Pub Date : 2024-08-01Epub Date: 2024-07-03DOI: 10.23736/S1973-9087.24.08577-0
Nikolaos Barotsis, Aydan Oral, Mauro Zampolini, Wim Janssen, Rolf Frischknecht, Piotr Tederko, Maria G Ceravolo
The mission of the European Board of Physical and Rehabilitation Medicine (PRM) is to the ensure a consistent and high-level education for PRM physicians across Europe. An important action to accomplish this mission is the publication and continuous update of the European Training Requirements (ETRs) for the specialty of PRM. The first version of the ETRs for PRM was issued in 2017. The aim was to present the up-to-date training standards for trainees, trainers, and training institutions. The revision of the first ETRs, aiming to reflect the current standards in medical education and clinical advances in the field or PRM, started in 2022 and was completed in 2023. It was based on the Rehabilitation Competency Framework and the "Guide for using a contextualised competency framework to develop rehabilitation programmes and their curricula" published by the WHO in 2021. An important addition in the new version of the ETRs is the integration of Entrustable Professional Activities. In all endeavours of the creation of the ETRs, setting the highest standards of training in PRM was pursued.
{"title":"Setting the European standards for training in Physical and Rehabilitation Medicine.","authors":"Nikolaos Barotsis, Aydan Oral, Mauro Zampolini, Wim Janssen, Rolf Frischknecht, Piotr Tederko, Maria G Ceravolo","doi":"10.23736/S1973-9087.24.08577-0","DOIUrl":"10.23736/S1973-9087.24.08577-0","url":null,"abstract":"<p><p>The mission of the European Board of Physical and Rehabilitation Medicine (PRM) is to the ensure a consistent and high-level education for PRM physicians across Europe. An important action to accomplish this mission is the publication and continuous update of the European Training Requirements (ETRs) for the specialty of PRM. The first version of the ETRs for PRM was issued in 2017. The aim was to present the up-to-date training standards for trainees, trainers, and training institutions. The revision of the first ETRs, aiming to reflect the current standards in medical education and clinical advances in the field or PRM, started in 2022 and was completed in 2023. It was based on the Rehabilitation Competency Framework and the \"Guide for using a contextualised competency framework to develop rehabilitation programmes and their curricula\" published by the WHO in 2021. An important addition in the new version of the ETRs is the integration of Entrustable Professional Activities. In all endeavours of the creation of the ETRs, setting the highest standards of training in PRM was pursued.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11391388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141491460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01Epub Date: 2024-07-03DOI: 10.23736/S1973-9087.24.08463-6
Karim Jamal, Simon Butet, Blandine Maitre, Jean-Michel Gracies, Sophie Hameau, Émilie Leveque LE Bras, Marjolaine Baude, Sébastien Cordillet, Isabelle Bonan
Background: Upper limb (UL) spastic paresis has been classically evaluated with assessments of passive movements with limited functional validity. The aim of this study was to assess whether a composite measure of active range of motion (AROM, or XA) is valid and reliable in chronic post-stroke spastic paresis.
Aim: The primary objective was to investigate the validity and reliability of a composite score, comprising multiple XA measurements, to assess UL spastic paresis in patients in chronic stages post-stroke. In addition to this, an exploratory analysis was conducted to identify which muscles should be optimally included in this composite score.
Design: A psychometric proprieties study.
Setting: Physical and Rehabilitation Medicine Department.
Population: twenty-eight chronic post-stroke participants with spastic paresis.
Methods: Composite UL XA measurement in twenty-eight chronic post-stroke participants (age=59±11 years; delay post-stroke=29±37 months) with spastic paresis was repeated twice about 40 days apart in a standardized body position. Concurrent and construct validity was evaluated exploring correlation with the Fugl-Meyer Assessment Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), and grip strength (JAMAR™). Reliability was assessed by calculating intraclass correlation coefficients (ICC). Regarding the exploratory analysis, a linear regression analysis was performed to examine the value of including various muscles.
Results: Composite XA against the resistance of elbow, wrist and finger flexors showed strong correlation with FMA-UE and ARAT (r=0.88; P<0.001 and r=0.82; P<0.001 respectively) and a weak association with grip strength (r=0.43; P=0.03). Test-retest reliability was excellent (ICC=0.92). However, the most effective regression model also included XA against the resistance of shoulder adductors as well as forearm pronator (adjusted R2=0.85; AIC=170).
Conclusions: The present study provided satisfactory psychometric data for the upper limb composite active movement (CXA), derived from the Five Step Assessment. For overall measurement of UL mobility after stroke, we strongly recommend including shoulder and forearm muscles to the score.
Clinical rehabilitation impact: Composite XA is a valid and reliable measure of upper limb motor function in chronic post-stroke patients and could be used in clinical practice and research.
