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Purpose: Strategy training is a rehabilitation intervention that aims to enhance problem-solving skills with respect to daily activity-related challenges and has achieved favorable results in Western countries. This study explored the perspectives of individuals with acquired brain injury (ABI) in Taiwan who received strategy training., Materials and Methods: Semi-structured interviews with community-dwelling adults with ABI were conducted, and reflective memos made by research team members were recorded. Interviews and memos were analyzed through thematic analysis., Results: This study included 55 participants. The analysis of the participants' interview responses and memos yielded nine themes under three categories: 1) expectations regarding strategy training, 2) perceived benefits of strategy training, and 3) barriers affecting the process and outcomes of strategy training., Conclusions: All the participants endorsed strategy training through different gains. Most participants' expectations before the intervention were uncertain. Including family members into the strategy training is of key importance for a successfulness of their goals. The participants' experiences about strategy training were affected by various barriers (i.e., health and medical problems, the physical environment, and natural events). Clinicians and researchers should consider these expectations, benefits, and barriers when studying and implementing strategy training in non-Western contexts.IMPLICATIONS FOR REHABILITATIONStrategy training provides clients the opportunity to actively engage in their own goal setting and decision making.Strategy training increases the client's confidence in their ability to participate in the community, communicate, and perform daily living and physical activities.Therapists should consider the health conditions and physical environment of clients when helping them set goals and before facilitating their engagement in the community.Taiwanese family members play a crucial role in supporting acquired brain injury survivors in strategy training.

Purpose: Strategy training is a promising stroke rehabilitation intervention commonly delivered in Western countries. We examined the perspectives of rehabilitation therapists who have delivered strategy training in Taiwan and the United States to understand the influence of culture on strategy training implementation., Materials and Methods: In this rapid ethnographic study, the maximum variation sampling approach was used to recruit seven therapists in Taiwan and seven therapists in the United States with experience delivering strategy training. Data was collected from multiple sources, including interviews, study documents, therapist notes, and reflective memos. Interviews with the recruited therapists in Taiwan and the United States were conducted in Mandarin and English, respectively. Data were analyzed using a constant comparative approach., Results: The following two themes were generated: (1) differences between conventional rehabilitation and strategy training, namely that conventional rehabilitation is therapist-directed and emphasizes impairment reduction, whereas strategy training empowers clients and focuses on real-life generalization, and (2) challenges in implementing strategy training in practice, including difficulty in achieving client buy-in and disengagement., Conclusions: Therapists from both countries shared similar perspectives on the perceived advantages of strategy training, such as enhancing client empowerment and engagement, and the generalization of strategies. Family involvement was more prominently discussed by therapists in Taiwan than by those in the United States.IMPLICATIONS FOR REHABILITATIONStrategy training differs from conventional rehabilitation in its emphasis on clients' life participation and empowerment, generalization of strategies, and enhancement of their engagement, confidence, and problem-solving skills.Therapists may face challenges related to client buy-in and disengagement as well as difficulties in establishing a therapeutic rapport at the beginning of strategy training because clients have different expectations from those of conventional rehabilitation.Cultural differences in norms and expectations and the clinical experiences of therapists may influence the delivery of strategy training to clients.Family support may influence the success of strategy training.Thoughtful conversations to reach a mutual understanding regarding the expectations of strategy training among clients, family, and rehabilitation practitioners are necessary prior to implementing strategy training.

