BackgroundStrokes pose a substantial health burden, impacting 1 in 6 people globally. One-tenth of patients will endure a second, often more severe, stroke within a year. Alarmingly, a younger demographic is being affected due to recent lifestyle changes. As fine motor and cognitive issues arise, patient disability as well as the strain on caregivers and health care resources is exacerbated. Contemporary occupational therapy assesses manual dexterity and cognitive functions through object manipulation and pen-and-paper recordings. However, these assessments are typically isolated, which makes it challenging for therapists to comprehensively evaluate specific patient conditions. Furthermore, the reliance on one-on-one training and assessment approaches on manual documentation is inefficient and prone to transcription errors. ObjectiveThis study examines the feasibility of using an interactive electronic pegboard for stroke rehabilitation in clinical settings. MethodsA total of 10 patients with a history of stroke and 10 healthy older individuals were recruited. With a limit of 10 minutes, both groups of participants underwent a series of challenges involving tasks related to manual operation, shape recognition, and color discrimination. All participants underwent the Box and Block Test and the Purdue Pegboard Test to assess manual dexterity, as well as an array of cognitive assessments, including the Trail Making Test and the Mini-Mental Status Examination, which served as a basis to quantify participants’ attention, executive functioning, and cognitive abilities. ResultsThe findings validate the potential application of an interactive electronic pegboard for stroke rehabilitation in clinical contexts. Significant statistical differences (P<.01) were observed across all assessed variables, including age, Box and Block Test results, Purdue Pegboard Test outcomes, Trail Making Test-A scores, and Mini-Mental Status Examination performance, between patients with a history of stroke and their healthy older counterparts. Functional and task testing, along with questionnaire interviews, revealed that patients with a history of stroke demonstrated prolonged completion times and slightly inferior performance. Nonetheless, most patients perceived the prototype as user-friendly and engaging. Thus, in the context of patient rehabilitation interventions or the evaluation of patient cognition, physical functioning, or manual dexterity assessments, the developed pegboard could potentially serve as a valuable tool for hand function, attention, and cognitive rehabilitation, thereby mitigating the burden on health care professionals. ConclusionsHealth care professionals can use digital electronic pegboards not only as a precise one-on-one training tool but also as a flexible system that can be configured for online or offline, single-player or multiplayer use. Through data analysis, a more informed examination of patients’ cognitive and functional issues can be conducted. Importantly, patient records will be fully retained throughout practices, exercises, or tests, and by leveraging the characteristics of big data, patients can receive the most accurate rehabilitation prescriptions, thereby assisting them in obtaining optimal care.

The use of virtual reality (VR) for stroke rehabilitation has been implemented during the last decade. At present, most studies still focus on the effects of VR on upper limb rehabilitation, and few studies have explored VR games, VR system designs, and rehabilitation modes for upper limb rehabilitation. This study aims to (1) evaluate the rehabilitation effect of stroke patients using a game-based VR upper limb rehabilitation system in clinical settings; (2) investigate the impact of custom and commercial VR games on patients in clinical settings; and (3) review VR upper limb rehabilitation modes. The PubMed, ScienceDirect, Scopus, Web of Science, and IEEE Xplore databases were searched, and related literature published through December 2021 was included. A total of 4700 articles were retrieved according to the search strategy. We identified 24 studies, including 793 patients. We conducted a systematic search for randomized controlled trials with adult stroke patients to analyze the effect of game-based VR upper limb rehabilitation systems. A meta-analysis was conducted to compare the effects of upper limb function, hand dexterity, daily living ability, and cognitive function between the experimental group (EG, using VR for upper limb rehabilitation) and control group (CG, receiving conventional rehabilitation, including physical therapy and occupational therapy). We also conducted an analysis of both custom and commercial games. The results of the meta-analysis proved that game-based VR upper limb rehabilitation therapy for cerebral apoplexy is an effective method of rehabilitation in clinical settings and is more effective than traditional rehabilitation in improving patients' upper limb function and hand mobility. Custom games heal better than commercial games. This study only includes nonimmersive device rehabilitation modes due to research constraints and classified them into four categories. The mode of VR games combined with rehabilitation instruments may solve the problem that patients with severe upper limb dysfunction cannot operate games. Whether the use of immersive VR devices and the fun of games will affect patients' rehabilitation motivation and effect is the direction of future research.

