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A systematic review of the effects of robotic exoskeleton training on energy expenditure and body composition in adults with spinal cord injury. 机器人外骨骼训练对脊髓损伤成人能量消耗和身体成分影响的系统性综述。
IF 1.7 4区 医学 Q2 Medicine Pub Date : 2024-06-01 Epub Date: 2024-04-09 DOI: 10.1097/MRR.0000000000000626
Alessandra Rigoli, Lucinda Francis, Margaret Nicholson, Gerard Weber, Jason Redhead, Priya Iyer

Metabolic diseases disproportionately affect people with spinal cord injury (SCI). Increasing energy expenditure and remodeling body composition may offset deleterious consequences of SCI to improve cardiometabolic health. Evidence is emerging that robotic exoskeleton use increases physical activity in SCI, but little is known about its effects on energy expenditure and body composition. This study therefore aimed to evaluate the impact of robotic exoskeleton training on body composition and energy expenditure in adults with SCI. A systematic literature review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Five databases were searched to retrieve studies meeting pre-set eligibility criteria: adults with SCI, interventions evaluating the effects of robotic exoskeleton devices on body composition or energy expenditure. The PEDro scale guided quality assessments with findings described narratively. Of 2163 records, 10 studies were included. Robotic exoskeleton training does not significantly improve energy expenditure compared to other exercise interventions. Significant changes ( P  < 0.05) in body composition, particularly reduced fat mass, however, were reported. High variability seen with the interventions was coupled with poor quality of the studies. While robotic exoskeleton interventions may propose modest cardiometabolic benefits in adults with SCI, further robust trials in larger samples are needed to strengthen these findings.

代谢性疾病对脊髓损伤(SCI)患者的影响尤为严重。增加能量消耗和重塑身体成分可以抵消脊髓损伤的有害后果,从而改善心脏代谢健康。有证据表明,使用机器人外骨骼可增加 SCI 患者的体力活动,但人们对其对能量消耗和身体成分的影响知之甚少。因此,本研究旨在评估机器人外骨骼训练对患有 SCI 的成年人身体成分和能量消耗的影响。根据《系统综述和元分析首选报告项目》指南进行了系统性文献综述。我们搜索了五个数据库,以检索符合预设资格标准的研究:患有 SCI 的成人、评估机器人外骨骼设备对身体成分或能量消耗影响的干预措施。采用 PEDro 量表进行质量评估,并对评估结果进行叙述性描述。在2163条记录中,共纳入了10项研究。与其他运动干预相比,机器人外骨骼训练并不能显著改善能量消耗。显著变化(P
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引用次数: 0
Challenges in applying minimal clinically important difference: a critical review. 应用最小临床意义差异的挑战:评论性综述。
IF 1.7 4区 医学 Q2 Medicine Pub Date : 2024-03-01 Epub Date: 2024-01-22 DOI: 10.1097/MRR.0000000000000613
Joseph Podurgiel, Daniele Piscitelli, Craig Denegar

Healthcare clinicians strive to make meaningful changes in patient function and participation. A minimal clinically important difference (MCID) is an estimate of the magnitude of change needed to be meaningful to a patient. Clinicians and investigators may assume that a cited MCID is a valid and generalizable estimate of effect. There are, however, at least two concerns about this assumption. First, multiple methods exist for calculating an MCID that can yield divergent values and raise doubt as to which one to apply. Second, MCID values may be erroneously generalized to patients with dissimilar health conditions. With this in mind, we reviewed the methods used to calculate MCID and citations of reported MCID values for outcome measures commonly used in neurologic, orthopedic, and geriatric populations. Our goal was to assess whether the calculation methods were acknowledged in the cited work and whether the enrolled patients were similar to the sample from which the MCID estimate was derived. We found a concerning variation in the methods employed to estimate MCID. We also found a lack of transparency in identifying calculation methods and applicable health conditions in the cited work. Thus, clinicians and researchers must pay close attention and exercise caution in assuming changes in patient status that exceed a specific MCID reflect meaningful improvements in health status. A common standard for the calculation and reporting of an MCID is needed to address threats to the validity of conclusions drawn from the interpretation of an MCID.

