European journal of physical and rehabilitation medicine最新文献

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.

Background: Acquired brain injury can lead to subtle cognitive disorders that can be challenging to detect albeit impacting patients' long-term functional prognosis. Cog-First has been developed as a tablet-based self-administered cognitive screening tool to assess executive function, memory and attention in approximately 20 minutes, in the acute phase following brain injury.

Aim: The aim of this study was to establish reliable normative data for Cog-First to enable meaningful comparisons between patients and a reference population.

Design: Cross-sectional study.

Setting: This study was conducted at the PRISME platform of Paris Brain Institute.

Population: Four hundred and six healthy French-speaking healthy volunteers were randomly selected from the Paris Brain Institute's database.

Methods: Each participant underwent the Cog-First assessment, which comprises seven subtests, in standardized conditions. Ninety-five participants performed the alternative version one month later to assess the test-retest effect. The effects of gender, age, years of education and test version, as well as their two-way interactions, were evaluated by generalized linear models (GLMs). Formulas from the GLMS were extracted to calculate a corrected score that removes the effects of age, sex, version and years of education. This enables us to derive percentiles in a population of healthy volunteers, allowing the development of the standardization process.

Results: The results revealed a significant influence of gender, age, level of education and version on several sub-scores. Based on these results, the standardization process was implemented by calculating the percentiles on the corrected scores in the population of healthy volunteers. Test-retest analyses indicated a learning effect on four out of seven subtests.

Conclusions: The standardization of Cog-First resulted in the development of score formulas adjusted for gender, age, education and version, integrated within the software for automated scoring.

Clinical rehabilitation impact: This study establishes reliable norms for Cog-First, enabling meaningful score interpretation and clinical use, thereby facilitating early detection of cognitive impairments and potentially improving patient outcomes. Further research is necessary to determine the tool's applicability and sensitivity in brain-injured patients.

Introduction: Non-invasive brain stimulation (NIBS) is widely used for motor recovery after stroke. Recent studies have investigated the efficacy of cerebellar NIBS (cNIBS) in enhancing lower limb functional recovery in individuals with stroke. Thus, this study aims to investigate the effect of cNIBS on balance and gait recovery in individuals with stroke.

Evidence acquisition: A systematic literature search was conducted in CINAHL, Cochrane Library, MEDLINE, Physiotherapy Evidence Database, PsyclNFO, PubMed, and Scopus from inception to April 29, 2024. Randomized controlled trials (RCTs) that investigated the effects of cNIBS on gait or balance performance in individuals with stroke were included. Studies involving participants with cerebellar or brainstem stroke were excluded. Two researchers independently conducted study selection and data extraction and examined the methodological quality of the included RCTs and the certainty of evidence. A random-effects meta-analysis was performed to estimate the between-group mean difference (MD) or standardized MD (SMD) based on pre-post changes along with the 95% confidence interval (CI).

Evidence synthesis: Fourteen RCTs involving 382 participants were included. The methodological quality of the included studies ranged from fair to excellent. Compared with sham conditions, cNIBS significantly improved balance, as measured using the Berg Balance Scale (MD=4.17, 95% CI=2.28-6.05, P<0.01, low certainty of evidence); walking speed, as assessed using the 10-m walk test and 25-Feet Walk Test (SMD=-0.36, 95% CI=-0.68 to -0.03, P=0.03, moderate certainty of evidence); and functional mobility, as measured using the Timed Up and Go test (MD: -3.34, 95% CI=-5.14 to -1.54, P<0.01, low certainty of evidence).

Conclusions: With low-to-moderate certainty, the evidence indicates that cNIBS, including tDCS and TMS, can improve balance in individuals with stroke. cNIBS is also a promising approach to facilitate gait and functional mobility in stroke survivors. Future studies should determine optimal stimulation protocols and elucidate the mechanisms underlying the treatment effects.

