Pub Date : 2024-02-22DOI: 10.1101/2024.02.21.24303128
Chantal M Hulshof, Marike van der Leeden, Jaap J van Netten, Maarten Gijssel, Jordi Evers, Sicco A Bus, Mirjam Pijnappels
Background: Peripheral neuropathy is a common complication of diabetes and increases the risk of falls, possibly through gait (quality) impairments in daily life. Characteristics of gait quality have been associated with peripheral neuropathy in a laboratory setting, but little is known about the more relevant association with gait quality in daily life. Research question: What is the association between peripheral neuropathy and gait quality characteristics in daily life in people with diabetes? Methods: Data from two cross-sectional studies were combined in an exploratory analysis, including a total of 98 participants with diabetes (mean age: 68 (SD 7) years, 32 females), of which 68 with peripheral neuropathy. Participants wore a tri-axial accelerometer for seven consecutive days. Walking episodes ≥5 seconds were identified and analysed to determine various gait quality characteristics. Associations were assessed using linear regression analyses, adjusted for walking speed and other potential confounders. Results: Peripheral neuropathy was significantly associated with a lower walking speed (people with neuropathy: 0.81 vs without neuropathy: 0.88 m/s; β (95% confidence interval (CI)): -0.114 (-0.202 to -0.026)), a lower stride frequency (0.81 vs 0.85 strides/s; β (95% CI): -0.030 (-0.057 to -0.003)), lower gait intensity (i.e. lower root mean square) in vertical direction (1.38 vs 1.63 m/s2; β (95% CI): -0.074 (-0.143 to -0.006)), and less gait symmetry (i.e. lower harmonic ratio) in vertical direction (1.82 vs 2.27; β (95% CI): -0.322 (-0.474 to -0.170)). People with peripheral neuropathy had non-significantly poorer gait quality for most of the other 21 gait quality characteristics. Significance: Peripheral neuropathy seems to negatively affect several gait quality characteristics measured in daily life. These results need to be replicated in future studies and may help to develop targeted gait training to improve gait quality and potentially reduce fall risk in people with diabetes and peripheral neuropathy.
背景：周围神经病变是糖尿病的一种常见并发症，可能会通过日常生活中的步态（质量）障碍增加跌倒风险。在实验室环境中，步态质量的特征与周围神经病变有关，但对于日常生活中步态质量的相关性却知之甚少。研究问题糖尿病患者的周围神经病变与日常生活中的步态质量特征之间有何关联？研究方法在一项探索性分析中合并了两项横断面研究的数据，共包括 98 名糖尿病患者（平均年龄：68（SD 7）岁，女性 32 人），其中 68 人患有周围神经病变。参与者连续七天佩戴三轴加速度计。对≥5秒的行走事件进行识别和分析，以确定各种步态质量特征。使用线性回归分析评估相关性，并对步行速度和其他潜在混杂因素进行调整。结果显示周围神经病变与较低的步行速度明显相关（有神经病变者：0.81 对无神经病变者：0.88 m/s；β（95% 置信区间 (CI)）：-0.114（-0.114 对-0.88 m/s）：-0.114（-0.202 至 -0.026）），步频较低（0.81 vs 0.85 步/秒；β（95% 置信区间（CI）：-0.030（-0.057 至 -0.003）），垂直方向的步态强度较低（即均方根较低）（1.38 vs 1.63 m/s2; β (95% CI): -0.074 (-0.143 to -0.006))，垂直方向的步态对称性较差（即谐波比较低）（1.82 vs 2.27; β (95% CI): -0.322 (-0.474 to -0.170)）。在其他 21 项步态质量特征中，周围神经病变患者的步态质量大多较差，但无显著性差异：意义：周围神经病变似乎会对日常生活中测量的几种步态质量特征产生负面影响。这些结果需要在今后的研究中得到证实，并可能有助于开发有针对性的步态训练，以改善步态质量，降低糖尿病合并周围神经病变患者跌倒的风险。
{"title":"The association between peripheral neuropathy and daily-life gait quality characteristics in people with diabetes","authors":"Chantal M Hulshof, Marike van der Leeden, Jaap J van Netten, Maarten Gijssel, Jordi Evers, Sicco A Bus, Mirjam Pijnappels","doi":"10.1101/2024.02.21.24303128","DOIUrl":"https://doi.org/10.1101/2024.02.21.24303128","url":null,"abstract":"Background: Peripheral neuropathy is a common complication of diabetes and increases the risk of falls, possibly through gait (quality) impairments in daily life. Characteristics of gait quality have been associated with peripheral neuropathy in a laboratory setting, but little is known about the more relevant association with gait quality in daily life. Research question: What is the association between peripheral neuropathy and gait quality characteristics in daily life in people with diabetes? Methods: Data from two cross-sectional studies were combined in an exploratory analysis, including a total of 98 participants with diabetes (mean age: 68 (SD 7) years, 32 females), of which 68 with peripheral neuropathy. Participants wore a tri-axial accelerometer for seven consecutive days. Walking episodes ≥5 seconds were identified and analysed to determine various gait quality characteristics. Associations were assessed using linear regression analyses, adjusted for walking speed and other potential confounders. Results: Peripheral neuropathy was significantly associated with a lower walking speed (people with neuropathy: 0.81 vs without neuropathy: 0.88 m/s; β (95% confidence interval (CI)): -0.114 (-0.202 to -0.026)), a lower stride frequency (0.81 vs 0.85 strides/s; β (95% CI): -0.030 (-0.057 to -0.003)), lower gait intensity (i.e. lower root mean square) in vertical direction (1.38 vs 1.63 m/s2; β (95% CI): -0.074 (-0.143 to -0.006)), and less gait symmetry (i.e. lower harmonic ratio) in vertical direction (1.82 vs 2.27; β (95% CI): -0.322 (-0.474 to -0.170)). People with peripheral neuropathy had non-significantly poorer gait quality for most of the other 21 gait quality characteristics.\u0000Significance: Peripheral neuropathy seems to negatively affect several gait quality characteristics measured in daily life. These results need to be replicated in future studies and may help to develop targeted gait training to improve gait quality and potentially reduce fall risk in people with diabetes and peripheral neuropathy.","PeriodicalId":501453,"journal":{"name":"medRxiv - Rehabilitation Medicine and Physical Therapy","volume":"182 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139946819","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 : 2024-02-20DOI: 10.1101/2024.02.17.24302733
