Disability and Rehabilitation最新文献

Purpose: This qualitative meta-synthesis aimed to identify facilitators and barriers to the transition of care from hospital to home in patients with traumatic brain injury (TBI).

Methods: Four electronic databases were systematically searched for qualitative research published from inception to January 2025 that explored the experiences, barriers, and facilitators of transitioning patients with traumatic brain injury from healthcare facilities to home. Papers that met the inclusion criteria were appraised using the Critical Appraisal Skills Programme tool, and a thematic synthesis was conducted according to the guidelines of Thomas and Harden (2008).

Results: Of the 769 papers retrieved, 12 met the inclusion and quality criteria. The synthesis identified six themes (1): personal capacity (2), family support (3), community support (4), personal barriers (5), unsupportive healthcare system, and (6) community-related barriers.

Conclusions: This study outlines the key components of effective transitional care, emphasizing that robust family support, access to community-based resources, and strengthening individual capacities are crucial in ensuring a successful transition. Conversely, barriers such as psychological and physical impairments, insufficient education for patients and caregivers, and the absence of structured follow-up programs impede this process. These findings provide a foundation for developing targeted interventions to enhance continuity of care and optimize rehabilitation outcomes.

PROSPERO registration ID: CRD420251084100.

Purpose: Carers of people with aphasia face unique challenges, experiencing a higher burden of care and more negative outcomes compared to carers of stroke survivors without aphasia. A screening tool was co-designed to address unmet needs related to caring for young stroke survivors and the carers' own health and wellbeing. However, it is not known whether this tool is suitable for carers of people with post-stroke aphasia across all age groups. The aim of this study was to evaluate the tool's suitability and, if required, adapt it for this population.

Materials and methods: A mixed-methods design was used with ten purposefully recruited carers of people with post-stroke aphasia. Participants completed a 5-point Likert scale rating their satisfaction with how well each section of the tool addressed their needs, followed by structured interviews to explore feedback and identify adaptations.

Results: Participants were generally satisfied with the tool (mean rating: 4.3/5). Structured interviews identified 17 new items, including communication strategies and carer burnout.

Conclusion: The adapted tool aims to identify individual needs of carers for people with aphasia across information provision, support or training within healthcare and the community.

Purpose: To develop an updated Measure of Processes of Care assessing parent/caregiver perceptions of the family-centredness of service providers' behaviour.

Method: Researchers and parent partners conducted a two-phase project involving (i) tool development, and (ii) field testing to determine psychometric properties. Sixty-five parents of children with disabilities participated in focus groups to discuss their wants and hopes for service delivery; six parents reviewed the measure for comprehensibility and clarity; and 10 parents and 10 service providers participated in a modified Delphi procedure to establish consensus about item wording. In the field testing phase, 58 parents were involved in the assessment of test-retest reliability, and 273 parents completed construct validity measures. MPOC 2.0 scales were determined through factor analysis. Internal consistency and construct validity hypotheses were examined.

Results: The resulting scales (Supportive and Collaborative Communication, Availability of Care, Family Well-being, and Coordinated Care) had high internal consistencies, good to excellent test-retest reliabilities, and moderate to strong correlations with construct validation measures.

Conclusions: In comparison to the original 30-year-old MPOC-20, the new measure highlights the importance of communication as a relational process involving reciprocal transactions between parents and service providers. It also highlights family well-being, service availability, and coordination of care.

Purpose: Narratives help people to make sense of illness and trauma experiences. Exposure to a breadth of narratives is proposed to offer validation, reassurance and support well-being. Previous research constructed five narratives from people with major lower limb amputation (MLLA). However, efforts to bridge the research-practice gap, and meet clinical priorities by translating the narratives into resources, remained. This study aimed to illustrate an immersive co-design process and develop narrative resources for healthcare professionals working within, and people undergoing MLLA rehabilitation.

Methods: Commissioned by a National Health Service (NHS) MLLA rehabilitation centre, a 27-month rigorous co-design process was undertaken. An immersive, iterative three-stage process involving multiple end-user groups (e.g. patients, therapists, managers) and co-design activities (e.g. immersion, workshops) was used.

