PM&R最新文献

Background: Group treatments and interdisciplinary collaboration are recommended in evidence-based guidelines for neurorehabilitation, including physical and speech-language therapy. Evidence suggests that activating overlapping neural networks for upper extremity motor control and speech-language processing produces synergistic effects during therapy. This systematic review aims to overview and appraise the efficacy of group treatments in traditional rehabilitation and telerehabilitation. In addition to summarizing evidence on monodisciplinary approaches in physical and speech-language therapy, it seeks data on integrative approaches involving one or both disciplines to inform further interdisciplinary collaboration.

Methods: The review was registered with PROSPERO (CRD42021288012) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Systematic searches were conducted in PubMed, CINAHL, and the Cochrane Library. Two reviewers independently screened studies, extracted data, and assessed quality using AMSTAR 2, the Physiotherapy Evidence Database (PEDro) scale, or the Joanna Briggs Institute (JBI) Checklist, as appropriate. The evidence was summarized in a systematic narrative synthesis and its certainty rated based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

Results: A total of 29 studies were included: 16 on speech-language therapy (861 participants) and 13 on physical therapy (1757 participants). No studies addressed interdisciplinary group interventions, and only two evaluated group telerehabilitation. Outcome domains and measures varied across studies and the certainty of evidence was predominantly low. However, moderate-certainty evidence supports that group speech-language therapy improves quality of life, communication, and language in stroke survivors, especially when interventions emphasize verbal production in communicative settings with multimodal materials and cueing. In physical therapy, circuit class training may be more effective than other group approaches for enhancing quality of life and mobility.

Conclusion: Group treatments in neurorehabilitation show some benefits, but further research is needed - especially regarding interdisciplinary approaches and telerehabilitation.

A systematic scoping review was conducted to examine how rest is operationalized and measured in daily life among adults with and without long-term conditions. Searches were performed in PubMed, Cumulative Index to Nursing and Allied Health Literature, and Psych databases for studies from 1990 to 2024. Two independent reviewers screened and selected eligible studies, which included adults with and without long-term conditions. A content analysis was used to synthesize qualitative and quantitative evidence, categorizing rest-related descriptions. Additionally, descriptive and narrative synthesis methods were employed. Of 9393 initial records, 17 studies were included in the review. The findings revealed that rest was operationalized by several key elements, including cessation of activity or engagement in low-energy tasks (n = 9 studies); detachment from activities (n = 4 studies); experiences of peace, joy, and tranquility (n = 5 studies); and time for self-reflection and solitude (n = 2 studies). The operationalization of rest showed both similarities and differences between adults with and without long-term conditions. Although all groups defined rest in physical, emotional, and social terms, mental rest was more prominently emphasized by adults without long-term conditions. The review also identified the effects of rest, including improvements in well-being and psychological functioning (n = 4 studies) and enhanced energy levels that facilitated daily activities (n = 4 studies). However, "excessive" rest was linked to negative outcomes, such as increased physical symptoms and disability (n = 3 studies). Notably, only two studies assessed rest measurement tools for adults with long-term conditions. The findings suggest that rest can enhance energy, well-being, and functioning, but excessive rest may worsen physical symptoms and disability. Tailored guidance on optimal rest is essential for maximizing health benefits. The review also highlights the need for further research on comprehensive tools to measure rest.

Background: There are conflicting findings in the literature about the association of body mass index (BMI) and pressure injury (PI) development in the population with traumatic spinal cord injury (SCI). It is important to investigate the relationship between BMI and risk of PI in persons with SCI because chronic PIs are associated with decreased participation in daily and community activities as well as the greatest average decline in life expectancy compared to other secondary health conditions.

Objective: To determine the relationship between BMI (kg/m²) and self-reported PI in the traumatic SCI population.

Design: Cross-sectional survey across 18 SCI Model Systems in the United States.

Setting: Institutional.

Participants: 2218 participants enrolled in the National SCI Model Systems Database age ≥20 years were divided into 8 BMI groups (<18.5, 18.5-19.9, 20-22.49, 22.5-24.9, 25-27.49, 27.5-29.9, 30-34.49, and ≥35 kg/m²).

Interventions: Not applicable MAIN OUTCOME MEASURE: The percentage of individuals reporting ≥1 PI with broken skin over the last 12 months.

