Clinical Rehabilitation最新文献

Objective: To identify literature on aquatic exercise therapy used to manage upper extremity musculoskeletal disorders and identify key concepts, intervention components, and gaps in the evidence base.

Data sources: The comprehensive search included MEDLINE (Ovid), CINAHL (EBSCOHost), Embase (Ovid), CENTRAL (Cochrane Central Register of Controlled Trials) databases and grey literature sources.

Review methods: JBI Scoping review methodology guided this review through protocol development, searching, screening, data extraction and analysis. Study Selection included: Participants - Adults with upper extremity musculoskeletal disorders; Concept - Aquatic based exercise therapy; Context - any setting in any very highly developed nation.

Results: The search identified 5045 sources with 68 studies included in the final synthesis. Findings outlined shoulder problems were the most reported upper extremity condition treated (n = 78) especially following rotator cuff repair (n = 17), followed by the hand and wrist (n = 9), and elbow (n = 6). Range of movement (n = 36) and resistance exercises (n = 17) were the most common interventions reported for aquatic therapy, however compliance with reporting guidance across included studies was poor. Sixteen health domains were identified with range of movement (n = 21) and pain (n = 20) the most common, and 62 outcome measures were reported related to the identified domains. Qualitative aspects of aquatic interventions were evaluated in two papers.

Conclusion: There is a need for more primary experimental and qualitative studies related to the upper extremity and aquatic therapy. Improved reporting quality of aquatic therapy exercise intervention is required as is the need to establish specific core outcome sets and domains in this area.

Objective: The Take Charge intervention, delivered early after hospital discharge following acute stroke, is effective at improving 12-month health status, independence and advanced activities of daily living. This study aims to provide a deeper understanding of the experiences of receiving Take Charge.

Design: This was a qualitative study nested within a large randomised control trial, the Taking Charge After Stroke (TaCAS) study. Data were analysed using thematic analysis, and we describe our findings using interpretive description.

Participants: People with stroke aged over 18 years, who were participants in the TaCAS study conducted in Aotearoa New Zealand.

Intervention: Take Charge, a person-centred conversation delivered face-to-face, designed to explore a person's identity and priorities, conducted by a trained facilitator and guided by a workbook.

Results: We interviewed nine participants, three from each of the three arms of the TaCAS trial - each would have received one, two, or zero Take Charge sessions (the control group). The overall theme of 'Doing things my way/coming to know my own wisdom and expertise' was enabled by 'being listened to and feeling heard' and 'focusing on the goals which were important to me', both strongly expressed by people who received the Take Charge intervention, and hindered by 'medical paternalism' and 'loss of sense of self/"not me"' most commonly expressed by people in the control arm.

Conclusions: The Take Charge intervention empowers people with stroke by enhancing intrinsic motivation. A trusting, therapeutic relationship and non-judgemental facilitation are essential to ensure that the person feels heard.

Objective: Conditions that could benefit from rehabilitation contribute to 310 million years of life lived with disability. Internationally rehabilitation could be part of the solution to the growing global disease burden. This register based study wanted to explore differences in patterns of rehabilitation among patients discharged from the hospital with a rehabilitation plan, explore rehabilitation initiation, and assess the activation of rehabilitation plans within legal requirements.

Setting: The study was conducted at Odense University Hospital in the Region of Southern Denmark.

Participants: The study investigated acute contacts by utilising rehabilitation referrals, demographic and municipal data from Odense Municipality residents from 2015 to 2020.

Main measures: Descriptive statistics, logistic regressions, cox regression and cumulative incidence rate were used to explore rehabilitation the activation of rehabilitation plans.

Results: The cohort consisted of 225,653 hospital contacts. Overall, 10,327 (5%) received a rehabilitation plan. Contacts were more often female or had increased co-morbidity. Prescription increased with age and for ethnical Danes. Initiation of prescribed plans increased within the first weeks, levelling from 30 to 60 days. Delayed initiation of the rehabilitation plan beyond 30 days raised the likelihood of non-initiating altogether.

Conclusions: Although evidence acknowledges the benefits of rehabilitation, this study showed that more than 25% of all referred municipality rehabilitation plans were never initiated. If the initiation of a rehabilitation plan was delayed beyond 30 days, it significantly reduced the likelihood of initiation. Therefore, the international community need to keep focus on early rehabilitation and increase the use of rehabilitation in the future.

Objectives: To investigate the efficacy of adding radial extracorporeal shockwave therapy or sham to exercise for people with insertional Achilles tendinopathy.

Design: A two-armed, parallel-group, explanatory, single-centre, randomised controlled trial within a superiority framework.

Setting: Private clinic.

Participants: People diagnosed with insertional Achilles tendinopathy who were over 18 years old with a symptom duration of greater than 3 months.

Intervention: A total of 76 people were randomly assigned (one-to-one ratio) to receive three sessions of radial extracorporeal shockwave therapy or sham to the affected side (or most affected side if bilateral). All participants received identical education and exercise.

