Tsan-Hon Liou | Taipei Medical University (original) (raw)

Papers by Tsan-Hon Liou

Medicine, 2017

Background: Sarcopenia is associated with loss of muscle mass and an increased risk of physical d... more Background: Sarcopenia is associated with loss of muscle mass and an increased risk of physical disability in elderly people. However, the prevalence of sarcopenia has increased in obese elderly populations. The purpose of this study was to identify the clinical efficacy of elastic resistance exercise training (RET) in patients with sarcopenic obesity. Methods: This study was conducted at the rehabilitation center of a university-based teaching hospital and was designed as a prospective and randomized controlled trial with an intention-to-treat analysis. A total of 46 women aged 67.3 (5.2) years were randomly assigned to an experimental group (EG) and control group (CG). The EG underwent elastic RET for 12 weeks, and the CG received no RET intervention. All outcome measures were assessed at the baseline and posttest, including body composition measured using dual-energy X-ray absorptiometry, muscle quality (MQ) defined as a ratio of muscular strength to muscle mass, and physical capacity assessed using functional mobility tests. One-way analysis of covariance and Pearson correlation were used to compare outcomes between the 2 groups and to identify the relationship between changes in body composition and physical outcomes, respectively. A chi-square test was performed to identify differences in qualitative data between the 2 groups. Results: At the posttest, a significant between-group difference was observed in fat-free mass, MQ, and physical capacity (all P < .05); and a significant correlation was found between leg-lean-mass change and gait speed (r = 0.36; P < .05). After 12 weeks of elastic RET intervention, the EG had significantly fewer patients exhibiting sarcopenia (P < .05) and experiencing physical difficulty (P < .001) than the CG. Conclusion: The present data suggest that elastic resistance exercise exerted benefits on the body composition, MQ, and physical function in patients with sarcopenic obesity. Regular exercise incorporating elastic RET should be used to attenuate muscle mass loss and prevent physical difficulty in obese older adults with sarcopenia on reconditioning therapy. Trial Registration: Chinese Clinical Trial Registry, ChiCTR-IPR-15006069. Abbreviations: aMD = adjusted mean difference, BF% = percentage body fat, CG = control group, CIRS = Cumulative Illness Rating Scale, EG = experimental group, MQ = muscle quality, RET = resistance exercise training, SLS = single-leg stance, SMI = skeletal muscle mass index, TCR = timed chair rise, TSM = total skeletal muscle mass, TUG = timed up-and-go.

International Journal for Equity in Health, 2017

Background: In 2010, the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0... more Background: In 2010, the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) was developed, based on the concept of the International Classification of Functioning, Disability and Health (ICF). The ICF provides a common language and framework for health and health-related status and attempts to integrate the biopsychosocial model as a multidimensional perspective in understanding functioning. Activities and participation (AP) is one salient component of the ICF refers to the execution of a task by an individual, and how such tasks are involved in their daily life. It is essential to examine the gap between the general adult population and adults with disabilities. This gap may be attributed to health status, personal factors, and natural and social environments, which include social and health services and policies. The purposes: (1) To develop a normative activity and participation (AP) value for the adult population and people with disabilities; and (2) to compare the gap in AP normative values between the two groups in Taiwan. Methods: We use the WHODAS 2.0 to survey and develop a normative AP value for the general adult population, and used secondary data from National Disability Eligibility Determination System (NDEDS) of Taiwan to describe the AP functioning distribution of adult with disability. There were 1100 participants, selected by stratified proportional sampling from two cities. There were also 144,850 participants who were adults with disability, selected from the secondary database in Taiwan. Results and conclusions: The AP curve for the disabled population increased rapidly at the beginning. The summary score was 13.21 in the performance at 90 percentile for the general population and 82.61 score for disabled adults that the similar gap in every domain, its means that there are significant functioning difference and health equality in general adults population and adults with disabilities. This presents a substantial challenge for both the government and the whole population of Taiwan, to begin considering how to reduce the gap in AP functioning and promote equality for people with disabilities, using social welfare policy. It is important to make sure disabled people have the same rights to be included in society as anybody else and better access to things in all areas of life that are according to Convention on the Rights of Persons with Disabilities (CRPD).

