Clinical Rehabilitation最新文献

ObjectiveTo evaluate changes in quality-of-life and explore psychosocial influences on social participation and recovery in chronic stroke survivors following intensive upper limb neurorehabilitation.DesignMixed-methods design with quantitative (pre-post design with follow-up) and qualitative (semi-structured interview) phases.SettingThree-week Queen Square upper limb neurorehabilitation programme.Participants65 stroke survivors who participated in the programme from July 2016 to March 2018.Main measuresStroke Impact Scale (3.0) (SIS) and Action Research Arm Test, collected on admission, discharge, 6-week and 6-month follow-up (n = 65). Beliefs and psychosocial factors influencing quality-of-life were investigated through thematic analysis of semi-structured interviews in two subgroups, based whether the SIS-participation domain change from admission to follow-up was high (> 20, n = 5) or low (<-24, n = 5).ResultsSeven out of eight SIS domains, overall self-rated recovery (p < 0.001) and Action Research Arm Test (p < 0.001) improved from admission to discharge. The emotion domain improved from admission to discharge (p < 0.001) and reduced from discharge to 6-month follow-up (p < 0.001). Interviews highlighted four key psychosocial themes with contrasting positive and negative perspectives between higher change and lower change groups; themes 'hidden negative effects' and 'loneliness' were evident in the lower change group and 'getting on with my life' in the higher change group.ConclusionThe Queen Square upper limb neurorehabilitation programme led to measurable therapeutic benefits on physical and non-physical quality-of-life outcomes. However, the lack of sustained improvement in self-reported emotion contrasts with the clear benefits in other domains. This indicates a need for ongoing psychosocial support for some stroke survivors, supported by the qualitative findings.

ObjectiveTo identify common barriers and facilitators among physical therapists to implementing high-intensity gait training for patients post-stroke during inpatient rehabilitation.DesignA three-round Delphi study using free text responses and five-point Likert scales for agreement.Participants60 physical therapists with expertise treating patients with stroke in inpatient rehabilitation were invited. 33 participants completed all three rounds of surveys.Main MeasuresRound 1 consisted of two free text questions. Qualitative responses from round one were coded using the Theoretical Domains Framework and used to generate Likert scale survey items for rounds two and three. Consensus was defined a priori as ≥75% agreement. Response stability was evaluated with the Wilcoxon rank sum test.ResultsAnalysis identified 24 themes (12 facilitators, 12 barriers). Seven facilitators reached consensus: access to equipment (84.9%), built environment (78.8%), administrative support (78.8%), peer support (75.8%), team commitment to evidence-based practice (75.8%), high-intensity gait training-specific training (75.8%), and observable patient improvement (75.8%). Only one barrier reached consensus: treatment time interruptions (97.9%), including delays from toileting, hygiene, and medication administration. Other themes ranged from 18.2% to 57.6% agreement. No significant change in responses was found between rounds (p > 0.05).ConclusionsMore facilitators than barriers reached consensus, with treatment time interruptions as the primary agreed-upon barrier. Despite knowledge of high-intensity gait training and supportive factors, fewer than half of participants reported daily use. Targeted implementation strategies addressing time and workflow disruptions are needed to increase high-intensity gait training adoption in inpatient rehabilitation.

