首页 > 最新文献

Physical Therapy最新文献

英文 中文
"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。
{"title":"\"It's Just Really Important for us all to be on the Same Page\": Qualitative Evaluation of Factors that Influence Written Mobility Communication.","authors":"Sally Yin, Prue McRae, Julie Adsett, Alison Mudge","doi":"10.1093/ptj/pzae158","DOIUrl":"https://doi.org/10.1093/ptj/pzae158","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p><p><strong>Impact: </strong>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.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591307","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
From Knowledge to Action: Fostering Advocacy Skills for Planetary Health in Physical Therapy. 从知识到行动:在物理治疗中培养行星健康的宣传技能。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-11-01 DOI: 10.1093/ptj/pzae130
Emma Swärdh, Filip Maric
{"title":"From Knowledge to Action: Fostering Advocacy Skills for Planetary Health in Physical Therapy.","authors":"Emma Swärdh, Filip Maric","doi":"10.1093/ptj/pzae130","DOIUrl":"10.1093/ptj/pzae130","url":null,"abstract":"","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11530356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Fine Motor Impairment and Its Impact on Social Outcomes in Survivors of Pediatric Acute Lymphoblastic Leukemia: St. Jude Lifetime Cohort Study. 小儿急性淋巴细胞白血病幸存者的精细运动障碍及其对社会结果的影响:圣裘德终身队列研究》。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-11-01 DOI: 10.1093/ptj/pzae142
Mayuko Iijima, Geehong Hyun, Tara M Brinkman, Raja B Khan, Deo Kumar Srivastava, Leslie L Robison, Melissa M Hudson, Ching-Hon Pui, Kevin R Krull, Hiroto Inaba, Kirsten K Ness

Aobjective: The impact of fine motor impairment among adult survivors of childhood acute lymphoblastic leukemia (ALL) on life after treatment is unknown.

Methods: This study evaluated prevalence and utilized multivariate logistic regression to identify risk factors for fine motor impairment among survivors of ALL, and associations with educational attainment and social independence. Latent class analysis defined social independence (independent, moderately independent, dependent), using employment, independent living, personal care assistance, routine need assistance, driver's license status, and marital status inputs.

Results: Among 875 survivors who were ≥ 25 years old (age when most adults achieve independence) and ≥ 5 years from diagnosis (mean = 28.97 years), 33.6% had fine motor impairment, with scores at or below the 10th percentile of the scores of community controls (n = 460) on fine motor components of the physical performance test and the grooved peg-board test. Survivors exposed to cranial radiation had more fine motor impairment than those without (45.8% vs 20.2%). Male sex (exposed: odds ratio [OR] = 2.55, 95% confidence interval [CI] = 1.65-3.92; unexposed: OR = 3.02, 95% CI = 1.69-5.38) and lower scores on the Wechsler abbreviated scale of intelligence (exposed: OR = 0.46, 95% CI = 0.36-0.58; unexposed: OR = 0.43, 95% CI = 0.31-0.58) were risk factors for neuropathy. A 1-point-higher total neuropathy score was associated with 8% (95% CI = 1%-17%) increased odds of fine motor impairment. Fine motor impairment was associated with less than a college education (less than high school: OR = 2.23, 95% CI = 1.20-4.14; high school diploma/general equivalency diploma: OR = 2.66, 95% CI = 1.65-4.30; vocational education: OR = 2.07, 95% CI = 1.38-3.13) and less social independence (moderately independent: OR = 1.80, 95% CI = 1.15-2.83; dependent: OR = 2.65, 95% CI = 1.25-5.64).

Conclusion: Fine motor impairment in survivors of childhood ALL may interfere with optimal educational attainment and social independence.

Impact: Early identification of survivors at risk for fine motor impairment, with timely intervention, may improve long-term outcomes.

目的:儿童急性淋巴细胞白血病成年幸存者的精细运动障碍对治疗后生活的影响尚不清楚:儿童急性淋巴细胞白血病成年幸存者的精细运动障碍对治疗后生活的影响尚不清楚:本研究评估了急性淋巴细胞白血病幸存者中精细运动障碍的患病率,并利用多变量逻辑回归确定了精细运动障碍的风险因素,以及与受教育程度和社会独立性之间的关联。潜类分析使用就业、独立生活、个人护理协助、日常需求协助、驾照状况和婚姻状况输入来定义社会独立性(独立、中度独立、依赖):在875名年龄≥25岁(大多数成年人实现独立的年龄)且距离确诊时间≥5年(平均年龄=28.97岁)的幸存者中,33.6%的人存在精细运动障碍,在体能测试(Physical Performance Test)和凹槽木板测试(Grooved Peg-Board Test)中精细运动部分的得分达到或低于社区对照组(460人)得分的第10百分位数。受到颅内辐射的幸存者比未受到颅内辐射的幸存者(45.8% 对 20.2%)更容易出现精细运动障碍。OR=3.02,95.0% CI=1.69-5.38),以及韦氏智力缩略量表(Wechsler Abbreviated Scale of Intelligence)得分较低(暴露:OR=0.46,95.0% CI=1.69-5.38):暴露:OR = 0.46,95.0% CI = 0.36-0.58;未暴露:OR = 0.43,95.0% CI = 0.31-0.58)是神经病变的风险因素。神经病变总分高 1 分与精细运动障碍几率增加 8%(95.0% CI = 1%-17%)有关。精细运动障碍与大学教育程度以下有关(高中以下:OR = 2.23,95.0% CI = 1.20-4.14;高中文凭/普通同等学历文凭:OR=2.66,95.0% CI=1.65-4.30;职业教育:OR=2.07,95.0% CI=1.38-3.13),社会独立性较差(中度独立:OR=1.80,95.0% CI=1.15-2.83;依赖性:结论:结论:儿童急性淋巴细胞白血病幸存者的精细运动障碍可能会影响其达到最佳教育水平和社会独立性:影响:早期发现有精细动作障碍风险的幸存者并及时干预,可改善长期预后。
{"title":"Fine Motor Impairment and Its Impact on Social Outcomes in Survivors of Pediatric Acute Lymphoblastic Leukemia: St. Jude Lifetime Cohort Study.","authors":"Mayuko Iijima, Geehong Hyun, Tara M Brinkman, Raja B Khan, Deo Kumar Srivastava, Leslie L Robison, Melissa M Hudson, Ching-Hon Pui, Kevin R Krull, Hiroto Inaba, Kirsten K Ness","doi":"10.1093/ptj/pzae142","DOIUrl":"10.1093/ptj/pzae142","url":null,"abstract":"<p><strong>Aobjective: </strong>The impact of fine motor impairment among adult survivors of childhood acute lymphoblastic leukemia (ALL) on life after treatment is unknown.</p><p><strong>Methods: </strong>This study evaluated prevalence and utilized multivariate logistic regression to identify risk factors for fine motor impairment among survivors of ALL, and associations with educational attainment and social independence. Latent class analysis defined social independence (independent, moderately independent, dependent), using employment, independent living, personal care assistance, routine need assistance, driver's license status, and marital status inputs.</p><p><strong>Results: </strong>Among 875 survivors who were ≥ 25 years old (age when most adults achieve independence) and ≥ 5 years from diagnosis (mean = 28.97 years), 33.6% had fine motor impairment, with scores at or below the 10th percentile of the scores of community controls (n = 460) on fine motor components of the physical performance test and the grooved peg-board test. Survivors exposed to cranial radiation had more fine motor impairment than those without (45.8% vs 20.2%). Male sex (exposed: odds ratio [OR] = 2.55, 95% confidence interval [CI] = 1.65-3.92; unexposed: OR = 3.02, 95% CI = 1.69-5.38) and lower scores on the Wechsler abbreviated scale of intelligence (exposed: OR = 0.46, 95% CI = 0.36-0.58; unexposed: OR = 0.43, 95% CI = 0.31-0.58) were risk factors for neuropathy. A 1-point-higher total neuropathy score was associated with 8% (95% CI = 1%-17%) increased odds of fine motor impairment. Fine motor impairment was associated with less than a college education (less than high school: OR = 2.23, 95% CI = 1.20-4.14; high school diploma/general equivalency diploma: OR = 2.66, 95% CI = 1.65-4.30; vocational education: OR = 2.07, 95% CI = 1.38-3.13) and less social independence (moderately independent: OR = 1.80, 95% CI = 1.15-2.83; dependent: OR = 2.65, 95% CI = 1.25-5.64).</p><p><strong>Conclusion: </strong>Fine motor impairment in survivors of childhood ALL may interfere with optimal educational attainment and social independence.</p><p><strong>Impact: </strong>Early identification of survivors at risk for fine motor impairment, with timely intervention, may improve long-term outcomes.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11531345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142352010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Short-Term Powered Mobility Intervention is Associated With Improvements in Development and Participation for Young Children with Cerebral Palsy: A Randomized Clinical Trial. 短期助力移动干预可改善脑瘫幼儿的发育和参与能力:随机临床试验
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-10-25 DOI: 10.1093/ptj/pzae152
Heather A Feldner, Samuel W Logan, Sango Otieno, Anna Fragomeni, Carissa Kono, Katie Riordan, Bethany Sloane, Lisa K Kenyon

