European journal of physical and rehabilitation medicine最新文献

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.

Background: Stroke is a highly prevalent and disabling acute cerebrovascular disease. Existing assessment methods for hemiplegic patients have subjectivity, and research on combining surface electromyography and color Doppler ultrasound (CDUS) to evaluate lower limbs of stroke patients is scarce.

Aim: The study explored the correlation between quadriceps femoris muscle function and femoral artery hemodynamic parameters in hemiplegic patients after stroke for more accurate rehabilitation assessment.

Design: A prospective control study.

Setting: Hospital in-patient population.

Population: The sample comprised 20 post-stroke hemiplegic patients aged 18 - 80 years who met specific inclusion and exclusion criteria. Then the healthy side and the affected side were compared respectively.

Methods: The study chose surface electromyography and color Doppler ultrasound. Femoral artery hemodynamic parameters and quadriceps femoris electromyographic signals were detected before and after maximum isometric contraction. Differences between the affected and healthy sides and correlations were analyzed.

Results: The affected side had lower peak systolic velocity, arterial diameter, and surface electromyography indicators of the quadriceps femoris (except for increased end-diastolic velocity) (P<0.05). Significant differences were found in mean power frequency and median frequency of vastus medialis and vastus lateralis muscles (P<0.05). A positive correlation was found between the healthy side's quadriceps femoris median frequency and arterial diameter during contraction (r=0.489, P<0.05).

Conclusions: Lower limb muscle function impairment in hemiplegic patients after stroke is closely related to hemodynamic abnormalities. Combining surface electromyography and CDUS provides comprehensive rehabilitation assessment.

Clinical rehabilitation impact: This combined method can reduce subjective bias of traditional assessment, improve early assessment accuracy, and provide more precise references for stroke rehabilitation assessment and treatment.

Background: Chronic obstructive lung disease is diverse and complex, exhibiting pulmonary and systematic symptoms that interrupt the patients' daily activities and sleep. The most frequent source of these symptoms is air stacking, which can be lessened by positive expiratory pressure Buddy, a simple and affordable device.

Aim: This study aimed to assess the impact of positive expiratory pressure Buddy during exercise on pulmonary function, functional performance, and sleep quality among those patients.

Design: Randomized controlled study.

Settings: Faculty of Physical Therapy, Cairo University, Outpatient Clinic.

Population: Sixty patients with moderate-to-severe chronic obstructive lung disease, aged 55 to 65.

Methods: The participants were allocated evenly into two groups: the experimental group, which used the positive expiratory pressure Buddy while doing the aerobic exercise, and the control group, which did the same aerobic training without using the PEP Buddy. Spirometry (forced expiratory volume in 1 second and forced expiratory volume in 1 second/forced vital capacity ratio), dyspnea, a six-minute walk test distance, sleep quality, and quality of life (St. George Respiratory Questionnaire) were used to evaluate the patients both before and after the study's eight-week timeframe.

Results: The experimental group showed higher significant improvements in all assessed parameters than the control group after eight weeks of intervention (P<0.001).

Conclusions: When combined with a regular exercise regimen, positive expiratory pressure Buddy is an extremely adherence intervention that improves sleep, exercise capacity, pulmonary function, and general quality of life. Thus, it can be considered an excellent choice for patients receiving at-home treatment.

Clinical rehabilitation impact: Chronic obstructive pulmonary disease is a major global health issue that affects society, healthcare systems, and patients' health and quality of life. Its management is still challenging, necessitating the use of alternative therapy approaches.

Background: Stroke rehabilitation - both inpatient and community - is an important part of current post-stroke care, aimed at improving outcomes. However, there is a lack of recent New Zealand research exploring associations between rehabilitation and health-related quality of life (HRQoL) post stroke.

Aim: To explore associations between stroke rehabilitation and HRQoL.

Design: Secondary analysis of data from a prospective, observational study.

Setting: Twenty-eight New Zealand hospitals.

Population: Overall, 2379 patients with stroke.

Methods: Data was collected from consecutive patients with stroke who were admitted to New Zealand hospitals between 1^st May and 31^st July 2018. Further data collection occurred until the target sample size was reached, or until 31^st October 2018, whichever occurred first. Patients were contacted for routine follow-up at three months and were invited to consent to follow-up at six and 12 months. We used the EQ-5D-3L and calculated the health utility score using weightings for the New Zealand population. We used linear regression to explore correlations between rehabilitation and HRQOL, adjusting for known confounders including stroke severity.

Results: There were 750/2379 (31.5%) patients who received inpatient rehabilitation and 838/2379 (35.2%) who received community rehabilitation. In a multivariate analysis, patients who received inpatient rehabilitation, compared to people who did not, had lower HRQoL scores at both three months (-0.07, 95% CI -0.10 to -0.04) and 12 months (-0.08, 95% CI -0.12 to -0.04). Patients who received community rehabilitation had higher HRQoL scores at 12 months (0.04, 95% CI 0.002 to 0.08)). Stratifying scores by stroke severity, we found results in favor of inpatient rehabilitation for only the most severely impaired patients and for community rehabilitation for all but the least impaired.

Conclusions: We found a negative correlation between HRQoL and inpatient rehabilitation, and a positive association between HRQoL and community rehabilitation. A combination of personal, environmental and service factors may explain this result. Future research directly comparing outcomes for patients receiving comprehensive community-based and inpatient rehabilitation, would be useful to support stroke rehabilitation service development.

Clinical rehabilitation impact: Individualized rehabilitation planning should consider social supports, the home environment, functional level and patient preference to support decision-making around rehabilitation location and optimize outcomes.

Background: Lower limb dysfunction is common after stroke. While physical rehabilitation is the most widely used treatment, its effectiveness is limited in improving motor function.

Aim: This study aimed to investigate the effect of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) combined with motor imagery (MI) on lower limb motor dysfunction in cerebral infarction patients.

Design: A randomized, double-blind, and controlled study.

Setting: The Rehabilitation Department of a single Hospital.

Population: Sixty patients with lower limb motor impairment post-cerebral infarction were randomly allocated to the rTMS group, the MI group, and the combined rTMS + MI group.

Methods: All groups received standard physical rehabilitation training and the allocated treatment for 3 weeks. Motor function was evaluated before and after intervention with the Fugl-Meyer Lower Extremity Motor Function Scale (FMA-LE), Holden Walking Functional Classification (FAC), and Time-Up-Go Time Test (TUGT). Magnetic resonance diffusion tensor imaging (DTI) was used to assess fractional anisotropy (FA) and the bilateral FA ratios (rFA) in the corona radiata, cerebral peduncles, posterior limb of the internal capsule, and infarction foci.

Results: The combined treatment increased lower limb motor function (FMA-LE), walking ability (FAC levels), and functional mobility of the lower limb (TUGT), compared to patients receiving MI therapy alone. The combined treatment also had a superior effect to rTMS alone on walking ability. Furthermore, DTI findings demonstrated a more prominent increase in FA and rFA, mainly in the corona radiata, posterior limb of the internal capsule, and the infarcted foci following the combined treatment.

Conclusions: LF-rTMS combined with MI could significantly enhance lower limb motor function in cerebral infarction patients, potentially by promoting neuroplasticity and functional connectivity along the motor pathways. Due to a lack of control group, much of the observed recovery was likely due to spontaneous improvement, given that our patients were in the sub-acute phase of stroke with mild to moderate motor impairment.

Clinical rehabilitation impact: This novel therapy provides a promising approach for improving lower limb motor recovery in stroke rehabilitation.