Literacy Survey Questionnaire assesses the 12 domains of health literacy among patients with stroke in a timely and precise manner.Our study has demonstrated the utility of the computerized adaptive test of the European Health Literacy Survey Questionnaire in reducing the assessment burden of patients in clinical practice.Developing of the computerized adaptive test of the European Health Literacy Survey Questionnaire provided findings that may benefit researchers and clinicians interested in developing efficient outcome measures.
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http://dx.doi.org/10.1080/09638288.2020.1855678DOI Listing
December 2020

Psychometric Properties and Factorial Structure of Vietnamese Version of the Hypertension Self-Care Profile Behavior Scale.

J Cardiovasc Nurs 2020 Dec 2. Epub 2020 Dec 2.

Pham Van Truong, MSN, RN PhD Student, School of Nursing, College of Nursing, Taipei Medical University, Taiwan; Nursing Department, Vinmec Times City, Vinmec Healthcare System, Hanoi, Vietnam. Mei-Yu Lin, PhD, RN Postdoctoral Fellow, School of Nursing, College of Nursing, Taipei Medical University, Taiwan. Hsiao-Yean Chiu, PhD, RN Associate Professor, School of Nursing, College of Nursing, Taipei Medical University, Taiwan. Wen-Hsuan Hou, MD, PhD Professor, Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taiwan. Pei-Shan Tsai, PhD, RN Professor, School of Nursing, College of Nursing, Taipei Medical University; Department of Nursing and Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taiwan.

Background: The Hypertension Self-Care Profile Behavior (HTN-SCPB) scale is a self-report instrument with which a patient's self-care behavior can be assessed. However, its psychometric properties for adult patients with hypertension in Vietnam require clarification.

Objective: The aim of this study was to translate the HTN-SCPB scale into Vietnamese and to assess its psychometric properties.

Methods: The study included 220 adult patients with hypertension. To evaluate test-retest reliability, 133 participants were tested twice with a 3-week interval between tests. For construct validity, exploratory factor analysis was used to assess factor structure, and confirmatory factor analysis was used to evaluate the structural model fit of the scale.

Results: Reliability was confirmed by internal consistency (Cronbach α = 0.79) and test-retest reliability (intraclass correlation coefficient, 0.88). The Kaiser-Meyer-Olkin value was 0.75, and Bartlett's test of sphericity was significant (P < .001) and adequate for exploratory factor analysis. A 5-factor structure was obtained, and the factors were named as follows: "advanced self-management skills," "adverse health behaviors," "medication adherence," "diet-related knowledge regarding hypertension," and "information skills." Confirmatory factor analysis revealed that the model fit indices were acceptable (root-mean-square error of approximation, 0.07) or slightly less than the good fit values (comparative fit index, 0.85; incremental fit index, 0.85; goodness-of-fit index, 0.88; adjusted goodness-of-fit index, 0.84; and Tucker-Lewis index, 0.82).

Conclusions: The Vietnamese HTN-SCPB scale had satisfactory validity and reliability for assessing self-care behaviors in patients with hypertension in Vietnam.
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http://dx.doi.org/10.1097/JCN.0000000000000770DOI Listing
December 2020

Exposure to radiofrequency radiation increases the risk of breast cancer: A systematic review and meta-analysis.

Exp Ther Med 2021 Jan 9;21(1):23. Epub 2020 Nov 9.

School of Nursing, College of Nursing, Taipei Medical University, Taipei 11031, Taiwan R.O.C.

The present systematic review and meta-analysis investigated the association between exposure to radiofrequency radiation and the risk of breast cancer. The published studies that were available in PubMed, Embase, Cochrane Library, Ovid MEDLINE, CINAHL Plus, Web of Science, Airiti Library, Networked Digital Library of Theses and Dissertations and ProQuest until May 2020 were investigated. A total of eight studies (four case-control and four cohort studies) were eligible for quantitative analysis. A significant association between radiofrequency radiation exposure and breast cancer risk was detected [pooled relative risk (RR)=1.189; 95% confidence interval (CI), 1.056-1.339]. Subgroup analyses indicated that radiofrequency radiation exposure significantly increased the risk of breast cancer susceptibility among subjects aged ≥50 years (RR=2.179; 95% CI, 1.260-3.770). Pooled estimates revealed that the use of electrical appliances, which emit radiofrequency radiation, such as mobile phones and computers, significantly increased breast cancer development (RR=2.057; 95% CI, 1.272-3.327), while occupational radiofrequency exposure and transmitters did not increase breast cancer development (RR=1.274; 95% CI, 0.956-1.697; RR=1.133; 95% CI, 0.987-1.300, respectively). It was concluded that radiofrequency radiation exposure significantly increased the risk of breast cancer, especially in women aged ≥50 years and in individuals who used electric appliances, such as mobile phones and computers. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-analysis, an evaluation protocol was prepared and registered with the PROSPERO database (registration no. CRD42018087283).
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http://dx.doi.org/10.3892/etm.2020.9455DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7690245PMC
January 2021

Reply to: Real-time audiovisual feedback during CPR: A clarification, meta-analysis update, and caution for interpretation.

Resuscitation 2021 01 19;158:298-300. Epub 2020 Nov 19.

Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.

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http://dx.doi.org/10.1016/j.resuscitation.2020.11.017DOI Listing
January 2021

Incidence of idiopathic cardiomyopathy in patients with type 2 diabetes in Taiwan: age, sex, and urbanization status-stratified analysis.

Cardiovasc Diabetol 2020 10 14;19(1):177. Epub 2020 Oct 14.

Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

Background: The epidemiology of diabetes and idiopathic cardiomyopathy have limited data. We investigated the overall and the age-, sex-, and urbanization-specific incidence and relative hazard of idiopathic cardiomyopathy in association with type 2 diabetes and various anti-diabetic medications used in Taiwan.

Methods: A total of 474,268 patients with type 2 diabetes were identified from ambulatory care and inpatient claims in 2007-2009 from Taiwan's National Health Insurance (NHI) database. We randomly selected 474,266 age-, sex-, and diagnosis date-matched controls from the registry of NHI beneficiaries. All study subjects were linked to ambulatory care and inpatient claims (up to the end of 2016) to identify the possible diagnosis of idiopathic cardiomyopathy. The person-year approach with Poisson assumption was used to estimate the incidence, and Cox proportional hazard regression model with Fine and Gray's method was used to estimate the relative hazards of idiopathic cardiomyopathy in relation to type 2 diabetes.

Results: The overall incidence of idiopathic cardiomyopathy for men and women patients, respectively, was 3.83 and 2.94 per 10,000 person-years, which were higher than the corresponding men and women controls (2.00 and 1.34 per 10,000 person-years). Compared with the control group, patients with type 2 diabetes were significantly associated with an increased hazard of idiopathic cardiomyopathy (adjusted hazard ratio [aHR]: 1.60, 95% confidence interval [CI]: 1.45-1.77] in all age and sex stratifications except in those men aged > 64 years. Patients with type 2 diabetes aged < 45 years confronted the greatest increase in the hazard of idiopathic cardiomyopathy, with an aHR of 3.35 (95% CI 2.21-5.06) and 3.48 (95% CI 1.60-7.56) for men and women, respectively. The usage of some anti-diabetic medications revealed lower risks of idiopathic cardiomyopathy.

Conclusions: In Taiwan, diabetes increased the risk of idiopathic cardiomyopathy in both sexes and in all age groups, except in men aged > 64 years. Younger patients were vulnerable to have higher HRs of idiopathic cardiomyopathy. Some anti-diabetic medications may reduce the risks of cardiomyopathy.
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http://dx.doi.org/10.1186/s12933-020-01144-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7558694PMC
October 2020

Trends and Contributing Factors to Contraceptive Use in Kenya: A Large Population-Based Survey 1989 to 2014.

Int J Environ Res Public Health 2020 09 27;17(19). Epub 2020 Sep 27.

Department and Graduate Institute of Public Health, National Cheng Kung University, Tainan 701, Taiwan.

Kenya is among the leading nations in family planning in Africa, having the first official nationwide family planning program in sub-Saharan Africa. However, Kenya is still one of the most highly populated countries in Africa with a population of more than 52 million. The objective of this study was to assess the trends and contributing factors of contraceptive use. We conducted a multi-wave cross-sectional study using both the demographic health survey (DHS) and family planning effort index (FPE) datasets, analyzing five-year waves from 1989 to 2014. This study indicates that contraceptive use increased from 24.0% to 42.6%, with a change % of 77.5%. Despite changes in women's characteristics, these characteristics posed little on the time trend of contraceptive use in Kenya. In addition, the policy component of FPE scores had a positive association with contraceptive use with negligible change after adjusting for social and demographic factors 1.055 (1.046-1.065). There was a fluctuating trend of the additional FPE components throughout the years. Women with lower education, those married to husbands with lower education, unmarried, and rural women remain behind in family planning service utilization. Targeted programs are still needed for these special groups. Policy adherence is vital for continued progress.
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http://dx.doi.org/10.3390/ijerph17197065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7579622PMC
September 2020

Effects of real-time feedback on cardiopulmonary resuscitation quality on outcomes in adult patients with cardiac arrest: A systematic review and meta-analysis.

Resuscitation 2020 10 2;155:82-90. Epub 2020 Aug 2.

Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Electronic address:

Aim: To investigate the relationship between the implementation of real-time audiovisual cardiopulmonary resuscitation (CPR) feedback devices with cardiac arrest patient outcomes, such as return of spontaneous circulation (ROSC), short-term survival, and neurological outcome.

Methods: We systematically searched PubMed, Embase, and the Cochrane CENTRAL from inception date until April 30, 2020, for eligible randomized and nonrandomized studies. Pooled odds ratio (OR) for each binary outcome was calculated using R system. The primary patient outcome was ROSC. The secondary outcomes were short-term survival and favorable neurological outcomes (cerebral performance category scores: 1 or 2).

