Clinical Rehabilitation最新文献

Objective: Handgrip dynamometry is recognised as a method for evaluating volitional muscle strength in the intensive care, but conventional handgrip dynamometers cannot accurately measure grip strength in very weak patients. The aim of this study was to determine the reliability, validity and usability of the K-force^® grip in patients with intensive care unit-acquired weakness.

Design: Evaluation of measurement properties of the K-force^® grip.

Setting: Two Intensive Care Units in The Netherlands.

Participants: Patients diagnosed with intensive care unit-acquired weakness according to a Medical Research Council sum score <48.

Intervention & main measures: Intra- and inter-rater reliability of the K-force^® grip were assessed using the intraclass correlation coefficient. Concurrent validity was examined using calibration weights. The usability was evaluated with the System Usability Scale.

Results: Intra-rater reliability showed an intraclass correlation coefficient of 0.987 for the dominant hand and 0.972 for the non-dominant hand. Inter-rater reliability showed coefficients of 0.944 for the dominant hand and 0.942 for the non-dominant hand. There was a perfect correlation (r = 1) between the K-force® grip and the calibration weights. The usability of the K-force® grip was rated excellent by 11 healthcare professionals with a System Usability Scale score of 86.

Conclusions: The K-force^® grip is a promising new tool for the evaluation of muscle strength in intensive care unit-acquired weakness patients who are too weak to use conventional hand dynamometers.

Objective: To evaluate the psychometric properties of the modified Oswestry Disability Index in adolescents with low back pain through Rasch analysis.

Design: This is a psychometric study.

Setting: Physical therapy clinics of a large pediatric hospital in Columbus, Ohio (United States).

Subjects: Two hundred adolescent patients with low back pain (112 female, 15.4 ± 1.9 years old).

Main measure: The modified Oswestry Disability Index.

Results: The mean modified Oswestry Disability Index score was 17.1 ± 12.1, with scores ranging from 0 to 56 on the 100-point scale. The Rasch person reliability for the Oswestry Disability Index was 0.70, representing minimal acceptable person reliability. The Oswestry Disability Index demonstrated poor item spacing, hierarchy, and targeting of the adolescents' disability level (>1 logit between person mean and item mean). A significant misfit was observed in three of 10 items. There were significant issues with the functioning of responses on all items of the Oswestry Disability Index. Principal component analysis of residuals revealed a ratio of 5.3:1, demonstrating acceptable unidimensionality.

Conclusion: Due to multiple psychometric issues, the Oswestry Disability should not be used to assess disability in adolescents with low back pain. The Oswestry Disability Index significantly mistargets adolescent ability and only provides an acceptable assessment of the most disabled adolescents.

Objective: Benign Paroxysmal Positional Vertigo is a vestibular disorder causing vertigo and imbalance. This systematic review and meta-analysis aims to explore the impact of benign paroxysmal positioning vertigo and repositioning maneuvers on postural control.

Data sources: In September 2024, PubMed, Web of Science, Scopus and reference lists of included studies were systematically searched. Articles comparing measures of postural control between patients and controls, and/or pre- and posttreatment were considered relevant.

Methods: Study selection, data extraction and identification of risk of bias were done by two researchers. If possible, meta-analysis was performed with Review Manager version 5.4.1 and standardized mean differences were calculated with a random-effects model.

Results: Twenty-one of the 37 included studies were useful for meta-analyses. Meta-analyses revealed that benign paroxysmal positional vertigo negatively affects perception of verticality (p < .001; SMD = 0.73; 95% CI = [0.39;1.08]) and sensory orientation (p < .001; SMD = -1.66; 95% CI = [-2.08, -1.23]). The perception of verticality (p < .001; SMD = 0.99; 95% CI = [0.76;1.21]) and sensory orientation (p < .001; SMD = -0.77; 95% CI = [-1.11, -0.44]) improved after treatment with repositioning maneuvers. Results of systematic review indicate stability in gait was impaired, vertigo but improve after repositioning maneuvers. Limits of stability were impaired in older patients, but did not improved after repositioning maneuvers.

