European journal of physical and rehabilitation medicine最新文献

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.

Background: Low back pain (LBP) accompanied by sciatica is a widespread musculoskeletal issue with multifactorial etiology, impacting individuals across various demographics. Conservative treatments, notably physiotherapy, are key in managing LBP with sciatica, with neural mobilization techniques emerging as beneficial adjuncts.

Aim: This research aims to assess the effectiveness of utilizing the sciatic slider technique (SST) in both supine and slump positions, compared to conventional physiotherapy alone, in alleviating pain severity, improving lumbar flexibility, lumbar lordosis, lower limb muscle strength, and functional ability in patients with LBP associated with sciatica.

Design: randomized controlled trial.

Setting: Department of Physiotherapy at Alia Hospital.

Population: Sixty participants with LBP associated with sciatica.

Methods: The participants were randomly allocated into three groups: Group (A) N.=20 received the SST in a slump position alongside conventional physiotherapy, Group (B) N.=20 received the same technique in a supine position with conventional physiotherapy, and Group (C) or (control) N.=20 underwent only conventional physiotherapy. Each group underwent three sessions per week for four weeks. Outcome measures included pain intensity (Numerical Pain Rating Scale), functional disability (Oswestry Disability Index), lumbar flexibility (Modified Schober test), lower limb muscle strength (Hand-held dynamometry), and lumbar lordosis (Flexible ruler).

Results: Analysis revealed significant differences between treatment groups. The slump position exhibited superior effectiveness in reducing pain intensity (P<0.001), and improving disability (P<0.001), with greater improvements in pain scores and disability index percentages. Additionally, slump position therapy led to significantly greater enhancements in range of motion (P<0.001), and hip abductor (P=0.007) when compared to the supine position. However, both techniques showed similar effects on lumbar lordosis angle and various lower limb muscle strength.

Conclusions: The sciatic nerve slider technique, whether applied in the slump or supine position, demonstrated superior outcomes compared to conventional physiotherapy alone in managing LBP with sciatica. Nevertheless, the slump position showed greater efficacy in reducing pain, improving disability, and enhancing certain functional parameters.

Clinical rehabilitation impact: These findings advocate for the inclusion of neural mobilization techniques, particularly in the slump position, in the management of LBP with sciatica.

Background: Obstetric brachial plexus injury (OBPI) is associated with several temporary or permanent impairments including muscle weakness/atrophy and retarded bone accrual, which negatively affect upper extremity functionality. Thus, to remedy these impairments, improved and unequivocally effective intervention strategies are required.

Aim: To evaluate the effectiveness of a 12-week stretch-shortening cycle exercise (SSC-Ex) program on muscle strength, bone mineral density, and upper extremity function in a convenience sample of children with OBPI.

Design: A prospective, dual-group randomized controlled trial with the outcome assessor being blinded to the treatment allocation.

Population: Fifty-six children with a confirmed diagnosis of the upper-arm type of OBPI (i.e. categorized as level I [C5/C6 injury] or II [C5/C6/C7 injury] per Narakas classification system) and aged between 10 and 16 years were randomly allocated to either the SSC-Ex group (N.=28) or the control group (N.=28).

Methods: The SSC-Ex group participants underwent a supervised SSC-Ex regimen for ~35 minutes, twice/week (with 2-day recovery intervals at minimum) over 12 consecutive weeks (totaling 24 sessions), while the control received the standard exercises (equated for the training volume, frequency, and duration). The primary outcomes included an assessment of muscle strength - specifically, shoulder flexors, abductors, external rotators, elbow flexors, and extensors - as well as the bone mineralization of the humerus, radius, and ulna. Functional performance was considered as a secondary outcome. These measures were undertaken both pre- and post-intervention.

Results: The SSC-Ex group exhibited favorable pre-to-post improvement in muscle strength measures (P<0.05; η²partial ranged between 0.11 and 0.17), bone mineralization variables (P<0.05; η²partial ranged between 0.13 and 0.21), and functional performance (P=0.006; η²partial=0.13) when compared with the control group.

Conclusions: The SSC-Ex showed promise in enhancing strength, bone mineralization, and functional capacity in children with OBPI.

Clinical rehabilitation impact: The SSC-Ex can be a beneficial component of the rehabilitation program for children with OBPI. Physical rehabilitation specialists might opt for such a training paradigm to improve several aspects of motor functions, bone mineral properties, and upper extremity function based on empirical evidence.

Background: The role of motivation per se in the presence or absence of depression in stroke-related cognitive and functional motor recovery has not been studied.

Aim: This study aimed to determine the role of motivation on cognition and functional motor recovery in patients after an acute and subacute ischemic stroke.

Design: Prospective, observational, single-center study.

Setting: Enrollment was undertaken in an inpatient neurorehabilitation facility.

Population: A total of 125 veterans with stroke were admitted to an inpatient neurorehabilitation facility.

Methods: Recovery locus of control (RLOC) measured the degree of motivation. The primary outcome measures were changes from baseline in the Action Research Arm Test (ARAT), total and sub-scores of Functional Independence Measures (TFIM), and the 2-minute walk test (2-MWT) on discharge from the IRF.

Results: The mean age of the study sample was 65±9.3 years, they were mainly non-Hispanic white (N.=92, 74%) men (N.=119, 95%) admitted 9±11 days after acute stroke. When the sample was divided into less motivated (score 0-25, N.=32) and motivated (score ≥ 26, N.=93) as measured by the total RLOC for a statistical median of 26, the two groups had similar baseline characteristics including admission depression, TFIM, ARAT, and 2-MWT scores. The change in the primary outcome measure scores from baseline was similar between the two groups. Motivated group veterans had a lower all-cause mortality rate at 12 months than less motivated veterans (P=0.001).

Conclusions: A higher level of motivation irrespective of the degree of depression did not improve cognitive or functional motor recovery scores. However, motivated veterans had a lower all-cause mortality at 12 months.

Clinical rehabilitation impact: The result of this study has important implications in clinical practice highlighting that motivated patients are more likely to be discharged home and have a lower all-cause mortality.