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Facial Swelling and Neuritis After Internal Carotid Endarterectomy in an 81-Year-Old Woman With Type 2 Diabetes Mellitus: A Case Report. 一名 81 岁的 2 型糖尿病患者在颈动脉内膜剥脱术后出现面部肿胀和神经炎:病例报告。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-11-01 DOI: 10.1093/ptj/pzae118
Jennifer A Simpson

Objective: Patients with type 2 diabetes mellitus (DM2) may develop carotid artery stenosis, requiring surgical intervention. Nerve injury following carotid endarterectomy (CEA) is a rare and often unrecognized postoperative side effect. This case report describes the diagnostic process and rehabilitation course of a patient with greater auricular and trigeminal neuritis symptoms following internal CEA.

Methods: The patient is an 81-year-old woman with DM2 who underwent a left internal CEA. She subsequently developed swelling in her left neck and face, and pain along the greater auricular and trigeminal nerve pathways. Pertinent examination findings included incision placement across the path of the greater auricular nerve and cervical lymphatic vessels that drain the face, with overlying scar adhesion. A course of physical therapy was initiated 12 days after surgery, and included mobilization and manual lymphatic drainage, modalities, and application of kinesiotape.

Results: The Patient-Specific Functional Scale improved from 10/30 at evaluation to 27/30 at discharge. Swelling and pain were significantly reduced, with patient reporting no difficulty with sleeping, chewing, or talking at discharge. The reported pain level consistently correlated with fluctuations in face swelling throughout treatment.

Conclusion: Patients with DM2 may present with symptoms of cardiovascular disease, requiring invasive surgical procedures. DM2 can cause damage to neural and vascular structures, predisposing patients to nerve injuries or hypersensitivity following procedures. This case report demonstrates a likely connection between postoperative facial swelling and nerve irritation in the head and neck. Mobilization and manual lymphatic drainage, modalities, and kinesiotape were effective to reduce pain and swelling.

Impact: Physical therapists are uniquely qualified to identify, evaluate, and treat postoperative swelling and nerve pain associated with CEA.

Lay summary: Patients with type 2 diabetes mellitus may develop carotid artery stenosis, requiring surgical intervention. Nerve injury following carotid endarterectomy (CEA) is a rare and often unrecognized postoperative side effect. Physical therapists diagnose and provide treatment to patients with greater auricular and trigeminal neuritis symptoms following internal CEA.

目的:2 型糖尿病(DM2)患者可能会出现颈动脉狭窄(CAS),需要手术治疗。颈动脉内膜剥脱术(CEA)后的神经损伤是一种罕见的术后副作用,而且往往未被认识到。本病例报告描述了一名内CEA术后出现大耳廓和三叉神经炎症状的患者的诊断过程和康复过程:患者是一名 81 岁的女性,患有 DM2,接受了左内 CEA 手术。随后,她的左颈部和面部出现肿胀,沿大耳廓和三叉神经通路出现疼痛。相关检查结果显示,切口位于大耳廓神经和颈部淋巴管的路径上,并有疤痕粘连。术后12天开始进行物理治疗,包括活动和人工淋巴引流、各种模式和运动磁带的应用:结果:患者特定功能量表(PSFS)从评估时的10/30提高到出院时的27/30。肿胀和疼痛明显减轻,出院时患者在睡眠、咀嚼或说话方面没有任何困难。在整个治疗过程中,患者报告的疼痛程度与脸部肿胀的波动一致:结论:DM2患者可能会出现心血管疾病症状,需要进行侵入性手术治疗。DM2 可导致神经和血管结构受损,使患者在手术后容易出现神经损伤或过敏。本病例报告显示,术后面部肿胀与头颈部神经刺激之间可能存在联系。调动和人工淋巴引流、各种方式和运动胶带都能有效减轻疼痛和肿胀:物理治疗师在识别、评估和治疗与 CEA 相关的术后肿胀和神经疼痛方面具有独特的资质。
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引用次数: 0
New Protocol for Evaluating Maximum Inspiratory Pressure: Concurrent Validity and Test-Retest Reliability. 评估最大吸气压力的新方案:同时有效性和测试-重测可靠性
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-11-01 DOI: 10.1093/ptj/pzae124
Ibai López-de-Uralde-Villanueva, Raúl Fabero-Garrido, Elena Alonso Rodríguez de Rivera, Rafael Santana, Carolina Gotera-Rivera, Germán Peces-Barba, Tamara Del Corral

Objective: The purpose of this study was to validate a maximum inspiratory pressure (MIP) test protocol based on the principles of the 1-repetition maximum (1RM) test, assess its test-retest reliability, and establish minimal detectable change (MDC) in individuals with chronic obstructive pulmonary disease (COPD).

