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Diabetic Foot Ulcer beyond Wound Closure: Clinical Practice Guideline. 伤口闭合后的糖尿病足溃疡:临床实践指南》。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-11-22 DOI: 10.1093/ptj/pzae171
Deborah M Wendland, Elizabeth A Altenburger, Shelley B Swen, Jaimee D Haan

A total of 37.3 million Americans have diabetes, and 96 million more have prediabetes. Hyperglycemia, the hallmark of diabetes, increases the risk for diabetes-related complications, including skin breakdown and cardiovascular disease. Many clinical practice guidelines exist, but there are gaps regarding the best approaches to assess physical fitness and mobility in adults with diabetes; incorporate exercise into the care plan; and reload the diabetic foot after ulcer closure has occurred to avoid ulcer reoccurrence. The purpose of this clinical practice guideline was to review and assess previously published guidelines and address gaps within the guidelines specific to the following: best screening tools/tests and interventions to prevent a future reulceration, best screening tools and interventions to assess and address mobility impairments, best tools to measure and interventions to address reduced physical fitness and activity, best approach to reloading the foot after ulceration closure and, finally, whether improvement in physical fitness will positively change quality of life and health care costs. The Guidelines Development Group performed a systematic literature search and review of the literature. A total of 701 studies were identified. Following duplicate removal and exclusion for irrelevance, 125 studies underwent full-text review and 38 studies were included. Recommendations were developed using a software assistant created specifically for guideline recommendation development. Recommendations resulted for physical fitness and activity inclusion and measurement for adults with diabetes and with or without foot ulceration. Exercise and physical activity should be prescribed according to the physiologic response of an adult with diabetes to exercise and preferences for optimizing long-term quality of life and reduce health care costs. Reloading following diabetic foot ulcer closure should include maximal offloading, especially during the first 3 months; loading should be titrated using a footwear schedule. Further research is necessary in the areas of exercise in the wound healing process and the assessment of methods to reload a newly reepithelialized ulcer to prevent recurrence.

共有 3 730 万美国人患有糖尿病,另有 9 600 万人患有糖尿病前期。高血糖是糖尿病的标志,会增加糖尿病相关并发症的风险,包括皮肤破损和心血管疾病。目前已有许多临床实践指南,但在评估成人糖尿病患者的体能和活动能力、将运动纳入护理计划以及在溃疡闭合后对糖尿病足进行再灌注以避免溃疡再次发生等方面的最佳方法仍存在空白。本临床实践指南的目的是回顾和评估之前发布的指南,并解决指南中在以下方面存在的不足:预防未来再次溃疡的最佳筛查工具/测试和干预措施;评估和解决行动障碍的最佳筛查工具和干预措施;测量和解决体能和活动减少问题的最佳工具和干预措施;溃疡闭合后重装足部的最佳方法;最后,体能改善是否会对生活质量和医疗成本产生积极影响。指南制定小组进行了系统的文献检索和文献综述。共确定了 701 项研究。在删除重复研究和排除无关研究后,对 125 项研究进行了全文审阅,并纳入了 38 项研究。使用专门为制定指南建议而开发的软件助手制定了建议。针对有或没有足部溃疡的成年糖尿病患者的体能和体育锻炼的纳入和测量提出了建议。应根据成人糖尿病患者对运动的生理反应以及优化长期生活质量和降低医疗成本的偏好来制定运动和体育锻炼计划。糖尿病足溃疡愈合后的重新负荷应包括最大限度的卸载,尤其是在最初的 3 个月;负荷量应根据穿鞋计划进行调整。有必要在伤口愈合过程中的运动以及评估重新加载新上皮化溃疡以防止复发的方法等方面开展进一步研究。
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引用次数: 0
Optimizing the Accuracy and Precision of the Minimal Detectable Change Statistic: Secondary Analysis of Test-Retest Data from the NIH Toolbox Study. 优化最小可检测变化统计量的准确性和精确度:美国国立卫生研究院工具箱研究中测试-重测数据的二次分析。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-11-22 DOI: 10.1093/ptj/pzae170
Jeremy Graber, Brian J Loyd, Thomas J Hoogeboom, Caitlin J Miller, Andrew J Kittelson

Objective: The minimal detectable change (MDC) statistic is often used by clinicians to monitor change in patients. However, the way in which the MDC is traditionally calculated might be suboptimal in terms of accuracy and precision, potentially resulting in erroneous clinical decisions. This study compared the performance of the MDC statistic as traditionally calculated to that of 2 regression-based alternatives.

