Disability and Rehabilitation最新文献

Purpose: Wearable robotic devices are currently being developed to improve upper limb function for individuals with hemiparesis after stroke. Incorporating the views of clinicians during the development of new technologies can help ensure that end products meet clinical needs and can be adopted for patient care.

Methods: In this cross-sectional mixed-methods study, an anonymous online survey was used to gather clinicians' perceptions of a wearable robotic hand orthosis for post-stroke hemiparesis. Participants were asked about their clinical experience and provided feedback on the prototype device after viewing a video.

Results: 154 participants completed the survey. Only 18.8% had previous experience with robotic technology. The majority of participants (64.9%) reported that they would use the device for both rehabilitative and assistive purposes. Participants perceived that the device could be used in supervised clinical settings with all phases of stroke. Participants also indicated a need for insurance coverage and quick setup time.

Conclusions: Engaging clinicians early in the design process can help guide the development of wearable robotic devices. Both rehabilitative and assistive functions are valued by clinicians and should be considered during device development. Future research is needed to understand a broader set of stakeholders' perspectives on utility and design.

Purpose: Reliable assessment of language comprehension is difficult for children with significant speech and motor limitations. The Computer-Based instrument for Low motor Language Testing (C-BiLLT) was designed for children with cerebral palsy (CP) and speech and motor limitations. A Canadian English version (C-BiLLT-CAN) has been validated. However, early investigation identified feasibility challenges necessitating further exploration. This study aimed to understand parents' perceived barriers and facilitators to implementing the C-BiLLT-CAN in the Canadian clinical context.

Materials and methods: Seven focus groups were conducted synchronously online with 16 parents from five Canadian provinces/territories. Transcripts were analyzed using semi-deductive thematic analysis, framing results within the Consolidated Framework for Implementation Research (CFIR).

Results: Parents unanimously expressed interest in making the C-BiLLT-CAN clinically available. Facilitators and barriers were discussed under five themes. Key facilitators included the unique design, standardized nature, and potential flexibility of the C-BiLLT-CAN. Barriers involved the inability to accommodate all children, the potential for unintended assessment impacts, and clinics' readiness and willingness to prioritize implementation.

Conclusions: This study contributes new knowledge surrounding the assessment needs of parents of children with CP and speech and motor limitations. Alongside findings from a parallel clinician study, results will inform adaptations to the C-BiLLT-CAN to facilitate implementation.

Purpose: Although the benefits of Assistive Robotic Manipulators (ARMs) have been recognized since their emergence over the past two decades, the number of ARM owners remains limited, though expected to grow. This study interviews current owners to gather their perspectives and uses the Human Activity Assistive Technology (HAAT) model to understand their usage experiences with ARMs.

Materials and methods: A semi-structured remote interview study was conducted with robotic arm owners ($\ge$3 months). Pre-interview surveys collected demographics and common tasks with the robotic arm. Thematic analysis identified key themes.

Results: Eleven ARM owners were recruited and gave examples of the Kinova^® Jaco^® robotic arm being a life-changing benefit promoting independence which emerged as a theme. Additional themes emerged around operation, caregiver influence, environment, and training. Common tasks included drinking and opening doors. Design recommendations focused on modular attachments, adjustable speed, smoother operation, intuitive control, and enhanced safety.

Conclusion: We performed a qualitative interview and drew conclusions guided by the HAAT model to better understand interactions between the user, the robotic arm, and contexts of its use for manipulation tasks. The insights gained can better inform prospective owners and guide future research in assistive robotics.

Purpose: Physiotherapists' varied interpretations of the International Classification of Functioning and Health (ICF) and the biopsychosocial model underlying it can significantly influence its dissemination, assimilation, and application. This study analyzed the diverse discourses of Brazilian physiotherapists engaged in teaching and researching the ICF.

