Clinical Rehabilitation最新文献

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.

ObjectiveThis study aimed to investigate the effects of high-intensity interval training (HIIT) versus different types of exercise or no exercise on peak oxygen consumption, muscle strength, health-related quality of life, and cardiometabolic risk factors in people with type 2 diabetes mellitus.Data SourcesWe searched in EMBASE, PubMed, Cochrane Central, Physiotherapy Evidence Database (PEDro), and SciELO for randomized controlled trials assessing the impact of HIIT in people with type 2 diabetes mellitus.Review MethodsStudy quality was evaluated using the PEDro scale, and certainty of evidence. We calculated mean differences, standardized mean difference and 95% confidence intervals.ResultsSixty-two studies (2204 participants) were included. Compared to control, HIIT increased peak oxygen consumption by 4.56 mL·kg^-1·min^-1 (95% confidence interval 3.54 to 5.58) and reduced glycosylated hemoglobin by 0.70% (95% confidence interval -0.88 to -0.51). Improvements were also observed in insulin resistance, systolic and diastolic blood pressure, lipid profile, body mass index, and fat mass. When compared with moderate-intensity continuous training, HIIT improved peak oxygen consumption (1.30 mL·kg^-1·min^-1; 95% confidence interval 0.28 to 2.43) and glycosylated hemoglobin (-0.12%; 95% confidence interval -0.24 to -0.01).ConclusionsHigh-intensity interval training improves peak oxygen consumption, glycosylated hemoglobin, insulin resistance, and various cardiometabolic risk factors in people with type 2 diabetes mellitus.

ObjectiveTo summarise the evidence for changes in physical activity outcomes during robot-assisted gait training in patients with spinal cord injury.Data sourcesThe Web of Science, Physiotherapy Evidence Database, Central, Medline, Scopus and SportDiscus databases were searched in August 2025 for studies that recorded ≥1 physical activity outcome during robot-assisted gait training.Review methodsData were synthesised according to the Synthesis Without Meta-analysis guidelines. Risk of bias was assessed using the Physiotherapy Evidence Database scale or the Revised Risk of Bias Assessment Tool for Non-Randomised Studies. Certainty of evidence was established following the Grading of Recommendations, Assessment, Development and Evaluations framework. The report followed the Preferring Reporting Items for Systematic Reviews and Meta-Analyses guidelines.ResultsThirty studies (638 participants) were eligible for inclusion. Quality of the randomised studies ranged from 'Fair' to 'Good', while there was high risk of bias for all non-randomised studies in ≥1 domain. Robot-assisted gait training significantly improved physical activity outcomes (up time, walk time, walk distance, walk speed and number of steps) over time, though these findings were constrained by very low certainty of evidence.ConclusionUp time, walk time, walk distance, walk speed, and number of steps were significantly improved across the robot-assisted gait training period for patients with spinal cord injury. Robot-assisted gait training during rehabilitation for people following spinal cord injury is a useful adjunct to support independence and improved walking ability.

ObjectiveTo generate a clinical roadmap for managing lateropulsion after supratentorial stroke which integrates theory and practice using a realist review strategy.Data SourcesMedline Complete, CINAHL Complete, PEDro, Academic Search Complete, Health and Psychosocial Instruments, Health Source: Nursing/Academic Edition, and Embase were searched until December 2025.Review MethodsTwo searches included review and non-review articles about people with contralesional lateropulsion after supratentorial stroke. We excluded articles about people with ipsilesional lateropulsion resulting from brainstem or cerebellar stroke and non-English articles. Guided by Realist and Meta-narrative Evidence Syntheses: Evolving Standards, pairs of authors independently screened titles and abstracts, determining final lists by consensus. Pairs of authors independently extracted data, ranked levels of evidence, and collaborated to synthesise findings following the context-mechanism-outcome configuration of realist reviews. All authors used this foundation to generate the Lateropulsion Clinical Roadmap and clinical recommendations.ResultsThe review article search yielded four systematic reviews and one scoping review (of 19 screened). The non-review article search yielded 39 articles (of 167 screened), categorised as neuroimaging, epidemiology, assessment and intervention. Clinical recommendations and a Lateropulsion Clinical Roadmap integrated this information.ConclusionA Lateropulsion Clinical Roadmap integrated theory with neuroimaging, epidemiology, assessment and interventions based upon a realist review. Thorough assessment of severity of lateropulsion and neurological impairments should guide clinical decisions about how to leverage sensorimotor systems while considering task difficulty and environment during interventions for lateropulsion. A new hypothesis linking patient presentation with interventions directed at improving sensorimotor performance of the paretic extremities requires further study.