Objective: The objective of this study was to evaluate the effects of 2 short-term powered mobility interventions across developmental domains, participation, and perceptions of intervention implementation for young children with cerebral palsy and their families.

Methods: This randomized, crossover clinical trial compared 2 powered mobility interventions: the Explorer Mini (Permobil AB, Timra, Sweden) and an adapted ride-on toy car. Analyses included 24 children aged 12 to 36 months, recruited from 3 sites. Each device was trialed in the home for an 8-week period for a total of 16 weeks. Three in-person study visits took place at baseline, crossover, and study completion, and 2 additional virtual check-ins were conducted for each device trial period. Outcome measures included all domains of the Bayley Scales of Infant and Toddler Development, Fourth Edition (Bayley-4); Child Engagement in Daily Life (CEDL) participation questionnaire; and t3 perceptual implementation measures: Acceptability of Intervention Measure, Intervention Appropriateness Measure, and Feasibility of Intervention Measure. Analyses included descriptive statistics, 2 by 3 group × time analysis of variance, and post hoc t tests as warranted.

Results: Statistically significant mean improvements were observed in all domains of the Bayley-4 and in the self-care subscale of the CEDL regardless of device order. Caregivers ranked both devices as acceptable and feasible to implement, although the Explorer Mini was ranked slightly more favorably than the adapted ride-on toy car, with a device order effect being observed.

Conclusion: Short-term powered mobility intervention may advance multiple domains of development and participation for young children with cerebral palsy. Caregivers rated 2 different powered mobility devices favorably as part of their child's early intervention strategies.

Impact: This study enhances the quality of evidence available to clinicians and families to support decision-making about powered mobility intervention for young children with motor disabilities, especially those who may be reluctant to begin powered mobility due to stigma or concern for motor skill development.

研究目的本研究的目的是评估两种短期电动移动干预措施对脑瘫幼儿及其家庭在发展领域、参与度以及对干预措施实施的看法等方面的影响:这项随机、交叉临床试验比较了两种电动移位干预措施:迷你探索者(Permobil AB,瑞典蒂姆拉)和改装的乘骑玩具车。分析对象包括从 3 个地点招募的 24 名 12 到 36 个月大的儿童。每种装置在家中试用 8 周,共 16 周。在基线期、交叉期和研究完成期进行了三次面对面的研究访问,并在每个设备试用期进行了两次额外的虚拟检查。结果测量包括贝利婴幼儿发展量表第四版(Bayley-4)的所有领域、儿童参与日常生活(CEDL)参与度问卷以及 t3 感知实施测量:干预可接受性测量、干预适宜性测量和干预可行性测量。分析包括描述性统计、2×3 组×时间方差分析以及必要的事后 t 检验:结果:无论装置顺序如何,Bayley-4 的所有领域和 CEDL 的自理能力分量表的平均值均有明显改善。护理人员认为这两种装置都是可以接受且可行的,但迷你探索者的评价略高于经过改装的乘骑玩具车,同时还观察到了装置顺序效应:结论:短期助力移动干预可促进脑瘫幼儿在多个领域的发展和参与。作为儿童早期干预策略的一部分,照护者对两种不同的电动代步设备给予了好评:本研究提高了临床医生和家庭可用证据的质量,为运动障碍幼儿的助力移动干预决策提供了支持,尤其是那些可能因耻辱感或对运动技能发展的担忧而不愿意开始助力移动的幼儿。
{"title":"Short-Term Powered Mobility Intervention is Associated With Improvements in Development and Participation for Young Children with Cerebral Palsy: A Randomized Clinical Trial.","authors":"Heather A Feldner, Samuel W Logan, Sango Otieno, Anna Fragomeni, Carissa Kono, Katie Riordan, Bethany Sloane, Lisa K Kenyon","doi":"10.1093/ptj/pzae152","DOIUrl":"https://doi.org/10.1093/ptj/pzae152","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to evaluate the effects of 2 short-term powered mobility interventions across developmental domains, participation, and perceptions of intervention implementation for young children with cerebral palsy and their families.</p><p><strong>Methods: </strong>This randomized, crossover clinical trial compared 2 powered mobility interventions: the Explorer Mini (Permobil AB, Timra, Sweden) and an adapted ride-on toy car. Analyses included 24 children aged 12 to 36 months, recruited from 3 sites. Each device was trialed in the home for an 8-week period for a total of 16 weeks. Three in-person study visits took place at baseline, crossover, and study completion, and 2 additional virtual check-ins were conducted for each device trial period. Outcome measures included all domains of the Bayley Scales of Infant and Toddler Development, Fourth Edition (Bayley-4); Child Engagement in Daily Life (CEDL) participation questionnaire; and t3 perceptual implementation measures: Acceptability of Intervention Measure, Intervention Appropriateness Measure, and Feasibility of Intervention Measure. Analyses included descriptive statistics, 2 by 3 group × time analysis of variance, and post hoc t tests as warranted.</p><p><strong>Results: </strong>Statistically significant mean improvements were observed in all domains of the Bayley-4 and in the self-care subscale of the CEDL regardless of device order. Caregivers ranked both devices as acceptable and feasible to implement, although the Explorer Mini was ranked slightly more favorably than the adapted ride-on toy car, with a device order effect being observed.</p><p><strong>Conclusion: </strong>Short-term powered mobility intervention may advance multiple domains of development and participation for young children with cerebral palsy. Caregivers rated 2 different powered mobility devices favorably as part of their child's early intervention strategies.</p><p><strong>Impact: </strong>This study enhances the quality of evidence available to clinicians and families to support decision-making about powered mobility intervention for young children with motor disabilities, especially those who may be reluctant to begin powered mobility due to stigma or concern for motor skill development.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505893","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
Effectiveness of an Exercise and Educational-Based Prehabilitation Program in Patients with Breast Cancer Receiving Neoadjuvant Chemotherapy (PREOptimize) on Functional Outcomes: A Randomized Controlled Trial. 基于运动和教育的乳腺癌患者新辅助化疗前康复计划 (PREOptimize) 对功能结果的影响:随机对照试验
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-10-18 DOI: 10.1093/ptj/pzae151
Anabel Casanovas-Álvarez, Blanca Estanyol, Magda Ciendones, Josep Padròs, Jordi Cuartero, Agustí Barnadas, Bárbara García-Valdecasas, Rubèn González-Colom, Raquel Sebio-García, Jaume Masià

