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Objective To evaluate the effect of wearable device training on improving upper limb motor function in patients who experienced strokes.Methods The PubMed, Embase, Cochrane Library, Web of Science, MEDLINE, SCOPUS, China National Knowledge Infrastructure, WanFang, and VIP databases were searched for randomized controlled trials (RCTs) that assessed the effectiveness of wearable device training in improving upper limb motor function in patients with stroke. Two investigators independently screened studies by their titles and abstracts and cross-checked, downloaded, and evaluated the results. Disagreements were resolved by a third highly experienced researcher. Risk of bias was evaluated using the Cochrane risk-of-bias tool. This meta-analysis was registered in PROSPERO (registration No. CRD42023421633).Results This study comprised 508 patients from 14 RCTs. The experimental group assessed various wearable devices, including 3D-printed dynamic orthoses, inertial measurement unit (IMU) sensors, electrical stimulation devices, and virtual reality (VR) devices for virtual interactive training. The control group received traditional rehabilitation therapies, including physical and conventional rehabilitation. The experimental group scored better on the Fugl–Meyer Assessment (FMA-UE) scale (standardized mean difference [SMD] 0.26, 95% confidence interval [CI] 0.07, 0.45) and Box and Block Test (BBT) (SMD 0.43, 95% CI 0.17, 0.69) versus controls. No significant intergroup differences were observed in the Action Research Arm Test (SMD 0.20, 95% CI −0.15, 0.55), motor activity log (mean difference [MD] 0.32, 95% CI −0.54, 0.33), and modified Ashworth scale (MD −0.08, 95% CI −0.81, 0.64). The probability rankings of wearable devices that improved FMA-UE scores in patients with stroke were: orthotic devices, with the highest probability ranking of 0.45, followed by sensor devices at 0.23, electrical stimulation devices at 0.21, and VR devices at 0.11.Conclusions Wearable device training was found to significantly improve upper limb motor function in patients with stroke, particularly for large-range movements. Improvements in FMA-UE and BBT scores reflected reduced impairment and enhanced manual dexterity, respectively. However, the training had no significant effect on hand movement frequency, fine motor skills, or spasticity. Among the different wearable devices tested, orthoses produced the most effective results.

Almost half of ischemic stroke (IS) survivors have poststroke fatigue (PSF) during rehabilitation, which can reduce their rehabilitation compliance and quality of life. The primary link of PSF management is early identification, which can guide bundle of care for prevention. This study aimed to explore the predictive value of serological indicators for guiding bundle of care to prevent the occurrence of PSF among IS survivors. This study was a prospective observational study. A total of 350 patients with IS who were hospitalized in 2 tertiary hospitals in Nanning from October 2022 to September 2023 were selected. The general data of patients and serological indicators within 24 hours of admission were collected. Based on the follow-up results, the patients were divided into the PSF group and the NPSF group. Multivariate logistic regression analysis was used to screen the risk factors affecting the occurrence of PSF, and the receiver operating characteristic curve (ROC curve) method was used to analyze the predictive value of this factor. The incidence of acute-phase PSF among elderly patients with IS was 49.26%. The elevated levels of fasting plasma glucose (FPG) (OR = 1.485, 95% CI: 1.145–1.925, P = .003), total cholesterol (TC) (OR = 1.394, 95% CI: 1.013–1.917, P = .041), C-reactive protein (CRP) (OR = 1.394, 95% CI: 1.013–1.917, P = .041), and homocysteine (Hcy) (OR = 1.370, 95% CI: 1.233–1.524, P < .001) were risk factors of PSF in elderly patients with acute IS (P < .05). FPG (area under the curve = 0.632), TC (area under the curve = 0.621), CRP (area under the curve = 0.889), and Hcy (area under the curve = 0.807) had a good predictive value for acute-phase PSF, and the combination of the 4 indicators could further improve the predictive efficacy (area under the curve = 0.938, sensitivity 86.2%, specificity 90.7%, P < .05). The elevated levels of FPG, TC, CRP, and Hcy could predict the risk of PSF, and the combination of the 4 indicators can effectively improve prediction efficiency and provide a reference for guiding the formulation of bundle nursing programs.

