Min Cheol Joo

Nonlinear Analysis of Heart Rate Variability During Qi Therapy (External Qigong)

Heart rate variability (HRV) was compared in 30 subjects receiving external Qi therapy (EQT) or placebo control therapy, in a crossover design experiment. Subjects who received the EQT reported more pleasant and calm emotions than did the placebo group. Qi therapy reduced the heart rate and increased HRV as indicated by a reduced low frequency/high frequency power ratio of HRV. With nonlinear analysis, the Poincaré plot index of HRV and approximate entropy was greater in the EQT group than in the control group. These findings suggest that EQT stabilizes the sympathovagal function and cardiac autonomic nervous system by inducing more positive emotions than the placebo therapy. In conclusion, EQT may act by stabilizing both the autonomic nervous system and the emotional state.

Patterns of using complementary and alternative medicine by stroke patients at two university hospitals in Korea.

This study measured the prevalence of complementary and alternative medicine (CAM) use among Korean stroke patients. Questionnaire-based 20-min interviews were conducted at the hospitals by a trained nurse after an outpatient visit. It included questions on demographic information, clinical information and the utilization of CAM. Of 304 stroke-patient respondents, 164 (54%) had used CAM, of which 66% had started taking CAM products following suggestions from family members and other relatives. Of the 57% of users who felt that CAM was effective, 84% considered that it improved the symptoms of stroke and 16% felt it was effective in achieving psychological relaxation. Of the eight CAM categories used by respondents, 92% used traditional Oriental medical treatments, 36% used plant- and animal-derived over-the-counter health care products, 24% used minerals and vitamins, and 11% used manual therapies. The majority of stroke patients (68%) were trying a new type of CAM, and half of the respondents (45%) relied on the knowledge of their general practitioner about CAMs when deciding whether to use them. Most of the stroke patients in this study used CAM, and a half of them reported beneficial effects. Despite the presence of adverse side effects, they tended to be used without discussion with chief physicians, and hence physicians should be actively involved in the usage of CAM.

Use of complementary and alternative medicine by rheumatoid arthritis patients in Korea.

This study measured the prevalence of use of complementary and alternative medicine (CAM) in Korean patients with rheumatoid arthritis (RA). A trained nurse conducted 20-min questionnaire-based interviews at the hospitals when each patient visited as an outpatient. The questionnaire included questions on demographic information, clinical information, and the use of CAM. Of the 153 respondents, 125 (82%) had used CAM; 37% of those who used CAM had started taking CAM products following suggestions from family members and other relatives. In users of CAM, 35% considered that it improved the symptoms of RA, and 14% felt it was effective in achieving psychological relaxation. We categorized treatment into six CAM categories used by the respondents: 84.0% of patients used traditional Oriental medical treatments, 70.4% used plant- and animal-derived over-the-counter health care products, and 13.6% used manual therapies. Most RA patients (64%) would like to try a new type of CAM. About half of the respondents (48%) expected to receive information about CAM from their general practitioner even if most (72%) did not discuss their use of CAM with their doctor. Most of the RA patients in this study used CAM, and half reported beneficial effects. Despite the presence of adverse side effects, patients tended to use CAM without discussing it with their main physicians, suggesting that physicians should be actively involved in the prescription and use of CAM.

Korean Stroke Cohort for functioning and rehabilitation (KOSCO): study rationale and protocol of a multi-centre prospective cohort study

BackgroundDevelopment of a long-term stroke care plan requires serial assessment of long-term patient function and consideration of caregiver mood. However, to date, few comprehensive cohort studies have included both stroke patients and caregivers.Methods/DesignKOSCO is a large, multi-centre prospective cohort study for all acute first-ever stroke patients admitted to participating hospitals in nine distinct areas of Korea. This study is designed as a 10-year, longitudinal follow-up investigating the residual disabilities, activity limitations, and quality of life issues arising in patients suffering from first-ever stroke. The main objectives of this study are to identify the factors that influence residual disability and long-term quality of life. The secondary objectives of this study are to determine the risk of mortality and recurrent vascular events in patients with acute first-ever stroke. We will investigate longitudinal health behaviors and patterns of healthcare utilization, including stroke rehabilitation care. We will also investigate the long-term health status, mood, and quality of life in stroke patient caregivers. In addition, we will identify baseline and ongoing characteristics that are associated with our secondary outcomes.DiscussionKOSCO is a prospective, multi-centre, 10-year longitudinal follow-up study investigating the residual disabilities, activity limitations, and quality of life issues arising in patients suffering from first-ever stroke.

Bowel dysfunction and colon transit time in brain-injured patients.

