Clinical Effectiveness of Craniosacral Therapy in Patients with Headache Disorders: A Systematic Review and Meta-analysis

OBJECTIVES

To analyze the effectiveness of craniosacral therapy in improving pain and disability among patients with headache disorders.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed, Physiotherapy Evidence Database, Scopus, Cochrane Library, Web of Science, and Osteopathic Medicine Digital Library databases were searched in March 2023.

REVIEW METHODS

Two independent reviewers searched the databases and extracted data from randomized controlled trials comparing craniosacral therapy with control or sham interventions. The same reviewers assessed the methodological quality and the risk of bias using the PEDro scale and the Cochrane Collaboration tool, respectively. Grading of recommendations, assessment, development, and evaluations was used to rate the certainty of the evidence. Meta-analyses were conducted using random effects models using RevMan 5.4 software.

RESULTS

The searches retrieved 735 studies, and four studies were finally included. The craniosacral therapy provided statistically significant but clinically unimportant change on pain intensity (Mean difference = -1.10; 95% CI: -1.85, -0.35; I2: 44%), and no change on disability or headache effect (Standardized Mean Difference = -0.34; 95% CI -0.70, 0.01; I2: 26%). The certainty of the evidence was downgraded to very low.

CONCLUSION

Very low certainty of evidence suggests that craniosacral therapy produces clinically unimportant effects on pain intensity, whereas no significant effects were observed in disability or headache effect.

Effect of Adding Transfer Energy Capacitive and Resistive Therapy to Conventional Therapy for Patients With Myofascial Pain Syndrome in Upper Trapezius: A Randomized Clinical Trial

Objective

The purpose of this study was to compare the effect of adding transfer energy capacitive and resistive (TECAR) therapy to conventional therapy on patients' symptoms of myofascial pain syndrome (MPS) in the upper trapezius.

Methods

Fifty patients with MPS in the upper trapezius were randomized into 2 groups. The intervention group received TECAR therapy (capacitive mode, 2 sessions weekly), and conventional treatment comprised of stretching exercise (9 times a day) and medication (acetaminophen and tizanidine) for 3 weeks, and the comparison group received conventional treatment (same as the intervention group) alone. The patients completed the Numeric Pain Scale, Neck Disability Index, and Shoulder Pain and Disability Index before, after, and 1 month after the treatment.

Results

All variables were significantly reduced within both groups by time and treatment separately (P < .001), while a general comparison among the groups showed a significant reduction for all variables in the intervention group compared with the comparison group (P < .05) except for shoulder disability (P = .114). Moreover, the intervention group had better results compared with the comparison group based on the minimal clinically important difference.

Conclusion

A combination of TECAR therapy, exercise, and medication substantially reduced symptom severity for patients with MPS in the upper trapezius when compared to only exercise and medication.

Home care for the elderly with dementia: a systematic review

Objetive

With the global population aging, there is a growing need for home-based care to meet the health needs of the elderly. However, the quality of care provided to the aged population is now arguably a significant challenge for most healthcare systems worldwide.

Methods

The present review included 13 original studies on home care and its effects on dementia patients, describing how patient care and adequate treatment can be collaborative for their improvement, for case management, and optimizing pain control and specificities.

Results

Among the findings, it was evidenced that the environment impacts the form of care, once being at home can improve communication and global monitoring of dementia patients.

Conclusion

In addition to the results analyzed in this review, there is a need for future, well-designed studies on the different aspects of home care, highlighting the importance of evaluating the type of care for each patient in the quest to optimize the care.

Immediate Effects of a Single Session of Cervical Spine Manipulation on Cervical Movement Patterns in People With Nonspecific Neck Pain: A Randomized Controlled Trial

OBJECTIVE

The aim of the present study was to assess the immediate effects of a single session of cervical spine manipulation on cervical movement patterns, disability, and the patient's perceived improvement in people with nonspecific neck pain.

METHODS

A single-blinded, randomized, sham-controlled trial was carried out at a biomechanics institute. Fifty participants diagnosed with acute and chronic nonspecific neck pain (minimum duration of the symptoms being 1 month) were randomized to an experimental group (EG, n = 25) or a sham-control group (CG, n = 25, 23 of whom completed the study). EG received a single cervical spine manipulation session; CG received a single placebo intervention. Both groups received manipulation or sham from the same physiotherapist. Main outcome measures were neck kinematics (ie, range of motion and movement harmony) during cyclic movements, self-reported neck disability, and impression of change assessed before and 5 minutes after treatment.

RESULTS

The EG showed no significant improvements (P > .05) in any of the studied biomechanical variables, except for right-side bending and left rotation, in which we found a range of motion significant mean difference of 1.97° and 1.95°, respectively (P < .05). The CG showed enhanced harmonic motion during flexion (P < .05). Both groups showed a significant decrease in self-reported neck disability after treatment (P < .05), and EG participants perceived a significantly larger improvement after manipulation compared with the CG (P < .05).

CONCLUSIONS

A single session of cervical manipulation provided by a physiotherapist had no impact on cervical motion during cyclic movements, but rather induced self-reported perceived improvement in neck disability and impression of change after treatment in people with nonspecific neck pain.

Effect of Transfer Energy Capacitive and Resistive Therapy on Shoulder Pain, Disability, and Range of Motion in Patients With Adhesive Capsulitis: A Study Protocol for a Randomized Controlled Trial

Objective

We describe a protocol to evaluate the effectiveness of transfer energy capacitive and resistive (TECAR) therapy on shoulder passive range of motion, shoulder pain, and disability index in patients with adhesive capsulitis.

Methods

This study will be a double-blinded randomized clinical trial with a 1-month follow-up. For the purpose of this research, 30 patients with a 3-month history of shoulder pain and disability diagnosed as adhesive capsulitis will be selected and then randomized into 2 groups, including conventional physiotherapy consisting of electrophysical modalities and therapeutic exercises, which will be given to the control group. In the intervention group, after conventional physiotherapy, 10 minutes of TECAR therapy in resistive mode will be applied on both the anterior and inferior aspects of the shoulder joint. Outcome measures will be related to shoulder passive range of abduction, flexion, and external rotation that will be measured using a digital inclinometer, as well as shoulder pain and disability index that will be assessed by the validated questionnaire. Assessment will be done at baseline, 1 day after the intervention, and by passing 1 month.

Results

The statistical analysis will describe within-group and between-group comparisons; the findings will be illustrated in tables and charts.

Conclusion

Given the reason that the effectiveness of TECAR therapy has not been widely evaluated in adhesive capsulitis, the findings of this pilot study would provide baseline information on the effectiveness and complications of this treatment method and possibly propose a more appropriate protocol for patients with adhesive capsulitis.