Medicine, 2015

World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is an assessment tool a... more World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is an assessment tool and it has been applied for disability status assessment of Taiwanese dementia patients since July 2012. The aim of this study was to investigate the predicting accuracy of WHODAS 2.0 for institutionalization of dementia patients.Of these patients, 13,774 resided in a community and 4406 in a long-term care facility. Demographic data and WHODAS 2.0 standardized scores were analyzed using the Chi-square test and independent t test to compare patients with dementia in an institution with those in a community. The receiver operating characteristic (ROC) curve was applied to investigate accuracy in predicting institutionalization, and the optimal cutoff point was determined using the Youden index. Binary logistic regression was used to analyze variables to determine risk factors for the institutionalization of patients with dementia.WHODAS 2.0 scores in all domains were higher in patients with...

Nutrients

Aging and osteoarthritis (OA) are associated with a high risk of muscle mass loss, which can lead... more Aging and osteoarthritis (OA) are associated with a high risk of muscle mass loss, which can lead to physical disability. This study investigated the effectiveness of protein supplementation combined with exercise training (PS + ET) in improving muscle mass and functional outcomes in older adults with lower-limb OA. A comprehensive search of online databases was performed to identify randomized controlled trials (RCTs) on the effectiveness of PS + ET in older adults with hip or knee OA. Meta-analysis and risk of bias assessment of the included RCTs were conducted. Six RCTs were included in this systemic review; they had a median (range/total) Physiotherapy Evidence Database (PEDro) score of 7 (6–9) out of 10, respectively. Five RCTs that enrolled patients who underwent total joint replacement were included in this meta-analysis. The PS + ET group exhibited significant improvements in muscle mass (standard mean difference [SMD] = 1.13, p < 0.00001), pain (SMD = 1.36, p < 0.0000...

Disability and rehabilitation, Jan 12, 2014

Purpose: The aim of this study is to test the psychometric properties and validity of the World H... more Purpose: The aim of this study is to test the psychometric properties and validity of the World Health Organization Assessment Schedule II Chinese Traditional Version (WHODAS II CT) in Traditional Chinese-speaking persons with disabilities and chronic illnesses. Method: The WHODAS II CT has been administrated to a sample of 1020 persons with disabilities and chronic illnesses. The construct validity, internal consistency, concurrent validity and convergent validity were evaluated. Results: WHODAS II CT showed a satisfactory model fit for the second-order confirmatory factor analysis model (χ(2)/df = 3.05, root means square error of approximation = 0.053, comparative fit index = 0.912, standardized root mean square residual = 0.076), high internal consistency (Cronbach's α = 0.98), high correlation with all domains of Dartmouth Primary Care Cooperative Research Network/World Organization of National Colleges, Academies, and Academic Associations of General Practices/Family Physic...

International Journal of Environmental Research and Public Health

Based on the International Classification of Functioning, Disability, and Health (ICF) and the Wo... more Based on the International Classification of Functioning, Disability, and Health (ICF) and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), The Functioning Disability Evaluation Scale-Adult version (FUNDES-Adult) began development in 2011. The FUNDES-Adult was designed to assess the difficulty level of an individual's activities and participation in daily life. There is a lack of research regarding the profile of activity and participation for the general adult population. The purposes of this study were to establish activity and participation norms for the general adult population in Taiwan and to describe, discuss, and compare the activity and participation profile with other population. Method: A population-based survey was administered in 2013 using a computer-assisted telephone interviewing system (CATI system). Using probability proportional to size (PPS) sampling and systematic sampling with random digit dialing (RDD), 1500 adults from Taiwan's general population were selected to participate in the survey. The FUNDES-Adult with six domains and two dimensions (performance and capability) was used to obtain data on activities and participation levels. A higher domain score indicated higher participation restriction. Results: Approximately 50% of the respondents were male, and the average age of the respondents was 45.23 years. There were no significant differences in the demographic features between the sample and the population. Among the six domains, the self-care domain score was the lowest (least restriction) and the participation domain score was the highest (most restriction). Approximately 90% of the sample scored were less than 15, and only 0.1% scored more than 80. This is the first cross-national population-based survey to assess norms of activity and participation relevant to the general population of Taiwan. As such, the results of this survey can be used as a reference for comparing the activity and participation (AP) functioning of other countries and subgroups.

