European journal of physical and rehabilitation medicine最新文献

Background: Although the benefits of sustained exercise for cardiopulmonary health in older adults are well-established, it remains unclear which specific groups of older adults benefit most from exercise.

Aim: We aimed to explore the relationship between baseline characteristics and peak oxygen uptake (peakVO2) improvements to identify potential exercise responders in older adults.

Design: This was single-arm pre-post cohort study of exercise intervention, with post hoc dichotomization by responses of peakVO2.

Setting: The study was conducted primarily at the geriatric rehabilitation clinic of Fuzhou University Affiliated Provincial Hospital.

Population: A total of 151 community-dwelling older adults with good functional status, with a mean age of 69 years.

Method: All participants underwent individualized, center-based, multicomponent exercise under supervision. And collecting data on functional oxygen uptake gain (ΔVO2/ΔWR), peakVO2, physical function, and laboratory indicators at baseline, 1-year, and 2-year. Participants were divided into exercise responders (ER, >2.5 mL/kg/min in absolute change of peakVO2) and exercise non-responders (ENR, ≤2.5 mL/kg/min in absolute change of peakVO2).

Results: 151 and 91 participants were included in the 1-year and 2-year analysis, respectively. At baseline, the mean ΔVO2/ΔWR was 9.76±1.98 mL/min/W in ER and 11.26±1.50 mL/min/W in ENR, with a significant difference (P<0.001). The optimal baseline ΔVO2/ΔWR cut-off for discriminating 1-year ER was 9.310 mL/min/W. For 2-year ER, the corresponding cut-off value was 9.805 mL/min/W. A negative correlation was identified between baseline ΔVO2/ΔWR and the absolute changes in peakVO2 at both the 1-year and 2-year follow-ups, using a multivariable linear regression model.

Conclusions: Older adults with lower ΔVO2/ΔWR gain the most from structured exercise. Future multicenter trials in more diverse populations are needed to confirm ΔVO2/ΔWR as a universal prognostic marker for exercise responders.

Clinical rehabilitation impact: Older adults with low baseline ΔVO2/ΔWR should be particularly encouraged to participate in center-based exercise programs to maximize their cardiopulmonary benefits.

Background: Muscle strength is crucial for predicting functional recovery in stroke patients, yet current assessment methods (manual muscle testing and instrument-based dynamometry) are limited in stroke patients due to interference from abnormal synergistic movements and operational complexity/cost, respectively. No validated tool addresses these constraints while quantifying strength across recovery stages.

Aim: To develop an integrative manual muscle test (iMMT) for measuring muscle function in stroke patients with abnormal synergistic movements and evaluate its psychometric properties.

Design: An observational study.

Setting: Rehabilitation hospital inpatient.

Population: Stroke patients.

Methods: The iMMT was developed through a multi-stage process. Initial development involved creating essential movement test items and a novel grading system. This was followed by a pretest to assess operability and refinement of content validity via expert panel review (10 physiotherapists). Finally, a pilot test with 104 stroke patients was conducted to optimize the scale's structure using factor analysis and evaluate its psychometric properties.

Results: The final 17-item iMMT (six upper limb, four trunk, seven lower limb items) was developed with dual six-point grading systems for active range of motion in a normal pattern (A-score) and strength within the active range (B-score) respectively, integrated into a C-score (C=A+B). It demonstrated satisfactory content validity (above moderate relevance), excellent internal consistency (α=0.949), high test-retest (ICC: 0.852-0.992) and inter-tester reliability (ICC: 0.829-0.992). The minimum detectable change (MDC95) was 9.69. Factor analysis confirmed the pre-specified body-part factor structure (AVE>0.5, CR>0.7) and revealed two categories of test items based on postural perturbation (69% variance explained). The iMMT showed excellent convergent and criterion validities demonstrating moderate-to-very-strong correlations with the Fugl-Meyer Assessment (r=0.954), Berg Balance Scale (r=0.747), 10-Meter Walk Test (r=0.769-0.810), the Timed Up and Go test (r=-0.767), Modified Barthel Index (r=0.627), and isokinetic measures (r=0.589-0.773). No ceiling/floor effects were observed.

Conclusions: The iMMT is the first muscle strength tool specifically designed to mitigate synergistic movement interference, providing reliable and valid assessment across stroke recovery stages.

Clinical rehabilitation impact: The iMMT provides precise, accessible muscle assessment in hemiplegic patients. This enables identification of specific neuromuscular deficits, thereby guiding targeted strength training and enhancing rehabilitation outcome prediction in clinical practice.

Background: Breast Cancer Survivors (BCs) often exhibit impaired mobility, balance deficits, and reduced gait speed at functional tests.

Aim: To assess gait patterns in a population of BCs by comparing spatiotemporal (ST) gait measures with those of healthy subjects.

Design: Cross-sectional study.

Setting: Outpatient rehabilitation services of the Breast Unit and the Motion Analysis Laboratory at the Neurorehabilitation Unit, University Hospital of Pisa, Italy.

Population: Twenty-three BCs (BCs-group), who completed active oncological treatments at least 3 months prior to study enrolment, and 16 age-matched healthy female controls (HC).

Methods: All subjects underwent 3-D gait analysis. ST measures of gait were compared between BCs-group and HC. Intra-patient comparisons were made between the operated and the contralateral side. BCs-group was then stratified into two sub-groups according to time from surgery (<12 months; >12 months) and compared to HC.

