International Journal of Rehabilitation Research最新文献

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.

Objective: This study aimed to investigate the improvements of functional independence following inpatient rehabilitation and compare those improvements between different levels and severities of Spinal Cord Injury (SCI). Prognostic factors affecting the patient's outcomes were also studied.

Settings: Rofeideh Rehabilitation Hospital.

Outcome measures: Spinal Cord Independence Measure version III (SCIM III), and Functional Independence Measure (FIM).

Method: In this retrospective cohort study, 180 patients with SCI were enrolled to record their functional independence upon admission and discharge, and the changes were compared between different levels and severities of injury using non-parametric tests. The prognostic factors of outcomes were studied by generalized estimating equation (GEE) analysis.

Results: The independence changes were significant for all the severities (American Spinal Injury Association Impairment Scale (AIS)) and levels of injury except for the patients with AIS A and B at upper cervical levels (P < 0.05). The level of injury, AIS, Length of Stay (LOS), and pressure ulcer had a significant prognostic value on patient's outcomes. Furthermore, there was a significant difference between different levels of injury with the same AIS grade in functional improvement (P < 0.05), while there was a significant difference between AIS groups with the same level of injury only at upper and middle cervical lesions (P < 0.05).

Conclusion: Recording the values of functional independence before and after rehabilitation in individuals with SCI can help clinicians approximately expect the outcomes of future patients. Moreover, a deeper study of the prognostic factors can provide a more logical expectation of rehabilitation outcomes.

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.

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.

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.

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.

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.

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.

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.