Methods: This analysis used test-retest data from adults who participated in usual walking speed (n = 169) or grip strength (n = 178) assessments as part of the NIH Toolbox Study. Three approaches for MDC calculation were compared: the traditional approach (MDCTrad), simple linear regression (MDCSLR), and generalized additive models for location, scale, and shape (MDCGAMLSS). These approaches were compared in terms of accuracy and precision across all levels of measurement and separately for initial test values above and below the median.

Results: Each of the 3 approaches accurately modeled detectable change thresholds when performance was averaged across all test values. However, MDCTrad demonstrated inaccuracies when performance was considered separately for initial test values below or above the median. For walking speed, average precision improved by 12% with MDCSLR and 16% with MDCGAMLSS, compared to MDCTrad. For grip strength, average precision improved by 3% with MDCSLR and 21% with MDCGAMLSS, compared to MDCTrad.

Conclusion: MDCSLR and MDCGAMLSS appeared to more accurately and precisely model detectable change thresholds, compared to MDCTRAD. In general, MDCGAMLSS demonstrated the best overall performance in this within-sample analysis.

Impact: Improved precision and accuracy in detectable change thresholds for walking speed or grip strength might facilitate clinicians' ability to promptly detect a decline in function and intervene and to confidently detect improvements in function over time.

目的:临床医生经常使用最小可检测变化(MDC)统计来监测患者的变化。然而,传统的 MDC 计算方法在准确性和精确性方面可能不够理想,从而可能导致错误的临床决策。本研究比较了传统计算的 MDC 统计量与两种基于回归的替代方法的性能:本分析使用了作为美国国立卫生研究院工具箱研究一部分的成人测试-再测试数据,这些成人参加了通常的步行速度(n = 169)或握力(n = 178)评估。比较了三种计算 MDC 的方法:传统方法 (MDCTrad)、简单线性回归 (MDCSLR) 和位置、比例和形状的广义加法模型 (MDCGAMLSS)。对这些方法在所有测量水平上的准确度和精确度进行了比较,并分别对高于和低于中位数的初始测试值进行了比较:结果:当对所有测试值的表现进行平均时,3 种方法中的每一种都能准确模拟可检测的变化阈值。然而,当分别考虑初始测试值低于或高于中位数时,MDCTrad 表现出不准确性。在步行速度方面,与 MDCTrad 相比,MDCSLR 和 MDCGAMLSS 的平均精确度分别提高了 12% 和 16%。在握力方面,与 MDCTrad 相比,MDCSLR 的平均精确度提高了 3%,MDCGAMLSS 的平均精确度提高了 21%:结论:与 MDCTRAD 相比,MDCSLR 和 MDCGAMLSS 似乎能更准确、更精确地模拟可检测到的变化阈值。总体而言,MDCGAMLSS 在样本内分析中表现出最佳的整体性能:影响:提高步行速度或握力的可检测变化阈值的精确度和准确性,可能有助于临床医生及时发现功能下降并进行干预,以及有把握地发现随着时间的推移功能有所改善。
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引用次数: 0
Chronic Underrepresentation of Females and Women in Stroke Research Adversely Impacts Clinical Care. 女性和妇女在中风研究中的代表性长期不足,对临床护理产生了不利影响。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-11-21 DOI: 10.1093/ptj/pzae155
Julia S Dahlby, Lara A Boyd

