Publications by authors named "Yi-Jing Huang"

33 Publications

Designing and pilot testing a novel high-definition transcranial burst electrostimulation device for neurorehabilitation.

J Neural Eng 2021 Sep 17;18(5). Epub 2021 Sep 17.

School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan.

Non-invasive brain stimulation has been promoted to facilitate neuromodulation in treating neurological diseases. Recently, high-definition (HD) transcranial electrical stimulation and a novel electrical waveform combining a direct current (DC) and theta burst stimulation (TBS)-like protocol were proposed and demonstrated high potential to enhance neuroplastic effects in a more-efficient manner. In this study, we designed a novel HD transcranial burst electrostimulation device and to preliminarily examined its therapeutic potential in neurorehabilitation.A prototype of the transcranial burst electrostimulation device was developed, which can flexibly output a waveform that combined a DC and TBS-like protocol and can equally distribute the current into 4 × 1 HD electrical stimulation by automatic impedance adjustments. The safety and accuracy of the device were then validated in a series ofexperiments. Finally, a pilot clinical trial was conducted to assess its clinical safety and therapeutic potential on upper-extremity rehabilitation in six patients with chronic stroke, where patients received either active or sham HD transcranial burst electrostimulation combined with occupational therapy three times per week for four weeks.The prototype was tested, and it was found to comply with all safety requirements. The output parameters were accurate and met the clinical study needs. The pilot clinical study demonstrated that the active HD transcranial burst electrostimulation group had greater improvement in voluntary motor function and coordination of the upper extremity than the sham control group. Additionally, no severe adverse events were noted, but slight skin redness under the stimulus electrode immediately after stimulation was seen.The results demonstrated the feasibility of incorporating the HD electrical DC and TBS-like protocol in our device; and the novel neuromodulatory device produced positive neurorehabilitation outcomes in a safe fashion, which could be the basis for the future clinical implementation for treating neurological diseases.ClinicalTrials.gov Identifier: NCT04278105. Registered on 20 February 2020.
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http://dx.doi.org/10.1088/1741-2552/ac23beDOI Listing
September 2021

FRET processes of bi-fluorophoric sensor material containing tetraphenylethylene donor and optical-switchable merocyanine acceptor for lead ion (Pb) detection in semi-aqueous media.

Dyes Pigm 2021 May 21;189. Epub 2021 Feb 21.

Department of Materials Science and Engineering, National Chiao Tung University, Hsinchu 300, Taiwan.

A novel aggregation-induced emission (AIE) structure containing a tetraphenylethene (TPE) unit covalently linked with a merocyanine (MC) unit was synthesized and investigated in semi-aqueous solutions with 90% water fraction. The open-form structure of red-emissive MC unit combined with TPE unit was utilized as a bi-fluorophoric sensor to detect lead(II) ion, which could be transformed from the close-form structure of non-emissive SP unit upon UV exposure. Moreover, the TPE unit as an energy donor with the blue-green photoluminescence (PL) emission at 480 nm was combined with the MC unit as an energy acceptor with the red PL emission at 635 nm. Due to the Förster resonance energy transfer (FRET) processes, the bi-fluorophoric sensor produced more efficient ratiometric PL behavior to induce a stronger red PL emission than that of the mono-fluorophoric MC unit. Hence, the PL sensor responses of the AIE bi-fluorophoric structure toward lead(II) ion could be further amplified via the FRET-OFF processes to turn off red PL emission of the coordinated MC acceptor and to recover blue-green PL emission of the TPE donor. Accordingly, the best LOD value for the AIE sensor detection toward Pb was 0.27 μM. The highest red MC emission with the optimum FRET process of AIE sensor could be utilized in cell viability tests to prove the non-toxic and remarkable bio-marker of AIE sensor to detect lead(II) ion in live cells. The developed FRET-OFF processes with ratiometric PL behavior of the bi-fluorophoric AIE sensor can be utilized for future chemo- and bio-sensor applications.
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http://dx.doi.org/10.1016/j.dyepig.2021.109238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7968855PMC
May 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

Cross-Validation of the Factorial Validity of the Stroke Impact Scale 3.0 in Patients With Stroke.

Am J Occup Ther 2021 Mar-Apr;75(2):7502205070p1-7502205070p10

Ching-Lin Hsieh, PhD, is Professor, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; 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;

Importance: The Stroke Impact Scale 3.0 appears to be a promising outcome measure of health-related quality of life (HRQOL) for clients with stroke. However, because the factorial validity of the Stroke Impact Scale 3.0 remains unclear, its validity is limited.

Objective: To examine the underlying structure of the Stroke Impact Scale 3.0 by comparing the currently available eight- and four-domain structures simultaneously.

Design: Secondary data analysis of responses to the Stroke Impact Scale 3.0 from a previous psychometric validation study.

Setting: Five general hospitals in northern and southern Taiwan.

Participants: Two hundred sixty-three patients with stroke from rehabilitation wards (inpatients) and neurology and rehabilitation clinics (outpatients).

Outcomes And Measures: Confirmatory factor analysis was used to examine the eight- and four-domain structures of the Stroke Impact Scale 3.0. Four fit indices were considered simultaneously to examine the model fits of both structures.

Results: The eight- and four-domain structures of the Stroke Impact Scale 3.0 were not supported by all four indices (χ²/df = 2.7 and 5.0, comparative fit index = .79 and .86, root mean square error of approximation = .08 and .12, standardized root mean square residual = .08 and .08, respectively). The unidimensionality of each domain in the two structures was not supported.

