Pub Date : 2024-08-21DOI: 10.1101/2024.08.18.24312177
Samuel Lane, Colin Ayre
Objectives: Rugby Union is a popular sport worldwide characterised by high intensity full contact match play. Injuries are common during matches and training. While musculoskeletal injury is expected in such a sport, there is emerging research evidence and increased public awareness of neurodegenerative disease risks. The objectives of the present study are to explore reasons for continued participation despite high risk of injury, gain understanding of perceived importance of participation and insight into why players may play with chronic injury. Design: 10 male amateur rugby union players in Gloucestershire and Yorkshire aged 30±5.75 with 20±6.93 years of playing experience participated in semi-structured interviews with subsequent thematic analysis of transcripts. Results: 4 major themes of identity, community, risk acceptance, and uniqueness of rugby were identified. None of the players reported plans to reduce participation in rugby. Conclusions: Despite risks of injury there were no plans to reduce participation amongst players interviewed. Benefits gained from rugby are abundant and meaningful to players. Understanding these beliefs is helpful for medical staff supporting players, especially through injury. Overall, commitment to amateur rugby union remains strong despite new knowledge of the long-term risks involved. The findings show that amateur rugby union remains a popular sport with benefits extending beyond physical activity.
{"title":"What keeps male amateur rugby union players committed to the game despite high risk of injury? A qualitative study.","authors":"Samuel Lane, Colin Ayre","doi":"10.1101/2024.08.18.24312177","DOIUrl":"https://doi.org/10.1101/2024.08.18.24312177","url":null,"abstract":"Objectives: Rugby Union is a popular sport worldwide characterised by high intensity full contact match play. Injuries are common during matches and training. While musculoskeletal injury is expected in such a sport, there is emerging research evidence and increased public awareness of neurodegenerative disease risks. The objectives of the present study are to explore reasons for continued participation despite high risk of injury, gain understanding of perceived importance of participation and insight into why players may play with chronic injury.\u0000Design: 10 male amateur rugby union players in Gloucestershire and Yorkshire aged 30±5.75 with 20±6.93 years of playing experience participated in semi-structured interviews with subsequent thematic analysis of transcripts.\u0000Results: 4 major themes of identity, community, risk acceptance, and uniqueness of rugby were identified. None of the players reported plans to reduce participation in rugby.\u0000Conclusions:\u0000Despite risks of injury there were no plans to reduce participation amongst players interviewed. Benefits gained from rugby are abundant and meaningful to players. Understanding these beliefs is helpful for medical staff supporting players, especially through injury. Overall, commitment to amateur rugby union remains strong despite new knowledge of the long-term risks involved. The findings show that amateur rugby union remains a popular sport with benefits extending beyond physical activity.","PeriodicalId":501453,"journal":{"name":"medRxiv - Rehabilitation Medicine and Physical Therapy","volume":"147 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-20DOI: 10.1101/2024.08.14.24311980
Laura Peterson Brown, Jai Joshi, Kate Kosmac, Douglas E Long, Ashley A Montgomery-Yates, Anna G Kalema, Jamie Sturgill, Hemendra Vekaria, Patrick Sullivan, Dylan Wilburn, Panagiotis Koutakis, Christine M Latham, Christopher Fry, Philip A Kern, Benjamin Miller, Esther Dupont-Versteegden, Ahmed Ismaeel, Kirby P Mayer, Yuan Wen
Post-acute sequelae of COVID (PASC) persist in many patients for weeks and months after recovery from initial SARS-CoV-2 infection. Recent evidence suggests that pathological changes in skeletal muscle may contribute significantly to ongoing pain and fatigue, particularly post-exertional malaise. This study aimed to investigate the underlying mechanisms of PASC-related fatigue by examining skeletal muscle function and circulating factors in affected individuals. We conducted a cross-sectional case-control study of patients with fatigue-associated PASC who had experienced mild to moderate COVID-19 without hospitalization. Skeletal muscle biopsies revealed reduced mitochondrial respiration and content in PASC participants compared to healthy controls. This lower respiratory capacity was accompanied by markedly elevated circulating levels of soluble IL-2 receptor alpha subunit (sIL2R), a T cell-specific receptor. In vitro experiments demonstrated that sIL2R directly impairs mitochondrial oxygen consumption and reduces mitochondrial complex III subunit protein levels in cultured muscle cells. These findings suggest a mechanism linking systemic immune dysregulation to muscle-specific mitochondrial dysfunction in PASC. This work provides new insights into the pathophysiology of PASC identifying sIL2R as a promising therapeutic target for addressing mitochondrial deficits in PASC-related fatigue and opening avenues for developing targeted interventions.
