Disability and Rehabilitation最新文献

Purpose: Sickle cell disease (SCD) causes abnormal hemoglobin, chronic pain, anemia, and organ damage. Virtual reality (VR) is a non-pharmacological tool for pain management; its effectiveness in SCD remains underexplored. This study evaluates the effect of an adjunctive fully immersive VR on daily pain and its impact on functional mobility and health-related quality of life (HRQOL) in children with SCD.

Materials and methods: In this single-blinded, randomized controlled trial, forty children (8-18 years) were randomized to VR + usual care (n = 20) or usual care alone (n = 20). The VR group received six 40-minute sessions over three weeks. Outcomes included pain (Numeric Rating Scale), mobility (Timed Up and Go test), and HRQOL (Pediatric Quality of Life Inventory). ClinicalTrials.gov (Identifier: NCT05952817).

Results: The intervention group showed significant pain reduction, improved mobility, and enhanced HRQOL compared to controls over five weeks (pain: η² = 0.28, p < 0.001; mobility: η² = 0.18, p < 0.001; HRQOL: η² = 0.08-0.68, p < 0.001). VR was safe and well-tolerated.

Conclusion: Adjunctive VR with usual care significantly reduces pain, improves mobility, and enhances HRQOL in children with SCD, supporting its feasibility and safety.

Purpose: This study evaluated combined restorative and compensatory rehabilitation on executive functions in acute stroke patients with mild cognitive impairment.

Materials and methods: A randomized controlled trial with 36 acute middle cerebral artery (MCA) stroke patients compared combined restorative and compensatory rehabilitation (n = 18) to conventional therapy (n = 18). Outcomes were assessed using the Montreal Cognitive Assessment (MOCA), Modified Rankin Scale (MRS), Cognitive Assessment Scale (CASP), and Stroke-Specific Quality of Life (SSQOL) at baseline, 3rd, 6th, and 9th weeks, analyzed with ANOVA methods.

Results: By week 9, the experimental group showed clear gains. MOCA rose from 20.5 ± 2.3 to 27.1 ± 1.8 (95% CI 26.3-28.0, p0.05). CASP from 45.2 ± 4.8 to 50.3 ± 4.0 (95% CI 48.0-52.6, p0.05) and MRS improved more than controls (3.5 ± 0.7 → 2.7 ± 0.5, p<0.05). SSQOL declined in controls 140.2 ± 12.1 to 128.0 ± 10.2 (p0.05).

Conclusions: Combined restorative and compensatory rehabilitation proved more effective than conventional cognitive training, enhancing executive functioning, independence, and quality of life in stroke survivors with mild cognitive impairment.

Purpose: To explore the experiences of Autistic adolescents and young adults who participated in a 12-week student-mentored community based physical activity program called FitSkills.

Methods: This qualitative study was embedded within a large implementation trial. The data sources were: (i) trial screening forms, including reasons for participation from 30 Autistic young people (24 with intellectual disability), and (ii) semi-structured interviews completed by telephone with 7 Autistic young people (6 male; M_age 18.6 years), 13 parents (11 mothers) and 16 student mentors (10 women). Data were analysed using content analysis (screening) and reflective thematic analysis (interviews).

Results: The most common reason Autistic young people and their parents gave for wanting to take part in FitSkills was improving physical fitness. Three themes were identified: (1) Relationships with student mentors 'made it' and evolved over time to becoming gym partners or friends; (2) Social support helped participants to navigate the gym environment, manage sensory needs and establish a routine; and (3) Exercise was perceived to have a positive effect on psychological wellbeing.

Conclusion: A student-mentored community-based program can facilitate Autistic young people to exercise, by overcoming barriers to their participation and supporting them to navigate the community gym environment.

