Clinical Rehabilitation最新文献

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.

ObjectivesTo examine the relationship between post-stroke cognitive impairment and return-to-work outcomes in working-aged stroke survivors and evaluate cognitive assessment methods used in included studies.Data sourcesMEDLINE, EMBASE, CINAHL, and APA PsycINFO databases were searched from 2003 to October 2025 according to PRISMA guidelines.Review methodsTwo reviewers independently screened titles and abstracts for inclusion. Data extraction and quality appraisal was completed by two reviewers. Narrative synthesis was completed due to substantial heterogeneity across studies.ResultsThirty-nine studies met inclusion criteria (observational studies (n = 33), qualitative (n = 5) and randomised control trial (n = 1)). Stroke severity was predominantly mild. Post-stroke cognitive impairment prevalence across study cohorts ranged from 17.5% at 28 days to 89% at 7 years with considerable variance in assessments and timing (range 2 days to 7 years). Concentration, memory and processing speed impairments were most frequently reported. Return-to-work rates ranged from 7.5% to 100%, with no clear trends for time post-stroke or stroke sub-type. Cognition was the most commonly associated variable influencing return-to-work outcomes followed by stroke severity, mood and functional status. The invisible nature of post-stroke cognitive impairment and limited awareness among employers and clinicians was highlighted.ConclusionPost-stroke cognitive impairment is commonly associated with poorer return-to-work outcomes even following milder stroke. Despite high detection, post-stroke cognitive impairment often remains hidden. This review highlights the substantial variation in post-stroke cognitive assessment practices and lack of intervention studies. Findings emphasise the need for consistent assessment and management of post-stroke cognitive impairment and increased awareness of its considerable negative impact on employment outcomes.PROSPERO: CRD42023462322.

ObjectiveThe 6-min walk test (6MWT) is an essential test during pulmonary rehabilitation. The significant learning effect of the 6MWT involves performing two tests. However, when tests are repeated three months later, the learning effect appears smaller in magnitude. Consequently, in clinical practice, only one test is performed after a pulmonary rehabilitation program. The aim of this study was to determine whether there is a benefit of performing two 6MWTs after pulmonary rehabilitation.DesignProspective, single center, noninterventional study.SettingPulmonary Rehabilitation Unit of the Centre Hospitalier des Pays de Morlaix (Morlaix, France) from 24 March 2023 to 19 March 2024.ParticipantsPatients aged 18 and older with moderate to very severe chronic obstructive pulmonary disease (COPD), admitted to a four-week pulmonary rehabilitation program.InterventionSubjects performed two 6MWTs at the end of the program.Main measuresThe primary outcome was the distance covered during the walk test. Secondary outcomes included oxygen saturation, heart rate, and lower limb fatigue.ResultsOne hundred seventy-six patients were included. Results revealed a significant difference (p < .05) in distance walked between the two 6MWT. Seventy-eight percent of patients (n = 135) walked further on the second test with a mean improvement of 14 m. The second test allowed an additional 15% (n = 26) to be classified as "responders" to the program regarding exercise capacity.ConclusionThe significant improvement in distance on the second test supports the value of performing two 6MWTs at the end of pulmonary rehabilitation in patients with COPD. Research is needed to extend findings to populations other than COPD.

ObjectivesScientific evidence showed that social networks and support are important for stroke rehabilitation. The Stroke Social Network Scale was developed for people with stroke but is not available in Cantonese. This study aimed to test the psychometric properties of the Cantonese scale (C-SSNS).DesignA validation study.SettingCommunity settings.SubjectsOne hundred people with stroke with a mean post-stroke duration of 6.76 years.Main measuresParticipants completed the C-SSNS, Multidimensional Scale of Perceived Social Support, Fugl-Meyer Assessment, Geriatric Depression Scale, Fatigue Assessment Scale, and Community Integration Measure. The psychometric properties of the C-SSNS were evaluated.ResultsThe C-SSNS had a Cronbach's α of 0.67-0.82 and ICC of 0.78-0.97. The standard error of measurement was 3.65-7.16. The minimal detectable change was 10.11-19.85. Floor effects were only found in the 'relatives' and 'groups' subscales. The item- and scale-level content validity indices were 1.0. In assessing construct validity, all subscores correlated with the overall score (r_s = 0.44-0.75). Confirmatory factor analysis supported a 5-factor model. For concurrent validity, the overall score correlated with perceived social support (r_s = 0.42, p < 0.001). Social network correlated with motor impairment (r_s = 0.32, p = 0.001), depressive symptoms (r_s = -0.37, p < 0.001), fatigue (r_s = -0.24, p = 0.015), and community integration (r_s = 0.38, p < 0.001). Known group differences were demonstrated between stroke participants with moderate-to-severe impairment and those with no-to-mild impairment, and those with and without depressive symptoms.ConclusionsThese findings revealed that the C-SSNS can capture meaningful data concerning social networks for evaluating interventions. This study supports its applicability in research and clinical practice.

