Annals of Rehabilitation Medicine-ARM最新文献

Objective: To increase participation in cardiac rehabilitation among outpatients with heart disease in Thailand. Factors contributing to low participation are poorly understood. A scale is needed to identify barriers to participation in cardiac rehabilitation. This study aimed to evaluate the psychometric properties of the newly translated Cardiac Rehabilitation Barriers Scale Thai version to justify its use in the Thai population with cardiovascular diseases.

Methods: Psychometric testing was conducted using a cross-sectional survey of 200 outpatients at a Bangkok hospital eligible for the cardiac rehabilitation program from April 2023 to mid-April 2024. Construct validity was evaluated using principal axis factor analysis and first- and second-order confirmatory factor analysis. Cronbach's alpha assessed the scale's internal consistency.

Results: The average age of the total sample was 62.60±12.37 years. Principal axis factoring with Oblimin rotation and Kaiser normalization extracted four components (subscales) that explained 61.8% of the cumulative percentage of variance. These were labeled work and time conflicts, lack of perceived need factors, comorbidities, and logistical barriers. Values for the confirmatory factor analysis goodness of fit indices exceeded recommended minimum thresholds. The internal consistencies for the total scale and the four components were entirely acceptable.

Conclusion: The Cardiac Rehabilitation Barriers Scale Thai version has acceptable psychometric properties for Thai outpatients with cardiovascular diseases. It may be used to identify barriers to participating in cardiac rehabilitation, promote rehabilitation attendance, and improve patient care.

Objective: To investigate muscle tone changes over time in contralateral homonymous muscles when unilateral muscles are stimulated, using F-wave measurements, we examined whether vibratory stimulation on the contralateral homonymous muscle of the affected side may reduce spasticity, whose optimal duration remains unclear.

Methods: Vibratory stimulation was applied to the right hand of healthy adults, using parameters of 80 Hz frequency, 0.4 mm amplitude, 400 g load, and 195 seconds of duration on the abductor digiti minimi muscle. F-wave was measured in the left hand before stimulation, at seven intervals during stimulation, and immediately after.

Results: The F/M amplitude ratio decreased immediately at stimulation onset, at 30 seconds, and at 60 seconds compared to baseline. A least-squares analysis revealed a negative slope from baseline to 60 seconds (f(x)=-0.11x+1.12), while the slope became positive after 90 seconds, continuing after stimulation ended (f(x)=0.04x+0.82).

Conclusion: Unilateral vibratory stimulation may decrease excitability in the spinal anterior horn cells of the contralateral homonymous muscle for up to 75 seconds post-stimulation, suggesting a potential mechanism for spasticity management.

Wearable robotic exoskeletons have emerged as promising technologies for enhancing gait rehabilitation and providing mobility assistance in individuals with neurological and musculoskeletal disorders. This narrative review summarizes recent advances in wearable robots-including both rigid exoskeletons and soft exosuits-and evaluates their clinical application across diverse conditions such as stroke, spinal cord injury, cerebral palsy, and Parkinson's disease. For rehabilitation purposes, these devices enable repetitive, task-specific gait training that promotes motor learning, reduces therapist burden, and facilitates improvements in walking speed, balance, and endurance. Rigid exoskeletons provide substantial joint support and are particularly effective for patients with severe gait impairments, whereas soft exosuits offer lightweight assistance suited to individuals with milder deficits or fatigue, albeit with limited capacity to deliver high-torque support. Beyond rehabilitation, wearable robots are increasingly used as assistive devices to compensate for permanent gait limitations and restore mobility in daily life. However, widespread clinical adoption remains constrained by several challenges, including a lack of standardized protocols; limited evidence from large-scale, multicenter studies; and practical issues such as device weight, comfort, and ease of use in community settings. Recent developments-such as adaptive control algorithms, volition-adaptive assistance, and artificial intelligence integration-are addressing these barriers by enabling more personalized and responsive support. With continued research investment, user-centered design, and supportive policies, wearable exoskeletons hold considerable potential to improve independence, participation, and quality of life for individuals across a broad spectrum of mobility impairments.

Objective: To examine the short-term and long-term effects of computer-based cognitive training on postural stability, locomotion, and cognitive performance in Parkinson's disease (PD) patients.

Methods: Sixty-eight PD participated in this randomized-controlled trial, were randomly allocated into two groups; control group (GA) received a designed physiotherapy program for 60 minutes, and an experimental group (GB) got 30 minutes physiotherapy program as GA, along with 30 minutes of computerized cognitive training. Treatment sessions were three times/week for eight weeks. Primary outcomes were balance and spatiotemporal gait parameters; cognition was a secondary outcome. Primary and secondary measures were examined at baseline, immediately post-treatment, and three months post-treatment.

