European journal of physical and rehabilitation medicine最新文献

Introduction: The efficacy of pulmonary rehabilitation (PR) in improving health-related quality of life (HRQoL) in patients with interstitial lung disease (ILD) still have some unresolved issues. This study aimed to identify this gap by using the 36-Item Short Form Survey (SF-36) to assess the advantages and disadvantages of PR in improving the HRQoL of patients with ILD.

Evidence acquisition: Self-controlled before-and-after interventional design research related to PR and ILD published in English were retrieved from PubMed, Embase, Web of Science, Scopus, Ovid, and Cochrane Library from inception to May 19, 2024. Data collected from the included studies were general clinical characteristics, study sample size, SF-36 physical component summary (PCS) score, SF-36 mental component summary (MCS) score, scores of the eight domains (physical function, role physical, bodily pain, general health, vitality, social function, role emotional, and mental health), PR time, and main elements of PR. Subgroup analysis was performed based on the PR time and ILD type. Sensitivity analysis was conducted by excluding one study at a time. Publication bias was assessed using Egger's Test, and the reliability of the studies was determined using the funnel plot and trim-and-fill method. Changes in SF-36 domain scores after PR were presented in a radar chart.

Evidence synthesis: Pooled analysis of 15 studies involving 1289 patients with ILD who underwent PR showed that the patients had significantly higher PCS scores (weighted mean difference [WMD]=2.07, 95% CI: 1.06, 3.09) and MCS scores (WMD=4.48, 95% CI: 3.21, 5.76) after PR. According to disease types, subgroup analyses showed that patients with idiopathic pulmonary fibrosis had significantly higher PCS scores (WMD=3.15, 95% CI: 0.05, 6.24) but no change in MCS scores after PR (WMD=1.97, 95% CI: -1.91, 5.85). Additionally, subgroup analysis based on PR time revealed that the PCS scores of patients with ILD were significantly increased after <8 weeks of PR (WMD=2.09, 95% CI: 1.02, 3.17) but not after ≥8 weeks of PR (WMD=1.94, 95% CI: -1.05, 4.93, P=0.204). All included studies were of good quality, and the pooled and subgroup results were robust without publication bias.

Conclusions: In patients with ILD, PR less than 8 weeks effectively improved the physical and mental HRQoL, but not the social function. Future studies should focus on determining the optimal PR time for enhancing HRQoL in patients with ILD and evaluating the efficacy of PR in different ILD types and other HRQoL domains.

Background: Physical and rehabilitation medicine (PRM) units promote health and autonomy. One way to achieve this is through physical activity (PA), yet research shows that individuals with physical impairments are not physically active. One way to motivate them is through adaptive sports (also named para sports), as this allows for a more enjoyable experience. Yet, it is unknown whether such activities are offered in PRM across Europe. The Special Interest Scientific Committees "Sports Affairs" of the European Society of PRM set out to fill this gap of knowledge.

Aim: To explore the use of adaptive sports within PRM units in European countries, to collect information on these practices, and to identify any barriers limiting the development of this offer. To investigate how PRM health care professionals view and promote adaptive sports to their patients.

Design: Cross-sectional survey.

Setting: European PRM units.

Population: PRM health care professionals.

Methods: An online questionnaire was developed and disseminated across Europe. Healthcare professionals working in PRM were invited to respond anonymously. Their views on adaptive sports, as well as the actions they undertook to promote it, were scored, and statistical analyses were performed on these scores.

Results: A total of 190 health care professionals, from 31 different European countries, participated. Only 8 of the 31 countries seem to have adopted adaptive sports as a tool in PRM. The main barrier which limited the development of this across Europe was lack of infrastructure. Yet, the majority of health care professionals acknowledge that their patients would largely benefit from such activities.

Conclusions: The offer of adaptive sports in European PRM is poor. Such activities are not systematically presented to patients with physical impairments. There is a need to improve the situation through structural and legislative changes on one end, but also by providing PRM professionals with adequate tools, resources and networks.

Clinical rehabilitation impact: By identifying barriers which limit the use of adaptive sports as a therapeutic tool, this study suggests several strategies to develop this in the European field of PRM, as it may be a way to enhance its effectiveness.