Milap S Sandhu, Robert W Motl, William Zev Rymer, Sherri L LaVela
Background: Despite advancements in MS treatment, alleviating existing motor and cognitive deficits remains a challenge. In this study, we evaluated the effect of acute intermittent hypoxia (AIH), a novel therapeutic approach to facilitate functional recovery, in patients with MS. Objective: To test the hypothesis that a single session of AIH enhances spinal motor output and cognitive performance in persons with relapsing remitting MS. Methods: In a randomized, blinded, crossover, placebo-controlled trial, ten individuals with relapsing-remitting MS received AIH (15, 60-second exposures at 9% O2) and sham AIH (21% O2) in a randomized manner, at least one week apart. We assessed changes in isometric ankle strength, lower extremity EMG activity, and cognitive processing speed using the Symbol Digit Modalities Test (SDMT) and California Verbal Learning Test II. Results: Participants showed a significant increase in plantarflexion and dorsiflexion torque at 60 minutes post-AIH (p < .05). Cognitive processing speed (i.e., SDMT scores) had a consistent and significant improvement following AIH (p < .01), but there was no change in auditory/verbal memory. There were no reported adverse events. Conclusion: AIH significantly improved motor and cognitive processing speeds, supporting its utility as a tool for inducing plasticity and complementing MS rehabilitation.
{"title":"Acute Intermittent Hypoxia Induces Motor and Cognitive Plasticity in Persons with Relapsing Remitting Multiple Sclerosis","authors":"Milap S Sandhu, Robert W Motl, William Zev Rymer, Sherri L LaVela","doi":"10.1101/2024.02.17.24302733","DOIUrl":"https://doi.org/10.1101/2024.02.17.24302733","url":null,"abstract":"Background: Despite advancements in MS treatment, alleviating existing motor and cognitive deficits remains a challenge. In this study, we evaluated the effect of acute intermittent hypoxia (AIH), a novel therapeutic approach to facilitate functional recovery, in patients with MS. Objective: To test the hypothesis that a single session of AIH enhances spinal motor output and cognitive performance in persons with relapsing remitting MS.\u0000Methods: In a randomized, blinded, crossover, placebo-controlled trial, ten individuals with relapsing-remitting MS received AIH (15, 60-second exposures at 9% O2) and sham AIH (21% O2) in a randomized manner, at least one week apart. We assessed changes in isometric ankle strength, lower extremity EMG activity, and cognitive processing speed using the Symbol Digit Modalities Test (SDMT) and California Verbal Learning Test II. Results: Participants showed a significant increase in plantarflexion and dorsiflexion torque at 60 minutes post-AIH (p < .05). Cognitive processing speed (i.e., SDMT scores) had a consistent and significant improvement following AIH (p < .01), but there was no change in auditory/verbal memory. There were no reported adverse events. Conclusion: AIH significantly improved motor and cognitive processing speeds, supporting its utility as a tool for inducing plasticity and complementing MS rehabilitation.","PeriodicalId":501453,"journal":{"name":"medRxiv - Rehabilitation Medicine and Physical Therapy","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139910177","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}
Background Neuroinflammatory responses reflecting disease progression are believed to be closely associated with the severity of prognosis in post-stroke. Purpose This study developed a combined predicted model of inflammation-derived biomarkers and clinical-based indicators using machine learning algorithms for differentiation of the functional outcome in patients with subacute ischemic stroke. Methods Clinical blood samples and patient data from individuals with subacute ischemic stroke were collected at admission. Based on activities of daily living assessments followed by a 3-month recovery, patients were categorized into two groups: those with little effective recovery (LE) and those with obvious effective recovery (OE). Serum samples underwent proteomic testing for initial candidates. Subsequently, multidimensional validation of candidates in models of ischemia-reperfusion at protein and mRNA levels was performed. T-test, Receiver Operating Characteristic (ROC), and LASSO analysis in an additional cohort were performed to confirm the clinical variables and candidate biomarkers in the discriminatory sensitivity and specificity between the LE and OE groups. Finally, models were developed based on candidates in the training dataset and predicted stroke recovery outcomes in another new dataset using ten standard two-categorical variable algorithms in machine learning. Results We identified higher tissue inhibitor metalloproteinase-1 (TIMP1) and LGALS3 levels were positively correlated with the severity of prognosis after ischemic stroke rehabilitation. TIMP1 (AUC=0.904, 0.873) and LGALS3 (AUC=0.995, 0.794) were confirmed to address superior sensitivity and specificity in distinguishing ischemic stroke from healthy control and LE group from OE group. The TIMP1 and Lgals3 expression exhibited an evident increase in microglia following ischemia-reperfusion. In addition, inflammation-derived biomarkers (TIMP1, LGALS3) coupled with clinical-based indicators (HGB, LDL-c, UA) were built in a combined model with random forest to differentiate OE from LE in 3-month follow-up with high accuracy (AUC = 0.8). Conclusion Our findings provided evidence supporting the critical prognostic potential and risk prediction of inflammation-derived biomarkers after ischemic stroke rehabilitation in complementary to current clinical-based parameters.
