Il-Young Jung

Objective: Primary frozen shoulder causes significant pain and progressively restricts shoulder movements. Diagnosis is primarily clinically based on patient history and physical examination. Management is mainly non-invasive owing to its self-limiting clinical course. However, clinical practice guidelines for frozen shoulder have not yet been developed in Korea. The developed guidelines aim to provide evidence-based recommendations for the diagnosis and treatment of frozen shoulder.Methods: A guideline development committee reviewed the literature from four databases (PubMed, Embase, Cochrane Library, and KMbase). Using the PICO (Population, Intervention, Comparator, and Outcome) framework, the committee formulated two backgrounds and 16 key questions to address common clinical concerns. Recommendations were made using the Grading of Recommendations, Assessment, Development, and Evaluation framework.Results: Diabetes, thyroid disease, and dyslipidemia significantly increase the risk of developing a frozen shoulder. Although frozen shoulder is often self-limiting, some patients may experience long-term disabilities. Ultrasound and magnetic resonance imaging should be used as adjunctive tools alongside clinical diagnosis, and not as independent diagnostic methods. Noninvasive approaches, such as medications, physical modalities, exercises, electrical stimulation, and manual therapy, may reduce pain and improve shoulder function. Other noninvasive interventions have limited evidence, and their application should be based on clinical judgment. Intra-articular steroid injections are recommended for treatment, and physiotherapy or hydrodilatation with steroid injections can also be beneficial.Conclusion: These guidelines provide evidence-based recommendations for diagnosing and treating primary frozen shoulder.

Objective: To investigate the feasibility and effects of a mobile app-based home cycling exercise program compared to home cycling exercise without additional monitoring system. Compared with fitness facilities or outdoor exercise, home-based exercise programs effectively improve physical performance in an indwelling community. However, a flexible, informal environment may decrease motivation and impair adherence to physical exercise. Mobile devices for aerobic exercise and mobile applications provide real-time monitoring, immediate feedback, and encouragement to increase motivation and promote physical performance. We investigated the feasibility and effects of a mobile app-based home exercise program on body composition, muscular strength, and cardiopulmonary function.Methods: Between February and May 2023, 20 participants were randomly allocated to the intervention (mobile application with a tablet) and control groups, and they performed aerobic exercise using a stationary bicycle for ≥150 minutes per week for 6 weeks (≤30-minute exercise session, with 3-minute warm-up and 3-minute cool-down). Karvonen formula-based heartrate defined the weekly increase in exercise intensity. Outcome measures included body-composition parameters, isokinetic knee flexor and extensor strength tests, cardiopulmonary exercise test results, and rate of target heart rate (HR) achievement. Participants were assessed at baseline and after the intervention.Results: Unrelated personal events led two participants to drop out. The intervention and control groups had similar baseline characteristics. Compared with the control group, in the post-intervention isokinetic strength test, bilateral knee flexor and extensor power, and time to target HR achievement significantly increased each week in the intervention group.Conclusion: Home-based exercise to achieve long-term cardiovascular fitness with portable electronic/mobile devices facilitates individualized exercise using real-time feedback to improve motivation and adherence.

Background Rotator cuff injury (RCI) and adhesive capsulitis of the shoulder (ACS) are musculoskeletal disorders (MSDs) characterized by limited motion of the shoulder. As symptoms of MSDs worsen over time, constant management and exercise are necessary. We hypothesized that shoulder pain can be managed through full-cycle rehabilitation exercises. Therefore, the purpose of this study is to confirm the effect of full-cycle rehabilitation exercises by providing exercise education in the community after hospital exercise intervention in subjects with RCI and ACS. Methods This is the protocol for a prospective, randomized controlled trial. Sixty subjects with shoulder pain will be recruited from the rehabilitation clinics of an urban medical hospital. Then, subjects will be randomly allocated into two groups. The intervention group will underwent 12 weeks of rehabilitation exercises in both the hospital and community, while the control group will conduct home exercises for 4 weeks using videos provided by the researchers. The main outcomes will be the change in shoulder pain and score of activities of daily living from initial evaluation to 3 months. The secondary outcomes will be functional measurements, such as ROM and the Manual Muscle Test (MMT), Timed Up and Go test (TUG), 10-meter walk test (10MWT), and Berg Balance Scale (BBS) scores, and will include subject-reported outcomes at multi-time points up to 3 months after the intervention. Discussion This is a randomized controlled trial to study the effectiveness of full-cycle rehabilitation exercises for shoulder pain. The results of this study will determine whether exercise from the hospital to the community is effective in subjects with RCI or ACS and will present evidence for the proper community connection guidelines for sustainable rehabilitation. Trial registration:

