Journal of Health Science and Medical Research

Exacerbation of Autoimmune Hepatitis following Inactivated SARSCoV- 2 Vaccination

2024-06-20T15:34:57+07:00

Autoimmune hepatitis (AIH) is a rare condition that has seldom been reported being reactivated by a coronavirus disease 2019 (COVID-19) vaccination, especially from an inactivated vaccine. This report presents the case of a 64-year-old male with quiescent AIH cirrhosis who exhibited jaundice and constitutional symptoms for three days at two weeks following his second dose of an inactivated vaccine. The patient had complied well with a four-year immunosuppressive medication regimen to treat AIH which maintained normalized liver enzymes. He also abstained from using herbal supplements. At his presentation, his liver chemistry showed acute hepatocellular jaundice, with histology revealing active AIH. Following extensive testing, he was diagnosed with an AIH exacerbation triggered by the COVID-19 vaccine. His symptoms improved following treatment with higher doses of immunosuppressive agents. This report underscores the potential effect of the COVID-19 vaccine on reactivating well-controlled AIH.

Twisted Ovarian Cyst, Galactorrhea and Pituitary Hyperplasia Misdiagnosed as Prolactinoma: An Overlooked Longstanding Overt Hypothyroidism from Hashimoto’s Thyroiditis

2024-06-21T10:38:05+07:00

We describe a 14-year-old girl who was referred for management of a prolactin-secreting pituitary adenoma as she had persistent milky discharge from her nipples, an elevated prolactin level and pituitary enlargement. Upon reviewing the medical history, it was noted that she had a history of secondary amenorrhea for 1 year, and had undergone an oophorectomy for twisted left ovarian cyst 5 months earlier. The physical examination found that she had a goiter, short stature and was relatively overweight. Based on these findings, it was thought that the patient likely had longstanding overt hypothyroidism. A thyroid function test (TFT) revealed a free thyroxine (FT4) level of 0.2 ng/dL and thyroid stimulating hormone (TSH) >100 mU/L, with high levels of antithyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-TG) antibodies, leading to the diagnosis of Hashimoto’s thyroiditis. After 8 months of levothyroxine treatment, the galactorrhea had disappeared, the pituitary enlargement had resolved and her menstruation had resumed normally, along with a 4-kg weight loss and 3-cm height gain. In summary, when evaluating a girl with ovarian cyst(s), especially if accompanied by other clinical findings like goiter, short stature, or menstrual irregularities, the physician should include hypothyroidism in the differential diagnosis. Early diagnosis and treatment of hypothyroidism can have a positive impact on the overall health and well-being of these patients, potentially preventing further complications related to both the thyroid disorder and ovarian cyst(s).

Complementary Feeding: Food Group Diversity and Probability of Nutrient Adequacy among 6-12-Month-Old Infants in Southern Thailand

2024-06-05T10:57:34+07:00

Objective: To determine complementary food intake, food group diversity and nutritional adequacy of 6-12-month-old infants in southern Thailand.
Material and Methods: A total of 120 healthy infants, aged 6-12 months, were enrolled: from December 2020 to November 2021. A 24-hour food record was used to assess the type, amount and frequency of food intake in each infant. The infants’ food intake was classified into seven food groups. Macronutrient and micronutrient intakes were analysed using the INMUCAL software program; the standard program for the calculation of nutrients in Thai food.
Results: Of the 120 infants, 10 (8.3%) received breast and/or formula feeding without complementary food; 30 (25%) received 1, 66 (55%) received 2, and 14 (11.7%) 3-4 received complementary meals a day. The 4 most common supplementary foods given to the infants were rice mixed with vitamin A-rich fruits or vegetables, meat, eggs, or other fruits (mostly bananas). Infants who received 1 complementary meal, with 1-3 food groups a day, had significantly higher percentages of micronutrient inadequacies (iron, magnesium, selenium and vitamin E) than those receiving at least 2 complementary meals; with at least 4 food groups a day.
Conclusion: Infants in southern Thailand who were fed <4 food groups with <2 complementary meals a day were at risk of micronutrient inadequacies; such as iron, magnesium, selenium and vitamin E. Therefore, infants aged 6-7 months should be given a minimum meal frequency (MMF) of 2 meals, with a minimum dietary diversity (MDD) of 4 food groups per day.