Unequal sex and gender sample sizes in rehabilitation studies have implications for the generalizability of the evidence and for the clinicians that utilize their recommendations. Physical therapists rely on evidence-based guidelines to tailor their assessments and interventions to optimize outcomes for patients. We currently know that females and women have worse stroke outcomes and prognoses than their counterparts, however, rehabilitation guidelines remain the same for all individuals. Notably, stroke prevention and acute care has recently shifted to include female- and women-oriented guidelines, however, rehabilitation guidelines have not yet caught up. This article summarizes the key differences that females and women with stroke experience, how they may impact recovery, and calls for researchers and rehabilitation professionals to consider sex and gender when working with patients who've had a stroke. Doing so will improve the lives for those with stroke and maximize treatment options and rehabilitation outcomes.

康复研究中不平等的性别样本对证据的可推广性和使用其建议的临床医生都有影响。物理治疗师依靠循证指南来调整他们的评估和干预措施,以优化患者的预后。我们目前知道,女性和妇女的卒中预后比同龄人差,但康复指南对所有人都是一样的。值得注意的是,卒中预防和急性期治疗最近已转向女性和以女性为导向的指南,但康复指南尚未跟上。本文总结了女性和女性脑卒中患者的主要差异,以及这些差异可能对康复产生的影响,并呼吁研究人员和康复专业人员在为脑卒中患者提供治疗时考虑性别因素。这样做可以改善中风患者的生活,最大限度地提高治疗方案和康复效果。
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引用次数: 0
Online Graded Motor Imagery Is Effective in Women Diagnosed with Pelvic Pain: A Randomized Controlled Trial. 在线分级运动想象对诊断为盆腔疼痛的妇女有效:随机对照试验。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-11-14 DOI: 10.1093/ptj/pzae164
Aida Lopez-Brull, Borja Perez-Dominguez, Maria Plaza-Carrasco, Cristina Blasco-Ortiz, Blanca Navarro-Ribera, Jose Casaña, Esther Diaz Mohedo, Irmina Nahon

Objective: Effective therapeutic strategies are crucial for managing Genito-Pelvic Pain/Penetration Disorder (GPPPD), a condition presenting challenges for both patients and health care providers. This study aims to assess the effectiveness of an online Graded Motor Imagery program in alleviating pain intensity and improving sexual function in women diagnosed with GPPPD.

Methods: Eighty-seven women were randomly assigned to either an online Graded Motor Imagery group or a control group. The online Graded Motor Imagery protocol involved engaging participants in 2-week segments of left/right judgment exercises, mental simulation of movements, and gradual exposure therapy. After 6 weeks, we assessed pain intensity and sexual function. The control group gained access to the program upon study completion.

Results: The online Graded Motor Imagery group demonstrated a significant reduction in pain intensity, coupled with improvements in sexual function. Notably, participants with enhanced movement imagery abilities experienced greater improvements, while those with negative beliefs and thoughts regarding vaginal penetration showed lower sexual function scores.

Conclusion: An online Graded Motor Imagery program is effective in alleviating the pain burden faced by women dealing with GPPPD.

Impact: Effectively addressing pelvic pain in patients remains a daunting challenge for physical therapists. Therefore, implementing efficient and easily accessible strategies is crucial. The incorporation of Graded Motor Imagery intervention proves to be an effective approach for improving both pain and sexual functioning in women with GPPPD.