医疗保健临床医生努力使患者的功能和参与发生有意义的改变。最小临床意义差异(MCID)是对患者所需的有意义改变的估计值。临床医生和研究人员可能会认为,所引用的 MCID 是有效且可推广的效果估计值。然而,这一假设至少存在两个问题。首先,计算 MCID 的方法有多种,可能会产生不同的值,并使人对应用哪种方法产生怀疑。其次,MCID 值可能会被错误地推广到健康状况不同的患者身上。有鉴于此,我们回顾了用于计算 MCID 的方法以及神经科、骨科和老年病科常用结果测量的 MCID 值的引用报告。我们的目标是评估引用文献中是否承认了计算方法,以及入组患者是否与得出 MCID 估计值的样本相似。我们发现估算 MCID 的方法存在令人担忧的差异。我们还发现,引用文献在确定计算方法和适用健康状况方面缺乏透明度。因此,临床医生和研究人员在假定患者状态的变化超过特定的 MCID 时,必须密切关注并谨慎行事,因为这种变化反映了健康状况的有意义改善。需要制定一个计算和报告 MCID 的通用标准,以解决通过解释 MCID 得出的结论的有效性所面临的威胁。
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引用次数: 0
Fitness and walking outcomes following aerobic and lower extremity strength training in facioscapulohumeral dystrophy: a case series. 面肱骨营养不良症患者接受有氧和下肢力量训练后的体能和行走效果:病例系列。
IF 1.7 4区 医学 Q2 Medicine Pub Date : 2024-03-01 Epub Date: 2024-01-06 DOI: 10.1097/MRR.0000000000000614
Nicolas Prieur-Blanc, Maëva Cotinat, Sebastien Vansteenkiste, Virginie de Bovis Milhe, Jean-Michel Viton, Sharam Attarian, Laurent Bensoussan

Facioscapulohumeral muscular dystrophy (FSHD) is a common form of adult muscular dystrophy often resulting also in cardiorespiratory deconditioning and weakness of the lower limbs. Although previous studies examined outcomes of interventions aimed at improving either cardiorespiratory fitness or muscle strength, the potential benefits of a rehabilitation program targeting both remain unexplored. Thus, the aim of this study was to evaluate changes following participation in a rehabilitation program combining aerobic and strength exercises. We conducted a retrospective analysis of 10 subjects with FSHD who participated in our rehabilitation program during 2018 and 2019. Each of the 20 sessions consisted of aerobic training on a cycloergometer and a moderate lower limb strength exercises on an isokinetic machine in combination with conventional therapy. The primary outcomes were walking speed, aerobic performance and isokinetic strength of the knee extensors and flexors. The secondary outcomes were fatigue, insomnia. VO2max and walking speed increased significantly by 2.125 ml·kg-1·min-1 [95% confidence interval (CI): 0.75-3.62, P = 0.022] and 0.28 m/s (95% CI: 0.16-0.4, P = 0.002), respectively. The effect size was small for V02max (Hedge's g, 0.44; 95% CI: -0.5 to 1.37) and large for walking speed (Hedge's g, 0.99; 95% CI: 0.06-1.92). The knee flexor strength significantly increased at rehabilitation discharge (repeated measures analysis of variance P = 0.004). Positive changes in fatigue and insomnia were also observed. Our preliminary results provide evidence that a relatively short course of a comprehensive rehabilitation program targeting both cardiorespiratory fitness and knee muscle strength can be beneficial for people with FSHD, which warrants further prospective studies.

