ASEAN Journal of Rehabilitation Medicine

Notes from the Editor-in-Chief

Kingkaew Pajareya — 2024-05-01

Comparative Effectiveness of High-intensity Laser Therapy and Radial Extracorporeal Shock Wave Therapy in Chronic Plantar Fasciitis: A Randomized, Single-blind Clinical Trial

Vichanee Tongthong — 2024-05-01

Objectives: To compare the effectiveness of high-intensity laser therapy (HILT) and radial extracorporeal shock wave therapy (rESWT) in reducing pain and improving foot function in patients with chronic plantar fasciitis (PF)

Study design: A randomized, single-blinded, non-inferiority clinical trial

Setting: Sirindhorn National Medical Rehabilitation Institute, Nonthaburi, Thailand

Subjects: Fifty-two patients suffering from chronic PF

Methods: Participants were randomly assigned to receive a total of 9 sessions of HILT or a total of 3 sessions of rESWT. Outcome measures were the visual analog scale (VAS) and the Thai version of the Foot and Ankle Ability Measure (FAAM) at 0, 3, and 7 weeks.

Results: There was no statistically significant difference between the two groups in VAS at baseline. The FAAM and VAS of both groups showed significant improvement at 3 and 7 weeks (p < 0.05). For instance, the FAAM scores of the rESWT group had significant improvement at 3 and 7 weeks (p < 0.05), while the FAAM scores of the HILT group had significant improvement only at 7 weeks (p < 0.05). There was no statistically significant difference in the VAS and total FAAM scores between the two groups. However, the rESWT group showed significant improvement compared to the HILT group in the ADL subgroup of FAAM at 3 weeks (p < 0.05).

Conclusions: HILT and rESWT for chronic PF have no statistical different pain reduction effect at 3 and at 7 weeks. Regarding foot function, rESWT helps improve ADL at 3 weeks but not in HILT. Both treatments improve overall foot function at 7 weeks.

Comparison of the Effectiveness of Telerehabilitation and Conventional Rehabilitation in Patients with Chronic Low Back Pain: A Randomized Controlled Trial

Threenuch Amornpinyokiat — 2024-05-01

Objectives: To compare the pain numeric rating scale (NRS) and Oswestry Disability Index (ODI) between telerehabilitation (TR) and conventional rehabilitation (CR) in patients with chronic low back pain

Study design: A randomized controlled trial

Setting: Department of Physical Medicine and Rehabilitation, King Taksin Memorial Hospital, Bangkok, Thailand

Subjects: Thirty-six participants with chronic low back pain

Methods: Participants were allocated by randomization into two groups. The conventional rehabilitation (CR) group (n = 18) was treated with a home exercise program demonstrated by a Bangkok Medical Association (BMA) specialist at the hospital, and the telerehabilitation (TR) group (n = 18) was treated with the same home exercise program by a BMA specialist via a video link. Participants in both groups were asked to do the exercises at home once a day for 8 weeks, with 10 repetitions of each exercise. NRS and ODI of both groups were rated prior to the exercise program and again at the end of the eight-week exercise program.

Results: Before beginning the exercises, the two groups had no statistically significant difference in either NRS (p = 1.00) or ODI (p = 0.97). After the 8-week exercise program, the NRS of the TR group was significantly lower than that of the CR group (p = 0.03) although the ODI was not significantly different between the two groups (p = 0.90). Group analysis found that NRS was significantly reduced by 2.06 in the CR group (p = 0.00) and 3.06 in the TR group (p = 0.00) and that ODI was significantly decreased by 12.26 in the CR group (p = 0.00) and by 12.13 in the TR group (p = 0.00) at the end of the study.

Conclusions: In treating chronic low back pain, telerehabilitation is not superior to conventional rehabilitation in reducing chronic pain, disability-related low back pain and is an option for individuals who can access the telerehabilitation service.

Cross-Cultural Adaptation of the Fall Risk for Older People – A Community Setting (FROP-Com) Assessment Tool - Thai Version

Thanyaporn Aranyavalai — 2024-05-01

Objectives: The primary aim of this study was to translate and culturally adapt the Fall Risk for Older People – Community Setting (FROP-Com) assessment tool for older Thai people and to evaluate the instrument’s internal consistency and reliability. The secondary goal was to identify contributing risk factors for falls in individuals assessed with the Thai-version FROP-Com tool.

Study design: Cross-sectional descriptive study

Setting: Faculty of Medicine, Vajira Hospital, Bangkok, Thailand

Subjects: Thai community-dwelling elders aged 60 years and over

Methods: This study utilized standard guidelines for the cross-cultural adaptation process, which consisted of (a) forward translation, (b) synthesis translation, (c) backward translation, (d) expert committee review, and (e) test of the pre-final version. Internal consistency was assessed using Cronbach’s alpha coefficient. This study used intraclass correlation coefficients (ICC) with 95% confidence intervals to evaluate intra-rater and inter-rater reliability.

Results: The Thai FROP-Com assessment tool was successfully adapted for the Thai language. A total of 140 Thai community-dwelling participants aged 60 and older who met the inclusion criteria completed the study. Validation showed a good internal consistency of 0.96, while the intra-rater reliability was 0.92 and the Kappa coefficient was 0.89. The inter-rater reliability was 0.91 and the Kappa coefficient was 0.86.

