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Objectives. To investigate (i) the interrater and test-retest reliabilities of completion time and number of steps in the Narrow Corridor Walking Test (NCWT); (ii) the minimal detectable changes (MDCs) in NCWT results; (iii) the correlations between NCWT results and stroke-specific outcome measures; and (iv) the optimal cut-off values of NCWT results for discriminating the difference in advanced balance ability between people with stroke and healthy older adults. Design. Cross-sectional. Subjects. Thirty people with stroke and 30 healthy older adults. Methods. People with stroke completed the NCWT on two separate days with a 7- to 10-day interval. The Fugl-Meyer Assessment (FMA), ankle dorsiflexor and plantarflexor muscle strength, Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and the Chinese version of the Community Integration Measure (CIM) were used to assess. The healthy older adults completed the NCWT once. Results. The NCWT completion time and NCWT steps showed excellent interrater reliability and test-retest reliability and significant correlations with FMA, affected ankle dorsiflexor muscle strength, BBS score, and TUG completion time. A cut-off value of 7.40 s for NCWT completion time and 13.33 for the NCWT steps distinguished people with stroke from healthy older adults. The MDCs of the NCWT completion time and NCWT steps were 6.87 s and 5.50, respectively. Conclusion. The NCWT is a reliable clinical measurement tool for the assessment of advanced balance ability in people with stroke.

Background. Social support is important for stroke rehabilitation. Conventionally, social support is evaluated from the level of support received. However, the bidirectional support hypothesis postulated that self-perceived social support is optimized if individuals provide and receive social support in a balanced manner. The Brief 2-Way Social Support Scale (Brief 2-Way SSS) is a social support instrument measuring the reciprocity of receiving and giving emotional and instrumental social support. Objective. (1) To translate and culturally adapt the English version of the Brief 2-Way SSS into Chinese (Cantonese) (Brief 2-Way SSS-C), (2) to report the results of validation of the Brief 2-Way SSS-C, and (3) to investigate the level of social support in people with stroke in Hong Kong. Methods. The Brief 2-Way SSS-C was produced following the standard forward-backward translation model. People with stroke ( n = 109 ) and age-matched controls ( n = 53 ) were recruited through a university-affiliated neurorehabilitation laboratory. Results. The Brief 2-Way SSS-C demonstrated excellent content validity, acceptable to good internal consistency (Cronbach’s alpha of 0.74–0.88), and good test-retest reliability (intraclass correlation coefficient of 0.76–0.81). There were no ceiling or floor effects, and the MDC95 across all subscales was 4. The Brief 2-Way SSS-C subscales had significant correlations with various health-related outcome measures. People with stroke had a lower level of social support than the age-matched healthy controls. Conclusions. The Brief 2-Way SSS-C is a culturally relevant, reliable, and valid outcome measure for the level of social support in community-dwelling people with stroke.

ObjectiveTo culturally adapt and examine the psychometric properties of the Chinese (Cantonese) version of the Upper Extremity Functional Index (C-UEFI) in people with chronic stroke.DesignCross-sectional study.SettingsUniversity-affiliated neurorehabilitation research laboratory.ParticipantsThe participants (N = 151) were people with chronic stroke (N = 101) and healthy controls (n = 50).Main outcome measuresWe assessed the C-UEFI, Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Wolf Motor Function Test (WMFT), Six-Minute Walk Test (6MWT), Motor Activity Log (MAL), Activity-Specific Balance Confidence (ABC) scale, Lawton Instrumental Activities of Daily Living (IADL) scale, Survey of Activities and Fear of Falling in the Elderly (SAFFE), Stroke Impact Scale (SIS) and Community Integration Measure (CIM) as outcome measures.ResultsThe C-UEFI items demonstrated good test–retest reliability (intraclass correlation coefficient [ICC]3, 1 = 0.872) and excellent internal consistency (Cronbach's α = 0.922). People with chronic stroke had poorer C-UEFI scores than the healthy controls. The overall C-UEFI mean score of 101 people with stroke was significantly correlated with the mean scores of the FMA-UE, WMFT, MAL, ABC scale, IADL scale, SAFFE, SIS and CIM and the distance covered in the 6MWT. The C-UEFI cut-off score to distinguish between people with chronic stroke and healthy older adults according to upper extremity function was 57.5 out of 59 (sensitivity: 88.1%; specificity: 84%). The C-UEFI had good content validity, with an acceptable fit to the two-factor structure model.ConclusionsThe C-UEFI is reliable and valid for assessing functional recovery of upper extremity activity in Chinese people with chronic stroke.