面肩胛肱肌营养不良症(FSHD)是一种常见的成人肌肉营养不良症,通常也会导致心肺功能减退和下肢无力。尽管以往的研究对旨在改善心肺功能或肌肉力量的干预措施的结果进行了研究,但针对这两种情况的康复计划的潜在益处仍未得到探讨。因此,本研究旨在评估参加有氧运动和力量锻炼相结合的康复计划后的变化。我们对2018年和2019年期间参加康复计划的10名FSHD受试者进行了回顾性分析。在20节课中,每节课都包括在单车计上进行有氧训练,以及在等速机上进行中等强度的下肢力量练习,并与传统疗法相结合。主要结果是步行速度、有氧运动表现以及膝关节伸屈肌的等速力量。次要结果是疲劳和失眠。VO2max 和步行速度分别显著提高了 2.125 ml-kg-1-min-1 [95% 置信区间 (CI):0.75-3.62,P = 0.022] 和 0.28 m/s(95% CI:0.16-0.4,P = 0.002)。对 V02max 的影响较小(Hedge's g,0.44;95% CI:-0.5 至 1.37),而对步行速度的影响较大(Hedge's g,0.99;95% CI:0.06-1.92)。康复出院时,膝关节屈肌力量明显增加(重复测量方差分析 P = 0.004)。在疲劳和失眠方面也观察到了积极的变化。我们的初步研究结果证明,针对心肺功能和膝关节肌力的综合康复计划疗程相对较短,对前列腺肥大症患者有益,值得进一步开展前瞻性研究。
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引用次数: 0
Differences in respiratory function, depressive symptoms and quality of life between patients with hereditary motor and sensory neuropathy and myotonic dystrophy undergoing maintenance rehabilitation. 接受维持性康复治疗的遗传性运动神经和感觉神经病以及肌营养不良症患者在呼吸功能、抑郁症状和生活质量方面的差异。
IF 1.7 4区 医学 Q2 Medicine Pub Date : 2024-03-01 Epub Date: 2023-12-14 DOI: 10.1097/MRR.0000000000000608
Nika Lajlar, Gaj Vidmar, Metka Moharić

Hereditary motor and sensory neuropathy (HMSN) and myotonic dystrophy (MD) are chronic neuromuscular diseases that cause progressive muscular impairment and impact patient's quality of life. Conflicting findings in existing literature underscore the need for focussed research on specific health aspects in these patients. The aim of the study was to explore the differences in respiratory function, depressive symptoms and quality of life between patients with HMSN and MD undergoing maintenance rehabilitation. Our prospective observational study included 62 HMSN patients (median age 53.5, range 19-79 years; 38 women) and 50 MD patients (median age 54.0, range 18-77 years; 34 women) undergoing maintenance rehabilitation. They performed respiratory function tests (vital capacity, forced vital capacity, forced expiratory volume and peak expiratory flow) and respiratory muscle strength tests (maximum inspiratory pressure, maximum expiratory pressure and sniff nasal inspiratory force). The Center for Epidemiological Studies-Depression Scale was used to evaluate depression, and their health-related quality of life was assessed using the Quality of Life in Genetic Neuromuscular Disease Questionnaire. Using logistic regression, we examined group-difference in presence of depressive symptoms while accounting for age, symptoms duration, and marital status. Multiple linear regression was used to assess the difference in quality-of-life scores, adjusting for age, gender, and symptoms' duration. The HMSN group achieved statistically significantly better results than the MD group on all respiratory measures (about 17% absolute difference in the respiratory function measures and 30% relative difference in the respiratory muscle strength measures on average). Both groups exhibited a high level of depression symptoms (HMSN 24%, MD 44%; estimated adjusted odds-ratio MD vs. HMSN 1.9, 95% CI 0.8-4.5, P  = 0.127). We did not find a statistically significant difference between the groups regarding quality-of-life domains, though a trend towards better quality-of-life among the HMSN patients could be observed. The implication for future practice is that the MD patients would potentially benefit the most from targeted respiratory-rehabilitation interventions, and both groups could benefit from focussed mental-health interventions.

