Frailty and Other Factors Associated With Early Outcomes in Middle-to Older Age Trauma Patients: A Prospective Cohort Study.

OBJECTIVES: To prospectively investigate associations of frailty and other predictor variables with functional recovery and health outcomes in middle-aged and older patients with trauma. DESIGN: Single-center prospective cohort study. SETTING: Emergency department of Wan Fang Hospital in Taiwan. PARTICIPANTS: Trauma patients aged 45 and older. MEASUREMENTS: Frailty was assessed with the Clinical Frailty Scale (CFS). Injury mechanisms, pre-existing diseases, and fracture locations were recorded at baseline. The primary outcome was functional recovery assessed using the Barthel Index (BI). Secondary outcomes were new care needs, unscheduled return visits, and falls 3 months postinjury. RESULTS: A total of 588 participants were included in the final analysis. For every one-point increase in the CFS, the multivariable-adjusted odds ratio (OR, 95% confidence interval [CI]) of failure to retain the preinjury BI was 1.34 (1.16-1.55); associations were consistent across levels of age and injury severities. Significant joint associations of frailty and age with poor functional recovery were observed. CFS was also associated with new care needs (OR for every one-point increase, 1.36, 95% CI, 1.17-1.58), unscheduled return visits (OR 1.26, 95% CI, 1.04-1.51), and falls (OR 1.23, 95% CI, 1.01-1.51). Other variables associated with failure to retain preinjury BI included road traffic accident and presence of hip fracture. CONCLUSION: Frailty was significantly associated with poor functional and health outcomes regardless of injury severity in middle-aged and older patients with trauma. Injury mechanisms and fracture locations were also significant predictors of functional recovery postinjury.

Prediction of posttraumatic functional recovery in middle-aged and older patients through dynamic ensemble selection modeling.

Introduction: Age-specific risk factors may delay posttraumatic functional recovery; complex interactions exist between these factors. In this study, we investigated the prediction ability of machine learning models for posttraumatic (6 months) functional recovery in middle-aged and older patients on the basis of their preexisting health conditions. Methods: Data obtained from injured patients aged ≥45 years were divided into training-validation (n = 368) and test (n = 159) data sets. The input features were the sociodemographic characteristics and baseline health conditions of the patients. The output feature was functional status 6 months after injury; this was assessed using the Barthel Index (BI). On the basis of their BI scores, the patients were categorized into functionally independent (BI >60) and functionally dependent (BI ≤60) groups. The permutation feature importance method was used for feature selection. Six algorithms were validated through cross-validation with hyperparameter optimization. The algorithms exhibiting satisfactory performance were subjected to bagging to construct stacking, voting, and dynamic ensemble selection models. The best model was evaluated on the test data set. Partial dependence (PD) and individual conditional expectation (ICE) plots were created. Results: In total, nineteen of twenty-seven features were selected. Logistic regression, linear discrimination analysis, and Gaussian Naive Bayes algorithms exhibited satisfactory performances and were, therefore, used to construct ensemble models. The k-Nearest Oracle Elimination model outperformed the other models when evaluated on the training-validation data set (sensitivity: 0.732, 95% CI: 0.702-0.761; specificity: 0.813, 95% CI: 0.805-0.822); it exhibited compatible performance on the test data set (sensitivity: 0.779, 95% CI: 0.559-0.950; specificity: 0.859, 95% CI: 0.799-0.912). The PD and ICE plots showed consistent patterns with practical tendencies. Conclusion: Preexisting health conditions can predict long-term functional outcomes in injured middle-aged and older patients, thus predicting prognosis and facilitating clinical decision-making.

Telerehabilitation in Older Thai Community-Dwelling Adults.

To investigate the impact on physical performance and walking abilities associated with fall risk and disability in the senior population, we created a telerehabilitation system. This is a multi-site, community setting, pre−post experimental study. We recruited participants from four rural areas in Thailand. All participants received eight weeks of tele-exercise, three sessions per week, via the telerehabilitation system. After the intervention, all participants underwent the Short Physical Performance Battery (SPPB), Timed Up and Go (TUG) test, and the six-minute walk test (6MWT) using a wearable sensor system. A total of 123 participants participated in the study and 2 participants dropped out while conducting the study, thus 121 participants were included in the analysis. In comparison to the baseline, we discovered a considerable improvement in the SPPB score (0.65 ± 0.22, p < 0.001), TUG (−1.70 ± 0.86, p < 0.001), and 6MWT (10.23 ± 7.33, p = 0.007). Our study demonstrates the benefits of telerehabilitation on SPPB, TUG, and 6MWT related to disabilities and fall risk. This telerehabilitation technology demonstrated its viability in the community environment and demonstrated its capacity to offer fundamental components of remote rehabilitation services within the healthcare system.