Objective: The study objective was to determine the effectiveness of a prehabilitation program to decrease postoperative musculoskeletal impairments in patients who have breast cancer and are receiving neoadjuvant therapy (NAT).

Methods: Patients who had breast cancer and were receiving NAT before surgery were invited to participate in this randomized controlled trial. Patients randomized to the intervention group participated in a group-based prehabilitation program consisting of Nordic walking, resistance training, and therapeutic education from month 4 of NAT until before surgery. Patients in the control group received usual care (no prehabilitation). The main outcome was arm function measured with the short version of the Disabilities of the Arm, Shoulder and Hand questionnaire 1 month after surgery. Other measures included pain, range of motion, functional capacity, cancer-related fatigue, handgrip strength, physical activity, and arm circumferences.

Results: A total of 64 patients were randomized during the study period, and 61 completed all assessments. A significant difference in the main outcome (short version of the Disabilities of the Arm, Shoulder and Hand questionnaire) was found before surgery as patients in the control group experienced worsening in arm function (mean difference = -9.84, 95% CI = -17.7 to -2). In addition, they also showed increased symptom frequency/severity according to the combined scale of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) (mean difference = +6.7 points, 95% CI = 13.4 to 0.1) compared to the intervention group. Prehabilitation also improved functional capacity (mean difference = 67.6 m, 95% CI = 37.4 to 97.7) and physical activity levels and decreased cancer-related fatigue (mean difference = -1.3, 95% CI = -0.29 to -2.4) compared to the control group but had no effect on other secondary outcomes. After surgery, patients receiving prehabilitation also exhibited greater functional capacity at both 1 and 3 months. No other difference was observed.

Conclusion: A prehabilitation program was able to maintain arm function and increase functional capacity while decreasing fatigue in patients with breast cancer receiving NAT.

Impact: Prehabilitation programs should be offered to patients with breast cancer to maintain functionality and enhance physical performance before surgery.

Lay summary: An exercise program combined with therapeutic education in patients with breast cancer who receive neoadjuvant therapy before surgery can improve functional capacity and prevent declines of arm mobility and function.

研究目的研究目的是确定术前康复计划对减少接受新辅助治疗(NAT)的乳腺癌患者术后肌肉骨骼损伤的效果:方法:邀请在手术前接受新辅助治疗的乳腺癌患者参加这项随机对照试验。被随机分配到干预组的患者从接受新辅助治疗的第 4 个月起至手术前参加了一个以小组为基础的康复计划,该计划包括北欧式步行、阻力训练和治疗教育。对照组患者接受常规护理(无康复训练)。主要结果是在手术后 1 个月使用简易版手臂、肩部和手部残疾问卷测量手臂功能。其他测量指标包括疼痛、活动范围、功能能力、癌症相关疲劳、手握力、体力活动和臂围:在研究期间,共有 64 名患者接受了随机治疗,其中 61 人完成了所有评估。主要结果(短版手臂、肩部和手部残疾问卷)显示,对照组患者的手臂功能恶化(平均差异 = -9.84,95% CI = -17.7至-2),而对照组患者的手臂功能恶化(平均差异 = -9.84,95% CI = -17.7至-2)。此外,根据欧洲癌症研究和治疗组织生活质量问卷(EORTC-QQL-C30)的综合量表,与干预组相比,他们的症状频率/严重程度也有所增加(平均差异=+6.7分,95% CI=13.4至0.1)。与对照组相比,康复治疗还提高了功能能力(平均差异=67.6米,95% CI=37.4至97.7)和体力活动水平,减少了癌症相关疲劳(平均差异=-1.3,95% CI=-0.29至-2.4),但对其他次要结果没有影响。术后 1 个月和 3 个月,接受术前康复训练的患者也表现出更强的功能能力。结论结论:接受 NAT 的乳腺癌患者在接受术前康复训练后,能够保持手臂功能并提高功能能力,同时减少疲劳感:影响:应向乳腺癌患者提供术前康复计划,以维持患者的功能并提高其术后体能。
{"title":"Effectiveness of an Exercise and Educational-Based Prehabilitation Program in Patients with Breast Cancer Receiving Neoadjuvant Chemotherapy (PREOptimize) on Functional Outcomes: A Randomized Controlled Trial.","authors":"Anabel Casanovas-Álvarez, Blanca Estanyol, Magda Ciendones, Josep Padròs, Jordi Cuartero, Agustí Barnadas, Bárbara García-Valdecasas, Rubèn González-Colom, Raquel Sebio-García, Jaume Masià","doi":"10.1093/ptj/pzae151","DOIUrl":"https://doi.org/10.1093/ptj/pzae151","url":null,"abstract":"<p><strong>Objective: </strong>The study objective was to determine the effectiveness of a prehabilitation program to decrease postoperative musculoskeletal impairments in patients who have breast cancer and are receiving neoadjuvant therapy (NAT).</p><p><strong>Methods: </strong>Patients who had breast cancer and were receiving NAT before surgery were invited to participate in this randomized controlled trial. Patients randomized to the intervention group participated in a group-based prehabilitation program consisting of Nordic walking, resistance training, and therapeutic education from month 4 of NAT until before surgery. Patients in the control group received usual care (no prehabilitation). The main outcome was arm function measured with the short version of the Disabilities of the Arm, Shoulder and Hand questionnaire 1 month after surgery. Other measures included pain, range of motion, functional capacity, cancer-related fatigue, handgrip strength, physical activity, and arm circumferences.</p><p><strong>Results: </strong>A total of 64 patients were randomized during the study period, and 61 completed all assessments. A significant difference in the main outcome (short version of the Disabilities of the Arm, Shoulder and Hand questionnaire) was found before surgery as patients in the control group experienced worsening in arm function (mean difference = -9.84, 95% CI = -17.7 to -2). In addition, they also showed increased symptom frequency/severity according to the combined scale of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) (mean difference = +6.7 points, 95% CI = 13.4 to 0.1) compared to the intervention group. Prehabilitation also improved functional capacity (mean difference = 67.6 m, 95% CI = 37.4 to 97.7) and physical activity levels and decreased cancer-related fatigue (mean difference = -1.3, 95% CI = -0.29 to -2.4) compared to the control group but had no effect on other secondary outcomes. After surgery, patients receiving prehabilitation also exhibited greater functional capacity at both 1 and 3 months. No other difference was observed.</p><p><strong>Conclusion: </strong>A prehabilitation program was able to maintain arm function and increase functional capacity while decreasing fatigue in patients with breast cancer receiving NAT.</p><p><strong>Impact: </strong>Prehabilitation programs should be offered to patients with breast cancer to maintain functionality and enhance physical performance before surgery.</p><p><strong>Lay summary: </strong>An exercise program combined with therapeutic education in patients with breast cancer who receive neoadjuvant therapy before surgery can improve functional capacity and prevent declines of arm mobility and function.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142472419","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
Determinants of Longitudinal Changes in Exercise Capacity in Patients with Independent Functioning on Hemodialysis. 血液透析独立功能患者运动能力纵向变化的决定因素。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-10-18 DOI: 10.1093/ptj/pzae147
Naoto Usui, Junichiro Nakata, Akimi Uehata, Sho Kojima, Hideki Hisadome, Akihito Inatsu, Atsuhiro Tsubaki, Masakazu Saitoh, Shuji Ando, Tatsuro Kitayama, Kenta Maikusa, Yuki Nishiyama, Yusuke Suzuki

