Yuh Jang

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.

Wheelchair-Related Accidents: Relationship With Wheelchair-Using Behavior in Active Community Wheelchair Users

OBJECTIVE To report the prevalence, mechanisms, self-perceived causes, consequences, and wheelchair-using behaviors associated with wheelchair-related accidents. DESIGN A case-control study. SETTING Community. PARTICIPANTS A sample of experienced, community-dwelling, active manual and powered wheelchair users (N=95) recruited from a hospital assistive technology service center. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Wheelchair-using behaviors, wheelchair-related accidents over a 3-year period, and the mechanisms and consequences of the accidents. RESULTS Among the 95 participants, 52 (54.7%) reported at least 1 accident and 16 (16.8%) reported 2 or more accidents during the 3 years prior to the interview. A total of 74 accidents, were categorized into tips and falls (87.8%), accidental contact (6.8%), and dangerous operations (5.4%). A logistic regression found individuals who failed to maintain their wheelchairs regularly (odds ratio [OR]=11.28; 95% confidence interval [CI], 2.62-48.61) and used a wheelchair not prescribed by professionals (OR=4.31; 95% CI, 1.10-16.82) had significantly greater risks of accidents. In addition to the risk factor, lack of regular wheelchair maintenance, the Poisson regression corroborated the other risk factor, seat belts not used (incident rate ratio=2.14; 95% CI, 1.08-4.14), for wheelchair-related accidents. CONCLUSIONS Wheelchair-related accidents are closely related to their wheelchair-using behaviors. Services including professional evaluation, repair, maintenance, and an educational program on proper wheelchair use may decrease the risks of wheelchair accidents.

Factors Associated With Quality of Life Among People With Spinal Cord Injury: Application of the International Classification of Functioning, Disability and Health Model

OBJECTIVE To identify the factors that influence an individuals quality of life (QOL) after spinal cord injury (SCI) based on the International Classification of Functioning, Disability and Health (ICF) framework. DESIGN Cross-sectional exploratory study. SETTING Taiwan community. PARTICIPANTS Community-dwelling adults (N=341) who had suffered an SCI at least 1 year previously and were between the ages of 18 and 60 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) A combination of self-report questionnaire and interview. The dependent variable, QOL, was measured by the abbreviated version of the World Health Organization Quality of Life, while the independent variables-participation, activity, impairment, and contextual factors-were measured using the Frenchay Activity Index, Barthel Index, and a demographic form. RESULTS Multivariate analysis results indicated that participation, activity, and marital status are significant factors in the QOL outcome. Results also indicated that among the various factors that affect each domain of QOL (physical health, psychological health, social relationships, and environment), participation was the strongest determinant. CONCLUSIONS The ICF provided an excellent framework with which to explore the factors influencing QOL after SCI. The results demonstrated that marital status, participation, and activity exert the strongest influence on QOL, while impairment and other variables do not directly influence QOL.

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.

Chinese Culture and Occupational Therapy

A study of the relationship between Chinese culture and occupational therapy is presented in this paper. Based on a literature review and direct observations and analysis by the author, it was found that Chinese culture and occupational therapy share common thinking on the concept of the use of activity, the concept of balance and harmony, the environmental influences in treatment and evaluation, intrinsic motivation and meaningful existence. The major difference between Chinese culture and occupational therapy is the perception of the role of the sick person. In the Chinese society, the role of the patient is dependent and passive, but occupational therapy believes that the patient should be independent and actively participate in the therapy. The implications of these aspects for clinical practice are also described. This article is reprinted from the Journal of the Occupational Therapy Association of the Republic of China, 1993, Volume 11, pp 95–104, by kind permission of the author and the Journal.

Factors Related to Returning to Work Following a Work-Oriented Occupational Therapy Program for Individuals with Physical Disabilities

The purpose of this study was to determine factors related to return to work following the completion of a Work-Oriented Occupational Therapy Program (WOOTP). This program is conducted at the Department of Occupational Therapy, National Taiwan University Hospital, Taipei, Taiwan, Republic of China. One hundred and twelve subjects were discharged from WOOTP between November 1, 1995 and May 31, 1997. Forty-five (40.2%) subjects returned to work. Univariate analysis showed that gender, marital status, area of injury, subjects physical capacity level, and change in physical demand level after WOOTP, ADL, and job waiting related to return-to-work status following the completion of WOOTP. Factors related to return to work were compared bivariately using forward stepwise logistic regression procedures. Results indicated that ADL, gender, and marital status contributed significantly to the logistic regression model. Those most likely to return to work were female, married, and/or that they had higher Barthel ADL index scores. It was concluded that further research was needed to determine the applicability of these results to broader groups of subjects, and to refine and expand the predictive model to include other relevant factors.

A Rasch analysis of the Frenchay Activities Index in patients with spinal cord injury.