Effect of Difficult Common Bile Duct Stone on Conversion Rate from Laparoscopic to Open Cholecystectomy

2024-06-05T11:24:35+07:00

Objective: This study aimed to evaluate the effect of difficult common bile duct (CBD) stone on conversion rate of Laparoscopic cholecystectomy (LC). In addition, this study evaluated the effect of difficult CBD stone on operative time and complications in LC procedures.
Material and Methods: The medical records at Her Royal Highness Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University; from January 2017 to December 2021, were retrospectively reviewed. We enrolled patients with CBD stone having undergone endoscopic retrograde cholangiopancreatography (ERCP), followed by LC. Difficult CBD stones was defined as: a stone diameter >1.5 cm, biliary stricture, Mirizzi’s syndrome, cystic duct stone or stone that could not be extracted in the first ERCP.
Results: Of the 140 patients, a total of 40.7% were male. The mean age was 60.8 years. From this 30% of patients had difficult CBD stones. The conversion rate was 10%. By univariate analysis, the difficult CBD stone was statistically significantly associated with a predictor of conversion rate (r=0.30, p-value<0.001). The odds ratio was 7.34 (95% confidence interval (CI) 2.15-25.05, p-value=0.001). From the result of LC, operation time (p-value=0.002), overall complications (p-value=0.003) and length of hospital stay (p-value=0.002) were significantly higher in difficult than non-difficult CBD stones.
Conclusion: Difficult CBD stones could increase the conversion rate from laparoscopic to open cholecystectomy, which requires more operation time, has complications and longer length of hospital stay than non-difficult CBD stones in LC procedures. LC after ERCP in this group should be carefully performed by an experienced surgeon.

Particulate Matter 2.5 and Respiratory Symptoms in Urban and Suburban Schoolchildren in Ho Chi Minh City, Vietnam

2024-06-05T14:43:28+07:00

Objective: To document the pattern of particulate matter 2.5 (PM2.5) concentration in urban and suburban schools in Ho Chi Minh City (HCMC) and to estimate the prevalence of wheezing and rhinitis among schoolchildren according to sociodemographic characteristics and school-related conditions.
Material and Methods: A cross-sectional study was conducted in two suburban and two urban schools in HCMC. PM2.5 concentrations were monitored hourly from August to December in 2022. Children aged 9-13 years (N=1,033) provided data on wheezing and rhinitis symptoms in the previous year. The daily levels of PM2.5 were monitored in each school. Respiratory symptoms were compared between areas and across school-related conditions.
Results: Geometric means of the daily PM2.5 concentration in the suburban and urban areas were 61.2 μg/m3 and 31.0 μg/m3, respectively (p-value<0.001). In both areas, PM2.5 levels increased in the evening to high levels at night and early morning. The prevalence of respiratory symptoms did not differ significantly between the suburban and urban areas: wheezing 20.6% and 16.9%, and rhinitis 55.7% and 61.5%, respectively. However, school-related conditions in which the prevalence was increased were travelling to school by bus, spending more than 15 minutes/day on the road and attending extra classes outside normal school hours.
Conclusion: Despite the significantly higher PM2.5 levels in suburban schools, the prevalence of wheezing and rhinitis did not reveal significant differences between areas. However, respiratory symptoms were more common among those travelling by bus, having been infected with Coronavirus Disease-19 (COVID-19), spending longer time on the road and attending classes outside normal school hours.

A Prospective Study of 18F-FDG PET-CT Application in Therapeutic Monitoring of Osteoarticular Tuberculosis

2024-06-06T14:24:20+07:00

Objective: Confident diagnosis, identification of occult sites, assessing treatment response, and precisely ascertaining the duration and endpoint of treatment in skeletal tuberculosis is often challenging. magnetic resonance imaging (MRI) and computed tomography (CT) are less dependable owing to low sensitivity and the inability to discern current illness and old changes. 18F-FDG PET/CT utilizes variations in glycolysis rates between healthy and diseased tissue to quantitatively estimate the maximal standard uptake value (SUVmax) of 18F-FDG to assess disease activity.
Material and Methods: 32 patients who presented to the department with a clinicoradiological suspicion and pathologically proven diagnosis of skeletal tuberculosis were prospectively analyzed. All patients underwent a whole body 18F-FDG PET-CT scan before initiation of anti-tubercular therapy (ATT), and then treatment was started as per the Revised National Tuberculosis Control Program (RNTCP) guidelines. All patients were followed up with repeat PET-CT scans and relevant clinical investigations at 2, 6, and 12 months.
Results: A gradual decrease in SUVmax values, as the treatment courses progressed indicated a decrease in disease activity with treatment. There was an overall mean decrease of 6.5 units in the SUVmax values when compared to the pre-treatment levels, which was statistically significant (p-value<0.001). At 2 months of anti-tubercular treatment, the mean SUVmax values decreased by 39%, and at 6 and 12 months of ATT, they were reduced by 60% and 81%, respectively.
Conclusion: 18F-FDG PET-CT helps to determine the prevalence of occult multifocal activity elsewhere in the body. The gradual decrease in SUVmax values during the course of ATT is a useful tool to assess disease response and to precisely decide the endpoint of ATT.

