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Two years after the SARS outbreak in Hong Kong, 128 healthcare workers continued to present with musculoskeletal complaints and 38 workers were diagnosed with avascular necrosis (AVN) in different joints. 13 healthcare workers were referred to six designated Physiotherapy Departments of the Hospital Authority for a tailor-made standardized Functional Capacity Evaluation (FCE) from 2004 to 2005 on a voluntary basis. Job analysis, workers' self-perceived disability and functional capacity, non-material handling tests, and the cardiopulmonary fitness test were performed. Retrospective review of the FCE data showed that there were 17 AVN of hips, 16 AVN of knees, 3 AVN of shoulders. All patients had AVN of lower limb joints. Nearly full ranges of movement (ROM) were observed in the knees involved, but the hip range was decreased for most subjects suffering from hip AVNs. Most workers (n=12) could not complete the cardiopulmonary test due to intolerable joint pain. Six workers' self-perceived physical demands level (PDC) matched with the physical demands level identified by the FCE. 12 healthcare workers attained a sedentary physical demands level and were unable to match with their previous job demands. One staff was classified as light physical demands and managed his original duty. Four workers had returned to work at the time FCE was performed. The tailor-made FCE added information to facilitate the return-to-work planning for the staff. Four more workers returned to work with modified duties one year after the FCE. [ABSTRACT FROM AUTHOR]

This study examines the physical, behavioral, emotional and social determinants of self-rated health among Chinese older persons, and investigates if the effect of social support varies by gender. A representative sample of 1589 elderly community dwellers in Hong Kong were interviewed using a structured questionnaire. Gender difference in the effect of social support was tested by an interaction term, 'genderxsocial support', in a hierarchical regression analysis. The frequency of falling ill, the number of chronic illnesses, sleep quality, mobility and positive emotions were most important determinants of self-rated health. The effect of social support was completely redundant when these factors were taken into account. The interaction term 'genderxsocial support' was significant and indicated a stronger effect for women, but the effect size was negligible (adding only 0.3% to the explained variance). This suggests that the effect of social support by and large is gender free. These findings suggest a high degree of similarity in the determinants of self-rated health between Western and Chinese older populations. [ABSTRACT FROM AUTHOR]

Chinese older persons (N = 164) recruited from social centers responded to a survey instrument tapping the perceived filial behaviors of children (close vs not close), and the degree to which these behaviors matched personal expectations (filial discrepancy). Across all kinds of filial behaviors, providing attention when the parent was ill or distressed was perceived to be the least performed and was most discrepant with expectations. Whether the children were paying respect and whether they were providing care in times of illness or distress were most important in determining a sense of filial discrepancy in the parent. However, after functional limitations and financial strain were controlled for, only respect emerged as a consistent predictor of psychological well-being. These findings were similar whether the target was the closest child(ren) or less close children. There was no evidence that a child's overdoing his or her filial role was detrimental to the parents' well-being among the Chinese individuals in this study. [ABSTRACT FROM AUTHOR]

In this study we investigated whether social relationship is a stronger determinant of life satisfaction in older women than in older men, and whether this is more obvious in widowed than in married persons, in a representative sample of Chinese individuals aged 60 or older in Hong Kong (N=1,616). We tested the moderating effect of gender and widowhood by means of a multigroup analysis in structural equation modeling that incorporated other major predictors of life satisfaction. Consistent with predictions, relatedness was much more important for women than for men. Furthermore, relatedness was the most important determinant of life satisfaction in women, regardless of marital status, but it was only a moderate predictor in married men, and even an irrelevant factor in widowers. We discuss the results in terms of how gender roles shape relationship goals, and thus how men and women evaluate life satisfaction differently in the context of relationship with others. [ABSTRACT FROM AUTHOR]

