Clinical Rehabilitation最新文献

ObjectiveStroke survivors often experience hemiparetic lower extremity impairment, which increases fall risk. This study investigates prospective fall risk prediction using gait kinematic markers analyzed through a markerless motion capture system on mobile devices for participants with chronic stroke.DesignA prospective cohort study.SettingLaboratory setting, with three iPad Pros positioned at the start, end, and lateral points along a 3-meter walkway. Participants: Adults with hemiplegic stroke (Modified Functional Ambulation Classification ≥ III) and age-matched healthy controls, all without a recent fall.Main measuresGait parameters including stride length, cadence, step width, stance/swing time, double support time at baseline, and fall history interview over the 18-month period following the walking experiment.ResultsFifty healthy adults and 46 participants with chronic stroke were recruited. The 18-month prevalence for fallers in participants with stroke was 13%. Participants with stroke demonstrated a slower walking speed, a shorter step width, and a longer standing time than the healthy adults. Cadence, stride length, stance time, and swing time were strong predictors of fallers among participants with chronic stroke. The relative risks for low cadence, low swing phase, and high stance phase were 2.163, 2.002, and 2.142, respectively.ConclusionOur findings support the importance of using gait parameters obtained from the markerless motion capture system on mobile devices to predict prospective fall risk in the stroke population. Future research with larger, diverse cohorts of the stroke population using markerless motion capture is recommended to validate and refine the fall prediction models.

ObjectiveTo validate a novel off-road assessment tool-the Planning Strategies for Driving on a Map (COMAP)-designed to evaluate strategic predriving planning in individuals with stroke.DesignCross-sectional observational study following COSMIN and STROBE guidelines.SettingResearch conducted at a university-affiliated research facility.ParticipantsA total of 41 stroke survivors (≥6 months poststroke) and 42 age- and gender-matched healthy controls. Participants with significant language or cognitive impairments (Mini-Mental State Examination < 24) were excluded.Main measuresParticipants completed the COMAP and a battery of cognitive tests including tests of attention, executive functions, working memory, and visuospatial organization.ResultsThe COMAP total performance showed good internal consistency (α = .885) and significant correlations with cognitive measures of executive function and memory. A cutoff score of 59 demonstrated strong diagnostic utility (area under the curve = .829; sensitivity = 78%; specificity = 87%) in identifying stroke-related cognitive impairments. Strategy use and planning time were associated with better task performance. The COMAP was more sensitive to within-group variability among stroke participants than between-group differences with healthy controls.ConclusionsThe COMAP is a valid and reliable tool for assessing strategic predriving planning after stroke. It offers clinically relevant insights into executive functioning and compensatory strategies, with potential applications in rehabilitation and driving-related decision-making.

ObjectiveInterdisciplinary interventions for chronic low back pain are diverse, and there is a need to reach consensus on the content of rehabilitation.DesignA three-round Delphi survey was conducted across international networks, a world physiotherapy specialty group, and the research team. The first round contained a checklist, based on previous research on interdisciplinary rehabilitation for people with chronic low back pain. Participants rated all items, subitems, clarifications, and questions on three content-validity indicators: (a) clarity and comprehensibility, (b) unique value, and (c) alignment with the goal. General questions were asked, together with qualitative feedback and missing items. A sensitivity analysis was conducted in anticipation of a possible overrepresentation of participants from a specific region.SettingClinical practice and research.ParticipantsClinicians or researchers with knowledge and/or experience in the field of chronic low back pain and/or rehabilitation.Main measuresConsensus scores and qualitative feedback.ResultsAfter three rounds, consensus was reached on all subitems. There was an overrepresentation of Belgian participants. The sensitivity analysis, removing Belgian responses, showed no or little differences in consensus scores. Consensus was reached on a comprehensive checklist comprising 11 items essential to rehabilitation for people with chronic low back pain. Additionally, 32 subitems with corresponding questions were identified, ensuring coverage of all aspects of rehabilitation for people with chronic low back pain.ConclusionThis study developed an evidence- and consensus-based checklist for interdisciplinary rehabilitation in people with chronic low back pain. Future work should assess implementation and uptake in research and clinical practice.