Outcome measures: The primary outcome was the Victorian Institute of Sports Assessment - Achilles questionnaire. Measures were recorded at baseline, 6 weeks and 12 weeks.

Results: At 12 weeks, the questionnaire data were available for 37 people (96%) in the radial extracorporeal shockwave therapy group and 36 people (95%) in the sham group. For the primary outcome, we found no evidence for between-group differences at 6 (3, 95% confidence interval -4.6-10.5) or 12 weeks (4.6, 95% confidence interval -2.5-11.6). There was also no evidence for a between-group difference for any secondary outcome measures at either 6 or 12 weeks (p > .05). No serious adverse events were reported.

Conclusion: The addition of radial extracorporeal shockwave therapy to exercise and education did not lead to improvements in pain, function or other outcomes compared to sham at 6 or 12 weeks among people with insertional Achilles tendinopathy.ANZCTR Reg No: ACTRN12620000035921.

Objective: To identify the challenges and key learning and development needs of First Contact Physiotherapists (FCPs) providing fitness for work and sickness absence certification from Occupational Health physiotherpists' viewpoints.

Design: An online modified version of the Nominal Group Technique.

Participants: A convenience sample of 21 expert occupational health physiotherapists as participants whose substantive job role was within a public or private UK based occupational health provider.

Main measure: Consensus on each competency was defined a priori as an agreement of more than 60%.

Results: Nine items ultimately reached the required 60% threshold consensus level from the Occupational Health expert group for Question 1 on the challenges involved in providing fitness for work and sickness absence certification. Of these items, five reached full consensus; two of which ('Time' and 'Lack of knowledge') were deemed the most important items. For Question 2 on the learning and development needs, six items reached full consensus from the group (100% of participants that ranked an item) and two of these items ('Work conversations' and 'Training in Occupational Health topics') both reached full consensus from the group and were deemed the most important items.

Conclusion: Most employees in the UK do not have access to Occupational Health services. Fit Notes can be an important vehicle to provide work-related, fitness for work and sickness absence advice to help prevent long-term sickness absence. This study provides insights into some barriers and educational development needs of FCPs in primary care, as judged by an expert Occupational Health physiotherapy group.

Objective: The purpose of this study was to clarify the concept of engagement in rehabilitation by analyzing its application in both theoretical and empirical literature.

Data sources: PubMed, Web of Science, CINAHL, Embase, and Scopus were searched for relevant studies published from January 1, 2003 to July 14, 2024.

Review methods: A literature-based concept analysis was carried out using Rogers' six-step evolutionary concept analysis method. Literature screening and data extraction were conducted separately by two researchers according to predetermined inclusion and exclusion criteria. The basic information and the relevant primary data of the included studies were extracted in detail.

Results: In total, 41 studies were included and analyzed. The antecedents included demographic factors, physical health, psychological and emotional factors, cognitive factors, behavioral factors, socio-cultural factors, environmental factors, and rehabilitation programs. The attributes contained collaborative therapeutic relationships, continual commitment and investment, a dynamic process and state, and goal-oriented. The consequences included multidisciplinary collaborations, communication, functional recovery, future independent exercise, and mental health.

Conclusion: This study clarified the concept of engagement in rehabilitation and identified antecedents, attributes, and consequences of the concept. Further research is required to investigate and apply this concept to specific populations and settings.

Objective: Fear of movement in patients with traumatic hand-arm injuries can negatively affect functional outcomes. Therefore, it is important to evaluate fear of movement in this patient population. The aim of this study was to investigate the validity and reliability of the Tampa Scale for Kinesiophobia in patients with traumatic hand-forearm injuries.

Design: Cross-sectional.

Setting: Hand rehabilitation unit in a university hospital.

Participants: The study included 170 patients with traumatic hand-arm injuries and a mean age of 37.57 (11.85) years.

Main measures: Tampa Scale for Kinesiophobia, Pain Catastrophizing Scale, Beck Anxiety Inventory and pain severity rating (via Visual Analog Scale) were completed by interview in the first session. In addition, Modified Hand Injury Scoring System was used to determine severity of the injury. Tampa Scale for Kinesiophobia was re-administered 15 days after the first session. Test-retest reliability, internal consistency, and construct validity of the Tampa Scale for Kinesiophobia were evaluated. In addition, exploratory factor analysis was completed using baseline data.

Results: Cronbach's alpha for the scale was 0.604, and test-retest reliability was acceptable (ICC = 0.646). Tampa Scale for Kinesiophobia had a significant relationship with Beck Anxiety Inventory (r = 0.269, p < 0.001), Pain Catastrophizing Scale (r = 0.457, p < 0.001) and pain severity at rest (r = 0.168, p = 0.029). Factor analysis estimated the scale represented five subsections in this population.

