Reliability and validity of the supine-to-stand test in people with stroke.

OBJECTIVE: To investigate the psychometric properties of the supine-to-stand test in people with stroke. DESIGN: Cross-sectional design. SUBJECTS: Fifty-two people with stroke (mean (standard deviation) age 63.13 (6.09) years; time post-stroke 93.13 (61.36) months) and 49 healthy older adults (61.90 (7.29) months). METHODS: Subjects with stroke were recruited from the community dwelling in Hong Kong and  assessed with the supineto- stand test, Fugl-Meyer Motor Assessment, ankle muscle strength test, Berg Balance Scale, limit of stability test, Timed Up-and-Go Test, Six-Minute Walk Test, Chinese version of Activities-specific Balance Confidence scale, Community Integration Measure (CIM-C), and 12-item Short-Form Health Survey (SF-12) in a university-based rehabilitation laboratory. RESULTS: The supine-to-stand test completion time demonstrated excellent intra-rater, inter-rater and test-retest reliability (intraclass correlation coefficient 0.946-1.000) for the people with stroke. The completion time was significantly negatively correlated with Berg Balance Scale, Six-Minute Walk Test, limit of stability - maximal excursion, and limit of stability - endpoint excursion results (r = -0.391 to -0.507), whereas it was positively correlated with the Timed Up-and-Go test results (r = 0.461). The optimal cut-off supine-to-stand test completion time of 5.25 s is feasible for a clinical measure to distinguish the performance of people with stroke from healthy older adults (area under the curve = 0.852, sensitivity = 81.1%, specificity = 84.0%). CONCLUSION: The supine-to-stand test is a reliable, sensitive, specific and easy-to-administer clinical test for assessing the supine-to-stand ability of people with stroke.

A music-with-movement exercise programme for community-dwelling older adults suffering from chronic pain: A pilot randomized controlled trial.

AIM: This study developed, implemented and tested the effectiveness of a music-with-movement exercise programme in improving the pain situations of older adults with chronic pain. DESIGN: A pilot randomized controlled trial. METHODS: This was a pilot randomized controlled trial. The intervention was an 8-week music-with-movement exercise (MMEP) programme for older adults with chronic pain recruited in elders' community centres. The control group received the usual care and a pain management pamphlet. Outcome variables were pain intensity, pain self-efficacy and pain interference, depression and loneliness. RESULTS: Seventy-one participants joined this study. Pain intensity was significantly reduced between the experimental group compared to the control group. The experimental group participants reported significant improvements in pain self-efficiency, pain interference and reduced loneliness and depressive symptoms. However, no significant difference was observed between groups.

Psychometric properties of Upper-body Dressing Scale in people with stroke.

OBJECTIVES: To investigate the psychometric properties of the Upper-Body Dressing Scale (UBDS), a tool for evaluating upper-body dressing performance in stroke patients. DESIGN: Cross-sectional study. SUBJECTS: Seventy-six chronic stroke patients and 49 healthy older adults. METHODS: UBDS, Fugl-Meyer Assessment (FMA), Wolf Motor Function Test (WMFT), Berg Balance Scale (BBS), Timed Up-and-Go Test (TUGT), Limit of Stability (LOS) test, Motor Activity Log (MAL-30), Arm Activity Measure (AAM), 12-item Short Form Health Survey, and Community Integration Measure - Cantonese version were assessed Results: UBDS time and UBDS score demonstrated good to excellent inter-rater and test-retest reliabilities for chronic stroke patients (intraclass correlation coefficient 0.759-1.000). UBDS time correlated significantly with FMA Upper and Lower Extremity, WMFT, and BBS scores, TUGT time, LOS Movement Velocity (affected side), LOS Maximal Excursion (composite), MAL-30 Amount of Use and Quality of Movement (affected side), and AAM (section B) scores (r = -0.61 to 0.63). The minimal detectable changes in UBDS time and UBDS score were 28.67 s and 0, respectively. The cut-off UBDS time and UBDS score were 37.67 s and 7.50, respectively. CONCLUSION: UBDS time is a reliable, sensitive, and specific measurement for assessing upper-body dressing performance in chronic stroke patients.