Archives of Physical Medicine and Rehabilitation

Scientific reports, Jan 2, 2018

Sarcopenia is associated with loss of muscle mass as well as an increased risk of physical disabi... more Sarcopenia is associated with loss of muscle mass as well as an increased risk of physical disability in elderly people. This study was aimed to investigate the effect of elastic band resistance training (ERT) on muscle mass and physical function in older women with sarcopenic obesity. A randomized controlled trial with an intention-to-treat analysis was conducted. A total of 56 women (mean ± SD age 67.3 ± 5.1 years) were randomly assigned to the experimental group receiving 12 weeks of ERT and to the control group receiving no exercise intervention. Lean mass (measured using a dual-energy X-ray absorptiometer), physical capacity (assessed using the global physical capacity score), and a 36-item short form questionnaire were conducted at the baseline examination (T), as well as the 3-month (T) and 9-month followups (T). At T and T, the between-group difference was measured in total skeletal mass relative to T, with mean differences of 0.70 kg (95% CI 0.12-1.28; P < 0.05) and 0.72...

The American journal of clinical nutrition, 2018

We thank Morton and Phillips for their insightful comments on our publication (1). We appreciate ... more We thank Morton and Phillips for their insightful comments on our publication (1). We appreciate the authors' comprehensive concerns, which brought some obvious faults to our attention. The results of our study showed that protein supplementation (PS) augments resistance exercise training (RET)-induced changes in lean body mass (LBM) in older individuals, including healthy and unhealthy ones (1), whereas Morton et al. (2) concluded that dietary PS during RET is less effective in healthy older individuals. The authors clearly address the discrepancy between the 2 studies as a result of divergent inclusion criteria and search strategy (1, 2). In addition, we focused on overweight or obese older participants, aged >60 y, and who had a mean BMI (kg/m 2) of ≥ 25 (or a mean body fat percentage of >27% for men and 38% for women). Therefore we excluded the studies in which the participants had a relatively young age (3-5) and a lower body fat percentage (6). A study that used lowdose PS in the control group was also excluded from our study (7). Morton and Phillips also had concerns about the variability of methodology among the included studies in our meta-analysis (1), including the participants' health status and PS type. On the basis of their comments and considerations, we agree to make additional analyses to clarify the uncertainty of our original results. First, we added 5 originally excluded trials (3-7) to our meta-analysis; second, with the newly included trials, we performed additional subgroup analyses based on participants' health status (healthy and unhealthy) and PS type [pure protein only, PS with other ingredients, other anabolic supplement (i.e., β-hydroxy-β-methylbutyrate)]. The results are presented as follows.

Asia-Pacific journal of public health, 2016

The impact of traumatic brain injury (TBI) on the pathogenic hazard ratio (HR) for dementia patie... more The impact of traumatic brain injury (TBI) on the pathogenic hazard ratio (HR) for dementia patients is still controversial. Some studies have supported the association between TBI and dementia, especially for Alzheimer's disease, and our study determined that the HR of dementia patients with and without a history of TBI or repeated TBI (RTBI). We determined the HR for dementia patients with a diagnosis of TBI (n = 12931) and a comparative cohort with age- and gender-matched controls (n = 51724) during 2004-2005, using Taiwan's National Health Insurance Research Database. The adjusted HR (HR = 3.21) for dementia patients with TBI showed that they were more likely to develop dementia than the comparison cohort. The HR for dementia patients with RTBI was increased to 3.62. The results of this large-scale study suggested that TBI increases dementia risk. Future studies using animal models and epidemiological databases could elucidate medical and biological mechanisms linking TB...

