Sam C.C. Chan

Evaluation of the chronic disease self-management program in a Chinese population

Abstract Objective This study evaluated the 6-week Chronic Disease Self-Management Program (CDSMP) in Hong Kong. Methods A total of 148 subjects with chronic illness were recruited. Subjects were matched on duration of illness and gender, and then randomly allocated to experimental and comparison groups. The experimental group participated in the CDSMP, while the comparison group joined a Tai-Chi interest class in a mass-activity format. Subjects completed evaluation questionnaires before beginning their program and 1 week following the program. Results Analysis of covariance showed that the CDSMP participants demonstrated significantly higher self-efficacy in managing their illness, used more cognitive methods to manage pain and symptoms, and felt more energetic than the subjects in the comparison group. The CDSMP participants also demonstrated changes in their profile of coping strategies, having a tendency to adopt the cognitive methods of diverting attention, reinterpreting pain, ignoring sensations, and making positive self-statements. Conclusion The short-term evaluation results showed that the CDSMP primarily increased the self-efficacy, exercise behavior, and application of cognitive coping strategies of the participants. Practice Implication The effect of the CDSMP in a Chinese population is similar to that found in studies in Western cultures, and the CDSMP could be applied effectively in a Chinese population.

Orienting attention modulates pain perception: an ERP study.

Introduction Research has shown that people with chronic pain have difficulty directing their attention away from pain. A mental strategy that incorporates focused attention and distraction has been found to modulate the perception of pain intensity. That strategy involves placing attention on the nociceptive stimulus felt and shifting attention to a self-generated sub-nociceptive image and rehearsing it. Event-related potential was used to study the possible processes associated with the focus-then-orient strategy. Methods Eighteen pain-free participants received different levels of 50-ms nociceptive stimulations elicited by electric shocks at the right lateral malleolus (ankle). In perception trials, participants maintained the perceived nociceptive stimulus in working memory for 3,000 ms. In imagery trials, participants mentally generated and maintained the corresponding sub-nociceptive image they had learned previously. After both types of trials, participants evaluated the pain intensity of the incoming stimulus by recalling the feeling of the nociceptive stimulation at the beginning of the trial. Results Shifting attention from the incoming nociceptive to a self-generated sub-nociceptive image elicited central P2 and centro-parietal P3 waves, which were found to correlate with proportional scores on the Stroop Test. They were followed by a frontal N400 and a parietal P600, denoting generation of sub-nociceptive images in working memory. The voltages elicited in these potentials correlated moderately with attenuation of the pain ratings of the recalled nociceptive stimulations. Conclusions Focus-and-orient attention across nociceptive and sub-nociceptive images appears to be related to response inhibition. Mental rehearsal of the sub-nociceptive images was found to modulate the perception of the nociceptive sensation felt prior to the imagery. Such modulation seems to be mediated by generating and maintaining sub-nociceptive images in working memory. Future studies should explore the mental processes associated with orienting attention for pain modulation among people with pathological pain and frontal lobe dysfunction.

Age effects on the asymmetry of the motor system: Evidence from cortical oscillatory activity

Functional hemispheric asymmetry can be lost with aging. In this electroencephalographic study, we assessed hemispheric asymmetries in regulating motor responses by analyzing oscillatory brain activity during a go/nogo task in younger and older right-handed participants. Three conditions were embedded in the task: go, high-conflict and low-conflict nogo. The hand used to respond to go stimuli was varied block-wise. Independently of the go/nogo conditions and responding hand, young participants showed asymmetric desynchronizations in the mu (10 Hz) and beta (18-22 Hz) frequency bands that was stronger in the scalp sensorimotor region contralateral to the hand used for the go responses, while older adults showed a more symmetric pattern of desynchronization. These findings indicate that a loss of hemispheric asymmetry is a hallmark of the aging motor system, consistent with a decline of inter-hemispheric motor inhibition in normal aging.