Results: We identified 11 studies (8 nonrandomized and 3 randomized studies) including 4851 patients. Seven studies documented patients with out-of-hospital cardiac arrest and four studies documented patients with in-hospital cardiac arrest. The pooled results did not confirm the effectiveness of CPR feedback device, possibly because of the high heterogeneity in ROSC (OR: 1.42, 95% CI: 1.03-1.94, I: 80%, tau: 0.1875, heterogeneity test p <  0.01) and survival-to-discharge (OR: 1.27, 95% CI: 0.74-2.18, I: 86%, tau: 0.4048, heterogeneity test p <  0.01). The subgroup analysis results revealed that heterogeneity was due to the types of devices used. Patient outcomes were more favorable in studies investigating portable devices than in studies investigating automated external defibrillator (AED)-associated devices.

Conclusions: Whether real-time CPR feedback devices can improve patient outcomes (ROSC and short-term survival) depend on the type of device used. Portable devices led to better outcomes than did AED-associated devices. Future studies comparing different types of devices are required to reach robust conclusion.

Protocol Registration: Prospero registration ID CRD42020155388.
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http://dx.doi.org/10.1016/j.resuscitation.2020.07.024DOI Listing
October 2020

Exploring the Influencing Factors of Health Literacy among Older Adults: A Cross-Sectional Survey.

Medicina (Kaunas) 2020 Jul 2;56(7). Epub 2020 Jul 2.

Master's Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei 110, Taiwan.

To investigate the health literacy (HL) among older adults in Taiwan, we referenced an existing integrated model of HL to confirm the influencing factors of HL in older adults. We propose this study to examine the personal, situational, and socioenvironmental factors influencing HL among older adults. : A cross-sectional survey was conducted at a district hospital and affiliated community center in northern Taiwan from August 2016 to May 2017. This study used the Mandarin Chinese version of the European Health Literacy Survey Questionnaire (EU-Q47). We designed three models based on the three domains of HL. Model 1 assesses personal factors. Model 2 incorporates situational factors. Model 3 adds the socioenvironmental factor. We recruited 161 participants aged over 65 years. Most adults in this study had limited overall HL. The final regression model revealed that age >85 years, unknown insurance status, and dominant spoken dialect of Hakka or Taiwanese were significantly associated with higher scores of HL. : Our study results may help clinicians with early identification of older adults at high risk for poor HL and help health administrators establish geriatric policies and health education plans.
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http://dx.doi.org/10.3390/medicina56070330DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7404792PMC
July 2020

Risk of Injury and Mortality among Driver Victims Involved in Single-Vehicle Crashes in Taiwan: Comparisons between Vehicle Types.

Int J Environ Res Public Health 2020 06 29;17(13). Epub 2020 Jun 29.

Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei 110, Taiwan.

Vehicle-type specific injury severity has rarely been investigated mainly because of a lack of such information in hospital-based studies that normally exclude those who are severely injured and die on the scene. No study has been conducted either on driver characteristics in single vehicle crashes in Taiwan according to vehicle type. This was the first population-based study aiming to describe demographic characteristics in association with vehicle-specific rates of injury and fatality among driver victims involved in single-vehicle crashes in Taiwan. We presented sex and age-specific number and proportion of driver victims according to vehicle type. We calculated sex and age-specific rates of injury and fatality. Injury and fatality rates were also graphically presented. Bicycle and motorcycle rider victims generally had higher injury rates but lower fatality rates. However, older (45+) bicycle rider victims had greater fatality risk. By contrast, truck and car driver victims were generally associated with lower injury rates but with higher fatality rates. Elderly (65+ years) truck driver victims suffered from higher rates of injury and fatality. Male victims were found to have a higher fatality rate than female victims regardless of vehicle type. The vehicle-type-specific analyses of injury and fatality are considered useful in identifying single-vehicle crash victims at greater risks of injury and fatality.
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http://dx.doi.org/10.3390/ijerph17134687DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7370069PMC
June 2020

Effects of extracorporeal magnetic stimulation on urinary incontinence: A systematic review and meta-analysis.

J Adv Nurs 2020 Sep 16;76(9):2286-2298. Epub 2020 Jul 16.

Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.

Aims: To examine the effectiveness of extracorporeal magnetic stimulation for treatment of stress urinary incontinence.

Design: Systematic review and meta-analysis.

Data Resources: Four electronic databases from inception to 18 May 2019.

Review Methods: Two authors independently performed the search, assessed the methodological quality, and extracted data. The final studies included in the analysis were selected after reaching consensus with the third author.

Results: A total of 20 studies were included in the systematic review and 12 of these in the meta-analysis. Quality assessment indicated that only 8 of 17 randomized controlled trials had low risk in overall risk of bias, whereas all controlled trials had serious risk of bias. The weighted mean effect size of magnetic stimulation on quality of life, number of leakages, pad test outcomes, and number of incontinence events was 1.045 (95% CI: 0.409-1.681), -0.411 (95% CI: 0.178-0.643), -0.290 (95% CI: 0.025-0.556), and -0.747 (95% CI: -1.122 to -0.372), respectively. Subgroup analysis revealed a significant difference in the type of quality of life measurement used. Sensitivity analyses revealed that a high degree of heterogeneity persisted even after omitting studies individually.

Conclusions: Extracorporeal magnetic stimulation may be effective in treating urinary incontinence and improving quality of life without major safety concerns. However, because of a high degree of heterogeneity among studies, inferences from the results must be made with caution.