{"title":"Soluble IL-2R impairs muscle cell mitochondrial respiration in fatigued individuals with post-acute sequelae of COVID-19.","authors":"Laura Peterson Brown, Jai Joshi, Kate Kosmac, Douglas E Long, Ashley A Montgomery-Yates, Anna G Kalema, Jamie Sturgill, Hemendra Vekaria, Patrick Sullivan, Dylan Wilburn, Panagiotis Koutakis, Christine M Latham, Christopher Fry, Philip A Kern, Benjamin Miller, Esther Dupont-Versteegden, Ahmed Ismaeel, Kirby P Mayer, Yuan Wen","doi":"10.1101/2024.08.14.24311980","DOIUrl":"https://doi.org/10.1101/2024.08.14.24311980","url":null,"abstract":"Post-acute sequelae of COVID (PASC) persist in many patients for weeks and months after recovery from initial SARS-CoV-2 infection. Recent evidence suggests that pathological changes in skeletal muscle may contribute significantly to ongoing pain and fatigue, particularly post-exertional malaise. This study aimed to investigate the underlying mechanisms of PASC-related fatigue by examining skeletal muscle function and circulating factors in affected individuals.\u0000We conducted a cross-sectional case-control study of patients with fatigue-associated PASC who had experienced mild to moderate COVID-19 without hospitalization. Skeletal muscle biopsies revealed reduced mitochondrial respiration and content in PASC participants compared to healthy controls. This lower respiratory capacity was accompanied by markedly elevated circulating levels of soluble IL-2 receptor alpha subunit (sIL2R), a T cell-specific receptor.\u0000In vitro experiments demonstrated that sIL2R directly impairs mitochondrial oxygen consumption and reduces mitochondrial complex III subunit protein levels in cultured muscle cells. These findings suggest a mechanism linking systemic immune dysregulation to muscle-specific mitochondrial dysfunction in PASC.\u0000This work provides new insights into the pathophysiology of PASC identifying sIL2R as a promising therapeutic target for addressing mitochondrial deficits in PASC-related fatigue and opening avenues for developing targeted interventions.","PeriodicalId":501453,"journal":{"name":"medRxiv - Rehabilitation Medicine and Physical Therapy","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-13DOI: 10.1101/2024.08.12.24311569
Laura Tabacof, Rebecca Howard, Jeffrey Bower, Erica Breyman, Sophie Dewil, Jenna Tosto-Mancuso, Richard Hanbury, Brandon Carmouche, Mark Robberson, Adam Fry, David Putrino
Neuropathic Pain (NP) affects 10% of the general population, decreasing quality of life for millions of Americans and contributing to higher physical and mental health care costs. The most widely used treatments for NP involve medications that show limitations in efficacy and burdensome side effects. This randomized controlled trial explored the efficacy of a wearable Audio-Visual Stimulation neuromodulation device (Sana) as a novel intervention for chronic NP in 64 participants. Outcomes were assessed at baseline, after 8-weeks of daily use of the assigned Sana or Sham device, and after 4 weeks of discontinued use. For the main outcome (Neuropathic Pain Symptom Inventory total), there were statistically significant improvements in the Active arm that were greater than those in the Sham Arm at Week-14 (Mean Difference = 10.04, p = 0.01). Both groups showed significant improvements at the end of the treatment period (Week-10), and the Active arm maintained this improvement after an additional 4 weeks of non-use, while the Sham arm almost returned to baseline (Active Change = 13.26, p <=0.001 | Sham Change = 3.22, p = 0.214). Participants in the Active arm had significant decreases in use of anxiolytic, opiate, antidepressant, and anticonvulsant medications compared to the Sham arm. The study provides strong evidence supporting the efficacy of a novel AVS Device in generating durable improvements in NP, with superiority over Sham at 14 weeks. The Sana device may also reduce the reliance on pain medications and is a safe and easy to use treatment option for patients.
{"title":"Audio-Visual Stimulation Therapy for Chronic Neuropathic Pain: A Sham-Controlled Randomized Clinical Trial","authors":"Laura Tabacof, Rebecca Howard, Jeffrey Bower, Erica Breyman, Sophie Dewil, Jenna Tosto-Mancuso, Richard Hanbury, Brandon Carmouche, Mark Robberson, Adam Fry, David Putrino","doi":"10.1101/2024.08.12.24311569","DOIUrl":"https://doi.org/10.1101/2024.08.12.24311569","url":null,"abstract":"Neuropathic Pain (NP) affects 10% of the general population, decreasing quality of life for millions of Americans and contributing to higher physical and mental health care costs. The most widely used treatments for NP involve medications that show limitations in efficacy and burdensome side effects. This randomized controlled trial explored the efficacy of a wearable Audio-Visual Stimulation neuromodulation device (Sana) as a novel intervention for chronic NP in 64 participants. Outcomes were assessed at baseline, after 8-weeks of daily use of the assigned Sana or Sham device, and after 4 weeks of discontinued use. For the main outcome (Neuropathic Pain Symptom Inventory total), there were statistically significant improvements in the Active arm that were greater than those in the Sham Arm at Week-14 (Mean Difference = 10.04, p = 0.01). Both groups showed significant improvements at the end of the treatment period (Week-10), and the Active arm maintained this improvement after an additional 4 weeks of non-use, while the Sham arm almost returned to baseline (Active Change = 13.26, p <=0.001 | Sham Change = 3.22, p = 0.214). Participants in the Active arm had significant decreases in use of anxiolytic, opiate, antidepressant, and anticonvulsant medications compared to the Sham arm. The study provides strong evidence supporting the efficacy of a novel AVS Device in generating durable improvements in NP, with superiority over Sham at 14 weeks. The Sana device may also reduce the reliance on pain medications and is a safe and easy to use treatment option for patients.","PeriodicalId":501453,"journal":{"name":"medRxiv - Rehabilitation Medicine and Physical Therapy","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-07DOI: 10.1101/2024.08.06.24311478
Shu Yang, Paula K Johnson, Elisabeth A Wilde, Colby R Hansen, Melissa M Cortez, Leland E Dibble, Peter C. Fino, Tiphanie E Raffegeau
Background: Deficits in dual-tasks (DT) are frequently observed post-concussion (i.e., mild Traumatic Brain Injury). However, traditional DT may not be relevant to daily life. Walking while talking elicits DT costs in healthy adults and is part of daily life. Objective: We investigated the effect of concussion on walking with extemporaneous speech and explored relationships between DT and acute symptoms. Methods: Participants with recent concussion (<14 days post-injury) and controls completed three tasks: single-task gait without speaking (STG), single-task speaking without walking (STS) and walking while speaking (DT). Silent pauses in speech audio reflected cognitive performance, and gait was quantified using inertial sensors. We used linear mixed models to compare groups and conditions and explored associations with self-reported symptoms. Results: Both concussion (n=19) and control (n=18) groups exhibited longer speech pauses (p < 0.001), slower walking speeds (p < 0.001), and slower cadence (p < 0.001) during the DT compared to ST conditions. There were no group differences or interactions for speech pauses (p > 0.424). The concussion group walked slower (p = 0.010) and slowed down more during DT than the control group (group*task p = 0.032). Vestibular symptoms strongly associated with ST speech pause duration (ρ = 0.72), ST gait speed (ρ = -0.75), and DT gait speed (ρ = -0.78). Conclusions: Extemporaneous speech is well-practiced, but challenging to complete while walking post-concussion. Strong associations between DT outcomes and vestibular-related symptoms suggest DT deficits vary with post-concussion symptomology. DT deficits may be deleterious to daily tasks post-concussion.