Conclusions And Relevance: Neither the eight- nor the four-domain structure of the Stroke Impact Scale 3.0 was supported, suggesting that scores may not provide valid assessments of HRQOL in clients with stroke. Further modification and validation of the Stroke Impact Scale 3.0 are warranted.

What This Article Adds: Our findings suggest that the eight- and four-domain scores of the Stroke Impact Scale 3.0 may not be valid. Therefore, until more supporting evidence is developed, these scores should be interpreted cautiously in regard to clients' HRQOL; alternatively, other measures could be used.
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http://dx.doi.org/10.5014/ajot.2021.040659DOI 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

Efficient FRET Approaches toward Copper(II) and Cyanide Detections via Host-Guest Interactions of Photo-Switchable [2]Pseudo-Rotaxane Polymers Containing Naphthalimide and Merocyanine Moieties.

ACS Appl Mater Interfaces 2020 Nov 16;12(47):53257-53273. Epub 2020 Nov 16.

Department of Materials Science and Engineering, National Chiao Tung University, Hsinchu 300, Taiwan.

A supramolecular [2]pseudo-rotaxane containing a naphthalimide-based pillararene host and a spiropyran-based imidazole guest was synthesized and investigated in a semiaqueous solution with 90% water fraction. Upon UV exposure, the close-form structure of nonemissive spiropyran guest could be transformed into the open-form structure of red-emissive merocyanine guest reversibly, which was utilized as a monofluorophoric sensor to detect copper(II) and cyanide ions. Moreover, the naphthalimide host as an energy donor with green photoluminescence (PL) emission at 505 nm was complexed with the merocyanine guest as an energy acceptor with red PL emission at 650 nm in 1:1 molar ratio to generate a [2]pseudo-rotaxane polymer, which was further verified by the diffusion coefficients of DOSY nuclear magnetic resonance (NMR) measurements. Due to the Förster resonance energy transfer (FRET) processes, the bifluorophoric [2]pseudo-rotaxane produced more efficient ratiometric PL behavior to induce a stronger red PL emission than that of the monofluorophoric guest; therefore, the PL sensor responses of the supramolecular [2]pseudo-rotaxane toward copper(II) and cyanide ions could be further amplified via the FRET-OFF processes to turn off red PL emission of the reacted merocyanine acceptor and to recover green PL emission of the naphthalimide donor. Accordingly, the best and prominent values of the limit of detection (LOD) for the host-guest detections toward Cu and CN were 0.53 and 1.34 μM, respectively. The highest red MC emission with the optimum FRET processes of [2]pseudo-rotaxane was maintained around room temperature (20-40 °C) in wide pH conditions (pH = 3-13), which can be utilized in the cell viability tests to prove the nontoxic and remarkable biomarker of [2]pseudo-rotaxane to detect Cu and CN in living cells. The developed FRET-OFF processes with ratiometric PL behavior of the bifluorophoric supramolecular [2]pseudo-rotaxane polymer will open a new avenue to the future applications of chemo- and biosensors.
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http://dx.doi.org/10.1021/acsami.0c15049DOI Listing
November 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

Correlations between subjective rating and objective assessment of balance function in individuals with stroke.

Disabil Rehabil 2020 May 6:1-7. Epub 2020 May 6.

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

To examine the relationships among therapist-reported, patient-reported, and objective assessment scores of balance function. Inpatients with stroke and occupational therapists were recruited. The objective balance scores were measured using the Balance Computerized Adaptive Testing (Balance CAT) system. The therapist and patient-reported scores were evaluated using a visual analogue scale (VAS) and Likert-type scale. Eighty-eight patients and 16 therapists participated. The correlations (= 0.64 and 0.65; -squared about 0.42 at baseline and follow-up assessments, respectively) between the therapist-reported VAS scores and the Balance CAT system were larger than those ( = 0.31 and 0.21) between the patient-reported VAS scores and the Balance CAT system. Low correlations ( = 0.27 and 0.26 for VAS and Likert-type scores, respectively) were found between the therapist-reported and patient-reported change scores. Low correlations ( = 0.12-0.17) were found between the change scores of therapist- and patient-reported ratings and those of the Balance CAT system. The therapists' judgments explained <50% of variance of the Balance CAT system scores. Neither therapist-reported nor patient-reported change scores reflected the changes demonstrated by the objective assessments. Further studies are warranted to confirm our findings.Implications for RehabilitationNeither therapist- nor patient-reported balance function and change could effectively reflect the scores resulting from objective assessments.The routine use of objective balance assessments should not be replaced by therapists' subjective judgments.Communications regarding the balance function measured by objective assessments between therapists and patients can help patients to better understand their balance function and progress.
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http://dx.doi.org/10.1080/09638288.2020.1751313DOI Listing
May 2020

A Comparison of the Responsiveness of the Postural Assessment Scale for Stroke and the Berg Balance Scale in Patients With Severe Balance Deficits After Stroke.

J Geriatr Phys Ther 2020 Oct/Dec;43(4):194-198

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

Background And Purpose: Previous evidence that the Postural Assessment Scale for Stroke (PASS) and the Berg Balance Scale (BBS) have similar responsiveness is doubtful. Compared with the BBS, the PASS has more items assessing basic balance abilities (such as postural transition during lying and sitting), so it should be more likely to detect changes in patients with severe balance deficits. We aimed to compare the responsiveness of the PASS and the BBS in patients with stroke who have severe balance deficits.

Methods: The PASS and BBS scores of 49 patients with severe balance deficits at 14 and 30 days after stroke were retrieved. The group-level responsiveness was examined with the standardized response mean (SRM). The individual-level responsiveness was examined by the proportion of patients who achieved clinically significant improvements (ie, their pre-post change scores in the PASS/BBS exceeded the minimal detectable change with 95% confidence of each measure). The responsiveness of the 2 measures was compared using the bootstrap approach.

