Clinical Rehabilitation最新文献

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 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.

Objectives: To evaluate the feasibility and acceptability of an emotional support programme for newly diagnosed people with multiple sclerosis.

Design: Three-arm, mixed methods, randomised controlled trial comparing usual care, versus usual care plus nurse-specialist support, versus usual care plus nurse-specialist support plus peer support.

Participants: Community-dwelling adults within two years of diagnosis or undergoing diagnosis.

Interventions: PrEliMS involves information provision, emotional support, and strategies and techniques based on psychoeducation, Acceptance and Commitment Therapy principles, supportive listening. One version of the intervention was provided by nurse-specialists alone and the other was provided by nurse-specialists plus peer support.

Main measures: The main outcome of interest was the feasibility of proceeding to a definitive trial, exploring recruitment rate, acceptability, completion of outcome measures (perceived stress, mood, self-efficacy, psychological impact, and service use), and signal of efficacy.

Results: Of 40 participants randomised (mean age 36.2 years (SD = 14.8); 54% women; 85% with relapsing-remitting MS), 36 and 38 returned 3- and 6-month questionnaires, respectively. Participant interviews suggested the trial was largely feasible, and the intervention acceptable, with some amendments to trial procedures and intervention delivery noted. There were, however, no statistically significant differences between groups at followup for any measures, and effect-size estimates were small.

Conclusion: A definitive trial combining nurse-specialist and peer support adjustment to diagnosis intervention is warranted, but more work exploring the delivery and fidelity of the intervention is needed before this is pursued.

Objective: No study has examined outcomes derived from blood flow restriction exercise training interventions using regulated compared with unregulated blood flow restriction pressure systems. Therefore, we used a systematic review and meta-analyses to compare the chronic adaptations to blood flow restriction exercise training achieved with regulated and unregulated blood flow restriction pressure systems.

Data sources: The electronic database search included using the tool EBSCOhost and other online database search engines. The search included Medline, SPORTDiscus, CINAHL, Embase and SpringerLink.

Methods: Included studies utilised chronic blood flow restriction exercise training interventions greater than two weeks duration, where blood flow restriction was applied using a regulated or unregulated blood flow restriction pressure system, and where outcome measures such as muscle strength, muscle size or physical function were measured both pre- and post-training. Studies included in the meta-analyses used an equivalent non-blood flow restriction exercise comparison group.

Results: Eighty-one studies were included in the systematic review. Data showed that regulated (n = 47) and unregulated (n = 34) blood flow restriction pressure systems yield similar training adaptations for all outcome measures post-intervention. For muscle strength and muscle size, this was reaffirmed in the included meta-analyses.

Conclusion: This review indicates that practitioners may achieve comparable training adaptations with blood flow restriction exercise training using either regulated or unregulated blood flow restriction pressure systems. Therefore, additional factors such as device quality, participant comfort and safety, cost and convenience are important factors to consider when deciding on appropriate equipment to use when prescribing blood flow restriction exercise training.

Objective: To evaluate the use of custom-made insoles adapted to flip-flops on pain intensity, foot function, and functional walking ability in individuals with persistent plantar heel pain in the short and medium term.

Design: Randomised controlled trial.

Setting: Flip-flop sandals in patients with persistent plantar heel pain.

Main measures: Participants (n = 80) were assessed at baseline, six and 12 weeks after the intervention, and 4 weeks post-intervention.

Results: For the primary outcomes, after 6 weeks of intervention, no between-group difference was observed in the intensity of morning pain or pain with walking, mean difference = -0.4 (95% confidence intervals = -1.5 to 0.8). Similarly, after 12 weeks of intervention, no between-group difference was observed in the intensity of morning pain or pain with walking, mean difference = -0.7 (95% confidence intervals = -1.9 to 0.6). Finally, at 4 weeks after the end of the intervention, there was no between-group difference in morning pain or pain on walking, mean difference = 0.01 (95% confidence intervals = -1.4 to 1.4). All differences and confidence intervals were smaller than the minimum clinically important difference for pain (2 points). There were no differences between the groups for the secondary outcomes. In addition, the mean differences were smaller than the minimum clinically important differences for pain intensity, foot function and functional walking ability.

Conclusion: Custom-made insoles fitted to flip-flops did not differ from flip-flops with sham insoles in improving pain intensity, foot function and functional walking ability in people with persistent heel pain.Trial registration: ClinicalTrials.gov (Identifier: NCT04784598). Data of registration: 2023-01-20.

