Disability and Rehabilitation最新文献

Purpose: Action observation (AO) and motor imagery (MI) are two forms of mental practice that can facilitate motor learning. We investigated if mental practice techniques (AO vs. combined AO+MI) can improve entry-level healthcare students' ability to locate anatomical structures in the immediate and short-term.

Materials and methods: Within a randomised control trial design, participants received a traditional anatomy lecture (Control, n = 13), or lecture plus AO (n = 13), or lecture plus combined AO+MI (n = 12). Mental practice involved either watching a physiotherapist's demonstration of (AO), or watching and imagining the feeling of (AO+MI) locating upper-limb anatomical points on a human model. Post intervention, participants located these points on a human model, assessed by diagnostic ultrasound, immediately and at one-week follow-up.

Results: Immediately post, accuracy was greater for AO+MI (M = 2.0, 95% CI = 1.6-2.4) and AO (M = 2.13, 95% CI = 1.7-2.6), than Control (M = 1.43, 95% CI = 1.0-1.8; ps < 0.05). At the follow-up, AO+MI (M = 2.23, 95% CI = 1.8-2.7) was significantly more accurate than AO (M = 1.30, 95% CI = 0.8-1.8; p < 0.01).

Conclusions: While mental practice groups out-performed the Control immediately post, only the AO+MI group retained this advantage. Educators should therefore consider augmenting traditional anatomy lectures with mental practice as a low-cost resource for enhancing learning.

Background: In 2020, clinical services noted an unexpected increase in functional tic disorders, which coincided with the timing of the COVID-19 pandemic. Evidence suggests that functional symptoms and tic disorders have a significant impact on family functioning and child and parent quality of life. However, little is currently known of the impact of a functional tics (FTs) diagnosis in adolescence, both on the young person and their family.

Methods: The current qualitative study explores adolescent and parent experiences of a FTs diagnosis, associated symptoms, and post-diagnostic support. Seven females aged between 12 and 18 years with a formal FTs diagnosis and eight parents were recruited through Tourette's Action, a UK-based charity concerning Tourette syndrome. Participants took part in individual semi-structured interviews via Microsoft Teams. Transcribed interviews were analysed using a reflexive Thematic Analysis.

Results: Themes generated from adolescent and parent interviews included (1) blamed, disbelieved, discounted, (2) fighting for help, (3) professional and community support and (4) changes in identity and relationships.

Conclusions: The findings emphasise the importance of psychoeducation encompassing FTs and young peoples' holistic needs, support to develop personalised strategies for management of FTs and interacting additional needs, alongside an increased public and professional understanding of FTs to aid stigma reduction.

Purpose: Return to work (RTW) after a major traumatic injury (MTI; traumatic brain injury, spinal cord injury, multi-trauma orthopaedic injury) is an important rehabilitation outcome. This study aimed to explore the experience of early vocational rehabilitation (EVR) after MTI, and RTW barriers/facilitators.

Methods: Adopting a qualitative design, 24 people with MTI were interviewed about participating in the Early Intervention Vocational Rehabilitation Service (EIVRS). Perceptions of EIVRS timing and RTW barriers/facilitators were explored. Data were analysed using reflexive thematic analysis.

Results: Participants experienced EIVRS as positive. The intervention's early timing was mostly appropriate, determined by individual factors. RTW barriers included injury impairments; difficulties adapting work roles and unstable employment; and psychological difficulties. RTW facilitators included ongoing recovery, employer flexibility, and feeling supported. Reported EIVRS benefits centred around three themes: gaining optimism and motivation through increased understanding; having a sense of control through the individualised program and vocational expertise; and feeling less worry and stress. Participants recommended long-term EIVRS availability.

Conclusions: Participants experienced EIVRS as an important component of their rehabilitation. Timing of vocational interventions needs to be individualised according to medical, cognitive, psychological, and employment factors. Embedding EVR within rehabilitation teams would facilitate this individualisation and may improve long-term rehabilitation outcomes.

Purpose: This study assessed the impact of refractive error (RE) correction on health-related quality of life (HRQoL) among nursing home residents.

Materials/methods: This quasi-experimental study with comparison group enrolled 249 participants for baseline and follow-up assessments in August 2021 and January 2022, respectively. Ophthalmic examination was conducted and visual acuity was assessed at baseline. Spectacles were distributed at three months before the follow-up. The interviewer-administered questionnaire assessed participants' socio-demographics and HRQoL using a 36-item Short-Form Health Survey (SF-36). Patient compliance with wearing spectacles was measured.

