European journal of physical and rehabilitation medicine最新文献

Background: Low back pain (LBP) is a common musculoskeletal condition. Kinesio Tape (KT) has been proposed as a non-pharmacological treatment, but its effectiveness remains unclear.

Evidence acquisition: A systematic review with meta-analysis was conducted according to PRISMA. Searches were performed in MEDLINE-Ovid, Embase-Ovid, PEDro, CENTRAL, CINAHL, LILACS, and Scopus up to January 2025. Randomized controlled trials (RCTs) evaluating KT in individuals with LBP were included. The primary outcomes were functionality and pain intensity, and the secondary outcomes were range of motion and adverse events.

Evidence synthesis: Fifty-four RCTs involving 3479 participants were included. In acute LBP, KT improved functionality by 14.95% (95% CI: -31.40 to 1.50) compared with no intervention on the Oswestry Disability Index (ODI). In chronic LBP, KT improved functionality by 11.9% (95% CI -18.07 to -5.73) compared to no intervention, and 2.31% (95% CI -5.83 to -1.22) versus placebo, both on ODI, and 0.97 points in the Roland-Morris Questionnaire (95% CI -2.45 to 0.51) versus Micropore^®. Physiotherapy improved 5.44% (95% CI -0.76 to 10.12) more than KT on ODI. In pregnant women, KT improved functionality by 1.45 points (95% CI -2.97 to 0.07) versus placebo and by 2.19 points (95% CI -4.35 to -0.03) versus no intervention on the Roland-Morris Questionnaire. In irradiated LBP, KT showed no benefit over placebo. For pain on the Visual Analog Scale, KT in acute LBP reduced pain intensity by 1.61 cm (95% CI: -2.54 to -0.08) compared with no intervention. In chronic LBP, KT was superior to no intervention by 1.93 cm (95% CI -2.17 to -1.69), to placebo 0.70 cm (95% CI -1.39 to -0.02), to Micropore^® 1.03 cm (95% CI -1.76 to -0.31), and 0.95 cm (95% CI -2.04 to 0.12) more than physiotherapy. In pregnant women, KT reduced pain by up to 3.01 cm (95% CI -4.39 to -1.62) compared to placebo and by -1.78cm (95% CI -3.34 to -0.22) compared to no intervention. Finally, in LBP irradiated, KT decreased by 0.31cm (95% CI -1.23 to 0.60) more than placebo.

Conclusions: KT may improve functionality and reduce pain in short-term LBP. However, its effects on long-term chronic and irradiated LBP remain limited, and further high-quality trials are needed.

Background: Wearable robots show promise for gait assistance in stroke patients, yet the clinical characteristics predicting a positive ambulatory response to exoskeletal assistance remain unclear.

Aim: To identify appropriate candidates for torque-assisted exoskeletal wearable robots in stroke patients.

Design: A subgroup analysis using data from an international, multicenter, randomised controlled trial.

Setting: Inpatient.

Population: Fifty-five early subacute stroke patients who completed four weeks of robot-assisted gait training (RAGT) with the wearable exoskeletal robot (ANGEL LEGS M20, Angel Robotics Co., Ltd.).

Methods: Immediately after RAGT for the four weeks, ambulatory function with the exoskeleton on and off was evaluated using the 10-Meter Walk Test (10MWT), 6-Minute Walk Test (6MWT), and Physiological Cost Index (PCI). At the same time, additional assessments included the Functional Ambulatory Category (FAC), Fugl-Meyer Assessment-Lower Extremity, Motricity Index-Lower Limb, Trunk Control Test, and Berg Balance Score. Participants were classified as good-responder, no-responder, or negative-responder groups based on changes in walking performance with exoskeletal assistance. Univariate and multivariate ordinal logistic regression analyses identified factors associated with responsiveness.

Results: In the good-responder group, 10MWT, 6MWT and PCI showed significant improvements in the robot-on state compared with the robot-off state, respectively (P<0.05). Good responders had significantly lower baseline ambulatory, balance, and lower limb motor function compared to negative-responders (P<0.05). Multivariate analysis identified lower FAC as the only independent predictor of positive response to exoskeletal assistance (P<0.05).

