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Hon Sun Lai,1,2 Grace PY Szeto,1 Chetwyn CH Chan3 1Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, 2Total Rehabilitation Management (Hong Kong) Limited, 3Applied Cognitive Neuroscience Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Abstract: When a worker is injured at work, he has to face a tough decision-making process about when and how to return to work (RTW). This study tests how the prospect theory can be applied to influence the injured workers’ perceptions about this important choice. One hundred forty-one injured workers were presented with wage- and pain-related information in four different message framing (negatively or positively) and precision (smaller or larger number) conditions. After exposure to the specific combination of this wage and pain information, the participants were asked to express intentions to RTW in terms of perceived chance, confidence, and anticipated sick leave duration. When asked to predict their RTW outcome, 101 participants (72.3%) responded favorably, whereas only 40 (27.7%) indicated an expectation for staying on sick leave. The present results did not show significant differences in the participants’ responses to the positively and negatively framed information about wage and pain. However, it was noted that the control group that was presented with positive framing for both “wage” and “pain” information showed higher scores in expectation and confidence for RTW, whereas the Ambivalent Group that had both negative messages showed lower scores. Seventy-nine participants who had ≥60% perceived improvement in condition were selected for further analysis, and those who were presented with “wage loss” information rated significantly higher perceived chance of RTW than those in the “pain gain” group. More in-depth investigation is warranted on this topic, with a larger sample of injured workers to investigate the effects of message framing on the decision-making process about RTW. Keywords: wages, injury, compensation, rehabilitation

This study attempts to formulate a prediction model of return to work for a group of workers who have been suffering from chronic pain and physical injury while also being out of work in Hong Kong. The study used Case-based Reasoning (CBR) method, and compared the result with the statistical method of logistic regression model. The database of the algorithm of CBR was composed of 67 cases who were also used in the logistic regression model. The testing cases were 32 participants who had a similar background and characteristics to those in the database. The methods of setting constraints and Euclidean distance metric were used in CBR to search the closest cases to the trial case based on the matrix. The usefulness of the algorithm was tested on 32 new participants, and the accuracy of predicting return to work outcomes was 62.5%, which was no better than the 71.2% accuracy derived from the logistic regression model. The results of the study would enable us to have a better understanding of the CBR applied in the field of occupational rehabilitation by comparing with the conventional regression analysis. The findings would also shed light on the development of relevant interventions for the return-to-work process of these workers. [ABSTRACT FROM AUTHOR]

Background and purpose: To investigate the factor structure and cut-off scores of the Elderly Mobility Scale for making placement decisions in extended care settings. Subjects: Ninety elderly residents of mean ages ranging from 79.0 to 86.4 years were recruited from homes for the aged (OAH group), and care and attention homes with or without supplemental infirmary care (IS and non-IS groups, respectively). Methods: The Elderly Mobility Scale was administered to all the residents by five trained practising physiotherapists. Results: Factor analysis revealed a two-factor structure, with two items into a bed mobility subscale and the other five items into a functional mobility subscale. Significant differences were found in the residents' Elderly Mobility Scale scores among the OAH, non-IS and IS groups. The accuracy of the three cut-off scores based on the five functional mobility items reached 90% for classifying the residents into different placements. Discussion and conclusion: The findings suggested that Elderly Mobility Scale scores can be better interpreted with the 'bed mobility' and 'functional mobility' subscales. The high accuracy of classification based on the cut-off scores reflects a good item and construct match of the Elderly Mobility Scale. Our findings support the usefulness of the Elderly Mobility Scale for residential placement of elderly people, which can be generalized to residential settings and post-discharge plans similar to those used in this study. [ABSTRACT FROM AUTHOR]

Objective This study was designed to explore the stages of change involved in return to work (RTW) for a group of workers who had been suffering from chronic pain. Method The participants were 67 (mean age = 42.67) injured workers who participated in a six-week RTW program. Assessments of the participants on various measures were conducted before and during the program, and at the end of the follow-up period (3 months post-program). Results The overall RTW rate of the participants was 65.7%. Most importantly, the participants' RTW outcomes were found to be significantly predicted by their readiness for RTW (action) at the baseline. In the third week, their RTW was significantly predicted by their confidence in returning to work and their readiness for RTW (action). By the sixth week, their RTW outcomes were predicted by their readiness for RTW (pre-contemplation). Conclusion The results enable us to better understand the stage-of-change factors that might influence injured workers' resumption of a productive work role and the rehabilitation process of RTW. [ABSTRACT FROM AUTHOR]

Objective: To establish the structural validity of the Chinese version of the Modified Barthel Index and to estimate its inter-rater reliability for use with patients who have had a stroke.Design: Prospective study.Setting: A regional general hospital and a day hospital in Hong Kong.Subjects: One hundred and sixteen older people who had had a stroke (mean age 76.0; SD 7.6) were involved in the establishment of evidence of the structural validity and item quality. Another 15 older people with stroke (mean age 78.0; SD 7.1) participated in estimating the reliability of the instrument.Methods and results: The Modified Barthel Index was translated into Chinese. Factor analyses revealed a two-factor structure that explained 75.7% of the total variance. Factor 1 was found to consist of eight items relating to patients' functional performance. Factor 2 consisted of the two items that focused on patients' ;physiological needs'. The test-retest reliability of the Chinese version at the item level was comparable with that of the original version, with kappa statistics ranging from 0.63 to 1.00 (P < 0.001).Conclusion: The Chinese version of the Modified Barthel Index (MBI-C) seems to be valid and reliable for use with older people with stroke. Changes were made to the item content and the rating criteria that were specific to Chinese culture. The structural validity and the reliability of the Chinese version were shown to be robust across the original and Chinese groups. [ABSTRACT FROM AUTHOR]

Introduction: This study was designed to explore the psychosocial aspects of injured workers, their self-perceived capacity and how these factors influence their success in Return To Work (RTW). Method: Seventy-five subjects were recruited from the Hong Kong Workers' Health Centre and were assessed on three occasions consisting of interviews and four self-rated instruments including the Chinese Lam's Assessment of Employment Readiness (C-LASER), the SF-36 health survey, the Chinese State Trait and the Anxiety Inventory (C-STAI). Results: Results showed that the contemplation and pre-contemplation sub-scores of C-LASER appeared to be the determining factors in predicting subjects' return-to-work status. Subjects who were more 'ready for action' (the Actioners) were found to have significantly higher confidence and advocacy in job seeking than the Pre-Contemplators. Their employment readiness was shown to be affected by psychosocial factors such as perceived functioning and bodily pain, Discussion: From this study, the injured workers' employment readiness appeared to associate with their RTW outcomes. Further studies would be needed to find out how the employment readiness of injured workers could be enhanced. [ABSTRACT FROM AUTHOR]

