Vilai Kuptniratsaikul

Efficacy and safety of Curcuma domestica extracts in patients with knee osteoarthritis.

OBJECTIVE The objective of this study was to determine the efficacy and safety of Curcuma domestica extracts in pain reduction and functional improvement in patients with knee osteoarthritis. STUDY DESIGN AND SETTING The design and setting were a randomized controlled study at a university hospital in Bangkok, Thailand. METHODS One-hundred and seven (107) patients with primary knee osteoarthritis (OA) with pain score of > or =5 were randomized to receive ibuprofen 800 mg per day or C. domestica extracts 2 g per day for 6 weeks. The main outcomes were improvement in pain on level walking, pain on stairs, and functions of knee assessed by time spent during 100-m walk and going up and down a flight of stairs. The adverse events were also recorded. RESULTS Fifty-two (52) and 55 patients were randomized to C. domestica extracts and ibuprofen groups, respectively. Baseline characteristics of the patients in both groups were not different. The mean scores of the aforementioned outcomes at weeks 0, 2, 4, and 6 were significantly improved when compared with the baseline values in both groups. There was no difference in those parameters between the patients receiving ibuprofen and C. domestica extracts, except pain on stairs (p = 0.016). No significant difference of adverse events between both groups was found (33.3% versus 44.2%, p = 0.36 in C. domestica extracts and ibuprofen groups, respectively). CONCLUSIONS C. domestica extracts seem to be similarly efficacious and safe as ibuprofen for the treatment of knee OA.

Efficacy and safety of Curcuma domestica extracts compared with ibuprofen in patients with knee osteoarthritis: a multicenter study

Objective To determine the efficacy and safety of Curcuma domestica extracts in pain reduction and functional improvement. Methods 367 primary knee osteoarthritis patients with a pain score of 5 or higher were randomized to receive ibuprofen 1,200 mg/day or C. domestica extracts 1,500 mg/day for 4 weeks. The main outcomes were Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total, WOMAC pain, WOMAC stiffness, and WOMAC function scores. Adverse events (AEs) were also recorded. Results 185 and 182 patients were randomly assigned into C. domestica extracts and ibuprofen groups, respectively. The baseline characteristics were no different between groups. The mean of all WOMAC scores at weeks 0, 2, and 4 showed significant improvement when compared with the baseline in both groups. After using the noninferiority test, the mean difference (95% confidence interval) of WOMAC total, WOMAC pain, and WOMAC function scores at week 4 adjusted by values at week 0 of C. domestica extracts were noninferior to those for the ibuprofen group (P=0.010, P=0.018, and P=0.010, respectively), except for the WOMAC stiffness subscale, which showed a trend toward significance (P=0.060). The number of patients who developed AEs was no different between groups. However, the number of events of abdominal pain/discomfort was significantly higher in the ibuprofen group than that in the C. domestica extracts group (P=0.046). Most subjects (96%–97%) were satisfied with the treatment, and two-thirds rated themselves as improved in a global assessment. Conclusion C. domestica extracts are as effective as ibuprofen for the treatment of knee osteoarthritis. The side effect profile was similar but with fewer gastrointestinal AE reports in the C. domestica extracts group.

Complications during the rehabilitation period in Thai patients with stroke: a multicenter prospective study.

