Clinical Rehabilitation最新文献

ObjectiveTo explore post-stroke body image experience and enhance understanding of its impacts on wellbeing and recovery.DesignCross-sectional qualitative semi-structured interview study with an interpretative phenomenological approach.SettingInterviews conducted in participants' homes, using video-calls, telephone or in-person.ParticipantsPeople treated for acute stroke at two UK hospitals were identified at six months post-stroke and purposively sampled for diversity. Participants were 22 adults (55% male), on average 6.3 months post-stroke and aged 48 to 82 years (median 66 years).ResultsTwo main themes were identified: (1) 'Body now perceived as an 'obstacle' to normality', comprising three subthemes around altered trust in the body, outward presentation of body image and the likening of body image to that of an older person and; (2) 'Responses to a new body image experience', comprising five subthemes around the importance of body image, societal pressures, acceptance/adjustment to a changed body image and positivity through experiencing improvements towards a perceived 'normal' body image.ConclusionsRegaining perceived pre-stroke 'normal' body image and ability to adjust to a new one is reported as important in recovery. We have demonstrated negative changes in body image experience, and it is possible this is a normal part of post-stroke adjustment. Further research is required to determine whether body image experience can be positively influenced by brief interventions such as guided self-help or psychological support to ensure that they do not persist long term.

ObjectiveTo explore the feasibility of tailored implementation of a stroke physical activity behaviour change intervention (Physical Activity Routines After Stroke (PARAS)) and the feasibility of the intervention.DesignFeasibility study applying mixed methods.SettingUK stroke services.ParticipantsFour stroke rehabilitation teams comprising 34 healthcare professionals.InterventionWe applied a tailored implementation process informed by the Integrated Theory-based Framework for Intervention Tailoring Strategies to the PARAS intervention. Teams each attended two facilitated workshops (face-to-face/hybrid/online) identifying barriers and facilitators (determinants) to PARAS implementation to enable development of tailored implementation plans. Plans were applied and reviewed.Main measuresFeasibility of the tailored implementation process and intervention was explored via analysis of online questionnaire responses and thematic analysis of workshop and review session content. Inductive analysis identified determinants to implementation plan completion and enabled mapping of promising implementation strategies and their operationalisation and intervention development needs.ResultsThirty-four healthcare professionals participated across four teams. The facilitated, tailored implementation process was deemed feasible. All teams reported partially achieving implementation plans. Factors influencing implementation plan success included: motivation; stakeholder involvement; leadership and planning; intervention delivery skills. Implementation strategies mapped to factors included: assess for readiness; build a coalition; identify champions; train for leadership; and develop an implementation plan and ongoing training. Intervention adaptations identified included intervention tailoring and digitising resources.ConclusionOur implementation process and the PARAS intervention were feasible with moderate amendments. Our findings enabled development of a model to support tailored implementation of PARAS and identified intervention development needs to guide future evaluation.

ObjectiveExercise is a well-recognized, safe, and effective strategy for breast cancer survivors. This study aimed to evaluate the effects of high-intensity interval training on multiple clinical outcomes in this population.Data sourcesWe conducted a search of the PubMed, EMBASE, and Cochrane Library databases from their inception through June 30, 2025, and updated on September 6, 2025.Review MethodsThis systematic review and meta-analysis included randomized controlled trials that compared high-intensity interval training with usual care, moderate-intensity continuous training, or resistance training for breast cancer survivors on multiple clinical outcomes.ResultsFifteen trials were included. High-intensity interval training significantly improved cardiorespiratory fitness compared to usual care, moderate-intensity continuous training, and resistance training. It was also superior to usual care for improving quality of life and reducing high-sensitivity C-reactive protein, and superior to moderate-intensity continuous training for reducing Interleukin-6. However, according to the GRADE assessment, the certainty of evidence for these outcomes was low, primarily due to the risk of bias and imprecision from small sample sizes. No major exercise-related adverse events were reported. A framework (Frequency, Intensity, Time, and Type) typically recommends three 30--40-minute sessions per week for a duration of 8-12 weeks, with adaptable protocols featuring various interval structures and exercise types.ConclusionsHigh-intensity interval training is a safe and effective modality for breast cancer survivors, demonstrating superior improvements in cardiorespiratory fitness over various control interventions. Its benefits for quality of life and inflammation support its use in clinical rehabilitation.

