Clinical Rehabilitation最新文献

ObjectiveThe aims of this study were to characterise proprioceptive impairment in individuals after stroke using the Wrist Position Sense Test (WPST) in a relatively large pooled sample, to re-establish the criterion of abnormality of the WPST, and to determine the sensitivity and specificity of a briefer test version for use in clinical settings.DesignCross-sectional observation study with pooling of data across studies.SettingRehabilitation or outpatient settings.SubjectsStroke survivors (n = 205) and neurologically healthy controls (n = 93) were assessed at baseline.Main measureWrist proprioception assessed using the WPST.MethodsBaseline data from stroke survivors and healthy controls assessed on the WPST was extracted from six studies. Raw data were pooled and analysed to determine an updated criterion of impairment and ability of a brief 10-trial version to detect proprioceptive impairment.ResultsProprioceptive impairment was common for the contralesional wrist (66%) and present in the ipsilesional wrist (21%). The new criterion of abnormality was established as 11.1⁰ average error. High sensitivity and specificity were found for the brief 10-trial version, with 85.3% sensitivity and 95.7% specificity.ConclusionClinicians can quantitatively and confidently identify proprioceptive impairment in the upper limb after stroke using either the original or brief version of the WPST. Routine use of this quantitative, standardised clinical assessment can contribute to improved identification, monitoring, and access to targeted intervention for proprioceptive impairment following stroke.

ObjectiveTo investigate how health professionals working in palliative care services understand rehabilitation related to oncology palliative care in England and Brazil, according to different health system contexts.DesignQualitative study.SettingHospices, hospitals, community-based palliative care centre, palliative care units, nursing care homes in different areas of Brazil and England.ParticipantsThirty-six nurses and occupational therapists experienced in providing palliative care interventions from England and Brazil.InterventionsIndividual interviews with open-ended questions.Main MeasuresIndividual semi-structured, in-depth interviews, analysed using Braun and Clarke's reflexive thematic analysis.ResultsProfessionals in England demonstrated a consolidated and integrated understanding of rehabilitation as part of palliative care, often supported by structured services such as hospices. In contrast, many Brazilian participants expressed uncertainty or perceived rehabilitation as incompatible with end-of-life care, reflecting conceptual misunderstandings, limited training and a lack of service infrastructure. The findings revealed divergence in how rehabilitation in palliative care is conceptualised and implemented in these countries. This divergence is reflected in structural, educational and cultural differences in how palliative care is organised and delivered. However, there is a growing recognition that rehabilitation and palliative care are not separate but complementary approaches.ConclusionsThe findings underscore the urgent need to clarify definitions, develop unified conceptual models and invest in policy and education to ensure that rehabilitation is no longer seen as contradictory to palliative goals, but as a complementary strategy to enhance quality of life in advanced cancer care.

ObjectiveTo examine the feasibility of a home-based high-intensity balance training programme (HBBT-MS) and its preliminary efficacy in individuals with multiple sclerosis (MS).DesignA single-group pretest-posttest design.SettingCommunity.SubjectsTwenty-eight individuals with MS (23 female (82%); mean age: 55.2 ± 11.9).InterventionsParticipants performed the program for 30 minutes per session, 3 days per week for 12 weeks, with the support of a family member to ensure safety while maintaining a high balance challenge.Main measuresFeasibility was assessed using four domains of process, resources, management, and scientific outcomes. Physical function (static balance, lower-extremity function, and mobility), dual-tasking, cognitive function (processing speed, verbal memory, and visuospatial memory), and self-reported outcomes (fatigue, dual-task difficulty, ambulation difficulty, and fear of falling) were assessed at baseline and post-intervention.ResultsTwenty-six out of 28 participants completed both the pretest and posttest (adherence rate: 92.9%). No severe adverse events attributed to this program were reported. There were significant and small-to-medium improvements in static balance (d = 0.74, p < 0.001), lower-extremity function (d = 0.70, p < 0.001), and mobility (d = 0.34, p = 0.004), with no improvement observed in dual-tasking. Participants showed significant and medium improvement in processing speed (d = 0.71, p = 0.007) and visuospatial memory (d = 0.55, p = 0.22), but not verbal memory (d = 0.02, p = 0.22). We observed significant improvements in all self-reported outcomes.ConclusionsThe HBBT-MS was feasible, safe, and acceptable. Further evaluation using a controlled design is warranted to examine the effectiveness of the programme.Clinical trial registration: clinicaltrials.gov; NCT06412003.

