首页 > 最新文献

Physical Therapy最新文献

英文 中文
Differences in Pain Experience Among Different Racial and Ethnic Groups. 不同种族和族裔群体的疼痛体验差异。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-10-02 DOI: 10.1093/ptj/pzae001
Elizabeth Lane, Chris Barnes, Julie M Fritz

Objective: The objective of this study was to examine the role of pain catastrophizing and pain self-efficacy as possible mediators of race-based differences in pain intensity and to evaluate the possible moderating role of race on the relationship between pain catastrophizing and pain self-efficacy with pain outcomes among persons with chronic spinal pain receiving physical therapy.

Methods: This study was a secondary analysis of a cluster-randomized trial. Participants were persons with chronic spinal pain in outpatient physical therapy clinics who consented to complete assessments at baseline and after 2 weeks and 12 weeks. Assessments included pain intensity, physical function, pain catastrophizing, and self-efficacy. Baseline comparisons between Black and non-Hispanic White participants were made. Mediation analyses used a regression-based framework to examine whether baseline pain catastrophizing and self-efficacy mediated the association between race and pain intensity. Moderation analyses used multiple linear regression to evaluate the role of race in the relationship of baseline pain catastrophizing and self-efficacy with 12-week pain intensity outcomes.

Results: A total of 274 participants were included (51 [18.6%] Black and 223 [81.4%] non-Hispanic White; mean age = 51.6 years [standard deviation = 14.9]; 180 [65.7%] female). At baseline, Black participants had higher pain intensity scores (mean difference = 0.80; 95% CI =1.5 to 0.12). Both pain catastrophizing and self-efficacy mediated the relationship between race and baseline pain intensity. Race moderated the relationships between baseline pain catastrophizing and self-efficacy and 12-week pain intensity scores.

Conclusion: Pain catastrophizing and self-efficacy had differential impacts on pain intensity based on race for both cross-sectional and longitudinal analyses among persons receiving physical therapy for chronic spinal pain.

Impact: Improved understanding of the differences in pain experience based on factors such as race, ethnicity, cultural background, and experience with the health care system may help reduce disparities in pain management.

研究目的本研究旨在探讨疼痛灾难化和疼痛自我效能感在疼痛强度种族差异中可能起到的中介作用,并评估种族在疼痛灾难化和疼痛自我效能感与接受物理治疗的慢性脊柱疼痛患者的疼痛结果之间可能起到的调节作用:本研究是对一项分组随机试验的二次分析。参与者为门诊物理治疗诊所的慢性脊柱疼痛患者,他们同意在基线期以及 2 周和 12 周后完成评估。评估内容包括疼痛强度、身体功能、疼痛灾难化和自我效能。对黑人和非西班牙裔白人参与者进行了基线比较。中介分析采用了基于回归的框架,以研究基线疼痛灾难化和自我效能是否对种族和疼痛强度之间的关联起中介作用。调节分析使用多元线性回归来评估种族在基线疼痛灾难化和自我效能与 12 周疼痛强度结果之间的关系:共纳入 274 名参与者(51 名 [18.6%] 黑人和 223 名 [81.4%] 非西班牙裔白人;平均年龄 = 51.6 岁 [SD = 14.9];180 名 [65.7%] 女性)。基线时,黑人参与者的疼痛强度得分更高(平均差异 = 0.80;95% CI = 1.5 至 0.12)。疼痛灾难化和自我效能对种族和基线疼痛强度之间的关系起到了中介作用。种族调节了基线疼痛灾难化和自我效能与12周疼痛强度评分之间的关系:结论:在对接受物理治疗的慢性脊柱疼痛患者进行横断面和纵向分析时,疼痛灾难化和自我效能感对疼痛强度的影响因种族而异:影响:进一步了解基于种族、民族、文化背景和医疗保健系统经验等因素的疼痛体验差异,有助于减少疼痛治疗中的差异。
{"title":"Differences in Pain Experience Among Different Racial and Ethnic Groups.","authors":"Elizabeth Lane, Chris Barnes, Julie M Fritz","doi":"10.1093/ptj/pzae001","DOIUrl":"10.1093/ptj/pzae001","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to examine the role of pain catastrophizing and pain self-efficacy as possible mediators of race-based differences in pain intensity and to evaluate the possible moderating role of race on the relationship between pain catastrophizing and pain self-efficacy with pain outcomes among persons with chronic spinal pain receiving physical therapy.</p><p><strong>Methods: </strong>This study was a secondary analysis of a cluster-randomized trial. Participants were persons with chronic spinal pain in outpatient physical therapy clinics who consented to complete assessments at baseline and after 2 weeks and 12 weeks. Assessments included pain intensity, physical function, pain catastrophizing, and self-efficacy. Baseline comparisons between Black and non-Hispanic White participants were made. Mediation analyses used a regression-based framework to examine whether baseline pain catastrophizing and self-efficacy mediated the association between race and pain intensity. Moderation analyses used multiple linear regression to evaluate the role of race in the relationship of baseline pain catastrophizing and self-efficacy with 12-week pain intensity outcomes.</p><p><strong>Results: </strong>A total of 274 participants were included (51 [18.6%] Black and 223 [81.4%] non-Hispanic White; mean age = 51.6 years [standard deviation = 14.9]; 180 [65.7%] female). At baseline, Black participants had higher pain intensity scores (mean difference = 0.80; 95% CI =1.5 to 0.12). Both pain catastrophizing and self-efficacy mediated the relationship between race and baseline pain intensity. Race moderated the relationships between baseline pain catastrophizing and self-efficacy and 12-week pain intensity scores.</p><p><strong>Conclusion: </strong>Pain catastrophizing and self-efficacy had differential impacts on pain intensity based on race for both cross-sectional and longitudinal analyses among persons receiving physical therapy for chronic spinal pain.</p><p><strong>Impact: </strong>Improved understanding of the differences in pain experience based on factors such as race, ethnicity, cultural background, and experience with the health care system may help reduce disparities in pain management.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139106500","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
Comparing Physical Activity and Exercise Experiences, Values, and Beliefs of Latino, Latina, and/or Latine People and Non-Latino, Non-Latina, and/or Non-Latine People With Parkinson Disease: A Qualitative Study. 比较拉美裔、拉丁裔和/或拉丁裔帕金森病患者与非拉美裔、非拉丁裔和/或非拉丁裔帕金森病患者的体育活动和锻炼经历、价值观和信念:定性研究。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-10-02 DOI: 10.1093/ptj/pzae119
Cristina Colón-Semenza, Paria Darbandsari, Kelsi Carolan, David X Marquez, Amy Gorin

Objective: The objective of this study was to examine and compare the beliefs, values, experiences, and barriers to and facilitators of exercise in Latino/a/e (Latino, Latina, and/or Latine) people and non-Latino/a/e (non-Latino, non-Latina, and/or non-Latine) people with Parkinson disease (PD).

