Clinical Rehabilitation最新文献

ObjectiveTo compare balance-confidence among patients with primary open-angle glaucoma, age-related macular degeneration, and controls in Brazil.DesignCase-control study.SettingCharity hospital in São Paulo, Brazil.ParticipantsPatients with glaucoma, age-related macular degeneration, and controls without eye diseases.Main outcomes measuresActivities-specific Balance Confidence (ABC) Scale scores.ResultsThe sample consisted of 64 patients with glaucoma, 60 with age-related macular degeneration, and 60 controls. All groups were matched by age, gender, ethnic distribution, and comorbidities. The ABC Scale score was 63.1 (25.9) in the glaucoma group, 69.5 (16.4) in the age-related macular degeneration group, and 95.3 (9.1) for the controls (P < 0.001; Hedges' g -1.65 and -1.93, large effect size); glaucoma patients score did not differ from age-related macular degeneration patients (P = 0.132; Hedges' g 0.30, small effect size).ConclusionBoth glaucoma and age-related macular degeneration patients reported lower balance-confidence in performing daily activities without losing balance as compared to controls.

ObjectiveIn this mixed-methods study, we aimed to develop a self-management education module within the ChestCare mHealth app, thus enabling patients with chronic obstructive pulmonary disease to self-manage their condition and empower healthy behaviours.DesignWe integrated the results of sequential focus group discussions and content validity evaluation to decide the topics. We then utilized the multimedia learning theory, the Lung Foundation Australia Guidelines, and consolidated theories of mHealth development to design the education module. Consequently, we used artificial intelligence-augmented platforms to develop the multimedia educational tools.SettingOutpatient physiotherapy department in a Malaysian public hospital.ParticipantsPhysiotherapists and patients with chronic obstructive pulmonary disease engaged in sequential focus group discussions to share their perspectives on the proposed educational topics. Then, nine experts, three in physiotherapy, clinical psychology, and dietetics, evaluated the content validity of the education module.InterventionSelf-management education module to empower patients with chronic obstructive pulmonary disease.Main measuresthe development of a validated self-management education module that aims to improve treatment outcomes and address rehabilitation challenges.ResultsThe sequential discussions resulted in modifications and refinements of the proposed topics, ultimately identifying 12 education topics. The content validity calculations for the three educational clusters resulted in a score of 1. We developed flipbooks, education cards, and videos, along with auditory recitation, using theoretical design and creative development.ConclusionsWe created 12 flipbooks, education cards, and videos that serve as self-management education embedded in mHealth, with the next step to evaluate their usability and feasibility in clinical practice.

ObjectiveThis study estimated the prevalence of facial palsy after stroke and identified risk factors; examined recovery patterns; and evaluated the effect of hyperacute treatments on its recovery.Design and settingThis was a secondary analysis of data prospectively collected in the first 7 days of stroke admission for the Bergen NORSTROKE study.ParticipantsOf 5987 patients, a subgroup of 2293 with facial palsy were analysed for recovery, including 1954 with ischaemic stroke assessed for treatment effect.Main measurementsFacial palsy was assessed repeatedly at irregular intervals from admission using the National Institute of Health Stroke Scale.AnalysisPrevalence was summarised descriptively, and multifactorial logistic regression identified risk factors. The recovery was analysed with Kaplan-Meier curves and Cox models.ResultsFacial palsy was observed in 2578 patients (43%), including 2406 (40%) with minor or partial paralysis and 172 (3%) with complete paralysis. Facial palsy was more common in haemorrhagic (360, 54%) than ischaemic stroke (2218, 42%), reflecting greater motor impairment. Among patients without motor impairment, prevalence was lower in haemorrhagic strokes (15, 10%) than in ischaemic strokes (284, 14%). Risk factors included sex, age, and the degree of motor and sensory deficit. By day 2, 573 patients (25%) had fully recovered, while 1434 (63%) still had symptoms by day 7. Worse recovery was associated with more severe motor and sensory impairments. Intravenous thrombolysis was associated with better recovery.ConclusionsOur study provides a comprehensive analysis of post-stroke facial palsy, highlighting recovery patterns and the need for ongoing monitoring and rehabilitation.

