European journal of physical and rehabilitation medicine最新文献

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.

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.

Introduction: Through methodological quality assessment, this paper summarized the report quality and evidence level of systematic reviews (SRs)/meta-analyses (MAs) of acupuncture and its related treatment of female urinary incontinence (UI).

Evidence acquisition: We conducted a comprehensive search in four internationally recognized databases (PubMed, Embase, Web of Science, Cochrane Library) for SRs/MAs pertaining to the treatment of female UI using acupuncture and its related therapies. We evaluated the methodological quality of the SRs/MAs using the "Assessing the Methodological Quality of Systematic Reviews 2" (AMSTAR-2) tool, assessed the quality of evidence using the "Grading of Recommendations, Assessment, Development, and Evaluation" (GRADE) system, and evaluated the reporting quality of the SRs/MAs using the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020" (PRISMA-2020) guidelines. This overview is registered with PROSPERO, CRD42024557600.

Evidence synthesis: In the final selection of 7 SRs/MAs, a consistent finding of the superiority of acupuncture and related therapies in the treatment of female UI was observed. Methodological quality was classified according to AMSTAR-2, with three rated as "high," two as "moderate," and two as "low." The main sources of downgrading included the absence of funding sources, failure to provide a reasonable explanation for heterogeneity, and not reporting potential conflicts of interest. According to the GRADE system, the quality of evidence ranged from moderate to very low. The most common reason for downgrading the evidence quality was the repeated utilization of the same original randomized controlled trials. Some results were also downgraded due to inconsistency, imprecision, and potential publication bias. According to the PRISMA-2020 statement, most SR/MAs clearly presented their title information, and almost all of them correctly used meta-analysis methods. However, some of them lacked comprehensive analysis and discussion of bias risk and consistency of results and were deficient in terms of protocol registration and documentation.

Conclusions: Acupuncture and related therapies demonstrate superiority in terms of efficacy and safety for the treatment of female urinary incontinence (UI). The overall quality of the SRs/MAs seems to be satisfactory, particularly when compared to studies of acupuncture for the treatment of other conditions. However, attention should still be given to the proper use of methods and ensuring completeness in reporting.

Background: There is growing evidence on Commitment Therapy for people with low back pain (LBP). A self-reported questionnaire is lacking which evaluates commitment by relying on the most recommended actions, the most important core outcome domains, and the most evidenced treatment options.

Aim: To describe the development and psychometric validation of the Work In Progress (WIP) questionnaire.

Design: Development and psychometric validation of the WIP questionnaire in the context of people with LBP, as a means to evaluate Commitment.

Setting: Outpatient facilities.

Population: People with LBP.

Methods: The new instrument was created by item generation and selection. Face validity, appropriateness, acceptability and feasibility were investigated. Psychometric testing was carried out in a cross-sectional study and included: 1) exploratory factor analysis; 2) reliability by internal consistency (Cronbach's alpha) and test-retest measurement (Intra-class Correlation Coefficient, ICC2.1); and 3) construct validity by hypothesis testing the correlation of the WIP questionnaire with the Pain Catastrophizing Scale (PCS), the Oswestry Disability Index (ODI), and a pain intensity Numerical Rating Scale (NRS) (Pearson's r correlations).

Results: The WIP questionnaire was successfully developed based on international guidelines and the testing of face validity, appropriateness, acceptability and feasibility were satisfactory. The instrument was administered to 102 people with LBP (39 females, mean age of 49.7±14.6 years [range 20-80], pain median duration of 42.1 weeks [range 3-360]). Factor analysis revealed a two-factor 10-item solution (57% of explained variance). The internal consistency was good (α=0.70-85) and test-retest assessment was excellent (ICC2.1=0.91-94). Construct validity was good, as ≥75% of hypotheses were confirmed.

Conclusions: The WIP questionnaire is a self-reported tool to evaluate commitment in persons with LBP showing satisfactory psychometric properties. It can be recommended for clinical and research purposes.

Clinical rehabilitation impact: This study adds original new data to the existing knowledge in the field of Commitment within the bio-psychosocial paradigm for disabled people. It is expected to contribute to the evaluative, clinical and rehabilitative approach of individuals with low back pain.

Background: Lymphedema of the upper limbs and persistent pain are frequent sequelae after surgical treatment of breast cancer.

Aim: The aim of this paper was to analyze the upper limb volume, pressure pain threshold, neural range of motion, pain intensity, kinesiophobia, pain hypervigilance and catastrophizing in patients with and without lymphoedema after breast cancer surgery. Secondly, we aimed to investigated the association between upper limb volume and these variables.

Design: Descriptive observational study.

Setting: Faculty of Health Sciences of the University of Granada.

Population: Fifty-eight post-surgical breast cancer survivors, 29 with upper limb lymphoedema and 29 without lymphoedema.

