Purpose: To investigate the effect of androgen deprivation therapy (ADT) on health-related quality of life (HRQOL) in Asian men with all stages of prostate cancer. Materials and Methods: READT (real-life evaluation of the effect of ADT in prostate cancer patients in Asia) was a multi-center, prospective observational study involving six sites across four Asian populations. We enrolled eligible prostate cancer patients, who opted for ADT alone or in combination without prior neoadjuvant or adjuvant ADT within 12 months. The EuroQoL-5 dimensions, 5 level scale (EQ-5D-5L) utility index scores and visual analog scale (VAS) were evaluated at baseline, month 6 and month 12. Results: A total of 504 patients were recruited into READT between September 2016 and May 2020 with 52.9% diagnosed with metastatic prostate cancer. The EQ-5D-5L was evaluable in 442/504 (87.7%) of patients. Overall baseline EQ-5D-5L utility index score was 0.924 (interquartile range [IQR] 0.876–1.000). We observed a statistically significant difference in baseline EQ-5D-5L utility index score among different populations with a median EQ-5D-5L utility index score of 1 for Taiwan & Hong Kong, 0.897 for China and 0.838 for Malaysia. Similar trend was observed throughout multiple treatment time-points. Stage IV prostate cancer were significantly associated with a lower baseline EQ-5D-5L utility index score compared to stage I–III prostate cancer, producing a median disutility value of -0.080. Participants had a high median VAS (80, IQR 70–90), indicating good overall health on average during ADT initiation. Conclusions The study highlights the differences in health state utility index scores among various Asian prostate cancer patients receiving ADT at real-world setting. Our findings will be informative and useful in cost-effectiveness evaluation and policy decision making.

Ambulatory Care ; COVID-19 ; Health Facility Planning ; Hospital Bed Capacity ; Hospitals, Rehabilitation ; Humans ; Infection Control ; Rehabilitation ; Remote Consultation ; SARS-CoV-2 ; Singapore ; Telerehabilitation ; Triage

INTRODUCTION: Frailty begins in middle life and manifests as a decline in functional fitness. We described a model for community frailty screening and factors associated with prefrailty and frailty and fitness measures to distinguish prefrail/frail from robust older adults. We also compared the Fatigue, Resistance, Ambulation, Illnesses and Loss of weight (FRAIL) scale against Fried frailty phenotype and Frailty Index (FI). MATERIALS AND METHODS: Community-dwelling adults ≥55 years old were designated robust, prefrail or frail using FRAIL. The multidomain geriatric screen included social profiling and cognitive, psychological and nutritional assessments. Physical fitness assessments included flexibility, grip strength, upper limb dexterity, lower body strength and power, tandem and dynamic balance and cardiorespiratory endurance. RESULTS: In 135 subjects, 99 (73.3%) were robust, 34 (25.2%) were prefrail and 2 (1.5%) were frail. After adjusting for age and sex, depression (odds ratio [OR], 2.90; 95% confidence interval [CI], 1.05-7.90; = 0.040) and malnutrition (OR, 6.07; 95% CI, 2.52-14.64; <0.001) were independently associated with prefrailty/frailty. Prefrail/frail participants had significantly poorer performance in upper limb dexterity ( = 0.030), lower limb power ( = 0.003), tandem and dynamic balance ( = 0.031) and endurance ( = 0.006). Except for balance and flexibility, all fitness measures differentiated prefrail/frail from robust women. In men, only lower body strength was significantly associated with frailty. Area under receiver operating characteristic curves for FRAIL against FI and Fried were 0.808 (0.688-0.927, <0.001) and 0.645 (0.546-0.744, = 0.005), respectively. CONCLUSION Mood and nutrition are targets in frailty prevention. Physical fitness declines early in frailty and manifests differentially in both genders.

INTRODUCTIONThis study aimed to evaluate the safety and efficacy of a combination of levodopa and virtual reality (VR)-based therapy for the enhancement of upper limb recovery following acute stroke.

METHODSThis was a pilot single-blinded case series of acute stroke patients with upper extremity hemiparesis. Patients were randomised to standard care with concomitant administration of either levodopa alone (control group) or combination therapy consisting of VR-based motivational visuomotor feedback training with levodopa neuromodulation (VR group). Main clinical outcome measures were the Fugl-Meyer Upper Extremity (FM-UE) assessment and Action Research Arm Test (ARAT). Kinematic measurements of affected upper limb movement were evaluated as a secondary measure of improvement.

RESULTSOf 42 patients screened, four patients were enrolled in each of the two groups. Two patients dropped out from the control group during the trial. Patients receiving combination therapy had clinically significant improvements in FM-UE assessment scores of 16.5 points compared to a 3.0-point improvement among control patients. Similarly, ARAT scores of VR group patients improved by 15.3 points compared to a 10.0-point improvement in the control group. Corresponding improvements were noted in kinematic measures, including hand-path ratio, demonstrating that the quality of upper limb movement improved in the VR group.

CONCLUSIONOur results suggest that VR-based therapy and pharmacotherapy may be combined for acute stroke rehabilitation. Bedside acquisition of kinematic measurements allows accurate assessment of the quality of limb movement, offering a sensitive clinical tool for quantifying motor recovery during the rehabilitation process after acute stroke.

