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Correction to: Video-Game-Based Exercises for Older People With Chronic Low Back Pain: A Randomized Controlled Trial (GAMEBACK). 更正:基于视频游戏的老年人慢性腰痛锻炼:随机对照试验 (GAMEBACK)。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-04 DOI: 10.1093/ptj/pzae131
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引用次数: 0
A Community Development Approach in Physical Therapist Education. 物理治疗师教育中的社区发展方法。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-04 DOI: 10.1093/ptj/pzae091
Kimberly Varnado, Anne Mejia-Downs, Alexander Scharmann, Shannon Richardson

Physical therapists should be able to screen patients for social determinants that impact health and refer to community resources as appropriate. To make appropriate referrals, physical therapists must equip themselves with skills to connect patients and clients to community resources outside the walls of their respective institutions, starting with developing these practices in physical therapist education programs. Experienced community builders recommend a community development approach where residents initiate and agree upon decisions, and outside stakeholders work as partners to elevate the community. The community should be supported to determine the desired outcomes in ways that enhance equity, inclusion, and social justice. Communities play a substantial role in health outcomes. Studies indicate that 85% of one's health is connected to community and economic resources, while only 15% is affected by medical interventions. Connected communities are potent tools to enhance health. Connected communities are places where residents nurture neighborhood relationships that enable them to work together to create a good life supporting their collective well-being. The community-builder approach recenters people and their communities as fundamental health leaders; institutions can use their resources to elevate communities by relocating authority back to communities. Communities have assets and resources largely unrecognized, disconnected, and not mobilized by residents. Institutions are positioned to support citizens and their associations in discovering, connecting, and mobilizing these assets. This asset-based community development approach focuses on 5 principles: place-based, citizen-led, relationship-oriented, asset-based, and inclusion-focused. This perspective paper will describe ways institutions can elevate communities; the benefits of community development practices in physical therapist education programs; and explore examples of community partnerships and best practices to develop equitable alliances with residents in the community.

Impact: A large part of one's health is directly related to where one lives. Physical therapists and physical therapist assistants can play a vital role in improving the health of society by engaging in their local communities through community development. Community development is a practice where community members and outside stakeholders, such as physical therapists, come together to meet the needs of a community.

理疗师应能够筛查影响健康的社会决定因素,并酌情转介给社区资源。要进行适当的转介,理疗师必须掌握将患者和客户与各自机构围墙外的社区资源联系起来的技能,首先要在理疗师教育计划中发展这些实践。有经验的社区建设者建议采用社区发展方法,由居民发起并同意决策,外部利益相关者作为合作伙伴共同提升社区。应支持社区以加强公平、包容和社会正义的方式来确定预期成果。社区在健康成果方面发挥着重要作用。研究表明,一个人的健康有 85% 与社区和经济资源有关,而只有 15% 受到医疗干预的影响。互联社区是增进健康的有力工具。互联社区是居民培养邻里关系的地方,这种关系使他们能够共同创造美好生活,支持他们的集体福祉。"社区建设者 "方法使人们及其社区成为基本的健康领导者;机构可以利用其资源,通过将权力交还给社区来提升社区。社区的资产和资源在很大程度上未被居民认识、切断联系和调动起来。机构的定位是支持公民及其协会发现、连接和调动这些资产。这种以资产为基础的社区发展(ABCD)方法注重五项原则:以地方为基础、以公民为主导、以关系为导向、以资产为基础、以包容为重点。本视角论文将介绍机构提升社区地位的方法;物理治疗师教育项目中社区发展实践的益处;探讨社区合作伙伴关系的实例以及与社区居民建立公平联盟的最佳实践:一个人的健康很大程度上与居住地直接相关。物理治疗师和物理治疗师助理可以通过社区发展参与当地社区,在改善社会健康方面发挥重要作用。社区发展是社区成员和外部利益相关者(如物理治疗师)共同满足社区需求的一种做法。
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引用次数: 0
Burnout, Exhaustion, Experiences of Discrimination, and Stress Among Underrepresented and First-Generation College Students in Graduate Health Profession Education. 健康专业研究生教育中代表性不足和第一代大学生的倦怠、疲惫、歧视经历和压力。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-04 DOI: 10.1093/ptj/pzae095
Bernadette Williams-York, Grace A Guenther, Davis G Patterson, Selina A Mohammed, Paula M Kett, Arati Dahal, Bianca K Frogner

Objectives: Mental health disorders are increasing among health profession students. Compounding this, students from underrepresented backgrounds may face additional stressors and challenges. The aims of this study were to: (1) assess the extent to which burnout, exhaustion, experiences of discrimination, and stress exist among students in dentistry, nursing, occupational therapy, pharmacy, and physical therapist professional education programs; (2) determine if there are significant differences by key demographic characteristics (those who are first-generation college students [FGCSs], a member of an underrepresented minority [URM] group, or both); and (3) highlight strategies and solutions to alleviate these challenges identified by students.