目的:有效的治疗策略对于控制生殖盆腔疼痛/插入障碍(GPPPD)至关重要,这种疾病给患者和医疗服务提供者都带来了挑战。本研究旨在评估在线分级运动想象程序在减轻确诊为 GPPPD 的妇女的疼痛强度和改善其性功能方面的有效性:87名女性被随机分配到在线分级运动想象组或对照组。在线分级运动想象方案包括让参与者参与为期两周的左右判断练习、心理模拟运动和渐进暴露疗法。6 周后,我们对疼痛强度和性功能进行了评估。对照组则在研究完成后获得该项目:结果:在线分级运动想象组的疼痛强度显著降低,性功能也有所改善。值得注意的是,运动想象能力增强的参与者的改善幅度更大,而那些对阴道插入有负面信念和想法的参与者的性功能评分较低:结论:在线分级运动想象计划能有效减轻患有 GPPPD 的女性所面临的疼痛负担:影响:对于物理治疗师来说,有效解决患者的骨盆疼痛仍然是一项艰巨的挑战。因此,实施高效且易于使用的策略至关重要。事实证明,结合分级运动想象干预是改善 GPPPD 女性患者疼痛和性功能的有效方法。
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引用次数: 0
Go with the Flow? Considerations for Blood Flow Restriction Training in People with Neurologic Conditions. 顺其自然?神经系统疾病患者进行血流限制训练的注意事项。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-11-09 DOI: 10.1093/ptj/pzae159
Mark M Mañago, Zachary Dunkle, Evan T Cohen, Michael Bade

Blood flow restriction training (BFRT) with low intensity resistance or aerobic exercise can improve muscle strength and aerobic capacity, respectively. Furthermore, low intensity BFRT with resistance or aerobic exercise can be as effective as training at higher intensities without BFR in healthy adult populations. The clinical use of BFRT is therefore becoming increasingly common, particularly in otherwise healthy adults recovering from musculoskeletal injury or orthopedic surgery, for whom training at high intensities is not indicated. People with neurologic conditions may also benefit from training at lower intensities, as many individuals with neurologic conditions may not tolerate higher intensities for a variety of reasons, including advanced mobility restrictions, extreme weakness, severe fatigue, and/or pain. Indeed, more and more rehabilitation clinicians are beginning to use BFRT with their patients who have neurologic conditions even though there is very little evidence to support its safety, feasibility, or efficacy in those populations. In this perspective, we propose that BFRT can be an important alternative to conventional exercise training approaches for some individuals with neurologic conditions, and in the right circumstances can be delivered both safely and effectively. This perspective will also provide considerations and decision-making strategies that can help inform clinical decisions for rehabilitation practitioners considering the use of BFRT in their patients with neurologic conditions.