ObjectiveTo evaluate the perceptions, knowledge, and attitudes of multidisciplinary clinicians within a healthcare organisation completing a stroke-integrated cardiac rehabilitation research programme in addition to usual care neurorehabilitation.DesignA qualitative study based on a phenomenological approach.SettingOne-on-one, semi-structured, qualitative interview completed either face-to-face or over the telephone.ParticipantsFourteen multidisciplinary clinicians (e.g., physical therapists, occupational therapists, psychologists, speech therapists, cardiac nurses and a physician) working in usual care neuro- and cardiac-rehabilitation.Main measuresTwo independent researchers completed line-by-line coding and thematic analysis and derived relevant themes and sub-themes addressing the research question. To enhance trustworthiness and transparency of findings, a third researcher reviewed final themes.ResultsThree main themes emerged with 3-4 relevant sub-themes. The first theme was clinicians' knowledge. Participants were aware of exercise recommendations within the clinical stroke guidelines, but their knowledge of the content of the recommendations, and the stroke-integrated cardiac rehabilitation programme, varied. The second theme was clinicians' attitudes and beliefs towards the stroke-integrated cardiac rehabilitation programme. All participants described exercise as being important and believed the stroke-integrated cardiac rehabilitation programme was a good idea. However, clinicians highlighted numerous barriers and suggested programme adaptations (third theme) to the stroke-integrated cardiac rehabilitation programme. Increased awareness of the stroke-integrated cardiac rehabilitation programme, and a more flexible and adaptable programme, may enhance future implementation.ConclusionClinicians believed the stroke-integrated cardiac rehabilitation programme was important and had clinical utility. Increased awareness of evidence-based recommendations, and a more flexible and adaptable programme may aid uptake and future implementation.

ObjectiveTo explore the perspectives and experiences of patients with knee osteoarthritis regarding physiotherapy care management in Hong Kong.DesignQualitative study using semi-structured, individual interviews.SettingCommunity.ParticipantsPatients age 50 years or older with knee osteoarthritis, purposively recruited.InterventionFace-to-face semi-structured interviews were conducted with patients who had completed a physiotherapy rehabilitation programme in the past six months.Main MeasuresA 21-question interview guide encouraged participants to discuss their physiotherapy management, experiences, and recommended interventions, covering all non-pharmacological treatments outlined in local clinical guidelines. Questions also explored factors influencing adherence to care during and after physiotherapy. Interviews were audio-recorded, transcribed verbatim, and analysed thematically.ResultsFourteen patients participated. Five key themes emerged: (a) navigating pain and management strategies; (b) adapting daily life and the impact of knee osteoarthritis on activities; (c) complexities of treatment and the need for personalised care; (d) the role of exercise and mobility; and (e) barriers to access and resources. While patients reported receiving various physiotherapy interventions, gaps were noted in aquatic therapy, neuromuscular training, weight management, and assistive devices. Barriers included limited access, financial constraints, and lack of home exercise equipment. Although participants valued physical activity, maintaining an exercise routine was challenging.ConclusionsA comprehensive, patient-centred approach is essential for effective physiotherapy care for knee osteoarthritis in Hong Kong. Addressing practical barriers and integrating patient feedback can enhance the accessibility and impact of evidence-based interventions.

ObjectiveThis study adopted a novel approach to exploring the content validity, safety, usability, and user experiences of different games for telerehabilitation purposes from the perspective of physiotherapists and stroke survivors.DesignA cross-sectional content validity and usability study.SettingLab and online.Participants23 participants were recruited; 11 neuro-physiotherapists and 12 chronic stroke survivors.OutcomesContent validity and safety were assessed using a bespoke state evaluation questionnaire. The usability was evaluated using the system usability scale (SUS) and user experience questionnaire (UEQ). House of Quality analysis was conducted to identify the priority aspects for improvement.ResultsPhysiotherapists perceived the usability of the games as good to excellent for three games, median SUS = 80%, and poor for two games SUS < 68%. Three games had a mean average content validity index (CVI) > 0.8, and all games were safe to be administrated at home; mean CVI-safety item = 0.90. Stroke survivors with Fugl-Meyer Assessment of Upper Extremity function mean (SD) = 41(19.4), and mild to moderate spasticity perceived usability as very good to excellent for four games (median SUS = 85%). UEQ scale showed good to excellent acceptance among most of the games. House of Quality analysis revealed that clear instructions, avatar quality, motivational exercise scenarios, and clinical assessment tools are important criteria that should be considered throughout the development.ConclusionThis study demonstrated the value of exploring patient and physiotherapist perspectives for better telerehabilitation interventions co-development. Clinical trials should be conducted after further refinement of the games to investigate their feasibility and potential efficacy as a telerehabilitation tool for arm and balance training.

