International Journal of Rehabilitation Research最新文献

Direct skeletal fixation (DSF) involves attaching the intramedullary portion of a prosthesis directly to the skeletal residuum, providing an alternative for amputees unable to mobilise with socket-based prostheses. This study investigates the effects of DSF on physical and mental health at 6- and 8-year follow-up for military bilateral transfemoral amputees in the UK. Eight male bilateral transfemoral military amputees who underwent implantation with the Osseointegration Group of Australia-Osseointegration Prosthetic Limb prosthesis consented to participate in the study. All patients are routinely reviewed annually in a dedicated clinic, and this paper reports the 6- and 8-year follow-ups. Patient-reported outcomes were assessed using the Short Form Health Survey (SF-36). Complications data were recorded at the 8-year follow-up. The SF-36 physical component score significantly increased from preoperative levels at 6 years (median: 29 vs. 47; P = 0.003) and 8 years (median: 29 vs. 45; P = 0.024). The SF-36 mental health component score improved significantly at 6 years from preop (median: 39 vs. 57; P = 0.011). Among 16 femoral residuums, there was one explantation because of infection at 8.5 years postimplantation, and two cases were managed with long-term suppressive antibiotics. A total of 17 additional procedures were performed on nine residuums: 11 for soft tissue revision, five for infection, and one for fracture repair. This research adds to the growing evidence base that DSF has the potential to enhance the health and well-being of amputee veterans and potentially the broader amputee population. Medical complications remain an important consideration.

Quick Disability of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) is commonly used in carpal tunnel syndrome, while the knowledge on its psychometrics in this disorder is limited. The objective of this study was to explore the internal consistency, factor structure, and floor/ceiling effect of QuickDASH among patients with carpal tunnel syndrome. This was a retrospective cross-sectional register-based study among 1597 patients with electromyography-confirmed carpal tunnel syndrome. The internal consistency was assessed using Cronbach's α . Exploratory factor analysis was used to evaluate factor structure. Of 1597 respondents, 896 (56%) were women. The average age was 55.0 (16.3) years. The mean QuickDASH score was 38 (23.2) points. QuickDASH demonstrated an excellent internal consistency with α of 0.92 (95% confidence interval: 0.92-0.93). Exploratory factor analysis demonstrated unidimensionality. Item loadings were moderate to substantial for all 11 items, varying from 0.55 to 0.83. A significant floor effect was observed for nine of 11 items varying from 20 to 51%. A ceiling effect was observed for one item (#6 'recreational activities'). Despite its significant floor effect, QuickDASH can be recommended as a valid and reliable scale to assess the severity of disability caused by carpal tunnel syndrome.

Valgus knee orthosis is a common conservative treatment for medial compartment knee osteoarthritis (OA), though its efficacy in diverse socioeconomic and cultural contexts remains understudied. This investigation evaluated the short-term effects of a valgus knee orthosis on knee OA patients from a developing country, while monitoring adherence, to address this gap in the literature. The study included 35 participants with radiographically confirmed OA (Kellgren-Lawrence grades 2-3). The Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index tool was used to assess participants. All participants utilized the Össur Unloader One orthosis, which was equipped with an integrated activPAL sensor to monitor adherence during a 2-week intervention period. WOMAC index demonstrated statistically significant improvement, with mean scores decreasing from 0.67 (0.15) to 0.42 (0.18) at 1 week ( P  < 0.001) and to 0.32 (0.16) at 2 weeks ( P  < 0.001) of wearing the orthosis. Notably, after 2 weeks, 86% of participants exceeded established minimal clinically important difference thresholds. ActivPAL data for adherence revealed a significant positive correlation between brace wearing time and clinical improvement ( P  = 0.008), with participants achieving ≥8 h daily wear time exhibiting the best outcomes (51% improvement in WOMAC index). The findings shed light on the possible usefulness of valgus knee orthosis in controlling symptoms of knee OA patients from resource-variable settings with unique cultural habits (i.e. kneeling and floor-sitting behaviors) while highlighting the critical role of adherence monitoring.

