Annals of Rehabilitation Medicine-ARM最新文献

Objective: To explore the integration of rehabilitation services into primary care, with discussions guided by open-ended questions to allow detailed responses on various aspects of this integration was the objective of the study. The integration of rehabilitative services into primary care in Pakistan, a nation attempting to attain universal health coverage (UHC) and facing major healthcare issues, is the primary focus of this study.

Methods: This qualitative study gathered insights from five experts in health systems, public health, and rehabilitation through semi-structured interviews. The data were analyzed using thematic analysis, identifying key themes such as integration challenges, financial planning, service delivery, and the roles of primary care providers.

Results: It has become clear that timely and efficient patient care requires the integration of general care with rehabilitation services, with primary care physicians being crucial in starting and managing rehabilitation initiatives. Another important subject was financial sustainability, highlighting the necessity of long-term budgeting and planning to provide equal and ongoing access to rehabilitation services. Experts also emphasized the importance of rehabilitation within healthcare systems, urging more public and professional awareness to enhance resource allocation and policy support.

Conclusion: In order to improve rehabilitation services, the study emphasizes the need for strong health information systems, strategic policy frameworks, and raised awareness. A resilient healthcare system that serves the needs of every person can be built, and UHC can be a reality, by addressing the obstacles that have been identified and capturing integration possibilities.

Objective: To investigate the effects of social restrictions imposed during the coronavirus disease 2019 (COVID-19) pandemic on postoperative functional recovery in patients who underwent surgery for degenerative musculoskeletal disorders.

Methods: This longitudinal prospective cohort study included 291 patients categorized into pre-pandemic (surgery in 2018), early pandemic (2019), and late-pandemic (2020) groups based on their 1-year recovery period. The primary outcome was improvement in locomotive syndrome (LS) status 1 year after surgery. We analyzed the association between social limitations and LS improvement using multivariate logistic and segmented regression analyses.

Results: The late-pandemic group exhibited the lowest LS improvement rate (50.6%) and the highest prevalence of postoperative social contact limitations (61.0%). Multivariate analysis identified the absence of postoperative social contact limitation as a highly potent independent predictor of LS improvement (odds ratio, 10.01; 95% confidence interval, 5.40-19.34; p<0.01). Segmented regression analysis revealed a time lag: social contact limitations peaked in March 2020, whereas the decline in LS improvement rates began in October 2020.

Conclusion: Prolonged social restrictions negatively impacted functional recovery, particularly during the late phase of the pandemic. Social participation, specifically direct social contact, could be a critical and independent component of postoperative rehabilitation. These findings underscore the need to integrate psychosocial assessments into standard postoperative care to optimize patient outcomes.

Objective: To translate the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) into Urdu and to determine the psychometric properties of its Urdu version.

Methods: This cross-sectional study recruited 300 participants (18-60 years) with non-specific low back pain (NSLBP), who were able to read Urdu. Test-retest reliability was assessed using intra-class correlation coefficient (ICC), and reproducibility through Cronbach's α. Face and content validity were examined via individual interviews, and construct validity by correlating with relevant reference standards. Exploratory factor analysis (EFA) & confirmatory factor analysis (CFA) was also carried out.

Results: ÖMPSQ was successfully translated into Urdu version with acceptable face and content validity. ÖMPSQ Urdu version showed acceptable internal consistency (α=0.789) & good test-retest reliability (ICC=0.784, 95% confidence interval, p<0.001) while good correlation was demonstrated between ÖMPSQ and Chronic Pain Grade Scale (pain and disability subscales i.e., r=0.809 and 0.807, respectively). However, Roland-Morris Disability Questionnaire showed moderate correlation (r=0.513). Additionally, no significant floor or ceiling effects were observed in the ÖMPSQ Urdu version. EFA revealed a five-factor solution using twenty items, 89.21% was the total item variance in the database, while CFA demonstrated good model fit with strong factor loadings and acceptable fit indices.

Conclusion: The ÖMPSQ Urdu version is valid and reliable for assessing the risk of long-term disability & workplace absence in NSLBP patients.

Objective: To assess maladaptive beliefs about low back pain (LBP), valid and reliable measurement tools are required. Although some tools exist to assess them, the Low Back Pain-related Beliefs Screening Tool (LBP-BST) was developed in order to explore all different categories of misbeliefs in individuals chronic low back pain (CLBP). This study aimed to evaluate the main psychometric properties of both the short and long versions of the revised LBPBSTv2.