ObjectiveTo determine if socket comfort predicts walking capacity, walking performance, and life-space mobility.DesignObservational exploratory study involving a secondary cross-sectional analysis using multiple regression of data collected from an exercise intervention trial.SettingLaboratory setting for clinical assessments; community setting for walking performance.ParticipantsCommunity-dwelling lower-limb prosthesis users over 50 years old (n = 72).Main measuresSocket Comfort Score, 2-Minute Walk Test, step count, Life Space Assessment, and control variables including demographics, Short Physical Performance Battery, Four Square Step Test, and Walking While Talking.ResultsRegression modeling showed Socket Comfort Score as a statistically significant predictor of 2-Minute Walk Test (B = 6.9 m, 95% CI [2.7, 11.1] m) alongside amputation level, Walking While Talking test, and Short Physical Performance Battery (greatest contribution to the model); the model accounted for 61% of the variance. Socket Comfort Score was not a statistically significant predictor of step count. Socket Comfort Score was the only statistically significant predictor of Life Space Assessment (B = 4.9, 95% CI [1.1, 8.8]); the model accounted for 12% of the variance.ConclusionsSocket comfort played a notable role in predicting walking capacity and life space mobility, but not in walking performance. Improving lower extremity function may have greater impact on walking overall. While this study provides context regarding socket comfort that clinicians may consider when planning holistic prosthetic rehabilitation, mixed findings in the literature suggest that further research on how socket comfort relates to walking outcomes in the community is warranted.

ObjectiveTo investigate whether immobilisation duration and rehabilitation initiation influence functional recovery, recurrence, and treatment failure in first-time anterior shoulder dislocation managed conservatively.DesignRetrospective multicentre cohort study.SettingOrthopaedic departments of multiple hospitals, data were collected between 2015 and 2021.ParticipantsA total of two hundred and one patients with first-time anterior shoulder dislocation were managed non-surgically. Patients were divided into three groups: Group 1 (early mobilisation; n = 61) - one to two weeks of immobilisation with rehabilitation starting in week two; Group 2 (standard protocol; n = 76) - three to four weeks of immobilisation with rehabilitation starting in week four; and Group 3 (delayed rehabilitation; n = 64) - more than four weeks of immobilisation with rehabilitation starting in week six.InterventionNon-surgical treatment with varying immobilisation durations followed by rehabilitation.Main MeasuresFunctional outcomes were the Rowe, Disabilities of the Arm, Shoulder and Hand, American Shoulder and Elbow Surgeons, and Western Ontario Shoulder Instability Scores. Clinical outcomes included shoulder range of motion, recurrence, return-to-activity time, and treatment failure.ResultsFunctional scores and range of motion did not differ significantly between groups. Recurrence occurred in 18.0% (Group 1), 23.7% (Group 2), and 23.4% (Group 3), with no statistically significant difference (p = .135). However, treatment failure - defined as persistent instability or the need for surgical stabilisation - was significantly higher in Group 3 (23.4%) compared with Group 1 (16.4%) and Group 2 (18.4%) (p = .022). Mean follow-up was 42.1 ± 10.2 months.ConclusionsImmobilisation duration and rehabilitation timing were not associated with statistically significant differences in functional recovery or recurrence. Prolonged immobilisation appeared to increase the risk of treatment failure. Early or standard protocols may therefore represent reasonable options, and prospective randomised studies are needed to define optimal management.Level of Evidence: Level Three.

ObjectiveTo examine how well acute stroke studies assessing upper limb sensorimotor capacity align with the Stroke Recovery and Rehabilitation Roundtable (SRRR) recommendations, focussing on the type of assessment tools used, study and participant characteristics, follow-up timings, and the use of clinical and multimodal data.DesignScoping review.Data sourcesEmbase, MEDLINE, PubMed, CINAHL, PsycINFO, Google Scholar, and Web of Science were searched for relevant studies published between 01 August 2017 and 30 September 2025.MethodsThis review included studies involving adults with stroke who underwent upper limb assessment during the acute phase. Data were extracted on clinical, structural, and functional assessments, as well as follow-up timing, study, and participant characteristics. Of the 3628 identified articles, 132 met the inclusion criteria.ResultsWhile global assessments (e.g. NIH stroke scale [NIHSS]) and impairment-level upper limb assessments (e.g. Upper-extremity Fugl-Meyer Assessment) were widely used, activity-level tools (e.g. Action Research Arm Test) were underrepresented. Structural brain imaging was common, though often used only diagnostically, while functional brain imaging and multimodal approaches were rare. Follow-up timing varied, with limited long-term tracking. Demographic reporting was inconsistent, with underrepresentation of young adults and women.ConclusionDespite progress, significant gaps remain in the standardisation and comprehensiveness of upper limb assessment in acute stroke research. Future studies should better align with SRRR recommendations to improve data comparability and scientific rigour.