Factors associated with the number of months of delaying in multiple sclerosis diagnosis: Comparison of count regression models

Background: It may take a long time to diagnose multiple sclerosis (MS) since the emergence of primary symptoms. This study aimed to use count regression models to compare their fit and to identify factors affecting delay in the diagnosis of MS. Methods: Data were collected from the Nationwide MS Registry of Iran (NMSRI) for Mazandaran Province, Iran, using census sampling until April 2022. The four models of Poisson regression, negative binomial (NB) regression, zero-inflated Poisson (ZIP) regression, and zero-inflated negative binomial (ZINB) regression were used in this study. Results: In this study on 2894 patients, 74.0% were women, and 8.5% had a family history of MS. The mean ± standard deviation (SD) of the patients' age was 34.96 ± 9.41 years, and the mean delay in diagnosis was 12.32 ± 33.26 months, with a median of 0 (Q1-Q3: 0-9). The NB regression model showed the best performance, and factors, including a history of hospitalization and the year of symptom onset, had significant effects on a delayed diagnosis. Besides, the Expanded Disability Status Scale (EDSS) score was significantly different before and after 2017; it was also associated with sex, type of MS, and history of hospitalization. Conclusion: The mean diagnostic delay and the mean age of MS diagnosis are critical in Mazandaran Province. Patients with MS develop the disease at an early age and are diagnosed with a long delay. The time of symptom onset is a significant factor in the diagnosis of MS, and in recent years, there have been improvements in the diagnostic process.

Efficacy of Intramuscular Injection of Calcitonin on Pain Functional Status of Patients with Knee Osteoarthritis

Background

Recently, increased attention has been paid to calcitonin for the management of osteoarthritis (OA) regarding its metabolic properties for bone turnover and cartilage.

Objectives

This study was designed to assess the efficacy of intramuscular calcitonin injection in the functional status of individuals suffering from knee OA.

Methods

A total of 40 eligible cases with OA were randomly assigned into intervention and control groups. At baseline, pain intensity and functional ability were evaluated based on the Numeric Rating scale (NRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaires. Both groups were prescribed with AcetaGel (500 mg) and piroxicam (0.5% topical gel) every 8 hours as needed, and the patients were instructed about conservative treatments and lifestyle modifications. In the case group, the patients received calcitonin (50 IU/mL solution for injection; Aburaihan Pharmaceutical Co., Iran) intramuscularly (gluteal muscle) once a week for 4 consecutive weeks. One month after the last dose, the patients were evaluated based on NRS and WOMAC questionnaires.

Results

Demographic data did not show any statistically significant difference. A total of 40 cases (male and female) with mean age values of 53.10 ± 5.28 and 54.55 ± 5.26 years were included in the case and control groups, respectively. The mean body mass index values of the case and control groups were 27.45 ± 1.57 and 27.15 ± 1.53 kg/m2, respectively. After 1 month of treatment with calcitonin, significant improvements were observed in NRS outcomes (P < 0.001). The total WOMAC score was also statistically improved (P < 0.001).

Conclusions

The findings of the present study revealed that the weekly administration of 50 IU calcitonin for 28 days could significantly improve physical ability and pain intensity in OA patients.

B vitamins and their combination could reduce migraine headaches: A randomized double-blind controlled trial

Background: The B vitamins can potentially help prevent migraine. This study was designed to examine the effects of supplementation with thiamine (B1), pyridoxine (B6), cobalamin (B12), folic acid (B9), and a combination of these vitamins on women with episodic migraine (EM). Methods: This study was a double-blind, placebo-controlled, randomized, clinical trial conducted on 120 women with EM. The participants were divided into the 6 groups of B1 (n = 20), B6 (n = 20), B12 (n = 20), B9 (n = 20), vitamin B complex (n = 20), and placebo (n = 20). Subjects received 1 capsule daily for 12 weeks. As part of the baseline and post-intervention phases, paper-based headache diaries were used to record the number of abortive drugs consumed and the frequency of headache attacks, and the Migraine Disability Assessment Questionnaire (MIDAS) was used to assess migraine disability. Results: A 16-week study on women with EM revealed that the mean changes in the frequency of headache attacks decreased significantly in all vitamin groups in comparison with the placebo group (P < 0.001). In contrast to the placebo, there was also a significant improvement in the migraine disability score in each vitamin group (P < 0.001). The 12-week supplementation with vitamins B9, B1, B6, B12, and B complex also brought on a significant decrease in the use of abortive drugs compared to the placebo group (P = 0.032). Conclusion: The results of this study showed that B1, B6, B12, and B9, and a combination of these vitamins could be effective as an adjuvant in treatment and prophylaxis of EM. Further large trials with long-term follow-ups will be required to confirm our results.

Causes and Trends of Disabilities in Community-Dwelling Stroke Survivors: A Population-Based Study

Many stroke survivors live with disabilities in the community. This study aimed to investigate the causes and trends of disabilities among community-dwelling stroke survivors. A total of 1547 community-dwelling stroke survivors ≥ 19 years were identified using the Korea National Health and Nutrition Examination Survey (KNHANES) database from 2007 to 2018. We analyzed the causes and trends of disabilities in strokes survivors using complex-samples procedures. During 2007-2018, 38.0% of stroke survivors were found to have disabilities. Stroke itself was the most common cause of disabilities (21.3%). Musculoskeletal (back or neck problems, 7.0%; arthritis, 5.7%; and leg pain excluding arthritis, 2.3%), sensory (visual problems, 3.6%; and auditory problems, 1.4%), and medical problems (diabetes 2.6%; hypertension, 2.3%; heart disease, 1.5%) accounted for the rest of the other causes of disabilities. Upon analyzing the trends, we found that both the proportion of stroke survivors with disabilities and that of stroke survivors with stroke-related disabilities decreased from KNHANES IV (2007-2009) to V (2010-2012). After 2010-2012, the proportion of both groups stayed constant. The burden of disabilities in non-hospitalized stroke survivors has decreased but still remains high. Attention is warranted because many other problems than a stroke can cause disabilities in community-dwelling stroke survivors.

The association between pain, balance, fall, and disability in patients with lumbar spinal stenosis with vascular claudication

Background

The effect of lumbar spinal stenosis (LSS) and peripheral vascular disease (PVD), which occurs with similar degenerative conditions, when seen together, has not been studied. The aim of this study is to examine and compare the relationship between pain, balance, disability, fear of falling, and kinesiophobia in LSS patients with intermittent vascular claudication (IVC).

Methods

Seventy-two patients diagnosed with LSS using magnetic resonance imaging participated in this study. Thirty-five patients with IVC symptoms and showing vascular lesions by lower extremity venous and arterial Doppler ultrasonography imaging were included in the IVC-LSS group. The pain, static balance, dynamic balance, disability, fear of falling, and kinesiophobia were evaluated using the numeric rating scale, single leg stance test, Time Up and Go (TUG), the Oswestry Disability Index (ODI), Fall Efficacy Scale-International (FES-I), and Tampa Scale for Kinesiophobia (TSK), respectively.

Results

Age and female sex were found to be higher in the IVC-LSS group (P = 0.024; P = 0.012). The IVC-LSS group had a shorter single leg stance time and TUG test duration, pain intensity, ODI, FES-I, and TSK scores were higher than patients with LSS (P = 0.001). Pain, fear of falling, and kinesiophobia were moderately correlated with disability in the IVC-LSS group. No relationship was found between pain and dynamic balance. Also, the pain was not related to kinesiophobia.

Conclusions

The findings indicated that IVC causes loss of balance and an increase in pain, disability, fear of falling, and kinesophobia in patients with LSS.

Is a Combination of Exercise and Dry Needling Effective for Knee OA?

OBJECTIVE

To assess the effectiveness of adding dry needling (DN) to an exercise program on pain intensity and disability in patients with knee osteoarthritis.

DESIGN

Double-blind randomized clinical trial with one-year follow-up.

SETTING

Older adults in a multicenter study.