Objective: To gather preliminary evidence on short- and long-term care priorities for people with lower extremity amputations.

Design: A three-round modified Delphi study using semi-structured interviews.

Participants: A convenience sample of 20 adult participants who had undergone lower extremity amputations at a tertiary public hospital.

Main measure: Consensus on each care priority was defined a priori as an agreement of more than 50%. Semi-structured interviews were conducted to understand the rationales for endorsing the care priorities.

Results: Consensus was reached on 24 short-term care priorities and 12 long-term care priorities in the biomedical, practical and psychological and spiritual domains. The rationales for endorsing each of the care priorities generated three themes: preparedness; mental health, psychological and spiritual well-being; and participating in life, with respect and dignity.

Conclusions: Our results highlight the substantial need to improve patient access to education and planning support prior to undergoing limb amputation, and optimising post-amputation rehabilitation programmes, enabling people with amputations to participate in meaningful life roles that provide them with purpose, dignity, and self-respect. The knowledge of care priorities revealed in this study may promote effective patient-centred care and improve clinical outcomes.

Objective: To assess the added value of caregiver-mediated exercises combined with telerehabilitation in addition to usual care compared to usual care alone on the self-reported mobility outcome after subacute stroke.

Design: Multicentre, observer-blinded, parallel randomised controlled trial. An off-site researcher allocated treatments using minimisation.

Setting: Four rehabilitation centres in the Netherlands.

Participants: Forty-one patient-caregiver dyads within 3 months poststroke.

Intervention: Eight-week blended care program with caregiver-mediated mobility exercises for 2.5 h per week supported by telerehabilitation and four face-to-face sessions in addition to usual care.

Main measures: Self-reported mobility domain of the Stroke Impact Scale postintervention. Secondary outcomes were functional outcome, dyads' psychosocial wellbeing, care transition to the community postintervention and after 6 months.

Results: Forty-one dyads (21 intervention, 20 control) were randomised, and 37 (N = 18; N = 19) were analysed following intention-to-treat. The Stroke Impact Scale mobility was not significantly different between groups postintervention (B 0.8, 95% CI -6.8-8.5, p = 0.826). The secondary outcomes, namely, (a) caregivers' quality of life postintervention (p = 0.013), (b) caregivers' symptoms of depression postintervention (p = 0.025), and (c) independence in leisurely activities at 6 months (p = 0.024), showed significant benefits in favour of caregiver-mediated exercises with telerehabilitation. A significant difference favouring controls was found in self-reported muscle strength at 6 months (p = 0.002).

Conclusions: Caregiver-mediated exercises combined with telerehabilitation yielded no differential effect on our primary outcome self-reported mobility. Although the trial is underpowered, current findings are in line with previous trials. Future studies should further explore beneficial effects of caregiver involvement in stroke rehabilitation targeting psychosocial wellbeing.

Objective: To describe hand grip strength, walking speed, functional mobility, and postural control at one year following intensive care unit admission for COVID-19, and to find any predictors that are associated with impaired hand grip strength, walking speed, functional mobility, or postural control at the 1-year follow-up.

Design: Retrospective cross-sectional and longitudinal observational study.

Setting: Intensive care unit and outpatient research clinic at Sahlgrenska University Hospital.

Participants: Of the 105 individuals in "The Gothenburg Recovery and Rehabilitation after COVID-19 and Intensive Care Unit" cohort, 78 participated in this study.

Main measures: Descriptive statistics for hand grip strength, walking speed, functional mobility, and postural control were presented and binary logistic regressions were performed to find their significant predictors.

Results: At 1-year following intensive care unit admission for COVID-19, impaired hand grip strength was found in 24.4% for the right hand and 23.1% for the left hand. Walking speed, functional mobility, and postural control were found to be impaired in 29.5%, 21.8%, and 5.1%, respectively. For impaired walking speed, longer length of stay at intensive care unit and presence of diabetes mellitus were risk factors. Diabetes mellitus was found to be the risk factor for impaired functional mobility.

Conclusion: In this study, 45% of the participants showed impairment in function, activity capacity or both. These results suggest that individuals who recovered after intensive care unit admission for COVID-19 would benefit from receiving long-term follow-up to enable identification of those with need of physical health assistance and rehabilitation.