Results: The mean age of participants was 72.6. About 42.0% had mild to severe visual impairment (VI), while 5.0% were blind. At the follow-up, the normal vision improved from 52.8% to 64.9%, while mild to severe VI decreased from 42.3% to 30.3%. In the RE correction group, 83.3% of visually impaired people improved their vision to normal after receiving spectacles and 70.8% had corrected presbyopia. At the follow-up, those who had corrected their vision reported significantly better physical (PHC) and mental health component (MHC) scores of SF-36, particularly in physical functioning, emotional well-being, and pain. Those who had not corrected their vision reported no significant improvement in both PHC and MHC. There were no significant differences in baseline to follow-up mean change scores for PHC and MHC between those who corrected their vision and those who had not.

Conclusion: Access to comprehensive eye care services including regular eye screenings, provision of spectacles, and interventions facilitating spectacle-wearing compliance might improve ophthalmic health and HRQoL in this population.

Purpose: To identify what constitutes a satisfactory outcome following ankle fracture from the perspectives of people with ankle fracture, clinicians and health service managers.

Methods: Semi-structured interviews were conducted with adults with lived experience of ankle fracture, clinicians experienced in ankle fracture treatment and managers of hospitals providing care for people with ankle fracture.

Results: Patients (n = 12), clinicians (n = 12) and managers (n = 8) were interviewed. We identified two themes. A satisfactory outcome at six to 12 months following ankle fracture is: (1) a collaborative construct determined by patients and clinicians; and (2) influenced by the patient's experience of care. The first theme was elaborated through three subthemes which explained how patients and clinicians collaborate to determine a satisfactory outcome: (1) establishing indicators; (2) consideration of contextual factors; and (3) revision throughout the patient recovery journey. Managers considered re-referrals and patient feedback reflecting patient outcome and experience of care.

Conclusion: A satisfactory outcome is determined collaboratively by patients and clinicians and monitored by organisational indicators. During this process patients preference outcomes of activity/participation and clinicians preference outcomes of body structure/function. Clinicians play an important role in determining a satisfactory outcome through consideration of patient preferences and providing a positive experience of care.

Purpose: Adults with cerebral palsy (CP) face challenges maintaining physical activity and good sleep. This study explores their experiences and describes factors influencing sleep and physical activity.

Methods: We conducted semi-structured interviews with fourteen adults aged 23 to 58, of whom thirteen were ambulant. Participants were recruited via the Dutch patient organization for individuals with CP. Data were analyzed using inductive qualitative content analysis.

Results: Three main themes emerged: balancing energy, rest and activity, and separate themes on sleep and physical activity. Balancing energy, rest and activity included subthemes of managing personal resources, interaction between sleep and physical activity, and presence of appropriate support and resources. Maintaining a healthy 24-h balance was crucial, yet participants often struggled achieving this balance and finding appropriate support. Experiences with sleep and physical activity were categorized into mental, physical, and environmental subthemes, which are closely interconnected.

Conclusions: People with CP have difficulties with sleep, physical activity, and maintaining a healthy 24-h balance. Despite their motivation to maintain well-being, they often lack adequate support. Addressing these issues holistically can improve care and support for adults with CP. Youth rehabilitation services play a critical role in preparing adolescents with CP for adulthood by fostering self-management skills.

Purpose: To determine the effectiveness of motivational interviewing (MI) in the treatment of adult patients with musculoskeletal (MSK) pain.

Materials and methods: A comprehensive search strategy without date or language restrictions was performed in five scientific databases. Manual searches and reference tracking were also carried out. Two reviewers independently performed title and abstract as well as full-text screening, data extraction, assessment of risk of bias, and evaluation of overall certainty with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Where possible, a meta-analysis was performed to identify effects across multiple studies.

Results: Ten studies reported in 16 manuscripts met the previously defined eligibility criteria. Many outcomes could be extracted and analyzed. Nine of the ten studies were considered to have a high risk of bias according to the revised Cochrane RoB 2.0. The majority of comparisons were based on low to very low overall certainty of the evidence.