Conclusions: Psychometric properties of the Tampa Scale for Kinesiophobia were acceptable in patients with hand-forearm injuries. However, since our results were weaker than those in the literature, this should be considered when interpreting the results.

Objective: To investigate the cost-effectiveness of a cardiac rehabilitation program in individuals with stroke compared with customary care.

Design: A Markov model was created using a 30-year time horizon, with cycle lengths of 1 year to determine the effectiveness and cost-effectiveness of a cardiac rehabilitation program in persons with stroke. Input parameters were based on recently published literature. Health states were defined as degree of disability evaluated by the modified Rankin scale score. Costs were based on recent cost-effectiveness analyses and inflated to 2024 US Dollars using the medical care component of the US Consumer Price Index.

Setting: Outpatient ambulatory setting.

Participants: Persons with mild disability after ischemic stroke.

Intervention: A model comparing cardiac rehabilitation versus usual care was created.

Main measures: Quality-adjusted life years (QALYs) were used to measure the effectiveness of cardiac rehabilitation versus usual care. The cost-effectiveness of cardiac rehabilitation versus usual care was compared with respect to incremental costs, incremental effectiveness, and incremental cost-effectiveness ratios (ICERs).

Results: Cardiac rehabilitation was the superior strategy, resulting in higher incremental effectiveness of 3.28 QALY at an increased incremental cost of $5704. The ICER was $1740/QALY. A two-way sensitivity analysis of these variables had no change, with cardiac rehab remaining the optimal strategy.

Conclusions: While numerous studies and systematic analyses have reported compelling evidence of the clinical benefits of cardiac rehabilitation for patients with stroke, the current study contributes to the existing body of literature, demonstrating that cardiac rehabilitation is also cost-effective in the stroke population.

Objective: To evaluate the reliability, identify the optimal cut-off points, and determine the diagnostic accuracy of the TULIA Apraxia test in a sample of Spanish-speaking post-stroke patients.

Design: Cross-sectional.

Setting: Public primary care.

Participants: 201 post-stroke patients.

Main measures: Reliability was assessed using Cronbach's alpha. Cut-off points were identified for each TULIA Apraxia sub-test and stratified for age (≤65 years, > 65 years) using ROC curve analysis, area under the curve, and Youden index. Diagnostic accuracy was evaluated using sensitivity, specificity, and predictive values.

Results: Cronbach's alpha of the sub-tests varied from 0.716 (95% CI 0.653-0.772) for pantomime intransitive to 0.824 (95% CI 0.784-0.858) for imitation non-symbolic. Cut-off points ranged from ≤25 to ≤35 points. For individuals aged ≤65 years, the cut-offs that best balanced sensitivity and specificity were ≤25 points for detecting alterations in imitation transitive and ≤33 points for pantomime non-symbolic. For individuals over 65 years, the imitation transitive cut-off (≤26 points) presented the most adjusted balance. The minimum positive predictive value was 0.667 (95% CI 0.542-0.777), indicating that the TULIA Apraxia tests correctly classified more than 67% of patients with apraxia. The minimum negative predictive value was 0.763 (95% CI 0.644-0.859), showing that the test accurately identified more than 76% of patients without apraxia.

Conclusions: The TULIA Apraxia test is reliable in Spanish-speaking post-stroke patients. Optimal cut-off points, along with their respective sensitivity and specificity values, exhibit adequate test accuracy. Predictive values indicate that the test correctly identifies individuals with and without apraxia.

Objective: Non-traumatic musculoskeletal shoulder disorders are common. Their treatment, surgical or non-surgical, is associated with a considerable financial burden to health systems. The aim of this study was therefore to investigate the cost-effectiveness of surgical or rehabilitative treatments in this population.

Data sources: PubMed, Embase, NHS Economic Evaluation Database, Cost-Effectiveness Analysis registry, PEDro Database, Cochrane Library, and Google Scholar.

Review methods: Trial-based economic evaluations assessing nonoperative and/or operative interventions for the management of non-traumatic shoulder disorders, published from January 2000 to October 2024, were searched. The selection process, data extraction and quality assessment (carried out with the Quality of Health Economic Studies instrument) were independently conducted by two reviewers.

Results: Four studies (883 patients) were included in the review. Subacromial decompression for rotator cuff-related shoulder pain was found not to be cost-effective when compared with physiotherapy. Although it was not as cost-effective, Physiotherapy could be a socially beneficial alternative to mobilisation under anaesthesia in the early management of a frozen shoulder, due to lower costs and the delays in accessing surgical management in the pain-predominant phase. Productivity loss was the main driver of costs. It was not possible to determine the cost-effectiveness of other shoulder-related disorders due to sparsity of evidence.

Conclusion: Priority should be given to interventions that reduce productivity loss and facilitate patients' return to work as soon as possible. There is a definite need for multiplication and standardization of high-quality economic studies (and the trials they are based on) regarding the management of non-traumatic musculoskeletal shoulder disorders.