European journal of physical and rehabilitation medicine最新文献

Background: The international expert consensus core outcome set for post-stroke aphasia recommends the Stroke and Aphasia Quality of Life Scale - 39/generic (SAQOL-39g) for assessing patient-reported health-related quality of life. Cultural adaptations of the SAQOL-39g are mandatory in stroke rehabilitation.

Aim: We adapted the original English SAQOL-39g into German and evaluated its psychometric quality.

Design: Evaluation of a self-report scale embedded in a prospective multicenter parallel group randomized waitlist-controlled trial on the effectiveness of intensive speech and language therapy.

Setting: Nineteen in- and outpatient aphasia rehabilitation centers in Germany.

Population: People with chronic post-stroke aphasia (N.=156) of all types and severity levels.

Methods: We followed applicable guidelines for cross-cultural test adaptations and psychometric evaluations. Psychometric analyses are based on the assessment before three weeks of intensive speech and language therapy (acceptability, internal consistency, validity; N.=156), on the assessments before and after three weeks of waiting in the control group (test-retest reliability; N.=78), and on the assessments before and after three weeks of intensive speech and language therapy (responsiveness; N.=156).

Results: The German SAQOL-39g was feasible across all aphasia severity grades (no missing data; no floor/ceiling effects). Internal consistency was excellent (Cronbach's α=0.90); test-retest reliability was moderate-to-good (intraclass-correlations: ICC=0.73 for single/0.85 for average measures). Both exploratory factor analyses and multidimensional scaling of proximity data/graphical network analysis supported the 3-dimensional structure (domains: physical, psychosocial, communication) of the English original version. Convergent (|r|=0.29 to 0.48) and discriminative (|r|=0.03 to 0.07) validities were acceptable. Responsiveness to intervention-induced change showed a small-to-medium treatment effect (group difference after intervention compared to waiting-list control: Cohen's d=0.34).

Conclusions: The German SAQOL-39g is a reliable, valid and change-sensitive patient-reported outcome measure to assess the physical, communication and psychosocial quality of life in chronic post-stroke aphasia, with comparable psychometric properties and factorial structure to the original English version.

Clinical rehabilitation impact: The German SAQOL-39g is an easy-to-administer and -score patient-reported scale that can be used in rehabilitation settings to measure health-related quality of life and support patient-centered goal setting in people with chronic post-stroke aphasia of different ages, stroke durations, severity and type of aphasia.

Background: Non-traumatic spinal cord injuries (NTSCI) represent an increasing public health concern, particularly in aging populations, yet there is limited literature on rehabilitation outcomes and key predictors of home discharge in this population.

Aim: This study evaluates the impact of demographic and clinical characteristics on rehabilitation outcomes and home discharge rates in individuals with NTSCI.

Design: Prospective observational cohort study.

Setting: Thirty-one specialized SCI centers in 13 Italian regions.

Population: Individuals with NTSCI.

Methods: Demographic and clinical characteristics of 394 rehabilitation were recorded at admission (T1) and discharge (T2). The American Spinal Injury Association (ASIA) Scale and Spinal Cord Independence Measure (SCIM) were used to assess motor function and functional independence. Binary logistic regression was employed to develop a predictive model for home discharge, incorporating categorical and continuous variables. Two common metrics for this purpose are the Akaike Information Criterion (AIC) and the Bayesian Information Criterion (BIC). Predictive factors for home discharge were analyzed using logistic regression and ROC curves.

Results: 80% of participants were discharged home. Key predictors of home discharge included higher SCIM scores, younger age, and being married. The SCIM score at discharge was a stronger predictor of home discharge than at admission. Length of stay (LOS) was also a significant factor, with longer stays associated with better functional outcomes, particularly in individuals with severe impairments.

Conclusions: SCIM scores at discharge, age, and marital status emerged as key predictors of home discharge, highlighting the importance of personalized rehabilitation strategies and structured discharge planning. Tailoring rehabilitation programs to maximize SCIM score improvements may enhance home discharge rates and long-term patient outcomes.

Clinical rehabilitation impact: This study emphasizes the importance of continuous functional assessment using SCIM during rehabilitation, allowing clinicians to optimize treatment plans and improve home discharge likelihood. Additionally, considering demographic factors such as age and marital status in discharge planning may facilitate better reintegration into home environments. Longer rehabilitation stays for individuals with more severe injuries (ASIA A/B) can significantly enhance outcomes. By incorporating these predictors into everyday practice, rehabilitation clinics can better optimize patient care, increase home discharge rates, and improve overall quality of life post-rehabilitation.

Background: People with neuromuscular disorders (NMD) are often provided with lower limb orthoses to improve walking. Guideline-based provision of lower limb orthoses in expert settings (i.e. specialized orthotic care) may improve treatment outcomes by better matching the orthotic properties to address walking problems in neuromuscular disorders (NMD).