Journal of Advanced Nursing, 2010

2 0 1 0 ) Obesity among adolescents: sedentary leisure time and sleeping as determinants.

Journal of voice : official journal of the Voice Foundation, Jan 10, 2015

This research used expiratory muscle strength training to explore the factors relevant to medical... more This research used expiratory muscle strength training to explore the factors relevant to medical professionals with voice disorders. The maximal expiratory pressure (MEP) improved, which is measured by the maximal contracting force of expiratory muscles. The expiratory muscle strength increased, which can affect the positive pressure of pulmonary volume, thereby influencing subglottal pressure for speech to change the voice performance and vocal-fold vibration. Twenty-nine participants with voice disorders who are working in a hospital and who are using their voice for more than 4 hours per day were recruited. The participants were randomly assigned to either the study group (STU) or the control group (CON). All participants underwent aerodynamics analysis, pulmonary function, MEP, and completed a vocal symptoms questionnaire before and after STU was provided. The interventions in the STU were conducted 3 days per week and involved performing 25 expiratory exercises (five cycles, e...

Physical Therapy in Sport, 2015

To appraise existing evidence of autologous blood injection in treating lateral epicondylosis. Me... more To appraise existing evidence of autologous blood injection in treating lateral epicondylosis. Meta-analysis of randomized controlled trials. A comprehensive search of the PubMed, Cochrane, SCOPUS, and CINAHL databases was performed to identify randomized controlled trials that reported the efficacy of autologous blood injection in treating lateral epicondylosis. The selected studies were subjected to a meta-analysis and risk of bias assessment. Patients with lateral epicondylosis. Pain-related measurement in each selected randomized controlled trial was pooled into meta-analysis. Nine randomized controlled trials were included in the analysis. The results of the meta-analysis including the pain scores indicated that autologous blood injection is more effective compared with corticosteroid injection (standard mean difference: -0.75; 95% confidence interval: -1.14 to -0.37) but not more effective compared with platelet-rich plasma injection (standard mean difference: 0.09; 95% confidence interval: -0.66 to 0.84). The risk of bias assessment indicated that all the included trials exhibited a moderate to high risk of bias. Autologous blood injection is more effective than corticosteroid injection but not more effective than platelet-rich plasma injection in treating lateral epicondylosis. However, this evidence is limited by the potential risk of bias.

Asia Pacific journal of clinical nutrition, 2007

Between July 2004 and June 2005, a cross-sectional study was performed to determine the prevalenc... more Between July 2004 and June 2005, a cross-sectional study was performed to determine the prevalence and patterns of anti-obesity medicine use among subjects seeking obesity treatment in Taiwan. Eighteen obesity outpatient clinics were selected via a random stratified sampling method and 1,060 first-visit clients (791 females and 269 males) aged above 18 years were enrolled and then completed a self-administered questionnaire. The prevalence of anti-obesity medicine use was 50.8%; more females than male used anti-obesity medicines (53.6% vs. 42.4%). Of the 1,060 subjects, 17.1% had used orlistat, 21.1% had taken sibutramine, and 18.3% had utilized un-proven drugs such as cocktail therapy and other anti-obesity drugs. Furthermore, 23.6% and 22.4% of subjects indicated that they concurrently used Chinese herbal preparations and dietary supplements, respectively. Logistic regression analyses demonstrated that the odds ratio (OR) for anti-obesity medicine use was substantially higher in f...