遗传性运动与感觉神经病(HMSN)和肌营养不良症(MD)是一种慢性神经肌肉疾病,会导致进行性肌肉损伤并影响患者的生活质量。现有文献中的研究结果相互矛盾,这突出表明有必要对这些患者的具体健康状况进行重点研究。本研究旨在探讨接受维持性康复治疗的 HMSN 和 MD 患者在呼吸功能、抑郁症状和生活质量方面的差异。我们的前瞻性观察研究包括 62 名接受维持性康复治疗的 HMSN 患者(中位年龄 53.5 岁,年龄范围 19-79 岁;38 名女性)和 50 名接受维持性康复治疗的 MD 患者(中位年龄 54.0 岁,年龄范围 18-77 岁;34 名女性)。他们进行了呼吸功能测试(生命容量、强迫生命容量、强迫呼气量和呼气流量峰值)和呼吸肌力测试(最大吸气压力、最大呼气压力和嗅鼻吸力)。流行病学研究中心抑郁量表用于评估抑郁情况,遗传性神经肌肉疾病生活质量问卷用于评估与健康相关的生活质量。在考虑年龄、症状持续时间和婚姻状况的情况下,我们使用逻辑回归法研究了存在抑郁症状的组间差异。在对年龄、性别和症状持续时间进行调整后,我们使用多元线性回归评估了生活质量得分的差异。在所有呼吸测量指标上,HMSN 组的结果在统计学上明显优于 MD 组(呼吸功能测量指标的绝对差异约为 17%,呼吸肌强度测量指标的相对差异平均为 30%)。两组均表现出较高程度的抑郁症状(HMSN 24%,MD 44%;估计调整后几率 MD vs. HMSN 1.9,95% CI 0.8-4.5,P = 0.127)。我们没有发现两组患者在生活质量方面存在统计学意义上的显著差异,但可以观察到 HMSN 患者的生活质量有提高的趋势。对未来实践的启示是,MD 患者可能会从有针对性的呼吸康复干预中获益最多,而两组患者都可能从有针对性的心理健康干预中获益。
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引用次数: 0
Barriers and facilitators to physical activity participation among community-dwelling physically inactive individuals after stroke: a qualitative exploratory study. 中风后在社区居住的非体育活动人士参与体育活动的障碍和促进因素:一项定性探索性研究。
IF 1.7 4区 医学 Q2 Medicine Pub Date : 2024-03-01 Epub Date: 2024-01-06 DOI: 10.1097/MRR.0000000000000610
Evrim Karadag-Saygi, Esra Giray, Nurullah Eren, Gunay Yolcu, Ozge Kenis Coskun, Serap Cifcili

Physical activity has been shown to reduce the risk for first-ever stroke as well as recurrent stroke with positive effects on almost all known modifiable risk factors. However, the perceived barriers and facilitators for engaging in physical activity have been insufficiently studied and may differ between cultures. Therefore, the aim of this study was to explore the perceptions of community-dwelling physically inactive individuals with stroke about barriers and facilitators to their participation in physical activity. This qualitative study included two focus groups of ten individuals with stroke classified as physically inactive based on accelerometer recordings. A semi-structured set of questions was posed in each focus group session and the transcripts were analysed using thematic analysis. The results revealed three main themes and subthemes: individual factors (physical impairments, psychological factors, spirituality), interaction with the family (attitudes of family members/close community) and social and environmental factors (hobbies, lack of or presence of facilities, the use of orthosis). We conclude that physical activity participation is affected by a multitude of factors as well as cultural differences. Thus, interventions aimed at increasing participation in physical activity after stroke should not only be planned according to individual clinical characteristics but also take into account a range of personal-to-social factors, including cultural differences.

事实证明,体育锻炼可降低首次中风和复发中风的风险,对几乎所有已知的可改变风险因素都有积极影响。然而,对参与体育锻炼的障碍和促进因素的认识研究不足,而且不同文化之间可能存在差异。因此,本研究旨在探讨居住在社区的非体力活动中风患者对参与体育锻炼的障碍和促进因素的看法。这项定性研究包括两个焦点小组,由 10 名根据加速度计记录被归类为身体不活跃的中风患者组成。每个焦点小组会议都提出了一系列半结构化问题,并使用主题分析法对记录誊本进行了分析。结果发现了三个主要主题和次主题:个人因素(身体缺陷、心理因素、精神因素)、与家庭的互动(家庭成员/近邻社区的态度)以及社会和环境因素(爱好、设施缺乏或存在、矫形器的使用)。我们的结论是,体育活动的参与受到多种因素和文化差异的影响。因此,旨在提高脑卒中后体育活动参与率的干预措施不仅要根据个体临床特征进行规划,还要考虑一系列个人与社会因素,包括文化差异。
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引用次数: 0
Factors affecting the efficiency of walking independence in patients with subacute stroke following robot-assisted gait training with conventional rehabilitation. 影响亚急性脑卒中患者在接受机器人辅助步态训练和传统康复训练后独立行走效率的因素。
IF 1.7 4区 医学 Q2 Medicine Pub Date : 2024-03-01 Epub Date: 2024-01-05 DOI: 10.1097/MRR.0000000000000609
Yoshiaki Maki, Takuma Ii, Masanari Yamada, Shigeo Tanabe