Reliability, Concurrent Validity, and Minimal Detectable Change of Timed Up and Go Obstacle Test in People With Stroke.

OBJECTIVE: The aims of this study were to investigate the psychometric property of the timed Up and Go Obstacle (TUGO) test in people with stroke. DESIGN: Cross-sectional design. SETTING: University based neurorehabilitation laboratory. PARTICIPANTS: Twenty-eight people with stroke and 30 healthy older adults. INTERVENTION: Not Applicable. OUTCOME MEASURES: The TUGO (obstacle heights: 0, 5, 17 cm) test completion times, Fugl-Meyer Assessment (FMA) score, ankle dorsiflexor and plantarflexor muscle strength, Berg Balance Scale (BBS) score, Narrow Corridor Walking Test (NCWT) completion time, timed Up and Go (TUG) test completion time, and Community Integrated Measure. RESULTS: Excellent inter-rater (intraclass correlation coefficient [ICC]=0.999-1.000) and test-retest reliabilities (ICC=0.917-0.975) were found for TUGO test completion times for all obstacle heights. The TUGO test completion times for all obstacle heights were significantly correlated with NCWT and TUG test completion times (r=0.817-0.912). Only TUGO test completion times for 0 and 5 cm obstacle heights showed significant correlations with BBS scores (r=-0.518 to -0.534), while the TUGO test completion time for the 17 cm obstacle height correlated significantly with FMA scores. The minimal detectable change and optimal cut-off values for TUGO test completion times for the 0, 5, and 17 cm obstacle heights were 2.54, 3.60, and 3.07 s, and 14.69, 14.76, and 16.10 s, respectively. CONCLUSION: The TUGO test is a reliable, valid, and easy-to-administer clinical measure to discriminate between people with stroke and healthy older adults.

Loaded and unloaded timed stair tests as tools for assessing advanced functional mobility in people with stroke.

BACKGROUND: The Timed Stair Test (TST) was originally designed to measure advanced functional mobility in patients who have undergone a total hip replacement. Its psychometric properties have not been examined systematically in people with stroke. AIM: The aims of this study were to: 1) determine the intra-rater reliability of TST under loaded and unloaded condition; 2) identify the minimal detectable changes (MDCs) in TST completion times; 3) investigate the concurrent validity between TST completion times and stroke-specific outcome measures; and 4) determine the cut-off TST completion time to differentiate the performance between people with stroke and healthy older adults. DESIGN: Cross-sectional study. SETTING: A university-based rehabilitation center. POPULATION: Ninety-four people with stroke and 34 healthy older adults. METHODS: TSTs were conducted under loaded and unloaded conditions. Two trials of the TST for each of the two conditions were performed on the same day. The Fugl-Meyer Assessment of Lower Extremity (FMA-LE), lower-limb muscle strength test assessed by a hand held dynamometer, Berg Balance Scale (BBS), Limit of Stability (LOS) Test, Timed Up and Go (TUG) Test, and the Cantonese version of the Community Integration Measure (CIM) were also used to assess the subjects. RESULTS: Excellent intra-rater reliability was demonstrated for TST completion times under loaded (intraclass correlation coefficient [ICC2,1]=0.991) and unloaded (ICC2,1=0.985) conditions. The MDCs in TST completion times were 6.55 seconds and 7.25 seconds under loaded and unloaded conditions, respectively. FMA-LE scores, mean strength of the affected-side dorsiflexors and plantar flexors, BBS scores, and LOS movement velocity and maximum excursion scores demonstrated fair to excellent negative correlations with TST completion times under both loaded (r=-0.314 to -0.786) and unloaded (r=-0.296 to -0.794) conditions. TUG results demonstrated good to excellent positive correlations with TST completion times under both loaded (r=0.875, P<0.001) and unloaded (r=0.872, P<0.001) conditions. The TST completion times of 26.3 seconds and 23.4 seconds under loaded and unloaded conditions, respectively, differentiated between people with stroke and healthy older adults. CONCLUSIONS: The TST is a reliable clinical tool for evaluating advanced functional mobility in people with stroke. CLINICAL REHABILITATION IMPACT: TST is a fast and simple test that does not require sophisticated equipment, making it suitable for busy hospital and rehabilitation settings.