背景:上肢(UL)痉挛性瘫痪的经典评估方法是被动运动评估,其功能有效性有限。本研究的目的是评估主动运动范围(AROM,或 XA)的综合测量方法在慢性中风后痉挛性瘫痪中是否有效和可靠。目的:本研究的主要目的是调查由多个 XA 测量方法组成的综合评分在评估慢性中风后阶段的 UL 痉挛性瘫痪患者中的有效性和可靠性。此外,还进行了一项探索性分析,以确定哪些肌肉应最佳地纳入该综合评分:环境:物理与康复医学科研究对象:28 名患有痉挛性瘫痪的慢性中风后参与者:方法:对 28 名慢性中风后痉挛性瘫痪患者(年龄=59±11 岁;中风后延迟时间=29±37 个月)进行 UL XA 综合测量,在标准化体位下重复测量两次,每次间隔约 40 天。通过探索与 Fugl-Meyer 上肢评估(FMA-UE)、行动研究手臂测试(ARAT)和握力(JAMAR™)的相关性,评估了并发有效性和结构有效性。可靠性通过计算类内相关系数(ICC)进行评估。在探索性分析方面,进行了线性回归分析,以研究纳入各种肌肉的价值:针对肘、腕和指屈肌阻力的综合 XA 与 FMA-UE 和 ARAT 显示出很强的相关性(r=0.88;针对肩内收肌和前臂前伸肌阻力的 PA 显示出很强的相关性(调整后 R2=0.85;AIC=170):本研究为上肢综合主动运动(CXA)提供了令人满意的心理测量数据,该数据来源于五步评估法。对于中风后UL活动能力的整体测量,我们强烈建议将肩部和前臂肌肉纳入评分范围:综合 XA 是衡量慢性中风后患者上肢运动功能的有效而可靠的方法,可用于临床实践和研究。
{"title":"Validity and reliability of the chronic composite XA, an upper limb motor assessment using Active Range of Motion in patients with chronic stroke.","authors":"Karim Jamal, Simon Butet, Blandine Maitre, Jean-Michel Gracies, Sophie Hameau, Émilie Leveque LE Bras, Marjolaine Baude, Sébastien Cordillet, Isabelle Bonan","doi":"10.23736/S1973-9087.24.08463-6","DOIUrl":"10.23736/S1973-9087.24.08463-6","url":null,"abstract":"<p><strong>Background: </strong>Upper limb (UL) spastic paresis has been classically evaluated with assessments of passive movements with limited functional validity. The aim of this study was to assess whether a composite measure of active range of motion (AROM, or X<inf>A</inf>) is valid and reliable in chronic post-stroke spastic paresis.</p><p><strong>Aim: </strong>The primary objective was to investigate the validity and reliability of a composite score, comprising multiple X<inf>A</inf> measurements, to assess UL spastic paresis in patients in chronic stages post-stroke. In addition to this, an exploratory analysis was conducted to identify which muscles should be optimally included in this composite score.</p><p><strong>Design: </strong>A psychometric proprieties study.</p><p><strong>Setting: </strong>Physical and Rehabilitation Medicine Department.</p><p><strong>Population: </strong>twenty-eight chronic post-stroke participants with spastic paresis.</p><p><strong>Methods: </strong>Composite UL X<inf>A</inf> measurement in twenty-eight chronic post-stroke participants (age=59±11 years; delay post-stroke=29±37 months) with spastic paresis was repeated twice about 40 days apart in a standardized body position. Concurrent and construct validity was evaluated exploring correlation with the Fugl-Meyer Assessment Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), and grip strength (JAMAR™). Reliability was assessed by calculating intraclass correlation coefficients (ICC). Regarding the exploratory analysis, a linear regression analysis was performed to examine the value of including various muscles.</p><p><strong>Results: </strong>Composite X<inf>A</inf> against the resistance of elbow, wrist and finger flexors showed strong correlation with FMA-UE and ARAT (r=0.88; P<0.001 and r=0.82; P<0.001 respectively) and a weak association with grip strength (r=0.43; P=0.03). Test-retest reliability was excellent (ICC=0.92). However, the most effective regression model also included X<inf>A</inf> against the resistance of shoulder adductors as well as forearm pronator (adjusted R<sup>2</sup>=0.85; AIC=170).</p><p><strong>Conclusions: </strong>The present study provided satisfactory psychometric data for the upper limb composite active movement (CX<inf>A</inf>), derived from the Five Step Assessment. For overall measurement of UL mobility after stroke, we strongly recommend including shoulder and forearm muscles to the score.</p><p><strong>Clinical rehabilitation impact: </strong>Composite X<inf>A</inf> is a valid and reliable measure of upper limb motor function in chronic post-stroke patients and could be used in clinical practice and research.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11391394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141491472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01Epub Date: 2024-06-26DOI: 10.23736/S1973-9087.24.08391-6
Stefan Metzger, Boris Polanco, Inge Eriks-Hoogland, Anke Scheel-Sailer, Diana Pacheco Barzallo
Background: The increasing prevalence of individuals experiencing disabilities underscores the importance of rehabilitation. Nevertheless, healthcare systems are already facing financial constraints, which makes it imperative to strive for a more efficient delivery of services. The first step, however, is to understand how the provision of services behaves for patients with different characteristics.
