Chih Yi Chen

A Randomized, Controlled Trial of Fall Prevention Programs and Quality of Life in Older Fallers

OBJECTIVES: To compare the effects of three fall‐prevention programs (education (ED), home safety assessment and modification (HSAM), and exercise training (ET)) on quality of life (QOL), functional balance and gait, activities of daily living (ADLs), fear of falling, and depression in adults aged 65 and older.

Comparisons of the brief form of the world health organization quality of life and short form-36 for persons with spinal cord injuries

Lin M-R, Hwang H-F, Chen C-Y, Chiu W-T. Comparisons of the Brief Form of the World Health Organization Quality of Life and Short Form-36 for Persons with Spinal Cord Injuries. Am J Phys Med Rehabil 2007;86:104–113. Objective:This study compared the psychometric performance of the brief form of the World Health Organization Quality of Life (WHOQOL-BREF) with the Short-Form 36 (SF-36) for people with traumatic spinal cord injuries in Taiwan. Design:From a nationwide registry of traumatic spinal cord injuries, 187 subjects completed telephone interviews. Score distributions, internal consistency, intrainterviewer and interinterviewer test-retest reliabilities, convergent and known-groups validities, and the responsiveness between the WHOQOL-BREF (with an overall quality-of-life facet and four domains) and the SF-36 (with eight domains) were compared. Results:Both the WHOQOL-BREF and the SF-36 exhibited low missing values (0.9∼7.7 vs. 2.1∼3.8), very good internal consistencies (Cronbachs alpha coefficients of 0.75∼0.87 vs. 0.72∼0.98), intrainterviewer reliabilities (intraclass correlation coefficients of 0.84∼0.98 vs. 0.71∼0.99) and responsive statistics (0.787∼1.83 vs. 0∼0.92), and fair interinterviewer reliabilities (intraclass correlation coefficients of 0.56∼0.95 vs. 0.41∼0.98), whereas the WHOQOL-BREFs domains converged with the conceptually related domains of the SF-36. Nonetheless, compared with the SF-36, the WHOQOL-BREF had lower percentages of ceiling (0.0%∼0.4% vs. 0.4%∼63.8%) and floor (0.0%∼1.3% vs. 0.4%∼ 28.1%) values and better known-groups validity and responsiveness. Conclusions:The WHOQOL-BREF is an appropriate generic health-related quality of life measure for persons with traumatic spinal cord injuries.

Relation between Motorcycle Helmet Use and Cervical Spinal Cord Injury

A case-control study was conducted to determine the relationship between motorcycle helmets, including type (i.e. partial or full coverage) and fastening status (i.e. loose or firm), and cervical spinal cord injuries (SCIs) in Taiwan. Based on a nationwide registry consisting of 396 motorcycle riders with traumatic SCIs during the 4-year period from July 1992 to June 1996, 229 subjects injured at cervical levels were defined as cases and 167 injured at other spinal levels as controls. Furthermore, additional information on the type and fastening status of the helmet was collected by telephone interview, and 147 subjects, including 79 with cervical and 68 with noncervical lesions, responded. Results of the logistic regression model show that neither different helmet types nor fastening status increased the occurrence of cervical SCIs when motorcycle riders were involved in severe crashes.

Effect of Fracture Type on Health-Related Quality of Life Among Older Women in Taiwan