ObjectiveCompare the effectiveness of integrating virtual reality systems, Nintendo Wii and Microsoft Kinect, integrated with conventional physiotherapy versus conventional physiotherapy alone, in improving lower limb physical function in people over 60 years of age undergoing total hip arthroplasty.DesignRandomised, single-blind clinical trial.SettingSan Borja Arriaran Clinical Hospital, Santiago, Chile.Participants111 individuals over 60 years of age, divided into three groups (n = 37 each).InterventionsFor six weeks, the control group received conventional physiotherapy. The Wii and Kinect groups received the same physiotherapy programme plus 15 min of exercise using virtual reality platforms.Outcome measuresThe primary outcome was the function subscale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes included WOMAC pain, Berg Balance Scale, Six-Minute Walk Test, and weight-bearing.ResultsAll groups improved. For WOMAC function, the Wii group surpassed the Kinect group (mean difference: 40.48 points; p < 0.001; minimum clinically important difference MCID: 11.9 points) but not the control group. The Wii group also led in balance (Berg Balance Scale mean difference: 19.41 points; p < 0.001; MCID: 11.5 points). The Kinect group was superior in the Six-Minute Walk Test (mean difference: 133.10 metres; p = 0.001) and WOMAC pain reduction (mean difference: 11.45 points; p < 0.003) exceeding the MCID of 2.2 points. No significant changes were observed in weight-bearing.ConclusionVirtual reality combined with physiotherapy improves clinically meaningful outcomes following hip arthroplasty. The Wii favours balance, while Kinect enhances pain and gait, supporting personalised rehabilitation.Trial registrationThis research was registered in the Clinical Trials Registry of Australia and New Zealand (ACTRN12618001252202).

ObjectivesTo estimate the comparative efficacy of rehabilitation interventions for pain reduction in cervical radiculopathy and evaluate the individual components of combined treatments to support clinical decision-making.Data sourcesA systematic search was conducted across the Cochrane, PubMed, Scopus, WOS, and PEDro databases up to 1 July 2025, for randomized controlled trials comparing rehabilitation interventions against no intervention or other rehabilitation approaches for cervical radiculopathy-related pain.Review methodsWe conducted a frequentist random effects network meta-analysis and a component network meta-analysis to isolate the effects of individual treatment components. We used CINeMA software to assess the confidence in our estimates.ResultsWe included 36 trials comparing 25 interventions composed by eight active components. The components associated with a decrease in pain were neurodynamic techniques (SMD = -1.45; 95%CI: -1.88 to -1.02), cervical traction(SMD = -0.66; 95%CI: -1.08 to -0.25), articular treatment (SMD = -0.72; 95%CI:-1.29 to -0.15), and dry needling(SMD = -3.40; 95%CI: -5.40 to -1.39). The most promising interventions for reducing pain in cervical radiculopathy patients were a combination of the above components (except dry needling) with analgesic electrotherapy and strengthening exercises with a moderate confidence rating.ConclusionsA combination of articular treatment, analgesic electrotherapy neurodynamic techniques strengthening exercises and cervical traction appears to offer the most effective pain relief for patients with cervical radiculopathy, with a moderate confidence rating. Individually, neurodynamic techniques, cervical traction, and articular treatment were the components associated with a significant reduction in pain. Although dry needling showed encouraging results, its limited presence in the network prevents drawing firm conclusions about its effectiveness.

ObjectiveThe aim was to adapt and validate the Nursing Critical Thinking in Clinical Practice Questionnaire of 109 items in four dimensions, for its application in physiotherapists in Spain.DesignDescriptive, cross-sectional, multicenter psychometric study carried out in two phases: phase 1, adaptation of the Nursing Critical Thinking in Clinical Practice Questionnaire to the physiotherapy setting and analysis of its content validity; phase 2, evaluation of the psychometric properties of the new instrument.SettingPhysiotherapists from a variety of work environments (public and private hospitals, geriatric institutions, home care services, clinics, and primary care, social health, educational and sports centers).ParticipantsA sample of 235 physiotherapists participated, of whom 108 completed the questionnaire for a second time after a two-week interval.Main measuresConstruct validity was analyzed using Confirmatory Factor Analysis, convergent validity and discriminant validity; reliability was analyzed using internal consistency and temporal stability (test-retest method).ResultsThe Average Scale Content Validity Index of 0.96 indicated high content validity. Confirmatory Factor Analysis confirmed the four-dimensional structure on which the original questionnaire is based, with acceptable model fit indices. Cronbach's alpha for the total questionnaire was 0.97, reaching values above 0.70 in each of the dimensions. Lin's Intraclass Correlation Coefficient was 0.71.ConclusionsThe Physiotherapy Critical Thinking in Clinical Practice Questionnaire showed appropriate psychometric properties. Its use among Spanish physiotherapists is recommended.ClinicalTrials.gov IdentifierNCT05059483.URLhttps://clinicaltrials.gov.