Factors affecting the efficiency of walking independence in patients with subacute stroke following robot-assisted gait training (RAGT) and conventional treatment (RAGT-CT) were examined. This retrospective cohort study included 37 patients with stroke [ n  = 11 ischemic; n  = 26 hemorrhagic; median poststroke interval, 28 days (interquartile range, IQR, 24-42)] who underwent RAGT using Welwalk for a median of 3 weeks (IQR, 2-4) followed by conventional training (median, 129 days; IQR, 114-146). The primary outcome was the change in functional independence measure (FIM)-walk item score from before to after RAGT (FIM-walk efficiency). The secondary outcome was the FIM-walk score at discharge. The independent variables included sensorimotor function [lower extremity (LE) motor and sensory scores and trunk function from the Stroke Impairment Assessment Set (SIAS) and Berg Balance Scale (BBS)] and cognitive function (FIM-cognitive, MMSE and Cognitive-related Behavioral Assessment) before RAGT-CT and RAGT dose duration per session, total steps and average treadmill speed at week 1, and number of sessions). We first determined the bivariate associations of each independent variable with the FIM-walk efficiency at the end of the RAGT period as decided by the therapists and with the FIM-walk score at discharge. Hierarchical multiple regression revealed that only the FIM-cognitive score was a significant predictor of the FIM-walk efficiency at the end of the RAGT period ( β  = 0.47; P  < 0.01, adjusted R2  = 0.21) after accounting for age, days post-stroke, SIAS-total lower extremity (SIAS-LE) motor score, and number of RAGT sessions (all nonsignificant). Furthermore, only the SIAS-trunk score was a significant predictor of the FIM-walk score at discharge ( β  = 0.52; P  < 0.01; adjusted R2  = 0.65) after accounting for age, days post-stroke, FIM-cognitive score, SIAS-LE motor score, and average treadmill speed at week 1 (all nonsignificant). Although patients with better cognition at the start of locomotor training achieved the pragmatic targets for terminating RAGT and proceeding with conventional therapy at a faster rate, the outcome at discharge is mainly dependent on early trunk function.

本研究探讨了影响亚急性中风患者在接受机器人辅助步态训练(RAGT)和常规治疗(RAGT-CT)后独立行走效率的因素。这项回顾性队列研究纳入了 37 名中风患者[n = 11 名缺血性患者;n = 26 名出血性患者;中位数中风后间隔 28 天(四分位数间距,IQR,24-42)],他们使用 Welwalk 接受了中位数为 3 周(IQR,2-4)的 RAGT 训练,随后接受了常规训练(中位数,129 天;IQR,114-146)。主要结果是功能独立性测量(FIM)--步行项目得分从 RAGT 前到 RAGT 后的变化(FIM-步行效率)。次要结果是出院时的 FIM 步行得分。自变量包括 RAGT-CT 和 RAGT 前的感觉运动功能(下肢(LE)运动和感觉评分以及卒中损伤评估集(SIAS)和伯格平衡量表(BBS)中的躯干功能)和认知功能(FIM-认知、MMSE 和认知相关行为评估),以及 RAGT 每次治疗的剂量持续时间、第 1 周的总步数和跑步机平均速度以及治疗次数。)我们首先确定了每个自变量与治疗师决定的 RAGT 结束时的 FIM 步行效率以及出院时的 FIM 步行得分之间的二元相关性。层次多元回归显示,只有 FIM 认知评分能显著预测 RAGT 结束时的 FIM 步行效率(β = 0.47; P.
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引用次数: 0
Intrathecal baclofen for the management of hereditary spastic paraparesis: a systematic review. 鞘内巴氯芬治疗遗传性痉挛性截瘫:系统综述。
IF 1.5 4区 医学 Q3 REHABILITATION Pub Date : 2024-03-01 Epub Date: 2024-01-20 DOI: 10.1097/MRR.0000000000000607
Luisa Viana Pinto, Isabel Romeiro, Filipa Gouveia, Joana Ramalho, Sara Ribeiro Silva, Maria Inês Táboas Simões, Joana Rodrigues Leal

