European journal of physical and rehabilitation medicine最新文献

Introduction: Post-stroke spasticity (PSS) is a common complication affecting motor function and quality of life in stroke patients. Extracorporeal shockwave therapy (ESWT) has been proposed as a non-invasive treatment for PSS, though variations in protocols raise questions about its efficacy and optimal dosage. This review aims to evaluate the efficacy of ESWT in reducing PSS and analyze its dose-response relationship.

Evidence acquisition: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted. Adults with spasticity following ischemic or hemorrhagic stroke in rehabilitation or hospital-based clinical settings were included. RCTs assessing ESWT versus sham or no intervention were selected, with spasticity reduction measured by the Modified Ashworth Scale (MAS) as the primary outcome. Secondary outcomes included range-of-motion (ROM), functionality, and the Modified Tardieu Scale, assessed in both the short and long term. Risk of bias was evaluated using the revised Cochrane Risk of Bias Tool. Meta-analyses and meta-regression were performed using R software.

Evidence synthesis: Thirteen RCTs with 533 participants were included. Meta-analyses demonstrated that ESWT significantly reduced MAS scores in the short term [mean difference (MD)=-0.85; 95% confidence interval (CI): -1.17 to -0.53, P<0.01] and long term (MD=-0.84; 95% CI: -1.31 to -0.38, P<0.01). Secondary outcomes also improved in both short-term (P<0.01) and long-term analyses (P=0.04). Meta-regression revealed a dose-response relationship for the primary outcome, showing that higher ESWT doses were associated with greater MAS improvement.

Conclusions: ESWT effectively reduces PSS with short- and long-term benefits. A dose-response relationship suggests higher doses provide better outcomes. However, further research is needed to optimize treatment protocols due to the observed heterogeneity.

Background: Community Balance and Mobility Scale (CB&M) is a comprehensive performance-based measure developed to assess functional balance and mobility. It represents a potential balance assessment tool for higher functioning stroke survivors.

Aim: The aim of this study was to investigate the psychometric property of CB&M in people with stroke.

Design: A methodological study evaluating the psychometric properties.

Setting: The setting of the study was a university-based rehabilitation center.

Population: Sixty people with stroke and thirty healthy older adults were included in this study.

Methods: Participants were recruited from community and assessed using CB&M and other well-established scales. Statistical analyses included descriptive statistics, 7-day test-retest reliability, inter-rater reliability and construct validity testing and receiver operating characteristic curve analysis.

Results: The CB&M demonstrated excellent internal consistency (Cronbach's α=0.943), inter-rater reliability (intraclass correlation coefficient = 0.992), and test-retest reliability (intraclass correlation coefficient = 0.983). The CB&M Score showed good to excellent correlations with the Berg Balance Scale (r=0.880, P<0.001) and 10-Metre Walk Test at maximum speed (r=-0.763, P<0.001), significant positive correlations with the Fugl-Meyer Assessment, ankle dorsiflexor strength on the affected side, and components of limits of stability test (r=0.341 - 0.631, P<0.01); and significant negative correlations with reaction time in limits of stability test, 10-Metre Walk Test at usual speed, Timed Up and Go test, and the routine activities domain of the questionnaire (r=-0.283 - -0.715, P<0.05). Receiver operating characteristic curve analysis revealed that a cutoff score of 62 could distinguish balance performance (area under the curve = 0.966) with high sensitivity (90.0%) and specificity (95.0%).

Conclusions: The CB&M is a reliable, valid, sensitive, and specific clinical performance measure for evaluating balance ability in individuals with stroke aged 55 years or above.

Clinical rehabilitation impact: Clinicians can use this tool to efficiently detect subtle balance and mobility deficits in higher-functioning stroke survivors. It can help clinicians identify those at risk for community mobility limitations and guide targeted rehabilitation to enhance community participation.

Background: Single-event multilevel surgery is a widely used intervention for improving gait in children with cerebral palsy. While its effects on kinematics and spatiotemporal parameters are well documented, its impact on gait efficiency remains underexplored.

Aim: To evaluate the impact of single-event multilevel surgery on gait efficiency and quality in children with cerebral palsy.