Objective: Patients with chronic kidney disease reportedly have decreased muscle oxygen utilization, which most substantially decreases exercise capacity, followed by cardiac reserve. However, determinants of longitudinal changes in exercise capacity in patients on hemodialysis and the effects of long-term exercise interventions are unknown. This study was conducted to clarify these concerns.

Methods: This was a prospective cohort study. Patients on hemodialysis that were not hospitalized were followed from baseline up to 2 years, and cardiopulmonary exercise testing results, including peak oxygen uptake, peak work rate, heart rate reserve, and ventilatory equivalent for carbon dioxide slope, as well as implementation of exercise interventions were assessed. Based on the 2-year change in peak oxygen uptake, they were divided into improvement or declined groups.

Results: Forty-five patients who were not hospitalized completed the follow-up were analyzed. In the improvement group, the variation was determined by an increase in peak work rate, which is a peripheral factor (partial regression coefficient 0.08 [95% CI = 0.01 to 0.16]), while in the decline group, the variation was determined by a decrease in the ventilatory equivalent for carbon dioxide slope, which is a cardiac factor (partial regression coefficient = -0.12; 95% CI = -0.21 to -0.03). Moreover, exercise intervention was associated with the change in peak oxygen uptake (partial regression coefficient = 3.09; 95% CI = 1.45 to 4.72).

Conclusion: Exercise intolerance even in patients on hemodialysis that were not hospitalized and stable progressed over time with deterioration of cardiac reserve, whereas exercise interventions were associated with improved exercise capacity through enhanced peripheral function.

Impact: The results support the early measurement of cardiopulmonary or skeletal muscle reserve through cardiopulmonary exercise testing and the implementation of long-term exercise interventions based on the measurement results to address the potential deterioration in exercise capacity associated with reduced cardiac reserve, even in patients on hemodialysis that are asymptomatic and stable.

目的:据报道,慢性肾病患者的肌肉氧利用率下降,这对运动能力的影响最大,其次是心脏储备。然而,血液透析患者运动能力纵向变化的决定因素以及长期运动干预的效果尚不清楚。本研究旨在澄清这些问题:这是一项前瞻性队列研究。方法:这是一项前瞻性队列研究,对未住院的血液透析患者进行了长达 2 年的基线随访,并评估了心肺运动测试结果,包括峰值摄氧量、峰值做功率、心率储备和二氧化碳斜率通气当量,以及运动干预措施的实施情况。根据峰值摄氧量在两年内的变化,将他们分为改善组和下降组:结果:对完成随访的 45 名未住院患者进行了分析。在改善组中,变化取决于峰值工作率的增加,这是一个外周因素(部分回归系数为 0.08 [95% CI = 0.01 至 0.16]),而在下降组中,变化取决于二氧化碳通气当量斜率的下降,这是一个心脏因素(部分回归系数 = -0.12; 95% CI = -0.21 至 -0.03)。此外,运动干预与峰值摄氧量的变化有关(部分回归系数 = 3.09;95% CI = 1.45 至 4.72):结论:即使是未住院且病情稳定的血液透析患者,运动不耐受也会随着时间的推移而加重,导致心脏储备功能恶化,而运动干预与通过增强外周功能提高运动能力有关:研究结果支持通过心肺运动测试对心肺或骨骼肌储备进行早期测量,并根据测量结果实施长期运动干预,以解决因心脏储备减少而导致的潜在运动能力下降问题,即使是无症状且病情稳定的血液透析患者也不例外。
{"title":"Determinants of Longitudinal Changes in Exercise Capacity in Patients with Independent Functioning on Hemodialysis.","authors":"Naoto Usui, Junichiro Nakata, Akimi Uehata, Sho Kojima, Hideki Hisadome, Akihito Inatsu, Atsuhiro Tsubaki, Masakazu Saitoh, Shuji Ando, Tatsuro Kitayama, Kenta Maikusa, Yuki Nishiyama, Yusuke Suzuki","doi":"10.1093/ptj/pzae147","DOIUrl":"https://doi.org/10.1093/ptj/pzae147","url":null,"abstract":"<p><strong>Objective: </strong>Patients with chronic kidney disease reportedly have decreased muscle oxygen utilization, which most substantially decreases exercise capacity, followed by cardiac reserve. However, determinants of longitudinal changes in exercise capacity in patients on hemodialysis and the effects of long-term exercise interventions are unknown. This study was conducted to clarify these concerns.</p><p><strong>Methods: </strong>This was a prospective cohort study. Patients on hemodialysis that were not hospitalized were followed from baseline up to 2 years, and cardiopulmonary exercise testing results, including peak oxygen uptake, peak work rate, heart rate reserve, and ventilatory equivalent for carbon dioxide slope, as well as implementation of exercise interventions were assessed. Based on the 2-year change in peak oxygen uptake, they were divided into improvement or declined groups.</p><p><strong>Results: </strong>Forty-five patients who were not hospitalized completed the follow-up were analyzed. In the improvement group, the variation was determined by an increase in peak work rate, which is a peripheral factor (partial regression coefficient 0.08 [95% CI = 0.01 to 0.16]), while in the decline group, the variation was determined by a decrease in the ventilatory equivalent for carbon dioxide slope, which is a cardiac factor (partial regression coefficient = -0.12; 95% CI = -0.21 to -0.03). Moreover, exercise intervention was associated with the change in peak oxygen uptake (partial regression coefficient = 3.09; 95% CI = 1.45 to 4.72).</p><p><strong>Conclusion: </strong>Exercise intolerance even in patients on hemodialysis that were not hospitalized and stable progressed over time with deterioration of cardiac reserve, whereas exercise interventions were associated with improved exercise capacity through enhanced peripheral function.</p><p><strong>Impact: </strong>The results support the early measurement of cardiopulmonary or skeletal muscle reserve through cardiopulmonary exercise testing and the implementation of long-term exercise interventions based on the measurement results to address the potential deterioration in exercise capacity associated with reduced cardiac reserve, even in patients on hemodialysis that are asymptomatic and stable.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142472318","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
Lower Extremity Osseointegration Postoperative Rehabilitation Protocols: A Scoping Review. 下肢骨结合术后康复方案:范围审查。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-10-10 DOI: 10.1093/ptj/pzae139
Matan Grunfeld, Taylor J Reif, S Robert Rozbruch, Jason S Hoellwarth

