International Journal of Rehabilitation Research最新文献

Mild traumatic brain injury (mTBI) can lead to lasting adverse outcomes, including post-traumatic stress disorder (PTSD) or post-traumatic stress symptoms (PTSS). This study examined whether PTSD and PTSS can occur even after mTBI and tracked the evolution of PTSD in the long term. A total of 85 youth post-mTBI (median age: 10.00, 25-75th percentile: 8.50-2.62; 24% girls) and their mothers participated in this study. Assessments included PTSS/PTSD, postconcussion symptoms, loss of consciousness status, child's anxiety, and maternal mental health, both shortly after mTBI (T1) and 1 year later (T2). Changes in PTSS scores from T1 to T2 were evaluated using the Wilcoxon test. T2 PTSS evolution was evaluated using correlations and partial correlations. To evaluate PTSD recovery trajectories, the percentage of youth in four recovery trajectories (chronic, delayed, recovery, and resilience) was calculated. Results showed a significant decrease in PTSS and PTSD rates from T1 (34%) to T2 (21%). PTSS at T2 was associated with PTSS and postconcussion symptoms at T1. After accounting for the child's sociodemographic and clinical characteristics, the child's self-reported PTSS at T1, along with self-reported postconcussion symptoms and symptom intensity, showed significant correlations with PTSS at T2 ( r  = 0.60, 0.32, and 0.37, respectively; P  < 0.05). Most youth fell into the 'resilient' (40%) or 'recovery' (35%) groups, with only 6% showing 'delayed' recovery. One year after mTBI, 20% of the youth still experienced PTSD. In conclusion, this study highlights the need for long-term monitoring of youth after mTBI, as a notable proportion continue to experience enduring PTSD or PTSS.

Acquired brain injuries can profoundly impact executive functioning, yet traditional neuropsychological assessments often have limitations, such as being time-intensive, lacking ecological validity, or failing to engage patients effectively. To address these challenges, CCRacer, a serious game, was developed as a novel tool for assessing executive functions in clinical populations. This study evaluated the convergent and discriminant validity of CCRacer by applying it alongside established neuropsychological tests to a sample of 78 participants with acquired brain injury. Results revealed varying levels of convergent validity across tasks, with stronger correlations for measures of working memory (0.28-0.51) and planning (-0.46 to 0.34) and weaker correlations for inhibitory control (0.22). These findings suggest that CCRacer has the potential as a complementary tool in the neuropsychological assessment of an acquired brain injury, combining engaging and ecologically valid testing with the possibility of future use in cognitive training.

Pain is the main symptom of inflammatory arthritis and it can impair physical functional performance and physical activity level. Some individuals can develop kinesiophobia and experience a vicious circle of worsening health. This study aimed to investigate the association between pain and physical functional performance/physical activity and determine whether kinesiophobia mediates this association. This was a cross-sectional study with individuals diagnosed with inflammatory arthritis (rheumatoid arthritis or spondyloarthritis) treated at a Rheumatology Outpatient Clinic. We assessed pain (Visual Analogue Scale), physical activity (International Physical Activity Questionnaire - long form), kinesiophobia (Tampa Scale for Kinesiophobia), and physical functional performance (Handgrip Strength Dynamometry, 30-second Sit-to-Stand test, Static Muscular Endurance test, and Timed Up and Go test). The mediating effect of kinesiophobia on the relationship between pain intensity and physical functional performance/physical activity was analyzed, and the significance of the mediating effect (kinesiophobia) was tested through a bootstrap approach. Thirty-three individuals with inflammatory arthritis (mean age: 48 ± 12 years) participated in the study. Kinesiophobia mediates the relationship between pain intensity and physical functional performance analyzed by the 30-second Sit-to-Stand test [indirect effect (IE)overall = -0.343, bootstrap 95% confidence interval (CI): -0.698 to -0.002] and by knee flexion at 90º of the dominant limb (IEoverall = -1.55, bootstrap 95% CI: -3.43 to -0.237). In conclusion, pain intensity can affect physical functional performance through kinesiophobia in individuals with inflammatory arthritis.