Effects of the Robot-Assisted Gait Training Device Plus Physiotherapy in Improving Ambulatory Functions in Patients With Subacute Stroke With Hemiplegia: An Assessor-Blinded, Randomized Controlled Trial.

OBJECTIVE: To investigate the effects of the robot-assisted gait training (RAGT) device plus physiotherapy vs physiotherapy alone in improving ambulatory functions in patients with subacute stroke with hemiplegia. DESIGN: A prospective, assessor-blinded, randomized controlled trial. SETTING: Patients with subacute stroke with hemiplegia admitted at the Rehabilitation Center. PARTICIPANTS: Twenty-six patients with subacute stroke with hemiplegia (N=26). INTERVENTION: All patients received 30 training sessions (5 d/wk for 6 wk), which included conventional physiotherapy training (60 minutes) and ambulation training (60 minutes). In the ambulation training session, the RAGT device group received robotic training (40 minutes) and ground ambulation training (20 minutes). The control group received only ground ambulation training (60 minutes). The outcomes were assessed at the initial session and at the end of the 15th and 30th sessions. Comparisons within groups and between groups were conducted. MAIN OUTCOME MEASURES: Primary outcome variables were the FIM-walk score and the efficacy of FIM-walk. RESULTS: The RAGT device group showed greater improvements from baseline than control in (1) the FIM-walk score at the end of the 15th session (P=.012), (2) the efficacy of FIM-walk at the end of the 15th session (P=.008), (3) walking distance in the 6-minute walk test at the end of the 15th session (P=.018), (4) the Barthel Index for Activities of Daily Living (ADL) at the end of the 30th session (P<.001), and (5) gait symmetry ratio at the end of the 30th session (P=.044). Other gait parameters showed tendencies of improvement in the RAGT device group, but there were no significant differences. CONCLUSIONS: RAGT devices plus physiotherapy showed early improvements in walking ability and Barthel ADL index compared with the ground level training plus physiotherapy in patients with subacute stroke with hemiplegia.

Differences between chronic low back pain patients in Germany and Thailand in terms of nature of disease and socioeconomic and psychological factors.

BACKGROUND: Worldwide, chronic low back pain (CLBP) is one of the most common causes of physical and psychological disabilities. The factors that affect low back pain (LBP) between Western and Eastern countries are different. OBJECTIVE: We assessed the factors associated with LBP and their impact in German and Thai CLBP participants. METHODS: This cross-sectional study was conducted in 100 Thai and 100 German CLBP participants. Data were collected before the participants received treatment in the outpatient rehabilitation clinic. We used standardized questionnaires to assess the demographic and socioeconomic data, clinical features of the pain, the impact of pain during daily activities, and psychological consequences. RESULTS: We found a statistically significant difference between the two groups for minimal pain intensity (NRS German = 3.01, Thai = 1.83), and the participants' acceptable pain intensity (NRS German = 1.97, Thai = 3.88). The German participants had a higher negative impact score in their daily living compared to the Thai participants (German = 23.5, Thai = 10). Also, the German participants suffered more often from depression (CES-D score; German = 17, Thai = 4). However, the average back pain intensity was the same for both groups. CONCLUSION: German CLBP participants had significantly more depressive symptoms and pain-related impairments compared to the Thai participants. On the other hand, there were no differences in maximum and average pain severities.

Physiological Localization by Sensory and Motor Inching Studies and Structural Abnormalities Detected by Ultrasonographic Changes in Carpal Tunnel Syndrome.