ObjectiveThis study aimed to compare the effects of different dual-task training modalities on walking and balance in stroke patients using network meta-analysis.Data sourcesRandomized controlled trials were searched in PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, and Chinese Biomedical Database from inception to September 2025.Review methodsMethodological quality was assessed using the Cochrane risk-of-bias tool. A frequentist approach was applied for network meta-analysis, and evidence quality was evaluated with confidence in the network meta-analysis framework.ResultsThirty-four trials covering 10 dual-task modalities were included. Network meta-analysis results showed that motor-walking dual-task training was the most effective in improving cadence (mean difference = 7.04, 95%CI: 1.95 to 12.12), walking speed (standardized mean difference = 0.67, 95%CI: 0.27 to 1.06), step length (standardized mean difference = 0.56, 95%CI: 0.20 to 0.92), stride (standardized mean difference = 0.76, 95%CI: 0.45 to 1.08), 10-Meter Walk Test (standardized mean difference = 0.73, 95%CI: 0.05 to 1.12) and berg balance scale (mean difference = 5.76, 95%CI: 1.38 to 10.14). Cognitive-balance dual-task training showed the greatest improvement in Timed Up and Go test (mean difference = -4.73, 95%CI: -10.24 to -0.78). The certainty of evidence for most outcomes, assessed using the Grading of Recommendations Assessment, Development and Evaluation framework, ranged from very low to high.ConclusionsMotor-walking dual-task training best improved cadence, walking speed, step length, stride, 10-Meter Walk Test, and Berg Balance Scale. Cognitive-balance dual-task training showed the greatest improvement in Timed Up and Go test. These results inform future guidelines and clinical decisions for stroke patients' walking and balance rehabilitation.

ObjectiveAustria's rehabilitation system lacked personalisation, alignment with the International Classification of Functioning, Disability, and Health (ICF), and measurable quality indicators. To address these gaps, a unified change management approach aligned with international standards and the biopsychosocial model was developed. The resulting Comprehensive Framework for Rehabilitation Standards, Practices, and Services aimed to establish a patient-centred, evidence-informed model integrating policy, quality, and practice.Local contextRehabilitation in Austria is provided by social insurance institutions, including the Pension Insurance Austria, which defines medical and therapeutic specifications for rehabilitation services. Historically, these were disease-centred, heterogeneous, and lacked individualisation.MethodsThe development followed a co-creation process involving focus groups with interdisciplinary staff from rehabilitation centres. Implementation in 17 centres across Austria required process and information technology adaptations as well as capacity building. Thirteen key performance indicators were established for monitoring, evaluation, and benchmarking.ResultsAfter three quarters of implementation, all centres adhered to six key performance indicators, including staff and patient satisfaction, functional status assessment, quality of life screening, work-related rehabilitation needs, and follow-up rehabilitation referrals. Challenges included consistent ICF application, individual goal-setting, and therapy planning tailored to impairment severity. Implementation problems mirrored those reported internationally. Strong leadership, interdisciplinary collaboration, and early information technology engagement were key enablers.ConclusionThe framework operationalised international rehabilitation standards into a scalable national model. Its ICF-based design demonstrated that large-scale, patient-centred, participation-oriented rehabilitation is achievable through structured change management. Future evaluations should assess long-term outcomes and adaptability across health systems with varying digital maturity.

ObjectivesCognitive decline and impaired balance are well-documented in people with diabetic peripheral neuropathy; however, no ambulation assessments currently address the cognitive dual-task demands specific to this population. The Six-Spot Step Test Cognitive is a brief, functional mobility test designed to equally emphasize cognitive and motor components. This study evaluated its construct validity and test-retest reliability in people with diabetic peripheral neuropathy.DesignCross-sectional study.SettingOutpatient clinics.ParticipantsFifty-five people with diabetic peripheral neuropathy.Main measuresThe Six-Spot Step Test Cognitive was completed twice within the same day and again three to seven days later. Additionally, the cognitive Timed "Up and Go" test and the Mini-BESTest were administered on the last day. Reliability and validity were estimated using Bland-Altman statistics, the minimal difference, Intraclass Correlation Coefficient, and Spearman's rank correlation coefficient.ResultsThe Six-Spot Step Test Cognitive was found reliable (Intraclass Correlation Coefficient: 0.88-0.92; minimal difference: 27.2%-31.4%) and showed moderate construct validity to the cognitive Timed "Up and Go" test (Spearman's rank correlation coefficient = 0.55, p < .001). Weak correlations with the Mini-BESTest (Spearman's rank correlation coefficient = -0.26, p < .06) indicated low construct validity. Significantly higher dual-task costs were observed when performing the Six-Spot Step Test Cognitive (58.7%) compared to the cognitive Timed "Up and Go" test (29.6%).ConclusionsIn people with diabetic peripheral neuropathy, the Six-Spot Step Test Cognitive demonstrated promising construct validity and acceptable to excellent reliability, making it a valid measure of functional mobility, including cognitive dual-tasking. Additionally, a higher dual-task cost indicated actual cognitive-motor interference while performing the test.