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Effects of combining a high-intensity interval training programme with a standard programme on mobility and function in lower limb amputees. 高强度间歇训练计划与标准计划相结合对下肢截肢者活动能力和功能的影响。
IF 1.5 4区 医学 Q3 REHABILITATION Pub Date : 2024-09-01 Epub Date: 2024-06-17 DOI: 10.1097/MRR.0000000000000631
Nicolás Bevacqua, Gabriela Dell Elce, Leonardo Intelangelo

High-energy expenditure during walking is one of the most important limiting factors for lower limb amputees. Although several physical training methods have been proposed to reduce energy expenditure, little is known about the effects of high-intensity interval training in lower limb amputees. This study aimed to test the effects of a 6-week high-intensity interval training protocol in subjects with lower limb amputation on walking distance, physiological cost of walking, and functional mobility. A quasi-experimental pre and post-study included 13 subjects with lower limb amputation. They performed 12 sessions of a high-intensity interval training protocol with a frequency of 2 days/week for 6 weeks. Walking distance, physiological cost of walking, and functional mobility before and after the training protocol were assessed. Walking distance increased from 204.48 to 229.09 m ( P  = 0.003), physiological cost of walking decreased from 0.66 to 0.31 beats/m ( P  = 0.001), and functional mobility improved from 30.38 to 33.61 points ( P  = 0.001). High-intensity interval training improved walking distance, physiological cost of walking, and functional mobility in subjects with lower limb amputation.

行走时的高能量消耗是限制下肢截肢者行走的最重要因素之一。虽然已经提出了几种减少能量消耗的体能训练方法,但对下肢截肢者进行高强度间歇训练的效果却知之甚少。本研究旨在测试为期 6 周的高强度间歇训练方案对下肢截肢者步行距离、步行生理代价和功能活动能力的影响。13名下肢截肢的受试者参加了一项准实验性的前后研究。他们进行了 12 次高强度间歇训练,频率为每周 2 天,为期 6 周。对训练前后的行走距离、行走的生理代价和功能活动度进行了评估。步行距离从 204.48 米增加到 229.09 米(P = 0.003),步行的生理代价从 0.66 次/米降低到 0.31 次/米(P = 0.001),功能活动度从 30.38 分提高到 33.61 分(P = 0.001)。高强度间歇训练改善了下肢截肢者的步行距离、步行生理成本和功能活动度。
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引用次数: 0
Cutoff values of motor and cognitive measures for predicting and discriminating levels of activities of daily living after stroke: a scoping review. 预测和区分中风后日常生活活动水平的运动和认知测量临界值:范围综述。
IF 1.5 4区 医学 Q3 REHABILITATION Pub Date : 2024-09-01 Epub Date: 2024-06-24 DOI: 10.1097/MRR.0000000000000633
Takaaki Fujita, Ryuichi Kasahara, Kenji Tsuchiya, Kazuaki Iokawa

The various assessments performed by rehabilitation professionals not only indicate the patient's current functional status but can also help determine the future status (prediction) or the ability to perform untested tasks (discrimination). In particular, the cutoff values are the simplest predictive and discriminative tool that can be widely used in clinical practice. The purpose of this scoping review was to summarize the current literature on cutoff values of motor and cognitive function for predicting or discriminating levels of activities of daily living after stroke. A literature search was conducted using the PubMed, CINAHL, and Scopus databases. The creation of the search criteria, primary screening of titles and abstract, and secondary screening by full-text review were performed by two rehabilitation professionals. A total of 54 articles were included. The summary of the cutoff values for prediction based on longitudinal studies revealed that an NIHSS score ≤8 and mRMI score ≥19 at acute hospitalization can predict good functional independence and walking independence, respectively, indicating reliable cutoff values. Cutoff values for predicting specific ADLs, such as toilet use or dressing, were not reported, which was a potential research gap identified in this review. Alternatively, the summary of the cutoff values for discrimination based on cross-sectional studies revealed that 288-367.5 m on the 6-min walk test and 25.5-27.6 points on the FMA-LL can discriminate community and noncommunity walkers. Considering the difference between prediction and discrimination, the reliable predicted cutoff values revealed in this review are useful for planning an intervention based on early prediction. Conversely, cutoff values for discrimination can estimate different performances with simpler test, or use as target values during rehabilitation.