Results: Two co-design workstreams were undertaken, one to develop resources for people with MLLA and one for new allied healthcare professionals (AHPs). Outcomes included perceptions of the narratives (e.g. authentic, awareness raising), content and format priorities (e.g. visual, novel), and factors likely to influence implementation and engagement (e.g. readiness, existing knowledge).

Conclusions: Two narrative resource packages were co-designed for use in MLLA rehabilitation. The importance of context, and the dilemmas of sharing regressive narratives in clinical practice are discussed.

Purpose: To examine rehabilitation service use and associated factors among children with cerebral palsy (CP) in Vietnam.

Materials and methods: This study uses data from hospital-based surveillance of children with CP who attended the National Children's Hospital, Hanoi between June and November 2017 using methodology modeled on the Pediatric Active Enhanced Disease Surveillance system in Australia. Descriptive statistics, exact tests, and logistic regression were used.

Results: Of 765 children with CP, 92.6% received rehabilitation services. The median age at first receipt of rehabilitation service was nine months. Physiotherapy (94.3%) was the most common service, followed by advice on treatment (21.5%), rehabilitation childcare, psychological counseling for parents and assistive devices (11.5%). Among children who received rehabilitation services, the majority (88.8%) received them at home.Lack of awareness of rehabilitation (98.2%) was the main barrier to service access. In univariate analysis, younger age (p < 0.01), no intellectual impairment (p < 0.001), Gross Motor Function Classification System levels IV-V (p < 0.05), and wasted weight-for-height (p < 0.05) were significantly associated with limited service use. In multivariate analysis, no intellectual impairment and wasted weight-for-height remained significant (p < 0.05).

Conclusion: While most children accessed rehabilitation services, younger age, severe motor impairment, and malnutrition were associated with limited access to these services.

Purpose: This review aims to examine the effects of Lee Silverman Voice Treatment^® BIG (LSVT^® BIG) on motor impairments, activities of daily living (ADLs), and quality of life (QoL) in patients with Parkinson's disease (PD).

Methods: PsycINFO, PubMed, EMBASE, SCOPUS, PEDro, CINAHL, and Web of Science were searched until June 2025. Studies were included if they included patients with PD, administered LSVT^® BIG, and assessed motor symptoms, ADLs, and QoL. The PEDro scale was used to assess methodological quality, and pooled effect sizes were calculated using Cohen's d and random-effects models.

Results: Ten studies (300 participants) met the inclusion criteria. No significant effects in the Time-Up & Go (TUG) test (SMD: 0.050, 95% CI: -0.550 to 0.650, p = 0.870) and the 10-Minute Walk Test (10MWT) (SMD: 0.415, 95% CI: -0.198 to 1.027, p = 0.184) were reported. Other outcome measures revealed significant improvements in balance, gait cycle symmetry, and manual dexterity in patients with PD.

Conclusions: The initial findings revealed that LSVT^® BIG improves balance and gait in patients with PD. The evidence for the effects of LSVT^® BIG on manual dexterity and overall ADLs is mixed and inconclusive for QoL. Further high-quality studies with long-term follow-ups are needed.

Purpose: Early gait training supports walking recovery after incomplete spinal cord injury (iSCI). This study examined usual care (UC) and overground robotic exoskeleton (ORE) gait training to determine the role distinct approaches may have on initiating gait training during inpatient rehabilitation.

Methods: Patients with subacute iSCI [ASIA Impairment Scale (AIS) B, C, D] admitted to inpatient rehabilitation and meeting ORE criteria were randomized to UC or ORE, with a recommendation of up to 90 min of gait training per week. Primary outcomes included time (days) to gait training initiation, gait training frequency, and walking outcomes [CARE Tool items ("Walk 50 feet", "Walk 150 feet") and Walking Index for Spinal Cord Injury (WISCI-II)].