Cochrane Rehabilitation and the World Health Organization (WHO) Rehabilitation Program are collaborating to produce four Cochrane overviews of systematic reviews that synthesize the current evidence from health policy and systems research (HPSR) in rehabilitation. They will focus on the four pillars of HPSR identified by the Cochrane Effective Practice and Organization of Care (EPOC) taxonomy: delivery arrangements, financial arrangements, governance arrangements, and implementation strategies. The protocol describes why HPSR is currently needed in rehabilitation, provides detailed information on the four EPOC pillars in interaction with rehabilitation and reports the Cochrane methods that will be followed to produce the overviews. 1. Del Furia MJ, Minozzi S, Arienti C, Battel I, Capodaglio P, Côté P, Décary S, De Groote W, Duttine A, Frontera WR, Gimigliano F, Kiekens C, Mudau Q, Ryan R, Sabariego C, Negrini S. Delivery arrangements for rehabilitation services in health systems: an overview of systematic reviews. 2. Gimigliano F, Arienti C, Butzback OK, Capodaglio P, Côté P, Décary S, Del Furia MJ, De Groote W, Duttine A, Frontera WR, Iolascon G, Kiekens C, Liguori S, Minozzi S, Mudau Q, Negrini S, Paoletta M, Ryan R, Sabariego C, Moretti A. Financial arrangements for rehabilitation services in health systems: an overview of systematic reviews. 3. Atkinson-Graham M, Mior S, Bakaa N, Konstantinidis T, Wong J, Arienti C, Capodaglio P, Décary S, De Groote W, Del Furia MJ, Duttine A, Frontera WR, Kiekens C, Minozzi S, Gimigliano F, Mudau Q, Negrini S, Ryan R, Sabariego C, Côté P. Governance arrangements for rehabilitation services in health systems: an overview of systematic reviews. 4. Touhami D, Ryan R, Engeda EH, Arienti C, Capodaglio P, Côté P, Décary S, Del Furia MJ, De Groote W, Duttine A, Frontera WR, Gimigliano F, Kiekens C, Minozzi S, Mudau Q, Negrini S, Sabariego C. Implementation strategies for rehabilitation services in health systems: an overview of systematic reviews. The protocol is largely common to all four overviews. The individual parts of each overview can be identified by the sub-titles delivery arrangements, financial arrangements, governance arrangements, and implementation strategies for overviews 1 to 4.

Background: Rehabilitation is an essential service for healthy ageing. Scoping reviews have described how rehabilitation is delivered to older people, however, their evidence is overwhelmingly derived from research published in high-income countries (HICs).

Aim: To a) assess whether descriptions of rehabilitation service delivery models derived from the literature reflect real-world practice, and b) gather knowledge about the use of different rehabilitation service delivery models in different settings and countries, including availability and implementation status.

Design: Observational study.

Setting: International online survey conducted in eight languages.

Population: Healthcare workers involved in the provision of rehabilitation for people over 60.

Methods: A 33-question questionnaire on the characteristics of rehabilitation service delivery models, their availability and implementation in different regions of the world was distributed globally using a three-layer stakeholder mapping approach. The CHERRIES checklist guided the reporting.

Results: The survey was completed by 1285 highly experienced health workers from 124 countries, representing all income levels and all WHO regions. The availability and implementation status of rehabilitation delivery models (inpatient, outpatient, telerehabilitation, home, community, and eldercare) was lower in low- and middle-income countries (LMICs) than in HICs, but none of the models was fully available or implemented nationwide in any region or income level. Physiotherapists, occupational therapists, speech-language therapists, nurses, and rehabilitation physicians are the most common healthcare workers providing rehabilitation in all models and regions. Rehabilitation is often fragmented and multidisciplinary teams are often only available in the inpatient model. Assistive technology is almost always provided in HICs, but only half the time in LMICs, while environmental adaptations are not fully reimbursed by any health system and are not prescribed in some regions.