康复专业人员进行的各种评估不仅可以显示患者当前的功能状态,还可以帮助确定未来的状态(预测)或执行未测试任务的能力(判别)。其中,截断值是最简单的预测和判别工具,可广泛应用于临床实践。本范围综述的目的是总结目前有关运动和认知功能临界值的文献,以预测或判别卒中后 日常生活活动的水平。我们使用 PubMed、CINAHL 和 Scopus 数据库进行了文献检索。检索标准的制定、标题和摘要的初筛以及全文审阅的二次筛选均由两名康复专业人员完成。共纳入 54 篇文章。基于纵向研究的预测截断值总结显示,急性期住院时 NIHSS 评分≤8 分和 mRMI 评分≥19 分可分别预测良好的功能独立性和行走独立性,表明截断值是可靠的。没有报告预测特定 ADL(如如厕或穿衣)的临界值,这是本综述中发现的一个潜在研究缺口。另外,基于横断面研究的分辨临界值总结显示,6 分钟步行测试的 288-367.5 米和 FMA-LL 的 25.5-27.6 分可以区分社区和非社区步行者。考虑到预测和鉴别之间的差异,本综述中揭示的可靠预测临界值有助于在早期预测的基础上制定干预计划。相反,分辨的临界值可以通过更简单的测试来估计不同的表现,或在康复过程中用作目标值。
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引用次数: 0
Life satisfaction and athletic identity among Olympic para-alpine skiers: a survey: Erratum. 奥林匹克准高山滑雪运动员的生活满意度和运动认同感:一项调查:勘误。
IF 1.5 4区 医学 Q3 REHABILITATION Pub Date : 2024-09-01 Epub Date: 2024-07-30 DOI: 10.1097/MRR.0000000000000640
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引用次数: 0
Is there a relationship between somatosensory impairment and the perception of pain in stroke survivors? An exploratory study. 中风幸存者的躯体感觉障碍与疼痛感之间有关系吗?一项探索性研究。
IF 1.5 4区 医学 Q3 REHABILITATION Pub Date : 2024-09-01 Epub Date: 2024-06-24 DOI: 10.1097/MRR.0000000000000629
Fatima-Tul Zahra, Maryam Zoghi, Brendon Haslam, Leeanne M Carey

Pain and somatosensory impairments are commonly reported following stroke. This study investigated the relationship between somatosensory impairments (touch detection, touch discrimination and proprioceptive discrimination) and the reported presence and perception of any bodily pain in stroke survivors. Stroke survivors with somatosensory impairment ( N  = 45) completed the Weinstein Enhanced Sensory Test (WEST), Tactile Discrimination Test, and Wrist Position Sense Test for quantification of somatosensation in both hands and the McGill Pain Questionnaire, visual analog scale and the Neuropathic Pain Symptom Inventory (NPSI) for reporting presence and perception of pain. No relationship was observed between somatosensory impairment (affected contralesional hand) of touch detection, discriminative touch or proprioceptive discrimination with the presence or perception of pain. However, a weak to moderate negative relationship between touch detection in the affected hand (WEST) and perception of pain intensity (NPSI) was found, suggesting that stroke survivors with milder somatosensory impairment of touch detection, rather than severe loss, are likely to experience higher pain intensity [rho = -0.35; 95% confidence interval (CI), -0.60 to -0.03; P  = 0.03]. Further, a moderate, negative relationship was found specifically with evoked pain (NPSI) and touch detection in the affected hand (rho = -0.43; 95% CI, -0.72 to -0.02; P  = 0.03). In summary, our findings indicate a weak to moderate, albeit still uncertain, association, which prevents making a definitive conclusion. Nevertheless, our findings contribute to our understanding of the complexities surrounding the experience of pain in survivors of stroke and provide direction for future studies.