Results: The prevalence for underweight (<18.5 kg/m²), normal (20-22.49 kg/m²), and severe high BMI (≥35 kg/m²) was 6.6%, 15.1%, and 10.2%, respectively. Overall, 29.8% of the sample experienced a PI within the 12 months prior to the interview. Individuals who were underweight had a higher rate of PI (43.2%) when compared to those in the normal range (31.7%) and severe high BMI (29.2%; p = .02). In subgroup analyses, this was significant in the groups who were 1-5 years since injury (41.2% underweight vs. 29.1% normal; p = .04), age 40-64 (57.5% underweight vs. 33.8% normal; p = .01) and male (48.4% underweight vs. 33.6% normal; p = .01).

Conclusion: Our study highlights the need for resources dedicated to PI prevention and surveillance in underweight individuals with SCI.

Background: Traumatic spinal cord injury (TSCI) and traumatic brain injury (TBI) remain health challenges with devastating biopsychological and socioeconomic consequences. The occurrence of dual diagnosis is a significant but poorly reported issue in U.S. emergency departments (EDs).

Objective: To evaluate the trend, demographic, and socioeconomic aspects of dual diagnosis compared to isolated TSCI and TBI.

Design: Observational cross-sectional study.

Setting: Nationwide Emergency Departments Sample, 2006-2020.

Participants: Data were extracted on number of ED visits nationwide by patients over 18 years of age with TBI, TSCI, and dual diagnoses based on International Classification of Diseases, Ninth Revision, Clinical Modification and Tenth Revision, Clinical Modification codes. From 2006 to 2020, there were 23,826,719 TBI and TSCI related visits to EDs nationwide. Of these, 68,578 were dual diagnoses (TSCI+TBI), 23,579,060 were isolated TBIs, and 356,562 were isolated TSCIs.

Interventions: Not applicable.

Main outcome measures: Trend analysis of dual diagnoses, TBI (mild, moderate, severe), and TSCI (cervical, thoracic, lumbar/sacral/cauda equina). Demographics including gender, age, income quartile, comorbidities, and hospital characteristics were compared between TSCI+TBI, TBI alone, and TSCI alone.

Results: There was an increase of 201 dual diagnosis ED visits per year from 2012 onwards and an increase of 465 TSCI ED visits per year from 2017. However, TBIs declined from 2014 onwards, following the Centers for Disease Control and Prevention's reclassification of unspecified TBI. Patients with dual diagnosis had a median age of 50 years and were predominantly male. Private insurance (TSCI+TBI: 39%; TBI: 32%; TSCI: 27%) was the most used by patients with dual diagnosis, although 29% (vs. TBI: 27%; TSCI: 32%) were in the lowest income quartiles. Most reported ED visits were in the southern United States, and most were at university hospitals. Importantly, patients treated at level 1 trauma hospitals were primarily dual diagnosis (48%).

Conclusion: TSCI alone and dual diagnosis visits are rising nationally in EDs; these patients have higher morbidity rates and may require more specialized care. These patients are among the most vulnerable socioeconomically. The increase in ED visits among these populations underscores the need for adequate and sufficient outpatient care to support their ongoing treatment and recovery.

Background: Preoperative physical activity (PA) levels persist in patients following total knee arthroscopy (TKA), despite improved function and mobility following rehabilitation. Long-standing activity behaviors and preexisting psychosocial characteristics may explain suboptimal PA post-TKA.

Objective: To (1) confirm latent constructs from outcome measures capturing symptoms, function, psychosocial factors, and mobility and (2) examine relationships between constructs measured pre-TKA and their influence on post-TKA outcomes using factor analyses and structural equation modeling.

Design: Secondary analysis of a randomized clinical trial.

Setting: Veterans Administration medical center.

Patients: U.S. military Veterans (n = 113; age 67.3 ± 7.3; mean ± SD; body mass index 29.0 ± 3.5 kg/m²; 90% male) scheduled for TKA.

Intervention: Participants received TKA postoperative rehabilitation and were randomized to a PA behavior-change intervention targeting increased walking exercise or control group.

Main outcome measures: The Western Ontario Measurement Arthritis, Falls Efficacy Scale International, Functional Comorbidity Assessment, Veterans RAND-12 Health Survey, Multidimensional Scale for Perceived Social Support, Geriatric Depression Scale, Self-Efficacy for Exercise scale, Timed-Up and Go, 6-minute walking test, and Life-Space Assessment (LSA) score.

Results: A direct relationship was observed between pre-TKA physical characteristics and pre-TKA psychosocial characteristics (β = .734, z = 7.871, p < .001). Pre-TKA psychosocial characteristics were directly associated with post-TKA LSA scores (β = -.627, z = 2.924, p = .003). Pre-TKA psychosocial characteristics explained 53.8% of the variability in post-TKA LSA scores and mediated the pre-post relationship between physical characteristics and LSA scores (β = -0.460, z = -2.455, p = .014). No significant relationship was observed between pre-TKA physical characteristics and post-TKA LSA scores.