Asia Pacific journal of clinical nutrition, 2006

Resting metabolic rate (RMR) accounts for about two thirds of total energy expenditure. The widel... more Resting metabolic rate (RMR) accounts for about two thirds of total energy expenditure. The widely used Harris-Benedict equations systematically overestimate RMR. This study assessed overall reliability and validity of a handheld indirect calorimeter, BodyGem, on a sample of women. Thirty healthy nurses participated in this study with an age of 41.9+/-9.0 years old and a body mass index of 24.0+/- 2.8 kg/m2. The Deltatrac Metabolic Monitor was used as the criterion method to validate BodyGem. Reliability was estimated by repeated measures of BodyGem to test internal consistency and stability. Analysis indicated that measurements of Deltatrac and BodyGem are well correlated (r=0.76, P<0.001). The correlation coefficients of two BodyGem RMR measurements were of large statistical significance (r=0.96, P<0.001, mean difference = 15.8+/-55.8 Kcal/d). A significant difference (F =3.81, P=0.04) in repeated measures ANOVA and post hoc revealed a difference between BodyGem and Deltatra...

Surgery for Obesity and Related Diseases, 2014

Hyperuricemia is associated with obesity. Few studies have reported the effects of different type... more Hyperuricemia is associated with obesity. Few studies have reported the effects of different types of bariatric surgery on uric acid metabolism. The aim of our study was to determine the relationships between serum uric acid reduction and estrogen receptor-α (ESR1) gene polymorphism, as well as the type of bariatric surgery received. The potential physiological pathways involved in postsurgery serum uric acid reduction were also discussed. A total of 508 severely obese Han Chinese patients, aged 20 to 50 years, with a body mass index (BMI)≥35 kg/m(2) were selected. Patients received either laparoscopic adjustable gastric banding (LAGB; n = 164) or laparoscopic mini-gastric bypass (LMGB; n = 344). A 12-month follow-up was performed to explore the effects of the type of bariatric surgery and ESR1 polymorphism on serum uric acid reduction. The rs712221 polymorphism of ESR1 affects serum uric acid reduction after bariatric surgery. The LMGB group exhibited a greater reduction in serum uric acid level compared with the LAGB counterpart after adjusting for sex, age, and metabolic confounders (-2.3 ± 2.1 mg/dL versus-1.2 ± 1.1 mg/dL; P = .002). Patients with the rs712221 genotype exhibited better glycemic control and a greater serum uric acid reduction at 12 months after surgery. The effects of the rs712221 polymorphism in LMGB patients resulted in the greatest serum uric acid reduction (-2.7 ± 1.4 mg/dL). For severely obese Han Chinese patients, bariatric surgery appears to reduce serum uric acid levels, potentially mediated by synergic effects of surgery type, BMI reduction, rs712221 locus, insulin sensitivity, and changed dietary factors via an unknown mechanism.

Obesity Surgery, 2011

Significant variability in weight loss and glycemic control has been observed in obese patients r... more Significant variability in weight loss and glycemic control has been observed in obese patients receiving bariatric surgery. Genetic factors may play a role in the different outcomes. Five hundred and twenty severely obese patients with body mass index (BMI) ≥35 were recruited. Among them, 149 and 371 subjects received laparoscopic adjustable gastric banding (LAGB) and laparoscopic mini-gastric bypass (LMGB), respectively. All individuals were genotyped for five obesity-related single nucleotide polymorphisms on ESR1, FTO, PPARγ, and UCP2 genes to explore how these genes affect weight loss and glycemic control after bariatric surgery at the 6th month. Obese patients with risk genotypes on rs660339-UCP2 had greater decrease in BMI after LAGB compared to patients with non-risk genotypes (-7.5 vs. -6 U, p = 0.02). In contrast, after LMGB, obese patients with risk genotypes on either rs712221-ESR1 or rs9939609-FTO had significant decreases in BMI (risk vs. non-risk genotype, -12.5 vs. -10.0 U on rs712221, p = 0.02 and -12.1 vs. -10.6 U on rs9939609, p = 0.04) and a significant amelioration in HbA1c levels (p = 0.038 for rs712221 and p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001 for rs9939609). The synergic effect of ESR1 and FTO genes on HbA1c amelioration was greater (-1.54%, p for trend &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) than any of these genes alone in obese patients receiving LMGB. The genetic variants in the ESR, FTO, and UCP2 genes may be considered as a screening tool prior to bariatric surgery to help clinicians predict weight loss or glycemic control outcomes for severely obese patients.