Chronic disease self-management program for Chinese patients: a preliminary multi-baseline study

This study reports the preliminary findings on the effects of the Chronic Disease Self-management Program on a group of Chinese participants who suffered from chronic diseases. A total of 23 participants were recruited in a multi-baseline study protocol. Their self-management behaviors, self-efficacy and health status were captured over three baseline assessments and one post-test assessment. The results indicated significant increases in the performance of stretching exercises, the management of cognitive symptoms and communication with physicians. Their self-efficacy in terms of these aspects was found to be significantly increased. However, changes in other aspects of self-management which required more special skills and coordination with outside agencies were not significant. The changes in the physical and mental statuses of the participants were also not significant. It was observed that the positive effects of the program could be attributed to traditional Chinese beliefs of ‘self-discipline’ and a welcoming response towards self-efficacy strategies. Further studies should adhere to standards of a randomized clinical trial and further examine the mechanisms underpinning the changes in self-management behaviors among Chinese people with chronic diseases.

Attitude, social influence, and self-efficacy among Chinese participants of chronic disease self-management program: a latent growth curve modeling study.

OBJECTIVES This study aimed to examine temporal relationships among psychological parameters (readiness to change, changes in self-efficacy [SE], social norm [SN], attitude [AT]) and two self-management behaviors: cognitive symptom management (CSM) and tangible help-seeking (TH) by constructing latent growth change models. METHOD This was a longitudinal study of 60 Chinese participants with various chronic diseases who completed a 6-week chronic disease self-management program. Psychological and behavioral variables were assessed at the beginning of the 1st, 4th, and 6th week of the program. RESULTS Latent growth change curve analysis revealed that, in the early stages of engagement in CSM, SE was a key determinant of behavior. During the 6-week period, changes in SE were influenced directly by both SN and AT. When engaging in TH, SE influenced the behavior with direct and indirect effect from AT and SN. Readiness for change, on the other hand, appeared to be more associated with psychological rather than behavioral changes. This study revealed different underlying change mechanisms for two types of self-management behaviors. CONCLUSION The findings shed light on program modifications that could further strengthen the therapeutic effects of the program.

The Hong Kong Chinese Version of the Jebsen Hand Function Test: Inter-rater and Test-retest Reliabilities

Objectives To investigate the inter-rater and test-retest reliability of the Hong Kong Chinese version of the Jebsen Hand Function Test (JHFT-HK); to evaluate the discriminative power of the JHFT between patients with rheumatoid arthritis (RA) and people free from the disease; and to investigate the relationship between the JHFT scores and the performance of grip and pinch strengths. Methods Twenty-four female subjects with RA and 28 healthy females matched for age and occupation were recruited by convenience sampling for testing of their hand function using the JHFT-HK. The relationship between JHFT-HK scores and grip and pinch strengths were also examined. Results The intraclass correlation coefficients (ICCs) of inter-rater reliability (0.70-0.98) and test- retest reliability (0.68-0.98) of the JHFT-HK were shown to be satisfactory. Independent t test revealed significant differences between the two groups in all subtests except for the writing test ( p t test also revealed that subjects without RA in the Hong Kong community performed significantly faster in most of the subtests of the JHFT-HK ( p Conclusion Simply assessing grip and pinch strength is not sufficient to represent the hand function abilities of an individual. It is suggested that the JHFT-HK is a useful and standardized test for reflecting the dynamic hand function of patients with RA.

Chinese Calligraphy Writing for Augmenting Attentional Control and Working Memory of Older Adults at Risk of Mild Cognitive Impairment: A Randomized Controlled Trial

BACKGROUND Nonpharmacological intervention for individuals with mild cognitive impairment (MCI) needs further investigation. OBJECTIVE Test efficacy of an eight-week Chinese calligraphy writing training course in improving attentional control and working memory. METHODS Ninety-nine participants with MCI were randomized into the eight-week calligraphy writing (n = 48) or control (tablet computer) training (n = 51). Outcomes of the interventions were attentional control, working memory, visual scan and processing speed. They were measured at baseline, post-training, and six-month follow-up. RESULTS Calligraphy writing, when compared with control, significantly improved working memory as reflected from DST-Backward sequence (p = 0.009) and span scores (p = 0.002), and divided attention as reflected from CTT2 (p < 0.001), and at the post-training. The unique improvement in working memory (span: p < 0.001; sequence: p = 0.008) of the intervention group was also found at follow-up when comparing with those at baseline. Changes in the other outcome measures were not statistically significant. CONCLUSION The findings provide support that Chinese calligraphy writing training for eight weeks using a cognitive approach would improve working memory and to a lesser extent attentional control functions of patients with early MCI. They also demonstrate the usefulness of using mind-and-body practice for improving specific cognitive functions.