ObjectiveTo evaluate the added value of sensor-based tests over conventional tests in explaining the variance in independence in activities of daily living (ADL) and independent walking in patients during inpatient stroke rehabilitation.DesignCross-sectional designSettingInpatient stroke rehabilitationParticipantsData were collected from 115 patients with stroke admitted to inpatient rehabilitation.InterventionNo intervention has been applied.Main measuresConventional measures and sensor-based tests in which postural sway and gait variables were measured using inertial measurement units. Outcome measures were ADL independence (determined by Barthel Index [BI]) and independent walking (determined by Functional Ambulation Categories [FAC]).ResultsWith univariable linear regression analyses showed that the Berg Balance Scale (BBS) explained most variance in ADL independence (R² = .527) and independent walking (R² = .727). In hierarchical multivariable regression analyses, symmetry during walking without a walking aid contributed most (ΔR²=18.6%) in explaining variance in ADL independency, resulting in a model explaining 15.7% (p = .029) of the variance in the BI. Tempo during walking with a walking aid contributed most (ΔR² = 20.1%) in explaining variance in independent walking, resulting in a model explaining 23.3% (p = .002) of the variance in the FAC. Adding sensor-based variables to models with the BBS did not significantly improve variance explanation.ConclusionsThe added value of variables measured with an inertial measurement unit in explaining ADL independence and walking ability after stroke is limited. These findings contribute to understanding the use of inertial measurement units in stroke rehabilitation, but caution is needed when applying them to predict physical recovery.

ObjectiveTo synthesise the evidence of the effectiveness of interventions to increase levels of physical activity or reduce levels of sedentary activity of inpatients after a new stroke.Data sourcesMedline, PsychINFO, AMED and CINAHL were search between inception and June 2025 for randomised controlled studies of in-hospital interventions for adults after stroke which measured physical activity.Review methodsInterventions were grouped by common components. For each intervention group, the outcomes of physical activity (primary outcome), physical functional ability, and quality of life were analysed with meta-analysis. Adverse events were synthesised narratively.ResultsTen studies (696 participants) were included in the review. General activity feedback (SMD = 0.52, 95% CI: -0.07 to 1.10; I² = 76.7%, 4 trials, n = 272) and additional physiotherapy (SMD = 0.89, 95% CI: -0.02 to 0.99; I² = 94.2%, 4 trials, n = 246) may result in moderate to large increases of in-hospital physical activity (very low certainty). Patient-directed activity programmes (one study) may have no effect on physical activity (low certainty). Upper-limb activity feedback (one study) may increase upper-limb activity (very low certainty).The evidence regarding the secondary outcomes demonstrated no effect (very low to moderate certainty), with the exception that additional physiotherapy may increase the risk of falls (low certainty).ConclusionsInterventions incorporating activity feedback or additional physiotherapy are promising, but further evidence is required for all interventions to increase the certainty in their estimates of effect.PROSPERO ID: CRD42024611456.

ObjectiveThis study aimed to explore the acceptability and factors that influenced implementation of a multidomain, home-based fall prevention programme (Integrate) for people with Parkinson's disease who fall recurrently, and their care-partners.DesignQualitative, inductive thematic analysis of semi-structured interviews.SettingHomes of Integrate participants in Sydney, Australia.ParticipantsEighteen interviews with people with Parkinson's disease and/or their care-partner who were purposively sampled after completing Integrate.InterventionIntegrate was delivered by occupational therapists and physiotherapists and included personally tailored home fall-hazard reduction, exercise (leg muscle strength, balance and freezing of gait) and safer mobility strategies delivered over 6 months.ResultsFive themes were identified: (a) the importance of personalisation, (b) a collaborative effort, (c) capacity building, (d) navigating fall risk with Parkinson's is complex and (e) the ease (or not) of making changes. Participants and their care-partners appreciated the personalised, home-based programme that involved shared decision-making and was delivered by expert therapists. They developed increased safety awareness and problem-solving skills. Making improvements, receiving ongoing support from therapists and care-partners and making change easier promoted sustained engagement. However, some participants faced emotional and psychological barriers to engagement including fatalistic beliefs about disease progression and a desire to avoid appearing 'disabled'. The reality of Parkinson's disease motivated participants to make changes but Parkinson's-related impairments such as apathy and motor fluctuations hindered this.ConclusionsPeople with Parkinson's disease who are recurrent fallers, and their care-partners, found the Integrate programme acceptable and were able to engage with it with guidance and support from therapists.

