ASEAN Journal of Rehabilitation Medicine

Blood Flow Restriction with Low-load Resistance Exercise Improves Strength in Adults with Risk Factors for Knee Osteoarthritis: A Double-Blind Randomized Controlled Trial

Sakolawat Jaroenpakdee, Rachawan Suksathien, Pimpisa Vongvachvasin — Mon, 22 Sep 2025 00:00:00 +0700

Objectives: To assess the efficacy of blood flow restriction (BFR) with Low-load Resistance Exercise improving knee exten-sor strength in adults with risk factors for symptomatic knee osteoarthritis (OA)

Study design: Double-blind randomized controlled trial

Setting: Department of Rehabilitation Medicine, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand

Subjects: Forty-four adults aged ≥ 40 years who engaged in irregular physical activity and had at least one risk factor for symptomatic knee OA were enrolled. Participants were randomly assigned to either the BFR or the control group using stratified and mixed block randomization.

Methods: The study employed a double-blind, randomized, controlled trial design. The BFR group exercised twice a week for 4 weeks, performing knee extension exercises at 30% of their one-repetition maximum (1RM) (15 reps × 4 sets) with cuff pressure, while the control group performed the same exercises but without using the cuff protocol. The outcomes measured included 1RM isokinetic knee extension, 1RM isokinetic leg press, 30-second chair stand test, and Knee Injury and Osteoarthritis Outcome Score (KOOS). Test results pre-exercise and post-exercise (3 days after the last exercise session) were recorded. Differences in results between groups were compared using the linear regression test.

Results: The post-test mean differences of 1RM isokinetic knee extensor, 1RM leg press, 30 second chair stand test, and KOOS between groups (adjusted mean difference, AMD) were 14.7 kg (95% confidence interval (95%CI) 4.0, 19.3; p < 0.001), 30.83 kg (95%CI: 18.0, 43.7; p < 0.001), 7.1 times (95%CI: 4.2, 10.1; p < .001) and 1.4 points (95%CI: 0.3, 2.5; p = 0.01) respectively, all of which were statistically significant (p < 0.05).

Conclusions: BFR can improve knee extensor strength in adults with risk factors for symptomatic knee OA compared to low-load resistance exercise alone without further worsening knee symptoms.

Effects of Focused ESWT in Moderate Degree Carpal Tunnel Syndrome: A Preliminary, Randomized Double-Blinded Controlled Trial

Cherdpong Pimubol, Jirapa Champaiboon, Jariya Boonhong — Mon, 22 Sep 2025 00:00:00 +0700

Objectives: To study the effects of focused extracorporeal shockwave therapy (f ESWT) combined with night splint and compare 4 and 10 treatment sessions in patients with moderate carpal tunnel syndrome (CTS)

Study design: A randomized, double-blinded, controlled trial

Setting: An outpatient rehabilitation clinic in King Chulalongkorn Memorial Hospital, Bangkok, Thailand

Subjects: Patients with a diagnosis of moderate CTS

Methods: Patients were randomly assigned to one of two groups. The intervention group received ESWT once a week for ten consecutive weeks, while the comparison group received sham ESWT for the first four weeks and real ESWT for the subsequent six weeks. All patients were advised to wear a night splint. The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) and the electrodiagnostic study were evaluated at baseline, 4, and 10 weeks.

Results: The f ESWT group improved significantly in both BCTQ symptoms (p = 0.022) and BCTQ function (p-value 0.025), whereas the comparison group improved only in BCTQ symptoms (p = 0.028). At 4 weeks, the f ESWT group showed statistically significant improvement in distal sensory latency (p-value 0.019) and sensory nerve conduction velocity across the wrist (p = 0.028) compared to the comparison group. Over the course of ten sessions of ESWT, clinical outcomes and neurophysio-logic parameters continued to improve. However, the number of patients exceeding the minimal clinically important difference in BCTQ did not change after the first 4 sessions.