Objective: Lower-extremity transcutaneous osseointegration is a rehabilitation alternative to socket-suspended prostheses. The rehabilitation process, philosophies, and routines remain under-described. This review, primarily, identifies commonalities and differences among protocols. Secondarily, strategies are proposed to streamline future research of post-osseointegration surgery rehabilitation.

Methods: Two differently phrased queries of Google Scholar, Pubmed, Embase, and Web of Science were performed. First using either "osseointegration" or "osseointegrated" or "bone anchored prosthesis" AND [last name]. Second, replacing author name with "physical therapy" or "rehabilitation." Six hundred eighty-eight articles were identified describing lower-extremity rehabilitation following osseointegration. Following software-based deduplication, manual abstract and full-text review, article reference evaluation, and use of Google Scholar's "Cited by" feature, 35 studies were fully analyzed. First, a consolidated summary was made of protocols focusing on stages, timing, and other descriptions of postoperative rehabilitation. Subsequently, strengths and limitations of protocols were considered to propose potential strategies to investigate and optimize postoperative rehabilitation.

Results: All articles describe rehabilitation having this same order of goal progression: from surgery to gradual weight bearing and final goal of independent ambulation. The most impactful difference influencing the stated final goal of independent ambulation was whether 1 or 2 surgical stages were performed. No articles reported patient success rate achieving proposed goals and timing, or challenges during rehabilitation. Therefore, the first research suggestion is to investigate actual success rates achieving proposed goals and timing. Second, to further explore rehabilitation of performance deficits, beyond unaided ambulation. Finally, to incorporate technology such as mobility trackers to more objectively understand prosthesis use and mobility.

Conclusion: All lower-extremity osseointegration rehabilitation literature recommends identical goal progression order. No studies evaluate patient challenges or variation. Understanding and addressing such challenges may enhance postoperative rehabilitation.

Impact: This article consolidates published rehabilitation protocols post-osseointegration surgery. Specific analysis and experimentation of the protocols may enhance the uniformity and potential of patient rehabilitation.

目的:下肢经皮骨结合是一种替代插座悬吊式假体的康复方法。关于康复过程、理念和常规的描述仍然不足。这篇综述主要指出了各种方案之间的共性和差异。其次,还提出了简化未来骨结合手术后康复研究的策略:方法:对 Google Scholar、Pubmed、Embase 和 Web of Science 进行了两种不同措辞的查询。首先使用 "osseointegration "或 "osseointegrated "或 "bone anchored prosthesis "和[姓氏]。其次,将作者姓名替换为 "物理治疗 "或 "康复"。共找到 68 篇描述骨结合术后下肢康复的文章。经过基于软件的重复数据删除、人工摘要和全文审阅、文章参考文献评估以及使用谷歌学术的 "被引用者 "功能,对 35 篇研究进行了全面分析。首先,针对术后康复的阶段、时间和其他描述,对方案进行了综合总结。随后,考虑了方案的优势和局限性,提出了研究和优化术后康复的潜在策略:结果:所有文章对康复的描述都遵循相同的目标进展顺序:从手术到逐渐负重,最后达到独立行走的目标。影响所述独立行走这一最终目标的最大不同之处在于是进行一个还是两个手术阶段。没有文章报告患者实现既定目标的成功率、时间安排或康复过程中遇到的挑战。因此,第一项研究建议是调查实现既定目标和时间安排的实际成功率。其次,进一步探索除无辅助行走以外的康复表现缺陷。最后,结合移动跟踪器等技术,更客观地了解假肢的使用和移动情况:结论:所有下肢骨结合康复文献都推荐了相同的目标进展顺序。没有研究对患者面临的挑战或差异进行评估。了解并应对这些挑战可提高术后康复效果:本文整合了已发表的骨结合术后康复方案。对方案进行具体分析和实验,可提高患者康复的统一性和潜力。
{"title":"Lower Extremity Osseointegration Postoperative Rehabilitation Protocols: A Scoping Review.","authors":"Matan Grunfeld, Taylor J Reif, S Robert Rozbruch, Jason S Hoellwarth","doi":"10.1093/ptj/pzae139","DOIUrl":"https://doi.org/10.1093/ptj/pzae139","url":null,"abstract":"<p><strong>Objective: </strong>Lower-extremity transcutaneous osseointegration is a rehabilitation alternative to socket-suspended prostheses. The rehabilitation process, philosophies, and routines remain under-described. This review, primarily, identifies commonalities and differences among protocols. Secondarily, strategies are proposed to streamline future research of post-osseointegration surgery rehabilitation.</p><p><strong>Methods: </strong>Two differently phrased queries of Google Scholar, Pubmed, Embase, and Web of Science were performed. First using either \"osseointegration\" or \"osseointegrated\" or \"bone anchored prosthesis\" AND [last name]. Second, replacing author name with \"physical therapy\" or \"rehabilitation.\" Six hundred eighty-eight articles were identified describing lower-extremity rehabilitation following osseointegration. Following software-based deduplication, manual abstract and full-text review, article reference evaluation, and use of Google Scholar's \"Cited by\" feature, 35 studies were fully analyzed. First, a consolidated summary was made of protocols focusing on stages, timing, and other descriptions of postoperative rehabilitation. Subsequently, strengths and limitations of protocols were considered to propose potential strategies to investigate and optimize postoperative rehabilitation.</p><p><strong>Results: </strong>All articles describe rehabilitation having this same order of goal progression: from surgery to gradual weight bearing and final goal of independent ambulation. The most impactful difference influencing the stated final goal of independent ambulation was whether 1 or 2 surgical stages were performed. No articles reported patient success rate achieving proposed goals and timing, or challenges during rehabilitation. Therefore, the first research suggestion is to investigate actual success rates achieving proposed goals and timing. Second, to further explore rehabilitation of performance deficits, beyond unaided ambulation. Finally, to incorporate technology such as mobility trackers to more objectively understand prosthesis use and mobility.</p><p><strong>Conclusion: </strong>All lower-extremity osseointegration rehabilitation literature recommends identical goal progression order. No studies evaluate patient challenges or variation. Understanding and addressing such challenges may enhance postoperative rehabilitation.</p><p><strong>Impact: </strong>This article consolidates published rehabilitation protocols post-osseointegration surgery. Specific analysis and experimentation of the protocols may enhance the uniformity and potential of patient rehabilitation.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392469","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
Differences in Abdominal and Lumbar Muscle Thickness and Contractile Function Between Nulliparous, Primiparous, and Multiparous Women 6 Months Postpartum. 单胎、一胎和多胎妇女产后 6 个月腹部和腰部肌肉厚度及收缩功能的差异。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-10-10 DOI: 10.1093/ptj/pzae141
Laura Fuentes-Aparicio, Sofia Pérez-Alenda, Juan J Carrasco, Begoña Valls-Donderis, Lirios Dueñas, Mercè Balasch-Bernat

