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。
{"title":"Facial Swelling and Neuritis After Internal Carotid Endarterectomy in an 81-Year-Old Woman With Type 2 Diabetes Mellitus: A Case Report.","authors":"Jennifer A Simpson","doi":"10.1093/ptj/pzae118","DOIUrl":"10.1093/ptj/pzae118","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p><p><strong>Impact: </strong>Physical therapists are uniquely qualified to identify, evaluate, and treat postoperative swelling and nerve pain associated with CEA.</p><p><strong>Lay summary: </strong>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.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142018287","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}
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.
{"title":"New Protocol for Evaluating Maximum Inspiratory Pressure: Concurrent Validity and Test-Retest Reliability.","authors":"Ibai López-de-Uralde-Villanueva, Raúl Fabero-Garrido, Elena Alonso Rodríguez de Rivera, Rafael Santana, Carolina Gotera-Rivera, Germán Peces-Barba, Tamara Del Corral","doi":"10.1093/ptj/pzae124","DOIUrl":"10.1093/ptj/pzae124","url":null,"abstract":"<p><strong>Objective: </strong>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).</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p><p><strong>Impact: </strong>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.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120441","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}
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
{"title":"Implementing the Effective Coach2Move Approach for Community-Dwelling Older Adults With Mobility Limitations in Physical Therapist Practice: A Multi-Methods Process Evaluation.","authors":"Ward Heij, Lieke Sweerts, J Bart Staal, Philip J van der Wees, Anne Thackeray, Maria W G Nijhuis-van der Sanden, Thomas J Hoogeboom","doi":"10.1093/ptj/pzae093","DOIUrl":"10.1093/ptj/pzae093","url":null,"abstract":"<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","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/PMC11586087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141627327","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}
{"title":"Author Response to Hébert and Perron.","authors":"Christopher T Joyce","doi":"10.1093/ptj/pzae105","DOIUrl":"10.1093/ptj/pzae105","url":null,"abstract":"","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748784","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}
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.
{"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}
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":" ","pages":""},"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}
{"title":"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.","authors":"Luc J Hébert, Marc Perron","doi":"10.1093/ptj/pzae104","DOIUrl":"10.1093/ptj/pzae104","url":null,"abstract":"","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748786","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}
{"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":" ","pages":""},"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}
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.
{"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":" ","pages":""},"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}
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.
{"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":" ","pages":""},"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}