Methods: We measured upper limb volume (perimetric method). Also, pressure pain thresholds were assessed with a digital algometer, neural range of motion (neurodynamic test for radial, ulnar and median nerves), pain intensity (visual analogue scale), kinesiophobia, pain hypervigilance and catastrophizing (validated tests). To detect differences between the groups for the measurement variables we performed a t-test for independent samples analysis. A simple linear regression analysis adjusting for age and body mass index was performed to check the association among upper limb volume and pain variables in the group with lymphoedema.

Results: The analysis showed that lymphoedema group had lower pressure pain threshold bilaterally in the masseter (origin P≤0.036; insertion P≤0.046), temporalis (insertion P≤0.021), suboccipitalis (P≤0.036); second (P≤0.014), third (P≤0.001) and tenth rib (P≤0.001); affected side of the temporalis (origin P=0.025); temporomandibular joint (P=0.024); neural range of motion in the median nerve (P=0.047), ulnar (P=0.042) on the affected side and radial (P=0.039) on the unaffected side; and greater kinesiophobia (P=0.042). Linear regression analysis only showed a significant association between upper limb volume and neural range of motion in the radial nerve (P=0.020) in the lymphedema group. No significant associations were obtained for the rest of variables.

Conclusions: These findings suggest that the presence of lymphoedema may contribute to an increased level of generalized mechanosensitivity and fear to movement in this population.

Clinical rehabilitation impact: Upper limb lymphedema can lead to heightened mechanosensitivity and movement-related fear in breast cancer survivors. Therefore, fast track rehabilitation approach should be focus in screening and rehabilitation methods for detection and control this sequalae.

Background: Spastic equinus (plantar flexed) foot is a common postural pattern in patients who suffer from post-stroke spasticity. To date, some clinicians use the Silfverskiöld Test in their practice to differentiate between gastrocnemius and soleus muscle overactivity in patients with spastic equinus (plantar flexed) foot. This use of the Silfverskiöld Test goes beyond its original aim, which was to distinguish isolated gastrocnemius contracture in patients with equinus deformity.

Aim: The aim of this study was to investigate the Silfverskiöld Test validity for evaluating spastic equinus (plantar flexed) foot (i.e., differentiation between gastrocnemius and soleus muscle overactivity) by checking its outcome against those of selective diagnostic nerve block of tibial motor nerve branches to the soleus, gastrocnemius and tibialis posterior muscles.

Design: The design of the study was retrospective observational.

Setting: The study was set in a university hospital.

Population: Sixty-seven adult stroke patients with spastic equinus (plantar flexed) foot.

Methods: Each patient underwent selective diagnostic nerve block of tibial motor nerve branches to the soleus, gastrocnemius and tibialis posterior muscles. All patients were evaluated before diagnostic nerve block by means of the Silfverskiöld Test which was considered positive when ankle joint passive dorsiflexion was greater with the knee flexed than extended. Furthermore, they were assessed before and after nerve block by means of the modified Ashworth Scale and the Tardieu Scale.

Results: Our sample included 41 males and 26 females (mean age 57.6 years) suffering from spastic equinus (plantar flexed) foot due to chronic stroke (mean time from onset 2.4 years). Forty-eight patients out of 67 presented with positive Silfverskiöld Test. The χ² test showed no association between the Silfverskiöld Test and spastic overactivity of the gastrocnemius (P=0.253), soleus (P=0.605) and tibialis posterior (P=0.462) muscles as evaluated by serial selective diagnostic block of the tibial nerve motor branches.

Conclusions: Our findings do not support the Silfverskiöld Test as a valid tool for evaluating spastic equinus (plantar flexed) foot to differentiate between gastrocnemius, soleus and tibialis posterior spastic muscle overactivity in adult patients with stroke.

Clinical rehabilitation impact: The choice for an appropriate management of spastic equinus (plantar flexed) foot in adults with stroke should not be mainly defined on the base of Silfverskiöld Test.

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.

Introduction: Post COVID-19 condition (PCC) is characterized by the persistence of symptoms associated with COVID-19 infection for more than 12 weeks, with worsening quality of life and physical function deconditioning being among the most commonly reported persistent symptoms. Pulmonary rehabilitation has emerged as a safe and viable option for these patients. Administered either face-to-face (FTF) or telemedicine (TL), it has been shown to improve symptoms associated with PCC. However, little is known about which approach is best for this population. Therefore, we conducted a systematic review and network meta-analysis on the efficacy of FTF versus TL compared to usual care in improving physical function and quality of life (physical and mental) in patients with PCC.

Evidence acquisition: A systematic search of PubMed, Cochrane Library, and Web of Science was performed from 2020 to January 5^th, 2024. Two independent reviewers performed study selection, data extraction, and risk of bias assessment; this selection included only randomized controlled trials. A network meta-analysis was performed to compare the effects of FTF and TL with usual care. Multivariate and univariate analysis were performed to evaluate the best intervention.