Aim: We assessed the (cost)-effectiveness of specialized orthotic care compared to usual orthotic care in adults with NMD.

Design: Randomized controlled trial with an economic evaluation.

Setting: Outpatient rehabilitation settings.

Population: Adults with plantar flexor and/or quadriceps weakness due to NMD with an indication for a lower limb orthosis.

Methods: Participants were randomly assigned to specialized orthotic care (N.=31), or usual orthotic care (N.=30). Primary endpoints were personal goal attainment (at 24 weeks follow-up), and walking energy cost at comfortable speed (change from baseline to 24 weeks follow-up). Secondary endpoints included comfortable walking speed, spatiotemporal gait parameters, gait biomechanics, stability, physical functioning, (fear of) falling, fatigue and satisfaction.

Results: Personal goal attainment was significantly higher for specialized orthotic care (P=0.011). Walking energy cost did not differ between groups (P=0.140) but decreased significantly with -11.8% (-0.55 J/kg/m; 95% CI: -0.99 to -0.11) following specialized, but not following usual orthotic care (-0.08 J/kg/m; 95% CI: -0.32 to 0.26). Secondarily, changes in step length, walking speed, physical functioning, and satisfaction were in favor of specialized orthotic care (P≤0.042). Specialized orthotic care was likely cost-effective from a societal and healthcare perspective.

Conclusions: Specialized orthotic care was beneficial in attaining personal goals, and likely cost-effective compared to usual orthotic care.

Clinical rehabilitation impact: Guideline-based provision of lower limb orthoses in expert settings could enhance functioning of adults with NMD and generate societal cost savings.

Background: Fibromyalgia is a chronic pain condition with symptoms such as pain, fatigue, and decreased quality of life. Although aerobic exercise is an effective treatment for fibromyalgia, patients often struggle with exercise intolerance due to fatigue, limiting long-term adherence. Research on blood flow-restricted (BFR) exercise suggests it may provide benefits similar to traditional exercise with reduced intensity, but its effects on fibromyalgia-related symptoms remain underexplored.

Aim: This study investigated the impact of a BFR aerobic exercise program on pain, functional status, quality of life, and hormonal response in women with fibromyalgia.

Design: A prospective, randomized, double-blind, sham-controlled trial.

Setting: Outpatient rehabilitation center.

Population: Fifty women diagnosed with fibromyalgia were included in this study.

Methods: Participants were randomly assigned to two groups receiving supervised aerobic exercise four times weekly for six weeks. The experimental group used blood flow restriction aid with elastic bandages at the groin level, while the control group received a sham restriction. Primary outcomes were assessed with the Fibromyalgia Impact Questionnaire (FIQ). Secondary outcomes included the Central Sensitization Index (CSI), Beck Depression Inventory (BDI), Visual Analogue Scale (VAS) for pain, Chronic Pain Acceptance Questionnaire-8 (CPAQ-8), and 24-hour urine levels of vanillyl mandelic acid (VMA) and 5-hydroxy indole acetic acid (5-HIAA). Evaluations were conducted before, immediately after, and three months post-intervention.

Results: The mean age of participants was 43.2±7.2 years, with comparable baseline characteristics between groups. Both groups showed significant improvements across all outcomes, with the BFR group exhibiting superior improvements in FIQ (P<0.001), CSI, and BDI scores, as well as increased urine levels of VMA and 5-HIAA. Although both groups improved in pain and pain acceptance, these changes were not significantly different between groups.

Conclusions: Patients with fibromyalgia who have limited exercise tolerance may find that BFR aerobic exercise improves pain, function, central sensitization, mood, and catecholamine-serotonin levels. Additional research is needed to further understand its effects and broaden the scope of this technique in the treatment of fibromyalgia.

Clinical rehabilitation impact: BFR aerobic training could improve adherence to exercise therapy in fibromyalgia by offering a lower-intensity alternative with enhanced benefits, potentially leading to better symptom management in clinical settings.

Background: Neck and back pain pathologies are currently the main cause of absenteeism from work in Spain and in the European Union, and represent a high socio-labor, economic and health cost for the Health Systems.

Aim: To assess the effectiveness of a Back School Program of a Spanish mutual insurance company (risk factors, pain and disability scales) in women workers with low back or neck pain.

Design: We combined a descriptive study of first-session data collected in the total sample and a prospective multicenter intervention study in those participants who completed the second and third check-up at 6 and 9 months.

Setting: Women workers with low back or neck pain, from different sectors and occupations, who participated in a Back School Program of Ibermutua, a Spanish mutual insurance company, during the period from April 1^st, 2009, to March 28^th, 2019.

