Li-Chieh Kuo

Aims: To evaluate the feasibility of a flipped learning low back training programme among nurses, focussing on ergonomic knowledge, exercise performance and confidence, and participant satisfaction. Background: Work‐related low back pain is a common occupational health problem among nurses. Comprehensive training programs including promotion of ergonomic knowledge, proper exercise performance, and confidence may enhance safe musculoskeletal practice. Design: Feasibility study. Methods: Twenty registered nurses were recruited from a graduate nursing programme between 2022 and 2023 with prior clinical experience. The training programme used a flipped‐learning approach, incorporating evidence‐based low back exercises and gamified strategies. Meanwhile, ergonomic knowledge was assessed post‐programme and at 1‐year follow‐up, the exercise performance was rated during training and confidence in back exercise performance was self‐reported at follow‐up. Participant satisfaction was also measured. Results: Participants demonstrated high ergonomic knowledge (mean score 71/100) after training, which remained satisfactory at 1‐year follow‐up (64.4/100). Peer scores of 13 low back exercises ranged from fair to excellent. Self‐confidence in performing the exercises 1 year later ranged from 7 to 9 out of 10, reflecting sustained ability to properly perform the exercises. Participants' satisfaction was high, indicating acceptance and perceived value in the programme. Conclusions: The flipped learning–based low back training programme was feasible for nurses and supported retention of ergonomic knowledge, correct exercise performance, and sustained confidence 1 year after training. High participant satisfaction further supports its acceptability, suggesting its potential for future implementation in clinical musculoskeletal practice. These observations are exploratory given the descriptive study design; hence, these findings should be interpreted cautiously.

Objective: Sustained postural loading is a common contributor to neck-shoulder pain, yet its effects on muscle microvascular function and cervical segmental motion are not fully understood. This study investigated changes in muscle microcirculation and cervical intervertebral mobility in individuals with postural neck-shoulder pain and examined the effects of therapeutic stretching. Methods: Thirty asymptomatic participants and thirty with neck-shoulder pain were assessed using laser-Doppler flowmetry and videofluoroscopy to measure blood flow in the sternocleidomastoid (SCM), upper trapezius (UT), and masseter (MA) muscles and spinal motion, respectively. The patient group participated in an 8-week supervised stretching intervention. Results: Compared to asymptomatic controls, patients with neck-shoulder pain showed 7.3%-11.2% lower blood volume and 5.8%-13.6% lower blood speed in target muscles. Post-intervention, significant improvements were observed in blood volume (SCM: 71.26 ± 9.00, UT: 75.80 ± 27.22, MA: 83.78 ± 19.26 au) and speed (SCM: 16.09 ± 4.75, UT: 17.65 ± 6.83, MA: 24.55 ± 10.58 au; all p < 0.05). Intervertebral flexion/extension mobility from C2/3 to C6/7 also significantly improved. Conclusions: Alterations in muscle microcirculation may be associated with impaired cervical biomechanics in postural neck-shoulder pain. Combined assessment of local blood perfusion and intervertebral mobility may provide valuable insights into the underlying mechanisms and support the development of targeted rehabilitation strategies to patients experiencing postural neck-shoulder pain.

Summary: The Taiwan-specific fracture risk assessment tool (FRAX) model is widely used to estimate 10-year fracture risk. However, FRAX with bone mineral density (BMD) may underestimate fracture risk, particularly in older adults. Purpose: To evaluate the predictive performance and calibration of the Taiwan-specific FRAX calculator using complete 10-year real-world outcomes and to establish data-driven, population-specific screening thresholds. Methods: A total of 1,976 participants aged ≥ 40 years were recruited from two population-based cohorts in Taiwan (2009–2010) and followed for 10 years via linkage with the National Health Insurance Research Database. Ten-year probabilities of major osteoporotic fracture (MOF) and hip fracture (HF) were estimated using Taiwan-specific FRAX calculators. Model calibration was evaluated using observed-to-expected (O/E) ratios. Statistically optimal thresholds were determined via receiver operating characteristic analysis maximizing the Youden index. Results: During follow-up, 213 (10.8%) participants experienced MOF, and 93 (4.7%) experienced HF. FRAX without BMD demonstrated strong calibration for both MOF (O/E = 1.08; 95% CI: 0.94–1.24) and HF (O/E = 1.10; 95% CI: 0.89–1.34). Conversely, FRAX with BMD systematically underestimated risk, particularly among individuals aged ≥ 65 years (MOF O/E = 1.23; 95% CI: 1.06–1.42). Age, female sex, prior fracture, and low BMD were significant independent risk factors. Crucially, population-specific data-driven thresholds were identified via ROC analysis at 9.0% for MOF and 4.5% for HF using FRAX without BMD, and 8.5% for MOF and 4.0% for HF using FRAX with BMD, respectively. Conclusion: FRAX ® remains a useful and widely applied tool for fracture risk prediction in Taiwan. However, fracture risk may be underestimated, particularly in adults aged ≥ 65 years. Taiwan-specific, data-driven thresholds may improve risk stratification and support more targeted fracture prevention strategies.