Objective To evaluate the relationship between femoral muscle volume (FMV) and physiological outcomes after trans-femoral amputations (TFAs) affecting overall locomotor function in patients.Methods Seven individuals who underwent TFA and had been using a prosthesis participated in this cross-sectional study. Gait and balance were assessed using clinical tests, such as 10-m walk test, 6-minute walk test, Berg Balance Scale, and automatic balance system. Respiratory gas analysis was performed to check oxygen consumption rate. Five participants were evaluated for bilateral FMV by MR imaging and FMV was reconstructed using three-dimentional remodeling.Results In five participants, significant differences were found between the non-involved and involved sides in femur length, total FMV, and functional muscle volume (all p<0.01) in all groups except for the hip adductor volume. The %mean difference between the non-involved and involved sides was 30% for femur length, 52.55% for hip flexor volume, 26.55% for hip adductor volume, 51.86% for hip extensor volume, and 60.21% for knee extensor volume. The hip flexor volume to hip extensor volume ratio in the involved limb and oxygen consumption rate during comfortable gait were negatively correlated (r=-0.96, p=0.04).Conclusion In individuals who underwent unilateral TFA, hip girdle muscle imbalance in the involved limbs may be associated with oxygen consumption rate while using a prosthesis.

Objectives: This study presents the Korean version of the Right Hemisphere Language Battery (K-RHLB), reports the preliminary results in healthy subjects, and evaluates inter- and intra-rater reliability. Methods: Fifty-two healthy patients underwent the RHLB, which was adapted to the Korean language. The rater reliability of the Emphatic Stress Test, which is a subtest of the battery, was examined. For inter-rater reliability, three raters evaluated the focus prosody of 35 randomly chosen subjects. For intra-rater reliability, one rater re-evaluated the prosody within 2-week and 3-month intervals. Results: The total mean score of the K-RHLB result was 110.75 ± 2.90 out of 116. The mean percentages of correct responses in the subtests were high and appeared in the following order: Discourse Analysis (99.9%), Written Metaphor Test (99.6%), Lexical Semantic Test (99.3%), Picture Metaphor Test (98.7%), Emphatic Stress Test (94.4%), Inference Test (83.5%), and Humor Test (76.5%). In addition, the inter-rater agreement was high (Gwet’s chance-corrected agreement coefficients AC1 of 0.83 ± 0.02, p < 0.001), as was the intra-rater consistency (Gwet’s AC1 0.93 ± 0.01, p < 0.001). However, some changes in evaluation criteria were confirmed for retest intervals longer than 2 months [Cochran’s Q (2) = 13.82, p < 0.001]. Conclusion: The preliminary results of the K-RHLB in healthy subjects showed overall high scores. Both inter- and intra-rater reliabilities were acceptable. The K-RHLB can be a starting point for more detailed assessment and elaborate intervention in patients with right hemisphere damage. The battery can also be used to evaluate neurodevelopmental disorders with symptoms such as deficits in understanding non-literal languages, semantic integration, and perception and production of appropriate prosody.

Objective To compare the biomechanical properties of the glenohumeral joint capsule between adhesive capsulitis (AC) after breast cancer surgery and idiopathic AC and demonstrate the effects of hydrodilatation (HD) with corticosteroid injection for AC after breast cancer surgery.Methods Twenty-three prospective patients with AC after breast cancer surgery (BC group) and 44 retrospective patients with idiopathic AC without breast cancer (CON group) underwent HD with corticosteroid injection and home exercise training. We compared their biomechanical characteristics (capsular capacity, maximal pressure, and capsular stiffness). In the BC group, the passive range of motion (ROM) of the affected shoulder and a questionnaire (Shoulder Pain and Disability Index [SPADI]) were evaluated at baseline and 2 and 4 weeks after treatment.Results The BC group showed higher biomechanical characteristics (maximal pressure and capsular stiffness) than did the CON group. The mean maximal pressure and capsular stiffness were 519.67±120.90 mmHg and 19.69±10.58 mmHg/mL in the BC group and 424.78±104.42 mmHg and 11.55±7.77 mmHg/mL in the CON group (p=0.002 and p=0.001, respectively). And, the BC group showed significant improvements in all ROMs (abduction, flexion, and external rotation) and the SPADI pain and disability sub-scores following the treatment.Conclusion The glenohumeral joint capsular stiffness was greater in the patients with AC after breast cancer surgery than in those with idiopathic AC. HD with corticosteroid injection was effective in treating AC after breast cancer surgery.

