International Journal of Rehabilitation Research最新文献

Few digital health interventions are currently used in the rehabilitation of ICU patients, despite growing interest in innovative approaches such as exergaming. We aimed to determine the requirements for a therapeutic exergaming system for use in ICU patients. A cross-sectional survey was developed through iterative feedback from a multidisciplinary panel of ICU professionals. The survey was distributed online among ICU professionals using convenience and snowball sampling. The survey was completed by 106 ICU professionals from 16 different countries across four continents. The willingness to use a therapeutic exergaming system to increase physical activity in ICU patients was high, with a median score of 9 (interquartile range: 7-10) on a 0-10 scale. System features rated as very important or absolutely essential included ease of use (85%), patient enjoyment (85%), increasing the patients' motivation for physical activity and mobility (84%), and the ease of transportation (82%). Respondents emphasized adaptability to physical, cognitive, and sensory impairments, suitability for bedridden patients, and ease of integration within the ICU environment, including hygiene, mobility, and space constraints. Over 80% of respondents (strongly) agreed with most proposed benefits of therapeutic exergaming, including stimulation of active participation (94%), activation of patients with ICU-acquired weakness or prolonged immobilization (91%), distraction from the ICU environment (91%), and improved patient motivation to engage in rehabilitation (82%). This survey identifies key requirements for the development of therapeutic exergaming systems and supports their potential role in ICU mobilization when designed to complement existing rehabilitation practices and the intensive care context.

Disease-specific cutoffs are essential for accurately assessing low muscle mass. We aimed to determine calf circumference cutoffs for identifying low muscle mass in older patients with subacute stroke and to compare their diagnostic accuracy with those used across various disease-specific criteria. This single-center, cross-sectional study included older patients with subacute stroke using consecutive sampling. Low muscle mass was defined as an appendicular skeletal muscle mass index of less than 7.0 kg/m² in men and less than 5.7 kg/m² in women. Calf circumference was measured on the nonparetic side, and the maximum value was used. We assessed the diagnostic accuracy of the derived cutoffs using sensitivity, specificity, predictive values, likelihood ratios, and Matthews correlation coefficient (MCC). The study adhered to the Standards for Reporting Diagnostic Accuracy 2015 guidelines. Among 253 participants, 188 met the inclusion criteria. The optimal cutoffs were 31 cm for men and 30 cm for women. These cutoffs yielded a sensitivity of 0.78 [95% confidence interval (CI): 0.69-0.85], specificity of 0.71 (95% CI: 0.59-0.82), positive likelihood ratio of 2.73 (95% CI: 1.86-4.00), and MCC of 0.47 (95% CI: 0.36-0.62). Compared with criteria used across-disease groups, the newly derived cutoffs yielded higher specificity, a greater positive likelihood ratio, and an improved MCC. These cutoffs provide acceptable diagnostic accuracy for identifying low muscle mass in this patient population and may offer a practical screening option in clinical settings.

The objective was to determine whether depressive symptoms, self-reported manual ability, self-reported locomotion ability, and functional independence, assessed at 6 months after stroke, are predictors of generic and specific health-related quality of life (HRQoL) at 24 months after stroke. This is a prospective longitudinal study with individuals with and without previous disability. The dependent variables, assessed at 24 months after stroke, were generic [short form-36 (SF-36)] and specific (stroke-specific quality of life) HRQoL. Potential predictors, assessed at 6 months after stroke, were: depressive symptoms (Geriatric Depression Scale), self-reported manual (ABILHAND) and locomotor (ABILOCO) abilities, and functional independence (Modified Barthel Index). Multiple linear regression analyses were employed to identify the potential predictors of generic (model-1) and specific (model-2) HRQoL (α = 5%). Sixty-eight individuals were evaluated at both 6 and 24 months after stroke (59 years, SD 13). The regression analysis showed that the self-reported manual ability and depressive symptoms at 6 months after stroke were significant predictors of generic ( R2  = 26.1%; F  = 24.96; P  = 0.001) and specific ( R2  = 26.4%; F  = 25.332; P  = 0.002) HRQoL at 24 months poststroke. Self-reported manual ability and depressive symptoms, at 6 months after stroke, are predictors of HRQoL at 24 months. Thus, these outcomes are important to be considered in the immediate chronic phase of the stroke since individuals with worse self-reported manual ability and presence of depressive symptoms are at risk of experiencing worse HRQoL in the late chronic phase.