Impact: We recommend that clinical nurses apply extracorporeal magnetic stimulation to treat stress urinary incontinence among female patients and encourage researchers to conduct further qualitative and quantitative studies to develop consistent content and dosage for the intervention.

Study Registration: The review protocol was registered a priori and published online in the PROSPERO database of systematic reviews (www.crd.york.ac.uk/Prospero with the registration number #CRD42019138835).
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http://dx.doi.org/10.1111/jan.14450DOI Listing
September 2020

Development of a battery of phase-adaptive health literacy tests for stroke survivors.

Patient Educ Couns 2020 11 27;103(11):2342-2346. Epub 2020 Apr 27.

Master Program in Long-Term Care and School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Center of Evidence-Based Medicine, Taipei Medical University Hospital, Taipei, Taiwan. Electronic address:

Objective: We aimed to develop a health literacy battery for three phases of stroke (HL-3S).

Methods: Three Rasch-based item banks corresponding to health care, disability prevention, and health promotion in the acute, subacute, and chronic phases of stroke, respectively, were developed by a multidisciplinary stroke team. To construct the HL-3S, a panel of clinical and Rasch experts selected items from the three Rasch-based item banks according to content representativeness and item difficulty diversity. Additionally, the validity and reliability of the HL-3S were examined using Rasch analysis.

Results: This study included 442 patients. Each of the three tests in the HL-3S contained 10 items with a 5-point scale of difficulty levels. The items in HL-3S demonstrated unidimensionality, local independence, and favorable Rasch reliability.

Conclusion: The HL-3S, with 10 items in each test, had favorable construct validity and Rasch reliability. The HL-3S can be considered as a quick-to-administer and phase-adaptive test battery of health literacy for stroke survivors.

Practice Implications: Clinicians may select one of the tests in the HL-3S corresponding with the patient's stroke recovery timeline and thereby provide adaptive health education programs to increase the patient's ability to actively participate in health care, disability prevention, and health promotion, respectively.
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http://dx.doi.org/10.1016/j.pec.2020.04.023DOI Listing
November 2020

Validation of the Mandarin Version of the Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" Among Patients in Acute Rehabilitation.

Am J Occup Ther 2020 May/Jun;74(3):7403205070p1-7403205070p9

Feng-Hang Chang, ScD, OTR/L, is Associate Professor, Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei City, Taiwan, and Associate Professor, Department of Physical Medicine and Rehabilitation, School of Medicine, Taipei Medical University, Taipei City, Taiwan;

Importance: A standardized functional measure that can be used across rehabilitation care settings in Taiwan is urgently needed.

Objective: To generate a Mandarin version of the Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" for patients in acute care.

Design: Mixed-methods study with a cross-sectional design.

Setting: Acute care wards of three teaching hospitals in Taiwan.

Participants: A sample of 231 neurological patients in acute care (62.3% female; mean age = 63.2 yr, standard deviation = 14.6).

Outcomes And Measures: The 6-Clicks consist of three subscales: Basic Mobility, Daily Activity, and Applied Cognition. They were translated into Mandarin, and their internal consistency, test-retest reliability, interrater reliability, and convergent validity were tested.

Results: All subscales of the Mandarin version of the 6-Clicks showed good internal consistency (α = .97-.98). Test-retest and interrater reliabilities were excellent for all subscales (intraclass correlation coefficients >.8). Convergent validity was supported by strong correlations of the Basic Mobility and Daily Activity subscales with the Barthel Index (r = .73 and .72, respectively) and between the Applied Cognition subscale and the Montreal Cognitive Assessment (r = .82).

Conclusion: Our results provide psychometric evidence supporting the use of the Mandarin version of the 6-Clicks in acute care settings in Taiwan.

What This Article Adds: This study confirms the appropriateness of the use of the Mandarin version of the AM-PAC "6-Clicks" with patients in acute rehabilitation, making it a valuable addition to validated measures available for use by occupational therapists in Taiwan.
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http://dx.doi.org/10.5014/ajot.2019.035725DOI Listing
September 2020

Does a Mobile app improve patients' knowledge of stroke risk factors and health-related quality of life in patients with stroke? A randomized controlled trial.

BMC Med Inform Decis Mak 2019 12 21;19(1):282. Epub 2019 Dec 21.

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

Background: Developing a stroke health-education mobile app (SHEMA) and examining its effectiveness on improvement of knowledge of stroke risk factors and health-related quality of life (HRQOL) in patients with stroke.

Methods: We recruited 76 stroke patients and randomly assigned them to either the SHEMA intervention (n = 38) or usual care where a stroke health-education booklet was provided (n = 38). Knowledge of stroke risk factors and HRQOL were assessed using the stroke-knowledge questionnaire and European Quality of Life-Five Dimensions (EQ-5D) questionnaire, respectively.

Results: Sixty-three patients completed a post-test survey (the SHEMA intervention, n = 30; traditional stroke health-education, n = 33). Our trial found that patients' mean knowledge score of stroke risk factors was improved after the SHEMA intervention (Mean difference = 2.83; t = 3.44; p = .002), and patients' knowledge was also improved in the after traditional stroke health-education (Mean difference = 2.79; t = 3.68; p = .001). However, patients after the SHEMA intervention did not have significantly higher changes of the stroke knowledge or HRQOL than those after traditional stroke health-education.

