PM&R最新文献

Background: Challenging behavior (CB) following acquired brain injury (ABI) has a direct impact on safety, the rehabilitation process, and societal participation. Early behavior management in inpatient rehabilitation (IPR) settings guided by appropriate assessment tools is critical for maximizing gains in IPR and successful community integration of individuals with CB following ABI.

Objective: To assess the validity and reliability of the Overt Behavior Scale-In Session (OBS-INS), a behavioral assessment tool created for the measurement of CB following ABI in IPR.

Design: Mixed-methods study.

Setting: An IPR facility that specializes in brain injury rehabilitation.

Participants: Nineteen of 54 adults ( ≥18 years of age) admitted under the services of the primary investigator following ABI (8 sustained a traumatic brain injury, 10 sustained a cerebral vascular accident, and 1 sustained an anoxic brain injury) participated in the validation of the OBS-INS. Twenty trained clinicians participated in assessing the reliability of this measure.

Interventions: Not applicable.

Main outcome measures: OBS-INS Clinical Weighted Severity ratings were compared to the Agitated Behavior Scale (ABS), Disability Rating Scale (DRS), and the Berg Balance Scale for convergent and divergent validity. Inter- and intrarater reliability were determined following video-rating sessions with trained clinicians. Clinicians also completed a study-specific questionnaire determining the utility of the OBS-INS in improving interdisciplinary communication, intervention selection, and discharge planning.

Results: A strong positive correlation was found between the OBS-INS CWS and ABS scores (r_s = .815, p < .001) with a strong correlation between the OBS-INS CWS and DRS discharge scores (r_s = .409). Interrater reliability (intraclass correlation coefficient = 0.982; [.929-1.00]) was excellent, and intrarater reliability (r_s = .825, p < .001) was strong. Most clinicians (85%) reported that the OBS-INS was effective in measuring CB following ABI and was beneficial for interdisciplinary communication.

Conclusion: The OBS-INS is a valid and reliable tool for assessing CB in individuals with ABI in IPR and promotes effective interdisciplinary communication.

Background: An existing association was noted between leisure time physical activity (LTPA) and quality of life (QOL) after spinal cord injury (SCI). Furthermore, electrical stimulation exercise program has been shown to improve domains of QOL. However, the relative causality between indices of LTPA and domains of QOL are not well studied before or after a regimen of electrical stimulation program in persons with SCI.

Objective: To examine the relationships between levels of weekly leisure-time physical activity (LTPA) and quality of life (QOL) domains before and after 24 weeks of an electrical stimulation exercise program in persons with spinal cord injury (SCI).

Design: Longitudinal exploratory trial as part of a randomized clinical trial.

Setting: Veterans Affairs medical center and SCI center.

Participants: A convenience sample of 31 participants with chronic SCI were randomized into two groups of 15 and 16, respectively.

Interventions: The first group underwent twice weekly sessions of lower extremity neuromuscular electrical stimulation-resistance training (NMES-RT) for 12 weeks and a subsequent 12 weeks of twice-per-week functional electrical stimulation lower extremity cycling. The second group underwent an identical regimen with the exception that NMES-RT was substituted for passive movement training.

Main outcome measures: Outcome measures included the QOL Short Form and the LTPA Questionnaire that were conducted at baseline (T1); post intervention one (T2) and post intervention two (T3). A series of cross-lagged panel models was run with Amos Version 29.0 to test relative directional effects of LTPA and QOL on each other over time.

Results: After combining both groups, psychological and social QOL tended to have a stronger directional effect on LTPA, but after the intervention the directional effect reversed. Although LTPA had no directional effect on physical health QOL, it became more dominant in the psychological health domain from T2 to T3. The cross-lagged effect from LTPA to psychological health QOL was either larger or demonstrated a more positive effect relative to the cross-lagged effect from psychological health QOL to LTPA.

Conclusions: Twenty-four weeks of an electrical stimulation program did not directly enhance indices of LTPA after SCI. However, suggested improvements in psychological and social domains may be due in part to LTPA following an electrical stimulation exercise program.

Objective: To assess the potential prognostic role of sonographic parameters such as glenohumeral joint effusion, subacromial-subdeltoid bursitis, and the type of intratendinous calcific deposition to predict the clinical and functional outcomes of focal extracorporeal shockwave therapy (fESWT) in patients with calcific tendinopathy of the shoulder.