{"title":"An inflammation-derived and clinical-based model for ischemic stroke recovery","authors":"Yulong Wang, Jiao Luo, You Cai, Peng Xiao, Changchun Cao, Meiling Huang, Xiaohua Zhang, Jie Guo, Yongyang Huo, Qiaoyan Tang, Liuyang Zhao, Jiabang Liu, Yaqi Ma, Mingchao Zhou","doi":"10.1101/2024.02.18.24303013","DOIUrl":"https://doi.org/10.1101/2024.02.18.24303013","url":null,"abstract":"Background Neuroinflammatory responses reflecting disease progression are believed to be closely associated with the severity of prognosis in post-stroke. Purpose\u0000This study developed a combined predicted model of inflammation-derived biomarkers and clinical-based indicators using machine learning algorithms for differentiation of the functional outcome in patients with subacute ischemic stroke.\u0000Methods\u0000Clinical blood samples and patient data from individuals with subacute ischemic stroke were collected at admission. Based on activities of daily living assessments followed by a 3-month recovery, patients were categorized into two groups: those with little effective recovery (LE) and those with obvious effective recovery (OE). Serum samples underwent proteomic testing for initial candidates. Subsequently, multidimensional validation of candidates in models of ischemia-reperfusion at protein and mRNA levels was performed. T-test, Receiver Operating Characteristic (ROC), and LASSO analysis in an additional cohort were performed to confirm the clinical variables and candidate biomarkers in the discriminatory sensitivity and specificity between the LE and OE groups. Finally, models were developed based on candidates in the training dataset and predicted stroke recovery outcomes in another new dataset using ten standard two-categorical variable algorithms in machine learning.\u0000Results\u0000We identified higher tissue inhibitor metalloproteinase-1 (TIMP1) and LGALS3 levels were positively correlated with the severity of prognosis after ischemic stroke rehabilitation. TIMP1 (AUC=0.904, 0.873) and LGALS3 (AUC=0.995, 0.794) were confirmed to address superior sensitivity and specificity in distinguishing ischemic stroke from healthy control and LE group from OE group. The TIMP1 and Lgals3 expression exhibited an evident increase in microglia following ischemia-reperfusion. In addition, inflammation-derived biomarkers (TIMP1, LGALS3) coupled with clinical-based indicators (HGB, LDL-c, UA) were built in a combined model with random forest to differentiate OE from LE in 3-month follow-up with high accuracy (AUC = 0.8).\u0000Conclusion\u0000Our findings provided evidence supporting the critical prognostic potential and risk prediction of inflammation-derived biomarkers after ischemic stroke rehabilitation in complementary to current clinical-based parameters.","PeriodicalId":501453,"journal":{"name":"medRxiv - Rehabilitation Medicine and Physical Therapy","volume":"181 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139910541","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 : 2024-02-15DOI: 10.1101/2024.02.11.24302642
Andrea Bolandrini, Francesca Forcina, Marco Segat, Martina Zaninetti, Matteo Fascia, Andrea Segat, Federico Minetti, Michele Margelli
Abstract: Background: Costochondritis is a frequent diagnosis related to chest pain but the etiology, treatment, and evolution of the disease are poorly documented. Clinical examination lacks specificity and most treatment recommendations are conservative in nature and have been traditionally accepted, perhaps because of the self- limited nature of the condition. However, costochondritis that does not self-resolve is referred to as atypical costochondritis and is associated with high medical expenses and psychological burden on the patient. This scoping review will aim to provide a clear overview about costochondritis, including definitions and terms, signs and symptoms, causes, diagnosis, treatment and prognosis. This work will also aim to propose shareable terms to describe this condition. Inclusion Criteria: Every study describing a condition of non-cardiac musculoskeletal chest pain due to inflammation of the costochondral junctions of ribs or costosternal joints where the areas of tenderness are not generally accompanied by heat, erythema or localized swelling (e.g.,Tietze syndrome). This scoping review will consider studies conducted in any context. Articles in English or Italian will be considered. Methods: The proposed scoping review will be conducted in accordance with the Joanna Briggs Institute methodology (JBI) for scoping reviews. The search will be carried out on 5 databases: MEDLINE, Embase, Cochrane Library, CENTRAL and CINAHL. Addictionally, research protocols will be searched on PROSPERO and ClinicalTrials.gov. Further research of grey literature will be carried out through OpenGrey and Google Scholar. Selection and data extraction will be conducted by two blind independent researchers and inconsistencies will be resolved by a third reviewer. The results will be presented in a schematic, tabular and descriptive format that will line up with the objectives and scope of the review. Conclusions: This scoping review will aim to provide a comprehensive overview of the topic. The results will add meaningful information for clinicians. Furthermore, any knowledge gaps of the topic will be identified.