Conclusions: The existing literature did not allow a reliable statement about the effectiveness of MI on pain-related outcomes in people with MSK pain. Only tendencies towards a positive influence of MI were recognisable. However, this must be confirmed by high-quality randomized controlled trials in the future.IMPLICATIONS FOR REHABILITATIONMotivational interviewing appears to be an option for patients with chronic musculoskeletal pain which presumably has few to no adverse effects.Motivational interviewing could represent an opportunity, particularly for patients for whom other treatment strategies have been ineffective so far.Motivational interviewing can safely be combined with other forms of treatment such as an active exercise therapy.

Purpose: In Sub-Saharan Africa, family caregivers (FCs) almost systematically-and sometimes indefinitely-assist stroke survivors with activities of daily living and the stroke rehabilitation process. This study explored the experiences of FCs of stroke survivors in Burkina Faso.

Materials and methods: A descriptive qualitative study was conducted with FCs recruited through convenience sampling. Semi-structured interviews were recorded and transcribed verbatim. A deductive thematic analysis based on the ICF framework was performed.

Results: Eleven FCs (female: 7; male: 4) participated in the study. Four main themes were identified: (1) Health and well-being (impact on health and well-being, and coping strategies); (2) Activities related to the caregiving role and social participation (activities and social participation); (3) Environmental factors (social support and lack of social security); (4) Personal factors (skills and knowledge about stroke). Furthermore, the facilitators and barriers associated with the caregiving role were synthesized.

Conclusion: FCs, particularly the wives of stroke survivors, experienced a significant impact on their physical and emotional well-being due to their caregiving responsibilities. Social support helped alleviate the burden, while its absence increased distress. Improving health services and policies, and promoting awareness of stroke knowledge, appear to be important in strengthening support for FCs.

Purpose: To evaluate the reliability and validity of the Chinese version of the Stroke Upper Limb Capacity Scale (SULCS) compared to the Wolf Motor Function Test (WMFT) and the Fugl-Meyer Assessment-Upper Extremity (FMA-UE).

Materials and methods: Patients with hemiplegia after stroke (n = 60). The intraclass correlation coefficient (ICC) and corresponding 95% confidence intervals (CI) were used to explore the reliability, and Spearman's correlation coefficient was used to analyze validity. Floor and ceiling effects were counted.

Results: The ICCs for inter-rater reliability and intra-rater reliability were ICC = 0.985 (95%CI = 0.966-0.992) and ICC = 0.982 (95%CI = 0.970-0.989), respectively. The SULCS demonstrated a strong correlation with the WMFT (r = 0.922, p < 0.001) and FMA-UE (r = 0.921, p < 0.001) at baseline. The WMFT and FMA at week 3 were as strong as those at baseline (r = 0.946, p < 0.001 and r = 0.952, p < 0.001, respectively). There was a strong longitudinal correlation between the changes in SULCS and WMFT and FMA-UE from baseline to week 3 (r = 0.745, p < 0.001 and r = 0.768, p < 0.001, respectively). No floor and ceiling effects were detected in any assessment.

Conclusions: Our analysis of the psychometric properties supports the use of the Chinese version of the SULCS to measure upper limb capacity in patients with hemiplegia after stroke.

Purpose: This study aimed to determine the feasibility and clinical utility of the Diego™ for people with a cervical spinal cord injury (CSI) in an acute spinal ward.

Materials and methods: A mixed methods study included prospective measurement of outcomes and qualitative interviews with participants and health professionals. A 22 day (4.4 weeks Monday to Friday) program incorporating baseline and follow up measurements, 2 × 1-h standard upper limb sessions per week, and 3 × 1-h Diego™ sessions per week were designed for implementation. Participants were assessed on recruitment and at the completion of the program.

Results: Seven eligible patients (6 male and 1 female) and eight health professionals participated. Participants improved in most muscle strength and range of motion scores across upper limb joints although these were not statistically significant, Spinal Cord Independence Measure scores (14.29 at baseline to 18.29 at follow up, p = 0.01) and fatigue scores (reduction of 1.57 points, p = 0.577). Pain scores remained stable. The Canadian Occupational Performance Measure indicated improvements in performance (+2.20 points, p = 0.028) and satisfaction scores (+2.53 points, p = 0.028). Qualitative findings from both participants and health professionals indicated that participants experienced psychological benefits using the Diego™.

Conclusions: Some gains in functioning occurred. Further research should include a randomised controlled trial to fully evaluate the effectiveness of the Diego™ in acute settings.