OBJECTIVE To investigate changes in health-related quality of life (HRQOL) during the first year after injury in elderly Taiwanese women who had fractured a hip, vertebra, distal forearm, or multiple sites. DESIGN Longitudinal cohort study. SETTING Personal or telephone interviews of patients from 3 teaching hospitals. PARTICIPANTS Women (N=347; mean age ± SD, 78.0±6.6y) who had sustained a fracture of the hip, vertebra, or distal forearm due to a fall participated in the baseline assessment, in which both current and prefracture HRQOL data were collected. At 6 and 12 months after the fracture, 285 and 254 women, respectively, completed the follow-up assessments. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The 4 domains of physical capacity, psychological well-being, social relationships, and environment of the brief version of the World Health Organization Quality of Life questionnaire were assessed. RESULTS After adjusting for prefracture HRQOL scores and baseline characteristics, women with a hip fracture showed a significant improvement in physical capacity (3.5 points) and a significant decline in social relationships (-3.7 points). Relative to women with a hip fracture at 12 months after injury, those with a vertebral fracture exhibited significantly greater improvement (5.2 points) in physical capacity; those with a distal forearm fracture had significantly greater improvements in physical capacity (11.5 points), psychological well-being (8.4 points), social relationships (7.2 points), and environment (10.9 points), while those with multiple fractures displayed significantly greater improvement in physical capacity (16.5 points), psychological well-being (13.3 points), and environment (10.3 points). CONCLUSIONS Among the 4 fracture types in elderly women, hip fractures may result in the smallest improvement in the physical domain and the greatest declines in the psychological, social, and environmental domains during the first year. The magnitude of the impact of each fracture type varied across different domains.

A prospective study of factors influencing return to work after traumatic spinal cord injury in Taiwan.

UNLABELLED Lin M-R, Hwang H-F, Yu W-Y, Chen C-Y. A prospective study of factors influencing return to work after traumatic spinal cord injury in Taiwan. OBJECTIVE To examine comprehensively the effects of physical, psychologic, and sociologic characteristics on employment among persons after a traumatic spinal cord injury (SCI) in Taiwan. DESIGN A prospective study with follow-up telephone interviews over a 3-year period. SETTING To register people who had sustained an SCI, medical records of 4 hospitals were reviewed using codes of the International Classification of Diseases-9th Revision-Clinical Modifications from 806.0 to 806.9 and from 952.0 to 952.9. PARTICIPANTS Subjects (N=219) employed at the time of injury. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Employment status after an SCI. RESULTS The employment rate was 32.9%. After controlling for other variables, education level (relative rate [RR]=4.01 approximately 8.17), autonomy in transportation (RR=5.13), professional licensure (RR=1.86), and thrill and adventure-seeking trait (RR=1.12) were positively and significantly associated with employment, while subjects with more severe overall injury severity (RR=0.95), preinjury chronic conditions (RR=0.20), necessity for aids for daily living (RR=0.31), and depression (RR=0.38) were less likely to have been employed than their counterparts. CONCLUSIONS In addition to education level and traditional physical factors, overall injury severity and psychologic factors such as thrill and adventure seeking and depression can also influence the return to work after an SCI.

Effects of Home-Based Tai Chi and Lower Extremity Training and Self-Practice on Falls and Functional Outcomes in Older Fallers from the Emergency Department-A Randomized Controlled Trial.

To compare the effects of guided home‐based tai chi chuan (TCC) and lower extremity training (LET) and of levels of self‐practice on falls and functional outcomes in older fallers.

Effects of fall injury type and discharge placement on mortality, hospitalization, falls, and ADL changes among older people in Taiwan

A longitudinal study was conducted to investigate the effects of injury type and discharge placement on mortality, falls, hospital admissions, and changes in activities of daily living (ADLs) over a 12-month period among older fallers. Of 762 community-dwelling people aged 65 years or older who visited an emergency department (ED) of a general hospital in Taiwan due to a fall, 273 sustained a hip fracture, 157 had a vertebral fracture, 47 had a distal forearm fracture, 102 had a traumatic brain injury, and 183 had soft-tissue injuries. Results showed that, compared to patients with a soft-tissue injury, those with TBI had significantly higher risks of dying (rate ratio (RR)=3.59) and hospital admissions (RR=3.23) and better improvement in ADLs (1.93 points) at 6 months post-injury, and those who sustained a hip fracture (4.26 and 4.41 points), a vertebral fracture (3.81 and 3.83 points), or a distal-forearm fracture (2.80 and 2.80 points) had significantly better improvement in ADLs at 6 and 12 months post-injury. Patients discharged to a nursing home had a significantly increased risk of death (RR=2.08) and hospital admission (RR=2.05) than those returning to their usual residence during the first year post-injury. No significant differences in the occurrence of falls during the first post-injury year were found among patients with different injury types or between those with different discharge placements. In conclusion, among the five major fall injury types in older people, TBIs result in the highest risk of death and hospital admissions, while hip and vertebral fractures exhibited the largest improvement during the first year after injury. Additionally, nursing home care may be associated with increased risks of death and hospital admissions than home care. In addition to primary prevention of falls, further research to investigate mechanisms leading to TBIs during a fall is needed to facilitate effective secondary fall-prevention programs for older people.