Background: The L Test of Functional Mobility (L Test) was developed to assess the advanced mobility, which includes both turning and walking ability. This study aimed to evaluate (1) the intra-rater reliability of the L Test in four turning conditions, (2) the correlation with other stroke-specific impairment for community-dwelling older adults with stroke, and (3) the optimal cut-off completion time of the L Test to distinguish the difference of performance between healthy older adults and people with stroke. Methods: This is a cross-sectional design. Thirty older adults with stroke and healthy older adults were included. The subjects were assessed by L Test along with other stroke-specific outcomes. Results: The L Test showed excellent intra-rater reliability (ICC = 0.945–0.978) for the four turning conditions. There were significant correlations between L Test completion times and Fugl–Meyer Assessment–Lower Extremity (FMA-LE) scores, Fugl–Meyer Assessment–Upper Extremity (FMA-UE) scores, Berg Balance Scale (BBS) score, and Timed Up and Go (TUG) Test scores. The cut-off of the L Test was established as 23.41–24.13 s. Conclusion: The L Test is an easy-to-administer clinical test for assessing the turning ability of people with stroke.

To culturally adapt and examine the psychometric properties of the Chinese (Cantonese) version of SATIS-Stroke (C-SATIS-Stroke) in people with chronic stroke.Forward and backward translations were performed in accordance with available guidelines. We administered the C-SATIS-Stroke to 101 people with stroke and 50 healthy older adults. We assessed the test-retest and internal reliability, measurement error, known-group validity, correlations with other outcome measures, optimal cut-off score and ceiling and floor effects.C-SATIS-Stroke demonstrated excellent internal consistency (Cronbach'sC-SATIS-Stroke is a reliable and valid measure for assessing satisfaction with social participation among Chinese people with chronic stroke.IMPLICATIONS FOR REHABILITATIONSatisfactory semantic, idiomatic, cultural, and conceptual equivalence of the C-SATIS-Stroke are in line with those of the original English version of the SATIS-StrokeExcellent reliability and validity of the C-SATIS-Stroke are also in line with those of the original English version of the SATIS-StrokeThe C-SATIS-Stroke can be used to assess the subjective satisfaction feeling in terms of social participation among Chinese people with chronic stroke.

Purpose To translate and culturally adapt the Modified Fatigue Impact Scale (MFIS) to Chinese version, and to psychometrically test it in stroke population. Methods This study consisted of 2 phases. In phase one, we translated and culturally adopted the original English version of MFIS into Chinese (Cantonese) (MFIS-C). In phase two, the MFIS was psychometrically tested using a cohort of community-dwelling people with stroke (n = 101) and healthy control (n = 50). Among the stroke participants, 52 of them were reassessed after a 1-week interval. Results The MFIS-C demonstrated satisfactory content validity and good to excellent internal consistency. The overall MFIS-C and its subscales have good test-retest reliability. The MDC95 were 14.86, 7.49, and 9.70 for the overall MFIS-C physical, cognitive and psychosocial subscales, respectively. The overall MFIS-C and its 2 subscales have significant weak to moderate negative correlations with the Community Integration Measure and the 12-item Short Form Health Survey Version 2. Our findings revealed that the people with chronic stroke living in Hong Kong were reported to have high level of fatigue. Conclusion The MFIS-C is a reliable and valid measure for assessing the level of fatigue in people with stroke.

Background: Recent evidence has shown bilateral transcutaneous electrical nerve stimulation (Bi-TENS) combined with task-oriented training (TOT) to be superior to unilateral transcutaneous electrical nerve stimulation (Uni-TENS)+TOT in improving lower limb motor functioning following stroke. However, no research explored the effect of Bi-TENS+TOT in improving upper limb motor recovery. This study aimed to compare Bi-TENS+TOT with Uni-TENS+TOT, Placebo transcutaneous electrical nerve stimulation (Placebo-TENS)+TOT, and no treatment (Control) groups in upper limb motor recovery. Methods: This is a 4-group parallel design. One hundred and twenty subjects were given either Bi-TENS+TOT, Uni-TENS+TOT, Placebo-TENS+TOT, or Control without treatment in this randomized controlled trial. Twenty 60-minute sessions were administered 3× per week for 7 weeks. The outcome measure was the Fugl-Meyer Assessment of Upper Extremity, which was assessed at baseline, after 10 sessions (mid-intervention) and 20 sessions (post-intervention) of intervention, and at 1- and 3-month follow-up. Results: Patients in the Bi-TENS+TOT group showed greater improvement in the Fugl-Meyer Assessment of Upper Extremity scores than Uni-TENS+TOT (mean difference, 2.13; P =0.004), Placebo-TENS+TOT (mean difference, 2.63; P P P P =0.018) showed significant within-group improvement in the Fugl-Meyer Assessment of Upper Extremity scores. Patients in the Bi-TENS+TOT group showed earlier within-group improvement in the Fugl-Meyer Assessment of Upper Extremity scores at mid-intervention than Uni-TENS+TOT. These improvements were maintained at the 3-month follow-up assessment. Conclusions: Bi-TENS combined with TOT is an effective therapy for improving upper limb motor recovery following stroke. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03112473.