Kuptniratsaikul V, Kovindha A, Suethanapornkul S, Manimmanakorn N, Archongka Y: Complications during the rehabilitation period in Thai patients with stroke: a multicenter prospective study. Am J Phys Med Rehabil 2009;88:92–99. Objective:To examine the frequency and types of complications in patients with stroke. Design:A multicenter, prospective cohort study was performed in 327 patients with stroke (134 women, 193 men), who attended inpatient rehabilitation in nine centers. The frequency and severity of consequences and complications related to strokes were monitored weekly. In addition, correlations with stroke-related complications were analyzed. Results:At least one complication after a stroke was found in 232 (71.0%) patients. The mean age was 62 (±12) yrs, and 59% were men. Shoulder subluxation was found in 37.3% with mild to moderate degree. Limb spasticity was presented in 41.6%, and almost all were a severity grade of less than 3 on the Modified Ashworth Scale. The common complications were musculoskeletal pain (32.4%), bowel/bladder dysfunction (31.5%), infection (16.5%), depression (13.8%), and anxiety (5.8%). Symptomatic urinary tract infection was found in 35 (10.7%) patients. Urinary incontinence was the most common among bowel/bladder problems (24.5%). Time since onset of stroke ≥1 mo (adjusted odds ratio [OR] = 2.12; 95% confidence interval [CI] = 1.07–4.17), length of stay >21 days (adjusted OR = 2.36; 95% CI = 1.26–4.43), and anxiety score at admission ≥11 (adjusted OR = 6.87; 95% CI = 2.45–19.29) were statistically associated with stroke-related complications. Conclusions:Medical complications were common among patients with stroke who had been hospitalized longer, during inpatient rehabilitation and among those who had high anxiety scores.

Validation of a modified Thai version of the Western Ontario and McMaster (WOMAC) osteoarthritis index for knee osteoarthritis

The aim of this study was to evaluate the psychometric properties (validity and reliability) of the Thai version of the Western Ontario and McMaster (WOMAC) index in knee osteoarthritis (OA) patients. After permission from the copyright holder of the WOMAC index was obtained, the questionnaire was translated into Thai, backtranslated, tested for face and content validities, and then modified. A convergent validity was evaluated in 114 patients with knee OA by comparing the scores of a modified Thai WOMAC index to those of the algofunctional Lequesne index. A test–retest reliability was evaluated in 89 patients who answered the modified Thai WOMAC index twice at 3-week intervals. The statistical analyses for the content validity were index of content validity (ICV), floor and ceiling effects, and skewness of distribution; for the convergent validity was Spearman’s correlation; for the test–retest reliability were Spearman’s correlation and intraclass correlation; and for the internal consistency was Chronbach’s α. The Thai WOMAC index had face validity. The ICV of the content validity ranged from 0.25–1.00. Two items (F05 and F12 of the original 24-item WOMAC index) that had an ICV of 0 were removed from the modified Thai version. The modified 22-item Thai WOMAC index had convergent validity to the algofunctional Lequesne index in pain and function dimensions (Spearman’s correlation coefficients were 0.66 and 0.69, respectively). The test–retest reliability had correlation coefficients ranging from 0.65 to 0.71. The internal consistency had an α ranging from 0.85 to 0.97. In conclusion, the modified Thai WOMAC index had acceptable psychometric properties for Thai patients with knee OA.

Effectiveness of simple balancing training program in elderly patients with history of frequent falls

Objective: To study the effectiveness of simply-performed balancing exercises in fall prevention. Design: Pre- and post-trial. Setting: University hospital from January 2009 to May 2010. Participants: Elderly with falls in the previous year. Intervention: Simple balancing exercise was performed at home every day and was recorded in the booklet. Measurements: New falling events and a battery of balancing abilities including the Timed Up and Go Test (TUGT), chair stand, functional reach, and Berg balance scale-short form were evaluated at baseline, 3-, 6-, 9-, and 12-month periods. Fear of falling and quality of life scores were assessed at baseline and 12-month periods. Results: 146 subjects were recruited, 116 female (79.5%) with a mean age of 67.1 years. At the end of the study, 49% of participants had not fallen. All of the balancing abilities were compared between frequent and infrequent fallers and were significantly improved (P < 0.001) except for functional reach in the frequent fall group. Most subjects (72%–79%) complied well with the exercise program. However, compliance had no effect on balancing abilities. About 36.4% of participants had adverse events from exercise, of which knee pain was the top ranked. The quality of life and the fall efficacy scores increased significantly at the end of the study. Factors affecting falling were compliance with exercise (adjusted odds ratio [OR]: 2.55, 95% confidence intervals [CI]: 1.04, 6.30) and a history of falling ≥3 times in the previous year (adjusted OR: 3.76, 95% CI: 1.18, 11.98). Conclusion: Performing simply-designed balancing exercises, at least 3 days per week, can increase balancing abilities, and decrease fall rates in the elderly with a history of previous falls. However, strategies to encourage elderly compliance may prevent falling.

