Raymond C. K. Chung

Review on vocational predictors: a systematic review of predictors of vocational outcomes among individuals with schizophrenia: an update since 1998

Objective: Predictors of employment outcomes of individuals with schizophrenia have continued to be studied over the past decade with implications for the development of vocational interventions to help the mentally ill get and keep jobs. Methods: A total of 62 relevant studies since 1998 were systematically reviewed by means of meta-analysis and frequency counts. Frequency count allowed all 62 studies to be included, whereas the meta-analysis excluded studies with inadequate information but made it possible to estimate the magnitude of effects. Results: Both methods resulted in similar findings. In contrast to an earlier review, cognitive functioning received overwhelming support as a significant predictor. Other significant predictors included education, negative symptoms, social support and skills, age, work history (previous history of successful employment), and rehabilitation service to restore community functioning and well-being by occupational therapists, psychiatrists, psychologists, social workers and other mental health professionals. Positive symptoms, substance abuse, gender and hospitalization history were found to be non-significant predictors. The frequency count did not support marital status as a significant predictor but the meta-analysis did. Conclusions: This review highlights increasing sophistication in understanding the links between individual characteristics and functional impairments. It also suggests that more research is needed into other potentially important predictors that may be changeable and relate to recovery. These include attitudes and beliefs about disability payments and psychological processes such as self-stigmatization, negative beliefs, and social skills deficits for which intervention may be possible.

The effect of whole body vibration on balance, mobility and falls in older adults: A systematic review and meta-analysis

This systematic review aimed to examine the effect of WBV on balance, mobility and falls among older adults. The databases used included MEDLINE, the Excerpta Medica database, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library Databases of Systematic Reviews, Physiotherapy Evidence Database (PEDro), PubMed, and Science Citation Index (last search in October 2011). Randomized controlled trials that investigated the effect of WBV on balance, mobility or falls in older adults were included in this review. The PEDro score was used to examine the methodological quality of the selected studies. The effect of WBV on balance, mobility and fall-related outcomes were extracted. The data extraction and rating were performed by a researcher and the results were confirmed by the principal investigator. Meta-analysis was done if 3 or more studies measured the same outcome of interest. Among 920 articles screened, fifteen articles (thirteen trials) satisfied the criteria and were included in this review. Methodological quality was good for six of the studies (PEDro score=6-7). Meta-analysis revealed that WBV has a significant treatment effect in Tinetti Total Score (p<0.001), Tinetti Body Balance Score (p=0.010) and Timed-Up-and-Go test (p=0.004). No significant improvement was noted in Tinetti Gait Score after WBV training (p=0.120). The effect of WBV on other balance/mobility outcomes and fall rate remains inconclusive. To conclude, WBV may be effective in improving relatively basic balance ability and mobility among older adults, particularly frailer ones. More good-quality WBV trials are required.

Using Aerobic Exercise to Improve Health Outcomes and Quality of Life in Stroke: Evidence-Based Exercise Prescription Recommendations