Conclusions: Both the SHEMA intervention and traditional stroke health-education can improve patients' knowledge of stroke risk factors, but the SHEMA was not superior to traditional stroke health-education.

Trial Registration: NCT02591511 Verification Date 2015-10-01.
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http://dx.doi.org/10.1186/s12911-019-1000-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6925878PMC
December 2019

Effectiveness of Tailored Rehabilitation Education in Improving the Health Literacy and Health Status of Postoperative Patients With Breast Cancer: A Randomized Controlled Trial.

Cancer Nurs 2020 Jan/Feb;43(1):E38-E46

Author Affiliations: Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital (Ms Huang and Drs CY Lin and Hou); School of Nursing, College of Nursing, Taipei Medical University (Drs Kuo, Tsai, and PC Lin); Department of Physical Medicine and Rehabilitation, E-Da Cancer Hospital/I-Shou University, Kaohsiung (Ms Tsai); Department of Physical Medicine and Rehabilitation, E-Da Hospital/I-Shou University, Kaohsiung (Mr Chen); Department of Nursing, Wang Fang Hospital, Taipei Medical University (Dr Tsai); Master Program in Long-term Care, College of Nursing, Taipei Medical University (Ms Huang and Drs PC Lin and Hou); School of Gerontology Health Management, College of Nursing, Taipei Medical University (Dr Hou); and Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taiwan (Dr Hou).

Background: The improvement of breast cancer treatment and the extension of survivorship have led to the development of postoperative complications among cancer survivors. Health literacy (HL), defined as patients' capability of using health information to maintain their health status, can enable breast cancer patients to manage postoperative complications.

Objective: The aims of this study were to develop a tailored rehabilitation education (TRE) program and examine the effectiveness of this program in improving the HL and health status with breast cancer.

Methods: This randomized controlled trial recruited 99 breast cancer patients (49 and 50 in the intervention and control groups, respectively) within 1 week after surgery. Four-week individualized TRE programs were implemented to improve their HL and health status.

Results: Our results showed that the TRE program produced significant improvements in HL and health status in the components of the International Classification of Functioning, Disability and Health. However, no significant difference was observed in the activity scores obtained using the Barthel Index between the 2 groups.

Conclusion: Our finding supports the effectiveness of 1-month TRE in improving HL and all components of the International Classification of Functioning, Disability and Health status, except the activity component among breast cancer in Taiwan.

Implications For Practice: Clinicians could incorporate the TRE techniques in the rehabilitation sessions according to the healthcare, disease prevention, and health promotion domains to improve the clinical outcomes as well as change their health behaviors and attitudes of patients with breast cancer.
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http://dx.doi.org/10.1097/NCC.0000000000000665DOI Listing
November 2020

Association between air pollution and risk of vascular dementia: A multipollutant analysis in Taiwan.

Environ Int 2019 12 1;133(Pt B):105233. Epub 2019 Nov 1.

School of Gerontology Health Management & Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, School of Medicine, Taipei Medical University, Taipei, Taiwan; Center of Evidence-Based Medicine, Taipei Medical University Hospital, Taipei, Taiwan. Electronic address:

Evidence regarding the association of specific air pollutants with vascular dementia (VaD) risk is limited. In this nested case-control study, we enrolled 831 adults aged >65 years with VaD (International Classification of Diseases, Ninth Revision, Clinical Modification code 290.4x) newly diagnosed during 2005-2013; 3324 controls were age-, sex-, and VaD diagnosis year-matched with the study patients. Both patients with VaD and controls were selected from among a cohort of one million beneficiaries of Taiwan's National Health Insurance program, all of whom were registered in 2005. Exposure to the mean daily air pollutant concentration, derived from 76 fixed air quality monitoring stations, in 3, 5, and 7 years before VaD diagnosis was assessed using the spatial analysis method (i.e., ordinary kriging) on ArcGIS. A logistic regression model was used to calculate covariate-adjusted odds ratios (ORs) of VaD in relation to specific air pollutants. After potential confounders and other air pollutants were controlled for, high concentrations of coarse particulate matter (10 µm or less in diameter) and carbon monoxide (CO) were sporadically associated with higher OR of VaD. The most prominent association was observed for nitrogen dioxide (NO) exposure within 5 and 7 years before diagnosis. Compared with the <25th percentile of NO exposure, the 25th-50th, 50th-75th, and >75th percentiles of NO exposure significantly increased ORs (95% confidence intervals): 1.62 (1.28-2.23), 1.61 (1.11-2.33), and 2.22 (1.35-3.65) within 5 years before diagnosis, respectively, and 1.59 (1.20-2.11), 1.65 (1.15-2.37), and 2.05 (1.28-3.28) within 7 years before diagnosis, respectively. We found that higher NO exposure in the past was significantly associated with an elevated risk of VaD. Although less consistent, higher exposure to CO was also associated with a higher risk of VaD. Most NO in cities originates from motor vehicle exhaust; other sources of NO are petrol and metal refining, electricity generation from coal-fired power stations, other manufacturing industries, and food processing. Future studies should investigate associations of VaD with specific sources of NO.
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http://dx.doi.org/10.1016/j.envint.2019.105233DOI Listing
December 2019

Effects of aromatherapy on sleep quality: A systematic review and meta-analysis.