Methods: This study involved a qualitative research design with data collection via focus groups of Latino/a/e and non-Latino/a/e people with PD. A semistructured interview protocol was used, and a theoretical (social ecological model) thematic analysis was used for data analysis.

Results: Twenty-five individuals (15 non-Latino/a/e and 10 Latino/a/e) participated across 5 focus groups. While there were several common themes among both groups, 7 themes related to exercise in the management of PD were unique to Latino/a/e participants: generalized versus specific knowledge of exercise components; family can have both facilitating and impeding roles; finances influence access to exercise and physical therapy; prior emotional experiences related to exercise and PD affect the future use of exercise; group exercise can have both facilitating and impeding roles; availability and access to a variety of modes and stratification of exercise classes for people with PD facilitate exercise; and cultural beliefs and expectations can impede the use of exercise at the population level.

Conclusion: Latino/a/e people with PD have overlapping and unique themes related to the use of exercise. Distinctive factors must be addressed in physical activity interventions and during physical therapists' care of people with PD to maximize the use of exercise and ultimately improve health equity in this overburdened and underserved population.

Impact: Physical therapists should provide information and education to their Latino/a/e patients with PD and family members on the frequency, intensity, type, and time of exercise and how to safely participate in physical activity in the home and community to best manage PD. Physical therapists and exercise professionals should work at the environmental level to increase access to affordable, culturally tailored, PD-specific exercise services and enhance community knowledge of PD.

研究目的本研究旨在考察和比较拉美裔/亚裔(拉丁裔、拉美人和(或)拉丁人)帕金森病(PD)患者和非拉美裔/亚裔(非拉丁裔、非拉美人和(或)非拉丁人)帕金森病患者的信念、价值观、经历以及运动的障碍和促进因素:本研究采用定性研究设计,通过重点小组收集拉美裔和非拉美裔帕金森病患者的数据。采用半结构式访谈协议,并使用理论(社会生态模型)主题分析法进行数据分析:25 人(15 名非拉美裔和 10 名拉美裔)参加了 5 个焦点小组。虽然两个小组有几个共同的主题,但有 7 个与运动治疗帕金森病有关的主题是拉丁裔/亚裔/男性参与者所独有的:运动组成部分的一般知识与具体知识;家庭既可以起到促进作用,也可以起到阻碍作用;经济状况影响运动和物理治疗的获得;以前与运动和帕金森病有关的情感经历会影响未来对运动的使用;集体运动既可以起到促进作用,也可以起到阻碍作用;为帕金森病患者提供和获得各种模式和分层的运动课程有利于运动;文化信仰和期望会在人群层面阻碍运动的使用:结论:拉美裔/亚裔/黑人帕金森病患者在使用运动方面有重叠和独特的主题。在体育活动干预和理疗师对帕金森病患者的护理过程中,必须解决这些独特因素,以最大限度地利用运动,并最终改善这一负担过重和服务不足人群的健康公平状况:影响:物理治疗师应向其患有帕金森病的拉美裔/亚裔/白人患者及其家人提供有关运动频率、强度、类型和时间的信息和教育,以及如何在家庭和社区安全地参加体育活动,以更好地管理帕金森病。物理治疗师和运动专业人员应在环境层面开展工作,以增加获得经济实惠、符合文化习俗、针对帕金森病的运动服务的机会,并提高社区对帕金森病的认识。
{"title":"Comparing Physical Activity and Exercise Experiences, Values, and Beliefs of Latino, Latina, and/or Latine People and Non-Latino, Non-Latina, and/or Non-Latine People With Parkinson Disease: A Qualitative Study.","authors":"Cristina Colón-Semenza, Paria Darbandsari, Kelsi Carolan, David X Marquez, Amy Gorin","doi":"10.1093/ptj/pzae119","DOIUrl":"10.1093/ptj/pzae119","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to examine and compare the beliefs, values, experiences, and barriers to and facilitators of exercise in Latino/a/e (Latino, Latina, and/or Latine) people and non-Latino/a/e (non-Latino, non-Latina, and/or non-Latine) people with Parkinson disease (PD).</p><p><strong>Methods: </strong>This study involved a qualitative research design with data collection via focus groups of Latino/a/e and non-Latino/a/e people with PD. A semistructured interview protocol was used, and a theoretical (social ecological model) thematic analysis was used for data analysis.</p><p><strong>Results: </strong>Twenty-five individuals (15 non-Latino/a/e and 10 Latino/a/e) participated across 5 focus groups. While there were several common themes among both groups, 7 themes related to exercise in the management of PD were unique to Latino/a/e participants: generalized versus specific knowledge of exercise components; family can have both facilitating and impeding roles; finances influence access to exercise and physical therapy; prior emotional experiences related to exercise and PD affect the future use of exercise; group exercise can have both facilitating and impeding roles; availability and access to a variety of modes and stratification of exercise classes for people with PD facilitate exercise; and cultural beliefs and expectations can impede the use of exercise at the population level.</p><p><strong>Conclusion: </strong>Latino/a/e people with PD have overlapping and unique themes related to the use of exercise. Distinctive factors must be addressed in physical activity interventions and during physical therapists' care of people with PD to maximize the use of exercise and ultimately improve health equity in this overburdened and underserved population.</p><p><strong>Impact: </strong>Physical therapists should provide information and education to their Latino/a/e patients with PD and family members on the frequency, intensity, type, and time of exercise and how to safely participate in physical activity in the home and community to best manage PD. Physical therapists and exercise professionals should work at the environmental level to increase access to affordable, culturally tailored, PD-specific exercise services and enhance community knowledge of PD.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142036632","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
Health Disparities in Rehabilitation-Practice/Research Focus. 康复中的健康差异--实践/研究重点。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-10-02 DOI: 10.1093/ptj/pzae143
Dawn Magnusson
{"title":"Health Disparities in Rehabilitation-Practice/Research Focus.","authors":"Dawn Magnusson","doi":"10.1093/ptj/pzae143","DOIUrl":"https://doi.org/10.1093/ptj/pzae143","url":null,"abstract":"","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":"104 10","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546764","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
Disparities in Physical Therapy Outcomes Based on Race and Ethnicity: A Scoping Review. 基于种族和民族的物理治疗结果差异:范围审查。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-10-02 DOI: 10.1093/ptj/pzae090
Rupal M Patel, Rachel A Prusynski, Bernadette Williams-York, Ndidiamaka D Matthews, Lisa VanHoose