Methods: Cross-sectional survey using a mix of question types of a sample of graduate students from dentistry, nursing, occupational therapy, pharmacy, and physical therapy programs from February to June 2020. Utilizing the Maslach Burnout Inventory Student Survey and campus climate and stress survey, mean subscale scores were calculated for the following outcomes of interest: MBI-SS burnout, dimensions of stress, and observed racism. Logistic regressions examined student factors that may help explain these outcomes. Content analysis examined participants' responses to open-ended questions.

Results: There were 611 individuals who completed all survey questions. FGCSs were significantly more likely than non-FGCSs to report exhaustion (adjusted odds ratio [aOR]: 1.50; 95% CI = 1.04-2.16), family stress (aOR: 3.11; 95% CI = 2.13-4.55), and financial stress (aOR: 1.74; 95% CI = 1.21-2.50). URM students reported not feeling supported in their program and mentioned needing additional support, particularly for well-being, from staff and faculty.

Conclusion: Findings from this study are consistent with literature that FGCSs experience additional stressors that may lead to burnout and exhaustion. URM students reported not feeling supported in their programs. This study's findings point to the need for leadership and faculty of health professional schools to implement or strengthen current policies, practices, and strategies that support URM students and FGCSs.

Impact: Research demonstrates that a diverse student body and faculty enhances the educational experience for health professional students, and that diversity strengthens the learning environment and improves learning outcomes, preparing students to care for an increasingly diverse population. However, this study finds that students from underrepresented backgrounds may still experience more burnout, exhaustion, discrimination, and stress than their peers. Programs and policies to support URM students and FGCSs throughout their academic careers can help improve graduation and retention rates, leading to improved workforce diversity.

目的:卫生专业学生的心理健康失调现象日益增多。此外,来自弱势背景的学生可能会面临更多的压力和挑战。本研究旨在1)评估牙科、护理、职业治疗、药学和理疗师专业教育项目的学生在多大程度上存在职业倦怠、精疲力竭、歧视经历和压力;2)确定主要人口统计特征(第一代大学生[FGCS]、未充分代表的少数群体成员[URM]或两者)是否存在显著差异;3)强调减轻学生所发现的这些挑战的策略和解决方案:2020年2月至6月,对牙科、护理、职业治疗、药学和物理治疗专业的研究生进行横断面调查,采用多种问题类型。利用马斯拉赫职业倦怠量表学生调查(MBI-SS)和校园环境与压力调查,计算出以下相关结果的平均子量表得分:MBI-SS 职业倦怠、压力维度和观察到的种族主义。逻辑回归分析了有助于解释这些结果的学生因素。内容分析研究了参与者对开放式问题的回答:共有 611 人完成了所有调查问题。报告精疲力竭(调整后的几率比 [AOR]:1.50;95% CI:1.04-2.16)、家庭压力(AOR:3.11;95% CI:2.13-4.55)和经济压力(AOR:1.74;95% CI:1.21-2.50)的非本地学生明显多于非本地学生。美国少数民族学生表示在他们的课程中没有感受到支持,并提到需要额外的支持,尤其是来自教职员工的福利支持:本研究的结果与文献一致,即女性外籍学生经历了额外的压力,这些压力可能会导致倦怠和精疲力竭。统招学生表示在他们的课程中没有感受到支持。本研究的结果表明,卫生专业学校的领导和教师有必要实施或加强当前的政策、实践和策略,为少数民族学生和女性外籍学生提供支持:影响:研究表明,多元化的学生群体和师资队伍能增强卫生专业学生的教育体验,多元化能强化学习环境,提高学习成绩,使学生为照顾日益多元化的人群做好准备。然而,本研究发现,与同龄人相比,来自少数族裔背景的学生可能仍然会经历更多的倦怠、疲惫、歧视和压力。在整个学业生涯中支持少数民族学生和女性全球儿童保育员的计划和政策有助于提高毕业率和保留率,从而改善劳动力的多样性。
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引用次数: 0
New Protocol for Evaluating Maximum Inspiratory Pressure: Concurrent Validity and Test-Retest Reliability. 评估最大吸气压力的新方案:同时有效性和测试-重测可靠性
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-03 DOI: 10.1093/ptj/pzae124
Ibai López-de-Uralde-Villanueva, Raúl Fabero-Garrido, Elena Alonso Rodríguez 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 test protocol based on the principles of the one-repetition maximum test, assess its test-retest reliability, and establish minimal detectable change 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 maximum inspiratory pressure test was performed using a threshold valve device (one-repetition maximum-based protocol) and the digital manometer (reference test). The one-repetition maximum-based protocol consisted of an incremental phase (inspiratory load increase [10 cmH2O] 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 one-repetition maximum-based protocol for the maximum inspiratory pressure test was good with respect to the reference test (day 1, 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 cmH2O and a minimal detectable change of 17.5 cmH2O.