ObjectiveTo evaluate the efficacy of intermittent pneumatic compression therapy after arthroscopic release for post-traumatic elbow stiffness.DesignRandomised controlled trial.SettingSingle-centre trial conducted in Shanghai Sixth People's Hospital, Shanghai, China.ParticipantsA total of 197 patients undergoing arthroscopic elbow release were randomised into intervention (n = 99) and control (n = 98) groups; 176 completed the study (intervention: n = 89, control: n = 87).InterventionThe intervention group received intermittent pneumatic compression therapy (GameReady™) for 2 weeks plus four-week standard rehabilitation; the control group had rehabilitation alone.Main measuresThe primary outcome was improvement in elbow flexion-extension range-of-motion at 12 weeks. Secondary outcomes included forearm rotation range-of-motion, elbow strength (measured by Baltimore Therapeutic Equipment), and patient-reported outcomes at 4, 12, and 24 weeks.ResultsAt 12 weeks, elbow flexion-extension range-of-motion did not differ significantly between groups. Secondary objective outcomes (forearm rotation and elbow strength) were also similar. However, the Intervention group reported significantly better elbow function at 24 weeks (American Shoulder and Elbow Surgeons Shoulder Score function subscore: 95% confidence intervals: 0.186-1.719; P = 0.015). Pain and disabilities of the arm, shoulder, and hand questionnaire scores showed no significant differences between groups.ConclusionsIntermittent pneumatic compression therapy did not significantly improve early elbow mobility or strength following arthroscopic release, but enhanced patient-reported elbow function at longer-term follow-up. Intermittent pneumatic compression therapy may be beneficial as an adjunct to standard rehabilitation. Further studies with larger samples and extended follow-up are needed.Trial registration numberChiCTR2500101221 (Chinese Clinical Trial Registry, https://www.chictr.org.cn/, date of registration: 2025-04-22).

ObjectiveThis meta-analysis evaluates the effectiveness of robot-assisted rehabilitation on various functional outcomes in patients with Parkinson's disease.Data sourcesA comprehensive search was conducted in databases including PubMed, Embase, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and Google Scholar up to April 2025.Review methodsRandomized controlled trials assessing the impact of robot-assisted rehabilitation were included. Pooled standardized mean differences (SMD) were calculated using a random-effects model, with heterogeneity assessed via I² and tau² statistics. Sensitivity analyses and publication bias assessments were also performed.ResultsThe meta-analysis included 22 studies with 819 participants. Significant improvements were observed in the Six-Minute Walk Test (SMD = 1.304, 95%CI: 0.387-2.221, p = 0.005, I² = 93.1%), timed up-and-go test (SMD = -0.302, 95%CI: -0.490 to -0.114, p = 0.002, I² = 0.0%), Unified Parkinson's Disease Rating Scale Part-III (SMD = -0.924, 95% CI: -1.330 to -0.518, p < 0.0001, I² = 79.9%), Berg Balance Scale (SMD = 0.986, 95% CI: 0.546-1.425, p < 0.0001, I² = 76.3%), and gait speed (SMD = 0.772, 95%CI: 0.290-1.255, p = 0.002, I² = 73.1%). Step length showed significant improvement (SMD = 0.848; 95%CI: 0.196-1.501, p = 0.011, I² = 87%).ConclusionRobot-assisted rehabilitation significantly improves functional outcomes in patients with Parkinson's disease, particularly in walking distance, balance, and gait speed. These findings support the integration of robot-assisted rehabilitation into clinical practice for enhancing mobility and reducing motor symptoms in Parkinson's disease.