Results And Discussion: The comparisons of responsiveness showed significant differences between the PASS and the BBS at both the group and individual levels. At the group level, the PASS indicated moderate changes in balance function (SRM = 0.79), but the BBS indicated only small changes (SRM = 0.39). At the individual level, the PASS showed that 42.9% of patients had clinically significant improvements, while the BBS showed that only 6.1% of patients had clinically significant improvements.

Conclusions: Compared with the BBS, the PASS was better able to detect balance improvements in patients having severe balance deficits. The PASS is recommended as an outcome measure to detect change in balance in patients with stroke who have severe balance deficits.
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http://dx.doi.org/10.1519/JPT.0000000000000247DOI Listing
March 2021

How and how much is spirituality discussed in palliative care consultations for advanced cancer patients with and without a question prompt list?

Patient Educ Couns 2019 12 19;102(12):2208-2213. Epub 2019 Jun 19.

Psycho-Oncology Collaborative Research Group (PoCOG), University of Sydney, Sydney, Australia.

Objective: Patients want to discuss spirituality more with their doctors but feel disempowered. Question prompt lists (QPLs) assist conversations. This study assessed the impact of a QPL on spirituality discussions in Palliative Care (PC).

Methods: This was a sub-study of a trial in which PC patients were randomised to either receive a QPL prior to a consultation or not, to see whether its provision influenced advanced cancer patients'/caregivers' questions and discussion of topics relevant to end-of-life care during consultations with a PC physician. Consultations were recorded and transcribed. Transcriptions were analysed to examine the frequency and content of spirituality discussions. We conducted logistic regression to investigate the impact of the QPL and other predictors.

Results: 174 patients participated. Spirituality was discussed in half the consultations. Patients receiving a QPL discussed spirituality 1.38 times more than controls. This finding did not reach statistical significance. First PC consultation and being asked about their concerns by the doctor were significant predictors of a spiritual discussion.

Conclusion: Patients are more likely to discuss spirituality in their first PC consultation, and when their doctor asks them about their concerns.

Practice Implications: Doctors caring for patients at the end of life should routinely raise spiritual issues.
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http://dx.doi.org/10.1016/j.pec.2019.06.016DOI Listing
December 2019

[Study on DNA methylation profiles in non-syndromic cleft lip/palate based on bioinformatics].

Shanghai Kou Qiang Yi Xue 2019 Feb;28(1):57-62

Department of Clinical Nutrition, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200011, China.

Purpose: To study DNA methylation patterns of non-syndromic cleft lip/palate(NSCL/P) using bioinformatic methods, including methylated positions and regions.

Methods: Whole blood DNA methylation data of NSCL/P samples was download from Gene Expression Omnibus(GEO) database, including 67 NSCL/P cases and 59 controls without birth defects. Data analysis included ①data cleaning, such as probes filtering, quality control and normalization; ②differential methylation analysis, including methylated positions and regions; ③Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis on differential methylated genes. R 3.4.3 software was used for data cleaning, differential methylated positions and regions analysis. DAVID6.8 tool was used for GO and KEGG analysis.

Results: 814 differential methylated positions were detected (adjusted P<0.001,|Δβ|>0.125), of which 178 were hypermethylated in NSCL/P patients, and 636 were hypomethylated. In addition, 386 differential methylated regions were identified (P<0.05), of which 204 were hypermethylation regions and 182 were hypomethylation regions. GO analysis showed that 38 differential methylated genes were involved in 7 kinds of biological processes, 163 differential methylated genes were involved in 3 kinds of molecular functions, and 114 differential methylated genes were involved in 3 kinds of cellular components (P<0.01). KEGG analysis showed that 59 differential methylated genes were involved in 9 kinds of signal pathways.

Conclusions: Abnormal DNA methylation patterns of NSCL/P might be an important epigenetic mechanism affecting the development of NSCL/P. This study might contribute to the identification of identification of biomarkers and targeted interventions of NSCL/P.
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February 2019

Development of a Computerized Adaptive Testing System for Assessing 5 Functions in Patients with Stroke: A Simulation and Validation Study.

Arch Phys Med Rehabil 2019 05 26;100(5):899-907. Epub 2018 Oct 26.

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, Taichung, Taiwan. Electronic address:

Objective: The authors aimed to develop and validate the Computerized Adaptive Testing System for Assessing 5 Functions in Patients with Stroke (CAT-5F) based on the Barthel Index (BI), Postural Assessment Scale for Stroke patients (PASS), and Stroke Rehabilitation Assessment of Movement (STREAM) to improve the efficiency of assessment. The purposes of the CAT-5F assessment are to describe patients' levels of impairments or disabilities in the 5 functions and to serve as an outcome measure in patients with stroke.

Design: This is a data-mining study based on data from a previous study using simulation analysis to develop and validate the CAT-5F.

Setting: One rehabilitation unit in a medical center in Taiwan served as the setting for this study.

Participants: Data were retrieved from totals of 540 (initial assessment) and 309 (discharge assessment) participants with stroke assessed in a previous study. The assessment data (N=540) were from the BI, PASS, and STREAM.

Interventions: Not applicable.

Main Outcome Measures: The outcome measures for this study were from BI, PASS, and STREAM.

Results: The CAT-5F using the optimal stopping rule (limited reliability increased <0.010) had good Rasch reliability across the 5 functions (0.86-0.96) and needed 12.7 items, on average, for the whole administration. The concurrent validity (Pearson product-moment correlation coefficient, r=0.91-0.96) and responsiveness (standardized response mean=0.33-0.91) of the CAT-5F were sufficient in the patients.

