Measurement of hand grip strength in the elderly: A scoping review with recommendations.

INTRODUCTION: Hand grip strength has been widely used as a lead measure in geriatric conditions such as frailty. However, diversity in assessment protocols and methodologies creates uncertainty in the comparison of outcome measurements. The aim of this study was to review the literature relating to the measurement of hand grip strength in older adults, in order to develop further consensus in relation to the use of existing protocols in clinical and community settings, with an emphasis on practicality and suitability for frail persons. METHODS: Five electronic English databases were searched using keywords such as 'hand grip strength', 'clinimetric assessment', and their synonyms. Age-related trends in adults aged ≥65 years were assessed, and comparisons were made of the following variables: dynamometer model and handle setting, hand positioning, warm-up trials, grip duration, number of repeated tests, rest periods, laterality of tested hand, and whether encouragement was given to the subjects. RESULTS: Thirty-four research papers met the inclusion criteria and were included. A Jamar hand dynamometer was most frequently used. Variations were found in the positioning of the subject and in the duration of the rest period, which ranged from 10 to 20 s to 1 min. Grip strength was typically measured three times in the dominant hand, with the strongest grip being recorded and no encouragement being provided during assessment. CONCLUSIONS: Based on the scoping review, we propose a detailed and standardised protocol that is suitable for the assessment of hand grip strength in frail older adults.

What is the optimal chair stand test protocol for older adults? A systematic review.

Purpose: To determine the chair stand test protocol that is most suitable for older adults in clinical settings by reviewing the currently available methods.Methods: Five electronic English databases were searched and details of methods used on individuals aged ≥65 years in the included studies were compared, including the instrument used to record time, units of measurement, chair characteristics (seat height, armrests), footwear, permission to use upper extremities and walking aids, pace of performance, total number of chair stands, timing points, total number of recorded and practice tests.Results: A total of 23 eligible studies were identified. The type of instrument to record performance time, characteristics of the chair and footwear were not frequently mentioned. A majority of studies did not permit the use of the upper extremities or walking aids during assessment. The performance of five chair stands at a fast pace recorded in seconds was most common, with the majority of studies recording the initial and end time point in a seated position. The total number of performed tests and practice tests was not specified in a majority of studies.Conclusion: A feasible and safe protocol for the chair stand test is proposed for assessment of older adults.Implications for RehabilitationThe chair stand test may provide valuable information on declines in mobility in older adults.The use of the chair stand test within clinical settings of older adults may provide a measure to identify frail individuals and to determine their level of frailty.Using the proposed protocol for the chair stand test may allow for the comparability of results.

Rumex japonicus Houtt.: A phytochemical, pharmacological, and pharmacokinetic review.

Rumex japonicus Houtt. (RJH-Yang Ti) RJH has been used as a folk medicine in East Asian countries for thousands of years. It has a wide range of therapeutic effects in terms of anti-microorganic, anti-oxidant, anti-inflammatory, and antitumor effects. Therefore, it is urgent to thoroughly review the existing knowledge for this herb from phytochemical, pharmacological, and pharmacokinetic perspectives. "Yang Ti" and its English, botanical and pharmaceutical names used as keywords to perform database search which included the Encyclopaedia of traditional Chinese Medicines, PubMed, EMBASE, AMED, CINAHL, Cochrane Library, MEDLINE, Science Direct, Scopus, Web of Science, and China Network Knowledge Infrastructure. Forty-five compounds identified from RJH. Besides, the therapeutic effects of RJH have been summarized as well. The root of RJH contains derivatives of anthraquinones, phytosterols, nepodin, oxanthrone c-glycosides, phenolic acid, cinnamic acid, flavonoid, epoxynaphthoquinol, triterpenoids, methoxynaphthalene, trihydroxybenzene, anthracene-9,10-dione, and other compounds. The extract of RJH and its chemical compounds showed the potentials as a complementary agent to exert antioxidant, antimicrobial, antisepsis, anticancer, anti-haematological disease, anti-dermatological disease, and antidiabetic activities. For the record, there is no study conducted on RJH regarding its pharmacokinetic aspect. Notably, Emodin may require additional attention due to its multiple organ toxicity concerns.

