Clinical Rehabilitation最新文献

ObjectiveTo explore the attitudes and practice of allied health professionals working in stroke care in Ireland regarding recommended amounts of therapy set out in the National Clinical Guideline for Stroke (2023).DesignQualitative descriptive study using one-to-one semi-structured interviews. Data were analysed using reflexive thematic analysis.SettingFive large acute teaching hospitals in Dublin, Ireland.ParticipantsThe 11 participants were allied health professionals working in acute and subacute stroke care in Dublin, and were recruited using a combination of purposive and snowball sampling.ResultsTwo main themes emerged: 'Barriers and enablers to achieving guideline recommended therapy time' and 'Methods of increasing therapeutic time'. Patient factors and clinical resources impact on the provision of therapy post-stroke. Overall, participants felt positive about the recent guideline recommendation for increased therapeutic time. Various methods are employed to augment patient therapeutic time, including technology and semi-supervised practice. Participants perceived that Therapy Assistants play an important role in achieving greater amounts of therapy.ConclusionsAllied health professionals view the new Stroke Guidelines recommendation for increased therapy intensity as challenging but are generally positive in trying to achieve it, citing the benefits of increased therapy time for patient outcomes. They utilise a wide range of methods to optimise therapeutic time for stroke survivors. The role of the therapy assistant in supporting the delivery of larger amounts of therapy time warrants further evaluation.

ObjectiveEvaluate the internal consistency, inter-rater and test-retest reliability, convergent and divergent validity and clinical usability of the Cognition in Daily Life scale for patients with acquired brain injury.DesignValidation study.ParticipantsA total of 75 patients with acquired brain injury (mostly male [n = 47, 68%]; mean age 67 years) were recruited from inpatient care facilities. Sixty participants (81%) had sustained a stroke.Main measuresOutcome measure: Cognition in Daily Life scale. Reference measures: Utrecht Scale for Rehabilitation-Cognition subscale, Montreal Cognitive Assessment, Barthel Index, Hospital Anxiety and Depression Scale and Fatigue Severity Scale.ResultsAfter removing redundant items, all subscales of the Cognition in Daily Life scale demonstrated satisfactory internal consistency. Test-retest reliability was good (intraclass correlation coefficient [ICC] = 0.847), and inter-rater reliability was moderate (ICC = 0.615). Convergent validity was confirmed through moderately strong correlations between most subscales of the Cognition in Daily Life Scale and other measures of cognition. Cognition in Daily Life subscales generally did not correlate with the Hospital Anxiety and Depression Scale and Fatigue Severity Scale, indicating divergent validity. Moderate correlations with the Barthel Index suggested related, but distinct constructs. Clinicians found the Cognition in Daily Life scale easy to administer and relevant for practice, though time-consuming. They suggested layout improvements for greater usability.ConclusionThe Cognition in Daily Life scale is adequately valid, reliable and clinically usable for assessing cognition in daily life in patients with acquired brain injury in a clinical setting. Future research needs to evaluate the scale's sensitivity to change and its performance in other settings and populations.

ObjectiveThis scoping review aimed to comprehensively map interventions for post-stroke apathy and their effects.Data sourcesThe literature search for this review was performed using PubMed, Cumulative Index to Nursing and Allied Health Literature, and Web of Science, targeting studies published until August 7, 2025.Review methodsThis scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. The population included patients with post-stroke apathy; the concept focused on post-stroke apathy assessment and interventions and their effects. The context covered both general and community healthcare settings. Controlled vocabulary (e.g., MeSH terms) such as "post-stroke apathy," "intervention," and "effect" was used to formulate the search strategy. The eligible studies were independently screened by three reviewers, and final inclusion was determined through discussion.ResultsOf the 565 studies identified, 13 met the inclusion criteria (n = 13). The mapping revealed that pharmacological interventions not only improved and prevented post-stroke apathy symptoms but also alleviated emotional blunting, reduced loss of motivation and interest, and enhanced social behavior and participation. Non-pharmacological interventions were associated with symptom relief and recovery over time. Furthermore, combined pharmacological and non-pharmacological approaches contributed to improvements not only in post-stroke apathy but also in depression, language function, and behavioral aspects.ConclusionThe findings suggest that appropriate treatment for post-stroke apathy may lead to symptom relief, improvement, and prevention while enhancing language function, behavior, and social participation. Future research should focus on systematic reviews and meta-analyses to establish evidence-based recommendations for post-stroke apathy treatment strategies and their optimal combinations.