Complement Ther Med 2019 Aug 15;45:156-166. Epub 2019 Jun 15.

Master Program in Long-Term Care and School of Gerontology Health Management, College of Nursing, Department of Physical Medicine & Rehabilitation, Center of Evidence-based Medicine, Taipei Medical University, Taipei, 11031, Taiwan. Electronic address:

Purpose: The objective of this study was to conduct a systematic review and meta-analysis to examine the effects of aromatherapy on sleep improvements.

Methods: A search of randomized controlled trials was conducted in four English and two Chinese medical electronic databases. Two authors independently performed the search, assessed the methodological quality, and extracted data. Then, final studies were selected after consensus with the third author.

Results: In total, 31 trials met the inclusion criteria, of which four had low risk, while the overall bias in 26 was uncertain in terms of methodological quality. The heterogeneity was high among the trials (Q = 341.544, p < 0.001, I = 91.216%). There was a significant effect of aromatherapy on sleep quality (Hedges's g = 1.103 (95% confidence interval: 0.813˜1.393, p < 0.001). There was a publication bias (Egger's regression intercept = 7.127, t = 3.055, p = 0.004 and Begg test, Kendall's tau with continuity correction, tau = 0.335 and Z = 2.651, p = 0.008). The subgroup analysis showed that there was a significant difference in the methodological quality among different studies (Q = 18.350, p <  0.001). Sensitivity analyses still revealed high heterogeneity after omitting one study at a time.

Conclusions: The results showed that aromatherapy can be applied by clinical staff to effectively improve sleep quality. However, because there was a high degree of heterogeneity among studies, the inferences of the results need to be applied with caution.
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http://dx.doi.org/10.1016/j.ctim.2019.06.006DOI Listing
August 2019

Responsiveness of the modified lower extremity functional scale in patients with low back pain and sciatica: A comparison with pain intensity and the modified Roland-Morris Disability Scale.

Medicine (Baltimore) 2019 Apr;98(14):e15105

Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, ROC.

We tested the responsiveness of the modified Lower Extremity Functional Scale (LEFS) for patients with low back pain (LBP) and sciatica and made a comparison with the modified Roland-Morris Disability Scale for sciatica (RMS-L) and self-reported pain intensity measured by visual analogue scale (VAS).One hundred and forty-eight participants were recruited from 2 university hospitals. The evaluation included demographic data, LBP history, and the modified LEFS, RMS-L, and VAS, with a follow-up one month later. Several responsiveness statistics were calculated.The study followed 132 participants, approximately 25% reported improvement. Guyatt responsiveness index (GRI) was 0.8 or higher for 3 measures, while standardized response means were 0.8 or higher for the RMS-L and VAS, but only 0.6 for the modified LEFS among improved group. According to ROC analysis, the modified LEFS had an area under curve (AUC) similar to that of the modified RMS-L, but significantly smaller than that of the VAS.The responsiveness of the modified LEFS was moderate but not superior to the VAS or RMS-L. Although, the modified LEFS could not replace the RMS-L or VAS, it could still be used as a complementary measure since these three measurements covered different body function, activity and participation domains.
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http://dx.doi.org/10.1097/MD.0000000000015105DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6455991PMC
April 2019

Development and psychometric testing of the Chinese version of the Resilience Scale for Southeast Asian immigrant women who divorced in Taiwan.

PLoS One 2019 4;14(2):e0211451. Epub 2019 Feb 4.

Master Program in Long-term Care, College of Nursing, Taipei Medical University, Taipei City, Taiwan.

Background: Only a few studies exist on the resilience of divorced women. Furthermore, relevant instruments for assessing the resilience of divorced immigrant Southeast Asian women are rare. Accordingly, the aim of this study was to develop and examine a new Resilience Scale-Chinese version (RS-C) that is specific to divorced immigrant Southeast Asian women in Taiwan.

Methods: The study was conducted in two phases. In phase 1, 20 items were used to evaluate face and content validities. In phase 2, a cross-sectional study was conducted. In total, 118 immigrant women participated in this study and were recruited from three nongovernmental organizations providing services for immigrants in Taipei City and Miaoli and Chiayi Counties. Psychometric properties of the instrument (i.e., internal consistency, test-retest reliability, item-to-total correlation, construct validity, and convergent validity) were examined. Significance was set at p < 0.05 for all statistical tests.

Results: The final 16-item RS-C resulted in a three-factor model. The three factors, namely personal competence, family identity, and social connections, were an acceptable fit for the data and explained 54.60% of the variance. Cronbach's α of the RS-C was 0.85, and those of its subscales ranged from 0.77 to 0.82. The correlation value of the test-retest reliability was 0.87. The RS-C was significantly associated with the General Self-Efficacy scale and the Chinese Health Questionnaire-12.

Conclusion: The RS-C is a brief and specific self-report tool for evaluating the resilience of divorced immigrant Southeast Asian women and demonstrated adequate reliability and validity in this study. This RS-C instrument has potential applications in both clinical practice and research with strength-based resiliency interventions. However, additional research on the RS-C is required to further establish its reliability and validity.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0211451PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6361505PMC
November 2019

The relationship between health literacy and perceived shared decision making in patients with breast cancer.

