Thai version of the Questionnaire for Diabetes-Related Foot Disease (Thai Q-DFD): validity and reliability.

AIMS: To reduce diabetic foot complications, an annual screening of diabetes-related foot disease (DRFD) should be promoted. The screening tool as the Thai translated Questionnaire for Diabetes-related Foot Disease, Thai Q-DFD, has been established. The study was designed to assess the validity and reliability of the Thai Q-DFD before practical use in the community. METHODS: One hundred and thirty-nine persons with diabetes volunteered in a concurrent validity testing for agreement in diagnosis between the Thai Q-DFD and the standard clinical examinations. The test-retest reliability (a stability of a tool over time between three days apart) was assessed in 50 volunteers. The agreement in either validity or reliability test was evaluated using kappa coefficient. RESULTS: The screening diagnosis as DRFD by the Thai Q-DFD substantially agreed with that by the standard clinical examinations (kappa = 0.71). The Thai Q-DFD also showed high sensitivity (0.92) and specificity (0.78). Additionally, the Thai Q-DFD presented good test-retest reliability for DRFD diagnosis (kappa = 0.74). CONCLUSIONS: The Thai Q-DFD is comparable to the original English version in terms of concurrent validity and test-retest reliability. Therefore, it can be used for a screening of DRFD in Thai people.

Medical complications and falls in patients with spinal cord injury during the immediate phase after completing a rehabilitation program.

BACKGROUND/OBJECTIVES: Complications and falls are crucial problems in patients with spinal cord injury (SCI). However, existing evidence on complications comes from data from hospital records over a long period of time, and falls were mostly reported retrospectively in patients with incomplete SCI. This study prospectively explored the occurrence of complications and falls, and associated factors in patients with SCI during the 6 months after discharge. METHODS: One hundred subjects with SCI (50 wheelchair-bound (WB) and 50 ambulatory (AM) subjects) from a tertiary rehabilitation center completed the study. Every month, subjects were monitored for data on medical complications and falls. Descriptive information is provided for each group. RESULTS: Every WB subject had complications and 14 subjects were re-hospitalized. The most frequent complications found in these subjects were neurogenic pain (36 subjects), urinary tract infection (UTI) (25 subjects), and pressure ulcers (21 subjects). In AM subjects, 38 subjects (76%) experienced complications and 3 subjects needed re-hospitalization. The most frequent complications included neurogenic pain (35 subjects) and UTI (11 subjects). Eighteen WB subjects (36%) and 27 AM subjects (54%) experienced falls. WB subjects had significantly increased odds for incidence of UTI and pressure ulcers, whereas AM subjects had significantly greater odds for falls (P < 0.05). CONCLUSION: A number of subjects with SCI experienced complications and falls after completing a rehabilitation program. The findings add to our knowledge about complications and falls after SCI, and confirm the importance of effective strategies to minimize the occurrence of complications and falls in these individuals.

Changes of functional ability in patients with spinal cord injury with and without falls during 6 months after discharge.

BACKGROUND: Ambulatory patients with spinal cord injury (SCI) encounter a high risk of falls. However, most of the fall data in the literature were subjectively reported, without evidence to confirm the functional ability of those with and without falls. OBJECTIVES: The purpose of this study was to prospectively evaluate changes in functional ability relating to falls in participants with SCI who fell and those who did not fall during the 6-month period after discharge. DESIGN: A 6-month prospective design was used in the study. METHOD: Fifty independent ambulatory participants with SCI were assessed for their functional ability using the Timed "Up & Go" Test, 10-Meter Walk Test, Berg Balance Scale, and Six-Minute Walk Test (6MWT) prior to discharge and 6 months afterward. After discharge, the participants' fall data were monitored monthly to categorize them into faller (≥1 fall in 6 months) and nonfaller (no fall) groups. RESULTS: Twenty-seven participants (54%) fell, and their baseline functional abilities were obviously lower than those who did not fall. After 6 months, the functional ability of these participants showed significant improvement for every test, whereas those who did not fall demonstrated a significant improvement only for the 6MWT. After adjusting for the baseline data, the functional ability at 6 months showed no significant differences between the groups. LIMITATIONS: The study did not monitor physical activities of the participants during the follow-up period. The findings on fear of falling were subjectively reported by the participants. CONCLUSIONS: Participants with SCI are commonly characterized as being active and enthusiastic, which may drive their physical activities. However, sensorimotor impairments following SCI hinder their ability to move safely, particularly in those with more functional deterioration. Therefore, greater functional improvement is accompanied by a higher risk of falls. Because falls can induce serious consequences, rehabilitation professionals may need to seek strategies to improve safety issues during movement for these patients, particularly in their own environments.