European journal of physical and rehabilitation medicine最新文献

Background: Individuals with dysphagia typically experience multiple co-occurring symptoms, whose interrelationships can vary in strength. The significance and impact of each symptom within dysphagia also differ. However, the intricate web of connections among these symptoms remains poorly understood, making it challenging to assess the importance of individual symptoms from a relational perspective.

Aim: The aim of this study was to: 1) construct a correlation map that identifies the risk associations within dysphagia-related syndromes; and 2) rank syndromes according to the Overall Benefit Index (OBI) of a specific functional intervention, which varies in their impact on the overall functional status.

Design: This study has a cross-sectional design.

Setting: The setting of this study was a tertiary hospital in Hunan Province, China.

Population: Population considered in this study included patients with non-esophageal dysphagia.

Methods: Adopting convenience sampling, we recruited 150 patients with dysphagia to assess their health-related quality of life through the dysphagia-specific International Classification of Functioning, Disability and Health (ICF) Scale. A network structure of 50 second-level or third-level ICF categories was investigated by the Ising model. The Bayesian model was applied to determine the probability of the existence of the connection among ICF functional categories.

Results: The resulting network consisted of 50 nodes and 64 connections. 48 functional categories demonstrated a significant OBI, with "d9102 Ceremonies" (OBI=1.00) achieving the highest OBI. "d9204 Hobbies" (OBI=0.862), and "d9205 Socializing" (OBI=0.847) were another top two categories with the 2^nd and 3^rd highest OBI. There was a significant correlation between network parameters, OBI, and item difficulty. Specifically, item difficulty showed a positive correlation with OBI (P<0.001, rPearson=0.712), indicating that more challenging items tend to correspond with higher OBIs.

Conclusions: The Ising model is a powerful tool that can assist rehabilitation clinicians in better understanding the complex functional network and guide specific rehabilitation interventions for patients with dysphagia.

Clinical rehabilitation impact: Cooperating the item difficulties from the Item Response Theory (IRT) into the OBI from the Ising model could guide individualized clinical decisions based on item difficulties and importance.

Background: Conventional rehabilitation (CR) and robotic hand rehabilitation (RR) are effective rehabilitation options for post-stroke hemiplegia. Combining these two rehabilitation protocols may positively affect the results.

Aim: To compare the effectiveness of individual and combined applications of CR and RR on hand and upper extremity function, spasticity, grip and tip pinch strength in the treatment of post-stroke hemiplegia.

Design: A three-arm, prospective randomized controlled trial.

Setting: Multidisciplinary rehabilitation facility.

Population: Sixty-six patients with post-stroke hemiplegia.

Methods: Participants were randomized into three groups: RR, CR, and combined conventional and robotic hand rehabilitation (CR-RR). For the RR group, a passive and active finger motion program (40 minutes a day), along with a home-based rehabilitation program, was administered using the robotic device. For the CR group, traditional manual therapy techniques were used to improve activities of daily living and to achieve isometric contractions in weak muscles (60 minutes a day). For the CR-RR group, 60 minutes of conventional rehabilitation was followed by 40 minutes of hand rehabilitation using the robotic device. The patients in all groups were rehabilitated for 1 month, 5 days a week. The Fugl-Meyer Upper Extremity Assessment Scale was used as primary outcome measure for evaluating the upper extremity function. The secondary outcome was evaluated based on hand function, upper extremity and hand motor function, activities of daily living (ADLs), upper extremity spasticity, and hand strength.

Results: CR-RR was significantly more effective than both CR and RR in improving upper extremity function, hand function, and ADLs. The only group that had no effect on upper extremity function was RR. All three rehabilitation protocols were ineffective in treating shoulder adductor and elbow flexor spasticity. While all three protocols effectively reduced spasticity in the wrist, fingers, and thumb flexors, CR was significantly less effective compared to the other groups. Although the CR-RR and RR groups had similar results in reducing wrist and finger flexor spasticity, the CR-RR group was significantly more effective than the RR group in reducing thumb spasticity. CR did not influence grip and tip pinch strength, whereas both CR-RR and RR led to significant improvements.

Conclusions: RR has no effect on upper extremity functional results. CR has no effect on grip and pinch strength and only a limited effect on wrist, finger, and thumb flexor spasticity. Combining conventional rehabilitation with robotic rehabilitation in the CR-RR protocol yields better results in daily living activities, upper extremity function, hand function, wrist, finger, and thumb flexor spasticity, as well

Introduction: Spasticity is a relatively common complication of stroke. In the lower limb, it generally involves the ankle and the foot, often leading to equinovarus deformity. Botulinum toxin (BoNT) injections are commonly used to manage spasticity, both in the subacute and chronic phase after stroke; however, their effects on function, particularly gait, are uncertain. This systematic review aims to update the current evidence on the effects of BoNT treatment on gait function in stroke survivors.

Evidence acquisition: This systematic review follows the PRISMA guidelines. We searched five databases (PubMed, Embase, Scopus, CINAHL, Web of Science) for Randomized Controlled Trials (RCTs) published in English that investigated the effects of BoNT injections on gait in individuals with stroke compared to any other treatment or no treatment. Two reviewers independently selected the studies, assessed the risk of bias using the PEDro scale, and extracted the results. Standardized mean differences were calculated and, when possible, meta-analyses were performed, using random effects models.

Evidence synthesis: From a total of 1238 records, 8 studies met the inclusion criteria, all but one study enrolling participants with chronic stroke. Sample sizes ranged from 16 to 468 subjects, for a total of 434 in the experimental groups and 568 in the control groups.. Gait function was assessed using a variety of gait tests, including instrumental gait analysis. Meta-analyses showed no significant effects of BoNT on gait speed, step frequency or step length. One small, underpowered study, with high risk of bias, reported significant improvements of gait speed in individuals with subacute stroke. Other gait-related variables were measured in single small trials, most often finding no differences between BoNT and control interventions.

Conclusions: Our findings indicate that current evidence shows no effects of BoNT treatment on gait speed, and insufficient evidence on its effects on other gait parameters. Adequately-powered, high-quality trials are needed to verify whether BoNT treatment, beyond reducing spasticity, can positively impact functional outcomes other than gait speed in individuals with chronic post-stroke lower limb spasticity and/or during early stroke recovery.

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.