Purpose: To determine predictors of chronic pain and disability among patients with distal radius fractures (DRF) treated conservatively with closed reduction and cast immobilization., Methods: This was a prospective cohort study. Information on patient characteristics, post-reduction radiographic parameters, finger and wrist range of motion, psychological status (Hospital Anxiety and Depression Scale or HADS), pain (Numeric Rating Scale or NRS), and self-perceived disability (Disabilities of the Arm, Should, and Hand or DASH) were taken at baseline, cast removal, and 24 weeks. Differences in outcomes between time points were determined using analysis of variance. Multiple linear regressions were used to determine predictors of pain and disability at 24 weeks., Results: One hundred forty patients with DRF (70% women, age: 67.0 ± 17.9) completed 24 weeks of follow-up and were included in the analysis. NRS (off-cast), range of ulnar deviation (off-cast), and greater occupational demands were significant predictors of pain at week 24 (adjusted R 2  = 0.331, p < 0.001). Significant predictors of perceived disability at week 24 were HADS (off cast), sex (female), dominant-hand injury, and range of ulnar deviation (off cast) (adjusted R 2  = 0.265, p < 0.001)., Conclusions: Off-cast NRS and HADS scores are important modifiable predictors of patient-reported pain and disability at 24 weeks in patients with DRF. These factors should be targeted in the prevention of chronic pain and disability post-DRF., (© 2023. The Author(s) under exclusive licence to SICOT aisbl.)

Background: Although balance is commonly assessed during the recovery of total knee arthroplasty (TKA), the minimal clinically important difference (MCID) values of frequently used balance assessment tools have not been established previously in this population., Objective: To determine the MCID of four balance tests-ie, the Balance Evaluation Systems Test (BESTest), Mini-BESTest, Brief-BESTest, and the Berg Balance Scale (BBS)-in individuals post-TKA., Design: Prospective cohort., Setting: Outpatient rehabilitation., Participants: Inclusion criteria: (1) first primary TKA with diagnosed knee osteoarthritis; (2) aged 50-85 years., Exclusion Criteria: (1) TKA due to rheumatoid arthritis of the knee or traumatic injury; (2) known medical conditions that influence balance ability. One hundred forty-six participants were recruited, and 134 of them with complete data were included in the analysis., Interventions: Participants received individualized physiotherapy, consisting of electrotherapy for pain and edema control, mobilization and strengthening exercises, and gait and balance training, once or twice per week between assessments., Main Outcome Measurements: Participants were assessed on the BESTest, Mini-BESTest, Brief-BESTest, BBS, and Functional Gait Assessment (FGA) 2 and 4 weeks after surgery. The FGA was used as the anchor reference measure to calculate the MCID of the other four balance tests. A distribution-based approach was also employed to derive the MCID (ie, standardized effect size of 0.5)., Results: The BESTest (area under curve [AUC] = 0.811, 95% confidence interval [CI] 0.739-0.883) had the highest accuracy in detecting clinically important improvements on the FGA (≥4 points), followed by the Mini-BESTest (AUC = 0.782, 95% CI 0.704-0.860), Brief-BESTest (AUC = 0.701, 95% CI 0.618-0.795), and BBS (AUC = 0.586, 95% CI 0.490-0.682). The anchor- and distribution-based MCIDs were 6-8 for the BESTest, 1-2 for the Mini-BESTest, and 2-3 for the Brief-BESTest., Conclusions: Improvements exceeding MCIDs established above are indicative of significant progress in balance function post-TKA. The BBS is not a recommended tool due to its low AUC value., (© 2019 American Academy of Physical Medicine and Rehabilitation.)

