Test-retest reliability of short- and long-term heart rate variability in individuals with spinal cord injury

Study design: Cross-sectional. Objectives: To investigate test-retest reliability of heart rate variability (HRV) metrics in SCI without restriction of activity over long (24-h) and shorter durations (5-min, 10-min, 1-h, 3-h and 6-h). Settings: University hospital in Khon Kaen, Thailand. Methods: Forty-five participants (11 with tetraplegia and 34 with paraplegia) underwent two 24-h recordings of RR-intervals to derive time and frequency HRV metrics. Relative reliability was assessed by intraclass correlation coefficient (ICC) and absolute reliability by coefficient of variation (CV) and Bland–Altman limits of agreement (LoA). Results: For 5- and 10-min durations, eight of eleven HRV metrics had moderate to excellent reliability (ICC 0.40–0.76); the remaining three were poor (ICC < 0.4). HRV values from 1-h and 3-h durations showed moderate to excellent reliability (ICC of 0.46–0.81), except for 1-h reliability of ULF and TP (ICC of 0.06 and 0.30, respectively). Relative reliability was excellent (ICC of 0.77–0.92) for 6-h and 24-h durations in all HRV metrics. Absolute reliability improved as recording duration increased (lower CVs and narrower LoAs). Participants with high AD risk (SCI level at or above T6) showed lower test-retest reliability of HF and LF values than participants with low AD risk. Conclusion: Relative reliability of HRV was excellent for 6-h and 24-h. The best absolute reliability values were for 24-h duration. Time-domain outcomes were more reliable than frequency domain outcomes. Participants with high risk of AD, particularly those with tetraplegia, showed lower reliability, especially for HF and LF

Diagnostic performance of urine dipstick test for urinary tract infection screening in individuals with spinal cord injury

Objectives: To determine the diagnostic performance of urine dipstick test for urinary tract infection (UTI) screening in spinal cord injury (SCI) patients. Study Design: A cross-sectional diagnostic study. Setting: Srinagarind Hospital, Khon Kaen, Thailand. Participants: SCI patients with neurogenic bladder. Materials and Methods: This study was a cross-sectional diagnostic study that compared the urine dipstick test (index test) with the National Institute on Disability and Rehabilitation Research (NIDRR) criteria (gold standard test) in SCI patients. The urine dipstick test reported positive and negative results. Moreover, the NIDRR criteria classified participants as patients with UTI and patients with no UTI. The diagnostic performance of urine dipstick test for UTI screening was measured in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (+LR), and negative likelihood ratio (-LR) and was summarized in percentage with 95% confidence interval (CI). Results: Out of the 77 participants, most of participants were paraplegia (74%). The combined nitrite and leukocyte esterase urine dipstick test showed the highest sensitivity (93%), PPV (79%), NPV (85%), and +LR (2.39), respectively. The urine dipstick test of nitrite gave the highest specificity (69%). The most common uropathogen was Escherichia coli (33%). Conclusion: In SCI patients, the combined positive nitrite and leukocyte esterase urine dipstick test showed the highest sensitivity. The combined nitrite and leukocyte esterase urine dipstick test should be promoted as a screening test for UTI in SCI patients

Lumbosacral plexopathies associated with acetabular fracture

Lumbosacral plexopathies are of considerably less epidemiologic common prevalence than brachial plexus. The most common form of trauma resulting in lesions affecting the lumbosacral plexus is injuries to sacroiliac region. The symptoms which are caused by compressing lumbosacral plexus are sensory disturbance and weakness in an affected leg. The author reports a case of a 65-year-old male with a history of right acetabular fracture status post open reduction and internal fixation by plate and screw who complained weakness and numbness in the right leg. Four months later, he still had difficulty in walking and felt paresthesia at the right lateral thigh and entire of the right foot. His further investigation which was electrodiagnostic study was diagnosed as right lumbosacral plexopathies

Proximal humerus fracture associated with delayed axillary nerve injury

Axillary nerve injury is the most common complication in humerus fracture. The symptoms that are caused by affecting axillary nerve vary according to the structures involved such as sensory disturbance and weakness of muscles, e.g., three parts of deltoid and teres muscles in an affected limb. The severity of injury is classified in demyelinating and axonal lesions, which usually occurs at the onset of fracture. The author reports a case of humerus fracture with delayed axonal lesion of axillary nerve result from inadvertent traction

Validity and Reliability of the Thai Version of the Gait Assessment and Intervention Tool (G.A.I.T.)

