Group Education and exercise program for overweight knee osteoarthritic patients.

Objective: To study the benefits of patient education and an exercise program for the overweight knee osteoarthritis (OA) patients. Methods: Group education (GE) was arranged for overweight patients for 2 weeks including how to use their joints properly in their daily activities, how to calculate energy of various kinds of food as well as performing controlled group exercise. Each parameter was evaluated at three time points including before joining GE, after 2 weeks of attending GE and 3 months later. The outcomes were determined by the knowledge score about the disease, gait speed calculated from a 50-meter walk, knee pain score after walking, body weight and quadriceps strength. Results: Eighty-seven subjects were recruited, 11 males (12.6%) and 76 females (87.4%) with a mean age of 59.5 ± 7.6 years, and an average body mass index of 27.5 ± 3.5 kg/m2. The duration of disease was 4.6 ± 4.7 years. Most subjects (79.3%) have good compliance on performing exercise with an average 9.15 ± 1.46 days (range 3-10). The knowledge score before and after attending the group education were 35.1 ± 4.2 and 38.1 ± 4.9, respectively (p < 0.001). After two weeks, their body weight and pain score decreased whereas quadriceps strength and gait speed increased. Those outcomes were even better at the 3-month follow up period. Conclusion: GE, comprised of providing appropriate knowledge, sharing ideas among groups, learning about diet and daily exercise for 2 weeks which can significantly increase knowledge scores, decrease knee pain and body weight, as well as increase quadriceps strength and gait speed.

Factors influencing home modification of stroke patients.

BACKGROUND: Home modification for stroke victims is often necessary to prevent falls and enable them to have a better quality of life. Up-to-date relationship between personal factors and home modifications in post-stroke patients has not been investigated. OBJECTIVE: To identify significant personal factors influencing the requirement for home modification in post-stroke patients. STUDY DESIGN: Prospective, analytical study. MATERIAL AND METHOD: Two hundred eighty one post-stroke patients were recruited from nine tertiary rehabilitation centers in Thailand. All patients received inpatient rehabilitation programs until either they reached the rehabilitation goals or registered two consecutive stable weeks as measured by their Barthel index score. Personal factors related to home modification were assessed at study entry, during hospital stay and at discharge. The correlation between personal factors and necessities of home modification in post-stroke patients were reported through univariate and multivariate modeling. RESULTS: The results of univariate analysis showed that a low Barthel index score (< or = 14/20) (at baseline and discharge), low Brunnstrom stage of arm or leg (< or = IV/VI) at baseline, and intolerance to intensive rehabilitation programs (< 3 hr/day) indicated a necessity for modifications in the patient's home (p < 0.05). The results of multivariate modeling showed that a low Barthel index score (at baseline and discharge), and intolerance to intensive rehabilitation were significant predictors of a requirement for home modification (p < 0.05). CONCLUSION: A low level of physical functioning and intolerance to intensive rehabilitation are significant predictors for the necessity of home modifications in stroke victims.

Post stroke shoulder subluxation and shoulder pain: a cohort multicenter study.