{"title":"Talking while Walking After Concussion: Acute effects of concussion on speech pauses and gait speed","authors":"Shu Yang, Paula K Johnson, Elisabeth A Wilde, Colby R Hansen, Melissa M Cortez, Leland E Dibble, Peter C. Fino, Tiphanie E Raffegeau","doi":"10.1101/2024.08.06.24311478","DOIUrl":"https://doi.org/10.1101/2024.08.06.24311478","url":null,"abstract":"Background: Deficits in dual-tasks (DT) are frequently observed post-concussion (i.e., mild Traumatic Brain Injury). However, traditional DT may not be relevant to daily life. Walking while talking elicits DT costs in healthy adults and is part of daily life. Objective: We investigated the effect of concussion on walking with extemporaneous speech and explored relationships between DT and acute symptoms.\u0000Methods: Participants with recent concussion (<14 days post-injury) and controls completed three tasks: single-task gait without speaking (STG), single-task speaking without walking (STS) and walking while speaking (DT). Silent pauses in speech audio reflected cognitive performance, and gait was quantified using inertial sensors. We used linear mixed models to compare groups and conditions and explored associations with self-reported symptoms.\u0000Results: Both concussion (n=19) and control (n=18) groups exhibited longer speech pauses (p < 0.001), slower walking speeds (p < 0.001), and slower cadence (p < 0.001) during the DT compared to ST conditions. There were no group differences or interactions for speech pauses (p > 0.424). The concussion group walked slower (p = 0.010) and slowed down more during DT than the control group (group*task p = 0.032). Vestibular symptoms strongly associated with ST speech pause duration (ρ = 0.72), ST gait speed (ρ = -0.75), and DT gait speed (ρ = -0.78).\u0000Conclusions: Extemporaneous speech is well-practiced, but challenging to complete while walking post-concussion. Strong associations between DT outcomes and vestibular-related symptoms suggest DT deficits vary with post-concussion symptomology. DT deficits may be deleterious to daily tasks post-concussion.","PeriodicalId":501453,"journal":{"name":"medRxiv - Rehabilitation Medicine and Physical Therapy","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141933615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-31DOI: 10.1101/2024.07.30.24311146
Bernat de las Heras, Lynden Rodrigues, Jacopo Cristini, Kevin Moncion, Numa Dancause, Alexander Thiel, Jodi Edwards, Janice J Eng, Ada Tang, Marc Roig
Background: The capacity to reacquire motor skills lost after a stroke is crucial to promote upper-limb motor recovery but the impact of lesion location on motor skill acquisition and the underlying neurophysiological mechanisms remain uncertain. Methods: We used transcranial magnetic stimulation to investigate associations between excitatory and inhibitory cortico-spinal excitability measures and the capacity to acquire a novel motor skill with the most affected hand in 103 individuals with cortical (n=34) or subcortical (n=69) lesions. Results: Both groups showed similar motor skill acquisition, but subcortical lesions exhibited more impairment in the most affected hand and lower excitability in the ipsilesional hemisphere. In cortical lesions, motor skill acquisition was associated with lower motor thresholds (?=-0.25, 95% CI [-0.47,-0.03]; p=0.024) and higher intracortical inhibition (?=-3.93, 95% CI [-6.89,-0.98]; p=0.011) in the ipsilesional hemisphere. In contrast, in subcortical lesions motor skill acquisition was associated with smaller motor evoked potentials (?=-4.46, 95% CI [-8.54,-0.38]; p=0.033), less intracortical inhibition (?=3.45, 95% CI [0.34,6.56]; p=0.030) and higher facilitation (?=1.34,95% CI [0.15,2.54]; p= 0.028) ipsilesionally. Sensitivity analyses revealed that associations with intracortical inhibition and facilitation in the subcortical group were driven by lesions affecting the corticospinal tract. No associations were found in the contralesional hemisphere. Conclusions: Reinforcing the existence of lesion-specific neurophysiological patterns, individuals with cortical and subcortical lesions show divergent associations between cortico-spinal excitability and motor skill acquisition. The use of cortico-spinal excitability as a biomarker to predict upper-limb recovery post-stroke or guide motor recovery interventions such as non-invasive brain stimulation should consider lesion location.