Aim: To determine the most frequently used healthcare services in the (sub)acute phase of rehabilitation of patients with spinal cord injury/disease (SCI/D) and the link with patient characteristics.
Design: Observational cohort study.
Population: This study analyzes the clinical data of patients discharged from a specialized SCI hospital and rehabilitation center in Switzerland.
Methods: We implemented a compound risk model to estimate the total amount of healthcare services used, defined by length of stay (LOS) and the units per day of health services (sub)acute phase of rehabilitation.
Results: The study included 403 individuals with SCI/D. The analysis of the intensity and severity of healthcare services across different patient and injury characteristics revealed differences in the intensity of healthcare use and variations in the length of stay (LOS). Male patients with a low SCIM upon admission tended to use healthcare services more extensively than female patients. In terms of etiology, therapies were employed more intensively for patients with traumatic SCI (TSCI). In addition, the analysis revealed that variations in the intensity of healthcare services used were more significant than those adjusted for LOS. Ultimately, similar patient groups received comparable quantities of healthcare services at the end of treatment.
Conclusions: This population-based study provides information for a better understanding of the determinants of health service use during the (sub)acute rehabilitation phase of individuals with SCI/D. When analyzing LOS, intensity, and severity of services, it shows that the use of healthcare services significantly differs for the level of SCIM at admission, age groups, sex, and etiology. However, the variation among individual patients also suggests the presence of other influential modifiers that were not considered in this analysis.
Clinical rehabilitation impact: The approach outlined enables a systematic follow-up of this data analysis by enriching the computed data with additional details about the patient, the patient's treatment, and outcomes.
{"title":"Utilization and features of rehabilitation and health services for persons with spinal cord injury.","authors":"Stefan Metzger, Boris Polanco, Inge Eriks-Hoogland, Anke Scheel-Sailer, Diana Pacheco Barzallo","doi":"10.23736/S1973-9087.24.08391-6","DOIUrl":"10.23736/S1973-9087.24.08391-6","url":null,"abstract":"<p><strong>Background: </strong>The increasing prevalence of individuals experiencing disabilities underscores the importance of rehabilitation. Nevertheless, healthcare systems are already facing financial constraints, which makes it imperative to strive for a more efficient delivery of services. The first step, however, is to understand how the provision of services behaves for patients with different characteristics.</p><p><strong>Aim: </strong>To determine the most frequently used healthcare services in the (sub)acute phase of rehabilitation of patients with spinal cord injury/disease (SCI/D) and the link with patient characteristics.</p><p><strong>Design: </strong>Observational cohort study.</p><p><strong>Population: </strong>This study analyzes the clinical data of patients discharged from a specialized SCI hospital and rehabilitation center in Switzerland.</p><p><strong>Methods: </strong>We implemented a compound risk model to estimate the total amount of healthcare services used, defined by length of stay (LOS) and the units per day of health services (sub)acute phase of rehabilitation.</p><p><strong>Results: </strong>The study included 403 individuals with SCI/D. The analysis of the intensity and severity of healthcare services across different patient and injury characteristics revealed differences in the intensity of healthcare use and variations in the length of stay (LOS). Male patients with a low SCIM upon admission tended to use healthcare services more extensively than female patients. In terms of etiology, therapies were employed more intensively for patients with traumatic SCI (TSCI). In addition, the analysis revealed that variations in the intensity of healthcare services used were more significant than those adjusted for LOS. Ultimately, similar patient groups received comparable quantities of healthcare services at the end of treatment.</p><p><strong>Conclusions: </strong>This population-based study provides information for a better understanding of the determinants of health service use during the (sub)acute rehabilitation phase of individuals with SCI/D. When analyzing LOS, intensity, and severity of services, it shows that the use of healthcare services significantly differs for the level of SCIM at admission, age groups, sex, and etiology. However, the variation among individual patients also suggests the presence of other influential modifiers that were not considered in this analysis.</p><p><strong>Clinical rehabilitation impact: </strong>The approach outlined enables a systematic follow-up of this data analysis by enriching the computed data with additional details about the patient, the patient's treatment, and outcomes.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11403627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141450234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Action observation treatment (AOT) is an innovative therapeutic approach consisting in the observation of actions followed by their subsequent repetition. The standard version of AOT consists in the observation/imitation of a typically developed individual, which is proposed as model (TDM-AOT).