Ear acupressure for perennial allergic rhinitis: A multicenter randomized controlled trial.

BACKGROUND: Perennial allergic rhinitis (PAR) has a high and increasing prevalence worldwide. Ear acupressure (EAP) is a noninvasive semi-self-administered form of acupuncture. Previous studies indicated that EAP could be effective and safe for AR symptom management. However, there was insufficient evidence to confirm this. This study investigated whether EAP, a noninvasive clinical alternative to acupuncture, is effective and safe for PAR. METHODS: This is an international, multicenter, randomized, single-blind, sham-controlled trial. The trial was conducted at two centers: Royal Melbourne Institute of Technology University (Melbourne, Australia) Clinical Trial Clinic and Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China. PAR participants were randomized to receive real or sham EAP treatment once a week for 8 weeks and then were followed-up for 12 weeks. Participants were instructed to administer EAP stimulation three times daily. Symptom severity and quality of life (QoL) were evaluated. Adverse events (AEs) were also monitored. Intention-to-treat analysis on change of symptom scores and QoL was applied. RESULTS: Two hundred forty-five participants were randomly assigned to real (n = 124) and sham EAP (n = 121) groups. Twenty-five participants discontinued during treatment and 15 participants dropped out during follow-up. At the end of treatment and follow-up periods, changes of global QoL score were significantly greater in the real EAP group compared with the sham group. At the end of follow-up, scores for total nasal symptom, runny nose, and eye symptoms in the real EAP group had a greater reduction compared with the sham group. Overall, both real and sham EAP were well tolerated. Two severe AEs were reported but were not considered related to the EAP procedures. CONCLUSION: In conclusion, EAP showed short-term and extended benefit for improving PAR symptoms and QoL for PAR patients.

Chinese herbal medicine for atopic eczema.

BACKGROUND: Chinese herbal medicine (CHM) has been increasingly used for atopic eczema. A previous version of this Cochrane review published in 2004 found some evidence of a possible benefit for oral ingestion of CHM for eczema, but the results were inconclusive and the evidence needs to be updated. We have expanded the scope of this review to include an assessment of the topical and oral effects of CHM for eczema. OBJECTIVES: To assess the effects of oral ingestion and topical applications of CHM for the management of eczema in children and adults. SEARCH METHODS: We searched the following databases up to September 2012: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2012, Issue 8), MEDLINE (from 1946), EMBASE (from 1974), AMED (from 1985), LILACS (from 1982), and CINAHL (from 1981). We searched the following from inception: SCOPUS, HERBMED, ProQuest, CQVIP, CNKI, and Wanfang Data. We also searched trials registers, handsearched conference proceedings, checked the reference lists of all included and excluded studies and review articles for further references to relevant trials, and contacted experts in Chinese medicine for unpublished studies. SELECTION CRITERIA: All randomised controlled trials (RCTs) in children and adults with eczema comparing CHM to placebo; no intervention; active controls, including acupuncture; or conventional medicines. DATA COLLECTION AND ANALYSIS: Two authors selected the RCTs, extracted data, and assessed quality independently. We contacted study authors for missing data. We collected adverse events from the included studies. MAIN RESULTS: We included 28 studies, with a total of 2306 participants. We assessed most of the studies at high 'risk of bias', particularly in blinding of participants and personnel, and there was substantial inconsistency between studies, so any positive effect of CHM must be treated with caution. We did not include the four studies from the previous version in this review, because they investigated a CHM product that has been withdrawn from the market since 2004.Four studies (three oral and one topical) compared CHM to placebo. Pooled data from 2 studies showed the total effectiveness rate in the CHM group was higher (by risk ratio (RR) 2.09, 95% confidence interval (CI) 1.32 to 3.32; 2 studies; n = 85), and the itching visual analogue score (VAS) in the CHM group was 1.53 lower (by standardised mean difference (SMD), 95% CI 2.64 to 0.41; 2 Studies; n = 94) than the placebo group, where a lower VAS score indicates reduced itch. One study of 85 participants with moderate to severe eczema who received an oral CHM formula for 12 weeks reported a quality of life (QoL) score 2.5 lower in the CHM group (by difference in means (MD), 95% CI 4.77 to 0.23; 1 study; n = 85) than the placebo group, where a lower score indicates better QoL.  Twenty-two studies and 1 arm from a study with a 4-arm parallel controlled design compared CHM (5 oral, 6 topical, and 12 mixed oral and topical) to conventional medicines. The total effectiveness rate in the CHM groups was superior (RR 1.43, 95% CI 1.27 to 1.61; 21 studies; n = 1868; very low quality evidence), and the itching VAS in the CHM groups was 0.83 lower (SMD, 95% CI 1.43 to 0.22; 7 studies; n = 465) than the comparators.Two studies compared combined oral and topical CHM to the same oral CHM formula alone. The total effectiveness rate in 1 study was not statistically significant (RR 1.13, 95% CI 0.78 to 1.63; 1 study; n = 20). In the other study, the itching VAS in the CHM group was 1.05 lower (MD, 95% CI 1.75 to 0.35; 1 study; n = 23) than the control group.With regard to side-effects, four studies did not give any report of adverse events. The other 24 studies reported minor adverse events, which were reversed soon after stopping CHM. One participant withdrew from one trial because of exacerbation of their condition after using the CHM intervention.Eight studies received government funding. AUTHORS' CONCLUSIONS: We could not find conclusive evidence that CHM taken by mouth or applied topically to the skin could reduce the severity of eczema in children or adults.Well-designed, adequately powered RCTs are needed to evaluate the efficacy and safety of CHM for managing eczema.