Conclusions: Our findings validate and complement previous reviews by incorporating insights from healthcare workers with real-world experience across income levels and regions. Older people in LMICs have less access to quality rehabilitation services than those in HICs. Globally, rehabilitation services are partially responsive and adequate for supporting healthy ageing.

Clinical rehabilitation impact: Rehabilitation stakeholders and policymakers can use this study to (re)design services to better support healthy ageing.

Background: Chronic low back pain continues to be a challenge in everyday rehabilitation services as improvement keeps being unpredictable.

Aim: To evaluate the role of pain coping strategies, fear-avoidance beliefs, anxiety and depression in pain and disability in patients with chronic low back pain.

Design: A cross sectional study.

Setting: Rehabilitation and Orthopedic departments in four tertiary hospitals in Spain.

Population: Overall, 276 patients (200 women) with nonspecific low back pain according COST-B13 guidelines and lasting more than 6 months.

Methods: Pain, disability, coping strategies, catastrophizing, anxiety, depression and fear-avoidance beliefs were evaluated with validated questionnaires. Predictive associations of disability and pain were analyzed by Pearson's test and by multivariate regression.

Results: Catastrophizing is the pain coping strategy with the highest association with disability (r=0.52, P<0.01). Low back pain and disability showed little correlation in between (r=0.40, P<0.01). The correlation between fear-avoidance ideas and pain and disability was slight (r=0.20, P<0.01). No association was found between anxiety and depression with low back pain and disability. In the regression model, catastrophizing, kinesiophobia and gender explained 35% of the variance in disability. In the subanalysis of patients with surgical indication the influence of catastrophizing was maintained. However, correlation between pain and disability is lower than in patients without surgical indication.

Conclusions: The limited correlation between pain and disability suggests that pain alone cannot explain the variability of disability. Catastrophizing and kinesiophobia are predictors of the degree of disability in chronic low back pain and are cognitions potentially modifiable.

Clinical rehabilitation impact: These results support the biopsychosocial model in the pathogenesis of chronic low back pain and support the use of cognitive behavioral therapy to modify maladaptive beliefs and attitudes as part of medical or surgical treatment in low back pain.

Background: Mirror therapy (MT) has been demonstrated as an effective intervention for promoting motor recovery post-stroke. Existing neuroimaging studies have demonstrated that the efficacy of MT is associated with its effect to increase the strength of brain activity and functional connectivity in the bilateral M1. However, its modulation on brain dynamics, which also hold physiological significance, remains unknown.

Aim: To investigate the potential influence of MT on brain dynamics in stroke patients.

Design: A randomized, single-blinded, controlled trial.

Setting: Inpatient.

Population: Fifty first-ever unilateral stroke patients with motor dysfunctions were recruited and randomly assigned to either an MT group (N.=25) or a conventional therapy (CT) group (N.=25) for a 4-week intervention.

Methods: Motor function assessments and resting-state fMRI scans were conducted both before and after the intervention. Images from sixteen healthy subjects were used as controls. A dynamic analysis of the fMRI data was performed using measures of the dynamic fractional amplitude of low-frequency fluctuation (dfALFF) and dynamic voxel-mirrored homotopic connectivity (dVMHC).

Results: Aberrant dynamics, characterized by increased variability (decreased stability) in spontaneous activity and interhemispheric functional connectivity in sensorimotor networks, were observed in stroke patients. MT but not CT intervention led to reduced variability of spontaneous activity in the ipsilesional primary motor cortex (M1) and interhemispheric M1 functional connectivity, which further exhibited a correlation with motor improvement. Notably, reduced variability of spontaneous activity showed significant mediation effects in the prediction of motor recovery with reduced variability of interhemispheric functional connectivity.

Conclusions: MT may reduce the excessive variability of interhemispheric M1 functional connectivity, thereby stabilizing the activity of ipsilesional M1 and then facilitating motor recovery.

Clinical rehabilitation impact: This study highlights the unique role of MT in addressing abnormal brain dynamics, emphasizing its addition to standard rehabilitation protocols.

Background: The effect of rehabilitation therapy on health-related quality of life (HRQOL) among patients with brain tumors has not been fully investigated.