Background As individuals age, the incidence and mortality rates of cerebrovascular accidents significantly rise, leading to fine motor impairments and cognitive deficits that impact daily life. In modern occupational therapy, assessing manual dexterity and cognitive functions typically involves observation of patients interacting with physical objects. However, this pen-and-paper method is not only time-consuming, relying heavily on therapist involvement, but also often inaccurate. Digital assessment methods, therefore, have the potential to increase the accuracy of diagnosis, as well as decrease the workload of health care professionals. Objective This study examined the feasibility of an interactive electronic pegboard for the assessment and rehabilitation of patients with stroke. Methods We explored the pegboard’s clinical applicability by examining the relationship among stages, timing, and difficulty settings, as well as their alignment with patient capabilities. In total, 10 participants used a prototype of the pegboard for functional and task assessments; questionnaire interviews were conducted simultaneously to collect user feedback. Results Patients with stroke consistently required more time to complete tasks than expected, significantly deviating from the initial time frames. Additionally, the participants exhibited a slight reduction in performance levels in both manual dexterity and cognitive abilities. Insights from questionnaire responses revealed that the majority of participants found the prototype interface easy and enjoyable to use, with good functionality. Conclusions This preliminary investigation supports the efficacy of interactive electronic pegboards for the rehabilitation of the hand functions of patients with stroke, as well as training their attentional and cognitive abilities. This digital technology could potentially alleviate the burden of health care workers, positioning it as a valuable and intelligent precision health care tool.

PURPOSE:Individuals who have experienced stroke may benefit from dual-task related training to improve gait speed performance. Whether noted improvements reflect true effects on gait or cognitive-motor trade-offs still remains unclear. Therefore, this study aimed to investigate the effects of dual-task training on dual-task effects of both walking and cognitive domains in stroke survivors. MATERIALS AND METHODS:Forty-four individuals with stroke were randomized to dual-task or single-task training groups. Both groups exercised three 60-minute sessions per week for 4 weeks. The primary outcomes were dual-task effects on gait speed and cognitive score. Outcomes were assessed before and after the intervention and 1-month follow-up. RESULTS:While both groups exhibited improvement in absolute gait speed under dual-task conditions, the dual-task training group demonstrated superior results by providing an additional gain on dual-task effects of gait speed. Compared to single-task training, dual-task training exhibited a significant improvement in dual-task effects of gait speed at post-treatment and follow-up. Regarding the dual-task effects on cognitive scores, no significant differences within and between groups after training were observed. CONCLUSION:Dual-task training enhances immediate and retained effects on the dual-task effects of gait speed in individuals with stroke, not by cognitive-motor trade-offs. TRIAL REGISTRATION:URL: https://www.clinicaltrials.gov. CLINICALTRIALS.GOV IDENTIFIER:NCT02686515.

AIM:To examine the main effects and interaction effects of outcome expectations (e.g., anticipated satisfactory salary and benefits), nurse identity (a sense of membership in the nursing profession), and information-access efficiency of the electronic medical record system (how the system enables nurses to quickly retrieve the needed information) on nurses' retention. DESIGN:This study uses a cross-sectional survey and adopts proportionate random sampling to recruit a representative sample of nurses of a medical centre in Taiwan. METHODS:This study successfully obtained completed questionnaires from 430 nurses during December 2021 to January 2022. Data are analysed by using hierarchical regressions. RESULTS:Positive outcome expectations and identification as a member in the nursing profession are associated with retention. Information-access efficiency strengthens the link between outcome expectations and retention, while nurse identity weakens this link. CONCLUSION:Outcome expectations can help retain nurses, particularly those who perceive high levels of information-access efficiency and possess weak nurse identity. That is, outcome expectations have a complementary role with nurse identity in retaining nurses. IMPLICATIONS FOR THE PROFESSION:Nurse managers should devise means to build positive outcome expectations for nurses. In addition, either strengthening nurses' identification with the nursing profession or improving the information-access efficiency of the electronic medical system may also help retain nurses. IMPACT:This study examined how to transform outcome expectation to nurse retention, offering nurse managers to devise new means to retain nurses. REPORTING METHOD:STROBE statement was chosen as EQUATOR checklist. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.