OBJECTIVE: To study the occurrence of shoulder subluxation, shoulder pain in stroke patients and identify factors associated to these conditions during rehabilitation period. MATERIAL AND METHOD: Stroke patients from 9 rehabilitation centers from March to December 2006 were enrolled in the present study. All subjects were registered for demographic data including risk factors and type of stroke. They were assessed for motor recovery, cognitive ability, functional ability, psychological reaction and quality of life by using Brunnstrom stage, Thai Mental State Examination (TMSE), Barthel ADL Index (BI), Hospital Anxiety and Depression Scale (HADS) and WHOQOL-BREF questionnaires respectively at the beginning and the end of the present study. The occurence of shoulder subluxation and shoulder pain were recorded and then were analyzed for the associated factors. All subjects received the conventional rehabilitation program until they reached their rehabilitation goals or discharge criteria. RESULTS: Of 376 stroke patients, 327 met the inclusion criteria, 62 patients (19%) were found to have shoulder pain and 122 (37%) patients had shoulder subluxation. Shoulder pain was significantly more frequent in subjects with shoulder subluxation (odds ratio (OR) 2.48, 95% confidence interval (CI) 1.38-4.46) and at 2-6 months after stroke onset (OR 4.0, 95% CI 2.06-7.79). Shoulder subluxation was significantly associated with hemorrhagic type of stroke (OR 2.06, 95% CI 1.08-3.93), loss of proprioceptive sensation (OR 3.03, 95% CI 1.26-7.29) and negatively associated with Brunnstrom's stage of arm recovery (OR 0.44, 95% CI 0.34-0.56). No significant functional and quality of life impact was found from these conditions. CONCLUSION: Post stroke shoulder pain and subluxation were common during the rehabilitation period. Shoulder pain significantly occurred within 6 months after stroke onset and increased risk in patients with shoulder subluxation. Shoulder subluxation was correlated with Brunnstrom's stage, proprioceptive loss and hemorrhagic type of stroke.

Anxiety and depressive symptoms after stroke in 9 rehabilitation centers.

OBJECTIVE: Determine the occurrence of anxiety and depressive symptoms in rehabilitation phase and identify the associated factors that include impact on functional outcome and quality of life in stroke patients. DESIGN: Prospective analytical study. MATERIAL AND METHOD: Two hundred fifty one stroke patients from nine rehabilitation centers admitted between March and December 2006 were enrolled into the present study. Anxiety and depressive symptoms were evaluated in stroke patients using the Hospital Anxiety and Depressive Scales (HADS) twice, on admission and at discharge to rehabilitation program. Factors associated with anxiety and depressive symptoms were identified using univariate and multiple logistic regression analyses. Functional ability and quality of life using Barthel ADL Index (BI) and WHOQOL-BREF questionnaires respectively were recorded and analyzed. RESULTS: Two hundred fifty one patients were assessed for anxiety and depressive symptoms using HADS. It was found that 25.5% of the patients suffered from anxiety symptoms, 37.8% from depressive symptoms, and 17.5% from both. Anxiety symptoms were associated with depressive symptoms (OR 5.49, 95%CI 2.89-10.43) and negatively associated with dyslipidemia (OR 0.48, 95%CI 0.25-0.94). Depressive symptoms were related to anxiety symptoms (OR 5.88, 95%CI 3.15-10.99) and female gender (OR 1.81, 95%CI 1.04-3.16). Patients with anxiety and depressive symptoms had lower functional ability and quality of life than patients without symptoms on admission and at discharge. After the rehabilitation program, patients without anxiety symptoms showed improvement in functional outcome and QOL. However, patients with or without depression symptoms have improvement in functional outcome after rehabilitation. However patients without depressive symptoms showed more items improvement in QOL than patients with depression. CONCLUSION: Symptoms of anxiety and depression are common after stroke. They are correlated with each other. Female gender also related to depressive symptoms. Patients with anxiety and depressive symptoms have lower functional ability and quality of life than those without symptoms.

Unit cost of stroke rehabilitation.

BACKGROUND: Rehabilitation costs borne by the service institution are part of the total cost incurred when a patient is admitted to hospital. The total costs cannot directly represent the rehabilitation costs. When considering the funding allocated for specific services, it is useful to have figures that represent the actual costs of those services. OBJECTIVE: Study the unit cost of rehabilitation. MATERIAL AND METHOD: The data were collected from March to December 2006. Three hundred twenty seven patients from nine collaborating centers, including 18 patients from Sirindhron National Medical Rehabilitation Center (SNMRC) participated in this study. Descriptive analysis produced results in percent, mean standard deviation, and p-value. One unit of rehabilitation treatment is equal to twenty minutes. RESULTS: The average unit cost of rehabilitation treatment among the nine collaborating centers was 94.56 units per week and 33.78 from rehabilitation nursing. At SNMRC, the average rehabilitation unit was 32.67 units per week and the cost for rehabilitation was 11,170.56 +/- 5641.73 baht. CONCLUSION: The calculated unit cost was 60 baht/20 minutes service time.