SUBJECTS

Sixty-two patients with knee osteoarthritis were randomly allocated into one of two groups: exercise plus DN (exercise + DN; N = 31) or exercise plus sham DN (exercise + sham DN; N = 31).

METHODS

Participants received six sessions of either DN or sham DN over the leg muscles related to knee pain from osteoarthritis plus a supervised exercise program. We evaluated between-group differences in terms of the numerical pain rating scale (NPRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. We used the EuroQol Group 5-Dimension Self-Report Questionnaire, Barthel Index, Timed Up & Go Test, and Global Rating of Change Scale to examine between-group differences for health-related quality of life, functional status evaluation, balance assessment, and clinical progress, respectively.

RESULTS

The groups were not different in terms of pain intensity (0.32 points, 95% confidence interval [CI] = -1.12 to 1.18, P = 0.92) or WOMAC score (0.29 points, 95% CI = -6.16 to 6.74, P = 0.92) at one year. Both groups presented within-group differences at all follow-up periods (F = 28.349, P < 0.0001, ηp2 = 0.32) on secondary outcomes. Nevertheless, 90.3% of the DN group had reduced medication consumption vs only 26.3% in the sham DN group.

CONCLUSIONS

The inclusion of DN to an exercise program does not reduce pain or disability in patients with knee osteoarthritis.

Development and validation of a prediction model for home discharge in patients with moderate stroke: The Korean stroke cohort for functioning and rehabilitation study

BACKGROUND

Previous studies have investigated the predictors for home discharge without considering stroke severity.

OBJECTIVES

To develop a practical assessment tool that predicts home discharge for moderate stroke patients after subacute rehabilitation therapy in the tertiary hospitals.

METHODS

Stroke patients with National Institutes of Health Stroke Scale scores of 6 to 13 were included in this prospective cohort study. Various demographic, clinical, and functional factors were analyzed as potential predictive factors. A weighted scoring model was developed through the following three-step process: 1) selection of the factors by logistic regression analyses, 2) development of a weighted scoring model, and 3) validation of the generalizability of the model.

RESULTS

The home discharge rate was 51% (n = 372), and the overall mean length of stay of hospitalization was 32.5 days. 1) The Cognitive Functional Independence Measure, 2) the Functional Ambulation Categories, 3) the modified Charlson Comorbidity Index, and 4) marital status were independent predictors of home discharge. The coefficient value for marital status was adjusted to 1 in the scoring system, and the values of the other parameters were proportionally converted to the nearest integer. Possible total scores ranged from 0 to 13 in the model, with a higher score indicating a higher probability of home discharge. With a cutoff point of 7, this model showed 87.0% sensitivity and 86.2% specificity (area under the curve = 0.90).

CONCLUSIONS

This novel assessment tool can be useful in predicting home discharge after subacute rehabilitation of moderate stroke patients.

A Novel Scale for Assessing the Burden of Caregiving for Functionally Compromised Patients: Proposal and Validation

Background

Disability not only burdens the patient, but also the caregiver. To quantify this caregiving burden, we propose a simple four-part questionnaire tool. Our objective is to validate this questionnaire by administering it to caregivers who oversee patients with low back pain and are functionally compromised.

Methods

Twenty-five spouse caregivers who were taking care of in-patients awaiting surgery for various lumbar spine pathologies were shortlisted. The content-validated questionnaire was administered on different occasions during the care recipient’s treatment. Cronbach’s α was calculated to assess internal consistency. Interrelationships between the care recipient’s pain score, extent of functional compromise, and caregiver burden were calculated. The questionnaire’s ability to track changes in the caregivers’ attitudes over time was assessed.

Results

The percentage of caregiver burden before the surgery of the care recipient was 52.5. This increased significantly to 61.1% (P=0.001) 3 days after surgery, but was found to decrease to 32.5% (P<0.001) a month after the surgery; demonstrating the questionnaire’s efficacy to track changes. Cronbach’s alpha of 0.948 signifies the questionnaire’s excellent internal consistency. Pearson’s correlation coefficient (r) between the care recipient’s pain score and caregiver’s burden score was 0.41 (P=0.04), and between the care recipient’s disability score and caregiver’s burden score was 0.9 (P<0.001).

Conclusion

The proposed questionnaire is consistent and can track changes in a caregiver’s attitude over time. It can be adopted for clinical use to assess the burden of caregiving for functionally compromised patients.

Effectiveness of intradiscal injection of radiopaque gelified ethanol (DiscoGel®) versus percutaneous laser disc decompression in patients with chronic radicular low back pain

Background

Low back pain secondary to discopathy is a common pain disorder. Multiple minimally invasive therapeutic modalities have been proposed; however, to date no study has compared percutaneous laser disc decompression (PLDD) with intradiscal injection of radiopaque gelified ethanol (DiscoGel^®). We are introducing the first study on patient-reported outcomes of DiscoGel^® vs. PLDD for radiculopathy.

Methods

Seventy-two patients were randomly selected from either a previous strategy of PLDD or DiscoGel^®, which had been performed in our center during 2016-2017. Participants were asked about their numeric rating scale (NRS) scores, Oswestry disability index (ODI) scores, and progression to secondary treatment.

Results

The mean NRS scores in the total cohort before intervention was 8.0, and was reduced to 4.3 in the DiscoGel^® group and 4.2 in the PLDD group after 12 months, which was statistically significant. The mean ODI score before intervention was 81.25% which was reduced to 41.14% in the DiscoGel^® group and 52.86% in the PLDD group after 12 months, which was statistically significant. Between-group comparison of NRS scores after two follow-ups were not statistically different (P = 0.62) but the ODI score in DiscoGel^® was statistically lower (P = 0.001). Six cases (16.67%) from each group reported undergoing surgery after the follow-up period which was not statistically different.

Conclusions

Both techniques were equivalent in pain reduction but DiscoGel^® had a greater effect on decreasing disability after 12 months, although the rate of progression to secondary treatments and/or surgery was almost equal in the two groups.

Radiographic changes in TMJ in relation to serology and disease activity in RA patients

OBJECTIVES

This study was undertaken as an attempt to assess radiographic temporomandibular joint (TMJ) changes in relation to rheumatoid factor (RF), anticitrullinated protein (ACCP) antibodies and disease activity score 28 (DAS28) in rheumatoid arthritis (RA) patients to find the best predictor of rheumatoid affection of the TMJ with the ultimate goal of maintaining TMJ function and preventing joint damage.

METHODS

20 Rheumatoid Arthritis patients as well as 20 volunteers were included in this study. RA group were assessed for RF, ACCP, DAS28. Both groups were assessed by CBCT for TMJ dimensions and radiographic osteoarthritic changes. All data were statistically analyzed.

RESULTS

Rheumatoid Arthritis group showed significantly less condylar height and more radiographic osteoarthritic changes than the control group. RF showed no significant correlation with either TMJ measurements or TMJ radiographic osteoarthritic changes. ACCP showed significant inverse correlation with condylar height and anteroposterior (AP) dimensions, but non-significant relation with mediolateral dimension and radiographic osteoarthritic changes. DAS28 showed significant inverse correlation with condylar AP and mediolateral dimensions. It also showed significant correlation with flattening of the TMJ condylar head and flattening of the articular fossa. Patients with high and moderate disease activity showed significantly smaller AP TMJ dimension than patients with low disease activity. Disease activity showed statistically significant direct correlation with all osteoarthritic changes except for erosions of the glenoid fossa and condyle.