疼痛和体感障碍是中风后的常见症状。本研究调查了中风幸存者的躯体感觉障碍(触觉检测、触觉辨别和本体感觉辨别)与所报告的身体疼痛的存在和感知之间的关系。有躯体感觉障碍的中风幸存者(N = 45)完成了韦恩斯坦增强感觉测试(WEST)、触觉辨别测试和腕部位置感测试,以量化双手的躯体感觉,并完成了麦吉尔疼痛问卷、视觉模拟量表和神经病理性疼痛症状量表(NPSI),以报告疼痛的存在和感知。没有观察到触摸检测、辨别触摸或本体感觉辨别的体感损伤(受影响的对侧手)与疼痛的存在或感知之间有任何关系。然而,在患手(WEST)的触觉检测与疼痛强度感知(NPSI)之间发现了弱至中等程度的负相关,这表明触觉检测体感损伤较轻而非严重的中风幸存者可能会经历较高的疼痛强度[rho = -0.35;95% 置信区间 (CI),-0.60 至 -0.03;P = 0.03]。此外,我们还发现诱发疼痛(NPSI)与患手的触觉检测之间存在中度负相关(rho = -0.43;95% 置信区间 (CI):-0.72 至 -0.02;P = 0.03)。总之,我们的研究结果表明,尽管仍存在不确定性,但两者之间存在着微弱至中等程度的关联,因此无法得出明确的结论。然而,我们的研究结果有助于我们了解中风幸存者疼痛体验的复杂性,并为今后的研究提供了方向。
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引用次数: 0
Development of the comprehensive inpatient transfer tool: initial reliability and validity. 开发住院病人综合转院工具:初步可靠性和有效性。
IF 1.5 4区 医学 Q3 REHABILITATION Pub Date : 2024-09-01 Epub Date: 2024-07-30 DOI: 10.1097/MRR.0000000000000637
Clare C Bassile, Emma Harmon, Jennifer Lehman, Brittany Shinn, Nancy Ferreira, Ramneet Manrai, Iris Platt, Marykay A Pavol

A new patient transfer assessment scale for use in inpatient rehabilitation facilities (IRFs) is warranted to assess level of assistance, adaptations needed for success, and movement strategies. This study presents initial psychometric analyses for the Comprehensive Inpatient Transfer Tool (CITT). CITT items were developed through interdisciplinary team discussions. Interrater reliability was assessed between blinded pairs of raters administering the CITT for each subject on the same day. Intrarater reliability was assessed with one rater administering the CITT for each subject twice within the same day. Thirty-six subjects in an IRF completed the CITT four times during their rehabilitation stay; three times at admission and once at discharge. Intraclass correlations (mixed models) were used in reliability and minimal detectable change (MDC) analyses. Spearman correlations of CITT and CITT change scores with their respective Functional Independence Measure (FIM) and Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) transfer scores were performed for concurrent validity. Responsiveness was assessed using paired t-tests on change scores. Interrater and intrarater reliability ranged from 0.90 to 0.98. Correlations between the CITT and FIM/IRF-PAI ranged from 0.6 to 0.8. The MDC for CITT was 7.11 pts. Differences between admission and discharge CITT were significant (P < 0.001). The CITT, developed by an interdisciplinary team, addresses limitations of existing transfer measures utilized in IRFs. The CITT demonstrated excellent inter and intrarater reliability. Concurrent validity demonstrated modest agreement between existing transfer measures and the CITT. The CITT is a reliable, useful scale for evaluating transfer skills in patients admitted to an IRF.