This systematic review aims to evaluate the use of intrathecal baclofen (ITB) for hereditary spastic paraparesis (HSP) treatment. An extensive search in two electronical databases was performed. We identified articles published between 1990 and 2022 (PubMed, Scopus), and applied the following inclusion criteria: diagnosis of HSP at the time of the intervention, either familial or sporadic; report on the effect of ITB in patients with HSP; test trial via either bolus injections or continuous infusion tests; and ITB pump implantation. A data extraction sheet based on the Cochrane Consumers and Communication Review Group's data extraction template was created and adapted to collect relevant data. A qualitative analysis was performed to present the results in narrative summary fashion. A total of 6 studies met our inclusion criteria. 51 patients with HSP had a pre-implantation ITB trial. The time since the diagnosis until the pump implantation ranged from 5 to 30 years. The initial bolus ranged from 20 to 50 μg and the mean doses used at steady state ranged from 65 to 705 μg. An improvement in spasticity was observed on the modified Ashworth Scale in patients treated with ITB. Although all studies reported a subjective gait improvement, not all found an objective improvement in gait. The most common side effect reported was catheter-related problems. The findings of this review support the use of ITB as an effective and a viable option for the treatment of spasticity in HSP refractory to conservative therapies.

本系统综述旨在评估鞘内巴氯芬(ITB)在遗传性痉挛性截瘫(HSP)治疗中的应用。我们在两个电子数据库中进行了广泛的检索。我们确定了 1990 年至 2022 年间发表的文章(PubMed、Scopus),并采用了以下纳入标准:干预时诊断为 HSP(家族性或散发性);关于 ITB 对 HSP 患者疗效的报告;通过栓剂注射或连续输注测试进行的试验;以及 ITB 泵植入。我们根据 Cochrane 消费者与沟通审查小组的数据提取模板制作并调整了数据提取表,以收集相关数据。我们进行了定性分析,以叙述总结的方式呈现结果。共有 6 项研究符合我们的纳入标准。51 名 HSP 患者接受了植入前 ITB 试验。从确诊到植入泵的时间从 5 年到 30 年不等。初始栓塞剂量从 20 微克到 50 微克不等,稳态时的平均剂量从 65 微克到 705 微克不等。根据改良的阿什沃斯量表,接受 ITB 治疗的患者痉挛状况有所改善。虽然所有研究都报告了主观步态的改善,但并非所有研究都发现了客观步态的改善。最常见的副作用是导管相关问题。本综述的研究结果支持使用 ITB 作为治疗保守疗法难治的 HSP 痉挛的一种有效且可行的方法。
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引用次数: 0
Editorial: message from the new Editor-in-Chief. 社论:新主编的致辞。
IF 1.7 4区 医学 Q2 Medicine Pub Date : 2024-03-01 Epub Date: 2024-01-06 DOI: 10.1097/MRR.0000000000000615
Dobrivoje S Stokic
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引用次数: 0
Reliability of the Montreal Cognitive Assessment in people with stroke. 蒙特利尔认知评估在中风患者中的可靠性。
IF 1.7 4区 医学 Q2 Medicine Pub Date : 2024-03-01 Epub Date: 2024-01-06 DOI: 10.1097/MRR.0000000000000612
Hiu-Ying Lau, Yi-Hung Lin, Keh-Chung Lin, Yi-Chun Li, Grace Yao, Chih-Yu Lin, Yi-Hsuan Wu

This study examined the relative and absolute reliability of the Taiwanese version of the MoCA (MoCA-T) in people with stroke. The study recruited 114 individuals who were at least 3 months after the onset of a first-ever unilateral stroke. The MoCA-T was administered twice, at a 6-week interval, to all participants. The relative reliability was assessed using the intraclass correlation coefficient (ICC), and the absolute reliability was assessed using standard error of measurement (SEM), the smallest real difference (SRD), the SRD percentage, and the Bland-Altman method. The ICC analysis showed the MoCA-T was highly reliable (ICC = 0.85). The absolute reliability was between an acceptable and excellent level, where the SEM and the SRD at the 95% confidence interval were 1.38 and 3.83, respectively. The Bland-Altman analyses showed no systematic bias between repeated measurements. The range of the 95% limits of agreement was narrow, indicating a high level of stability over time. These findings suggest that the MoCA-T has high agreement between repeated measurements without systematic bias. The threshold to detect real change stands between an acceptable and excellent level. The MoCA-T is a reliable tool for cognitive screening in stroke rehabilitation.