Objective: This scoping review synthesizes and summarizes the evidence on racial and ethnic disparities in outcomes after physical therapist treatment.

Methods: Four databases from 2001 through 2021 were searched for articles reporting physical therapy outcomes across racial and ethnic groups. The Arksey and O'Malley methodological framework was adapted for this scoping review. Two reviewers screened the abstracts, and 5 reviewers screened full texts for inclusion. Five reviewers extracted information including study design, diagnoses, setting, outcomes reported, the domains the outcomes measured, and racial and ethnic groups included. To identify disparities, summarized differences in outcomes (better, worse, no difference) for each racial and ethnic group compared to White patients were calculated.

Results: Of 1511 abstracts screened, 65 met inclusion criteria, 57 of which were observational designs. All 65 articles included non-Hispanic White patients as the reference group. A majority of the physical therapy outcomes reported by race were for Black patients and/or Hispanic or Latino patients, whereas outcomes for Asian, American Indian, Alaskan Native, and/or Native Hawaiians or Pacific Islander patients were reported infrequently. Most articles reported disparities in health outcomes for patients in the inpatient rehabilitation setting (n = 48) and for adults (n = 59) with neurologic diagnoses (n = 36). Compared to White patients, worse outcomes were reported more frequently for all marginalized racial and ethnic groups after physical therapy, with the exception of marginalized groups having the same or better outcomes for successful post-rehabilitation community discharge.

Conclusion: Gaps remain in understanding outcome disparities beyond older adult and neurologic populations as well as for musculoskeletal diagnoses frequently treated by physical therapists.

Impact: The presence of racial and ethnic disparities in physical therapy outcomes should motivate physical therapists to understand the mechanisms underlying disparities and focus on social and structural drivers of health inequity in their clinical decision-making.

摘要本范围综述综合并总结了理疗师治疗后结果中种族和民族差异的证据:方法: 我们检索了 2001 年至 2021 年的四个数据库,以查找报告不同种族和民族理疗结果的文章。Arksey和O'Malley的方法论框架经调整后用于此次范围界定综述。两名审稿人对摘要进行了筛选,五名审稿人对全文进行了筛选。五位审稿人提取的信息包括研究设计、诊断、环境、报告结果、测量结果的领域以及纳入的种族和民族群体。为了确定差异,计算了每个种族和民族群体与白人患者相比的结果差异(更好、更差、无差异):在筛选出的 1511 篇摘要中,有 65 篇符合纳入标准,其中 57 篇为观察性设计。所有 65 篇文章都将非西班牙裔白人患者作为参照组。大多数按种族报告的物理治疗结果都是针对黑人患者和/或西班牙裔或拉丁裔患者的,而针对亚裔、美国印第安人、阿拉斯加原住民和/或夏威夷原住民或太平洋岛民患者的结果报告并不多见。大多数文章都报道了住院康复患者(48 人)和有神经系统诊断的成人患者(59 人)(36 人)的健康结果差异。与白人患者相比,所有被边缘化的种族和民族群体在接受物理治疗后的疗效更差,但边缘化群体在康复后成功出院时的疗效与白人患者相同或更好:结论:在了解老年人和神经系统疾病人群以及物理治疗师经常治疗的肌肉骨骼诊断结果差异方面仍存在差距:影响:物理治疗结果中存在的种族和民族差异应促使物理治疗师了解造成差异的机制,并在临床决策中关注造成健康不平等的社会和结构性因素。
{"title":"Disparities in Physical Therapy Outcomes Based on Race and Ethnicity: A Scoping Review.","authors":"Rupal M Patel, Rachel A Prusynski, Bernadette Williams-York, Ndidiamaka D Matthews, Lisa VanHoose","doi":"10.1093/ptj/pzae090","DOIUrl":"10.1093/ptj/pzae090","url":null,"abstract":"<p><strong>Objective: </strong>This scoping review synthesizes and summarizes the evidence on racial and ethnic disparities in outcomes after physical therapist treatment.</p><p><strong>Methods: </strong>Four databases from 2001 through 2021 were searched for articles reporting physical therapy outcomes across racial and ethnic groups. The Arksey and O'Malley methodological framework was adapted for this scoping review. Two reviewers screened the abstracts, and 5 reviewers screened full texts for inclusion. Five reviewers extracted information including study design, diagnoses, setting, outcomes reported, the domains the outcomes measured, and racial and ethnic groups included. To identify disparities, summarized differences in outcomes (better, worse, no difference) for each racial and ethnic group compared to White patients were calculated.</p><p><strong>Results: </strong>Of 1511 abstracts screened, 65 met inclusion criteria, 57 of which were observational designs. All 65 articles included non-Hispanic White patients as the reference group. A majority of the physical therapy outcomes reported by race were for Black patients and/or Hispanic or Latino patients, whereas outcomes for Asian, American Indian, Alaskan Native, and/or Native Hawaiians or Pacific Islander patients were reported infrequently. Most articles reported disparities in health outcomes for patients in the inpatient rehabilitation setting (n = 48) and for adults (n = 59) with neurologic diagnoses (n = 36). Compared to White patients, worse outcomes were reported more frequently for all marginalized racial and ethnic groups after physical therapy, with the exception of marginalized groups having the same or better outcomes for successful post-rehabilitation community discharge.</p><p><strong>Conclusion: </strong>Gaps remain in understanding outcome disparities beyond older adult and neurologic populations as well as for musculoskeletal diagnoses frequently treated by physical therapists.</p><p><strong>Impact: </strong>The presence of racial and ethnic disparities in physical therapy outcomes should motivate physical therapists to understand the mechanisms underlying disparities and focus on social and structural drivers of health inequity in their clinical decision-making.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141580528","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
Activity and Participation Are Associated With Future Falls, Hospitalizations, and Emergency Visits in Community-Dwelling Older Adults. 活动和参与与社区老年人未来的跌倒、住院和急诊就诊有关。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-10-02 DOI: 10.1093/ptj/pzae087
Brooke N Klatt, Subashan Perera, Pamela M Dunlap, Andrea L Rosso, Jennifer S Brach