背景：中风后重新获得丧失的运动技能对促进上肢运动恢复至关重要，但病变位置对运动技能获得的影响以及潜在的神经生理机制仍不确定。研究方法我们使用经颅磁刺激研究了皮质（34 例）或皮质下（69 例）病变的 103 例患者的兴奋性和抑制性皮质脊髓兴奋性测量值与用受影响最大的手获得新运动技能的能力之间的关系。结果显示两组患者的运动技能掌握能力相似，但皮层下病变患者受影响最严重的那只手的功能受损更严重，同侧半球的兴奋性更低。在皮层病变中，运动技能的掌握与同侧半球较低的运动阈值（?=-0.25，95% CI [-0.47,-0.03]；P=0.024）和较高的皮层内抑制（?=-3.93，95% CI [-6.89,-0.98]；P=0.011）有关。相反，在皮层下病变中，运动技能获得与同侧较小的运动诱发电位（?=-4.46，95% CI [-8.54,-0.38]；p=0.033）、较少的皮层内抑制（?=3.45，95% CI [0.34,6.56]；p=0.030）和较高的促进（?=1.34，95% CI [0.15,2.54]；p= 0.028）相关。敏感性分析表明，皮层下组中皮层内抑制和促进的相关性是由影响皮层脊髓束的病变引起的。对侧半球未发现相关性。结论皮质和皮质下病变的个体在皮质脊髓兴奋性和运动技能习得之间表现出不同的关联，这强化了病变特异性神经生理学模式的存在。使用皮质脊髓兴奋性作为生物标志物来预测中风后上肢的恢复或指导运动恢复干预（如无创脑刺激），应考虑病变位置。
{"title":"Lesion location changes the association between brain excitability and motor skill acquisition post-stroke","authors":"Bernat de las Heras, Lynden Rodrigues, Jacopo Cristini, Kevin Moncion, Numa Dancause, Alexander Thiel, Jodi Edwards, Janice J Eng, Ada Tang, Marc Roig","doi":"10.1101/2024.07.30.24311146","DOIUrl":"https://doi.org/10.1101/2024.07.30.24311146","url":null,"abstract":"Background: The capacity to reacquire motor skills lost after a stroke is crucial to promote upper-limb motor recovery but the impact of lesion location on motor skill acquisition and the underlying neurophysiological mechanisms remain uncertain. Methods: We used transcranial magnetic stimulation to investigate associations between excitatory and inhibitory cortico-spinal excitability measures and the capacity to acquire a novel motor skill with the most affected hand in 103 individuals with cortical (n=34) or subcortical (n=69) lesions. Results: Both groups showed similar motor skill acquisition, but subcortical lesions exhibited more impairment in the most affected hand and lower excitability in the ipsilesional hemisphere. In cortical lesions, motor skill acquisition was associated with lower motor thresholds (?=-0.25, 95% CI [-0.47,-0.03]; p=0.024) and higher intracortical inhibition (?=-3.93, 95% CI [-6.89,-0.98]; p=0.011) in the ipsilesional hemisphere. In contrast, in subcortical lesions motor skill acquisition was associated with smaller motor evoked potentials (?=-4.46, 95% CI [-8.54,-0.38]; p=0.033), less intracortical inhibition (?=3.45, 95% CI [0.34,6.56]; p=0.030) and higher facilitation (?=1.34,95% CI [0.15,2.54]; p= 0.028) ipsilesionally. Sensitivity analyses revealed that associations with intracortical inhibition and facilitation in the subcortical group were driven by lesions affecting the corticospinal tract. No associations were found in the contralesional hemisphere. Conclusions: Reinforcing the existence of lesion-specific neurophysiological patterns, individuals with cortical and subcortical lesions show divergent associations between cortico-spinal excitability and motor skill acquisition. The use of cortico-spinal excitability as a biomarker to predict upper-limb recovery post-stroke or guide motor recovery interventions such as non-invasive brain stimulation should consider lesion location.","PeriodicalId":501453,"journal":{"name":"medRxiv - Rehabilitation Medicine and Physical Therapy","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141867404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-27DOI: 10.1101/2024.07.26.24311068
Taym Alsalti, Ian Hussey, Malte Elson, Robert Krause, Steffi Pohl
With transcranial direct-current stimulation's (tDCS) rising popularity both in motor learning research and as a commercial product, it is becoming increasingly important that the quality of evidence on its effectiveness be evaluated. Special attention should be paid to meta-analyses, as they usually have a large impact on research and clinical practice. The aim of this study was to evaluate the methodological quality of meta-analyses estimating the effect of tDCS on motor learning with respect to reproducibility as the main focus, and reporting quality and publication bias control as secondary aspects. The three meta-analyses we reviewed largely adhered to PRISMA reporting guidelines and reported the primary effect sizes and sampling variances / confidence intervals they calculated, enabling successful reproductions of pooled effect size estimates. However, akin to previous meta-research reviews with similar aims, we found the methods and results sections of the meta-analyses to be severely underreported, which compromises the ability to judge the soundness of the methodological procedure adopted as well as its reproducibility. While publication bias detection methods were applied, the approaches chosen do not allow for well informed decisions about the presence or extent of publication bias. These results reemphasise the need to clearly report on the methods in meta-analyses and to evaluate the quality of meta-analyses.