Methods: Forty-nine individuals with COPD were included in the study, of whom 44 individuals attended 2 appointments separated by 7 to 10 days for test-retest reliability. The MIP test was performed using a threshold valve device (1RM-based protocol) and the digital manometer (reference test). The 1RM-based protocol consisted of an incremental phase (inspiratory load increase [10 cm H2O] to achieve respiratory failure) and an approach phase (load halfway between the lowest failed attempt and the last valid attempt was prescribed).

Results: The concurrent validity of the 1RM-based protocol for the MIP test was good with respect to the reference test (day 1, intraclass correlation coefficient [ICC] = 0.81; day 2, ICC = 0.85). The test-retest reliability was excellent (ICC = 0.92), with a standard error of measurement of 6.3 cm H2O and a MDC of 17.5 cm H2O.

Conclusion: This study validated a new 1RM-based protocol for the MIP test using an inspiratory muscle training (IMT) device in individuals with COPD, showing good concurrent validity compared with the reference test, as well as excellent test-retest reliability. The MDC reported can be interpreted and applied in the clinical setting.

Impact: There was a need for developing new, inexpensive, simple, and feasible methods for the MIP test. The validation of the 1RM-based protocol addresses this issue, allowing for the appropriate prescription of IMT, favoring its widespread use in people with COPD, and therefore improving their physical therapist care.

研究目的本研究旨在验证基于单次重复最大吸气压力测试原理的最大吸气压力测试方案,评估其重测可靠性,并确定慢性阻塞性肺病(COPD)患者的最小可检测变化:方法:49 名慢性阻塞性肺病患者参加了研究,其中 44 人参加了两次预约,每次间隔 7 至 10 天,以确保测试的重复可靠性。最大吸气压力测试使用阈值阀装置(基于一次重复最大值的方案)和数字压力计(参考测试)进行。基于一次重复最大值的方案包括一个递增阶段(吸气负荷增加[10 cmH2O]以达到呼吸衰竭)和一个接近阶段(规定最低失败尝试和最后有效尝试之间一半的负荷):基于最大吸气压力测试的一次重复最大值方案与参考测试的并发有效性良好(第 1 天,ICC = 0.81;第 2 天,ICC = 0.85)。测试重复可靠性极佳(ICC = 0.92),测量标准误差为 6.3 cmH2O,最小可检测变化为 17.5 cmH2O:这项研究验证了使用吸气肌肉训练装置对慢性阻塞性肺病患者进行最大吸气压力测试的新方案,与参考测试相比,该方案显示出良好的并发效度和极佳的测试重复可靠性。所报告的最小可检测变化可在临床环境中解释和应用:影响:有必要为最大吸气压力测试开发新的、廉价的、简单可行的方法。基于最大吸气压力的单次重复方案的验证解决了这一问题,可为吸气肌肉训练开出适当的处方,有利于其在慢性阻塞性肺病患者中的广泛应用,从而改善物理治疗师的护理。
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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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引用次数: 0
Author Response to Hébert and Perron. 作者回复:Hébert 和 Perron。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-11-01 DOI: 10.1093/ptj/pzae105
Christopher T Joyce
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引用次数: 0
Computerized Adaptive Testing for the Berg Balance Scale Improves Measurement Efficiency Without Compromising Precision in People With Stroke. 伯格平衡量表计算机自适应测试提高了脑卒中患者的测量效率,同时又不影响精确度。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-11-01 DOI: 10.1093/ptj/pzae112
Bryant A Seamon, Steven A Kautz, Craig A Velozo

Objective: The objectives of this study were to confirm the Berg Balance Scale's (BBS) measurement properties and unidimensionality with an item response theory analysis in persons with subacute and chronic stroke and to examine the precision and efficiency of computerized adaptive testing (CAT).

Methods: Data were obtained from 519 ambulatory persons with subacute and chronic stroke in 2 retrospective databases. A principal component analysis (PCA) of residuals was used to evaluate unidimensionality. BBS fit to a rating scale model versus a partial credit model was examined, and item parameters were generated for CAT calibration. Person measures from all 14 items were defined as actual balance ability. BBS CAT simulations were used to examine changes in measurement precision with increasing number of items administered and a precision-based stopping rule (0.5 logit standard error [SE] threshold).

Results: A PCA of residuals supports the BBS unidimensionality and Rasch analysis supports using the rating scale model for measurement. Maximum precision for BBS CAT was SE = 0.40 logits when administering all items. BBS CAT estimated balance ability was highly correlated with actual ability when 4 or more items were administered (r > 0.9). Precision was within 0.5 logits when 5 or more items were administered (SE < 0.48 logits). BBS CAT estimated balance ability was highly correlated with actual ability (r = 0.952) using a precision-based stopping rule. The average number of items administered with the precision-based stopping rule was 5.43.

