European journal of physical and rehabilitation medicine最新文献

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.

Background: Research has shown that late fatigue post-stroke is associated with poorer long-term outcomes, but the association between early fatigue with concurrent outcomes like physical function within six months is underexplored.

Aim: To explore the interrelationship between stroke survivors' adaptation to fatigue and physical function changes during hospitalization and at one, three, and six months post-stroke.

Design: A prospective longitudinal cohort study with a convergent mixed-methods design.

Methods: Adults (≥18 years) with first-ever ischemic stroke were included. Fatigue, physical function, and data from semi-structured interviews were collected at four time points. A mixed-effect model was used to explore the quantitative relationship, with physical function as the dependent outcome and fatigue as the fixed-effect variable. Directed content analysis was used for qualitative data. A side-by-side display was used to present mixed-methods findings.

Results: Thirty-two survivors were in the quantitative arm; nine of those were in the qualitative arm. Quantitative analysis showed that each unit increase in fatigue decreased physical function by 0.27, adjusting for age, depression, and time. Qualitative findings confirmed that fatigue hindered recovery and pre-stroke activity resumption. Survivors described a vicious cycle between fatigue and function, with varying fatigue patterns and exacerbating factors within six months.

Conclusions: Fatigue and physical function were interrelated within six months after stroke. Given the small, single-center sample, these results should be interpreted cautiously. Still, our findings highlight the value of early, systematic fatigue assessment and collaborative discussions between survivors and health professionals to guide individualized management strategies.

Clinical rehabilitation impact: Managing post-stroke fatigue requires both survivor-led strategies (e.g., self-monitoring, rest, pacing) and professional support to address contributing conditions. Routine follow-up should include systematic fatigue assessment, collaborative discussion of management options, and periodic re-evaluation to optimize recovery.

Introduction: Artificial intelligence (AI) is revolutionizing many fields of science, including medicine, by enhancing diagnostic, therapeutic, and decision-making processes. However, understanding how AI can be truly useful in everyday clinical practice remains challenging. This living review systematically investigates current clinical applications of AI in the rehabilitation field, clarifies key concepts, and identifies knowledge gaps.

Evidence acquisition: PubMed, Scopus, WOS/Embase, and PEDro were systematically searched from December 1, 2014, to December 1, 2024. Retrieved articles were independently screened by two reviewers, with a third reviewer resolving any disagreements. Extracted data (including bibliometric, clinical, and AI-related variables) were synthesized into a synoptic table using a semi-automated Python pipeline. Reporting adhered to PRISMA guidelines, and the review protocol was registered in the PROSPERO database (CRD420250622434).

Evidence synthesis: Of 4193 records identified, 240 studies applying AI for rehabilitative purposes met the inclusion criteria. Most studies focused on neurological (57.9%) and orthopedic (22.7%) rehabilitation, particularly involving stroke, Parkinson's disease, and amputation, with research activity mainly concentrated in China (24.6%) and the USA (16.7%). AI has been tested across all stages of the medical process, with a slight predominance in intervention (23.8%), followed by prognosis (17.5%), assessment (16.7%), diagnosis (12.9%), and monitoring (12.5%). It was frequently integrated with wearable sensors, robotic systems, and digital technologies, especially inertial measurement units, surface EMG, mobile apps and EEG. Most AI studies in rehabilitation used raw (37.9%) or tabular data (27.5%), with multimodal inputs in only 11.3%. Over half lacked a comparator (50.8%). Supervised learning (70.8%) and classical machine learning (43.8%) predominated, while external validation (5.8%) and explainability (10.2%) were rarely applied.

Conclusions: AI applications in rehabilitation are rapidly expanding, particularly in neurological and orthopedic fields where data-driven and technology-assisted approaches prevail. While this progress is promising, current evidence remains largely based on supervised learning with small, single-type datasets, limited external validation, and scarce explainability, critical issues that must be addressed to enable reliable translation into clinical practice.