Background: This is a clinical randomized trail (RCT) to investigate the effects of a three-week training program on work readiness designed for musculoskeletal injured workers with long-term sick leave who had difficulties resuming their work role. The program was planned to help injured workers overcome the psychological and psychosocial problems and to facilitate their Work Readiness on Return to Work (RTW) based on the Employment readiness model. Methodology: A total of 64 injured workers were recruited and randomly assigned into the training (T) and control (C) groups. Observations were blinded between service providers and evaluators. A three-week intensive training on work readiness program was given to the T group while subjects in the C group were given advice on job placement by social workers in a community work health center. The training program was comprised of individual vocational counseling and group therapy using cognitive behavioral approach to alleviate symptoms of stress, pain and anxiety. The Chinese Lam Assessment of Stages of Employment Readiness (C-LASER), the Chinese State Trait and Anxiety Inventory (C-STAI) and the Short form of Health Survey (SF-36) were used to evaluate all subjects' psychological health status and behavioral changes on job readiness before and after the intervention. Results: Subjects in the T group showed significant improvement in their work readiness ( p < 0.05), level of anxiety ( p < 0.05) and their self perception of health status measured by SF-36 ( p < 0.02) when compared with subjects in the C group. Control of chronic pain, negative motivation, and anxiety level were some of the key behavioral changes found from the study. Conclusion: The TWR program appeared to improve injured workers' motivation and employment readiness. Further study on the employment outcomes of subjects is recommended. [ABSTRACT FROM AUTHOR]

This study reports the preliminary findings on the effects of the Chronic Disease Self-management Program on a group of Chinese participants who suffered from chronic diseases. A total of 23 participants were recruited in a multi-baseline study protocol. Their self-management behaviors, self-efficacy and health status were captured over three baseline assessments and one post-test assessment. The results indicated significant increases in the performance of stretching exercises, the management of cognitive symptoms and communication with physicians. Their self-efficacy in terms of these aspects was found to be significantly increased. However, changes in other aspects of self-management which required more special skills and coordination with outside agencies were not significant. The changes in the physical and mental statuses of the participants were also not significant. It was observed that the positive effects of the program could be attributed to traditional Chinese beliefs of 'self-discipline' and a welcoming response towards self-efficacy strategies. Further studies should adhere to standards of a randomized clinical trial and further examine the mechanisms underpinning the changes in self-management behaviors among Chinese people with chronic diseases. [ABSTRACT FROM AUTHOR]

OBJECTIVES: This study aimed to analyze the ability of the Patient Retraining and Vocational Resettlement (PRAVR) program to enhance the vocational outcomes of individuals with chronic illness, and to study the socio-demographic factors associated with successful vocational outcome. STUDY DESIGN: A retrospective study of 548 individuals with various types of chronic illness who enrolled in the program between 1995 and 2003. Their socio-demographic data and their employment outcome after a six-month job skills retraining and job settlement service were collected for analysis. RESULTS: The program was found to enhance the vocational outcomes of patients who completed the program. Logistic regression identified significant factors predicting successful vocational outcomes. For the male patients, the chances of employment were higher if the onset of illness had occurred at least 10 years before (odd ratios = 0.326). For the female patients, the chances of employment were higher if they had been unemployed for less than 1 year (odd ratio = 3.8). CONCLUSIONS: The PRAVR program is able to enhance the vocational outcomes of people with chronic illness in Hong Kong. The factors which were found to relate to successful employment were unique to the local situation. Further studies should explore these factors in a more in-depth manner. [ABSTRACT FROM AUTHOR]

This study aimed to collect evidence on the structural and substantive validity, and test-retest reliability of the Chinese version of the Oswestry Disability Index (CODI). Seventy-nine patients suffering from chronic low back pain were assessed with the CODI. The results of explorative factor analysis primarily suggested a single-factor structure with nine out of 10 items (factor loading = 0.66-0.79). The sex life item was found to load on a different factor. The Cronbach's alpha of all 10 items was 0.81 (p<0.05). When the sex life item was removed from the analysis, the alpha value was increased to 0.89 (p<0.05). The test-retest reliability was estimated based on 56 participants who completed two administrations of CODI in 48 hours. The intraclass correlation coefficient (ICC) computed for the total CODI scores was 0.86 (95% C.I. = 0.81-0.91). The reliability estimated for the item scores using Kappa statistics ranged from a high of k=0.80 for the sitting item to a low of k=0.49 for the traveling item. Kappa statistics were not available for three items. The Chinese version of the Oswestry Disability Index demonstrated satisfactory validity and test-retest reliability, and so could be considered as an appropriate instrument for assessing chronic back pain-related disability in Chinese patients in Hong Kong. Further research should address the cross-cultural and measurement issues in regard to sex life in order to further improve the test content of the instrument. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore the changes in work-related abilities of members after attending the Clubhouse program for 12 weeks. The extent to which the changes would contribute to members' performance on simulated work tasks was also investigated. A total of 39 people with mental illnesses, primarily schizophrenia, attending Phoenix Clubhouse participated in the study. Seventeen were newly recruited members to the Clubhouse. The other 22, who served as the control group, were existing members who had been attending the Clubhouse for more than three months. All the participants were assessed by the McCarron-dial System (Observational Emotional Inventory-Revised, McCarron Assessment of Neuromuscular Development), Cognistat, Chinese Work Personality Profile, WHO Disability Assessment Schedule and WHOQOL-Bref-HK at the baseline and 12 weeks after attending the Clubhouse program. They were required to complete a set of simulated work tasks after 12 weeks. New members showed significant improvement in emotional-coping abilities (impulsive-frustration and depression-withdrawal) and work personality (task orientation, social skills, and team work) after attending the Clubhouse program for 12 weeks. The increase in emotional-coping skills (depression-withdrawal) was found to contribute to better performance on typing tasks, whereas emotional coping (anxiety) contributed to better performance on cleansing tasks. Three months' participation in the Clubhouse program appears to have positive effects on emotional-coping abilities and work personality. The emotional-coping abilities were found to predict good performance in simulated clerical and maintenance jobs. Recommendations and suggestions for further research are discussed. [ABSTRACT FROM AUTHOR]

