International Journal of Rehabilitation Research最新文献

The purpose of this review was to examine the effects of hip muscle botulinum toxin injections for the treatment of hip instability reported in studies of children with cerebral palsy. Searches in PubMed , CINAHL , and Web of Science were performed using the term hips combined with botulinum toxin and its various abbreviations and brand names. Reference lists and citations of the reviewed studies were also searched. Nine studies were reviewed: two randomized controlled trials plus a subsequent long-term follow-up of one of them, and six nonrandomized studies of interventions with two including comparison group(s) and four being single group pre-post studies. Hip adductors were injected in all studies with other hip muscles added in most cases. The outcome measure analyzed was the change in migration percentage defined as postinjection minus preinjection migration percentage with the recommendation of a change of ±10% indicating a true change. Only two studies reported a change exceeding this criterion. One randomized controlled trial demonstrated a 10.4% improvement in the botulinum toxin-treated group, which was statistically significantly greater than a 2.95% worsening in the comparison group. Additionally, a preliminary study of five participants found a statistically significant median change of ≥10% at two of the eight follow-up time points. Therefore, the results of most studies showed neither postinjection improvement nor worsening of this magnitude. The low level of rigorousness of the reviewed studies suggests that any of the results should be viewed cautiously.

Cardiac rehabilitation (CR) is a cornerstone of heart disease (HD) management, enhancing functional capacity and quality of life. Hybrid cardiac rehabilitation (hCR), combining supervised center-based sessions with synchronous, real-time telerehabilitation at home, offers an alternative to conventional CR to overcome logistical barriers such as facility limitations, distance, and pandemic-related disruptions. This randomized controlled trial evaluated the noninferiority of hCR compared to standard CR in improving functional capacity in patients with chronic heart disease, including those with stable coronary artery disease. Seventy-five participants were randomized into two groups: the CR group, with exclusively center-based sessions, and the hCR group, with synchronous tele-rehabilitation sessions at home complemented by center-based sessions. Functional capacity was assessed using cardiopulmonary exercise testing, the six-minute walk test, and the wall squat test. Both groups showed significant improvements in functional outcomes, including walking distance (six-minute walk test), strength capacity (wall squat test), and cardiopulmonary exercise testing performance ( P  < 0.001). The improvements in the hCR group were statistically noninferior to those in the CR group. These findings demonstrate that hCR provides an effective alternative to conventional CR while addressing practical challenges in access to care. The hCR protocol represents a viable solution for expanding rehabilitation options without compromising outcomes, particularly for patients facing logistical constraints or during emergencies such as pandemics.

Approximately 10% of patients experience persistent symptoms following COVID-19, known as long-COVID syndrome. This cross-sectional study explored factors of quality of life (QoL) in 53 long-COVID patients. QoL was measured using the World Health Organization-Five Well-Being Index, fatigue with the Fatigue Visual Analogue Scale, and psychological health with the Depression-Anxiety-Stress-21 questionnaire. Six neuropsychological tests assessed information processing speed, verbal memory, visual memory, working memory, attention, language, fluency, recall, and visuospatial function with a composite score calculated by averaging z scores. Patients (76% female, mean age: 54.1 years) were assessed 8.7 months postinfection. Cognitive impairment, present in 49% of the sample, was not associated with QoL. In multiple linear regression, gender, fatigue, and psychological distress accounted for 42% of QoL variance, with fatigue and distress contributing 7% and 11%, respectively. Further studies are needed to determine if fatigue and psychological distress are causally related to QoL in long-COVID and could be treatment targets.