血流限制训练(BFRT)与低强度阻力或有氧运动相结合,可分别提高肌肉力量和有氧能力。此外,在健康的成年人群中,低强度血流限制训练与阻力或有氧运动的效果不亚于不进行血流限制训练的高强度训练。因此,BFRT 在临床上的应用越来越普遍,尤其是在肌肉骨骼损伤或骨科手术后恢复期的健康成年人中,因为这些人不适合进行高强度训练。神经系统疾病患者也可以从低强度训练中获益,因为许多神经系统疾病患者可能会因为各种原因而无法忍受较高强度的训练,其中包括活动能力严重受限、极度虚弱、严重疲劳和/或疼痛。事实上,越来越多的康复临床医生开始对患有神经系统疾病的患者使用 BFRT,尽管很少有证据支持其在这些人群中的安全性、可行性或有效性。在本视角中,我们提出,对于某些神经系统疾病患者来说,BFRT 可以作为传统运动训练方法的重要替代方法,而且在适当的情况下可以安全有效地进行。本视角还将提供一些考虑因素和决策策略,以帮助康复医师在考虑对神经系统疾病患者使用 BFRT 时做出临床决策。
{"title":"Go with the Flow? Considerations for Blood Flow Restriction Training in People with Neurologic Conditions.","authors":"Mark M Mañago, Zachary Dunkle, Evan T Cohen, Michael Bade","doi":"10.1093/ptj/pzae159","DOIUrl":"https://doi.org/10.1093/ptj/pzae159","url":null,"abstract":"<p><p>Blood flow restriction training (BFRT) with low intensity resistance or aerobic exercise can improve muscle strength and aerobic capacity, respectively. Furthermore, low intensity BFRT with resistance or aerobic exercise can be as effective as training at higher intensities without BFR in healthy adult populations. The clinical use of BFRT is therefore becoming increasingly common, particularly in otherwise healthy adults recovering from musculoskeletal injury or orthopedic surgery, for whom training at high intensities is not indicated. People with neurologic conditions may also benefit from training at lower intensities, as many individuals with neurologic conditions may not tolerate higher intensities for a variety of reasons, including advanced mobility restrictions, extreme weakness, severe fatigue, and/or pain. Indeed, more and more rehabilitation clinicians are beginning to use BFRT with their patients who have neurologic conditions even though there is very little evidence to support its safety, feasibility, or efficacy in those populations. In this perspective, we propose that BFRT can be an important alternative to conventional exercise training approaches for some individuals with neurologic conditions, and in the right circumstances can be delivered both safely and effectively. This perspective will also provide considerations and decision-making strategies that can help inform clinical decisions for rehabilitation practitioners considering the use of BFRT in their patients with neurologic conditions.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142626225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Author Response to Kumar et al. 作者对库马尔等人的回应
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-11-09 DOI: 10.1093/ptj/pzae162
Leonardo Avila, Morgana Duarte Silva, Marcos Lisboa Neves, Andre Rogerio Abreu, Cibelle Ramos Fiuza, Leandro Fukusawa, Arthur Sá Ferreira, Ney Meziat-Filho
{"title":"Author Response to Kumar et al.","authors":"Leonardo Avila, Morgana Duarte Silva, Marcos Lisboa Neves, Andre Rogerio Abreu, Cibelle Ramos Fiuza, Leandro Fukusawa, Arthur Sá Ferreira, Ney Meziat-Filho","doi":"10.1093/ptj/pzae162","DOIUrl":"https://doi.org/10.1093/ptj/pzae162","url":null,"abstract":"","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142626222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
"It's Just Really Important for us all to be on the Same Page": Qualitative Evaluation of Factors that Influence Written Mobility Communication. 对我们所有人来说,"保持一致非常重要":对影响书面流动性沟通因素的定性评估。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-11-06 DOI: 10.1093/ptj/pzae158
Sally Yin, Prue McRae, Julie Adsett, Alison Mudge

Objective: Poor interdisciplinary team communication is a known barrier to increasing inpatient mobility. Understanding why and how clinicians from different disciplines communicate about mobility would help inform communication improvements. This qualitative interview study aimed to describe and explore clinician perceptions about written mobility communication, and perceived barriers and enablers to this communication.

Methods: A rapid deductive qualitative approach was used to efficiently capture information for local improvement. Clinicians (physical therapists, nurses, physicians, and occupational therapists) working on 3 internal medicine wards in a metropolitan teaching hospital in Brisbane, Australia were purposefully sampled and invited to participate in individual interviews. Questions were based on the Consolidated Framework for Implementation Research. Interviews were recorded, transcribed, and analyzed using deductive and inductive thematic methods.

Results: From 17 interviews, key themes identified that written communication about patient mobility is important and valued by clinicians; clinicians learn documentation on the job, often from physical therapists; clinicians are not aware of organizational responsibility for mobility communication; multiple purposes for written communication contribute to multiple locations and inconsistency; and clinicians perceive that improvement would require a multi-disciplinary and multi-level approach. Suggestions for improvement included use of a common language, consistent use of existing bedside communication tools, and clearer responsibility for written communication about mobility.

Conclusion: Written communication about patient mobility was valued by clinicians and a range of barriers to effective interdisciplinary communication identified. Clear professional roles and responsibility for written mobility communication is important. Suggestions for improvement included an interdisciplinary language supported by multi-disciplinary education and organizational governance.

Impact: Written communication about patient mobility is recognized as critical to safe, high-quality hospital care. Our findings suggest that successful mobility communication improvements must involve multiple disciplines and include clear organizational governance to support staff training, clear role responsibilities, and quality monitoring.