Assessing the Turning Ability during Walking in People with Stroke Using L Test.

BACKGROUND: The L Test of Functional Mobility (L Test) was developed to assess the advanced mobility, which includes both turning and walking ability. This study aimed to evaluate (1) the intra-rater reliability of the L Test in four turning conditions, (2) the correlation with other stroke-specific impairment for community-dwelling older adults with stroke, and (3) the optimal cut-off completion time of the L Test to distinguish the difference of performance between healthy older adults and people with stroke. METHODS: This is a cross-sectional design. Thirty older adults with stroke and healthy older adults were included. The subjects were assessed by L Test along with other stroke-specific outcomes. RESULTS: The L Test showed excellent intra-rater reliability (ICC = 0.945-0.978) for the four turning conditions. There were significant correlations between L Test completion times and Fugl-Meyer Assessment-Lower Extremity (FMA-LE) scores, Fugl-Meyer Assessment-Upper Extremity (FMA-UE) scores, Berg Balance Scale (BBS) score, and Timed Up and Go (TUG) Test scores. The cut-off of the L Test was established as 23.41-24.13 s. CONCLUSION: The L Test is an easy-to-administer clinical test for assessing the turning ability of people with stroke.

A Dyadic Pain Management Program for Community-Dwelling Older Adults with Chronic Pain: Study Protocol for a Cluster Randomized Controlled Trial.

Community-dwelling older adults suffer from chronic pain. Pain negatively affects their physical and psychosocial wellbeing. The majority of pain management education and programs focus only on older adults. Their informal caregivers should be involved in pain management. A dyadic pain management program for reducing pain and psychological health symptoms, and improving pain self-efficacy, quality of life, and physical function in older adults is proposed for evaluation of its effectiveness. This will be a cluster randomized controlled trial. Community-dwelling older adults aged 60 or above and their informal caregivers will be recruited. The dyadic pain management program will be an eight-week group-based program. The participants in the experimental group will receive four weeks of center-based, face-to-face activities and four weeks of digital-based activities via a WhatsApp group. The control group will receive the usual care and a pain management pamphlet. Data will be collected at baseline, and at the eighth-week and sixteenth-week follow-up session. The outcome measurements will include pain intensity, pain self-efficacy, perceived quality of life, depression, anxiety, and stress levels. Data on the caregiver burden will be collected from the informal caregivers. Because of the COVID-19 pandemic, all social activities have been suspended. In the near future, as the pandemic subsides, the dyadic pain management program will be launched to benefit community-dwelling older adults and informal caregivers and to reduce their pain and the care burden, respectively.

Translation and Initial Validation of the Chinese (Cantonese) Brief 2-Way Social Support Scale for Use in People with Chronic Stroke.

