PM&R最新文献

Objective: To estimate the comparative clinical efficacy and acceptability of different intensity levels of extracorporeal shock wave therapy (ESWT) in adults with plantar heel pain (PHP). TYPE: Systematic review and network meta-analysis.

Literature survey: PubMed, EMBASE, Cochrane Library electronic databases and Web of Science for randomized controlled trials from inception to March 2024.

Methodology: We included placebo-controlled and head-to-head trials of different intensity levels of ESWT used to treat adults with PHP. Data were extracted following a predefined hierarchy. We assessed the studies' risk of bias in according to the Cochrane risk of bias tool, and the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Primary outcomes were efficacy (success rate) and acceptability (all-course discontinuation rate). Secondary outcomes were pain and function scores changes. All interventions were ranked using the surface under the cumulative ranking curve to determine the hierarchy of treatment.

Synthesis: 22 RCTs comprising 2299 participants met the inclusion criteria. In terms of efficacy, all intensity levels of ESWT were more effective than placebo, with ORs ranging from 2.29 (95% CI 1.39-3.76) for medium intensity ESWT (M-ESWT) to 5.50 (95% CI 1.00-30.29) for low intensity ESWT (L-ESWT). In terms of acceptability, there was no statistically significant difference between all intensity levels of ESWT and placebo, with ORs ranging from 0.83 (0.47-1.45) for M-ESWT to 1.42 (0.19-10.71) for L-ESWT. For pain relief, only M-ESWT and H-ESWT were superior to placebo (SMD -0.60, 95% CI -0.94 to -0.26; SMD -0.28, 95% CI -0.44 to -0.11), whereas there was no difference between them (p = .05). For function improved, there was no statistically significant difference between all intensity levels of ESWT and placebo (range of ORs 1.02-3.44). In contrast, there were no significant differences among the intensity levels in all outcomes. Of the 22 trials, 7 (32%) were assessed as high risk of bias, and the rest (68%) were assessed as unclear risk. The certainty of evidence was low to very low.

Conclusion: Compared to the placebo, all intensity levels of ESWT were more favorable in terms of efficacy, but there was no difference in terms of acceptability. In addition, M-ESWT appeared to provide additional benefits in pain and function for patients with PHP compared to the other intensity levels. The results provide an evidence-based basis for considering ESWT as an alternative for patients with PHP for whom conservative treatment is not effective, and also highlight future research priorities to providing more decision-making for the clinical management of PHP.

Background: Frailty is a risk factor for poor outcomes in lung transplantation. Identifying the causes of frailty and addressing reversible risk factors that contribute to poor outcomes in this population is complex.

Objective: To describe the results of frailty measures associated with poor outcomes and the prehabilitation plan prescribed for patients at their initial assessment for lung transplantation at our institution. We describe how a prehabilitation approach to improve function and mitigate risk factors can be incorporated into lung transplant selection committee recommendations.

Methods: Data were analyzed from 186 patients seen in an outpatient physical medicine and rehabilitation (PM&R) clinic as part of their initial assessment for lung transplantation and their lung selection committee recommendations.

Results: All 186 patients who initiated evaluation for lung transplant were evaluated by PM&R during their transplant initial evaluation period. Low objective and self-reported physical function were present in the majority of patients. All patients received a multimodal prehabilitation plan to address these reversible risk factors. Prehabilitation recommendations were integrated into their lung selection committee recommendations.

Conclusion: A comprehensive physiatric assessment for the purpose of identifying reversible risk factors for poor outcomes such as frailty and prescribing interventions to improve function is a feasible addition to the lung transplant evaluation process. This patient population has high prehabilitation needs.

Background: Portable technology that records movements with high accuracy provides potential for sensitive clinical movement tests for individuals who experienced a traumatic brain injury (TBI).

Objective: (1)To present impairments assessed using markerless motion capture (MMC) and (2) to compare the sensitivity and specificity of the MMC-mediated tests to each other and to common clinical tests.

Design: Screening study, using as criterion standard the ability to classify participant with TBI versus control participant.

