PM&R最新文献

Background: Rock climbing offers numerous health benefits, but accessibility and safety concerns limit its therapeutic use, especially for individuals with disabilities. No prior studies have explored the potential benefits of integrating the Treadwall, a rotating climbing wall with improved accessibility and safety, into rehabilitation protocols.

Objective: To evaluate the safety and feasibility of implementing a Treadwall climbing intervention as a novel therapy tool for children with hemiplegic cerebral palsy. Additionally, we seek to explore potential functional benefits derived from the Treadwall intervention.

Design: This prospective, observational, single-site study assessed Treadwall training in a cohort of children with hemiparetic cerebral palsy while attending a 3-week intensive therapy program.

Setting: The study was conducted at the BECOME Program in Children's Specialized Hospital, Mountainside, NJ.

Participants: A total of 10 participants, aged 4 to 9 years, diagnosed with hemiparesis, were enrolled, with nine completing the intervention.

Interventions: The intervention involved 15 10-minute climbing sessions during the 3-week intensive therapy program. Participants' climbing distance, intensity, and active mobility rate were recorded.

Main outcome measure(s): Primary outcome measures included climbing distance, intensity, and active mobility rate. Secondary measures, the Assisting Hand Assessment (AHA) and Melbourne Assessment of Unilateral Upper Limb Function, were collected to assess upper limb function.

Results: The study demonstrated significant improvements in distance climbed (p < .01), intensity (p < .05), and active mobility rate (p < .05). Participants showed enhanced upper limb function, indicated by improved AHA and Melbourne Assessment scores (p < .01). Qualitative therapist reports showed positive feedback regarding the Treadwall's potential benefits.

Conclusions: The study supports the feasibility and safety of using the rock climbing Treadwall as a novel therapy tool for children with hemiplegic cerebral palsy. The intervention showed promising results in improving climbing skills, motor learning, and coordination. Future investigations should explore dosing and long-term outcomes to fully assess the Treadwall's therapeutic potential.

Background: Patellofemoral pain (PFP) is a common knee condition in young and active individuals that is managed with highly variable treatment strategies.

Objective: To determine whether the length, number of visits, and content of physical therapy care for patients with PFP differ between a Clinical Practice Guidelines (CPG) adherent program and usual care. Additionally, the percentage of patients reporting clinically important improvements in patient-reported outcomes in each group was evaluated as an exploratory aim.

Design: Retrospective analysis of clinical data.

Setting: Military outpatient physical therapy clinics.

Patients: Thirty-two patients who received CPG-adherent care and 46 patients who received usual care.

Interventions: Patients in the CPG-adherent group were classified into overuse/overload, movement coordination deficits, muscle performance deficits, or mobility impairments subcategories based on CPG-recommended examination procedures and received the CPG-recommended interventions. Patients in the usual care group received interventions based on clinical expertise and organizational practice standards.

Main outcomes measures: Length of care, number of visits, and intervention content were used as primary outcomes. The Anterior Knee Pain Scale (AKPS), Defense and Veterans Pain Rating Scale (DVPRS), and Global Rating of Change (GROC) scores were used as secondary outcomes. These scores were extracted from routinely collected health data available in medical records; as a result, not all patients completed these outcomes during the follow-up time points because they were optional.

Results: The number of physical therapy visits and percentage of patients receiving knee-targeted exercises, soft tissue mobility interventions, neuromuscular reeducation, patient education, patellar taping, and foot orthoses were greater in the CPG-adherent group compared to usual care (p < .05). Additionally, most patients in the CPG-adherent group reported clinically meaningful improvements in secondary outcomes: AKPS (1 month: 13/23; 3 months: 11/16), DVPRS (1 month: 11/20; 3 months: 8/14), and GROC (1 month: 14/22; 3 months: 11/16). In contrast, fewer than half of the patients in the usual care group reached clinically meaningful thresholds: AKPS (1 month: 1/17; 3 months: 3/8), DVPRS (1 month: 3/15; 3 months: 3/7), and GROC (1 month: 2/12; 3 months: 2/7).

