Journal of Neurologic Physical Therapy最新文献

Background and purpose: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a well-established tool for assessing disability. However, diverse factor structures complicate its interpretation, necessitating further validation. This study examined the factorial validity of the 32-item WHODAS 2.0 in persons with stroke using 1-factor, 6-factor, and 2-level hierarchical structures.

Methods: A cross-sectional design was used with data from 1343 persons with stroke in the Taiwan Databank of Persons with Disabilities. Confirmatory factor analysis (CFA) was used to determine the valid structure of the 32-item WHODAS 2.0.

Results: The 1-factor structure exhibited poor model fits, while the 6-factor and the overall 2-level hierarchical structure had acceptable model fits. However, the relationships between domains and overall score of the 2-level structure yielded poor fits. Excellent internal consistencies (Cronbach's α ≥ 0.90) were obtained for the 6 domain scores and the overall score.

Discussion and conclusions: Our results revealed poor model fit for the 1-factor model, whereas the 6-factor structure and the overall 2-level hierarchical structure were both acceptable. However, the relationships between domains and the overall score within the 2-level structure were poor. The 6-factor model is preferable due to its better fit and alignment with WHODAS 2.0's design to assess multiple life perspectives. The 6-domain structure appears the most robust for persons with stroke. Thus, the 6 domain scores of the 32-item WHODAS 2.0 are recommended.

Purpose: Moderate-to-high intensity locomotor training (M-HIT) is strongly recommended in stroke rehabilitation, but outcomes are variable. This study aimed to identify baseline clinical characteristics that predict changes in walking capacity following M-HIT in chronic stroke.

Methods: This analysis used data from the HIT-Stroke Trial ( N = 55), which involved up to 36 sessions of either moderate- or high-intensity locomotor training. A prespecified model assessed how well baseline motor impairment (Fugl-Meyer lower limb motor scale [FM-LL]), comfortable gait speed (CGS), and balance confidence (Activities-specific balance confidence scale [ABC]) independently explain changes in 6-minute walk distance (∆6MWD), while controlling for the treatment group. Exploratory analysis tested additional baseline covariates using the all-possible regressions procedure. The predictive value of each potential covariate was assessed by its average contribution to the explained variance in ∆6MWD (∆pseudo- R2 ).

Results: With the prespecified model, 8-week ∆6MWD was significantly associated with baseline FM-LL (β = 5.0 [95% CI: 1.4, 8.6]) and ABC (β = 0.7 [0.0, 1.4]), but not CGS (β = - 44.6 [-104.7, 15.6]). The exploratory analysis revealed that the top 7 covariates with the highest mean ∆pseudo- R2 were FM-LL, pain-limited walking duration, ABC, the use of an assistive device, fatigue, depression, and recent walking exercise history >2 days per week.

Discussion and conclusions: On average, participants with less motor impairment and higher balance confidence exhibit greater walking capacity improvements after M-HIT in chronic stroke. Additional negative predictive factors may include pain-limited walking duration, use of an assistive device, fatigue, depression, and recent walking exercise; however, these exploratory findings need to be confirmed in future studies.

Video abstract: Supplemental Digital Content available at [ http://links.lww.com/JNPT/A533 ].

Background and purpose: In 2013, the American Physical Therapy Association put forth a vision statement that declared that the movement system be central to physical therapy practice. Since then, the Academy of Neurologic Physical Therapy has supported this vision by creating task forces that have worked to advance the utility of movement analysis and movement diagnoses. In 2021, the Movement Analysis of Tasks (MAT) Subgroup created and defined a series of observable movement constructs and developed a systematic method for movement analysis of specific high-priority tasks. Since then, we have sought feedback across the physical therapy community through informal methods, including national stakeholder discussions, and a formal qualitative survey of 30 physical therapists in a single health system. The purpose of this project is to provide an update to the Framework for MAT based on this feedback.

Summary of key points: The updates to the 2021 Framework for MAT include (1) presentation of a revised set of observable movement constructs that reduces redundancy, (2) proposal of a generalized method for standardized MAT that more comprehensively considers environmental and sociocultural factors during any movement-centered examination, and (3) provide guidance on how the MAT fits within the physical therapy examination and facilitates clinical reasoning.

Recommendations for clinical practice: Through the use of case presentations, we demonstrate the use of these tools across a wide variety of patient scenarios, thereby advocating for continued professional conversation about their clinical utility.

Video abstract available: for more insights from the authors (see the Video, Supplemental Digital Content available at: http://links.lww.com/JNPT/A556 ; http://links.lww.com/JNPT/A557 ; http://links.lww.com/JNPT/A558 .

Background and purpose: Few studies have examined the long-term effects of lung volume recruitment (LVR) in amyotrophic lateral sclerosis (ALS). This study aimed to clarify the impact of LVR on respiratory function (Aim 1) and survival (Aim 2).

Methods: This retrospective cohort included hospitalized patients with ALS who underwent LVR from 2015 to 2020. For Aim 1, longitudinal changes in forced vital capacity (%FVC) were assessed every 3 months before and after LVR. For Aim 2, the survival study, data on sex, onset age, delay in diagnosis, duration of LVR, and subtype were also collected.