Background: Social support is important for stroke rehabilitation. Conventionally, social support is evaluated from the level of support received. However, the bidirectional support hypothesis postulated that self-perceived social support is optimized if individuals provide and receive social support in a balanced manner. The Brief 2-Way Social Support Scale (Brief 2-Way SSS) is a social support instrument measuring the reciprocity of receiving and giving emotional and instrumental social support. Objective: (1) To translate and culturally adapt the English version of the Brief 2-Way SSS into Chinese (Cantonese) (Brief 2-Way SSS-C), (2) to report the results of validation of the Brief 2-Way SSS-C, and (3) to investigate the level of social support in people with stroke in Hong Kong. Methods: The Brief 2-Way SSS-C was produced following the standard forward-backward translation model. People with stroke (n = 109) and age-matched controls (n = 53) were recruited through a university-affiliated neurorehabilitation laboratory. Results: The Brief 2-Way SSS-C demonstrated excellent content validity, acceptable to good internal consistency (Cronbach's alpha of 0.74-0.88), and good test-retest reliability (intraclass correlation coefficient of 0.76-0.81). There were no ceiling or floor effects, and the MDC95 across all subscales was 4. The Brief 2-Way SSS-C subscales had significant correlations with various health-related outcome measures. People with stroke had a lower level of social support than the age-matched healthy controls. Conclusions: The Brief 2-Way SSS-C is a culturally relevant, reliable, and valid outcome measure for the level of social support in community-dwelling people with stroke.

The Predictive Role of Hand Section of Fugl-Meyer Assessment and Motor Activity Log in Action Research Arm Test in People With Stroke.

Background: Recent findings of clinical studies have demonstrated a significant positive relationship between Fugl-Meyer Assessment of upper extremity score and the action research arm test (ARAT) score in people with stroke. Although the motor activity log (MAL) can assess the self-perception of motor performance, which can affect the performance of the upper limb, the relationship between MAL score and ARAT score still remains unclear. The objective of this study is to quantify the independent contribution of MAL score and FMA-hand score on the ARAT score in people with stroke. Methods: This is a cross-sectional study. There were a total of 87 subjects (50 males, 37 females; mean age = 61.12 ± 6.88 years, post-stroke duration=6.31 ± 2.84 years) included in this study. Self-perceived performance in using the paretic limb was measured by MAL, including subscale of the amount of usage (MAL-AOU) and quality of movement (MAL-QOM). Functional performance of the upper limb was measured by action research arm test (ARAT). Upper limb motor control of the hand was measured by hand section of Fugl-Meyer assessment (FMA-hand). Results: The result showed that MAL-QOM (r = 0.648, p < 0.001), MAL-AOU (r = 0.606, p < 0.001), FMA-hand scores (r = 0.663, p < 0.001), and the use of a walking aid (r = -0.422, p < 0.001) were significantly correlated with the ARAT scores. A total 66.9% of the variance in the ARAT scores was predicted by the final regression model including MAL-QOM, MAL-AOU, FMA-hand scores, and walking aid. The FMA-hand score was the best predictor of ARAT scores, which can predict a 36.4% variance of ARAT scores in people with stroke, which controlled the effect of using a walking aid. After controlling for use of a walking aid and FMA-hand scores, the multiple linear regression modeling showed that MAL-QOM and MAL-AOU scores could also independently predict an additional 10.4% of the variance in ARAT scores. Conclusion: In addition to the FMA-hand score, the MAL score was significantly correlated with the ARAT score. Improving self-perceived performance should be one goal of rehabilitation in people with stroke. Further work developing and testing techniques to do so is clearly warranted.

Psychometric Properties of the Trail Walking Test for People With Stroke.

