European journal of physical and rehabilitation medicine最新文献

Considering the growing role of ultrasound-guided procedures in musculoskeletal medicine, training as regards these interventions is pivotal. While hands-on training on cadavers can be considered optimal, it has several drawbacks, e.g., high cost, poor availability, and technical challenges regarding preservation. Apart from cadavers, different approaches to practicing needle guidance are taught in ultrasound workshops whereby phantoms from meat (e.g., chicken breast), cheese or gelatin are used. Likewise, this article aims to provide a detailed description as to how different gelatin-based phantoms can be prepared. In line with the EURO-MUSCULUS/USPRM (European Musculoskeletal Ultrasound Study Group/Ultrasound Study Group of the International Society of Physical and Rehabilitation Medicine) protocols/background, the authors describe particular basic and advanced phantoms to be used for practicing different technical/manual skills pertaining to common ultrasound-guided procedures. The present manuscript can be considered a practical and ready-to-use "recipe book" for readers who are interested in the wide spectrum of interventional ultrasound.

Background: Following upper motor neuron syndromes (UMNS), intrinsic viscoelastic muscle properties such as elastic stiffness may be altered, which leads to muscle hyper-resistance to passive mobilization. So far, no gold standard assessment of hyper-resistance, whether clinical or instrumental, is available. Shear wave elastography (SWE) has been increasingly used for non-invasive evaluation of elastic stiffness of skeletal muscles in people with hyper-resistance.

Aim: Our study aimed to evaluate the validity of SWE at ankle neutral resting position (ANRP). Additional objectives included assessing the influence of ankle position, muscle contraction, and laterality on elastic stiffness, and evaluating the reproducibility and responsiveness of SWE.

Design: Observational cohort study.

Setting: Outpatients of the physical and rehabilitation medicine department of a university hospital in Brussels.

Population: Thirty hemiparetic patients following UMNS with hyper-resistance in gastrocnemii muscles.

Methods: Elastic stiffness was quantified by shear wave velocity (SWV) measurements of gastrocnemii muscles. A higher SWV corresponds to a higher elastic stiffness. Measurements were performed on the affected and less-affected limbs in ANRP, in passive dorsiflexion and during isometric contraction. Assessments were performed 3 times. Criterion validity, reproducibility, and responsiveness were evaluated. A linear mixed model was used to study position and laterality effect.

Results: In ANRP, reproducibility was excellent and SWV was significantly higher in the affected limb than in the less-affected limb. This laterality effect disappeared in passive dorsiflexion and was even reversed during isometric contraction. SWV was significantly higher on both sides in passive dorsiflexion and during contraction than in ANRP.

Conclusions: Our results suggest that SWE measurements in ANRP are reliable and may provide a more valid measurement of gastrocnemii elastic stiffness following UMNS.

Clinical rehabilitation impact: SWE may be a useful clinical tool as an extension of the physical exam for longitudinal monitoring of passive muscle elastic stiffness, to assist with treatment decisions and to better quantify the therapeutic effect of procedures to reduce muscle overactivity. However, a standardized protocol should be used. ANRP seems to be the most valid position for assessing gastrocnemius elastic stiffness in neurological populations. This should be kept in mind for the choice of positioning in further studies.

Introduction: Although kinematic assessments for stroke-induced lower limb impairments offer a promising alternative to conventional scale evaluations, interpreting high-dimensional kinematic data remains challenging due to numerous metrics reported in past studies. This study aimed to provide an exhaustive overview of existing studies using kinematics data to assess the gait impairments in individuals with stroke, along with examining their clinimetric properties for future clinical applications.

Evidence acquisition: A systematic search was conducted across PubMed (08/2024), Scopus (08/2024), Web of Science (08/2024), CINAHL (08/2024), EMBASE (08/2024), and IEEE (08/2024). We included articles that recruited individuals over 18 years old with stroke and utilized motion capture technologies to evaluate lower limb kinematics. Similar metrics were consolidated in the analysis, and the COSMIN Risk of Bias Checklist was used to evaluate the methodological quality of studies investigating the clinimetric properties of kinematic metrics. Convergent validity of metrics was evaluated by examining their association with the Fugl-Meyer scale of lower limbs and walking speed. Moreover, the GRADE approach was used to rate the quality of evidence.