{"title":"Costochondritis and thoracic-chest related pain: a scoping review","authors":"Andrea Bolandrini, Francesca Forcina, Marco Segat, Martina Zaninetti, Matteo Fascia, Andrea Segat, Federico Minetti, Michele Margelli","doi":"10.1101/2024.02.11.24302642","DOIUrl":"https://doi.org/10.1101/2024.02.11.24302642","url":null,"abstract":"Abstract:\u0000<br/>Background: Costochondritis is a frequent diagnosis related to chest pain but the etiology, treatment, and evolution of the disease are poorly documented. Clinical examination lacks specificity and most treatment recommendations are conservative in nature and have been traditionally accepted, perhaps because of the self- limited nature of the condition. However, costochondritis that does not self-resolve is referred to as atypical costochondritis and is associated with high medical expenses and psychological burden on the patient. This scoping review will aim to provide a clear overview about costochondritis, including definitions and terms, signs and symptoms, causes, diagnosis, treatment and prognosis. This work will also aim to propose shareable terms to describe this condition. Inclusion Criteria: Every study describing a condition of non-cardiac musculoskeletal chest pain due to inflammation of the costochondral junctions of ribs or costosternal joints where the areas of tenderness are not generally accompanied by heat, erythema or localized swelling (e.g.,Tietze syndrome). This scoping review will consider studies conducted in any context. Articles in English or Italian will be considered. Methods: The proposed scoping review will be conducted in accordance with the Joanna Briggs Institute methodology (JBI) for scoping reviews. The search will be carried out on 5 databases: MEDLINE, Embase, Cochrane Library, CENTRAL and CINAHL. Addictionally, research protocols will be searched on PROSPERO and ClinicalTrials.gov. Further research of grey literature will be carried out through OpenGrey and Google Scholar. Selection and data extraction will be conducted by two blind independent researchers and inconsistencies will be resolved by a third reviewer. The results will be presented in a schematic, tabular and descriptive format that will line up with the objectives and scope of the review. Conclusions: This scoping review will aim to provide a comprehensive overview of the topic. The results will add meaningful information for clinicians. Furthermore, any knowledge gaps of the topic will be identified.","PeriodicalId":501453,"journal":{"name":"medRxiv - Rehabilitation Medicine and Physical Therapy","volume":"169 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139760120","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 : 2024-02-13DOI: 10.1101/2024.02.11.24302069
Andrew Huntley, Alison Schinkel-Ivy, Avril Mansfield
Trial design: Pilot study embedded within an assessor-blinded parallel randomized controlled trial. Objective: To determine the feasibility of using unexpected and novel balance perturbations to assess the efficacy of reactive balance training. Methods: Participants: Community-dwelling adults with chronic stroke who could walk independently without a gait aid for at least 10 m. Interventions: Reactive balance training, using manual and internal perturbations, or 'traditional' balance training (control group). Training took place for one hour per session, twice per week for six weeks. Outcome: Proportion of unexpected slips triggered as intended; state anxiety, perceptions of situations, and participants' subjective responses to the unexpected slip perturbation; and spatiotemporal and kinematic features of unperturbed and perturbed walking (step length, width, and time, and mechanical stability) pre- and post-training. Randomisation: Blocked stratified randomization. Blinding: Assessors were blinded to group allocation. Results: Numbers randomised: 28 participants were randomized (15 to reactive balance training, 13 to control). Of these, nine reactive balance training group participants and seven control participants were eligible and consented to additional data collection for the pilot study. Numbers analysed: 12 participants (six per group) completed the post-training unexpected slip data collection and were included in analysis of the pilot objective. Outcome: All unexpected slips triggered as intended. Overall, participants did not report increased state anxiety or any concerns about the unexpected slip. Analysis of spatiotemporal and kinematic data suggested better stability following the unexpected slip for reactive balance trained participants than control participants; however, there were also between-group differences in spatiotemporal and kinematic features of walking pre- and post-training. Conclusions: Unexpected slips are feasible in research. However, their value as outcomes in clinical trials may depend on ensuring the groups are balanced on prognostic factors. Trial registration: ISRCTN05434601 Funding: Canadian Institutes of Health Research.