Objective: The purpose of this study was to evaluate the differences between primiparous and multiparous women at 6 months postpartum and nulliparous women regarding the thickness (including thickness pattern) and contractile function of the abdominal and lumbar muscles.

Methods: A cross-sectional observational study of 80 women, both primiparous (n = 29) and multiparous (n = 25), as well as including nulliparous as a comparison group (n = 26), was conducted. B-mode ultrasound imaging was used for the measurement of abdominal and lumbar muscle thickness in 2 conditions (resting and activation). Moreover, the contractile function of these muscles was determined by the thickness ratio.

Results: Significant differences between groups were observed in abdominal muscle thickness. During activation, the obliques showed a lower thickness in both groups of postpartum women compared to nulliparous women, while lower values for the thickness for the transverse abdominis (TrA) were only observed in primiparous women. The thickness pattern observed in nulliparous women both in resting and in activation (internal oblique [IO] > external oblique [EO] > TrA) was also achieved among postpartum women, despite no statistical differences observed between IO and EO in these groups. No significant differences between groups were observed for contractile function, showing the TrA greater values, followed by IO and EO in both nulliparous and postpartum women.

Conclusions: This study suggests that the thickness (and the thickness pattern) of the abdominal muscles in women at 6 months postpartum differs from nulliparous, while for the lumbar muscles, it is comparable to nulliparous. However, despite the obliques being thinner in postpartum women, the abdominal muscles are functionally competent.

Impact: This is believed to be the first study to compare abdominal and lumbar muscles thickness and contractile function specifically between primiparous and multiparous women. Although at 6 months' postpartum abdominal thickness differs from nulliparous women, these muscles are functionally competent. These findings provide valuable insights for use in the development of postpartum interventions.

研究目的本研究的目的是评估产后 6 个月的初产妇和多产妇与非初产妇在腹肌和腰肌的厚度(包括厚度模式)和收缩功能方面的差异:对 80 名初产妇(29 人)和多产妇(25 人)进行了横断面观察研究,并将无产妇作为对比组(26 人)。B 型超声波成像用于测量两种状态(静止和激活)下的腹肌和腰肌厚度。此外,这些肌肉的收缩功能是通过厚度比来确定的:结果:腹部肌肉厚度在各组之间存在显著差异。在激活过程中,两组产后妇女的斜方肌厚度均低于无产褥期妇女,而只有初产妇的腹横肌厚度值较低。产后妇女在静止和激活状态下观察到的厚度模式(腹内斜肌[IO]>腹外斜肌[EO]>TrA)也同样存在,尽管在这些组别中腹内斜肌和腹外斜肌之间没有观察到统计学差异。在收缩功能方面,各组间未观察到明显差异,在无产褥期妇女和产后妇女中,TRA 的值更大,其次是 IO 和 EO:这项研究表明,产后 6 个月妇女腹部肌肉的厚度(和厚度模式)与无产褥期妇女不同,而腰部肌肉的厚度与无产褥期妇女相当。然而,尽管产后妇女的斜方肌较薄,但腹部肌肉的功能却很强:这被认为是第一项专门比较初产妇和多产妇腹肌和腰肌厚度及收缩功能的研究。虽然产后 6 个月的腹部厚度与无产褥期妇女不同,但这些肌肉的功能是正常的。这些发现为制定产后干预措施提供了宝贵的启示。
{"title":"Differences in Abdominal and Lumbar Muscle Thickness and Contractile Function Between Nulliparous, Primiparous, and Multiparous Women 6 Months Postpartum.","authors":"Laura Fuentes-Aparicio, Sofia Pérez-Alenda, Juan J Carrasco, Begoña Valls-Donderis, Lirios Dueñas, Mercè Balasch-Bernat","doi":"10.1093/ptj/pzae141","DOIUrl":"https://doi.org/10.1093/ptj/pzae141","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to evaluate the differences between primiparous and multiparous women at 6 months postpartum and nulliparous women regarding the thickness (including thickness pattern) and contractile function of the abdominal and lumbar muscles.</p><p><strong>Methods: </strong>A cross-sectional observational study of 80 women, both primiparous (n = 29) and multiparous (n = 25), as well as including nulliparous as a comparison group (n = 26), was conducted. B-mode ultrasound imaging was used for the measurement of abdominal and lumbar muscle thickness in 2 conditions (resting and activation). Moreover, the contractile function of these muscles was determined by the thickness ratio.</p><p><strong>Results: </strong>Significant differences between groups were observed in abdominal muscle thickness. During activation, the obliques showed a lower thickness in both groups of postpartum women compared to nulliparous women, while lower values for the thickness for the transverse abdominis (TrA) were only observed in primiparous women. The thickness pattern observed in nulliparous women both in resting and in activation (internal oblique [IO] > external oblique [EO] > TrA) was also achieved among postpartum women, despite no statistical differences observed between IO and EO in these groups. No significant differences between groups were observed for contractile function, showing the TrA greater values, followed by IO and EO in both nulliparous and postpartum women.</p><p><strong>Conclusions: </strong>This study suggests that the thickness (and the thickness pattern) of the abdominal muscles in women at 6 months postpartum differs from nulliparous, while for the lumbar muscles, it is comparable to nulliparous. However, despite the obliques being thinner in postpartum women, the abdominal muscles are functionally competent.</p><p><strong>Impact: </strong>This is believed to be the first study to compare abdominal and lumbar muscles thickness and contractile function specifically between primiparous and multiparous women. Although at 6 months' postpartum abdominal thickness differs from nulliparous women, these muscles are functionally competent. These findings provide valuable insights for use in the development of postpartum interventions.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392467","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
Modeling Upper Limb Rehabilitation-Induced Recovery after Stroke: The Role of Attention as a Clinical Confounder. 中风后上肢康复诱导恢复模型:注意力作为临床混杂因素的作用
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-10-10 DOI: 10.1093/ptj/pzae148
Silvia Salvalaggio, Simone Gambazza, Martina Ando', Ilaria Parrotta, Francesca Burgio, Laura Danesin, Pierpaolo Busan, Sara Zago, Dante Mantini, Daniela D'Imperio, Marco Zorzi, Nicola Filippini, Andrea Turolla

