European journal of physical and rehabilitation medicine最新文献

The mission of the European Board of Physical and Rehabilitation Medicine (PRM) is to the ensure a consistent and high-level education for PRM physicians across Europe. An important action to accomplish this mission is the publication and continuous update of the European Training Requirements (ETRs) for the specialty of PRM. The first version of the ETRs for PRM was issued in 2017. The aim was to present the up-to-date training standards for trainees, trainers, and training institutions. The revision of the first ETRs, aiming to reflect the current standards in medical education and clinical advances in the field or PRM, started in 2022 and was completed in 2023. It was based on the Rehabilitation Competency Framework and the "Guide for using a contextualised competency framework to develop rehabilitation programmes and their curricula" published by the WHO in 2021. An important addition in the new version of the ETRs is the integration of Entrustable Professional Activities. In all endeavours of the creation of the ETRs, setting the highest standards of training in PRM was pursued.

Background: Exercise has been shown to reduce the rate of mild cognitive impairment (MCI) and Alzheimer's disease. Although motor coordination movements and poses in Ruesi Dadton (RD) exercises may improve cognitive function, RD is rarely used for MCI. To date, there is insufficient evidence on whether 12 weeks of RD exercise correlates with blood biomarkers related to neurogenesis and plasticity.

Aim: To determine the effects on blood biomarkers of 12-week RD in MCI.

Design: Two-group parallel randomized controlled trial.

Setting: Community exercise.

Population: Individual with MCI.

Methods: Fifty-eight participants (n.=29 in each group). The RD group performed 60min of RD exercises (15 poses) three times weekly for 12 weeks. The control group received no intervention. In addition, both groups were given information regarding MCI symptoms by the physician on the first day. Peripheral blood was collected to measure serum brain-derived neurotrophic factor (BDNF) and sirtuin 1 (SIRT1) levels before and after intervention.

Results: The effects of 12-week RD pre- and post-intervention were examined using 2×2 repeated multivariate analyses, which showed significant differences in interaction by group and time. Student's t-tests and paired t-tests were employed in subsequent analyses to evaluate between-group and within-group differences for both biomarkers.

Conclusions: In each test, we discovered increased levels of BDNF and SIRT1 in the RD group but not in the control group. These findings suggested that RD could benefit MCI patients through enhanced BDNF and SIRT1 levels.

Clinical rehabilitation impact: Twelve weeks of RD might be helpful to patients with MCI and older people who experience cognitive impairment by improving blood biomarkers responsible for brain plasticity and amyloid plaque degradation.

Background: Upper limb (UL) spastic paresis has been classically evaluated with assessments of passive movements with limited functional validity. The aim of this study was to assess whether a composite measure of active range of motion (AROM, or XA) is valid and reliable in chronic post-stroke spastic paresis.

Aim: The primary objective was to investigate the validity and reliability of a composite score, comprising multiple XA measurements, to assess UL spastic paresis in patients in chronic stages post-stroke. In addition to this, an exploratory analysis was conducted to identify which muscles should be optimally included in this composite score.

Design: A psychometric proprieties study.

Setting: Physical and Rehabilitation Medicine Department.

Population: twenty-eight chronic post-stroke participants with spastic paresis.

Methods: Composite UL XA measurement in twenty-eight chronic post-stroke participants (age=59±11 years; delay post-stroke=29±37 months) with spastic paresis was repeated twice about 40 days apart in a standardized body position. Concurrent and construct validity was evaluated exploring correlation with the Fugl-Meyer Assessment Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), and grip strength (JAMAR™). Reliability was assessed by calculating intraclass correlation coefficients (ICC). Regarding the exploratory analysis, a linear regression analysis was performed to examine the value of including various muscles.

Results: Composite XA against the resistance of elbow, wrist and finger flexors showed strong correlation with FMA-UE and ARAT (r=0.88; P<0.001 and r=0.82; P<0.001 respectively) and a weak association with grip strength (r=0.43; P=0.03). Test-retest reliability was excellent (ICC=0.92). However, the most effective regression model also included XA against the resistance of shoulder adductors as well as forearm pronator (adjusted R²=0.85; AIC=170).

Conclusions: The present study provided satisfactory psychometric data for the upper limb composite active movement (CXA), derived from the Five Step Assessment. For overall measurement of UL mobility after stroke, we strongly recommend including shoulder and forearm muscles to the score.

Clinical rehabilitation impact: Composite XA is a valid and reliable measure of upper limb motor function in chronic post-stroke patients and could be used in clinical practice and research.

Background: Action observation treatment (AOT) is an innovative therapeutic approach consisting in the observation of actions followed by their subsequent repetition. The standard version of AOT consists in the observation/imitation of a typically developed individual, which is proposed as model (TDM-AOT).