Cross-Cultural Adaptation and Psychometric Properties of The Thai Versions of The Patient-Reported Outcomes Measurement Information System Short Form – Anxiety 8a and the Pain Anxiety Symptoms Scale-20 in Individuals with Chronic Low Back Pain

2024-06-11T11:05:59+07:00

Objective: To translate and cross-culturally adapt the Patient-Reported Outcomes Measurement Information System Short Form v1.0–Anxiety 8a and the Pain Anxiety Symptoms Scale-20 into Thai versions (T-PROMIS-Anx8a and T-PASS-20, respectively) and evaluate their psychometric properties in individuals with chronic low back pain (CLBP).
Material and Methods: The translations and cultural adaptations were performed using the Functional Assessment of Chronic Illness Therapy (FACIT) guidelines. Thai individuals with CLBP completed the T-PROMIS-Anx8a and T-PASS-20. Psychometric evaluation including: internal consistency, test-retest reliability, and dimensionality. Construct validity was evaluated by computing correlations among the scores on the T-PROMIS-Anx8a, T-PASS-20, Thai version of the Hospital Anxiety and Depression Scale–Anxiety (T-HADS-A), and Thai version of the Fear Avoidance Beliefs Questionnaire (T-FABQ).
Results: A total of 269 individuals with CLBP were included in the analyses. The T-PROMIS-Anx8a showed unidimensionality and the T-PASS-20 evidenced a 4-factor structure. Both measures demonstrated good to excellent internal consistency (Cronbach’s alphas ranged from 0.85 to 0.95), good test-retest reliability (ICC(2,1) ranged from 0.79 to 0.88), and neither ceiling nor floor effects were observed for any of the scales. Both measures evidenced acceptable convergent and discriminant validity, based on their associations with the T-HADS-A and T-FABQ.
Conclusion: The T-PROMIS-Anx8a and T-PASS-20 were culturally adapted and evidenced acceptable psychometric properties for assessing anxiety in Thai individuals with CLBP.

Physical Activity Levels and Associated Factors for Health Complaints among Female University Students During the COVID-19 Pandemic in Malaysia: A University-based Cross-Sectional Survey

2024-06-11T11:22:10+07:00

Objective: This cross-sectional study assessed the prevalence of health complaints and physical activity levels among female university students; including determining the risk factors of health complaints during the pandemic.
Material and Methods: Data were collected from 205 female university students, aged 18-29 years old via self-administered online questionnaires during a nationwide movement-restricted order. The Global Physical Activity Questionnaire (GPAQ) and a modified health symptoms questionnaire were used to assess physical activity levels and health complaints.
Results: The most prevalent daily health complaint was sleeping difficulties (8.3%). The total minutes of sedentary behaviour were positively associated with health complaints (r=0.131, p-value=0.031), while the total minutes of moderate recreation were negatively associated with health complaints (r=-0.166, p-value=0.009). Marital status (standardised beta coefficient, β=-0.167, p-value=0.030) and employment (β=-0.180, p-value=0.017) were risks of health complaints.
Conclusion: Sedentariness; including sociodemographic factors during the pandemic was associated with health
complaints. Appropriate counselling, finance and social supports and physical activity programmes are recommended at
universities to prevent future health risks.