Objective: To investigate (i) the inter-rater and test-retest reliability of the trail walking test (TWT) and the minimum detectable change in the TWT completion time; (ii) the correlations between the TWT completion time and stroke-specific impairments; and (iii) the cutoff TWT completion time to distinguish between people with stroke and healthy older adults according to dual-tasking ambulation ability. Design: Cross-sectional study. Setting: University-based rehabilitation center. Participants: In total, 104 people with stroke and 53 healthy older adults. Main Outcome Measures: The TWT, the Fugl-Meyer Assessment of Lower Extremity (FMA-LE), the ankle muscle strength test, the limit of stability (LOS) test, the Berg Balance Scale (BBS), the Timed Up and Go test (TUG), and the Community Integration Measure (CIM). Results: The mean TWT completion time in subjects with stroke was 124.906 s. The TWT demonstrated excellent inter-rater reliability [intraclass correlation (ICC) = 0.999] and good test-retest reliability (ICC = 0.876) in people with stroke. The TWT performance demonstrated significant negative correlations with the FMA-LE scores (r = -0.409), LOS movement velocity (affected and unaffected sides; r = -0.320 and -0.388, respectively), and LOS endpoint excursion (affected and unaffected sides; r = -0.357 and -0.394, respectively); a significant positive correlation with the LOS reaction time (affected side; r = 0.256); a moderate negative correlation with the BBS scores (r = -0.72); and an excellent positive correlation with the TUG completion time (r = 0.944). The receiver operating characteristic curve analysis revealed that an optimal cutoff of 69.61 s for the TWT completion time had an outstanding diagnostic power to distinguish between people with stroke and healthy older adults (area under the curve = 0.919) with high sensitivity (88.5%) and specificity (83.0%). Conclusion: Results of our preliminary study demonstrated that the TWT is a reliable, valid, sensitive, and specific clinical test for evaluating dual-tasking ambulation ability in people with stroke aged 45 years or above and without cognitive impairments. It can differentiate the dual-tasking ambulation ability between people with stroke and healthy older adults.

Magnitude, Temporal Trends, and Inequalities in the DALYs and YLDs of Nutritional Deficiency among Older Adults in the Western Pacific Region: Findings from the Global Burden of Disease Study 1990-2019.

The population in the Western Pacific region is aging rapidly. Nutritional deficiency is prevalent in older adults; however, information regarding nutritional deficiency in this population is scarce. Using the 2019 Global Burden of Disease (GBD) results, the age-standardized disability-adjusted life years (DALYs) and years of healthy life lost due to disability (YLDs) from nutritional deficiency were estimated between 1990 and 2019 for this population. Average annual percentage change (AAPC) was used to assess temporal trends, and linear mixed-effects models were used to examine socioeconomic and sex inequalities. From 1990 to 2019, the age-standardized DALYs of nutritional deficiency in this population decreased from 697.95 to 290.95 per 100,000, and their age-standardized YLDs decreased from 459.03 to 195.65 per 100,000, with the greatest declines seen in South Korea (AAPCs < -5.0). Tonga had the least decline in DALYs (AAPC = -0.8), whereas Fiji experienced an increase in YLDs (AAPC = 0.1). Being female and having a lower sociodemographic index score was significantly associated with higher age-standardized DALYs and YLDs. The magnitude and temporal trends of the nutritional deficiency burden among older adults varied across countries and sex in the region, indicating that health policies on nutritional deficiency among older adults must be crafted to local conditions.

Assessing the fidelity of a peer-led chronic pain management program (PAP).

BACKGROUND: Intervention fidelity is the core component of a well-designed clinical trial and processes that are used to ensure that the study intervention is delivered as planned. It affects the design and implementation of a study as well as the analysis of the results and interpretation of the findings. The objectives of this study are (a) to describe the methods of assessing the intervention fidelity used in the peer-led chronic pain management program (PAP) and (b) to report the findings on the PAP's intervention fidelity. METHODS: To optimize fidelity to the intervention, we used various strategies and measured them in a continuous process using several different approaches: (a) peer volunteer (PV) training workshop, (b) biweekly meetings with the research team, (c) a detailed teaching manual, (d) a fidelity checklist, (e) on-site visits and direct observations, and (f) semi-structured interview. RESULTS: The PVs' attendance was high, and most of them achieved a high level of implementation in following the fidelity checklist. As part of a large clustered RCT, the fidelity assessment was carried out to help determine the effectiveness of the intervention. CONCLUSIONS: Overall, the PVs successfully delivered the intervention, and the results of the study indicate the effectiveness of the PAP. TRIAL REGISTRATION: ClinicalTrials.gov NCT03823495 . Registered on 30 January 2019.

Effectiveness of a Peer-Led Pain Management Program in Relieving Chronic Pain and Enhancing Pain Self-Efficacy Among Older Adults: A Clustered Randomized Controlled Trial.