{"title":"A Methodological Evaluation of Meta-Analyses in tDCS - Motor Learning Research","authors":"Taym Alsalti, Ian Hussey, Malte Elson, Robert Krause, Steffi Pohl","doi":"10.1101/2024.07.26.24311068","DOIUrl":"https://doi.org/10.1101/2024.07.26.24311068","url":null,"abstract":"With transcranial direct-current stimulation's (tDCS) rising popularity both in motor learning research and as a commercial product, it is becoming increasingly important that the quality of evidence on its effectiveness be evaluated. Special attention should be paid to meta-analyses, as they usually have a large impact on research and clinical practice. The aim of this study was to evaluate the methodological quality of meta-analyses estimating the effect of tDCS on motor learning with respect to reproducibility as the main focus, and reporting quality and publication bias control as secondary aspects. The three meta-analyses we reviewed largely adhered to PRISMA reporting guidelines and reported the primary effect sizes and sampling variances / confidence intervals they calculated, enabling successful reproductions of pooled effect size estimates. However, akin to previous meta-research reviews with similar aims, we found the methods and results sections of the meta-analyses to be severely underreported, which compromises the ability to judge the soundness of the methodological procedure adopted as well as its reproducibility. While publication bias detection methods were applied, the approaches chosen do not allow for well informed decisions about the presence or extent of publication bias. These results reemphasise the need to clearly report on the methods in meta-analyses and to evaluate the quality of meta-analyses.","PeriodicalId":501453,"journal":{"name":"medRxiv - Rehabilitation Medicine and Physical Therapy","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141783667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-23DOI: 10.1101/2024.07.22.24310752
James Sliwa, Julia Carpenter, Andrew J Bodine, Caitlin Deom, Richard L Lieber
Objective: Recent work has highlighted the importance of data-driven decision making as it relates to precision medicine and the field of rehabilitation as a whole. One promising method of facilitating the integration of data into patient care involves the use of data warehousing to process and host stores of patient data, analytics to produce useful results, and dashboarding technology to disseminate those analytical results to care teams in a digestible and interpretable format. This report describes the implementation of a new composite rehabilitation outcome, the AbilityQuotient, and predictive modeling into inpatient interdisciplinary conferences through a patient data dashboard and its impact on outcomes. Design: Longitudinal Intervention Setting: Inpatient Rehabilitation Hospital Participants: 13,397 patients completing inpatient rehabilitation from January 1, 2019 to December 31, 2023 Intervention: A patient centered, composite outcome score and predictive modeling dashboard implemented into team conference Main Outcome Metrics: Self-care and mobility IRF-PAI Form GG change scores, length of stay pre- and post-dashboard implementation; GG change scores compared to weighted national averages; clinician survey regarding perspectives of dashboard use; GG item long term goal modifications and goal attainment as measures of influence on clinical plan of care Results: Following implementation of the patient outcomes dashboard into routine care, IRF-PAI Form GG self-care scores rose by 2.09 points and corresponding mobility scores rose by 7.18 points despite a 2.29 day reduction in length of stay in a sample of patients at the facility of interest. A further exploration investigating these changes as they pertain to payor reveals that these benefits occur irrespective of insurer. Reports comparing facility to national averages extracted from eRehabData, a national outcomes data system and registry, suggest that the facility utilizing the outcomes dashboard saw greater reductions in length of stay and greater improvements in functional outcomes during the 2019-2023 period. A corresponding survey assessing clinical perceptions of dashboard implementation revealed that it facilitated tracking and summarizing patient progress, reinforced the use of outcome metrics, and was perceived as valuable in goal setting and adjustment. Clinicians modified self-care goals six times more frequently and patients met these goals 19% more of the time while they changed mobility goals nine times more frequently and patients met these goals 21% more of the time. Conclusion: The incorporation of individual patient data and predictive modeling into rehabilitation patient care through use of a team conference dashboard has potential as a means to move toward precision rehabilitation. It also has the potential to impact outcome metrics improving value-based care and consequently deserves further study.
