Clinical Rehabilitation最新文献

ObjectiveThis systematic review aimed to assess the safety and effectiveness of acute intermittent hypoxia to improve motor outcomes in individuals with incomplete spinal cord injury.Data sourcePubmed, Embase, Scopus, and Cochrane Library databases were searched.Review methodsWe only included randomized controlled trials (published up to September 2025) that met the following criteria: participants were adults with incomplete spinal cord injury; the intervention involved acute intermittent hypoxia with or without motor training; the control group received sham acute intermittent hypoxia with or without motor training; outcomes included motor functions. Risk of bias was evaluated using RoB2 tool. Risk and mean differences were computed, with a random-effects model.ResultsNine randomized controlled trials (n = 114) were included. Overall risk of bias was with some concerns. The review indicates that acute intermittent hypoxia is safe and has good treatment adherence, with low drop-out rates for acute intermittent hypoxia alone (RD = 0.08; 95% confidence interval (CI): -0.11-0.26; I² = 0%; n = 66) or with gait training (RD = 0.04; 95% CI: -0.11-0.18; I² = 0%; n = 57). Acute intermittent hypoxia was found to have beneficial effects on walking speed (MD = 5.97; 95% CI: 1.4-10.54; I² = 0%; n = 53), endurance (MD = 39.39; 95% CI: 1.92-76.86; I² = 50%; n = 54), muscle strength, and manual dexterity. However, no significant effects were observed on balance functions.ConclusionAcute intermittent hypoxia may be a promising adjunctive therapy to enhance motor function in individuals with incomplete spinal cord injury. Further research with standardized protocols and larger sample sizes is needed to optimize its use in clinical practice.

ObjectiveTo investigate the effect of early balance training combined with traditional Phase I cardiac rehabilitation (based on circulatory, respiratory and progressive aerobic exercises) compared to Phase I cardiac rehabilitation alone, on balance, functional capacity, quality of life, length of hospital stay and adverse events in patients post coronary artery bypass graft surgery.DesignRandomized controlled trial.SettingCardiothoracic surgery departments from the Cairo University Hospitals.ParticipantsAdults (≥55 years) undergoing coronary artery bypass graft were randomly allocated to either an early balance training plus Phase I cardiac rehabilitation group or a Phase I cardiac rehabilitation alone group. Both groups commenced within 48 hours postoperatively and performed 30 minutes of moderate-intensity Phase I cardiac rehabilitation, thrice daily for 7 days. The cardiac rehabilitation Balance group performed an additional 5 minutes of balance training each session.Main measuresBalance (Berg Balance Scale), functional capacity (5-Repetition-Sit-to-Stand test), quality of life (Short Form-36 Health Survey Questionnaire), length of hospital stay (number of days hospitalized) and adverse events were evaluated.ResultsSixty coronary artery bypass graft patients completed the study. When compared to cardiac rehabilitation Alone group, the cardiac rehabilitation balance group significantly improved balance (39.77 ± 4.73 vs 34.03 ± 4.94, respectively, P < .001) functional capacity (11.93 ± 1.70 vs 15.97 ± 2.01, respectively, P < .001), quality of life (71.87 ± 3.21 vs 66.17 ± 2.94, respectively, P < .001) and hospital length stay (11.47 ± 1.22 vs 14.93 ± 1.36, respectively, P < .01). Additionally, both groups showed significant improvements in balance, functional capacity and quality of life. No adverse events were registered in any of the groups.ConclusionsPhase I cardiac rehabilitation plus early balance training improves balance, functional capacity, quality of life, and decreases length of hospital stay beyond that of Phase I cardiac rehabilitation alone, without an increase in adverse events.Institutional Research CommitteeNo: P.T.REC/012/004372Registrationclinicaltrails.gov NCT06490458).