The objective of this study was to examine the effect of therapists' methods of addressing patients' problems (based on assessment results and discussions of patients' needs compared with assessment results only) on the level of agreement, between patients and therapists, over patients' daily living problems. A comparative design was adopted to examine the five most important daily living problems identified by patients and their occupational therapists. Twelve occupational therapists and five stroke patients of each therapist under in-patient rehabilitation were recruited. Thus, a total of 60 patients were recruited. Content analyses of the therapists' methods of analysing their patients' problems revealed that eight therapists had discussed their patients' needs with their patients (66.7%) and four relied on the assessment results (33.3%). The kappa statistics showed that a higher agreement of daily living problems was identified for the patients of those therapists who had held discussions (kappa=0.76; P<0.001). The results suggested that therapists should take their patients' needs into account in the planning of interventions. If therapists could help their patients to carry out their future life roles, it would lead the patients to better participate in the rehabilitation process. [ABSTRACT FROM AUTHOR]

OBJECTIVES: This study aimed at investigating the utilization and applicability of the Dictionary of Occupational Titles (DOT) as a methodology to study the job profile (nature and physical demand) of formwork carpentry in the local situation. STUDY DESIGN: Thirty male formwork carpenters were recruited by convenient sampling to participate in a two-hour interview, with reference to the DOT Physical Demand Questionnaire (DOTPDQ) and the WestTool Sort Questionnaire. The information obtained was further consolidated by comparing the results from the interview to three construction sites and training guidelines from the formwork carpentry training centers. The triangulation of the data formulated a job profile of formwork carpenters. RESULTS: The results from the DOTPDQ revealed that workers' work demands were standing, walking, pushing, pulling, reaching, climbing, balancing, stooping, crouching, lifting, carrying, handling and near acuity. This produced an agreement of 84.6% with the original DOT. A discrepancy was found in the demands of kneeling, fingering, far acuity and depth perception. CONCLUSIONS: The discrepancy between the data from the United States and local appeared to be minimal. It was thus inferred that the DOT-based job profile was largely valid for describing formwork carpentry in Hong Kong. In-depth analysis should be conducted to further substantiate the validity of utilizing the DOT system for other job types and their physical demands. [ABSTRACT FROM AUTHOR]

Providers of Disability Management services were surveyed regarding their perceptions of major job functions and corresponding knowledge and skill requirements. The results indicated that knowledge in the areas of Case Management Techniques, Psychosocial Intervention, Vocational Aspects of Disability, Managed Care and Managed Disability, and Human Resources/Business is essential to perform Disability Management job functions. Implications for Disability Management training and clinical practice are discussed. [ABSTRACT FROM AUTHOR]

This study was a clinical series to pilot test the benefits of a 6-week standardized program designed for a group of patients with work-related lateral epicondylitis. The program was formulated based on a dose-and-response model. A total of 15 female patients were recruited. All patients were involved in educational sessions, home exercise, and progressive work-hardening training. Patients were assessed at admission, predischarge, and 4th week and 12th week follow-ups. The results indicated significant improvements in pain intensity (p

Throw and catch are fundamental motor skills that are closely related to eye-hand coordination, reaction speed, and spatial awareness in children. Current research on throw and catch mainly focuses on the impact of attentional focus, anticipatory knowledge, and training on visuomotor control. Little work has been done on the synchronized movements of eyes and joints during the throw and catch. To understand how these synchronized movements contribute to the success rate of throwing and catching, we proposed a video-based framework named Synchronized Eye and Joint Analysis (SEJA). This framework locates, extracts, and analyzes the essential eye and joint movements from untrimmed first-person and third-person view videos. Using the proposed framework, throw and catch events in long untrimmed videos were successfully identified, and whether each catch was successful was accurately assessed. Additionally, detailed metrics related to predictive gaze behaviors and predictive hand movements for each catch event were obtained. On a dataset consisting of videos from 56 children aged 7 to 10, the proposed framework delivered an average precision (AP) ranging from 0.5 to 0.95 at 0.881 for task localization and achieved an accuracy of 0.985 in predicting whether a catch was successful. Our research indicated that children with higher catch success rates showed shorter delays in predicting the ball's trajectory, smaller amplitudes of body movement, and more pronounced predictive saccades (rapid eye movements to anticipate the ball's position). These findings are crucial for comprehending and improving the development of motor skills in children.

This study explored aural perception in children with autism using an aural perception test and electrophysiological responses to sound stimuli. The results demonstrated unique responses to sound stimuli at different sound intensity levels, emphasising the need for customised noise-control strategies targeting specific troublesome frequencies. To address this issue, headset intervention technology with a hybrid active noise control system integrated with an aural perception controlling function was developed for children with autism with distinct auditory perception based on their psychoacoustic characteristics. The results showed that the noise-control strategy was effective in mitigating unpleasant feelings and reducing the loudness and sharpness of daily stimuli. The proposed aural perception controllable headset can minimise noise, leading to a noticeable reduction in the magnitude of the auditory evoked potential at the midline central brain region for children with autism exposed to certain sounds, such as heavy vehicles and thunder, providing a more pleasant aural perception. A diminished auditory evoked potential response was associated with lower annoyance and pleasant aural perception. This study suggests that the proposed aural-perception-based noise-control method has the potential to alleviate behaviours related to auditory hyperreactivity in children with autism., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Biological brain age is a brain-predicted age using machine learning to indicate brain health and its associated conditions. The presence of an older predicted brain age relative to the actual chronological age is indicative of accelerated aging processes. Consequently, the disparity between the brain's chronological age and its predicted age (brain-age gap) and the factors influencing this disparity provide critical insights into cerebral health dynamics during aging. In this study, we employed a Lasso regression model and analyzed multimodal imaging data from 124 participants aged 53 to 76 to formulate and predict brain age. Additionally, we conducted partial correlation analyses to explore the complex relationship between the brain-age gap and network metrics, cognitive assessments, and emotional evaluations, while controlling for chronological age, gender, and education. Our findings highlight psychological resilience as a significant mitigating factor against premature brain aging. It is established that psychological resilience significantly influences the modulation of the brain-age gap. Moreover, psychological resilience and the brain-age gap exhibit a high accuracy (above 0.72) in segregating Montreal Cognitive Assessment score-based cohorts. This observation underscores significant insight into the potential of utilizing the brain-age gap as a diagnostic tool for the early detection of accelerated aging. It advocates for the timely application of interventions, including the development of programs aimed at bolstering psychological resilience., Competing Interests: Declarations. Ethics approval and consent to participate: All participants provided informed consent prior to their involvement in the study conducted at Fujian University of Traditional Chinese Medicine. Participants were informed about the purpose of the study, the procedures involved, and their right to withdraw at any time without any consequences. Consent for publication: All authors consent to the publication of this manuscript. Competing interest: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Cognitively combined/engaged physical activity (CC/CE-PA) has been used as an intervention for children/adolescents with attention-deficit/hyperactivity disorder (ADHD)., Method: This review aimed to quantify the effects of CC/CE-PAs on enhancing executive and physical function and alleviating ADHD symptoms in children/adolescents with ADHD. An extensive literature search of online databases identified 32 studies (75 % high-quality studies), of which 22 (pooled n=968) were included in the meta-analysis., Results: The included studies covered five PA types with varying intervention periods, frequencies, and exercise durations. The CC/CE-PAs showed an overall significant effect on improving executive function (standardized mean difference [SMD]: 1.10) and motor competence (SMD: 0.52) and alleviating ADHD symptoms (SMD: -0.75). Program design and participants' medication status were found to significantly moderate the effect of CC/CE-PA., Conclusion: More evidence is needed to support the effect of CC/CE-PA by comparing it with other interventions and using a rigorous experimental design., Competing Interests: Conflict of Interest All authors declared no conflict of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