ObjectiveThis scoping review aimed to map outcome measures collected in randomised controlled trials investigating prehabilitation interventions in total hip and knee arthroplasty, and timepoints of collection.Data sourcesA systematic search of MEDLINE, EMBASE, Web of Science, Cochrane, and CINAHL was conducted.MethodsThis review followed the Joanna Briggs Institute Scoping Review methodology. Outcome domains, concepts of interest and assessment tools were characterised using the International Society for Pharmacoeconomics and Outcomes Research Framework, and timepoints for data collection were extracted.ResultsNinety-two trials (published between June 2001 and March 2025) were included. Most delivered unimodal prehabilitation, with exercise the most common intervention (n = 37). The review identified 36 outcome concepts measured with 219 assessment tools. Patient-reported outcomes were collected in 92% of trials (n = 85), and was the most heterogenous domain with 102 assessment tools. Performance-based outcomes, most commonly muscle strength, were collected in 66% of trials (n = 61) and utilised 47 different tools. Observer-reported outcomes were reported in 60% of trials (n = 55), with healthcare utilisation (e.g. hospital length of stay) the most common concept. Clinician-reported outcomes were reported in 48% of trials (n = 44) and most frequently included post-operative complications. Biomarker outcomes were rare (n = 7, 8%). Timing of outcome collection varied, with just over half the trials collecting both a pre-operative and post-operative timepoint.ConclusionThis review identified significant variability in outcome measures collected in prehabilitation trials for total hip and knee arthroplasty, highlighting the need for a core set of assessments to facilitate consistent reporting and robust meta-analyses of prehabilitation efficacy.

ObjectiveTo assess the responsiveness and interpretability (by the minimal important change [MIC]) of the Knee Outcome Survey - Activities of Daily Living Scale (KOS-ADLS) in patients with knee disorders and to evaluate potential differences between samples with surgical and with non-surgical history using both patient- and physiotherapist-reported perspectives.Study designClinimetric longitudinal study.SettingThree private physiotherapy clinics.Participants115 patients with knee disorders undergoing physiotherapy.InterventionParticipants completed the KOS-ADLS and other measurement instruments at baseline and after the treatment.Main measuresResponsiveness was assessed through hypothesis testing using effect sizes (ESs), standardised response means (SRM), change score correlations between KOS-ADLS and other measurement instruments, and area under the curve (AUC) values. Interpretability was assessed with MIC, determined using receiver operating characteristic (ROC)-based anchor methods via patient- and physiotherapist-reported Global Rating of Change. Responsiveness and MIC were provided for the total sample, sample with surgical history and sample with non-surgical history.ResultsKOS-ADLS demonstrated large ES (0.90) and SRM (1.03) values in the total sample, with better responsiveness in sample with surgical history patients. AUC values exceeded 0.70 across groups. Responsiveness was satisfactory as 91.7% hypotheses were confirmed. MIC values ranged from 8.5 to 18 points, with the highest estimates in the sample with surgical history patients and from the physiotherapist's perspective.ConclusionThe KOS-ADLS is a responsive and interpretable instrument for assessing change in knee-related function. Its findings vary by sample (sample with surgical history, sample with non-surgical history) rather than perspective (patient, physiotherapist).