Age-related rehabilitation outcome in stroke patients.

BACKGROUND: Patients who survive a stroke usually have residual neurological deficits. Consequently, a rehabilitation program is valuable for improving their quality of life (QOL). However, age is a known factor that needs qualification vis-à-vis rehabilitation outcomes among Thai patients. OBJECTIVE: To study the functional and psychological outcomes and the QOL before and after rehabilitation program among three age groups of Thai stroke patients (< or = 44, 45-64 and > or = 65 years of age). STUDY DESIGN: Prospective, analytical study. MATERIAL AND METHOD: Three hundred and twenty seven stroke patients were measured using the Barthel index, the Hospital Anxiety and Depression scale (HADS) and the WHO QOL BREF questionnaire before and after undergoing an in-patient rehabilitation program. Data were collected from nine sites around Thailand. RESULTS: Functional and psychological outcomes and the quality of life score improved after the rehabilitation program. The youngest group of stroke victims showed the greatest improvement in functional outcome and QOL score in both the physical and social domains. No significant difference was found regarding anxiety and depression among the three groups. CONCLUSION: An in-patient rehabilitation program was of benefit to Thai stroke patients but age significantly determined rehabilitation outcomes.

Quality of life after stroke rehabilitation among urban vs. rural patients in Thailand.

BACKGROUND: Stroke patients who live in different areas might have different adjustments for their impairment and disability after stroke attack. These factors should be evaluated in Thai patients. OBJECTIVE: To compare functional outcome, psychological outcome and quality of life of stroke patients who live in urban vs. rural areas, before and after an in-patient rehabilitation program. STUDY DESIGN: A multi-center, prospective, analytical study. MATERIAL AND METHOD: Urban and rural stroke patients admitted to the rehabilitation ward received a rehabilitation program. Pre- and post-rehabilitation, patients were measured using the Barthel index, the Hospital Anxiety and Depression scale (HADS) and the WHO BREF QOL questionnaire. The data were collected from nine rehabilitation centers in Thailand. RESULTS: Significant improvement in functional outcome, psychological condition and quality of life score was achieved via the rehabilitation program in both groups. There was no statistically significant difference between urban vs. rural patients. CONCLUSION: Previous living areas (urban vs. rural) before admission had no effect on functional outcome, psychological outcome and quality of life among stroke patients after an in-patient rehabilitation program conducted in Northeast Thailand.

An epidemiologic study of the Thai Stroke Rehabilitation Registry (TSRR): a multi-center study.

OBJECTIVE: To perform the registry of stroke patients receiving the in-patient comprehensive rehabilitation program at main tertiary hospitals from March to December 2006. MATERIAL AND METHOD: Demographic data including medical history and pathology of stroke were recorded. All subjects received a comprehensive rehabilitation program until they reached their rehabilitation goals or discharge criteria. RESULTS: Three hundred twenty seven patients met the inclusion criteria. The mean age was 62 +/- 12 years, and 59% were males. Most of the patients were married (73.1%), lived in an urban area (62.1%), and had an education level of primary school or lower (58.7%). The median duration from onset to admission for rehabilitation was 24 days. The major medical history was hypertension (74.9%), followed by dyslipidemia (54.4%), diabetes mellitus (26.6%), and ischemic heart disease (18.0%). Fifty-one (15.6%) patients had a history of previous stroke. Cerebral infarction was found in 71.9%, including thrombosis (45.3%), lacuna infarction (15.3%), and emboli (8.0%) and 28.1% had hemorrhagic stroke. On admission, more than half (51.8%) had cognitive impairment and one-third (31.5%) had bowel-bladder problems. Almost all of the patients (99.4%) had family support. Either their spouse or siblings had undertaken the main caregiver role (46.5% and 40.4% respectively). However, more than 80% of the patients were discharged to their own homes or immediate family's house. CONCLUSION: This was the first multi-center registry of inpatient stroke rehabilitation in Thailand. It presented the epidemiologic aspects in order to become national data of stroke patients receiving medical rehabilitation services.