Conclusion: The CAT-5F has sufficient administrative efficiency, reliability, concurrent validity, and responsiveness to simultaneously assess basic activities of daily living, postural control, upper extremity/lower extremity motor functions, and mobility in patients with stroke.
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http://dx.doi.org/10.1016/j.apmr.2018.09.122DOI Listing
May 2019

Health literacy and cancer care coordination in Chinese migrant patients and their carers: A cross-sectional survey.

Psychooncology 2019 05 18;28(5):1048-1055. Epub 2019 Mar 18.

Faculty of Science, School of Psychology, Psycho-oncology Co-operative Research Group, The University of Sydney, Sydney, NSW, Australia.

Objectives: This study aimed to describe the levels of health literacy and experience of care coordination among Chinese migrant patients with cancer and their carers in Australia, and to examine factors associated with these.

Methods: Patients' self-reported data were collected using the Health Literacy and Cancer Care Coordination questionnaires. We conducted multivariate linear regression analyses to investigate predictors of patients' health literacy and their care experience. Canonical correlation analysis was used to examine the relationship between patients' health literacy and their care experience.

Results: A total of 68 patients and eight carers participated in the survey. Patients and carers reported similar levels of health literacy, with the lowest scores being in the "Having sufficient information to manage health" and "Navigating the health system" subscales. Gender (P = 0.026, partial η  = 0.281) and educational attainment (P = 0.015, partial η  = 0.250) had significant and large effects on patients' health literacy, after controlling for each other. Educational attainment showed a significant and medium association with patients' experience of cancer care coordination (P = 0.041, partial η  = 0.101). A large and positive correlation was found between patients' health literacy and experience of cancer care coordination (canonical correlation = 0.81).

Conclusions: Our findings reveal the health literacy and care coordination needs of Chinese migrant patients with cancer in Australia, especially those with lower educational attainment. Future efforts are necessary to enhance Chinese migrants' health literacy and establish an accessible and easy-to-navigate care environment.
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http://dx.doi.org/10.1002/pon.5050DOI Listing
May 2019

Computerized Adaptive Testing System of Functional Assessment of Stroke.

J Vis Exp 2019 01 7(143). Epub 2019 Jan 7.

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

The computerized adaptive testing system of the functional assessment of stroke (CAT-FAS) can simultaneously assess four functions (motor functions of the upper and lower extremities, postural control, and basic activities of daily living) with sufficient reliability and administrative efficiency. CAT, a modern measurement method, aims to provide a reliable estimate of the examinee's level of function rapidly. CAT administers only a few items whose item difficulties match an examinee's level of function and, thus, the administered items of CAT can provide sufficient information to reliably estimate the examinee's level of function in a short time. The CAT-FAS was developed through four steps: (1) determining the item bank, (2) determining the stopping rules, (3) validating the CAT-FAS, and (4) establishing a platform of online administration. The results of this study indicate that the CAT-FAS has sufficient administrative efficiency (average number of items = 8.5) and reliability (group-level Rasch reliability: 0.88 - 0.93; individual-level Rasch reliability: ≥70% of patients had Rasch reliability score ≥0.90) to simultaneously assess four functions in patients with stroke. In addition, because the CAT-FAS is a computer-based test, the CAT-FAS has three additional advantages: the automatic calculation of scores, the immediate storage of data, and the easy exporting of data. These advantages of the CAT-FAS will be beneficial to data management for clinicians and researchers.
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http://dx.doi.org/10.3791/58137DOI Listing
January 2019

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

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

Development of a Computerized Adaptive Testing System of the Functional Assessment of Stroke.

Arch Phys Med Rehabil 2018 04 16;99(4):676-683. Epub 2017 Oct 16.

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, Taichung, Taiwan. Electronic address:

Objective: To develop a computerized adaptive testing system of the Functional Assessment of Stroke (CAT-FAS) to assess upper- and lower-extremity (UE/LE) motor function, postural control, and basic activities of daily living with optimal efficiency and without sacrificing psychometric properties in patients with stroke.

Design: Simulation study.

Setting: One rehabilitation unit in a medical center.

Participants: Patients with subacute stroke (N=301; mean age, 67.3±10.9; intracranial infarction, 74.5%).

Interventions: Not applicable.

Main Outcome Measures: The UE and LE subscales of the Fugl-Meyer Assessment, Postural Assessment Scale for Stroke Patients, and Barthel Index.

Results: The CAT-FAS adopting the optimal stopping rule (limited reliability increase of <.010) had good Rasch reliability across the 4 domains (.88-.93) and needed few items for the whole administration (8.5 items on average). The concurrent validity (CAT-FAS vs original tests, Pearson r=.91-.95) and responsiveness (standardized response mean, .65-.76) of the CAT-FAS were good in patients with stroke.

Conclusions: We developed the CAT-FAS, and our results support that the CAT-FAS has sufficient efficiency, reliability, concurrent validity, and responsiveness in patients with stroke. The CAT-FAS can be used to simultaneously assess patients' functions of UE, LE, postural control, and basic activities of daily living using, on average, no more than 10 items; this efficiency is useful in reducing the assessment burdens for both clinicians and patients.
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http://dx.doi.org/10.1016/j.apmr.2017.09.116DOI Listing
April 2018

Development of a Social Functioning Assessment Using Computerized Adaptive Testing for Patients With Stroke.

Arch Phys Med Rehabil 2018 02 5;99(2):306-313. Epub 2017 Oct 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; Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taiwan.

Objective: To develop a computerized adaptive test of social functioning (Social-CAT) for patients with stroke.