Objective To report the defecation patterns of brain-injured patients and evaluate the relationship between functional ability and colon transit time (CTT) in stroke patients. Method A total of 55 brain-injured patients were recruited. Patient interviews and medical records review of pattern of brain injury, anatomical site of lesion, bowel habits, constipation score, and Bristol scale were conducted. We divided the patients into constipation (n=29) and non-constipation (n=26) groups according to Rome II criteria for constipation. The CTTs of total and segmental colon were assessed using radio-opaque markers Kolomark® and functional ability was evaluated using the functional independence measure (FIM). Results Constipation scores in constipation and non-constipation groups were 7.32±3.63 and 5.04±2.46, respectively, and the difference was statistically significant. The CTTs of the total colon in both groups were 46.6±18.7 and 32.3±23.5 h, respectively. The CTTs of total, right, and left colon were significantly delayed in the constipation group (p<0.05). No significant correlation was found between anatomical location of brain injury and constipation score or total CTT. Only the CTT of the left colon was delayed in the patient group with pontine lesions (p<0.05). Conclusion The constipation group had significantly elevated constipation scores and lower Bristol stool form scale, with prolonged CTTs of total, right, and left colon. In classification by site of brain injury, we did not find significantly different constipation scores, Bristol stool form scale, or CTTs between the groups with pontine and suprapontine injury.

Effect of obesity on functional outcomes at 6 months post-stroke among elderly Koreans: a prospective multicentre study

Objectives We examined whether obesity based on body mass index (BMI) was a predictor of functional independence measure (FIM) at 6 months after ischaemic stroke onset while adjusting for stroke risk factors and covariates and stratifying by age group. Design This is an interim report of the Korean Stroke Cohort for Functioning and Rehabilitation that was designed as a nested case study within a nationwide hospital-based cohort. Setting We identified all patients who were admitted to nine representative hospitals in Korea from 2012 until 2014 under a diagnosis of acute first-ever ischaemic stroke. The hospitals were selected from the metropolitan district, mid-sized cities and a small-sized city. Participants The sample included 2057 patients with acute ischaemic stroke who were at least 18 years old. Primary and secondary outcome measures We divided participants into two age levels (<65 and ≥65 years). Participants were classified into five groups according to their baseline BMI at admission: underweight (BMI<18.5), normal (18.5≤BMI<23), overweight (23≤BMI<25), obese (25≤BMI<30) and extremely obese (30≤BMI). Results The proportion of patients who were aged ≥65 years was 55.0%. The proportions of underweight, normal, overweight, obese and extremely obese patients were 2.6%, 24.3%, 29.6%, 37.2% and 6.3%, respectively, in the <65 years group and 5.5%, 34.5%, 27.9%, 28.8% and 3.3%, respectively, in the ≥65 years group. In a multiple linear regression, the 6-month FIM after stroke in the elderly group was significantly associated with being extremely obese (7.95, p<0.05) after adjusting for confounding variables. In the <65 years group, the 6-month FIM was not associated with any weight category. Conclusions This nationwide hospital-based cohort study showed that extreme obesity is a predictor of a good 6-month FIM, especially in patients with ischaemic stroke who are at least 65 years of age.

Return to work after stroke: The KOSCO Study.

OBJECTIVE To investigate the return to work status of patients with first-ever stroke with functional independence 6 months post-stroke. DESIGN Prospective cohort study. PARTICIPANTS Nine hundred and thirty-three patients with functional independence at 6 months after stroke onset. METHODS A complete post-enumeration survey was performed through a review of the medical records for first admission. In addition, structured self-administered questionnaires and a face-to-face interview were performed assessing occupational status, quality of life, and emotional status at 6 months after stroke. RESULTS Of the patients in this study, 60.0% returned to work at 6 months after stroke. Sex, age, educational level, and comorbidity level were independent factors related to return to work. The rate of return to work in female patients under 65 years of age was similar to that of male patients 65 years of age or older. Stroke patients who returned to work showed better emotional statuses than those who did not return to work. CONCLUSION Many stroke patients did not return to work despite functional independence at 6 months after stroke. Based on the results of this study, we suggest providing appropriate vocational rehabilitation for stroke patients and proper education for employers to increase the rate of early return to work in stroke patients.