Genetic testing has improved the accuracy of diagnosis of brain tumors, and treatment is now tailored to the type of brain tumor. In contrast, the factors that influence the improvement in independence in activities of daily living (ADLs) following rehabilitation have not been clarified, particularly the role of tumor type. In this retrospective cohort study of 358 participants, we analyzed changes in the Functional Independence Measure (FIM) from pre-rehabilitation to post-rehabilitation provided in an acute care hospital. Multiple regression was used to determine whether FIM gain is associated with age, gender, preadmission Karnofsky Performance Status (KPS), number of rehabilitation days, average duration of daily therapy (min/day), and tumor recurrence and type (WHO grade 1, 2, 3, and 4 gliomas; primary central nervous system lymphomas; and metastatic brain tumors). The results showed that older age ( β -0.183), tumor recurrence ( β -0.137), preadmission KPS < 80 ( β -0.180), and higher baseline total FIM score ( β -0.470) were associated with lower FIM gain whereas the average duration of daily therapy ( β 0.153) was associated with higher FIM gain. Brain tumor type was not associated with FIM gain. Improved independence in ADLs is more influenced by demographic, functional status, and treatment factors than differences in brain tumor type.

The Australian Spasticity Assessment Scale (ASAS) is a relatively new scale used to rate the severity of spasticity. Although the reliability of the ASAS has been investigated, its ability to detect a clinically important change (responsiveness) has not. The objective of this study was to investigate the responsiveness of the ASAS in adult patients with acquired brain injury-related wrist flexor spasticity treated with botulinum neurotoxin A. The responsiveness of the ASAS was assessed by the standardized response mean at the group level. At the individual level, responsiveness was assessed by the percentage of responders and nonresponders. Those who had at least a 1 grade reduction in spasticity severity were considered responders. In addition, the magnitude of the goniometric change in R1 (angle of catch response) across the responders and nonresponders was studied as a distribution of frequency. Significant improvements in R1 and ASAS were achieved with the treatment. The standardized response mean based on the ASAS grades was 1.50 with a 95% confidence interval of 1.16-1.89. At the individual level, 40 of all cases (78.4%) were responders, and 11 (21.6%) were nonresponders. Three of the 11 nonresponders (27.3%) improved R1 beyond the 10 ° margin of error (20, 50, and 50 °). In contrast, the percentage of responders who had a change within the margin of error was 27.5% (11 out of 40). Although ASAS can reveal a decrease in wrist flexor spasticity, it has some shortcomings in detecting the potentially clinically important response at the individual level.

Successful total knee replacement (TKR) heavily depends on postoperative rehabilitation. This study aims to investigate the efficacy of continuous passive motion (CPM) partially replacing group physiotherapy in an inpatient rehabilitation setting in order to contribute to the lack of physiotherapists in patients' care. Adult patients after TKR were included. A prospective randomized controlled two-center trial was conducted across inpatient rehabilitation facilities in Germany. Participants were randomly assigned to CPM or group physiotherapy. In addition, all participants received the same standard rehabilitation program. Primary outcome was the Staffelstein Score, and secondary outcome measures included Oxford Knee Score, range of motion (ROM), pain, and return to work. Non-inferiority margin for Staffelstein Score was set at ±5% of maximum scores based on previous collected data. Results indicate no significant differences between CPM and physiotherapy groups in the Staffelstein Score (CPM: 94 ± 10 points; group physiotherapy: 92 ± 10 points; P  > 0.05), ROM, or pain management at discharge from rehabilitation facility. This study underscores the potential of CPM as a valuable component of TKR rehabilitation, providing comparable outcomes to traditional physiotherapy. However, individualized physiotherapy remains integral to optimizing long-term success. Future research should explore extended follow-up periods and diverse patient populations to further elucidate CPM's role in TKR rehabilitation.