Acquired brain injuries can profoundly impact executive functioning, yet traditional neuropsychological assessments often have limitations, such as being time-intensive, lacking ecological validity, or failing to engage patients effectively. To address these challenges, CCRacer, a serious game, was developed as a novel tool for assessing executive functions in clinical populations. This study evaluated the convergent and discriminant validity of CCRacer by applying it alongside established neuropsychological tests to a sample of 78 participants with acquired brain injury. Results revealed varying levels of convergent validity across tasks, with stronger correlations for measures of working memory (0.28-0.51) and planning (-0.46 to 0.34) and weaker correlations for inhibitory control (0.22). These findings suggest that CCRacer has the potential as a complementary tool in the neuropsychological assessment of an acquired brain injury, combining engaging and ecologically valid testing with the possibility of future use in cognitive training.

Mild traumatic brain injury (mTBI) can lead to lasting adverse outcomes, including post-traumatic stress disorder (PTSD) or post-traumatic stress symptoms (PTSS). This study examined whether PTSD and PTSS can occur even after mTBI and tracked the evolution of PTSD in the long term. A total of 85 youth post-mTBI (median age: 10.00, 25-75th percentile: 8.50-2.62; 24% girls) and their mothers participated in this study. Assessments included PTSS/PTSD, postconcussion symptoms, loss of consciousness status, child's anxiety, and maternal mental health, both shortly after mTBI (T1) and 1 year later (T2). Changes in PTSS scores from T1 to T2 were evaluated using the Wilcoxon test. T2 PTSS evolution was evaluated using correlations and partial correlations. To evaluate PTSD recovery trajectories, the percentage of youth in four recovery trajectories (chronic, delayed, recovery, and resilience) was calculated. Results showed a significant decrease in PTSS and PTSD rates from T1 (34%) to T2 (21%). PTSS at T2 was associated with PTSS and postconcussion symptoms at T1. After accounting for the child's sociodemographic and clinical characteristics, the child's self-reported PTSS at T1, along with self-reported postconcussion symptoms and symptom intensity, showed significant correlations with PTSS at T2 ( r  = 0.60, 0.32, and 0.37, respectively; P  < 0.05). Most youth fell into the 'resilient' (40%) or 'recovery' (35%) groups, with only 6% showing 'delayed' recovery. One year after mTBI, 20% of the youth still experienced PTSD. In conclusion, this study highlights the need for long-term monitoring of youth after mTBI, as a notable proportion continue to experience enduring PTSD or PTSS.

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.

Pain is the main symptom of inflammatory arthritis and it can impair physical functional performance and physical activity level. Some individuals can develop kinesiophobia and experience a vicious circle of worsening health. This study aimed to investigate the association between pain and physical functional performance/physical activity and determine whether kinesiophobia mediates this association. This was a cross-sectional study with individuals diagnosed with inflammatory arthritis (rheumatoid arthritis or spondyloarthritis) treated at a Rheumatology Outpatient Clinic. We assessed pain (Visual Analogue Scale), physical activity (International Physical Activity Questionnaire - long form), kinesiophobia (Tampa Scale for Kinesiophobia), and physical functional performance (Handgrip Strength Dynamometry, 30-second Sit-to-Stand test, Static Muscular Endurance test, and Timed Up and Go test). The mediating effect of kinesiophobia on the relationship between pain intensity and physical functional performance/physical activity was analyzed, and the significance of the mediating effect (kinesiophobia) was tested through a bootstrap approach. Thirty-three individuals with inflammatory arthritis (mean age: 48 ± 12 years) participated in the study. Kinesiophobia mediates the relationship between pain intensity and physical functional performance analyzed by the 30-second Sit-to-Stand test [indirect effect (IE)overall = -0.343, bootstrap 95% confidence interval (CI): -0.698 to -0.002] and by knee flexion at 90º of the dominant limb (IEoverall = -1.55, bootstrap 95% CI: -3.43 to -0.237). In conclusion, pain intensity can affect physical functional performance through kinesiophobia in individuals with inflammatory arthritis.