Evidence synthesis: A total of 383 studies were classified into 10 categories. Seven studies on metric reliability were rated high for methodological quality. Metrics with satisfactory reliability included spatiotemporal, spatial metrics, and a data-driven score. Six studies with high methodological quality assessed convergent validity. The dynamic gait index, angular component of the coefficient of correspondence (ACC), change in cadence, stride length, and hip range of motion showed satisfactory validity. Among the 13 studies, 12 studies were rated as moderate quality of evidence using the GRADE approach.

Conclusions: There are significant variations in measurements across studies, and high-quality studies evaluating clinimetric properties are scarce. For a more standardized evidence-based approach to kinematic lower limb assessment, further high-quality research validating these assessments' clinimetric properties is essential.

Background: Balance deficits are one of the most common impairments in developmental coordination disorder (DCD) and cerebral palsy (CP), with shared characteristics between both groups. However, balance deficits in DCD are very heterogeneous, but unlike in CP, they are poorly understood.

Aim: To unravel the heterogeneity of balance performance in children with DCD by comparing them with CP and typical development (TD).

Design: Cross-sectional case-control study.

Setting: Different outpatient settings and the community.

Population: Children aged 5-10.9 years with TD (N.=64, boys: 34, mean [SD] age: 8.1 [1.6]), DCD (N.=39, boys: 32, mean [SD] age: 8.1 [1.5], formal diagnosis [N.=27]), and CP (N.=24, boys: 14, mean [SD] age: 7.5 [1.4], GMFCS level I [N.=14]/II [N.=10], unilateral [N.=13]/bilateral [N.=11]).

Methods: We evaluated balance performance with the extended version of the Kids-Balance Evaluation Systems Test (Kids-BESTest). Between-group differences in domain and total scores (%) were assessed via ANCOVA (covariate: age), with Tukey post-hoc analyses (P≤0.01).

Results: Children with DCD and CP performed poorer than TD children on total and domain scores with large effects (domains: η²=0.25-0.66 [P<0.001], total: η²=0.71 [P<0.001]). Still, post hoc comparisons revealed that DCD children scored significantly better than CP on the total score and four domains (P≤0.009), while performing similarly on tasks related to stability limits (P=0.999) and gait stability (P=0.012).

Conclusions: There is a continuum of balance performance between children with TD, DCD and CP, but with great inter- and intra-individual heterogeneity in DCD and CP. DCD and CP children have difficulties with tasks requiring anticipatory postural adjustments, fast reactive responses, and with tasks that require complex sensory integration, suggesting an internal modeling deficit in both groups. This implies that these children must rely on slow conscious feedback-based control rather than fast feedforward control and fast automatic feedback. The performance of both DCD and CP children on their stability limits/verticality is similarly poor which further emphasizes a potential deficit in their sensory input and/or integration. Future research must focus on unraveling the control mechanisms, to further understand the heterogeneity of these balance deficits.

Clinical rehabilitation impact: The heterogeneous balance performances in both children with DCD and CP underscore the importance of comprehensively evaluating balance deficits in both groups. This comprehensive assessment contributes to a better understanding of individual balance deficits, thereby facilitating more tailored treatment programs.

Introduction: Ultrasound-guided lavage (UGL) is a minimally invasive percutaneous treatment for rotator cuff calcific tendinopathy (RCCT). It involves the use of a syringe containing saline and/or anesthetic solution injected directly into the calcification allowing aspiration of the fragmented calcific material. The aim of this systematic review is to investigate if UGL is effective in improving pain, function, quality of life, range of motion (ROM), and in promoting complete resorption of calcifications in patients with RCCT.