Purpose: To learn about the experiences of stroke recovery among young stroke survivors in Taiwan and to elucidate the beliefs, goals, and facilitators of and barriers to their recovery., Methods: A qualitative approach was used for data collection, and data were obtained from five focus groups consisting of stroke survivors aged 20-64 years ( n  = 25). Data were transcribed verbatim and analyzed thematically by two independent coders using NVivo version 10., Results: "Returning to prestroke status" was a common belief of recovery for stroke survivors; their goals of recovery changed overtime from regaining physical functions, independent living, and participating in work and leisure activities to maintaining functions or returning to normality. Their perceived personal and environmental facilitators of recovery included positive attitude, family and friends, and rehabilitation, whereas barriers to recovery included psychological factors, social stigma, and physical environment., Conclusion: These findings provide useful insights for rehabilitation clinicians to develop culturally tailored interventions to improve poststroke recovery outcomes in young stroke survivors.Implications for rehabilitationRehabilitation clinicians should understand stroke survivors' beliefs and goals of recovery to provide tailored services.Optimizing the goal-setting process and patient-provider communication may help clinicians and survivors examine and adjust their expectations toward recovery during rehabilitation.Interventions will be needed to address personal and environmental supports and barriers, such as motivation, psychological factors, social support, and the physical environment to help survivors achieve their recovery goals.

Purpose: To develop a tablet-based participation measure and to evaluate its reliability and acceptability to an older Chinese population in rehabilitation settings. Method: A multidimensional, self-reported participation measure, the Participation Measure-3 Domains, 4 Dimensions (PM-3D4D), was programed into mobile application software and presented on tablet computers. To explore the reliability of the tablet-based PM-3D4D, 80 adults in rehabilitation outpatient settings aged ≥65 years completed the tablet and the paper versions of the measure at baseline and at 1-week follow-up. Intraclass correlation coefficients were calculated for concordance and test-retest reliability. Participants' acceptability toward the two versions of the measure was described. Results: The tablet-based PM-3D4D showed good to excellent test-retest reliability (Intraclass correlation coefficients = 0.79 ∼ 0.96) and high concordance with the paper-form (Intraclass correlation coefficients = 0.74-1.00). Approximately, 44% participants reported preference for the tablet-based measure, and 20% reported preference for the paper-form measure. Many participants found the tablet-based measure user-friendly, convenient, and environmentally-friendly. Conclusions: Findings of this study provide supportive evidence for administering the tablet-based PM-3D4D to an older Chinese population in rehabilitation settings and suggest a promising measurement methodology for future clinical practice.Implications for rehabilitationThe developed tablet-based participation measure, the Participation Measure-3 Domains, 4 Dimensions (PM-3D4D), fills a critical void for an efficient and reliable rehabilitation outcome measure tailored to the needs of older adults in rehabilitation settings.The tablet-based PM-3D4D is a reliable outcome measure.Most of the older adults in rehabilitation settings preferred to use the tablet-based participation measure than the paper-form measure; and very few of them reported difficulty with using the tablet-version measure.A high concordance was found between data collected by the tablet version PM-3D4D and data collected by the paper version PM-3D4D.

Purpose: The purpose of this study was to investigate the cultural and semantic equivalence of the Activity Measure Post-Acute Care (AM-PAC) outpatient short forms after they were translated from American English to Mandarin Chinese. Method: This study was conducted with a composite sample of a group of 483 American adults (mean age 63.1 years, 42.4% males) and 553 Taiwanese adults (mean age 60.6 years, 47.2% males) who were undergoing home care or outpatient rehabilitation services. A confirmatory factor analysis tested the cultural equivalence of the AM-PAC dimensions between the US and Taiwanese samples. Semantic equivalence was tested through an item response theory-based differential item functioning (DFI) analysis. Results: Results of the confirmatory factor analysis demonstrated good model-data fit of the AM-PAC in both the US and Taiwanese samples. Significant DFI was found for six Basic Mobility items, two Daily Activity items, and four Applied Cognition items. A DFI adjusted conversion table was generated to transform the raw scores of the measure for comparisons between the two countries. Conclusions: This study provides evidence to support the conceptual equivalence of the AM-PAC when used in rehabilitation patients between American and Taiwanese cultural contexts. Some DFI items between the two groups were found, suggesting that some differences in semantic understanding of these items between cultures require cross-cultural adjustments. Implications for Rehabilitation Cultural equivalence needs to be tested before applying a clinical measure to another context. The findings of this study supported the three activity domains that the Activity Measure Post-Acute Care measures: Basic Mobility, Daily Activity, and Applied Cognition, which are all important rehabilitation outcomes that need to be assessed and monitored across rehabilitation settings. Differential item functioning was observed between the English and Chinese versions of the Activity Measure Post-Acute Care, indicating that linguistic and cultural differences across countries need to be adjusted for before using the translated measure in clinical practice.