Results: Results obtained provide evidence that BCs display an abnormal gait pattern characterized by slower gait velocity (0.66±0.21 vs. 0.89±0.22 m/s, P<0.01), shorter step length (0.48±0.10 vs. 0.54±0.07 m; P<0.05) and stride length (0.90±0.16 vs. 1.07±0.14 m; P<0.01), and increased step width (0.12±0.03 vs. 0.10±0.03 m; P<0.01). Cadence was also reduced (81.12±13.68 vs. 98.78±12.48 steps/min; P<0.01) while time of stance (63.1±3.7 vs. 57.69±3.69%; P<0.01) and double support time (14.53±4.85 vs. 8.39±2.87%; P<0.01) were significantly prolonged. The intrapatient analysis of ST measures between the operated and unoperated side revealed no significant differences, but abnormal step length and step width were found only on the operated side. Altered ST parameters were already detectable within 12 months from breast surgery.

Conclusions: A slower and less stable gait pattern develops early after BC treatments, and it can be detected by assessment of ST measures within 12 months from breast surgery.

Clinical rehabilitation impact: Early tailored rehabilitation may help prevent gait deterioration and reduce fall risk in BCs.

Introduction: Pediatric brain injuries frequently result in impaired mobility and functional limitations. Although treadmill-based exoskeletal robotic-assisted gait training (RAGT) may enhance gait performance, the optimal treatment parameters remain undefined. The present study evaluated the effects of treadmill-based exoskeletal RAGT on walking-related outcomes in children with brain injuries and examined the influence of training dosage on therapeutic outcomes.

Evidence acquisition: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Six databases (PubMed, Embase, Science Direct, ProQuest, Cochrane Library, and PEDro) were searched for studies published between January 2010 and February 2025. Eligible studies included participants aged 2-18 years with brain injuries who received treadmill-based exoskeletal RAGT. Risk of bias was assessed using the Risk of Bias tool 2.0, Risk of Bias in Nonrandomized Studies of Intervention tool, and PEDro scale. Meta-analyses were conducted to estimate pooled effects and explore dose-response relationships.

Evidence synthesis: Twenty-four studies (N.=837) met the inclusion criteria; twenty were included in this meta-analysis. RAGT significantly increased gait speed (standardized mean difference [SMD]=0.40; 95% confidence interval [CI]=0.04 to 0.76; I²=30%; P=0.003) and Gross Motor Function Measure (GMFM) Dimension D (SMD=1.02; 95% CI=0.23 to 1.81; I²=83%; P=0.001). Improvements in the 6-minute walk test (SMD=0.43; 95% CI=-0.28 to 1.14; I²=76%; P=0.23) and GMFM Dimension E (SMD=0.49; 95% CI=-0.13 to 1.12; I²=77%; P=0.12) were nonsignificant. Subgroup and meta-analyses identified high session frequency, ≥20 total sessions, and initial body weight support ≤50% as factors associated with superior outcomes. By contrast, excessive frequency and high initial body weight support adversely affected GMFM Dimension E scores.

Conclusions: Treadmill-based exoskeletal RAGT with conventional physical therapy improves gait speed and gross motor function in children with brain injuries. These findings provide preliminary guidance for optimizing training dosage. Additional high-quality trials with standardized protocols and extended follow-ups are required to validate these outcomes.

Background: Transcranial magnetic stimulation (TMS) has recently been used to great effect to enhance the motor function and performance of patients with stroke by modifying cerebral cortex excitability. But few studies have directly compared the effectiveness of stimulating the M1 and cerebellar regions in using rTMS to improve lower limb motor function in stroke patients.

Aim: To assess the effectiveness of high-frequency (HF) repetitive TMS (rTMS) applied to the primary motor cortex (M1) versus the cerebellar region for improving lower limb dsyfunction and maintaining balance ability in people suffering from stroke.

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

Setting: Department of rehabilitation medicine in a general hospital.

Population: Patients with stroke with first unilateral lesions were enrolled in the study.

Methods: Seventy-one patients were randomly allocated to sham stimulation group, acerebellum group, and M1 group. Each group received rTMS alongside their routine rehabilitation. The M1 group received stimulation to the affected lower limb motor cortex, while the cerebellum group received stimulation to the contralesional cerebellum. The sham stimulation group had a non-stimulating setup. The stimulation parameters were as follows: the stimulation intensity of 80%RMTand frequency of 10 Hz. The stimulation lasted 20 minutes per session, comprising 3 seconds of stimulation followed by a 17-second interval. This equated to 1,800 pulses per day, five times a session for two weeks.

Results: Before the intervention, no significant differences was found in terms of the Fugl-Meyer Assessment for the Lower Extremities (FAM-LE), the Berg Balance Scale (BBS), movement trajectory length, center of movement trajectory area and the Modified Barthel Index (MBI) (P>0.05). Two weeks later, however, the M1 group and cerebellar group demonstrated statistically significant improvements in the FAM-LE, BBS and MBI (P<0.05). The cerebellar and M1 groups outperformed the sham stimulation group in terms of movement trajectory measures (P<0.05), with the cerebellar group achieving the best results.

Conclusions: Both M1 and cerebellar HF stimulation have been shown to play a positive role in the functionality of the lower limbs and the ability of balance in stroke patients, with cerebellar stimulation proving to be especially efficacious in the amelioration of balance.

Clinical rehabilitation impact: M1 and cerebellar can improve stroke patient lower limb function, but cerebellar maybe a more perfect region for improving balance function compare with M1.

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.