Clinical Rehabilitation最新文献

ObjectiveTo examine the feasibility and acceptability of Neuromuscular Bridges, a personalised self-management support intervention adapted for people with neuromuscular disorders, and to explore contextual factors influencing its implementation in specialist care.DesignA hybrid type II feasibility study employing mixed methods to evaluate clinical and implementation feasibility, incorporating quantitative outcomes with qualitative process evaluation.SettingA specialist neuromuscular tertiary centre in the United Kingdom.ParticipantsThirty-three adults with diverse neuromuscular disorders and six trained clinicians (physiotherapists and clinical nurse specialists).InterventionNM-Bridges, a co-designed, person-centred self-management support intervention delivered in a single clinical consultation, underpinned by the Bridges approach and Social Cognitive Theory.Main measuresRecruitment, retention, fidelity, and patient-reported outcomes were collected at baseline, post-intervention, and 3-month follow-up. Implementation was assessed using validated instruments and qualitative interviews.ResultsOf 106 eligible patients invited, 33 (31.1%) enrolled, with full retention and no missing data. Quantitative outcomes showed moderate pre- and post-improvements in patient-centred care, especially goal setting and activation. Small positive changes were noted in social participation, emotional well-being, mood, and self-efficacy, with effects generally sustained at follow-up. Fidelity was high, and implementation measures indicated strong clinician engagement. Qualitative data reinforced these findings, highlighting collaboration, relevance, and acceptability within routine care.ConclusionNM-Bridges was feasible and acceptable within specialist neuromuscular care. By integrating clinical outcomes with implementation learning, this hybrid feasibility study provides early evidence and a foundation for future evaluation of self-management support as a relational and sustainable component of neuromuscular rehabilitation.

ObjectiveFibrosis can develop after surgical or radiation treatments for cancer and is often seen in rehabilitation settings, yet few measures exist for standardized assessment. The aims of this study are to describe the validity and reliability of a new measure for cancer treatment-related fibrosis in survivors of breast or head/neck cancer.DesignFace validity of the Courage Kenny-Fibrosis Grading Scale was established using an iterative survey process. Reliability and concurrent validity were assessed using repeated measures by blinded raters and concurrent assessment with the Common Terminology Criteria for Adverse Events, Late Effects Normal Tissue-Subjective, Objective, Management, Analytic scales, and adheremeter rating of skin mobility.SettingOutpatient rehabilitation clinic.ParticipantsQuestionnaires were completed by 43 clinicians and researchers in the first round of face validation and 21 in the second. For reliability and concurrent validity, 41 cancer survivors, including 26 post-breast cancer and 15 post-head/neck cancer, were assessed by four physical therapists.ResultsAdequate face validity of the final version was established using responses from 21 clinicians. Inter-rater and intra-rater reliability of the final scale was adequate at ICC = 0.810 and 0.941, respectively. Associations between the Fibrosis Grading Scale and the Common Terminology Criteria for Adverse Events and Late Effects Normal Tissue scales were moderately significant (r_S = 0.290-0.574, p < 0.05), indicating concurrent validity.ConclusionAfter development of the Fibrosis Grading Scale using an iterative survey process, sufficient reliability and validity was established to use as an assessment in breast and head/neck cancer survivors.

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.