Purpose: To explore the perceptions and attitudes among people with disabilities towards the newly implemented International Classification of Functioning, Disability and Health-based disability evaluation system (the new system) in Taiwan., Method: Using a self-administered questionnaire, we conducted a nationwide survey. The questionnaire focused on the domains of quality, satisfaction, and revision of the new system. In total, 1073 persons (age, ≥18 years) with disabilities or their primary caregivers, who experienced both the old and the new system, responded to the questionnaire., Results: Most participants were satisfied with the new system overall (58.7%) and the subscale of quality of structure (91.3%) and quality of outcome (63.6%). However, only 20.5% of the participants were favourable to the quality of process. The probability of being satisfied with the system overall was low for the quality of process subscale (adjusted odds ratio range, 0.3 ∼ 0.4) and its item of long interval (0.2 ∼ 0.6). Contrariwise, the probability was high for the other subscales (3.9 ∼ 13.7) and the item of identifying needs (21.9 ∼ 23.4)., Conclusions: Persons with disabilities and their primary caregivers have positive attitudes towards the new system. It is important to simplify the assessment tools and procedures to improve the system's quality of process and facilitate its usability. IMPLICATIONS FOR REHABILITATION Persons with disabilities have positive attitudes towards the newly implemented International Classification of Functioning, Disability, and Health-based disability evaluation system in Taiwan. The system that provides comprehensive information about functioning and disability of persons with disabilities is able to capture the difficulties and needs of those individuals in their daily lives. The system hence helps people to mitigate the effects of disability and guide rehabilitation. The assessment items and processes of the system, however, were perceived to be complicated, time-consuming, and inconvenient. Simplifying the assessment items and processes, such as developing a short form version of the assessment tool and increasing the service time, may facilitate the usability of the system.

Purpose: The aims of this study were to translate and adapt the Activity Measure Post-Acute Care (AM-PAC) from US English to Mandarin using the dual-panel method, and to assess its psychometric properties in an outpatient rehabilitation setting., Methods: The AM-PAC outpatient short forms were translated using the dual-panel method. The translated AM-PAC was tested in 550 Chinese-speaking rehabilitation outpatients. Floor and ceiling effects were evaluated and internal consistency was assessed using Cronbach's alpha. Spearman correlation was used to assess the concurrent validity of the AM-PAC with the Barthel Index and the Mini-Mental State Examination. Test-retest reliability was determined by administering the AM-PAC twice to 57 participants within a 2-7 day interval., Results: Some ceiling effects (>20%) were observed in the Applied Cognition subscale. All subscales exhibited good internal consistency (α > 0.70). Supportive evidence for concurrent validity was found in strong correlations between Basic Mobility subscale and Barthel Index (r = 0.68), and Daily Activity subscale and Barthel Index (r = 0.70); and moderate correlations between Applied Cognition subscale and Mini-Mental State Examination (r = 0.50). Test-retest reliability for all subscales was high (intraclass correlation coefficient =0.89-0.98)., Conclusions: The dual-panel approach was successfully used to translate the AM-PAC from English to Mandarin. Adequate reliability and validity in rehabilitation outpatients in Taiwan were established. Implications for Rehabilitation The dual-panel method is a modern translation technique, which was successfully used to adapt the Activity Measure Post-Acute Care from English to Mandarin. The Mandarin version of Activity Measure Post-Acute Care demonstrates adequate internal consistency, concurrent validity, and test-retest reliability in rehabilitation outpatients. The Activity Measure Post-Acute Care is superior to existing functional measures used to monitor activity performance for rehabilitation patients in Taiwan.