ObjectiveThis scoping review evaluates the current use of driving simulators in neurorehabilitation, focusing on diagnostic assessment and therapeutic training in neurological populations.Data SourcesWe searched nine major databases for studies published through September 2025, using broad terms related to simulated driving and neurorehabilitation.Review MethodsFollowing PRISMA-ScR guidelines, we used ASReview software with active learning to identify relevant studies. Articles were grouped into diagnostic, therapeutic, review, and special interest categories, with data charted manually by two reviewers.ResultsOf 224 included articles, 124 addressed diagnostic use and 25 examined therapeutic interventions. Simulated driving was often evaluated for its predictive value in determining fitness-to-drive. Combined with neuropsychological tests, simulator outcomes reliably identified key cognitive predictors such as attention and executive function. Twenty-eight studies included on-road driving comparisons, supporting simulator validity. Simulator-based interventions showed benefits for patients with stroke, traumatic brain injury, or Parkinson's disease, particularly for improving tactical driving skills and awareness. Benefits were more pronounced in individuals with mild to moderate impairments. Simulators were generally well-accepted across patient populations.ConclusionDespite the heterogeneity of the literature, there is evidence to support the use of driving simulators as a promising tool for evaluating and improving fitness to drive in neurorehabilitation.

ObjectiveTo identify healthcare professionals' perceptions of pulmonary rehabilitation as a management strategy for people with chronic obstructive pulmonary disease (COPD).DesignA qualitative interview study which adopted an interpretive phenomenological approach.MethodsTwenty-seven healthcare professionals were recruited from general practices in the North West of England and two hospital trusts, consisting of: general practitioners, practice nurses, and doctors and nurses working on general medical wards. Audio recorded semi-structured interviews investigated healthcare professionals' perceptions and knowledge of pulmonary rehabilitation; interpretive phenomenological analysis was conducted on the transcribed interviews.ResultsThree themes were identified: COPD Illness Perceptions, Pulmonary Rehabilitation Beliefs, and Organisational and Referral Pathway Perceptions. Commonalities and disparities were identified between primary and secondary care and amongst the different professional groups. Healthcare professionals held negative COPD illness perceptions including stigmatising beliefs in relation to the disease. These beliefs impacted their referral practice. Beliefs about pulmonary rehabilitation included views about patient suitability for the pulmonary rehabilitation programme. A lack of knowledge of pulmonary rehabilitation and the referral process was evident. Surprisingly, many working on general medical wards had not heard of pulmonary rehabilitation and none in their current role had referred to the programme. Organisational and referral pathway perceptions revealed barriers and facilitators to referral.ConclusionReferral to pulmonary rehabilitation programmes is influenced by healthcare professionals' perceptions and knowledge of pulmonary rehabilitation, referral pathways and how COPD affects patients. Together health professional perceptions could act as a predictor of referral practice and inform strategies for increasing referral rates.

ObjectiveTo review challenges associated with health economic studies in rehabilitation, providing a context for the new Clinical Rehabilitation collection of papers concerned with health economics.RehabilitationAnalysis of the health economic effects associated with rehabilitation must recognise that rehabilitation consists of both a problem-solving process that facilitates the person's adaptation by providing information, advice, and sometimes specific interventions targeting multiple areas. Second, it operates within a complex, adaptive system, specifically the biopsychosocial model of illness. Third, its goals are to enhance well-being and quality of life through its effects on lower-level systems. Consequently, the effects of rehabilitation are unpredictable and typically manifest in several domains. Comprehensive single or multiple focused outcome measures are needed. As evidence-based selection of people who might benefit from rehabilitation is impossible, evaluative studies should have broad inclusion criteria.SystemsRehabilitation is a healthcare service. Traditionally, it is delivered in series, after the biomedical treatment has ended. This allows researchers, including health economists, to isolate the influence of rehabilitation. However, it will be more effectively delivered in parallel, with biomedical care from the outset, as happens, for example, in trauma and intensive care units. Evaluating individual components of healthcare in isolation is unnecessary. Rehabilitation will always involve non-healthcare services. Conversely, the effects of rehabilitation may significantly reduce non-healthcare costs. This close interrelationship necessitates a societal perspective on the economics of rehabilitation.ConclusionsUsing a combination of a global, comprehensive clinical outcome measure and societal-level health economic data will increase the likelihood of detecting effects.

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).