Obesity Research & Clinical Practice, 2009

Objective: To assess weight loss strategies and behaviors in obese patients prior to seeking prof... more Objective: To assess weight loss strategies and behaviors in obese patients prior to seeking professional obesity treatment in Taiwan. Design: A cross-sectional study was conducted between 1 July 2004 and 30 June 2005. Setting and subjects: Obese subjects (1060; 791 females; age, ≥18 years; median BMI, 29.5 kg/m 2 ) seeking treatment in 18 Taiwan clinics specializing in obesity treatment were enrolled and completed a self-administered questionnaire. Results: Of the 1060 subjects, the prevalence of anti-obesity drug use was 50.8%; more females than males used anti-obesity drugs (53.6% vs. 42.4%). Approximately one-third of normal weight or overweight subjects with no concomitant obesityrelated risk factors took anti-obesity drugs. Merely 26.7% of female and 34.7% of male subjects regularly received panel-recommended levels of physical activity. Further, two-thirds (66.1%) of subjects expressed an intention to lose more than 20% of initial body weight. Multiple logistic regression analyses revealed a substantially higher odds ratio (OR) for anti-obesity drug use in females than in males (OR, 2.3, 95% CI: 1.7-3.2). Obesity was also associated with younger age and higher body mass index (BMI). Females were more likely than males to have unrealistic have unrealistic weight goals than their reference groups. Conclusion: Obese patients in Taiwan tend to use anti-obesity drugs, receive inadequate physical activity and have unrealistic weight loss expectations before seeking professional treatment for obesity.

Journal of the Formosan Medical Association, 2013

The aims of our study were to: (1) develop the Disability Grading Decision Support System (DGDSS)... more The aims of our study were to: (1) develop the Disability Grading Decision Support System (DGDSS) and to (2) compare the new International Classification of Functioning, Disability, and Health (ICF)-based disability determination tool (ICF-DDT) with the diagnosis-based disability determination tool (D-DDT). A total of 9357 patients recruited from 236 accredited institutions were evaluated using the ICF-DDT and the D-DDT, and the presence, severity, and category of the disability identified using the two determination tools were compared. In the DGDSS, the ICF-DDT consisted of four models comprising nine modules to determine the presence and the severity of the disability. The differences between models (modules) are the different combinations of World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) and Scale of Body Functions and Structures. Compared with the D-DDT, more patients were determined to be disability-free when using the ICF-DDT. Module 1-1 had the highest profoundly severe rate, and module 2-2 had the highest mild and moderate disability rates. Module 2-1 had the highest severe disability rate. Module 1-1 resulted in the smallest difference, and module 3-1 resulted in the largest difference, compared with the D-DDT. Feedback from users suggested that the DGDSS is a robust system if the original data are accurate. The presence, severity, and category of the disability determined using the ICF-DDT and the D-DDT were significantly different. The results of the DGDSS provide information for policymakers to determine the optimal allocation of social welfare and medical resources for people with disabilities.

Journal of Medical Systems, 2012

A lot of researches have proven that health education can help patients to maintain and improve t... more A lot of researches have proven that health education can help patients to maintain and improve their health. And it also shortens the time staying in hospital to save medication resource. Because the patients are willing to get healthcare knowledge to enhance the ability of self-care, they pay more attention to the health education. In Taiwan, the clinical nurses play an important role in patient education, and the health education take most time in their daily work. Such work includes the collection, production and delivery of education materials. To generate the correct and customized health education material is the key of success of patient education. In this study, we established a computer-aided health education contents generating system for psychiatric patients by integrating the databases for disease, medicine and nursing knowledge to assist nurse generating the customized health education document suitable for different patients. This system was evaluated by clinical nurses in usability and feasibility. This system is helpful for nurse to carry out the clinical health education to patients and further to encourage patient to pay attention to self-health.