Background: Stroke patients often suffer from poor cardiovascular health and deficits in physical, psychosocial and cognitive functioning. Aerobic exercise training may be a viable treatment approach to address these health issues. The objective of this systematic review was to determine the effects of aerobic exercise on various indicators of health, functioning and quality of life in stroke patients. It was hypothesized that the systematic review would reveal compelling support for the effectiveness of aerobic exercise in stroke patients, such that detailed evidence-based exercise prescription recommendations could be derived. Methods: Major electronic databases were searched systematically to identify randomized controlled studies that examined the effects of aerobic exercise in stroke patients (last search performed in January 2012). The methodological quality of each study was evaluated using the PEDro scale (9–10 = excellent; 6–8 = good; 4–5 = fair; <4 = poor). Based on the methodological quality and sample size used, the level of evidence was determined for each study (level 1: PEDro ≥6 and sample size >50; level 2: PEDro ≤5 or sample size ≤50). Meta-analysis was performed on a given outcome when appropriate. Results: Twenty-five trials fulfilled the selection criteria, of which 8 were level 1 studies. Treadmill and cycle ergometer were the two most popular modalities used to provide aerobic training. The most commonly adopted exercise session duration and frequency was 21–40 min and 3–5 days per week, respectively. The duration of the training programme varied, ranging from 3 weeks to 6 months. Over 60% of the trials used a high training intensity [60–80% heart rate reserve (HRR)]. Meta-analysis showed a significant effect on peak oxygen consumption (p < 0.001), peak workload (p < 0.001), maximal gait speed (p = 0.003) and walking endurance (p < 0.001) in favour of aerobic exercise. Meta-analysis revealed no significant effect on self-selected gait speed, Berg balance score and Functional Independence Measure score. The efficacy of aerobic exercise in improving other health outcomes in physical, psychosocial and cognitive domains as well as quality of life was inconclusive. The health risk associated with engaging in such exercise is small. Conclusions: There is strong evidence that aerobic exercise (40–50% HRR progressing to 60–80%) conducted 20–40 min and 3–5 days per week is beneficial for enhancing aerobic fitness, walking speed and walking endurance in people who have had mild to moderate stroke and are deemed to have low cardiovascular risk with exercise after proper screening assessments (grade A recommendation). The effects of aerobic exercise on other health outcomes require further study.

Psychometric Properties of the Mini-Balance Evaluation Systems Test (Mini-BESTest) in Community-Dwelling Individuals With Chronic Stroke

Background The Mini-Balance Evaluation Systems Test (Mini-BESTest) is a new balance assessment, but its psychometric properties have not been specifically tested in individuals with stroke. Objectives The purpose of this study was to examine the reliability and validity of the Mini-BESTest and its accuracy in categorizing people with stroke based on fall history. Design An observational measurement study with a test-retest design was conducted. Methods One hundred six people with chronic stroke were recruited. Intrarater reliability was evaluated by repeating the Mini-BESTest within 10 days by the same rater. The Mini-BESTest was administered by 2 independent raters to establish interrater reliability. Validity was assessed by correlating Mini-BESTest scores with scores of other balance measures (Berg Balance Scale, one-leg-standing, Functional Reach Test, and Timed “Up & Go” Test) in the stroke group and by comparing Mini-BESTest scores between the stroke group and 48 control participants, and between fallers (≥1 falls in the previous 12 months, n=25) and nonfallers (n=81) in the stroke group. Results The Mini-BESTest had excellent internal consistency (Cronbach alpha=.89–.94), intrarater reliability (intraclass correlation coefficient [3,1]=.97), and interrater reliability (intraclass correlation coefficient [2,1]=.96). The minimal detectable change at 95% confidence interval was 3.0 points. The Mini-BESTest was strongly correlated with other balance measures. Significant differences in Mini-BESTest total scores were found between the stroke and control groups and between fallers and nonfallers in the stroke group. In terms of floor and ceiling effects, the Mini-BESTest was significantly less skewed than other balance measures, except for one-leg-standing on the nonparetic side. The Berg Balance Scale showed significantly better ability to identify fallers (positive likelihood ratio=2.6) than the Mini-BESTest (positive likelihood ratio=1.8). Limitations The results are generalizable only to people with mild to moderate chronic stroke. Conclusions The Mini-BESTest is a reliable and valid tool for evaluating balance in people with chronic stroke.

Efficacies of different external controls for excessive foot pronation: a meta-analysis

Objectives This meta-analysis investigated the efficacies of foot orthoses, motion control footwear and therapeutic adhesive taping in controlling foot pronation as compared with no-intervention conditions. Data sources Electronic searches on four electronic databases were performed and the reference lists of the screened articles were also scrutinised. Review methods Two reviewers screened the quasi-randomised or clinical controlled trials that examined the efficacy of the selected interventions in controlling calcaneal eversion. Heterogeneity and publication bias were assessed by I2 index and Eggers regression intercept, respectively. Trial quality was rated by the Physiotherapy Evidence Database scale. Results 29 studies were selected. The I2 indices revealed large heterogeneity which supported the use of a random effect model of meta-analysis. The Eggers regression intercepts suggested that publication bias of the included studies was marginally present in the motion control footwear and the therapeutic adhesive taping groups (p=0.06–0.07). All three interventions were effective in reducing calcaneal eversion (p<0.001) with therapeutic adhesive taping being most effective whereas Low-dye taping was less effective than the other taping techniques, such as high-dye and stirrups taping. Custom-made foot orthoses were more effective than prefabricated orthoses. Motion control footwear with heel flare or wedge design was less effective than those with dual midsole materials. Conclusions Foot orthoses, motion control footwear and therapeutic adhesive taping were able to control rearfoot eversion with therapeutic adhesive taping being the most effective. In the clinical practice, selection of an antipronation intervention should be based on patient characteristics, type of activity and personal preference.