Telehealth pulmonary rehabilitation (telePR) has been proven equally effective as standard pulmonary rehabilitation (PR). Although PR can improve symptoms and the quality of life for patients with chronic lung diseases, the potential challenges that users face in operating a rehabilitation system at home are not well understood from the perspective of the user experience. To assess the feasibility of implementing a telePR system for home use, this study developed a telePR intervention system called the Intelligent Pulmonary Rehabilitation Exercise System (IPRES) and evaluated its effectiveness for patients with chronic lung diseases upon being discharged and returning home. The components of the telePR intervention system included physical components such as an ergonomic recumbent bike, a telehealth electronic tablet, and connected wearable devices. The aim of this study was to employ a human-centric approach to examine the system operation of the IPRES through user experiences, thereby reducing potential barriers to implementation for home use. Serving as a preliminary investigation, this study involved usability testing, acceptability, and satisfaction assessments. The objective was to refine this telePR intervention before the recruitment of a larger sample of chronic pulmonary disease patients for a more extensive home-based telePR study. This study employed the System Usability Scale (SUS) and Post-Study System Usability Questionnaire (PSSUQ) as tools by which to assess the feasibility and usability of IPRES as a non-pharmacological intervention as well as to investigate participants' operational capabilities and acceptance of the system. The experiment comprised two phases. The first phase involved feasibility testing, in which observations were made regarding technology, user safety, physical components, and environmental factors to ensure optimal placement and practical support for all intervention components. In the second phase, usability testing was conducted. Following the completion of physical and environmental feasibility assessments, participants engaged in the IPRES experience and subsequently completed the SUS and PSSUQ scales. The study identified several system issues and implemented improvements, including adjustments to the recumbent bike, enhancements to the tablet messaging interface, and improvements in network stability. These factors could impact the level of patient engagement and willingness to participate in rehabilitation. Additionally, usability testing indicated that participants rated the equipment, ease of operation, and user experience highly. Nonetheless, a number of details still require further refinement. The feasibility and usability assessments revealed that the IPRES was rated by participants as intuitive and easy to use, with high satisfaction with and acceptance of the system. Although some details still require improvement, these surveys and qualitative data analysis provide deeper insights into the needs of telePR and essential design factors. This research was approved by the Research Ethics Committee of the Chang Gung Medical Foundation (IRB NO. 202200070B0).

BackgroundThe feasibility of implementing home-based pulmonary rehabilitation (PR) can be assessed from the perspectives of patients with chronic lung disease and health care professionals involved in PR. ObjectiveThrough a qualitative inquiry using interviews and the adoption of the people-object-environment framework, this study aims to understand the influences of interpersonal, environmental, and situational factors on the perceptions and considerations of individuals involved in home-based PR for patients with chronic lung disease. MethodsOne-on-one interviews were conducted with 20 patients with chronic lung disease and 20 health care professionals for investigating their attitudes and opinions based on their experiences regarding home-based PR as well as for identifying the key factors affecting the benefits and drawbacks of such therapies. This study further evaluates the feasibility of using digital tools for medical diagnosis and treatment by examining the technology usage of both parties. ResultsThe 4 key issues that all participants were the most concerned about were as follows: distance to outpatient medical care, medical efficiency, internet connectivity and equipment, and physical space for diagnosis and treatment. Interviews with patients and health care professionals revealed that the use of technology and internet was perceived differently depending on age and area of residence. Most participants reported that digital tools and internet connectivity had many benefits but still could not solve all the problems; moreover, these same digital tools and network transmission could lead to problems such as information security and digital divide concerns. This study also emphasizes the significant impact of human behavior and thinking on shaping the design of health care interventions and technologies. Understanding user perspectives and experiences is crucial for developing effective solutions for unmet needs. ConclusionsThe results of this study indicate that despite the different perspectives of patients and health care professionals, their considerations of the key issues are very similar. Therefore, the implementation of plans related to telemedicine diagnosis, treatment, or rehabilitation should take the suggestions and considerations of both parties into account as crucial factors for telehealth care design.