Patient Educ Couns 2019 02 18;102(2):360-366. Epub 2018 Sep 18.

Cochrane Taiwan, Taipei Medical University, No. 250, Wuxing Street, Xinyi District, Taipei City, 11031, Taiwan. Electronic address:

Objectives: We explored the relationship between patient-perceived shared decision making (SDM) and three domains of health literacy (HL) in patients with breast cancer.

Methods: In this cross-sectional study, we prospectively recruited a convenience sample of 511 breast cancer patients from 3 hospitals in Taiwan. Patients completed questionnaires about HL and perceived SDM in a recent consultation. Sequential regressions, controlling for International Classification of Functioning, Disability and Health (ICF)-related factors) were conducted. Interactions of each HL domain with age or education were also assessed for the relationship with perceived SDM.

Results: Higher scores in the HL domains of healthcare and disease prevention, but lower scores in the health promotion domain, were significantly associated with a higher perceived level of SDM after controlling for ICF-related factors (R = 33.44%). The association of SDM with two domains of HL varied with age, while the relationship between the 3 HL domains and SDM differed across education levels.

Conclusion: Each HL domain was significantly associated with perceived SDM after controlling for the ICF-related factors and across different age- and education-stratifications.

Practice Implications: Clinicians should be cognizant of patients' HL levels and incorporate HL best practices into consultations and interactions with patients with breast cancer to facilitate SDM.
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http://dx.doi.org/10.1016/j.pec.2018.09.017DOI Listing
February 2019

Dipeptidyl peptidase-4 inhibitor use is associated with decreased risk of fracture in patients with type 2 diabetes: a population-based cohort study.

Br J Clin Pharmacol 2018 09 29;84(9):2029-2039. Epub 2018 Jun 29.

National Cheng Kung University, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, Tainan City, Taiwan.

Aims: The aim of this study was to investigate the putative link between dipeptidyl peptidase-4 inhibitor (DPP-4i) use and the risk of fracture in patients with type 2 diabetes.

Methods: This propensity-score-matched population-based cohort study was performed between 2009 and 2013 on patients with type 2 diabetes who were stable metformin users. A total of 3996 patients with type 2 diabetes used DPP-4i as a second-line antidiabetic drug. The same number of matched non-DPP-4i users were followed up until fracture occurrence, health insurance policy termination, or the end of 2013. The incidence rates of overall and cause-specific fractures were estimated based on the Poisson assumption. A multiple Cox proportional hazard model was used to estimate the covariate-adjusted hazard ratio (HR) and 95% confidence interval (CI) to determine the association between DPP-4i use and overall and cause-specific fractures stratified by age and sex.

Results: Over a maximum follow-up period of 5 years, 340 DPP-4i users and 419 non-DPP-4i users were newly diagnosed with fractures, yielding incidence rates of 28.03 and 32.04 per 1000 people per year, respectively. The Cox proportional hazard model revealed that DPP-4i use significantly reduced the risk of all-cause fractures and upper extremity fractures, with adjusted HRs of 0.86 (95% CI: 0.74-0.99) and 0.75 (95% CI: 0.59-0.95), respectively. The aforementioned associations of DDP-4i use with fracture were sustained across sex and age stratifications.

Conclusions: The results of this study supported the premise that DPP-4i usage is associated with a reduced risk of all-cause fractures and upper extremity fractures in patients with type 2 diabetes.
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http://dx.doi.org/10.1111/bcp.13636DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6089813PMC
September 2018

Rasch Analysis of the 9-Item Shared Decision Making Questionnaire in Women With Breast Cancer.

Cancer Nurs 2019 May/Jun;42(3):E34-E42

Author Affiliations: Institute of Economics, Academia Sinica, Taipei (Dr Wu); Center for Teacher Education, National Tsing Hua University, Hsinchu (Dr Chen); School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei (Ms Huang and Dr Hsieh); School of Gerontology Health Management and Master Program in Long-term Care, College of Nursing (Dr Hou), and Department of Physical Medicine and Rehabilitation, College of Medicine, School of Medicine (Dr Hou), Taipei Medical University; Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital (Dr Hou); Departments of Internal Medicine and Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan (Dr Wang); Department of Public Health, College of Medicine, National Cheng Kung University, Tainan (Dr Wang); and Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei (Dr Hsieh), Taiwan.

Background: Shared decision making (SDM) is a best practice to help patients make optimal decisions by a process of healthcare, especially for women diagnosed with breast cancer and having heavy burden in long-term treatments. To promote successful SDM, it is crucial to assess the level of perceived involvement in SDM in women with breast cancer.

Objective: The aims of this study were to apply Rasch analysis to examine the construct validity and person reliability of the 9-item Shared Decision Making Questionnaire (SDM-Q-9) in women with breast cancer.

Methods: The construct validity of SDM-Q-9 was confirmed when the items fit the Rasch model's assumptions of unidimensionality: (1) infit and outfit mean square ranged from 0.6 to 1.4; (2) the unexplained variance of the first dimension of the principal component analysis was less than 20%. Person reliability was calculated.