Effects of Hippotherapy on Psychosocial Aspects in Children With Cerebral Palsy and Their Caregivers: A Pilot Study

Objective To investigate the effects of hippotherapy on psychosocial and emotional parameters in children with cerebral palsy (CP) and their caregivers. Methods Eight children with CP were recruited (three males and five females; mean age, 7.3 years; Gross Motor Function Classification System levels 1–3). Hippotherapy sessions were conducted for 30 minutes once weekly for 10 consecutive weeks in an indoor riding arena. The Gross Motor Function Measure (GMFM), Pediatric Balance Scale (PBS), and the Korean version of the Modified Barthel Index were evaluated. All children were evaluated by the Childrens Depression Inventory, Trait Anxiety Inventory for Children, State Anxiety Inventory for Children, Rosenberg Self Esteem Scale, and the Korean-Satisfaction with Life Scale (K-SWLS). Their caregivers were evaluated with the Beck Depression Inventory, the Beck Anxiety Inventory, and the K-SWLS. We assessed children and their caregivers with the same parameters immediately after hippotherapy. Results Significant improvements on the GMFM, dimension E in the GMFM, and the PBS were observed after hippotherapy compared with the baseline assessment (p<0.05). However, no improvements were detected in the psychosocial or emotional parameters in children with CP or their caregivers. None of the participants showed any adverse effects or accidents during the 10 weeks hippotherapy program. Conclusions Hippotherapy was safe and effectively improved gross motor and balance domains in children with CP. However, no improvements were observed in psychosocial or emotional parameters.

Effects of Bladder Function by Early Tamsulosin Treatment in a Spinal Cord Injury Rat Model

Objective To investigate the effects of early tamsulosin treatment on changes in bladder characteristics after a spinal cord injury. Methods We divided 45 rats into three groups: the control (CON) group, the spinal cord injury (SCI) group, and the SCI+tamsulosin treatment (SCI+TAM) group. Spinal cord transection was performed in the SCI and SCI+TAM groups. Tamsulosin was injected for 7 days in the SCI+TAM group. Intravesical and intra-abdominal catheters were implanted before cord injury. Basal pressure (BP), maximal vesical pressure (MVP), micturition volume (MV), and voiding interval time (VIT) were measured at 7 days after SCI. The bladder was then removed and used for an in vitro organ bath study and Western blot analysis. The percentage changes in contractility from baseline after acetylcholine alone, pretreatment with a muscarinic 2 (M2) receptor blocker (AQ-RA741), and pretreatment with a M3 receptor blocker (4-DAMP) were compared among the groups. Western blot analyses were performed to determine expression levels of pERK1/2 and rho-kinase. Results In cystometry, MVP, BP, MV, and VIT showed changes in the SCI and SCI+TAM groups versus the CON group (p<0.05). In the organ bath study, acetylcholine-induced contractility in the three groups differed significantly (p<0.05). Additionally, acetylcholine-induced contractility with 4-DAMP pretreatment was reduced significantly in the SCI+TAM group versus the SCI group. In Western blotting, pERK1/2 expression was stronger (p<0.05) and rho-kinase expression was weaker in the SCI+TAM group than the SCI group (p<0.05). Conclusion These results suggest that the bladder contraction due to acetylcholine after SCI can be decreased by tamsulosin in the acute stage and this involves changes in pERK1/2 and rho-kinase.

Accuracy of Heart Rate Measurement Using Smartphones During Treadmill Exercise in Male Patients With Ischemic Heart Disease

Objective To evaluate the accuracy of a smartphone application measuring heart rates (HRs), during an exercise and discussed clinical potential of the smartphone application for cardiac rehabilitation exercise programs. Methods Patients with heart disease (14 with myocardial infarction, 2 with angina pectoris) were recruited. Exercise protocol was comprised of a resting stage, Bruce stage II, Bruce stage III, and a recovery stage. To measure HR, subjects held smartphone in their hands and put the tip of their index finger on the built-in camera for 1 minute at each exercise stage such as resting stage, Bruce stage II, Bruce stage III, and recovery stage. The smartphones recorded photoplethysmography signal and HR was calculated every heart beat. HR data obtained from the smartphone during the exercise protocol was compared with the HR data obtained from a Holter electrocardiography monitor (control). Results In each exercise protocol stage (resting stage, Bruce stage II, Bruce stage III, and the recovery stage), the HR averages obtained from a Holter monitor were 76.40±12.73, 113.09±14.52, 115.64±15.15, and 81.53±13.08 bpm, respectively. The simultaneously measured HR averages obtained from a smartphone were 76.41±12.82, 112.38±15.06, 115.83±15.36, and 81.53±13 bpm, respectively. The intraclass correlation coefficient (95% confidence interval) was 1.00 (1.00–1.00), 0.99 (0.98–0.99), 0.94 (0.83–0.98), and 1.00 (0.99–1.00) in resting stage, Bruce stage II, Bruce stage III, and recovery stage, respectively. There was no statistically significant difference between the HRs measured by either device at each stage (p>0.05). Conclusion The accuracy of measured HR from a smartphone was almost overlapped with the measurement from the Holter monitor in resting stage and recovery stage. However, we observed that the measurement error increased as the exercise intensity increased.