{"title":"The AbilityQuotient Dashboard: Outcomes of Implementing Patient-Specific Predictive Modeling in Inpatient Team Conference","authors":"James Sliwa, Julia Carpenter, Andrew J Bodine, Caitlin Deom, Richard L Lieber","doi":"10.1101/2024.07.22.24310752","DOIUrl":"https://doi.org/10.1101/2024.07.22.24310752","url":null,"abstract":"Objective: Recent work has highlighted the importance of data-driven decision making as it relates to precision medicine and the field of rehabilitation as a whole. One promising method of facilitating the integration of data into patient care involves the use of data warehousing to process and host stores of patient data, analytics to produce useful results, and dashboarding technology to disseminate those analytical results to care teams in a digestible and interpretable format. This report describes the implementation of a new composite rehabilitation outcome, the AbilityQuotient, and predictive modeling into inpatient interdisciplinary conferences through a patient data dashboard and its impact on outcomes.\u0000Design: Longitudinal Intervention\u0000Setting: Inpatient Rehabilitation Hospital\u0000Participants: 13,397 patients completing inpatient rehabilitation from January 1, 2019 to December 31, 2023\u0000Intervention: A patient centered, composite outcome score and predictive modeling dashboard implemented into team conference Main Outcome Metrics: Self-care and mobility IRF-PAI Form GG change scores, length of stay pre- and post-dashboard implementation; GG change scores compared to weighted national averages; clinician survey regarding perspectives of dashboard use; GG item long term goal modifications and goal attainment as measures of influence on clinical plan of care Results: Following implementation of the patient outcomes dashboard into routine care, IRF-PAI Form GG self-care scores rose by 2.09 points and corresponding mobility scores rose by 7.18 points despite a 2.29 day reduction in length of stay in a sample of patients at the facility of interest. A further exploration investigating these changes as they pertain to payor reveals that these benefits occur irrespective of insurer. Reports comparing facility to national averages extracted from eRehabData, a national outcomes data system and registry, suggest that the facility utilizing the outcomes dashboard saw greater reductions in length of stay and greater improvements in functional outcomes during the 2019-2023 period. A corresponding survey assessing clinical perceptions of dashboard implementation revealed that it facilitated tracking and summarizing patient progress, reinforced the use of outcome metrics, and was perceived as valuable in goal setting and adjustment. Clinicians modified self-care goals six times more frequently and patients met these goals 19% more of the time while they changed mobility goals nine times more frequently and patients met these goals 21% more of the time.\u0000Conclusion: The incorporation of individual patient data and predictive modeling into rehabilitation patient care through use of a team conference dashboard has potential as a means to move toward precision rehabilitation. It also has the potential to impact outcome metrics improving value-based care and consequently deserves further study.","PeriodicalId":501453,"journal":{"name":"medRxiv - Rehabilitation Medicine and Physical Therapy","volume":"108 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141783658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-10DOI: 10.1101/2024.07.09.24309987
Evan MacEachern, Miranda Wu, Shawna Cronin, Áine Carroll, Marco Inzitari, Gaston Perman, Janet Prvu-Bettger, Michelle L.A. Nelson
Background: Various terms are used interchangeably to describe health care services that focus on supporting functional recovery after experiencing a health event. Previous literature has identified these terms as the 4R’s: rehabilitation, reablement, reactivation, and restorative health care services. However, there lacks a clear understanding and delineation between these concepts, making it difficult to measure the efficacy of each program type. This study protocol proposes a bibliometric and content analysis to map the current scientific literature within each 4R term. Methods: Using a predefined search strategy, we will identify and retrieve publications from databases Scopus and PubMed between the years 1924-2024 for each 4R concept. Two independent researchers will screen articles for eligibility. Bibliometric analyses will be conducted using RStudio software and Bibliometrix and Biblioshiny extensions. Bibliometric analyses will each include a performance analysis, citation analysis, co-citation analysis, bibliographic coupling, and co-word analysis to identify key research connections and emerging trends temporally and geographically. Bibliometric indicators of interest will include total publications, yearly output, author names, and countries, among others. In addition, we will also perform a qualitative content analysis to provide a more in-depth examination of the characteristics of each program type. Implications: Our line of inquiry intends to clarify the similarities and differences among the 4R terms to conceptualize each definition. Findings from this study have several implications for research, practice, and policy within the 4Rs, and can overall help to delineate these concepts and facilitate decision-making and resource allocation for these health care services. This study will reveal citation patterns, research connections, and foundation themes that can inform the suitability of practice transfer and resource allocation within and between rehabilitation fields. A methodological understanding of the 4R service types can inform decision-making on the patient, healthcare professional, and system level for each service.