The aim of this study was to investigate the feasibility, test-retest reliability, and construct validity of the 2-min step test (2MST) in measuring aerobic exercise capacity and functional endurance in participants with anterior cruciate ligament reconstruction (ACLR). Fifty participants with quadriceps tendon autograft, bone-patellar tendon-bone graft, or hamstring autograft were included. Feasibility was assessed by the time and support required to complete the measures and the feedback from participants, including their satisfaction ratings. Test-retest reliability was assessed using the intraclass correlation coefficients (ICC2,1), a Bland-Altman plot with 95% limits of agreement (LoA), SEM, SEM%, and minimum detectable change (MDC95). The participants were assessed with the visual analogue scale (VAS), Lysholm Knee Scoring Scale, Knee Injury and Osteoarthritis Outcome Score (KOOS), stair climbing test (SCT), and 6-min walk test to assess construct validity. The test took less than 5 min to describe and perform, and participants required minimal verbal support. The satisfaction rate was notably high. The ICC2,1 was 0.98 (0.96-0.99). SEM and MDC95 were 2.96 and 8.20 (2.41-14.00), respectively. The SEM% of 2.99 was considered to be at a very good level. The Bland-Altman plot illustrates that the 2MST scores had a 95% LoA ranging from -21.52 to 2.68 steps. The SCT score and VAS rest score were found to be associated with the 2MST performance, explaining 42.5% of the variance. The 2MST is a feasible, reliable, and valid test to measure aerobic exercise capacity and functional endurance in participants with ACLR.

People with lower limb loss often experience psychological concerns related to falling. A concern for falling (CFF) includes four subdomains: fear of falling, self-efficacy, consequences of falling, and perceptions of falls. Limited research exists on how these subdomains are influenced by clinical factors and falls history. This cross-sectional online survey evaluated: (1) associations among CFF outcome measures; (2) relationships between falls history and outcome measures; and (3) clinical and demographic factors related with outcome measures. Inclusion criteria: ≥18 years old, unilateral transtibial amputation and ambulating with a prosthesis. Eight measures assessed CFF: visual analog scale fear of falling, Modified Survey of Activities and Fear of Falling in the Elderly (mSAFFE), Activities-specific Balance Confidence (ABC), Falls Efficacy Scale International (FES-I), Prosthetic Limb Users Survey - Mobility (PLUS-M), Locomotor Capabilities Index, Consequences of Falling Scale, and Perceived Ability to Manage Falls. Pearson bivariate correlation analysis assessed associations among outcome measures. T tests evaluated the association of falls status on outcome scores. Multiple linear regression modelled the clinical and demographic factors related to each measure. Sixty-eight adults (mean 61.8 ± 12.0) participated. Moderate statistically significant ( P < 0.001) correlations were found across most outcome measures, with the strongest between PLUS-M and mSAFFE ( r  = -0.841), and ABC and FES-I ( r  = -0.821). Faller status was not associated with any measure ( P  > 0.05). Quality of life was associated with fear of falling, activity avoidance, self-efficacy, and certainty to managing falls ( R2 ranged from 0.27 to 0.47). CFF should be evaluated independently of falls history.

We extended the assessment of our recently developed technology to help people with neuromotor, intellectual, and speech disabilities access (listen to) music, communicate with distant partners, and answer questions. The technology included a tablet (1) fitted with an Internet connection, a SIM card, WhatsApp Messenger, and MacroDroid application, and (2) interfaced with different pairs of response sensors. Six participants were included in the study, which was carried out according to a nonconcurrent multiple baseline design across participants. During the baseline phase (5-8 sessions carried out over 1-2 weeks), participants were unable to access music, make video calls, or answer questions using a regular tablet. During the intervention phase (50-102 sessions carried out with the technology over 2-4 months), however, they activated means of 4.7-7.6 songs and 0.4-3.6 video calls per session. Moreover, they answered correctly a mean of 69-96% of the questions presented to them. These results suggest that our technology solution is a viable and potentially valuable resource for people with extensive disabilities.

The aim of this study was to detect a possible age-related differential item functioning (DIF) of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) among people with musculoskeletal disorders. This was a cross-sectional study of 1739 consecutive patients with chronic musculoskeletal pain at a university clinic. Difficulty and discrimination parameters were calculated for each of 12 items of the WHODAS 2.0 using item response theory. The presence of DIF was assessed both numerically and graphically. When considering differences in both difficulty and discrimination, a statistically significant DIF was observed for all the items except for the item 'washing' (P values <0.001). The DIF was mostly uniform. Items 'standing', 'household responsibilities', 'learning a new task', 'emotional affectedness', 'concentrating', 'washing' and 'dressing' showed better precision among older patients. Items 'walking', 'dealing with strangers', 'maintaining a friendship' and 'day-to-day work' were more informative among younger patients. Difficulty and discrimination parameters were alike for all 12 items. The DIF was mostly uniform. These results can be taken into account when applying the WHODAS 2.0 to people with musculoskeletal complaints, especially when the studied groups are predominated by people of certain age.