One-year follow-up of Chinese people with spinal cord injury: A preliminary study

Abstract Background A tertiary spinal cord injury (SCI) center was established in the northern region of Hong Kong, China and a multidisciplinary SCI rehabilitation program was developed to reintegrate patients into the community. Objective To investigate functional outcomes for Chinese people with SCI across a 1-year period. Design Longitudinal prospective design. Methods Thirty community-dwelling participants with traumatic SCI were recruited. Functional status was measured using functional independence measure (FIM) on admission, upon discharge, 1-month, 3-month, 6-month, and 1-year post-discharge. Information on use of assistive devices and life role were also obtained. Results Twenty-three (76.67%) participants were men. Seventeen participants (10 with tetraplegia and 7 with paraplegia) were classified ASIA A, B, or C; 13 (7 with tetraplegia and 6 with paraplegia) were classified as ASIA D. Significant differences in FIM motor scores were only found between the tetraplegia group and three other diagnostic groups using Bonferroni post-hoc tests of repeated measure ANOVA (analysis of variance) (P < 0.05). Longitudinally, contrast tests of repeated measure ANOVA showed significant differences during the hospitalization period for all diagnostic groups. People in the ASIA D group showed significant functional improvement even after 1-year post-discharge (P < 0.05). At 1-year post-discharge, only two participants were engaged in either remunerative employment or academic pursuit. Conclusion Despite functional status improvement, few people with traumatic SCI were re-engaged in productive life role 1 year after discharge. Studies with longer follow-up would be beneficial.

Meaning making through occupational storytelling: Case study of a Chinese retiree

ABSTRACT Occupational storytelling and occupational coaching can cultivate meaning for people living with various types of dysfunction but the processes are seldom systematically illustrated. A retiree with chronic obstructive pulmonary disease in a rehabilitation program participated in a process of occupational storytelling and occupational coaching. The in-depth life history approach reconstructed his life history as a part of communal horizon building and encouraged him to resume an occupation he had given up: playing a musical instrument. The interviews that were part of the occupational coaching process enabled him to re-visit the past in order to seek a more positive life path that was more congruent with personal values and goals. Storytelling and story coaching processes can address issues of occupational disruption, helping people regain life meaning through occupation.

Salience of Somatosensory Stimulus Modulating External-to-Internal Orienting Attention

Shifting between one’s external and internal environments involves orienting attention. Studies on differentiating subprocesses associated with external-to-internal orienting attention are limited. This study aimed to reveal the characteristics of the disengagement, shifting and reengagement subprocesses by using somatosensory external stimuli and internally generated images. Study participants were to perceive nociceptive external stimuli (External Low (EL) or External High (EH)) induced by electrical stimulations (50 ms) followed by mentally rehearsing learned subnociceptive images (Internal Low (IL) and Internal High (IH)). Behavioral responses and EEG signals of the participants were recorded. The three significant components elicited were: fronto-central negativity (FCN; 128–180 ms), fronto-central P2 (200–260 ms), and central P3 (320–380 ms), which reflected the three subprocesses, respectively. Differences in the FCN and P2 amplitudes during the orienting to the subnociceptive images revealed only in the EH but not EL stimulus condition that are new findings. The results indicated that modulations of the disengagement and shifting processes only happened if the external nociceptive stimuli were of high salience and the external-to-internal incongruence was large. The reengaging process reflected from the amplitude of P3 correlated significantly with attenuation of the pain intensity felt from the external nociceptive stimuli. These findings suggested that the subprocesses underlying external-to-internal orienting attention serve different roles. Disengagement subprocess tends to be stimulus dependent, which is bottom-up in nature. Shifting and reengagement tend to be top-down subprocesses, which taps on cognitive control. This subprocess may account for the attenuation effects on perceived pain intensity after orienting attention.