Clinical Rehabilitation最新文献

ObjectiveTo explore the views of staff in hospital rehabilitation wards about factors influencing implementation of Exergames for older adults with mild to moderate frailty.DesignQualitative descriptive study.SettingThree rehabilitation and frailty wards across two NHS hospital settings in the North West of England.ParticipantsA purposive sample of 22 healthcare professionals was recruited to take part in the study.InterventionTherapy staff were instructed on how to use the Exergames with patients. Trained therapists, and other healthcare professionals, took part in a focus group or semi-structured interview to share perceived constraints to Exergames implementation. The research physiotherapist also reflected on each ward's response to the intervention, and the Exergames training sessions. Pre-implementation actions in the Quality Implementation Framework informed the topic guide and analysis. Data was analysed using the Framework approach.ResultsThree face-to-face focus groups and seven interviews (in-person or online) were conducted, and the research physiotherapist recorded 25 h of observations. Themes represented factors impacting Exergames use in a hospital environment. These included: competing priorities for staff availability and time; buy-in from key stakeholders; the user-friendly integration of the Exergames system; flexible training sessions and development of a feasible and effective delivery framework.ConclusionsThe dynamic nature of hospital wards, such as changes of staff and ward focus, and complexity of interactions within and between individual, ward and organisational levels, means effective Exergames implementation requires coordinated efforts and ongoing adaptability.

ObjectiveTo investigate the association between individualised rehabilitation dose levels and functional outcomes across age- and frailty-specific cohorts of critically ill patients.DesignMulticentre prospective observational cohort studySettingIntensive care units at 22 hospitals in Japan.ParticipantsOverall, 422 adult patients receiving mechanical ventilation for ≥48 h were categorised into old non-frail (age ≥65 years, clinical frailty scale: 1-4), old frail (age ≥65 years, clinical frailty scale: > 4) and middle-aged/young (age <65 years) cohorts.Main measuresThe primary outcome was independence in activity of daily living at hospital discharge, defined by a Barthel Index score of ≥90. Rehabilitation parameters dose, intensity, duration, frequency and timing were assessed. Multivariable logistic regression analysis was performed for each cohort.ResultsIn the old non-frail cohort, activity of daily living independence was associate with higher dose (odds ratio: 1.10, 95% confidence interval: [1.04-1.17]), higher intensity (odds ratio: 1.18 [1.02-1.37]) and shorter time to first mobilisation (odds ratio: 0.92 [0.86-0.98]), whereas, in the old frail cohort, it was higher dose (odds ratio: 1.07 [1.02-1.18]), longer duration (odds ratio: 1.05 [1.01-1.12]) and higher frequency (odds ratio: 1.82 [1.07-4.62]). In the middle-aged/young cohort, activity of daily living independence was associated with higher dose (odds ratio: 1.14 [1.05-1.28]) and higher intensity (1.30 [1.06-1.62]).ConclusionsThe impact of rehabilitation dose on functional recovery varies across age- and frailty-specific cohorts. These findings highlight the importance of tailoring rehabilitation dose to patient characteristics to optimise functional outcomes in critical illness.Trial registration: UMIN000036503.

ObjectiveTo adapt the Outpatient Physical Therapy Improvement in Movement Assessment Log questionnaire into Turkish and to evaluate its cultural adaptation, validity, and reliability.DesignA cross-sectional study involving cross-cultural adaptation and psychometric validation.SettingOutpatient physiotherapy clinics at a university hospital in Turkey.Participants272 adult patients receiving outpatient physiotherapy.InterventionParticipants completed the Turkish version of the scale, along with the Tampa Kinesiophobia Scale, Katz Activities of Daily Living Scale, and the International Physical Activity Questionnaire-Short Form. A subgroup of 84 participants completed the questionnaire again after two weeks to assess test-retest reliability.Main measuresContent validity was assessed using the Davis technique; structural validity was examined using exploratory factor analysis and confirmed using confirmatory factor analysis. Internal consistency was determined using Cronbach's alpha coefficient; test-retest reliability was evaluated using the intraclass correlation coefficient; and parallel-forms reliability was assessed.ResultsThe Content Validity Index of the scale was 0.92. Confirmatory factor analysis fit indices for the three-factor structure were acceptable: chi-square/degrees of freedom = 1.672; root mean square error of approximation = 0.047; comparative fit index = 0.953; Tucker-Lewis index = 0.945. Cronbach's alpha was .859, and the intraclass correlation coefficient was 0.856, indicating high internal consistency and reliability.ConclusionsThe Turkish version of the scale is a culturally adapted, valid, and reliable tool for assessing movement-related confidence in adult outpatients receiving physiotherapy. It can guide clinical decisions and support patient-centered rehabilitation.