Design: This study contained 2 phases. First, a unidimensional item bank was formed using social-related items with sufficient item fit (ie, infit and outfit mean square [MNSQ]). The social-related items were selected from 3 commonly used patient-reported quality-of-life measures. Items with differential item functioning (DIF) of sex were deleted. Second, we performed simulations to determine the best set of stopping rules with both high reliability and efficiency. The participants' responses to the items were extracted from a previous study.

Setting: Rehabilitation wards and departments of rehabilitation/neurology of 5 general hospitals.

Participants: Patients (N=263) with stroke (47.1% were inpatients).

Interventions: Not applicable.

Main Outcome Measure: Social-CAT.

Results: The unidimensionality of the 24 selected items was supported (infit and outfit MNSQs =0.8-1.2). One item had DIF of sex and was deleted. The item bank was composed of the remaining 23 items. With the best set of stopping rules (person reliability ≥.90 or limited reliability increased ≤.001), the Social-CAT used on average 10 items to achieve sufficient reliability (average person reliability =.88; 81.0% of the patients with reliability ≥.90).

Conclusions: The Social-CAT appears to be a unidimensional measure with acceptable reliability and efficiency, and it could be useful for both clinicians and patients in time-pressed clinical settings.
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http://dx.doi.org/10.1016/j.apmr.2017.08.492DOI Listing
February 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

Validation of the Integrated Model of Health Literacy in Patients With Breast Cancer.

Cancer Nurs 2018 Nov/Dec;41(6):498-505

Author Affiliations: Master Program in Long-term Care and School of Gerontology Health Management, College of Nursing, and Cochrane Taiwan, Taipei Medical University; and Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taiwan (Dr Hou); and School of Occupational Therapy, College of Medicine, National Taiwan University (Ms Huang, Mr Lin, and Dr Hsieh), Taipei, Taiwan; Department of Educational Psychology, University of Wisconsin-Madison (Ms Lee); and Department of Educational Psychology and Counseling, National Tsing Hua University, Hsinchu, Taiwan (Dr Chen); and Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei (Dr Hsieh), Taiwan.

Background: Health literacy (HL) enables patients with breast cancer to actively participate in health decisions and promote positive health outcomes. The Integrated Model of Health Literacy (IMHL), defined as the personal, situational, and societal/environmental factors that predict the level of HL that can influence health outcomes, incorporates the concepts, determinants, and consequences of HL.

Objective: The aim of this study was to examine the mechanisms and completeness of the IMHL in patients with breast cancer.

Methods: Five hundred eleven Taiwanese patients were prospectively recruited. We conducted structural equation modeling to confirm and modify the predictive pathways linking the HL-related factors in the IMHL.

Results: Results on a total of 511 breast cancer patients showed good model-data fit. An alternative model revealed better fit with 2 pathways added from cancer stage to self-rated health and from cancer duration to shared decision making. Both the original model and alternative model modification revealed that only personal determinants (age, education, cancer stage, and duration) and not situational determinants (marital status) or social/environmental determinants (residence and occupation) could significantly predict the 3 domains of HL. Theorized consequences of HL were significantly influenced by HL in both models.

Conclusions: Our results partially support the relationships proposed in the IMHL for patients with breast cancer as only personal determinants significantly predicted HL.

Implications For Practice: Understanding the predictive pathways of the integrated HL model could help clinicians to tailor HL interventions using a patient's personal determinants to facilitate participation in decision making and promote health for breast cancer patients.
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http://dx.doi.org/10.1097/NCC.0000000000000540DOI Listing
August 2019

Group- and Individual-Level Responsiveness of the 3-Point Berg Balance Scale and 3-Point Postural Assessment Scale for Stroke Patients.

Arch Phys Med Rehabil 2018 03 9;99(3):529-533. Epub 2017 Sep 9.

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, Taichung, Taiwan.

Objectives: To examine both group- and individual-level responsiveness of the 3-point Berg Balance Scale (BBS-3P) and 3-point Postural Assessment Scale for Stroke Patients (PASS-3P) in patients with stroke, and to compare the responsiveness of both 3-point measures versus their original measures (Berg Balance Scale [BBS] and Postural Assessment Scale for Stroke Patients [PASS]) and their short forms (short-form Berg Balance Scale [SFBBS] and short-form Postural Assessment Scale for Stroke Patients [SFPASS]) and between the BBS-3P and PASS-3P.

Design: Data were retrieved from a previous study wherein 212 patients were assessed at 14 and 30 days after stroke with the BBS and PASS.

Setting: Medical center.

Participants: Patients (N=212) with first onset of stroke within 14 days before hospitalization.

Interventions: Not applicable.

Main Outcome Measures: Group-level responsiveness was examined by the standardized response mean (SRM), and individual-level responsiveness was examined by the proportion of patients whose change scores exceeded the minimal detectable change of each measure. The responsiveness was compared using the bootstrap approach.

Results: The BBS-3P and PASS-3P had good group-level (SRM, .60 and SRM, .56, respectively) and individual-level (48.1% and 44.8% of the patients with significant improvement, respectively) responsiveness. Bootstrap analyses showed that the BBS-3P generally had superior responsiveness to the BBS and SFBBS, and the PASS-3P had similar responsiveness to the PASS and SFPASS. The BBS-3P and PASS-3P were equally responsive to both group and individual change.

Conclusions: The responsiveness of the BBS-3P and PASS-3P was comparable or superior to those of the original and short-form measures. We recommend the BBS-3P and PASS-3P as responsive outcome measures of balance for individuals with stroke.
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http://dx.doi.org/10.1016/j.apmr.2017.08.472DOI Listing
March 2018

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

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

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

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

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

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

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

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

Refining 3 Measures to Construct an Efficient Functional Assessment of Stroke.