Background: Impaired body perception could contribute to the pain experience and be a possible treatment target. The Fremantle Back Awareness Questionnaire (FreBAQ) is the only self-report questionnaire to assess back-specific self-perception.

Aim: The aim of this study was to develop a French version of the FreBAQ (FreBAQ-FR) and to evaluate its psychometric properties.

Design: Observational study.

Setting: Department of Physical Medicine and Rehabilitation at University Hospital.

Population: One hundred eighteen patients with chronic low back pain (cLBP) and 30 healthy participants were included.

Methods: A forward-backward method was used to translate the FreBAQ into French. Unidimensionality was assessed by exploratory factor analysis, and internal consistency was quantified by Cronbach's alpha coefficient. Known-groups validity was assessed by comparing results between cLBP patients and healthy participants. Temporal stability was assessed in participants who completed the FreBAQ-FR 7 days later using the intraclass correlation coefficient (ICC). Patients' FreBAQ-FR scores were correlated with functional questionnaires and two-point discrimination thresholds (TPD) for tactile acuity.

Results: The FreBAQ-FR showed good internal consistency with a Cronbach's alpha coefficient of 0.78 and can be considered unidimensional. The cLBP group scored significantly higher than the control group (11 [6 ; 17] vs. 0.5 [0 ; 5], P<0.0001). The temporal stability of the FreBAQ-FR was acceptable, with an ICC of 0.84 (95% CI: 0.77 to 0.89) and an estimated bias of -0.71±4.2 (95% CI: -1.61 to 0.18, P=0.12). In the cLBP group, FreBAQ-FR total scores correlated moderately with the Oswestry Disability Index (r=0.53, 95% CI: 0.39 to 0.65) and the Pain Catastrophizing Scale total score (r=0.53, 95% CI: 0.38 to 0.65). TPD results did not correlate with FreBAQ-FR scores (r=0.06, 95% CI: -0.12 to 0.24).

Conclusions: The FreBAQ-FR showed acceptable psychometric properties and is suitable to assess back-specific body perception in the French-speaking population with cLBP.

Clinical rehabilitation impact: This questionnaire may help researchers and clinicians to assess disrupted self-perception of the back, improve our understanding of the multifaceted experience of cLBP, and potentially offer better tailored treatment to patients.

Background: There is limited research on the Minimal Important Change (MIC) of the Chinese Western Aphasia Battery (WAB). Since an MIC for Chinese WAB has yet to be established, the clinical implications of data using the Chinese WAB remain unclear.

Aim: This study was to establish the MIC of the Aphasia Quotient (AQ) of the Chinese WAB.

Design: The study is a prospective, longitudinal study.

Setting: The rehabilitation department of a Class A tertiary hospital.

Population: One hundred six patients with aphasia after stroke were included and analyzed in the study.

Methods: Patients were evaluated by a speech and language therapist using the Chinese version of WAB before and after the 2 week intervention. Patients and their primary therapist and caregiver provided a global rating of changes in patients' oral communication ability using the 7-point Likert Scale after the speech and language therapy. Three anchor-based methods were used to examine the MIC: the ROC-based method (MICROC), the predictive modeling method (MICpred), and the MICpred-based method adjusted for the proportion of improvement (MICadj).

Results: MICadj was the best parameter in this study. The participant, caregiver, and therapist anchor-based MICadj estimated in the present study was 6.98, 6.73, and 6.00, respectively.

Conclusions: Our data provide the first estimate of MIC value for the Chinese WAB-AQ. Future studies with larger sample sizes are needed to refine the estimated value.

Clinical rehabilitation impact: The current study has advanced the research on the properties of Chinese WAB.

Background: Sedentary behavior (SB) is associated with chronic musculoskeletal pain, but limited evidence exists about its impact on chronic spinal pain (CSP).

Aim: This study aims to explore the relationship between SB, physical activity, and the risk of CSP.

Design: Cross-sectional and cohort study design.