Diarylheptanoid 7-(3,4-Dihydroxyphenyl)-5- Hydroxy-1-Phenyl- (1E)-1-Heptene from Curcuma Comosa Roxb. Inhibits Nucleophosmin Localization and Induces Apoptosis in KG-1a Leukemic Stem Cells

2024-06-11T11:33:04+07:00

Objective: This study aimed to investigate the effect of the diarylheptanoid 7-(3,4-dihydroxyphenyl)-5- hydroxy-1-phenyl-(1E)-1-heptene (DDHPH) from the rhizome of Curcuma comosa Roxb. on nucleophosmin (NPM) protein localization followed by induced cell death in KG-1a leukemic stem cells.
Material and Methods: DDHPH was purified by column chromatography and characterized by nuclear magnetic resonance (NMR). Localization of NPM was determined by a confocal microscopy. Induction of cell death was determined by flow cytometry and Western blotting.
Results: A previous study showed that NPM directly interacted with p53 and activates p53 function. In this study, DDHPH was found to modify the translocation of NPM and enhance both p53 and cleaved caspase-3 expression. These proteins were found to control cell cycle progression and cell apoptosis induction.
Conclusion: This study demonstrated that DDHPH is a novel compound which induces cell death through NPM localization.

Factors Associated with the Incidence of COVID-19 Infectious Disease in Muang Pattani District, Thailand

2024-06-11T13:45:07+07:00

Objective: This study aimed to investigate the COVID-19 incidence in Muang Pattani district; from April 2021 and September 2022, Specifically, the main objective was to study the varying distribution by demographic, area and period of COVID-19.
Material and Methods: COVID-19 data, with 15,807 reported cases was obtained from the Muang Pattani District Health Office. A descriptive analysis was used to describe the characteristics of the COVID-19 cases. A negative binomial model was used to investigate COVID-19 incidence.
Results: The overall incidence of COVID-19 was around 1,188.9 cases per 100,000 of the population. Females had a higher incidence rate of COVID-19 infection than males. People aged from 20 to 39 years old had significantly higher incidence rates than the average, with the highest rate being found in the Barohom sub-district. In 2021, the highest rates were in the month of October, followed by July and August; while March was reported as the highest rate in 2022.
Conclusion: The findings of this study can be used by the public health organizations and others involved in COVID-19 for direct prevention and control in those high-incidence areas. This study has also proven that its findings can be applied to cases related to the prevention programs of other infectious diseases in Thailand.

Effectiveness of Pharmacist-led Intervention on Physicians Prescribing for Outpatients in Vietnam: A Before- and After-intervention Study

2024-06-11T13:57:04+07:00

Objective: Drug-related problems (DRPs) can lead to treatment failures and high risks of hospitali-zation. This study aimed to evaluate the effect of pharmacist-led interventions on DRPs in outpa-tient prescribing and to determine the risk factors relative to these DRPs.
Material and Methods: A prospective study was conducted that compared before- (April 1 to June 30, 2020) and after- (June 1 to June 15, 2021) interventions on the outpatient prescribing process from a public hospital in Vietnam. The PCNE classification version 9.1 and suitable drug information were used to determine DRPs, which then used Drugs.com to find drug-drug interactions for each prescription. Collaborated with hospital pharmacists via reporting on the pre-intervention results, sending information sheets, and reminding doctors of the DRPs was conducted.
Results: 32.8% of prescriptions had at least 1 DRP in 500 pre-intervention prescriptions. In 500 post-intervention prescriptions, the proportion of at least 1 DRP prescription decreased from 32.8% to 31.0% (p-value>0.05). Prescriptions with ≥5 drugs increased the possibility of a DRP appearance (p-value<0.001).
Conclusion: This intervention method was not thorough, so it was ineffective in reducing DRPs on outpatient prescriptions. It is necessary to conduct specific interventions on each DRP and more time to discuss with doctors to improve the effectiveness of prescribing.

Incidence of Extravasation during Norepinephrine Administration via Peripheral Venous Catheter in Emergency Patients