Background: Stroke is a leading cause of long-term disability, with the sub-acute phase (1-6 months post-stroke) being critical for recovery. While gait-oriented motor training is widely used in rehabilitation, its efficacy may be enhanced by adjunctive neuromodulation through transcranial direct current stimulation (tDCS). However, evidence remains limited regarding the combined impact of these approaches on both functional and quality-of-life outcomes in sub-acute stroke patients.

Aim: To assess the effectiveness of tDCS combined with gait-oriented motor training on disability, quality of life, motor function, and balance in individuals with sub-acute stroke.

Design: A prospective, parallel-group, randomized controlled trial.

Setting: Outpatient rehabilitation clinics affiliated with King Khalid University, Saudi Arabia.

Population: Fifty-seven participants (aged 18-80 years) with medically stable, first-ever ischemic or hemorrhagic sub-acute stroke and lower limb motor deficits.

Methods: Participants were randomized into an intervention group (tDCS + gait-oriented motor training, N.=29) or a control group (gait-oriented motor training only, N.=28). tDCS was administered at 2 mA for 20 minutes, three times per week for four weeks. Primary outcomes were stroke-specific health-related quality of life (Stroke Impact Scale, SIS) and general functioning/disability (WHODAS 2.0), in line with WHO's ICF framework. Secondary outcomes included motor function (Fugl-Meyer Assessment), balance (Berg Balance Scale), and mobility (Timed Up and Go test). Assessments occurred at baseline, post-intervention, and at three-month follow-up.

Results: The intervention group showed significantly greater improvements than the control group across all primary and secondary outcomes (P<0.01). Effect sizes were moderate to large (Cohen's d=0.44-1.2). Improvements in motor function and balance were positively correlated with gains in independence and social participation.

Conclusions: The combination of tDCS and gait-oriented training significantly improves motor function, participation, and self-perceived social and emotional functioning in sub-acute stroke rehabilitation and demonstrates sustained effects over time.

Clinical rehabilitation impact: This integrated intervention provides a viable and effective strategy for enhancing motor recovery, balance, and quality of life in stroke patients, supporting its incorporation into routine outpatient rehabilitation protocols.

Background: Hand function is critical for independence in activities of daily living (ADL). Resulting in debilitating conditions, neuromuscular disease (NMD) sufferers have loss of hand grip and pinch functions.

Aim: We aimed to measure the grip strength, its impact on and correlation with functional independency in NMD patients.

Design: Retrospective analysis of correlations between cross-sectional observational tests.

Setting: Outpatients of NMD Center.

Population: Ninety-six people's files with NMD registered in the Center during the year 2024 are enrolled. Sample consist of four groups broadly; patients with motor neuron disease (10.4%), neuromuscular junctionopathies (16.7%), neuropathies (27.1%) and muscle pathologies (45.8%).

Methods: To investigate hand functions grip strength was measured with CAMRY electronic hand dynamometer and BASELINE hydraulic pinch gauge. ABILHAND NMD hand ability questionnaire and Barthel Index for activities in daily living (ADL) were recorded. Neurological examination and manual muscle testing were performed as a routine part of physical examination. Descriptive statistics, bivariate and multivariate correlation analysis between functional scores are accomplished.

Results: Mean of age was 44.3±19.7 years with a female/male ratio of 50%/50% in 96 subjects. Only myopathy group including 44 patients has 44±17.9 years mean of age and 47.7%/52.3% female/male ratio. Mean of Barthel scores was 90.7±18.5/91.9±20.3 in all patients/myopathies respectively. Independency scores were almost high by the mean of ABILHAND score 31.2±7.6/32.0±7.6 over 36 marks perhaps due to short timespan since diagnosis (10.13/10.38 months). There was significant correlation between Barthel scores and muscle testing, ABILHAND, dynamometric HGS, lateral and pinch grip measurements.

Conclusions: Dynamometric measurements are objective, harmless, easily applicable and satisfactory continuation of physical examination. We pointed its reflecting effect of functional impairment status by the significant correlation between Barthel scores.

Clinical rehabilitation impact: In such a vulnerable patient group it is important to determine the functional capacity and prediction of prognosis as a rehabilitation cult. Dynamometric evaluations strengthen our hand to step to the fore.