Objectives(1) Explore the effects of a 12-week home-based rehabilitation programme on cardiorespiratory fitness in kidney transplant recipients; (2) Compare cardiorespiratory fitness parameters in kidney transplant recipients and age-sex matched healthy volunteers to aid the justification for routine rehabilitation programmes.DesignPilot randomised controlled trial with nested case-control.SettingHome-based rehabilitation; hospital-based outcome assessments.ParticipantsPilot randomised controlled trial: 50 stable kidney transplant recipients (>1 year post-transplant) (randomised 1:1; n = 25 control and n = 25 intervention). Nested case-control: 30 kidney transplant recipients and 30 healthy volunteers.InterventionA 12-week home-based aerobic and resistance rehabilitation programme or guideline-directed care control.Main measuresCardiorespiratory fitness measured by cardiopulmonary exercise testing.ResultsPilot randomised controlled trial: After adjusting for baseline, follow-up values were significantly greater in intervention compared to control for peak oxygen uptake (V̇O_2peak) mL/kg/min, (+1.50, p = .03) and maximum workload (+8 W, p = .04) but not V̇O_2peak L/min or variables at the gas exchange threshold. Higher frequency of aerobic exercise sessions was associated with greater improvements in cardiorespiratory fitness (R₂ = .252, p = .040).Nested case-control: V̇O_2peak was reduced in kidney transplant recipients compared to healthy volunteers (18.81 ± 4.61 vs 24.06 ± 5.72 mL/kg/min; p < .01), as was V̇O₂ at the gas exchange threshold (11.70 ± 2.67 vs 14.47 ± 3.39 mL/kg/min; p < .01).ConclusionsA 12-week home-based rehabilitation programme induced a significant improvement in some cardiorespiratory fitness variables and higher frequency of aerobic exercise associated with greater improvements. Cardiorespiratory fitness is significantly impaired in kidney transplant recipients compared to age-sex-matched healthy volunteers. Together, these findings highlight the clinical importance of promoting aerobic exercise and the integration of rehabilitation programmes into routine care for this population.Trial registrationClinicalTrials.gov, NCT04123951 (https://clinicaltrials.gov/study/NCT04123951).

ObjectiveTo adapt the Outpatient Physical Therapy Improvement in Movement Assessment Log questionnaire into Turkish and to evaluate its cultural adaptation, validity, and reliability.DesignA cross-sectional study involving cross-cultural adaptation and psychometric validation.SettingOutpatient physiotherapy clinics at a university hospital in Turkey.Participants272 adult patients receiving outpatient physiotherapy.InterventionParticipants completed the Turkish version of the scale, along with the Tampa Kinesiophobia Scale, Katz Activities of Daily Living Scale, and the International Physical Activity Questionnaire-Short Form. A subgroup of 84 participants completed the questionnaire again after two weeks to assess test-retest reliability.Main measuresContent validity was assessed using the Davis technique; structural validity was examined using exploratory factor analysis and confirmed using confirmatory factor analysis. Internal consistency was determined using Cronbach's alpha coefficient; test-retest reliability was evaluated using the intraclass correlation coefficient; and parallel-forms reliability was assessed.ResultsThe Content Validity Index of the scale was 0.92. Confirmatory factor analysis fit indices for the three-factor structure were acceptable: chi-square/degrees of freedom = 1.672; root mean square error of approximation = 0.047; comparative fit index = 0.953; Tucker-Lewis index = 0.945. Cronbach's alpha was .859, and the intraclass correlation coefficient was 0.856, indicating high internal consistency and reliability.ConclusionsThe Turkish version of the scale is a culturally adapted, valid, and reliable tool for assessing movement-related confidence in adult outpatients receiving physiotherapy. It can guide clinical decisions and support patient-centered rehabilitation.