2024-06-11T14:26:22+07:00

Objective: To describe the incidence of extravasation resulting from the administration of norepinephrine through a peripheral venous catheter in emergency patients.
Material and Methods: This prospective observational study was conducted on 150 adult patients in the emergency department at Siriraj Hospital, Thailand. Physicians closely monitored patients who received norepinephrine via a peripheral venous catheter examining the intravenous access sites during the period of treatment and for up to 48 hours after discontinuation of treatment. We collected demographic data, norepinephrine administration details, potential risk factors for extravasation, the incidence of extravasation, and mortality rate.
Results: The median age of the patients was 67 years, and 60.7% were male. Most patients (93.3%) received peripheral intravenous norepinephrine for septic shock, administered below the wrist joint (47.3%) through a 22-gauge catheter (82.7%). The median duration of total peripheral intravenous norepinephrine administration was 19.92 hours (interquartile range (IQR) 9.48-38.09). The median maximum dose was 0.07 mcg/kg/min (IQR 0.04-0.10). Extravasation occurred in three patients (2.0%) (95% CI: 0.6 - 6.1), none of which resulted in significant morbidity. The timing from shock diagnosis to peripheral intravenous norepinephrine administration did not statistically differ between survivors and non-survivors at both 7 and 30 days. However, the median time from shock diagnosis to achieve mean arterial pressure (MAP)≥65 mmHg, and time from norepinephrine administration to achieve MAP ≥65 mmHg, was shorter in the survivors compared to the non-survivors.
Conclusion: Given that the incidence of extravasation events was low and did not result in significant morbidity, we suggest that peripheral intravenous norepinephrine administration is safe under close observation and for a limited duration.

Surgical Experience and Results of Retzius Sparing Robotic Assisted Laparoscopic Radical Prostatectomy: First Report in Thailand

2024-06-11T14:45:40+07:00

Objective: To evaluate the outcomes and safety of the surgical technique Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RS-RALRP), with prostatic cancer; the first report in Thailand.
Material and Methods: The authors conducted a retrospective analysis from the medical records of 100 patients who underwent RS-RALRP by a single surgeon; from 1st January 2021 until 31st May 2023, at Rajavithi Hospital. The authors analyzed demographic data, clinical staging, Gleason grade group, operative time, pathologic staging, positive surgical margin rate; postoperative continence recovery and postoperative complications.
Results: The median age was 71.34±6.84 years: mean total PSA was 17.16±17.55 ng/ml; with the majority in clinical T1 and T2. The mean operative time was 221.7±51.93 minutes, and the mean estimated blood loss was 312.30±264.55 ml. Of all patients, 88% did not require blood transfusion. The complication rate was 8%. The pathologic stages pT2 and pT3 or greater were 62% and 38%, respectively. Positive surgical margins (PSM) pT2 and pT3 were 14.5% and 63.2%. The postoperative continence recovery after RS-RALRP were 83%, 95%, 97%,100% and 100%: at 1, 3, 6, 9 and 12 months postoperatively, respectively.
Conclusion: RS-RALRP has a potential to become the new standard for prostate cancer treatment, with improved early continence and equivalent oncologic efficacy. The limitations of this study are the small number of population, which require prospective multicenter studies.

Hemodialysis-Related Infections: A 4-Year Surveillance

2024-06-11T16:24:38+07:00

Objective: To analyze the results from the surveillance of hemodialysis-related infections.
Material and Methods: Data was prospectively gathered from outpatients attending a hemodialysis unit from April 2019 until March 2023. The National Healthcare Safety Network (NHSN) Dialysis Event Surveillance was used to identify three types of infection-related dialysis events. Event rates were calculated and stratified by vascular access type, standardized infection ratios for bloodstream infections (BSI), intravenous antimicrobial starts, and described pathogens identified among BSI.
Results: A total of 2,288 patient-month follow-ups were included. There were 79 infection-related dialysis events (24 BSI; 46 intravenous antimicrobial starts, nine pus, redness, or increased swelling at the vascular access site). The incidence of BSI per 100 patient-months was 1.05 (0.59 arteriovenous fistula, 0.83 arteriovenous graft, and 2.22 central venous catheter). Seventeen BSI were vascular access-related. Access-related BSI per 100 patient-months was 0.74 (0.39 arteriovenous fistula, 0.41 arteriovenous graft, and 1.85 central venous catheter). Intravenous antimicrobial starts per 100 patient-months was 2.01 (0.98 arteriovenous fistula, 2.62 arteriovenous graft, and 3.14 central venous catheter). Most events occurred in patients with a central venous catheter. When benchmarked with the 2014 NHSN, the standardized infection ratio of BSI, access-related BSI, and intravenous antimicrobial starts were 1.40, 1.26, and 0.55, respectively. The most serious outcome was BSI; resulting in 83.3% hospitalizations, 25% loss of vascular access, and 15.8% deaths.
Conclusion: Surveillance of infection-related dialysis events is important for prevention. These events were highest among patients with a central venous catheter compared with other vascular access types.