INTRODUCTIONThe poststroke acute and rehabilitation length of stay (LOS) are key markers of stroke care efficiency. This study aimed to describe the characteristics and identify the predictors of poststroke acute, rehabilitation and total LOS. This study also defined a subgroup of patients as "short" LOS and compared its complication rates and functional outcomes in rehabilitation with a "long" acute LOS group.

MATERIALS AND METHODSA prospective cohort study (n = 1277) was conducted in a dedicated rehabilitation unit within a tertiary academic acute hospital over a 5-year period between 2004 and 2009. The functional independence measure (FIM) was the primary functional outcome measure in the rehabilitation phase. A group with an acute LOS of less than 7 days was defined as "short" acute LOS.

RESULTSIschaemic strokes comprised 1019 (80%) of the cohort while the rest were haemorrhagic strokes. The mean acute and rehabilitation LOS were 9 ± 7 days and 18 ± 10 days, respectively. Haemorrhagic strokes and anterior circulation infarcts had significantly longer acute, rehabilitation and total LOS compared to posterior circulation and lacunar infarcts. The acute, rehabilitation and total LOS were significantly shorter for stroke admissions after 2007. There was poor correlation (r = 0.12) between the acute and rehabilitation LOS. In multivariate analyses, stroke type was strongly associated with acute LOS, while rehabilitation admission FIM scores were significantly associated with rehabilitation LOS. Patients in the short acute LOS group had fewer medical complications and similar FIM efficacies compared to the longer acute LOS group.

CONCLUSIONConsideration for stroke type and initial functional status will facilitate programme planning that has a better estimation of the LOS duration, allowing for more equitable resource distribution across the inpatient stroke continuum. We advocate earlier transfers of appropriate patients to rehabilitation units as this ensures rehabilitation efficacy is maintained while the development of medical complications is potentially minimised.

Activities of Daily Living ; Acute Disease ; Brain Ischemia ; rehabilitation ; therapy ; Humans ; Intracranial Hemorrhages ; rehabilitation ; therapy ; Length of Stay ; statistics & numerical data ; Prospective Studies ; Stroke ; therapy ; Stroke Rehabilitation ; statistics & numerical data ; Treatment Outcome

Stroke remains one of the major causes of disability worldwide. This case report illustrates the complementary use of biomechanical and kinematic in-game markers, in addition to standard clinical outcomes, to comprehensively assess and track a patient's disabilities. A 65-year-old patient was admitted for right-sided weakness and clinically diagnosed with acute ischaemic stroke. She participated in a short trial of standard stroke occupational therapy and physiotherapy with additional daily virtual reality (VR)-based therapy. Outcomes were tracked using kinematic data and conventional clinical assessments. Her Functional Independence Measure score improved from 87 to 113 and Fugl-Meyer motor score improved from 56 to 62, denoting clinically significant improvement. Corresponding kinematic analysis revealed improved hand path ratios and a decrease in velocity peaks. Further research is being undertaken to elucidate the optimal type, timing, setting and duration of VR-based therapy, as well as the use of neuropharmacological adjuncts.
Aged ; Biomechanical Phenomena ; Female ; Humans ; Occupational Therapy ; Physical Therapy Modalities ; Recovery of Function ; Stroke ; therapy ; Stroke Rehabilitation ; methods ; Treatment Outcome ; Upper Extremity ; physiopathology ; Video Games ; Virtual Reality Exposure Therapy ; methods

In Singapore and worldwide, large numbers of people live with disabling illness. In the first part of this paper, we address the assessment of activities of daily living (ADL). Disability charting is important as a clinical tool to document functional recovery as well as to assess the effectiveness of medical and rehabilitation interventions. Disability assessment is also important epidemiologically, in developing social policies, planning disability resources and in medical research and education. We review the concepts and general principles of disability assessment with reference to the WHO International Classification of Functioning, Disability and Health (ICF) as well as to local contexts. We also describe in further detail 6 basic ADLs of feeding, dressing, toileting, transfers and mobility used in disability-related national schemes. In the second part of this article, we introduce how the concepts of frailty have changed the paradigm in which we approach geriatric rehabilitation, through interactive overlaps with the psychosocial, disability and comorbidity domains. We describe the consequences of functional deterioration in the frail elderly, and how to screen for frailty. We also outline therapeutic exercise as a form of prehabilitation to improve the resilience of these vulnerable people and possibly return them to robust health. Family physicians are best equipped in the management of frailty, as they have the holistic and comprehensive medical skill set to treat the associated comorbidity, disability and psychosocial domains in integrative geriatric rehabilitation.

The assessment of disability including activities of daily living (ADL) is important as a clinical tool to document functional recovery as well as to assess the effectiveness of medical and rehabilitation interventions. Disability assessment is also important epidemiologically, in developing social policies, planning disability resources and in medical research and education. In this article, we review the definitions, history and advances in the field of disability assessment. We then describe the general principles of disability assessment in adults with a further detailed focus on six basic ADLs: feeding, bathing, dressing, toileting, transfers and mobility. We use a practical framework of an independent category and four dependent categories corresponding to an increasing level of assistance for each ADL. Finally we summarise the inherent problems and difficulties in disability assessment and emphasise the important role of rehabilitation in improving functional outcomes including the basic ADLs.