Clinical Rehabilitation最新文献

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.

ObjectiveTo investigate the association between individualised rehabilitation dose levels and functional outcomes across age- and frailty-specific cohorts of critically ill patients.DesignMulticentre prospective observational cohort studySettingIntensive care units at 22 hospitals in Japan.ParticipantsOverall, 422 adult patients receiving mechanical ventilation for ≥48 h were categorised into old non-frail (age ≥65 years, clinical frailty scale: 1-4), old frail (age ≥65 years, clinical frailty scale: > 4) and middle-aged/young (age <65 years) cohorts.Main measuresThe primary outcome was independence in activity of daily living at hospital discharge, defined by a Barthel Index score of ≥90. Rehabilitation parameters dose, intensity, duration, frequency and timing were assessed. Multivariable logistic regression analysis was performed for each cohort.ResultsIn the old non-frail cohort, activity of daily living independence was associate with higher dose (odds ratio: 1.10, 95% confidence interval: [1.04-1.17]), higher intensity (odds ratio: 1.18 [1.02-1.37]) and shorter time to first mobilisation (odds ratio: 0.92 [0.86-0.98]), whereas, in the old frail cohort, it was higher dose (odds ratio: 1.07 [1.02-1.18]), longer duration (odds ratio: 1.05 [1.01-1.12]) and higher frequency (odds ratio: 1.82 [1.07-4.62]). In the middle-aged/young cohort, activity of daily living independence was associated with higher dose (odds ratio: 1.14 [1.05-1.28]) and higher intensity (1.30 [1.06-1.62]).ConclusionsThe impact of rehabilitation dose on functional recovery varies across age- and frailty-specific cohorts. These findings highlight the importance of tailoring rehabilitation dose to patient characteristics to optimise functional outcomes in critical illness.Trial registration: UMIN000036503.

BackgroundAgitation is frequently observed in patients with severe acquired brain injury and prolonged disorders of consciousness.ObjectivesTo evaluate the incidence of agitation and its diagnostic and predictive value, in patients with disorders of consciousness.MethodsIn this retrospective observational cohort study, data from patients in unresponsive wakefulness state, minimally conscious state and emerged from the minimally conscious state was analyzed. Demographic and clinical information on agitation, disability, and neurobehavioral condition (i.e., Overt Agitation Severity Scale, Disability Rating Scale, and the Coma Recovery Scale-Revised Index) were collected at admission to a rehabilitation facility and long-term acute care hospital, and 24 months post admission.ResultsOne hundred and nineteen patients (unresponsive wakefulness state = 62, minimally conscious state = 57), of which 68.1% (unresponsive wakefulness state = 35, minimally conscious state = 46) exhibited signs of agitation with varying intensity. Patients in minimally conscious state showed significantly higher Overt Agitation Severity Scale scores in the upper and lower limb subscales, compared to patients in unresponsive wakefulness state (p < .001 and p = .007, respectively). The Overt Agitation Severity Scale total score showed significant correlations with both the Coma Recovery Scale-Revised Index and the Disability Rating Scale total score. At 24 months after admission, 41 patients (11.3% unresponsive wakefulness state, 59.7% MCS) emerged from the minimally conscious state, whereas 78 patients were still in a disorder of consciousness. A logistic regression model found that traumatic etiology, higher Coma Recovery Scale-Revised Index and higher Overt Agitation Severity Scale total score increased the probability of emergence from the minimally conscious state at 24 months (accuracy = 80.7%).ConclusionsOur results provide the first evidence for agitation as a diagnostic and prognostic marker of recovery of consciousness.

ObjectiveTo synthesise evidence regarding the safety, feasibility and acceptability of high-intensity interval training in adults post-stroke.Data sourcesA systematic literature search using eight major databases from inception to January 2025.Review methodsStudies of any design, involving adults post-stroke, reporting on safety, feasibility and/or acceptability of any type of high-intensity interval training, were eligible. Methodological quality was assessed using the Effective Public Health Practice Project or the Mixed Methods Appraisal Tool, as appropriate. Meta-analyses of adverse events and dropouts were undertaken on data from randomised controlled trials. GRADE methodology was used to categorise the level of certainty of the evidence from each meta-analysis.ResultsTwenty studies plus one follow-up and a cost analysis, involving 658 participants, were included. Methodological quality varied. High-intensity interval training was mainly conducted individually and in supervised settings. There were no fatalities related to high-intensity interval training. There was low-moderate certainty of no difference in the risk of adverse events, whether these were intervention-related, non-intervention related or unclear. Average attendance at high-intensity interval training sessions was 94.4%. Reporting on acceptability of high-intensity interval training was scarce, but where reported participants' experiences were generally favourable.ConclusionThis systematic review found low-moderate certainty evidence that high-intensity interval training can be safe and feasible for carefully selected, generally younger, mildly affected, male stroke survivors in the chronic stage, supervised by trained professionals in controlled settings. Future studies should investigate experiences of high-intensity interval training and explore its use in a wider stroke population and range of settings.

ObjectiveTo explore the views of staff in hospital rehabilitation wards about factors influencing implementation of Exergames for older adults with mild to moderate frailty.DesignQualitative descriptive study.SettingThree rehabilitation and frailty wards across two NHS hospital settings in the North West of England.ParticipantsA purposive sample of 22 healthcare professionals was recruited to take part in the study.InterventionTherapy staff were instructed on how to use the Exergames with patients. Trained therapists, and other healthcare professionals, took part in a focus group or semi-structured interview to share perceived constraints to Exergames implementation. The research physiotherapist also reflected on each ward's response to the intervention, and the Exergames training sessions. Pre-implementation actions in the Quality Implementation Framework informed the topic guide and analysis. Data was analysed using the Framework approach.ResultsThree face-to-face focus groups and seven interviews (in-person or online) were conducted, and the research physiotherapist recorded 25 h of observations. Themes represented factors impacting Exergames use in a hospital environment. These included: competing priorities for staff availability and time; buy-in from key stakeholders; the user-friendly integration of the Exergames system; flexible training sessions and development of a feasible and effective delivery framework.ConclusionsThe dynamic nature of hospital wards, such as changes of staff and ward focus, and complexity of interactions within and between individual, ward and organisational levels, means effective Exergames implementation requires coordinated efforts and ongoing adaptability.

ObjectiveTo evaluate the efficacy and safety of blood flow restriction (BFR) training on exercise capacity, muscle strength, pulmonary function, and fatigue in individuals with chronic obstructive pulmonary disease (COPD).MethodsA comprehensive search was conducted in six databases up to April 2025. Randomized controlled trials involving adults with COPD undergoing BFR training were included. Methodological quality was assessed using the Cochrane Risk of Bias 2 tool, and the certainty of evidence was graded according to Grading of Recommendations Assessment, Development and Evaluation guidelines.ResultsOf 573 records identified, three randomized clinical trials with a total of 127 participants met the inclusion criteria. Intervention durations ranged from 2 to 24 weeks with varying occlusion pressures and outcome measures. Meta-analysis showed no significant improvements in six-minute walk distance (mean difference: 20.83; 95% CI [-14.97 to 56.63]; very low certainty), or muscle strength (SMD: 0.78; 95% CI [-0.66 to 2.22]; very low certainty). A significant reduction in fatigue was observed (SMD: -0.48; 95% CI [-0.92 to -0.04]; very low certainty). Overall, the quality of evidence was rated very low.ConclusionCurrent evidence is insufficient to draw firm conclusions regarding the efficacy and safety of BFR training in COPD. Further high-quality, standardized RCTs are necessary to clarify its clinical utility and safety.