Objective: Activity and participation are important for older adults as they are associated with well-being and quality of life. Falls, emergency department (ED) visits, and hospitalizations are adverse health outcomes that impact older adults. Limited research has investigated whether measurement of activity and participation are related to adverse health events in community dwelling older adults. This study sought to examine the association between activity and participation with falls, ED visits, and hospitalization over 1 year in community dwelling older adults.

Methods: A secondary analysis of a longitudinal clinical trial of 341 community dwelling older adults was conducted. The sample mean age was 80.9 (SD = 7.7) years and 83% were female. One-year risk of falls was associated with baseline Late Life Function and Disability Instrument (LLFDI) components of overall function and disability (frequency and limitations dimensions). Incident rate ratios (IRRs) and 95% CIs were calculated.

Results: For each five-point higher score (clinically meaningful difference) in activity as measured by LLFDI-overall function (adjusted for age, race, sex, comorbidities and fall history), there was an 18% lower rate of falls (IRR = 0.82, 95% CI = 0.74-0.92), 12% reduction in hospitalizations (IRR = 0.88; 95% CI = 0.77-0.99), and 11% lower rate of emergency room visits (IRR = 0.89, 95% CI = 0.81-0.98). Greater participation as measured by the LLFDI limitations dimension was related to fewer falls (IRR = 0.93, 95% CI = 0.87-1.00) and hospitalizations (IRR = 0.91, 95% CI = 0.83-0.99).

Conclusion: Greater activity and participation are associated with a lower incidence of falls, ED visits, and hospitalizations representing an important consideration for targeted physical therapist interventions.

Impact statement: Physical therapists are uniquely positioned to identify and address reduced activity and participation. If activity and participation are specifically targeted and improved through physical therapy, undesirable distal health outcomes might be prevented or minimized.

Lay summary: Greater activity and participation were found to be related to lower rate of falls, ED visits, and hospitalizations in a sample of 341 older adults who lived in the community.

目的:活动和参与对老年人非常重要,因为它们与老年人的福祉和生活质量息息相关。跌倒、急诊室就诊和住院是影响老年人健康的不良后果。对于活动和参与的测量是否与居住在社区的老年人的不良健康事件有关,研究有限。本研究旨在探讨社区老年人一年内活动和参与与跌倒、急诊就诊和住院之间的关系:对 341 名社区老年人的纵向临床试验进行了二次分析。样本的平均年龄为 80.9 岁(SD = 7.7),83% 为女性。一年的跌倒风险与晚年功能和残疾指数(LLFDI)中的总体功能和残疾(频率和限制)基线相关。计算出了发病率比(IRRs)和 95% CIs:根据 LLFDI 整体功能(已对年龄、种族、性别、合并症和跌倒史进行调整)衡量的活动得分每提高 5 分(临床意义差异),跌倒率降低 18%(IRR = 0.82,95% CI = 0.74-0.92);住院率降低 12%(IRR = 0.88;95% CI = 0.77-0.99);急诊就诊率降低 11%(IRR = 0.89,95% CI = 0.81-0.98)。以 LLFDI 限制维度衡量的更多参与与更少的跌倒(IRR = 0.93,95% CI = 0.87-1.00)和住院(IRR = 0.91,95% CI = 0.83-0.99)有关:结论:更多的活动和参与与较低的跌倒、急诊室就诊和住院率有关,是物理治疗师进行有针对性干预的重要考虑因素:物理治疗师在识别和解决活动和参与减少的问题方面具有独特的优势。如果通过物理治疗有针对性地提高活动和参与度,就可以预防或最大限度地减少不良的远端健康后果。
{"title":"Activity and Participation Are Associated With Future Falls, Hospitalizations, and Emergency Visits in Community-Dwelling Older Adults.","authors":"Brooke N Klatt, Subashan Perera, Pamela M Dunlap, Andrea L Rosso, Jennifer S Brach","doi":"10.1093/ptj/pzae087","DOIUrl":"10.1093/ptj/pzae087","url":null,"abstract":"<p><strong>Objective: </strong>Activity and participation are important for older adults as they are associated with well-being and quality of life. Falls, emergency department (ED) visits, and hospitalizations are adverse health outcomes that impact older adults. Limited research has investigated whether measurement of activity and participation are related to adverse health events in community dwelling older adults. This study sought to examine the association between activity and participation with falls, ED visits, and hospitalization over 1 year in community dwelling older adults.</p><p><strong>Methods: </strong>A secondary analysis of a longitudinal clinical trial of 341 community dwelling older adults was conducted. The sample mean age was 80.9 (SD = 7.7) years and 83% were female. One-year risk of falls was associated with baseline Late Life Function and Disability Instrument (LLFDI) components of overall function and disability (frequency and limitations dimensions). Incident rate ratios (IRRs) and 95% CIs were calculated.</p><p><strong>Results: </strong>For each five-point higher score (clinically meaningful difference) in activity as measured by LLFDI-overall function (adjusted for age, race, sex, comorbidities and fall history), there was an 18% lower rate of falls (IRR = 0.82, 95% CI = 0.74-0.92), 12% reduction in hospitalizations (IRR = 0.88; 95% CI = 0.77-0.99), and 11% lower rate of emergency room visits (IRR = 0.89, 95% CI = 0.81-0.98). Greater participation as measured by the LLFDI limitations dimension was related to fewer falls (IRR = 0.93, 95% CI = 0.87-1.00) and hospitalizations (IRR = 0.91, 95% CI = 0.83-0.99).</p><p><strong>Conclusion: </strong>Greater activity and participation are associated with a lower incidence of falls, ED visits, and hospitalizations representing an important consideration for targeted physical therapist interventions.</p><p><strong>Impact statement: </strong>Physical therapists are uniquely positioned to identify and address reduced activity and participation. If activity and participation are specifically targeted and improved through physical therapy, undesirable distal health outcomes might be prevented or minimized.</p><p><strong>Lay summary: </strong>Greater activity and participation were found to be related to lower rate of falls, ED visits, and hospitalizations in a sample of 341 older adults who lived in the community.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11485024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141591026","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
Prestroke Physical Activity Matters for Functional Limitations: A Longitudinal Case-Control Study of 12,860 Participants. 中风前体育锻炼对功能限制的影响:一项针对 12,860 名参与者的纵向病例对照研究。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-10-02 DOI: 10.1093/ptj/pzae094
Zachary M van Allen, Dan Orsholits, Matthieu P Boisgontier