ObjectiveTo compare balance-confidence among patients with primary open-angle glaucoma, age-related macular degeneration, and controls in Brazil.DesignCase-control study.SettingCharity hospital in São Paulo, Brazil.ParticipantsPatients with glaucoma, age-related macular degeneration, and controls without eye diseases.Main outcomes measuresActivities-specific Balance Confidence (ABC) Scale scores.ResultsThe sample consisted of 64 patients with glaucoma, 60 with age-related macular degeneration, and 60 controls. All groups were matched by age, gender, ethnic distribution, and comorbidities. The ABC Scale score was 63.1 (25.9) in the glaucoma group, 69.5 (16.4) in the age-related macular degeneration group, and 95.3 (9.1) for the controls (P < 0.001; Hedges' g -1.65 and -1.93, large effect size); glaucoma patients score did not differ from age-related macular degeneration patients (P = 0.132; Hedges' g 0.30, small effect size).ConclusionBoth glaucoma and age-related macular degeneration patients reported lower balance-confidence in performing daily activities without losing balance as compared to controls.

ObjectiveAustria's rehabilitation system lacked personalisation, alignment with the International Classification of Functioning, Disability, and Health (ICF), and measurable quality indicators. To address these gaps, a unified change management approach aligned with international standards and the biopsychosocial model was developed. The resulting Comprehensive Framework for Rehabilitation Standards, Practices, and Services aimed to establish a patient-centred, evidence-informed model integrating policy, quality, and practice.Local contextRehabilitation in Austria is provided by social insurance institutions, including the Pension Insurance Austria, which defines medical and therapeutic specifications for rehabilitation services. Historically, these were disease-centred, heterogeneous, and lacked individualisation.MethodsThe development followed a co-creation process involving focus groups with interdisciplinary staff from rehabilitation centres. Implementation in 17 centres across Austria required process and information technology adaptations as well as capacity building. Thirteen key performance indicators were established for monitoring, evaluation, and benchmarking.ResultsAfter three quarters of implementation, all centres adhered to six key performance indicators, including staff and patient satisfaction, functional status assessment, quality of life screening, work-related rehabilitation needs, and follow-up rehabilitation referrals. Challenges included consistent ICF application, individual goal-setting, and therapy planning tailored to impairment severity. Implementation problems mirrored those reported internationally. Strong leadership, interdisciplinary collaboration, and early information technology engagement were key enablers.ConclusionThe framework operationalised international rehabilitation standards into a scalable national model. Its ICF-based design demonstrated that large-scale, patient-centred, participation-oriented rehabilitation is achievable through structured change management. Future evaluations should assess long-term outcomes and adaptability across health systems with varying digital maturity.

ObjectiveIn this mixed-methods study, we aimed to develop a self-management education module within the ChestCare mHealth app, thus enabling patients with chronic obstructive pulmonary disease to self-manage their condition and empower healthy behaviours.DesignWe integrated the results of sequential focus group discussions and content validity evaluation to decide the topics. We then utilized the multimedia learning theory, the Lung Foundation Australia Guidelines, and consolidated theories of mHealth development to design the education module. Consequently, we used artificial intelligence-augmented platforms to develop the multimedia educational tools.SettingOutpatient physiotherapy department in a Malaysian public hospital.ParticipantsPhysiotherapists and patients with chronic obstructive pulmonary disease engaged in sequential focus group discussions to share their perspectives on the proposed educational topics. Then, nine experts, three in physiotherapy, clinical psychology, and dietetics, evaluated the content validity of the education module.InterventionSelf-management education module to empower patients with chronic obstructive pulmonary disease.Main measuresthe development of a validated self-management education module that aims to improve treatment outcomes and address rehabilitation challenges.ResultsThe sequential discussions resulted in modifications and refinements of the proposed topics, ultimately identifying 12 education topics. The content validity calculations for the three educational clusters resulted in a score of 1. We developed flipbooks, education cards, and videos, along with auditory recitation, using theoretical design and creative development.ConclusionsWe created 12 flipbooks, education cards, and videos that serve as self-management education embedded in mHealth, with the next step to evaluate their usability and feasibility in clinical practice.