住院康复机构(IRF)需要一种新的病人转运评估量表来评估协助程度、成功转运所需的适应性以及移动策略。本研究对住院病人转运综合工具(CITT)进行了初步心理计量分析。CITT 项目是通过跨学科团队讨论开发的。在同一天对每个受试者进行 CITT 测评时,由一对双盲测评者进行互测信度评估。在同一天内,由一名评分员对每个受试者进行两次 CITT 评分,以评估评分员之间的可靠性。在 IRF 中的 36 名受试者在康复住院期间完成了四次 CITT,其中三次在入院时完成,一次在出院时完成。在可靠性和最小可检测变化(MDC)分析中使用了类内相关性(混合模型)。CITT和CITT变化得分与各自的功能独立性测量(FIM)和住院患者康复机构-患者评估工具(IRF-PAI)转移得分之间的斯皮尔曼相关性被用于同期有效性分析。采用配对 t 检验对变化分数进行反应性评估。内部和外部信度为 0.90 至 0.98。CITT 与 FIM/IRF-PAI 之间的相关性为 0.6 至 0.8。CITT 的 MDC 为 7.11 pts。入院和出院 CITT 之间的差异显著(P
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引用次数: 0
Effect of insole on postural control and gait of stroke patients: a systematic review and meta-analysis. 鞋垫对中风患者姿势控制和步态的影响:系统综述和荟萃分析。
IF 1.5 4区 医学 Q3 REHABILITATION Pub Date : 2024-09-01 Epub Date: 2024-06-17 DOI: 10.1097/MRR.0000000000000632
Menna Hozein, Hossam Mortada, Maged Hamed, Naglaa Abdelhaleem, Shorouk Elshennawy

This systematic review aims to examine the evidence of adding postural insole to traditional physical therapy to improve weight distribution, gait, mobility, balance, and postural control in stroke survivors. Five databases were searched to retrieve all related randomized controlled trials examining the effect of insole on stroke patients. Two independent authors checked the potential articles against eligibility criteria according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A meta-analysis was conducted for available outcomes and the statistical heterogeneity was examined using the I2 test. Of 762 articles, only 15 with 448 patients were included after they met the inclusion criteria with most of them including participants exceeding 6 months of stroke incidence. When insole was used as compelled body weight shifting method, pooled statistical analysis revealed significant improvement in gait velocity [standardized mean difference (SMD) = 0.67; 95% confidence interval (CI): 0.31, 1.02; P  = 0.0003], cadence (SMD = 0.67; 95% CI: 0.16, 1.18; P  = 0.01] and stride length (SMD = 1.11; 95% CI: 0.57, 1.65; P  < 0.0001), while no significant effect on step length (SMD = 0.48; 95% CI: -0.37, 1.33; P  = 0.27). Pooled statistical analysis of balance outcomes revealed significant improvement in weight-bearing symmetry balance (SMD = 0.82; 95% CI: 0.25, 1.39; P  = 0.005) and long-term improvement in Berg Balance Scale (SMD = 1.19; 95% CI: 0.19, 2.20; P  = 0.02), while no difference was observed in balance confidence (SMD = 0.44; 95% CI: -0.15, 1.04; P  = 0.14) and sensorimotor functions (SMD = 0.36; 95% CI -0.39, 1.11; P  = 0.35). Insoles significantly improved spatiotemporal gait parameters, gait symmetry, and static balance compared with traditional physical therapy alone.