Objective: In the chronic phase after a stroke, limitations in basic activities of daily living (ADLs) and instrumental activities of daily living (IADLs) initially plateau before steadily increasing. The benefits of prestroke physical activity on these limitations remain unclear. To clarify this relationship, the effect of physical activity on the long-term evolution of functional limitations in a cohort of people with stroke compared to a cohort of matched adults without stroke was examined.

Methods: Longitudinal data from 2143 people with stroke and 10,717 adults without stroke aged 50 years and older were drawn from a prospective cohort study based on the Survey of Health, Ageing and Retirement in Europe (2004-2022; eight data collection waves). Physical activity was assessed in the prestroke wave. Functional limitations were assessed in the poststroke waves. Each person with stroke was matched with five adults without stroke who had similar propensity scores computed on the basis of key covariates, including baseline age, sex, body mass index, limitations in ADLs and IADLs, chronic conditions, and country of residence, before any of the participants from either cohort had experienced a stroke.

Results: Results showed an interaction between stroke status and physical activity on ADL limitations (b = -0.076; 95% CI = -0.142 to -0.011), with the beneficial effect of physical activity being stronger in people with stroke (b = -0.345; 95% CI = -0.438 to -0.252) than in adults without stroke (b = -0.269; 95% CI = -0.269 to -0.241).

Conclusion: The beneficial effect of prestroke physical activity on ADL limitations after stroke is stronger than its effect in matched adults without stroke followed for a similar number of years.

Impact: Physical activity, an intervention within the physical therapist's scope of practice, is effective in reducing the risk of functional dependence after stroke. Moreover, prestroke levels of physical activity can inform the prognosis of functional dependence in people with stroke.

目的:在脑卒中后的慢性期,日常生活活动(ADLs)和工具性日常生活活动(IADLs)的限制最初趋于平稳,然后稳步增加。卒中前体育锻炼对这些限制的益处尚不清楚。为了澄清这种关系,我们研究了体育锻炼对中风患者队列中功能限制的长期演变的影响,并将其与匹配的未中风成人队列进行了比较:方法:2143 名中风患者和 10717 名无中风的 50 岁及以上成年人的纵向数据来自一项基于欧洲健康、老龄化和退休调查(2004-2022 年;8 次数据收集波)的前瞻性队列研究。在中风前的波次中对体力活动进行了评估。功能限制在中风后进行评估。每个中风患者与 5 个未中风的成年人进行配对,这些成年人在任何一个队列中的任何参与者发生中风之前,根据主要协变量(包括基线年龄、性别、体重指数、ADLs 和 IADLs 限制、慢性病和居住国)计算出相似的倾向分数:结果表明,中风状态与体育锻炼对 ADL 限制的交互作用(b = -0.076;95% CI = -0.142--0.011),体育锻炼对中风患者的影响(b = -0.345;95% CI = -0.438--0.252)强于对未中风成人的影响(b = -0.269;95% CI = -0.269--0.241):结论:卒中前体育锻炼对卒中后ADL受限的有益影响要强于对匹配的无卒中成人进行类似年限的随访:影响:体育锻炼是理疗师执业范围内的一项干预措施,可有效降低中风后功能依赖的风险。此外,中风前的体力活动水平可以为中风患者功能依赖的预后提供参考。
{"title":"Prestroke Physical Activity Matters for Functional Limitations: A Longitudinal Case-Control Study of 12,860 Participants.","authors":"Zachary M van Allen, Dan Orsholits, Matthieu P Boisgontier","doi":"10.1093/ptj/pzae094","DOIUrl":"10.1093/ptj/pzae094","url":null,"abstract":"<p><strong>Objective: </strong>In the chronic phase after a stroke, limitations in basic activities of daily living (ADLs) and instrumental activities of daily living (IADLs) initially plateau before steadily increasing. The benefits of prestroke physical activity on these limitations remain unclear. To clarify this relationship, the effect of physical activity on the long-term evolution of functional limitations in a cohort of people with stroke compared to a cohort of matched adults without stroke was examined.</p><p><strong>Methods: </strong>Longitudinal data from 2143 people with stroke and 10,717 adults without stroke aged 50 years and older were drawn from a prospective cohort study based on the Survey of Health, Ageing and Retirement in Europe (2004-2022; eight data collection waves). Physical activity was assessed in the prestroke wave. Functional limitations were assessed in the poststroke waves. Each person with stroke was matched with five adults without stroke who had similar propensity scores computed on the basis of key covariates, including baseline age, sex, body mass index, limitations in ADLs and IADLs, chronic conditions, and country of residence, before any of the participants from either cohort had experienced a stroke.</p><p><strong>Results: </strong>Results showed an interaction between stroke status and physical activity on ADL limitations (b = -0.076; 95% CI = -0.142 to -0.011), with the beneficial effect of physical activity being stronger in people with stroke (b = -0.345; 95% CI = -0.438 to -0.252) than in adults without stroke (b = -0.269; 95% CI = -0.269 to -0.241).</p><p><strong>Conclusion: </strong>The beneficial effect of prestroke physical activity on ADL limitations after stroke is stronger than its effect in matched adults without stroke followed for a similar number of years.</p><p><strong>Impact: </strong>Physical activity, an intervention within the physical therapist's scope of practice, is effective in reducing the risk of functional dependence after stroke. Moreover, prestroke levels of physical activity can inform the prognosis of functional dependence in people with stroke.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11446638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141620686","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
Maternal Health Disparities in Acute Care Rehabilitation. 急症护理康复中的孕产妇健康差异。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-10-02 DOI: 10.1093/ptj/pzae117
Rebeca Segraves, Jenna Segraves, Rebecca Parr, Erin Samel, Vivian Smith-Aldrick