Conclusions: This preliminary study shows that adding f ESWT to a night splint is safe and effective for improving symptoms, function, and neurophysiologic parameters in moderate CTS. In terms of cost-effectiveness, four sessions may be more appropriate.

Factors Associated with Goal Attainment in Children with Cerebral Palsy: An Ambidirectional Cohort Study

Mon, 22 Sep 2025 00:00:00 +0700

Objectives: This study aimed to identify factors influencing goal attainment in children with cerebral palsy (CP) while evaluating the appropriateness of established therapeutic goals.

Study design: An ambidirectional cohort study

Setting: The Rehabilitation Department, Siriraj Hospital, Bangkok, Thailand

Subjects: Patients aged 0 to 15 years with a diagnosis of cerebral palsy were eligible if they had received at least two sessions of goal-directed therapy (GDT) and a post-therapy Goal Attainment Scale (GAS) evaluation between January 2016 and March 2022.

Methods: A total of 462 goals were evaluated using the GAS. Clinical variables, including age, sex, CP type, functional classification, goals, comorbidities, and therapy frequency, were analyzed for associations with goal attainment.

Results: Clinical data were collected from 111 pediatric CP patients (51.4% female) undergoing GDT at a university hospital rehabilitation unit. The participants had a mean age of 4.7 years (SD = 2.7), with spastic CP being the most prevalent type (77.7%). The goals for high-functioning participants frequently targeted ambulation and hand function, while the goals for low-functioning groups focused on sitting, hand function, and swallowing. Overall, therapeutic goals were found to be appropriate, with a GAS T score of 50.2. The Gross Motor Function Classification System (GMFCS) levels I and II emerged as the sole statistically significant independent predictor of goal attainment (p = 0.04).

Conclusion: Children with CP who demonstrate greater gross motor function exhibit a greater likelihood of therapeutic goal attainment. The GMFCS should inform the selection of appropriate therapeutic goals. High-functioning children may benefit from active goals such as improving ambulation and hand function, while low-functioning groups progress best with passive goals centered on preventing complications and achieving early motor milestones.

A Clinical Predictive Score to Predict Functional Outcomes After Intensive Rehabilitation Programs for Patients with Stroke: A Retrospective Cohort Study

Paveenrath Charussuriyong, Rachawan Suksathien — Mon, 22 Sep 2025 00:00:00 +0700

Objectives: To develop a clinical predictive score to predict functional outcomes of intensive rehabilitation programs for stroke patients

Study design: A retrospective, observational cohort study

Setting: The inpatient rehabilitation ward of the Maharat Nakhon Ratchasima Hospital

Subjects: Stroke patients aged ≥ 18 years who had undergone admission for intensive rehabilitation

Methods: The study reviewed the demographic data, associated impairment, clinical assessment, and Barthel index (BI) at admis-sion to and at discharge from the rehabilitation ward. The patient’s functional outcome was classified based on the BI at discharge. Predictive variables were identified using stepwise multivariable logistic regression. A predictive score was constructed and validated.

Results: Among 250 patients, 81 achieved a good rehabilitation outcome. Eight variables were predictive of outcome: age < 70 years, interval from onset to intensive rehabilitation admission, neglect syndrome, cognitive impairment, depression, muscle strength of the affected distal upper extremity and proximal lower extremity ≥ grade 3, and Functional Ambulation Categories (FAC). These variables were used to construct a predictive score, resulting in a model with an area under the curve (AUC) of 0.77 (95%CI: 0.71, 0.83). The total score range was from 0 to 33. The Youden index determined a cutoff of 19.5, categorizing patients into two groups: good (> 19.5) and poor rehabilitation outcomes (≤ 19.5). The positive likelihood ratio for good was 2.32 (95%CI: 1.85, 2.90), while for poor rehabilitation outcomes, it was 0.27 (95%CI: 0.17, 0.44). Internal validity confirmed the model’s good discrimination, calibration, and minimal overfitting.