ObjectiveTo evaluate the effects of a polycentric microprocessor-controlled knee joint on functional mobility and user satisfaction.DesignBefore-after pilot trial.SettingTertiary-level physical therapy and rehabilitation hospital.ParticipantsTen adults with unilateral transfemoral or through-knee amputations due to trauma.InterventionTransition from various monocentric microprocessor-controlled knees to a polycentric microprocessor-controlled hydraulic knee.Main measuresFunctional performance assessed using the Timed Up and Go, 6-Minute Walk Test, Hill Assessment Index, Stair Assessment Index, and user satisfaction measured by the Satisfaction with Prosthesis Questionnaire.ResultsThe Time Up and Go and 6-Minute Walk Test showed nonsignificant improvements with moderate effect sizes (Cohen's d = 0.43 and 0.58; p = .205 and .098, respectively). No significant change was observed in the Stair Assessment Index. A statistically significant improvement was found in the descend-specific Hill Assessment Index, accompanied by a significant reduction in task duration (r = 0.95; p = .034; Cohen's d = 0.85; p = .025, respectively). User satisfaction demonstrated a positive trend, with a moderate-to-large effect size (Cohen's d = 0.68; p = .059), although this did not reach statistical significance.ConclusionsTransitioning to the polycentric microprocessor-controlled knee joint may enhance incline-related mobility in active prosthesis users. The positive trend in user satisfaction suggests potential benefits; however, this requires confirmation in larger studies. Outcomes may be influenced by learning effects and socket comfort variability. These preliminary findings support the need for individualized prosthetic prescriptions and warrant larger, controlled trials with extended follow-up.

ObjectiveTo compare the outcome scores and reliability of performance-based tests (Timed "Up and Go," 10-Meter Walk Test at comfortable and maximal speeds, and Five Times Sit-to-Stand Test) in individuals with Parkinson's disease, considering one repetition and the mean of two and three repetitions.DesignReliability study.SettingResearch laboratory.Participants52 individuals with Parkinson's disease were included and assessed for inter-rater reliability (66.9 ± 6.2 years; 61.5% men) and 50 for test-retest reliability (67.1 ± 6.8 years; 62.5% men).Main measuresAssessments were conducted in two sessions, seven to 14 days apart, by two independent raters. Four performance-based tests were applied. ANOVA and intraclass correlation coefficient (ICC) were used (α=5%).ResultsFor all tests, the results were similar among the different outcome scores (0.269 ≤ F ≤ 0.046; 0.995 ≤ p ≤ 0.764), with high to very high test-retest reliability (0.73 ≤ ICC ≤ 0.96; p ≤ 0.001) and high to very high of inter-rater (0.84≤ ICC ≤ 0.96; p ≤ 0.001) reliabilities, except for Five Times Sit-to-Stand Test at one repetition, which inter-rater reliability was classified as moderate (ICC = 0.68; p ≤ 0.001).ConclusionFor all investigated tests, only one repetition, after familiarization, was necessary to provide consistent and reliable results for mobility assessment in individuals with Parkinson's disease.

ObjectiveGait biomechanics changes after lower limb amputation. This study aims to determine how amputation level may impact gait biomechanics and compensatory behaviour in people with unilateral amputation.Study designObservational study.SettingLaboratory.ParticipantsThis study included eight participants with unilateral transtibial amputation, 10 individuals with unilateral transfemoral amputation, and 11 older persons with no history of amputation.Main outcome metricsGait kinetics and kinematics.ResultsThe transfemoral group significantly walked slower compared to the older persons (p-value = 0.005). Knee adduction moment on intact side was greater during midstance in the transfemoral group compared to the transtibial (0.16 ± 0.16 Nm/kg). The older persons showed greater hip adduction moment on the amputated side during initial midstance compared to those in the transfemoral (0.28 ± 0.18 Nm/kg) and transtibial (0.21 ± 0.16 Nm/kg) groups. The transtibial group demonstrated greater lateral trunk flexion towards the intact side during initial contact (4.08 ± 4.05°) and swing phase (4.36 ± 3.66°) compared to older persons. The transfemoral group also had greater lateral flexion towards the intact side during early swing (2.78 ± 2.70°) compared to older persons.ConclusionsBoth groups of transtibial and transfemoral used trunk lateral flexion toward their intact side as a compensatory behaviour to enhance stability and minimize activation of the hip abductors, which can contribute to lower back pain. The increased knee adduction moment in the transfemoral group indicates a higher risk of knee osteoarthritis. Rehabilitation and physical therapy may prove beneficial in improving muscle strength, which can lead to better gait mechanics.