Background. Rehabilitation is known to have many positive effects for cancer patients. However, patients with head, neck and lung cancer generally have a low uptake of rehabilitation. Therefore, the aim of this study was to explore patient and healthcare professionals' perspectives on rehabilitation uptake after treatment for head, neck and lung cancer in a municipal setting. Methods. Semi-structured formal interviews were conducted with patients and healthcare professionals across hospital and rehabilitation settings in northern Denmark. All interviews were transcribed verbatim and analyzed using reflexive thematic content analysis. Results. There are multiple factors underlying the low uptake of rehabilitation for head, neck and lung cancer patients, ranging from systemic barriers, to matters of health (i)literacy and a perceived lack of interest, which upon further reflection often masks a deeper existential and/or physical vulnerability. Discussion. Our findings indicate that while many of the barriers to rehabilitation uptake arise in the transitions between care sectors, there is also a need to rethink how rehabilitation fits into the cancer care trajectory at hospital level. Current praxis leaves many opportunities for inequalities in rehabilitation access and uptake to arise.

Purpose: To enhance quality and equity in the model of care for specialised rehabilitation in a large regional service in Aotearoa New Zealand, this study aimed to explore the experiences and improvement ideas of patients, whaanau (wider family), staff and community providers.

Materials and methods: This qualitative study represents the experience capture phase of a service co-design project. Semi-structured interviews drawing on culturally informed methods were conducted with spinal, stroke and amputee patients (n = 14), whaanau (n = 7), staff (n = 14), and community organisation representatives (n = 10). Data were analysed using reflexive thematic analysis.

Results: Four overarching themes were generated: respecting the whole person and whaanau; fostering a collaborative rehabilitation culture; milestones and speedbumps on the road to recovery; and an enriching environment.

Conclusion: Strengthening a holistic, person and whaanau-centred approach to specialised rehabilitation services may better support equitable outcomes. Priorities for service co-design are enhancing cultural safety and responsiveness, supporting whaanau, and enabling smooth transitions.

Purpose: The benefits of motor control-based therapeutic exercise and its combination with whole-body vibration in individuals with nonspecific Low Back Pain (NSLBP) are not well established.

Methods: Seventy-five females with NSLBP were randomly assigned to control, motor control, and combination groups. The experimental group received 3 therapeutic exercise sessions per-week for 8 weeks. The pre- and post-intervention measurements used in the current research included trunk muscle activation, the VAS, and postural stability assessments.

Results: The results indicated a decrease in the center of pressure path length in both the anterior-posterior and medial-lateral directions, a drop in pain, and an increase in all studied muscle activation following the intervention in the freestyle lifting task in the motor control and combination groups (p < 0.05). However, post-hoc analysis revealed no significant difference between the motor control and combination groups at post-test in any of the measured parameters (p > 0.05).

Conclusion: Both motor control exercises and their combination with whole-body vibration effectively improve pain, postural stability, and trunk muscle activation in individuals with NSLBP. Effects were generally comparable, with the combination offering only a slight additional pain reduction. Motor control exercises alone may be sufficient, while the combination can be an alternative.

Purpose: This study aimed to develop and validate the Health Impairment Grief Scale (HIGS) to assess grief reactions among sick-listed employees experiencing health loss, thereby increasing understanding of their emotional experiences during sickness absence.

Materials and methods: The 10-item HIGS was developed with input from academic experts in grief and labor, occupational health professionals, and sick-listed employees. Psychometric evaluation of the HIGS was conducted using data from 226 sick-listed employees. Participants were mostly women (81%), highly educated (52%), were on average 49.3 years old, and have been sick-listed for 90.3 weeks.

Results: The HIGS demonstrated a unidimensional structure, robust internal consistency, and temporal stability. Additionally, its items showed clear differentiation from symptoms of depression and anxiety, and exhibited solid convergent validity. These findings indicate that individuals can experience grief due to health problems.

Conclusions: This study identifies health loss-related grief as a distinct psychological phenomenon among sick-listed employees. The association between health loss-related grief and pre-job loss grief suggests that employees may face interconnected emotional challenges during return-to-work. The HIGS provides rehabilitation professionals with a valid tool to identify grief reactions in return-to-work assessments, enabling recognition of employees who may require support that addresses both health-related and anticipated work-related losses.