Objective To develop and evaluate the Korean version of a hospital-based transitional rehabilitation program (TRP), using daily living home for spinal cord injury (SCI) patients.Methods In this study, we developed the Korean version of a hospital-based TRP through domestic and overseas surveys and focus group meetings. By applying this to chronic SCI patients, we observed the functional and quality of life (QOL) changes and evaluated the degree of achievement of the core goals set for each patient during hospital-based TRP.Results Hospital-based TRP, for 21.8±3.9 days on average, was applied to four chronic SCI patients (two patients with long-term hospital stays and two homebound disabled individuals) with an average injury period of 736.8±185.4 days. The Korean version of the Spinal Cord Independence Measure (49.3±6.9 vs. 62.5±6.0; p<0.05) showed functional improvement at the end of TRP, when compared to that before the TRP. The Korean version of the World Health Organization’s QOL scale, abbreviated version (159.8±36.6 vs. 239.8±36.1; p<0.05), showed improvement in QOL. Goal attainment scaling showed a significant degree of achievement for the core goals through TRP (33.6±4.4 vs. 70.0±2.8; p<0.05). These results confirmed that the effect was maintained 1 month after the end of TRP. Additionally, two patients were successfully discharged after TRP completion, and the other two could start social activities.Conclusion The Korean version of the hospital-based TRP, applied to chronic SCI patients, showed the potential to improve the patients’ functioning and QOL and appeared to be effective in successful discharge and social participation.

To evaluate the feasibility of brainstem auditory evoked potential (BAEP) for rehabilitation prognosis prediction in patients with ischemic stroke, 181 patients were tested using the Korean version of the modified Barthel index (K-MBI) at admission (basal K-MBI) and discharge (follow-up K-MBI). The BAEP measurements were performed within two weeks of admission on average. The criterion between favorable and unfavorable outcomes was defined as a K-MBI score of 75 at discharge, which was the boundary between moderate and mild dependence in daily living activities. The changes in the K-MBI scores (discharge-admission) were analyzed by nonlinear regression models, including the artificial neural network (ANN) and support vector machine (SVM), with the basal K-MBI score, age, and interpeak latencies (IPLs) of the BAEP (waves I, I–III, and III–V). When including the BAEP features, the correlations of the ANN and SVM regression models increased to 0.70 and 0.64, respectively. In the outcome prediction, the ANN model with the basal K-MBI score, age, and BAEP IPLs exhibited a sensitivity of 92% and specificity of 90%. Our results suggest that the BAEP IPLs used with the basal K-MBI score and age can play an adjunctive role in the prediction of patient rehabilitation prognoses.

Purpose: The purpose of this study was to analyze the association between the brainstem auditory evoked potential (BAEP) and clinical outcomes at discharge in patients who have had subacute ischemic stroke. Methods: A total of 210 patients who have had ischemic stroke, confirmed by MRI within 3 months after onset, were enrolled. Demographics and stroke-related clinical assessment scales, such as the modified Barthel index and National Institute of Health Stroke Scale (NIHSS), were collected. Recorded latencies of waveforms I, III, and V of BAEP were bilaterally collected and analyzed. The results of the patients with supratentorial brain lesions were further analyzed. Results: The mean BAEP latencies of waveforms I, III, and V in the subjects were 1.84 ± 0.22, 4.07 ± 0.27, and 6.07 ± 0.33 ms, respectively. As the modified Barthel index and NIHSS scores at discharge functionally worsened, the latencies of all lesion-side BAEP waveforms were significantly delayed. In patients with supratentorial brain lesions only, there was a significant delay in the latency of waveform V at the lesion side as modified Barthel index severity increased (P = 0.048). As the NIHSS score functionally worsened, BAEP latencies III and V recorded at the lesion side significantly delayed (P = 0.023 and P = 0.003, respectively). In multivariate linear regression models, latency V was found to be a significant factor in predicting outcome at discharge, among other factors. Conclusions: In patients with ischemic stroke with the poor clinical outcome at discharge, there were delayed latencies of waveforms I, III, and V of BAEP performed in the early phase of stroke.

Study design A retrospective observational study. Objective To identify the difference between patients with and without healthcare-associated infection (HAI) after spinal cord injury (SCI), changes in the quantity of rehabilitation after HAI, and resistance to and application of empirical antibiotics. Setting University hospital-affiliated rehabilitation center. Methods Altogether, 338 patients with SCI receiving inpatient rehabilitation from January 2015 to March 2018 were categorized into two groups based on the presence or absence of HAI. Demographic and clinical characteristics, amount of rehabilitation performance between before and after HAI, resistance to antibiotics, and empirical antibiotic change rates were investigated. Results In 79 patients, 117 HAI cases occurred, with an overall incidence of 34.6%. Male sex, complete SCI, and trauma history were more frequent in the HAI group than in the non-HAI group. Length of stay (LOS) was longer at 28.9 days in the HAI group. The incidence of lower respiratory tract infections (LRIs) and urinary tract infections (UTIs) was 5.0 and 16.9%, respectively. The rehabilitation loss rates due to LRIs and UTIs were 40.0 and 20.2%, respectively, which were not statistically significant. The rates of resistance to recommended empirical antibiotics for LRIs and UTIs were 26.9–57.7% and 54.2–67.8%, respectively. The rates of empirical antibiotic changes for LRIs and UTIs were 35.3 and 43.9%, respectively. Conclusions HAI after SCI was more common in men, complete SCI and trauma history. LOS was prolonged in the HAI group. A quantitative reduction of rehabilitation treatment after HAI was observed, but further research is needed for validation.