ObjectiveTo adapt and modify the successful SIESTA (Sleep for Inpatients: Empowering Staff to Act) sleep-promoting hospital protocol to an acute stroke rehabilitation setting.DesignThis study utilized a mixed methods design, involving qualitative surveys and interviews. Needs assessment and staff interviews informed the development of the adapted protocol, SIESTA-Rehab.SettingInpatient unit treating persons with neurological injury, primarily stroke, in an acute rehabilitation hospital.ParticipantsNursing staff on the inpatient unit where SIESTA-Rehab was implemented.InterventionAfter identifying needs, we adapted the SIESTA protocol with relevant modifications to SIESTA-Rehab. Protocol adaptations were guided by the Culture, Oversight, Systems Change, Training framework, with a focus on developing nursing education and sleep-enhancing tools. The protocol was implemented over a four-year period, sustained through periodic staff re-education, and nursing staff perceptions of the intervention were evaluated using fidelity interviews.Main MeasuresQualitative assessments were conducted from a convenience sample of nurses to gauge understanding, recall, ease of implementation, and individual re-education needs for SIESTA-Rehab.ResultsInitial staff feedback indicated limited awareness of sleep disorder screening and sleep optimization practices, highlighting the absence of sleep-based assessments during standard care. Initial unit-wide training was conducted on SIESTA-Rehab for nursing staff (N = 29), with ongoing education for new staff and periodic re-education for existing staff over 4 years of implementation. Fidelity interviews revealed high understanding, recall, and ease of implementing the intervention over survey periods.ConclusionsSIESTA-Rehab can be successfully implemented in an acute rehabilitation setting, as indicated through positive staff responses.

ObjectiveThis systematic review and meta-analysis aimed to evaluate the effects of cervical lateral glide and median nerve neural mobilisation compared to no treatment and other physical therapy treatments on pain, function and disability in patients with nerve-related neck and arm pain.Data sourcesElectronic searches were conducted in MEDLINE, Science Direct, Cochrane Library, PEDro and Google Scholar up to 30 June 2025.Review methodsRandomised controlled trials were included following PRISMA guidelines. Two authors independently selected relevant studies, extracted data, assessed risk of bias (RoB2 tool), and rated evidence quality. Meta-analysis was performed using random-effects models due to expected heterogeneity. The study was registered on PROSPERO (CRD42020216739).ResultsOverall, 20 studies with 953 patients met the inclusion criteria. Cervical lateral glide reduced pain compared to no treatment (3 studies, MD -2.47; 95%CI: -3.41, -1.53; P < .001) and other physical therapy techniques (2 studies, MD -1.29; 95%CI: -2.54, -0.05; P = .04). Median nerve neural mobilisation also reduced pain compared to no treatment (4 studies, MD -3.07; 95%CI: -3.78, -2.37; P < .001). Both interventions had modest effects on disability (12 studies, SMD -0.50 to -1.22), with moderate-to-high heterogeneity in analyses. The certainty of evidence was low to very low.ConclusionCervical lateral glide and median nerve neural mobilisation are clinically effective for reducing nerve-related neck and arm pain as part of multimodal management strategies. The quality of evidence remains low as the level of certainty. Targeting a population with a clear nociceptive, increased neural mechanosensitivity or neuropathic component should lead to better clinical outcomes.

ObjectiveModerate to severe persistent pain can affect up to 25% of people after a knee replacement for osteoarthritis. The aim of the trial was to test the feasibility of implementing Kneed, a novel digital pain rehabilitation self-management programme.DesignProspective, two group parallel randomised pilot study.SettingOnline in Australia.ParticipantsAdults with persistent pain rated as ≥4/10 in the operated knee more than 3 months post-knee replacement for osteoarthritis.InterventionThe Kneed group were provided with 8 weeks of access to a digital pain rehabilitation self-management programme and compared to usual care.Main measuresRecruitment, acceptability, usability and limited efficacy with descriptive statistics.ResultsSixty participants, mean age 68.7 years, 75% female, 66.7% retired and 43% living outside metropolitan areas, were recruited between 15 October and 19 December, 2024 via social media advertising with 418 online eligibility surveys performed. There were 190 (45.5%) deemed potentially eligible; 82 (19.6%) left contact details and 60 (14.4%) consented. At 8 weeks, there were 48 (80%) participants remaining in the trial (20 Kneed (64.5%), 28 usual care (96.6%)). A majority of the Kneed group found the Kneed programme acceptable, would use it again and found that it helped them effectively manage pain and function.ConclusionIt is feasible to recruit and retain older Australians with moderate to severe knee pain post-knee replacement for a trial testing a digital pain rehabilitation self-management programme. A larger trial is indicated to further test the clinical effectiveness of Kneed to reduce pain and improve function.