ObjectiveTo assess the feasibility of the Yale Swallow Protocol and refine it for parsimony.DesignCross-sectional study.SettingFour diverse units at a medical centre.ParticipantsHospitalised adults at high risk of dysphagia (i.e., those aged over 65 years, admitted for stroke, Parkinson's disease, or head and neck cancer treatment) using consecutive sampling.Main MeasuresA research nurse administered the protocol, recording adverse events, administration time, and failure rates, with an 85% failure rate threshold to assess the ceiling effect. The protocol consists of contraindications, cognitive screenings, oral motor examinations, and a 3-ounce water swallow challenge, but pass/fail decisions are based solely on contraindications and the water challenge. Parsimonious combinations of items were explored to refine and potentially shorten the protocol. The measurement precision of the refined and shortened protocols was evaluated using the Rasch model.ResultsOf the 502 patients enrolled (mean age 71; 59.8% male), no adverse events occurred, and the protocol took under 3 min. The failure rate was 41.8%, indicating no ceiling effect. Five well-fitting items were retained from cognitive screenings and oral motor examinations: location, year, tongue sticking out, lingual motion, and facial symmetry. Both refined protocol (contraindications, five well-fitting items and water challenge) and shortened protocol (contraindications and five well-fitting items) enhanced measurement precision beyond the original version.ConclusionThe Yale Swallow Protocol is a safe, quick, and ceiling-effect-free screening for identifying dysphagia, even among diverse high-risk hospitalised patients. Our study also refined the protocol, achieving better measurement precision than the original protocol.

ObjectiveEarly mobility after cardiac surgery in the intensive care unit improves patient outcomes, yet implementation by clinicians remains inconsistent. To inform interventions to increase adoption, this study sought to explore clinicians' perspectives on the definition of early mobility in the cardiac surgery intensive care unit and describe perceived barriers and facilitators to implementation.DesignThis qualitative study was guided by interpretive description.SettingA tertiary hospital that performs 1000 cardiac surgeries annually.ParticipantsA total of 26 clinicians, including nurses, physicians, healthcare aides, respiratory therapists, and physiotherapists, participated.Main MeasuresThe nine focus groups and four individual interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis.ResultsThree themes and 13 categories were created from the data: (1) Incongruent operationalization and conceptualization (across micro, meso, and macro levels), (2) uncertainty, and (3) inconsistency in mobilization practices. Themes were rooted in ambiguous definitions of "early" and "mobility," discrepancy between conceptualization and implementation of timing, varied interpretations of success, and perceived safety concerns. In addition, 4 barriers and 4 facilitators were identified and categorized into patient-care and clinician-related.ConclusionDeveloping early mobility protocols and education informed by clinicians may enhance its implementation in the cardiac surgery intensive care unit. Incorporating the perspectives of clinicians into early mobility protocol development is essential to support behaviour change and provide this beneficial care.

ObjectiveTo describe the structure and composition of personal social networks in burn survivors and examine their associations with social participation.DesignA 6-month cohort study.SettingCommunity.Participants23 adult burn survivors.Main MeasuresParticipants completed the Personal Network Survey and Life Impact Burn Recovery Evaluation Social Interactions and Social Activities short forms at baseline, 3-month, and 6-month. Personal Network Survey assesses individual social network in two categories: network structure depicts the architecture of social connections, while network composition describes the characteristics of network members. Life Impact Burn Recovery Evaluation measures social participation after burn injury.ResultsThe average age of the 23 participants was 49.1 (SD 12.5) years, with an average of 45.0% (SD 25.9%) total body surface area burned. Friends and family were the major relationship types, while camaraderie, emotion, and advice were the major support types. Multilevel models results showed that within-person smaller (β=-0.91; 95% CI = -1.48, -0.33; p = .004) and more close-knit (β=-1.29; 95% CI = -2.22, -0.37; p = .009) networks, as well as between-person networks in which burn survivors had fewer advisors (β=-40.97; 95% CI = -69.56, -12.38; p = .008) and received less health support (β=-20.35; 95% CI = -37.91, -2.79; p = .030), were significantly associated with better social participation.ConclusionThe findings advance the current understanding of burn survivors' social networks and their impact on social participation and lay the foundation for developing targeted strategies to promote social engagement and well-being by optimizing network composition and the balance of received support.