No additional benefit of shortwave diathermy over exercise program for knee osteoarthritis in peri-/post-menopausal women: an equivalence trial

OBJECTIVE To evaluate the benefit of shortwave diathermy (SWD) supplemented to an exercise program for knee osteoarthritis (OA) in peri-/post-menopausal women. METHODS A double-blind randomized placebo-controlled equivalence trial was conducted in a university hospital. Participants including 113 women aged 50-85 years with primary knee OA were instructed to do regular quadriceps exercise, and randomized to control (n=60) and treatment (n=53) groups receiving sham SWD and therapeutic SWD, respectively. The treatment being evaluated was continuous SWD, 20 min/session, 3 sessions/week for 3 weeks. The outcomes including Thai Western Ontario and McMaster Universities OA (WOMAC) index, 100-m walking speed, stair ascent-and-descent time, global assessment, patients satisfaction, and adverse events were assessed at baseline and end of treatment. RESULTS At the end of treatment, both groups had trivial but statistical improvement in all outcomes. Intention-to-treat analysis showed no statistically significant difference between the two groups in all outcomes. Per protocol analysis demonstrated the equivalence in Thai WOMAC total score, as the 95% confidence interval of difference (-0.62, 0.92) was within confidence limits of +/-1cm. CONCLUSION The addition of SWD to an exercise program for knee OA in peri-/post-menopausal women is not superior to the exercise program alone.

PREVALENCE OF INCONTINENCE IN PATIENTS AFTER STROKE DURING REHABILITATION: A MULTI-CENTRE STUDY

OBJECTIVE To report the prevalence and degree of isolated urinary and faecal incontinence and double incontinence (i.e. both urinary and faecal incontinence) in patients after stroke during post-acute rehabilitation and the factors related to incontinence. DESIGN A multi-centre prospective study. METHODS Data were extracted from the Thai Stroke Rehabilitation Registry. A total of 185 patients admitted within 4 weeks post-stroke were recruited. Based on the Barthel Index of Activities of Daily Living, the prevalence and degree of isolated urinary incontinence or faecal incontinence, and double incontinence were reported. Multivariate analysis was performed to identify any factors related to incontinence. RESULTS The admission prevalence for isolated urinary incontinence was 12.4%, for isolated faecal incontinence 7.6% and for double incontinence 33%. At discharge, the prevalence had decreased, to 8.1% for isolated urinary incontinence, 4.9 % for isolated faecal incontinence and 15.1% for double incontinence. Cognitive (adjusted odds ratio (OR) 3.63; 95% confidence interval (CI) 1.71-7.70) and leg muscle functions impairments (adjusted OR 2.79; 95% CI 1.29-6.07) were significantly related to urinary incontinence; whereas, age (adjusted OR 1.98; 95% CI 1.07-3.67) was related to faecal incontinence at admission. CONCLUSION Double incontinence was more prevalent than isolated incontinence in patients after stroke during post-acute rehabilitation. The decrease in prevalence at discharge reflected a recovery of bladder and bowel control. Age, cognitive and leg motor function impairments were related to incontinence.