Setting: Research laboratory.

Participants: The study included 30 individuals with TBI and 101 control participants. Entry criteria included most recent head injury <5 years old, no history of movement issues prior to injury, no movement-affecting medications, and sufficient cognitive ability to follow instructions.

Interventions: Not applicable.

Main outcome measures: Performance on MMC-mediated tests and existing clinical analogs. MMC-mediated tests included finger oscillation, simple reaction time, and visually guided movement tasks. For comparison, participants also completed the following clinical tests: Halstead-Reitan finger tapping, simple reaction time test, and Beery Visuomotor Integration test. Impairments were identified as test scores of participants with TBI that fell outside of the 95% interval of control participants' test scores. Random forest analysis was used to calculate the sensitivity and specificity of MMC and clinical tests according to their ability to correctly classify participants with TBI and control participants.

Results: MMC-mediated tests revealed impairments in more participants with TBI than clinical tests in all three TBI groups (mild, repeated, and moderate to severe). Similarly, MMC-mediated tests revealed a higher percentage of scores as impairments than clinical tests in all three groups with TBI. Furthermore, MMC-mediated tests proved more sensitive and more specific than clinical tests (70% versus 50% and 98% versus 93%, respectively).

Conclusion: MMC-mediated tests are sensitive and specific (compared to traditional clinical tests) and have potential to fill a gap in clinical care of TBI.

Background: Therapeutic tools are critical for poststroke rehabilitation. The potential benefits of dual-task training assisted by a lower-extremity exoskeleton robot to enhance gait and postural control have yet to be studied.

Objective: To determine the effects of lower-extremity exoskeleton robot-assisted dual-task training on gait and postural control after stroke.

Design: Single-blind, randomized controlled trial.

Setting: Outpatient clinic and ward, Department of Rehabilitation Medicine, Huadong Hospital affiliated with Fudan University.

Participants: Forty-four participants in the recovery and sequela phases of stroke with deficits in gait and postural control.

Interventions: Participants were randomly assigned to two groups: lower-extremity exoskeleton robot-assisted walking cognitive dual-task training (experimental group) or lower-extremity exoskeleton robot-assisted walking training (control group). Each participant received 40 minutes per intervention, 1 time per day, 6 times per week for 3 weeks.

Main outcome measures: The primary outcome was gait variability performance. The secondary outcomes included the Timed Up and Go, Berg Balance Scale, Montreal Cognitive Assessment, Fugl-Meyer assessment of lower extremity, and International Classification of Functioning, Disability and Health-activities and participation assessment scale.

Results: Individuals who participated in exoskeleton robot-assisted walking cognitive dual-task training improved more than those in the control group in partial gait variability performance analysis, Timed Up and Go test, Berg Balance Scale, and Fugl-Meyer assessment for the lower extremities (p < .05).

Conclusions: Compared to lower-extremity exoskeleton robot-assisted walking training, robot-assisted dual-task training improves gait and postural control, walking, balance, and lower extremity motor function in survivors of stroke.

Objective: Balance training with visual occlusion positively affects the improvement of proprioception and reduction of visual dependence in individuals with chronic ankle instability (CAI). However, the effect of visual occlusion balance training alone on postural control in individuals with CAI remains controversial. This review conducted a meta-analysis of existing randomized controlled trials (RCTs) to investigate the influence of balance training with visual occlusion on the postural control of individuals with CAI.

Literature survey: PubMed, Embase, The Cochrane Library, Web of Science, EBSCO, China National Knowledge Infrastructure (CNKI), and WanFang database were searched until July 20, 2024. RCTs were eligible if they compared the effects of balance training with visual occlusion with balance training on the postural control of individuals with CAI.

Methodology: The following information from the included articles was extracted: basic study information, interventions, and outcomes. The primary outcomes included Y-balance test (YBT) distance and center of pressure (COP) area, and the secondary outcomes were Cumberland ankle instability tool (CAIT) and Foot and Ankle Ability Measure (FAAM) scores.