Aim: This study aims to compare the effectiveness of AOT based on a pathological ameliorative model (PAM-AOT) versus TDM-AOT in improving upper limb ability in children with unilateral cerebral palsy (UCP).
Design: The study consists in a prospective randomized controlled, evaluator-blinded trial (RCT), with two active arms, designed to evaluate the effectiveness of AOT based on pathological model (PAM-AOT) as compared to a standard AOT based on TDM (TDM-AOT).
Setting: The 3-week AOT program was administered in a clinical setting. For some patients, the treatment was delivered at participant's home with the remote support of the physiotherapist (tele-rehabilitation).
Population: Twenty-six children with UCP (mean age 10.5±3.09 years; 14 females) participated in the study, with the experimental group observing a pathological model and the control group observing a typically developed model.
Methods: Motor assessments included unimanual and bimanual ability measures conducted at T0 (baseline, before the treatment), T1 (3 weeks after T0), T2 (8-12 weeks after treatment) and T3 (24-28 weeks after treatment); a subset of 16 patients also underwent fMRI motor assessment. Generalized Estimating Equations models were used for statistical analysis.
Results: Both groups showed significant improvement in bimanual function (GEE, Wald 106.16; P<0.001) at T1 (P<0.001), T2 (P<0.001), and T3 (P<0.001). Noteworthy, the experimental group showed greater improvement than the control group immediately after treatment (P<0.013). Both groups exhibited similar improvement in unimanual ability (GEE, Wald 25.49; P<0.001). The fMRI assessments revealed increased activation of ventral premotor cortex after treatment in the experimental compared with control group (GEE, Wald 6.26; P<0.012).
Conclusions: Overall, this study highlights the effectiveness of PAM-AOT in achieving short-term improvement of upper limb ability in children with UCP.
Clinical rehabilitation impact: These findings have significant implications for rehabilitative interventions based on AOT in hemiplegic children, by proposing a non-traditional approach focused on the most functional improvement achievable by imitating a pathological model.
{"title":"Effectiveness of action observation treatment based on pathological model in hemiplegic children: a randomized-controlled trial.","authors":"Antonino Errante, Laura Beccani, Jessica Verzelloni, Irene Maggi, Mariacristina Filippi, Barbara Bressi, Settimio Ziccarelli, Francesca Bozzetti, Stefania Costi, Adriano Ferrari, Leonardo Fogassi","doi":"10.23736/S1973-9087.24.08413-2","DOIUrl":"10.23736/S1973-9087.24.08413-2","url":null,"abstract":"<p><strong>Background: </strong>Action observation treatment (AOT) is an innovative therapeutic approach consisting in the observation of actions followed by their subsequent repetition. The standard version of AOT consists in the observation/imitation of a typically developed individual, which is proposed as model (TDM-AOT).</p><p><strong>Aim: </strong>This study aims to compare the effectiveness of AOT based on a pathological ameliorative model (PAM-AOT) versus TDM-AOT in improving upper limb ability in children with unilateral cerebral palsy (UCP).</p><p><strong>Design: </strong>The study consists in a prospective randomized controlled, evaluator-blinded trial (RCT), with two active arms, designed to evaluate the effectiveness of AOT based on pathological model (PAM-AOT) as compared to a standard AOT based on TDM (TDM-AOT).</p><p><strong>Setting: </strong>The 3-week AOT program was administered in a clinical setting. For some patients, the treatment was delivered at participant's home with the remote support of the physiotherapist (tele-rehabilitation).</p><p><strong>Population: </strong>Twenty-six children with UCP (mean age 10.5±3.09 years; 14 females) participated in the study, with the experimental group observing a pathological model and the control group observing a typically developed model.</p><p><strong>Methods: </strong>Motor assessments included unimanual and bimanual ability measures conducted at T0 (baseline, before the treatment), T1 (3 weeks after T0), T2 (8-12 weeks after treatment) and T3 (24-28 weeks after treatment); a subset of 16 patients also underwent fMRI motor assessment. Generalized Estimating Equations models were used for statistical analysis.</p><p><strong>Results: </strong>Both groups showed significant improvement in bimanual function (GEE, Wald 106.16; P<0.001) at T1 (P<0.001), T2 (P<0.001), and T3 (P<0.001). Noteworthy, the experimental group showed greater improvement than the control group immediately after treatment (P<0.013). Both groups exhibited similar improvement in unimanual ability (GEE, Wald 25.49; P<0.001). The fMRI assessments revealed increased activation of ventral premotor cortex after treatment in the experimental compared with control group (GEE, Wald 6.26; P<0.012).</p><p><strong>Conclusions: </strong>Overall, this study highlights the effectiveness of PAM-AOT in achieving short-term improvement of upper limb ability in children with UCP.</p><p><strong>Clinical rehabilitation impact: </strong>These findings have significant implications for rehabilitative interventions based on AOT in hemiplegic children, by proposing a non-traditional approach focused on the most functional improvement achievable by imitating a pathological model.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11391395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141174943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-29DOI: 10.23736/S1973-9087.24.08364-3
Delphine Besson, Amadou-Khalilou Sow, Isabelle Fournel, Anaïs Gouteron, Aurélie Gudjoncik, Jean M Casillas, Paul Ornetti, Davy Laroche
Background: This randomized controlled trial examined the feasibility of adding eccentric exercise to a conventional cardiac rehabilitation program (CCRP) for coronary heart disease patients.