Materials and methods: This descriptive cross-sectional study employed Q methodology to explore participants' viewpoints. Participants ranked diverse statements about the ICF into nine categories from "strongly disagree" (-4) to "strongly agree" (+4). Rankings were analyzed through factor analysis to identify emerging factors, then interpreted as viewpoints based on the average ranking of statements within each factor.

Results: A total of 48 experts ranked 59 statements. Participants had diverse specialties, with an average of 19.1 years of professional experience, 13.62 years of teaching, and 16.04 years of engagement with the ICF. Most were affiliated with public universities and held doctoral degrees. Factor analysis revealed two distinct viewpoints, both supporting a biopsychosocial understanding of functionality, emphasizing the ICF's value in either pragmatic or conceptual terms.

Conclusions: The two viewpoints by experts emphasize the practical and theoretical value of the ICF, reinforcing its biopsychosocial approach to functioning.

Purpose: This study aimed to further investigate the effectiveness of activity-based interventions (ABI) for individuals with spinal cord injury (SCI).

Materials and methods: A systematic literature search was conducted in eight electronic databases up to 1 January, 2024. Standardized mean difference (SMD) or MD with 95% confidence intervals (CI) was used to express the estimates of the effectiveness of ABI.

Results: Compared to controls, ABI for lower limbs does not significantly improve independence, but it does improve mobility; however, ABI for upper limbs significantly improve independence and mobility. In the intermediate SCI subgroup, the ABI group suggested significant improvement in functional independence and mobility. In the chronic SCI subgroup, the ABI group did not show improvement in independence, but it suggested significant improvement in mobility. Nevertheless, the ABI group did not show statistically significant differences for independence and mobility in the acute SCI subgroup. Moreover, the application of ABI was not associated with an improvement in quality of life but significantly improved 6-minute walk test (6-MWT) and 10-meter walk test (10MWT). Except for ABI for lower limbs for independence, meta-analyses for the remaining outcomes were free of publication bias.

Conclusions: Application of ABI may benefit SCI individuals by improving independence, mobility, 6MWT, and 10MWT.

Purpose: Whilst evidence about mealtime delivery exists in acute and aged care settings, there is limited understanding of patient and staff preferences for rehabilitation settings. This study aimed to explore patient and staff perceptions about how mealtimes should be delivered to support rehabilitation goals of care. Method: This qualitative descriptive study involved semi-structured interviews with nine patients (previous or current admission) and ten staff from a single metropolitan rehabilitation service. Data were analysed using qualitative content analysis.

Results: Two key categories were identified, including (1) the role of mealtimes in patients' rehabilitation, and (2) factors underpinning ideal mealtime delivery for rehabilitation. Mealtimes help to facilitate recovery, support socialisation, rest, and routine, but were also a time of frustration and challenge for patients. The ideal mealtime was described as creating a therapeutic experience, integrating systems and processes that support rehabilitation, systems that offer flexibility and choice, enhancing mealtime care through interdisciplinary collaboration, and using supportive mealtime care practices.

Conclusion: The ideal mealtime in rehabilitation should be underpinned by principles of flexibility, adaptability, and supportive care. Incorporating rehabilitation goals of care can be enabled through mealtime systems that encourage functional therapy activity, optimal nutrition, and time for rest and social engagement.

Purpose: Exercise-based rehabilitation interventions can improve functional outcomes in pulmonary arterial hypertension (PAH), but barriers to participation are common and little is known about the patient-reported experience. This study evaluated the patient experience of participating in structured, outpatient exercise interventions for PAH, and explored how participation may impact knowledge, attitudes and engagement in physical activity.

Methods: A mixed-methods evaluation was conducted alongside a pilot trial (ExPAH). Semi-structured interviews were completed with participants who undertook a 12-week, outpatient exercise-based intervention for PAH. Interview data were analyzed via descriptive and inductive thematic analyses.