Purpose: To identify environmental factors associated with participation and gain an in-depth understanding of relationships between environmental factors and participation among people with spinal cord injury., Method: Six focus groups (n= 30) with individuals with spinal cord injury were conducted. Two independent coders thematically analyzed the transcribed data., Results: Twenty environmental factors were identified, all of which were classified into eight categories: built environment; natural environment; assistive technology; transportation; information and technology access; economics; social support and social attitudes; and systems, services and policies. While all factors had direct impacts on individuals' participation outcomes, factors within the categories of societal attitudes, policies and economics also affected participation through affecting other environmental factors. Some factors together also showed cumulative or countering effects on participation. Accordingly, a conceptual model of the relationships between environmental factors and participation was constructed., Conclusions: This study highlighted key environmental factors and their impacts on participation of people with spinal cord injury. The findings support previous research findings but also suggest that different factors may have different levels of impact on participation. Based on our findings, rehabilitation practitioners and policymakers can prioritize intervention plans to optimize the environment for people with spinal cord injury and improve their societal participation. Implications for rehabilitation Environmental factors are critical contributors to participation among people with spinal cord injury (SCI) and need to be addressed in rehabilitation programs. Factors with broader impacts on participation, such as societal attitudes and policies, should be treated as priorities in intervention plans aimed at improving participation among people with SCI. Rehabilitation practitioners should not only consider how the community supports people with SCI but also consider how rehabilitation programs change the community.

Purpose: To identify the contextual factors that influence community participation in rehabilitation outpatients from the perspectives of patients and their service providers., Method: Five focus groups with rehabilitation outpatients (n = 22) and three focus groups with occupational and physical therapists (n = 17) were conducted. Two independent coders thematically analyzed the transcribed data., Results: Patients and their providers identified three common personal factors (personal interests, personal values, and finances) and four major categories of environmental factors (products and technology; support and relationships; attitudes; and services, systems, and policies) that have great influence on patients' participation in the community. Additionally, some patients perceived the impacts of fear of falling and climate on their participation, whereas some service providers reported that age, adaptability, and successful experiences could determine the patients' participation in the community., Conclusions: This study synthesized and contrasted perspectives from both rehabilitation outpatients and their service providers to identify the contextual factors that enable or restrict patients from participating in the community. Both patients and service providers identified numerous personal and environmental factors associated with participation, thus highlighting areas that can be addressed in rehabilitation outpatient programs and considered in policy development. Implications for Rehabilitation Community participation is an outcome of dynamic interactions among multiple factors and is highly environmentally and culturally sensitive. Both personal and environmental factors have substantial impacts on rehabilitation patients' participation outcomes. Rehabilitation practitioners and policy-makers need to incorporate perspectives from both patients and providers when developing interventions targeting to improve patients' community participation.

Background: To analyse the disability status of elderly Taiwanese dementia patients by using the World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0)., Methods: We enrolled 12 126 disabled elderly (>65 years) patients with dementia during July 2012-January 2014 from the Taiwan Data Bank of Persons with Disability. Trained interviewers evaluated the standardised scores in the six WHODAS 2.0 domains. Student's t test was used for comparing WHODAS 2.0 scores of male and female dementia patients with different age groups., Results: The study population comprised 12 126 patients; 7612 were women and 4514 were men. The WHODAS 2.0 scores showed that the dementia patients had global activity limitation and participation restriction in all domains. Dementia-induced disability was prominent in male patients in all of the domains of the WHODAS 2.0. The domains of life activities, getting along with people and cognition were more strongly affected than the other domains. However, women experienced more rapid functional decline than men did as they aged., Conclusion: The data analysed in this large-scale, population-based study revealed crucial information on dementia-induced disability in elderly patients on the basis of the WHODAS 2.0 framework. Implications for rehabilitation Dementia patients have global functional disability in all domains of WHODAS 2.0 and multidisciplinary team is needed for rehabilitation programme intervention for these patients. When considering the rehabilitation resource and strategy, the domains of cognition, activities of daily living and life activities should be focussed. When dementia patients aged 65-75 years old, male patients got more restriction of function than female and more medical resource allocation for disabled male patients is recommended. With ageing, female dementia patients exhibited more rapid functional decline than male patients did and more budget about rehabilitation for maintain functional and dementia progression is crucial for female patients.