Stroke 2017 06 3;48(6):1630-1635. Epub 2017 May 3.

From the Department of Rehabilitation, Chi Mei Medical Center, Tainan, Taiwan (Y.-L.W.); Center of General Education, Southern Taiwan University of Science and Technology, Tainan (Y.-L.W.); School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei (G.-H.L., Y.-J.H., C.-L.H.); Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei (C.-L.H.); Department of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan (M.-H.C.); and Occupational Therapy Room, Chung Shan Medical University Hospital, Taichung (M.-H.C.).

Background And Purpose: The Fugl-Meyer Assessment motor scale, Postural Assessment Scale for Stroke patients, and Barthel Index are widely used to assess patients' upper extremity and lower extremity motor function, balance, and basic activities of daily living after stroke, respectively. However, these 3 measures (72 items) require a great amount of time for assessment. Therefore, we aimed to develop an efficient test, the Functional Assessment of Stroke (FAS).

Methods: The FAS was constructed from 4 short-form tests of the Fugl-Meyer Assessment-upper extremity, Fugl-Meyer Assessment-lower extremity, Postural Assessment Scale for Stroke patients, and Barthel Index based on the results of Rasch analyses and the items' content. We examined the psychometric properties of the FAS, including Rasch reliability, concurrent validity, convergent validity, known-group validity, and responsiveness.

Results: The FAS contained 29 items (10, 6, 8, and 5 items for the 4 short-form tests, respectively). The FAS demonstrated high Rasch reliability (0.92-0.94), concurrent validity (=0.90-0.97 with the original tests), convergent validity (=0.62-0.94 with the 5-scale Fugl-Meyer Assessment), and known-group validity (significant difference in the FAS scores among 3 groups of disability levels; <0.001). In addition, the responsiveness of the FAS (standardized response mean=0.55-1.93) was similar or significantly superior to those of the original tests (standardized response mean=0.46-1.39).

Conclusions: The FAS contains 29 items and has sufficient Rasch reliability, validities, and responsiveness. These findings support that the FAS is efficient for reliably and validly assessing upper extremity/lower extremity motor function, balance, and basic activities of daily living and for sensitively detecting change in those functions in patients with stroke.
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http://dx.doi.org/10.1161/STROKEAHA.116.015516DOI Listing
June 2017

Validation of the European Health Literacy Survey Questionnaire in Women With Breast Cancer.

Cancer Nurs 2018 Mar/Apr;41(2):E40-E48

Author Affiliations: School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei City (Ms Huang, Mr Lin, and Dr Hsieh); School of Occupational Therapy, Chung Shan Medical University; and Occupational Therapy Room, Chung Shan Medical University Hospital, Taichung City (Dr Lu); Division of General Surgery, Department of Surgery, Taipei Medical University-Shuang Ho Hospital, New Taipei City; and Department of Surgery, School of Medicine, Taipei Medical University (Dr Tam); Division of Plastic Surgery, Department of Surgery, Taipei Medical University-Wan Fang Hospital; and Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University (Dr Chen); and Master Program in Long-Term Care and School of Gerontology and Health Management, College of Nursing, Taipei Medical University; and Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital (Dr Hou); and Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei City (Dr Hsieh).

Background: Health literacy enables effective communication, participation, and cooperation with clinicians of patients with breast cancer in healthcare processes. The European Health Literacy Survey Questionnaire (HLS-EU-Q) comprehensively assesses multiple conceptual domains of health literacy in a diverse range of health contexts. However, the HLS-EU-Q has not been validated in women with breast cancer.

Objectives: We examined the psychometric properties, particularly the factorial validity, of the HLS-EU-Q in women with breast cancer.

Methods: We performed a first-order confirmatory factor analysis (CFA) to verify the 12-subdomain model of the 47-item HLS-EU-Q. A second-order CFA was conducted to investigate whether the 12 subdomains reflected the 3 domains of healthcare, disease prevention, and health promotion correspondingly.

Results: A total of 475 women with breast cancer participated in this study. The first-order CFA fitted with the HLS-EU-Q containing 47 items. However, item 29, with a low factor loading (-0.05), was deleted. The modified first-order CFA adequately fitted the data of the HLS-EU-Q with 46 items. The second-order CFA model acceptably fitted with the data, but the 3 domains with high correlations (0.92-1.00) were merged into a single domain, health literacy.

Conclusions: Our results supported the factorial validity of the 12-subdomain HLS-EU-Q with 46 items in women with breast cancer. It is recommended that the 12 subdomain scores be summed up to represent overall health literacy.

Implications For Practice: The HLS-EU-Q with 46 items is recommended for use in capturing the diverse health literacy competencies of women with breast cancer in different health contexts.
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http://dx.doi.org/10.1097/NCC.0000000000000475DOI Listing
April 2019

Test-retest reliability and minimal detectable change of two simplified 3-point balance measures in patients with stroke.

Eur J Phys Rehabil Med 2017 Oct 12;53(5):719-724. Epub 2017 Jan 12.

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

Background: The 3-point Berg Balance Scale (BBS-3P) and 3-point Postural Assessment Scale for Stroke Patients (PASS-3P) were simplified from the BBS and PASS to overcome the complex scoring systems. The BBS-3P and PASS-3P were more feasible in busy clinical practice and showed similarly sound validity and responsiveness to the original measures. However, the reliability of the BBS-3P and PASS-3P is unknown limiting their utility and the interpretability of scores.