本研究考察了台湾版 MoCA(MoCA-T)在脑卒中患者中的相对和绝对可靠性。研究招募了 114 名首次单侧脑卒中发病至少 3 个月后的患者。对所有参与者进行了两次 MoCA-T,每次间隔 6 周。相对可靠性采用类内相关系数(ICC)进行评估,绝对可靠性采用测量标准误差(SEM)、最小实际差异(SRD)、SRD 百分比和布兰德-阿尔特曼法进行评估。ICC 分析表明,MoCA-T 具有高度可靠性(ICC = 0.85)。绝对可靠度介于可接受和优秀之间,在 95% 置信区间内的 SEM 和 SRD 分别为 1.38 和 3.83。布兰-阿尔特曼分析表明,重复测量之间没有系统性偏差。95%的一致性界限范围较窄,表明随着时间的推移稳定性较高。这些结果表明,MoCA-T 在重复测量之间具有很高的一致性,没有系统性偏差。检测实际变化的阈值介于可接受水平和优秀水平之间。MoCA-T 是脑卒中康复认知筛查的可靠工具。
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引用次数: 0
Cognitive status and sleep quality can explain the fear of falling and fall history in people with Parkinson's disease. 认知状态和睡眠质量可以解释帕金森病患者对跌倒的恐惧和跌倒史。
IF 1.7 4区 医学 Q2 Medicine Pub Date : 2023-12-01 Epub Date: 2023-08-15 DOI: 10.1097/MRR.0000000000000596
Nesreen Alissa, Reem Rehan, Alham Al-Sharman, Mariem Latrous, Ala' S Aburub, Khalid El-Salem, Linzette Morris, Hanan Khalil

Fear of falling (FOF) is highly prevalent in people with Parkinson's disease (PwPD) and contributes to high fall risk. Studies reporting on the relationship between falls, FOF, and non-motor factors such as cognitive function and sleep quality in Parkinson's disease are limited. This study aimed to investigate (1) the relationship of cognitive function and sleep quality with FOF, and history of falls in PwPD; (2) differences in cognitive function and sleep quality between Parkinson's disease fallers and non-fallers; and (3) a cut-off score for cognitive function and sleep quality to discriminate Parkinson's disease fallers from non-fallers. Fifty PwPD were assessed for FOF [Falls Efficacy Scale-International (FES-I)], cognition [Montréal Cognitive Assessment (MOCA)], sleep quality [Pittsburgh Sleep Quality Index (PSQI)], and falls history. The MOCA is significantly associated with FES-I scores ( R2  = 0.429, P  < 0.0001). Both MOCA ( P  = 0.012) and PSQI ( P  = 0.027) were associated with falls history even after adjusting for confounding factors (age, sex, L-dopa use, Parkinson's disease severity). Both MOCA and PSQI scores were able to distinguish fallers from non-fallers with cut-off scores of 15.5 and 7.5, respectively. Although our findings revealed that both cognitive function and sleep quality are important factors influencing falls and FOF in PwPD, it remains to be determined if addressing cognitive impairments and poor sleep quality may favorably impact balance before integrating such screenings into fall prevention programs.

对跌倒的恐惧(FOF)在帕金森病(PwPD)患者中非常普遍,并导致高跌倒风险。关于帕金森病患者跌倒、FOF和认知功能和睡眠质量等非运动因素之间关系的研究报道有限。本研究旨在探讨(1)认知功能和睡眠质量与PwPD患者FOF和跌倒史的关系;(2) 帕金森病跌倒者和非跌倒者认知功能和睡眠质量的差异;以及(3)认知功能和睡眠质量的临界分数,以区分帕金森病患者和非患者。对50名PwPD进行了FOF[国际跌倒疗效量表(FES-I)]、认知[蒙特利尔认知评估(MOCA)]、睡眠质量[匹兹堡睡眠质量指数(PSQI)]和跌倒史评估。MOCA与FES-I评分显著相关(R2 = 0.429,P
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International Journal of Rehabilitation Research
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