Self-perceived upper extremity motor function predicts health-related quality of life in chronic stroke survivors.

PURPOSE: To examine whether the Upper Extremity Functional Index (UEFI) score independently contributes to the Stroke Impact Scale (SIS) score and quantified its relative contribution to SIS scores in chronic stroke survivors. MATERIALS AND METHODS: A cross-sectional study in a university-based rehabilitation centre with people with chronic stroke (N = 95) aged ≥ 50 years. The outcome measures included paretic hand grip strength, Fugl-Meyer Upper Extremity Assessment (FMA-UE), Wolf Motor Function Test (WMFT), UEFI, and SIS. RESULTS: Correlation analysis revealed that paretic hand grip strength, FMA-UE, UEFI, and WMFT scores exhibited a significant moderate positive correlation with SIS scores (r = 0.544-0.687, p < 0.001). The results of a regression model indicated that after adjustment for demographic factors and stroke-related impairments, the UEFI scores remained independently associated with SIS scores, accounting for 18.8% of the variance. The entire model explained 60.3% of the variance in SIS scores. CONCLUSIONS: Self-perceived UE motor function is a crucial component to be included in rehabilitation programmes aimed at enhancing quality of life and participation among chronic stroke survivors.

Observation-based outcome measures, e.g., Fugl­Meyer Assessment for Upper Extremity (FMA-UE), Wolf Motor Function Test (WMFT) could not predict the health-related quality of life (Stroke Impact scale (SIS)) in chronic stroke survivors in our study, which was contradictory with current studies.A self-perceived outcome measure to evaluate upper extremity function (Upper Extremity Functional Index (UEFI)) could independently predict the health-related quality of life (SIS), accounting for 18.8% of the variance.Our study demonstrated that self-perceived UE motor function would be an important component to optimize the rehabilitation programmes aimed at enhancing quality of life and social participation among chronic stroke survivors.

Effects of mirror therapy with electrical stimulation for upper limb recovery in people with stroke: a systematic review and meta-analysis.

PURPOSE: To provide updated evidence about the effects of MT with ES for recovering upper extremities motor function in people with stroke. METHODS: Systematic review and meta-analysis were completed. Methodological quality was assessed using the version 2 of the Cochrane risk-of-bias tool. The GRADE approach was employed to assess the certainty of evidence. RESULTS: A total of 16 trials with 773 participants were included in this review. The results demonstrated that MT with ES was more effective than sham (standardized mean difference [SMD], 1.89 [1.52-2.26]) and ES alone (SMD, 0.42 [0.11-0.73]) with low quality of evidence, or MT alone (SMD, 0.47[0.04-0.89]) with low quality of evidence for improving upper extremity motor control assessed using Fugl-Meyer Assessment. MT with ES had significant improvement of (MD, 6.47 [1.92-11.01]) the upper extremity gross gripping function assessed using the Action Research Arm Test compared with MT alone with low quality of evidence. MT combined with ES was more effective than sham group (SMD, 1.17 [0.42-1.93) for improving the ability to perform activities of daily living with low quality of evidence assessed using Motor Activity Log. CONCLUSION: MT with ES may be effective in improving upper limb motor recovery in people with stroke.

Combining Mirror Therapy (MT) and Electrical Stimulation (ES) modality could improve upper limb motor control, gross gripping function, and performance in ADLs based on ICF for people with stroke.Those individuals with subacute stroke are recommended as the optimal target group for the combined MT and ES.

Testing the psychometric properties of the Chinese (Cantonese) version of SATIS-Stroke in people with chronic stroke.

PURPOSE: To culturally adapt and examine the psychometric properties of the Chinese (Cantonese) version of SATIS-Stroke (C-SATIS-Stroke) in people with chronic stroke. MATERIALS AND METHODS: Forward and backward translations were performed in accordance with available guidelines. We administered the C-SATIS-Stroke to 101 people with stroke and 50 healthy older adults. We assessed the test-retest and internal reliability, measurement error, known-group validity, correlations with other outcome measures, optimal cut-off score and ceiling and floor effects. RESULTS: C-SATIS-Stroke demonstrated excellent internal consistency (Cronbach's α = 0.959) and good test-retest reliability (intraclass correlation coefficient3,1 = 0.913). Compared with healthy controls, people with chronic stroke had lower C-SATIS-Stroke scores. The mean C-SATIS-Stroke score was significantly correlated with the mean scores of the Activities-specific Balance Confidence Scale, Stroke Impact Scale, Community Integration Measure and Survey of Activities and Fear of Falling in the Elderly. The cut-off score to distinguish the levels of satisfaction with activity and participation between people with chronic stroke and healthy older adults was 80 out of 108 (sensitivity: 77%; specificity: 72%). C-SATIS-Stroke exhibited ceiling effects but not floor effects. CONCLUSIONS: C-SATIS-Stroke is a reliable and valid measure for assessing satisfaction with social participation among Chinese people with chronic stroke.IMPLICATIONS FOR REHABILITATIONSatisfactory semantic, idiomatic, cultural, and conceptual equivalence of the C-SATIS-Stroke are in line with those of the original English version of the SATIS-StrokeExcellent reliability and validity of the C-SATIS-Stroke are also in line with those of the original English version of the SATIS-StrokeThe C-SATIS-Stroke can be used to assess the subjective satisfaction feeling in terms of social participation among Chinese people with chronic stroke.

Measuring safety climate in elderly homes.

