International Journal of Rehabilitation Research最新文献

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.

Physical activity (PA) is recommended as a primary treatment to reduce pain and improve function in chronic low back pain (cLBP). However, adherence to PA guidelines and the limitation of sedentary behavior (SB) remain challenging for cLBP patients. While some studies focus on PA promotion, past results are mixed, and the role of SB has not been thoroughly investigated. This observational study aims to assess changes in PA and SB levels among cLBP patients participating in a rehabilitation program (RP) and explore related changes in both explicit and implicit motivational factors. Patients wore an accelerometer for 1 week before the RP (T1) and 3 months afterward (T4) to measure PA and SB. At the start (T2) and at the end (T4) of the RP, we measured motivation, including implicit attitudes, toward these two behaviors. Between T1 and T4 ( n  = 33), the results show a significant decrease in SB. Between T2 and T3 ( n  = 62), all motivational variables were significantly more in favor of an active lifestyle, but implicit attitudes did not significantly change. This study shows that an RP can transform behavior determinants and reduce SB but is less efficient to increase PA levels. It also emphasizes the need to work with patients to enhance adherence and objectively measure behaviors in the future.

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.

Background: Physical activity (PA) is recommended as a primary treatment to reduce pain and improve function in chronic low back pain (cLBP). However, adherence to PA guidelines and the limitation of sedentary behavior (SB) remain challenging for cLBP patients. While some studies focus on PA promotion, past results are mixed, and the role of SB has not been thoroughly investigated.

Objective: This observational study aims to assess changes in PA and SB levels among cLBP patients participating in a rehabilitation program (RP) and explore related changes in both explicit and implicit motivational factors.

Methods: Patients wore an accelerometer for 1 week before the RP (T1) and 3 months afterward (T4) to measure PA and SB.

Results: At the start (T2) and at the end (T4) of the RP, we measured motivation, including implicit attitudes, toward these two behaviors. Between T1 and T4 (n = 33), the results show a significant decrease in SB. Between T2 and T3 (n = 62), all motivational variables were significantly more in favor of an active lifestyle, but implicit attitudes did not significantly change.

Conclusion: This study shows that an RP can transform behavior determinants and reduce SB but is less efficient to increase PA levels. It also emphasizes the need to work with patients to enhance adherence and objectively measure behaviors in the future.

The secondary prevention benefits of cardiac rehabilitation and similar exercise classes for stroke survivors are well established, however post-stroke exercise participation remains low. This research aimed to explore the factors affecting participation and engagement in UK-based post-stroke cardiac rehabilitation and exercise, from the perspective of the service user and service provider. An exploratory study, using semi-structured interviews, was conducted ( n  = 8, service user = 4), adopting a phenomenological approach. All interviews applied a topic guide informed by the Health Belief Model and the International Classification of Functioning, Disability and Health, and were analysed using inductive thematic analysis. Post-stroke cardiac rehabilitation and exercise participation was influenced by numerous factors, encompassed into three themes: Accessibility (describing the environmental pre-class limiting factors), Programme Structure (valuing in-class supervision, socialisation and adaptations) and Patient Characteristics (encompassing the influence of the service user's personality and experiences). Effective secondary prevention of stroke through cardiac rehabilitation and other exercise-based rehabilitation requires policy development and commissioning to ensure appropriate delivery. Further research should determine the feasibility of novel exercise class formats, in addition to larger trials investigating their clinical benefit and cost effectiveness.

The objective of this study was to further validate the Goal Processing Scale (GPS), an ecologically valid functional assessment of executive functioning requiring planning and executing a complex goal. Veterans (N = 69, mean age = 44.5 years) with a history of chronic mild traumatic brain injury and self-reported cognitive difficulties completed the GPS and neuropsychological measures of working memory, sustained attention, mental flexibility, inhibition, and memory during participation in one of three studies. Associations between overall GPS performance and composite neuropsychological measures of attention/executive functioning and memory were significant and medium-to-large in magnitude. Associations of similar magnitude also emerged between subcomponents of the GPS (e.g. self-monitoring, attentional switching, attention maintenance) and neuropsychological subdomains (e.g. mental flexibility, inhibition, working memory). Results suggest that the GPS facilitates structured assessment of goal-directed performance requiring integration of multiple executive functioning subdomains. The GPS may be valuable in assessing and predicting real-world functional difficulties not captured by traditional neuropsychological assessment.