Design: Retrospective study.

Setting: Pediatric Rehabilitation Unit at AUSL-IRCCS, Reggio Emilia, Italy, using pre- and post-surgical gait analysis data collected from 2011 to 2022.

Population: The study included 109 children with cerebral palsy, categorized into a surgical group (81 patients) who underwent single-event multilevel surgery and a non-surgical group (28 patients).

Methods: Single-event multilevel surgery targeted lower limb pathologies using soft tissue and skeletal corrections. Gait efficiency was assessed through maximum knee and hip extension, and push-off power and energy. Gait quality was evaluated using the Gait Profile Score and Gait Variable Scores. Spatiotemporal parameters were also measured.

Results: In the surgical group, maximum knee extension improved by 6.1° (P<0.001) and hip extension by 1.6° (P=0.023). Ankle push-off power (+24.1%) and energy (+19.8%) increased significantly, while knee energy production decreased (-14%). Gait Profile Score improved by -2.8° (P<0.001). Significant gait variable score reductions included knee flexion-extension (-4.0°), ankle plantarflexion-extension (-3.8°), and foot progression angle (-4.0°). Spatiotemporal metrics remained largely unchanged. Correlations revealed a modest inverse relationship between age and push-off power (rho=-0.28, P=0.012) and an association between Gross Motor Function Classification System levels and push-off power (P=0.018). The non-surgical group showed no significant changes in any efficiency or quality metrics.

Conclusions: Single-event multilevel surgery significantly improves gait efficiency and quality in children with cerebral palsy by enhancing joint kinematics and dynamics.

Clinical rehabilitation impact: these findings highlight single-event multilevel surgery's capacity to optimize gait mechanics, prioritizing efficiency and quality improvements over maximal walking performance. This supports its use as a key intervention for improving functional mobility in rehabilitation settings.

Background: Traumatic brain injury (TBI) often leads to neurobehavioral disorders (NBDs) that hinder functional recovery. Although demographic (gender, age, years of education) and clinical factors (post-traumatic amnesia duration [PTA], Glasgow Coma Scale severity) have been studied as potential predictors of NBDs, the impact of the levels of cognitive functioning (LCF) and traumatic axonal injury (TAI) has received less attention.

Aim: This study investigates the relationship between the variables and the onset of NBDs following TBI. It also examines the correlation between NBDs and patients' functional outcome and community participation, as measured by the Glasgow Outcome Scale Extended (GOSE) and the Community Integration Questionnaire (CIQ).

Design: Observational, longitudinal study.

Setting: Inpatient rehabilitation setting.

Population: The study cohort comprised 54 TBI patients (12 females, 42 males; mean age 46.1 years).

Methods: Patients underwent comprehensive neuropsychological, neurobehavioral, and psychological assessments at 12 months. Clinical variables were collected during the acute/subacute phase, and functional outcomes were measured in the chronic phase (GOSE and CIQ).

Results: The most frequent NBDs observed by caregivers included anger, difficulty controlling temper, impulsivity, and irritability. The findings highlight years of education, PTA duration, LCF score at rehabilitation admission (LCFa) and TAI as the key drivers of long-lasting NBDs (R²≈0.4-0.5). There was a significant moderate negative correlation between NBDs and GOSE (r=-0.67, P<0.001) as well as CIQ (r=-0.71, P<0.001).

Conclusions: The study highlights that lower education levels, prolonged PTA duration, lower LCFa, and presence of TAI are linked to a higher likelihood of developing persistent NBDs, which negatively impact functional outcomes and community participation.

Clinical rehabilitation impact: Regular monitoring and early intervention for patients with these risk factors - lower education, prolonged PTA, lower LCFa and TAI - could help mitigate the long-term effects of NBDs, improving rehabilitation outcomes through timely and targeted therapeutic approaches.

Background: The International Classification of Functioning, Disability and Health (ICF) provides a comprehensive framework for evaluating stroke patients across four key domains. However, due to the large number of ICF items and the complexity of its classification system, its practical application is often time-consuming, and requires substantial training for evaluators.

Aim: To generate and validate a decision tree model based on ICF items for assessing upper limb dysfunction after stroke.