ObjectiveTo evaluate the efficacy and safety of blood flow restriction (BFR) training on exercise capacity, muscle strength, pulmonary function, and fatigue in individuals with chronic obstructive pulmonary disease (COPD).MethodsA comprehensive search was conducted in six databases up to April 2025. Randomized controlled trials involving adults with COPD undergoing BFR training were included. Methodological quality was assessed using the Cochrane Risk of Bias 2 tool, and the certainty of evidence was graded according to Grading of Recommendations Assessment, Development and Evaluation guidelines.ResultsOf 573 records identified, three randomized clinical trials with a total of 127 participants met the inclusion criteria. Intervention durations ranged from 2 to 24 weeks with varying occlusion pressures and outcome measures. Meta-analysis showed no significant improvements in six-minute walk distance (mean difference: 20.83; 95% CI [-14.97 to 56.63]; very low certainty), or muscle strength (SMD: 0.78; 95% CI [-0.66 to 2.22]; very low certainty). A significant reduction in fatigue was observed (SMD: -0.48; 95% CI [-0.92 to -0.04]; very low certainty). Overall, the quality of evidence was rated very low.ConclusionCurrent evidence is insufficient to draw firm conclusions regarding the efficacy and safety of BFR training in COPD. Further high-quality, standardized RCTs are necessary to clarify its clinical utility and safety.

ObjectiveThis study estimated the prevalence of facial palsy after stroke and identified risk factors; examined recovery patterns; and evaluated the effect of hyperacute treatments on its recovery.Design and settingThis was a secondary analysis of data prospectively collected in the first 7 days of stroke admission for the Bergen NORSTROKE study.ParticipantsOf 5987 patients, a subgroup of 2293 with facial palsy were analysed for recovery, including 1954 with ischaemic stroke assessed for treatment effect.Main measurementsFacial palsy was assessed repeatedly at irregular intervals from admission using the National Institute of Health Stroke Scale.AnalysisPrevalence was summarised descriptively, and multifactorial logistic regression identified risk factors. The recovery was analysed with Kaplan-Meier curves and Cox models.ResultsFacial palsy was observed in 2578 patients (43%), including 2406 (40%) with minor or partial paralysis and 172 (3%) with complete paralysis. Facial palsy was more common in haemorrhagic (360, 54%) than ischaemic stroke (2218, 42%), reflecting greater motor impairment. Among patients without motor impairment, prevalence was lower in haemorrhagic strokes (15, 10%) than in ischaemic strokes (284, 14%). Risk factors included sex, age, and the degree of motor and sensory deficit. By day 2, 573 patients (25%) had fully recovered, while 1434 (63%) still had symptoms by day 7. Worse recovery was associated with more severe motor and sensory impairments. Intravenous thrombolysis was associated with better recovery.ConclusionsOur study provides a comprehensive analysis of post-stroke facial palsy, highlighting recovery patterns and the need for ongoing monitoring and rehabilitation.

ObjectiveTrismus is a common and debilitating complication following head and neck cancer treatment, with significant consequences for quality of life, nutrition and oral function. Although several rehabilitation strategies have been proposed, their design and effectiveness remain poorly systematized. This review aimed to summarize evidence from randomized controlled trials on rehabilitation interventions for treatment-induced trismus in HNC.Data sourcesA scoping review was performed using PubMed, PEDro, Web of Science, Scopus and EMBASE, covering publications up to May 2025.Review methodsWe included randomized controlled trials in English or Spanish evaluating any rehabilitation intervention in adults with trismus following HNC treatment. One author conducted the search, and two authors independently screened articles for inclusion.ResultsFrom 2215 records identified, 25 randomized controlled trials met the inclusion criteria. Twelve investigated preventions during or shortly after cancer treatment, while 13 addressed established trismus. Most interventions were based on exercise therapy, delivered in hospitals, private clinics or at home. Only a minority incorporated manual therapy or physical agents. Devices such as TheraBite or JawTrainer were evaluated in several studies. While most trials reported improvements in maximal mouth opening, few assessed condition-specific patient-reported outcomes. Rehabilitation interventions were predominantly implemented by physiotherapists.ConclusionExercise therapy, often combined with devices, is the most frequently studied approach for treatment-induced trismus. Evidence for manual therapy and physical modalities remains limited. Considerable heterogeneity across studies hinders comparison and replication, underlining the need for standardized protocols and outcomes in future trials.