Clinical Rehabilitation最新文献

ObjectivesThe aims of this scoping review were to (i) map education from randomised controlled trials and public websites for Achilles tendinopathy to pre-defined categories and (ii) appraise the quality of education available.Data sourcesSources were extracted via a search of multiple databases and from the first three pages of targeted Google searches in English, Chinese, and Spanish (websites).Review methodsThe frequency of sources that reported on each pre-defined category (n = 15) was reported, and the content within each category was summarised descriptively. Quality and reliability were assessed with the DISCERN tool (1-5 points, higher score means higher quality and trustworthiness). Understandability and actionability of education was assessed using Patient Education Materials Assessment tool (0-100%, higher scores indicate more comprehensible information with clearer messages and more identifiable actions). Alignment with current international guidelines was reported.Results119 randomised controlled trials and 385 websites were included. Education coverage was better in websites compared to trials, particularly related to pathology and management. Conflicting advice was found on websites (e.g. when treatment should be sought). Quality (1.6 ± 0.5) and reliability (2.1 ± 0.7) of education were poor, with low scores for treatment risks and shared decision-making. Understandability was moderate (59%) and actionability was poor (28%). Alignment with clinical guidelines was low, with key information commonly omitted.ConclusionEducational sources found in randomised controlled trials and public websites on Achilles tendinopathy are poorly aligned with clinical guidelines. The information gaps in these sources mean that they are unhelpful to patients and may steer them towards inappropriate decisions. The review highlights the need for the development of accurate, meaningful, and evidence-based educational resources for individuals with Achilles tendinopathy.

ObjectiveTo identify and prioritize aspects of quality in geriatric rehabilitation from the perspective of older adults.DesignQualitative study using a structured Nominal Group Technique.SettingThree nominal group technique sessions were conducted in geriatric rehabilitation settings in the Netherlands.ParticipantsWe included older adults admitted to geriatric rehabilitation, Dutch proficiency, the ability to communicate and engage in group discussions, and an intention to return to independent living.InterventionParticipants engaged in structured nominal group technique sessions. Each session included five steps: introduction, idea generation, exchange of ideas, discussion, and ordering and rankingMain measuresAudio-recorded sessions were transcribed verbatim and analyzed using a combined inductive and deductive coding. Quality aspects were prioritized based on their summed ranking scores, relative importance, and selection frequency.ResultsEighteen older adults were included. Participants identified five key priorities for quality in geriatric rehabilitation: (1) good preparation with clear expectations, (2) well-organized therapy and care, (3) relationships with healthcare professionals that acknowledge individual needs, (4) clear, respectful communication, and (5) autonomy in treatment decision-making. The qualitative analysis supported these priorities with three overarching themes: the value of a supportive environment, feeling heard and understood, and the need for guidance and involvement.ConclusionThis study provides priorities for improving quality in geriatric rehabilitation, according to the experiences of older adults and offers direction for implementation in clinical practice.

ObjectiveTo determine the characteristics of patients admitted to inpatient rehabilitation services for reconditioning to inform clinical care.DesignAn exploratory audit.SettingA major tertiary hospital service in Australia providing 48 inpatient beds across two facilities.ParticipantsPatients admitted to a rehabilitation service over two years (2019-2020) and categorised under Australasian Rehabilitation Outcomes Centre impairment codes for reconditioning.Main measuresDemographic and clinical service data.MethodsDescriptive analysis of data from the hospital admissions data base.ResultsOf the 368 patients in the study sample (432 admissions), the age range was 22-100 years of age (mean = 75 years). Data on smoking, language and age groups was trended and identified a younger group of patients with 16% (58 of 368 patients) being aged 60 and under. The gender split was 54.2% male and 45.8% female. Admissions of Indigenous people was higher than the recorded population with females being disproportionately categorised as deconditioned, and an overall mean age 24 years younger than the sample mean. Identified for increased attention were nephology patients and a group of 58 people (15.7%) with two or more admissions for reconditioning rehabilitation in the two-year period. This group were older (aged over 80) and male.ConclusionLiterature on reconditioning programs has a predominant focus on the older, more frail population. Patients admitted to inpatient rehabilitation for reconditioning are a diverse population and further study is required to determine effective interventions for specific groups of patients, particularly younger cohorts, and those with frequent readmissions.

ObjectiveTo identify and prioritize personal risk factors for pressure injuries in wheelchair users.DesignA Delphi survey was conducted with clinicians specializing in pressure injury prevention and care.SettingThe study was conducted online using LimeSurvey software.ParticipantsIn the first round, 90 clinicians participated and completed the survey; in the second round, 68 continued their involvement.ResultsAcross all rounds, 39 risk factors were identified by the experts. These factors were weighted according to expert consensus. Immobility, current or past pressure injuries, malnutrition, and sensory perception impairment are ranked among the highest important.ConclusionThese findings underscore the importance of considering both physiological and behavioral factors when assessing pressure injurie risk. The weighted list of expert-validated factors offers clinicians a practical foundation for more targeted and individualized prevention strategies, ultimately supporting improved care and quality of life for this population.