Patients with a high-risk pregnancy or who immediately give birth are often not provided access to acute care occupational and physical therapy during their hospital admission. The greatest potential for health care crises, including maternal mortality, occurs during the first 6 weeks after birth. Maternal mortality and morbidity, which continue to rise in the United States, are considered indicators of the overall population health of a country. It is estimated that over 80% of pregnancy-related deaths are preventable. The leading causes of death within the first 6 weeks after birth are hemorrhage, hypertensive disorders, and infection. Implicit biases about childbearing individuals who are perceived to be relatively young, independent, active, and healthy may unintentionally contribute to areas of substandard care that adversely impact maternal health outcomes. It is a professional and ethical imperative that health providers, including occupational and physical therapists, establish themselves as allies to patient groups at high risk for disparate treatment. The Acute Care OB Rehab Implicit Bias Self-Reflection Tool is an instrument designed for health providers to identify stereotypes that may contribute to inequitable access to rehabilitation in the hospital after birth. Including rehabilitation services for the perinatal population in the hospital setting can play a pivotal role in early detection of adverse events with activity that may directly impact the increasing maternal mortality rate in the United States.

高危妊娠患者或立即分娩的患者在入院期间往往无法获得急症护理职业治疗和物理治疗。产后 6 周内最有可能出现医疗危机,包括孕产妇死亡。在美国,孕产妇死亡率和发病率持续上升,被认为是一个国家整体人口健康的指标。据估计,80% 以上与妊娠有关的死亡是可以预防的。产后 6 天内死亡的主要原因是大出血、高血压和感染。人们认为育龄妇女相对年轻、独立、活跃、健康,对她们的偏见可能会无意中造成护理不达标,从而对孕产妇的健康产生不利影响。包括职业治疗师和物理治疗师在内的医疗服务提供者在专业和职业道德上必须将自己定位为高风险患者群体的盟友。急症护理产科康复隐性偏见自我反思工具是专为医疗服务提供者设计的工具,用于识别可能导致产后在医院获得康复服务不公平的陈规定型观念。在医院环境中为围产期人群提供康复服务,可在早期发现不良活动事件方面发挥关键作用,这可能会直接影响美国日益增长的孕产妇死亡率。
{"title":"Maternal Health Disparities in Acute Care Rehabilitation.","authors":"Rebeca Segraves, Jenna Segraves, Rebecca Parr, Erin Samel, Vivian Smith-Aldrick","doi":"10.1093/ptj/pzae117","DOIUrl":"10.1093/ptj/pzae117","url":null,"abstract":"<p><p>Patients with a high-risk pregnancy or who immediately give birth are often not provided access to acute care occupational and physical therapy during their hospital admission. The greatest potential for health care crises, including maternal mortality, occurs during the first 6 weeks after birth. Maternal mortality and morbidity, which continue to rise in the United States, are considered indicators of the overall population health of a country. It is estimated that over 80% of pregnancy-related deaths are preventable. The leading causes of death within the first 6 weeks after birth are hemorrhage, hypertensive disorders, and infection. Implicit biases about childbearing individuals who are perceived to be relatively young, independent, active, and healthy may unintentionally contribute to areas of substandard care that adversely impact maternal health outcomes. It is a professional and ethical imperative that health providers, including occupational and physical therapists, establish themselves as allies to patient groups at high risk for disparate treatment. The Acute Care OB Rehab Implicit Bias Self-Reflection Tool is an instrument designed for health providers to identify stereotypes that may contribute to inequitable access to rehabilitation in the hospital after birth. Including rehabilitation services for the perinatal population in the hospital setting can play a pivotal role in early detection of adverse events with activity that may directly impact the increasing maternal mortality rate in the United States.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142043999","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
Diversity, Equity, Inclusion, and Antiracism Research in Physical Therapy Over the Last 25 Years: A Scoping Review. 过去 25 年物理治疗领域的多样性、公平性、包容性和反种族主义研究:范围综述》。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-10-02 DOI: 10.1093/ptj/pzae072
K Michael Rowley, An Ky, Ndidiamaka D Matthews

Objective: Discussions of the root causes of health disparities and educational inequities often neglect to identify racism as a primary factor. Researchers must take a systems perspective to identify the effects of racism and other forms of systemic oppression on health. It is unclear to what extent this perspective exists in the physical therapy research literature. We conducted a scoping review to quantify and describe the volume of research in physical therapy pertaining to diversity, equity, and inclusion specifically examining race and/or ethnicity and references racism or antiracism.

Methods: A systematic search of PubMed and Scopus databases for articles published between 1997 and 2021 was conducted. Articles were screened to ensure they were focused exclusively or primarily on physical therapy and used diversity, equity, and inclusion terms in the context of personal identity factors. This resulted in 158 relevant articles. Each was tagged with an article type and personal identity factor focus.

Results: A majority of the included articles were descriptive/observational in nature. The included articles explored various personal identity factors, with race and ethnicity being the most common focus followed by culture, disability, and socioeconomic status. A small proportion of articles explicitly discussed racism or antiracism.

