PM&R最新文献

Background: Respiration is a crucial determinant of autonomic balance and heart rate variability (HRV). The comparative effect of spontaneous versus paced breathing on HRV has been almost exclusively explored in healthy adults and never been investigated in an injured military cohort.

Objective: To examine the effect of spontaneous versus paced breathing on HRV in veterans with combat-related traumatic injury (CRTI).

Design: Observational cohort study.

Setting: ArmeD serVices trAuma rehabilitatioN outComE (ADVANCE) study, Stanford Hall, UK.

Participants: The sample consisted of 100 randomly selected participants who sustained CRTI (eg, amputation) during their deployment (Afghanistan 2003-2014) and were recruited into the ongoing ADVANCE prospective cohort study.

Intervention: Not applicable.

Main outcome measure: HRV was recorded using a single-lead ECG. HRV data were acquired during a sequential protocol of 5-minute spontaneous breathing followed immediately by 5 minutes of paced breathing (six cycles/minute) among fully rested and supine participants. HRV was reported using time domain (root mean square of successive differences), frequency domain (low frequency and high frequency) and nonlinear (sample entropy) measures. The agreement between HRV during spontaneous versus paced breathing was examined using the Bland-Altman analysis.

Results: The mean age of participants was 36.5 ± 4.6 years. Resting respiratory rate was significantly higher with spontaneous versus paced breathing (13.4 ± 3.4 vs. 7.6 ± 2.0 breaths/minute; p < .001), respectively. Resting mean heart rate and root mean square of successive differences were significantly higher with paced breathing than spontaneous breathing (p < .001). Paced breathing significantly increased median low frequency power than spontaneous breathing (p < .001). No significant difference was found in the absolute power of high frequency between the two breathing protocols. The Bland-Altman analysis revealed poor agreement between HRV values during spontaneous and paced breathing conditions with wide limits of agreement.

Conclusion: Slow-paced breathing leads to higher HRV than spontaneous breathing and could overestimate resting "natural-state" HRV.

Background: Mobilization with movement has been recommended to improve foot mobility in people with ankle impairments and could improve walking after stroke.

Objective: To examine the effects of the addition of mobilization with movement to commonly used exercises in physiotherapy for improving ankle range of motion and walking in people who have had a stroke.

Design: Systematic review of randomized controlled trials.

Settings: Not applicable.

Participants: Ambulatory adults at any time after stroke.

Intervention: The experimental intervention was exercises plus ankle mobilization with movement, in comparison with exercises alone.

Main outcome: Ankle range of motion.

Measurements: Walking parameters (ie., walking speed, cadence, step length).

Results: Six trials, involving 160 participants, were included. The mean PEDro score of the trials was 6 (range 4 to 7). Mobilization with movement in addition to exercises improved range of motion by 4° (95% CI 2 to 6), walking speed by 0.08 m/s (95% CI 0.05 to 0.11), cadence by 9 steps/min (95% CI 7 to 12), and step length by 5 cm (95% CI 3 to 7) more than exercises alone. The quality of evidence was low for range of motion and moderate for walking outcomes.

Conclusion: This systematic review provided evidence that the addition of mobilization with movement to commonly used exercises in neurological rehabilitation increases ankle dorsiflexion, and benefits are carried over to improving walking speed, cadence, and step length in moderately disabled individuals with chronic stroke.

Review registration: PROSPERO (CRD42023405130).

Background: Little is known about the mechanisms of exercise intolerance and exertional symptoms in children with long COVID. Through utilization of cardiopulmonary exercise testing (CPET), this study is the first of its kind to evaluate exertional symptoms and attempt to identify potential mechanism of long COVID-19 in children.

Objective: To determine if CPET will uncover potential reasons for persistent symptoms of long COVID when there is no indication of cardiopulmonary or upper airway disease.

Methods: We performed a retrospective chart review study involving children 6-17 years of age with symptoms of long COVID at Phoenix Children''s Hospital from January 1, 2021, to June 1, 2022. Symptoms included but were not limited to exercise intolerance, fatigue, shortness of breath, dyspnea on exertion, and chest pain. We recorded any measurable abnormalities present on CPET after comparing it to established normal reference ranges. Range, median, and SD of data points were calculated and p values were determined using the Mann-Whitney U and Fisher's exact test.

Results: Twenty-three children with exertional symptoms consistent with long COVID were identified. The most frequent symptoms reported during exercise include dyspnea on exertion (35%), followed by chest pain (30%) and dizziness (13%). Nearly half of the children (47%) demonstrated decreased exercise capacity with 30% displaying limitations due to deconditioning, 22% limited by body habitus, and 13% due to bronchospasm. Other contributing factors include ventilation to perfusion mismatch and volitional hyperventilation.

Conclusion: Decreased aerobic activity due to multiple factors was found in 47% of children with a history of COVID-19. This study illustrates the importance of ongoing research into this phenomenon to elucidate its mechanism and assist physicians in making decisions regarding referral to specialists for further testing.

Background: This study investigated the association between stroke severity, functional status measured by the Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI), and community discharge from IRF.

Objectives: Aim one examined the association between National Institutes of Health Stroke Scale (NIHSS) scores measured during the acute care stay and IRF admission functional status, measured by the admission IRF-PAI self-care and mobility functional measures, to deduce if functional measures can serve as a proxy for stroke severity. Aim two investigated the ability of the NIHSS and IRF-PAI admission functional measures to predict community discharge from IRF after stroke.

Design: Retrospective cohort study using electronic health records and Uniform Data System. Medical Record file data from January 1, 2018, to December 30, 2019.