CONCLUSION

Disease Activity Score28 score and disease activity are strong indicators of TMJ affection in RA patients when compared to RF and ACCP. ACCP is a better indicator of changes in condylar measurements than TMJ osteoarthritic changes. While RF is the least efficient indicator of TMJ involvement in RA patients.

A Comparison Between the Effects of Scapulothoracic Mobilization Plus Physical Therapy With Physical Therapy Alone in Patients With Mechanical Neck Pain: A Randomized Clinical Trial

Objective

The purpose of this study was to compare the effects of scapulothoracic (ST) mobilization plus physical therapy (PT) with PT alone in patients with mechanical neck pain.

Methods

This double-blinded randomized clinical trial was conducted at Shiraz School of Rehabilitation Sciences and involved 46 patients with mechanical neck pain and scapular dyskinesia. The patients were randomly assigned to the ST mobilization + PT group (scapulothoracic mobilization and physical therapy) or the PT group (physical therapy treatment) by a computer-generated randomized table of numbers. Both groups received 5 sessions of treatment during 1 week. Pain intensity and grip strength were evaluated 3 times: baseline, after the first session, and after the fifth session. Furthermore, functional disability of the upper limbs and the neck were evaluated before and at the fifth session.

Results

The results showed that the pain intensity was reduced and grip strength increased significantly after the first session (P = .01) and at the end of the treatment (P = .01) in the ST mobilization + PT group in comparison with the PT group. Also, the mean difference of upper limb (P = .01) and neck disability (P = .02) decreased significantly in the ST mobilization + PT group in comparison with the PT group.

Conclusion

Scapulothoracic mobilization in combination with physical therapy may be superior to physical therapy alone in reducing pain intensity, maximizing grip strength, and reducing upper limb and neck disability in mechanical neck pain.

The validation of the PRISMA-7 questionnaire in community-dwelling elderly people living in Antalya, Turkey

Background

The screening of frailty in older adults is an important issue in the preventive approach in medicine. Frailty is one of the leading causes of morbidity and premature mortality in older adults.

Objective

The aim of this study was to validate the PRISMA-7 questionnaire in community-dwelling elderly people living in Antalya, Turkey.

Methods

This study was cross-sectional and observational in nature and was conducted in Antalya (Turkey) from February 2016 to April 2017. One hundred fifty patients participated in this study. PRISMA-7 and the CSHA Clinical Frailty Scale were applied to these patients along with a questionnaire on socio-demographics. No translations were available for the PRISMA-7 or the CSHA in Turkish language. The PRISMA-7 and the CSHA Clinical Frailty Scale were translated by two translators to Turkish language; after compilation and agreeing to one Turkish translation, the text was translated back by two translators to English. The translation was then compiled to one text and compared with the original text. After agreement on the translation, both translations were piloted in 10 elderly people. The final form has been applied in this study. Data of the ten piloted patients have not been included into the dataset. Data were analyzed by IBM-SPSS version 22, using descriptive statistics, Pearson product-moment correlation, and receiver operator characteristic (ROC) analysis. The level of significance was set at 0.05.

Results

Our study showed that participants were in average vulnerability to frailty. The test-retest reliability score for the PRISMA-7 Scale and for the CSHA Clinical Frailty Scale were (r= 99.2; p<0.001) and (r=97.5; p<0.05), respectively. After using CSHA Clinical Frailty Scale as a reference standard, PRISMA-7 showed that the area under ROC curve (AUC) was 0.903; which is the best accuracy; and medium level for internal consistency (Cronbach’s α =0.714) as a measure for reliability. A cut-off point of 4 or higher for PRISMA-7revealed high sensitivity (81.5%) and specificity (88.2%) for frailty.

Conclusion

We would recommend PRISMA-7 as a reliable and valid instrument, with high-level accuracy in the screening process of frailty.

A Consensus Set of Outcomes for Parkinson's Disease from the International Consortium for Health Outcomes Measurement

BACKGROUND

Parkinson's disease (PD) is a progressive neurodegenerative condition that is expected to double in prevalence due to demographic shifts. Value-based healthcare is a proposed strategy to improve outcomes and decrease costs. To move towards an actual value-based health care system, condition-specific outcomes that are meaningful to patients are essential.

OBJECTIVE

Propose a global consensus standard set of outcome measures for PD.

METHODS

Established methods for outcome measure development were applied, as outlined and used previously by the International Consortium for Health Outcomes Measurement (ICHOM). An international group, representing both patients and experts from the fields of neurology, psychiatry, nursing, and existing outcome measurement efforts, was convened. The group participated in six teleconferences over a six-month period, reviewed existing data and practices, and ultimately proposed a standard set of measures by which patients should be tracked, and how often data should be collected.

RESULTS

The standard set applies to all cases of idiopathic PD, and includes assessments of motor and non-motor symptoms, ability to work, PD-related health status, and hospital admissions. Baseline demographic and clinical variables are included to enable case mix adjustment.

CONCLUSIONS

The Standard Set is now ready for use and pilot testing in the clinical setting. Ultimately, we believe that using the set of outcomes proposed here will allow clinicians and scientists across the world to document, report, and compare PD-related outcomes in a standardized fashion. Such international benchmarks will improve our understanding of the disease course and allow for identification of 'best practices', ultimately leading to better informed treatment decisions.

Functional, Sensorial, Mobility and Communication Difficulties in the Portuguese Oldest Old (80+)

INTRODUCTION

The ageing of populations is evident in most developed countries, and the oldest old group is one of the segments with the fastest growing. The aim of this paper is to examine sociodemographic and health related characteristics of the portuguese oldest old, using a census-based approach.

MATERIAL AND METHODS

A descriptive study considering all residents aged 80 years and older at the time of the 2011 Census (n = 532 219) was conducted. Information on sociodemographic characteristics, sensory functions (seeing, hearing), functional status (walking/climbing stairs, bathing/dressing alone), cognition (memory/concentration), and communication (understanding others/being understood) as assessed by the Portuguese census official questionnaires were analyzed.

RESULTS

Findings revealed that most of the oldest old are women (64.5%), widowed (53.9%), illiterate (46.1%) and live in private households (88.8%). Walking/climbing stairs (57.1%), vision (39.1%) and hearing (35.1%) were the dimensions where the oldest old presented major constrains. In parallel, understanding others/being understood (25.9%) and memory/concentration (34.4%) were the dimensions with lower percentages of difficulties. Significant differences were found between octogenarians/nonagenarians and centenarians for vision, walk/climb stairs, and bathing/dressing alone, with centenarians presenting a higher percentage of difficulties.

DISCUSSION

Portuguese oldest old showed significant difficulties in activities of daily living, nevertheless cognitive and communication capacities seem to be commonly maintained. Taken together, these findings suggest the need for functional assistance, which can be ultimately managed by the older person him/herself.

CONCLUSION

Based on the observed differences between centenarians and younger oldest old, specific interventions should be equated to better respond to their potentially distinctive needs.

Lumbar Kinematics, Functional Disability and Fear Avoidance Beliefs Among Adults with Nonspecific Chronic Low Back Pain

OBJECTIVES

This study aimed to examine correlations between lumbar kinematics, functional disability and fear avoidance beliefs among adults with nonspecific chronic low back pain (LBP).