Objective: To test the acceptability and feasibility of self-administered acupressure as an intervention for knee pain among middle-aged and older adults with knee osteoarthritis (KOA).Methods: In this pilot randomized controlled trial, 35 participants with KOA were randomized to receive self-administered acupressure (n = 17, two self-administered acupressure training sessions followed by self-practice for 6 weeks) or knee health education (n = 18, two health education sessions about KOA management followed by self-care for 6 weeks). Current pain intensity (primary outcome) was measured using a Numeric Rating Scale (NRS) at baseline and weeks 1, 2, 4 and 6 (post-intervention). Secondary outcome measures included worst and least pain intensity, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), range of motion (ROM) of the knee joints and Short-Form Six-Dimension (SF-6D) scores for health-related quality of life.Results: Participants in both groups attended all training sessions. In the self-administered acupressure group, all subjects mastered the acupressure technique and passed a consistency check. Both groups showed a decreasing trend in current knee pain intensity measured using NRS post-intervention. A medium between-group effect size (0.40) was found, but between-group differences were not statistically significant. The other secondary outcome measures were also comparable between both groups post-intervention (all p > 0.05).Conclusion: A two-session self-administered acupressure training was acceptable to and feasible in participants with KOA. The data generated allowed for calculation of a sample size for a definitive randomized controlled trial (RCT) to confirm whether self-acupressure is effective for pain management in KOA. Furthermore trials with adequate power and longer follow-up periods are warranted.

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Challenge-Based Learning (CBL), which is an experiential team-based pedagogy, was adopted in the baccalaureate nursing programme to foster nursing students' collaboration ability. One core feature of CBL that warrants such experience is that students must work out an intervention for the target clients in a big team comprising classmates and other relevant personnel in the community. It is believed that such feature can cultivate nursing students' collaboration skill.

AbstractBackground:This article presents a clinical application for a comprehensive and systematic auricular diagnosis protocol for musculoskeletal system disorder and a treatment protocol for chronic low-back pain (CLBP). This protocol includes (1) locating the somatotopic correspondences between the auricular zone and musculoskeletal system, (2) visual inspection, (3) palpitation, and (4) electrical detection.Methodology:To treat CLBP, the current authors have developed an auricular therapy protocol. In this CLBP protocol, the selection of ear acupuncture points (EAPs) takes into account (1) corresponding points, (2) points featuring both disharmony of Zangorgans and disturbance of meridians, and (3) active points located at the Waist triangle, groove of Spinal posterior,and groove of Sciatic posteriorareas of the ear. The Chinese Standard Ear-Acupoints Chart is used to locate the EAPs. The clinical application of this comprehensive and systematic auricular diagnosis protocol for diagnosing musculoskeletal system disorder is summarized. A treatment protocol for CLBP is presented that can be replicated by clinicians or researchers for pain managment.Conclusions:Auricular therapy is a relatively safe treatment, having minimal adverse effects in patients who have chronic pain. The treatment can be used as an adjunct therapy with conventional biomedical treatments.

AbstractBackground:Auricular diagnosis has been used as a complementary approach that is simple, effective, and inexpensive for identifying chronic illnesses. This diagnostic method has prediagnostic value and is important for a secondary level of prevention, so that earlier treatment can be provided.Objective:This article describes how this diagnostic method was applied in cases with coronary heart disease (CHD) or lower urinary-tract symptoms (LUTS), which are common chronic illnesses among the adult population.Materials and Methods:Design:A case-control study approach was adopted, with the utilization of visual inspection, electrical skin-resistance measurement, and tenderness testing to investigate the auricular signals and their relationship with specific chronic illnesses. The practitioners who conducted the auricular diagnosis were blinded to the known medical conditions of the subjects. Setting and Subjects:Subjects from the CHD +ve (positive) group (n=50) were recruited from the cardiac unit of a regional hospital in Hong Kong; whereas the subjects in the CHD −ve (negative; controls) group (n=50) and participants in the LUTS study (LUTS +ve and LUTS −ve; n=113) were recruited from the local community. Subjects with known health conditions were matched in age and gender with control subjects.Results:In the CHD study, the presence of an ear lobe crease was significantly associated with CHD. The Heart zone of the CHD +ve cases had significantly higher conductivity and had significant tenderness in both ears, compared with the control group. Similarly, nearly all of the specific acupoints in the participants in the LUTS +ve group indicated significantly higher conductivity and a tenderness sensation in the auricular areas associated with the kidneys and urinary tract than those in the LUTS −ve group. The predictive value of auricular signals for CHD/LUTS—which were detected by visual inspection, electrical skin-resistance measurement, and tenderness testing—was observed in a Chinese population.Conclusions:A systematic and scientific approach for the diagnostic accuracy of auricular signals involves using visual inspection, electrical skin-resistance measurement, and tenderness testing to investigate these signals and their relationship with specific chronic illnesses.