Evidence synthesis: Data were extracted from 10 studies, five of which were treated with FTF and five of which were TL, involving 765 adults with PCC, ranging in age from 22 to 66 years. Interventions consisted of isolated or combined exercises (aerobic, resistance, breathing) and lasted between three and ten weeks in most of the included studies. Multivariate analysis found that FTF produced significant differences compared to TL or usual care with moderate quality of evidence. Univariate analysis found that significant differences were only found for physical function and mental domain of quality of life for TL vs. usual care, with moderate quality of evidence.

Conclusions: This study supports the use of FTF as a therapy to improve physical function and quality of life in patients with PCC. However, in the absence of differences between FTF and TL in the univariate model for any of the outcomes studied, the choice of the form of pulmonary rehabilitation administration should be individualized. Future studies should compare FTF with TL directly to clarify which is the best approach.

The randomized controlled trial (RCT) is the study design with the greatest potential to maximize internal validity when assessing the effectiveness of medical interventions, making it invaluable for evidence-based medicine. Yet, especially in the field of rehabilitation, it is not universally accepted as an unassailable gold standard due to serious problems of its implementation. This paper first examines three factors that limit the applicability of RCTs in rehabilitation practice. The first two factors stem from the nature of rehabilitative treatment itself: the complexity of rehabilitation interventions and the long-term and holistic nature of rehabilitation goals. The third factor relates to the differing functions of RCTs. Interventions vary in their complexity in increasing degree between component, measure, and program interventions. Lower complexity is associated with a greater likelihood of using high rigor efficacy studies. Methodological rigor further depends on the degree to which intervention conditions or contexts can be controlled for. This is particularly the case when examining body-related short-term outcomes. Whether it is reasonable to conduct an RCT also hinges on its function: to gain knowledge or to legitimate the utilization of an intervention in rehabilitation practice. The discussion highlights key challenges to RCT implementation and states questions that should help to identify an RCT as the most appropriate research design. Further empirical and theoretical research is indicated to clarify the distinction between levels of intervention, as this paper is based on theoretical considerations. Additionally, a concise explication of the different functions of an RCT and its meanings for their implementation is needed.

Introduction: Fibromyalgia is characterized by chronic widespread pain accompanied by reduced levels of physical activity and associated comorbidities such as overweight and obesity which have been associated to sarcopenia development. The aim of this systematic review is to ascertain whether Europeans with fibromyalgia show a reduction in sarcopenia determinants compared to apparently-healthy controls and to determine the risk of sarcopenia and its possible risk factors (PROSPERO: CRD42023439839).

Evidence acquisition: Systematic searches were conducted on six databases (Academic-Search-Ultimate, CENTRAL, PubMed, SciELO, WOS-Core Collection, and ClinicalTrials.gov last-search February-2024) looking for original studies developed in European countries which assessed any of the sarcopenia determinants proposed by the EWGSOP2-guidelines (handgrip strength, five sit-to-stand, appendicular skeletal mass [ASM], skeletal muscle index [SMI]) and included fibromyalgia and healthy-control individuals. Studies mixing fibromyalgia with other diagnoses were excluded. Random-effects meta-analyses and meta-regressions were used to analyze possible differences and associated risk factors. The risk of bias was assessed using the Cochrane-Rob tool and the Quality Assessment Tool for Observational Studies, and the certainty of the evidence using GRADE-approach.

Evidence synthesis: A total of 25 studies (6393 individuals; 97% women; 20-65 years) were included. Fibromyalgia individuals showed reduced muscle strength ([handgrip] SMD: -1.16 [-1.29, -1.03]; high-certainty; [five sit-to-stand] not-assessed) and muscle quantity ([ASM] mean-difference: -0.83 kg [-1.41, -0.37]; [SMI] mean-difference: -0.26 kg/m² [-0.41, -0.10]; both low-certainty) compared to healthy-controls. Fibromyalgia individuals had nine-times greater risk for probable sarcopenia (OR: 9.23 [6.85, 12.45]; high-certainty), but not for confirmed sarcopenia ([ASM] OR: 0.91 [0.49, 1.67]; [SMI] OR: 0.67 [0.19, 2.33]; both low-certainty) according to the EWGSOP2 cut-off points. Reduced muscle strength was strongly associated to fibromyalgia-severity (β=-0.953 [-0.069, -0.038]). Studies were rated as high-risk of bias overall because did not account for some potential confounders (physical activity, sedentary time, Body Mass Index) which could influence the estimated effect.

Conclusions: Europeans with fibromyalgia have a large reduction in muscle strength and may have a reduction in muscle quantity. The risk of probable sarcopenia according to the EWGSOP2 cut-off points was nine-times higher, but may have no difference in risk of reduced muscle quantity relative to healthy-controls. Muscle strength was strongly associated to disease severity.