Huey-Wen Liang

Predicting health-related quality of life in patients with low back pain

Study Design. Cross-sectional surveys of health-related quality of life (HRQOL) in patients with low back pain at ambulatory clinics plus 8 weeks of follow-up. Objective. The objective of this study is to predict the HRQOL in patients with low back pain. Summary of Background Data. There is disagreement on the relative contribution of pain, physical impairment, functional status, and psychological factors on the disability and HRQOL in patients with low back pain. Methods. Data were collected from 232 patients with low back pain who were consecutively recruited from several clinics of physical medicine and rehabilitation. Every patient received physical examination and completed a set of questionnaire, including the Taiwan version of the Brief Questionnaire of the World Health Organization on quality of life (WHOQOL-BREF), Modified Roland and Morris Disability Questionnaire, and visual analogue scale for pain intensity and for HRQOL. These patients were observed with a mail questionnaire 8 weeks later. The results of WHOQOL-BREF were also compared to those obtained from another 213 healthy volunteers who were accompanied persons with patients, volunteer workers in hospitals, and hospital employees. Results. Results showed that there were significant correlations of HRQOL with pain intensity, disability scale, and disability days. Among the results of physical examination, lumbosacral radiculopathy was the only factor with moderate correlation with HRQOL. The significant predictors for HRQOL included physical domain, psychological domain, pain intensity, and family income. Among all the 232 study patients, 100 of them responded to thefollow-up questionnaire. Changes in environmental domain, disability days, educational level, receiving herb drugs, and physiotherapy were the significant predictors for the changes of HRQOL. Conclusions. The HRQOL of patients with low back pain depended on functional status and psychological factors more than simple physical impairment. Future intervention may need to put more emphasis on improving functional status and psychological stress for these patients.

Thinner plantar fascia predicts decreased pain after extracorporeal shock wave therapy

Increased plantar fascia thickness is common with chronic plantar fasciitis, and reduction of the thickness after extracorporeal shock wave therapy or steroid injection has been reported. We hypothesized a decrease of plantar fascia thickness was associated with pain reduction after extracorporeal shock wave therapy. Fifty-three eligible patients with 78 symptomatic feet were randomly treated with piezoelectric-type extracorporeal shock wave therapy of two intensity levels (0.12 and 0.56 mJ/mm2). Two thousand shock waves for three consecutive sessions were applied at weekly intervals. A visual analog scale for pain, the Foot Function Index, the Short Form-36 Health Survey, and ultrasonographic measurement of plantar fascia thickness were evaluated at baseline and 3 and 6 months after treatment. We analyzed the association between pain level and plantar fascia thickness with generalized estimating equation analysis and adjusted for demographic and treatment-related variables. Patients with thinner plantar fascia experienced less pain after treatment; high-intensity treatment and regular exercise were associated with lower pain level. The overall success rates were 63% and 60% at the 3- and 6-month followups. High- and low-intensity treatments were associated with similar improvements in pain and function. Receiving high-intensity treatment, although associated with less pain at followup, did not provide a higher success rate.Level of Evidence: Level I, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Impact of age on the injury pattern and survival of people with cervical cord injuries

Study design: A retrospective, follow-up study.Objectives: To differentiate the injury pattern and survival of people with cervical cord injuries with onset at different ages.Setting: Rehabilitation wards of a university hospital that is a tertiary referral center in Taipei, Taiwan.Methods: The records of acute and traumatic cervical cord injury patients hospitalized from 1989 to 1997 were reviewed. All subjects received comprehensive rehabilitation programs during hospitalization. Their survival status at the end of follow-up was studied.Results: Forty-seven of 109 (43.1%) people with cervical cord injuries were 50 years or older at onset. Older patients were more frequently injured by minor falls, resulting in more incomplete quadriplegia. They also showed fewer spinal fractures, and more demonstrated associated spondylosis and ossification of the posterior longitudinal ligament. Eleven (10.2%) subjects were deceased, found by a linkage to a death registration database at the end of follow-up. The significant predictor of survival status at follow-up was older age at injury using Cox proportional hazards model.Conclusion: Spinal cord injured patients had different injury patterns, demanding different preventative strategies. Those injured at older ages were at higher risk of mortality according to our study.Sponsorship: This study was supported in part by grants from the National Taiwan University Hospital (89S2005), Taipei, Taiwan.Spinal Cord (2001) 39, 375–380.