Methods: This retrospective observational study included 18 patients (6 men and 12 women, mean age 63.5 ± 10.8 years) with shoulder calcific tendinopathy. Prior to treatment with fESWT the sonographic features of the shoulder were assessed and these findings were compared with the clinical and functional scores (Numeric Rating Scale [NRS]; Disabilities of the Arm, Shoulder and Hand [DASH]; and Shoulder Pain and Disability Index [SPADI]) measured before and 90 days after treatment. Each fESWT session was performed using a technical setting of 1500 hits with a 3 Hz frequency and 0.45 mJ/mm² of maximal flux energy delivered by an electromagnetic shockwave generator.

Results: The average posttreatment NRS, DASH, and SPADI values were significantly higher in patients with subacromial-subdeltoid bursitis than in patients without (6.29 ± 2.21 vs. 3.36 ± 1.75 for NRS, 44.09 ± 8.72 vs. 19.35 ± 7.13 for DASH, 44.08% vs. 27.38% for SPADI, with a p < .05 for all the scores), indicating worse clinical and functional outcomes. In patients with glenohumeral joint effusion, mean posttreatment clinical and functional scores were also higher than in patients without (5.40 ± 2.15 vs. 3.38 ± 1.70 for NRS, 33.64 ± 7.93 vs. 23.14 ± 6.12 for DASH, 39.64% vs. 33.14% for SPADI); but the results did not reach statistical significance (p > .05 for all the scores). Lastly, in patients with hard calcification and complete acoustic shadow, mean posttreatment clinical and functional scores were higher than in patients with soft calcification showing incomplete acoustic shadow and/or multiple calcific spots inside the tendon (5.44 ± 2.20 vs. 3.56 ± 1.20 for NRS, 35.31 ± 9.21 vs. 22.63 ± 7.44 for DASH, 42.31% vs. 33.88% for SPADI). However, the results did not reach statistical significance (p > .05 for all the scores).

Conclusions: In patients with shoulder calcific tendinopathy who are referred for fESWT, the presence of subacromial-subdeltoid bursitis appears to be a potential negative prognostic factor for pain relief and functional improvement.

Background: Traumatic spinal cord injury (TSCI) and traumatic brain injury (TBI) present their own health challenges and socioeconomic impact. Individuals with dual diagnosis (DD) of the two traumas may have different impacts on outcomes, health care utilization, and costs.

Objective: To evaluate the outcomes of DD compared to isolated TSCI at initial acute hospital stay and 12 months after discharge across TSCI level and completeness.

Design: Observational longitudinal study.

Setting: Merative MarketScan Research Database, 2000-2022.

Participants: Data were extracted for individuals with TSCI alone and DD who were over 18 years of age. The study cohort was composed of 20,212 individuals with either TSCI alone or DD (TSCI+TBI). Injury level groups consisted of cervical incomplete TSCI (CI: 6310 alone, 3962 with TBI); cervical complete TSCI (CC: 393 alone, 269 with TBI); thoracic incomplete TSCI (TI: 3542 alone, 1014 with TBI); thoracic complete TSCI (TC: 508 alone, 210 with TBI); and lumber/sacral/cauda equina TSCI (LSCE: 3227 alone, 777 with TBI).

Interventions: Not applicable.

Main outcome measures: Demographics, initial acute hospital outcomes (length of stay, index payments, complications, discharge disposition), and 12-month postdischarge outcomes (rehabilitation services, complications, overall health care utilization, and 12-month payments).

Results: Individuals with DD were predominantly younger, male, and commercially insured. During acute hospitalization, outcomes were worse for cervical and thoracic incomplete injuries and LSCE with DD compared to TSCI alone; CI-DD had 9% higher rates of overall complications, and LSCE-DD had 2-day longer hospital stay. Median hospital payments were 1.5- to 2.7-fold higher across most groups with DD, except for CC. One year after injury, overall complications were 5%-15% higher across all DD groups, with most differences in respiratory, cardiovascular, metabolic, and psychiatric complications. Health care utilization of rehabilitation services, emergency room visits, and 12-month payments were similar or worse in DD groups compared to TSCI alone.

Conclusion: Individuals with DD had worse outcomes and higher health care utilization compared to those with isolated TSCI, including increased hospital payments, rehabilitation use, and overall complications in the first year after injury. Our findings highlight the increased burden of DD and contribute knowledge for future treatment decision-making, resource allocation, and research initiatives.

Objective: Sleeper stretching (SS) and cross-body stretching (CS) are common nonsurgical interventions for the management of glenohumeral internal rotation deficit (GIRD) in overhead athletes such as baseball and volleyball players. However, the effectiveness of these stretching interventions in enhancing the range of motion (ROM) of shoulder internal rotation (IR) in overhead athletes with GIRD remains a subject of uncertainty. This systematic review and meta-analysis aim to critically assess the efficacy of SS and CS in the ROM of the IR among overhead athletes with GIRD, thereby providing evidence-based recommendations for their use.