Design: A cross-sectional study.

Setting: Rehabilitation department of five hospitals.

Population: This study included stroke patients (including ischemic or hemorrhagic; first-ever or recurrent), who were stratified according to disease phase: acute (1-7 days, 1.94%), subacute (8-180 days, 53.02%), and chronic (>180 days, 41.38%). All patients had CT/MRI-confirmed diagnosis, stable vital signs, and upper limb dysfunction.

Methods: All participants completed the 56 items of the comprehensive ICF Core Set for stroke. The decision tree model of ICF items significantly associated with the Fugl-Meyer Upper Extremity Scale (FM-UE) was constructed by using the R package rpart.

Results: A total of 464 participants after stroke were recruited. Ten ICF items that were strongly correlated with the FM-UE and P<0.05, and the items were "d4400," "d4401," "d4402," "d4403," "d4450," "d4451," "d4452," "d4453," "d4454," "d4455". Finally, the decision tree model included: "d4401: grasping," "d4553: turning or twisting the hands or arms" and "d4551: pushing". The statistical significant accuracy of the model confusion matrix in validation was 0.7381 (P=5.008e-13), and the AUC was 0.8406.

Conclusions: This study identified ICF items highly correlated with the FMA-UE and developed a statistically significant decision tree model for the assessing of upper limb dysfunction after stroke.

Clinical rehabilitation impact: The decision tree model based on key ICF items, substantially reduces evaluation time. It simplifies upper limb dysfunction assessment, enhances ICF application, and provides a simpler and more efficient assessment tool that represents a valuable addition to the clinical tool for stroke rehabilitation.

Background: Previous analyses demonstrated that Italian versions of the five short forms of the Brain Injury Rehabilitation Trust Personality Questionnaires (SF-BIRT-PQs) showed strong psychometric properties. However, evidence on their interpretability lacks.

Aim: To calculate cutoffs for each of the SF-BIRT-PQ to discriminate between the subject's behavior that deviates significantly (D+) or not (D-) from the average of healthy individuals.

Design: Multicenter prospective study.

Population: One hundred and fifty-four subjects with acquired brain injury, their 154 caregivers, and 120 healthy subjects.

Methods: SF-BIRT-PQs and disability measures were administered to the included subjects. Moreover, subjects scored the Satisfaction Profile (SAT-P) and disability measures, while the Caregiver Burden Inventory (CBI) and Frontal Behavioral Inventory (FBI) were administered to caregivers. Cutoffs between scores indicating D- or D+ patients were calculated with Z-scores, and Mann-Whitney Tests were used to assess the scores of the comparator instruments across the two groups (i.e., D+ and D-) generated by the cutoff for each SF-BIRT-PQs separately for the patient (using SAT-P, DRS, LCF) and caregiver samples (using CBI, FBI, DRS, LCF).

Results: Cutoffs to discriminate between D+ and D- were identified (SF-BMQ ≥25 points, SF-BREQ ≥19 points, SF-BSCQ ≥14 points, SF-BDQ ≥15 points, SF-BIQ ≥18 points indicated D+). Generally, for the patients' sample, between-group comparisons showed significant differences between all SF-BIRT-PQs (except BDQ and BIQ) and the SAT-P subscales (P<0.05) but not with disability measures (P>0.05). In contrast, for the caregivers' sample, between-group comparisons showed significant differences between all SF-BIRT-PQs and the CBI and FBI subscales (P<0.05) but not with disability measures (P>0.05). A digital ruler was devised to convert raw scores into interval measures.

Conclusions: We provided evidence in support of the construct validity of the proposed cutoffs for each SF-BIRT-PQ.

Clinical rehabilitation impact: These cutoffs make the short forms of the BIRT-PQs interpretable by quantifying the amount of the patient's behavior divergence from that of the average healthy individual. The electronic rulers for each BIRT-PQ provide several functions that greatly facilitate the SF-BIRT-PQ administration and interpretation.

