Disability and Rehabilitation最新文献

Purpose: To summarise information about tools available to rate observed performance in activities, tested with populations with upper limb impairment.

Methods and materials: A scoping review was conducted. Articles were included if they reported psychometric properties of tools that could be used with populations with upper limb impairment, had at least one activity item, and item/s involved use of the upper limbs. Information about the tools was extracted, summarised and key findings are presented.

Results: Twenty-seven tools met the inclusion criteria. The results indicated that few tools used client-selected (19%) items or clinician-selected (11%) items. Most tools (70%) used pre-defined items. Fourteen tools (52%) included activity-only items. Eleven tools (41%) had less than half activity items. An in-depth summary of the tools with activity-only items is reported.

Conclusion: Many tools exist for assessing observed performance in activities to examine use of the upper limb. However, there were few tools (N = 6) available that assess observed performance in client-selected activities.

Purpose: While stroke is becoming increasingly prevalent in young people (<65 years), diagnosis, treatment, rehabilitation, and management continue to reflect the needs of older people. This study aimed to characterise and appreciate the healthcare experiences of young stroke survivors, whose needs and trajectories differ from those of older people.

Materials and methods: Qualitative in-depth semi-structured interviews were conducted with 11 stroke survivors aged 18-49 using virtual conferencing software. The data were analysed using interpretative phenomenological analysis.

Results: Four main themes were identified that reflect the experiences and needs of young stroke survivors and are (1) The health system overlooks the experiences and needs of young stroke survivors; (2) Support is fragmented rather than holistic; (3) Feelings of helplessness at a time agency is required; and (4) Positive attitudes despite challenges.

Conclusions: The experiences of young stroke survivors are distinct. Health services that consider the unique trajectories of young stroke survivors will better facilitate rehabilitation and support for this population.

Purpose: Engaging parents in child-focused interventions is considered important for intervention effectiveness but is rarely investigated in behaviour analysis literature.

Methods: This qualitative study conducted semi-structured interviews with 13 clinicians working with parents in child-focused behavioural interventions in Aotearoa New Zealand. Interpretive description was the overarching methodology for the study, with thematic analysis utilised to analyse data. The study was guided by the research question; 'how is parent engagement understood by behavioural clinicians?'

Results: Three themes were developed to explain the process of parent engagement from the perspective of clinicians: (a) establishing parent context and needs, (b), developing connection and relationship, (c) facilitating behaviour change. These findings suggest that parent engagement is heavily relational and occurs over time.

Conclusions: Aligned with parent engagement literature from other allied health fields, this study highlights the relational and dynamic elements of engagement within a child-focused intervention. Behaviour analysts should focus on interpersonal connections with parents at the start of intervention and may benefit from additional training to achieve this.

Purpose: To examine the effects of inspiratory muscle training (IMT) on pulmonary and diaphragmatic function, exercise capacity, balance and quality of life (QOL), in post-stroke individuals.

Methods: A literature search was conducted using MEDLINE, CINAHL, EMBASE, PubMed, PEDro, Web of Science and China Biological Medicine databases. Randomized controlled trials (RCTs) with a PEDro score ≥6 focusing on the effects of IMT were included. The GRADE system was used to determine the certainty of evidence for each outcome.

Results: Nine studies (255 participants) were included. IMT significantly increased forced expiratory volume in one second (FEV₁) (4 studies, 112 participants, mean difference (MD)=0.18 litre, 95% confidence interval (CI): 0.14-0.23); maximal inspiratory pressure (MIP) (8 studies, 226 participants, MD = 6.37 cm H₂O, 95% CI: 1.26-11.49); and diaphragm thickness fraction (DTf) on both sides (MD of affected side vs. unaffected side: 51 vs. 37%). The evidence certainty for diaphragmatic function was moderate. No significant change was observed in forced vital capacity (FVC), balance function, exercise capacity and QOL.

Conclusion: This review reveals moderate evidence certainty in support of IMT improving diaphragmatic function. It appears that a training intensity between 30 and 50% MIP results in a significantly improved MIP.

Purpose: To identify factors that contribute to the enhanced life of people with spinal cord injury (SCI) in Sweden.

Materials and methods: This cross-sectional study combined workshops (n = 38) and survey data (n = 243) from people living with SCI and their relatives, health professionals, and personal care assistants working with people living with SCI. The data were first categorized using Bronfenbrenner's bioecological model, followed by a conventional content analysis.

Results: The factors that contribute to an enhanced life for people living with SCI are similar to those of the general population, including relationships, leisure activities, and occupation within the mesosystem. However, the unique components of the exosystem and macrosystem are specifically associated with people living with SCI. The exosystem, particularly in healthcare, plays a major role for medical reasons but also tends to obtrude and minimize the mesosystem. The macrosystem is essential, as it sets the rules that govern the actors in the other layers, creating prerequisites for meeting the needs of the mesosystem and exosystem.

Conclusions: The needs that contribute to an enhanced life are multifaceted and individualized. Therefore, these systems must be flexible throughout the lifespan of individuals with SCI.

Purpose: This study compares the effect of intensive motor learning approaches on improving the quality of upper extremity skills in children with unilateral cerebral palsy (UCP) by working on vertical surfaces versus horizontal surfaces during rehabilitation sessions.