ObjectiveTo explore the perceptions and experiences of stroke survivors with pain regarding the use of mind-body therapies.DesignQualitative.SettingCommunity.ParticipantsFifteen Australian stroke survivors with pain; 11 women and four men, aged 28-84 years, and 5 months to 24 years post-stroke.Main MeasuresSemi-structured, one-to-one qualitative interviews, transcribed verbatim and analysed using reflexive thematic analysis.ResultsFour themes described participants' perceptions and experiences of mind-body therapies. Theme 1 detailed our stroke survivors' determination to improve, openness to mind-body therapies and desire to have these therapies provided in rehabilitation. Theme 2 collated suggestions and reasons for individualising/tailoring mind-body therapy use, including having a range of formats/modes available. Theme 3 described reported benefits of mind-body therapies for pain post-stroke, while Theme 4 summarised perceived benefits for pain-related biopsychosocial wellbeing.ConclusionsPeople with pain post-stroke are open to using mind-body therapies when ready/able in order to improve ongoing post-stroke symptoms. If used, healthcare professionals should tailor mind-body therapy format and delivery to individual stroke survivors' needs and preferences to maximise treatment benefits, which stroke survivors with pain report to include improved pain management and physical and psychosocial functioning.

Objective: The primary objective of this study was to evaluate the feasibility of tailored circuit training associated with patient education versus patient education alone in individuals with knee osteoarthritis. Design: randomised controlled parallel-group feasibility study. Setting: one centre. Participants: 30 participants with a clinical diagnosis of knee osteoarthritis and a primary symptom of knee pain (≥4). Interventions: The participants were randomly allocated to two groups for the 14-week intervention. The experimental group performed exercises three times a week and had an individualised progression of exercise duration and intensity. Both groups participated in an educational programme with health professionals. Main measures: feasibility and acceptability rates. Physical performance tests, muscle strength, quantitative sensory testing, and self-administered questionnaires were used to assess the impact of the interventions. Results: The rates of recruitment (2.73 participants/week), eligibility (31.50%), long-term retention (80% at 14 weeks and 73% at 26 weeks), and adherence to educational sessions (80% attended most lectures) were adequate, whereas the adherence to the exercise programme (60% completion of exercise sessions) was partially adequate. Acceptability and perceived usefulness were high in both groups, and the main barriers were related to accessing programmes via the Internet. Changes in physical performance tests, muscle strength, quantitative sensory testing, and self-administered questionnaires for both groups have been reported. Conclusion: This study demonstrated good feasibility and acceptability rates. The results will guide strategies to improve adherence and retention in clinical trials.

ObjectiveThis review aims to conduct a systematic review and meta-analysis on the effectiveness of botulinum toxin in the treatment of spasticity and the improvement of lower limb function in adult stroke survivors, based on randomized clinical trials.Data sourcesSearches were conducted across multiple databases, including Medline, Scopus, CINAHL, SPORTDiscus, Psychology and Behavioral Sciences Collection, and Cochrane, from inception until September 2025.Review MethodThis systematic review and meta-analysis was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. The meta-analysis was performed using Review Manager 5 software, with mean differences pooled using a random-effects model.ResultsThe analysis included 11 studies, with a total of 1740 adult participants. The results confirm that botulinum toxin is effective in reducing spasticity; however, the benefits on other outcomes, namely gait and balance, were limited and inconsistent. Considerable heterogeneity was also observed in intervention protocols, participant characteristics, dosing regimens, and the selection of target muscle groups.ConclusionIt is recommended that future studies prioritize the inclusion of subgroups and medium- and long-term follow-up. Only in this way will it be possible to clarify the true efficacy of botulinum toxin in different patient profiles and to contribute to the optimization of lower limb rehabilitation strategies after stroke.