A tunable active-noise-control (ANC) circuit topology for headsets used in different applications is presented in this article. In the current consumer headset market, ANC is a mature technology that is commonly applied to wireless headsets connected to smartphones for listening to music and making phone calls. The development of ANC headsets has resulted in low-cost and simple devices due to the built-in ANC registers in the digital circuit. Digital circuit implementation is important to provide ultra-low latency processing for different algorithms compared with using digital signal processors (DSPs). However, a limitation associated with these built-in ANC filters is that the ANC digital circuit has been designed only for the wireless headset consumer market. Consequently, ANC headsets can only be used for designated features. ANC tuned for planes by eliminating low-frequency engine noise has been commonly used in the past twenty years. Pass-through (PT) amplification is also commonly tuned to allow users to hear external sounds and have conversations without having to remove their headset. In addition, ANC and PT amplification are also not allowed to operate simultaneously on the existing chipsets. In this paper, an ANC circuit topology with ultra-low latency processing is presented, where the ANC response of the headset can be tuned without any restriction imposed by the built-in ANC filters. The proposed ANC circuit topology consists of a commercial ANC chipset with an external audio codec to provide tunable characteristics. It is achieved by fixed maximum noise cancellation of ANC chipset being modified by summing with the signal from audio-codec path via an audio mixer. Acoustic performance for several headset applications implemented using the proposed circuit is validated. This simple circuit topology can be easily developed and adapted to the current headset consumer market for consumer-selective ANC in different environments., (© 2024. The Author(s).)

Background: The fronto-cerebellar functional network has been proposed to subserve cognitive processing speed. This study aims to elucidate how the long-range frontal-to-cerebellar effective connectivity contributes to faster speed., Methods: In total, 60 healthy participants were randomly allocated to three five-daily sessions of transcranial magnetic stimulation conditions, namely intermittent theta-burst stimulation (iTBS, excitatory), continuous theta-burst stimulation (CTBS, inhibitory), or a sham condition. The sites of the stimulations were the right pre-supplementary motor area (RpSMA), medial cerebellar vermis VI (MCV6), and vertex, respectively. Performances in two reaction time tasks were recorded at different time points., Results: Post-stimulation speeds revealed marginal decreases in the simple but not complex task. Nevertheless, participants in the excitatory RpSMA and inhibitory MCV6 conditions showed direct and negative path effects on faster speeds compared to the sham condition in the simple reaction time (SRT) task ( β = -0.320, p = 0.045 and β = -0.414, p = 0.007, respectively). These path effects were not observed in the SDMT task., Discussion: RpSMA and MCV6 were involved in promoting the path effects of faster reaction times on simple cognitive task. This study offers further evidence to support their roles within the long-range frontal-to-cerebellar connectivity subserving cognitive processing speed. The enhancement effects, however, are likely limited to simple rather than complex mental operations., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Zhao, Tao, Wong, Wu, Liu, Chen, Lee, Xu and Chan.)

There are multiple risk and protective factors for depression. The association between these factors with vulnerability to depression is unclear. Such knowledge is an important insight into assessing risk for developing depression for precision interventions. Based on the behavioral data of 496 participants (all unmarried and not cohabiting, with a college education level or above), we applied machine-learning approaches to model risk and protective factors in estimating depression and its symptoms. Then, we employed Random Forest to identify important factors which were then used to differentiate participants who had high risk of depression from those who had low risk. Results revealed that risk and protective factors could significantly estimate depression and depressive symptoms. Feature selection revealed four key factors including three risk factors (brooding, perceived loneliness, and perceived stress) and one protective factor (resilience). The classification model built by the four factors achieved an ROC-AUC score of 75.50% to classify the high- and low-risk groups, which was comparable to the classification performance based on all risk and protective factors (ROC-AUC = 77.83%). Based on the selected four factors, we generated a mood vulnerability index useful for identifying people's risk for depression. Our findings provide potential clinical insights for developing quick screening tools for mood disorders and potential targets for intervention programs designed to improve depressive symptoms., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

This study aimed to develop and validate a new measurement tool, the Rehabilitation Adherence Inventory (RAI), to measure patients' rehabilitation adherence. We recruited 236 patients with anterior cruciate ligament (ACL) ruptures from the United Kingdom (Mage = 33.58 ± 10.03, range = 18 to 59; female = 46.2%). Participants completed a survey, that measured their rehabilitation adherence, rehabilitation volume, psychological needs support, autonomous motivation, and intention at baseline, and at the 2nd and 4th month. Factorial, convergent, discriminant, concurrent, predictive, ecological validity and test-retest reliability of the RAI were tested via exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and structural equation modelling (SEM). All the EFAs, CFAs, and SEMs yielded acceptable to excellent goodness-of-fit, χ2 = 10.51 to 224.12, df = 9 to 161, CFI > 0.95, TLI > 0.95, RMSEA <0.09 [90%C I < 0.06 to 0.12], SRMR <0.04. Results fully supported the RAI's factorial, convergent, discriminant, and ecological validity, and test-retest reliability. The concurrent and predictive validity of the RAI was only partially supported because the RAI scores at baseline was positively associated with rehabilitation frequency at all time points ( r  = 0.34 to 0.38, p  < 0.001), but its corresponding associations with rehabilitation duration were not statistically significant ( p  = 0.07 to 0.93). Overall, our findings suggest that this six-item RAI is a reliable and valid tool for evaluating patients' rehabilitation adherence., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Lee, Xu, Yung, Ong, Chan, Chung and Chan.)