OBJECTIVE: To study mild to moderate carpal tunnel syndrome (CTS), compare median nerve entrapment sites detected by electrophysiological inching studies with ultrasonographic abnormalities of cross-sectional area (CSA), and correlate focal points of conduction delays detected by sensory and motor inching recorded from the third digit and second lumbrical muscle. DESIGN: Analytic cross-sectional study. SETTING: Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. PARTICIPANTS: Hands from 10 participants without CTS (n=15) and hands with mild to moderate CTS from 29 participants (n=40) were selected by convenience sampling (N=55). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Correlation of electrophysiological entrapment site localization by inching study with anatomic entrapment site detected by ultrasound (US). RESULTS: In all 40 hands tested, a sharply localized latency was found to increase across a 1-cm segment, most commonly 2-3 cm distal to the distal wrist crease for both sensory and motor studies, showing a good match between the 2 with Pearson correlation coefficient value (r=0.72). US revealed a narrowing CSA of the median nerve at 1-2 cm distal to the distal wrist crease. CONCLUSIONS: This study showed a high correlation for focal point conduction delay detected by sensory and motor nerve conduction study. Recording from the second lumbricalis facilitated motor inching along the straight course of the nerve instead of the arcuate recurrent branch innervating the abductor pollicis brevis, the muscle traditionally used. US examination also revealed a localized narrowing of the median nerve CSA at 1-2 cm distal to the distal wrist crease, a possible site for anatomic entrapment. The most enlarged CSA was seen at the distal wrist crease, a level corresponding to the inlet of the carpal tunnel.

Effect of Anodal Transcranial Direct Current Stimulation at the Right Dorsolateral Prefrontal Cortex on the Cognitive Function in Patients With Mild Cognitive Impairment: A Randomized Double-Blind Controlled Trial.

OBJECTIVES: To study the effect of anodal transcranial direct stimulation (atDCS) of the right dorsolateral prefrontal cortex (DLPFC) on cognitive function and side effects in patients with mild cognitive impairment. DESIGN: Experimental double-blind randomized, sham-controlled trial. SETTING: Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital PARTICIPANTS: Volunteers (N=45) with mild cognitive impairment. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The atDCS group (n=23) were stimulated at 2 mA for 20 minutes with the anode on the right DLPFC and the cathode on the left supraorbital area. The control group (n=22) received placebo stimulation. Baseline cognitive function was assessed using the Cambridge Neuropsychological Test Automated Battery test. Participants were treated 3 times per week for 4 weeks (12 sessions). Cognitive function and side effects were assessed immediately after the first stimulation, the last session, and 4 weeks after treatment. RESULTS: Cambridge Neuropsychological Test Automated Battery results revealed a significant improvement in the accuracy of the visual sustained attention (VSA) in the atDCS group at all 3 time points, the spatial working memory and visual memory (VM) immediately after the first stimulation, and a decreased VM reaction time after 12 sessions. A long-lasting effect on VSA and VM were found 4 weeks after treatment. CONCLUSIONS: Anodal tDCS over the right DLPFC enhanced the VSA, spatial working memory, and VM accuracy after the first stimulation and reduced the reaction time of VM after 12 sessions. A long-lasting effect on VSA and VM was found 4 weeks after treatment. This study corroborated atDCS as a safe technique to improve cognitive function.

Effects of Transcranial Direct Current Stimulation Plus Physical Therapy on Gait in Patients With Parkinson Disease: A Randomized Controlled Trial.

OBJECTIVE: The aim of the study was to study the combined effects of transcranial direct current stimulation (tDCS) and physical therapy on the walking ability of patients with Parkinson disease (PD). STUDY DESIGN: The study used an experimental, double-blinded, randomized controlled trial. RESULTS: After intervention, group 1 (only tDCS) demonstrated a significant increase in gait speed by 0.13 to 0.14 m/sec (17.8%-19.2%) and an increase in step length by 5.9 to 6.1 cm (14.0%-14.5%), whereas group 2 (tDCS and physical therapy) revealed a significant increase in gait speed by 0.10 to 0.13 m/sec (14.9%-19.4%) and step length by 4.5 to 5.4 cm (10.6%-12.8%) and group 3 (sham tDCS and physical therapy) showed a significant increase in gait speed by 0.09 to 0.14 m/sec (13.0%-20.3%) and step length by 3.0 to 5.4 cm (6.8%-12.3%). All these results lasted for at least 8 wks after intervention. Upon comparing the parameters of gait among the three groups at every follow-up visit, no significant difference was observed. CONCLUSIONS: Anodal tDCS or physical therapy could be used alone or together as a combination treatment to improve the walking speed of patients with Parkinson disease. The effects lasted for approximately 8 wks. The combination treatment was not superior to the use of tDCS or physical therapy alone.