The Six-Spot Step Test (SSST) was originally developed to assess walking ability while challenging balance during walking in patients with multiple sclerosis. It provides more comprehensive information on ambulatory abilities than several existing measures such as the Timed Up and Go test (TUG test), the Functional Gait Assessment, and the Dynamic Gait Index. To assess the advanced balance control ability of stroke survivors, we modified the SSST to serve this purpose.The aim of this study was to expand the current understanding of the psychometric properties of the SSST using healthy older adults and stroke survivors.This study adopted an experimental design.University-affiliated neurorehabilitation laboratory.A total of 50 study participants, including 25 chronic stroke survivors and 25 healthy older adults, were recruited from the community.The SSST was administered to the stroke survivors twice (day 1 and 2) with a 1-week interval. The Fugl-Meyer assessment for the lower extremities (FMA-LE), the Berg Balance scale (BBS), the limit of stability (LOS) test, the Timed Up and Go test (TUG test), and the Chinese version of the Community Integration Measures (CIM-C) were assessed on day 1 by random order. The healthy control group was assessed with the Six-Spot Step Test only on day 1.The SSST showed excellent inter-rater, intra-rater, and test-retest reliability (intraclass correlation coefficient0.95, P0.001). Significant correlations were found between SSST performance and the FMA-LE results (r=0.517, P0.05), BBS scores (r=-0.531, P0.05), and TUG test scores (r=0.828, P0.001). The MDC in the mean SSST time for the affected leg and the unaffected leg in stroke survivors was 6.05s. The cutoff time was 10.11s (sensitivity, 80%; specificity, 92%) when kicking obstacles with the affected leg and 10.18s (sensitivity, 80%; specificity, 92%) when kicking obstacles with the unaffected leg.The SSST was a reliable test and showed a significant correlation with FMA-LE scores, BBS scores, and TUG test times in stroke survivors.The SSST can be used to assess the advanced balance control of stroke survivors.

ObjectiveTo investigate (i) the inter-rater and test–retest reliability of the trail walking test (TWT) and the minimum detectable change in the TWT completion time; (ii) the correlations between the TWT completion time and stroke-specific impairments; and (iii) the cutoff TWT completion time to distinguish between people with stroke and healthy older adults according to dual-tasking ambulation ability.DesignCross-sectional study.SettingUniversity-based rehabilitation center.ParticipantsIn total, 104 people with stroke and 53 healthy older adults.Main Outcome MeasuresThe TWT, the Fugl–Meyer Assessment of Lower Extremity (FMA-LE), the ankle muscle strength test, the limit of stability (LOS) test, the Berg Balance Scale (BBS), the Timed Up and Go test (TUG), and the Community Integration Measure (CIM).ResultsThe mean TWT completion time in subjects with stroke was 124.906 s. The TWT demonstrated excellent inter-rater reliability [intraclass correlation (ICC) = 0.999] and good test–retest reliability (ICC = 0.876) in people with stroke. The TWT performance demonstrated significant negative correlations with the FMA-LE scores (r = −0.409), LOS movement velocity (affected and unaffected sides; r = −0.320 and −0.388, respectively), and LOS endpoint excursion (affected and unaffected sides; r = −0.357 and −0.394, respectively); a significant positive correlation with the LOS reaction time (affected side; r = 0.256); a moderate negative correlation with the BBS scores (r = −0.72); and an excellent positive correlation with the TUG completion time (r = 0.944). The receiver operating characteristic curve analysis revealed that an optimal cutoff of 69.61 s for the TWT completion time had an outstanding diagnostic power to distinguish between people with stroke and healthy older adults (area under the curve = 0.919) with high sensitivity (88.5%) and specificity (83.0%).ConclusionResults of our preliminary study demonstrated that the TWT is a reliable, valid, sensitive, and specific clinical test for evaluating dual-tasking ambulation ability in people with stroke aged 45 years or above and without cognitive impairments. It can differentiate the dual-tasking ambulation ability between people with stroke and healthy older adults.

