ABSTRACT: To investigate the criterion-related validity, responsiveness, and clinically important differences of the ABILHAND questionnaire in patients with stroke.
Validation and clinimetric study.
Three medical centers.
Patients with stroke (N=51).
A total of 51 patients with stroke received 1 of 3 upper extremity rehabilitation programs for 4 weeks.
The ABILHAND and the criterion measures, including the Stroke Impact Scale (SIS), FIM, Nottingham Extended Activities of Daily Living (NEADL), and accelerometers, were administered at pretreatment and posttreatment. The score of the ABILHAND, given in logits, was based on the conversion of the ordinal score into a linear measure of ability.
Correlation coefficients (Pearson r) were moderate to large between the ABILHAND and SIS physical domains (.54-.66), fair to moderate between the ABILHAND and FIM-motor and NEADL (.28-.48), and moderate between the ABILHAND and accelerometer data (.45-.54). The responsiveness of the ABILHAND was large (standardized response mean=1.27). The minimal clinically important difference range for the ABILHAND was .26 to .35, and 51.0% of the patients showed a positive change that exceeded the lower bound of a clinically important difference after intervention.
The results support that the ABILHAND is an appropriate outcome measure for assessing upper extremity performance in daily activities in patients with stroke and is sensitive to detect change after rehabilitative interventions. The change score of a patient with stroke on the ABILHAND should reach .26 to .35 logits points to be regarded as a clinically important change.
Archives of physical medicine and rehabilitation 07/2011; 92(7):1086-91. · 2.18 Impact Factor
ABSTRACT: The objectives of this prospective study were to identify birth-related fatigue trajectories in expectant fathers with the progress of labour and the physiological, psychological and situational factors related to specific trajectory patterns.
An increasing number of fathers participate in their partner's labour; however, their fatigue experience remains unclear. Previous studies have focused on overall groups without considering the possibility of between-subject heterogeneity. With an advanced data-analytic strategy, it is feasible to identify subgroup variation within the population over time.
A prospective, repeated measures design was used.
A convenience sample of 108 Taiwanese expectant fathers was followed throughout the labour process. Data were collected by visual analogue scales and self-administered questionnaires. The repeated measures of fatigue were analysed by using semi-parametric, group-based modelling.
Two distinct groups of individual trajectories among the expectant fathers were identified; the persistent low-fatigue group (49.2%) and the persistent high-fatigue group (50.8%). After birth, a moderate level of fatigue persisted in the high-fatigue group. The fastest period of increasing level in the persistent high-fatigue group was in the latent phase. The persistent high-fatigue group also experienced significantly more sleep difficulties prior to labour and more anxiety than the persistent low-fatigue group.
Identifying and characterising meaningful clusters of trajectories could provide a better understanding of the birth-related fatigue experience of fathers and contributes to recognising the target client and timing for early intervention.
There are points in time at which professional caregiver actions may have an effect on the birth-related fatigue of fathers. Caregivers should prevent high levels of fatigue, which could accumulate as fathers accompany the women entering the labour phase. Fathers who present with high fatigue at onset of labour should receive early intervention, especially in the rapid-increasing fatigue period.
Journal of Clinical Nursing 07/2009; 18(12):1674-83. · 1.12 Impact Factor
ABSTRACT: This paper is a report on a study identifying trajectories of childbirth-related fatigue intensity changes over time and the influencing factors related to specific trajectory patterns.
Childbirth is a period of time that encompasses considerable physiological and psychological fatigue, often having an adverse impact on women in labour. Empirical studies on this issue are scarce. How childbirth-related fatigue changes over time, and factors influencing fatigue development, remain unclear.
A prospective, correlational design with repeated measures was used. Data were collected by self-reported measures and laboratory analysis of blood specimens. From December 2004 to November 2005 a convenience sample of 209 low-risk pregnant Taiwanese women was followed throughout the labour process. Repeated measures of fatigue were analysed by using a semiparametric mixture model. Variables explaining trajectory class membership were identified by means of logistic regression.
Two distinct trajectories of childbirth-related fatigue were identified: low intensity (30.8% of women) and high intensity (69.2% of women). Fatigue level of both classes intensified following labour. The fastest period of fatigue-increasing rate was in the active phase. After birth, fatigue levels in the high-fatigue intensity class remained high. Primiparas in the high-fatigue intensity class experienced significantly more anxiety and higher lactate concentration at admission than the low-intensity class.
Caregivers should endeavour to prevent high levels of fatigue once women enter the labour phase. Women who present with high fatigue at onset of labour should be targeted for early intervention, especially in the period of rapid fatigue increase.
Journal of Advanced Nursing 09/2008; 63(3):240-9. · 1.48 Impact Factor
ABSTRACT: While taking an enema to induce labor is a controversial issue worldwide, in Taiwan it remains a routine procedure in many hospitals in preparation for birth. Episiotomy is also a prevalent procedure performed during the birthing process. Some physicians believe that enemas help reduce the risk of feces contamination of the episiotomy incision and, therefore, are justified as a routine procedure. This study compared the neonatal infection rates, times to appearance of fetal head, times to first post-labor bowel movement, and rates of episiotomy dehiscence of women receiving a pre-labor enema against those who did not. A total of 534 women classified with low-risk pregnancies were recruited from a medical center in central Taiwan and assigned randomly into one of two groups for a six-month period. The first group (264 subjects) received routine enema procedures prior to delivery in the first 6 months. The second group (270 subjects) did not receive enemas. Study results revealed no significant difference between enema and non-enema groups in terms of infection rates in mothers or infants or in terms of average time to fetal head appearance. While labor duration was the same for the two groups in the first and third stages of labor, the enema group experienced a relatively shorter second stage. No significant difference was observed in times to first post-labor bowel movement or episiotomy dehiscence rates. The results of this study indicate that the administration of enemas as a routine practice prior to labor is not substantiated by medical necessity. However, limitations of the research design suggest that a randomized clinical trial be adopted in the future to explore further the scientific validity of study results.
The journal of nursing research: JNR 01/2006; 13(4):263-70. · 0.69 Impact Factor