BACKGROUND:Emerging evidence has revealed that cricothyroid (CT) muscle dysfunction in unilateral vocal fold paralysis (UVFP) further impairs patients' voices. Given that CT muscle dysfunction does not influence vocal fold position, the mechanism of voice dysfunction induced by dysfunction of CT muscle in UVFP patients remains controversial. This study compares aerodynamics between UVFP patients with and without CT muscle involvement.METHODS:This cross-sectional study recruited patients with UVFP manifesting dysphonia, and UVFP was confirmed with videolaryngoscopy and laryngeal electromyography (LEMG). Voice analysis and aerodynamic tests were further performed. Patients with (CT+ group) and without (CT- group) CT muscle involvement were compared.RESULT:A total of 175 patients (40 in the CT+ group and 135 in the CT- group) with UVFP were analyzed. The CT+ group showed lower maximal sound pressure level (SPL) (P=0.039), mean SPL (P=0.042), peak air pressure (P<0.001), mean peak air pressure (P<0.001) and aerodynamic power (P=0.004) than the CT- group.CONCLUSION:The decrease in SPL, peak air pressure, and aerodynamic power in UVFP patients with CT muscle dysfunction suggests that the effect of CT muscle dysfunction is mediated by a change in aerodynamics.

Objective: The purpose of this paper is to investigate whether playing exergames can enhance quality of life among young adults and it examines the potential moderators. Methods: A 12-week randomized controlled trial was conducted. Quality of life was measured using the short-form 36-item version (SF-36) scale. All the participants were between 20 and 24 years old in Taiwan. Participants in the intervention group (n = 55) were asked to play exergames for 12 weeks, three times a week and 30 minutes at a time, while participants in the control group (n = 62) did not play exergames. The changes in the scores on quality of life between the beginning and the end of the 12-week trial were calculated. Independent t-tests were used to analyze the differences. Results: The intervention group participants experienced an enhanced quality of life in terms of physical functioning, role-physical (role limitations due to physical health), general health, and social functioning. Moreover, the intervention group participants who were not enthusiastic about exercisers experienced an enhanced quality of life in physical functioning, role-physical, and general health. The intervention group participants who attempted to control their weight experienced enhanced general health, vitality, and mental health. Conclusion: Playing exergaming could contribute to users’ quality of life in terms of both physical and mental health.

IntroductionTo assess the association between a three-month interruption of language intervention programs and the language performance of children with language delay during the COVID-19 pandemic, and to identify which children are more vulnerable to such interruptions.Materials and methodsThis is a retrospective study involving 33 children with language delay who experienced a three-month suspension of language interventions due to the COVID-19 pandemic. We collected their demographic data and language performance scores from the Comprehensive Developmental Inventory for Infants and Toddlers—Diagnostic test (CDIIT-DT) at four different time points. The scores were analyzed using a Wilcoxon Signed Ranks test.ResultsThe median scores of language comprehension and overall language ability showed a decreasing trend during the interruption period. However, resuming interventions post-interruption showed a statistically significant increase in all language domains. Children in the borderline delay group (CDIIT-DT DQ scores between 71 and 85) were more likely to experience a decline in their language abilities during the interruption.DiscussionThis is the first study to reveal a decreasing trend in language performance during interruption periods, and highlighting the significance of post-interruption language interventions in facilitating improvements. Furthermore, our study brings attention to the heightened vulnerability of children exhibiting borderline language delay in overall language ability tests when faced with interruptions in language interventions.

Background A critical shortage of nurses worldwide makes research necessary to address the problem. Research examining whether and how temperament and character may lead to nurses’ professional turnover intention can offer insights to address the nurse shortage issue.Purpose To examine the impact of temperament and character on nurses’ intention and actions to improve professional capabilities and professional turnover intention.Method This study surveyed 502 nurses in a major medical centre in Taiwan in 2018. The measures came from the literature. Structural Equation Modeling was used for analysis.Results Self-directedness, cooperativeness, and persistence were positively related to intention (or actions) to improve professional capabilities. Harm avoidance was negatively related to actions to improve professional capabilities. Such actions were subsequently negatively related to nurses’ professional turnover intention.Conclusions This study contributes to the literature by being the first to clarify how nurses’ temperament and character dimensions may lead to professional turnover intention.Implications for Healthcare Managers Our findings contribute insights for healthcare managers, i.e. they should pay particular attention to nurses with high levels of harm avoidance or low levels of persistence, self-directedness, and cooperativeness to retain nurses and, thus, improve the quality of a healthcare system.