Aim: This study aimed to evaluate the effect of rehabilitation therapy on HRQOL among patients with brain tumors using the HRQOL index. We also examined factors that influenced changes in HRQOL, including differences in brain tumor type.

Design: Prospective cohort study.

Setting: University Medical and Dental Hospital.

Population: Patients with brain tumors aged 20 years or older undergoing rehabilitation therapy were included. Patients with cognitive decline, aphasia, or poor general condition who had difficulty answering HRQOL questions were excluded.

Methods: The EuroQol-5 Dimension 5-Level (EQ-5D-5L), EORTC Quality of Life Questionnaire Core 30 (QLQ-C30), and EORTC Quality of Life Questionnaire Brain Cancer Module (BN20) were used to assess HRQOL before and after rehabilitation treatment. Brain tumor type was classified into five groups: World Health Organization (WHO) grade 1, WHO grade 2/3, WHO grade 4, primary central nervous system lymphoma, and metastatic brain tumor. We compared EQ-5D-5L index scores and QLQ-C30 and BN20 scores before and at the end of rehabilitation. Multiple regression analysis was used to examine factors affecting changes in EQ-5D-5L index score (EQ-5D-5L gain).

Results: In total, 112 patients participated in this study. The median EQ-5D-5L index score significantly improved from 0.698 before rehabilitation to 0.772 at the end of rehabilitation (P<0.001, r=0.46). QLQ-C30 and BN20 scores showed significant improvement in physical functioning, global health status, pain, and motor dysfunction (P<0.001, r>0.3). Multiple regression analysis revealed that recurrence (β=-0.191, P=0.037) and baseline EQ-5D-5L index score (β=-0.595, P<0.001) affected EQ-5D-5L gain, whereas differences in brain tumor type did not.

Conclusions: HRQOL among patients with brain tumors improved at the end of rehabilitation therapy compared with before therapy. Furthermore, the EQ-5D-5L index score gain was not affected by brain tumor type.

Clinical rehabilitation impact: These results suggest rehabilitation therapy may contribute to improved HRQOL irrespective of brain tumor type.

Background: Virtual reality (VR) Serious Games (SG) offer greater sensitivity and specificity than traditional diagnostics. The playfulness of the SG reduces stress, enhancing motivation and reliability. We developed immersive (iVR) and non-immersive (niVR) versions of REAsmash, a SG based on Feature Integration Theory (FIT) to assess distractor inhibition attention.

Aim: The aim of this study was to verify the transfer of the REAsmash FIT diagnostic properties across VR devices with different degrees of immersion.

Design: Cross-sectional clinical study.

Setting: Inpatient, outpatient and healthy controls.

Population: Post-stroke and healthy individuals.

Methods: The REAsmash involves searching for a (target) mole with a red miner's helmet. The target is either presented alone (baseline), or presented with distractors (11, 17 or 23) that contrast the target by high or low saliency (moles with blue miner's and horned helmets vs. blue miner's and red horned helmets). Stimuli appeared randomly from a 24-molehill grid. Participants (15 with and history of cortical-subcortical stroke and 15 age matched controls) hit the target with their response hand in niVR and with a virtual hammer in iVR. Post-stroke participants used their less impaired hand, controls their dominant hand. ANOVA tested VR type (niVR vs. iVR), group (post-stroke vs. healthy), saliency (high vs. low) and distractor number (11, 17, 23), with the interaction between saliency and distractor number defining FIT. The dependent variable was relative mean response time, calculated by subtracting the mean baseline response time from each response to targets presented with distractors, for each participant. This variable exemplifies the costs to response time cause by the manipulation of independent variables.

Results: We found significant main effects and an interaction for saliency and distractor number, confirming FIT. Group and VR type main effects were significant, with slower responses for post-strokes and for iVR, but with no interactions.

Conclusions: To evaluate performance across acute to chronic post-stroke phases, diagnostic measures must be transferable between test devices, ensuring compatibility from hospital to outpatient settings.

Clinical rehabilitation impact: Our results demonstrated that the REAsmash diagnostic properties were consistent across immersive and non-immersive VR, as well as within both groups of participants.