METHODS

This cross-sectional study was conducted between March and December 2014. A total of 32 adults diagnosed with nonspecific chronic LBP were recruited from outpatients attending either an orthopaedic clinic at a university hospital or a private physiotherapy clinic in Malaysia. Lumbar kinematics were measured using sensors attached at the first lumbar (L1) and second sacral (S2) vertebrae levels. The Oswestry Disability Index (ODI) and Fear-Avoidance Beliefs Questionnaire (FABQ) were used to assess degree of functional disability and fear avoidance beliefs, respectively.

RESULTS

For maximum range of motion, positive correlations were observed between ODI scores and right lateral flexion and right rotation (P = 0.01 each), although there was a negative correlation with left rotation (P = 0.03). With maximum angular velocity, ODI scores were positively correlated with right and left lateral flexion L1 (P = 0.01 and <0.01, respectively) but negatively correlated with left lateral flexion L2 (P = 0.04). Regarding minimum angular velocity, ODI scores were positively correlated with left lateral flexion S2 (P <0.01) but negatively correlated with right and left lateral flexion L1 (P = 0.02 each), right rotation L1 (P = 0.02) and left rotation S2 (P = 0.01). No significant correlations were found between lumbar kinematics and FABQ scores.

CONCLUSION

These findings suggest that certain lumbar kinematic parameters are correlated with functional disability, but not with fear avoidance beliefs.

A Preliminary Randomized Clinical Trial on the Effect of Cervicothoracic Manipulation Plus Supervised Exercises vs a Home Exercise Program for the Treatment of Shoulder Impingement

OBJECTIVE

The purpose of this study was to investigate changes in pain, disability, and range of movement after cervicothoracic manipulation plus exercise therapy in individuals with unilateral shoulder impingement syndrome.

METHODS

Forty-one patients (30 men, 11 women; aged 47 ± 9) diagnosed with unilateral shoulder impingement syndrome attended 10 sessions for 5 weeks (2 sessions/wk). Eligible patients were randomly allocated to 2 study groups: cervicothoracic manipulation plus exercise therapy (n = 21) or home exercise program (n = 20). The outcomes measures included the visual analog scale (VAS); the Disabilities of the Arm, Shoulder, and Hand score; Shoulder Disability Questionnaire; subacromial impingement syndrome (Hawkins-Kennedy Test and Neer Test); and shoulder active range of motion (movements of flexion, extension, rotation, adduction, and abduction). Assessments were applied at baseline and 24 hours after completing 5 weeks of related interventions.

RESULTS

After 5 weeks of treatment significant between-group differences were observed in the Disabilities of the Arm, Shoulder, and Hand score (P = .012); however, no statistically significant differences were achieved for Shoulder Disability Questionnaire (P = .061) and pain intensity (P = .859). Both groups improved with regard to disability and clinical tests for detecting subacromial impingement syndrome.

CONCLUSIONS

This clinical trial suggests that cervicothoracic manipulative treatment with mobilization plus exercise therapy may improve intensity of pain and range of motion compared with the home exercise group alone; the home exercise group had significant changes for flexion, extension, adduction, and abduction, but not for external and internal rotation movement in patients with shoulder impingement.

Evaluation of complete functional status of patients with stroke by Functional Independence Measure scale on admission, discharge, and six months poststroke

Background: To evaluate the patients with stroke by Functional Independence Measure (FIM) scale, at the times of admission to hospital, discharge, and six-month poststroke, and to determine the level of improvement in patients after rehabilitative procedures. Methods: A total number of 108 patients with stroke entered the study who were admitted to neurology ward. They all received rehabilitation consultation, and occupational and physical therapies were prescribed for them. Finally, their functional status was evaluated by FIM scale. Results: The median (and range) of FIM scores were 86 (15-119), 102 (16-123) and 119 (17-126) at admission, discharge, and after six-month follow-up, respectively. Our observations showed a significant improvement in FIM scores (P < 0.001). About 13, 30, and 76 percent of the patients in individual functional tasks of motor domain and 61, 75, and 86 percent in cognitive domain got the score of 6 or 7 (complete or partial independence) on admission, discharge, and after six months, respectively. There was a reverse correlation between age and FIM improvement and also duration of hospitalization (P = 0.002). Conclusion: The study showed that the FIM is a valid tool for evaluation of patients with stroke, their follow-up and tracking the disease course. Moreover, we concluded that patients with stroke make a significant improvement in their functional status overtime. The exact effect of rehabilitative procedures and comparison with no treatment, must be assessed in separate studies.

Cross-cultural Adaptation of the Pelvic Girdle Questionnaire for the French-Canadian Population

OBJECTIVE

The Pelvic Girdle Questionnaire (PGQ) is the only condition-specific tool assessing activity limitations and symptoms for those with pelvic girdle pain (PGP). It is simple to administer and can be used in research and clinical settings during pregnancy and postpartum periods; however, there currently is no version for the French-Canadian population. The aim of this study was to translate and culturally adapt the PGQ for the French-Canadian population.

METHODS

The French-Canadian translation and adaptation of the PGQ was completed following a 4-stage approach: (1) forward translation, (2) synthesis, (3) expert committee review, and (4) testing of the prefinal version of the questionnaire. The testing stage was conducted with a cohort of 34 women, aged 18 to 45 years, who experienced PGP over the span of pregnancy or during the first year postpartum.

RESULTS

The global understanding of the PGP concept was rated as either "Fair" (41.2%) or "Good" (32.4%) by the majority of participants, which led to the consensual decision to add an illustration of the pelvic girdle region to the final version of the French-Canadian PGQ. Only 1 item ("Has your leg/have your legs given way?") was reported as unclear by 12 participants (35.3%). The expert committee unanimously agreed to add a brief explanation of the term "given way" to the final version to ensure proper understanding of the question.

CONCLUSIONS

The current study yielded a satisfactory French-Canadian translation of the PGQ.

Functional Independence Measure in Iran: A Confirmatory Factor Analysis and Evaluation of Ceiling and Floor Effects in Traumatic Brain Injury Patients

Background:

The functional independence measure (FIM) is one of the most important assessment instruments for motor and cognitive dependence in rehabilitation medicine; however, there is little data about its confirmatory factor analysis (CFA) and ceiling/floor effects from other countries and also in Iranian patients.

Objectives:

The aim of this study was to evaluate a two-factor model (motor and cognitive independence as latent variables) and ceiling/floor effects for FIM in Iranian patients with traumatic brain injuries (TBI).

Patients and Methods:

In this cross-sectional study, 185 subacute TBI patients were selected from emergency and neurosurgery departments of Poursina Hospital (the largest trauma hospital in northern Iran, Rasht) using the consecutive sampling method and were assessed for functional independence.

Results:

The results of this study showed that the floor effect was not observed; however, ceiling effects were observed for the FIM total score and its subscales. The confirmatory factor analysis showed that the chi-square/df ratio was 2.8 for the two-factor structure and the fit indices for this structural model including root mean square error of approximation (RMSEA) = 0.099, normed fit index (NFI) = 0.96, tucker lewis index (TLI) = 0.97, comparative fit index (CFI) = 0.97 were close to standard indices.

Conclusions:

Although ceiling effects should be considered for rehabilitation targets, the two-factor model of FIM (motor and cognitive independence) has an eligible fitness for Iranian patients with TBI.