INTRODUCTION: Provision of a valid and reliable safety climate dimension brings enormous benefits to the elderly home sector. The aim of the present study was to make use of the safety climate instrument developed by OSHC to measure the safety perceptions of employees in elderly homes such that the factor structure of the safety climate dimensions of elderly homes could be explored. METHOD: In 2010, surveys by mustering on site method were administered in 27 elderly homes that had participated in the "Hong Kong Safe and Healthy Residential Care Home Accreditation Scheme" organized by the Occupational Safety and Health Council. RESULTS: Six hundred and fifty-one surveys were returned with a response rate of 54.3%. To examine the factor structure of safety climate dimensions in our study, an exploratory factor analysis (EFA) using principal components analysis method was conducted to identify the underlying factors. The results of the modified seven-factor's safety climate structure extracted from 35 items better reflected the safety climate dimensions of elderly homes. The Cronbach alpha range for this study (0.655 to 0.851) indicated good internal consistency among the seven-factor structure. Responses from managerial level, supervisory and professional level, and front-line staff were analyzed to come up with the suggestion on effective ways of improving the safety culture of elderly homes. The overall results showed that managers generally gave positive responses in the factors evaluated, such as "management commitment and concern to safety," "perception of work risks and some contributory influences," "safety communication and awareness," and "safe working attitude and participation." Supervisors / professionals, and frontline level staff on the other hand, have less positive responses. The result of the lowest score in the factors - "perception of safety rules and procedures" underlined the importance of the relevance and practicability of safety rules and procedures. CONCLUSION: The modified OSHC safety climate tool provided better evidence of structural validity and reliability for use by elderly homes' decision makers as an indicator of employee perception of safety in their institution. IMPACT ON INDUSTRY: The findings and suggestions in the study provide useful information for the management, supervisors/professionals and frontline level staff to cultivate the safety culture in the elderly home sector. Most important, elderly homes can use the modified safety climate scale to identify problem areas in their safety culture and safety management practices and then target these for intervention.

Optimism, positive affectivity, and salivary cortisol.

OBJECTIVES: Research on stress and salivary cortisol has focused almost exclusively on the effects of negative psychological conditions or emotional states. Little attention has been drawn to the impact associated with positive psychological conditions, which have been shown recently to have significant influences on neuroendocrine regulation. The aim of this study is to examine the impact of optimism and positive affect on salivary cortisol with the effects of their negative counterparts controlled for. DESIGN: Optimism and pessimism, and positive and negative affectivity were studied in relation to the diurnal rhythm of salivary cortisol in a group of 80 Hong Kong Chinese, who provided six saliva samples over the course of a day on two consecutive days. The separate effects of optimism and positive affect on two dynamic components of cortisol secretion, awakening response, and diurnal decline were examined. METHODS: Optimism and pessimism were measured using the Chinese version of the revised Life Orientation Test while generalized affects and mood states were assessed by the Chinese Affect Scale. An enzyme-linked immunoabsorbent assay kit (EIA) developed for use in saliva was adopted for the biochemical analysis of cortisol. Testing of major group differences associated with positive psychological conditions was carried out using two-way (group by saliva collection time) ANOVAs for repeated measures with negative psychological conditions and mood states as covariates. RESULTS: Participants having higher optimism scores exhibited less cortisol secretion in the awakening period when the effect of pessimism and mood were controlled. This effect was more apparent in men than in women who had higher cortisol levels in the awakening period. Optimism did not have similar effect on cortisol levels during the underlying period of diurnal decline. On the other hand, higher generalized positive affect was associated with lower cortisol levels during the underlying period of diurnal decline after the effects of negative affect and mood states had been controlled. Generalized positive affect did not significantly influence cortisol secretion during the awakening period. CONCLUSIONS: These findings suggest that positive psychological resources including optimism and generalized positive affect had higher impact on cortisol secretion than their negative counterparts, and point to the need for increased attention to the potential contribution of positive mental states to well-being.

Vessel caliber and restenosis: a prospective clinical and angiographic study of NIR stent deployment in small and large coronary arteries in the same patient.

Retrospective analyses of patient cohorts undergoing stent deployment have shown that small vessel diameter and long lesion length are two angiographic predictors of increased restenosis. We determined the effects of these factors in patients with lesions treated in both small- and large-diameter coronary arteries. This multicenter prospective quantitative angiographic study evaluated patients with de novo coronary disease undergoing intervention who had at least two lesions < or = 16 mm length, one in a vessel < or = 2.75 mm diameter (9 or 16 mm length seven-cell NIR stent) and the other in a vessel > or = 3.0 mm diameter (9 or 16 mm nine-cell NIR stent). Of 94 patients enrolled, 76% were male, mean age was 62 years (range, 40-85), 41% were hypertensive, 18% had diabetes, 15% were current smokers, and 64% had hypercholesterolemia. Additional lesions were treated in 23% of patients. The procedural success rate was 99%. Six months postprocedure, there were no deaths or late stent occlusions. One patient suffered a Q-wave myocardial infarction, one a non-Q-wave infarction, eight underwent percutaneous reintervention, two coronary artery bypass graft surgery operations, and five stenting of other nonstudy lesions. The mean reference diameter for the small vessel was 2.35 mm and the large vessel 3.22 mm. Six-month angiography was performed in 87 patients (92% of those eligible). The overall restenosis rate was 24% in the small vessel (9 mm length stent, 17%; 16 mm length stent, 30%) and 15% in the large vessel (9 mm length stent, 3%; 16 mm length stent, 22%), respectively. Multivessel stenting including treatment of lesions in small-caliber vessels can be performed with a good clinical and angiographic outcome. When the patient, operator, technique, and stent type are the same, vessel caliber and stent length both appear to influence the restenosis rate.