Effects of Whole-Body Vibration on Sensorimotor Performance in People With Parkinson Disease: A Systematic Review

Background Earlier studies show that whole-body vibration (WBV) has beneficial effects on neuromuscular performance in older adults and may be a viable treatment option for people with Parkinson disease (PD). Purpose This systematic review was aimed at determining whether WBV improves sensorimotor performance in people with PD. Data Sources The sources used in this review were MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Excerpta Medica database (EMBASE), the Cochrane Database of Systematic Reviews, and the Physiotherapy Evidence Database (PEDro) (last searched in April 2010). Study Selection Randomized and nonrandomized controlled studies examining the effects of WBV in people with PD were selected. Six studies fulfilled the selection criteria and were included in this review. Data Extraction The PEDro score was used to evaluate methodological quality. The effects of WBV on various sensorimotor outcomes were noted. Data Synthesis Methodological quality was rated as good for 1 study (PEDro score of 6), fair for 4 studies (PEDro score of 4 or 5), and poor for 1 study (PEDro score of 2). Two studies showed that, compared with no intervention, WBV treatment led to significant reductions in tremor and rigidity, as measured with the Unified Parkinson Disease Rating Scale (UPDRS). The findings for other UPDRS cluster scores were conflicting, however. Two studies showed that longer-term WBV (3–5 weeks) did not result in better sensorimotor outcomes than conventional exercise training. Limitations The studies reviewed here are limited by their methodological weaknesses and small, heterogeneous samples. Conclusions There is insufficient evidence to prove or refute the effectiveness of WBV in enhancing sensorimotor performance in people with PD (ie, grade D recommendations). More good-quality trials are needed to establish the clinical efficacy of WBV in improving sensorimotor function in people with PD.

Rehabilitation Interventions for Unilateral Neglect after Stroke: A Systematic Review from 1997 through 2012.

A systematic review of the effectiveness of rehabilitation for persons with unilateral neglect (UN) after stroke was conducted by searching the computerized databases from 1997 through 2012. Randomized controlled trials (RCTs) of neglect treatment strategies for stroke patients which used the Behavioral Inattention Test (BIT) as the primary outcome measure were eligible for inclusion. Out of 201 studies initially identified, 12 RCTs covering 277 participants were selected for analysis. All had the same weakness of low power with smaller samples and limitation in the blinding of the design. Prism Adaptation (PA) was the most commonly used intervention while continuous Theta-burst stimulation (cTBS) appeared to be a new approach. Meta-analysis showed that for immediate effects, the BIT conventional subscore had a significant and large mean effect size (ES = 0.76; 95% CI 0.28–1.23; p = 0.002) whereas the BIT total score showed a modestly significant mean ES (ES = 0.55; 95% CI 0.16–0.94; p = 0.006). No significant mean ES in sensitivity analysis was found for long-lasting effects across all BIT outcomes. PA appeared to be the most effective intervention based on the results of pooled analysis. More rigorous studies should be done on repetitive transcranial magnetic stimulation (rTMS) before it can be concluded that it is a promising treatment for UN.

Determinants of Activity and Participation in Preschoolers with Developmental Delay.