Aim: We aimed to examine the test-retest reliability and minimal detectable change (MDC) of the BBS-3P and PASS-3P in patients with stroke.

Design: Cross-sectional study.

Setting: The rehabilitation departments of a medical center and a community hospital.

Population: A total of 51 chronic stroke patients (64.7% male).

Methods: Both balance measures were administered twice 7 days apart. The test-retest reliability of both the BBS-3P and PASS-3P were examined by intraclass correlation coefficients (ICC). The MDC and its percentage over the total score (MDC%) of each measure was calculated for examining the random measurement errors.

Results: The ICC values of the BBS-3P and PASS-3P were 0.99 and 0.97, respectively. The MDC% (MDC) of the BBS-3P and PASS-3P were 9.1% (5.1 points) and 8.4% (3.0 points), respectively, indicating that both measures had small and acceptable random measurement errors.

Conclusions: Our results showed that both the BBS-3P and the PASS-3P had good test-retest reliability, with small and acceptable random measurement error. These two simplified 3-level balance measures can provide reliable results over time.

Clinical Rehabilitation Impact: Our findings support the repeated administration of the BBS-3P and PASS-3P to monitor the balance of patients with stroke. The MDC values can help clinicians and researchers interpret the change scores more precisely.
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http://dx.doi.org/10.23736/S1973-9087.17.04463-XDOI Listing
October 2017

[Efficacy of ultrasound-guided lauromacrogol sclerotherapy for benign thyroid cysts and factors affecting the therapeutic effect].

Nan Fang Yi Ke Da Xue Xue Bao 2016 Dec;36(12):1694-1699

Department of Endocrinology, Guangdong General Hospital/Guangdong Academy of Medical Sciences,Guangzhou 510080, China. E-mail:

Objective: To evaluate the clinical efficacy of ultrasound-guided lauromacrogol sclerotherapy for benign thyroid cysts and analyze the factors affecting the efficacy.

Methods: Ultrasound-guided lauromacrogol sclerotherapy was performed in 97 patients with a total of 99 benign thyroid cysts. The changes in cystic volume and other thyroid parameters were evaluated at 1, 3, 6, and 12 months after sclerotherapy. According to changes in the cystic volume, the efficacy of sclerotherapy was defined as therapeutic failure (with a volume reduction <50%), treatment success (volume reduction ≥50%) and cure (volume reduction ≥90%). The factors of affecting the efficacy of sclerotherapy was analyzed using COX regression.

Results: The mean cystic volume at 1, 3, 6 and 12 months after sclerotherapy were reduced from the baseline volume of 12.08∓11.56 cm to 5.63∓8.51 cm, 5.96∓8.42 cm, 3.80∓5.50 cm and 2.85∓3.98 cm, respectively, with an average cystic volume reduction rate of (70.02∓33.72)%. Therapeutic success was achieved 82 of the 99 cysts (82.83%) and cure was achieved 63cysts (63.64%) at 12 months after the procedure. A second sclerotherapy was performed for 13 cysts which did not show a volume reduction at 1-3 months after the initial procedure. A disease course of over 12 months was an independent risk factor for a second sclerotherapy (23.7% [9/38] vs 6.6% [4/61], OR=4.473 [1.238-16.169], P=0.022). The efficacy of sclerotherapy was related to cystic cavity separation, cystic fluid viscosity, cystic/solid ratio and cystic wall thickness. COX regression analysis revealed that cystic cavity separation (HR=2.25, 95%CI: 1.19-4.25) and cystic fluid viscosity (HR=2.02, 95%CI: 1.19-3.43) were the major factors affecting the treatment efficacy.

Conclusion: Ultrasound-guided lauromacrogol sclerotherapy is effective and safe for treatment of benign thyroid cysts, and the maximal treatment effect can be achieved at 6 months after sclerotherapy and in cases of uncomplicated cysts with non-viscous cystic fluid, no solid cystic cavity separation and a disease course of less than 12 months.
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December 2016

Improving the utility of the Brunnstrom recovery stages in patients with stroke: Validation and quantification.

Medicine (Baltimore) 2016 Aug;95(31):e4508

Department of Occupational Therapy, I-Shou University, Kaohsiung, Taiwan School of Occupational Therapy, College of Medicine, National Taiwan University Department of Health Promotion and Gerontological Care, Taipei College of Maritime Technology, Taipei Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taichung Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei School of Occupational Therapy, Chung Shan Medical University Occupational Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan.

The Brunnstrom recovery stages (the BRS) consists of 2 items assessing the poststroke motor function of the upper extremities and 1 assessing the lower extremities. The 3 items together represent overall motor function. Although the BRS efficiently assesses poststroke motor functions, a lack of rigorous examination of the psychometric properties restricts its utility. We aimed to examine the unidimensionality, Rasch reliability, and responsiveness of the BRS, and transform the raw sum scores of the BRS into Rasch logit scores once the 3 items fitted the assumptions of the Rasch model.We retrieved medical records of the BRS (N = 1180) from a medical center. We used Rasch analysis to examine the unidimensionality and Rasch reliability of both upper-extremity items and the 3 overall motor items of the BRS. In addition, to compare their responsiveness for patients (n = 41) assessed with the BRS and the Stroke Rehabilitation Assessment of Movement (STREAM) on admission and at discharge, we calculated the effect size (ES) and standardized response mean (SRM).The upper-extremity items and overall motor items fitted the assumptions of the Rasch model (infit/outfit mean square = 0.57-1.40). The Rasch reliabilities of the upper-extremity items and overall motor items were high (0.91-0.92). The upper-extremity items and overall motor items had adequate responsiveness (ES = 0.35-0.41, SRM = 0.85-0.99), which was comparable to that of the STREAM (ES = 0.43-0.44, SRM = 1.00-1.13).The results of our study support the unidimensionality, Rasch reliability, and responsiveness of the BRS. Moreover, the BRS can be transformed into an interval-level measure, which would be useful to quantify the extent of poststroke motor function, the changes of motor function, and the differences of motor functions in patients with stroke.
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http://dx.doi.org/10.1097/MD.0000000000004508DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4979857PMC
August 2016

A Systematic Review of Tests Assessing Stroke Knowledge.