Results: Fourteen participants were included (mean 53 ± 14.9 years, 79% females). Formal therapy programs were reported to be enjoyable and increased participant's knowledge, confidence to exercise, and daily physical activity. Six dominant themes described the subjective experience of undertaking a structured program: confronting a sense of loss and limitation through exercise; "permission to try" built knowledge and confidence; finding joy and empowerment through physical activity; the importance of motivation; reframing exercise as part of daily life; and exercise as liberating.

Conclusions: Structured therapy programs can increase knowledge, confidence, and positive perceptions of physical activity for people with PAH. Structured programs were reported to be enjoyable, empowering and increased functional independence.

Purpose: This overview aims to assess the methodological and evidence quality of systematic reviews related to radiofrequency ablation (RFA) for knee osteoarthritis (KOA).

Methods: A comprehensive search strategy was conducted through two independent researchers in eight electronic databases from the inception to September 1, 2024. The methodological quality of the included systematic reviews was assessed by the Assessing the Methodological Quality of Systematic Reviews 2 tool. The Grading of Recommendations Assessment, Development, and Evaluation tool assessed the evidence quality.

Results: Eight systematic reviews were finally included. The results of the methodological quality of the included systematic reviews were generally unsatisfactory. The limitations were a lack of pre-designed protocols, reasons for the inclusion of study types, a list of excluded studies, the consideration of the single study risk of bias, and management of conflicts of interest. A total of 56 outcome indicators were evaluated, with one item receiving a moderate quality rating, while the rest were classified as low or very low. Limitations were identified as the primary factors leading to the downgrade.

Conclusions: RFA shows efficacy in treating KOA, with tolerable side effects. However, systematic reviews' poor quality indicates cautious interpretation needed. Future studies must enhance quality for robust EBM.

Purpose: This pilot study assessed the feasibility, safety, and acceptability of a physical training program combined with parental meetings for children with heritable connective tissue disorders (HCTD), including Marfan syndrome (MFS), Loeys-Dietz syndrome (LDS), and Ehlers-Danlos syndromes (EDS). Secondary, it aimed to explore preliminary observations regarding the program's impact on individual training goals and physical fitness, including aerobic and anaerobic capacity, strength, agility, pain, fatigue, and disability.

Materials and methods: The intervention comprised functional power training (FPT) and high-intensity interval training (HIIT) conducted three times a week over 12 weeks. Data on feasibility, safety, and acceptability were collected, along with preliminary observations on physical fitness performance.

Results: The intervention was feasible and safe, with no serious adverse events reported. However, acceptability was limited, with a participation rate of 27.8%. Preliminary findings revealed that 80% of participants achieved their training goals, 75% improved their aerobic capacity, and 70% showed gains in strength and agility, alongside reported reductions in pain and fatigue.

Conclusion: This study highlights the potential benefits of tailored physical training for children with HCTD. Despite acceptability challenges, the intervention demonstrated feasibility and safety, providing a foundation for larger-scale effectiveness studies that include systematic feedback mechanisms to enhance participant engagement.

Purpose: Person-centred physiotherapy in Intensive Care Units (ICU) supports patients' early rehabilitation. Yet little is known about the activity required to enable person-centred physiotherapy in this setting. This study explores the experiences and interpretations of people who received physiotherapy.

Methods: A qualitative study using Interpretative Phenomenological Analysis was conducted. Eight participants, recruited from a Ventilation Unit in Northwest England, were interviewed. Data were transcribed and managed using NVivo 12 software.

Results: Participants described being "pushed" and guided by physiotherapists. The "emotional" pushing through motivation and encouragement, and "physical" pushing through setting goals, were perceived as person-centred activities, despite physiotherapists initially directing them. Other important aspects of individualised care were feeling safe and understanding how their body had changed.

Conclusions: Patients viewed physiotherapist led rehabilitation in ICU as being person-centred, despite the lack of collaboration during early recovery, because they were too ill. Models of person-centred physiotherapy could be made more applicable to clinical settings by fully integrating the patient perspective.