Case fatality rate ‎and disability of stroke in Isfahan, Iran: Isfahan stroke registry

BACKGROUND

Few investigators have reported case fatality and disability of Iranian patients with stroke. This study was designed to collect morbidity and case fatality data of hospitalized patients with stroke, and stroke care quality in Isfahan, Iran.

METHODS

From 2006 to 2011, from overlapping sources (discharge diagnoses, attending physicians, and hospitalization wards), all hospitalized patients with possible strokes were enrolled in the study, their hospital records were summarized by experienced personnel and reviewed by a neurologist with stroke experience. Patients were followed by phone calls or visited to their addresses and their 28(th) day functional status was checked by translated modified Rankin Scale (mRS). Forms and methods were derived from the World Health Organization (WHO) Monitoring Trends and Determinants in Cardiovascular Disease and STEPS projects.

RESULTS

A total of 9487 patients were identified to suffer from stroke. Their ages' mean was 68.98 ± 13.63 years, and 50.0% were females. In hospital, case fatality was 16.5% and the 28(th) day case fatality was 25.6%. The greatest case fatality was among intracerebral hemorrhage (ICH) patients and the least among ischemic stroke (IS) ones. Case fatality was greater among female and older patients and those with the previous history of stroke. Among survivors, only 26.9% were functionally independent (mRS < 3) which was the greatest among subarachnoid hemorrhage (SAH) patients and least among ICH patients. None of the patients were admitted to specific stroke units or received thrombolytic therapy.

CONCLUSION

The hospitalized patients with stroke in Isfahan have unfavorable outcome compared with their mates in developed countries. A low quality of stroke care may be responsible, and urgent attention is needed.

Comparison of Transforaminal and Parasagittal Epidural Steroid Injections in Patients With Radicular Low Back Pain

BACKGROUND

Epidural steroid injection (ESI), including transforaminal (TF) epidural injections and interlaminar (IL) epidural steroid injections are commonly performed procedures for the management of lumbosacral radicular pain. Parasagittal interlaminar (PIL) approach could enable higher ventral epidural spread, with fewer complications than TF.

OBJECTIVES

This study aims to compare the effectiveness of PIL and TF ESI in relieving the pain and disability of patients with lumbosacral pain.

PATIENTS AND METHODS

This prospective study enrolled 64 patients, aged between 18 to 75 years, with a diagnosis of low back pain and unilateral lumbosacral radicular pain. The patients were randomized to receive fluoroscopically guided epidural injection, through either the PIL or TF approach. Patients were evaluated for effective pain relief [numerical rating scale (NRS) < 3] by 0 - 10 numeric rating scale (NRS) and functional improvement by the Oswestry Disability Index (ODI).

RESULTS

Effective pain relief [numeric rating scale (NRS) < 3] was observed in 77.3% (95% CI: 67‒90.5%) of patients in PIL group and 74.2% (95% CI: 62.4 - 89.4%) of patients in the TF group (P = 0.34), at 4 weeks. Mean NRS score was not significantly different between the PIL group compared to the TF group, at 4 weeks (P = 0.19). Number of patients with improved disability (measured by ODI < 20%) was not significantly different in PIL group (78% of cases) compared to the TF group (76% of cases), at 4 weeks (P = 0.21). There were no adverse effects observed in any of our patients.

CONCLUSIONS

The PIL epidural injection is as effective as TF epidural injection in improving pain and functional status, in patients with chronic lumbosacral low back pain, due to disc degeneration.

Measurement of Disability and Its Predictors Among Trauma Patients: A Follow-up Study

Background:

Globally more than a billion people, 15% of the population, lives with disability and most of disabilities are caused by injuries.

Objectives:

The aim of this study was to describe the prevalence of disability and its predictors at 1 and 3 months post-injury in Kashan City during 2014 - 2015.

Patients and Methods:

In this longitudinal follow-up study, 400 injured patients 15 - 65 years referred to Shahid Beheshti hospital in Kashan and hospitalized more than 24 hours were assessed for disability status with the WHODAS II 12-item instrument at 1 and 3-months post-injury. Patients based on their disability scores were divided into 5 groups: none, mild, moderate, severe and very severe. Work status was assessed at the 3-month follow-up with one question “Are you back at work following your injury”. Also, demographic characteristics and information about injury were gathered by a checklist. Data were analyzed using chi-square, Mann-Whitney U, Kruskal Wallis, Pearson correlation coefficient and logistic regression by SPSS software. The significance level was set at P < 0.05.

Results:

The mean disability scores at 1 and 3 months post-injury was 30.3 (9.2) and 18.8 (8.3), respectively and there was a statistical significant difference between disability status at 1 and 3 months after trauma (P < 0.0001). The rates of return to work in 262 employed patients at 1 and 3 months after injury were 29% and 55.4%, respectively. The disability score showed a statistically significant correlation with Injury Severity Score (ISS) (P < 0.0001), work return (P = 0.033), intensive care unit transfer (P < 0.0001), trauma type (P = 0.001) and age (P = 0.004). Also, age, ISS, duration of hospital stay and injury to extremities were predictors of disability.

Conclusions:

More than half of the patients were disabled after 3 months of trauma. Elderly patients, patient with severe trauma, and long hospitalization and patients with extremity injuries were high risk for disability.

Association between muscle trigger points, ongoing pain, function, and sleep quality in elderly women with bilateral painful knee osteoarthritis

OBJECTIVE

The objectives of this study were to investigate if referred pain elicited by active trigger points (TrPs) reproduced the symptoms in individuals with painful knee osteoarthritis (OA) and to determine the relationship between the presence of active TrPs, intensity of ongoing pain, function, quality of life, and sleep quality in individuals with painful knee OA.

METHODS

Eighteen women with bilateral painful knee OA, aged 79 to 90 years, and 18 matched controls participated. Muscle TrPs were bilaterally explored in several muscles of the lower extremity. Trigger points were considered active if the elicited referred pain reproduced knee symptoms, and TrPs were considered latent if the elicited pain did not reproduce symptoms. Pain was collected with a numerical pain rate scale (0-10), function was assessed with Western Ontario and McMaster Universities, quality of life was assessed with the Medical Outcomes Study Short Form 36 questionnaire, and sleep quality was determined with the Pittsburgh Sleep Quality Index.

RESULTS

Women with knee OA exhibited a greater number of active TrPs (mean, 1 ± 1; P < .001) but similar number of latent TrPs (mean, 4 ± 2) than healthy women (mean, 4 ± 3; P = .613). A greater number of active TrPs were associated with higher intensity of ongoing pain (r = 0.605; P = .007). Higher intensity of ongoing knee pain was associated with lower physical function (P < .05).

CONCLUSIONS

The referred pain elicited by active TrPs in the lower extremity muscles contributed to pain symptoms in painful knee OA. A higher number of active TrPs was associated with higher intensity of ongoing knee pain.

Disabling hearing impairment in the Bangladeshi population

OBJECTIVE

This study aimed to determine the prevalence of hearing impairment in Bangladeshi people of all ages.

METHODS

A nationally representative cross-sectional survey was carried out in 2013. A total of 4260 subjects (1774 males and 2486 females), with a mean age of 32 years, participated. Hearing impairment was determined by pure tone audiometry and otoacoustic emissions testing.