Population: Overall, 1452 women workers participated in the first session, 150 in the second session (6-month review) and 133 in the third session (9-month review).

Methods: Different questionnaires and scales were used for data collection, Visual Analog Scale, Neck Disability Index, Oswestry Disability Index, Concept Check Questionnaire and Back School Program Effectiveness Questionnaires.

Results: A total of 1095 (75.4%) had low back pain and 742 (51.1%) had neck pain (497 of them had pain in both locations); 42.8% (622) related the pain to their work activity. One in four women workers (390, 26.9%) performed a high-risk work activity (handling, weight transport, mechanical vibrations), 27.4% were prolonged standing and 22.8% were prolonged sitting. The workers participated in the Back School Program for two purposes: therapeutic (1150 women, 79.2%) and preventive (302 women, 20.8%).

Conclusions: The Back School is an effective intervention to manage pain and reduce disability in women workers.

Clinical rehabilitation impact: This study provided evidence that the Back School Program can be suitable for preventing and improving low back and neck pain and functional disability among women workers. The success of the Back Schools depends on women workers becoming aware of the importance of preventive measures aimed at strengthening the back muscles and collaborating actively, thus significantly reducing the incidence of low back and cervical pain in the workplace.

Background: Spinal cord injury (SCI) is associated with long-term limitations in daily functioning and secondary complications, including hormonal dysregulation.

Aim: The aim of this paper was to investigate the association between serum androgen levels within 30 days post-SCI and functioning during initial inpatient rehabilitation.

Design: Prospective cohort study.

Setting: Four specialized SCI rehabilitation centers in Switzerland.

Population: Individuals with newly diagnosed traumatic or non-traumatic SCI, undergoing specialized initial inpatient rehabilitation in Switzerland.

Methods: Nested in the prospective Swiss Spinal Cord Injury Cohort Study (SwiSCI), functioning metrics and serum androgen levels (total testosterone [TT], free testosterone [FT], sex hormone-binding globulin, dehydroepiandrosterone [DHEA], and DHEA sulfate [DHEAS]) were measured at baseline and followed-up until discharge from initial inpatient rehabilitation. Functioning was operationalized with the interval-based Spinal Cord Independence Measure version III (SCIM-III). Multivariable time-varying regression analyses were performed, adjusting for confounders. Missing data were handled by multiple imputations.

Results: Participants (N.=80; 15 (19%) female) had a median follow-up of 167 days (IQR:128-224). In males, lower baseline FT was associated with a significantly lower rate of functioning improvement in all models, from baseline to three months after the SCI (e.g., univariable model=-35.9 [95% CI:-79 to -3], P value=0.03) and also from baseline to discharge from inpatient rehabilitation (e.g., in males and age-adjusted model=-49.2 [95% CI:-118 to -2 ], P value=0.04). Similarly, baseline FT levels were positively associated with functioning at discharge (e.g., in the fully-adjusted model, one SD increase in FT was associated with a 26.9% increase in functioning [95% CI: 9 to 42, P=0.01]). Similar trends were observed for TT. DHEA and DHEAS were negatively associated with the improvement in functioning and results were significant only in subgroup analyses. All results for females were null.

Conclusions: Our results suggest that low testosterone levels in the acute phase of SCI reduce the rate of functioning improvement and total functioning gained during initial inpatient rehabilitation in males.

Clinical rehabilitation impact: Our results underscore the potential role of early androgen assessment and modulation in optimizing rehabilitation outcomes in males with SCI.

Introduction: This review aimed to collect the current evidence from the Cochrane systematic reviews (CSRs) concerning interventions for rehabilitation of people with amputation, in the context of the World Health Organization - Package of Interventions for Rehabilitation.

Evidence acquisition: The Cochrane Rehabilitation team led the CSRs' search. Search strings were composed of "amputation" and "rehabilitation" and run in the Cochrane Library. We used the AMSTAR 2 to assess the methodological quality of the included CSRs. All rehabilitation-relevant data were summarized in an evidence map.

Evidence synthesis: Out of the 95 CSRs found, eight related to people with amputation and rehabilitation. We found very low-certainty evidence to support the use of gabapentin in treating phantom limb pain. There was very low-certainty evidence against the use of memantine. Very low-certainty evidence showed faster wound healing, shorter time gaps from amputation to first prosthetic fit, shorter hospital stays and short-term changes in swelling after rigid dressing for people with transtibial amputations. Very low-certainty evidence revealed no difference for mobility assessment or adverse events after different forms of motor rehabilitation after transtibial amputation.

Conclusions: Evidence for interventions for rehabilitation after amputation is scarce and the available evidence is of very low certainty. More studies of higher quality are needed to provide evidence to ensure that people with an amputation receive the best rehabilitation possible.

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.