Conclusion: These findings highlight the need in physical therapy research for greater attention to racism as a fundamental cause of health disparities and educational inequities. Addressing this gap is crucial for promoting diversity, equity, and inclusion within the field and ultimately achieving optimal health outcomes for marginalized populations.

Impact: Including consideration of racism and other forms of systemic oppression in the motivation, design, and interpretation of research in physical therapy will help to make more visible the root causes of inequity and improve our ability to develop effective, multi-level interventions.

目的:在讨论健康差距和教育不平等的根源时,往往忽略了种族主义是一个主要因素。研究人员必须从系统的角度来识别种族主义和其他形式的系统性压迫对健康的影响。目前还不清楚物理治疗研究文献在多大程度上采用了这种视角。我们进行了一次范围界定综述,以量化和描述物理治疗中与多样性、公平性和包容性相关的研究数量,这些研究专门研究了种族和/或民族性,并提到了种族主义或反种族主义:对 PubMed 和 Scopus 数据库中 1997 年至 2021 年间发表的文章进行了系统检索。对这些文章进行了筛选,以确保它们只关注或主要关注物理治疗,并在个人身份因素的背景下使用了多样性、公平性和包容性术语。最终筛选出 158 篇相关文章。每篇文章都标注了文章类型和个人身份因素重点:结果:收录的大部分文章都是描述性/观察性的。收录的文章探讨了各种个人身份因素,其中种族和民族是最常见的重点,其次是文化、残疾和社会经济地位。小部分文章明确讨论了种族主义或反种族主义问题:这些发现突出表明,物理治疗研究需要更多地关注种族主义,因为种族主义是造成健康差距和教育不公平的根本原因。解决这一差距对于促进该领域的多样性、公平性和包容性以及最终实现边缘化人群的最佳健康结果至关重要:影响:在物理治疗研究的动机、设计和解释中考虑种族主义和其他形式的系统性压迫,将有助于使不平等的根源更加明显,并提高我们开发有效的多层次干预措施的能力。
{"title":"Diversity, Equity, Inclusion, and Antiracism Research in Physical Therapy Over the Last 25 Years: A Scoping Review.","authors":"K Michael Rowley, An Ky, Ndidiamaka D Matthews","doi":"10.1093/ptj/pzae072","DOIUrl":"10.1093/ptj/pzae072","url":null,"abstract":"<p><strong>Objective: </strong>Discussions of the root causes of health disparities and educational inequities often neglect to identify racism as a primary factor. Researchers must take a systems perspective to identify the effects of racism and other forms of systemic oppression on health. It is unclear to what extent this perspective exists in the physical therapy research literature. We conducted a scoping review to quantify and describe the volume of research in physical therapy pertaining to diversity, equity, and inclusion specifically examining race and/or ethnicity and references racism or antiracism.</p><p><strong>Methods: </strong>A systematic search of PubMed and Scopus databases for articles published between 1997 and 2021 was conducted. Articles were screened to ensure they were focused exclusively or primarily on physical therapy and used diversity, equity, and inclusion terms in the context of personal identity factors. This resulted in 158 relevant articles. Each was tagged with an article type and personal identity factor focus.</p><p><strong>Results: </strong>A majority of the included articles were descriptive/observational in nature. The included articles explored various personal identity factors, with race and ethnicity being the most common focus followed by culture, disability, and socioeconomic status. A small proportion of articles explicitly discussed racism or antiracism.</p><p><strong>Conclusion: </strong>These findings highlight the need in physical therapy research for greater attention to racism as a fundamental cause of health disparities and educational inequities. Addressing this gap is crucial for promoting diversity, equity, and inclusion within the field and ultimately achieving optimal health outcomes for marginalized populations.</p><p><strong>Impact: </strong>Including consideration of racism and other forms of systemic oppression in the motivation, design, and interpretation of research in physical therapy will help to make more visible the root causes of inequity and improve our ability to develop effective, multi-level interventions.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141071751","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
News From the Foundation for Physical Therapy Research, October 2024. 物理治疗研究基金会新闻》,2024 年 10 月。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-10-02 DOI: 10.1093/ptj/pzae140
{"title":"News From the Foundation for Physical Therapy Research, October 2024.","authors":"","doi":"10.1093/ptj/pzae140","DOIUrl":"https://doi.org/10.1093/ptj/pzae140","url":null,"abstract":"","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":"104 10","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505894","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
Optimizing Total Knee Arthroplasty Rehabilitation With Telehealth Physical Activity Behavior Change Intervention: A Randomized Clinical Trial. 通过远程医疗体育活动行为改变干预优化全膝关节置换术康复:随机临床试验。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-10-02 DOI: 10.1093/ptj/pzae088
Cory L Christiansen, Paul W Kline, Chelsey B Anderson, Edward L Melanson, William J Sullivan, Vanessa L Richardson, Elizabeth Juarez-Colunga, Jennifer E Stevens-Lapsley

Objective: Conventional total knee arthroplasty (TKA) rehabilitation has little impact on sedentary lifestyles that have negative long-term health consequences. The purpose of this trial was to determine the effect of telehealth-based physical activity behavior change intervention on physical activity and functional outcomes following TKA.

Methods: This study was a 2-arm, parallel randomized controlled superiority trial at a regional Veterans Affairs medical center. The participants were 92 US military veterans (mean age = 65.7 [SD =7.8] y) undergoing unilateral TKA. The Physical Activity Behavior Change (PABC) intervention included telehealth-based self-management training (10 30-minute sessions) delivered over 12 weeks. The control intervention included telehealth-based health education sessions that matched PABC frequency and duration. Both groups participated in standardized conventional outpatient rehabilitation. Physical activity, measured as average daily step count, was the primary outcome. Secondary outcomes were Life-Space Assessment questionnaire, 30-Second Chair-Stand test, Timed "Up & Go" Test, 6-Minute Walk Test, Western Ontario and McMaster Universities Osteoarthritis Index, and Veterans RAND 12-Item Health Survey. The Self Efficacy for Exercise scale and daily time spent in different postures (sitting/lying, standing, stepping) were exploratory variables. Outcomes were measured at baseline (before surgery), mid-intervention (8 weeks after surgery), after the intervention (14 weeks after surgery; primary endpoint), and follow-up (38 weeks after surgery).