Given the key roles of the cerebellum in motor, cognitive, and affective operations and given the decline of brain functions with aging, cerebellar circuitry is attracting the attention of the scientific community. The cerebellum plays a key role in timing aspects of both motor and cognitive operations, including for complex tasks such as spatial navigation. Anatomically, the cerebellum is connected with the basal ganglia via disynaptic loops, and it receives inputs from nearly every region in the cerebral cortex. The current leading hypothesis is that the cerebellum builds internal models and facilitates automatic behaviors through multiple interactions with the cerebral cortex, basal ganglia and spinal cord. The cerebellum undergoes structural and functional changes with aging, being involved in mobility frailty and related cognitive impairment as observed in the physio-cognitive decline syndrome (PCDS) affecting older, functionally-preserved adults who show slowness and/or weakness. Reductions in cerebellar volume accompany aging and are at least correlated with cognitive decline. There is a strongly negative correlation between cerebellar volume and age in cross-sectional studies, often mirrored by a reduced performance in motor tasks. Still, predictive motor timing scores remain stable over various age groups despite marked cerebellar atrophy. The cerebello-frontal network could play a significant role in processing speed and impaired cerebellar function due to aging might be compensated by increasing frontal activity to optimize processing speed in the elderly. For cognitive operations, decreased functional connectivity of the default mode network (DMN) is correlated with lower performances. Neuroimaging studies highlight that the cerebellum might be involved in the cognitive decline occurring in Alzheimer's disease (AD), independently of contributions of the cerebral cortex. Grey matter volume loss in AD is distinct from that seen in normal aging, occurring initially in cerebellar posterior lobe regions, and is associated with neuronal, synaptic and beta-amyloid neuropathology. Regarding depression, structural imaging studies have identified a relationship between depressive symptoms and cerebellar gray matter volume. In particular, major depressive disorder (MDD) and higher depressive symptom burden are associated with smaller gray matter volumes in the total cerebellum as well as the posterior cerebellum, vermis, and posterior Crus I. From the genetic/epigenetic standpoint, prominent DNA methylation changes in the cerebellum with aging are both in the form of hypo- and hyper-methylation, and the presumably increased/decreased expression of certain genes might impact on motor coordination. Training influences motor skills and lifelong practice might contribute to structural maintenance of the cerebellum in old age, reducing loss of grey matter volume and therefore contributing to the maintenance of cerebellar reserve. Non-invasive cerebellar stimulation techniques are increasingly being applied to enhance cerebellar functions related to motor, cognitive, and affective operations. They might enhance cerebellar reserve in the elderly. In conclusion, macroscopic and microscopic changes occur in the cerebellum during the lifespan, with changes in structural and functional connectivity with both the cerebral cortex and basal ganglia. With the aging of the population and the impact of aging on quality of life, the panel of experts considers that there is a huge need to clarify how the effects of aging on the cerebellar circuitry modify specific motor, cognitive, and affective operations both in normal subjects and in brain disorders such as AD or MDD, with the goal of preventing symptoms or improving the motor, cognitive, and affective symptoms., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: The Prince of Wales Hospital (PWH) Real-world Analysis of People with Drug-Resistant Epilepsy (DRE) on PERampanel (WRAPPER) study assessed effectiveness and tolerability of adjunctive perampanel in people with DRE attending PWH., Methods: This was a prospective single-center real-world observational study involving 70 people with DRE between July 2016 and June 2021. A post hoc analysis after the initial study period of 16 weeks assessed outcomes for an extended period up to 52 weeks., Results: After 16 weeks, median dose of perampanel was 2 mg (IQR 24 mg). 50% responder rates were 40.0%, 41.5%, and 48.7% at 16, 26, and 52 weeks. Seizure freedom was 12.9%, 20.7%, and 25.6% at 16, 26, and 52 weeks. Monthly seizure frequency reduced from 3.0 (IQR 3.0-6.6) at baseline to 2.0 (IQR 2.0-6.0, p = 0.005) at 16 weeks; 2.0 (IQR 2.0-5.0, p = 0.01) at 26 weeks; and 2.0 (IQR 0.0-4.0, p = 0.018) at 52 weeks. Older age predicted 50% responders (OR 1.08, 95% CI 1.01-1.14, p = 0.048). At 16 weeks, 51.4% (36/70) had treatment-emergent adverse effects (TEAEs). Most common was seizure exacerbation at 35.7% (25/70) followed by fatigue at 15.7% (11/70). NPI-12 and ZBI scores indicated no increase in neuropsychiatric symptoms on perampanel., Significance: Low-dose 2-4 mg adjunctive perampanel for people with DRE conferred appreciable improvements in seizure reduction without significant neuropsychiatric adverse effects in the real-world setting at a tertiary center in Hong Kong and had better antiseizure effect with advancing age., Plain Language Summary: This real-world study from Hong Kong found low-dose perampanel was effective and tolerable for people with drug-resistant epilepsy. Furthermore, perampanel was also potentially more effective with advancing age., (© 2023 The Authors. Epilepsia Open published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.)

Objective: This study investigates the impact of primary care utilisation of a symptom-based head and neck cancer risk calculator (Head and Neck Cancer Risk Calculator version 2) in the post-coronavirus disease 2019 period on the number of primary care referrals and cancer diagnoses., Methods: The number of referrals from April 2019 to August 2019 and from April 2020 to July 2020 (pre-calculator) was compared with the number from the period January 2021 to August 2022 (post-calculator) using the chi-square test. The patients' characteristics, referral urgency, triage outcome, Head and Neck Cancer Risk Calculator version 2 score and cancer diagnosis were recorded., Results: In total, 1110 referrals from the pre-calculator period were compared with 1559 from the post-calculator period. Patient characteristics were comparable for both cohorts. More patients were referred on the cancer pathway in the post-calculator cohort (pre-calculator patients 51.1 per cent vs post-calculator 64.0 per cent). The cancer diagnosis rate increased from 2.7 per cent in the pre-calculator cohort to 3.3 per cent in the post-calculator cohort. A lower rate of cancer diagnosis in the non-cancer pathway occurred in the cohort managed using the Head and Neck Cancer Risk Calculator version 2 (10 per cent vs 23 per cent, p = 0.10)., Conclusion: Head and Neck Cancer Risk Calculator version 2 demonstrated high sensitivity in cancer diagnosis. Further studies are required to improve the predictive strength of the calculator.