Results: Among 106 patients (mean age 51.5 ± 18.5 years, 78% male, 17.9% AIS B, 28.3% AIS C, 53.8% AIS D), ORE patients (n = 64) initiated gait training earlier than UC (n = 42) post-admission [12(8,20) vs. 14(9,29) days, p = 0.007] and post-injury [32(23,57) vs. 35.5(24,61) days, p = 0.031], with more frequent sessions [11(6,20) vs. 6.5(0,14), p = 0.003]. Moderate effect sizes were observed for patients with AIS C in 50- and 150-foot walking tasks (0.41, 0.34, respectively).

Conclusion: ORE may support earlier and more frequent gait training during rehabilitation, particularly benefiting patients with moderate severity iSCI.

Purpose: The long-term effect of corrective calcaneal kinesio-taping on adolescents with pronated feet and its influence on structural changes of the plantar fascia have not been studied before. This study investigated the efficacy of long-term application of corrective Kinesio-taping compared to an exercise program on pain, function, and structural changes within the plantar fascia in adolescents with pronated feet.

Materials and methods: Using a randomized controlled trial design, 36 adolescents with pronated feet were randomized into 2 groups with a 1:1 ratio, the experimental (n = 18) and the control (n = 18). Within a 6-week time frame, the experimental group received 6 weeks of corrective calcaneal Kinesio-tapping, while the control group performed a home exercise program.

Results: The experimental group demonstrated significant improvement in pain intensity, foot function, plantar fascial structural echotexture, thickness, and vascularity compared to the control group (p < 0.05); however, no significant difference was noted between groups regarding vascularity (p > 0.05).

Conclusion: Long-term corrective kinesio-taping has a significant effect on pain severity, foot function, and the structural abnormalities resulting from faulty mechanics in those patients as it focuses not only on symptom management but also on the pathology and improper foot mechanics.

Purpose: To investigate the experiences with a new child-centred approach to promote participation in local sport clubs for children with a physical disability. The approach was implemented through an outpatient clinic for sport advice and support (Esther Vergeer Foundation Clinic), embedded in all children's hospitals affiliated with University Medical Centres in the Netherlands.

Materials and methods: Semi-structured individual interviews were conducted with 49 stakeholders: children (n = 9), their parents (n = 13), referring professionals (n = 8), sport club staff (n = 13), and Clinic counsellors (n = 6). Interviews were transcribed verbatim, and transcripts were analysed using inductive thematic analysis.

Results: Stakeholders reported mainly positive experiences. Five major themes emerged: (1) an individualised approach, (2) guidance throughout the process, (3) building networks with hospitals and sport clubs, (4) added value of the Clinic support compared with earlier attempts, and (5) added value of participation in a regular sport club.

Conclusions: Effective support requires three key elements: an individualised approach, structured guidance for children and parents, and strong networks linking hospitals and sport clubs. Stakeholders emphasised that the Clinic's added value lies in addressing all these factors simultaneously and in developing expertise to match children with suitable sport opportunities.

Purpose: Tourette syndrome is a debilitating neurodevelopmental disorder. Despite the recent increase in the use of deep brain stimulation for the treatment of refractory Tourette syndrome, few qualitative studies have explored the post-surgical experiences of individuals. This research aimed to explore the lived experience of individuals who underwent deep brain stimulation for Tourette syndrome.

Method: This qualitative study was informed by the phenomenological design. Semi-structured interviews were conducted with the first cohort of five individuals to have undergone anterior-medial globus pallidus internus deep brain stimulation in South Africa. Interpretative phenomenological analysis was utilised to analyse the data.

Results: Four key themes were identified: (1) Battle with Tourette syndrome; (2) Temporal journey with deep brain stimulation; (3) Transformation: (Re)constructing the self in context after deep brain stimulation; and (4) Fusion: brain, technology and me.

Conclusion: Living with Tourette syndrome was described by the participants as a fight for control, with symptoms having profound effects on family and social relationships. Identity reconstruction following surgery was complex, but treatment led to a change in social interactions and personal growth. Improvement was not immediate but rather a gradual process to find optimal settings. Most participants managed to integrate the device successfully into their identity.