Evidence acquisition: Only randomized controlled trials considering people diagnosed with RCCT, at any stage and at any time of the onset of symptoms treated with UGL, were included. Embase, CENTRAL, CINHAL, PEDro and MEDLINE were explored up until May 2024. Two independent authors selected randomized controlled trials by title and abstract; afterwards, the full text was thoroughly evaluated. The risk of bias (ROB) was assessed using the Cochrane risk of bias 2 (ROB2) tool and the certainty of evidence was evaluated through the GRADE approach.

Evidence synthesis: Seven studies (709 subjects) were included. Overall, three studies were judged as low risk of bias. Pooled results showed non-significant differences between UGL and extracorporeal shock-wave therapy (ESWT) at 12 weeks (SMD=-0.52, 95% CI -1.57, 0.54, P=0.34, I²=93%) and at 26 weeks (MD=-1.20, 95% CI -2.66, 0.27, P=0.11, I²=82%), while a significant difference favoring UGL (SMD=-0.52, 95% CI -0.85, -0.19, P=0.002, I²=38%) resulted at 52 weeks. In regard to function, pooled results showed non-significant difference between UGL and ESWT at 6 weeks (MD=3.34, 95% CI -11.45, 18.12, P=0.66, I²=79%) and at 52 weeks (SMD=0.10, 95% CI -0.40, 0.60, P=0.69, I²=30%). Considering the rate of resorption of calcifications between UGL combined with subacromial corticosteroid injection (SCI) versus injection alone, pooled results showed significant difference favoring UGL at <52 weeks (RR=1.63 95% CI 1.34, 1.98, P<0.00001, I²=0%). Certainty of evidence ranged from low to very low.

Conclusions: UGL seems to be a reasonable and safe treatment for RCCT, however compared to other non/mini-invasive approaches, UGL showed doubtful results in controlling pain and increasing function and rate of calcifications resorption. These results should be interpreted with caution because certainty of evidence ranged from low to very low.

Background: International studies identified comparable or better effects for telerehabilitation compared with face-to-face rehabilitation or no rehabilitation in people with back pain. In German rehabilitation centers, a standardized back school for patients with back pain is provided usually face-to-face as part of a multimodal rehabilitation program.

Aim: To examine the non-inferiority of a three-week, digitally assisted, multimodal rehabilitation that applies a digital version of a standardized back school (intervention group [IG]) against the same rehabilitation program applying the back school face-to-face (control group [CG]).

Design: Our study was a non-blinded multicenter randomized controlled trial. Recruitment was conducted from 2022 to 2023. We analyzed outcomes at the end of rehabilitation and 3 months later.

Setting: Implementation of the study and enrollment of participants was conducted in 8 German outpatient rehabilitation centers.

Population: Rehabilitants aged 18-65 years with back pain were included.

Methods: 284 patients with back pain were randomized into the IG or CG using computer-generated block randomization. We excluded 14 patients as they withdrew their consent and requested removal of their data. We finally included 270 patients (IG: N.=127, CG: N.=143). The primary outcome was self-reported pain self-efficacy (10-60 points). Secondary outcomes were, amongst others, current health status and pain.

Results: Our primary adjusted intention-to-treat analysis demonstrated that hybrid digitally assisted rehabilitation was non-inferior to face-to-face rehabilitation at the end of rehabilitation (b=-0.55; 95% CI=-2.75 to ∞) and at the 3-month follow-up (b=0.24; 95% CI=-2.86 to ∞). These results were in line with a non-adjusted intention-to-treat analysis, an adjusted complete case analysis, and an adjusted per-protocol analysis. Secondary outcomes were tested for superiority. Our primary adjusted intention-to-treat analysis found no significant group differences in the secondary outcomes.

Conclusions: This study provides evidence that hybrid digitally assisted rehabilitation in patients with back pain is a sound alternative to face-to-face rehabilitation in an outpatient rehabilitation setting.

Clinical rehabilitation impact: Hybrid digitally assisted rehabilitation can improve flexibility and access to rehabilitation. Further studies should examine which components and which time frame of rehabilitation can be digitized without any loss of effectiveness.