Objective: Multisensory integration enhances sensory processing in older adults. This study aimed to investigate how the sensory enhancement would modulate the motor related process in healthy older adults., Method: Thirty-one older adults (12 males, mean age 67.7 years) and 29 younger adults as controls (16 males, mean age 24.9 years) participated in this study. Participants were asked to discriminate spatial information embedded in the unisensory (visual or audial) and multisensory (audiovisual) conditions. The responses made by the movements of the left and right wrists corresponding to the spatial information were registered with specially designed pads. The electroencephalogram (EEG) marker was the event-related super-additive P2 in the frontal-central region, the stimulus-locked lateralized readiness potentials (s-LRP) and response-locked lateralized readiness potentials (r-LRP)., Results: Older participants showed significantly faster and more accurate responses than controls in the multisensory condition than in the unisensory conditions. Both groups had significantly less negative-going s-LRP amplitudes elicited at the central sites in the between-condition contrasts. However, only the older group showed significantly less negative-going, centrally distributed r-LRP amplitudes. More importantly, only the r-LRP amplitude in the audiovisual condition significantly predicted behavioral performance., Conclusion: Audiovisual integration enhances reaction time, which associates with modulated motor related processes among the older participants. The super-additive effects modulate both the motor preparation and generation processes. Interestingly, only the modulated motor generation process contributes to faster reaction time. As such effects were observed in older but not younger participants, multisensory integration likely augments motor functions in those with age-related neurodegeneration., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2023 Zou, Zhao, Ting, Wong, Hou and Chan.)

The human vestibular system is crucial for motion perception, balance control, and various higher cognitive functions. Exploring how the cerebral cortex responds to vestibular signals is not only valuable for a better understanding of how the vestibular system participates in cognitive and motor functions but also clinically significant in diagnosing central vestibular disorders. Near-infrared spectroscopy (NIRS) provides a portable and non-invasive brain imaging technology to monitor cortical hemodynamics under physical motion., Objective: This study aimed to investigate the cerebral cortical response to naturalistic vestibular stimulation induced by real physical motion and to validate the vestibular cerebral cortex previously identified using alternative vestibular stimulation., Approach: Functional NIRS data were collected from 12 right-handed subjects when they were sitting in a motion platform that generated three types of whole-body passive translational motion (circular, lateral, and fore-and-aft)., Main Results: The study found that different cortical regions were activated by the three types of motion. The cortical response was more widespread under circular motion in two dimensions compared to lateral and fore-and-aft motions in one dimensions. Overall, the identified regions were consistent with the cortical areas found to be activated in previous brain imaging studies., Significance: The results provide new evidence of brain selectivity to different types of motion and validate previous findings on the vestibular cerebral cortex., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2023 Zhao, Wei, Wang, So, Chan, Cheung and Wilkins.)

In this study, we studied historical case notes to examine nomenclature of congenital upper limb anomalies and explore the changes in terminologies over time. Original diagnoses were reclassified according to previously published classifications and the most recent Oberg, Manske and Tonkin system. Two hundred and thirty-eight case notes were obtained from the period 1961-1991. Hand plate malformations where the diagnosis was obvious or traumatic defects, were excluded. Eighty-six cases (106 extremities) were finally included where an ambiguous diagnosis, such as 'congenital absence' was initially given. None of the re-classifications matched the original diagnoses except for cleft hand and radial dysplasia ( n  = 31). Eighteen phocomelia-type limbs were re-classifiable when seen as a continuum of longitudinal deficiency, but not as an intercalary deficit. This study provided further insights into the evolving nature of nomenclature in congenital upper limb anomalies, especially for the condition of phocomelia. Level of evidence: IV., Competing Interests: Declaration of conflicting interestsThe authors declare no potential conflicts of with respect to the research, authorship, and/or publication of this article.

Background: The International Classification of Functioning, Disability, and Health (ICF) model has been applied in post-stroke rehabilitation, yet limited studies explored its clinical application on enhancing patients' Activity and Participation (ICF-A&P) level., Purpose: This study gathered evidence of the effects of an ICF-based post-stroke rehabilitation program (ICF-PSRP) in enhancing community reintegration in terms of ICF-A&P of post-stroke patients., Methods: Fifty-two post-stroke patients completed an 8 to 12 weeks multidisciplinary ICF-PSRP after setting personal treatment goals in an outpatient community rehabilitation center. Intake and pre-discharge assessments were administered for primary outcomes of Body function (ICF-BF; e.g., muscle strength) and ICF-A&P (e.g., mobility), and secondary outcomes of perceived improvements in ability (e.g., goal attainment and quality of life)., Results: There were significantly higher levels in the ICF-BF and ICF-A&P domains, except cognitive function under the ICF-BF. Improvements in the primary outcomes predicted corresponding secondary outcomes. Firstly, expressive and receptive functions (ICP-BF) were mediated by the everyday language (ICF-A&P) which predicted patients' satisfaction with the language-related quality of life. Secondly, upper extremity function (ICP-BF) was mediated by the lower extremity mobility (ICF-A&P) predicting work and productivity-related quality of life. Content analyses showed that combined ICF-BF and ICF-A&P contents throughout the ICF-PSRP contributed to the positive treatment effects., Conclusion: The ICF-PSRP was effective in promoting body function, and activity and participation levels of post-stroke patients. Positive treatment effects are characterized by goal-setting process, cross-domain content design, and community-setting delivery. Clinical trial registration : https://clinicaltrials.gov/study/NCT05941078?id=NCT05941078&rank=1, identifier NCT05941078., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Wong, Cheung, Ng, Yuan, Lam, Fu and Chan.)