Comparison of the effectiveness between generic and original form of gabapentin for pain relief in suspected neuropathic component of low back pain.

OBJECTIVE: To compare effectiveness of the generic form of gabapentin with its original form. MATERIAL AND METHOD: A single-blind evaluation randomized controlled trial (RCT) of patients that were diagnosed with low back pain with suspected neuropathic component at the Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital were included in the present study. Patients were randomized into two treatment groups. The first group received gabapentin generic form (GGF) or Gabapentin Sandoz, whereas the other received gabapentin original form (GOF) or Neurontin. The primary endpoint was the VisualAnalogue Scale (VAS) pain score. The secondary endpoints were the Thai version of the Oswestry low back pain disability index (ODI) score, lumbar spine's range ofmotion, safety profiles, and average medical cost. Non-inferiority was pre-specified at 20%. The amount of medication was increased to maintain VAS less than 40 mm and tapered off in case of adverse event. RESULTS: Forty-one patients, GGF 21 and GOF 20, had completed the study. At 8th week, the visual analogue scale (VAS) and ODI scores significantly decreased in both groups. Mean and standard deviation (SD) of VAS improvement were 31.4+/- 22.1 mm for the GGF group versus 34.3 +/- 22.6 mm for the GOF group (p = 0.69), within pre-specified 20% non-inferiority margin (difference 2.9 mm 95% CI-17.7 mm, 11.8 mm). Mean ODI improvement was 1.1% for the GGF group versus 7.6%for the GOF group (p = 0.42), within pre-specified 20% non-inferiority margin, (difference 3.5, 95% CI = -12.3%, 5.3%). Both groups have significantly gainedflexion of the lumbar spine. Both groups revealed similar safety profiles. The GGF group showed significantly lower average cost for medications (2,844 baht). CONCLUSION: In comparison with the GOF (Neurontin) group, the non-inferior effectiveness for pain reduction and improvement of back function has been revealed in the GGF (Gabapentin Sandoz) group. Similar safety profiles were demonstrated in both groups. The average medication cost of GGF is much lower than GOF (4.67 times).

A newly identified locus for benign adult familial myoclonic epilepsy on chromosome 3q26.32-3q28.

Benign Adult Familial Myoclonic Epilepsy (BAFME) is an autosomal dominant disorder characterized by adult-onset cortical tremor or action myoclonus predominantly in the upper limbs, and generalized seizures. We investigated a Thai BAFME family. Clinical and electrophysiological studies revealed that 13 were affected with BAFME. There were a total of 24 individuals studied. Genetic analysis by genome-wide linkage study (GWLS) was performed using 400 microsatellite markers and excluded linkage of the previous BAFME loci, 8q23.3-q24.1, and 2p11.1-q12.2. GWLS showed that the disease-associated region in our Thai family was linked to a newly identified locus on chromosome 3q26.32-3q28. This locus represents the fourth chromosomal region for BAFME.

Relationship between the ability to change from a supine to a sitting position at admission and mobility outcomes after stroke rehabilitation.

BACKGROUND: Regarding observations, stroke patients able to change their basic body position from supine to sitting at admission usually could walk by the end of rehabilitation. However, there was not yet supported by any research evidence. OBJECTIVE: To study the relationship between the patient's ability at admission to change basic body position from a supine to a sitting position and the mobility outcome after stroke rehabilitation. MATERIAL AND METHOD: Data were gathered and analyzed from the case record forms (including the Barthel ADL Index assessment sheets) of 327 stroke patients in nine tertiary in-patient rehabilitation settings in Thailand between March and December 2006. RESULTS: On admission, 58.7% of the patients were able to change their basic position from supine to sitting. At the end of rehabilitation, the group which was able to sit had a higher mobility sub-score (OR = 6.15; 95% CI 3.24 -11.67) and total Barthel ADL index score (OR = 9.64; 95% CI 5.74-16.18) than the group which was unable to sit. CONCLUSION: The ability at admission to change from a supine to a sitting position was significantly related to a better mobility outcome after stroke rehabilitation.

Effects of Thai traditional massage on autistic children's behavior.