Aim: This study aims to compare the effectiveness of AOT based on a pathological ameliorative model (PAM-AOT) versus TDM-AOT in improving upper limb ability in children with unilateral cerebral palsy (UCP).

Design: The study consists in a prospective randomized controlled, evaluator-blinded trial (RCT), with two active arms, designed to evaluate the effectiveness of AOT based on pathological model (PAM-AOT) as compared to a standard AOT based on TDM (TDM-AOT).

Setting: The 3-week AOT program was administered in a clinical setting. For some patients, the treatment was delivered at participant's home with the remote support of the physiotherapist (tele-rehabilitation).

Population: Twenty-six children with UCP (mean age 10.5±3.09 years; 14 females) participated in the study, with the experimental group observing a pathological model and the control group observing a typically developed model.

Methods: Motor assessments included unimanual and bimanual ability measures conducted at T0 (baseline, before the treatment), T1 (3 weeks after T0), T2 (8-12 weeks after treatment) and T3 (24-28 weeks after treatment); a subset of 16 patients also underwent fMRI motor assessment. Generalized Estimating Equations models were used for statistical analysis.

Results: Both groups showed significant improvement in bimanual function (GEE, Wald 106.16; P<0.001) at T1 (P<0.001), T2 (P<0.001), and T3 (P<0.001). Noteworthy, the experimental group showed greater improvement than the control group immediately after treatment (P<0.013). Both groups exhibited similar improvement in unimanual ability (GEE, Wald 25.49; P<0.001). The fMRI assessments revealed increased activation of ventral premotor cortex after treatment in the experimental compared with control group (GEE, Wald 6.26; P<0.012).

Conclusions: Overall, this study highlights the effectiveness of PAM-AOT in achieving short-term improvement of upper limb ability in children with UCP.

Clinical rehabilitation impact: These findings have significant implications for rehabilitative interventions based on AOT in hemiplegic children, by proposing a non-traditional approach focused on the most functional improvement achievable by imitating a pathological model.

Background: The increasing prevalence of individuals experiencing disabilities underscores the importance of rehabilitation. Nevertheless, healthcare systems are already facing financial constraints, which makes it imperative to strive for a more efficient delivery of services. The first step, however, is to understand how the provision of services behaves for patients with different characteristics.

Aim: To determine the most frequently used healthcare services in the (sub)acute phase of rehabilitation of patients with spinal cord injury/disease (SCI/D) and the link with patient characteristics.

Design: Observational cohort study.

Population: This study analyzes the clinical data of patients discharged from a specialized SCI hospital and rehabilitation center in Switzerland.

Methods: We implemented a compound risk model to estimate the total amount of healthcare services used, defined by length of stay (LOS) and the units per day of health services (sub)acute phase of rehabilitation.

Results: The study included 403 individuals with SCI/D. The analysis of the intensity and severity of healthcare services across different patient and injury characteristics revealed differences in the intensity of healthcare use and variations in the length of stay (LOS). Male patients with a low SCIM upon admission tended to use healthcare services more extensively than female patients. In terms of etiology, therapies were employed more intensively for patients with traumatic SCI (TSCI). In addition, the analysis revealed that variations in the intensity of healthcare services used were more significant than those adjusted for LOS. Ultimately, similar patient groups received comparable quantities of healthcare services at the end of treatment.

Conclusions: This population-based study provides information for a better understanding of the determinants of health service use during the (sub)acute rehabilitation phase of individuals with SCI/D. When analyzing LOS, intensity, and severity of services, it shows that the use of healthcare services significantly differs for the level of SCIM at admission, age groups, sex, and etiology. However, the variation among individual patients also suggests the presence of other influential modifiers that were not considered in this analysis.

Clinical rehabilitation impact: The approach outlined enables a systematic follow-up of this data analysis by enriching the computed data with additional details about the patient, the patient's treatment, and outcomes.

Introduction: Over the last few decades, the use of neo/adjuvant therapies has significantly increased the number of breast cancer survivors who experience chemotherapy-induced peripheral neuropathy (CIPN). To date, few, low-efficacy, pharmacological remedies exist to manage this side effect. For this reason, alternative treatments are increasingly being investigated as possible strategies to prevent or promote faster recovery from CIPN. In this review we aimed to provide an overview of the literature evidence regarding all the non-pharmacological and rehabilitative interventions for patients affected by CIPN secondary to breast cancer care.

Evidence acquisition: A comprehensive literature search was conducted on PubMed, Scopus and Web of Science and included a total of 1895 patients (1528 with breast cancer) with a wide range of CIPN (motor, sensory and autonomic neuropathies) and chemotherapy treatments (e.g., Taxanes, Platins, Vinca alkaloids or monoclonal antibody drugs).