目的:众所周知,跨学科团队沟通不畅是提高住院患者流动性的一个障碍。了解不同学科的临床医生为何以及如何就流动性问题进行沟通,将有助于改进沟通。这项定性访谈研究旨在描述和探讨临床医生对书面流动性沟通的看法,以及对这种沟通的障碍和促进因素的认识:方法:我们采用了快速演绎定性方法来有效地获取信息,以便在当地进行改进。我们有目的地抽取了澳大利亚布里斯班一家大都市教学医院 3 个内科病房的临床医生(物理治疗师、护士、医生和职业治疗师),并邀请他们参加个别访谈。访谈问题以实施研究综合框架为基础。采用演绎和归纳主题方法对访谈进行记录、转录和分析:从 17 次访谈中,我们发现了以下关键主题:有关患者移动能力的书面交流非常重要,并受到临床医生的重视;临床医生在工作中学习文件记录,通常是向理疗师学习;临床医生没有意识到组织在移动能力交流方面的责任;书面交流的多种目的导致了多地点和不一致;临床医生认为改进需要多学科和多层次的方法。改进建议包括使用共同语言、统一使用现有的床边沟通工具以及更明确地规定流动性书面沟通的责任:结论:临床医生重视与患者移动能力相关的书面沟通,同时也发现了阻碍跨学科有效沟通的一系列障碍。明确移动能力书面沟通的专业角色和责任非常重要。改进建议包括在多学科教育和组织管理的支持下使用跨学科语言:影响:有关患者移动性的书面沟通被认为是安全、高质量医院护理的关键。我们的研究结果表明,成功的移动沟通改进必须涉及多个学科,并包括明确的组织管理,以支持员工培训、明确职责和质量监控。
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引用次数: 0
Associations of Co-Occurring Chronic Conditions With Use of Rehabilitation Services in Older Adults With Back Pain: A Population-Based Cohort Study. 慢性病并发症与患有背痛的老年人使用康复服务的关系:一项基于人群的队列研究。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-11-01 DOI: 10.1093/ptj/pzae110
Sean D Rundell, Amol Karmarkar, Kushang V Patel

Objective: The objective was to examine the associations of number and type of chronic conditions with the use of rehabilitation services among older adults with bothersome back pain.

Methods: We conducted a cohort study using the National Health and Aging Trends Study, a longitudinal survey of Medicare beneficiaries ≥65 years. We included community-dwelling older adults with bothersome back pain in 2015. We assessed 12 self-reported chronic conditions, including arthritis, depression, and anxiety. We used 2016 data to ascertain self-reported use of any rehabilitation services in the prior year. We used weighted, logistic regression to examine the association of conditions with rehabilitation use.

Results: The sample size was 2443. A majority were age ≥75 years (59%); female (62%); and White, non-Hispanic (71%). The median number of chronic conditions was 3 (interquartile range, 2-4). Arthritis was the most common chronic condition (73%); 14% had anxiety; and 16% had depression. For every additional chronic condition, adjusted odds of any rehabilitation use increased 21% (Odds Ratio = 1.21, 95% CI = 1.11-1.31). Those with ≥4 chronic conditions had 2.13 times higher odds (95% CI = 1.36-3.34) of any rehabilitation use in the next year versus those with 0-1 condition. Participants with arthritis had 1.96 times higher odds (95% CI = 1.41-2.72) of any rehabilitation use versus those without arthritis. Anxiety and depression were not significantly associated with rehabilitation use.

Conclusions: Among older adults with back pain, a greater number of chronic conditions and arthritis were associated with higher use of rehabilitation services. Those with anxiety or depression had no difference in their use of rehabilitation care versus those without these conditions.

Impact: This pattern suggests appropriate use of rehabilitation for patients with back pain and multiple chronic conditions based on greater need, but there may be potential underuse for those with back pain and psychological conditions.

