PM&R最新文献

Introduction: Understanding individual patient preferences for chronic low back pain (cLBP) outcomes is essential for targeting available therapeutic options; yet tools to elicit patient outcome preferences are limited.

Objective: To develop and test a choice-based conjoint (CBC) measure, commonly used in behavioral economics research, to elicit what outcomes patients with cLBP want to achieve and avoid.

Design: We developed a survey-based CBC measure to allow patients to make risk/benefit trade-off choices between possible treatment outcomes. After extensive literature, clinician, and patient input, our measure included seven attributes: fatigue, anxiety/depression, difficulty thinking/making decisions, pain intensity, physical abilities, change in pain, and ability to enjoy life despite pain. Random-parameters logit models were used to estimate strength of preferences, and latent class analysis was used to identify patient characteristics associated with distinct preference.

Setting: Online study using the Sawtooth web-based platform.

Participants: Two hundred eleven individuals with cLBP recruited from online advertising as well as at clinical sites across multiple academic and private institutions.

Interventions: Not applicable.

Results: The most valued outcome was the highest level of physical activity (β = 1.6-1.98; p < .001), followed by avoiding cognitive difficulties (β = -1.48; p < .001). Avoidance of severe pain was comparable to avoiding constant fatigue and near-constant depression/anxiety (β = -0.99, -1.02); p < .001). There was an association between preferences and current pain/disability status; patients with higher pain had a stronger preference to avoid severe pain, whereas those with higher disability have stronger preferences for achieving physical activity. The latent class analysis identified two distinct groups: (1) more risk-seeking and willing to accept worse outcomes (56%); and (2) more risk-averse with a stronger preference for achieving maximum benefits (44%).

Conclusions: Our study illuminated cLBP patient preferences for treatment outcomes and heterogeneity in these preferences. Patients stressed the importance of reaching high physical activity and avoiding cognitive declines, even over a desire to avoid pain. More work is needed to understand patient preferences to aid informed, shared decisions.

Background: Telerehabilitation in spinal cord injury (teleSCI) is a growing field that can improve access to care and health outcomes in patients with spinal cord injury (SCI). The clinical effectiveness of teleSCI is not known.

Objectives: To compare independence in activities of daily living and mobility capacity in patients following teleSCI and matched controls undergoing traditional rehabilitation.

Design: Matched case-control study.

Setting: TeleSCI occurring in home setting (cases) versus traditional rehabilitation on inpatient unit (controls).

Participants: Forty-two consecutive patients with SCI followed with teleSCI were compared to 42 historical rehabilitation inpatients (controls) matched for age, time since injury to rehabilitation admission, level of injury (paraplegia/tetraplegia), complete or incomplete injury, and etiology (traumatic/nontraumatic). The teleSCI group (n = 42) was also compared to the complete cohort of historical controls (n = 613).

Interventions: The teleSCI group followed home-based telerehabilitation (3.5 h/day, 5 days/week, 67 days average duration) and historical controls followed in-person rehabilitation.

Main outcome measure(s): The Functional Independence Measure (FIM), the Spinal Cord Independence Measure (SCIM) and the Walking Index for Spinal Cord Injury (WISCI). We formally compared gains, efficiency and effectiveness. International Standards for Neurological Classification of Spinal Cord Injury and the American Spinal Injury Association Impairment Scale (AIS) were used.

Results: The teleSCI group (57.1% nontraumatic, 71.4% paraplegia, 73.8% incomplete, 52.4% AIS grade D) showed no significant differences compared with historical controls in AIS grades, neurological levels, duration, gains, efficiency and effectiveness in FIM, SCIM, or WISCI, although the teleSCI cohort had significantly higher admission FIM scores compared with the complete cohort of historical controls.

Conclusions: TeleSCI may provide similar improvements in mobility and functional outcomes as traditional rehabilitation in medically stable patients (predominantly with paraplegia and motor incomplete SCI) when provided with appropriate support and equipment.