Disability assessment in elderly orthopedic patients.

OBJECTIVE: To assess the disability level in elderly patients with orthopedic conditions. MATERIAL AND METHOD: All possible patients aged more than 60 years, who attended the Out-patient Clinic of Orthopedic Department, Siriraj Hospital, between October and December 2005, were recruited. They were assessed for the disability level by using a Brief Disability Questionnaire (BDQ), Thai version. It is a simple and practical tool for assessing disability levels. It is an eight-item scale with the total score ranging from 0 to 16. A higher score indicates a greater disability. RESULTS: Two hundred and thirteen patients participated in the study. The mean age was 69.4 years and 64% had degenerative joint diseases. The affected parts were the lower extremity and back (56.8% and 26.8% respectively). The three most common limited activities were vigorous activities, long distance walking, and stair climbing or walking uphill (55.9%, 51.6%, and 42.7% respectively). The mean BDQ score of the subjects was 7.9 +/- 3.8. Patients with lower extremity problems including back problems had the highest BDQ score (8.2 +/- 3.7). According to the BDQ, the number of patients with a moderate-to-severe degree of disability was 79%. CONCLUSION: The majority of elderly patients with orthopedic problems had moderate-to-severe disability as assessed by the BDQ. Physicians and other health care personnel should consider the management of the principal diseases, and the assessment of the disability level to improve the patients' quality of life, which is the ultimate goal of the treatment in clinical practice.

Intra-articular injection of deproteinized hemodialysate in osteoarthritis of the knee: a case-series.

OBJECTIVE: To report the efficacy of intra-articular injection of deproteinized hemodialysate including its side effects in a case-series of knee osteoarthritic (OA) patients. MATERIAL AND METHOD: Intra-articular injection of deproteinized hemodialysate was performed in 17 subjects (3 male and 14 female) with primary knee OA. Their average age was 63 years (min, max = 50, 80 yrs). The X-ray appearance was grade II-III according to Kellgren-Lawrence criteria. MEASUREMENTS: 100 mm visual analogue scale (VAS) and any side effects. RESULTS: The mean (95% CI) of the VAS before and after injection were 70.0 (59.9-80.1) and 42.7 (31.2-54.2) respectively, with a p-value of < 0.001. The mean difference in pain score was 27.35 (95% CI = 17.0-37.7). The symptoms of knee pain resolved in an average of 4.8 (2.9) days (min, max = 1, 10). No side effects were found. CONCLUSION: Intra-articular injection of deproteinized hemodialysate is effective and safe. However, a further controlled trial with an adequate sample size should be performed to confirm the efficacy as well as to detect any adverse effects of this drug.

Epidemiology of spinal cord injuries: a study in the Spinal Unit, Siriraj Hospital, Thailand, 1997-2000.

A prospective study of 83 patients with spinal cord injuries admitted to the Spinal Unit, Siriraj Hospital, Bangkok, Thailand from January 1997 to December 2000 was conducted. The average age was 33.2 +/- 11.7 years (range from 10 to 68 years) with a male: female ratio of 4 : 1. Most subjects (83.2%) were aged between 16-45 years. About half of them had no associated injuries and no financial problems. Three-fourths of the spinal injuries were caused by traffic accidents (49.4 and 25.3% car and motorcycle respectively). The other two causes were falls (16.9%) and gunshot wounds (8.4%). The neurological classification was as follows: 34 (41.0%) patients had ASIA D grade of injury, 28 (33.7%) were paraplegic with ASIA A, B or C grade and 21 (25.3%) were tetraplegic with ASIA A, B, or C grade. Traffic accidents most frequently resulted in an incomplete ASIA D grade (40.3%). Males were more predominant for all causes of injury especially motorcycle accidents. The average Barthel Index score was 24.3 +/- 24.7 and 51.9 +/- 31.8 at admission and discharge respectively. The prevalence of depression was 24.1 per cent. The average length of stay for the depressed and non-depressed groups was 117.4 +/- 59.1 and 73.4 +/- 54.4 days respectively.