AimTo establish and clarify the concept of 'prenatal rehabilitation' within maternal health management by identifying its defining attributes, antecedents and consequences.DesignA concept analysis.MethodsWalker and Avant's concept analysis method was employed to identify the antecedents, attributes and consequences of prenatal rehabilitation.Data sourcesComprehensive searches were conducted in PubMed, Web of Science, Embase, Medline, CINAHL, CNKI, VIP, WanFang and CBM databases from their inception to November 2024. Dictionary sources, grey literature and manual reference checks were also utilised to capture diverse perspectives related to 'prenatal rehabilitation'.ResultsA total of 34 studies were included. Five defining attributes of prenatal rehabilitation were identified: (1) dual therapeutic and preventive functions, (2) proactive and dynamic integrated interventions, (3) focus on specific physiological needs during pregnancy, (4) goal-oriented towards functional recovery and birth readiness and (5) foundation and facilitation for postpartum rehabilitation. Antecedents included pregnancy-induced dysfunction and discomfort, individual characteristics and external resources. Consequences were improved maternal outcomes, better neonatal health indicators and decreased utilisation of healthcare resources.ConclusionA clarifying definition and conceptual model of prenatal rehabilitation was developed, highlighting its proactive, personalised and multidisciplinary nature in promoting maternal health management. These findings provide a theoretical foundation for clinical practice and future research.

ObjectiveTo examine the interaction between baseline Multiple Long-term Conditions (multimorbidity) and baseline knee osteoarthritis with longitudinal fall risk and fall counts.DesignA longitudinal study using publicly available data from the osteoarthritis initiative.SettingMultisite centres.ParticipantsParticipants (45-79 years) with or without knee osteoarthritis at baseline were included (n = 4449).Main outcome measuresMultimorbidity was categorised as having ≥ two chronic conditions using the Charlson Comorbidity Index at baseline and having knee osteoarthritis (Kellgren and Lawrence grade ≥ two) or without knee osteoarthritis (Kellgren and Lawrence grades < two) were the main predictor variables. The occurrence of falls was the main dependent outcome variables as evaluated at the initial visit, 12, 24, 36, 48, 72, and 96 months.ResultsAfter adjustments for false discovery rate using Benjamini-Hochberg correction for p-values, having one chronic disease with knee osteoarthritis (odds ratio 1.21, p = .016) and without knee osteoarthritis (odds ratio 1.29, p = .004) were significantly associated with over time increased risk of fall. Having multimorbidity (≥ two chronic conditions) with knee osteoarthritis (odds ratio 1.21, p = .010) was associated with increased over time number of falls. Having one chronic disease with knee osteoarthritis (Incidence Rate Ratio: 1.28, p < .001) and without knee osteoarthritis (Incidence Rate Ratio: 1.33, p < .001) were associated with increased over time number of falls.ConclusionsThe interaction between baseline one chronic disease and the presence or absence of baseline knee osteoarthritis was associated with a longitudinal increased risk of fall. Multimorbidity with knee osteoarthritis was linked with number of falls.

ObjectiveTo explore, through reflective practice, physiotherapists' perspectives on the meaning and establishment of the therapeutic relationship with patients.DesignThe study formed part of a broader mixed-methods implementation study based on participatory action research and corresponded to the initial stages of recognition, analysis, action and observation, framed within a constructivist paradigm aimed at improving the therapeutic relationship. A qualitative study was conducted.SettingThe study was carried out at the Rehabilitation Service of El Bierzo Hospital (Ponferrada, Spain).ParticipantsAll physiotherapists were invited to participate. Of the 19 physiotherapists and one physiotherapist manager invited, 18 consented to take part in the study.Main measuresFocus groups and self-observation through reflective diaries were undertaken. Focus groups were audio-recorded, and data from both methods were transcribed, coded, and thematically analysed.ResultsSix key categories were identified that provide insight into how physiotherapists understand, construct, and experience the therapeutic relationship: (1) meaning of the therapeutic relationship, (2) importance of the therapeutic relationship, (3) purpose of the therapeutic relationship, (4) establishment of the therapeutic relationship, (5) bi-directionality in the therapeutic relationship, and (6) the environment of the therapeutic relationship.ConclusionThis study highlights physiotherapists' perceptions regarding the therapeutic relationship and how these are transferred to daily clinical practice. The therapeutic relationship is centred on accompaniment and trust. Participants emphasised the importance of initial patient contact, during which the therapeutic bond is established through a friendly and cordial approach. Subsequently, physiotherapists lack a structured process for the development of the therapeutic relationship.