本系统综述旨在研究在传统物理治疗的基础上增加姿势鞋垫以改善中风幸存者体重分布、步态、移动性、平衡和姿势控制的证据。我们搜索了五个数据库,以检索所有研究鞋垫对中风患者影响的相关随机对照试验。两位独立作者根据 PRISMA(系统综述和荟萃分析的首选报告项目)指南检查了潜在文章的资格标准。对现有结果进行了荟萃分析,并使用 I2 检验对统计异质性进行了检查。在 762 篇文章中,只有 15 篇文章的 448 名患者符合纳入标准,其中大部分文章的参与者中风发病时间超过 6 个月。当使用鞋垫作为强制体重转移方法时,汇总统计分析显示步速(SMD = 0.67;95% 置信区间 (CI):0.31, 1.02;P = 0.0003)、步幅(SMD = 0.67;95% CI:0.16, 1.18;P = 0.01)和步长(SMD = 1.11;95% CI:0.57, 1.65;P = 0.01)均有显著改善。
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引用次数: 0
The cutoff values of functional independence measure scores for predicting discharge destination in the early stroke phase. 预测卒中早期出院去向的功能独立性测量评分的临界值。
IF 1.5 4区 医学 Q3 REHABILITATION Pub Date : 2024-09-01 Epub Date: 2024-07-08 DOI: 10.1097/MRR.0000000000000636
Kennosuke Toi, Daisuke Ishiyama, Yoichiro Aoyagi, Kentaro Suzuki, Toshiyuki Takayama, Hitomi Yazu, Madoka Yoshida, Kazumi Kimura

This study aimed to determine cutoff values of functional independence measure (FIM) scores to predict the discharge destinations of patients with acute stroke. The sample included 318 patients with acute stroke (mean age, 72.0 years; women, 39%). The discharge destination was categorized into three groups: home, postacute rehabilitation (hospital with convalescent rehabilitation wards), and postacute care (institution without convalescent rehabilitation wards). We assessed FIM after lifting bed restriction. Multinomial logistic regression analyses were used to estimate odds ratios (OR) and 95% confidence intervals (CI) of the FIM scores for predicting discharge destinations, with postacute rehabilitation as a reference. Cutoff values of motor and cognitive FIM scores for distinguishing home from postacute rehabilitation and postacute care from postacute rehabilitation were determined using receiver operating characteristic curves. The proportion of home, postacute rehabilitation, and postacute care were 34.6%, 41.8%, and 23.6%, respectively. After adjustments for clinical variables, the ORs (95% CIs) for motor and cognitive FIM scores for home versus postacute rehabilitation were 1.08 (1.04-1.11) and 1.05 (0.98-1.12). Furthermore, those for postacute care versus postacute rehabilitation were 1.01 (0.98-1.04) and 0.92 (0.87-0.98). The cutoff values of the motor and cognitive FIM scores for distinguishing home from postacute rehabilitation were 37.5 (sensitivity: 0.92; specificity: 0.64) and 23.5 (sensitivity: 0.78; specificity: 0.67). Furthermore, those for distinguishing postacute care from postacute rehabilitation were 15.5 (sensitivity, 0.81; specificity, 0.51) and 12.5 (sensitivity, 0.74; specificity, 0.64). The identified cutoff values may serve as early indicators for predicting discharge destinations from acute stroke care.

本研究旨在确定功能独立性测量(FIM)分数的临界值,以预测急性脑卒中患者的出院去向。样本包括 318 名急性脑卒中患者(平均年龄 72.0 岁;女性占 39%)。出院目的地分为三组:家庭、急性期后康复(有疗养康复病房的医院)和急性期后护理(无疗养康复病房的机构)。我们对限制抬床后的 FIM 进行了评估。我们使用多项式逻辑回归分析估算了预测出院目的地的 FIM 评分的几率比(OR)和 95% 置信区间(CI),并以急性期后康复作为参考。利用接收器操作特征曲线确定了运动和认知FIM评分的临界值,以区分居家和急性期后康复以及急性期后护理和急性期后康复。居家、康复后和康复后护理的比例分别为 34.6%、41.8% 和 23.6%。在对临床变量进行调整后,家庭康复与急性期后康复相比,运动和认知FIM评分的ORs(95% CI)分别为1.08(1.04-1.11)和1.05(0.98-1.12)。此外,护理后与康复后的运动和认知 FIM 分值的临界值分别为 1.01(0.98-1.04)和 0.92(0.87-0.98)。用于区分居家护理和康复后护理的运动和认知 FIM 评分的临界值分别为 37.5(灵敏度:0.92;特异度:0.64)和 23.5(灵敏度:0.78;特异度:0.67)。此外,用于区分急性期后护理和急性期后康复的临界值分别为 15.5(灵敏度:0.81;特异度:0.51)和 12.5(灵敏度:0.74;特异度:0.64)。确定的临界值可作为预测急性卒中治疗出院目的地的早期指标。
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引用次数: 0
The effectiveness of mindfulness-based cognitive therapy during poststroke rehabilitation: a randomized controlled trial. 中风后康复期间正念认知疗法的有效性:随机对照试验。
IF 1.5 4区 医学 Q3 REHABILITATION Pub Date : 2024-09-01 Epub Date: 2024-07-15 DOI: 10.1097/MRR.0000000000000639
Veronika Udvardi, Gabor Szabo, Johanna Takacs, Gabor Fazekas