Soetomo COVID-19 Prognostic Score: A Multi-Parametric Model for Early Prediction of Disease Severity of COVID-19 in Tertiery -Resource Hospital

2024-06-13T16:19:59+07:00

Objective: Coronavirus disease 2019 (COVID-19) became a global pandemic, with high mortality in severely ill patients. This study aimed to develop a novel scoring system to prognosticate disease severity in COVID-19 patients that is effective and widely available in tertiary medical resource settings.
Material and Methods: Laboratory-confirmed COVID-19 patients were enrolled in this retrospective cohort, divided into severe and non-severe groups. We randomly assigned 70% of the subjects to establish a novel scoring system, while the remaining 30% was used for internal validation. The model was constructed by multivariate logistic regression using the first clinical, laboratory, and radiological finding of statistically analysis of group patients. receiver operating characteristic (ROC) and cross-tabulation were used to evaluate the performance of our score and compare it with other models.
Results: A total of 599 patients were included. The Soetomo COVID-19 prognostic score predictors included age, fever, specific comorbidities (diabetes, hypertension, cardiac disease, lung tuberculosis), respiratory rate, heart rate, SF ratio, whole blood cell (WBC) count, neutrophil lympocyte ratio (NLR), blood urea nitrogen (BUN), and a RALE score. The area under the ROC of the model indicated an excellent discriminatory ability (training datasets 0.715 [95% CI 0.664-0.767, p-value<0.001]; testing datasets 0.720 [95% CI 0.638-0.802, p-value<0.001]). Our scoring system was superior to both qSOFA and MEWS regarding predictive value. The sensitivity and specificity were 60.6% and 82.5%, respectively.
Conclusion: The developed scoring system accurately predicted a significant proportion of severe disease in COVID-19 patients.

Modified Computed Tomography Scoring System for Ovarian Tumors

2024-06-20T14:41:00+07:00

Objective: Ovarian cancer is the sixth most common cancer in Thailand. Given the absence of a computed tomography (CT) score for differentiating between benign and malignant ovarian tumors, this study aimed to develop a CT scoring system for differentiating between benign and malignant ovarian tumors using pathologic findings as the reference standard.
Material and Methods: This retrospective study included all female patients having undergone abdominal/pelvic CT scans for evaluation of ovarian masses at our institute, from January 2011 to December 2021. Two radiologists independently reviewed CT features and obtained a CT score for each tumor. Comparison of the differentiation performance of the CT score, with reference to the pathologic findings, was performed using Fisher’s exact or chi-squared test. The diagnostic performance of the CT score was evaluated.
Results: A total of 144 patients with 191 ovarian masses were enrolled. Tumor component characteristics, septate thickness, ascites, and metastasis significantly differed between benign and malignant tumors (p-value<0.05). Multivariate logistic regression analysis showed that the presence of solid components and metastasis were significant independent differentiating factors (p-value<0.001). The CT score significantly differed between benign and malignant tumors (p-value<0.001), with 93.5% sensitivity and 81.6% specificity.
Conclusion: The CT scoring system can differentiate between benign and malignant ovarian tumors with high sensitivity and specificity. Furthermore, the presence of a solid component and metastasis are CT features that can be used to differentiate between benign and malignant tumors.

Effect of Cognitive Orientation to Daily Occupational Performance (CO-OP) Programme on Playfulness in Children with Attention Deficit Hyperactivity Disorder

2024-06-20T15:21:12+07:00

Objective: To investigate the effect of cognitive orientation to daily occupational performance (CO-OP) programme on playfulness in children with attention deficit hyperactivity disorder.
Material and Methods: Seventy Attention deficit hyperactivity disorder participants (N=70), aged between 6-8 years were recruited from a local community-based setting. The children were divided into an experimental (n=35) and a control group (n=35). The experimental group participants received CO-OP and the control group participants received the conventional occupational therapy programme; for 12 weeks. The test on playfulness was used to measure playfulness in children.
Results: There were statistically significant differences between pretest and post-test scores of the test of playfulness (TOP) in the experimental group (p-value≤0.05) components of: Extent, Intensity and Skillfulness, and there were statistically significant differences between pretest and post-test group of TOP in the control group (p-value≤0.05) in Intensity and Skillfulness. There was no statistically significant difference in pretest and post-test scores of TOP in the component of Extent. Further analysis revealed that clinically there was significant differences in the post-test scores of TOP between the control and experimental group components of Extent, Intensity and Skillfulness.
Conclusion: CO-OP was effective in improving playfulness in children with attention deficit hyperactivity disorder.