Background: Patients' socioeconomic status on hospitals' efficiency in controlling for clinical component characteristics may have a role that has few been studied in rehabilitation centers.

Design: Because of the national health insurance system, rehabilitation centers are free of charge. To answer whether a patient's socioeconomic status (SES) is associated with efficiency and performance, we use a counterfactual analysis to get the patient's SES effect "as if" the patient's case was identical to whatever hospital. We restrained the data to patients from public acute care units where the decision on rehabilitation sector admission is based on availability, limiting bias by confounding factors. Besides, an analysis of six pathologies led to the same results.

Setting: An exhaustive, detailed administrative database on rehabilitation center stays in France. To define the patients' socioeconomic status, we use two sources of data: the information collected at the time of the patient's entry into rehabilitation care and the information collected during the patient's stay in acute care. This double information avoids possible loss of socio-economic details between the two admissions.

Population: Patients recruited were exhaustively admitted over the year 2018 for stroke, chronic obstructive pulmonary disease, heart failure, or total hip replacement in France in the acute care unit and then in a rehab center. Mainly the elderly population. Information on patients' demography, comorbidities, and SES are coded due to the reimbursement system. Different dimensions controlling for factors (hospital ownership, patient clinical characteristics, rehabilitation care specificities, medical staff detailed information, and patients' socioeconomic status), were progressively added to control for any differences in baseline data between the two groups.

Methods: We assess rehabilitation centers' efficiency by combining selected outcome quality indicators (Physical score improvement, Cognitive score improvement, Mortality, Return-to-home). The specific Providers' Activity Index is used to get the performance index.

Conclusions: The performance of healthcare institutions is correlated not only to the case mix of their patients but also to the socioeconomic status of the patients admitted. The performance needs to be seen in light of patients' socioeconomic status.

Clinical rehabilitation impacts: The data reveals that patients' socioeconomic status affects rehabilitation care efficiency and performance. In controlling patients' socioeconomic status, for-profit rehabilitation hospitals seemed more efficient than public ones.

Background: There is limited evidence depicting ways that behavioral theory and techniques have been incorporated into cancer rehabilitation interventions. Examining their use within cancer rehabilitation interventions may provide insight into the active ingredients that can maximize patient engagement and intervention effectiveness.

Aim: This secondary analysis aimed to describe the use of behavior change theory and behavior change techniques (BCTs) in two previously conducted systematic reviews of cancer rehabilitation interventions.

Design: Secondary analysis of randomized controlled trials (RCTs) drawn from two systematic reviews examining the effect of cancer rehabilitation interventions on function and disability.

Setting: In-person and remotely delivered rehabilitation interventions.

Population: Adult cancer survivors.

Methods: Data extraction included: behavior change theory use, functional outcome data, and BCTs using the Behavior Change Technique Taxonomy (BCTTv1). Based on their effects on function, interventions were categorized as "very", "quite" or "non-promising". To assess the relative effectiveness of coded BCTs, a BCT promise ratio was calculated (the ratio of promising to non-promising interventions that included the BCT).

Results: Of 180 eligible RCTs, 25 (14%) reported using a behavior change theory. Fifty-four (58%) of the 93 BCTs were used in least one intervention (range 0-29). Interventions reporting theory use utilized more BCTs (median=7) compared to those with no theory (median=3.5; U=2827.00, P=0.001). The number of BCTs did not differ between the very, quite, and non-promising intervention groups (H(2)=0.24, P=0.85). 20 BCTs were considered promising (promise ratio >2) with goal setting, graded tasks, and social support (unspecified) having the highest promise ratios.

Conclusions: While there was a wide range of BCTs utilized, they were rarely based on theoretically-proposed pathways and the number of BCTs reported was not related to intervention effectiveness.

Clinical rehabilitation impact: Clinicians should consider basing new interventions upon a relevant behavior change theory. Intentionally incorporating the BCTs of goal setting, graded tasks, and social support may improve intervention efficacy.