Mood disturbance is a common, long-term, negative consequence of traumatic brain injury (TBI) that is insufficiently addressed by most traditional treatment modalities. A large body of evidence supports the efficacy of exercise training (ET) to broadly improve mood, as measured most often by the Profile of Mood States (POMS). However, this behavioral approach is not used nearly enough in the TBI population, and when it is, mood is rarely measured. This scoping review will evaluate the use of POMS as a mood measure in TBI research and to establish a rationale for using ET as a behavioral approach to broadly improve mood in persons with TBI.

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.

Introduction: Patients with low back pain may play an active role in the prescription of excessive spine imaging.

Objective: To determine the proportion of patients with low back pain who have beliefs not aligned with current evidence regarding the use of imaging and to identify factors associated with these beliefs.

Design: Secondary analysis of baseline data of a previously published randomized clinical trial.

Setting: Outpatient physical therapy clinic in a middle-income country.

Patients: Individuals with non-specific low back pain.

Methods: Outcome variables were two statements assessing the extent of patient agreement on the need for imaging in the management of low back pain. The predictor variables were age, educational level, duration of symptoms, disability level, pain intensity in the last 24 hours, beliefs about inevitable consequences of low back pain (assessed using the Back Belief Questionnaire), and having received imaging previously. Multivariable logistic models were used for data analysis.

Main outcome measure(s): Level of agreement with Statement 1: X-rays or scans are necessary to get the best medical care for low back pain and Statement 2: Everyone with low back pain should have spine imaging.

Results: A total of 159 patients were included. Of these, 88.1% believed that imaging was necessary for the best medical care for low back pain and 62.9% believed that everyone with low back pain should obtain imaging. Lower scores on the Back Belief Questionnaire were associated with beliefs that imaging was necessary (odds ratio [OR] = 0.90, 95% confidence interval [CI]: 0.81, 0.99) and low education level was associated with the belief that everyone with low back pain should obtain imaging (OR = 3.03, 95% CI: 1.38, 6.61), after controlling for potential confounders.

Conclusion: Nearly 90% of patients believe that spine imaging is necessary for the management of low back pain. Beliefs about the inevitable consequences of low back pain and low education level may be factors that need to be considered when developing new interventions.

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.

Background: Postmenopausal bone loss and decreased physical performance are commonly presented issues. This study aimed through systematic review and meta-analysis to examine the benefits of adding exercise to medicine/supplements in postmenopausal women.

Methods: A systematic search was conducted of four electronic databases for articles published from inception to December 2023. Clinical controlled trials comparing the effect of additional exercise and medicine/supplements alone in postmenopausal women were included. The outcomes studied were bone mineral density (BMD) and physical performance. The quality of evidence was evaluated by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE).

Results: Nineteen articles with 1249 participants were included in this study for systematic review and meta-analysis. The results showed that additional exercise was not associated with significantly improved BMD at the lumbar spine and hip joint compared with medicine/supplements only. However, results of subgroup analysis of exercise types showed a significant improvement in lumbar spine BMD by combining multiple types of exercise training (SMD = 0.37; 95% confidence interval [CI] = 0.01-0.72; p = .04). Furthermore, additional exercise significantly improved lower extremity muscle strength (Standard Mean Difference [SMD] = 1.77; 95% CI = 0.56-2.98; p = .004), Berg's Balance Scale (SMD = 0.72; 95% CI = 0.12-1.32; p = .02), Timed Up and Go (SMD = -1.07; 95% CI = -1.35--0.78; p < .001), fear of falling (SMD = 1.32; 95% CI = 0.89-1.75; p < .001), and the quality of life (SMD = 1.39; 95% CI = 0.74-2.05; p < .001). The quality level of the evidence was between low to very low.

Conclusions: The significant value of the exercise was demonstrated through enhancing physical performance and quality of life. Moreover, combining various exercise training programs has shown a positive effect on BMD at the lumbar spine. Therefore, for postmenopausal women, combining exercise with medicine/supplements is recommended to further improve physical function and specific areas of BMD. (PROSPERO: CRD42023390633).