Methods: Ninety-three patients were randomly assigned to either the MIX group (eccentric ergometer + CCRP) or the CON group (concentric ergometer + CCRP) for 7 weeks. Training effectiveness was assessed based on "good responders" showing improved functional capacities, such as 6-minute walk test (6MWT) distance and maximal voluntary contraction of the plantar flexors (ankle MVC). Safety was monitored with a visual analog scale for muscle soreness, perceived exertion, and heart rate during training.
Results: The proportion of good responders was similar between groups (26% in MIX, 29% in CON, P=0.744). Both groups improved in 6MWT (CON: 12.6%, MIX: 16.14%) and ankle MVC (CON: 15.5%, MIX: 11.30%), with no significant differences. Exercise tolerance did not differ significantly between the groups, but perceived effort was significantly lower in the MIX group (P<0.0001) compared to the CON group.
Conclusions: Integrating eccentric exercise into cardiac rehabilitation is safe and well-tolerated. Nevertheless, this study did not find significant advantages over conventional programs for coronary heart disease patients. Further research should explore specific patient groups or conditions where eccentric exercise may be more beneficial, emphasizing personalized prescriptions and gradual workload progression for better cardiac rehabilitation outcomes.
{"title":"Impact of eccentric cycling in coronary rehabilitation program: a pragmatic randomized controlled trial versus conventional rehabilitation.","authors":"Delphine Besson, Amadou-Khalilou Sow, Isabelle Fournel, Anaïs Gouteron, Aurélie Gudjoncik, Jean M Casillas, Paul Ornetti, Davy Laroche","doi":"10.23736/S1973-9087.24.08364-3","DOIUrl":"https://doi.org/10.23736/S1973-9087.24.08364-3","url":null,"abstract":"<p><strong>Background: </strong>This randomized controlled trial examined the feasibility of adding eccentric exercise to a conventional cardiac rehabilitation program (CCRP) for coronary heart disease patients.</p><p><strong>Methods: </strong>Ninety-three patients were randomly assigned to either the MIX group (eccentric ergometer + CCRP) or the CON group (concentric ergometer + CCRP) for 7 weeks. Training effectiveness was assessed based on \"good responders\" showing improved functional capacities, such as 6-minute walk test (6MWT) distance and maximal voluntary contraction of the plantar flexors (ankle MVC). Safety was monitored with a visual analog scale for muscle soreness, perceived exertion, and heart rate during training.</p><p><strong>Results: </strong>The proportion of good responders was similar between groups (26% in MIX, 29% in CON, P=0.744). Both groups improved in 6MWT (CON: 12.6%, MIX: 16.14%) and ankle MVC (CON: 15.5%, MIX: 11.30%), with no significant differences. Exercise tolerance did not differ significantly between the groups, but perceived effort was significantly lower in the MIX group (P<0.0001) compared to the CON group.</p><p><strong>Conclusions: </strong>Integrating eccentric exercise into cardiac rehabilitation is safe and well-tolerated. Nevertheless, this study did not find significant advantages over conventional programs for coronary heart disease patients. Further research should explore specific patient groups or conditions where eccentric exercise may be more beneficial, emphasizing personalized prescriptions and gradual workload progression for better cardiac rehabilitation outcomes.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Meta-learning is a metacognitive function for successful, efficient learning in various tasks. While it is possible that meta-learning is linked to functional recovery in stroke, it has not been investigated in previous clinical research on metacognition.
Aim: Examine if individual meta-learning ability is associated with functional outcomes.
Design: Cohort study.
Settings: Rehabilitation ward in Fujita Health University Hospital.
Population: Twenty-nine hemiparetic people after stroke.
Methods: The study measured individual sensorimotor adaptation rate, meta-learning (acceleration of adaptation through training), and Functional Independence Measure (FIM) motor effectiveness, an index of functional outcome measuring improvement in proficiency of activity of daily living (ADL). Participants performed visuomotor adaptation training sessions with their less-affected arm. They made arm-reaching movements to hit a target with cursor feedback, which was occasionally rotated with regard to their hand positions, requiring them to change the movement direction accordingly. Initial adaptation rate and meta-learning were quantified from pre- and post-training tests. The relationship between these indices of adaptation ability and FIM motor effectiveness was examined by multiple linear regression analyses.