An instrument for assessment of depression among spinal cord injury patients: comparison between the CES-D and TDI.

OBJECTIVE: To search for a simple, practical and appropriate instrument for the assessment of depression among Thai SCI patients: comparison between two self-rating instruments. MATERIAL AND METHOD: Eighty-three SCI patients were asked to complete a questionnaire composed of the Thai depression inventory (TDI) and the Center for Epidemiological Studies Depression Scale (CES-D), Thai version. All subjects were interviewed by a psychiatrist and were diagnosed according to the categories of depression of the Diagnostic and Statistical Manual of Mental fourth edition, (DSM-IV). STATISTICS: Receiver Operating Characteristic (ROC) curve and Logistic regression analysis. RESULTS: Twenty patients were confirmed to have a depressed mood or adjustment disorder. The area under the ROC curve for the CES-D and TDI was 0.826 and 0.827. The sensitivities and specificities of the CES-D and TDI were 80.0, 69.8 per cent and 70.0, 79.4 per cent respectively. The positive predictive value and negative predictive value of the two tests were 45.7, 91.7 per cent and 51.9, 89.3 per cent. Using Logistic regression analysis, the CES-D produces a better model than the TDI (Chi-square value = 23.196 and 4.578). CONCUSION: The CES-D is more appropriate for screening for depression in SCI patients than the TDI.

Distal radius bone mineral density and grip strength in peri/postmenopausal Thai women.

To determine the relationship between distal radius bone mineral density (BMD) and grip strength (GS) in peri/post menopausal Thai women. 177 healthy volunteers, > or = 40 years old, were included. Distal radius BMD of the non-dominant side was measured using dual energy X-ray absorptiometry. GS of both dominant and non-dominant sides was measured using a Jamar dynamometer. The association between BMD and GS was determined by correlation analysis. Other factors possibly affecting the BMD or GS including age, years since menopause (YSM), body weight (BW), height (Ht) and body mass index (BMI) were analyzed by the multiple regression method. It was found that BMD had statistically significant but weak, positive correlation to GS (r = 0.262, p < 0.001 for the dominant side, r = 0.193, p < 0.001 for non-dominant side). Age and YSM had a negative correlation, whereas, BW and Ht had a positive correlation to either BMD or GS. After multiple regression analysis, the significant predictors of BMD were age and BW, of dominant GS were age and Ht, and of non-dominant GS was YSM. In conclusion, decrements in distal radius BMD and in GS were found in peri/postmenopausal women. Aging seems to be the most important factor for these features. Although the GS has statistically significant correlation to the corresponding BMD, the clinical significance might not be obvious. Furthermore, the stronger correlation of BMD to the contralateral dominant GS than to the ipsilateral non-dominant GS implies that the influence of muscular strength on BMD, if present, is not due to a direct effect in this age group.

The perceived handicap questionnaire: a self perceived handicap measurement in patients with spinal cord injury.

Handicap exists when individuals with impairment or disability are unable to fulfill one or more of the roles that are considered normal for their age, gender, and culture. In fact, handicap is one of the most poorly measured of all rehabilitation outcomes. This study was performed to measure the subjective experience of handicap in spinal cord injury (SCI) patients who had permanent disabilities and were often faced with environmental barriers. Eighty-three new traumatic SCI patients with a mean age of 33 years were interviewed during follow-up outpatient clinic visits using the Perceived Handicap Questionnaire (PHQ). This test provides a global measurement of the extent of self-perceived handicap across five dimensions based on the WHO's classification of handicap. When compared with normal persons, SCI subjects perceived themselves as more handicapped in all dimensions especially mobility and physical independence. In contrast, the majority of SCI subjects perceived themselves as less handicapped than others with SCI in physical independence, and equally handicapped in social integration and in economic self-sufficiency. In addition, the Barthel Index Score of self-care activities was negatively correlated with the PHQ score, but the depression score and hospitalization period were positively correlated with the PHQ score. Rehabilitation professionals should pay attention to the measurement of societal functioning or handicap in addition to disability.