目的目的是研究患有背部疼痛的老年人中,慢性疾病的数量和类型与使用康复服务之间的关系:我们利用 "全国健康与老龄化趋势研究"(National Health and Aging Trends Study)开展了一项队列研究,该研究是一项针对年龄≥65 岁的医疗保险受益人的纵向调查。我们纳入了 2015 年在社区居住、患有背部疼痛的老年人。我们评估了 12 种自我报告的慢性疾病,包括关节炎、抑郁症和焦虑症。我们使用 2016 年的数据来确定上一年自我报告的任何康复服务的使用情况。我们使用加权逻辑回归法来研究病情与使用康复服务之间的关联:样本量为 2443 个。大多数人的年龄≥75 岁(59%);女性(62%);非西班牙裔白人(71%)。慢性疾病的中位数为 3 种(四分位数间距为 2-4)。关节炎是最常见的慢性病(73%);14%患有焦虑症,16%患有抑郁症。每增加一种慢性病,使用任何康复治疗的调整后几率就会增加 21%(Odds Ratio = 1.21,95% CI:1.11-1.31)。与患有 0-1 种慢性疾病的人相比,患有≥4 种慢性疾病的人在未来一年内使用康复治疗的几率要高出 2.13 倍(95% CI:1.36-3.34)。患有关节炎的参与者与没有关节炎的参与者相比,使用康复治疗的几率高出 1.96 倍(95% CI:1.41-2.72)。焦虑和抑郁与康复治疗的使用没有明显关系:结论:在背痛的老年人中,慢性疾病和关节炎的数量越多,康复服务的使用率就越高。结论:在患有背痛的老年人中,慢性疾病和关节炎的数量越多,康复服务的使用率就越高,而患有焦虑症或抑郁症的老年人与没有这些疾病的老年人在使用康复护理方面没有差异:这一模式表明,背痛和多种慢性疾病患者需要更多的康复服务,因此可以适当使用康复服务,但背痛和心理疾病患者可能存在使用不足的情况。
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引用次数: 0
On "Is it Time to Reframe How Health Care Professionals Label Musculoskeletal Conditions?" Zadro JR, O'Keeffe M, Ferreira GE. Phys Ther. 2024;104:pzae018. https://doi.org/10.1093/ptj/pzae018. 关于 "是时候重塑医护人员对肌肉骨骼疾病的标签了吗?Zadro JR、O'Keeffe M、Ferreira GE。Phys Ther.2024;104:pzae018. https://doi.org/10.1093/ptj/pzae018.
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-11-01 DOI: 10.1093/ptj/pzae116
Seth Peterson
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引用次数: 0
Implementing the Effective Coach2Move Approach for Community-Dwelling Older Adults With Mobility Limitations in Physical Therapist Practice: A Multi-Methods Process Evaluation. 在物理治疗师的实践中,针对社区居住的行动不便的老年人实施有效的 Coach2Move 方法:多方法过程评估》。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-11-01 DOI: 10.1093/ptj/pzae093
Ward Heij, Lieke Sweerts, J Bart Staal, Philip J van der Wees, Anne Thackeray, Maria W G Nijhuis-van der Sanden, Thomas J Hoogeboom
<p><strong>Objective: </strong>The aims of this study were to evaluate the adoption of and fidelity to the Coach2Move approach; identify differences between physical therapists with a specialization in geriatrics and physical therapists without a specialization; explore if level of adoption and specialization explain variances in effectiveness; and explore group differences in attitudes and experiences with implementation.</p><p><strong>Methods: </strong>A multi-methods process evaluation of Coach2Move implementation through 2 education days, 3 peer-assessment meetings, and an adapted electronic health record was performed alongside a cluster randomized stepped-wedge trial comparing regular care physical therapy with Coach2Move. Participants were 36 physical therapists with a specialization (n = 17) and without a specialization (n = 19) who treated 292 community-dwelling older adults. Level of adoption and fidelity were analyzed by comparing preimplementation scores with scores 1 year later. Coach2Move adoption was measured by e-assessment scores, and fidelity through health record indicators. The impact of specialization and adoption on health outcomes was examined using a mixed-model analysis of variance. Therapists' attitudes and experiences were collected through a survey based on semistructured interviews.