Conclusion: This study validated a new one-repetition maximum-based protocol for the maximum inspiratory pressure test using an inspiratory muscle training device in individuals with COPD, showing good concurrent validity compared with the reference test, as well as excellent test-retest reliability. The minimal detectable change 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 maximum inspiratory pressure test. The validation of the one-repetition maximum-based protocol addresses this issue, allowing for the appropriate prescription of inspiratory muscle training, favoring its widespread use in people with COPD and therefore improving their physical therapist care.

研究目的本研究旨在验证基于单次重复最大吸气压力测试原理的最大吸气压力测试方案,评估其重测可靠性,并确定慢性阻塞性肺病(COPD)患者的最小可检测变化:方法:49 名慢性阻塞性肺病患者参加了研究,其中 44 人参加了两次预约,每次间隔 7 至 10 天,以确保测试的重复可靠性。最大吸气压力测试使用阈值阀装置(基于一次重复最大值的方案)和数字压力计(参考测试)进行。基于一次重复最大值的方案包括一个递增阶段(吸气负荷增加[10 cmH2O]以达到呼吸衰竭)和一个接近阶段(规定最低失败尝试和最后有效尝试之间一半的负荷):基于最大吸气压力测试的一次重复最大值方案与参考测试的并发有效性良好(第 1 天,ICC = 0.81;第 2 天,ICC = 0.85)。测试重复可靠性极佳(ICC = 0.92),测量标准误差为 6.3 cmH2O,最小可检测变化为 17.5 cmH2O:这项研究验证了使用吸气肌肉训练装置对慢性阻塞性肺病患者进行最大吸气压力测试的新方案,与参考测试相比,该方案显示出良好的并发效度和极佳的测试重复可靠性。所报告的最小可检测变化可在临床环境中解释和应用:影响:有必要为最大吸气压力测试开发新的、廉价的、简单可行的方法。基于最大吸气压力的单次重复方案的验证解决了这一问题,可为吸气肌肉训练开出适当的处方,有利于其在慢性阻塞性肺病患者中的广泛应用,从而改善物理治疗师的护理。
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引用次数: 0
Physical Therapists in Primary Care in the United States: An Overview of Current Practice Models and Implementation Strategies. 美国初级保健中的物理治疗师:当前实践模式和实施策略概览》。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-03 DOI: 10.1093/ptj/pzae123
Katie O'Bright, Seth Peterson

In the United States, physician shortages and increases in noncommunicable disease burden have resulted in a growing demand for primary care providers (PCPs). Patients with physical and functional impairments have been especially affected by these challenges. However, physical therapists are well suited to meet patient needs in primary care settings by working alongside PCPs and other primary health care team members. When included in a primary care team, physical therapists can improve patient access to care, optimize care navigation, and reduce the overall cost of care. Therefore, the purpose of the current perspective was to (1) provide an overview of established integrated primary care models in the United States that include physical therapists in the care team and (2) outline operational and practice considerations for health care administrators and professionals interested in integrating physical therapists into primary care teams.

Impact statement: Given physician shortages and increasing burden in primary care in the United States, inclusion of a physical therapist in a primary care team can improve patient access to care, optimize care navigation, and reduce the overall cost of care for patients with physical and functional needs.