Introduction. The Gait Assessment and Intervention Tool (G.A.I.T.) is well-accepted for determining changes in gait quality in neurological patients. This study is aimed at translating the G.A.I.T. to Thai and to examine its validity and reliability. Methods. The Thai translation and back-translation into English were done according to international guidelines. Sixty-eight patients with subacute to chronic stroke were recruited. Concurrent validity was determined by the correlation coefficient between the Thai G.A.I.T. scale and a comfortable vs. fast gait speed. The convergent validity was determined by the correlation coefficient between the Thai G.A.I.T. and the lower extremity Motricity Index, the Functional Ambulation Category (FAC), and the National Institutes of Health Stroke Scale (NIHSS). Interrater reliability was assessed using videos of 68 patients analysed by two independent raters. Each rater was randomly assigned to rescore the Thai G.A.I.T. for each patient over at least two weeks to assess intrarater reliability. Results. The concurrent validity of the Thai G.A.I.T. vs. the respective comfortable and fast gait speeds was excellent (Rs=−0.79 and Rs=−0.68, p<0.001). The respective convergent validity with the lower extremity Motricity Index, NIHSS, and FAC was Rs=−0.62, 0.57, and -0.51, respectively. The respective inter- and intrarater reliabilities were excellent (ICC=0.93, 95% CI 0.88-0.96 and 0.95, 95% CI 0.91-0.97). Conclusion. A Thai version of the G.A.I.T. was developed, and its validity and reliability for use among patients with subacute to chronic stroke were established. Further work regarding the responsiveness of the tool is needed

The reliability and validity of using the urine dipstick test by patient self-assessment for urinary tract infection screening in spinal cord injury patients

Aims: The aim of this is to evaluate the reliability of the urine dipstick test by patients' self-assessment for urinary tract infection (UTI) screening and to determine the validity of urine dipstick test. Settings: Rehabilitation Department, Srinagarind Hospital, Thailand. Study Design: A diagnostic study. Subjects and Methods: This study compared the urine dipstick test (index test) with the National Institute on Disability and Rehabilitation Research (NIDRR) criteria (gold standard test) in spinal cord injury (SCI) patients. The urine dipstick test informed positive and negative results. Besides the NIDRR criteria classified as UTI and no UTI. The interrater reliability was measured in the sense of Kappa whereas the validity of urine dipstick test was reported in terms of sensitivity, specificity, positive likelihood ratio (LR) (+LR), negative LR (−LR), positive predictive value (PPV), and negative predictive value (NPV). Results: Out of the 56 participants, the kappa of urine dipstick test for leukocyte esterase, nitrite, and combined leukocyte esterase and nitrite were 0.09, 0.21, and 0.52, respectively. The nitrite urine dipstick test showed the highest sensitivity (90%). The combined leukocyte esterase and nitrite urine dipstick test gave the highest specificity (87%), PPV (60%), NPV (93%), and +LR (5.63). Conclusions: The interrater reliability of combined leukocyte esterase and nitrite urine dipstick test was moderate agreement. The combined leukocyte esterase and nitrite urine dipstick test showed high level of both sensitivity and specificity. The combined leukocyte esterase and nitrite urine dipstick test should be promoted for patients' self-assessment for UTI screening in SCI patients

The prevalence of median neuropathy at wrist in systemic sclerosis patients at Srinagarind Hospital

Objectives: To determine the prevalence and factor related with median neuropathy at wrist (MNW) in systemic sclerosis patients. Study Design: Cross-sectional study. Setting: Srinagarind Hospital, Khon Kaen, Thailand. Participants: Systemic sclerosis patients who attended the Scleroderma Clinic, Srinagarind Hospital. Materials and Methods: Seventyfive systemic sclerosis patients were prospectively evaluated by questionnaire, physical examination, and electrodiagnostic study. The questionnaire consisted of the symptoms, duration, and type of systemic sclerosis. The physical examination revealed skin score of systemic sclerosis, pinprick sensation of median nerve distribution of both hands, and weakness of both abductor pollicis brevis muscles. The provocative test which were Tinel′s sign and Phalen′s maneuver were also examined. Moreover, electrodiagnostic study of the bilateral median and ulnar nerves was conducted. Results: The prevalence of MNW in systemic sclerosis patients was 44% - percentage of mild, moderate, and severe were 28%, 9.3%, and 6.7%, respectively. The prevalence of asymptomatic MNW was 88%. There were no association between the presence of MNW and related factors of systemic sclerosis. Conclusions: MNW is one of the most common entrapment neuropathies in systemic sclerosis patients. Systemic sclerosis patients should be screened for early signs of MNW

Acute Effects of Percussive Massage Therapy on Thoracolumbar Fascia Thickness and Ultrasound Echo Intensity in Healthy Male Individuals: A Randomized Controlled Trial