Chinese herbal medicine for Mild Cognitive Impairment and Age Associated Memory Impairment: a review of randomised controlled trials.

This review assesses the effectiveness and safety of Chinese herbal medicines (CHM) for Mild Cognitive Impairment (MCI) and Age Associated Memory Impairment (AAMI). Electronic searches of English and Chinese databases and hand searches of Chinese journal holdings were conducted. Randomised controlled trials comparing orally administered CHM with placebo, no intervention or other therapy were considered. Ginkgo biloba was excluded. Ten trials met inclusion criteria. Eight different CHM were investigated. Methodological quality was assessed using the Jadad scale and five studies scored three or above. Two studies compared CHM with placebo and eight with another intervention. This review found an overall benefit on some outcome measures for the eight CHMs involved in the 10 RCTs but methodological and data reporting issues were evident. Meta-analysis of three studies found the effects of the CHMs were at least equivalent to piracetam on Mini-Mental State Examination (MMSE) scores. No severe adverse events were reported.

Herbal medicine for dementia: a systematic review.

This systematic review aimed to assess the effectiveness and safety of herbal medicines (HM) for treating dementia. Databases in English and Chinese were searched from their inceptions to February 2007. References in reviews and randomized controlled trials (RCTs) were screened by hand. Trials comparing orally administered HM with placebo, no intervention or other therapy were considered. Trials on Ginkgo biloba and its extracts were excluded to avoid duplication of existing reviews. Pairs of authors independently applied eligibility criteria, extracted data and assessed methodological quality using the Jadad Scale. Thirteen RCTs met the inclusion criteria of three or above on this scale. Six trials compared herbal medicine with placebo, one with no treatment, and the remainder with pharmaceutical intervention. Meta-analyses were performed on common cognitive performance outcome measures. All studies reported HM had significant effects in improving symptoms. In studies that employed active controls, HM was at least as effective as the pharmaceutical intervention. Meta-analyses found HM more effective than no treatment or placebo and at least equivalent to control interventions, although the overall effect was small. No severe adverse events were reported. These trials provide overall positive evidence for the effectiveness and safety of certain HMs for dementia management.