Evidence synthesis: Of the initial 1108 hits, only 25 studies - describing different treatment modalities for peripheral neuropathies - were finally included in the qualitative synthesis. Most studies focused on acupuncture, physiotherapy, cryotherapy, and yoga.

Conclusions: There is still controversial evidence on conservative non-pharmacological interventions for the management of CIPN symptoms. We believe however that moderate exercise, as well as all types of stress reducing activities like sport, yoga and mindfulness, should be encouraged in cancer patients for their positive effect on global physical and psychological health. Further studies of higher methodological quality are needed to determine the best conservative approach to CIPN.

Introduction: The intersection of ageing and spinal cord injury (SCI) is of global concern. Two scenarios have been described: 1) "SCI with ageing," an increase in the average age of SCI onset, and 2) "ageing with SCI," an increase in post-injury life expectancy. These scenarios entail complex health care and rehabilitation needs due to the accumulation of comorbidities, ageing-related and SCI-induced physiological changes, and post-SCI secondary health conditions. We systematically reviewed Clinical Practice Guidelines (CPGs) with the objective of identifying the extent to which SCI CPGs include recommendations for the rehabilitation and management of people who are "ageing with SCI" or who have acquired an "SCI with ageing". We termed these as "ageing-related recommendations". We also aimed to describe them and identify gaps.

Evidence acquisition: We searched PubMed (NCBI), CINAHL Complete (EBSCOhost) and Embase (Elsevier) for relevant CPGs between 28 December 2022 and 5 January 2023. Included CPGs were evidence-based and had at least one ageing-related recommendation for SCI rehabilitation and management. We used the two core sets of the International Classification of Functioning, Disability and Health (ICF) to identify gaps.

Evidence synthesis: Only 16 (30%) of the 52 identified CPGs included ageing-related recommendations. Most were recent US or European publications and lacked specific chapters on ageing. These CPGs included 40 ageing-related recommendations, mostly "strong" but based on "low" to "very low" quality of evidence. The overall quality of the development process was low and did not consider the values and preferences of stakeholders and patients. Common topics included cardiovascular, bone, metabolic, bowel, bladder, and skin health. The recommendations could be linked to 30 ICF categories which represented only 18% of the ICF categories included in the comprehensive versions of two ICF Core Sets. Key gaps were found in mobility, interpersonal interactions, and relationships, neuromusculoskeletal and movement-related, mental, sensory and pain functions.

Conclusions: There is a notable lack of high-quality ageing-related recommendations for SCI management and rehabilitation. Future research should prioritize the generation of high-quality evidence to develop age-sensitive CPGs. Future SCI CPGs need to address the complex challenges at the interface of ageing and SCI, considering patient and stakeholder preferences.

Background: Carpal tunnel syndrome (CTS) is a common condition resulting from compression of the median nerve at the wrist. First-line treatment typically involves conservative management, which commonly includes splinting and gliding exercises. Emerging evidence suggests the potential benefits of using virtual reality (VR) in rehabilitation.

Aim: This study aimed to assess the effects of VR-mediated tendon and nerve gliding exercises on the conservative treatment of CTS, compared to video-assisted (sham virtual) and home-based gliding exercises.

Design: This study was a prospective, double-blind, randomized, placebo controlled interventional trial.

Setting: The study was conducted in the Department of Physical Medicine and Rehabilitation at a university hospital.

Population: The study included patients with mild to moderate CTS.

Methods: The study included a total of 54 hands from 33 patients. The participants were randomly allocated into three groups: the VR-mediated group (VG), the sham VR-mediated group (SG), and the control (home-based) group (CG). Both intervention groups engaged in gliding exercises utilizing a Leap Motion Controller-based VR system and instructional videos, under the supervision of a physical therapist. The VR system was activated for the VG and deactivated for the SG. Exercises were performed twice weekly for eight weeks. The CG received a brochure describing the gliding exercises. Primary outcomes were symptom severity measured by the Numerical Rating Scale (NRS) and the Boston Carpal Tunnel Questionnaire (BCTQ), along with nerve conduction studies. Secondary outcomes included muscle strength (hand grip, key pinch), sensory measures (static two-point discrimination, vibration), and quality of life.

Results: Both the VG and SG showed significant improvements in NRS and BCTQ scores compared to the CG in within-group comparisons. Nighttime symptoms improved significantly in the VG compared to the CG in between-group analyses. Electrophysiological findings showed no significant changes.

Conclusions: An eight-week VR-mediated exercise program may enhance tendon and nerve gliding exercise effectiveness, particularly for nighttime symptoms in CTS patients.

Clinical rehabilitation impact: In the future, challenging exercises requiring time and supervision could be effectively performed through VR, offering an alternative to traditional methods.