Synthesis: Eight RCTs were included in this work. The results show that balance training with visual occlusion significantly improved YBT distance (standardized mean difference [SMD] = 0.40 [95% confidence interval [CI], 0.23-0.57], p < .001) and CAIT scores (mean difference [MD] = 3.03 [95% CI, 1.76-4.29], p < .001) in individuals with CAI compared with balance training alone. However, no significant difference was found between the two groups in terms of the COP area (SMD = 0.18 [95% CI, 0.51-0.86], p = .62) and FAAM scores (MD = 1.79 [95% CI, -0.03 to 3.62], p = .05).

Conclusions: Compared with balance training alone, balance training with visual occlusion may help improve the dynamic postural control ability of individuals with CAI. However, its effect on static postural control ability still needs further study.

Background: Femoral neck stress fractures are prevalent injuries among young female runners, yet biomechanical and strength features have not been well-described in adolescents and young adults.

Objective: To compare running gait biomechanics and strength measures of female runners diagnosed with a femoral neck bone stress injury (BSI) to healthy female runner controls.

Design: Retrospective case-control study.

Setting: Outpatient sports medicine department.

Patients: There were 18 female runners with a history of femoral neck BSI (age: 20.3 ± 1.0 years, BMI: 19.8 ± 0.6 kg/m²) and 18 healthy female runners without femoral neck BSI (age: 18.3 ± 0.7 years, BMI: 21.5 ± 0.6 kg/m²).

Methods: Participants underwent instrumented running gait analyses with 2-dimensional videos, and standardized handheld dynamometry hip strength measures.

Main outcome measures: Primary outcomes included spatiotemporal, kinematic, and kinetic running gait biomechanics, and tri-planar hip muscle strength. Non-parametric Mann-Whitney U tests were used to compare participant demographics. Linear regressions were used to compare strength and continuous gait outcomes, and logistic regressions were used to compare categorical gait outcomes between groups, covarying for age and body mass index (α = .05).

Results: A higher proportion of those with a history of femoral neck BSI demonstrated limb midline cross-over (Adjusted Probability [Adj.]: 65.0% vs. 38.5 %; p = .04), contralateral pelvic drop (Adj.: 99.0% vs. 52.9%; p = .02), medial knee displacement (Adj.: 67.0% vs. 37.9%; p = .03), and pronation at midstance (Adj.: 86.5% vs. 41.2%; p = .02) compared to those without a history of BSI. Those with a history of femoral neck BSI had lower hip abduction strength on dynamometry testing (1.64 ± 0.30 Nm/kg vs. 1.99 ± 0.66 Nm/kg; p = .01).

Conclusions: Female runners with a history of femoral neck BSI demonstrated characteristic coronal plane gait and hip abductor strength deficits, suggesting an association between impaired lower limb proximal and distal biomechanics during femoral neck BSI recovery.

Background: Children with cerebral palsy and other disabilities face barriers in obtaining equitable medical care. Although many factors contribute to these disparities, physicians' lack of knowledge and comfort when caring for patients with cerebral palsy have been reported to play a role. We propose that this gap in understanding may reflect a deficit in disability education during medical school.

Objective: To (1) obtain insight into medical students' knowledge regarding cerebral palsy at two medical schools in the United States; and (2) determine whether viewing a brief educational video increases short-term knowledge regarding cerebral palsy.

Methods: All medical students attending Wayne State University School of Medicine and Central Michigan University College of Medicine in November-December 2023 were invited to participate in the study. Respondents completed a three-step survey, in which they answered nine multiple-choice knowledge-based questions about cerebral palsy, viewed a 10-minute educational video, and responded to the same nine knowledge-based questions after viewing the video.

Results: A total of 221 surveys were received (response rate: 14%). For the submitted surveys in which paired data were available, the percentage of correct responses at baseline (prevideo), averaged for the nine knowledge-based questions, was 45 ± 15% and increased to 67 ± 11% after viewing the educational video (p < .01).

Conclusions: Our results reveal that medical students' knowledge of cerebral palsy is limited and that a brief, focused educational session may have a short-term beneficial effect in mitigating this gap in knowledge.