Results: From baseline to post-treatment, GB showed greater reductions in postural sway compared to GA. The mean differences in stability indices were 1.461±1.240, 0.982±1.185, and 1.006±0.982 in GB, vs. 0.581±1.503, 0.426±1.459, and 0.374±1.072 in GA. For gait parameters (gait velocity, stride length, and cadence), GB demonstrated larger improvements, with mean differences of -0.361±0.245, -0.242±0.158, and -11.606±12.628, compared to -0.155±0.254, -0.191±0.248, and -4.516±10.773 in GA. PD-Cognitive Rating Scale improved more substantially in GB (-16.091±6.978) than in GA (-1.129±4.552). These gains in postural stability, gait, and cognition were statistically significant (p<0.001) and sustained at the 3-month follow-up.

Conclusion: Computerized cognitive training as an add-on in the rehabilitation of PD is efficient in improving postural stability and locomotion, as well as the cognitive performance. The consistency of these findings for 3 months is an imperative point in the clinical course of PD patients.

Objective: To compare the Hong (GH) and sustained insertion (GS) dry needling methods in patients with myofascial neck pain, this experimental study was conducted.

Methods: A randomized controlled trial included 30 participants, assigned to either the GH (n=15) or GS (n=15) group. Each group received treatment on either the right or left side, with one side receiving experimental DN and the other receiving control (sham) DN. The GS method involved a single needle insertion per myofascial trigger point for one minute, while the GH method used multiple rapid needle insertions over two minutes without needle retention. Measurements were taken before therapy, 5 minutes post-DN session (post-5min), 24 hours post-session (post-24h), and 7 days post-session (post-7d). Muscle tension (MT) and muscle stiffness (MS) were measured with a myotonometer, pressure pain threshold (PPT) with an algometer, maximum isometric strength (Fmax) with a handheld dynamometer, and transcutaneous perfusion (PU) with laser Doppler flowmetry. Power Doppler Score (PDS) and minor adverse events were also recorded.

Results: Results showed that GH led to significantly higher MT and MS values at post-24h and post-7d (p<0.001). In contrast, GS showed greater PPT and Fmax at post-5min, post-24h, and post-7d (p<0.001). Additionally, GH exhibited higher PU values at post-5min and post-7d (p<0.001), while GS showed higher PDS values at post-5min and post-24h (p<0.001).

Conclusion: The GH method resulted in less favorable outcomes in terms of MT and MS, while the GS method showed superior improvements in pain relief and functional recovery.

Diabetic peripheral neuropathy (DPN), a common complication of type 2 diabetes mellitus, leads to sensory and motor impairments that significantly affect fine motor skills, grip strength, and dexterity, limiting daily functioning. Understanding the impact of DPN on hand-related activities of daily living (ADLs) is crucial for improving patient care and outcomes. This review employed the International Classification of Functioning, Disability, and Health (ICF) framework to assess hand function issues. A systematic search of peer-reviewed studies was conducted across multiple databases to identify research examining the impact of DPN on hand-related ADLs. The findings were categorised using relevant ICF codes linked to hand function issues. The analysis identified four major themes: (1) the impact of DPN on daily activities and participation; (2) sensory impairments affecting hand function; (3) muscle weakness and functional limitations; and (4) unaddressed areas, such as structural changes, driving, assisting others, and preparing meals. DPN was found to significantly hinder hand function, reducing independence in ADLs and overall quality of life. This review highlights the need for comprehensive assessments that address not only impairments, but also activity limitations and participation restrictions, to capture the multifaceted challenges of DPN. Developing targeted assessments tailored to the specific needs of individuals with DPN is essential for improving intervention strategies and overall quality of care.

Objective: To investigate the effects of a home-based rehabilitation program on physical capacity, lung function, and health-related quality of life (QOL) in patients with advanced lung cancer undergoing platinum-based chemotherapy.

Methods: Between December 2021 and December 2023, participants were randomly assigned to exercise and control groups. The exercise group engaged in a home-based exercise program, including respiratory, aerobic, and resistance training, for 60 minutes per session, three times per week, before the first tumor response evaluation. Outcome evaluations included the 6-minute walk test, spirometry to measure lung function (specifically assessing forced expiratory volume in 1 second [FEV1] and forced vital capacity, hand grip strength, and QOL assessments using the Short Form 36-Item Health Survey and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Lung Cancer Module 29. Participants were assessed at baseline, post-intervention, and followed up for 1 year.

