Clinical Rehabilitation最新文献

Objective: To use behavioural science frameworks to synthesise evidence on the factors influencing physical activity of patients hospitalised after stroke outside of staff-led rehabilitation sessions.

Data sources: A systematic review of qualitative and mixed-methods studies. MEDLINE, PsycINFO, CINAHL, and AMED were searched from inception to October 2024 for studies that explored influences on the physical activity of patients hospitalised after stroke.

Review methods: Data were coded with reference to the Theoretical Domains Framework and the COM-B ('capability', 'opportunity', 'motivation' and 'behaviour') model. Thematic analysis was used to group data extracts into themes within each Theoretical Domains Framework domain. Risk of bias was assessed using the Mixed Methods Appraisal Tool.

Results: We identified 17 studies. There was no significant risk of bias concerns. We identified 19 themes across eight Theoretical Domains Framework domains and all COM-B model categories. The most frequently recognised themes were found in three Theoretical Domains Framework domains: Environmental Context and Resources (themes: 1 -- availability of sufficient skilled staff to facilitate physical activity; 2 - design and use of the physical environment; 3 - lack of opportunities or incentives; 4 - passivity and institutionalisation; 5 - perceived and actual rules and culture of the ward); Skills (theme: physical impairments); and Social Influences (theme: activity influenced by family and friends).

Conclusions: The review highlights the complexity of the influences on the physical activity of patients hospitalised after stroke outside of staff-led rehabilitation sessions. It is likely multi-component interventions addressing a number of influences will be required to effectively improve physical activity. PROSPERO ID: CRD42022383506.

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 explore physiotherapists' perspectives on current and alternative models of physiotherapy delivery in acute stroke rehabilitation.

Design: Qualitative service evaluation.

Setting: An acute stroke rehabilitation unit within a London teaching hospital in the UK.

Participants: A purposive sample of 17 physiotherapy staff (qualified physiotherapists and physiotherapy support staff) working in the acute stroke rehabilitation unit at the time of, or in the previous 3 months of the study were recruited to participate.

Results: Three themes were identified: barriers to effective physiotherapy delivery, enablers of effective physiotherapy delivery, and alternative models of physiotherapy delivery. Themes were framed by the concept of providing effective and efficient physiotherapy guided by reflection. Main barriers included patients not being ready for and underutilisation of time within physiotherapy sessions. Use of timetabling and access to senior therapy support enabled more effective and efficient physiotherapy delivery. Alternative models to optimise physiotherapy delivery included different staff to patient ratios, group therapy, opportunistic physiotherapy delivery and self-management.

Conclusions: Several enablers of and barriers to providing effective and efficient physiotherapy post-stroke exist. Physiotherapists should consider implementing alternative models of physiotherapy delivery to increase the amount of physiotherapy provided to patients' post-stroke, thereby facilitating post-stroke functional recovery.

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: The study purpose was twofold: (1) to develop the Children's Amputee Mobility Predictor and establish its content and social validity and (2) to determine its intra and inter-rater reliability.

Design: A reliability and validity study.

Setting: Pediatric rehabilitation hospital.

Participants: Content validity study: 10 clinical experts; Social validity study: 24 stakeholders (i.e., children's parents); Reliability study: 3 physical therapists.

Intervention: Not applicable.

Main measure: The functional capability of 30 children with leg length discrepancy was evaluated using the Children's Amputee Mobility Predictor. The Intraclass Correlation Coefficient, two-way mixed model, and absolute agreement for a single measure were used to establish intra and inter-rater reliability.

Results: Experts reached a consensus on the relevancy and clarity of all 26 tasks included in the Children's Amputee Mobility Predictor. The intra- and inter-rater reliability were excellent, Intraclass Correlation Coefficient (ICC)_2,1= .95, with 95% CI ranging from 0.88-0.98; and ICC_3,1 = 0.96 with 95% CI ranging from 0.93-0.98, respectively. Parent feedback indicated the relevancy of tasks for children with leg length discrepancies.

Conclusions: The Children's Amputee Mobility Predictor is a comprehensive outcome measure that requires minimal equipment or space. It appears stable over time when used by the same physical therapist and results suggest that it may be used by multiple physical therapists. The Children's Amputee Mobility Predictor appears to measure important and relevant aspects of functional capability and be a meaningful and relevant assessment tool, helping to guide the determination of medical necessity for specific prosthetic and physical therapy interventions.

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.

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 investigate the effect of acetic acid shockwave phonophoresis on spur morphology, foot pain, and function in patients with calcaneal spurs.

Design: A double-blinded, randomised clinical trial.

Setting: Outpatients physical therapy clinics.

Participants: One hundred forty-seven patients with calcaneal spurs, 18-65 years old, were randomly allocated to three equal groups.

Intervention: The study group (A) received acetic acid shockwave phonophoresis plus conventional physical therapy. The study group (B) received shockwave therapy plus conventional physical therapy. The control group received conventional physical therapy programme only. Interventions were applied twice a week for 3 weeks.

Outcome measures: Calcaneal spur width, calcaneal spur length, pain intensity level, pain pressure threshold and foot and ankle ability measure activities of daily living subscale were measured at baseline, after 3 weeks of interventions and after 4 weeks of follow-up with no intervention.

Results: Between-group differences were observed for calcaneal spur width and length, pain intensity, pain pressure threshold and function after 3 weeks favouring Group A (p < 0.001). Mean differences (95% CI) between study groups were -1.11 mm (-1.46, -0.77) for spur width; -1.34 mm (-1.67, -1.01) for spur length; -20.71 mm (-24.66, -16.77) for pain; 1.45 kg/cm² (1.05, 1.85) for pain pressure threshold; and 12.16 points (9.24, 15.09) for function after 3 weeks.

Conclusions: Acetic acid shockwave phonophoresis combined with exercise clinically and statistically improves calcaneal spur width, length, pain intensity, pain pressure threshold and foot function more than shockwave therapy alone or conventional physical therapy. This method might be considered an effective, feasible, safe, non-invasive and locally applicable treatment for heel spurs.

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: To quantitatively describe therapists' use of coaching with stroke survivors, in a hospital-based rehabilitation setting, to promote perseverance with longer-term practice.

Design: Prospective observational behavioural mapping study.

Setting: Rehabilitation unit of a regional public hospital in Queensland, Australia.

Main measures: A custom-designed behavioural mapping tool was used to collect rehabilitation session contextual data and therapists' use of coaching. Data were captured in 3-minute epochs for a maximum of 30 minutes. Data were analysed using descriptive statistics.

Results: Thirty-six rehabilitation sessions, including 34 participants (therapists n = 22, stroke survivors n = 12) were observed. Rehabilitation sessions were mostly inpatient (n = 33, 91.7%), one-on-one (n = 30, 83.3%), and conducted in the physiotherapy (n = 160, 45.5%) or occupational therapy (n = 155, 44.0%) gym. Strategies to promote perseverance were used in 76.7% (n = 267) of observed epochs. The most frequently used strategy was monitoring the quality of practice and the least frequently used strategy was utilising a support person to facilitate practice.

Conclusion: Coaching that may promote perseverance with practice was regularly used by therapists during hospital-based rehabilitation sessions. Coaching that may enable longer-term perseverance beyond a therapist-dependent rehabilitation model was less commonly observed.