International Journal of Rehabilitation Research最新文献

This retrospective study aimed to identify factors that best discriminate the presence of early dysphagia after mild stroke. We performed a retrospective analysis of prospectively collected routine-care data from consecutive first-ever subacute stroke patients. We included 140 first-ever subacute stroke patients greater than 18 years or older, within 3 weeks of stroke onset, with hemiparesis and a Mini-Mental State Examination score greater than 24, recruited from an inpatient rehabilitation unit. Dysphagia was assessed using the Volume-Viscosity Swallow Test and videofluoroscopy, with swallowing function evaluated by the Penetration-Aspiration Scale. The outcome measures included maximal inspiratory and expiratory muscle pressures (MIP and MEP) for respiratory muscle strength, peak expiratory cough flow (PECF) for cough function, and the Trunk Control Test for trunk control. We found respiratory muscle weakness and impaired cough function (MIP 55.5 ± 23.4; MEP 84.5 ± 33.9 cmH2O; PECF 244.9 ± 87.5 L/min); however, no deficits in trunk control were observed. Dysphagia was present in 30 patients (26.3%), who were older and had lower PECF (215.0 ± 85.8 vs. 255.6 ± 90.3 L/min; P = 0.02). In multivariable analysis, only age predicted dysphagia [odds ratio 1.09, 95% confidence interval (CI): 1.03-1.16; P = 0.03]; receiver operating characteristic area under the curve was 0.717 (95% CI: 0.613-0.821; P < 0.001) with a cutoff of 64.5 years. In early poststroke patients, dysphagia was primarily associated with older age, whereas respiratory muscle strength, cough function, and trunk control - although frequently impaired - were not independent predictors. An age threshold of ~65 years best discriminated between patients with and without dysphagia.

Knee osteoarthritis (KOA) is a prevalent musculoskeletal disorder characterized by pain, functional impairment, and structural degeneration. While quadriceps and hip abductor weakness are well-established in KOA, the role of hip extensor strength remains underexplored despite its biomechanical importance in lower limb alignment and joint loading. This cross-sectional study aimed to examine whether hip extensor strength differs between asymptomatic individuals and symptomatic KOA patients, and its relationship with pain, function, and radiographic severity. Adults aged 45-70 years (N = 112; 56 asymptomatic, 56 symptomatic for KOA) were included. Pain, function, and hip extensor strength were evaluated using Visual Analogue Scale, Western Ontario and McMaster Universities Osteoarthritis Index and modified sphygmomanometer respectively; radiographic severity was graded by Kellgren-Lawrence system. Between-group differences were analyzed using the Mann-Whitney U test, associations by Spearman's correlation, and multiple linear regression adjusted for age, gender, and BMI. Symptomatic participants demonstrated significantly lower bilateral hip extensor strength than asymptomatic subjects (P < 0.001). Lower strength was associated with greater pain, poorer function, and higher Kellgren-Lawrence grades (P < 0.05). Strength reductions were more pronounced in females across radiographic grades. After adjustment, age and gender were significantly associated with strength in the asymptomatic group, whereas only gender remained significant in the symptomatic group. These findings highlight hip extensor strength as a clinically relevant yet underemphasized factor associated with symptom and structural severity in KOA. Targeted strengthening warrants exploration as a rehabilitation component; however, causality cannot be inferred from this cross-sectional design, and longitudinal studies are needed to establish its effect on clinical or structural outcomes.

There is a need for a reliable and culturally appropriate Turkish instrument to evaluate community integration after stroke, as the Community Integration Questionnaire-Revised (CIQ-R) has not previously been validated in Turkish. This study aimed to translate and culturally adapt the CIQ-R and examine its validity and reliability in stroke survivors. The adaptation process followed internationally accepted guidelines. A total of 166 individuals with stroke were included, and test-retest reliability was assessed in 146 participants over a 2-week interval. Construct validity was examined using exploratory and confirmatory factor analyses, and internal consistency and test-retest reliability were evaluated. The Turkish CIQ-R demonstrated acceptable internal consistency (Cronbach's alpha = 0.775) and excellent test-retest reliability (intraclass correlation coefficient = 0.952). Exploratory factor analysis supported a 14-item, four-factor structure, which was confirmed by confirmatory factor analysis with good model fit (χ2/df = 1.609, Comparative Fit Index = 0.950, root mean square error of approximation = 0.060). These findings indicate that the Turkish CIQ-R is a valid and reliable instrument for assessing community integration in individuals with stroke. The availability of this tool may support clinical practice, outcome evaluation, and cross-cultural research in stroke rehabilitation.

This retrospective cohort study compared functional recovery and rehabilitation efficiency among older adults undergoing inpatient geriatric-orthopedic rehabilitation following elective versus urgent trauma-related orthopedic surgery and examined independent predictors of total Functional Independence Measure (FIM) gain. The sample included 563 adults aged greater than or equal to 65 years (elective surgery, n = 219; urgent surgery, n = 344) admitted to a government-funded geriatric rehabilitation hospital, all of whom received standardized multidisciplinary rehabilitation. Functional status was assessed at admission and discharge using the FIM. Outcomes included total FIM gain, motor FIM gain, cognitive FIM gain, and rehabilitation efficiency (functional gain per day). Multivariable regression models adjusted for age, sex, comorbidity burden, admission FIM, and length of stay. Patients in the group were older and had significantly lower admission FIM scores (P < 0.001). Both groups demonstrated significant improvements in total, motor, and cognitive FIM scores during rehabilitation (P < 0.001). Although discharge FIM scores remained lower among urgent-surgery patients, total FIM gain did not differ between groups. Motor rehabilitation efficiency was higher in the elective-surgery group (0.83 versus 0.70 points/day; P = 0.025), and admission FIM emerged as the strongest independent predictor of total FIM gain. These findings suggest that older adults may achieve meaningful functional recovery during inpatient orthopedic rehabilitation regardless of surgical pathway and support consideration of equitable access to intensive post-acute rehabilitation services.

Gait variability in patients with stroke is often related to gait stability. Although it is reasonable to expect that gait variability is associated with walking-related outcomes, this relationship is unclear. This scoping review aimed to summarize existing evidence on the relationship between gait variability and walking-related outcomes after stroke and to identify knowledge gaps to guide future research. The literature was searched in PubMed, WoS, CINAHL, MEDLINE, Scopus, PEDro, and Igaku Chuo Zasshi databases. Included studies investigated the relationship between gait variability and walking speed, balance, self-efficacy, independent walking, and falls in patients with stroke. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. Twenty-two observational studies were included, of which six examined walking speed, three balance, three self-efficacy, three walking independence, and eight falls. Measurement devices included pressure-sensitive mats, accelerometers, inertial measurement units, and three-dimensional motion analysis systems. Gait variability was quantified using spatiotemporal, kinematic, and center-of-pressure parameters. Most studies demonstrated a low risk of bias. Gait variability showed associations or correlations with the following outcomes: walking speed (r = -0.586 to 0.61), the Berg Balance Scale (r = -0.567 to -0.744), the Activities-specific Balance Confidence Scale (partial R2 = 0.11-0.24), the Functional Ambulation Category (r = -0.586), and the fall risk (odds ratio: 0.717-5.98). Given heterogeneity in gait variability parameters and outcomes, future research should prioritize more clinically meaningful outcomes and robust study designs with larger samples to clarify how gait variability may be related to and potentially impact walking-related outcomes after stroke.

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.