Clinical Rehabilitation最新文献

ObjectiveTo explore stroke survivors', caregivers', and therapists' experiences of the implementation and perceived impacts of the Dyad-Focused Strategy Training program.DesignA qualitative descriptive study using semi-structured interviews and thematic analysis.SettingSix academic medical centers in Taiwan.ParticipantsForty-one stroke survivor-caregiver dyads and 10 occupational therapists who completed the Dyad-Focused Strategy Training intervention.InterventionThe Dyad-Focused Strategy Training program is a therapist-guided, dyadic intervention focused on shared goal setting, problem-solving, and strategy development to improve stroke rehabilitation outcomes.Main Outcome MeasuresThematic analysis identified key themes related to therapists' roles, benefits for dyads, implementation challenges, and therapists' professional reflections.ResultsTwo overarching themes emerged: (1) Experiences with Dyad-Focused Strategy Training Implementation-participants emphasized the essential role of therapists, the emotional benefits of personalized strategies, and the complexity of balancing differing goals, fluctuating motivation, and emotional challenges within dyads; (2) Perceived Impact of Dyad-Focused Strategy Training on Individual, Dyadic, and Professional Outcomes-survivors reported improved independence and participation, caregivers noted reduced stress and clearer caregiving strategies, dyads described strengthened emotional bonds and communication, and therapists experienced professional growth and deeper insight into dyadic dynamics.ConclusionsDyad-Focused Strategy Training fostered meaningful improvements in participation of stroke survivors and caregivers, survivor independence, and caregiver well-being, while contributing to therapist development. Addressing emotional and motivational challenges and providing structural support to therapists are key for successful and sustainable implementation in clinical practice.

ObjectiveTo study the effects of a year-long, supervised home-based exercise training on perceived pain, pain interference, and use of pain medication over 12 months after hip fracture.DesignRandomised clinical trial, secondary analysisSettingHomeParticipantsParticipants (n = 121) had surgical repair of a hip fracture, were ≥60 years old, and community-living.InterventionParticipants were allocated into 12-month home-based Physical Exercise (n = 61) or Usual Care (n = 60). Exercise sessions (60 minutes/twice a week) at participants' home under physiotherapist supervision including strength, balance, and functional exercises.Main measuresPain intensity, interference, and locations, and information of the pain medication were queried at baseline, 3, 6 and 12 months.ResultsThe mean age was 81 (SD 7) years, 91 (75%) were women, and 74 (61%) had fractured femoral neck. At baseline, in Physical Exercise 46 (75%) and in Usual Care 43 (72%) reported some sort of pain. After discharge, 118 (98%) used pain medication: 116 (96%) paracetamol and 41 (34%) opioids. At 12 months, there was no difference between groups in global pain prevalence, or in pain intensity, but the prevalence of hip pain (P = .047, effect size -0.38 (95% CI -0.51 to -0.22)) and pain interference (P = .042, effect size -0.18 (95% CI -0.52 to -0.05)) were lower in Physical Exercise than in Usual Care. At 12 months, there was no difference in medication use between the groups.ConclusionThe year-long supervised home-exercise reduced pain interference, and the prevalence of hip pain compared to usual care. Over 12 months the use of pain medication decreased in both groups.RegistrationClinicalTrials.gov (NCT02305433).

ObjectiveTo propose three areas of cognitive expertise as the foundation of rehabilitation, uniting the many varieties of rehabilitation.Five issuesThe following matters require an explanation: (i)  Does only providing assistive technology constitute rehabilitation?(ii)  What explains the dramatic success of spinal cord injury rehabilitation?(iii)  How did stroke rehabilitation units reduce mortality and morbidity?(iv)  How does rehabilitation improve outcomes in progressive conditions?(v)  How does rehabilitation benefit people born with a disabling condition?FoundationsPeople naturally adapt to illness, and rehabilitation facilitates this adaptation within the holistic biopsychosocial framework.Three featuresThree cognitive characteristics of rehabilitation practice are identified: (i)  Recognising that the person's adaptation to any limitations imposed by a health condition is the fundamental process underlying change, and that rehabilitation expertise enhances and facilitates it.(ii)  Being person-centred, considering the patient's situation using the holistic biopsychosocial model of illness, paying particular attention to the potential long-term social outcomes, including living arrangements.(iii)  Using systematic and evidence-based clinical reasoning to achieve a holistic formulation focused on functional problems, collaborating with other professions and services in the interventions.HealthcareRehabilitation is one of many specialities using a biopsychosocial healthcare approach, focused on these principles, which contrasts with a biomedical approach focused on disease.ConclusionRehabilitation expertise has a broader scope than biomedical practice, emerging from rehabilitation thinking, which combines three key features: enhancing the person's adaptation, being person-centred, and employing a systematic approach to clinical reasoning. These differences resolve the five issues.