We investigated the potential to improve motor learning and performance in people with multiple sclerosis (PwMS) with OPTIMAL theory conditions. OPTIMAL theory predicts that three main factors [i.e. autonomy support (AS), enhanced expectancies (EE), and external focus (EF)] facilitate performance and learning. We examined whether the implementation of all three combined in a consecutive manner during practice would be beneficial for the motor learning and performance in a clinical population facing physical, cognitive, and emotional challenges. Thirty PwMS with mild-to-moderate disability (Expanded Disability Status Scale = 2.0-5.0) were randomly assigned to one of two groups (optimized and control) and practiced a novel motor-cognitive task involving rapid square-stepping to memorized patterns. Following a pretest (no group difference), optimized group participants practiced under each of three factors across practice phase (EE: feedback after good trials; AS: choice of mat color; and EF: external focus to the mat). Control group participants practiced under neutral conditions. The optimized group had significantly shorter movement times than the control group in the practice phase [174.7 (27.4) s vs. 236.8 (35.8) s, P  < 0.0001], on the 24-h retention test [69.3 (9.3) s vs. 159.7 (15.5) s, P  < 0.0001], and the 24-h transfer test [146.1 (14.9) s vs. 223.1 (38.9) s, P  < 0.0001]. Thus, optimized practice combining AS, EF, and EE enhanced motor skill learning. Key factors in the OPTIMAL theory can be used to improve patients' motor learning. Further studies are warranted to extend these proof-of-concept observations for potential clinical applications.

This study determined the characteristics of the phase angles (PhAs) of the trunk, affected limb, and unaffected limb at admission and their relationship with walking ability at discharge in patients with stroke and traumatic brain injury in a convalescent rehabilitation ward. Stroke and traumatic brain injury survivors with hemiplegia admitted to a convalescent rehabilitation ward were divided into independent- and dependent-walking groups. The trunk, affected limb, and unaffected limb PhAs were evaluated using bioelectrical impedance analysis and compared between the independent- and dependent-walking groups. Friedman's test was performed to analyze differences in the trunk, affected limb, and unaffected limb PhAs within each group. Multiple regression was performed to examine the association between walking ability and segmental PhAs. We enrolled 47 patients (independent-walking group: n  = 12; dependent-walking group: n  = 35). The dependent-walking group had a significantly lower trunk, affected limb, and unaffected limb PhAs. The segmental PhA was higher in the trunk than in the affected and unaffected limbs in the independent-walking group and lower in the affected limb than in the trunk and unaffected limb in the dependent-walking group. Only the trunk PhA at admission was significantly associated with walking ability at discharge ( β = 0.367; P  = 0.002). The trunk PhA at admission may be related to walking ability at discharge in patients undergoing stroke and traumatic brain injury rehabilitation.

Acute inpatient rehabilitation is crucial for improving mobility and balance for individuals with stroke. A potentially important factor in the recovery of mobility and balance is cognition. The purpose of this study was to determine the effect of cognition on mobility and balance in acute stroke rehabilitation. This was a longitudinal cohort study based on an inpatient rehabilitation unit at a large academic medical center. Participants were individuals with stroke admitted to acute rehabilitation after an acute care hospital stay ( N  = 281). Demographic data and predictor variables were collected on admission to the unit. Outcomes were collected at discharge from the unit. Multiple regression analyses were used to determine the associations between cognition (Montreal Cognitive Assessment) on mobility (Functional Independence Measure mobility subscale) and balance (Berg Balance Scale). Subtests from the Montreal Cognitive Assessment were also examined to determine if specific dimensions of cognition could predict balance after controlling for covariates. Dominance analysis was used to determine the relative importance of baseline predictors. In separate models, cognition was a significant predictor of mobility ( B  = 0.19) and balance ( B  = 0.28) at discharge after adjusting for admission mobility and balance, as well as age, sex, and length of stay. The most important predictors in both models were baseline mobility and balance, but cognition contributed to the models independently of baseline scores. Cognition was generally more important than age and sex while about equally important as length of stay. In separate models, the visuospatial/executive ( B  = 0.42) and the delayed recall ( B  = 0.37) subtests were also significant predictors of mobility. The models' most important predictors were baseline mobility and balance scores. Cognition is a clinically relevant predictor of mobility and balance in acute stroke rehabilitation. Specific dimensions of cognition, such as executive function, visuospatial function, and delayed recall, may be especially important. Cognitive challenges and meta-cognitive strategies should be included in mobility and balance tasks when possible. Studies that evaluate the efficacy of dual-task training and meta-cognitive approaches are needed.