Chronic pain is common in nursing home residents, who may have difficulty seeking out pain management strategies. Peer support model show promise as a strategy for managing chronic conditions. This was a clustered randomized controlled trial. A peer-led pain management program was provided for the experimental group. Pain situation, depression, quality of life, non-drug strategies used, and pain knowledge were measured. A total of 262 participants joined the study (146 were allocated as experimental group and 116 as control group). Before our intervention, the mean pain score reported was as high as 6.36 on a 10-point Likert Scale. The high intensity of their pain very much interfered with the daily activities of the participants. Pain interference was high and the participants had poor coping as indicated by the low pain self-efficacy. Depression and a low quality of life score was found. Upon completion of our PAP, there was a significant increase in pain self-efficacy, pain interference as well as quality of life for the participants in the experimental group and not in the control group, and this improvement sustained in 3-month follow up. The present study used a peer support models and proven to be effective in managing pain and pain related situations for nursing home residents with chronic pain. The peer volunteers involved in the pain management program taught relevant pain knowledge and pain management strategies to help our participants. Clinical Trial Registration:https://clinicaltrials.gov/ct2/show/NCT03823495, NCT03823495.

Reliability and validity of Six-Spot Step Test (SSST) in stroke survivors.

BACKGROUND: The Six-Spot Step Test (SSST) was originally developed to assess walking ability while challenging balance during walking in patients with multiple sclerosis. It provides more comprehensive information on ambulatory abilities than several existing measures such as the Timed Up and Go test (TUG test), the Functional Gait Assessment, and the Dynamic Gait Index. To assess the advanced balance control ability of stroke survivors, we modified the SSST to serve this purpose. AIM: The aim of this study was to expand the current understanding of the psychometric properties of the SSST using healthy older adults and stroke survivors. DESIGN: This study adopted an experimental design. SETTING: University-affiliated neurorehabilitation laboratory. POPULATION: A total of 50 study participants, including 25 chronic stroke survivors and 25 healthy older adults, were recruited from the community. METHODS: The SSST was administered to the stroke survivors twice (day 1 and 2) with a 1-week interval. The Fugl-Meyer assessment for the lower extremities (FMA-LE), the Berg Balance scale (BBS), the limit of stability (LOS) test, the Timed Up and Go test (TUG test), and the Chinese version of the Community Integration Measures (CIM-C) were assessed on day 1 by random order. The healthy control group was assessed with the Six-Spot Step Test only on day 1. RESULTS: The SSST showed excellent inter-rater, intra-rater, and test-retest reliability (intraclass correlation coefficient >0.95, P<0.001). Significant correlations were found between SSST performance and the FMA-LE results (r=0.517, P<0.05), BBS scores (r=-0.531, P<0.05), and TUG test scores (r=0.828, P<0.001). The MDC in the mean SSST time for the affected leg and the unaffected leg in stroke survivors was 6.05s. The cutoff time was 10.11s (sensitivity, 80%; specificity, 92%) when kicking obstacles with the affected leg and 10.18s (sensitivity, 80%; specificity, 92%) when kicking obstacles with the unaffected leg. CONCLUSIONS: The SSST was a reliable test and showed a significant correlation with FMA-LE scores, BBS scores, and TUG test times in stroke survivors. CLINICAL REHABILITATION IMPACT: The SSST can be used to assess the advanced balance control of stroke survivors.

Psychometric testing of the Fall Risks for Older People in the Community screening tool (FROP-Com screen) for community-dwelling people with stroke.