ProblemHow does someone altered by illness adjust their view of themselves and how could rehabilitation help?BackgroundRehabilitation is expanding its scope to become more holistic, beyond a preoccupation with physical functioning, which requires an understanding of the concept of personal identity. One currently employed approach defines the self as expressed through the physical.PhilosophySuch a view risks reifying the self into something owned. Instead, the change a person experiences with illness or injury is not a shift within themselves but reflects alterations in their interactions with the world. A person is not an internal self, mediated by the form of a body. Instead, a person is a body existing in and experiencing the world, particularly through interactions with others.ApplicationThis revised understanding is significant in rehabilitation because it increases conceptual clarity, removing the perceived challenge associated with defining the self or personal identity. Moreover, by moving towards an integrated view of self, our perspective shifts, such that when a person says, 'I have changed', what we can appreciate is 'things have changed', thus reducing the blame on them. Consequently, there is increased hopefulness and better acknowledgement of patients' social situations.ImplicationsThe purpose of this is not to police colloquial language but to heed against over-interpreting certain common expressions in ways that lead to increased alienation.ConclusionRehabilitation should understand that no self is lost or transformed, but that there is a social identity which changes with altered circumstances and challenges around a person, who remains themselves.

ObjectiveTo develop and validate an evidence-based framework guiding therapists in arm-hand rehabilitation in individuals with cervical spinal cord injury, to enhance performance and activities of daily living.DesignThe framework was developed using a mixed-method approach: (1) item generation based on the UK Medical Research Council's guidelines for complex interventions; (2) four-round e-Delphi study with Likert scales and qualitative input; and (3) expert panel discussion.ParticipantsThe e-Delphi panel comprised 24 international rehabilitation professionals (16 occupational therapists and eight physiotherapists) with mostly ≥5 years of clinical and/or scientific experience in spinal cord injury rehabilitation. A separate expert panel included seven individuals with cervical spinal cord injury.Main measurese-Delphi consensus for each item was predefined as ≥70% agreement or inclusion across four rounds, with content analysis for qualitative input. Items were further discussed and validated during the expert panel and analyzed by content analysis.Results65 initially generated items were included in the e-Delphi; 36 were added from qualitative input; consensus was reached on 100 of the 101 items. The expert panel confirmed these items, added five, and reprioritized personal load capacity and motivation. The validated framework comprises three interrelated phases: (a) knowledge gathering-assessing personal needs, load capacity, and environment; (b) goal setting-collaboratively formulating person-centered, realistic goals; and (c) acting-a task- and goal-oriented training targeting meaningful activities and daily life integration. Motivation plays a key role across all phases.ConclusionsThis evidence-based framework provides guidance for therapists to deliver person-centered arm-hand rehabilitation tailored to patients' needs.