OBJECTIVES: The objective of this study was to access whether there were any therapeutic effects of Thai Traditional Massage (TTM) on major behavioral and emotional disturbances in Thai autistic children. DESIGN: This was a randomized controlled trial study. SETTINGS/LOCATION: The study was conducted at the Rehabilitation Centre of the Thai Red Cross Society. SUBJECTS: A total of 60 autistic children between the ages of 3 and 10 completed this study. INTERVENTIONS: Standard sensory integration therapy (SI) was compared to the SI with TTM treatments. OUTCOME MEASURES: Parents and teachers assessed major behavior disturbances using the Conners' Rating Scales at 0 and 8 weeks. Sleep Diary (SD), recorded by the parents, assessed the patient's sleeping patterns every week. RESULTS: Sixty (60) autistic children, mean age 4.67 +/- 1.82, were recruited. No statistical differences were seen in the demographic and baseline data among both groups. From both the Conners' Teacher Questionnaire and SD, statistical improvement was detected for conduct problem, hyperactivity, inattention-passivity, hyperactivity index, and sleeping behavior. However, results from the Conners' Parent Questionnaire revealed an improvement only for anxiety (p = 0.04) in the massage group, whereas when both groups were compared, a significant improvement in conduct problem (p = 0.03) and anxiety (p = 0.01) was found. Results indicated that TTM may have a positive effect in improving stereotypical behaviors in autistic children. CONCLUSIONS: Over a period of 8 weeks, our findings suggested that TTM could be used as a complementary therapy for autistic children in Thailand.

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.

Main outcomes of stroke rehabilitation: a multi-centre study in Thailand.

OBJECTIVE: To estimate the efficiency of inpatient rehabilitation for patients after stroke in Thailand. DESIGN: Multi-centre, prospective study. SUBJECTS: Patients after stroke, aged >or= 18 years, with stable medical signs, able to follow 1-step commands and to sit for at least 30 min. METHODS: Main outcomes included Barthel Index (BI) scores, BI effectiveness, BI efficiency, length of stay, Thai Hospital Anxiety and Depression Scale (HADS) scores, and quality of life. RESULTS: Of a total of 327 patients, 285 completed the programmes, with a mean length of stay of 27.3 days. Mean age was 62.1 (standard deviation (SD) 12.1) years and 59% of patients were male. Mean BI scores on admission and at discharge were 7.48 (SD 3.96; range 0-19) and 13.27 (SD 4.86; range 0-20), respectively. The change score was 5.79 (SD 3.89) and the efficiency of functional score was 0.28 points/day. Using multivariate analysis, factors associated with change in BI score were age, previous stroke and length of stay. Sixty-four patients (25.5%) had anxiety and 95 (37.8%) had depression on admission. At discharge, the numbers of patients with anxiety and depression decreased to 17 (6.8%) and 41 (16.3%), respectively. The quality of life scores at discharge were significantly higher than those on admission. CONCLUSION: Inpatient rehabilitation enabled stroke patients to reach optimal functional ability, and improved psychological status and quality of life.

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.

Combination of acute stroke unit and short-term stroke ward with early supported discharge decreases mortality and complications after acute ischemic stroke.

BACKGROUND: The stroke unit has been established as a standard care for stroke. However, it has not been widely established in developing countries due to the lack of understanding and limited resources. OBJECTIVE: To compare the complications and mortality of stroke patients admitted in the stroke unit and short-term ward with those admitted in the general medical ward. MATERIAL AND METHOD: The authors prospectively collected data of acute stroke patients who were admitted after the set up of the stroke unit and stroke short-term ward in 2003, and compared with the data of those who were admitted in a general medical ward in 2001. All acute stroke patients who presented within seven days of the onset were admitted and those who had final diagnosis of ischemic stroke or transient ischemic attack (TIA) were studied. Patients in the stroke unit were taken care of by a multidisciplinary team approach under clinical guidelines and a care map. The short-term ward is a part of the general medical ward and stroke patients were treated by a multidisciplinary team followed by homecare treatment. The endpoints were mortality rate, neurological and medical complications during admissions, and the mean length of stay. RESULTS: Seven hundred and ninety-four patients were studied. Three hundred and eighty-seven patients were admitted in 2001 and 407 patients in 2003. Among patients presented 2003, three hundred and one cases were treated in the acute stroke unit whereas 106 were admitted in the short-term ward. There was no difference in stroke risk factors and stroke subtypes between the two groups, except for dyslipidemia and cigarette smoking, which were more prevalent in patients admitted in 2003. Patients in the stroke unit and the short-term ward had significantly less mortality than those in the general medical ward (8.9 and 2.1%). Overall complications in the stroke unit and the short-term ward were 16.8%, compared to 26% of those admitted into the general medical ward. Significantly less brain edema, hemorrhagic infarction, urinary tract infection, pneumonia, and pressure sore were also observed. The length of hospital stay of the patients admitted in 2001 and 2003 was 11.26 and 8.09 days, respectively. CONCLUSION: Combination of organized acute stroke unit and short-term ward with early supported discharge reduces the mortality and complications of ischemic stroke patients during admission as well as the length of stay when compared to the general medical ward. The present study reassures that the combination is useful for hospitals in developing countries, which have limited number of beds in their stroke units.