OBJECTIVE: The Falls Risk for Older People in the Community assessment (FROP-Com) was originally developed using 13 risk factors to identify the fall risks of community-dwelling older people. To suit the practical use in busy clinical settings, a brief version adopting 3 most fall predictive risk factors from the original FROP-Com, including the number of falls in the past 12 months, assistance required to perform domestic activities of daily living and observation of balance, was developed for screening purpose (FROP-Com screen). The objectives of this study were to investigate the inter-rater and test-retest reliability, concurrent and convergent validity, and minimum detectable change of the FROP-Com screen in community-dwelling people with stroke. PARTICIPANTS: Community-dwelling people with stroke (n = 48) were recruited from a local self-help group, and community-dwelling older people (n = 40) were recruited as control subjects. RESULTS: The FROP-Com screen exhibited moderate inter-rater (Intraclass correlation coefficient [ICC]2,1 = 0.79, 95% confidence interval [CI]: 0.65-0.87) and test-retest reliability (ICC3,1 = 0.70, 95% CI: 0.46-0.83) and weak associations with two balance measures, the Berg Balance Scale (BBS) (rho = -0.38, p = 0.008) and the Timed "Up & Go" (TUG) test (rho = 0.35, p = 0.016). The screen also exhibited a moderate association with the Chinese version of the Activities-specific Balance Confidence Scale (ABC-C) (ABC-C; rho = -0.65, p<0.001), a measure of subjective balance confidence. CONCLUSIONS: The FROP-Com screen is a reliable clinical tool with convergent validity paralleled with subjective balance confidence measure that can be used in fall risk screening of community-dwelling people with stroke. However, one individual item, the observation of balance, will require additional refinement to improve the potential measurement error.

Reliability and validity of the long-distance corridor walk among stroke survivors.

OBJECTIVE: To identify the psychometric properties of the Long-Distance Corridor Walk (LDCW) among community-dwelling stroke survivors. DESIGN: Cross-sectional. SUBJECTS: Twenty-five stroke survivors and 25 healthy older adults. METHODS: The LDCW was administered to the 25 stroke survivors on 2 separate days with a 7-day interval. Fugl-Meyer Assessment for the Lower Extremities (FMA-LE), measurement of lower limb muscle strength, Berg Balance Scale (BBS), limit of stability (LOS), Narrow-Corridor Walk Test (NCWT), Timed Up and Go (TUG) test, and the Community Integration Measure-Cantonese version (CIM) were performed on either day. The healthy older adults completed the LDCW once, and the results were recorded by a random rater. RESULTS: The LDCW showed excellent inter-rater reliability and test-retest reliability, and significant correlations with FMA-LE, BBS, TUG, and NCWT. A cut-off score of 127.5 m for the 2-min walk and 426.69 s for the 400-m walk distinguished stroke survivors from healthy older adults. The MDC in the LDCW in the 2-min walk and 400-m walk were 18.69 m and 121.43 s, respectively. CONCLUSION: The LDCW is a reliable clinical measurement tool for the assessment of advanced walking capacity in stroke survivors.

Frailty is associated with pain and cognitive function in older people in post-acute care settings.

BACKGROUND: To describe pain, cognitive function, and frailty of older people in post-acute care settings and examine the association between the three elements. METHODS: This cross-sectional study involved 142 participants from a rehabilitation ward and a geriatric day centre. Pain, cognitive function and frailty were assessed using Brief Pain Inventory, Abbreviated Mental Test, and 5-item Frail Scale respectively. RESULTS: Participants were mostly women (51.7%) with a mean age of 76.5 (SD 7.8). Mean scores for pain, cognition, and frailty were 9.0 ±â€¯1.0, 4.0 ±â€¯2.8, and 2.2 ±â€¯1.2, respectively. Cognition had a significant inverse association with frailty (ß = -0.160, p = 0.047), and pain had a significant positive association with frailty (ß = 5.122, p < 0.001). This linear regression model explained a variance of 0.269. CONCLUSIONS: The study demonstrated the association between pain, cognitive function, and frailty. In predicting frailty, however, more studies are required to determine the predictive value and cut-off points for pain and cognitive measures.

Pain situations among working adults and the educational needs identified: an exploratory survey via WeChat.