The association between device-based (activPAL) and self-reported [Incidental Exercise and Planned Exercise Questionnaire (IPEQ)] measures of physical activity has not been investigated. This study aimed to determine the association between activPAL and IPEQ measures of physical activity in a sample of community-dwelling older people after stroke. Data from an exploratory analysis embedded within a randomized trial was used. Spearman correlation was used to assess the relationship between activPAL (upright time and step count) and IPEQ (self-reported total exercise time) measures at three timepoints [months 0 ( n  = 46), 6 ( n  = 39) and 12 ( n  = 36)] Strong Spearman correlation between upright time and self-reported total exercise time ( r  = 0.51-0.72) and step count and self-reported total exercise time was found at all timepoints ( r  = 0.54-0.62). Though further research could confirm these results in a larger sample, there is potential for the IPEQ to be used as a simple estimate of physical activity in a clinical setting.

We investigated if preinjury perceived social support moderated the association between pre- and postinjury functional status after hip fracture in older adults. Using data from the longitudinal Health and Retirement Study (biennial interviews from 1998 to 2018), we analyzed perceived social support measured preinjury and functional status [activities of daily living (ADL) or instrumental activities of daily living (IADL) limitations] measured at pre- and postinjury interviews. Among 709 respondents, 61% anticipated social support from friends or family if they required future assistance with personal care, 16% had difficulty with ADL preinjury, and 9% had difficulty with IADL preinjury. Among 1697 postinjury follow-up interviews (mean follow-up time: 2.8 years), ADL limitations and IADL limitations were reported in 752 and 683 interviews, respectively. During follow-up, any preinjury IADL limitations were associated with more postinjury IADL limitations among people without social support [adjusted incidence rate ratio (aIRR): 2.505, 95% confidence interval (CI): 1.765-3.555] but not among people with preinjury perceived social support (aIRR: 1.355, 95% CI: 0.950-1.940, interaction P  = 0.016). Any preinjury ADL limitations were associated with more postinjury ADL limitations among people with (aIRR: 1.471, 95% CI: 1.124-1.925) or without (aIRR: 2.084, 95% CI: 1.563-2.778) preinjury perceived social support. Preinjury perceived social support moderates the association between pre- and postinjury functional status in older adults experiencing a hip fracture. Older adults experiencing pre-existing IADL limitations without social support are at high risk for continued or increased activity limitations.

Caring for a child with cerebral palsy (CP) is challenging and can significantly impact caregivers' quality of life. This study aimed to examine the psychological state, perceived social support, and quality of life of parents of children with CP in Benin, West Africa. This cross-sectional, case-control design included 50 parents of children with CP (mean age 39.4 ± 8.3 years, 46 mothers) paired with 58 parents of typically developing children (mean age 38.1 ± 7.4 years, 52 mothers) as controls. Both groups completed the Social Provisions Scale (SPS-10), Patient Health Questionnaire-9 (PHQ-9), and Medical Outcome Study Short Form (SF-12) to assess social support, depression, and quality of life. Additionally, parents of children with CP completed the Impact on Family Scale to evaluate caregiving burden. The results showed that parents of children with CP reported lower social support and higher depression levels than controls ( P  < 0.05). However, their quality of life (both physical and mental scores) was similar to the control group ( P  > 0.05). Only depression was significantly linked to lower quality of life ( P  < 0.05) in parents of children with CP. In conclusion, parents of children with CP have a comparable physical and mental health-related quality of life to parents of typically developing children, despite experiencing lower perceived social support and higher levels of depression in Benin country. These findings underscore the need for enhanced social and psychological support systems to improve the well-being of families caring for children with CP in such environments.

The aim of this study was to determine the validity and reliability of the 10-meter walk test modified by adding 5 and 17 cm obstacles (10MWT-O) in community-dwelling older adults and to examine its ability to differentiate between older and younger adults. The study included 65 older adults and 55 younger adults. 10MWT-O (obstacle height: 0, 5, 17 cm) was performed on two different days (day 1 and day 2). All participants were assessed by the same assessor on days 1 and 2. Berg Balance Scale (BBS), Time Up and Go (TUG) test, Mini Mental State Test, and Functional Reach Test (FRT) assessments were performed on day 1. 10MWT-O speed for all obstacle heights showed moderate to good correlations with FRT distance ( r  = 0.474-0.539, P  < 0.001), TUG Test time ( r  = -0.722 to -0.671, P  < 0.001), and BBS score ( r  = 0.619-0.660, P  < 0.001). Test-retest reliability (intraclass correlation coefficient = 0.924-0.960) was found to be within the excellent range for 10MWT-O speed across all obstacle heights. For obstacle heights of 0, 5, and 17 cm, the minimum detectable change for 10MWT-O speed was 0.16, 0.19, and 0.20 m/s, and the optimal cutoff values for differentiating older from young adults were 1.12, 0.98, and 0.85 m/s, respectively. The 10MWT-O is a reliable and valid clinical measure for assessing walking ability and adaptability in older adults. ClinicalTrials.gov identifier: NCT06307769.