The Oxford Participation and Activities Questionnaire was developed for generic use in the assessment of participation and activity levels. However, it is not available in Chinese and has not been tested in the stroke population. The Oxford Participation and Activities Questionnaire was translated into Chinese and culturally adapted. Its psychometric properties were examined in 100 people with stroke. The participation and activity levels of people with stroke and healthy people were also compared. Content validity and internal consistency (Cronbach’s α = 0.86–0.91) were excellent. The test–retest reliability (intraclass correlation coefficient = 0.91–0.94) was also satisfactory. The standard error of the measurement was 4.10–5.31, and the minimal detectable change was 11.37–14.71. Convergent and divergent validity were supported by hypothesis testing. The instrument had a five-factor structure without a ceiling effect. Its routine activity and social engagement scores discriminated people with stroke from healthy people. In conclusion, the Chinese version of the Oxford Participation and Activities Questionnaire is reliable and valid for assessing participation and activity levels in the stroke population.

Background: Previous studies have reported that movement-based computer gaming is more effective than conventional intervention in enhancing upper limb rehabilitation.Objective: To evaluate whether the use of bilateral movement-based computer games could augment the effects of conventional intervention in improving the upper limb motor function, grip strength and health-related quality of life of subacute stroke survivors.Methods: A total of 93 subjects with subacute stroke were randomized into 2 groups receiving one of two 3.5-h interventions for 2 days per week over 8 weeks: (i) “bilateral movement-based computer games + conventional rehabilitation”; and (ii) “video-directed exercise + conventional rehabilitation” (control group).Results: A total of 83 subjects completed the interventions and follow-up assessments. Compared with video-directed exercise + conventional rehabilitation, bilateral movement-based computer games + conventional rehabilitation produced greater improvementsin upper limb motor impairment from midtreatment to follow-up 1 month post-intervention, greater improvements in upper limb function from post-intervention to 1 month follow-up, and earlier improvements in grip strength (paretic) from midintervention to follow-up 1 month post-intervention. Subjects who received bilateral movement-based computer games + conventional rehabilitation also continued to improve in motor function from postintervention to 1 month post-intervention.Conclusion: Bilateral movement-based computer games may serve as an adjuvant therapy to conventional rehabilitation programmes for improving upper limb recovery among stroke survivors. LAY ABSTRACTUpper limb sensorimotor impairment is a common and serious post-stroke sequel, affecting up to two-thirds of stroke survivors. Simultaneous bilateral training is a rehabilitative method that requires the use of both paretic and non-paretic sides completing identical tasks at the same time. Previous findings suggested that bilateral upper limb training was superior to unilateral upper limb training in improving upper limb motor impairment. Given that virtual reality-based therapy can be advantageous for engaging and encouraging participation in repetitive rehabilitative training tasks, this study aimed to investigate whether bilateral movement-based computer gaming (BMCG) using custom-made handlebars could better improve the upper limb motor function, grip strength and health-related quality of life of subacute stroke survivors than a conventional rehabilitation programme. After 16 sessions of bilateral BMCG, it was found that subacute stroke survivors had greater improvements in upper limb motor control, functional use of paretic upper limb and health-related quality of life than after a conventional rehabilitation programme. Thus, the combined use of computer gaming and bilateral movement-based training could be an adjunct therapy to conventional physiotherapy and occupational therapy in cognitively intact subacute stroke survivors.