Comparisons of different screening tools for identifying fracture/osteoporosis risk among community-dwelling older people

Abstract A prospective study was conducted to compare criterion, predictive, and construct validities of 9 fracture/osteoporosis assessment tools, including calcaneal quantitative ultrasonography (QUS), Age Bulk One or Never Estrogens (ABONE), body weight criterion (BWC), Fracture Risk Assessment Tool (FRAX), Garvan fracture risk calculator (GARVAN), Osteoporosis Risk Assessment Instrument (ORAI), Osteoporosis Index of Risk (OSIRIS), Osteoporosis Self-Assessment Tool for Asians (OSTA), and Simple Calculated Osteoporosis Risk Estimation (SCORE), among older men and women in Taiwan. Using the femoral neck dual-energy x-ray absorptiometry (DXA) T-score as an external criterion, the sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and the area under the receiver operating characteristic curve (AUC) for each tool were calculated. The ability of these tools to predict injurious falls was examined. A principal component analysis was applied to understand whether these tools were measuring the same underlying construct. The FRAX, BWC, ORAI, OSIRIS, OSTA, and SCORE had AUCs of ≥0.8 in men, while the GARVAN, OSIRIS, OSTA, and SCORE had AUCs of ≥0.8 in women. The sensitivity, negative predictive value, and likelihood ratio of the ABONE, BWC, ORAI, OSIRIS, OSTA, and SCORE tools in both men and women were 100%, ≥90%, and 0.0, respectively; the specificity and positive predictive value and likelihood ratio were far from satisfactory. The GARVAN displayed the best predictive ability of a fall in both men (AUCs, 0.653–0.686) and women (AUCs, 0.560–0.567), despite being smaller in women. The 9 screening tools and 2 central DXA measurements assessed 5 different factors, while the ABONE, BWC, ORAI, OSIRIS, OSTA, and SCORE measured the same one. Simple self-assessment tools can serve as initial screening instruments to rule out persons who have osteoporosis; however, these tools may measure a different construct other than fracture/osteoporosis risk.

Risk factors for crash involvement in older motorcycle riders

A prospective cohort study was conducted to identify risk and protective factors for crash involvement in older motorcyclists. Over a 1-year study period from August 2013 to July 2014, study participants were recruited from local community centers of five cities in Taiwan. People aged ≥60 years who rode a motorcycle at least once per week were eligible and were invited to participate in the study. Among 256 older riders who completed the baseline assessment and at least one of the four follow-up assessments, 79 (33.7%) experienced a motorcycle crash over the study period. Results of the proportional hazards model showed that after controlling for age, gender, and riding distance, older riders who had sustained hearing impairment (hazard ratio (HR)=2.58; 95% confidence interval (CI), 1.30-5.15), rode a motorcycle at speeds of ≥41km/h (HR=2.31; 95% CI, 1.26-4.23), and had experienced a motorcycle crash in the past year (HR=1.81; 95% CI, 1.06-3.09) were more likely to be involved in a crash, compared to their counterparts. Conversely, older riders who were obese (HR=0.43; 95% CI, 0.22-0.82) were less likely to be involved in a crash than those with a normal weight, while longer functional reach distances (HR=0.96; 95% CI, 0.93-0.99) and higher Tinetti balance scores (HR=0.79; 95% CI, 0.69-0.91) were associated with a reduced risk of crash involvement. Among older people riding a motorcycle as their primary source of transportation, several factors associated with the occurrence of motorcycle crashes were identified. Restrictions and modifications of these risk factors may help design effective safety interventions for reducing crash and injury risks of this increasing riding population.