ObjectiveTo systematically evaluate the effects of cardiopulmonary exercise test-derived, tailored pulmonary rehabilitation on cardiopulmonary outcomes in individuals with interstitial lung diseases.Data sourcesMEDLINE, Embase, CINAHL Ultimate, SPORTDiscus, CENTRAL, and the Cochrane Library were searched from inception up to 4th September 2025. Reference lists of the included studies were hand-searched for additional sources.Review methodsReporting followed PRISMA 2020 guidelines. Studies of any design published in English and involving participants with interstitial lung disease were eligible. Due to intervention heterogeneity, meta-analysis was not conducted.ResultsEleven studies comprising 321 participants were included, with sample sizes ranging from 1 to 52. Designs encompassed single-cohort interventions (n = 4), comparative interventional studies (n = 3), randomised controlled trials (n = 3), and one case report. Pulmonary rehabilitation interventions included aerobic, interval, and resistance training, delivered over study durations ranging from 4 weeks to 4.5 years. Cardiopulmonary exercise testing outcomes included peak oxygen uptake; peak work rate; peak minute ventilation; maximum heart rate, and rate of perceived exertion. All studies assessing peak oxygen uptake and peak work rate reported improvements. Peak minute ventilation improvements were reported in six of seven studies. No serious adverse events were reported.ConclusionTailored pulmonary rehabilitation via cardiopulmonary exercise test metrics appears to enhance peak oxygen uptake and peak work rate in individuals with interstitial lung disease. Findings support its potential efficacy; however, future research should prioritise standardised methods, consistent reporting, and longer follow-up durations to inform clinical practice.

ObjectivesTo investigate the immediate effects of radial shockwave therapy versus sham on movement evoked pain in people with insertional Achilles tendinopathy.DesignRandomised controlled trial.SettingPrivate clinic.ParticipantsPeople diagnosed with insertional Achilles tendinopathy who were over 18 years old with a symptom duration of greater than 3 months.InterventionSeventy-six participants (53% female, mean age 51 years) were randomly allocated to a radial shockwave (n = 38) or sham (n = 38) group. Three sessions of radial shockwave or sham (no pressure) to the most affected side in 5-to-10-day intervals. All participants received identical education and exercises.Main measuresThe primary outcome measure was movement evoked pain (measured on a 100 mm visual analogue scale) at the first, second and third session immediately after each application.ResultsThere was 96% follow up of participants at the third session. Over half of the participants believed they were receiving the 'real' treatment (average 58%). The mean movement evoked pain scores improved each session by 0.6 points for the radial shockwave therapy and 0.7 points for the sham group. There was no difference between the groups after the first (-0.4, 95% confidence interval (CI) -1.6 to 0.8), second (0.4, 95% CI -0.8 to 1.6) or third session (-0.4, 95% CI -1.6 to 0.8).ConclusionsIn adults with insertional Achilles tendinopathy, radial shockwave therapy demonstrated no more efficacy than a sham in reducing immediate movement evoked pain. These results do not support the use of radial shockwave therapy for immediate pain relief among people with this condition.Clinical trial registrationACTRN12620000035921.

ObjectiveThis study aims to explore the role of patient activity in the clinical decision-making processes of various health care practitioners working in hospital care.DesignQualitative research study.SettingThe study was conducted in the hospital care setting of UMC Utrecht, the Netherlands.ParticipantsHealth Care Practitioners working in the hospital setting were selected through purposive sampling. Doctors, nurses, and physiotherapists were included if their professional activity centered on inpatient care, they had worked in the hospital for over four weeks and were not students in the department.Main measuresData were collected through observations and interviews. Interview recordings were transcribed, and both the interview transcripts and observation fieldnotes were coded and analyzed using reflexive thematic analysis, following Braun and Clarke's approach. Themes were iteratively reviewed and refined, leading to the development of core themes, which were constructed by synthesizing subthemes and examining their interrelationships.ResultsThe study involved forty-two participants working at UMC Utrecht. Four core themes were identified: 1) Patient activity influences clinical decision-making, 2) clinical decision-making influences patient activity, 3) multidisciplinary dynamics influence how patient activity is valued in clinical decisions, and 4) limited use of objective measurements influences how patient activity informs clinical decisions.ConclusionThis study explores the complex interaction between clinical decision-making and patient activity and how patient activity is integrated from a multidisciplinary perspective in the hospital setting. The results highlight the importance of interdisciplinary communication, barriers and facilitators for improved decision-making and examines both implicit and explicit processes involved.