We developed a 28-item Chinese Eyes Test and tested its psychometric properties with a mixed sample of high-functioning adults with autism or Asperger syndrome and neurotypical adults. The Chinese Eyes Test showed good convergent and divergent validity, satisfactory known-group discrimination, and acceptable internal consistency. The identified cutoff score of 18 or below (Sensitivity: 66.7%; Specificity: 84.0%) should be useful for identifying clinically significant levels of social cognitive deficits, in terms of difficulty with the perceptual understanding of others' mental states, in high-functioning adults with autism or Asperger syndrome., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Objective: The neural mechanisms underlying the beneficial effects of a computerized cognitive training (CCT) program for improving episodic memory in older persons with mild cognitive impairment (MCI) remain unclear. This study aimed to use both functional and structural brain changes to elucidate the treatment effects of CCT on enhancing episodic memory., Design, Setting, and Participants: Single-blinded, multicenter randomized controlled trial on 60 older adults with MCI in Fuzhou, China., Intervention: Participants were randomly assigned to either an 8-week 24-hour CCT program or a health education program as the control., Measurements: Clinical outcomes included changes in scores on the immediate and/or delayed recall subtests of the Chinese auditory verbal learning test (CAVLT) and rey complex figure test (CFT), and changes in gray matter volume and the functional connectivity of the posterior cingulate cortex (PCC) and hippocampus in the Papez circuit on magnetic resonance imaging., Results: Significant group-by-time effects showed greater improvements in both immediate and delayed recall scores of CAVLT and delayed recall scores of Rey CFT in participants receiving the CCT program compared to those in the health education program. Among the CCT participants, seed-based analyses revealed decreases in functional connectivity of the PCC and hippocampus with neural substrates in the parietal and occipital regions. The decreased PCC and precuneus connectivity were found to mediate patients' improvements in immediate recall function., Conclusion: An 8-week CCT program was effective for improving episodic memory in older individuals with MCI. The decrease in connectivity originating from the PCC and hippocampus is suggestive of potential plastic changes in the Papez circuit, which could have alleviated the age-related compensatory mechanism. The findings of this study also shed light on expanding the content and extending the frequency and duration of the CCT program in future studies., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Subthreshold depression is a highly prevalent mood disorder in young adults. Mind-body exercises, such as Tai Chi, have been adopted as interventions for clinical depressive symptoms. However, the possible effect and underlying mechanism of Tai Chi on subthreshold depression of young individuals remain unclear. This randomized controlled study aimed to evaluate the effects of Tai Chi training and tested the combined stress and reward circuitry model for subthreshold depression., Results: A total of 103 participants completed this trial, with 49 in the 12-week 24-style Tai Chi group and 54 participants in control group. Our results showed significantly lower scores on depressive symptoms (P = 0.002) and anxiety symptoms (P = 0.009) and higher scores on quality of life (P = 0.002) after Tai Chi training. There were significant reductions in salivary cortisol levels (P = 0.007) and putamen gray matter volume (P < 0.001) in the Tai Chi group. The changes in cortisol levels and putamen gray matter volume had direct (bootstrapping confidence interval [- 0.91, - 0.11]) and indirect effects (bootstrapping confidence interval [- 0.65, - 0.19]) on the changes induced by Tai Chi training on depressive symptoms, respectively., Conclusion: The stress-reward complex results indicated an interaction between lowering stress levels and increasing reward circuitry activity associated with the alleviation of depressive symptoms among participants. The 12-week Tai Chi training was effective in improving the symptoms and quality of life of young adults with subthreshold depression. Trial Registration Chinese Registry of Clinical Trials (Registration Number: ChiCTR1900028289, Registered December 12, 2019)., (© 2023. Springer Nature Switzerland AG.)

Background: People with mild cognitive impairment (MCI) experience a loss of cognitive functions, whose mechanism is characterized by aberrant structure‒function (SC-FC) coupling and topological attributes of multiple networks. This study aimed to reveal the network-level SC-FC coupling and internal topological changes triggered by computerized cognitive training (CCT) to explain the therapeutic effects of this training in individuals with MCI., Methods: In this randomized block experiment, we recruited 60 MCI individuals and randomly divided them into an 8-week multidomain CCT group and a health education control group. The neuropsychological outcome measures were the Montreal Cognitive Assessment (MoCA), Chinese Auditory Verbal Learning Test (CAVLT), Chinese Stroop Color-Word Test (SCWT), and Rey-Osterrieth Complex Figure Test (Rey CFT). The brain imaging outcome measures were SC-FC coupling and topological attributes using functional MRI and diffusion tensor imaging methods. We applied linear model analysis to assess the differences in the outcome measures and identify the correspondence between the changes in the brain networks and cognitive functions before and after the CCT., Results: Fifty participants were included in the analyses after the exclusion of three dropouts and seven participants with low-quality MRI scans. Significant group × time effects were found on the changes in the MoCA, CAVLT, and Rey CFT recall scores. The changes in the SC-FC coupling values of the default mode network (DMN) and somatomotor network (SOM) were higher in the CCT group than in the control group (P(unc.) = 0.033, P(unc.) = 0.019), but opposite effects were found on the coupling values of the visual network (VIS) (P(unc.) = 0.039). Increasing clustering coefficients in the functional DMN and SOM and subtle changes in the nodal degree centrality and nodal efficiency of the right dorsal medial prefrontal cortex, posterior cingulate cortex, left parietal lobe, somatomotor area, and visual cortex were observed in the CCT group (P < 0.05, Bonferroni correction). Significant correspondences were found between global cognitive function and DMN coupling values (P(unc.) = 0.007), between immediate memory and SOM as well as FPC coupling values (P(unc.) = 0.037, P(unc.) = 0.030), between delayed memory and SOM coupling values (P(unc.) = 0.030), and between visual memory and VIS coupling values (P(unc.) = 0.007)., Conclusions: Eight weeks of CCT effectively improved global cognitive and memory functions; these changes were correlated with increases in SC-FC coupling and changes in the topography of the DMN and SOM in individuals with MCI. The CCT regimen also modulated the clustering coefficient and the capacity for information transformation in functional networks; these effects appeared to underlie the cognitive improvement associated with CCT., Trial Registration: Chinese Clinical Trial Registry, ChiCTR2000034012. Registered on 21 June 2020., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Body functions and structures, activities, and participation are the core components in the International Classification of Functioning, Disability, and Health (ICF) to identify post-stroke patients' health conditions. The specification of health conditions enhances the outcomes of post-stroke rehabilitation., Purpose: This study aimed to explore the extent and the processes in an ICF-based post-stroke rehabilitation program (ICF-PSRP) that could enhance patients' community reintegration level., Methods: Post-stroke patients who completed the ICF-PSRP participated in intake and pre-discharge individual face-to-face semi-structured interviews. In addition, case therapists were invited to a face-to-face semi-structured group interview. Clinician experts were invited to complete an interview with the same interview contents as case therapists but in an online format. All interview recordings were analyzed with the Framework analysis. Patients' treatment goals were mapped with the ICF Core Set for Stroke., Results: Out of 37 invited post-stroke patients, thirty-three of them completed the interview. Three case therapists and five clinicians completed the interviews. The goals set by the patients and their caregivers showed a broadening of their scope over the course of the program. The changes in scope ranged from the activities to the participation and environmental components. Increases in patient-therapist interactions played an essential role in the goal-setting process, which were integral to personalizing the treatment content. These characteristics were perceived by all parties who contributed to the program outcomes., Conclusion: The application of ICF's principles and core components offers a useful framework for enhancing post-stroke patients' community reintegration level. Future studies should explore the way in which patient-therapist interaction, exposure to environmental factors, and personalized interventions maximize the benefits of applying this framework to the community integration of post-stroke patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Wong, Tong, Cheung, Ng, Yuan, Lam, Fu and Chan.)