RESULTS

Disabling hearing loss (greater than 40 dB loss in adults, and greater than 30 dB loss in children younger than 15 years, in their better hearing ears) was present in 9.6 per cent (95 per cent confidence interval, 8.5-10.8 per cent) of the respondents. Hearing loss was more prevalent in socio-economically deprived people and in those older than 60 years. Multiple logistic regression analysis identified age, socio-economic deprivation, family history, impacted ear wax, chronic suppurative otitis media, otitis media with effusion, and otitis externa as the significant predictors of disabling hearing loss.

CONCLUSION

Deafness prevention should focus mainly on chronic suppurative otitis media, otitis media with effusion, and impacted ear wax prevention, integrated within the primary healthcare system and addressing the equity issue.

Disability in Inflammatory Bowel Disease: Translation to Portuguese and Validation of the "Inflammatory Bowel Disease - Disability Score"

BACKGROUND

Inflammatory bowel disease (IBD) has a physical, psychological and social impact, often compromising the patient's ability to perform daily activities. Recently a new measurement for disability in IBD was developed. The Inflammatory Bowel Disease-Disability Score (IBD-DS) comprises the following domains: mobility, self-care, major daily life activities, gastrointestinal-related problems, mental health and interaction with the environment. The aim of our study was to translate to Portuguese and to validate the IBD-DS.

METHODS

Eighty-five patients, 55 with Crohn's disease (CD) and 30 with ulcerative colitis (UC), completed the Portuguese version of the IBD-DS and the short inflammatory bowel disease questionnaire (SIBDQ-10 questions). Disease activity was assessed using the Harvey-Bradshaw (HB) for CD and partial Mayo score (pMayo) for UC. Pearson's correlation coefficient was used to assess the correlation between the IBD-DS and SIBDQ. The Student's t-test was used to compare the mean of IBD-DS between active and inactive disease. Statistical analysis was performed with SPSS 21.0 and the statistical level of significance (α) was established at 5%.

RESULTS

In our study, a significant negative correlation between the IBD-DS and the SIBDQ was observed (r = -0.858, p < 0.001 for CD and r = -0.933, p < 0.001 for UC). There was a statistically significant difference of the mean of IBD-DS between inactive vs. active disease (93.78 vs. 117.57, p = 0.016 for CD and 78.96 vs. 137.14, p < 0.001 for UC).

CONCLUSION

The Portuguese version of the inflammatory bowel disease-disability score has a strong correlation with patients' quality of life and clinical disease activity and was shown to be a valid tool to measure disability in patients with inflammatory bowel disease.

[Translation, cultural adaptation, validity and reliability of the shoulder rating questionnaire for use in Brazil]

OBJECTIVE

To translate and culturally adapt the Shoulder Rating Questionnaire (SRQ) to the Brazilian Portuguese language, and to determine its validity, reliability and sensitivity to change in patients with functional impairment of the shoulder.

METHODS

After translation and back-translation of the original version by four independent translators, the instrument was reviewed by a committee of experts and subsequently applied to eight patients with shoulder injury (target audience) to produce the Portuguese version. Then, this version was applied to 102 patients selected from four reference centers for functional treatment of the shoulder, who had a variety of clinical diagnoses, educational levels, socioeconomic, and cultural backgrounds. The evaluation was performed twice with an interval of four weeks between each application.

RESULTS

The Brazilian version of SRQ was equivalent in terms of semantics and showed good levels of reliability (Cronbach's Alpha=0.89 and ICC=0.83). The reproducibility was high (Spearman Correlation Coefficient=0.82) and validity of the items that ranged from 0.54 to 0.99 was considered excellent. The Cohen's d and T test for repeated measures showed that the instrument is able to monitor and track improvements in shoulder function.

CONCLUSION

Psychometric criteria were found, which justify the applicability of the Brazilian version of SRQ in individuals with shoulder functional impairments.

A new disability rating method according to the job using the Korean Academy of Medical Science disability guideline

The purpose of this study was to develop a disability rating scale according to job classification using the Korean Academy of Medical Society (KAMS) guidelines. All jobs were categorized based on their level of physical activity and professional skills. The KAMS guidelines were used for the impairment rating. We modified the California Schedule for rating permanent disabilities. The differences were plotted to compare between the impairment rate and the job-adjusted disability rate. The KAMS job-adjusted disability rates were then compared to the McBride and workers' compensation rates. A total of 1,206 occupations were classified into 44 groups. The occupational disability indexes were rated on a scale of 1 to 7. The differences in the McBride disability rates varied inconsistently from 0% to 35%, while the differences in the KAMS disability rates were between 0% and 18%. The KAMS disability rates were slightly higher than the McBride disability rates for the upper extremities, but were lower for the lower extremities and internal organs. This is the first Korean job-adjusted disability rating method. There are several limitations, but its impairment rating is more scientific and reflects the current Korean occupational environment.

Development of Korean Academy of Medical Sciences Guideline rating the physical impairment: lower extremities

Lower Extremities Committee of Korean Academy of Medical Sciences Guideline for Impairment Rating develops new guidelines which are based on McBride method, American Medical Association Guides, Disability evaluation by The Korean Orthopaedic Association, The Korean Neurosurgery Society, and Korean Academy of Rehabilitation Medicine. The committee analyzed and discussed to create an ideal method practical in Korea. Our committee endeavors to develop new methods which are easy to use, but are suitable for professional use and also independent from the examinee's intentions. The lower extremities are evaluated on the basis of anatomic change, functional change, and diagnosis based evaluation. Nine methods are used to assess the lower extremities. Anatomic assessment includes leg length discrepancy, ankylosis, amputation, skin loss, peripheral nerve injury, and vascular disease. In functional assessment, range of motion and muscle strength are included. Diagnosis-based assessments are used to evaluate impairment caused by specific fractures, deformities, ligament instability, meniscectomies, post-traumatic arthritis, fusion of the foot, and lower extremity joint replacements.

Guideline of the Korean Academy of Medical Sciences for assessing respiratory impairment

The presently used impairment rating guidelines in Korea do not accurately reflect the injury in various lung diseases. Therefore, they need to be made more objective and quantitative with new measurements, using indicators to more precisely represent impairment in the major respiratory diseases. We develop a respiratory impairment rating guideline to ensure that the same grade or impairment rating would be obtained regardless of surgeons who determinate it. Specialists in respiratory medicine and thoracic surgeons determined the impairment grades. Moreover, the impairment should be irreversible for more than 6 months. The impairment rating depends on the level of forced vital capacity, forced expiratory volume 1 second, diffusion capacity of carbon monoxide, arterial oxygen pressure, and arterial carbon dioxide pressure. The degree of whole body impairment is defined by each grade: first 81-95%, second 66-80%, third 51-65%, fourth 36-50%, and fifth 21-35%. In conclusion, we develop a respiratory impairment rating guideline for Koreans. Any qualified specialist can easily use it and judge objective scoring.

Development of Korean Academy of Medical Sciences Guideline on the skin and related system: impairment evaluation of disfigurement in skin and appearance

The purpose of this study is to develop new standards for the disability evaluation with reference to existing laws and other study reports regarding disabilities for the rational evaluation of the diverse kinds of disfigurement in appearance and skin. Three plastic surgery specialists and 3 dermatology specialists developed a new standard for the disability evaluation which is appropriate for circumstances in Korea. Disability rate does not take into account the social occupation, gender or age of the patient, but instead, evaluate the Activity of Daily Living and the social adaptability of the appearance and skin disfigurement regardless of the balance between different disabilities. We tried to include most cutaneous disorders and categorized them into 3 types; congenital (Type 1), acquired (Type 2) as well as any permanent skin impairment sequelae of disease, trauma or treatment process (Type 3). For type 3 disorders, we tried to rate the score according to the size of involved skin lesion. The disability rate is determined by dividing the disability class into 8 steps based on the seriousness of each type of disability.