ObjectiveTo evaluate the psychometric properties of the modified Iowa Level of Assistance (mILOA) in general medical patients aged ≥65 years.DesignProspective observational psychometric measurement study.Main outcome measures: The mILOA was completed at hospital admission (n = 246) and discharge (n = 121). A second measure was completed within 24-h to establish inter-rater reliability and measurement error (n = 50). Criterion predictive validity for discharge destination, floor and ceiling effects, responsiveness, and construct validity, via convergent validity (with the de Morton Mobility Index, DEMMI) and known group validity (discharge home), were assessed using standard psychometric techniques.ResultsThere were 246 included participants (median age = 83.2; interquartile range = 46.1-88.0 years; 47% female). The mILOA took a median of 12.5 [interquartile range = 8.0-18.0] minutes to complete. There were no systematic differences across the range of scores (mean difference = 1.1) with limits of agreement of 7.7 and -5.4 (variability due to measurement error = 2.36). It was able to predict discharge destination (area under the curve = 0.74; 95% CI = 0.66-0.81). No floor or ceiling effects were observed, and it was highly responsive to change (effect size = 0.80). Scores correlated significantly and positively with DEMMI scores (Spearman's rho = 0.86, 95% confidence interval = 0.81-0.90, p < .001) and showed a median difference of 8 points between known groups.ConclusionThe mILOA has good inter-rater reliability, no floor or ceiling effects, strong responsiveness, high correlation with the DEMMI, and the ability to discriminate between known groups in older general medical patients.

ObjectiveTo cocreate and synthesize financial empowerment ideas for people living with acquired brain injury from multiple perspectives.DesignWe completed a qualitative descriptive study using focus-group methods. Content analysis was guided by deductive categorization across overlapping idea areas of educational products, human-interaction services, and advocacy approaches, followed by inductive idea subcategorization.SettingWe held seven focus groups, five online and two in-person. Participants were recruited via community organization advertisements and convenience sampling. Four researchers analyzed transcripts using a triangulation approach.ParticipantsTwenty-five adults (ages 18+) participated in seven different focus groups: 15 individuals living with acquired brain injury (five groups); 2 close others (one group); and 8 project advisory members (one group). Demographics varied across age, education, and time since injury; most were women.ResultsWe generated 20 idea subcategories for financial empowerment after brain injury. Participants discussed ideas related to advocacy and service ideas more than products, but noted the salience of varied option availability to meet different needs across individuals. Participants living with brain injury identified seven unique ideas compared to the close other group and project advisory group.ConclusionsFinancial empowerment to address economic factors of financial capability and financial well-being after brain injury is important to brain injury rehabilitation, health, and well-being. Including lived experience voices provided unique ideas for addressing financial empowerment. Providing a spectrum of options and addressing contextualization factors could enhance the financial well-being of adults living with brain injury, which can contribute to brain injury recovery and improve community participation.

ObjectiveIndividuals with spinal pain often show breathing dysfunctions. Although the effects of breathing interventions in general have been studied, no distinctions regarding types of breathing interventions were made. Therefore, we summarized the effects of different types of breathing interventions on spinal pain and disability.Data sourcesPubMed, Web of Science, PEDro, Cochrane, PsycArticles, and Embase were systematically searched till September 2, 2025.Review methodsStudies that described therapies using active instructions to modulate breathing or increase breathing awareness in adults with spinal pain were eligible. Breathing interventions were categorized into slow deep breathing, respiratory resistive breathing, and breathing awareness. Effects were subdivided into additional (breathing intervention + other intervention vs. other intervention) and comparative effects (breathing intervention vs. other intervention). The Downs and Black checklist was used to assess methodological quality. Meta-analyses were performed with standardized mean differences, and certainty of evidence was evaluated based on the GRADE assessment.ResultsTwenty studies involving 814 participants were included. Seventeen were of fair to good quality, three of poor quality. Meta-analyses revealed that slow deep breathing positively affected spinal pain (n = 223; SMD = -1.03; low certainty of evidence) and disability (n = 132; SMD = -1.34; very low certainty of evidence) when added to other interventions. Moreover, respiratory resistive breathing decreased spinal pain compared to other interventions (n = 75; SMD = -1.31; low certainty of evidence).ConclusionBreathing interventions may be valuable for the management of patients with spinal pain. Clinicians should be aware of, and consider, the various types of breathing interventions and their underlying mechanisms to tailor them to the treatment goals of their patients.

ObjectiveTo evaluate the feasibility of delivering 50 h of comprehensive, high-dose aphasia treatment via telerehabilitation (TeleCHAT) to people with aphasia and their support people.DesignA non-randomised one-armed quasi-experimental pre-post feasibility study.SettingTeleCHAT was delivered from dedicated tele-suites in university spaces within a tertiary hospital. Participants received therapy in their homes via telerehabilitation using a configured telerehabilitation system which used videoconferencing software Zoom^®.ParticipantsThree cohorts of people with aphasia (n = 12), support people (n = 11), and speech-language pathologists (n = 2) participated.InterventionParticipants completed technology training, goal setting, and clinical treatment planning prior to the intervention. The TeleCHAT intervention included 50 h of goal-directed aphasia therapy, delivered 3-5 days per week over 8 weeks.Main measuresMixed-methods data was collected on participant demographics, aphasia profiles, achievement of dose, comprehensiveness of therapy, and support people participation.ResultsA diverse group of people with aphasia completed TeleCHAT. Nine participants received the intended dose of 50 h, with the remaining three closely approaching dose. A high proportion of sessions were spent actively engaged in therapeutic tasks (94-100%). A comprehensive array of 42 therapy activities was delivered and tailored to goals across the International Classification of Functioning, Disability and Health Framework. All participants had a support person participate actively in at least one session.ConclusionsIt was feasible to deliver the core components of the TeleCHAT programme via telerehabilitation. As intended, a heterogeneous group of people with aphasia received a high-dose of tailored, comprehensive aphasia therapy, with the active participation of support people.