Important decisions often involve choosing between complex environments that define future item encounters. Despite its importance for adaptive behavior and distinct computational challenges, decision-making research primarily focuses on item choice, ignoring environment choice altogether. Here we contrast previously studied item choice in ventromedial prefrontal cortex with lateral frontopolar cortex (FPl) linked to environment choice. Furthermore, we propose a mechanism for how FPl decomposes and represents complex environments during decision making. Specifically, we trained a choice-optimized, brain-naive convolutional neural network (CNN) and compared predicted CNN activation with actual FPl activity. We showed that the high-dimensional FPl activity decomposes environment features to represent the complexity of an environment to make such choice possible. Moreover, FPl functionally connects with posterior cingulate cortex for guiding environment choice. Further probing FPl's computation revealed a parallel processing mechanism in extracting multiple environment features., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Age-related cognitive slowing is a prominent precursor of cognitive decline. Functional neuroimaging studies found that cognitive processing speed is associated with activation and coupling among frontal, parietal and cerebellar brain networks. However, how the reciprocal influences of inter- and intra-network coupling mediate age-related decline in processing speed remains insufficiently studied. This study examined how inter- and intra-brain network influences mediate age-related slowing. We were interested in the fronto-insular salience network (SN), frontoparietal dorsal attention network (DAN), cerebellar network (CN) and default mode network (DMN). Reaction time (RT) and functional MRI data from 84 participants (aged 18-75) were collected while they were performing the Arrow Task in visual or audial forms. At the subject level, effective connectivities (ECs) were estimated with regression dynamic causal modelling. At the group level, structural equation models (SEMs) were used to model latent speed based on age and the EC mediators. Age was associated with decreased speed and increased inter-network effective connectivity. The CN exerting influence on the DAN (CN → DAN EC) mediated, while the SN → DAN EC suppressed age-related slowing. The DMN and intra-network ECs did not seem to play significant roles in slowing due to ageing. Inter-network connectivity from the CN and SN to the DAN contributes to age-related slowing. The seemingly antagonizing influences of the CN and SN indicate that increased task-related automaticity and decreased effortful control on top-down attention would promote greater speed in older individuals., (© 2022. The Author(s).)

Background: Early detection of mild cognitive impairment (MCI) symptoms is an important step to its diagnosis and intervention. We developed a new screening test called "Efficient Online MCI Screening System" (EOmciSS) for use in community-dwelling older adults. It is a self-paced cognitive test to be completed within 10 minutes on tablets or smartphones in homes or care centers for older adults., Objective: This study aims to test the validity of EOmciSS for identifying community-dwelling older adults with MCI risks., Methods: Participants (N=827) completed EOmciSS and other screening tests for MCI. The psychometric properties tested were "subscale item difficulty," "discriminative index," "internal consistency," and "construct validity." We also tested between-group discrimination using the cross-validation method in an MCI group and a normal cognitive function (NCF) group., Results: A total of 3 accuracy factors and 1 reaction time factor explained the structure of the 20 item factors. The difficulty level of accuracy factors (ie, "trail making," "clock drawing," "cube copying," "delayed recall") was 0.63-0.99, whereas that of the reaction time factor was 0.77-0.95. The discriminative index of the medium-to-high-difficulty item factors was 0.39-0.97. The internal consistency (Cronbach α) ranged from .41 (for few item factors) to .96. The training data set contained 9 item factors (CC-Acc1, P<.001; CD-Acc1, P=.07; CD-Acc2, P=.06; CD-Acc3, P<.001; TM-Acc4, P=.07; DR-Acc1, P=.03; RS, P=.06; DR-RT1, P=.02; and DR-RT2, P=.05) that were significant predictors for an MCI classification versus NCF classification. Depressive symptoms were identified as significant factors (P<.001) influencing the performance of participants, and were an integral part of our test system. Age (P=.15), number of years of education (P=.18), and proficiency in using an electronic device (P=.39) did not significantly influence the scores nor classification of participants. Application of the MCI/NCF cutoff score (7.90 out of 9.67) to the validation data set yielded an area under the curve of 0.912 (P<.001; 95% CI 0.868-0.955). The sensitivity was 84.9%, specificity was 85.1%, and the Youden index was 0.70., Conclusions: EOmciSS was valid and reliable for identifying older adults with significant risks of MCI. Our results indicate that EOmciSS has higher sensitivity and specificity than those of the Computer-Administered Neuropsychological Screen for Mild Cognitive Impairment and the Computerized Cognitive Screen. The user interface, online operation, and self-paced format allowed the test system to be operated by older adults or their caregivers in different settings (eg, home or care centers for older adults). Depressive symptoms should be an integral part in future MCI screening systems because they influence the test performance and, hence, MCI risk., Trial Registration: Chinese Clinical Trial Registry ChiCTR2000039411; http://www.chictr.org.cn/showprojen.aspx?proj=62903., (©Jingsong Wu, Jingnan Tu, Zhizhen Liu, Lei Cao, Youze He, Jia Huang, Jing Tao, Mabel N K Wong, Lidian Chen, Tatia M C Lee, Chetwyn C H Chan. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 30.01.2023.)