Objective: People who have survived stroke may have motor and cognitive impairments. High dose of motor rehabilitation was found to provide clinically relevant improvement to upper limb (UL) motor function. Besides, mounting evidence suggests that clinical, neural, and neurophysiological features are associated with spontaneous recovery. However, the association between these features and rehabilitation-induced, rather than spontaneous, recovery has never been fully investigated.The objective was to explore the association between rehabilitation dose and UL motor outcome after stroke, as well as to identify which variables can be considered potential candidate predictors of motor recovery.

Methods: People who survived stroke were assessed before and after a period of rehabilitation using motor, cognitive, neuroanatomical, and neurophysiological measures. We investigated the association between dose of rehabilitation and UL response (ie, Fugl-Meyer Assessment for upper extremity [FMA-UE]), using ordinary least squares regression as the primary analysis. To obtain unbiased estimates, adjusting covariates were selected using a directed acyclic graph.

Results: Baseline FMA-UE was the only factor associated with motor recovery (b = 0.99; 95% CI = 0.83 to 1.15 points). Attention emerged as a confounder of the association between rehabilitation and final FMA-UE (b = 5.5; 95% CI = -0.8 to 11.9 points), influencing both rehabilitation and UL response.

Conclusion: Preserved attention in people who have survived stroke might lead to greater UL motor recovery, albeit estimates have high levels of variability. Moreover, the increase in the dose of rehabilitation can lead to 5.5 points improvement on the FMA-UE, a nonsignificant but potentially meaningful finding. The approach described here discloses a new framework for investigating the effect of rehabilitation treatment as a potential driver of recovery.

Impact: Attentional resources could play a key role in UL motor recovery. There is a potential association between amount of UL recovery and dose of rehabilitation delivered, needing further exploration. Preserved attention and rehabilitation dose are candidate predictors of UL motor recovery.

目的中风后幸存者可能存在运动和认知障碍。研究发现,大剂量的运动康复训练可在临床上改善上肢(UL)的运动功能。此外,越来越多的证据表明,临床、神经和神经生理学特征与自发康复有关。本研究旨在探讨康复剂量与脑卒中后上肢运动结果之间的关系,并确定哪些变量可被视为运动恢复的潜在候选预测因子:方法:对脑卒中幸存者进行康复治疗前后的运动、认知、神经解剖和神经生理学评估。我们使用普通最小二乘法回归作为主要分析方法,研究了康复剂量与 UL 反应(即上肢 Fugl-Meyer 评估 [FMA-UE])之间的关系。为获得无偏估计值,使用有向无环图选择调整协变量:结果:基线 FMA-UE 是与运动恢复相关的唯一因素(b = 0.99;95% CI = 0.83 至 1.15 分)。注意力是影响康复和最终FMA-UE之间关系的混淆因素(b = 5.5;95% CI = -0.8至11.9分),同时影响康复和UL反应:结论:中风后遗症患者保持注意力可能会导致更大的超能力运动恢复,尽管估计值存在很大的变异性。此外,康复剂量的增加可使 FMA-UE 提高 5.5 分,这一结果并不显著,但可能很有意义。本文所描述的方法为研究康复治疗作为康复潜在驱动力的效果提供了一个新的框架:影响:注意力资源可能在 UL 运动康复中发挥关键作用。UL恢复量与康复剂量之间存在潜在联系,需要进一步探讨。保持注意力和康复剂量是UL运动康复的候选预测因素。
{"title":"Modeling Upper Limb Rehabilitation-Induced Recovery after Stroke: The Role of Attention as a Clinical Confounder.","authors":"Silvia Salvalaggio, Simone Gambazza, Martina Ando', Ilaria Parrotta, Francesca Burgio, Laura Danesin, Pierpaolo Busan, Sara Zago, Dante Mantini, Daniela D'Imperio, Marco Zorzi, Nicola Filippini, Andrea Turolla","doi":"10.1093/ptj/pzae148","DOIUrl":"https://doi.org/10.1093/ptj/pzae148","url":null,"abstract":"<p><strong>Objective: </strong>People who have survived stroke may have motor and cognitive impairments. High dose of motor rehabilitation was found to provide clinically relevant improvement to upper limb (UL) motor function. Besides, mounting evidence suggests that clinical, neural, and neurophysiological features are associated with spontaneous recovery. However, the association between these features and rehabilitation-induced, rather than spontaneous, recovery has never been fully investigated.The objective was to explore the association between rehabilitation dose and UL motor outcome after stroke, as well as to identify which variables can be considered potential candidate predictors of motor recovery.</p><p><strong>Methods: </strong>People who survived stroke were assessed before and after a period of rehabilitation using motor, cognitive, neuroanatomical, and neurophysiological measures. We investigated the association between dose of rehabilitation and UL response (ie, Fugl-Meyer Assessment for upper extremity [FMA-UE]), using ordinary least squares regression as the primary analysis. To obtain unbiased estimates, adjusting covariates were selected using a directed acyclic graph.</p><p><strong>Results: </strong>Baseline FMA-UE was the only factor associated with motor recovery (b = 0.99; 95% CI = 0.83 to 1.15 points). Attention emerged as a confounder of the association between rehabilitation and final FMA-UE (b = 5.5; 95% CI = -0.8 to 11.9 points), influencing both rehabilitation and UL response.</p><p><strong>Conclusion: </strong>Preserved attention in people who have survived stroke might lead to greater UL motor recovery, albeit estimates have high levels of variability. Moreover, the increase in the dose of rehabilitation can lead to 5.5 points improvement on the FMA-UE, a nonsignificant but potentially meaningful finding. The approach described here discloses a new framework for investigating the effect of rehabilitation treatment as a potential driver of recovery.</p><p><strong>Impact: </strong>Attentional resources could play a key role in UL motor recovery. There is a potential association between amount of UL recovery and dose of rehabilitation delivered, needing further exploration. Preserved attention and rehabilitation dose are candidate predictors of UL motor recovery.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392470","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
Experiences of People With Persistent Nonspecific Neck Pain Who Used Immersive Virtual Reality Serious Games in the Home Setting: A Qualitative Study. 持续性非特异性颈痛患者在家庭环境中使用沉浸式虚拟现实严肃游戏的体验:定性研究。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-10-10 DOI: 10.1093/ptj/pzae149
Alexandre Luc, Nicolas Lambricht, Isabelle Aujoulat, Christine Detrembleur, Laurent Pitance