ABSTRACT Background The prevalence of chronic diseases and functional disorders is projected to escalate as the older adult population increases. Thus, the demand for and burdens of long-term care are increasing. Training middle-aged and older volunteers at the community level will enhance health promotion and disease prevention in communities. Purpose In this study, multilevel volunteer training programs and related implementation methods were designed for neighborhood caregivers Methods This study was divided into two phases. In Phase 1, an expert review was conducted using the modified Delphi method to congregate expert opinions into an interdisciplinary consensus and establish the content and methods of implementation of the multilevel training program. In Phase 2, the training programs were implemented and evaluated. Results In Phase 1, 17 experts in geriatric and long-term care were enrolled in the Delphi surveys. Consensus was defined as at least 80% agreement. These experts devised volunteer training programs for neighborhood caregivers at three levels: basic caregiver training, advanced caregiver training, and volunteer caregiver instructor training. The curriculum focused on fulfilling the health demands of neighborhood care; adopted disability-prevention and disability-delaying healthcare as the basic framework; and referred to the attention, relevance, confidence, and satisfaction model of motivational design. This model of motivational design drew on the attributes of volunteers and the current state of care programs, including interest, program difficulty, and feasibility of future services. In Phase 2, 50 community middle-aged and older volunteers enrolled in the training programs and, after completing the program, were asked to evaluate their satisfaction with the program content and program effectiveness. A high level of satisfaction was reported across all three levels. Conclusions/Implications for Practice The training programs achieved satisfactory consistency and convergence and were well received by the volunteer trainees. These programs may be referenced in the development of future training programs and the creation of a model of community healthcare services. The curriculum was designed from the learners' perspective with direct healthcare applications. A progressive multilevel set of neighborhood care volunteer training programs was offered to cultivate community volunteers.

Background Robots are introduced into health care contexts to assist health care professionals. However, we do not know how the benefits and maintenance of robots influence nurse–robot engagement. Objective This study aimed to examine how the benefits and maintenance of robots and nurses’ personal innovativeness impact nurses’ attitudes to robots and nurse–robot engagement. Methods Our study adopted a 2-wave follow-up design. We surveyed 358 registered nurses in operating rooms in a large-scale medical center in Taiwan. The first-wave data were collected from October to November 2019. The second-wave data were collected from December 2019 to February 2020. In total, 344 nurses participated in the first wave. We used telephone to follow up with them and successfully followed-up with 331 nurses in the second wave. Results Robot benefits are positively related to nurse–robot engagement (β=.13, P<.05), while robot maintenance requirements are negatively related to nurse–robot engagement (β=–.15, P<.05). Our structural model fit the data acceptably (comparative fit index=0.96, incremental fit index=0.96, nonnormed fit index=0.95, root mean square error of approximation=0.075). Conclusions Our study is the first to examine how the benefits and maintenance requirements of assistive robots influence nurses’ engagement with them. We found that the impact of robot benefits on nurse–robot engagement outweighs that of robot maintenance requirements. Hence, robot makers should consider emphasizing design and communication of robot benefits in the health care context.

Unilateral vocal fold paralysis (UVFP) causes glottal incompetence and poor vocal efficiency. The influence of laryngeal neuromuscular control on aerodynamics in UVFP remains unclear. This study investigated the relationship between laryngeal muscle activities using quantitative laryngeal electromyography (LEMG) and aerodynamics in UVFP. This prospective study recruited patients with UVFP, and the diagnosis was confirmed with videolaryngostroboscopy and LEMG. The patient received aerodynamic assessment and LEMG of the thyroarytenoid-lateral cricoarytenoid (TA-LCA) muscle complex and the cricothyroid (CT) muscle. The relationship between quantitative LEMG and aerodynamic parameters was analyzed. A total of 134 UVFP patients without concurrent CT muscle involvement were enrolled. Compared with the normal side, the peak turn frequency of the lesioned side was lower in the TA-LCA (p < 0.001) and CT (p = 0.048) muscles. Stepwise linear regression revealed that the turn ratio of TA-LCA muscles was a robust factor in the decrease in peak expiratory airflow (β = −0.34, p = 0.036), mean airflow during voicing (β = −0.28, p = 0.014), and aerodynamic power (β = −0.42, p = 0.019), and an increase in aerodynamic efficiency (β = 27.91, p = 0.012). In addition, the turn ratio of CT muscles was a potent factor in inducing an increase in aerodynamic resistance (β = 14.93, p = 0.029). UVFP without CT involvement still showed suppression of CT muscles on the lesioned side, suggesting that neurological impairment of the TA-LCA complex could cause asymmetrical compensation of CT muscles, further impeding aerodynamics. The residual function of TA-LCA muscle complexes facilitates less air leakage and power dissipation, enhancing aerodynamic efficiency. On the other hand, the symmetrical compensation of the CT muscles improves aerodynamic resistance.