Percussive massage therapy (PT) has been widely used by therapists and the fitness population to treat myofascial-related conditions. However, there is no evidence to confirm the effects of PT on the fascia. This study aimed to investigate the effects of PT on thoracolumbar fascia (TLF) morphology and other related outcomes. Methods: Sixty-six healthy males participated and were randomly allocated into a percussive massage group (PT group) and a control group. The PT group received 15 min of back percussion massage, while the control group rested prone lying in the same environment for 15 min. Thoracolumbar fascia (TLF) thickness and echo intensity, perceived stiffness, lumbar flexibility, and skin temperature were measured in both groups before and immediately after the intervention. Result: TLF thickness and lumbar flexibility did not change when compared in the two groups. However, the echo intensity (left side, difference −3.36, 95% CI −5.1 to −1.6; right side, difference −4.39, 95% CI −6.1 to −2.7) and perceived stiffness (difference, −1.18, 95% CI −1.84 to −0.52) in the TLF region were significantly lower in the PT group than in the control group and were accompanied by increased skin temperature (difference 0.29, 95% CI 0.11 to 0.48). Conclusion: We suggest that a 15 min PT with 30 Hz on the back region could reduce TLF echo intensity and perceived stiffness and increase skin temperature in healthy men individual

Diurnal variation of heart rate variability in individuals with spinal cord injury

Abstract Background Heart rate variability (HRV) may provide objective information about cardiogenic autonomic balance in individuals with spinal cord injury (SCI). The aim of this study was to characterize the diurnal variation of HRV in individuals with SCI at lesion level T6 and above and lesion level below T6. Methods This was a retrospective analysis of a prior cross-sectional study. Individuals with chronic SCI underwent 24 h recording of the time between consecutive R waves (RR interval) to derive parameters of HRV as follows: standard deviation of all normal-to-normal R–R intervals (SDNN) and square root of the mean of the squared differences between successive R–R intervals (RMSSD) (time domain); and high frequency power (HF), low-frequency power (LF), very low frequency power (VLF), ultra-low frequency power (ULF) and total power (TP) (frequency domain). Changes in the magnitude of HRV outcomes over the 24 h period were investigated using a novel multi-component cosinor model constrained to the form of a three-harmonic Fourier series. Results Participants were grouped as lesion level T6 and above (n = 22) or below T6 (n = 36). Most of them were male (n = 40, 69%) and the median age (interquartile range) was 50.5 (28) years. Both groups exhibited similar diurnal patterns in most HRV metrics. The lowest values occurred in the late afternoon (4–6 pm) and gradually increased, peaking around midnight to early morning (1–6 am). Exceptions included RMSSD, which peaked before midnight, and ULF, which showed a double peak pattern that peaked from 11 am to 1 pm and 4–6 am in participants with lesion level at T6 and above. The HRV values in participants with lesion level T6 and above were generally lower than participants with lesion level below T6, except for peak values of RMSSD, HF and LF. Conclusion This study demonstrated substantial diurnal variation of HRV in participants with SCI in both groups of participants. In clinical and research settings, diurnal variations in HRV must be taken into consideration

The Prevalence of Dyslipidemia in Patients with Spinal Cord Lesion in Thailand

Objective. To assess the prevalence of dyslipidemia in 90 patients with spinal cord lesion (SCL) of duration greater than 2 years. The study was carried out from November 2007 to September 2008. Methods. Clinical history, physical examination, and lipid profiles were recorded and analyzed. Dyslipidemia was assessed using guidelines from the National Cholesterol Education Project Adult Treatment Panel III (ATP III). Results. The prevalence of dyslipidemia in at least one lipid parameter was 76.7%. The most frequent finding was low HDL-C (58.9%). Hypertriglyceridemia, hypercholesterolemia and high LDL-C were found in 28.9%, 26.7% and 21.1% of patients, respectively. The factors sex=male and age ≥45 years were associated with high LDL-C (<0.05 and <0.01). Patients who exercised less than 30 minutes per day had associated hypercholesterolemia (<0.01), hypertriglyceridemia (<0.01), and higher LDL-C (<0.05). Patients with BMI ≥23 kg/m2 had associated hypercholesterolemia and high LDL-C. Age was a significant determinant of high LDL-C. BMI was the most powerful and significant determinant of hypercholesterolemia and high LDL-C. Conclusion. SCL patients should have a regular lipid checkup, especially those patients having the following risk factors: males, age ≥45 years, BMI ≥23 kg/m2 and exercise duration <30 minutes per day