Conclusion: Benign paroxysmal positioning vertigo affects several underlying components of postural control. Repositioning maneuvers can significantly improve the related postural control impairments. This may partly explain the increased odds of falling in these patients, and the positive treatment effect of repositioning maneuvers on falls and fear of falling.

Objective: To describe the status of return to work and identify predictors of return to work among Chinese postoperative patients with colorectal cancer.

Design: A cross-sectional study.

Setting: Conducted in two tertiary hospitals in China.

Participants: A total of 210 postoperative patients with colorectal cancer were included in the study.

Main measures: Two hundred and ten postoperative patients with colorectal cancer who were working at the time of their diagnosis were assessed with the Perceived Social Support Scale, the Return-To-Work Self-Efficacy Questionnaire, Kessler Psychological Distress Scale, Cancer Fatigue Scale, and Social Impact Scale. Descriptive statistics, univariate logistic regression analysis, and multivariate logistic regression analysis were used for data analysis in SPSS 26.0.

Results: Around a third of participants (n = 74, 35.2%) returned to work after surgery. Multiple stepwise regression analysis indicated that more family income (odds ratio (OR) = 5.769, 95% confidence interval (CI) = 1.666-19.972), time span after surgery 5-10 months, and ≥10 months (OR = 3.546, 95% CI = 1.084-11.598; OR = 3.077, 95% CI = 1.074-8.818), with a stoma (OR = 0.221, 95% CI = 0.075-0.653), psychological distress (OR = 0.912, 95% CI = 0.843-0.987), cancer fatigue (OR = 0.924, 95% CI = 0.872-0.978), and stigma (OR = 0.928, 95% CI = 0.886-0.971) were significantly associated with return to work.

Conclusions: A high proportion of patients with colorectal cancer did not return to work within 1 year after diagnosis. Those with shorter postoperative time, lower family income, stoma, greater psychological stress, higher level of cancer fatigue, and more stigma may have a higher risk in delayed work resumption.

Objective: To evaluate efficacy, safety, and adherence to using adjustable compression wraps (ACWs) for upper limb volume control in women with breast cancer-related lymphedema.

Design and setting: Randomized controlled trial at a reference hospital for breast cancer treatment in Brazil.

Participants: Women in control phase of the breast cancer-related lymphedema.

Interventions: Compared use of ACWs versus compressive mesh.

Main measures: Evaluated before treatment, at 30 days, and 6 months after initiating therapy. The primary outcome was the change in excess limb volume. Secondary outcomes included adherence, incidence of adverse events, functionality, quality of life, and hand grip. Statistical analysis involved calculating the effect size (ES) with a 95% confidence interval.

Results: Were included 71 women with mean excess limb volume of 321.79 mL (±194.98). In the 30-day analysis (Time 1), a reduction of 37.6 mL in volume was observed only in the ACW group (p = .041, ES 0.20), with improved functionality (p = .013, ES 0.22). In the six months analysis (Time 2), the compressive mesh group increased by 2.48% in volume (p = .023, ES 0.26) and demonstrated improvement functionality (p = .036, ES 0.27). Mild adverse events and satisfactory adherence were observed. However, in the intergroup comparison, no statistically significant difference was observed for any evaluated outcome-excess volume, incidence of adverse events, adherence, hand grip, quality of life, and functionality between the groups (p > .05) at both times.

Conclusions: Both compression therapies achieved satisfactory adherence, were safe, effective and equivalent for controlling limb volume in breast cancer-related lymphedema.

Objective: To determine the effect of time waiting for admission to inpatient neurorehabilitation following acquired brain injury on rehabilitation outcomes.

Design: A retrospective observational case series.

Setting: A specialist brain injury inpatient rehabilitation service.

Subjects: Consecutive 235 admissions to specialist brain injury rehabilitation following acutely-acquired brain injury between 2019 and 2022.

Main measures: Waiting time from the point of injury to admission, diagnostic category, admission complexity (patient categorisation tool), functional status (functional independence measure/functional attainment measure), care needs (Northwick Park Care Needs Assessment), change in functional status and care needs over duration of admission (efficiency). Subgroup analysis was performed for patients with a tracheostomy, enteral feeding, anticonvulsant treatment and prior neurosurgery.