</p><p><strong>Results: </strong>Mean (SD) total indicator scores on the e-assessment (adoption of a Coach2Move mindset) increased from baseline 17% (5%) to 47% (9%) at follow-up. Physical therapists with a specialization in geriatrics scored (mean [SD]) higher than physical therapists without (54% [6%] vs 41% [6%]). Mean (SD) indicator scores on health records (fidelity) increased from 35% (12%) at baseline to 47% (15%) at follow-up. Mean scores of physical therapists with a specialization in geriatrics were higher. Level of adoption and specialization (yes/no) did not explain the variance in effectiveness. Physical therapists identified important facilitators, including tailored education and peer-assessment meetings, whereas adequate reimbursement for the extra time investment was considered a necessity. Different workflows in practices were perceived as a barrier.</p><p><strong>Conclusion: </strong>Implementation led to increased adoption and fidelity of the Coach2Move intervention by physical therapists but shows room for improvement. Attitudes toward the approach and its implementation were positive. Future implementation efforts on adoption could be improved by focusing on a fair compensation structure by third-party payers and insurance companies and optimizing organizational and financial context within practices.</p><p><strong>Impact: </strong>This study evaluated the implementation of Coach2Move, a clinical reasoning approach designed to increase physical activity and improve self-efficacy in older adults. Overall, the study demonstrates the potential of Coach2Move to be effectively adopted by physical therapists. However, addres
研究目的本研究旨在评估 Coach2Move 方法的采用情况和忠实度;确定老年医学专业物理治疗师和非专业物理治疗师之间的差异;探讨采用水平和专业是否能解释有效性差异;以及探讨实施态度和经验方面的群体差异:通过 2 个教育日、3 次同行评估会议和改编的电子健康记录,对 Coach2Move 的实施过程进行了多方法评估,同时还进行了分组随机阶梯试验,将常规护理理疗与 Coach2Move 进行了比较。参与试验的有 36 名专业物理治疗师(n = 17)和非专业物理治疗师(n = 19),他们为 292 名社区老年人提供治疗。通过比较实施前的得分和实施一年后的得分,对采用水平和忠实度进行了分析。Coach2Move 的采用率通过电子评估得分来衡量,忠实度则通过健康记录指标来衡量。采用混合模式方差分析检验了专业化和采用对健康结果的影响。在半结构化访谈的基础上,通过调查收集了治疗师的态度和经验:结果:电子评估(采用 Coach2Move 思维模式)的平均指标总分从基线的 17%(SD = 5%)增加到随访时的 47%(SD = 9%)。具有老年病学专业的物理治疗师的得分高于不具有老年病学专业的物理治疗师(54% [SD = 6%] vs 41% [SD = 6%])。健康记录(忠实性)指标的平均得分从基线时的 35% (SD = 12%)上升到随访时的 47%(SD = 15%)。专攻老年医学的物理治疗师的平均得分更高。采用水平和专业化(是/否)并不能解释有效性的差异。理疗师认为有针对性的教育和同行评估会议是重要的促进因素,而为额外的时间投入提供足够的补偿则被认为是必要的。实践中不同的工作流程被认为是一个障碍:结论:物理治疗师对 Coach2Move 干预方法的采用和忠诚度有所提高,但仍有改进的余地。对该方法及其实施的态度是积极的。未来的实施工作可以通过关注第三方支付方和保险公司的公平补偿结构以及优化实践中的组织和财务环境来改进采用情况:本研究评估了 Coach2Move 的实施情况,这是一种临床推理方法,旨在增加老年人的体育锻炼并提高其自我效能。总体而言,研究表明 Coach2Move 有潜力被理疗师有效采用。然而,解决治疗师补偿问题和适应实践工作流程是成功大规模实施的重要考虑因素。
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Physical Therapy
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