Background: Transcutaneous electrical nerve stimulation(TENS) is an effective physiological intervention for people with stroke which aims at reducing muscle spasticity, enhancing muscle strength, and improving motor control and function. In view of the potentials to enhance greater cortical activation of the lesion side by eliciting spare neural pathways through bilateral intervention, this study examined whether the combined use of bilateral TENS (Bi-TENS) and task-oriented training (TOT) was superior to unilateral TENS(Uni-TENS)+TOT, placebo-TENS+TOT and no active treatment to improve the motor impairment of upper limb function in people with stroke. Method: There were 120 subjects with stroke(44 females, mean age=61.52±6.73 years, post-stroke duration=6.04±3.12years) being randomly allocated into 4 groups, including the Bi-group (n=30), Uni-group (n=30), placebo group (n=30) and control group (n=30). Subjects in the Bi-group, Uni-group and placebo group got 60 minutes TENS and TOT simultaneously per time for 20 times(3 times per week for 7 weeks). In the Bi-group, TENS stimulated the radial and median nerves of the bilateral upper limbs. In the Uni-group, TENS and placebo-TENS stimulated the affected and unaffected side, respectively. In the placebo group, placebo-TENS were placed on bilateral sides. In the control group, subjects did not receive any active treatment. Level of motor impairment was assessed by the Fugl-Meyer Assessment of Upper Extremity (FMA-UE). Result: The Bi-group had a significant greater improvement in FMA-UE than the Uni-group(mean change=2.02, p=0.005), placebo group (mean change=2.49, p=0.001) and control group(mean change=3.08, p Conclusion: Bi-TENS is superior to Uni-TENS, placebo-TENS and no active treatment in augmenting the recovery of upper limb motor impairment in people with chronic stroke. Author Disclosures: The authors received research support from the Health and Medical Research Fund12131821 from the Food and Health Bureau, HKSAR.

Objective: To identify the psychometric properties of the Long-Distance Corridor Walk (LDCW) among community-dwelling stroke survivors. Design: Cross-sectional. Subjects: Twenty-five stroke survivors and 25 healthy older adults. Methods: The LDCW was administered to the 25 stroke survivors on 2 separate days with a 7-day interval. Fugl-Meyer Assessment for the Lower Extremities (FMA-LE), measurement of lower limb muscle strength, Berg Balance Scale (BBS), limit of stability (LOS), Narrow-Corridor Walk Test (NCWT), Timed Up and Go (TUG) test, and the Community Integration Measure—Cantonese version (CIM) were performed on one of the days. The healthy older adults completed the LDCW once, and the results were recorded by a random rater. Results: The LDCW showed excellent inter-rater reliability and test-retest reliability, and significant correlations with FMA-LE, BBS, TUG, and NCWT. A cut-off score of 127.5 m for the 2-min walk and 426.69 s for the 400-m walk distinguished stroke survivors from healthy older adults. The MDC in the LDCW in the 2-min walk and 400-m walk were 18.69 m and 121.43 s, respectively. Conclusion: The LDCW is a reliable clinical measurement tool for the assessment of advanced walking capacity in stroke survivors.

Background Hoarding disorder is a chronic and debilitating illness associated with restrictions on activities of daily living, compromised social and occupational functioning, and adverse health outcomes. However, researchers lack a brief and self-administered screening measurement to assess compulsive hoarding in the Chinese speaking population. This study aimed to adapt and validate the Hoarding Rating Scale-Interview (HRS-I) to as a tool for screening compulsive hoarding behavior in Chinese population. Methods This study comprised two phases. During Phase 1, the English-language HRS-I was translated into Chinese (CHRS) (comprehensible for most Chinese speaking population, e.g., Cantonese & Mandarin) and subjected to an equivalence check. In Phase 2, the CHRS was validated by examining internal consistency, stability, and construct validity. Different samples were used appropriately to verify the items and reflect the psychometric properties. Results In Phase 1, the CHRS yielded satisfactory content (S-CVI = 0.93) and face validity ratings (comprehensibility = 100%, N = 20 participants of general public with age 18–72) and the English and Chinese versions were found to be equivalent (ICC = 0.887; N = 60 university staff and students). Phase 2 revealed satisfactory levels of internal consistency (Cronbach’s α = 0.86; corrected item-total correlation = 0.60–0.74; N = 820 participants of general public), 2-week test-retest reliability (ICC = 0.78; N = 60 university students), and construct validity (one-factor CFA solution matched with the hypothesized model, χ2/d.f. = 2.26, RMSEA = 0.049, CFI = 0.99, IFI = 0.99, NFI = 0.99; n = 520 participants of general public). Conclusions This study provides sufficient evidence of the reliability and validity of the CHRS for compulsive hoarding behavior screening in the Chinese population through self-administered method.