AimThe development of a new intervention designed to reduce persistent fatigue following acquired brain injury through personalised support.RationaleFatigue is a common and long-lasting consequence after brain injury. Evidence indicates that tailored, multimodal interventions targeting individual experiences are more effective than standardised approaches.Materials and proceduresThe intervention combines real-time data collection using the Experience Sampling Method via a dedicated mHealth app with a workbook containing practical instructions and an online secure feedback environment. Patients complete eight short daily assessments for three consecutive days each week, collecting detailed information on fatigue and contextual factors such as mood, physical activities and social situations.Providers, setting, and deliveryTied by Tiredness is delivered by psychologists or occupational therapists in rehabilitation or outpatient settings to adults with acquired brain injuries aged 18 and over. In face-to-face therapy sessions, patient-collected data are used to tailor personalised feedback and advice on strategies, emphasising collaborative decision-making and active engagement.Dose and personalisationPatients attend six weekly 1-h sessions. Intervention strategies are adjusted to individual needs and goals throughout the programme, based on ongoing assessment data.Unique featuresContinuous personalisation and the integration of real-time data into therapy sessions distinguish this intervention.Purpose and implicationsThe programme aims to provide insight into the personal and environmental factors that contribute to a person's fatigue, enabling patients to implement cognitive and behavioural strategies for effective daily fatigue management. Tied by Tiredness represents a novel, practical approach to supporting self-management after brain injury.Trial registrationOverview of Medical Research in the Netherlands (OMON), ID: NL-OMON21265.

ObjectiveTo qualitatively explore the perceptions and experiences of patients with coronary artery disease regarding discontinuation of home-based exercise rehabilitation.DesignA qualitative, descriptive design was utilized in this study.SettingThis study focused on home-based exercise rehabilitation.ParticipantsA purposive sample of 24 patients who had voluntarily participated in the home-based exercise rehabilitation program was recruited.Main measuresSemistructured interviews were undertaken. Data were analyzed using a framework approach.ResultsA total of 24 participants (13 males and 11 females) from 28 to 77 years were recruited for this study to examine the endogenous and exogenous factors that influence withdrawal from exercise rehabilitation. The four major themes identified were (1) "exercise inertia," (2) "perception deviation," (3) "disruption of habit loop," and (4) "weakness in exercise literacy." These themes were further divided into 12 subthemes.ConclusionsSustained implementation of home-based exercise rehabilitation is crucial for patients with coronary heart disease. Discontinuation of exercise regimens frequently stems from patients' internal perceptions, including exercise inertia, cognitive biases, disruptions in established habit loops, and insufficient exercise literacy. Consequently, enhancing patient awareness of exercise rehabilitation and strengthening supervision of exercise routines are imperative. Establishing a multidisciplinary home-based exercise management system would further facilitate the optimization of exercise-related benefits.

ObjectiveTo explore how task and stimuli influence response accuracy in assessing functional communication in adults emerging from a Prolonged Disorder of Consciousness (PDOC).SettingSpecialist post-acute brain injury assessment centre.SubjectsTwelve adults (7 male; 5 female) emerging from PDOC, recruited consecutively between June 2021 and August 2023.MethodsA prospective study exploring the impact of task and stimuli on response accuracy. Yes/no questions and spoken word-to-referent (colour/object) matching tasks were presented. Stimuli were controlled for psycholinguistic variables to reduce linguistic confounds in the assessment of consciousness. Accuracy was compared to a standard measure (visually based situational yes/no questions from the Coma Recovery Scale-Revised).ResultsResponses were most accurate for word-to-referent matching tasks compared to yes/no questions (t(23) = -6.49, P < 0.001, d = 1.33), with greater accuracy to colour than object stimuli (t(23) = 2.79, P = 0.01, d = 0.57). Participants also responded with greater accuracy to word-to-referent matching and yes/no questions involving colours and objects compared to the Coma Recovery Scale-Revised situational yes/no questions.ConclusionTask influences accuracy of responses in assessing return of consciousness. The advantage of colours over objects can be attributed to simpler visual processing and higher lexical frequency of these words. The current standard situational yes/no tasks from the Coma Recovery Scale-Revised resulted in lowest scores and should not be relied upon as the only measure of functional communication.