Conclusion: The BBS is sufficiently unidimensional, and the rating scale model can be used for measurement. BBS CAT is efficient and replicates the full instrument's reliability when measuring balance ability in ambulatory persons with subacute and chronic stroke. Future work should aim to enhance the interpretability of measures to facilitate clinical decision-making.

Impact: BBS CAT provides an efficient way of measuring balance ability for individuals in stroke rehabilitation giving clinicians more time with patients.

研究目的本研究的目的是在亚急性和慢性脑卒中患者中通过项目反应理论分析确认 Berg 平衡量表(BBS)的测量属性和单维性,并检验计算机自适应测试(CAT)的精确性和效率:方法:从 2 个回顾性数据库中获取了 519 名亚急性和慢性脑卒中患者的数据。残差的主成分分析(PCA)用于评估单维性。检查了 BBS 与评分量表模型和部分积分模型的拟合情况,并生成了用于 CAT 校准的项目参数。所有 14 个项目的个人测量值都被定义为实际平衡能力。利用 BBS CAT 模拟检查了测量精度随施测项目数量增加和基于精度的停止规则(0.5 logit 标准误差 (SE) 临界值)而发生的变化:残差的 PCA 支持 BBS 的单维性,Rasch 分析支持使用评分量表模型进行测量。在对所有项目进行测量时,BBS CAT 的最大精确度为 SE = 0.40 logits。当进行 4 个或更多项目时,BBS CAT 估算的平衡能力与实际能力高度相关(r > 0.9)。进行 5 个或更多项目时,精确度在 0.5 个对数以内(SE 结论):BBS 具有足够的单维性,可采用等级量表模型进行测量。在测量亚急性和慢性脑卒中患者的平衡能力时,BBS CAT 是有效的,并能复制整个工具的可靠性。未来的工作应致力于提高测量结果的可解释性,以促进临床决策:BBS CAT 提供了一种有效的方法来测量中风康复患者的平衡能力,使临床医生有更多的时间与患者在一起。
{"title":"Computerized Adaptive Testing for the Berg Balance Scale Improves Measurement Efficiency Without Compromising Precision in People With Stroke.","authors":"Bryant A Seamon, Steven A Kautz, Craig A Velozo","doi":"10.1093/ptj/pzae112","DOIUrl":"10.1093/ptj/pzae112","url":null,"abstract":"<p><strong>Objective: </strong>The objectives of this study were to confirm the Berg Balance Scale's (BBS) measurement properties and unidimensionality with an item response theory analysis in persons with subacute and chronic stroke and to examine the precision and efficiency of computerized adaptive testing (CAT).</p><p><strong>Methods: </strong>Data were obtained from 519 ambulatory persons with subacute and chronic stroke in 2 retrospective databases. A principal component analysis (PCA) of residuals was used to evaluate unidimensionality. BBS fit to a rating scale model versus a partial credit model was examined, and item parameters were generated for CAT calibration. Person measures from all 14 items were defined as actual balance ability. BBS CAT simulations were used to examine changes in measurement precision with increasing number of items administered and a precision-based stopping rule (0.5 logit standard error [SE] threshold).</p><p><strong>Results: </strong>A PCA of residuals supports the BBS unidimensionality and Rasch analysis supports using the rating scale model for measurement. Maximum precision for BBS CAT was SE = 0.40 logits when administering all items. BBS CAT estimated balance ability was highly correlated with actual ability when 4 or more items were administered (r > 0.9). Precision was within 0.5 logits when 5 or more items were administered (SE < 0.48 logits). BBS CAT estimated balance ability was highly correlated with actual ability (r = 0.952) using a precision-based stopping rule. The average number of items administered with the precision-based stopping rule was 5.43.</p><p><strong>Conclusion: </strong>The BBS is sufficiently unidimensional, and the rating scale model can be used for measurement. BBS CAT is efficient and replicates the full instrument's reliability when measuring balance ability in ambulatory persons with subacute and chronic stroke. Future work should aim to enhance the interpretability of measures to facilitate clinical decision-making.</p><p><strong>Impact: </strong>BBS CAT provides an efficient way of measuring balance ability for individuals in stroke rehabilitation giving clinicians more time with patients.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11584411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141902609","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。
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引用次数: 0
On "Concerns on the Science and Practice of a Movement System." Joyce CT, Beneciuk JM, George SZ. Phys Ther. 2023;103:pzad087. https://doi.org/10.1093/ptj/pzad087. 关于 "对运动系统科学与实践的关注"。乔伊斯-CT、贝内丘克-JM、乔治-SZ。Phys Ther.2023;103:pzad087. https://doi.org/10.1093/ptj/pzad087.
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-11-01 DOI: 10.1093/ptj/pzae104
Luc J Hébert, Marc Perron
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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
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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。
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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。
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Physical Therapy
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