Neurolathyrism causes lifelong, incurable spastic paralysis of the lower limbs and permanent disability. Evidence on its impact on daily functioning and quality of life is limited. This study assessed functional impairment among people with neurolathyrism in grass pea-growing districts of Amhara, Ethiopia. A community-based cross-sectional quantitative study was conducted among 346 individuals diagnosed with neurolathyrism from grass pea-producing districts of the Amhara National Regional State. Functional impairment was assessed using the 12-item, interviewer-administered WHO Disability Assessment Schedule. Thirty-five trained BSc nurses collected data using tablets with Kobo Collect v2024.1.3. Data were analyzed using STATA 17, applying descriptive statistics and ordinary logistic regression. More than half of the participants reported severe functional impairment. Mobility was most affected (79.2%), with nearly nine in 10 experiencing difficulties. Participants aged 45-54 years had over twice the odds of functional disability compared with those aged 18-25 years [adjusted odds ratio (AOR) = 2.3, 95% confidence interval (CI): 1.0-5.3]. Men were more likely to experience functional disability than women (AOR = 1.9, 95% CI: 1.2-2.9). Living with neurolathyrism for 21-25 years was also significantly associated with higher odds of functional disability. Being married was protective compared with being unmarried (AOR = 0.5, 95% CI: 0.3-0.9), and those who sought spiritual treatment were 63% less likely to report functional disability (AOR = 0.4, 95% CI: 0.2-0.6). These findings show that neurolathyrism places a significant long-term burden on adults, particularly affecting mobility and self-care, highlighting the need for targeted rehabilitation and sustained support.

The purpose of this cross-sectional, web-based survey was to identify environmental barriers to accessibility experienced by people with lower limb loss and evaluate the association between environmental barriers and quality of life. Eligibility criteria include people aged 18 years old, have a major lower limb loss (at the ankle or above), greater than or equal to 3 months post-amputation surgery, using a prosthesis for mobility (beyond transfers), are no longer receiving prosthesis-related rehabilitation care, and understand English. Demographic and clinical characteristics were collected through self-report. Outcome measures collected were the Prosthesis Evaluation Questionnaire Mobility Scale, Perceived Environmental Barriers to Outdoor Mobility Scale, Craig Hospital Inventory of Environmental Factors, and WHO Quality of Life-Brief Questionnaire. Descriptive statistics summarized clinical, demographic, and survey variables. Simple linear regression modeling evaluated the association between environmental barriers and quality of life. Seventy-eight [mean age: 59.3 (14.0) years, 67% male, and 59% transtibial] individuals participated. A one-unit increase on the Craig Hospital Inventory of Environmental Factors Scale, indicating greater environmental barriers to mobility, was significantly associated with an 8.07 decrease on the WHO Quality of Life-Brief (95% confidence interval: -15.46 to -0.68, R2  = 0.38). A safe and barrier-free environment is crucial for accessibility following lower limb loss. Future research should enhance accessibility through collaboration among end users, clinicians, and policymakers to address the built environmental needs of this population.

Sarcopenia and frailty are common in liver transplant candidates and often deteriorate early posttransplantation, negatively affecting recovery and survival. Since 5 years, we refer liver transplant recipients who, despite being medically stable, are considered unfit for safe discharge home because of physical, social, or functional limitations for continued care at an independent rehabilitation hospital. This retrospective observational study evaluated safety and functional outcomes of this rehabilitation program and explored clinical characteristics associated with referral. We reviewed all adult liver transplant recipients at University Hospitals Leuven between July 2020 and 2025. Collected data included demographics, frailty, BMI, neuropathy, laboratory model for end-stage liver disease/Stanford Integrated Psychosocial Assessment for Transplant scores, ICU/hospital length of stay, and referral for inpatient rehabilitation. For referred patients, rehabilitation duration and functional outcomes were analyzed. Of 380 liver transplant recipients, 34 (8.9%) were referred for inpatient rehabilitation. Median rehabilitation duration was 30 days [interquartile range (IQR): 21-40]. Significant functional improvements were observed, with 6-min walk distance increasing from 130 (IQR: 33-225) to 300 (IQR: 220-423; P ≤ 0.001) m, and Tinetti scores improving from 21 (IQR: 18-23) to 25 (IQR: 22-27; P = 0.001). No mortality occurred during rehabilitation. Four patients were readmitted for reasons unrelated to rehabilitation. Multivariable logistic regression identified lower pretransplant BMI and higher frailty scores as independent predictors of referral, with a trend toward an association with peroneal neuropathy. Continued inpatient rehabilitation following liver transplant is feasible, safe, and associated with clinically relevant functional improvements. Pretransplant malnutrition and frailty, as well as posttransplant peroneal neuropathy, may represent targets to facilitate posttransplant recovery.