Research Objectives To determine whether self-perceived performance of upper limb movement makes an independent contribution and to quantify its relative contribution to the performance of functional activity of upper limb in patients with stroke. Design This is a cross-sectional design. Setting This study was held in the neurorehabilitation laboratory in the university. Participants Total 87 subjects (50 males, 37 females, mean age=61.12±6.88 years, time post-stroke=6.31±2.84 years) were recruited. Interventions No intervention Main Outcome Measures The paretic hand control was assessed by hand section in Fugl-Meyer Assessment (FMA-hand). The performance of functional activity of upper limb was assessed by Action Research Arm Test (ARAT). The self-perceived performance was assessed by Quality of Movement section in Motor Activity Log (MAL-QOM). The relative contributions of the independent variables in predicting the ARAT scores was determined by multiple linear regressions with the forced entry method. Results The mean ARAT score of 23.8±16.6. The mean FMA-hand score was 7.6±2.8. The mean MAL-QOM score was 39.4±37.8. After controlling for age, gender and body mass index, results of multiple linear regression analysis indicated that the FMA-hand score could independently predict 41.6% of the variance in the ARAT scores. The MAL-QOM score could predict an extra 16.9% variance in the ARAT scores after controlling the demographic information and the FMA-hand score. A total of 65.0% variance of the ARAT score was explained by the final regression model. Conclusions Self-perceived performance of upper limb motor function (MAL-QOM score) is a significant predictor of performance of functional activity of upper limb in patients with stroke. Strategies in improving the self-perceived performance of using paretic upper limb, (e.g. incorporate “graded” activity training into customary physical training, and give positive feedback on functionally relevant improvements), could be implemented in order to enhance upper limb motor function after a stroke. Author(s) Disclosures The authors received research support from the Health and Medical Research Fund 12131821 from the Food and Health Bureau, HKSAR.

Objective To examine whether selection of the nonparetic or paretic leg as the weight-bearing leg in item 13 (standing unsupported one foot in front) and item 14 (standing on one leg) of the Berg Balance Scale (BBS) influences the item scores, and thus the total score. Design Cross-sectional study. Setting University-based rehabilitation laboratory. Participants Community-dwelling people (N=63, aged ≥50y) with chronic stroke. Interventions Not applicable. Main Outcome Measure BBS. Results The 4 BBS total scores ranged from 48.4 to 50.7. The total score was significantly lower when a participant was asked to step forward with the nonparetic leg in item 13, and stand on the paretic leg in item 14. Fewer participants received a maximum score with the BBS 1 formulation than the others. In addition, the correlations with walking speed and Activities-specific Balance Confidence Scale scores were greatest with the BBS 1 score. Conclusions Our findings suggest that BBS 1 was the most challenging formulation for our participants; this might serve to minimize the ceiling effect of the BBS. These findings provide a rationale for amending the BBS administration guidelines with the BBS 1 formulation.

Objectives To investigate (1) the intrarater, interrater, and test-retest reliability of the timed 360° turn test in subjects with stroke; (2) the concurrent validity of the timed 360° turn test by exploring its correlation with other measures of stroke-specific impairments; and (3) the cutoff times that best discriminate individuals with stroke from healthy older adults. Design Cross-sectional study. Setting University-based rehabilitation center. Participants Individuals with chronic stroke (n=72) and healthy individuals (n=35) of similar age (N=107). Interventions Not applicable. Main Outcome Measures The timed 360° turn test was administered along with the Fugl-Meyer assessment of the lower extremity, measurement of muscle strength of ankle dorsiflexors and plantarflexors using a handheld dynamometer, Berg Balance Scale, limit of stability test, five times sit-to-stand (FTSTS) test, 10-m walk test, and timed Up and Go (TUG) test. Results The 360° turn times showed excellent intrarater, interrater, and test-retest reliability in individuals with stroke. A minimal detectable change of .76 seconds was found for subjects turning toward the affected side and 1.22 seconds for subjects turning toward the unaffected side. The 360° turn times were found to correlate significantly with Fugl-Meyer assessment of the lower extremity scores, dosiflexor strength of the affected ankle, plantarflexor strength of both ankles, FTSTS test times, balance performance, gait speed, and TUG test times. The 360° turn times of 3.43 to 3.49 seconds were shown to discriminate reliably between individuals with stroke and healthy older adults. Conclusions The timed 360° turn test is a reliable and an easily administered clinical tool to assess the turning ability of subjects with chronic stroke.