{"title":"What's in a name? Protocol for a bibliometric and content analysis of rehabilitation, reablement, reactivation, and restorative health care services","authors":"Evan MacEachern, Miranda Wu, Shawna Cronin, Áine Carroll, Marco Inzitari, Gaston Perman, Janet Prvu-Bettger, Michelle L.A. Nelson","doi":"10.1101/2024.07.09.24309987","DOIUrl":"https://doi.org/10.1101/2024.07.09.24309987","url":null,"abstract":"Background: Various terms are used interchangeably to describe health care services that focus on supporting functional recovery after experiencing a health event. Previous literature has identified these terms as the 4R’s: rehabilitation, reablement, reactivation, and restorative health care services. However, there lacks a clear understanding and delineation between these concepts, making it difficult to measure the efficacy of each program type. This study protocol proposes a bibliometric and content analysis to map the current scientific literature within each 4R term. Methods: Using a predefined search strategy, we will identify and retrieve publications from databases Scopus and PubMed between the years 1924-2024 for each 4R concept. Two independent researchers will screen articles for eligibility. Bibliometric analyses will be conducted using RStudio software and Bibliometrix and Biblioshiny extensions. Bibliometric analyses will each include a performance analysis, citation analysis, co-citation analysis, bibliographic coupling, and co-word analysis to identify key research connections and emerging trends temporally and geographically. Bibliometric indicators of interest will include total publications, yearly output, author names, and countries, among others. In addition, we will also perform a qualitative content analysis to provide a more in-depth examination of the characteristics of each program type. Implications: Our line of inquiry intends to clarify the similarities and differences among the 4R terms to conceptualize each definition. Findings from this study have several implications for research, practice, and policy within the 4Rs, and can overall help to delineate these concepts and facilitate decision-making and resource allocation for these health care services. This study will reveal citation patterns, research connections, and foundation themes that can inform the suitability of practice transfer and resource allocation within and between rehabilitation fields. A methodological understanding of the 4R service types can inform decision-making on the patient, healthcare professional, and system level for each service.","PeriodicalId":501453,"journal":{"name":"medRxiv - Rehabilitation Medicine and Physical Therapy","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141573046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-08DOI: 10.1101/2024.07.04.24309908
Gitendra Uswatte, Edward Taub, Karlene Ball, Brandon S Mitchell, Jason A Blake, Staci McKay, Fedora Biney, Olesya Iosipchuk, Piper Hempfling, Elise Harris, Anne Dickerson, Kristine Lokken, Amy J Knight, Victor W Mark, Shruti Agnihotri, Garry Cutter
Purpose: Long COVID brain fog is often disabling. Yet, no empirically-supported treatments exist. This study′s objectives were to evaluate feasibility and efficacy, provisionally, of a new rehabilitation approach, Constraint-Induced Cognitive Therapy (CICT), for post-COVID-19 cognitive sequelae. Design: Sixteen community-residents ≥ 3-months post-COVID-19 infection with mild cognitive impairment and dysfunction in instrumental activities of daily living (IADL) were enrolled. Participants were randomized to Immediate-CICT or treatment-as-usual (TAU) with crossover to CICT. CICT combined behavior change techniques modified from Constraint-Induced Movement Therapy with Speed of Processing Training, a computerized cognitive-training program. CICT was deemed feasible if (a)≥80% of participants completed treatment, (b) the same found treatment highly satisfying and at most moderately difficult, and (c) <2 study-related, serious adverse-events occurred. The primary outcome was IADL performance in daily life (Canadian Occupational Performance Measure). Employment status and brain fog (Mental Clutter Scale) were also assessed. Results: Fourteen completed Immediate-CICT (n=7) or TAU (n=7); two withdrew from TAU before their second testing session. Completers were [M (SD)]: 10 (7) months post-COVID; 51 (13) years old; 10 females, 4 males; 1 African American, 13 European American. All the feasibility benchmarks were met. Immediate-CICT, relative to TAU, produced very large improvements in IADL performance (M=3.7 points, p<.001, d=2.6) and brain fog (M=-4 points, p <.001, d=-2.9). Four of five non-retired Immediate-CICT participants returned-to-work post-treatment; no TAU participants did, p=.048. Conclusions: CICT has promise for reducing brain fog, improving IADL, and promoting returning-to-work in adults with Long COVID. Findings warrant a large-scale RCT with an active-comparison group.
{"title":"Long COVID Brain Fog Treatment: Findings from a Pilot Randomized Controlled Trial of Constraint-Induced Cognitive Therapy","authors":"Gitendra Uswatte, Edward Taub, Karlene Ball, Brandon S Mitchell, Jason A Blake, Staci McKay, Fedora Biney, Olesya Iosipchuk, Piper Hempfling, Elise Harris, Anne Dickerson, Kristine Lokken, Amy J Knight, Victor W Mark, Shruti Agnihotri, Garry Cutter","doi":"10.1101/2024.07.04.24309908","DOIUrl":"https://doi.org/10.1101/2024.07.04.24309908","url":null,"abstract":"Purpose: Long COVID brain fog is often disabling. Yet, no empirically-supported treatments exist. This study′s objectives were to evaluate feasibility and efficacy, provisionally, of a new rehabilitation approach, Constraint-Induced Cognitive Therapy (CICT), for post-COVID-19 cognitive sequelae.\u0000Design: Sixteen community-residents ≥ 3-months post-COVID-19 infection with mild cognitive impairment and dysfunction in instrumental activities of daily living (IADL) were enrolled. Participants were randomized to Immediate-CICT or treatment-as-usual (TAU) with crossover to CICT. CICT combined behavior change techniques modified from Constraint-Induced Movement Therapy with Speed of Processing Training, a computerized cognitive-training program. CICT was deemed feasible if (a)≥80% of participants completed treatment, (b) the same found treatment highly satisfying and at most moderately difficult, and (c) <2 study-related, serious adverse-events occurred. The primary outcome was IADL performance in daily life (Canadian Occupational Performance Measure). Employment status and brain fog (Mental Clutter Scale) were also assessed. Results: Fourteen completed Immediate-CICT (n=7) or TAU (n=7); two withdrew from TAU before their second testing session. Completers were [M (SD)]: 10 (7) months post-COVID; 51 (13) years old; 10 females, 4 males; 1 African American, 13 European American. All the feasibility benchmarks were met. Immediate-CICT, relative to TAU, produced very large improvements in IADL performance (M=3.7 points, p<.001, d=2.6) and brain fog (M=-4 points, p <.001, d=-2.9). Four of five non-retired Immediate-CICT participants returned-to-work post-treatment; no TAU participants did, p=.048. Conclusions: CICT has promise for reducing brain fog, improving IADL, and promoting returning-to-work in adults with Long COVID. Findings warrant a large-scale RCT with an active-comparison group.","PeriodicalId":501453,"journal":{"name":"medRxiv - Rehabilitation Medicine and Physical Therapy","volume":"63 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141573044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-05DOI: 10.1101/2024.07.04.24309955