Introduction: This study aims to investigate the effect of pre-operative intravenous methylprednisolone on post-operative pain control and joint mobility in Chinese patients undergoing single primary total knee arthroplasty., Methods: This is a prospective, randomized, double-blinded, placebo-controlled single-centre trial. Sixty subjects were randomized into intervention and control group. The peri-operative anaesthetic and analgesic regimes were standardized. The intervention group received 125 mg methylprednisolone intravenously on the induction of anaesthesia. Subjects were assessed at 24, 30 and 48 h after surgery and upon discharge for pain scores and range of movement from the operated knee. Change in C-reactive protein level was calculated. Patient's satisfaction was recorded. Adverse reactions were documented. Subjects were followed up at 6 weeks, 4 months and 1 year., Results: Rest pain and pain on movement were significantly reduced in the methylprednisolone group at 24 and 30 h after surgery (ANOVA p = 0.030, p = 0.003, p = 0.032, p = 0.010). The methylprednisolone group demonstrated a greater range of movement from the operated knee up to 30 h after surgery (ANOVA p = 0.031). Post-operative C-reactive protein level was significantly less in the methylprednisolone group (p < 0.001). Methylprednisolone group had a higher patient's satisfaction than the control group (p < 0.01). No adverse effects were noted at the 1-year follow-up., Conclusion: Pre-operative intravenous methylprednisolone improves post-operative pain and joint mobility after total knee arthroplasty up to 30 h after operation. It results in a higher patients' satisfaction. It can act as an effective adjunct in the multimodal analgesic regime., Trial Registration: ClinicalTrials.gov ID: NCT03082092.

Background: Individuals with total knee arthroplasty (TKA) often experience pain and reduced balance control, which may predispose them to greater fall risk., Objective: The objective of this study was to determine the frequency and circumstance of falls and fall-related risk factors within a 6-month follow-up period in individuals after TKA., Design: This study was a prospective cohort study., Methods: Knee proprioception, the Balance Systems Evaluation Test, knee pain, knee extension and flexion muscle strength, knee range of motion, and balance confidence were evaluated in 134 individuals (39 men, 95 women; mean age = 66.3 years [SD = 6.6 years]) 4 weeks after TKA. Monthly follow-up sessions, via face-to-face or telephone interviews, were implemented to obtain data on fall incidence over 6 months., Results: Twenty-three individuals after TKA (17.2%) sustained at least 1 fall during the 6-month follow-up period. The median time of the first fall episode was 15 weeks after TKA. Of the 31 fall episodes, most occurred during walking (67.7%). Slipping (35.5%) and tripping (35.5%) were identified as the most frequent causes of falling. Most falls occurred at home (45.2%) or another indoor environment (29.0%). Multivariate binary logistic regression revealed that younger age (odds ratio: 0.91), reduced proprioception of the knee that had undergone surgery ("operated knee") (odds ratio: 1.62), reduced sensory orientation (odds ratio: 0.92), and greater operated knee pain (odds ratio: 1.68) were significantly associated with more falls during the follow-up period., Limitations: The results of this study may be generalizable up to 6 months after TKA., Conclusions: Intervention efforts should target deficits in knee proprioception and sensory orientation and operated knee pain to prevent future falls in individuals with TKA.

Background and Aim: Balance deficits are common after total knee arthroplasty (TKA); however the responsiveness of commonly used balance measurement tools has not been well defined. The objective of this prospective study was to compare the internal and external responsiveness of four measurement tools in assessing recovery of balance function following TKA., Methods: A total of 134 individuals with TKA (95 women; age: 66.3±6.6years) completed the Balance Evaluation Systems Test (BESTest), Mini-BESTest, Brief-BESTest, and Berg Balance Scale (BBS) at 2, 4, 8, 12, and 24 weeks post-TKA. The Functional Gait Assessment (FGA) served as the anchor measure, and was also measured across these time points. Internal responsiveness was indicated by the standardized response mean (SRM), while external responsiveness was reflected by the degree of association of the changes of balance scores with those of FGA., Results: The SRM ranged from 0.60-1.14 for the BESTest, 0.40-0.94 for the Mini-BESTest, 0.27-0.91 for the Brief-BESTest, and 0.19-0.70 for the BBS, over time. The change in BESTest and Mini-BESTest scores predicted the change in the FGA scores across all time periods, except for the Mini-BESTest between weeks 12-24, accounting for 13-27%, and 12-24% of the variance, respectively. The Brief-BESTest scores only predicted FGA scores between the weeks 2-4 (R 2 =20%). The changes in BBS scores were not associated with the FGA., Conclusion: The BESTest is the most responsive in measuring recovery of balance among individuals with TKA. The Mini-BESTest is a reasonable option during time constraints., (Copyright © 2017. Published by Elsevier B.V.)