Results: The PABC group had an estimated 931 (95% CI = 42-1819) more daily steps than the control group from baseline to 14 weeks, though a between-group effect was not sustained at 38 weeks. There were no group differences in secondary outcomes. Participants included only military veterans using Veterans Health Administration services. The intervention targeted self-management and did not include peer support.

Conclusion: The PABC intervention improved physical activity for veterans recovering from unilateral TKA at 14 weeks after surgery, though the effect was not sustained at 38 weeks. Physical function improved with rehabilitation but was not different between groups, indicating that physical function was not a primary driver of physical activity behavior.

Impact: Conventional TKA rehabilitation has a negligible effect on free-living physical activity, which is relevant to long-term health outcomes. This trial identified telehealth physical activity self-management as effective in addressing activity behaviors, separate from conventional rehabilitation strategies.

目的:传统的全膝关节置换术(TKA)康复治疗对久坐不动的生活方式影响甚微,而久坐不动的生活方式会对长期健康造成负面影响。本试验旨在确定基于远程医疗的体育锻炼行为改变干预对 TKA 术后体育锻炼和功能结果的影响:本研究是在地区退伍军人事务医疗中心进行的一项双臂平行随机对照优效试验。参与者为 92 名接受单侧 TKA 手术的美国退伍军人(平均年龄为 65.7 [SD =7.8] 岁)。体育锻炼行为改变(PABC)干预包括基于远程医疗的自我管理培训(10 节 30 分钟的课程),为期 12 周。对照干预包括与 PABC 频率和持续时间相匹配的远程健康教育课程。两组患者都参加了标准化的常规门诊康复治疗。以每日平均步数衡量的身体活动量是主要结果。次要结果包括生活空间评估问卷、30 秒椅子站立测试、定时起立行走测试、六分钟步行测试、西安大略和麦克马斯特大学骨关节炎指数以及退伍军人兰德 12 项健康调查。运动自我效能量表和每天保持不同姿势(坐/卧、站立、迈步)的时间是探索性变量。结果在基线(手术前)、干预中期(手术后 8 周)、干预后(手术后 14 周;主要终点)和随访(手术后 38 周)进行测量:从基线到 14 周,PABC 组的每日步数估计比对照组多 931 步(95% CI = 42-1819),但在 38 周时,组间效应并未持续。次要结果方面没有组间差异。参与者只包括使用退伍军人健康管理局服务的退伍军人。干预以自我管理为目标,不包括同伴支持:PABC干预改善了单侧TKA术后14周的退伍军人的体育锻炼,但在38周时效果并不持久。身体功能在康复过程中有所改善,但各组之间并无差异,这表明身体功能并不是体育锻炼行为的主要驱动力:影响:传统的 TKA 康复对自由生活的体力活动影响微乎其微,而这与长期的健康结果息息相关。这项试验发现,远程医疗身体活动自我管理能有效解决活动行为问题,与传统康复策略不同。
{"title":"Optimizing Total Knee Arthroplasty Rehabilitation With Telehealth Physical Activity Behavior Change Intervention: A Randomized Clinical Trial.","authors":"Cory L Christiansen, Paul W Kline, Chelsey B Anderson, Edward L Melanson, William J Sullivan, Vanessa L Richardson, Elizabeth Juarez-Colunga, Jennifer E Stevens-Lapsley","doi":"10.1093/ptj/pzae088","DOIUrl":"10.1093/ptj/pzae088","url":null,"abstract":"<p><strong>Objective: </strong>Conventional total knee arthroplasty (TKA) rehabilitation has little impact on sedentary lifestyles that have negative long-term health consequences. The purpose of this trial was to determine the effect of telehealth-based physical activity behavior change intervention on physical activity and functional outcomes following TKA.</p><p><strong>Methods: </strong>This study was a 2-arm, parallel randomized controlled superiority trial at a regional Veterans Affairs medical center. The participants were 92 US military veterans (mean age = 65.7 [SD =7.8] y) undergoing unilateral TKA. The Physical Activity Behavior Change (PABC) intervention included telehealth-based self-management training (10 30-minute sessions) delivered over 12 weeks. The control intervention included telehealth-based health education sessions that matched PABC frequency and duration. Both groups participated in standardized conventional outpatient rehabilitation. Physical activity, measured as average daily step count, was the primary outcome. Secondary outcomes were Life-Space Assessment questionnaire, 30-Second Chair-Stand test, Timed \"Up & Go\" Test, 6-Minute Walk Test, Western Ontario and McMaster Universities Osteoarthritis Index, and Veterans RAND 12-Item Health Survey. The Self Efficacy for Exercise scale and daily time spent in different postures (sitting/lying, standing, stepping) were exploratory variables. Outcomes were measured at baseline (before surgery), mid-intervention (8 weeks after surgery), after the intervention (14 weeks after surgery; primary endpoint), and follow-up (38 weeks after surgery).</p><p><strong>Results: </strong>The PABC group had an estimated 931 (95% CI = 42-1819) more daily steps than the control group from baseline to 14 weeks, though a between-group effect was not sustained at 38 weeks. There were no group differences in secondary outcomes. Participants included only military veterans using Veterans Health Administration services. The intervention targeted self-management and did not include peer support.</p><p><strong>Conclusion: </strong>The PABC intervention improved physical activity for veterans recovering from unilateral TKA at 14 weeks after surgery, though the effect was not sustained at 38 weeks. Physical function improved with rehabilitation but was not different between groups, indicating that physical function was not a primary driver of physical activity behavior.</p><p><strong>Impact: </strong>Conventional TKA rehabilitation has a negligible effect on free-living physical activity, which is relevant to long-term health outcomes. This trial identified telehealth physical activity self-management as effective in addressing activity behaviors, separate from conventional rehabilitation strategies.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141604020","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