在美国,医生短缺和非传染性疾病负担的增加导致对初级保健提供者(PCP)的需求不断增长。有身体和功能障碍的患者尤其受到这些挑战的影响。然而,物理治疗师通过与初级保健医生和其他初级保健团队成员合作,非常适合在初级保健环境中满足患者的需求。如果将理疗师纳入初级保健团队,理疗师可以改善患者获得护理的机会,优化护理导航,并降低总体护理成本。因此,本视角的目的是:(1)概述美国已建立的将物理治疗师纳入医疗团队的综合初级医疗模式;(2)为有意将物理治疗师纳入初级医疗团队的医疗管理者和专业人士概述操作和实践方面的注意事项:影响声明:鉴于美国医生短缺以及初级医疗负担日益加重,将物理治疗师纳入初级医疗团队可改善患者获得医疗服务的机会,优化医疗导航,并降低有身体和功能需求的患者的总体医疗成本。
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引用次数: 0
Type and Distribution of Gross Motor Activity During Physical Therapy in Young Children With Cerebral Palsy. 脑瘫幼儿物理治疗期间粗大运动活动的类型和分布。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-03 DOI: 10.1093/ptj/pzae125
Laura A Prosser, Athylia C Paremski, Julie Skorup, Morgan Alcott, Samuel R Pierce

Objective: Physical therapists routinely deliver and prescribe motor practice to improve function. The ability to select optimal practice regimens is limited by a current lack of detail in the measurement of motor practice. The objective of this study was to quantify the type, amount, and timing of gross motor practice during physical therapist sessions.

Methods: A secondary video coding analysis of physical therapist sessions from the iMOVE clinical trial (NCT02340026) in young children with cerebral palsy (CP) was conducted. The 37 children who completed the treatment phase were included (mean age = 22.1 months). Children could initiate pulling to stand but were unable to walk. Videos of randomly selected therapy sessions were coded for gross motor activity (422 videos total). The 10 gross motor activity codes included lying, sitting, four point, crawling, kneeling, knee walking, standing, walking, transitions between floor postures, and transitions to/from an upright posture. Twenty percent of each video was double coded for reliability. Time per session, number of bouts, and median time per bout were calculated for each gross motor activity and for 2 aggregate measures: movement time and upright time.

Results: Participants spent more than half of therapy time in sitting and standing combined (60.3%). Transitions occurred more frequently than any other motor activity (49.3 total transitions per session). Movement time accounted for 16.3% of therapy time. Upright time accounted for 53.3% of therapy time.

Conclusions: Critical practice time to gain motor skill is not equivalent to chronological time or time spent in therapy. Toddlers with CP spent a small amount of therapy time moving. Future work should explore the relations between motor practice and rehabilitation outcomes.

Impact: Physical therapists are ideally suited to detail the content of motor practice and ultimately to prescribe optimal patterns of motor practice. We report the characteristics of gross motor practice during therapy in children with CP.

目的:物理治疗师经常提供和规定运动练习,以改善功能。由于目前缺乏对运动练习的详细测量,选择最佳练习方案的能力受到了限制。本研究旨在量化物理治疗师治疗过程中粗大运动练习的类型、数量和时间:对iMOVE临床试验(NCT02340026)中物理治疗师对脑瘫(CP)幼儿的治疗过程进行了二次视频编码分析。37名完成治疗阶段的儿童被纳入其中(平均年龄=22.1个月)。患儿可以主动牵拉站立,但无法行走。对随机抽取的治疗过程视频进行了粗大运动活动编码(共 422 个视频)。10 个粗大运动活动代码包括躺、坐、四点、爬、跪、膝行、站、走、地面姿势之间的转换以及从直立姿势到直立姿势之间的转换。为确保可靠性,每段视频中的 20% 都进行了双重编码。针对每项粗大运动活动以及运动时间和直立时间这两项综合指标,计算了每次治疗的时间、治疗次数和每次治疗的中位时间:结果:参与者的坐姿和站姿时间加起来超过治疗时间的一半(60.3%)。转换动作的频率高于其他任何运动活动(每次治疗共转换 49.3 次)。运动时间占治疗时间的 16.3%。直立时间占治疗时间的 53.3%:结论:获得运动技能的关键练习时间并不等同于计时时间或治疗时间。患有先天性脑瘫的学步儿童花费在运动上的治疗时间较少。未来的工作应探索运动练习与康复效果之间的关系:影响:物理治疗师非常适合详细说明运动练习的内容,并最终规定最佳的运动练习模式。我们报告了CP患儿治疗期间大运动练习的特点。
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引用次数: 0
On "Is it Time to Reframe how Health Care Professionals Label Musculoskeletal Conditions?" Zadro JR, O'Keeffe M, Ferreira GE. Phys Ther. 2024;104:pzae018. https://doi.org/10.1093/ptj/pzae018. 关于 "是时候重塑医护人员对肌肉骨骼疾病的标签了吗?Zadro JR、O'Keeffe M、Ferreira GE。Phys Ther.2024;104:pzae018. https://doi.org/10.1093/ptj/pzae018.
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-08-21 DOI: 10.1093/ptj/pzae116
Seth Peterson
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引用次数: 0
Facial Swelling and Neuritis After Internal Carotid Endarterectomy in an 81-Year-Old Woman With Type 2 Diabetes Mellitus: A Case Report. 一名 81 岁的 2 型糖尿病患者在颈动脉内膜剥脱术后出现面部肿胀和神经炎:病例报告。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-08-21 DOI: 10.1093/ptj/pzae118
Jennifer A Simpson