J Cardiovasc Nurs 2017 May/Jun;32(3):271-280

Wen-Hsuan Hou, MD, PhD Associate Professor, Master Program in Long-Term Care and School of Gerontology Health Management, College of Nursing, and Center of Evidence-Based Medicine, Taipei Medical University; and Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taiwan. Tammy Hoffmann, PhD Professor of Clinical Epidemiology, Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia. Yi-Jing Huang, BS PhD student, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan. Tzu-Yi Wu, PhD Postdoctoral Fellow, Institute of Economics, Academia Sinica, Taipei, Taiwan. Sheng-Shiung Chen, MS Occupational Therapist, Department of Physical Medicine and Rehabilitation, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan. Ching-Lin Hsieh, PhD Professor, School of Occupational Therapy, College of Medicine, National Taiwan University, and Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.

Background: Accurate assessment of stroke knowledge (SK) is fundamental to the successful understanding of, monitoring of, and intervening to improve the SK of patients and the public.

Purpose: The purpose of this study is to perform a systematic review of the existing SK tests and appraise their conceptual basis, feasibility, and psychometric properties. We conducted 2-step searching of MEDLINE, CINAHL, PsycINFO, and Scopus electronic databases from January 1, 2000, to December 31, 2014, to identify relevant SK tests for the appraisal.

Results: Our study found 59 SK tests, out of a total of 93 articles, with full content available that had been referred to in the published literature. Ten of them had been used in more than 1 study, and 2 (the Stroke Knowledge Test and the Stroke Action Test) of them have had at least 1 of their psychometric properties validated. Only 1 test (the Stroke Knowledge Test) was developed using rigorous methodology, covers a wide range of concepts, and met all feasibility criteria; however, its limitations include no articulated conceptual basis, inadequate internal consistency reliability (α = .65), and lack of some validated psychometric properties.

Conclusions: Our study revealed that current available tools are not sufficiently able to accurately and reliably assess SK to promote stroke prevention and management.

Clinical Implications: This study highlights the attention of applying current SK tests and need for revising existing tests or developing a new test.
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http://dx.doi.org/10.1097/JCN.0000000000000345DOI Listing
February 2018

Trajectories of quality of life in patients with traumatic limb injury: a 2-year follow-up study.

Qual Life Res 2016 09 26;25(9):2283-93. Epub 2016 Mar 26.

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

Purpose: Traumatic limb injury (TLI) can have a negative impact on a patient's quality of life (QOL), and the patient's QOL may fluctuate over time. However, the longitudinal change patterns of QOL in patients with TLI are largely unknown. The aim of this study was to investigate the QOL trajectories in patients with TLI in 4 QOL domains: physical capacity, psychological well-being, social relationships, and environment.

Methods: The patients' QOL was assessed within 14 days and at 1, 3, 6, 12, and 24 months after injury. In each QOL domain, 4 latent growth curve models (LGMs, including non-growth, linear growth, quadratic growth, and cubic LGM) were adopted to examine the QOL trajectories across the 6 time points.

Results: A total of 499 patients completed the 6 assessments. For all 4 QOL domains, the cubic LGM had the best model fitting (root-mean-square error of approximation < 0.01) revealing that the patients' 4 QOL domains changed with cubic trajectories: QOL improved in the first 6 months, deteriorated in the second 6 months, and improved smoothly at 12-24 months after injury.

Conclusions: This study found that the trajectories in the 4 QOL domains were cubic trajectories in patients with TLI. These findings indicate that clinicians should pay additional attention to improve the patients' QOL in the first 6 months after injury and to prevent or reduce QOL deterioration at 6-12 months.
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http://dx.doi.org/10.1007/s11136-016-1274-xDOI Listing
September 2016

Validation of the short-form Health Literacy Scale in patients with stroke.

Patient Educ Couns 2015 Jun 5;98(6):762-70. Epub 2015 Mar 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.

Objective: We aimed to validate a Mandarin version of the short-form Health Literacy Scale (SHEAL) in patients with stroke.

Methods: Each patient with stroke was interviewed with the SHEAL. The Public Stroke Knowledge Quiz (PSKQ) was administered as a criterion for examining the convergent validity of the SHEAL. The discriminative validity of the SHEAL was determined with age and education level as independent grouping variables.

Results: A total of 87 patients with stroke volunteered to participate in this prospective study. The SHEAL demonstrated sufficient internal consistency reliability (alpha=0.82) and high correlation with the PSKQ (r=0.62). The SHEAL scores between different age groups and education level groups were significantly different. The SHEAL, however, showed a notable ceiling effect (24.1% of the participants), indicating that the SHEAL cannot differentiate level of health literacy between individuals with high health literacy.

Conclusion: The internal consistency reliability, convergent validity, and discriminative validity of the SHEAL were adequate. However, the internal consistency reliability and ceiling effect of the SHEAL need to be improved.

Practice Implications: The SHEAL has shown its potential for assessing the health literacy of patients with stroke for research purposes. For clinical usage, however, the SHEAL should be used with caution.
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http://dx.doi.org/10.1016/j.pec.2015.02.021DOI Listing
June 2015
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