The objective of this retrospective cross-sectional register-based study among 1597 patients with electromyography-confirmed carpal tunnel syndrome (CTS) was to evaluate the psychometric properties of the quick disabilities of the arm, shoulder, and hand questionnaire (QuickDASH). Two-parameter item response theory analysis with a rating scale model was applied. Of the respondents, 896 (56%) were women. The average age was 55.0 (SD: 16.3) years. Mean QuickDASH score was 38.0 (SD: 23.2%) points. For difficulty parameter estimates, some items demonstrated a slight shift to the right toward higher QuickDASH scores. The intervals between the difficulty estimates across all scoring options were highly similar, exhibiting only minor fluctuation. Overall, the test characteristic curve for the entire QuickDASH showed a slight shift toward worse disability and higher scores. Item discrimination estimates ranged from moderate 1.20 to perfect 3.31. For 9 out of 11 items, the discrimination estimates were perfect, that is, greater than 1.7. Overall, QuickDASH demonstrated consistent difficulty across item response options and good ability to differentiate between respondents with varying degrees of functional limitations. In other words, QuickDASH in this sample proved to be a measure that was well able to distinguish patients at different levels of functional limitations caused by CTS. A modest shift toward higher disability levels was observed for most of the items and for the overall scale, suggesting that patients might tend to underestimate their disability severity assessed by QuickDASH. However, this shift was so mild that it would hardly be of any significance in a typical clinical situation.

Quadriceps muscle weakness is a common clinical feature in individuals with knee osteoarthritis (KOA) and contributes to pain, functional limitations, and reduced quality of life. While quadriceps strengthening exercises are well-established, the additional benefits of electromyographic biofeedback (EMG-BFB) and neuromuscular electrical stimulation (NMES) remain inconclusive. This single-blind randomized controlled trial investigated whether EMG-BFB or NMES provides added benefits when combined with isometric quadriceps strengthening exercises in patients with mild-to-moderate KOA. Ninety-three participants aged over 55 years, meeting the American College of Rheumatology criteria and classified as Kellgren-Lawrence grades 1-2, were randomly assigned to three groups: exercise only, exercise plus EMG-BFB, and exercise plus NMES. All participants completed 15 supervised sessions over 3 weeks. Pain intensity (Visual Analogue Scale) was the primary outcome. Secondary outcomes included physical function (Western Ontario and McMaster Universities Osteoarthritis Index), muscle activation (raw EMG amplitude), and quality of life (36-Item Short Form Health Survey), assessed at baseline, immediately after the intervention, and at 3- and 6-month follow-up. All groups demonstrated significant improvements in pain, knee function, muscle activation, and quality of life following the intervention, with benefits maintained at follow-up. However, no significant differences were observed between groups at any time point. These results suggest that isometric quadriceps strengthening exercises alone are effective in managing KOA, while the addition of EMG-BFB or NMES does not yield superior clinical outcomes. Given the simplicity, accessibility, and effectiveness of exercise alone, it may serve as a first-line intervention, while the specific clinical indications for adding EMG-BFB and NMES to isometric exercises remain to be determined.

This case report details the potential benefits of an implanted neural stimulation system for walking to assist stair climbing after stroke. A 12-channel stimulation system was implanted in a stroke survivor for walking. Despite biweekly gait training with functional electrical stimulation (FES) that yielded locomotor improvements, the participant did not feel comfortable attempting stair climbing due to the lack of stability and fear of falling. During physical therapy, he previously limited his attempts at stair climbing to a step-to strategy with the paretic limb. The participant agreed to attempt stair climbing in a controlled environment with and without FES and displayed a marked improvement with stimulation, including increased hip/knee flexion, higher toe clearance, and the ability to use a step-over-step strategy which reduced his ascent time. This case report highlights the potential of using a multi-joint FES system for improving functions beyond walking in individuals with hemiplegia.