Effect of ultrasound thermotherapy in mild to moderate carpal tunnel syndrome.

OBJECTIVE: To investigate the efficacy of low intensity ultrasound thermotherapy, a conservative option of treatment of mild to moderate carpal tunnel syndrome (CTS). DESIGN: Prospective experimental, placebo- controlled, before-after treatment trial. SETTING: King Chulalongkorn Memorial Hospital, Outpatient Clinic and Electrodiagnostic Laboratory, Department of Rehabilitation Medicine. PATIENTS: Eighteen women, 30 hands who had clinical and electrophysiologic evidence of mild to moderate CTS. INTERVENTIONS: Patients of CTS were divided into two groups; A and B of 15 hands by random sampling. Group A was given placebo and continuous ultrasound therapy with the intensity of 0.5 W/cm2 applied to the palmar carpal tunnel for 10 minutes. Group B was given Diclofenac 75 mg/day in divided doses and sham ultrasound. The ultrasound was applied 5 days a week for 4 weeks. OUTCOME MEASURES: Each patient was clinically and electrophysiologically evaluated before and after treatment. RESULTS: There were statistically significant improvements (p < 0.05), in the clinical parameters of both groups after treatment. In the electrophysiologic study, the median SNAP amplitude was increased significantly after the treatment in ultrasound group (group A). When both groups were compared, group A had significant difference in increasing of median SNAP amplitude after treatment. CONCLUSION: The therapeutic efficacy of low intensity ultrasound thermotherapy was satisfied for mild to moderate CTS. However, the electrophysiological changes after ultrasound treatment need further investigation.

Risk factors for stroke in Thai patients.

OBJECTIVE: To demonstrate risk factors for stroke in Thai patients at King Chulalongkorn Memorial Hospital. DESIGN: Analytic cross-sectional study. SETTING: Stroke unit, Department of Neurology, King Chulalongkorn Memorial Hospital. MATERIAL AND METHOD: The patients admitted to the stroke unit of King Chulalongkorn Memorial Hospital with the diagnosis of acute stroke and community-based age control matched subjects were recruited. They were counselled about the possible risk factors for stroke and the stroke patients' medical records were carefully reviewed within 72 hours after admission. This study was done from November 2001 to May 2002. There were two hundred stroke cases and one hundred control subjects enrolled in the present study. The possible risk factors were compared between the two groups. RESULTS: The male:female stroke patients were 1.2:1 with a mean age of 63.10 +/- 12.76 years. The etiology of stroke was ischemic 78 per cent and hemorrhagic 22 per cent. The mean duration of stroke onset was 4.11 +/- 1.96 days. The risk factors for stroke with their relative risks were: transient ischemic attack (TIA) 9.3, previous stroke 9, moderate to severe hypertension (HT) 6.5, heart disease 5.2, hyperlipidemia 4.6, diabetes mellitus 4.5, current smoking 3.8 and daily drinking 3.6. Whereas, physical exercise showed a protective effect on the development of stroke. CONCLUSION: Risk factors for stroke in Thai patients at King Chulalongkorn Memorial Hospital were TIA, previous stroke, moderate to severe HT, heart disease, hyperlipidemia, diabetes mellitus, current smoking and daily drinking. Physical exercise was a positive predictor.