Materials and methods: Forty UCP children of both sexes were randomized into two equal groups. All participants received 60 min of intensive motor learning approaches three days/week for three successive months. These approaches included constraint-induced movement therapy (CIMT), in which children wore a splint or sling on the unaffected upper limb, as well as hand-arm bimanual intensive training (HABIT) that requires the use of both hands during specific play-based activities. The control group received training on a horizontal surface while the child sat in front of an elbow-height table while the study group (vertical surface training) sat or stood in front of a wall/mirror/board. The task requirements were graded to ensure success.

Results: Statistically significant differences were detected between the mean values of post-treatment of all scorers, with a greater percentage of improvement in favor of the study group.

Conclusions: This study revealed that working on a vertical surface improved upper limb motor skills more significantly than working on a horizontal surface.

Purpose: Rehabilitation can positively affect quality of life, functional status, and physiological status for patients with head and neck or lung cancer. However, barriers and facilitators regarding access, referral, and participation in rehabilitation have not been outlined in the literature either from a healthcare professional or from a structural perspective. Therefore, the objective of this paper was to identify and map barriers and facilitators from structural and healthcare professionals' perspectives in relation to access, referral, and participation in rehabilitation for patients with head and neck or lung cancer.

Materials and methods: Two systematic searches were conducted in five databases mapping peer-reviewed research literature.

Results: In total, 17 studies of 3918 potential sources were included. Seven themes were identified. Four themes concerned access: Understanding Patients' Resources; Collaboration Determining Access; Education, Knowledge, and Evidence Impact Access to Rehabilitation; and Resources Affecting Availability to Rehabilitation Services. Two themes concerned referral: Referral Criteria; and Elements Affecting Referral Pathway. One theme concerned participation: Factors Influencing Participation.

Conclusion: From structural and healthcare professionals' perspectives, barriers and facilitators impact access, referral and participation in rehabilitation. However, the findings on facilitators were limited; only one theme addressed participation and two findings concerned patients with low socioeconomic status.IMPLICATIONS FOR REHABILITATIONHealthcare professionals should be mindful that a diverse array of barriers and facilitators may impact the rehabilitation pathway for patients with head, neck, and lung cancer.Engagement by healthcare professionals and structural initiatives are needed to ensure comprehensive access to information concerning rehabilitation options.Local guidelines should be developed to prescribe methods for informing and guiding patients towards suitable rehabilitation options.It is important that healthcare professionals take the individual patient's resources into account when navigating aspects of access, referral, and participation in rehabilitation.

Purpose: To identify and examine subgroups of people with spinal cord injury (SCI) with different patterns of lived experience, and examine hidden impairments and disability among functionally independent and ambulant people.

Materials and methods: Latent profile analysis of population-based data from the Australian arm of the International Spinal Cord Injury (InSCI) Community survey (n = 1579).

Results: Latent subgroups reflected levels of functional independence and extent of problems with health, activity/participation, environmental barriers, and self-efficacy. Quality of life (QoL), psychological profiles, and activity/participation were often as good or better in participants who reported lower (vs. higher) functional independence alongside comparable burden of health problems and environmental barriers. QoL, mental health, and vitality reflected self-efficacy and problem burdens more closely than functional independence. Ambulant participants reported a substantial burden of underlying, potentially hidden impairments, with QoL and mental health similar to wheelchair users.

Conclusion: Hidden disability among more independent and/or ambulant people with SCI can affect well-being substantially. Early and ongoing access to support, rehabilitation, and SCI specialist services is important irrespective of cause, type, severity of injury, and level of functional independence. Improved access to SCI expertise and equity of care would help to improve early recognition and management of hidden disability.

Trial registration: Not applicable.

Purpose: To investigate the experience of working age adults living with chronic post-stroke pain in the United Kingdom (UK).

Methods: Semi-structured interviews were conducted with eight working age (46-64 years) UK-based stroke survivors who experience chronic post-stroke pain (≥3 months). The interviews were analysed using interpretative phenomenological analysis.

Results: The analysis led to three Group Experiential Themes: "The Solitude of the Pain Experience," "Unsatisfactory Healthcare and the Need for Self-Care" and "The Development of Pain Acceptance." Findings suggest that individuals see their post-stroke pain as an invisible disability, which is overlooked and misunderstood by others. Furthermore, in the absence of a differential post-stroke pain diagnosis, clear, accurate information and alternatives to pharmacological treatments, individuals with post-stroke pain invest their own resources in finding answers and a way to live with the pain.

Conclusions: The findings suggest the need for further education on post-stroke pain for healthcare professionals, the consideration of pain in post-stroke assessments, the need for clear differential pain diagnoses and the provision of accurate information to patients. Research is needed to establish non-pharmacological evidence-based treatment approaches, such as pain management programmes, peer support and psychological interventions.

Purpose: This scoping review was conducted to synthesize existing literature into a map of the common needs of families caring for patients with traumatic brain injury (TBI) at home.

Materials and methods: A systematic search of studies published between January 2012 and December 2022 was conducted across databases. The selected studies reported the needs or unmet needs of patients with TBI and/or their family caregivers (FCs).

Results: A total of 12 publications were identified. The results suggest that the common needs of families caring for patients with TBI at home include: information about TBI as a disease; information about the continuum of TBI healthcare services; information about adaptive technologies; education and skilling of FCs; psychological support and counseling; physical and occupational therapy services; follow-up care and transitional care management; respite care; peer support; financial assistance, advocacy, and legal services; emotional support from the family and community; and assistance with physical patient care and instrumental activities of daily living.

Conclusion: The mapped needs provide insight into supportive interventions required to enhance the health outcomes of patients with TBI and their families during and after rehabilitation. The needs also highlight directions for research and healthcare services for patients with TBI.