{"title":"The effect of reactive balance training on responses to novel unexpected balance perturbations: a feasibility study","authors":"Andrew Huntley, Alison Schinkel-Ivy, Avril Mansfield","doi":"10.1101/2024.02.11.24302069","DOIUrl":"https://doi.org/10.1101/2024.02.11.24302069","url":null,"abstract":"Trial design: Pilot study embedded within an assessor-blinded parallel randomized controlled trial.\u0000Objective: To determine the feasibility of using unexpected and novel balance perturbations to assess the efficacy of reactive balance training.\u0000Methods: Participants: Community-dwelling adults with chronic stroke who could walk independently without a gait aid for at least 10 m. Interventions: Reactive balance training, using manual and internal perturbations, or 'traditional' balance training (control group). Training took place for one hour per session, twice per week for six weeks. Outcome: Proportion of unexpected slips triggered as intended; state anxiety, perceptions of situations, and participants' subjective responses to the unexpected slip perturbation; and spatiotemporal and kinematic features of unperturbed and perturbed walking (step length, width, and time, and mechanical stability) pre- and post-training. Randomisation: Blocked stratified randomization. Blinding: Assessors were blinded to group allocation. Results: Numbers randomised: 28 participants were randomized (15 to reactive balance training, 13 to control). Of these, nine reactive balance training group participants and seven control participants were eligible and consented to additional data collection for the pilot study. Numbers analysed: 12 participants (six per group) completed the post-training unexpected slip data collection and were included in analysis of the pilot objective. Outcome: All unexpected slips triggered as intended. Overall, participants did not report increased state anxiety or any concerns about the unexpected slip. Analysis of spatiotemporal and kinematic data suggested better stability following the unexpected slip for reactive balance trained participants than control participants; however, there were also between-group differences in spatiotemporal and kinematic features of walking pre- and post-training. Conclusions: Unexpected slips are feasible in research. However, their value as outcomes in clinical trials may depend on ensuring the groups are balanced on prognostic factors.\u0000Trial registration: ISRCTN05434601\u0000Funding: Canadian Institutes of Health Research.","PeriodicalId":501453,"journal":{"name":"medRxiv - Rehabilitation Medicine and Physical Therapy","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139759978","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 : 2024-02-12DOI: 10.1101/2024.02.09.24302483
Maria Swennergren Hansen, Morten Tange Kristensen, Camilla Kampp Zilmer, Anja L Berger, Jeanette Wassar Kirk, Kira Marie Skibdal, Thomas Kallemose, Thomas Bandholm, Mette Merete Pedersen
Objectives: The evidence supports early and intensive mobilization and physical activity for hospitalized patients following a hip fracture. Since bedrest and inactivity during acute care are potentially fatal, we need updated knowledge of levels of physical activity in a diverse clinical population. Therefore, the objective was to determine levels of physical activity among a broad representation of patients hospitalized following hip fracture, and secondly to explore the association with 30-day post-discharge readmission, and mortality. Design: Prospective cohort study Setting: Data were collected at two university hospitals in the Capital Region of Denmark from March to June 2023. Participants: Patients hospitalized following hip fracture. Main outcome measures: 24-hr upright time (time standing and walking) was measured from inclusion (post-operative day (POD) 1-3) to discharge using a thigh-worn accelerometer. Readmission and mortality were verified by electronic patient records. Results: 101 patients (62 women) with a mean (SD) age of 79.9 (8.4) years were included. The median (IQR) 24-hr upright time on POD2-6 ranged from 15 (6.9:31.0) to a maximum of 34 (16:67) mins. Patients with cognitive impairment had less upright time than patients without. Post-surgery length of stay was a median of 7 (5:8) days. 25% of the patients were readmitted or had emergency ward referrals and 3% died within 30 days of discharge (no clear association with upright time). Conclusions: Physical activity seems extremely low among a broad representation of patients within the first week following a hip fracture but was not found to influence readmissions. Considering the strong evidence supporting physical activity during acute hospitalization, the low activity level in these patients calls for action. Clinicaltrials.gov-identifier: NCT05756517
{"title":"Very low levels of physical activity among a broad group of patients hospitalized following hip fracture: A prospective cohort study (the HIP-ME-UP cohort study)","authors":"Maria Swennergren Hansen, Morten Tange Kristensen, Camilla Kampp Zilmer, Anja L Berger, Jeanette Wassar Kirk, Kira Marie Skibdal, Thomas Kallemose, Thomas Bandholm, Mette Merete Pedersen","doi":"10.1101/2024.02.09.24302483","DOIUrl":"https://doi.org/10.1101/2024.02.09.24302483","url":null,"abstract":"Objectives: The evidence supports early and intensive mobilization and physical activity for hospitalized patients following a hip fracture. Since bedrest and inactivity during acute care are potentially fatal, we need updated knowledge of levels of physical activity in a diverse clinical population. Therefore, the objective was to determine levels of physical activity among a broad representation of patients hospitalized following hip fracture, and secondly to explore the association with 30-day post-discharge readmission, and mortality. Design: Prospective cohort study Setting: Data were collected at two university hospitals in the Capital Region of Denmark from March to June 2023. Participants: Patients hospitalized following hip fracture. Main outcome measures: 24-hr upright time (time standing and walking) was measured from inclusion (post-operative day (POD) 1-3) to discharge using a thigh-worn accelerometer. Readmission and mortality were verified by electronic patient records. Results: 101 patients (62 women) with a mean (SD) age of 79.9 (8.4) years were included. The median (IQR) 24-hr upright time on POD2-6 ranged from 15 (6.9:31.0) to a maximum of 34 (16:67) mins. Patients with cognitive impairment had less upright time than patients without. Post-surgery length of stay was a median of 7 (5:8) days. 25% of the patients were readmitted or had emergency ward referrals and 3% died within 30 days of discharge (no clear association with upright time). Conclusions: Physical activity seems extremely low among a broad representation of patients within the first week following a hip fracture but was not found to influence readmissions. Considering the strong evidence supporting physical activity during acute hospitalization, the low activity level in these patients calls for action. Clinicaltrials.gov-identifier: NCT05756517","PeriodicalId":501453,"journal":{"name":"medRxiv - Rehabilitation Medicine and Physical Therapy","volume":"94 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139760114","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 : 2024-02-11DOI: 10.1101/2024.02.09.24302501
Daniel Biggs, Laura Blackburn, Cameron Black, Sivaramkumar Shanmugam
Background: Given the escalating challenges for UK-based physiotherapists in workload pressures, budget constraints, staff shortages and patient wait times, the profession (of 65,000 registered physiotherapists) requires immediate care and review of therapist health. This pioneering study aims to examine perfectionism, moral injury, and burnout among UK-based physiotherapists across the NHS, private practice, sports, and academia. Method: This cross-sectional study utilised an online survey and implementation of Structure Equation Modelling (SEM) to assess the interplay of Perfectionism (Multidimension Perfectionism Scale-Short Form), Moral Injury (Moral Injury Symptoms Scale-Healthcare Professionals) and Burnout (Shirom-Melamed Burnout Questionnaire). Our sample size calculation shows representation of the UK physiotherapy profession via utilisation of 95% confidence interval with a 5% margin of error. Findings: Our analysis conducted on (n=402) UK-based physiotherapists reveals significant burnout levels – 96% are categorised as moderate to high. Furthermore, associations and SEM of Perfectionism and Moral Injury collectively account for a substantial proportion of burnout variability (r2.62), highlighting their sequential impact on burnout manifestation. Interpretation: With such high levels of burnout, urgent intervention is paramount. Elevated burnout presents challenges for the physiotherapy profession as staff retention, accurate and effective patient care, and overall health are severely impacted due to burnout. Recognising and addressing perfectionism and moral injury becomes pivotal to mitigate its impact on individual and collective health.