Conclusions: Based on reliable and straightforward admission variables, the clinical predictive score presented in this study could help guide physicians in decision-making regarding selection of patients for admission to intensive rehabilitation programs.

Experience and Satisfaction with Non-surgical Hallux Valgus Treatment Among Patients in Siriraj Hospital

Mon, 22 Sep 2025 00:00:00 +0700

Objectives: To describe patient experiences, treatments, outcomes, side effects, and satisfaction with hallux valgus treatments at Siriraj Hospital.

Study design: A cross-sectional study

Setting: Siriraj Hospital, Bangkok, Thailand

Subjects: Two hundred thirty participants aged over 18 who were diagnosed with hallux valgus by their physician for over a year and were able to communicate in Thai. Participants had to use the treatment for at least 5 hours per day, 5 days per week, for a minimum of 1 month.

Methods: Data was collected via questionnaires from July 2021 to April 2022. Proportions of experience and satisfaction with non-surgical hallux valgus treatment were calculated to measure the patient’s experience and satisfaction with treatment options from the patient’s perspective. Mean pain score differences before and after treatment were analyzed using a paired sample t-test.

Results: The study included 217 females (94.3%) with a mean age of 56 (16.4). Fifty-six percent had bilateral hallux valgus. The most common treatment was changing footwear or shoe modification, which was used by 93.0% of participants. The most preferred treatment was changing footwear or shoe modification (65.2%), followed by insoles (20.0%) and dynamic splints (5.7%). These treatments all showed statistically significant clinical improvement (p < 0.001, p < 0.001 and p = 0.008, respectively). Most participants (81.3%) felt their deformity remained unchanged. The median satisfaction score was high for all treatments (8 out of 10). No serious complications were reported.

Conclusions: Changing footwear or shoe modification was the most utilized and the preferred treatment, demonstrating significant clinical improvement. Further studies are recommended to investigate the effectiveness of newer treatments and potential alternatives, e.g., bunion shields, toe separator socks, and cotton toe separators.

Prevalence, Characteristics, and Impacts of Urinary Tract Infection on Functional Outcomes: A Retrospective Study of Inpatient Stroke Rehabilitation at Siriraj Hospital, Thailand

Patcharee Aueaananratthakit, Kamontip Harnphadungkit — Mon, 22 Sep 2025 00:00:00 +0700

Objectives: To investigate the prevalence, characteristics, associated factors, and impacts of urinary tract infections (UTI) on the Barthel Index (BI) during inpatient stroke rehabilitation.

Study design: Retrospective study

Setting: Inpatient Rehabilitation Unit, Department of Rehabilitation Medicine, Siriraj Hospital, Bangkok, Thailand

Subjects: Inpatients with stroke, aged ≥ 18 years old, admitted to the Rehabilitation Ward, Siriraj Hospital during 2019-2021

Methods: Demographic, clinical, and functional data of eligible patients were retrieved from the rehabilitation admission medical records in the hospital information system.

Results: Of 399 stroke patients identified, 11.5% had been diagnosed with UTI. Of these, 30.4% had catheter-associated UTIs (CAUTIs), while 69.6% had non-CAUTIs. Escherichia coli was identified as the most common pathogen. UTI was significantly associated with advanced age (p < 0.001), indwelling catheter use (p < 0.001), recurrent stroke (p = 0.031), and dysphagia (p < 0.019). Patients with UTI exhibited a statistically significant reduction in BI normalized gain per 21-day length of stay (BIg21days) (p = 0.033) and experienced longer rehabilitation length of stay (LOS) (p = 0.002). Using forward stepwise linear regression, only age and dysphagia, but not UTI, were found to be statistically significantly associated with BIg21days.

Conclusions: The prevalence of UTI is 11.5%, with higher rates in older individuals, those with recurrent stroke, dysphagia, and those using urinary catheters. Functional gain per 21 days of rehabilitation admission is associated with age and dysphagia, but not with UTI.

Letter from the Editor

Kingkaew Pajareya — Mon, 22 Sep 2025 00:00:00 +0700