Kristen Dams-O'Connor, Enna Selmanovic, Lisa Spielman, Ariel Pruyser, Ashlyn Bulas, Eric Watson, Jesse Mez, Jeanne M Hoffman
Importance:Traumatic encephalopathy syndrome (TES),the suggested clinical manifestation of chronic traumatic encephalopathy(CTE),is believed to result from repetitive head impacts (RHI) and the prevalence of TES and its component symptoms have not been thoroughly investigated in individuals with single TBI.Objective:To use prospectively collected data to operationalize TES per consensus research diagnostic criteria and examine the rates of TES in a sample of individuals with isolated TBI, a subset of whom also had RHI exposure, and to determine whether any demographic or injury factors predicted likelihood of meeting TES diagnostic criteria.Design:295 participants from the Late Effects of TBI (LETBI) study had complete data for all key variables. The sample was categorized by TBI severity and presence of RHI history leading to 6 groups (those with isolated mild, moderate, and severe TBI, with and without RHI). Chi-squared tests were used to compare the proportion of each group that met each of the core clinical criteria overall TES diagnosis. Binary logistic regression models were used to examine the associations of demographic and injury characteristics on TES diagnosis. Levels of functional dependence and levels of certainty for CTE neuropathology in the sample were characterized and applied with the core clinical features to explore consensus-based provisional levels of certainty of CTE pathology across study groups.Results: In addition to history of TBI, 141 (47.7%) participants had RHI exposure meeting the TES criteria exposure threshold. In the full sample, 56.9%, 33.2% and 45.7% of participants met TES core criterion of cognitive impairment, neurobehavioral dysregulation, and progressive course of clinical features, respectively. Overall, 15.2% of this LETBI sample had substantial RHI exposure and met all 3 clinical features, meeting consensus-based TES criteria. When RHI exposure criterion was lifted, 33.5% of the LETBI sample with isolated TBI met all core clinical criteria. No significant differences were found in clinical diagnostic criteria between individuals with and without RHI exposure. When exploring consensus-based Levels of Diagnostic Certainty, rates of suggestive, possible, and probable CTE were found to be 2.7%, 6.8%, and 5.8%, respectively. No injury or demographic variables significantly predicted the likelihood of meeting all 3 Core Clinical Criteria for TES.Conclusion:In this community based TBI sample, we found high rates of TES clinical features among those with and without RHI, across TBI across injury severity groups. Presence of TES core clinical features was greatest among those with isolated TBI, suggesting that chronic and sometimes progressive sequelae of TBI are similar to those described in TES, but may reflect a distinct pathobiological process from CTE neuropathologic change which is very rarely seen in isolated TBI. Finding
{"title":"Traumatic Encephalopathy Syndrome in the Late Effects of Traumatic Brain Injury (LETBI) study cohort","authors":"Kristen Dams-O'Connor, Enna Selmanovic, Lisa Spielman, Ariel Pruyser, Ashlyn Bulas, Eric Watson, Jesse Mez, Jeanne M Hoffman","doi":"10.1101/2024.07.04.24309955","DOIUrl":"https://doi.org/10.1101/2024.07.04.24309955","url":null,"abstract":"<strong>Importance:</strong>Traumatic encephalopathy syndrome (TES),the suggested clinical manifestation of chronic traumatic encephalopathy(CTE),is believed to result from repetitive head impacts (RHI) and the prevalence of TES and its component symptoms have not been thoroughly investigated in individuals with single TBI.<strong>Objective:</strong>To use prospectively collected data to operationalize TES per consensus research diagnostic criteria and examine the rates of TES in a sample of individuals with isolated TBI, a subset of whom also had RHI exposure, and to determine whether any demographic or injury factors predicted likelihood of meeting TES diagnostic criteria.<strong>Design:</strong>295 participants from the Late Effects of TBI (LETBI) study had complete data for all key variables. The sample was categorized by TBI severity and presence of RHI history leading to 6 groups (those with isolated mild, moderate, and severe TBI, with and without RHI). Chi-squared tests were used to compare the proportion of each group that met each of the core clinical criteria overall TES diagnosis. Binary logistic regression models were used to examine the associations of demographic and injury characteristics on TES diagnosis. Levels of functional dependence and levels of certainty for CTE neuropathology in the sample were characterized and applied with the core clinical features to explore consensus-based provisional levels of certainty of CTE pathology across study groups.<strong>Results:</strong> In addition to history of TBI, 141 (47.7%) participants had RHI exposure meeting the TES criteria exposure threshold. In the full sample, 56.9%, 33.2% and 45.7% of participants met TES core criterion of cognitive impairment, neurobehavioral dysregulation, and progressive course of clinical features, respectively. Overall, 15.2% of this LETBI sample had substantial RHI exposure and met all 3 clinical features, meeting consensus-based TES criteria. When RHI exposure criterion was lifted, 33.5% of the LETBI sample with isolated TBI met all core clinical criteria. No significant differences were found in clinical diagnostic criteria between individuals with and without RHI exposure. When exploring consensus-based Levels of Diagnostic Certainty, rates of suggestive, possible, and probable CTE were found to be 2.7%, 6.8%, and 5.8%, respectively. No injury or demographic variables significantly predicted the likelihood of meeting all 3 Core Clinical Criteria for TES.<strong>Conclusion:</strong>In this community based TBI sample, we found high rates of TES clinical features among those with and without RHI, across TBI across injury severity groups. Presence of TES core clinical features was greatest among those with isolated TBI, suggesting that chronic and sometimes progressive sequelae of TBI are similar to those described in TES, but may reflect a distinct pathobiological process from CTE neuropathologic change which is very rarely seen in isolated TBI. Finding","PeriodicalId":501453,"journal":{"name":"medRxiv - Rehabilitation Medicine and Physical Therapy","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141573047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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