Results: There was no relationship between admission wait and initial complexity (r_s= 0.006; p = 0.923), functional status (r_s= -0.070; p = 0.284) or care needs (r_s= 0.019; p = 0.768). Longer waiting times were significantly associated with reduced efficiency of rehabilitation (r_s= -0.240; p = 0.0002) and change of care needs (r_s= -0.246; p = 0.0001). Longer waits were associated with reduced rehabilitation efficiency for patients prescribed anticonvulsants (n = 115; r_s= -0.243; p = 0.009), with a tracheostomy (n = 46; r_s= -0.362; p = 0.013), requiring enteral nutrition (n = 137; r_s= -0.237; p = 0.005) or having had intracranial surgery (n = 97; r_s= -0.344; p = 0.0006). There was a negative association between waiting times and reduction in care needs for patients admitted on anticonvulsants (r_s= -0.319; p = 0.0005) and requiring enteral nutrition (r_s= -0.269; p = 0.001).

Conclusion: Longer wait for transfer to rehabilitation following brain injury is associated with reduced improvement in functional status and care needs over time. Attention should be given to ensuring rapid transfer into inpatient rehabilitation services.

Objectives: To understand the nature and effectiveness of interventions aimed at improving informal stroke caregiver burden, stress, and strain.

Data sources: In line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search of CENTRAL, CINAHL, MEDLINE, Embase, APA PsycInfo, and Web of Science was conducted in May 2022.

Review methods: Studies were eligible if they included an intervention designed for informal stroke caregivers, reported on caregiver burden, strain, or stress, were published in English, and used a randomized controlled trial design. An updated search was conducted in June 2024. The methodological quality of studies was appraised using the Cochrane risk-of-bias tool for randomized trials. The data were pooled, and a meta-analysis was completed for caregiver burden and strain outcomes.

Results: Nineteen studies met inclusion criteria and were meta-analyzed. Interventions ranged from 4 days to 12 months. Most studies incorporated educational and/or support components. Meta-analyses revealed nonsignificant effects on caregiver burden or strain. Significant between-group differences for caregiver strain and burden were, however, found in seven studies.

Conclusion: Limited studies, small sample sizes, and conflicting results made definitive conclusions on the most effective intervention characteristics for improving caregiver outcomes difficult. Of the 19 studies, seven found significant between-group differences for caregiver outcomes postintervention, and these tended to incorporate educational components and comprised between seven and nine sessions. Further high-quality research is required to identify optimal format, duration, and frequency for improving caregiver outcomes.

Background: Physical activities performed under free-living conditions that are unsupervised in the home or community have the potential to modulate non-motor symptoms in people with Parkinson's disease.

Objective: This systematic review investigates the relationships between physical activities performed in free-living conditions and non-motor symptoms in people with Parkinson's disease: cognition, anxiety, apathy, depression, sleep disturbances, fatigue, and pain.

Data sources: A database search was performed on Scopus, Web of Science, Ovid (PsycINFO), CINAHL, PubMed, and ProQuest (Health and Medicine).

Review methods: Observational studies published from 2000 to 2024 that examined the relationships between physical activity and non-motor symptoms were included. The methodological quality of reports was evaluated using critical appraisal checklists appropriate to the study design. Where appropriate, a meta-analysis was conducted to combine data from the included articles.

Results: A total of 14 articles met the criteria and used various tools to evaluate non-motor symptoms and physical activity. Meta-analyses showed that people with Parkinson's who are more physically active have better global cognition [β ranged from 0.12 to 0.28; p = 0.00-0.02] and less affective disorders [β -0.20, p = 0.00]. Increased physical activity levels were also associated with better sleep quality (n = 1) and less chronic pain (n = 1). The overall methodological quality of the included articles was considered high.

Conclusion: Engagement in increased levels of physical activities performed under free-living conditions is associated with better cognition and less anxiety, apathy, and depression in people with Parkinson's disease.