Objective The Falls Risk for Older People in the Community assessment (FROP-Com) was originally developed using 13 risk factors to identify the fall risks of community-dwelling older people. To suit the practical use in busy clinical settings, a brief version adopting 3 most fall predictive risk factors from the original FROP-Com, including the number of falls in the past 12 months, assistance required to perform domestic activities of daily living and observation of balance, was developed for screening purpose (FROP-Com screen). The objectives of this study were to investigate the inter-rater and test-retest reliability, concurrent and convergent validity, and minimum detectable change of the FROP-Com screen in community-dwelling people with stroke. Participants Community-dwelling people with stroke (n = 48) were recruited from a local self-help group, and community-dwelling older people (n = 40) were recruited as control subjects. Results The FROP-Com screen exhibited moderate inter-rater (Intraclass correlation coefficient [ICC]2,1 = 0.79, 95% confidence interval [CI]: 0.65–0.87) and test-retest reliability (ICC3,1 = 0.70, 95% CI: 0.46–0.83) and weak associations with two balance measures, the Berg Balance Scale (BBS) (rho = -0.38, p = 0.008) and the Timed “Up & Go” (TUG) test (rho = 0.35, p = 0.016). The screen also exhibited a moderate association with the Chinese version of the Activities-specific Balance Confidence Scale (ABC-C) (ABC-C; rho = -0.65, p

Background and Purpose— Research has shown that balance training is effective for reducing the fear of falling in individuals with a history of stroke. In this study, we evaluated (1) whether cognitive behavior therapy could augment the beneficial effects of task-oriented balance training (TOBT) in reducing the fear of falling in chronic stroke survivors and (2) whether it could, in turn, reduce fear-avoidance behavior and improve related health outcomes. Methods— Eighty-nine cognitively intact subjects with mildly impaired balance ability were randomized into the following 2 groups that underwent 90-minutes interventions 2 days per week for 8 weeks: (1) cognitive behavior therapy + TOBT or (2) general health education + TOBT (control). The primary outcome was the fear of falling, and the secondary outcomes were fear-avoidance behavior, balance, fall risk, independent daily living, community integration, and health-related quality of life. The outcomes were assessed at baseline, after 4 and 8 weeks of intervention, and 3 and 12 months after completing the intervention. Results— Eighty-two subjects completed the intervention and follow-up assessments. From postintervention to 12 months after completing the intervention, the cognitive behavior therapy + TOBT participants reported greater reduction in the fear of falling and fear-avoidance behavior and greater improvements in balance and independent daily living than the general health education + TOBT participants. Conclusions— Cognitive behavior therapy should be considered as an adjuvant therapy to standard physiotherapy for cognitively intact individuals with a history of stroke. Clinical Trial Registration— URL: https://clinicaltrials.gov . Unique identifier: NCT02937532.

The consequences of falls are devastating for patients with stroke. Balance problems and fear of falling are two major challenges, and recent systematic reviews have revealed that habitual physical exercise training alone cannot reduce the occurrence of falls in stroke survivors. However, recent trials with community-dwelling healthy older adults yielded the promising result that interventions with a cognitive behavioral therapy (CBT) component can simultaneously promote balance and reduce the fear of falling. Therefore, the aim of the proposed clinical trial is to evaluate the effectiveness of a combination of CBT and task-oriented balance training (TOBT) in promoting subjective balance confidence, and thereby reducing fear-avoidance behavior, improving balance ability, reducing fall risk, and promoting independent living, community reintegration, and health-related quality of life of patients with stroke. The study will constitute a placebo-controlled single-blind parallel-group randomized controlled trial in which patients are assessed immediately, at 3 months, and at 12 months. The selected participants will be randomly allocated into one of two parallel groups (the experimental group and the control group) with a 1:1 ratio. Both groups will receive 45 min of TOBT twice per week for 8 weeks. In addition, the experimental group will receive a 45-min CBT-based group intervention, and the control group will receive 45 min of general health education (GHE) twice per week for 8 weeks. The primary outcome measure is subjective balance confidence. The secondary outcome measures are fear-avoidance behavior, balance ability, fall risk, level of activities of daily living, community reintegration, and health-related quality of life. The proposed clinical trial will compare the effectiveness of CBT combined with TOBT and GHE combined with TOBT in promoting subjective balance confidence among chronic stroke patients. We hope our results will provide evidence of a safe, cost-effective, and readily transferrable therapeutic approach to clinical practice that reduces fear-avoidance behavior, improves balance ability, reduces fall risk, promotes independence and community reintegration, and enhances health-related quality of life. ClinicalTrials.gov, NCT02937532 . Registered on 17 October 2016.