Results: A total of 79 patients underwent LVR (Aim 2), 48 patients had %FVC data before and after LVR (Aim 1). Regarding long-term effects on respiratory function (Aim 1), %FVC declined at approximately 2% per month before LVR, with significant decreases observed at 12, 9, and 6 months relative to baseline (P < .001). After LVR, the decline slowed to less than 1% per month, and no significant decreases were observed at 3, 6, 9, or 12 months. In Aim 2, patients continuing LVR ≥6 months had longer survival than those with shorter use. Multivariate Cox regression identified LVR ≥6 months as a prognostic factor (hazard ratio [95% CI] = 0.42 [0.19-0.96], P = .04).

Discussion and conclusions: These findings suggest a potential association between continued LVR and both a slower decline in %FVC and longer survival in patients with ALS. Further prospective studies are warranted to confirm these findings.

Video abstract available: For more insights from the author (see the Video, Supplemental Digital Content Video, available at http://links.lww.com/JNPT/A552.

Background and purpose: Pain is a frequent symptom of multiple sclerosis (MS). Algometry as a method to measure pressure pain threshold (PPT) has not yet been validated for test-retest reliability and construct validity in persons with MS (pwMS). This research aims to investigate the test-retest reliability and construct validity of the pressure algometry for pain in MS.

Methods: Sixty pwMS with pain were included (mean age: 51.08 ± 11.61, Expanded Disability Status Scale [IQR]: 3.75 [3.3]). The reliability (test-retest, measurement error) and construct validity (hypothesis testing) were analyzed. A digital algometer (Somedic Sales AB, Hörby, Sweden) was applied perpendicularly and bilaterally on the trapezius muscle, thumbnails, low back, and quadriceps muscle to assess local PPTs. Three trials were performed on each body site, and the mean of the trials was used for statistical analysis. To investigate test-retest reliability, participants repeated the testing at 3- to 8-day intervals.

Results: PPTs obtained by algometry showed good to excellent test-retest reliability (ICC [95% CI]: 0.82 [0.70-0.89]-0.91 [0.85-0.95]) in 4 different body parts. PPT measures had significant negative moderate correlations with pain outcome measures (the Neuropathic Pain Scale, Neuropathic Pain Symptom Inventory, Brief Pain Inventory-Short Form, Douleur Neuropathique en 4, and painDETECT) (Spearman's rho = -0.265 to -0.456) and the Modified Fatigue Impact Scale (Spearman's r = -0.281 to -0.392). Weak nonsignificant correlations were found between PPT measures and clinical variables (Spearman's r = -0.201 to 0.227).

Discussion and conclusions: PPT measurement can reliably assess pain in MS with weak to moderate validity in the neck, thumbnails, lower back, and legs.

Background and purpose: The American Physical Therapy Association's (APTA) vision of transforming society by optimizing movement to improve the human experience must include a reduction in the unwarranted variation in physical therapist practice. The APTA proposed that the profession adopt the movement system as a basis for developing diagnoses to classify movement dysfunction so that treatment is more consistent and specific. In 2021, the Academy of Neurologic Physical Therapy Movement System Diagnosis Task Force developed 10 movement system diagnoses for balance dysfunction, a diagnostic process, and recommended intervention strategies. The purpose of this special interest paper is to report on the ongoing refinement of the balance diagnoses and the diagnostic process based on a pilot survey of practicing clinicians and colleagues' informal feedback.

Summary of key points: Pilot survey participants largely agreed on the clarity of the definitions, the accuracy of the key movement observations, and appropriateness of the key findings from tests and measures, but not the mutual exclusivity of the balance diagnoses. Using an iterative process, the authors considered the feedback to arrive at a consensus to address these concerns. The result is an updated set of 12 balance diagnoses, revision of some key definitions, a refined diagnostic process, and an updated summary of the evidence for task-specific balance-related interventions. These updated diagnoses and diagnostic processes must be examined for mutual exclusivity, validity, and reliability prior to clinical adoption.

Recommendations for clinical practice: Until the balance diagnoses are shown to be mutually exclusive, valid, and reliable, we recommend that clinicians conceptualize balance control dysfunction using the well-established postural control strategies and apply well-supported principles of task-specific interventions when managing individuals with balance dysfunction.(JNPT 2025;24: 1-13).

Background: Sustainable utilization of neurology and allied health professions' services is pivotal for effective management of Parkinson disease (PD) and is correlated with positive health-related outcomes.

Objectives: (1) To describe the utilization of neurology and allied health services by people with PD (PwP); (2) to explore the associations between demographic and structural variables and utilization; and (3) to test associations between utilization and unplanned hospitalizations.

Methods: A retrospective observational cohort study of 1761 PwP in the years 2014-2019 was conducted. Utilization of neurology and allied health services was mapped. Regression models were examined to test associations between demographic and structural variables, utilization of neurology and physical therapy (PT), and unplanned hospitalizations.

Results: Approximately 50% of the study population utilized neurology services. Utilization rate of allied health services ranged between 0% and 19%. The likelihood of utilizing neurology services increased for people with extended health insurance and people with more years since diagnosis and decreased for women and for people living at a great distance from a neurology service. The likelihood of utilizing PT increased for Jews and people with extended health insurance and decreased for people with more years since diagnosis and for people living at a great distance from a PT service. Among patients with fewer years since diagnosis (<5 years), those who utilized PT had a higher likelihood of unplanned hospitalization.

Conclusions: Neurology and allied health services are underutilized by PwP, particularly by minorities and women. Policymakers should take proactive steps to increase utilization.

Video abstract available: for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A496 ).