The purpose of this study was to evaluate the separate effects of tactile stimulation (TS) and transcutaneous electrical nerve stimulation (TENS), combined with occupational therapy (OT) and physiotherapy (PT), on sensory-motor recovery in the upper limb of patients with stroke. Thirty-six patients were randomly assigned to three groups (mean age: TS group = 60.7, TENS group = 54.1, control group = 52.2 years). The average onset time was 9.7 months for the TS group, 11.1 months for the TENS group, and 10.2 months for the control group. Participants underwent a 2-week intervention provided in addition to standard OT and PT. The TS group received coarse sand stimulation (rubbing) over the affected hand and forearm for 15 min per session. The TENS group underwent electrical stimulation applied to the affected forearm for 30 min per session (10 Hz), while the control group received sham stimulation with 1 min of active current. Hand function was assessed with the Semmes-Weinstein monofilaments and grip strength, dexterity with the box and block test and Southampton hand assessment procedure, and performance in daily activities with the assessment of motor and process skills. In the TS group, patients significantly improved hand sensory perception, grip strength, and dexterity while the TENS group showed improvement in grip strength and dexterity. The control group exhibited no significant changes. Between-group comparisons revealed significant differences favoring TS for hand sensory perception and TENS for dexterity. These findings suggest that adding TS or TENS to OT and PT may enhance sensory-motor recovery after a stroke.

While botulinum toxin injections (BTX-A) have been long used to treat myofascial pain (MFP) in the neck and shoulder region, the evidence of its effectiveness remained unclear. Thus, we aimed to examine the existing evidence on the efficacy of BTX-A injections for reducing MFP in the neck and shoulder areas. This was a systematic review of Medline, Embase, Cinahl, Scopus, and Central databases. Only randomized controlled trials were included. Random effects meta-analysis with effect size index as weighted mean difference (WMD) was applied. The search resulted in 100 records, of them seven were considered relevant and included in the meta-analysis. In total, the data from 261 patients were analyzed. Five trials focused on entire neck/upper back and shoulder pain, one on the infraspinatus muscle and one on the trapezius muscle. The dose of BTX-A varied from 20 to 400 UI. The risk of systematic bias was high for three trials and low for four trials. The pooled WMD was statistically significant [-10.22 (95% confidence interval (CI) -12.77 to -7.68)] on a scale from 0 to 100 in favor of BTX-A over sham. However, the difference was not clinically significant. Also, the meta-regression coefficient was insignificant [-0.01 (95% CI -0.04 to 0.02)]. The overall quality of evidence was moderate. In conclusion, there is moderate evidence that BTX-A injections are not more effective than saline injections to treat MFP in the neck and shoulder region. The effect of BTX-A did not exceed the level of clinical significance. So far, BTX-A cannot be recommended for clinical use when dealing with MFP in the neck and shoulder.

Spondylodiscitis is a life-threatening neurological condition that, if not diagnosed early, can lead to severe complications, including progressive neurological deterioration. Diagnosis involves clinical evaluation, imaging, and microbiological testing. Delayed recognition, advanced age, virulent pathogens, and comorbidities increase the risk of poor outcomes. We report the case of a middle-aged male with diabetes, hypertension, and chronic kidney disease who developed noncontiguous multifocal spondylodiscitis. Initially presenting with progressive neck pain and urinary tract infection, his condition worsened over 3 months, resulting in lower limb weakness, bladder and bowel dysfunction, and quadriparesis. MRI spine revealed spinal infections at multiple levels and extended-spectrum beta-lactamase Escherichia coli in cultures. He underwent meropenem treatment, surgical decompression, and spinal fusion. Despite C6 quadriparesis, intensive rehabilitation enabled him to walk with assistance and achieve partial independence in daily activities within 6 months. This case underscores the necessity of early diagnosis, proper management, and long-term rehabilitation for optimal recovery.