Conclusions: The FROP-Com assessment tool displayed positive reliability and internal consistency for assessing risk factors among Thai older people. The tool was demonstrated to be valid and is now available for use with older members of the Thai population.

Ultrasonography Lower Extremity Nerve Cross-sectional Area Reference Values including Demographic and Electrophysiological Relationships in Healthy Thai Adults

Chapa Puprasert — 2024-05-01

Objectives: To establish the average values of cross-sectional area (CSA) in the sural, fibular, and tibial nerves by ultrasonography and to investigate correlations with demographic data and nerve conduction studies (NCS)

Study design: A cross-sectional study

Setting: Lerdsin Hospital, Bangkok, Thailand

Subjects: Healthy Thai adults aged 19-80 years

Methods: Ninety participants were recruited and their CSA was measured at seven sites within the three nerves of the lower extremities. The NCS was performed and the mean was calculated for the values at each site. Demographic data or NCS para-meters were identified as correlations with the CSA.

Results: The mean and standard deviation values of the CSA (mm²) were: (1) sural: 2.4 (0.5), (2) fibular nerve - ankle 1.6 (0.5), fibular neck (FN) 8.3 (1.5), fibular head (FH) 9.5 (1.7), popliteal fossa (PF) 12.5 (1.5), (3) tibial nerve - ankle 11.5 (2.5), PF 16.4 (2.9), (4) the FH/PF and FH/FN ratios were 1.1 (0.2), and 1.2 (0.2). The CSAs of the sural (p = 0.048), fibular at FN (p = 0.025), fibular at PF (p = 0.043), and tibial at PF (p = 0.043) nerves were significantly greater in male than those in female. The CSA was statistically correlated with age, weight, and body mass index in the sural nerve, several sites of the fibular nerve, and the tibial nerve at the ankle. Height was associated with the CSA of the tibial nerve at the ankle (r = 0.209, p = 0.048). The CSA of the tibial nerve at PF was statistically significantly correlated with the proximal amplitude of the tibial motor NCS (r = -0.233, p = 0.027).

Conclusions: Establishing nerve CSA particular to the Thai population may offer normative values and differentiate aberrant neural structures. Some demographic characteristics and NCS can have an impact on the CSA.

Factors Related to Quality of Life in Patients with Carpal Tunnel Syndrome: A Cross-sectional Study

Raksit Phitsa-ard — 2024-05-01

Objectives: To determine the association between the quality of life (QoL) of patients diagnosed with carpal tunnel syndrome (CTS) by electrodiagnostic study (EDX) and CTS severity, as well as to identify other associated factors

Study design: Cross-sectional study

Setting: Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University

Subjects: A total of 140 CTS participants diagnosed by EDX including patients aged 18 or over, who were able to communicate in Thai, were fully conscious, and were willing to participate in this research.

Methods: Participants were recruited and asked to complete the questionnaire about demographic and clinical characteristics related to CTS, the Boston questionnaire (Thai version), the Thai version of the Hospital Anxiety and Depression Scale (Thai HADS), and the EQ-5D-5L questionnaire. The data from questionnaires and the EDX results were collected and analyzed.

Results: Utility scores of the EQ-5D-5L questionnaire were correlated with Boston functional severity score (FSS) (r = -0.603, p < 0.001), Boston symptom severity score (SSS) (r = -0.546, p < 0.001), and anxiety (p=0.004). The electrophysiological severity had no association with patients’ QoL (r_s = 0.079, p = 0.354). Health visual analog scale (VAS) scores were correlated with anxiety, Boston functional severity score, and leisure activity. Other factors studied, e.g., age and income, were not associated with the patient’s QoL.

Conclusions: CTS patients’ QoL is correlated with the subjective symptom severity, functional severity, anxiety, and the inability to participate in leisure activities, but not electrophysiologic severity.

Facilitators and Barriers to Cardiac Rehabilitation Uptake Among Patients with Coronary Artery Disease in Thailand: A Qualitative Study

Rakchanoke Kotcharoen — 2024-05-01

Objectives: This study explored factors affecting cardiac rehabilitation (CR) uptake among patients with coronary artery disease (CAD) in Thailand.

Study design: An exploratory qualitative design

Setting: Data collection was conducted at two CR centers, one in an urban hospital and one in a remote hospital.

Subjects: CR healthcare providers (HPs) and patients with CAD who had been referred for CR by medical staff during their in-patient stay.

Methods: An exploratory qualitative research design using semi-structured interviews of 20 patients and 22 HPs was employed. Data were collected from June 2018 to July 2019. Transcribed interview data were analyzed thematically.

Results: The common themes identified by patients and HPs that contributed to uptake of CR included culture and religion, as well as social, logistical, and educational themes. Knowledge of CR and its benefits also facilitated attendance. Both groups recog-nized commitments to family and work as barriers to CR. Both groups also perceived that they had misconceptions about CR exercise programs and inaccurate communication regarding CR as barriers to CR attendance. Importantly, high respect for doctors as well as Buddhist beliefs and practices were cultural factors mentioned by patients as important enablers of CR. Notably, this is the first study in Thailand to identify feeling safe attending CR as being a major enabling factor for CR uptake.

Conclusions: Religious and cultural factors impact the uptake of CR among patients with CAD in Thailand. Creation of culturally- based CR programs should be considered a priority, as should identifying potential approaches to successful delivery of CR in rural areas of the country.