ObjectiveTo characterize the trajectory and identify early predictors of bimanual performance at 6 and 12 months post-stroke.DesignProspective longitudinal study with assessments at admission, 6, and 12 months post-stroke.SettingInpatient rehabilitation centre.ParticipantsFirst-ever stroke survivors with unilateral upper limb motor impairment.Main MeasuresBimanual performance was assessed using the Adult Assisting Hand Assessment Stroke. Potential predictors were collected at admission through comprehensive clinical and functional assessments. We used multivariate linear regression to identify key predictors and a Chi-square Automatic Interaction Detection analysis to derive a clinical decision tree.ResultsNinety-two participants (mean age 67 ± 12 years; 22 ± 8 days post-stroke) participated. Bimanual performance improved over time (p < 0.001), with median scores increasing from 8 (interquartile range 0-52) at admission to 48 (8-70) at 6 months, and 48 (8-75) at 12 months. At 6 months, admission grasp function and stroke severity (64% and 9%) jointly explained 73% of the variance in bimanual performance scores. At 12 months, admission stroke severity, grasp function, and Barthel Index (66%, 10%, and 2%) accounted for 78% of the variance. Decision tree analysis confirmed stroke severity and grasp function as the primary predictors and generated a clinically interpretable model.ConclusionBimanual performance improves most within the first 6 months post-stroke. Grasp function and stroke severity at admission strongly predict long-term bimanual outcomes. The decision tree derived from the Chi-square Automatic Interaction Detection analysis may support stratified rehabilitation and realistic goal-setting for daily bimanual use.

ObjectiveTo evaluate changes in quality-of-life and explore psychosocial influences on social participation and recovery in chronic stroke survivors following intensive upper limb neurorehabilitation.DesignMixed-methods design with quantitative (pre-post design with follow-up) and qualitative (semi-structured interview) phases.SettingThree-week Queen Square upper limb neurorehabilitation programme.Participants65 stroke survivors who participated in the programme from July 2016 to March 2018.Main measuresStroke Impact Scale (3.0) (SIS) and Action Research Arm Test, collected on admission, discharge, 6-week and 6-month follow-up (n = 65). Beliefs and psychosocial factors influencing quality-of-life were investigated through thematic analysis of semi-structured interviews in two subgroups, based whether the SIS-participation domain change from admission to follow-up was high (> 20, n = 5) or low (<-24, n = 5).ResultsSeven out of eight SIS domains, overall self-rated recovery (p < 0.001) and Action Research Arm Test (p < 0.001) improved from admission to discharge. The emotion domain improved from admission to discharge (p < 0.001) and reduced from discharge to 6-month follow-up (p < 0.001). Interviews highlighted four key psychosocial themes with contrasting positive and negative perspectives between higher change and lower change groups; themes 'hidden negative effects' and 'loneliness' were evident in the lower change group and 'getting on with my life' in the higher change group.ConclusionThe Queen Square upper limb neurorehabilitation programme led to measurable therapeutic benefits on physical and non-physical quality-of-life outcomes. However, the lack of sustained improvement in self-reported emotion contrasts with the clear benefits in other domains. This indicates a need for ongoing psychosocial support for some stroke survivors, supported by the qualitative findings.

ObjectiveTo identify common barriers and facilitators among physical therapists to implementing high-intensity gait training for patients post-stroke during inpatient rehabilitation.DesignA three-round Delphi study using free text responses and five-point Likert scales for agreement.Participants60 physical therapists with expertise treating patients with stroke in inpatient rehabilitation were invited. 33 participants completed all three rounds of surveys.Main MeasuresRound 1 consisted of two free text questions. Qualitative responses from round one were coded using the Theoretical Domains Framework and used to generate Likert scale survey items for rounds two and three. Consensus was defined a priori as ≥75% agreement. Response stability was evaluated with the Wilcoxon rank sum test.ResultsAnalysis identified 24 themes (12 facilitators, 12 barriers). Seven facilitators reached consensus: access to equipment (84.9%), built environment (78.8%), administrative support (78.8%), peer support (75.8%), team commitment to evidence-based practice (75.8%), high-intensity gait training-specific training (75.8%), and observable patient improvement (75.8%). Only one barrier reached consensus: treatment time interruptions (97.9%), including delays from toileting, hygiene, and medication administration. Other themes ranged from 18.2% to 57.6% agreement. No significant change in responses was found between rounds (p > 0.05).ConclusionsMore facilitators than barriers reached consensus, with treatment time interruptions as the primary agreed-upon barrier. Despite knowledge of high-intensity gait training and supportive factors, fewer than half of participants reported daily use. Targeted implementation strategies addressing time and workflow disruptions are needed to increase high-intensity gait training adoption in inpatient rehabilitation.