Conclusions: Latent constructs representing physical health and psychosocial traits were directly related in veterans scheduled for TKA. Elevated psychosocial characteristics observed before TKA were associated with decreased life space mobility at 12 weeks post-TKA. Our findings support addressing psychosocial factors before and throughout TKA rehabilitation as these may have implications on postoperative life space mobility.

Background: Previous studies on microprocessor-controlled prosthetic knees (MPKs) often investigate benefits of MPKs as a class of knees rather than clinically relevant differences between specific knees, despite their distinct features.

Objectives: To systematically evaluate and report outcomes associated with three commercially available MPKs following a standardized real-world use period.

Design: Randomized crossover study.

Setting: Research laboratory and community environment.

Participants: Ten patients with transfemoral amputation.

Interventions: Three MPKs were fitted, trained, and worn for a 1-week period including C-Leg 4.0 (Ottobock, Duderstadt, Germany), Rheo Knee-Model RM7 (Össur, Reykjavik, Iceland), and Power Knee-PKA01 (Össur, Reykjavik, Iceland).

Main outcome measures: Primary outcomes were the 10-meter walk test (10-mwt), the 2-minute walk test (2-mwt), and the Prosthesis Evaluation Questionnaire (PEQ). Secondary outcomes were stance time asymmetry, physiological cost index, stair and ramp speeds, the narrowing beam walking test, and community ambulation monitoring.

Results: Participants walked 11% faster in Rheo than Power Knee during the 10-mwt (95% confidence interval [CI]: 0.046-0.184, p = .015). In the 2-mwt, participants walked 12% faster in C-Leg (95% CI: 0.034-0.241, p = .003) and 9% faster in Rheo (95% CI: 0.031, 0.163, p = .027) than in Power Knee. On the PEQ, participants reported greater satisfaction with C-Leg compared to Power Knee (p = .006). Ramp ascent speed was 8% faster in Rheo than Power Knee (95% CI: 0.026-0.130, p = .024). No significant differences were found for other secondary outcomes. Notably, 10 of 12 outcomes showed individuals performing their best by a defined difference on an MPK different from the cohort's best-performing MPK.

Conclusions: Participants walked faster in C-Leg and Rheo than Power Knee and reported greater satisfaction with C-Leg. Consideration of patient needs and characteristics may allow more individualized MPK prescription and thereby improve rehabilitation outcomes.

Database registration: NCT06399471.

Background: Gait training approaches that facilitate moderate-to-high intensities while adapting to individual capabilities can enhance walking recovery and cardiovascular fitness in persons with incomplete spinal cord injury (SCI).

Objective: To measure and compare the metabolic intensity of overground robotic exoskeleton gait training (ORE) and usual care gait training (UC) among patients with incomplete SCI during inpatient rehabilitation.

Design: Substudy of a prospective randomized control trial.

Setting: Inpatient rehabilitation hospital.

Participants: Patients >15 years of age with incomplete SCI.

Interventions: ORE and UC.

Main outcome measures: Metabolic intensity during gait training (oxygen consumption [VO₂]) was measured during the initial and final gait training sessions in inpatient rehabilitation using a wearable metabolic system. Hedges' g effect sizes were calculated to estimate the magnitude of change in metabolic intensity between ORE and UC.

Results: Ten (n = 5 ORE, n = 5 UC) patients ([mean ± SD] 45.1 ± 9.5 years old, 90% male, 60% White, and 80% non-Hispanic) completed both metabolic assessments. Assessments were 30.7 ± 17.8 days post SCI, and the median (min-max) inpatient rehabilitation length of stay was 35.5 (27-51) days. Injury characteristics included incomplete American Spinal Injury Association Impairment Scale (AIS) C (60%), AIS D (40%), paraplegia (40%), and tetraplegia (60%). ORE metabolic intensity was 616.2 ± 340.9 mL/min during initial and 919.6 ± 480.1 mL/min during final assessments (change = 303.4 ± 314.4 mL/min). UC metabolic intensity was 1088.9 ± 582.8 mL/min during initial and 1098.8 ± 644.4 mL/min during final assessments (change = 9.8 ± 93.6 mL/min). Large effect sizes were observed in the increase in metabolic intensity (g = 1.27) from initial to final gait training sessions between groups.

Conclusions: ORE and UC elicited moderate-to-high metabolic intensity among patients with incomplete SCI in inpatient rehabilitation. Greater increases in metabolic intensity from initial to final assessments were observed in the ORE group, suggesting the potential for ORE to support progressive increases in training intensity alongside functional recovery during inpatient rehabilitation.