A capsular dilatation facilitated shoulder manipulation for treating patients with frozen shoulder.

Forty patients with a diagnosis of frozen shoulder who had symptom for an average of 8 months and failed conservative treatment of at least 6 weeks of physical therapy were treated with capsular dilatation facilitated shoulder manipulation. Post-manipulation, the patient underwent arthroscopy for visualization, fibrin debridement and bleeding point coagulation. All the essential intra-articular structures ie, glenohumeral ligament, rotator cuff were intact. Post-operatively, all patients revealed substantial gain in shoulder range of motion as well as diminished shoulder pain. The average flexion, abduction, and internal rotation gain were 76.9+/-8.9, 18.1+/-5.7, 9.6+/-7.1 degrees respectively. External rotation gain in the position of 90 degrees shoulder abduction and shoulder adduction were 53.0+/-9.97 and 31.4+/-7.2 degrees respectively. The average pain score by visual analogue scale pre and 6-month post-manipulation were 80.6+/-8.6 and 7.6+/-7.3 respectively with the average of pain score of 73.0+/-10.4. The authors proposed an effective and safe technique employing intra-articular pressure to facilitate shoulder manipulation in order to treat frozen shoulder.

The epidemiology of osteoarthritis of the knee in elderly patients living an urban area of Bangkok.

An epidemiological study of 392 elderly Thai patients with osteoarthritis (OA) of the knee, 86 males and 306 females, with a mean age of 67.8 years, was performed. The prevalence of knee OA was 34.5-45.6 per cent. Most of the patients had completed primary education and had sufficient income. More than half of the patients had pain in both knees, but many of the elderly people used neither knee supports nor walking aids (82.7 and 90.6%). Sixty-four per cent had no previous knowledge concerning the value of exercise. Sixty-five per cent of the patients had never used any pain medication. Three-fourths of the subjects evaluated themselves to have fair to good health. Sixty per cent presented with knee pain when climbing the stairs, and 64.8 per cent had a fair quality of life. Almost all the subjects had mild to moderately severe grade of OA and their X-ray findings were level II-III. The average quadriceps strength and six-minute walking distance were 12.95 +/- 5.51 kilograms and 363.69 +/- 99.34 meters respectively. The five factors that significantly correlated with walking ability were age, sex, the functional incapacity score, using walking aids and level of severity found on X-ray. Previous knowledge about knee exercise did not affect walking ability, but may have been due to the irregularity of the exercise schedule they performed. The elderly should be encouraged to exercise regularly in addition to receive knowledge about proper exercise.

The efficacy of a muscle exercise program to improve functional performance of the knee in patients with osteoarthritis.

Osteoarthritis (OA) is a common chronic and progressive degenerative joint condition. A major consequence of knee OA is physical disability; especially difficulty with activities requiring ambulation and transfer, which are necessary to maintain independence and a good quality of life. The purposes of this study were to determine the efficacy of a muscle exercise program along with education about knee care, and investigate the clinical factors which influence its therapeutic efficacy. A prospective study was carried out among elderly Thai people aged 60 years and over, living in an urban community of the Bangkok metropolitan area around Siriraj Hospital, between October 1997 and September 1999. The number of elderly people with osteoarthritis of the knee was 392 (male:female=86:306) with a mean age of 67.7+/-6 years. They were interviewed for demographic data and information about their symptoms. The range of the knee movement, quadriceps strength and the six-minute walking distance and a knee X-ray were evaluated. Group exercise was arranged twice a week for 8 weeks for the intervention group only. The results of the study revealed that the quadriceps strength in the intervention group had a tendency to increase and the walking distance was significantly improved especially in the first two months but there was a tendency to decline by the sixth and twelfth month after enrollment. On the other hand, there was no statistically significant difference of both important outcomes for the control group when assessed in the second month. The findings at the sixth and twelfth month after enrollment were that the quadriceps strength was slightly increased but the walking distance was decreased when compared with the initial assessment. An exercise frequency of 12 sessions in two months was sufficient to improve muscle strength and walking distance. Group exercise produces a significant improvement in strength and walking ability, especially in the first two months. Deterioration over time could be due to multiple factors, such as lack of regular exercise, lack of motivation, lack of family support or poor economic status, so we should encourage the elderly to exercise regularly.