背景：鉴于英国物理治疗师在工作量压力、预算限制、人员短缺和病人等待时间等方面面临的挑战不断升级，该行业（65,000 名注册物理治疗师）需要立即关注和审查治疗师的健康状况。这项开创性的研究旨在考察英国国家医疗服务系统、私人诊所、体育界和学术界物理治疗师的完美主义、道德伤害和职业倦怠。研究方法：这项横断面研究利用在线调查和结构方程模型（SEM）来评估完美主义（多维完美主义量表-简表）、道德伤害（道德伤害症状量表-医疗保健专业人员）和职业倦怠（Shirom-Melamed 职业倦怠问卷）之间的相互作用。我们的样本量计算采用了 95% 的置信区间和 5% 的误差范围，显示了英国物理治疗行业的代表性。研究结果我们对英国物理治疗师（n=402）进行的分析表明，他们的职业倦怠程度很高--96%的人被归类为中度至高度职业倦怠。此外，完美主义和道德伤害的关联和 SEM 在倦怠变异中占了很大比例（r2.62），突出了它们对倦怠表现的连续影响。解释：面对如此高水平的职业倦怠，紧急干预至关重要。职业倦怠的升高给物理治疗行业带来了挑战，因为职业倦怠会严重影响员工的留任、准确有效的患者护理和整体健康。认识并解决完美主义和道德伤害问题对于减轻其对个人和集体健康的影响至关重要。
{"title":"Physiotherapy Under Pressure: A Cross-Sectional Study on The Interplay Between Perfectionism, Moral Injury, and Burnout","authors":"Daniel Biggs, Laura Blackburn, Cameron Black, Sivaramkumar Shanmugam","doi":"10.1101/2024.02.09.24302501","DOIUrl":"https://doi.org/10.1101/2024.02.09.24302501","url":null,"abstract":"Background: Given the escalating challenges for UK-based physiotherapists in workload pressures, budget constraints, staff shortages and patient wait times, the profession (of 65,000 registered physiotherapists) requires immediate care and review of therapist health. This pioneering study aims to examine perfectionism, moral injury, and burnout among UK-based physiotherapists across the NHS, private practice, sports, and academia. Method: This cross-sectional study utilised an online survey and implementation of Structure Equation Modelling (SEM) to assess the interplay of Perfectionism (Multidimension Perfectionism Scale-Short Form), Moral Injury (Moral Injury Symptoms Scale-Healthcare Professionals) and Burnout (Shirom-Melamed Burnout Questionnaire). Our sample size calculation shows representation of the UK physiotherapy profession via utilisation of 95% confidence interval with a 5% margin of error. Findings: Our analysis conducted on (n=402) UK-based physiotherapists reveals significant burnout levels – 96% are categorised as moderate to high. Furthermore, associations and SEM of Perfectionism and Moral Injury collectively account for a substantial proportion of burnout variability (r2.62), highlighting their sequential impact on burnout manifestation. Interpretation: With such high levels of burnout, urgent intervention is paramount. Elevated burnout presents challenges for the physiotherapy profession as staff retention, accurate and effective patient care, and overall health are severely impacted due to burnout. Recognising and addressing perfectionism and moral injury becomes pivotal to mitigate its impact on individual and collective health.","PeriodicalId":501453,"journal":{"name":"medRxiv - Rehabilitation Medicine and Physical Therapy","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139759979","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 : 2024-02-09DOI: 10.1101/2024.02.07.24302477
Dongwon Kim, Sung-Hwa Ko, Junhee Han, Young-Taek Kim, Yun-Hee Kim, Won Hyuk Chang, Yong-Il Shin
Objective: The flexion synergy and extension synergy are a representative consequence of a stroke and appear in the upper extremity and lower extremity. Since the ipsilesional corticospinal tract (CST) is the most influential neural pathway for both extremities in motor execution, damage by a stroke to this tract could lead to similar motor pathological features (e.g., abnormal synergies) in both extremities. However less attention has been paid to the inter-limb correlations in the flexion synergy and extension synergy across different recovery phases of a stroke. Methods: In this study, we used results of the Fugl-Meyer assessment (FMA) to characterize those correlations in a total of 512 participants with hemiparesis post stroke from the acute phase to 1 year. The FMA provides indirect indicators of the degrees of the flexion synergy and extension synergy post stroke. Results: We found that generally, strong inter-limb correlations (r>0.65 with all p-values<0.0001) between the flexion synergy and extension synergy appeared in the acute-to-subacute phase (<90 days). But correlations of lower-extremity extension synergy with upper-extremity flexion synergy and extension synergy decreased (down to r=0.38) around 360 days after stroke (p<0.05). Interpretation: These results suggest that the preferential use of alternative neural pathways after damage by a stroke to the CST enhances inter-limb correlations between the flexion synergy and extension, however a recovery of the CST or/and the functional fragmentation (remodeling) of the alternative neural substrates in the chronic phase contribute to diversity in neural pathways in motor execution, eventually leading to reduced inter-limb correlations.