ObjectiveTo examine to what extent the Bern Ambulatory Interprofessional Rehabilitation results in statistically significant and clinically meaningful changes in self-rated quality of and satisfaction with occupational performance, health-related quality of life, pain intensity, and burden of suffering of persons with chronic pain.DesignRegistry-based longitudinal cohort study.SettingDepartment of Rheumatology and Immunology at the Bern University Hospital, Switzerland.ParticipantsA total of 172 participants with chronic musculoskeletal pain.InterventionThe Bern Ambulatory Interprofessional Rehabilitation is a biopsychosocial intervention for persons with chronic pain.Main measuresCanadian Occupational Performance Measure, Pictorial Representation of Illness and Self Measure, European Quality of Life and Health Measure Visual Analogue Scale, and Visual Analogue Scale for pain intensity.ResultsChanges over time were statistically significant and clinically meaningful for quality of occupational performance (post-treatment p ≤ 0.001, 95% confidence interval (CI) [1.62-2.31], d = 0.8; follow-up p ≤ 0.001, 95% CI [1.23-2.20], d = 0.70), satisfaction with occupational performance (post-treatment p ≤ 0.001, 95% CI [2.35-3.22], d = 0.95; follow-up p ≤ 0.001, 95% CI [1.95-3.14], d = 0.87), burden of suffering (post-treatment p ≤ 0.001, 95% CI [0.25 to -0.42], d = 0.61; follow-up p ≤ 0.001, 95% CI [0.20-0.40], d = 0.55), and health-related quality of life (post-treatment p ≤ 0.001, 95% CI [6.30-15.66], d = 0.43; follow-up p ≤ 0.001, 95% CI [3.08-15.28], d = 0.36). Changes for pain intensity were not statistically significant nor clinically meaningful (post-treatment p = 0.676, 95% CI [-3.85 to 5.45], d = 0.03; follow-up p = 0.243, 95% CI [-8.91 to 1.72], d = -0.09).ConclusionsThis study confirms the short- and mid-term effectiveness of the Bern Ambulatory Interprofessional Rehabilitation on occupational performance, burden of suffering, and health-related quality of life of persons with chronic pain.

ObjectiveThis study aimed to examine the test-retest reliability and responsiveness of the Self-Regulation Assessment, a recently developed patient-reported outcome measure designed to evaluate self-regulation in a multi-diagnostic rehabilitation population.DesignA prospective cohort study following COSMIN guidelines. Participants completed the Self-Regulation Assessment and other measurements at start of rehabilitation (T0), 6 months later (T1), and 2 weeks after T1 (T2). Test-retest reliability (T1-T2) was quantified by intraclass correlation coefficient values, Bland-Altman plots, and the smallest detectable change. Responsiveness (T0-T1) was quantified by hypothesis testing, effect size, area under the curve, and minimal important change based on the anchor Global Rating of Change scale of self-regulation.Setting and participantsInpatients and outpatients of 14 Dutch rehabilitation institutions with various diagnosis.Main measureThe Self-Regulation Assessment.ResultsIn total, 555 patients completed the Self-Regulation Assessment at T0 and T1 and 167 patients at T1 and T2. In inpatients and outpatients, the Self-Regulation Assessment showed adequate to good reliability, with smallest detectable changes ranging from 16.0 to 22.9 points at individual level and 1.5 to 3.3 at group level for outpatients and inpatients, respectively. Significant changes (T0-T1) were observed in both groups, with a small effect size for inpatients and large for outpatients. Hypothesis testing indicated near sufficient responsiveness in both groups (67% confirmed). Minimal important change values ranged from 6.25 to 9.8 points for outpatients.ConclusionThe Self-Regulation Assessment demonstrated sufficient reliability and detected changes at group level, but was not suitable for detecting changes at individual level in outpatient rehabilitation.

ObjectiveTo evaluate the long-term effects of a structured, home-based, video-guided exercise programme on disability, health-related quality of life, fear of movement, and depressive symptoms after lumbar spine surgery.DesignQuasi-randomized controlled trial.SettingSingle university-affiliated spine centre in Japan.ParticipantsOne hundred ninety-six patients (mean age 70 years, 62% male) who underwent posterior decompression surgery for lumbar disc herniation or spinal canal stenosis. Of these, 168 patients (84 per group) completed the 24-month follow-up.InterventionParticipants were assigned by hospital registration number to a video-guided exercise group (n = 103) or a control group (n = 93). The intervention group performed a 15-min daily home exercise routine for 2 years. The control group received standard post-operative care.Main measuresPrimary outcomes were disability (Oswestry disability index), fear of movement (Tampa Scale for Kinesiophobia), and Physical Function and General Health (36-Item Short Form Survey). Secondary outcomes included depressive symptoms (Zung Self-Rating Depression Scale) and pain (10-cm Visual Analogue Scale). Assessments occurred pre-operatively and at 1, 3, 6, 12, and 24 months. Longitudinal analysis used mixed-effects models.ResultsThe intervention group had significantly lower disability and fear of movement scores throughout (p < 0.05). Physical Function and General Health were higher, and depressive symptoms were significantly lower at 1, 6, and 12 months. Pain did not differ at 12 or 24 months.ConclusionsA home-based video-guided exercise programme improved long-term physical and psychological outcomes after lumbar spine surgery. This low-cost, scalable method may enhance standard rehabilitation.