Stroke can have a range of physical, psychological, cognitive, and social impacts that are challenging for survivors. This study aimed to evaluate the efficacy of a group-based mindfulness intervention integrated into an inpatient rehabilitation program compared to standard care. A single-center, randomized, controlled trial was conducted in 93 poststroke patients. The intervention group received 6-weeks of mindfulness-based cognitive therapy (MBCT) and standard care; the control group received standard care. Primary outcomes were depression and trait anxiety; secondary outcomes were trait mindfulness and attention. Participants completed questionnaires at baseline, and postintervention (6 weeks). Mixed-effect model repeated measures analysis of variance was conducted between groups and across time. A total of 80 participants (intervention n  = 43; standard care n  = 37) were included in the postintervention analysis. There were no statistically significant differences in the primary outcomes between the groups over time. An improvement was found, however, on the trait mindfulness observing subscale in favor of the intervention group. Eight sessions of MBCT integrated into an inpatient stroke rehabilitation program over 6 weeks was not effective in improving depression and anxiety compared to standard care. Lack of follow-up and low to moderate pathological symptoms at baseline may have limited the effectiveness of this intervention.

脑卒中会对幸存者的身体、心理、认知和社交产生一系列影响,这对他们来说是一项挑战。本研究旨在评估将正念干预纳入住院康复计划与标准护理相比的疗效。研究在 93 名脑卒中后患者中进行了单中心随机对照试验。干预组接受了为期 6 周的正念认知治疗(MBCT)和标准护理;对照组接受了标准护理。主要结果是抑郁和特质焦虑;次要结果是特质正念和注意力。参与者在基线和干预后(6 周)填写问卷。对不同组别和不同时间进行了混合效应模型重复测量方差分析。共有 80 名参与者(干预 n = 43;标准护理 n = 37)被纳入干预后分析。各组间的主要结果在统计学上没有显著差异。不过,干预组在特质正念观察分量表上有所改善。与标准护理相比,在为期 6 周的中风住院康复计划中融入 8 节 MBCT 课程并不能有效改善抑郁和焦虑。缺乏随访和基线时的中低度病理症状可能限制了该干预的效果。
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引用次数: 0
Improvements in activities of daily living among patients with brain tumors are associated with age, baseline physical function, duration of rehabilitation, and tumor recurrence but not type. 脑肿瘤患者日常生活活动能力的提高与年龄、基线身体功能、康复持续时间和肿瘤复发有关,但与类型无关。
IF 1.5 4区 医学 Q3 REHABILITATION Pub Date : 2024-08-28 DOI: 10.1097/MRR.0000000000000641
Takahiro Watanabe, Shinichi Noto, Manabu Natsumeda, Shinji Kimura, Fumie Ikarashi, Satoshi Tabata, Mayuko Takano, Yoshihiro Tsukamoto, Makoto Oishi

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.