Objective: Patients with type 2 diabetes mellitus (DM2) may develop carotid artery stenosis (CAS), requiring surgical intervention. Nerve injury following carotid endarterectomy (CEA) is a rare and often unrecognized post-operative 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 (PSFS) 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 post-operative 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 post-operative swelling and nerve pain associated with CEA.

目的:2 型糖尿病(DM2)患者可能会出现颈动脉狭窄(CAS),需要手术治疗。颈动脉内膜剥脱术(CEA)后的神经损伤是一种罕见的术后副作用,而且往往未被认识到。本病例报告描述了一名内CEA术后出现大耳廓和三叉神经炎症状的患者的诊断过程和康复过程:患者是一名 81 岁的女性,患有 DM2,接受了左内 CEA 手术。随后,她的左颈部和面部出现肿胀,沿大耳廓和三叉神经通路出现疼痛。相关检查结果显示,切口位于大耳廓神经和颈部淋巴管的路径上,并有疤痕粘连。术后12天开始进行物理治疗,包括活动和人工淋巴引流、各种模式和运动磁带的应用:结果:患者特定功能量表(PSFS)从评估时的10/30提高到出院时的27/30。肿胀和疼痛明显减轻,出院时患者在睡眠、咀嚼或说话方面没有任何困难。在整个治疗过程中,患者报告的疼痛程度与脸部肿胀的波动一致:结论:DM2患者可能会出现心血管疾病症状,需要进行侵入性手术治疗。DM2 可导致神经和血管结构受损,使患者在手术后容易出现神经损伤或过敏。本病例报告显示,术后面部肿胀与头颈部神经刺激之间可能存在联系。调动和人工淋巴引流、各种方式和运动胶带都能有效减轻疼痛和肿胀:物理治疗师在识别、评估和治疗与 CEA 相关的术后肿胀和神经疼痛方面具有独特的资质。
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引用次数: 0
Associations of Co-Occurring Chronic Conditions With Use of Rehabilitation Services in Older Adults With Back Pain: A Population-Based Cohort Study. 慢性病并发症与患有背痛的老年人使用康复服务的关系:一项基于人群的队列研究。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-08-16 DOI: 10.1093/ptj/pzae110
Sean D Rundell, Amol Karmarkar, Kushang V Patel