The effectiveness of a neck and shoulder stretching exercise program among office workers with neck pain: A randomized controlled trial

Objective: To determine the effectiveness of neck and shoulder stretching exercises for relief neck pain among office workers. Design: Randomized controlled trial. Setting: An outpatient setting. Participants: A total of 96 subjects with moderate-to-severe neck pain (visual analogue score ⩾5/10) for ⩾3 months. Interventions: All participants received an informative brochure indicating the proper position and ergonomics to be applied during daily work. The treatment group received the additional instruction to perform neck and around shoulder stretching exercises two times/day, five days/week during four weeks. Main outcomes: Pain, neck functions, and quality of life were evaluated at baseline and week 4 using pain visual analogue scale, Northwick Park Neck Pain Questionnaire, and Short Form-36, respectively. Results: Both groups had comparable baseline data. All outcomes were improved significantly from baseline. When compared between groups, the magnitude of improvement was significantly greater in the treatment group than in the control group (–1.4; 95% CI: –2.2, –0.7 for visual analogue scale; –4.8; 95% CI: –9.3, –0.4 for Northwick Park Neck Pain Questionnaire; and 14.0; 95% CI: 7.1, 20.9 for physical dimension of the Short Form-36). Compared with the patients who performed exercises <3 times/week, those who exercised ⩾3 times/week yielded significantly greater improvement in neck function and physical dimension of quality of life scores (p = 0.005 and p = 0.018, respectively). Conclusion: A regular stretching exercise program performed for four weeks can decrease neck and shoulder pain and improve neck function and quality of life for office workers who have chronic moderate-to-severe neck or shoulder pain.

Efficacy and Safety of Derris scandens Benth Extracts in Patients with Knee Osteoarthritis

OBJECTIVES The objectives of this study were to determine the efficacy and safety of Derris scandens Benth extracts in pain reduction and functional improvement in patients with knee osteoarthritis (OA). DESIGN This was a prospective, randomized, controlled trial, single-blinded (assessor). SETTINGS The study was conducted at the Rehabilitation Medicine Department, Siriraj Hospital. SUBJECTS One hundred and seven (107) patients with primary OA knee who had pain score of ≥ 5 were recruited. INTERVENTIONS Patients were randomized to receive naproxen 500 mg/day or Derris 800 mg/day for 4 weeks. OUTCOME MEASUREMENTS Western Ontario McMaster Osteoarthritis Index (WOMAC) scores and 6-minute walking distance were the outcome measurements. RESULTS Fifty-five (55) and 52 patients were randomized to Derris and naproxen groups, respectively. The mean differences of all WOMAC scores between 2 groups at week 4 adjusted by week 0 were within ± 1 point. The mean scores of the aforementioned outcomes at weeks 0, 2, and 4 were significantly improved compared to the baseline values. There was no difference of WOMAC scores between groups. The gastrointestinal irritation and dyspepsia were observed more often in the naproxen than in the Derris group. CONCLUSIONS Derris scandens Benth extracts were efficacious and safe for the treatment of knee OA.

MAIN OUTCOMES OF STROKE REHABILITATION: A MULTI-CENTRE STUDY IN THAILAND

OBJECTIVE To estimate the efficiency of inpatient rehabilitation for patients after stroke in Thailand. DESIGN Multi-centre, prospective study. SUBJECTS Patients after stroke, aged >or= 18 years, with stable medical signs, able to follow 1-step commands and to sit for at least 30 min. METHODS Main outcomes included Barthel Index (BI) scores, BI effectiveness, BI efficiency, length of stay, Thai Hospital Anxiety and Depression Scale (HADS) scores, and quality of life. RESULTS Of a total of 327 patients, 285 completed the programmes, with a mean length of stay of 27.3 days. Mean age was 62.1 (standard deviation (SD) 12.1) years and 59% of patients were male. Mean BI scores on admission and at discharge were 7.48 (SD 3.96; range 0-19) and 13.27 (SD 4.86; range 0-20), respectively. The change score was 5.79 (SD 3.89) and the efficiency of functional score was 0.28 points/day. Using multivariate analysis, factors associated with change in BI score were age, previous stroke and length of stay. Sixty-four patients (25.5%) had anxiety and 95 (37.8%) had depression on admission. At discharge, the numbers of patients with anxiety and depression decreased to 17 (6.8%) and 41 (16.3%), respectively. The quality of life scores at discharge were significantly higher than those on admission. CONCLUSION Inpatient rehabilitation enabled stroke patients to reach optimal functional ability, and improved psychological status and quality of life.