{"title":"Interactions in abnormal synergies between the upper and lower extremities in various phases of stroke: A cohort study","authors":"Dongwon Kim, Sung-Hwa Ko, Junhee Han, Young-Taek Kim, Yun-Hee Kim, Won Hyuk Chang, Yong-Il Shin","doi":"10.1101/2024.02.07.24302477","DOIUrl":"https://doi.org/10.1101/2024.02.07.24302477","url":null,"abstract":"Objective: The flexion synergy and extension synergy are a representative consequence of a stroke and appear in the upper extremity and lower extremity. Since the ipsilesional corticospinal tract (CST) is the most influential neural pathway for both extremities in motor execution, damage by a stroke to this tract could lead to similar motor pathological features (e.g., abnormal synergies) in both extremities. However less attention has been paid to the inter-limb correlations in the flexion synergy and extension synergy across different recovery phases of a stroke. Methods: In this study, we used results of the Fugl-Meyer assessment (FMA) to characterize those correlations in a total of 512 participants with hemiparesis post stroke from the acute phase to 1 year. The FMA provides indirect indicators of the degrees of the flexion synergy and extension synergy post stroke. Results: We found that generally, strong inter-limb correlations (r>0.65 with all p-values<0.0001) between the flexion synergy and extension synergy appeared in the acute-to-subacute phase (<90 days). But correlations of lower-extremity extension synergy with upper-extremity flexion synergy and extension synergy decreased (down to r=0.38) around 360 days after stroke (p<0.05). Interpretation: These results suggest that the preferential use of alternative neural pathways after damage by a stroke to the CST enhances inter-limb correlations between the flexion synergy and extension, however a recovery of the CST or/and the functional fragmentation (remodeling) of the alternative neural substrates in the chronic phase contribute to diversity in neural pathways in motor execution, eventually leading to reduced inter-limb correlations.","PeriodicalId":501453,"journal":{"name":"medRxiv - Rehabilitation Medicine and Physical Therapy","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139759915","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 : 2024-02-08DOI: 10.1101/2024.02.07.24302467
Ashwini Sansare, Hendrik Reimann, Barry Bodt, Maelyn Arcodia, Khushboo Verma, John Jeka, Samuel Lee
Aim: To investigate the relationship between somatosensory deficits, specifically ankle and hip joint position sense, two-point discrimination, and vibration on the (1) responses to visual perturbations during walking and (2) response improvements to visual perturbations while receiving a sensory-centric treatment, i.e., stochastic resonance (SR) stimulation, in individuals with and without cerebral palsy (CP). Methods: Twenty-eight individuals (14 CP, 14 age-and sex-matched controls) walked in a virtual reality cave while receiving visual perturbations. We applied SR to the ankle and hip joints. Data analysis consisted of bivariate correlations, and multiple regression analysis (MRA) using all four sensory tests as predictors with the responses to visual perturbation and the improvements in the responses when SR is applied as outcomes. Results: We found significant and strong correlations between performance on sensory tests and the responses to visual perturbations, and improvements in the responses with SR. Only one predictor could be entered into the MRA, indicating that performance on any of the sensory tests could predict the responses to visual perturbation and the improvements with SR. Interpretation: Individuals with sensory deficits are more responsive to sensory-centric interventions. This study is an initial step in identifying potential responders to sensory therapies in individuals with CP.