Study Design. A prospective interview study. Objective. To determine whether items of the Frenchay Activities Index (FAI) measure Instrumental Activities of Daily Living (IADL), as a unidimensional construct, in patients with spinal cord injury (SCI). To examine whether the response categories of the FAI are useful in discerning the various ability levels of IADL. Summary of Background Data. No known IADL scale has been designed for SCI patients. The FAI, to our knowledge, has never been validated in patients with SCI. Methods. A total of 233 persons with SCI participated in this study. The FAI was administered to the patients by interview at locations convenient for the participants. A Rasch analysis was used to examine the unidimensionality and appropriateness of the response categories of the FAI. Results. All but 2 items (“going outside” and “reading books”) of the FAI fitted the models expectations. The results of Rasch analysis indicated that the response categories for the remaining 13 items of the FAI should be collapsed to create more suitable response categories (4 items, into dichotomies, and the remaining 9 items, into trichotomies). Thus, a revised 13-item FAI was formed by deleting the 2 misfitting items and collapsing the response categories of the items. Conclusions. This study demonstrated that the revised 13-item FAI assesses a single, unidimensional IADL for SCI patients living in the community. The revised FAI shows potential for assessment of IADL in SCI patients.

Factors Affecting Employment Outcomes for People with Disabilities Who Received Disability Employment Services in Taiwan

Purpose. One of the most important rehabilitation goals is to return people with disabilities to paid employment. The purposes of this study were (1) to explore employment status and (2) to identify factors that may affect the employment outcomes of people with disabilities who received Disability Employment Services (DES). Methods. A retrospective study was conducted on clients who commenced and closed DES between January 2008 and December 2010 in a metropolitan city in Taiwan, using the files from the National Vocational Rehabilitation Services Documentary System. Results. Sixty-nine percent (1,684 out of 2,452) of the clients in this study were engaged in paid employment after receiving DES. Logistic regression analyses indicated that clients with no psychiatric disability or mild impairment and with useful vocational qualifications, typical work experience, more post-employment services, and less pre-employment services were associated with a higher rate of successful employment outcomes. Conclusion. This study provides empirical evidence of the association between person- and DES-related factors and the employment outcomes of people with disabilities. Future improvements in health, school-to-work transition services, and vocational rehabilitation for people with disabilities should place more emphasis on providing work-based work experience, professional vocational training, access to college/professional education, career exploration, effective supported employment services, and other post-employment services.

A simple self-rating assessment method of residual work capability for occupational permanent disabilities†

BACKGROUND To explore the validity, reliability, and determinants of a simple self-rating assessment method of residual work capability (RWC) after occupational permanent disabilities. METHODS Five hundred and thirty-nine compensated permanent disability workers answered three consecutive visual analogue questionnaires wherein they self-rated their residual work capability in terms of speed (RWCS), quality (RWCQ) and a combination of speed and quality (RWCC). At two major hospitals in Taiwan, 169 of these subjects were evaluated with physical capacity assessment (PCA), cognition and sensation assessment (CSA), the work ability index (WAI), and the 12-item Chinese health questionnaire (CHQ-12). RESULTS High test-retest reliability (Pearsons correlation coefficient 0.77) and satisfactory concurrent validity were shown for RWCS and RWCC. All PCA, CSA and WAI showed significant correlation with RWCs, while CHQ-12 displayed borderline correlation. Employment status after injury and status of the victims salary as the main source of income for his/her family before injury, were the major determinants of RWCs, in addition to the scales of PCA, CSA and WAI. CONCLUSIONS The RWCC resulting from the self-rating method may be used as a simple assessment of a victims residual work capability after occupational permanent disabilities.

Increased Mortality Risk for Workers With a Compensated, Permanent Occupational Disability of the Upper or Lower Extremities: A 21-Year Follow-up Study

This 1986-2006 study sought to determine whether specific causes led to increased mortality risks for Taiwanese workers with an approved compensation claim for permanent occupational disability (ACCPOD) of the upper or lower extremities. All cases of ACCPOD between 1986 and 2006 were collected from the database of compensation claims at the Bureau of Labor Insurance. Standardized mortality ratios and 95% confidence intervals were calculated for different causes of death among workers with an ACCPOD of the upper or lower extremities. A total of 800,047 person-years were accrued for 71,001 workers with a single type of disability. Standardized mortality ratios were significantly increased for all causes, including liver cirrhosis, injuries, and intentional self-harm. Standardized mortality ratios for workers with amputations of the lower extremities increased to 7.66 (95% confidence interval (CI): 5.36, 10.61), 2.40 (95% CI: 1.44, 3.75), 2.07 (95% CI: 1.03, 3.70), and 5.09 (95% CI: 2.20, 10.03) for those with diabetes mellitus, cerebrovascular disease, liver cirrhosis, and chronic renal failure, respectively. The authors concluded that workers with occupational disabilities involving an upper or lower extremity should be assisted to prevent further injuries or intentional self-harm, whereas those with lower limb amputations should be provided care related to proactive control of diabetes mellitus and associated complications during rehabilitation.