Results: Twenty-one of the 26 participants completed the study. The control group showed a significant decrease in FEV1 (p=0.011). Delays in chemotherapy occurred in 40.0% of participants in the control group but none in the exercise group (p=0.019). Mental health showed improvement in the exercise group (p=0.041), whereas adverse effects were more common in the control group (p=0.007), according to QOL questionnaire results.

Conclusion: Home-based rehabilitation during chemotherapy may help maintain lung function, improve mental health, and reduce side effects in patients with lung cancer, warranting further research.

Objective: Primary frozen shoulder causes significant pain and progressively restricts shoulder movements. Diagnosis is primarily clinically based on patient history and physical examination. Management is mainly non-invasive owing to its self-limiting clinical course. However, clinical practice guidelines for frozen shoulder have not yet been developed in Korea. The developed guidelines aim to provide evidence-based recommendations for the diagnosis and treatment of frozen shoulder.

Methods: A guideline development committee reviewed the literature from four databases (PubMed, Embase, Cochrane Library, and KMbase). Using the PICO (Population, Intervention, Comparator, and Outcome) framework, the committee formulated two backgrounds and 16 key questions to address common clinical concerns. Recommendations were made using the Grading of Recommendations, Assessment, Development, and Evaluation framework.

Results: Diabetes, thyroid disease, and dyslipidemia significantly increase the risk of developing a frozen shoulder. Although frozen shoulder is often self-limiting, some patients may experience long-term disabilities. Ultrasound and magnetic resonance imaging should be used as adjunctive tools alongside clinical diagnosis, and not as independent diagnostic methods. Noninvasive approaches, such as medications, physical modalities, exercises, electrical stimulation, and manual therapy, may reduce pain and improve shoulder function. Other noninvasive interventions have limited evidence, and their application should be based on clinical judgment. Intra-articular steroid injections are recommended for treatment, and physiotherapy or hydrodilatation with steroid injections can also be beneficial.

Conclusion: These guidelines provide evidence-based recommendations for diagnosing and treating primary frozen shoulder.

The effect of inspiratory muscle training (IMT) on cervical spinal cord injury (SCI) remains controversial. This study aimed to assess the efficacy of IMT in enhancing breathing muscle strength, pulmonary function, and quality of life (QoL) among patients with cervical SCI. A search was performed using the PubMed, Cochrane Library, Scopus, Embase, and Web of Science databases through December 2023. This review was conducted according to PRISMA guidelines and the Cochrane Library Handbook. The meta-analysis used mean differences (MDs) or standardized mean differences to pool the results. The Risk of Bias 2 and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) were used to assess the methodological quality of the included studies. This systematic review included five randomized controlled trials (202 participants). The results of the meta-analysis showed that IMT significantly improved maximal inspiratory pressure (MIP) with MD 12.13 cmH2O (95% confidence interval [CI] 4.22 to 20.03), maximal expiratory pressure (MEP) with MD 8.98 cmH2O (95% CI 6.96 to 11.00), and vital capacity (VC) with MD 0.25 L (95% CI 0.21 to 0.28). There were no significant improvements in forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and QoL. The quality of the evidence ranged from very low to moderate, owing to bias and heterogeneity. Our results showed that IMT may improve MIP, MEP, and VC, but not FEV1, FVC, or QoL, in patients with cervical SCI. Further large-scale studies are required to determine this effect's optimal dosage and duration.

Objective: To examine the contribution of perceived upper limb function to participation and activity among community-dwelling people with chronic stroke.

Methods: A cross-sectional study was conducted with eighty-one people with stroke aged ≥50 years. The outcome measures included the Oxford Participation and Activities Questionnaire (Ox-PAQ), Arm Activity Measure (ArmA), Wolf Motor Function Test (WMFT), Timed Up and Go Test (TUG), and Geriatric Depression Scale (GDS).

Results: Correlation analyses revealed that perceived upper limb function, as measured using the ArmA, had the strongest and most significant correlations with the levels of participation and activity, as measured using the Ox-PAQ, among all of the tested variables (rs=0.35-0.59, p<0.01). Multiple linear regression analyses also showed that perceived upper limb function significantly associated the levels of participation and activity, accounting for 2.0% to 9.0% of the variance in the Ox-PAQ scores. The final model, which included TUG time, the GDS score, the WMFT score, and the ArmA score, could explain 54% and 28% of the variance in the routine activities and social engagement subscales of the Ox-PAQ, respectively. The model including the GDS score, the WMFT score, and the ArmA score explains 32% of the variance in the emotional well-being subscale of the Ox-PAQ.

Conclusion: Perceived upper limb function is a crucial determinant of participation and activity among community-dwelling people with chronic stroke. It could thus be a target component of stroke rehabilitation interventions to facilitate participation and activity after stroke.