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.
{"title":"Effects of combining a high-intensity interval training programme with a standard programme on mobility and function in lower limb amputees.","authors":"Nicolás Bevacqua, Gabriela Dell Elce, Leonardo Intelangelo","doi":"10.1097/MRR.0000000000000631","DOIUrl":"10.1097/MRR.0000000000000631","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":14301,"journal":{"name":"International Journal of Rehabilitation Research","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141330857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Cutoff values of motor and cognitive measures for predicting and discriminating levels of activities of daily living after stroke: a scoping review.","authors":"Takaaki Fujita, Ryuichi Kasahara, Kenji Tsuchiya, Kazuaki Iokawa","doi":"10.1097/MRR.0000000000000633","DOIUrl":"10.1097/MRR.0000000000000633","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":14301,"journal":{"name":"International Journal of Rehabilitation Research","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141442598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-07-30DOI: 10.1097/MRR.0000000000000640
{"title":"Life satisfaction and athletic identity among Olympic para-alpine skiers: a survey: Erratum.","authors":"","doi":"10.1097/MRR.0000000000000640","DOIUrl":"10.1097/MRR.0000000000000640","url":null,"abstract":"","PeriodicalId":14301,"journal":{"name":"International Journal of Rehabilitation Research","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141855533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-06-24DOI: 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.
{"title":"Is there a relationship between somatosensory impairment and the perception of pain in stroke survivors? An exploratory study.","authors":"Fatima-Tul Zahra, Maryam Zoghi, Brendon Haslam, Leeanne M Carey","doi":"10.1097/MRR.0000000000000629","DOIUrl":"10.1097/MRR.0000000000000629","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":14301,"journal":{"name":"International Journal of Rehabilitation Research","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140854805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-07-30DOI: 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.
{"title":"Development of the comprehensive inpatient transfer tool: initial reliability and validity.","authors":"Clare C Bassile, Emma Harmon, Jennifer Lehman, Brittany Shinn, Nancy Ferreira, Ramneet Manrai, Iris Platt, Marykay A Pavol","doi":"10.1097/MRR.0000000000000637","DOIUrl":"10.1097/MRR.0000000000000637","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":14301,"journal":{"name":"International Journal of Rehabilitation Research","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141855532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Effect of insole on postural control and gait of stroke patients: a systematic review and meta-analysis.","authors":"Menna Hozein, Hossam Mortada, Maged Hamed, Naglaa Abdelhaleem, Shorouk Elshennawy","doi":"10.1097/MRR.0000000000000632","DOIUrl":"10.1097/MRR.0000000000000632","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":14301,"journal":{"name":"International Journal of Rehabilitation Research","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141330856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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。
{"title":"The cutoff values of functional independence measure scores for predicting discharge destination in the early stroke phase.","authors":"Kennosuke Toi, Daisuke Ishiyama, Yoichiro Aoyagi, Kentaro Suzuki, Toshiyuki Takayama, Hitomi Yazu, Madoka Yoshida, Kazumi Kimura","doi":"10.1097/MRR.0000000000000636","DOIUrl":"10.1097/MRR.0000000000000636","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":14301,"journal":{"name":"International Journal of Rehabilitation Research","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141537881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-07-15DOI: 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。
{"title":"The effectiveness of mindfulness-based cognitive therapy during poststroke rehabilitation: a randomized controlled trial.","authors":"Veronika Udvardi, Gabor Szabo, Johanna Takacs, Gabor Fazekas","doi":"10.1097/MRR.0000000000000639","DOIUrl":"10.1097/MRR.0000000000000639","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":14301,"journal":{"name":"International Journal of Rehabilitation Research","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141590316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"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.","authors":"Takahiro Watanabe, Shinichi Noto, Manabu Natsumeda, Shinji Kimura, Fumie Ikarashi, Satoshi Tabata, Mayuko Takano, Yoshihiro Tsukamoto, Makoto Oishi","doi":"10.1097/MRR.0000000000000641","DOIUrl":"https://doi.org/10.1097/MRR.0000000000000641","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":14301,"journal":{"name":"International Journal of Rehabilitation Research","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142072793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Association of comorbidities with postoperative walking independence in patients with hip fractures: a single-center, retrospective, observational study.","authors":"Shinnosuke Ishida, Yu Kitaji, Kimi Yasuda, Haruya Yamashita, Hiroaki Harashima, Satoshi Miyano","doi":"10.1097/MRR.0000000000000622","DOIUrl":"10.1097/MRR.0000000000000622","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":14301,"journal":{"name":"International Journal of Rehabilitation Research","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140184386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}