Clinical Rehabilitation最新文献

ObjectiveTo investigate whether presence of aphasia is associated with differences in inpatient stroke rehabilitation care and outcomes.DesignObservational study of cross-sectional data from hospitals participating in the biennial National Stroke Audit - Rehabilitation Services (Stroke Foundation, 2016, 2018 and 2020). Descriptive statistics and multi-level multi-variable logistic regression were used to examine associations between aphasia status, processes of care, and patient outcomes, with level defined as hospital.SettingAustralian inpatient rehabilitation hospitals.ParticipantsAll patients with stroke who had aphasia status recorded.Main measuresAdherence to processes of care recommended in the Australian and New Zealand Clinical Guidelines for Stroke Management. In-hospital outcomes included complications, independence, survival, and discharge destination.ResultsOverall, 9960 audits were included; 3160 (33%) patients had aphasia (56% male; median age 75; no aphasia: 56% male; median age 76). Patients with aphasia were more likely to have a mood impairment (54% vs. 44%) and less likely to be assessed by a psychologist (40% vs. 49%). Fewer patients with aphasia were involved in goal setting (84% vs. 88%) or development of care plans (91% vs. 96%); or asked about returning to work (67% vs. 74%) or driving (41% vs. 45%). Patients with aphasia had a longer length of stay (median 26 vs. 21 days, p≤0.001) and were less independent on discharge (adjusted odds ratio (aOR) 0.80, 95% CI 0.71, 0.90).ConclusionsIdentified differences in stroke rehabilitation highlight the need for equitable access to care and effective patient-provider communication enabling people with aphasia to more fully participate in their rehabilitation.

ObjectiveTo investigate stakeholder experiences on return-to-work after stroke and preferences to co-design a return-to-work cognitive intervention, addressing a gap in post-stroke rehabilitation.DesignIn-depth semi-structured interviews were conducted and reflexive thematic analysis guided by Braun and Clarke's six-phase approach was employed to analyse transcribed data, with iterative coding to identify themes until thematic saturation was achieved.SettingCommunity, work, and healthcare settings.ParticipantsTwenty purposively sampled participants across four stakeholder groups: stroke survivors (n = 7), caregivers (n = 4), healthcare professionals (n = 5), and employers (n = 4).Main measuresStakeholder perspectives on (i) the return-to-work process after stroke and (ii) preferences for the design and delivery of a return-to-work cognitive intervention after stroke.ResultsThree core themes emerged: (i) barriers to return-to-work, (ii) intervention content, and (iii) intervention delivery. Each theme comprised several subthemes and dimensions that offered deeper insight into participants' perspectives. Barriers to return-to-work encompassed lack of awareness of resources, ineligibility of support schemes, and lack of understanding from workplace. Intervention content comprised subthemes of awareness, acceptance and adjustment, goal setting, strategies for self-management, and navigating the return-to-work journey. Intervention delivery included programme structure, social support, format and accessibility. While there was broad agreement, stakeholders also expressed divergent priorities shaped by their roles and experiences.ConclusionsThis study synthesises lived experiences, clinical expertise, and employer insights from stakeholders to inform the co-design of a return-to-work cognitive intervention. This work advances a paradigm shift towards a patient-centred and ecological approach to improve post-stroke workforce reintegration.

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.