The attitude of chronically ill patients and personnel of Siriraj Hospital to a recreational therapy service.

A study of the attitudes of 507 patients with chronic illnesses and 961 personnel working with these patients towards a recreational activity service was performed using a questionnaire. Most of them agreed that the hospital should arrange recreational activity for patients with chronic illnesses in addition to physical treatment (95.6, 99.0 percent of patient and personnel groups respectively). Both groups evaluated the benefit of recreational activity with a score of 7.93 ฑ 2.09 and 8.71 ฑ 1.42. Activities ranked first were reading books, watching television or a video, gardening and singing/listening to music. Concerning health professionals willingness to join these activities, 80% of the nurse group (registered nurses and practical nurses) were willing to do so whereas only 51.4 percent of the doctor group were available due to different working styles. Most of the personnel accepted that the recreational therapist should be the one who arranges this service. Both groups agreed that a recreational activity service should be free of charge (45.2-51.4 percent). From the results of this study, we can conclude that patients and personnel appreciate a recreational activity service for chronically ill patients, so we should develop and distribute this service to patients in order to improve their quality of life and the quality of our service.

Grip and quadriceps strength: Normative values in the Thai population.

A study of grip strength of the dominant hand and quadriceps strength in the Thai population was carried out. Seven hundred and forty four healthy volunteers, 265 males and 479 females with a mean age of 44 ฑ 13 years old, were evaluated by using a hand dynamometer and a leg dynamometer. The mean grip strength of males was 45.2 ฑ 8.2 kg, significantly greater than of females which was 28.5 ฑ 5.6 kg. The mean quadriceps strength of males was 25.4 ฑ 4.4 kg was also significantly greater than of females which was 16.9 ฑ 4.2 kg. The elderly population had significantly decreased grip strength which was 39.9 ฑ 6.4 kg for males and 23.8 ฑ 5.2 kg for females and likewise had significantly decreased quadriceps strength which was 22.2 ฑ 4.4 kg for males and 15.0 ฑ 3.5 kg for females. In a stepwise linear regression, grip strength was positively correlated with sex, quadriceps strength and height but negatively correlated with age. Whereas quadriceps strength was positively correlated with grip strength, height, body mass index, sex and absence of knee pain but negatively correlated with age. These normal values will be beneficial in helping to determine early neuromuscular impairment affecting hand function and mobility as well as in therapeutic goal setting for training in rehabilitation.

The assessment of psychological health by the general health questionnaire-28, Thai version.

The prevalence of psychological problems in rehabilitation patients was assessed, using the General Health Questionnaire-28, Thai version (Thai GHQ-28) and the Barthel Index score for the assessment of functional ability in self care. One-hundred and thirteen subjects; 55 men and 58 women with an average age of 38.8 ฑ 17.2 years (min, max = 10, 83) were studied. The average score of Thai GHQ-28 and Barthel score were 7.0 ฑ 5.8 and 52.6 ฑ 34.1 respectively, and the prevalence of psychological problems was 53.98 percent. Patients paralysed following accidents had higher Thai GHQ-28 scores and lower Barthel scores than patients with chronic illness. The functional ability score was the only factor that related to the prevalence. Psychological problems are common in the medical illness patient group, especially in the permanently disabled subjects. The Thai GHQ-28 can be used as a screening test in the early detection and treatment of psychological problems in relabilitation patients.