According to the International Classification of Functioning, Disability and Health model endorsed by the World Health Organization, activity (the execution of a task or action by an individual), and participation (involvement in a life situation) are important components in the assessment of health and functioning of an individual. The purpose of this study was to compare the activity performance and school participation of preschool children with developmental delay (DD) and age-matched typically developing children, and to identify the determinants of activity and participation in preschoolers with DD. Fifty-four children with DD (37 boys, 17 girls; mean age: 66 months) and 54 age-matched typically developing children (34 boys, 20 girls; mean age: 65 months) were recruited from the mainstream preschools with integrated program units. Activity and participation were evaluated using the Vineland Adaptive Behavior Scales (VABS) and School Function Assessment (SFA). Other factors that may influence activity and participation such as impairments in sensory, motor, and mental functioning, and other contextual factors (e.g. family income) were also measured. The DD group had significantly lower VABS (p < 0.001) and SFA (p<0.001) scores than controls, indicating suboptimal activity and participation. Multiple regression analysis revealed that deficits in social and motor skills, and in inattention/hyperactivity, were significantly associated with activity and participation in children with DD, accounting for approximately 35-37% of the variance in the VABS and SFA scores ( p<0.001). In conclusion, deficits in social and motor functioning, and attention-deficit hyperactivity disorder-related symptoms, are important determinants of activity and participation in preschoolers with DD. One may consider targeting these specific areas to enhance activity and participation amongst these children.

Meta‐analysis on the effect of mental imagery on motor recovery of the hemiplegic upper extremity function

BACKGROUND/AIM Studies have shown that mental imagery can enhance relearning and generalisation of function after stroke. The aim of this meta-analysis was to evaluate evidence on the effects of mental imagery on motor recovery of the hemiplegic upper extremities after stroke. METHODS A comprehensive data base search of the literature up to December 2012 was performed using PubMed, EBSCO host (Academic Search Premier, CINAHL and Educational Resource Information Center), PsycINFO, Medline, and ISI Web of Knowledge (Science Citation Index and Social Sciences Citation Index). Randomised clinical trials or controlled clinical trials that included mental imagery for improving upper extremity motor function for stroke patients were located. Relevant articles were critically reviewed and methodological quality was evaluated using the PEDro Scale, and study results synthesised. RESULTS Five randomised clinical trials and one controlled clinical trial met the inclusion criteria. Five of the six studies yielded positive findings in favour of mental imagery. Quantitative analysis showed a significant difference in the Action Research Arm Test (overall effect: Z=6.75; P<<0.001). CONCLUSION Review of the literature revealed a trend in support of the use of motor imagery for upper extremity motor rehabilitation after stroke. Mental imagery could be a viable intervention for stroke patients given its benefits of being safe, cost-effective and rendering multiple and unlimited practice opportunities. It is recommended that researchers incorporate imaging techniques into clinical studies so that the mechanism whereby mental imagery mediates motor recovery or neural adaptation for people with stroke can be better understood.

Peak Flow Rate During Induced Cough: A Predictor of Successful Decannulation of a Tracheotomy Tube in Neurosurgical Patients

BACKGROUND An accurate predictor of successful decannulation in neurosurgical patients that indicates the best time for tracheotomy decannulation would minimize the risks of continued cannulation and unsuccessful decannulation. OBJECTIVE To determine whether the peak flow rate during induced cough is an appropriate predictor of successful decannulation. METHODS A total of 32 neurosurgical patients with a tracheotomy were enrolled. The highest peak expiratory flow rate during 3 induced coughs, the total volume of tracheal secretions collected in 6 hours, and scores on the Glasgow Coma Scale were recorded. Logistic regression analysis was applied to determine the relationship between these variables and successful decannulation (reintubation not required within 72 hours). RESULTS Decannulation was attempted in 23 of 32 patients. The remaining 9 patients were considered clinically inappropriate for the procedure. Of the 23 patients decannulated, 2 required reinsertion of the tracheotomy tube. Analysis revealed that peak flow rate during induced cough (odds ratio, 1.12; 95% confidence interval, 1.02-1.23) was independently associated with successful decannulation (accuracy, 75%; sensitivity, 85.7%; specificity, 54.5%). The receiver operating characteristic curve indicated an optimal cutoff point of 29 L/min. CONCLUSION Measurement of peak flow rate during induced cough is a simple and reproducible intervention that improves predictability of successful decannulation in patients with tracheotomy.