AbstractBackground:Auricular therapy is a promising treatment for pain. However, the physiologic mechanisms of analgesic effects are not well-understood, which limits the scientific credibility of auricular therapy for pain management.Objectives:This prospective, randomized clinical trial (RCT) was conducted to determine whether or not the levels of pro- and anti-inflammatory cytokines change in response to auricular point acupressure (APA) for chronic low-back pain (CLBP).Methods:Blood samples (10 mL) were collected in a vacutainer, based on standard phlebotomy procedures. Blood was drawn at the following timepoints: before APA treatment to measure the baseline; 30 minutes after the first APA treatment; weekly for 4 weeks; and within 1 month of a follow-up visit (a total of seven timepoints) for each subject).Results:Participants with CLBP reported a mean 70% reduction of pain intensity at the completion of the 4-week APA regimen. The participants also had changes in serum pro- and anti-inflammatory cytokines. In particular, interleukin (IL)-1β, IL-4, and IL-10 were decreased. IL-2, IL-6, and tumor necrosis factor (TNF)-α were increased. In contrast, the participants who were in the sham APA group, with a 29% pain reduction, had a different profile. In particular, I-L2, IL-4, and TNF-α were decreased. IL-1β, IL-6, and IL-10 were increased. IL-1β, IL-2, IL-6, and IL-10 levels were associated with the worst pain intensity score, suggesting that these cytokines had an important role in mediating the APA effect on CLBP.Conclusions:The changes in cytokine levels in response to APA treatment suggested that APA could influence the level of circulating cytokines in patients with CLBP.

Advances in medical technology have increased treatment modalities for premature infants and have greatly improved their survival and clinical outcomes. However, saving the lives of extremely premature infants has become an ethical dilemma, considering the potential undesirable consequences on the baby and the family as a result of the intensive life-support efforts. The authors draw on 2 case scenarios to illustrate the limitations of advanced medical technology on extremely premature infants who experience significant morbidities and mortality. The ethical discussion concerns the doctrines of the sanctity of life and the quality of life, with emphasis on the best interest of the infant.

Background Physical activity in old age probably protects against hip fracture. However, very little is known about the impact of occupation during working life, in terms of its physical activity level and the socio-economic status (SES) it indicates, on the risk of hip fracture in later life. Method A population-based case-control study was conducted on 416 subjects to investigate relationships between risk of hip fracture and occupational physical activity and occupation-related SES. Occupational physical activity was coded according to the proportion of the working day at ages 20 and 50 years that the subjects were likely to have spent sitting. The Australian Classification of Standard Occupations (ASCO) was used as the basis for the coding of SES, indicated by job titles. Results Compared with those in the intermediate category, women with a sedentary job at age 50 years (odds ratio (OR) 7.2, 95 per cent confidence interval (CI) 1.2–41.9) or a mainly weight-bearing job (OR 5.1, 95 per cent CI 1.1–23.2) had an increased risk of hip fracture. A decreasing hip fracture risk with increasing SES of the longest held job was also observed Conclusion The finding of a J-shaped relationship in women between occupational physical activity and risk of hip fracture supports the need for research into the most effective types of exercise for maintenance of bone strength. Furthermore, the protective effect of SES demonstrated in this study still need to be corroborated in other studies before establishing evidence of a causal relationship.