ObjectiveCompare the effectiveness of integrating virtual reality systems, Nintendo Wii and Microsoft Kinect, integrated with conventional physiotherapy versus conventional physiotherapy alone, in improving lower limb physical function in people over 60 years of age undergoing total hip arthroplasty.DesignRandomised, single-blind clinical trial.SettingSan Borja Arriaran Clinical Hospital, Santiago, Chile.Participants111 individuals over 60 years of age, divided into three groups (n = 37 each).InterventionsFor six weeks, the control group received conventional physiotherapy. The Wii and Kinect groups received the same physiotherapy programme plus 15 min of exercise using virtual reality platforms.Outcome measuresThe primary outcome was the function subscale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes included WOMAC pain, Berg Balance Scale, Six-Minute Walk Test, and weight-bearing.ResultsAll groups improved. For WOMAC function, the Wii group surpassed the Kinect group (mean difference: 40.48 points; p < 0.001; minimum clinically important difference MCID: 11.9 points) but not the control group. The Wii group also led in balance (Berg Balance Scale mean difference: 19.41 points; p < 0.001; MCID: 11.5 points). The Kinect group was superior in the Six-Minute Walk Test (mean difference: 133.10 metres; p = 0.001) and WOMAC pain reduction (mean difference: 11.45 points; p < 0.003) exceeding the MCID of 2.2 points. No significant changes were observed in weight-bearing.ConclusionVirtual reality combined with physiotherapy improves clinically meaningful outcomes following hip arthroplasty. The Wii favours balance, while Kinect enhances pain and gait, supporting personalised rehabilitation.Trial registrationThis research was registered in the Clinical Trials Registry of Australia and New Zealand (ACTRN12618001252202).

ObjectivesTo estimate the comparative efficacy of rehabilitation interventions for pain reduction in cervical radiculopathy and evaluate the individual components of combined treatments to support clinical decision-making.Data sourcesA systematic search was conducted across the Cochrane, PubMed, Scopus, WOS, and PEDro databases up to 1 July 2025, for randomized controlled trials comparing rehabilitation interventions against no intervention or other rehabilitation approaches for cervical radiculopathy-related pain.Review methodsWe conducted a frequentist random effects network meta-analysis and a component network meta-analysis to isolate the effects of individual treatment components. We used CINeMA software to assess the confidence in our estimates.ResultsWe included 36 trials comparing 25 interventions composed by eight active components. The components associated with a decrease in pain were neurodynamic techniques (SMD = -1.45; 95%CI: -1.88 to -1.02), cervical traction(SMD = -0.66; 95%CI: -1.08 to -0.25), articular treatment (SMD = -0.72; 95%CI:-1.29 to -0.15), and dry needling(SMD = -3.40; 95%CI: -5.40 to -1.39). The most promising interventions for reducing pain in cervical radiculopathy patients were a combination of the above components (except dry needling) with analgesic electrotherapy and strengthening exercises with a moderate confidence rating.ConclusionsA combination of articular treatment, analgesic electrotherapy neurodynamic techniques strengthening exercises and cervical traction appears to offer the most effective pain relief for patients with cervical radiculopathy, with a moderate confidence rating. Individually, neurodynamic techniques, cervical traction, and articular treatment were the components associated with a significant reduction in pain. Although dry needling showed encouraging results, its limited presence in the network prevents drawing firm conclusions about its effectiveness.

ObjectiveThe aim was to adapt and validate the Nursing Critical Thinking in Clinical Practice Questionnaire of 109 items in four dimensions, for its application in physiotherapists in Spain.DesignDescriptive, cross-sectional, multicenter psychometric study carried out in two phases: phase 1, adaptation of the Nursing Critical Thinking in Clinical Practice Questionnaire to the physiotherapy setting and analysis of its content validity; phase 2, evaluation of the psychometric properties of the new instrument.SettingPhysiotherapists from a variety of work environments (public and private hospitals, geriatric institutions, home care services, clinics, and primary care, social health, educational and sports centers).ParticipantsA sample of 235 physiotherapists participated, of whom 108 completed the questionnaire for a second time after a two-week interval.Main measuresConstruct validity was analyzed using Confirmatory Factor Analysis, convergent validity and discriminant validity; reliability was analyzed using internal consistency and temporal stability (test-retest method).ResultsThe Average Scale Content Validity Index of 0.96 indicated high content validity. Confirmatory Factor Analysis confirmed the four-dimensional structure on which the original questionnaire is based, with acceptable model fit indices. Cronbach's alpha for the total questionnaire was 0.97, reaching values above 0.70 in each of the dimensions. Lin's Intraclass Correlation Coefficient was 0.71.ConclusionsThe Physiotherapy Critical Thinking in Clinical Practice Questionnaire showed appropriate psychometric properties. Its use among Spanish physiotherapists is recommended.ClinicalTrials.gov IdentifierNCT05059483.URLhttps://clinicaltrials.gov.