OBJECTIVES: The aim of this study is to 1) investigate the pain situation among working adults in China; 2) explore the self-initiate pain reliving strategies applied by working adults; and 3) collect people's interests and suggestions to the topics of the online pain education program. METHODS: This is an exploratory survey through WeChat. The study was conducted from May 2018 to December 2018. Participants were recruited following the snowball sampling. In total of 664 people were recruited and 502 satisfied the criteria. SPSS was used for data analysis. Descriptive statistical analysis were used to present the utilization of pain treatments and suggested topics. Chi-square test, independent multiple logistic regression and Spearman's correlation were used to analysis the data. RESULTS: The overall incidence of pain among the participants is 45% and higher among female (63%) than male (37%). Neck (68.72%, 4.10 ± 2.31), shoulder (62.56%, 3.78 ± 2.41) and head (49.34%, 4.23 ± 2.52) are reported as the most common and severe pain sites. Working is affected by pain and the results show that there is a negative correlation between pain intensity and work (rs = - 0.194) among the working population. Non-pharmacological treatments (55.77%) were chosen more by pain suffers. Totally 63.39% of participants show interests in the online pain education program and physical and psychological impact of pain is the most suggested topic (22.51%). CONCLUSION: The pain prevalence is high among working adults in China. Impact of pain on work is a significant problem for the working adults. It is important to identify people at risk and deliver timely intervention to reduce pain. People showed their willingness in joining the online program. Therefore, future online pain education program can be developed.

Effects of horticultural therapy: Perspectives of frail and pre-frail older nursing home residents.

AIM: The aim of the study was to explore the perceptions and experiences of a group of frail and/or pre-frail older nursing home residents in relation to horticultural therapy. METHOD: A total of 22 frail/pre-frail residents were interviewed. A qualitative content analysis approach was adopted to interpret the data from four nursing homes. RESULTS: Four main themes were identified: (a) "Horticultural therapy is an enjoyable activity and a good pastime in nursing home life"; (b) "Joining the programme made me happier"; (c) "Horticultural activities facilitated socialization among the residents"; and (4) "Not much mention was made of the programme by the staff outside the sessions." CONCLUSION AND IMPLICATION FOR PRACTICE: The findings provide evidence of the positive effects of horticultural therapy on perceived well-being among frail nursing home residents and expand the existing state of knowledge on the use of horticultural therapy in long-term residential care. Among others nursing implications, they are also important to develop appropriate and meaningful nursing practice to improve frail residents' perceived quality of life in the institution they now call "home."

The Effectiveness of a Multidisciplinary Exercise Program in Managing Work-Related Musculoskeletal Symptoms for Low-Skilled Workers in the Low-Income Community: A Pre-Post-Follow-Up Study.

Studies on work-related musculoskeletal symptoms (WRMSs) have been conducted mainly on different types of workforce but not many on low-skilled workers. The purpose of this study was to evaluate the effectiveness of a multidisciplinary exercise program in decreasing the number of body parts with WRMSs for low-skilled workers. This study used a repeated-measures, single-group design. One hundred and five (105) workers participated in eight weekly 90-min sessions (including 45-min workshops and 45-min exercises) in low-income community settings. The exercise program involved a 21-movement stretching exercise and a 10-movement muscle-strengthening exercise. Questionnaire and health-assessment data were collected at the baseline (N = 105) and immediately after the 8-week program (n = 86). The average age of the 105 participants was 50.5 ± 8.7 years (ranging from 31 to 67). Over 80% (n = 87) of them were female, 68.6% (n = 72) were married, and 68.6% (n = 72) had completed secondary school. They reported an average of three body parts with WRMSs at baseline (T0). By the end of the eight weeks (T1), the participants had reduced the number of WRMS-affected body parts, job stress, and incidences of working through pain, and had improved spine flexibility and handgrip strength. The factors significantly affecting the reduction in the number of body parts with WRMSs were change in the workstyle of working through pain, and self-rated health status. Our study has demonstrated that a community-based multidisciplinary program can reduce the number of body parts affected by WRMSs in low-skilled workers in low-income communities.