Utility of a unilateral accelerometer for monitoring upper extremity use in subacute stroke patients after discharge from hospital.

This study was to investigate the utility of a unilateral accelerometer, which is commonly used for monitoring upper extremity performance, in subacute stroke patients by comparing its use with other upper extremity assessments. Twenty-four participants were recruited and required to wear an accelerometer on the affected wrist for 3 hours daily for the first 4 weeks after discharge from hospital. Assessments included Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), Box and Block Test (BBT), and self-reporting Motor Activity Log (MAL). Assessments were made at 0, 4, 8, and 12 weeks after hospital discharge. How long the device was worn, movement amount, and movement percentage were extracted from the accelerometer. Throughout the 12-week observation, significant improvements in the participants were shown by the FMA-UE, ARAT, and BBT (p < 0.001, p = 0.026, and p < 0.001, respectively), but no significant change could be found using MAL or the accelerometer parameters across time (p = 0.068 to 0.999). There was moderate-to-good correlation among the assessments; however, no significant correlation was obtained between any of the assessments and the accelerometer data. We suggest that the unilateral accelerometer might not be useful to reflect actual arm functions in daily activities.

"Remind-to-Move" for Promoting Upper Extremity Recovery Using Wearable Devices in Subacute Stroke: A Multi-Center Randomized Controlled Study.

This paper examined the effects of "Remind-to-Move" (RTM) via vibration cueing using wearable devices to increase the use of the affected upper limb and integrate upper limb activities undertaken at home in patients with subacute stroke after inpatient discharge. In a multi-centered randomized controlled trial, 84 eligible patients from four general hospitals, who had a first stroke in the last six months, were randomly allocated to either an experimental, sham, or control group, stratified by arm function levels. Patients in the experimental group were treated by RTM, using wearable devices for three consecutive hours daily, over four weeks. The sham group used sham devices, and the control group received usual care alone. A masked assessor evaluated the patients at 0th, 4th, 8th, and 12th weeks using outcome measures included arm function tests, motor activity log, and movement recorded by the devices. Results showed that there was a significant group by time interaction, and the average movement amount and Action Research Arm Test score in the experimental group were significantly higher than in the sham group. This paper demonstrates that RTM via wearable devices used for the hemiplegic upper extremities could promote more arm recovery than the sham or control and, hence, produce an optimal functional improvement for subacute stroke patients.

Validation of the World Health Organization Assessment Schedule II Chinese Traditional Version (WHODAS II CT) in persons with disabilities and chronic illnesses for Chinese population.

PURPOSE: The aim of this study is to test the psychometric properties and validity of the World Health Organization Assessment Schedule II Chinese Traditional Version (WHODAS II CT) in Traditional Chinese-speaking persons with disabilities and chronic illnesses. METHOD: The WHODAS II CT has been administrated to a sample of 1020 persons with disabilities and chronic illnesses. The construct validity, internal consistency, concurrent validity and convergent validity were evaluated. RESULTS: WHODAS II CT showed a satisfactory model fit for the second-order confirmatory factor analysis model (χ(2)/df = 3.05, root means square error of approximation = 0.053, comparative fit index = 0.912, standardized root mean square residual = 0.076), high internal consistency (Cronbach's α = 0.98), high correlation with all domains of Dartmouth Primary Care Cooperative Research Network/World Organization of National Colleges, Academies, and Academic Associations of General Practices/Family Physicians (COOP/WONCA) charts (partial correlation coefficient ranged from 0.26 to 0.74) and significance between persons with and without co-morbidity (all regression coefficients >0). CONCLUSIONS: WHODAS II CT is a reliable and valid instrument to measure the disability in persons with disabilities and chronic illnesses among Traditional Chinese-speaking population. A further study is required to validate the short version of WHODAS II in order to enhance its applicability in usual and clinical practices. Implications for Rehabilitation This is the first study to evaluate the reliability and validity of WHODAS II in persons with disability and chronic illnesses among Traditional Chinese-speaking population. The WHODAS II CT is a valid instrument in Chinese adults with disabilities and chronic illnesses. The WHODAS II CT is recommended to be used in population-based survey to investigate the health needs of persons with disabilities and chronic illnesses as well as in the rehabilitation programs as an outcome measure.