AIMS:The aim of this study is to examine the relationship between psychological ownership of the nursing profession and turnover intention.BACKGROUND:There is a severe shortage of nurses worldwide. Research is needed to understand how nurses' intention to leave hospitals and the nursing profession can be alleviated.METHODS:This study adopted a cross-sectional design and a survey method. Proportionate random sampling was used to ensure sample representativeness. This study surveyed 430 registered nurses in a medical centre in Taiwan between December 2021 and January 2022. We used Turnover Scale and Self-Efficacy Scale and developed Having a Place Scale.RESULTS:Psychological ownership comprises three dimensions: self-efficacy, nurse identity and 'having a place' in the nursing profession. This research is the first to examine how these three dimensions of psychological ownership of the nursing profession are related to the intention to leave a hospital or the nursing profession. Self-efficacy and 'having a place' are negatively related to nurses' intention to leave a hospital (r = -.23 and -.31, p < .001). Nurse identity is negatively related to nurses' intention to leave the nursing profession (r = -.38, p < .001). Intention to leave a hospital is positively related to nurses' intention to leave the profession (r = .76, p < .001).CONCLUSION:The findings provide novel insights for retaining nurses. Nurse managers could use strategies such as including nurses in making workplace decisions and encouraging them to personalize their workspace.IMPLICATIONS FOR NURSING MANAGEMENT:Nurse managers can enhance nurses' self-efficacy and sense of 'having a place' to retain nurses in hospitals, while enhancing nurse identity to retain nurses in the profession.

Abstract Background Unilateral vocal fold paralysis (UVFP) affects the glottal gap, voice, and aerodynamics, whereas injection laryngoplasty (IL) using hyaluronate is an effective treatment for UVFP by decreasing the glottal gap to improve voice. Previous studies have shown that the involvement of cricothyroid (CT) muscle in UVFP patients further affects patients' aerodynamics, but it remains unclear whether the difference remains after IL. This study investigates whether the aerodynamic features observed in UVFP with CT involvement could still be observed after IL. Methods This study recruited UVFP patients with dysphonia, and IL was performed within 6 months of initial symptoms. All subjects received assessments including videolaryngoscopy, voice analysis, and aerodynamics at three time points: before IL, 1 month after IL, and 6 months after IL. The glottal gap, voice, and aerodynamics between patients with and without CT involvement (the CT+ and CT− groups) were compared, and the change (Δ) before and after IL and repeated‐measures analysis of variance (ANOVA) were also compared between the two groups. Result A total of 71 patients with UVFP (22 in the CT+ group and 49 in the CT− group) were analyzed. After IL, the CT+ group showed a lower sound pressure level (SPL), higher Δair pressure, and smaller Δaerodynamic power than the CT− group. Conclusion The CT+ group had a lower SPL, even after elevating air pressure to attempt to achieve a higher vocal intensity. The results suggest that although closure of the glottal gap was achieved by IL, the CT+ group still had a lower loudness and needed to sustain a higher peak air pressure when producing voice. Level of evidence Level 4.

Purpose Nurses' health is vital for retaining nurses in the profession. However, lack of study has examined how headaches and professional commitment interact to impact professional turnover intention. This study aims to examine the moderating effect of nurses' headaches on the relationship among professional commitment factors (affective professional commitment, continuance professional commitment and normative professional commitment) and nurses' professional turnover intention. Design/methodology/approach This study employed a two-wave design and questionnaires to survey 524 nurses from a large medical center in Taiwan during February and March 2017 (the first wave) and June and August 2017 (the second wave). Headaches were measured using descriptions formulated by the International Headache Society. Items measuring other constructs came from relevant literature. Regression analysis was used to assess relationships between the constructs. Findings All aspects of professional commitment are negatively related to professional turnover intention (B [CI] = −0.47 [−0.58, −0.36], −0.20 [−0.29, −0.11], −0.22 [−0.32, −0.12], p < 0.001). Headaches reduce the negative relation between affective professional commitment and professional turnover intention (B [CI] = 0.14 [0.02,0.27], p = 0.02). Practical implications Headaches could interfere with nurses' commitment to the nursing profession and influence nurses' intention to leave. Managers should seek means to help alleviate nurses' headaches. Originality/value This study is the first to examine how headaches and professional commitment interact to influence nurses' professional turnover intention.