Results: One participant was excluded before data collection in the motor task. In the remaining 28 individuals, the regression analyses revealed that FIM motor effectiveness positively correlated with meta-learning (µ=0.90, P=0.008), which was attenuated by age (µ=-0.015, P=0.005), but not with initial adaptation rate (P=0.08). Control analyses suggested that this observed association between FIM motor effectiveness and meta-learning was not mediated by patients' demographics or stroke characteristics.
Conclusions: This study demonstrates that those who can accelerate adaptation through training are likely to improve ADL, suggesting that meta-learning may be linked with functional outcomes in some stroke individuals. Meta-learning may enable the brain to keep (re-)learning motor skills when motor functions change abruptly due to stroke and neural recovery, thereby associated with improvement in ADL.
Clinical rehabilitation impact: Meta-learning is part of metacognitive functions that is positively associated with functional outcomes.
背景介绍元学习是在各种任务中成功、高效学习的元认知功能。虽然元学习有可能与中风患者的功能恢复有关,但在以往的元认知临床研究中尚未对此进行调查。目的:研究个体元学习能力是否与功能结果有关:设计:队列研究:研究对象: 29名偏瘫患者:方法:测量个体的感觉运动适应能力:该研究测量了个体感觉运动适应率、元学习(通过训练加速适应)和功能独立性测量(FIM)运动效果,后者是测量日常生活活动(ADL)熟练程度改善情况的功能结果指标。参与者使用受影响较小的手臂进行视觉运动适应训练。他们在光标反馈下做出伸臂动作以击中目标,光标偶尔会随着他们的手部位置旋转,要求他们相应地改变动作方向。训练前和训练后的测试对初始适应率和元学习进行了量化。通过多元线性回归分析研究了这些适应能力指数与 FIM 运动效果之间的关系:一名学员在运动任务数据收集前被排除在外。在其余28人中,回归分析表明,FIM运动效能与元学习呈正相关(µ=0.90,P=0.008),并因年龄而减弱(µ=-0.015,P=0.005),但与初始适应率无关(P=0.08)。对照分析表明,所观察到的 FIM 运动有效性与元学习之间的关联并不受患者人口统计学或中风特征的影响:本研究表明,能够通过训练加速适应的患者有可能改善 ADL,这表明元学习可能与某些中风患者的功能结果有关。元学习可使大脑在运动功能因中风和神经恢复而发生突然变化时继续(重新)学习运动技能,从而与 ADL 的改善相关联:元学习是元认知功能的一部分,与功能结果呈正相关。
{"title":"Learning-to-learn as a metacognitive correlate of functional outcomes after stroke: a cohort study.","authors":"Taisei Sugiyama, Shintaro Uehara, Akiko Yuasa, Kazuki Ushizawa, Jun Izawa, Yohei Otaka","doi":"10.23736/S1973-9087.24.08446-6","DOIUrl":"https://doi.org/10.23736/S1973-9087.24.08446-6","url":null,"abstract":"<p><strong>Background: </strong>Meta-learning is a metacognitive function for successful, efficient learning in various tasks. While it is possible that meta-learning is linked to functional recovery in stroke, it has not been investigated in previous clinical research on metacognition.</p><p><strong>Aim: </strong>Examine if individual meta-learning ability is associated with functional outcomes.</p><p><strong>Design: </strong>Cohort study.</p><p><strong>Settings: </strong>Rehabilitation ward in Fujita Health University Hospital.</p><p><strong>Population: </strong>Twenty-nine hemiparetic people after stroke.</p><p><strong>Methods: </strong>The study measured individual sensorimotor adaptation rate, meta-learning (acceleration of adaptation through training), and Functional Independence Measure (FIM) motor effectiveness, an index of functional outcome measuring improvement in proficiency of activity of daily living (ADL). Participants performed visuomotor adaptation training sessions with their less-affected arm. They made arm-reaching movements to hit a target with cursor feedback, which was occasionally rotated with regard to their hand positions, requiring them to change the movement direction accordingly. Initial adaptation rate and meta-learning were quantified from pre- and post-training tests. The relationship between these indices of adaptation ability and FIM motor effectiveness was examined by multiple linear regression analyses.</p><p><strong>Results: </strong>One participant was excluded before data collection in the motor task. In the remaining 28 individuals, the regression analyses revealed that FIM motor effectiveness positively correlated with meta-learning (µ=0.90, P=0.008), which was attenuated by age (µ=-0.015, P=0.005), but not with initial adaptation rate (P=0.08). Control analyses suggested that this observed association between FIM motor effectiveness and meta-learning was not mediated by patients' demographics or stroke characteristics.</p><p><strong>Conclusions: </strong>This study demonstrates that those who can accelerate adaptation through training are likely to improve ADL, suggesting that meta-learning may be linked with functional outcomes in some stroke individuals. Meta-learning may enable the brain to keep (re-)learning motor skills when motor functions change abruptly due to stroke and neural recovery, thereby associated with improvement in ADL.</p><p><strong>Clinical rehabilitation impact: </strong>Meta-learning is part of metacognitive functions that is positively associated with functional outcomes.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In line with the World Health Organization's Rehabilitation 2030 initiative that led to its landmark resolution on rehabilitation, the Physical and Rehabilitation Medicine (PRM) Section and Board of the European Union of Medical Specialists have been developing functioning-based standards and tools using the International Classification of Functioning, Disability and Health (ICF) as a reference framework the past few years. This evidence brief aims to enable rehabilitation practitioners to implement these functioning-based standards and tools in rehabilitation care, management, and programming by clarifying functioning as the foundational concept for rehabilitation, introducing the functioning-based standards and tools and presenting concrete applications. This evidence brief also calls for the continuous development of these standards and tools and discusses the implementation challenges and opportunities in the context of the interaction between practice, science and governance.