Conclusions: Torque-assisted exoskeletal wearable robots may improve ambulatory function in stroke patients with low ambulatory function.

Clinical rehabilitation impact: To achieve meaningful effects through exoskeleton robots, patient selection must be adjusted according to clinical needs.

Background: One of the frequently used standardized tools for balance assessment is the Mini-BESTest. Creating validated versions in national languages is very important for its correct administration and usability in people with acquired brain injury.

Aim: Our intention was to verify the validity of the Czech translation Mini-BESTestCZ and describe experiences with its implementation in clinical practice.

Design: Validation study.

Setting: Department of Rehabilitation Medicine, University Hospital.

Population: Patients after stroke or traumatic brain injury.

Methods: The Mini-BESTest was translated and cross-culturally adapted into Czech according to established guidelines. The validation of this test was performed on a group of individuals with acquired brain damage in comparison with the Berg Balance Scale (BBS) and the Timed Up and Go test (TUG). Subsequently, physiotherapists who used the Mini-BESTestCZ in their practice were also contacted to evaluate their feedback and experiences with implementing the test into clinical practice.

Results: A total of 63 people with acquired brain damage participated in the study. Internal consistency of the Czech version of the Mini-BESTest was excellent, with intra-class correlation coefficient ICC=0.99. There were very high correlations between the Mini-BESTest and the BBS (r=0.86) or the TUG (r=-0.74). These results indicate excellent convergent validity for the Mini-BESTestCZ. Physiotherapists considered items related to reactive postural control to be the most difficult to evaluate, and together with Timed Up and Go with cognitive dual task to be the most difficult for patients to understand.

Conclusions: The Czech version of the Mini-BESTest showed great inter-rater reliability and strong convergent validity with neither floor nor ceiling effects (as compared to the Berg Balance Scale), and can be recommended for the use in research and clinical practice for patients with acquired brain damage in subacute or chronic phase.

Clinical rehabilitation impact: The creation of a validated language version of the Mini-BESTest will contribute to better administration and evaluation of this test, not only for people with neurological disorders. We also describe therapists' practical experiences with administering this test.

Introduction: Stable coronary artery disease (SCAD) is frequently accompanied by dyslipidemia, and residual lipid abnormalities persist despite pharmacological therapy. Exercise training has been shown to improve lipid metabolism, but the comparative efficacy of different exercise modalities remains unclear.

Evidence acquisition: We conducted a PRISMA-based network meta-analysis including randomized controlled trials (RCTs) that evaluated exercise interventions in patients with stable coronary artery disease and reported lipid-related outcomes. Risk of bias (RoB 2.0) and GRADE were applied. Pairwise and network meta-analyses estimated effects, with SUCRA rankings, consistency, and publication bias assessments.

Evidence synthesis: Twenty randomized controlled trials (RCTs; N.=2314) were included. Combined aerobic and resistance exercise (CAREX) produced the most pronounced reductions in total cholesterol (TC) (MD=-0.88, 95% CrI -1.36 to -0.37) and triglycerides (TG) (MD=-0.49, 95% CrI -0.74 to -0.23), and outperformed continuous aerobic exercise (CAE) in both outcomes. High-intensity interval training (HIIT) and CAE also significantly reduced TG. Mind-body exercise (MBE) and CAREX significantly increased high-density lipoprotein cholesterol (HDL-C) (MD=0.16, 95% CrI 0.04-0.26; MD=0.11, 95% CrI 0.01-0.22, respectively), with mind-body exercise (MBE) ranked highest for this outcome. No exercise modality significantly improved LDL-C. Certainty of evidence was rated as moderate for HDL-C and TG, and low for TC and LDL-C.

Conclusions: CAREX is most effective for lowering TC and TG, while MBE optimally raises HDL-C. Exercise has limited effects on LDL-C, likely due to statin therapy. CAREX and MBE may be prioritized in secondary prevention for SCAD.

Background: Balneotherapy is used since ancient times, effects on hand osteoarthritis however are not well elucidated.