Objective: The primary aim of this study was to examine and refine a modified measure of participation for adults with spinal cord injury (SCI) based on a conceptual model of participation., Method: This study involved secondary analysis of data from a larger study designed to identify a standard measure of participation for use in SCI research. The larger study recruited 634 community-dwelling adults with SCI from seven collaborating SCI Model Systems Centers, of whom 520 subjects (average age 45.1 ± 13.6 years, 76% were male) completed the survey that is the focus of the present analysis. Content review, confirmatory factor analysis (CFA), Rasch analysis, and precision analysis were employed to select the items for the modified participation measure., Results: Three participation domains were supported: Productivity, Social, and Community, that displayed good model-fit (CFI=0.984, TLI=0.982, RMSEA=0.043) in CFA and good item-fit (infit= 0.6 to 1.4) in Rasch analysis. Differential Item Functioning (DIF) was found in one item, however its magnitude was small. The precision of each scale was better for participants in the middle range of participation and was lower for participants with extremely low or high participation., Conclusion: The study results support the proposed three-dimensional construct of participation by demonstrating good model-fit and item-fit. Ongoing efforts are needed to expand the domain coverage and increase the precision of the instrument.

Purpose: The aims of this study were to (1) construct a multidimensional measure of participation (the Community Participation Domains Measure (CPDM)) based on a conceptual model of participation and (2) test the construct validity of the CPDM in adults with serious mental illnesses (SMI)., Methods: The sample consisted of 235 adults with SMI who completed the Temple University Community Participation Measure (TUCP), Community Participation Indicators (CPIs), Colorado Symptom Index (CSI), along with other scales. A conceptual model, descriptive analysis and expert reviews were employed to select a subset of items to include in the measure. Confirmatory factor analysis (CFA) and Rasch analysis were used to test the item and model fit for each scale., Results: Based on the conceptual model, the items of the CPDM were divided into three domains: Productive Activities, Social Participation and Recreation/Leisure. This 3-factor model showed good model-fit (CFI = 0.940, TLI = 0.933, RMSEA = 0.048) in CFA and good item-fit in Rasch analysis., Conclusions: The CPDM is a validated measure that can be used to assess levels of participation in adults with SMI., Implications for Rehabilitation: Participation is an important goal and rehabilitation outcome indicator for individuals with serious mental illnesses (SMI). Participation is a multidimensional concept, which includes three distinct domains: Productive Activities, Social Participation and Community Activities. The Community Participation Domains Measure (CPDM) is a valid measure that can be used to assess the multidimensional construct of participation in adults with SMI.

In Taiwan and China, calcium carbonate is commonly added as a filler during incense production to lower the cost. This study has found an unexpected benefit for this practice: it reduces particulate emission. Nine types of the popular incense on the local market were chosen for this study. The calcium content in raw material incense was analyzed by inductively coupled plasma atomic emission spectrometry, followed by X-ray diffraction (XRD) spectroscopy. The correlation between the calcium content and emission characteristics of incense was investigated. The calcium content varied from 1.8 to 60 mg/g (incense burned) among those nine different types of incense. Very little calcium (< 1%) was found in natural wood or plants, which is mainly the raw material of incense. Instead, most calcium was artificially added in the form of CaCO3 during manufacturing. The combustion characteristics, including burning rate, emission factors of particulate, ash, and solid-phase polycyclic aromatic hydrocarbons (S-PAHs), varied significantly among the nine types of incense. Incense containing 2% calcium would emit 30% less S-PAHs, compared with those with little (< 0.2%) calcium. More importantly, increasing the calcium content from 0.5 to 5% by adding CaCO3 reduced the particulate emission from incense by approximately 50%.