Conclusion: The content of the CPG-adherent care was significantly different versus usual care and associated with meaningful changes in outcomes. Several CPG-recommended interventions appeared to be underused in usual care, underscoring the value of further CPG adoption.

Background: Physical activity (PA) after stroke has significant health benefits if it is conducted regularly, with sufficient intensity and duration. Because of the health benefits, it is important to identify those below the World Health Organization (WHO) recommended level of PA. However, few studies have assessed the level of PA after stroke in relation to the WHO recommendations and which sociodemographic factors and stroke characteristics are associated with those below the WHO recommendations.

Objective: To assess survivors of stroke at least 1 year after onset and (1) describe their self-reported level of PA; (2) explore the association between PA, sociodemographics, and stroke characteristics, and (3) determine the characteristics of those below the WHO recommended level of PA.

Design: Cross-sectional descriptive survey.

Setting: Community settings.

Participants: Data were collected from 160 survivors of stroke (mean age 73 years, 46% women, mean time since stroke onset 35 months).

Interventions: Not applicable.

Main outcome measures: The Swedish National Board of Health and Welfare Physical Activity Questionnaire and the following sociodemographics and stroke characteristics: gender, age, marital status, vocational situation, need for home help, use of mobility devices, time since stroke onset, first-time stroke, type of stroke, location of stroke, and stroke treatment.

Results: Two thirds (66.3%) of the participants were below the WHO recommendations. The hierarchical regression analysis explained 13% of the variance in PA with need for home help as a single significant contributor. Those who did not meet the WHO recommendations were significantly older, more likely to live alone, and in need of home help and mobility devices.

Conclusions: A majority of survivors of stroke do not meet the WHO recommended level of PA. Future studies should assess how other factors characterize those who are physically inactive. This knowledge could help rehabilitation professionals to target interventions and self-management programs to promote PA among survivors of stroke.

Intraarticular knee injuries and subsequent posttraumatic arthritis (PTOA) are common in athletes. Unfortunately, PTOA may significantly affect performance and overall function, but this condition remains difficult to characterize. In this review, we provide an overview of imaging modalities used to evaluate PTOA among athletes and physically active individuals following knee injury, with the goal to discuss the strengths and limitations of their application in this population. A literature search was performed to identify clinical studies focusing of knee injuries in athletes and athletic persons, specifically using imaging for diagnosis or monitoring disease progression. A total of 81 articles were identified, and 23 were included for review. Studies on plain radiographs (n = 8) and magnetic resonance imaging (MRI) assessed arthritic burden (n = 13), with MRI able to depict the earliest cartilage changes. Few studies (n = 2) leveraged ultrasound. Challenges persist, particularly regarding standardization and reliability across different radiographic grading systems. Additionally, further research is needed to establish the clinical significance of techniques to assess cartilage composition on MRI, including ultrashort echo-time enhanced T2*, T1rho and T2 imaging. Addressing these challenges through standardized protocols and intensified research efforts will enhance the diagnostic utility of imaging modalities in musculoskeletal medicine and enable high-quality prospective studies.

Background: Lower limb amputation can have profound physical, psychological, and social effects on individuals. Assistive aids like prosthetic lower limbs can help an individual regain mobility and thereby affect their self-esteem and quality of life.

Objective: To assess self-esteem and quality of life in patients with transtibial amputations who are using a transtibial prosthesis and explore the association between sociodemographic and amputation-related factors with self-esteem and prosthesis-related quality of life measures.

Design: A cross-sectional study.

Setting: An orthotics and prosthetics center (Bhagwan Mahaveer Viklang Sahayata Samiti) in Jaipur, Rajasthan.

Participants: Patients with transtibial amputations using exoskeletal prostheses between July and September 2022, in Jaipur, Rajasthan.