Setting: Academic hospital-based IRF.

Participants: Five hundred forty-four patients transferred from acute care hospital to IRF after an ischemic or hemorrhagic stroke. Exclusion criteria included a transient ischemic attack, discharge against medical advice, death during IRF stay, or readmission to acute care within 48 hours of IRF admission.

Interventions: Not applicable.

Main outcome measures: Admission IRF-PAI self-care and mobility scores and discharge status from IRF.

Results: Of the 544 patients, 76.7% had community discharge. NIHSS scores were significantly associated with IRF-PAI admission self-care scores across each NIHSS stroke category. There was no statistically significant association between NIHSS and IRF-PAI admission mobility score. IRF admission self-care and mobility scores were each statistically significant predictors of community discharge (odds ratio [OR] = 1.10, 95% confidence interval [CI]: 1.03-1.17; OR = 1.10, CI: 1.03-1.18, respectively). NIHSS scores were not a statistically significant predictor of community discharge (OR = 0.70, CI: 0.47-1.04) from IRF.

Conclusions: IRF-PAI self-care functional measure is associated with the NIHSS and can serve as a proxy for stroke severity. IRF-PAI self-care and mobility measures each predict community discharge.

Background: Reduced walking ability, especially decreased gait speed, is one of the most common and disabling impairments reported by people with multiple sclerosis (MS). Considering the impact of muscle strength on walking ability, resistance training may have the potential to improve walking speed in MS. Therefore, this systematic review and meta-analysis aims to evaluate the effect of lower limb resistance training on walking speed in people with MS.

Methods: Seven databases (CINAHL, MEDLINE, The Allied and Complimentary Medicine Database, Web of Science, Physiotherapy Evidence Database [PEDro], PsycINFO, and Sports Medicine and Education Index) were searched in March 2024 for studies that met the following eligibility criteria: randomized controlled trials investigating the effects of resistance training interventions on objective measures of walking speed in people with MS. Risk of bias was assessed using the PEDro scale. Meta-analysis was performed to quantify intervention effect using a random effects model.

Results: Twelve randomized controlled trials were included, reporting data on 425 individuals with MS. Participants had mostly relapsing-remitting MS (85%) and a mild-moderate level of disability (Expanded Disability Status Score 1.0-6.0). Results of the meta-analysis (based on 7 of the included studies) indicated a significant yet variable improvement in walking speed in favor of the intervention (0.10 m/s, 95% confidence interval 0.01-0.19, p < .05). Sensitivity analysis indicates that larger improvements in walking speed were found over tests covering shorter distances.

Conclusions: Resistance training was found to significantly improve walking speed in people with MS. However, variability in results were noted across studies; accordingly, future research should determine how variables-particularly related to resistance training prescription-influence the intervention effect.

Background: Interventions based on pain neuroscience education and exercise have emerged as effective in the management of chronic neck pain in adolescents. No studies have explored factors that might be associated with recovery in adolescents with neck pain.

Objective: To explore predictors of improvement after an intervention based on exercise and pain neuroscience education.

Design: Secondary analysis of a randomized trial.

Setting: Community.

Participants: 127 community adolescents with neck pain.

Interventions: Blended-learning intervention based on exercise and pain neuroscience education.

Main outcome measures: A set of variables including sociodemographic data, pain characteristics, physical activity, disability, sleep, catastrophizing, fear of movement, self-efficacy, symptoms of central sensitization, knowledge of pain neuroscience, pressure pain thresholds, and neck muscles endurance were used to predict a clinical response at 1 week after intervention and at 6-month follow-up.

Results: Different predictors of improvement and non-improvement to intervention were found, but common predictors were not found for all the improvement criteria explored and time points.

Conclusions: These findings suggest that using different criteria to characterize adolescents with neck pain as improved and non-improved after pain neuroscience education and exercise have an effect on the variables associated with a response to the intervention.

Background: Medial meniscal extrusion (MME) plays an important role in the progression of knee osteoarthritis. Exploring the factors associated with MME in non-osteoarthritic knees may assist in the prevention of osteoarthritis.

Objective: To identify the factors associated with pathologic MME in non-osteoarthritic knees with medial meniscus tears (MMTs).

Design: A cross-sectional study.

Participants: One hundred fifty patients with non-osteoarthritic knees who underwent arthroscopic surgery for MMT. Patients were divided into a pathologic MME group (n = 54) and a control group (n = 96) based on whether a pathologic MME was present on magnetic resonance (MR) images.

Setting: Tertiary medical institution.

Interventions: Not applicable.

Main outcome measures: The MME distance was measured on a coronal MR image obtained at the midpoint of the medial femoral condyle. An MME distance ≥3 mm was considered to indicate pathologic MME. Demographic and clinical data were collected as variables. Multivariable logistic regression analysis was performed to identify factors associated with pathologic MME.

Results: After multivariable adjustment, body mass index (BMI) and the type of MMT were associated significantly with pathologic MME in the multivariable logistic regression model. Each unit higher in BMI was associated with a 13% higher risk of pathologic MME (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.01-1.28, p = .04). The odds of pathologic MME were approximately four times and three times higher for radial tears (OR 4.34, 95% CI 1.25-15.03, p = .02) and complex tears (OR 3.07, 95% CI 1.17-8.05, p = .02) than for horizontal and longitudinal tears.

Conclusions: BMI and the type of MMT were independent factors associated with pathologic MME in non-osteoarthritic knees with MMT. A higher BMI, radial tears, and complex tears were predisposed to pathologic MME.