Purpose: Measure the benefits and experiences of stroke survivors, carers and staff involved in the piloting of the Exercising, Socialising and Thinking: An Environmental Enrichment Model (ESTEEM) Program.

Materials and methods: Concurrent triangulation mixed-methods were used; (i) physical (leg strength, endurance, falls efficacy and frailty), psychological (anxiety and depression) and quality of life outcomes were collected at baseline, post-intervention, and 3-month follow-up, and (ii) inductive analysis of semi-structured interviews with end-users, described the experience of participation in and delivery of the ESTEEM Program.

Results: Stroke survivors [n = 25, median age 76 (IQR = 68-79) years, 40% female] demonstrated significant improvements at (i) post-intervention, in leg strength [1.2 repetitions, 95% confidence interval (CI) (0.22, 2.3)] and walking endurance [31m, (2.3, 60)] and, (ii) 3-month follow-up, in leg strength [0.99 repetitions (0.01, 2.0)], frailty [-0.79 (-1.3, -0.34)], anxiety [-1.8 (-3.1, -0.45)], depression [-2.1 (-3.5, -0.83)] and QoL [0.30 (0.13, 0.47)]. Stroke survivors [n = 10], carers [n = 3] and staff [n = 5]) perceived the Program to be beneficial, desirable and "worth the effort" of attending.

Conclusions: The ESTEEM Program may benefit both physical and emotional recovery after stroke and is acceptable to end-users. Results will inform future clinical research to determine the effectiveness of the ESTEEM Program.

Purpose: Post-stroke fatigue affects rehabilitation, daily activities, and quality of life. Its relationship with sleep remains unclear. We aimed in the acute stroke phase to (a) describe fatigue and sleep using self-reported and objective sleep measures, (b) describe sleep apnoea and (c) explore the associations between sleep measures and post-stroke fatigue.

Material and methods: This cross-sectional study examined Norwegian adults within 14 days of first ischaemic stroke. Fatigue was assessed with the Fatigue Severity Scale. Self-reported sleep factors (Pittsburgh Sleep Quality Index [PSQI], Epworth Sleepiness Scale) and objective WatchPAT measures (apnoea-hypopnea, sleep time, efficiency, REM/deep sleep) served as exposure variables. Multivariable regression models, adjusted for age, sex, mRS, and depression or anxiety symptoms, were used to examine associations between sleep and fatigue.

Results: Participants (n = 107, mean age 65 (SD14) years, n = 65(61%) male) had a mean NIHSS score of 2.5 [SD3.3], Fatigue Severity Scale score of 3.11 [SD1.82], and n = 71 (66%) scored as having disturbed sleep (PSQI). Mean total sleep time (n = 81) was 7.04 [SD1.46] hours and 54 (71%) had sleep apnoea. In the final multivariable model, only poor sleep quality (b = 0.45, p = 0.010) was associated with post-stroke fatigue.

Conclusions: Addressing sleep quality in the acute stroke phase may benefit post-stroke fatigue.

Purpose: Physical activity at home is vital after hospital or rehabilitation admission to support recovery and participation in society. This study aimed to identify determinative factors for physical activity at home during the first year post-discharge from the patient's perspective.

Materials and methods: Narrative storytelling was used to explore the underlying emotions and motivations behind physical activity behavior among orthopedic and neurological patients during the first year post-discharge. Analysis included extracting multiple real-life stories from each interview, followed by reflexive thematic analysis.

Results: Fourteen participants (9 orthopedic, 5 neurological) were interviewed. Across the extracted stories, 45 topics were identified and grouped into 4 main themes and 9 subthemes. Findings underscore that long-term physical activity requires rehabilitation to be rooted in patients' life roles, values, and priorities, enhancing autonomy and opportunities for personal functional activities in supportive clinical and home environments. Positive reinforcement and involvement of significant others, provided with practical strategies, were seen as essential for sustaining activity at home. Across neurological and orthopedic subgroups, shared determinative factors included focusing on daily life participation and fostering patients' responsibility and resilience.

Conclusions: Emphasizing participation in personal environments and fostering self-management, autonomy, and resilience may enhance physical activity at home.