Literature survey: A comprehensive search of MEDLINE, Embase, and Scopus databases up to November 2024 was conducted to identify randomized controlled trials investigating the influence of SS and CS on the ROM of shoulder IR in overhead athletes with GIRD.

Methodology: Data including study characteristics and outcomes were extracted. Risk of bias assessment and random-effects model meta-analysis were performed.

Synthesis: Six eligible studies involving 255 athletes with GIRD were included. The meta-analysis demonstrated statistically significant differences between stretching and control groups in terms of enhancing the ROM of IR (mean difference [MD], 7°; 95% confidence interval [CI], 1°-13°; p = .02) and horizontal adduction (HAD) ([MD], 6°; [CI], 1°-11°; p = .03).

Conclusion: SS or combination of SS and CS interventions significantly enhanced the ROM of IR compared to the control group in overhead athletes diagnosed with GIRD. Furthermore, the review confirmed that SS alone also markedly enhances the ROM of HAD. These findings highlight the potential benefits of SS and CS in managing GIRD and suggest a need for further research to optimize these interventions for broader application in overhead athletes.

Background: Sensory and behavioral difficulties are frequently observed in children with cerebral palsy (CP), and these challenges may intensify when cerebral visual impairment (CVI) co-occurs. However, the extent and nature of these combined effects remain underexplored.

Objective: The aim of this study is to compare sensory processing skills and behavior of children with CP and CVI, CP without CVI, and typically development (TD) and to examine the relationship between sensory processing skills and behavior in children in these groups.

Design: Prospective, cross-sectional study with control group.

Setting: Special education and rehabilitation center.

Participants: A total of 120 children aged 3-6 years, consisting of three groups, were included in the study: 40 children with CP and CVI, 40 children with CP without CVI, and 40 children with TD.

Main outcomes measures: The Sensory Profile (SP) was used to assess sensory skills and the Child Behavior Rating Scale (CBRS) was used to assess behavior.

Results: There were significant differences in all pairwise comparisons between the three groups and between SP subdomains and CBRS scores (p < .05). Children with CP and CVI had the lowest median scores (SP: 7-78.5; CBRS: 26), followed by those with CP without CVI (SP: 9-95; CBRS: 33), whereas TD children had the highest scores (SP: 12-129; CBRS: 49). These findings suggest a trend toward worsening sensory and behavioral outcomes in the presence of CVI in addition to CP and in CP alone. Furthermore, moderate to strong positive correlations were observed between SP and CBRS scores in all groups (rho = 0.468-0.872; p < .001), suggesting that behavioral problems increase with decreased sensory processing skills.

Conclusions: This study reveals that children with CP have more problems in sensory processing and behavioral functioning compared to their peers with TD and that these problems are exacerbated in the presence of CVI accompanying CP. In addition, the significant relationship observed between the decrease in sensory processing skills and the increase in behavioral problems emphasizes the importance of evaluating these two areas together and adopting a holistic approach in intervention planning.

Objective: The goal of this study was to examine if differing platelet counts in platelet-rich plasma (PRP) formulations affected overall pain and function outcomes when compared to hyaluronic acid or placebo control saline injections.

Design/methods: We conducted a systematic review and meta-analysis (International Prospective Register of Systematic Reviews CRD42022340057) evaluating randomized controlled trials comparing injections of PRP to hyaluronic acid (HA) or saline (NS) control in patients with mild or moderate knee osteoarthritis. All studies used a validated outcome measure that examined pain, function, or overall patient global assessment. Study PRP interventions were subclassified as investigating the total number of platelets delivered in a low dose (1-5 billion total deliverable platelets), moderate dose (5-10 billion total deliverable platelets), or high dose (greater than 10 billion total deliverable platelets) injected into the joint.

Results: A total of 32 trials met inclusion criteria. All three PRP groups had significant improvements in validated patient-reported outcomes when compared to HA. Both the "low" and "high" platelet count groups resulted in a moderate effect size, respectively (standardized mean difference [SMD] = .47; 95% confidence interval [CI] .05-0.89, p < .01; SMD = .68; 95% CI .26-1.09, p < .01). Only the "moderate" (SMD = 1.48; 95% CI .71-2.58 p < .01) platelet count group resulted in large effect size on validated patient-reported outcomes. When compared to NS, all three PRP groups resulted in significant large effect sizes when examining pain reduction.

Conclusions: When compared to HA, PRP with platelet counts between 1 and 10 billion total deliverable platelets may result in a larger decrease in pain symptoms when compared to platelet counts greater than 10 billion at 6 months. In addition, platelet counts between 5 and 10 billion total deliverable platelets may be associated with greater improvement in functional outcomes.