Results: A total of 212 participants were recruited in this study. Item 1 did not fit the model's assumptions and was deleted. The unidimensionality of the remaining 8 items (SDM-Q-8) was supported with good item fit (infit and outfit mean square ranging from 0.6 to 1.3) and very low unexplained variance of the first dimension (5.3%) of the principal component analysis. The person reliability of the SDM-Q-8 was 0.90.

Conclusions: The SDM-Q-8 was unidimensional and had good person reliability in women with breast cancer.

Implications For Practice: The SDM-Q-8 has shown its potential for assessing the level of perceived involvement in SDM in women with breast cancer for both research and clinical purposes.
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http://dx.doi.org/10.1097/NCC.0000000000000607DOI Listing
March 2020

Rasch Analysis of the 9-Item Shared Decision Making Questionnaire in Women With Breast Cancer.

Cancer Nurs 2019 May/Jun;42(3):E34-E42

Author Affiliations: Institute of Economics, Academia Sinica, Taipei (Dr Wu); Center for Teacher Education, National Tsing Hua University, Hsinchu (Dr Chen); School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei (Ms Huang and Dr Hsieh); School of Gerontology Health Management and Master Program in Long-term Care, College of Nursing (Dr Hou), and Department of Physical Medicine and Rehabilitation, College of Medicine, School of Medicine (Dr Hou), Taipei Medical University; Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital (Dr Hou); Departments of Internal Medicine and Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan (Dr Wang); Department of Public Health, College of Medicine, National Cheng Kung University, Tainan (Dr Wang); and Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei (Dr Hsieh), Taiwan.

Background: Shared decision making (SDM) is a best practice to help patients make optimal decisions by a process of healthcare, especially for women diagnosed with breast cancer and having heavy burden in long-term treatments. To promote successful SDM, it is crucial to assess the level of perceived involvement in SDM in women with breast cancer.

Objective: The aims of this study were to apply Rasch analysis to examine the construct validity and person reliability of the 9-item Shared Decision Making Questionnaire (SDM-Q-9) in women with breast cancer.

Methods: The construct validity of SDM-Q-9 was confirmed when the items fit the Rasch model's assumptions of unidimensionality: (1) infit and outfit mean square ranged from 0.6 to 1.4; (2) the unexplained variance of the first dimension of the principal component analysis was less than 20%. Person reliability was calculated.

Results: A total of 212 participants were recruited in this study. Item 1 did not fit the model's assumptions and was deleted. The unidimensionality of the remaining 8 items (SDM-Q-8) was supported with good item fit (infit and outfit mean square ranging from 0.6 to 1.3) and very low unexplained variance of the first dimension (5.3%) of the principal component analysis. The person reliability of the SDM-Q-8 was 0.90.

Conclusions: The SDM-Q-8 was unidimensional and had good person reliability in women with breast cancer.

Implications For Practice: The SDM-Q-8 has shown its potential for assessing the level of perceived involvement in SDM in women with breast cancer for both research and clinical purposes.
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http://dx.doi.org/10.1097/NCC.0000000000000607DOI Listing
March 2020

Cultural and semantic equivalence of the activity measure post-acute care (AM-PAC) after its translation into Mandarin Chinese.

Disabil Rehabil 2019 08 21;41(16):1937-1942. Epub 2018 Mar 21.

c Health & Disabilities Research Institute , Boston University, School of Public Health , Boston , MA , USA.

The purpose of this study was to investigate the cultural and semantic equivalence of the Activity Measure Post-Acute Care (AM-PAC) outpatient short forms after they were translated from American English to Mandarin Chinese. This study was conducted with a composite sample of a group of 483 American adults (mean age 63.1 years, 42.4% males) and 553 Taiwanese adults (mean age 60.6 years, 47.2% males) who were undergoing home care or outpatient rehabilitation services. A confirmatory factor analysis tested the cultural equivalence of the AM-PAC dimensions between the US and Taiwanese samples. Semantic equivalence was tested through an item response theory-based differential item functioning (DFI) analysis. Results of the confirmatory factor analysis demonstrated good model-data fit of the AM-PAC in both the US and Taiwanese samples. Significant DFI was found for six Basic Mobility items, two Daily Activity items, and four Applied Cognition items. A DFI adjusted conversion table was generated to transform the raw scores of the measure for comparisons between the two countries. This study provides evidence to support the conceptual equivalence of the AM-PAC when used in rehabilitation patients between American and Taiwanese cultural contexts. Some DFI items between the two groups were found, suggesting that some differences in semantic understanding of these items between cultures require cross-cultural adjustments. Implications for Rehabilitation Cultural equivalence needs to be tested before applying a clinical measure to another context. The findings of this study supported the three activity domains that the Activity Measure Post-Acute Care measures: Basic Mobility, Daily Activity, and Applied Cognition, which are all important rehabilitation outcomes that need to be assessed and monitored across rehabilitation settings. Differential item functioning was observed between the English and Chinese versions of the Activity Measure Post-Acute Care, indicating that linguistic and cultural differences across countries need to be adjusted for before using the translated measure in clinical practice.
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http://dx.doi.org/10.1080/09638288.2018.1453874DOI Listing
August 2019