Methods: A total of 108 patients with CLBP completed the LBP-BSTv2 to assess its potential floor/ceiling effects, internal consistency, and construct validity. The latter was evaluated by comparing scores with the Back Beliefs Questionnaire (BBQ). Test-retest reliability was assessed in 47 of the participants one week later.

Results: No floor or ceiling effects were observed. The short and long versions of the LBPBSTv2 showed strong construct validity, with significant correlations with BBQ scores. Internal consistency was acceptable to good (Cronbach's alpha: 0.77-0.84), and test-retest reliability was high (intraclass correlation coefficient: 0.76-0.81).

Conclusion: The LBP-BSTv2 is a valid and reliable tool for assessing maladaptive beliefs in patients with CLBP. Its integration into clinical practice could help healthcare professionals identify and address unhelpful beliefs that may hinder rehabilitation. Further research is needed to confirm its usefulness in tracking changes over time and guiding individualized interventions and to study other psychometric properties such as responsiveness.

Objective: To identify the asymmetric spinal stabilizing exercise (ASSE) postures that selectively activate the multifidus (Mu) relative to the erector spinae (ES) in patients with adolescent idiopathic scoliosis (AIS), thereby supporting the development of curve-specific exercise programs for three-dimensional spinal deformities.

Methods: Surface electromyography recordings were obtained bilaterally from the ES and Mu muscles during ASSE postures. Signals were normalized to the maximal voluntary isometric contraction. The asymmetry ratio, Mu/ES ratio, and additional asymmetric contraction of the Mu were analyzed.

Results: The study included 40 patients with AIS. The Mu demonstrated greater ipsilateral activation in the side-lying posture, whereas greater contralateral activation was observed during unilateral lower extremity lifting and combined upper-lower extremity lifting in the prone posture, as well as during combined upper-lower extremity lifting in the bird-dog posture. In the prone and bird-dog postures, the Mu/ES ratio exceeded 1.0, indicating relatively stronger Mu recruitment under rotational loading. Additional asymmetric contraction of the Mu was greatest in the side-lying posture (47%), with differences<15% in all other postures.

Conclusion: ASSE induces posture-specific asymmetric activation of the paraspinal muscles in patients with AIS. Although the side-lying posture produced the largest asymmetry, this reflected increased ES activity for trunk elevation rather than true selective Mu contraction. In contrast, the prone and bird-dog postures demonstrated a greater Mu contribution relative to the ES under rotational loading. These findings suggest that ASSE can be adapted to target specific paraspinal muscle components: side lying for lateral bending and bird-dog variations to enhance rotational stability.

Objective: To develop and validate a clinically actionable prediction model for postoperative pulmonary complications (PPCs) in cardiac surgery patients, focusing on modifiable preoperative risk factors amenable to targeted optimization.

Methods: In this prospective observational cohort study, 492 adults undergoing open-chest cardiac surgery between August 15, 2023 and December 31, 2023 were analyzed. Prespecified predictors included gas exchange variables, pulmonary function, inspiratory muscle strength, and physical performance. Univariable and multivariable logistic regression analyses were used to develop the prediction model. Discrimination was assessed by the area under the receiver operating characteristic curve (AUC).

Results: A total of 90 patients (14.1%) developed PPCs after surgery. Five independent predictors were identified: elevated arterial PaCO2 (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.00-1.26), oxygen desaturation (SpO2<93%) (OR 12.47, 95% CI 3.51-48.13), reduced gait speed (OR 0.17, 95% CI 0.04-0.71), lower FEV1/FVC ratio (OR 0.96, 95% CI 0.92-1.00), and diminished inspiratory muscle strength (MIP % predicted) (OR 0.96, 95% CI 0.92-0.99). The model demonstrated good discriminative ability with an AUC of 0.86 (95% CI 0.80-0.93) in the training cohort and 0.87 (95% CI 0.74-0.93) in the validation cohort.

Conclusion: This parsimonious model achieved high predictive accuracy using five modifiable physiological variables. By targeting abnormalities in gas exchange, pulmonary mechanics, muscle strength, and functional reserve, the model offers a practical tool to guide individualized prehabilitation strategies for reducing PPC risk in cardiac surgery patients.

Objective: To evaluate the effectiveness of the National Health Screening Program for Infants and Children (NHSPIC) in the early diagnosis of neurodevelopmental disorders (NDDs) utilizing data from the National Health Insurance Database of South Korea.