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

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

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

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

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

目的目的是研究患有背部疼痛的老年人中,慢性疾病的数量和类型与使用康复服务之间的关系:我们利用 "全国健康与老龄化趋势研究"(National Health and Aging Trends Study)开展了一项队列研究,该研究是一项针对年龄≥65 岁的医疗保险受益人的纵向调查。我们纳入了 2015 年在社区居住、患有背部疼痛的老年人。我们评估了 12 种自我报告的慢性疾病,包括关节炎、抑郁症和焦虑症。我们使用 2016 年的数据来确定上一年自我报告的任何康复服务的使用情况。我们使用加权逻辑回归法来研究病情与使用康复服务之间的关联:样本量为 2443 个。大多数人的年龄≥75 岁(59%);女性(62%);非西班牙裔白人(71%)。慢性疾病的中位数为 3 种(四分位数间距为 2-4)。关节炎是最常见的慢性病(73%);14%患有焦虑症,16%患有抑郁症。每增加一种慢性病,使用任何康复治疗的调整后几率就会增加 21%(Odds Ratio = 1.21,95% CI:1.11-1.31)。与患有 0-1 种慢性疾病的人相比,患有≥4 种慢性疾病的人在未来一年内使用康复治疗的几率要高出 2.13 倍(95% CI:1.36-3.34)。患有关节炎的参与者与没有关节炎的参与者相比,使用康复治疗的几率高出 1.96 倍(95% CI:1.41-2.72)。焦虑和抑郁与康复治疗的使用没有明显关系:结论:在背痛的老年人中,慢性疾病和关节炎的数量越多,康复服务的使用率就越高。结论:在患有背痛的老年人中,慢性疾病和关节炎的数量越多,康复服务的使用率就越高,而患有焦虑症或抑郁症的老年人与没有这些疾病的老年人在使用康复护理方面没有差异:这一模式表明,背痛和多种慢性疾病患者需要更多的康复服务,因此可以适当使用康复服务,但背痛和心理疾病患者可能存在使用不足的情况。
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引用次数: 0
Factors Associated With Physical Activity and Sedentary Behavior in People With Parkinson Disease: A Systematic Review and Meta-Analysis. 帕金森病患者体育锻炼和久坐行为的相关因素:系统回顾与元分析》。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-08-10 DOI: 10.1093/ptj/pzae114
Vitoria L Domingues, Marina P Makhoul, Tatiana B Freitas, Janaine C Polese, Carla Silva-Batista, Fabio A Barbieri, Camila Torriani-Pasin

Objective: The goal of this review was to investigate factors associated with physical activity and sedentary behavior in people with Parkinson disease (PD). The magnitude of these associations were investigated in line with the International Classification of Functioning, Disability and Health components.

Methods: A systematic literature review was conducted until February 2023, searching 4 databases (PubMed, EMBASE, Web of Science, and Scopus) for original articles investigating associations with physical activity or sedentary behavior in people with PD. Two independent researchers performed data extraction, and the risk of bias in the included studies was assessed using the Quality in Prognosis Studies tool. Meta-analyses were conducted to determine the magnitude of the associations, and significant regression models from the included studies were described.

Results: Forty-two studies were included. Twenty-one factors associated with overall physical activity were identified. Higher levels of physical activity had small association with cognition and body mass index, and fair association with 17 factors related to self-efficacy, physical function, mobility, quality of life, age, PD symptoms, and more. Better manual dexterity and functional gait had moderate to good association with higher levels of physical activity. The regression model with the higher magnitude was composed mostly of contextual factors, except for the body max index. The magnitude of factors associated with physical activity intensity or sedentary behavior could not be identified.

Conclusion: Functional gait and manual dexterity were the strongest factors related to physical activity in people with PD. Further investigation is needed to understand the factors associated with physical activity intensity and sedentary behavior.

Impact: This study emphasizes the significance of considering contextual factors alongside body function and structure, activity and participation, and the health condition to enhance physical activity improvement during the rehabilitation process. By adopting such holistic approach, rehabilitation professionals can optimize the overall health and wellbeing of individuals with Parkinson disease.

目的:本综述旨在研究与帕金森病(PD)患者体育锻炼和久坐行为相关的因素。根据《国际功能、残疾和健康分类》(International Classification of Functioning, Disability and Health components)对这些关联的程度进行了调查:在 2023 年 2 月之前,我们对 4 个数据库(PubMed、EMBASE、Web of Science 和 Scopus)进行了系统性文献综述,搜索研究帕金森病患者体育锻炼或久坐行为相关性的原创文章。两名独立研究人员进行了数据提取,并使用 "预后研究质量 "工具评估了纳入研究的偏倚风险。研究人员进行了元分析以确定关联的程度,并对纳入研究中的重要回归模型进行了描述:结果:共纳入 42 项研究。结果:共纳入 42 项研究,确定了 21 个与总体体力活动相关的因素。较高水平的体育锻炼与认知能力和体重指数的关系不大,与自我效能、身体功能、活动能力、生活质量、年龄、帕金森病症状等17个相关因素的关系一般。较好的手部灵活性和功能性步态与较高水平的体育锻炼有中度到良好的关系。除身体最大指数外,回归模型中幅度较大的主要是环境因素。结论:结论:功能性步态和徒手灵活性是与帕金森病患者体力活动相关的最强因素。需要进一步调查以了解与体力活动强度和久坐行为相关的因素:本研究强调,在康复过程中,除了考虑身体功能和结构、活动和参与以及健康状况外,还需考虑环境因素,以提高身体活动能力。通过采用这种整体方法,康复专业人员可以优化帕金森病患者的整体健康和福祉。
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Physical Therapy
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