Adherence to pelvic floor muscle training (PFMT) remains a major challenge in the conservative management of pelvic floor disorders in women. Although biof

Balance deficits are a common consequence of stroke, increasing the risk of falls. The Pinnacle Trainer (PT), which features a multi-planar exercise trajectory, has been shown to significantly activate hip abductors—key muscles for lateral stability. The elliptical trainer (ET), which simulates gait-like movement, is another commonly used rehabilitation tool. Both may offer viable options for gait training in individuals with chronic stroke. This study investigated the intervention effects of PT and ET on walking and balance abilities in individuals with chronic stroke. Thirty-six individuals with chronic stroke were randomly assigned to one of three groups: Pinnacle Trainer group (n = 12), ET group (n = 12), and control group (n = 12). Each group participated in an 8-week intervention program. The 6-minute walk test, 10-meter walk test, and the center of pressure (COP) displacements during obstacle crossing were measured as outcome measurements. The assessors (one therapist and one biomechanist) were blinded to the participants’ group assignments. All groups demonstrated significant improvements on the walking ability. Compared to the ET and control groups, the PT group showed significant improvements in mediolateral COP displacement, indicating enhanced balance and gait performance. These results support the integration of PT exercises into stroke rehabilitation programs targeting functional balance and mobility.

Various strategies have been proposed to reduce operator-dependent variability in musculoskeletal ultrasound, including mechanical stabilization techniques. However, their effects on image reproducibility and transducer handling remain unclear in anatomically complex regions such as hand. This two-phase study aimed to (1) develop and validate a transducer guiding system for hand ultrasound and (2) evaluate its influence on image reproducibility and operational stability through image-based analyses. In Phase I, test–retest reliability of the guiding system was examined by repeatedly measuring soft-tissue thickness in 30 healthy participants. Intraclass Correlation Coefficients (ICC) ranged from 0.766 to 0.948, demonstrating good to excellent reliability. In Phase II, 16 ultrasound users acquired images under handheld and guiding-system-assisted conditions based on predefined reference images. Image reproducibility was evaluated using Normalized Cross-Correlation (NCC) and ICC, while operational stability was assessed via cosine similarity derived from M-mode segments during the pre-capture period, with group comparisons performed using the Wilcoxon signed-rank test. Novice users showed substantial ICC improvement when using the guiding system (0.487–0.681), approaching the consistency observed in experienced users. Both novice and experienced groups displayed higher NCC and cosine similarity values with the guiding system, indicating improved reproducibility and operational stability. Overall, the guiding system enhanced image outcomes by providing standardized positioning and mechanical stabilization. These findings highlight its potential to improve consistency in hand ultrasound assessments and serve as a supportive tool for novice ultrasound training. The results further demonstrate the feasibility of mechanical stabilization in reducing operator-related variability and enhancing image consistency in hand ultrasound examinations.

Dysphagia, a common condition in older adults and patients with neurological or head and neck conditions, can lead to severe complications if not promptly detected and managed. Conventional clinical assessments of tongue motion primarily rely on pressure measurements or subjective observation, lacking real-time, objective, and quantitative analysis. To address this, we developed a system that combines intraoral imaging, deep learning-based segmentation, and monocular depth estimation (MDE) to quantify tongue motion. Using a compact intraoral camera and AI models, our system identified tongue regions and estimated depth during the articulation of /a/, /i/, and /u/. It then calculated the triangle area formed by three articulation points as a measure of mobility. Training with a synthetic digital twin dataset ensures robust performance. Validation on tongue phantoms and clinical images demonstrated high accuracy (error < 6 mm) and strong agreement with expert annotations. The TS-MDE Area effectively distinguished healthy subjects from those with dysphagia (p < 0.05), showcasing its potential value for clinical dysphagia assessment and monitoring.

Summary Patients with lower bone mineral density (BMD) face an increased risk of fragile fractures and should be actively screened to mitigate this vulnerability. Given the limitations of dual-energy X-ray absorptiometry (DXA), it is possible to identify high-risk osteoporosis groups through simple self-assessment tools for further BMD measurements. Purpose This study aims to evaluate the sex- and age-specific sensitivity and specificity of these simple tools for predicting osteoporosis risk to enhance the overall management of osteoporosis risk in the community. Methods This study enrolled subjects surveyed from epidemiological cohorts in Taiwan. Osteoporosis risk was assessed via the OSTA (for Asian women), and the OSTAi and MOSTAi (for Taiwanese women and men). Osteoporosis was defined as the lowest T-score ≤ − 2.5 based on the BMD of the lumbar spine and hip, as measured via DXA. The OSTAi and MOSTAi algorithms were used to analyze the self-assessment performance via receiver operating characteristic (ROC) and area under the curve (AUC) analyses. Results A total of 1976 participants were enrolled in the study; 52.8% were women, with a mean age of 65.4 years. The sensitivity and specificity for detecting osteoporosis were as follows: MOSTAi (sensitivity/specificity = 0.53/0.72), OSTA (0.71/0.77), and OSTAi (0.77/0.73). The eOSTAi demonstrated favorable sensitivity in women, with AUCs of 0.8200 for osteoporosis and 0.7643 for osteopenia. In men, eMOSTAi showed fair sensitivity (AUC = 0.6690 for osteoporosis and 0.5626 for osteopenia). The cutoffs of the eOSTAi and eMOSTAi for detecting osteoporosis decreased with age. Conclusion The cutoff of OSTAi is suitable for self-assessment of osteoporosis in Taiwanese women. However, for men, the cutoff of MOSTAi may need to be adjusted. Considering the differences in the prevalence of osteoporosis in the community, it is recommended that the cutoff be set according to gender and age.