ObjectiveTo culturally adapt the Stroke Drivers' Screening Assessment (SDSA) and evaluate its construct and predictive validity in a Spanish stroke population.DesignCultural adaptation and validation study.SettingHospitals and neurorehabilitation clinics in Spain.ParticipantsForty-five stroke patients completed the SDSA-Spain, a neuropsychological battery, and a road test.Adaptation processA panel of experts (two occupational therapists, a psychologist specializing in driving, and a driving instructor) adapted the SDSA to the Spanish context.Main measuresThe correlations of the SDSA-Spain with attention and memory tests, its ability to discriminate between fit and unfit drivers according to the instructor's judgment, and its predictive validity for the road test were analyzed.ResultsThe SDSA-Spain correlated significantly with the Useful Field of View subtests 2 and 3, and with the Trail Making Test-part B time. No significant differences were observed in discriminative ability alone between pass and fail participants. A logistic regression was performed selecting Dot Cancellation-time, Dot Cancellation-errors, Road Sign Recognition from the Spanish SDSA, and Useful Field of View-subtest 2. The model achieved an area under the curve of 0.81, accuracy of 0.73, specificity of 0.75, and sensitivity of 0.714.ConclusionsThe SDSA-Spain is an off-road tool that can be useful for assessing fitness to drive in stroke patients, especially when combined with other tests.

ObjectiveThis systematic review explored whether individuals with preoperative mental health diagnoses undergoing total knee replacement experience worse outcomes compared to patients without such diagnoses.Data SourcesMEDLINE, CINAHL, PSYCINFO, SPORT Discus, and PEDro databases were searched from inception to October 2025 to identify relevant articles.Review MethodsTwo independent reviewers screened and extracted data from relevant studies. The risk of bias for each study was assessed using the Quality in Prognostic Studies Tool. Meta-analysis using the standardized mean differences was employed to analyse associations between preoperative mental health diagnoses and pain and function at six months and ≥one year after total knee replacement. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation tool.ResultsThe literature search yielded 53 articles eligible for the review, of which 13 were rated as low risk of bias. Preoperative mental health diagnoses were not associated with worse pain at six months (standardized mean differences = -0.68, P  =  .21) or ≥ one year (standardized mean differences = -0.48, P = .08) post-total knee replacement. Similarly, preoperative mental health diagnoses were also not associated with functional outcomes at six months (standardized mean differences = -0.34, P = .07) or ≥one year (standardized mean differences = -0.56, P = .32). Considerable heterogeneity and imprecise estimates limited the certainty of these findings.ConclusionFindings suggest that preoperative mental health conditions alone may not predict poor pain and function outcomes post-total knee replacement. Given the heterogeneity and low certainty of evidence, further research should explore associations between mental health and other risk factors to guide personalized preoperative interventions.

ObjectiveTo explore physiotherapists' experiences with and perspectives on providing care to acute mechanically ventilated spinal cord injury patients in intensive care units to better understand physiotherapy practice with this patient population.DesignQualitative descriptive study.SettingLevel 1 intensive care units in hospitals across Ontario.ParticipantsEleven physiotherapists working in level 1 intensive care units who had experience treating at least one mechanically ventilated spinal cord injury patients within the year prior to recruitment.MethodsSemistructured interviews were conducted with participants. Interviews lasted approximately 60 minutes, were transcribed verbatim and anonymised. Interview transcripts were analyzed using an inductive thematic analysis approach.ResultsThree overarching themes with several subthemes were identified: (1) spinal cord injury care provision is improved by physiotherapist presence and collaboration with patients' circle of care in the intensive care unit; (2) increased access to resources, specialized education and training could address challenges in physiotherapist treatments and assessments; and (3) physiotherapist involvement in acute spinal cord injury patients' care can optimize safety.ConclusionsOur findings suggest that integrating physiotherapist into intensive care unit spinal cord injury care may support early mobilization and improved patient outcomes. Physiotherapist presence enhanced interprofessional collaboration and communication. Physiotherapists faced challenges such as training gaps and limited autonomy, but informal mentorship improved physiotherapist integration. This qualitative study of 11 intensive care unit physiotherapists from one region suggests that greater physiotherapist involvement may improve care processes and warrants larger multisite studies.