基因检测提高了脑肿瘤诊断的准确性,现在可以根据脑肿瘤的类型进行治疗。相比之下,影响康复后日常生活活动(ADLs)独立性改善的因素尚未明确,尤其是肿瘤类型的作用。在这项对 358 名参与者进行的回顾性队列研究中,我们分析了从康复前到康复后在一家急症医院进行的功能独立性测量(FIM)的变化。研究采用多元回归法确定 FIM 的增加是否与年龄、性别、入院前的 Karnofsky 表情状态(KPS)、康复天数、每日治疗的平均持续时间(分钟/天)以及肿瘤复发和类型(WHO 1、2、3 和 4 级胶质瘤;原发性中枢神经系统淋巴瘤;转移性脑肿瘤)有关。结果显示,年龄较大(β -0.183)、肿瘤复发(β -0.137)、入院前 KPS
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引用次数: 0
Association of comorbidities with postoperative walking independence in patients with hip fractures: a single-center, retrospective, observational study. 合并症与髋部骨折患者术后独立行走能力的关系:一项单中心、回顾性、观察性研究。
IF 1.7 4区 医学 Q2 Medicine Pub Date : 2024-06-01 Epub Date: 2024-04-22 DOI: 10.1097/MRR.0000000000000622
Shinnosuke Ishida, Yu Kitaji, Kimi Yasuda, Haruya Yamashita, Hiroaki Harashima, Satoshi Miyano

Hip fractures (HFs) are common in the elderly and lead to decreased walking independence. Although comorbidities may be associated with gaining walking independence, few studies have comprehensively examined baseline and preoperative clinical factors. We aimed to evaluate the effects of comorbidities on the postoperative walking independence of patients with HFs. This single-center, retrospective, observational study included patients with HFs admitted to an acute care hospital between 1 May 2022 and 1 March 2023, who before the incident were able to walk independently [functional independence measure (FIM) walk score ≥6 points]. Postoperative walking independence was evaluated using the walk item of the FIM. The Charlson comorbidity index (CCI) was used to evaluate comorbidities at admission, and the patients were divided into two categories with CCI scores of 0 points and ≥1 point. The effect of comorbidities, assessed using the CCI, on postoperative walking independence was evaluated using Cox proportional hazards analysis. Ninety-four participants were included in the analysis. The Cox proportional hazards model adjusted for potential confounders (age, operative delay and nutritional status) revealed that the CCI was significantly associated with postoperative walking independence ( P < 0.05). The hazard ratio and 95% confidence interval (CI) for the CCI for postoperative walking independence were 0.40 (95% CI, 0.189-0.865). Preoperative assessment of comorbidities using the CCI may aid in predicting the postoperative walking independence of patients with HFs.

髋部骨折(HF)在老年人中很常见,会导致行走能力下降。虽然合并症可能与获得行走独立性有关,但很少有研究对基线和术前临床因素进行全面检查。我们旨在评估合并症对高血压患者术后行走独立性的影响。这项单中心、回顾性、观察性研究纳入了2022年5月1日至2023年3月1日期间入住急诊医院的高血压患者,这些患者在发病前能够独立行走[功能独立性测量(FIM)行走评分≥6分]。术后行走独立性使用 FIM 的行走项目进行评估。入院时采用夏尔森合并症指数(Charlson comorbidity index,CCI)评估合并症,并将患者分为CCI得分为0分和≥1分的两类。使用CCI评估的合并症对术后行走独立性的影响采用Cox比例危险分析法进行评估。共有 94 名参与者参与了分析。根据潜在混杂因素(年龄、手术延迟和营养状况)调整后的 Cox 比例危险模型显示,CCI 与术后行走独立性显著相关(P < 0.05)。CCI与术后独立行走的危险比和95%置信区间(CI)为0.40(95% CI,0.189-0.865)。使用CCI对合并症进行术前评估有助于预测高血压患者术后的行走独立性。
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International Journal of Rehabilitation Research
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