Disability evaluation in Japan

To examine the current state and social ramifications of disability evaluation in Japan, public data from Annual Reports on Health and Welfare 1998-1999 were investigated. All data were analyzed based on the classification of disabilities and the effects of age-appropriate welfare services, which have been developed through a half-century of legislative efforts to support disability evaluation. These data suggest that disability evaluation, while essentially affected by age and impairment factors at a minimum, was impacted more by the assistive environment for disabilities. The assistive environment was found to be closely linked with the welfare support system related to a global assessment in the field of community-based rehabilitation.

Development of the Korean Academy of Medical Sciences Guideline for rating the impairment in the brain injured and brain diseased persons with motor dysfunction

To develop an objective and scientific method to evaluate the brain injured and brain diseased persons with motor dysfunction, American Medical Association's Guides to the Evaluation of Permanent Impairment was used as an exemplar. After the motor dysfunction due to brain injury or brain disease was confirmed, active range of motion and muscle strength of affected extremities were measured. Also, the total function of extremities was evaluated through the assessment of activities of daily living, fine coordination of hand, balance and gait. Then, the total score of manual muscle test and functional assessment of impaired upper and lower extremity were added, respectively. Spasticity of upper and lower extremity was used as minus factors. Patients with movement disorder such as Parkinson's disease were assessed based on the degree of dysfunction in response to medication. We develop a new rating system based on the concept of total score.

Consensus making process in the Korean Academy of Medical Sciences Guideline for Physical Impairment: evaluation as a social process

The steering committee of the Korean Academy of Medical Sciences Guideline for Physical Impairment was fully aware of the social processes of disability evaluation from the beginning and thus, developed a series of strategies to examine and incorporate social property of the evaluation into the evaluation guide. Although those strategies could not be implemented to full extent because of lack of budget and time, we believe it worthwhile to share those in this paper as an example of general framework for developing disability evaluation. A series of strategies will be introduced and discussed that views the evaluation process as social per se, and propose a scheme that is designed to obtain growing legitimacy starting from core experts to expanded experts to general public. Also preliminary analyses on surveys of public attitude and experts' opinion with regard to the relative importance of each possible disability revealed the following three facts: 1) Public had difficulty weighing relative importance of many impairments. 2) Regarding some impairments including complex regional pain syndrome many doctors had varied opinions. 3) Public attitude did not always consistent with doctor's opinion. All these findings strongly suggest the need for developing strategies to draw consensus for legitimate and effective evaluation.

Development of a rating system for digestive system impairments: Korean Academy of Medical Sciences Guideline

A systematic and effective welfare system for people with digestive system impairments is required. In Korea, an objective and scientific rating guideline does not exist to judge the digestive system impairments. Whether the impairments exist or not and the degree of it need to be examined. Thus, with these considerations we need a scientific rating guideline for digestive system impairments to fit our cultural and social background. In 2007, a research team, for the development of rating impairment guidelines, was organized under the supervision of Korean Academy of Medical Sciences. The rating guidelines for digestive system impairments was classified into upper and lower gastrointestinal tracts impairments and liver impairment. We developed objective rating guidelines for the upper gastrointestinal tract, the impairment generated after surgery for the stomach, duodenum, esophagus, and for the lower gastrointestinal tract, the impairment generated after construction and surgery for colon, rectum, anus, and intestinal stomas. We tried to make the rating impairment guidelines to include science, objectivity, convenience, rationality, and actuality. We especially emphasized objectivity as the most important value. We worked to make it easy and convenient to use for both the subjects who received the impairment ratings and the doctors who will give the ratings.

Developing Korean Academy of Medical Sciences Guideline for rating the impairment in mental and behavioral disorders; a comparative study of KNPA's new guidelines and AMA's 6th Guides

Quantifying and rating the impairments due to mental and behavior disorders are difficult for their own characteristics. Korean Academy of Medical Sciences (KAMS) is developing guidelines of rating impairment in mental and behavioral disorders based on Korean Neuropsychiatric Association (KNPA)'s new guidelines. We compared the new KNPA's guidelines and the American Medical Association (AMA)'s 6th Guides in assessing impairment due to mental and behavioral disorders to develop new guidelines of KAMS. Two guidelines are different in diagnosing system, applicable disorders, qualification of assessors, application of scales, contents of assessment and rate of impairment of the whole person. Both AMA's and the proposed guidelines have individual merits and characteristics. There is a limitation in using the 6th AMA's Guides in Korean situation. However to improve objectivity in Korean assessment of psychiatric impairment, the new AMA's Guides can serve as a good reference.

Development of the Korean Academy of Medical Sciences Guideline for rating physical impairment

Systematic and effective welfare for the disabled is possible when there are scientific and objective criteria demonstrating either presence or severity of the impairment. We need our own scientific criteria suitable for our culture and society, since the impairment is influenced by them. In 2007, we established the Developing Committee of Korean Academy of Medical Sciences (KAMS) Guideline for Impairment Rating under KAMS supervision. We included all fixed and permanent physical impairments after a sufficient medical treatment. The impairment should be stable and medically measurable. If not, it should be reevaluated later. We benchmarked the American Medical Association Guides. The KAMS Guideline should be scientific, objective, valid, reasonable and practical. In particular, we tried to secure objectivity. We developed the KAMS Guideline for Impairment Rating.

Development of Korean Academy of Medical Sciences guideline-rating the impairment in pain

Pain-related impairment assessment by the fifth edition of the American Medical Association Guides had many ambiguous points, and therefore, it was not applicable directly in Korea. Several disputable pain disorders were excluded from the list of impairment evaluation, and complex regional pain syndrome was chosen as the first object of impairment evaluation. Scales such as Korean version of modified Barthel index for assessing the activity of daily livings and Beck Depression Inventory for assessing depression were added, and pain severity, pain treatment, pain behavior, etc. were scored. In order to objectify as much as possible and to remove the room for misuse, we develop a new rating system based on the concept of total score.

Development of Korean Academy of Medical Sciences Guideline for rating physical disability of upper extremity

While the lower extremities support the weight and move the body, the upper extremities are essential for the activities of daily living, which require many detailed movements. Therefore, a disability of the upper extremity function should include a limitation of all motions of the joints and sensory loss, which affects the activities. In this study, disabilities of the upper extremities were evaluated according to the following conditions: 1) amputation, 2) joint contracture, 3) diseases of upper extremity, 4) weakness, 5) sensory loss of the finger tips, and 6) vascular and lymphatic diseases. The order of 1) to 6) is the order of major disability and there is no need to evaluate a lower order disability when a higher order one exists in the same joint or a part of the upper extremity. However, some disabilities can be either added or substituted when there are special contributions from multiple disabilities. An upper extremity disability should be evaluated after the completion of treatment and full adaptation when further functional changes are not expected. The dominance of the right or left hand before the disability should not be considered when there is a higher rate of disability.