Objective To examine the contribution of walking endurance, subjective balance confidence, and fear avoidance behavior to community reintegration among community-dwelling stroke survivors. Design Cross-sectional study. Setting University-based rehabilitation center. Participants Patients with chronic stroke (N=57) aged ≥50 years. Interventions None. Main Outcome Measure The Chinese version of the Community Integration Measure (CIM). Results Our correlation analyses revealed that fear avoidance behavior as measured by the Chinese version of the Survey of Activities and Fear of Falling in the Elderly (SAFE) scores had the highest significant negative correlation with CIM scores among all the variables tested. Our regression analyses also revealed that walking endurance and subjective balance confidence were not significant predictors of CIM scores. Based on scores on the number of falls in the previous 6 months, Chinese version of the Geriatric Depression Scale scores, distance covered in the 6-minute walk test, and Chinese versions of the Activities-specific Balance Confidence Scale scores and SAFE scores, our final regression model predicted 49.7% of the variance in the Chinese version of the CIM scores. Conclusions The levels of walking endurance and subjective balance confidence are not significant predictors of community reintegration of community-dwelling stroke survivors but the fear avoidance behavior. Future studies addressing fear avoidance behavior is clearly warranted for stroke rehabilitation.

Background fear of falling is prevalent among older people and associated with various health outcomes. A growing number of studies have examined the effects of interventions designed to reduce the fear of falling and improve balance among older people, yet our current understanding is restricted to physiological interventions. Psychological interventions such as cognitive behavioural therapy (CBT) have not been reviewed and meta-analysed. Objective to perform a systematic review and meta-analysis evaluating the effects of CBT on reducing fear of falling and enhancing balance in community-dwelling older people. Method randomised controlled trials (RCTs) addressing fear of falling and balance were identified through searches of six electronic databases, concurrent registered clinical trials, forward citation and reference lists of three previous systematic reviews. Results a total of six trials involving 1,626 participants were identified. Four studies used group-based interventions and two adopted individual intervention. Intervention period ranged from 4 to 20 weeks, and the number and duration of face-to-face contact varied. Core components of the CBT intervention included cognitive restructuring, personal goal setting and promotion of physical activities. The risk of bias was low across the included studies. Our analysis suggests that CBT interventions have significant immediate and retention effects up to 12 months on reducing fear of falling, and 6 months post-intervention effect on enhancing balance. Conclusions CBT appears to be effective in reducing fear of falling and improving balance among older people. Future researches to investigate the use of CBT on reducing fear of falling and improving balance are warranted.

[Purpose] To investigate the inter-rater and test-retest reliability of the sitting-rising test (SRT), the correlations of sitting-rising test scores with measures of strength, balance, community integration and quality of life, as well as the cut-off score which best discriminates people with chronic stroke from healthy older adults were investigated. [Subjects and Methods] Subjects with chronic stroke (n=30) and healthy older adults (n=30) were recruited. The study had a cross-sectional design, and was carried out in a university rehabilitation laboratory. Sitting-rising test performance was scored on two occasions. Other measurements included ankle dorsiflexor and plantarflexor strength, the Fugl-Meyer assessment, the Berg Balance Scale, the timed up and go test, the five times sit-to-stand test, the limits of stability test, and measures of quality of health and community integration. [Results] Sitting-rising test scores demonstrated good to excellent inter-rater and test-retest reliabilities (ICC=0.679 to 0.967). Sitting-rising test scores correlated significantly with ankle strength, but not with other test results. The sitting-rising test showed good sensitivity and specificity. A cut-off score of 7.8 best distinguished healthy older adults from stroke subjects. [Conclusions] The sitting-rising test is a reliable and sensitive test for assessing the quality of sitting and rising movements. Further studies with a larger sample are required to investigate the test's validity.

Objectives. To (1) translate and culturally adapt the English version Community Integration Measure into Chinese (Cantonese), (2) report the results of initial validation of the Chinese (Cantonese) version of CIM (CIM-C) including the content validity, internal consistency, test-retest reliability, and factor structure of CIM-C for use in stroke survivors in a Chinese community setting, and (3) investigate the level of community integration of stroke survivors living in Hong Kong.Design. Cross-sectional study.Setting. University-based rehabilitation centre.Participants. 62 (n=62) subjects with chronic stroke.Methods. The CIM-C was produced after forward-backward translation, expert panel review, and pretesting. 25 (n=25) of the same subjects were reassessed after a 1-week interval.Results. The items of the CIM-C demonstrated high internal consistency with a Cronbach’sαof 0.84. The CIM-C showed good test-retest reliability with an intraclass correlation coefficient (ICC) of 0.84 (95% confidence interval, 0.64–0.93). A 3-factor structure of the CIM-C including “relationship and engagement,” “sense of knowing,” and “independent living,” was consistent with the original theoretical model. Hong Kong stroke survivors revealed a high level of community integration as measured by the CIM-C (mean (SD): 43.48 (5.79)).Conclusions. The CIM-C is a valid and reliable measure for clinical use.