Methods: We enrolled children born between 2011 and 2018 who completed the first to fourth stages of the NHSPIC. A positive finding was defined as a recommendation for further evaluation during one or more stages. Participants were categorized into the positive and negative finding groups. Following 1:1 propensity score matching, 82,138 participants were assigned to each group.

Results: Comparative analysis revealed that participants with positive findings exhibited a higher risk of developing all seven NDDs, particularly for autism spectrum disorder (hazard ratio [HR], 19.70; 95% confidence interval [CI], 17.48-22.20), intellectual disability (HR, 17.11; 95% CI, 14.69-19.93), developmental language disorder (HR, 11.74; 95% CI, 10.73- 12.84), and cerebral palsy (HR, 11.34; 95% CI, 8.67-14.84). The HR for learning disability was 4.31 (95% CI, 2.94-6.34), whereas attention-deficit hyperactivity disorder had an HR of 3.57 (95% CI, 3.37-3.78). Tic disorder had the lowest HR (HR, 1.64; 95% CI, 1.48-1.82). Additionally, HRs were calculated for each NHSPIC stage, demonstrating the utility of specific stages in the early detection of each NDD.

Conclusion: Developmental screening tests in the NHSPIC contributed to the early diagnosis of NDDs. This study underscores the significance of the NHSPIC and provides foundational evidence to inform and enhance policies related to child health screenings.

Objective: To explore whether ultrasonographic measurements of tongue thickness are associated with swallowing function and related clinical domains in patients with amyotrophic lateral sclerosis (ALS), this feasibility study was conducted. Few studies have examined the usefulness of ultrasonographic tongue thickness measurement in patients with ALS, but its association with physiological measures remains unclear.

Methods: Ten patients with ALS underwent tongue thickness measurement using ultrasonography. Clinical assessments including the Korean version of the ALS Functional Rating Scale-Revised (K-ALSFRS-R), Functional Oral Intake Scale (FOIS), Eating Assessment Tool-10 (EAT-10), Dysphagia Handicap Index, Korean version of the Swallowing Quality of Life Questionnaire, Mini Nutritional Assessment-Short Form (MNA-SF), handgrip strength, and bioelectrical impedance analysis for skeletal muscle index (SMI) were performed. Swallowing physiology was evaluated using the Modified Barium Swallow Impairment Profile (MBSImP), Penetration-Aspiration Scale. Simple and partial Pearson's correlation analyses as well as univariate regression were performed with adjustments for age, sex, and body mass index (BMI).

Results: Tongue thickness showed significant associations with multiple functional and systemic measures in the unadjusted analyses, including FOIS, EAT-10, MNA-SF, BMI, SMI, K-ALSFRS-R. After adjustment, the most consistent associations were observed with the MBSImP oral, pharyngeal, and combined phase scores.

Conclusion: Tongue ultrasonography may serve as a radiation-free method to preliminarily assess bulbar involvement in ALS. Tongue thickness was most specifically associated with dysphagia outcomes, particularly MBSImP. Given the feasibility design and small sample size, larger longitudinal studies are warranted to confirm its clinical utility in monitoring the progression of dysphagia in patients with ALS.

Objective: To examine back muscle activity and fatigue behavior in female patients with degenerative thoracolumbar kyphosis (DTK) using high-density surface electromyography (HDSEMG) and evaluate the effects of using a soft spinal orthosis.

Methods: Seven female participants with DTK (mean age: 73.6 years) were assessed during static standing and a weighted holding task with and without a soft spinal orthosis. HDSEMG signals were obtained from the lumbar erector spinae using a 64-electrode array. Time to fatigue (TTF), spatial displacement, and directional consistency of muscle activation were analyzed using the spatial center of activity (SCoA) and circular variance (CV).

Results: Orthosis use significantly reduced the sagittal vertical axis and low back pain. TTF was significantly prolonged during the weighted holding task with the orthosis (p=0.012), indicating delayed fatigue onset. SCoA displacement was significantly reduced in both tasks (p<0.001), whereas CV analysis demonstrated improved directional consistency of muscle activation.

Conclusion: HD-SEMG revealed early fatigue onset and unstable muscle activation patterns in patients with DTK, particularly during load-bearing tasks performed without orthotic support. Orthosis used improved endurance and neuromuscular efficiency by reducing spatial and directional variability in muscle recruitment. These findings underscore the utility of HDSEMG for elucidating the neuromuscular pathophysiology of DTK and support the use of spinal orthoses as a conservative treatment approach.