The effectiveness of a functional training programme for patients with chronic low back pain - a pilot study

Introduction. To investigate the effect of an individualised functional training programme for patients with low back pain (LBP). Methods. A randomised, controlled trial with single-blind design was conducted. Patients with non-specific LBP for at least 3 months were recruited and randomised into training and control groups. Both groups maintained their current treatment, and the training group participated in an additional programme for 100 h. Measures were performed initially and after completing the programme, and included rating determining impairment associated with pain, Oswestry disability index (ODI) and functional capacity evaluation (FCE). Results. Thirteen in the training group completed the training and measurements, and 12 in the control group completed their measurements. Twelve items in FCE had significant improvement in training group, but only one in control group. Severity of pain (11.8 ± 3.6–5.6 ± 3.6), activity limitation from pain (3.2 ± 1.5–1.5 ± 1.1) and emotional disturbance by pain (4.3 ± 1.7–2.2 ± 1.4) significantly decreased in the training group, no significant change in the control group. The ODI demonstrated a significant reduction (p = 0.044) in the training group (22 ± 9–16 ± 9), but not in the control group. Conclusion. An individualised functional training programme benefits chronic LBP patients.

Delayed Suspicion, Treatment and Isolation of Tuberculosis Patients in Pulmonology/ Infectious Diseases and Non-Pulmonology/ Infectious Diseases Wards

Background/Purpose Delayed diagnosis and isolation increases the risk of nosocomial transmission of tuberculosis (TB). To assess the risk of delayed management of TB, we analyzed the risk factors of prolonged delay in isolation of smear-positive TB patients in pulmonology/infectious diseases and other wards in a tertiary teaching hospital. Methods We enrolled smear-positive TB patients aged > 16 years with delayed respiratory isolation following hospitalization. Medical records were reviewed retrospectively. Time intervals between admission, order of sputum acid-fast staining, initiation of anti-tuberculous treatment and isolation were compared between pulmonology/infectious diseases wards (PIWs) and other wards. Risk factors were analyzed in patients with prolonged isolation delay of > 7 days in individual groups. Results Isolation was delayed in 191 (73.7%) of 259 hospitalized smear-positive TB patients. Median suspicion, treatment and isolation delays were 0, 3 and 4 days in PIWs and 1, 5 and 7 days in other wards. For patients admitted to non-PIWs, atypical chest radiographs, symptoms without dyspnea or not being admitted from the emergency department (ED) were risk factors for prolonged isolation delay exceeding 7 days. The only risk factor for delayed isolation in patients admitted to PIWs was age ≥ 70 years. Conclusion Delays in suspicion, treatment and isolation of TB patients were longer in non-PIWs. Clinicians should be alert to those admitted to non-PIWs with atypical chest radiographs, atypical symptoms, or not admitted from the ED.

ELECTROPHYSIOLOGICAL AND FUNCTIONAL EFFECTS OF SHOCK WAVES ON THE SCIATIC NERVE OF RATS

Extracorporeal shockwave therapy (ESWT) has been applied in lithotripsy and treatments of musculoskeletal disorders over the past decade, but its effects on peripheral nerves remain unclear. This study investigated the short-term effects of shockwaves on the sciatic nerve of rats. The nerves were surgically exposed and then stimulated with shockwaves at three intensities. We evaluated the motor nerve conduction velocity (MNCV) of treated sciatic nerves before, immediately after (day 0) and at 1, 4, 7 and 14 d after shockwave treatment. Two functional tests-the sciatic functional index and the withdrawal reflex latency-were evaluated before and at 1, 4, 7 and 14 d after shockwave application. The rats were sacrificed on days 0, 1, 4, 7 and 14 for morphologic observation. The degassed treatment group received high-intensity shockwave treatment using degassed normal saline as the contact medium, and MNCV was measured before and on days 0, 1, 4, 7 and 14. The sham group received the same procedure as the treatment groups (i.e., the surgical operation to expose the sciatic nerve) but with no shockwave treatment. The control group received no surgical operation or shockwave treatment. The results showed moderate decrease in the MNCV after shockwave treatment and damage to the myelin sheath of large-diameter myelinated fibers. The effect was largest (reduction to 60.9% of baseline MNCV) and of longest duration (7 to 14 d) in the high-intensity group. There were no significant changes in functional tests. These results indicated that direct application of shockwaves can induce reversible segmental demyelination in large-diameter fibers, with the electrophysiological changes being positively correlated with the intensity of the shockwaves.