The Australian Spasticity Assessment Scale (ASAS) is a relatively new scale used to rate the severity of spasticity. Although the reliability of the ASAS has been investigated, its ability to detect a clinically important change (responsiveness) has not. The objective of this study was to investigate the responsiveness of the ASAS in adult patients with acquired brain injury-related wrist flexor spasticity treated with botulinum neurotoxin A. The responsiveness of the ASAS was assessed by the standardized response mean at the group level. At the individual level, responsiveness was assessed by the percentage of responders and nonresponders. Those who had at least a 1 grade reduction in spasticity severity were considered responders. In addition, the magnitude of the goniometric change in R1 (angle of catch response) across the responders and nonresponders was studied as a distribution of frequency. Significant improvements in R1 and ASAS were achieved with the treatment. The standardized response mean based on the ASAS grades was 1.50 with a 95% confidence interval of 1.16-1.89. At the individual level, 40 of all cases (78.4%) were responders, and 11 (21.6%) were nonresponders. Three of the 11 nonresponders (27.3%) improved R1 beyond the 10 ° margin of error (20, 50, and 50 °). In contrast, the percentage of responders who had a change within the margin of error was 27.5% (11 out of 40). Although ASAS can reveal a decrease in wrist flexor spasticity, it has some shortcomings in detecting the potentially clinically important response at the individual level.

Successful total knee replacement (TKR) heavily depends on postoperative rehabilitation. This study aims to investigate the efficacy of continuous passive motion (CPM) partially replacing group physiotherapy in an inpatient rehabilitation setting in order to contribute to the lack of physiotherapists in patients' care. Adult patients after TKR were included. A prospective randomized controlled two-center trial was conducted across inpatient rehabilitation facilities in Germany. Participants were randomly assigned to CPM or group physiotherapy. In addition, all participants received the same standard rehabilitation program. Primary outcome was the Staffelstein Score, and secondary outcome measures included Oxford Knee Score, range of motion (ROM), pain, and return to work. Non-inferiority margin for Staffelstein Score was set at ±5% of maximum scores based on previous collected data. Results indicate no significant differences between CPM and physiotherapy groups in the Staffelstein Score (CPM: 94 ± 10 points; group physiotherapy: 92 ± 10 points; P  > 0.05), ROM, or pain management at discharge from rehabilitation facility. This study underscores the potential of CPM as a valuable component of TKR rehabilitation, providing comparable outcomes to traditional physiotherapy. However, individualized physiotherapy remains integral to optimizing long-term success. Future research should explore extended follow-up periods and diverse patient populations to further elucidate CPM's role in TKR rehabilitation.

The aim of this study was to investigate the feasibility, test-retest reliability, and construct validity of the 2-min step test (2MST) in measuring aerobic exercise capacity and functional endurance in participants with anterior cruciate ligament reconstruction (ACLR). Fifty participants with quadriceps tendon autograft, bone-patellar tendon-bone graft, or hamstring autograft were included. Feasibility was assessed by the time and support required to complete the measures and the feedback from participants, including their satisfaction ratings. Test-retest reliability was assessed using the intraclass correlation coefficients (ICC2,1), a Bland-Altman plot with 95% limits of agreement (LoA), SEM, SEM%, and minimum detectable change (MDC95). The participants were assessed with the visual analogue scale (VAS), Lysholm Knee Scoring Scale, Knee Injury and Osteoarthritis Outcome Score (KOOS), stair climbing test (SCT), and 6-min walk test to assess construct validity. The test took less than 5 min to describe and perform, and participants required minimal verbal support. The satisfaction rate was notably high. The ICC2,1 was 0.98 (0.96-0.99). SEM and MDC95 were 2.96 and 8.20 (2.41-14.00), respectively. The SEM% of 2.99 was considered to be at a very good level. The Bland-Altman plot illustrates that the 2MST scores had a 95% LoA ranging from -21.52 to 2.68 steps. The SCT score and VAS rest score were found to be associated with the 2MST performance, explaining 42.5% of the variance. The 2MST is a feasible, reliable, and valid test to measure aerobic exercise capacity and functional endurance in participants with ACLR.