Introduction: Post-stroke upper extremity (UE) pain is a frequent and debilitating problem, with an incidence of 15 to 40% at 6 months. No clinical guidelines are available on the primary prevention of UE pain. The aim of this research was to identify and summarize the effectiveness of methods for the primary prevention of post-stroke UE pain.

Evidence acquisition: This systematic review received no external funding and was conducted according to PRISMA guidelines (PROSPERO registration number: CRD42023445110). Two independent investigators searched PubMed, PEDro, EMBASE, Cochrane Library, SCOPUS and EBSCO (Cinahl Complete) until January 30^th, 2025, for eligible studies comparing adult stroke patients undergoing any type of prevention method to avoid the development of UE pain, with control patients. Meta-analysis, using a random-effects model, was performed per type of prevention method.

Evidence synthesis: A systematic review of 29 eligible articles (total number of patients: N.=1436) identified 7 categories of prevention methods: orthotics, taping, exercise, positioning, neuromuscular stimulation, intramuscular drug injections and education. Meta-analysis showed with a very low level of certainty that orthotics (SMD=0.45; 95% CI=-0.24 to 1.14; P=0.2; I²=80.96%), taping (SMD=-0.15; 95% CI=-0.69 to 0.39; P=0.58; I²=68.4%) and exercise (SMD=-0.47; 95% CI=-1 to 0.06; P=0.08; I²=60.36%) are not more effective than standard care for the prevention of UE pain after stroke. Due to a small number of studies, meta-analysis was not performed for other categories of primary prevention methods.

Conclusions: This meta-analysis revealed, with a very low-certainty of evidence, that the effect of primary prevention methods on UE pain after stroke is uncertain. An increased number of studies is necessary in this area of clinical research. A combination of methods may increase the clinical relevance of preventive strategies.

Background: Cubital tunnel syndrome (CuTS) is a frequent complication in wheelchair users, but optimal sonographic cross-sectional area (CSA) cutoff values and their diagnostic performances remain unclear. Electrodiagnosis studies for confirmation can be uncomfortable and may require another visit.

Aim: To evaluate the diagnostic performance of the sonographic ulnar nerve CSA (CSA-U) cutoff value of 10 mm², and to identify alternative CSA-U cutoffs and assess their diagnostic accuracy at and around the medial epicondyle.

Design: Single-centre, prospective, observational, cross-sectional study.

Setting: Outpatient rehabilitation clinic.

Population: Wheelchair users aged ≥20 years with spinal cord injury or lesion.

Methods: Participants completed a CuTS symptom questionnaire, underwent ultrasonographic CSA measurements at the medial epicondyle (ME) and 2 cm proximal (P2) and distal (D2) to it, and electrodiagnostic studies. CuTS was confirmed by clinical symptoms and positive electrodiagnostic findings. Diagnostic performance was evaluated using the area under the receiver operating characteristic curve (AuROC), sensitivity, and specificity across CSA cutoffs.

Results: Seventy-seven participants (142 arms) were included, with 28 (19.7%) arms diagnosed with CuTS. The diagnostic performance of a 10 mm² cutoff at ME and P2 showed high specificity, at 91.2% (95% CI 84.5-95.7) and 89.5% (95% CI 82.3-94.4), respectively. Sensitivity was below 40% at both sites. At D2 no CuTS cases met the 10 mm² threshold. The highest diagnostic performance was observed at P2 level (AuROC 0.65, 95% CI 0.56-0.75), with an observable pattern of gradually decreasing nerve size proximally to distally, as demonstrated by the greatest proximal average CSA-U at P2, down to the smallest average at D2.

Conclusions: The CSA-U 10 mm² cutoff value at both ME and P2 locations demonstrated high specificity despite limited sensitivity; therefore, it is suitable for ruling in CuTS diagnosis. The P2 location with a 10 mm² cutoff appears to be a promising sonographic site for assessment. Ultrasonography may serve as a valuable adjunctive diagnostic tool in diagnosing CuTS in wheelchair users.

Clinical rehabilitation impact: Implementation of ultrasonographic CSA measurement at ME and P2 level could aid early detection of CuTS and enhance clinical decision-making due to greater accessibility at the outpatient clinic. Additionally, it also provides anatomical insights to electrodiagnostic evaluation.