Aim: To evaluate therapeutic effects of serial thermal brine hand baths (tbhb) in patients experiencing painful hand osteoarthritis (HOA).

Design: Randomized, double-blind, sham-controlled monocentric clinical trial.

Setting: Outpatient clinic, monocentric.

Population: Patients with painful bilateral painful HOA meeting the 1990 American College of Rheumatology classification criteria with a baseline pain level >30 mm on the Visual Analog Scale (VAS) and radiographic evidence of hand osteoarthritis in posteroanterior X-ray projection, classified as Kellgren and Lawrence grade ≥2.

Methods: Probands were randomized to the intervention group (IG) receiving tbhb or the control group (CG) receiving tap water hand baths (sham). Both hand baths (tbhb and sham) were performed 6 times in 3 weeks with 15 min/bath at a water temperature of 25 °C.

Outcomes: The primary outcome was the change in pain intensity (VAS [mm]) following the intervention. Secondary outcomes were changes in the Australian Canadian Osteoarthritis Hand Index (AUSCAN), grip strength, functional parameters of microcirculation (by O2C method), vascular endothelial growth factor (VEGF) and safety. Outcomes were primarily analysed after the last intervention followed by secondary analysis of the follow-up visits 4 and 12 weeks after intervention and during intervention.

Results: A total of 38 patients successfully completed the trial. Pain intensity significantly decreased due to tbhb (P<0.001), with sustained benefits observed up to 3 months post-intervention. The AUSCAN pain subscore was significantly reduced (P<0.001). There was no significant change in other AUSCAN subscores, nor in grip strength or functional parameters of microcirculation including VEGF due to tbhb. No adverse events due to tbhb were observed.

Conclusions: Thermal brine hand baths represent a simple, effective, and well-tolerated method to achieve pain relief in HOA with results lasting up to 12 weeks after intervention.

Clinical rehabilitation impact: Thermal brine hand baths can be used to reduce pain in HOA.

Background: Early identification and appropriate management of dysphagia are critical for improving outcomes of acute ischemic stroke.

Aim: To develop a simple and reliable scoring system to predict the severity of dysphagia in patients with acute ischemic stroke by integrating ultrasound (US) parameters with clinical variables.

Design: Prospective, cross-sectional observational study.

Setting: Inpatient neurology department of a university-affiliated hospital.

Population: A total of 212 patients with acute ischemic stroke were prospectively enrolled in this study. The mild dysphagia group and severe dysphagia group comprised 146 patients and 66 patients, respectively. Group assignment was based on the need for dietary modifications confirmed via retrospective review of dietary status, videofluoroscopic swallowing study results, and the occurrence of aspiration pneumonia during hospitalization.

Methods: Dynamic M-mode US of the suprahyoid muscle (SHM) was performed during swallowing. The following six SHM parameters were obtained: SHM thickness (baseline thickness of the SHM); SHM displacement (peak-to-peak amplitude of SHM movement); SHM difference (SHM displacement - SHM thickness); SHM ratio (SHM displacement/SHM thickness); peak-to-peak time; and total duration. The study population was randomly split into training (70%) and test (30%) sets. Least absolute shrinkage and selection operator and logistic regression analyses were performed to identify significant predictors of severe dysphagia. These predictors were used to develop and validate a simple scoring system.

Results: Brainstem lesion, bilateral lesion, National Institutes of Health Stroke Scale (NIHSS) score, SHM difference, and total duration were identified as key predictors of severe dysphagia. A simple scoring system based on these variables showed excellent discriminative performance. Areas under the receiver-operating characteristic curves (AUCs) of the training set and the test set were 0.963 and 0.935, respectively. A cutoff of ≥3 points yielded sensitivity of 97.9% and specificity of 86.4% for the training set as well as sensitivity of 78.9% and specificity of 95.3% for the test set.

Conclusions: This simple scoring system combining US and clinical parameters enabled early identification of patients at increased risk for severe dysphagia.

Clinical rehabilitation impact: The dysphagia severity prediction score can facilitate timely management of patients with acute ischemic stroke, thus potentially reducing complications and enhancing dysphagia rehabilitation.