Main outcome measures: The study used Rosenberg self-esteem questionnaire and Prosthesis Evaluation Questionnaire (PEQ) for self-esteem and quality of life assessment, respectively. Descriptive analysis was used to present the demographic details, and nonparametric tests examined the relationship between PEQ dimensions and sociodemographic variables.

Results: The study included 138 participants, primarily <40 years old (45.7%) and mostly engaged in high-activity occupations. Self-esteem mean score (SD) was 19.9 (3.9), with 89.1% exhibiting normal self-esteem. Prosthesis-related quality of life, showed high satisfaction across various domains, including ambulation, appearance, frustration, perceived response, residual limb health, social burden, sounds, utility, and well-being. No significant associations were found between sociodemographic factors, amputation-related variables, and self-esteem. However, PEQ scales showed associations with gender, age, occupation, type of amputation, and years of prosthesis use.

Conclusion: These results highlight the potential advantages of exoskeletal prostheses in improving the standard of living for people with transtibial amputations. Further research is essential to develop targeted interventions for improving their overall quality of life.

Background: Muscle weakness is common and significantly affects persons with multiple sclerosis (PwMS), with dysfunction in upper limb (UL) muscle groups occurring in approximately 60% of PwMS.

Objective: To develop gender-specific regression-based prediction equations, with 95% confidence intervals for maximal bilateral UL isometric strength (shoulder abduction and adduction, wrist flexion and extension) and hand grip strength in PwMS.

Design: Cross-sectional study.

Setting: Comprehensive MS center.

Participants: 256 PwMS.

Interventions: Not Applicable.

Main outcome measures: Shoulder abduction and adduction and wrist flexion and extension isometric strength (Biodex System 4 Pro Dynamometer) and hand grip strength (Jamar handheld dynamometer) were measured. Disease characteristics (disability and disease duration) and demographics (age, height, and weight) were collected. Regression-based predictive equations were generated for the UL muscle groups for each gender and limb, using age, height, weight, disability, and disease duration as covariates. Variables were compared between genders using the Mann-Whitney U test. Maximal voluntary contraction (MVC) reference values (mean ± SD) were reported based on age (<30, 30-39, 40-49, 50-59, 60-69 years) and disability (mild, moderate, severe ambulant, and severe nonambulant) for each gender and limb.

Results: Regression-based equations were developed for both genders' strongest and weakest limb, accounting for age, height, weight, disability, and disease duration. MVC was higher in men than women (p < .001) in all muscle groups. Overall, MVC was significantly related to age in 14, height in 5, weight in 6, disability in 14, and disease duration in none of the 20 models.

Conclusion: This is the first study to provide regression-based prediction equations for strongest and weakest MVC of UL muscle groups and demonstrated an inverse relationship between MVC with disability and age. Regression-based reference strength values can help clinicians understand muscular strength along a spectrum of PwMS and can aid in goal setting and education for realistic outcomes.

Osteoarthritis affects a significant portion of U.S. adults, and knee osteoarthritis contributes to 80% of disease burden. Previous data have shown that non-White patient populations often report worse symptoms and less favorable outcomes following arthroplasty, a definitive treatment for knee osteoarthritis. There is a lack of demographics data on race/ethnicity, as well as socioeconomic status (SES) and social determinants of health (SDOH), in knee osteoarthritis treatment guidelines and knee arthroplasty research. In addition, there is underrepresentation of non-White patient populations in the existing treatment guidelines for knee osteoarthritis. Over the past decade, orthobiologics have emerged as an alternative to surgical intervention. Our hypothesis is that there would be a similar lack of reporting of demographics data and underrepresentation of non-White populations in studies pertaining to orthobiologics, including evaluating differences in outcomes. This study reviewed U.S.-based research in orthobiologics as a treatment option for knee osteoarthritis. We identified a lack of demographics reporting in terms of race/ethnicity, and none of the studies reported SES or SDOH. Non-White populations were underrepresented; White patients contributed to 80% or more of all study populations that reported race/ethnicity. None studied the correlation between symptoms and outcome measures, and the race/ethnicity, SES, and SDOH of the patients. Based on a review of existing literature, we strongly advocate for ongoing research encompassing patients of all races/ethnicities, SES, and SDOH, and an exploration into potential variations in symptoms and outcomes among distinct population subgroups. Furthermore, SES barriers may influence health care delivery on orthobiologics for disadvantaged populations.