目的：研究躯体感觉缺陷（尤其是踝关节和髋关节位置感、两点辨别力和振动）与以下两方面的关系：(1) 在行走过程中对视觉扰动的反应；(2) 在接受以感觉为中心的治疗（即随机共振（SR）刺激）时，脑瘫（CP）患者和非脑瘫（CP）患者对视觉扰动的反应改善情况。研究方法28 名患者（14 名 CP，14 名年龄和性别匹配的对照组）在虚拟现实洞穴中行走，同时接受视觉干扰。我们对踝关节和髋关节施加了 SR。数据分析包括双变量相关性和多元回归分析（MRA），将所有四项感觉测试作为预测因子，将视觉扰动的反应和应用 SR 时反应的改善作为结果。结果：我们发现，感官测试成绩与视觉扰动反应之间存在明显且紧密的相关性，而采用 SR 后，视觉扰动反应有所改善。只有一个预测因子可以被输入 MRA，这表明任何一项感官测试的成绩都可以预测视觉扰动的反应和 SR 的改善情况：解释：有感官缺陷的人对以感官为中心的干预措施反应更强烈。这项研究是确定CP患者对感官疗法的潜在反应者的第一步。
{"title":"Reliance on vision for walking balance is related to somatosensory deficits in individuals with cerebral palsy","authors":"Ashwini Sansare, Hendrik Reimann, Barry Bodt, Maelyn Arcodia, Khushboo Verma, John Jeka, Samuel Lee","doi":"10.1101/2024.02.07.24302467","DOIUrl":"https://doi.org/10.1101/2024.02.07.24302467","url":null,"abstract":"Aim: To investigate the relationship between somatosensory deficits, specifically ankle and hip joint position sense, two-point discrimination, and vibration on the (1) responses to visual perturbations during walking and (2) response improvements to visual perturbations while receiving a sensory-centric treatment, i.e., stochastic resonance (SR) stimulation, in individuals with and without cerebral palsy (CP). Methods: Twenty-eight individuals (14 CP, 14 age-and sex-matched controls) walked in a virtual reality cave while receiving visual perturbations. We applied SR to the ankle and hip joints. Data analysis consisted of bivariate correlations, and multiple regression analysis (MRA) using all four sensory tests as predictors with the responses to visual perturbation and the improvements in the responses when SR is applied as outcomes. Results: We found significant and strong correlations between performance on sensory tests and the responses to visual perturbations, and improvements in the responses with SR. Only one predictor could be entered into the MRA, indicating that performance on any of the sensory tests could predict the responses to visual perturbation and the improvements with SR.\u0000Interpretation: Individuals with sensory deficits are more responsive to sensory-centric interventions. This study is an initial step in identifying potential responders to sensory therapies in individuals with CP.","PeriodicalId":501453,"journal":{"name":"medRxiv - Rehabilitation Medicine and Physical Therapy","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139760415","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 : 2024-02-06DOI: 10.1101/2024.02.05.24302365
Becky Lammers, Myra J Sydnor, Sarah Cust, Ji Hyun Kim, Gayane Yenokyan, Argye E Hillis, Rajani Sebastian
In this randomized, double-blind, sham-controlled trial of Cerebellar Stimulation for Aphasia Rehabilitation (CeSAR), we will determine the effectiveness of cathodal tDCS (transcranial direct current stimulation) to the right cerebellum for the treatment of chronic aphasia (>6 months post stroke). We will test the hypothesis that cerebellar tDCS in combination with an evidenced-based anomia treatment (semantic feature analysis, SFA) will be associated with greater improvement in naming untrained pictures (as measured by the change in Philadelphia Picture Naming Test), 1-week post treatment, compared to sham plus SFA. We will also evaluate the effects of cerebellar tDCS on naming trained items as well as the effects on functional communication, content, efficiency, and word-retrieval of picture description, and quality of life. Finally, we will identify imaging and linguistic biomarkers to determine the characteristics of stroke patients that benefit from cerebellar tDCS and SFA treatment. We expect to enroll 60 participants over five years. Participants will receive 15, 25-minute sessions of cerebellar tDCS (3-5 sessions per week) or sham tDCS combined with 1 hour of SFA treatment. Participants will be evaluated prior to the start of treatment, one-week post-treatment, 1-, 3-, and 6-months post treatment on primary and secondary outcome variables. The long-term aim of this study is to provide the basis for a Phase III randomized controlled trial of cerebellar tDCS vs sham with concurrent language therapy for treatment of chronic aphasia.
{"title":"Protocol for Cerebellar Stimulation for Aphasia Rehabilitation (CeSAR): A randomized, double-blind, sham-controlled trial","authors":"Becky Lammers, Myra J Sydnor, Sarah Cust, Ji Hyun Kim, Gayane Yenokyan, Argye E Hillis, Rajani Sebastian","doi":"10.1101/2024.02.05.24302365","DOIUrl":"https://doi.org/10.1101/2024.02.05.24302365","url":null,"abstract":"In this randomized, double-blind, sham-controlled trial of Cerebellar Stimulation for Aphasia Rehabilitation (CeSAR), we will determine the effectiveness of cathodal tDCS (transcranial direct current stimulation) to the right cerebellum for the treatment of chronic aphasia (>6 months post stroke). We will test the hypothesis that cerebellar tDCS in combination with an evidenced-based anomia treatment (semantic feature analysis, SFA) will be associated with greater improvement in naming untrained pictures (as measured by the change in Philadelphia Picture Naming Test), 1-week post treatment, compared to sham plus SFA. We will also evaluate the effects of cerebellar tDCS on naming trained items as well as the effects on functional communication, content, efficiency, and word-retrieval of picture description, and quality of life. Finally, we will identify imaging and linguistic biomarkers to determine the characteristics of stroke patients that benefit from cerebellar tDCS and SFA treatment. We expect to enroll 60 participants over five years. Participants will receive 15, 25-minute sessions of cerebellar tDCS (3-5 sessions per week) or sham tDCS combined with 1 hour of SFA treatment. Participants will be evaluated prior to the start of treatment, one-week post-treatment, 1-, 3-, and 6-months post treatment on primary and secondary outcome variables. The long-term aim of this study is to provide the basis for a Phase III randomized controlled trial of cerebellar tDCS vs sham with concurrent language therapy for treatment of chronic aphasia.","PeriodicalId":501453,"journal":{"name":"medRxiv - Rehabilitation Medicine and Physical Therapy","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139760113","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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