{"title":"The standards and tools of the European Union of Medical Specialists Physical and Rehabilitation Medicine Section and Board for rehabilitation management and care: an evidence brief for rehabilitation practitioners.","authors":"Melissa Selb, Mauro Zampolini, Nikolaos Barotsis, Aydan Oral, Gerold Stucki","doi":"10.23736/S1973-9087.24.08653-2","DOIUrl":"https://doi.org/10.23736/S1973-9087.24.08653-2","url":null,"abstract":"<p><p>In line with the World Health Organization's Rehabilitation 2030 initiative that led to its landmark resolution on rehabilitation, the Physical and Rehabilitation Medicine (PRM) Section and Board of the European Union of Medical Specialists have been developing functioning-based standards and tools using the International Classification of Functioning, Disability and Health (ICF) as a reference framework the past few years. This evidence brief aims to enable rehabilitation practitioners to implement these functioning-based standards and tools in rehabilitation care, management, and programming by clarifying functioning as the foundational concept for rehabilitation, introducing the functioning-based standards and tools and presenting concrete applications. This evidence brief also calls for the continuous development of these standards and tools and discusses the implementation challenges and opportunities in the context of the interaction between practice, science and governance.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: The objective of this study was to identify relevant aspects for disability evaluation used in scientific literature for older adults.
Evidence acquisition: We employed a systematic review methodology as outlined by the ICF Research Branch. The methodology consists of four steps: 1) identifying studies that focus on disability evaluation among older adults; 2) identifying disability measures used in these studies; 3) linking the concepts contained in these measures to ICF categories; 4) conducting frequency analysis.
Evidence synthesis: A total of 1942 concepts contained in disability measures from 137 studies were extracted. About 97.7% of the concepts could be linked, and 1862 concepts were linked to 52 second-level ICF categories. Of these, 44 categories found in at least 5% of the studies (range 5.1-85.4%) were selected to develop an outcome set that represents the relevant categories, including five categories in the Body Functions component and 39 categories from the Activities and Participation component.
Conclusions: The relevant categories identified in our study reflect the essential areas that measure disability for older adults, providing a scientific basis for developing an ICF Core Set for disability evaluation, in combination with further empirical study and expert survey. Information from the outcome set is also valuable for providing a standardized minimal set for disability measurement, which can be used for data comparison across different studies and the development of an ICF-based disability measurement tool.
{"title":"Employing the International Classifications of Functioning, Disability, and Health to identify relevant categories for disability evaluation in older adults from the research perspective: a systematic review.","authors":"Heng-Yu Hu, Ming-Yue Hu, Jia-Hui Nan, Pan-Pan Cui, Hui Feng, Jun-Mei Zhang","doi":"10.23736/S1973-9087.24.08320-5","DOIUrl":"https://doi.org/10.23736/S1973-9087.24.08320-5","url":null,"abstract":"<p><strong>Introduction: </strong>The objective of this study was to identify relevant aspects for disability evaluation used in scientific literature for older adults.</p><p><strong>Evidence acquisition: </strong>We employed a systematic review methodology as outlined by the ICF Research Branch. The methodology consists of four steps: 1) identifying studies that focus on disability evaluation among older adults; 2) identifying disability measures used in these studies; 3) linking the concepts contained in these measures to ICF categories; 4) conducting frequency analysis.</p><p><strong>Evidence synthesis: </strong>A total of 1942 concepts contained in disability measures from 137 studies were extracted. About 97.7% of the concepts could be linked, and 1862 concepts were linked to 52 second-level ICF categories. Of these, 44 categories found in at least 5% of the studies (range 5.1-85.4%) were selected to develop an outcome set that represents the relevant categories, including five categories in the Body Functions component and 39 categories from the Activities and Participation component.</p><p><strong>Conclusions: </strong>The relevant categories identified in our study reflect the essential areas that measure disability for older adults, providing a scientific basis for developing an ICF Core Set for disability evaluation, in combination with further empirical study and expert survey. Information from the outcome set is also valuable for providing a standardized minimal set for disability measurement, which can be used for data comparison across different studies and the development of an ICF-based disability measurement tool.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-15DOI: 10.23736/S1973-9087.24.08346-1
Romain David, Mahdis Hashemi, Laura Schatz, Paul Winston
{"title":"Multisite treatment with percutaneous cryoneurolysis for the upper and lower limb in long-standing post-stroke spasticity: a case report.","authors":"Romain David, Mahdis Hashemi, Laura Schatz, Paul Winston","doi":"10.23736/S1973-9087.24.08346-1","DOIUrl":"https://doi.org/10.23736/S1973-9087.24.08346-1","url":null,"abstract":"","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141616102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-26DOI: 10.23736/S1973-9087.24.08459-4