ObjectiveTo explore physiotherapists' perceptions of integrating scientific knowledge into clinical practice and the role of social media in supporting evidence-based rehabilitation.DesignQualitative exploratory study.SettingOnline interviews.ParticipantsTwenty-eight physiotherapists representing a range of clinical specialities.MethodsSemi-structured interviews were conducted via Google Meet, lasting on average 25 minutes. Sessions were recorded, transcribed verbatim and analysed using Braun and Clarke's thematic analysis. Coding was performed independently by two researchers, with triangulation to ensure trustworthiness. Data collection continued until thematic saturation was reached.ResultsTwo overarching themes were identified, comprising 10 sub-themes. (1) Application of scientific knowledge in clinical practice: participants recognised the importance of research evidence but reported barriers such as limited time, complex academic language and lack of institutional support. Strategies to overcome these challenges included targeted reading, continuing professional development and peer exchange. (2) Social media as a source of scientific information: platforms such as Instagram and YouTube were valued for accessibility, brevity and opportunities to share knowledge, but concerns were raised regarding superficiality, misinformation and commercial interests.ConclusionPhysiotherapists value scientific knowledge in clinical decision making but face persistent obstacles to its systematic use. Social media was perceived as a complementary resource for professional development, provided it is approached critically. Enhancing scientific and media literacy may improve the safe integration of digital content into evidence-based practice.

ObjectiveThe aims of this study were to characterise proprioceptive impairment in individuals after stroke using the Wrist Position Sense Test (WPST) in a relatively large pooled sample, to re-establish the criterion of abnormality of the WPST, and to determine the sensitivity and specificity of a briefer test version for use in clinical settings.DesignCross-sectional observation study with pooling of data across studies.SettingRehabilitation or outpatient settings.SubjectsStroke survivors (n = 205) and neurologically healthy controls (n = 93) were assessed at baseline.Main measureWrist proprioception assessed using the WPST.MethodsBaseline data from stroke survivors and healthy controls assessed on the WPST was extracted from six studies. Raw data were pooled and analysed to determine an updated criterion of impairment and ability of a brief 10-trial version to detect proprioceptive impairment.ResultsProprioceptive impairment was common for the contralesional wrist (66%) and present in the ipsilesional wrist (21%). The new criterion of abnormality was established as 11.1⁰ average error. High sensitivity and specificity were found for the brief 10-trial version, with 85.3% sensitivity and 95.7% specificity.ConclusionClinicians can quantitatively and confidently identify proprioceptive impairment in the upper limb after stroke using either the original or brief version of the WPST. Routine use of this quantitative, standardised clinical assessment can contribute to improved identification, monitoring, and access to targeted intervention for proprioceptive impairment following stroke.

ObjectiveTo investigate how health professionals working in palliative care services understand rehabilitation related to oncology palliative care in England and Brazil, according to different health system contexts.DesignQualitative study.SettingHospices, hospitals, community-based palliative care centre, palliative care units, nursing care homes in different areas of Brazil and England.ParticipantsThirty-six nurses and occupational therapists experienced in providing palliative care interventions from England and Brazil.InterventionsIndividual interviews with open-ended questions.Main MeasuresIndividual semi-structured, in-depth interviews, analysed using Braun and Clarke's reflexive thematic analysis.ResultsProfessionals in England demonstrated a consolidated and integrated understanding of rehabilitation as part of palliative care, often supported by structured services such as hospices. In contrast, many Brazilian participants expressed uncertainty or perceived rehabilitation as incompatible with end-of-life care, reflecting conceptual misunderstandings, limited training and a lack of service infrastructure. The findings revealed divergence in how rehabilitation in palliative care is conceptualised and implemented in these countries. This divergence is reflected in structural, educational and cultural differences in how palliative care is organised and delivered. However, there is a growing recognition that rehabilitation and palliative care are not separate but complementary approaches.ConclusionsThe findings underscore the urgent need to clarify definitions, develop unified conceptual models and invest in policy and education to ensure that rehabilitation is no longer seen as contradictory to palliative goals, but as a complementary strategy to enhance quality of life in advanced cancer care.