Purpose : To examine the relationship between self efficacy and health-related quality of life (HRQOL) in patients who received total joint replacement (TJR). Methods : This multicentre, prospective, observational study was conducted from April to September 2009 and included the Timed Up and Go (TUG) test, a visual analogue scale (VAS) for pain, and the Falls Efficacy Scale (FES) as independent variables and SF-36, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) as dependent variables. Scores were evaluated 1 month prior to surgery, at discharge, and at 1 month after discharge. ANCOVA was conducted to assess the relationship between the dependent and independent variables. Results : Eighty-one patients were included in this study. After TJR, the VAS, TUG, and FES, scores all improved. In addition, scores on the Physical Functioning (PF) subscale of SF-36 and on the WOMAC functional domain improved. FES scores at discharge were associated with PF (F=10.32, p< 0.01) at 1 month after discharge. Higher self efficacy at discharge was associated with higher HRQOL (average WOMAC score : 84.5) at 1 month after discharge. Lower self efficacy was associated with poor HRQOL (average WOMAC score : 74.8) at 1 month after discharge. Conclusion : After TJR, patient HRQOL was associated with self efficacy at discharge. To facilitate rehabilitation, self efficacy must be improved in patients with low perceived self efficacy by, for example, presenting the cases of other patients with TJR as models.

Diffuse axonal injury (DAI) is identified as one of the most important causes of cognitive disorders in patients with traumatic brain injury. Radiologic recognition of DAI can help in understanding the clinical syndrome and in making treatment decisions. However, CT and conventional MRI are often normal or demonstrate lesions that are poorly related to the cognitive disorders present. Recently, diffusion tensor imaging (DTI) and fiber tractography (FT) have been shown to be useful in detecting various types of white matter damage. The aim of this study was to evaluate the feasibility of using DTI and FT to detect lesions in DAI patients, and to correlate these DAI lesions with the patients' cognitive disorders. We investigated 9 normal volunteers and 9 patients with DAI. The DAI patients had impaired intelligence, as well as attention, memory and executive function disorders that restricted their activities of daily living. In the DAI patients, DTI showed abnormal brain areas in the corpus callosum, fornix, frontal and parietal lobe white matter, and FT revealed interruptions of the white matter fibers in the corpus callosum and the fornix when compared with the normal volunteers, while no lesions were found on conventional MRI. DTI and FT can directly visualize DAI lesions, which cannot be reliably detected by conventional methods. Accordingly, both DTI and FT may be useful techniques for the evaluation of DAI, and may have the potential to be applied to planning rehabilitation therapy, and predicting the neurologic prognosis in DAI patients with cognitive disorders.