Background: There is little research regarding the self-perceived preparedness of residents to enter independent practice after training. Given the vast breadth of physical medicine & rehabilitation (PM&R) and the increasingly complex and wide-ranging responsibilities and roles of physiatrists, this study is necessary to evaluate residents' perspectives of how programs are preparing them in the face of the changing practice environment.

Objective: To identify how graduating PM&R residents perceived their training to prepare them for future practice. The researchers assessed perceived preparedness in six domains: (1) evaluation and management of conditions, (2) settings and responsibilities of practice, (3) familiarity with administrative processes, (4) physiatric-specific prescriptions, (5) performing procedures, and (6) interpretation of diagnostic studies.

Design: Survey.

Setting: Virtual.

Participants: Graduating PM&R residents in their final year of training in the United States were invited to complete the survey. Of 415 graduating residents, 54 accessed the survey, and 40 (9.6%) fully completed questions relating to preparation by residency.

Interventions: Not applicable.

Main outcome measure: Self-perceived preparedness for practice among graduating residents across 70 subdomains of practice.

Results: Mean preparedness was highest in the domain of physiatric prescription (3.45/5), and preparedness for administrative processes was significantly lower than all other domains (mean 2.25/5, p < .001). Across subdomains, the highest preparedness was in performing electromyography (4.48/5). Medical skills rated less than 2.50/5 included interpreting urodynamics (1.93/5), performing osteopathic manipulative therapy (1.57/5), and performing unguided peripheral nerve injections (2.25/5).

Conclusions: Ultimately, residency programs should increase administrative training and identify internal strengths and weaknesses by polling their residents.

Objective: The aim of this systematic review and meta-analysis is to assess the efficacy of mirror neuron system-based therapy for managing pain and improving motor and upper limb function in patients with upper limb orthopedic conditions.

Literature survey: Systematic bibliographical searches of the PubMed, SCOPUS, and CENTRAL registries and databases up to September 2023 were conducted to find randomized controlled trials (RCTs) assessing the efficacy of mirror neuron system-based therapy for rehabilitation of upper limb orthopedic conditions.

Methodology: Two reviewers assessed the RCTs using a Cochrane risk-of-bias tool and extracted data from studies with similar outcome measures in the domains of pain, motor function, or functional score, which were pooled into meta-analyses.

Synthesis: The review included 13 studies to compare the efficacy of mirror neuron system-based therapy with that of conventional rehabilitation programs. The therapy reduced pain intensity (mean difference [MD] 2.04, 95% confidence interval [CI] 1.46-2.63) and kinesiophobia (MD 8.43, 95% CI 6.98 to 9.88), and increased grip strength (MD 1.86, 95% CI 0.28-3.45). The therapy also improved upper limb functional outcomes as assessed by the 30-item Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score (MD 13.52, 95% CI 10.63-16.41). However, the outcomes as assessed by the 11-item QuickDASH questionnaire and the Shoulder Pain and Disability Index (SPADI) were not superior to conventional rehabilitation.

Conclusions: Mirror neuron system-based therapy for rehabilitation of upper limb orthopedic conditions may reduce pain intensity and kinesophobia, and improve grip strength and DASH scores compared with conventional rehabilitation programs. However, this interpretation is limited by the heterogeneity and various quality of the RCTs included in our meta-analysis.