Objective: The purpose of this study was to explore the experiences of individuals with persistent nonspecific neck pain who used immersive virtual reality (VR) serious games at home for 2 weeks.

Methods: In this descriptive qualitative study, semi-structured one-on-one interviews were conducted at the participant's home after the 2-week period. Interviews were analyzed using qualitative content analysis. Sample size was determined using the information power concept (where "information power" refers to the amount of relevant information the sample provides for addressing the research question).

Results: Eleven adults with continuous or recurrent nonspecific neck pain participated in the study. Three main categories were identified. The first revolves around the home environment, revealing that participants had mixed perceptions about being at home, yet held a positive perspective on the utilization of immersive VR in that setting. The second pertains to immersive VR as a novel technology, indicating its overall comfort, user-friendliness, and varying degrees of immersion and presence experienced by the participants. The third focuses on exercising in immersive VR, drawing comparisons with conventional exercises, exploring the facilitators and barriers to usage, and addressing various aspects of integrating this technology into rehabilitation.

Conclusion: Immersive VR was deemed comfortable for almost all participants and easy to use. Participants found exercising in immersive VR motivating and enjoyable, compared to conventional exercises. The home environment proved suitable for using immersive VR, though challenges included autonomy and reduced human contact. Participants highlighted facilitators and barriers in using immersive VR serious games, as well as immersive VR's rehabilitation potential. They also underscored the crucial role of physical therapists for guidance, remote supervision, and personalized treatment.

Impact: These findings could help clinicians to better understand the experiences of individuals with persistent nonspecific neck pain when using immersive VR, as well as its use at home. This understanding can improve patient care and optimize the effectiveness of immersive VR as a treatment method.

研究目的本研究旨在探讨持续性非特异性颈部疼痛患者在家中使用沉浸式虚拟现实(VR)严肃游戏两周后的体验:在这项描述性定性研究中,我们在 2 周后在参与者家中进行了半结构化一对一访谈。采用定性内容分析法对访谈进行分析。样本量的确定采用了信息功率概念("信息功率 "是指样本为解决研究问题所提供的相关信息量):11名患有持续性或复发性非特异性颈部疼痛的成年人参与了研究。研究确定了三个主要类别。第一类与家庭环境有关,表明参与者对在家的感受不一,但对在家中使用沉浸式 VR 持积极态度。第二项涉及作为一种新技术的沉浸式 VR,表明其总体舒适度、用户友好性以及参与者体验到的不同程度的沉浸感和临场感。第三部分侧重于在沉浸式 VR 中进行锻炼,与传统锻炼进行比较,探讨使用的促进因素和障碍,并讨论将该技术融入康复的各个方面:结论:几乎所有参与者都认为身临其境的虚拟现实技术舒适且易于使用。与传统练习相比,参与者认为在身临其境的 VR 中进行锻炼既有动力又令人愉悦。事实证明,家庭环境适合使用沉浸式 VR,但面临的挑战包括自主性和与人的接触减少。与会者强调了使用身临其境虚拟现实严肃游戏的促进因素和障碍,以及身临其境虚拟现实的康复潜力。他们还强调了物理治疗师在指导、远程监督和个性化治疗方面的关键作用:这些发现有助于临床医生更好地了解持续性非特异性颈部疼痛患者在使用沉浸式 VR 时的体验,以及在家中的使用情况。这种理解可以改善对患者的护理,并优化沉浸式 VR 作为一种治疗方法的效果。
{"title":"Experiences of People With Persistent Nonspecific Neck Pain Who Used Immersive Virtual Reality Serious Games in the Home Setting: A Qualitative Study.","authors":"Alexandre Luc, Nicolas Lambricht, Isabelle Aujoulat, Christine Detrembleur, Laurent Pitance","doi":"10.1093/ptj/pzae149","DOIUrl":"https://doi.org/10.1093/ptj/pzae149","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to explore the experiences of individuals with persistent nonspecific neck pain who used immersive virtual reality (VR) serious games at home for 2 weeks.</p><p><strong>Methods: </strong>In this descriptive qualitative study, semi-structured one-on-one interviews were conducted at the participant's home after the 2-week period. Interviews were analyzed using qualitative content analysis. Sample size was determined using the information power concept (where \"information power\" refers to the amount of relevant information the sample provides for addressing the research question).</p><p><strong>Results: </strong>Eleven adults with continuous or recurrent nonspecific neck pain participated in the study. Three main categories were identified. The first revolves around the home environment, revealing that participants had mixed perceptions about being at home, yet held a positive perspective on the utilization of immersive VR in that setting. The second pertains to immersive VR as a novel technology, indicating its overall comfort, user-friendliness, and varying degrees of immersion and presence experienced by the participants. The third focuses on exercising in immersive VR, drawing comparisons with conventional exercises, exploring the facilitators and barriers to usage, and addressing various aspects of integrating this technology into rehabilitation.</p><p><strong>Conclusion: </strong>Immersive VR was deemed comfortable for almost all participants and easy to use. Participants found exercising in immersive VR motivating and enjoyable, compared to conventional exercises. The home environment proved suitable for using immersive VR, though challenges included autonomy and reduced human contact. Participants highlighted facilitators and barriers in using immersive VR serious games, as well as immersive VR's rehabilitation potential. They also underscored the crucial role of physical therapists for guidance, remote supervision, and personalized treatment.</p><p><strong>Impact: </strong>These findings could help clinicians to better understand the experiences of individuals with persistent nonspecific neck pain when using immersive VR, as well as its use at home. This understanding can improve patient care and optimize the effectiveness of immersive VR as a treatment method.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142472420","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
期刊
Physical Therapy
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1