In this cross-sectional study, we compared voice tone and activities relating to the laryngeal muscle between unilateral vocal fold paralysis (UVFP) patients with and without cricothyroid (CT) muscle dysfunction to define how CT dysfunction affects language tone. Eighty-eight female surgery-related UVFP patients were recruited and received acoustic voice analysis and laryngeal electromyography (LEMG) when the patient was producing the four Mandarin tones. The statistical analysis was compared between UVFP patients with (CT+ group, 17 patients) and without CT muscle (CT− group, 71 patients) involvement. When producing Mandarin Tone 2, the voice tone in the CT+ group had smaller rise range (p = 0.007), lower rise rate (p = 0.002), and lower fundamental frequency (F0) at the offset point of the voice (p = 0.023). When producing Mandarin Tone 4, the voice tone in the CT+ group had smaller drop range (p = 0.019), lower drop rate (p = 0.005), and lower F0 at voice onset (p = 0.025). The CT+ group had significantly lower CT muscle activity when producing the four Mandarin tones. In conclusion, CT dysfunction causes a limitation of high-rising tone in Tone 2 and high-falling tone in Tone 4, a property that dramatically limits the tonal characteristics in Mandarin, a tonal language. This limitation could further impair the patient’s communication ability.

Studies have found that older adults often experience severe problems due to a lack of exercise, including an increased risk of falls, increased psychological problems and reduced social participation. However, the practicality and sustainability of exercise or physical fitness activities among older adults are questionable because these adults may face physical and psychological obstacles. Hence, this study proposed a research model to explore the physical fitness behaviours of the elderly subjects and the specific factors for maintaining their motivation to participate in exercise or physical fitness activities. A survey for a total of 101 subjects of residents of Chang Gung Health and Culture Village (CGHCV) was conducted to investigate the effects of the elderly’s group identification and psychological proximity on their attitude and intention toward physical fitness. The results show that the group identification of the physical fitness activities, psychological proximity, intention toward physical fitness and subjective norms of the subjects did not affect their attitudes towards physical fitness or their intention to participate in exercise or physical fitness activities in the future. Therefore, the influence of group identification with other older adults of the same age on empathy allowed the subjects to understand the problematic aspects of physical fitness. Group identification among the subjects allowed them to adjust to their physical fitness problems through sympathy. It mediated the physical fitness problems of the subjects through the ageism effect.

AIMS AND OBJECTIVES To test how the three components of professional commitment (i.e. affective, continuance and normative professional commitment) are associated with nurse-reported patient-centred care and care quality. BACKGROUND Patient-centred care and care quality are the two critical care outcomes. However, no study has yet examined how the three components of professional commitment are related to nurse-reported patient-centred care and care quality, showing a research gap. DESIGN This study adopted a two-wave design (first wave in 2017 and second wave in 2019), which is known to reduce the possibility of reverse causality, and which was conducted in a large hospital in Northern Taiwan. METHODS Proportionate random sampling was used. Full-time nurses were surveyed, while nursing students, interns, nurse practitioners and nursing supervisors were excluded. The first wave included 524 nurses, and 438 nurses were retained in the second wave. We used confirmatory factor analysis to verify the psychometric properties of the measures. Structural equation modelling was used to implement hypothesis testing. We used the Professional Commitment Scale of Meyer et al. (Journal of Applied Psychology, 1993, 78, 538), the Patient-Centered Care Scale of Laird-Fick et al. (Patient Education and Counseling, 2011, 84, 90) and the Care Quality Perceptions Scale of Teng et al. (Journal of Nursing Management, 2010, 18, 275). The STROBE statement was chosen as the EQUATOR checklist. RESULTS Affective professional commitment was positively associated with nurse-reported patient-centred care (β = .18, p = .002 and .01), which was positively associated with nurse-reported care quality (β = .85, p < .001). Affective and normative professional commitment were also positively associated with nurse-reported care quality (β = .17, p < .001). CONCLUSIONS Our findings offer insights for nursing managers that nurses' affective and normative professional commitment could help upgrade care outcomes. Hospital managers should consider professional commitment as relevant to their workforce. RELEVANCE TO CLINICAL PRACTICE Nursing managers could publicise reports documenting nurses' significant contributions to public health. This could strengthen affective professional commitment among nurses.