William M Levack, Douglas P Gross, Rachelle A Martin, Susanna Every-Palmer, Carlotte Kiekens, Claudio Cordani, Stefano Negrini
According to Cochrane Rehabilitation's recently published definition for research purposes, rehabilitation is inherently complex. Rehabilitation teams frequently implement multiple strategies concurrently, draw on input from a range of different health professionals, target multiple outcomes, and personalize therapeutic plans. The success of rehabilitation lies not only in the specific therapies employed, but also in how they are delivered, when they are delivered, and the capability and willingness of patients to engage in them. In 2021, the UK Medical Research Council (MRC) and the National Institute of Health Research (NIHR) released the second major update of its framework for developing and evaluating complex interventions. This framework has direct relevance to the development and implementation of evidence-based practice in the field of rehabilitation. While previous iterations of this framework positioned complex interventions as anything that involved multiple components, multiple people, multiple settings, multiple targets of effect, and behavior change, this latest framework expanded on this concept of complexity to also include the characteristics and influence of the context in which interventions occur. The revised MRC-NIHR framework presents complex intervention research as comprising the following four inter-related and overlapping phases: 1) development or identification of the intervention; 2) feasibility; 3) evaluation; and 4) implementation, with different methods and tools required to address each of these phases. This paper provides an overview of the MRC-NIHR framework and its application to rehabilitation, with examples from past research. Rehabilitation researchers are encouraged to learn about the MRC-NIHR framework and its application. Funders of rehabilitation research are also encouraged to place greater emphasis on supporting studies that involve the right design to address key uncertainties in rehabilitation clinical practice. This will require investment into a broader range of types of research than simply individual-level randomized controlled trials. Rehabilitation research can both learn from and contribute to future iterations of the MRC-NIHR framework as it is an excellent environment for exploring complexity in clinical practice.
{"title":"Designing studies and reviews to produce informative, trustworthy evidence about complex interventions in rehabilitation: a narrative review and commentary.","authors":"William M Levack, Douglas P Gross, Rachelle A Martin, Susanna Every-Palmer, Carlotte Kiekens, Claudio Cordani, Stefano Negrini","doi":"10.23736/S1973-9087.24.08459-4","DOIUrl":"https://doi.org/10.23736/S1973-9087.24.08459-4","url":null,"abstract":"<p><p>According to Cochrane Rehabilitation's recently published definition for research purposes, rehabilitation is inherently complex. Rehabilitation teams frequently implement multiple strategies concurrently, draw on input from a range of different health professionals, target multiple outcomes, and personalize therapeutic plans. The success of rehabilitation lies not only in the specific therapies employed, but also in how they are delivered, when they are delivered, and the capability and willingness of patients to engage in them. In 2021, the UK Medical Research Council (MRC) and the National Institute of Health Research (NIHR) released the second major update of its framework for developing and evaluating complex interventions. This framework has direct relevance to the development and implementation of evidence-based practice in the field of rehabilitation. While previous iterations of this framework positioned complex interventions as anything that involved multiple components, multiple people, multiple settings, multiple targets of effect, and behavior change, this latest framework expanded on this concept of complexity to also include the characteristics and influence of the context in which interventions occur. The revised MRC-NIHR framework presents complex intervention research as comprising the following four inter-related and overlapping phases: 1) development or identification of the intervention; 2) feasibility; 3) evaluation; and 4) implementation, with different methods and tools required to address each of these phases. This paper provides an overview of the MRC-NIHR framework and its application to rehabilitation, with examples from past research. Rehabilitation researchers are encouraged to learn about the MRC-NIHR framework and its application. Funders of rehabilitation research are also encouraged to place greater emphasis on supporting studies that involve the right design to address key uncertainties in rehabilitation clinical practice. This will require investment into a broader range of types of research than simply individual-level randomized controlled trials. Rehabilitation research can both learn from and contribute to future iterations of the MRC-NIHR framework as it is an excellent environment for exploring complexity in clinical practice.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141450232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}