Setting: United Kingdom (UK).

Population: We included 481872 data collected between 2006 and 2010 for cross-sectional analysis and 45,096 data with the longest follow-up up to 2019 for longitudinal analysis of data from the UK.

Methods: Screen-based SB was defined as self-reported television (TV) viewing time, computer usage time, and total screen time. CSP was characterized as self-reported neck/shoulder or back pain for more than 3 months.

Results: Cross-sectional analyses suggested that screen-based SB is associated with a high risk of chronic neck/shoulder (OR [95%CI]=1.43 [1.31 to 1.57]) and back pain (OR [95%CI]=1.39 [1.28 to 1.52]). The longitudinal analysis showed that an increase of 1 h in daily screen-based SB was correlated with chronic back pain risk (RR [95% CI]=1.05 [1.03 to 1.07]). Replacing an equivalent amount of TV viewing time with 1 h of walking per day exhibited a connection with a lower potential for chronic neck/shoulder pain (4.82% reduction) and chronic back pain (5.26% reduction). Even replacing 10 min of TV viewing time with 10 min of physical activity demonstrated a similar trend.

Conclusions: Daily screen-based SB is associated with CSP, but a causal relationship cannot be established. Replacing sedentary TV time with 10 minutes of physical activity per day shows potential benefits for CSP.

Clinical rehabilitation impact: The public should be encouraged to reduce screen-based sedentary behavior and increase physical activity to mitigate the risk of chronic spinal pain.

Background: Spinal cord injury (SCI) is a serious injury that leads to motor and sensory disorders and ultimately affects people's physiological, psychological, and social well-being.

Aim: To test patient activation from discharge from the department of spinal surgery until 6-month follow-up.

Design: Longitudinal inception cohort study.

Setting: This study was conducted at the Spinal Surgery Department of the Third Affiliated Hospital of Soochow University in China.

Population: A total of 367 participants with traumatic SCI received community-based or hospital-based rehabilitation between October 2020 and November 2023 and were recruited using convenience sampling.

Methods: Patient activation was evaluated using the short version of the Patient Activation Measure (PAM). Assessments were conducted at baseline, 3-month, and 6-month follow-up.

Results: At baseline, the mean PAM score was 53.2, with the number of participants in PAM levels 1, 2, 3, and 4 being 92, 142, 114, and 19, respectively. Between baseline and 6-month, 164 participants remained at the same PAM level, 85 participants increased, 86 participants decreased. The multivariate mixed-effects model analysis showed that the PAM score decreased significantly over time (P=0.007). Older age had a positive effect on improvement over time (P=0.023). Higher self-efficacy, resilience, health literacy, and Modified Barthel Index (MBI) remained significantly related with higher PAM scores over time (P<0.001, P<0.001, P<0.001, and P=0.010, respectively). Fewer symptoms of depression remained significantly related with higher PAM scores over time (P<0.001).

Conclusions: PAM scores decreased slightly over time from the start of rehabilitation up to the 6-month follow-up. Furthermore, about two-third of participants remained at low levels of patient activation, which suggests that patient-centered care interventions during rehabilitation to improve patient activation might be of value.

Clinical rehabilitation impact: This study examined the course of patient activation from the start of SCI rehabilitation to the 6-month follow-up period. These findings provide the necessary basis for the development and evaluation of effective interventions to promote patient activation levels and enhance self-management in people with SCI.

Background: The Achilles tendon is one of the most frequent sites of tendinopathy in both healthy and pathological subjects. An innovative approach for the quantitative assessment of the Achilles tendon structure, named Ultrasound Tissue Characterization (UTC), has recently been developed. However, no previous study performed the UTC-based assessment of the tendon structure in rheumatologic patients affected by insertional Achilles tendinopathy.

Aim: To characterize the Achilles tendon structure and function in psoriatic arthritis patients with symptomatic insertional tendinopathy.

Design: Cross-sectional study.