Ultrasound-guided injection of steroid in multiple postamputation neuromas.

After limb amputation, neuromas may be asymptomatic when not compressed, but can cause unexplained discomfort when a prosthesis is worn. The sonographic presentation of multiple postamputation neuromas has rarely been reported. A 40‐year‐old female with a left, below‐elbow amputation suffered from late‐onset stump pain and prosthesis intolerance. Physical examination revealed a painful nodule, whereas sonographic findings disclosed three hypoechoic masses derived from the median, ulnar, and radial nerves. Marked pain reduction was reported 2 weeks after sonography‐guided steroid injection. Investigation of all damaged nerves in the residual limbs is important.

Correlation Between Subclinical Median Neuropathy and the Cross-Sectional Area of the Median Nerve at the Wrist

Although subclinical median neuropathy is not uncommon, its correlation with sonographic changes to the median nerve at the wrist has not been studied. We included 62 subjects (with 107 wrists) who reported experiencing no hand numbness. All subjects underwent nerve conduction studies (NCS) and sonography for median nerve at the pisiform level. The cross-sectional area (CSA), perimeter, long axis and short axis of median nerve were obtained off-line by manual tracing with a mouse and computed by one algorithm written in MatLab. Eighteen wrists met the inclusion criteria of subclinical median neuropathy. The CSA, perimeter and long axis of the median nerve were significantly different between normal and abnormal NCS wrists. Mixed model analysis showed that subclinical neuropathy was associated with enlarged CSA, but the other demographic variables (gender, age and body mass index and occupational categories) were not. Our findings support the use of both patient symptoms and NCS to define normal subjects during further studies. In addition, enlarged CSA within asymptomatic individuals should raise concern for subclinical median neuropathy.

Effects of passive computer use time and non-computer work time on the performance of electronic activity monitoring

This study aimed to examine the effects of passive and non-computer work time on the estimation of computer use times by electronic activity monitoring. A total of 20 subjects with computers were monitored for 3 h. Average relative error for total computer use time estimation was about 4%, given that non-computer work time was 20% of the 3-h monitored period. No significant impact of passive computer use time was found in this study. Non-computer work time of 40% or less is suggested as criteria for the application of electronic activity monitoring to ensure reliability in the physical work loading assessment. Statement of Relevance: This research studied the criteria of non-computer work time for the appropriate use of electronic activity monitoring to ensure reliability in the assessment of physical work loading. It is suggested that it should be set to 40% or less of the 3-h monitoring period.

Influence of smartphone use styles on typing performance and biomechanical exposure

Abstract Twenty-seven subjects completed 2-min typing tasks using four typing styles: right-hand holding/typing (S-thumb) and two-hand typing at three heights (B-low, B-mid and B-high). The styles had significant effects on typing performance, neck and elbow flexion and muscle activities of the right trapezius and several muscles of the right upper limb (p < 0.0001 by repeated-measure analysis of variance). The subjects typed the fewest words (error-adjusted characters per minute: 78) with the S-thumb style. S-thumb style resulted in similar flexion angles of the neck, elbow and wrist, but significantly increased muscle activities in all tested muscles compared with the B-mid style. Holding the phone high or low reduced the flexion angles of the neck and right elbow compared with the B-mid style, but the former styles increased the muscle activity of the right trapezius. Right-hand holding/typing was not a preferable posture due to high muscle activities and slow typing speed. Practitioner Summary: Right-hand holding/typing was not favoured, due to increased muscle activities and slower typing speed. Holding the phone high or low reduced the flexion angles of the neck and right elbow, but the former styles increased the muscle activity of the right trapezius compared with holding the phone at chest level.