Setting: University laboratory.

Population: Psoriatic arthritis patients (N.=17).

Methods: Anthropometric measurements, administration of outcome and pain questionnaires, and tendon function and structure assessments were performed in a single experimental session.

Results: Pain intensity and interference and the perceived tendinopathy-related disability were moderate-severe. A relevant impairment of the strength (for both lower limbs) and walking performance was observed in all patients. In fact, the plantarflexion strength values (median values for the two sides: 10.0 and 11.5 kg) and fast walking speed (median value: 1.7 m/s) were lower than the normative values for healthy controls, respectively, in all patients for the strength values and in 14 out of 17 patients for the walking speed. The conventional ultrasound (i.e., the quantification of tendon thickness and the qualitative assessments of tendon structure and neovascularization) showed greater changes in the symptomatic (or more symptomatic) side compared with the asymptomatic (or less symptomatic) side of the insertional region of the Achilles tendon. The UTC imaging showed comparable impairment of the tendon structure between the symptomatic (or more symptomatic) side and the asymptomatic (or less symptomatic) side of the insertional region of the Achilles tendon (i.e., reduced echo-type I percentages in both tendons of all patients).

Conclusions: Psoriatic arthritis patients with symptomatic insertional Achilles tendinopathy present moderate-severe pain and perceived disability, physical function impairments, and bilateral deterioration of the tendon structure (also in case of unilateral symptoms) that can be documented through the UTC analysis.

Clinical rehabilitation impact: The evaluation of the insertional Achilles tendinopathy through UTC imaging can be useful for the diagnostic and prognostic assessment of psoriatic arthritis patients in combination with the assessments of pain, disability, and functional performance.

Background: Advanced chronic kidney disease disrupts the delicate equilibrium between protein anabolism and catabolism, leading to alterations in muscle quantity, quality, and function. Musculoskeletal ultrasound emerges as a promising assessment tool due to its widespread availability and high reliability.

Aim: To evaluate the efficacy of rectus femoris (RF) echogenicity, measured using greyscale software, in identifying diminished muscle quality and strength in candidates for kidney transplant.

Design: Post-hoc diagnostic accuracy study.

Setting: Outpatients in a multimodal prehabilitation program pre kidney transplantation (KT).

Population: Patients on the waiting list for KT.

Methods: Sensitivity, specificity, likelihood ratios and area under the curve (AUC) for diagnostic efficacy of echogenicity (index test) assessed with the ImageJ software greyscale as a potential marker of quadriceps muscle weakness (reference test) were calculated. Muscle weakness was considered as maximal voluntary isometric contraction of the quadriceps (Q-MVIC) <40% of body weight. Other variables included body composition parameters derived from multifrequency electrical bioimpedance, upper limb muscle strength (handgrip), and RF thickness assessed by ultrasound. Statistical tests: Chi-square, t-Student, Pearson correlation coefficients (r), bivariate and multivariate logistic regression models. Statistical significance level ≤0.05.

Results: Of 112 patients (mean age: 63.6, 76% male), 72 (63.7%) exhibited quadriceps weakness, while 80 (70.8%) had some degree of overhydration (extracellular water/total body water ratio >0.390). The echogenicity cut-off point of highest concordance with muscle weakness was 70, boasting a sensitivity of 83%, specificity of 57%, and AUC of 0.671 (CI 95% 0.570-0.772 [P=0.003]). Echogenicity >70 was associated with a 3.4-fold higher risk of muscle weakness (crude OR = 3.4 [CI95% 1.4 to 8.0]), which persisted after adjusting for age, height, weight and RF thickness.

Conclusions: The RF echogenicity exhibits fair validity in identifying muscle weakness among candidates for KT. However, it cannot be endorsed as a standalone diagnostic tool in this population.

Clinical rehabilitation impact: Early identification of muscle weakness would advance efforts to mitigate morbidity and mortality through targeted measures.