Disability and Rehabilitation最新文献

Purpose: To evaluate the feasibility and safety of a high-intensity physical rehabilitation programme for children and adolescents with acquired brain injury (ABI) during inpatient rehabilitation. We also explored changes in outcomes of physical and cognitive functioning by structured monitoring of recovery trajectories with a coreset of clinical outcome measures.

Materials and methods: A prospective case-series design was used. Fourteen children and adolescents aged 6-20 years (mean 14,1 years, SD 2,7) with ABI were included. Feasibility and safety data were collected from children, parents and professionals, alongside measures of physical and cognitive functioning.

Results: Seventy-five percent of the 14 participants achieved the minimum of 3 h of physical activity per day (median 3h09m, IQR 1h33m). Improvements were observed on measures of physical and cognitive functioning. No adverse events were reported, indicating safety of the programme. The programme was well accepted by both families and professionals.

Conclusion: Our findings indicates that it is feasible and safe for children and adolescents with ABI during subacute rehabilitation to engage in high levels of physical activity (>3h p/day). We provide a foundation for future larger-scale studies on effectiveness of increased dosage of physical rehabilitation on daily functioning and participation of children and adolescents with ABI.

Purpose: Injury beliefs can affect how people navigate recovery and influence how they seek treatments. The aim of this study was to explore what influences beliefs about the cause(s) of persisting symptoms after an isolated extremity injury.

Methods: Data were collected using semi-structured interviews. Participants (n = 12; 67% female) were purposively sampled from a cohort study exploring recovery trajectories after isolated extremity injuries. We used a descriptive approach to reflexive thematic analysis.

Results: Beliefs were formed through (1) expectations of what recovery entails (2) interactions with trusted others, (3) experience, and (4) prior knowledge and identity (Theme 1 and subthemes 1a-d). Persistent distress was understood as a normal response to an abnormal situation (Theme 2). Causal beliefs were influenced by concerns about judgement from others, particularly when symptoms did not match objective findings (Theme 3).

Conclusion: Beliefs about the cause of persisting post-injury symptoms can be understood as a network of interrelated beliefs, moulded by individual experience and knowledge, but also interpersonal elements such as therapeutic alliance and fear of not being taken seriously by others. Causal beliefs were sometimes at odds with what patients were told by healthcare professionals, leading patients to seek alternate views.

Purpose: Time management is essential to handle daily life in today's society. This study aimed to evaluate the effectiveness of the Swedish version of the Let's Get Organised (LGO-S) intervention to improve time-management skills for adults with impaired time management due to attention deficit hyperactivity disorder (ADHD), autism or mental disorders compared to treatment as usual (TAU), which is individual occupational therapy.

Materials and methods: This was a multi-centre, open, two-armed pragmatic randomised controlled trial. The setting was out-patient adult habilitation centres and psychiatric clinics. At baseline the study had 75 participants aged 19-61 years (mean 32.3 years) whereof 44 were women.

Results: Both intervention groups showed statistically significant improvements in time-management skills, organisation and planning, emotional regulation, general self-efficacy and satisfaction with activities at post-intervention test. Most of these within-group improvements were sustained after 3 months. Changes in time-management skills between LGO-S and TAU intervention were not statistically significant at post-intervention or after 3-months. Programme completers in LGO-S had significantly better time management skills at the 3-month follow-up than non-completers.

Conclusions: This pragmatic RCT, conducted in a clinical environment including participants with complex difficulties, showed that both LGO-S and individual occupational therapy are clinically useful/applicable interventions that effectively improve time-management skills.

Purpose: To investigate the effects of two neuromuscular electrical stimulation (NMES) techniques applied to the lumbar multifidus on spine, pelvis, and hip kinematics during sit-to-stand (STS) in individuals with chronic nonspecific low back pain (CNLBP).

Methods: Twenty-two individuals with CNLBP were randomized into conventional NMES (CNMES; n = 11) or functional NMES (FNMES; n = 11) groups. A control group of ten healthy individuals was included for comparison. The CNMES group received stimulation in the prone position without voluntary contraction, whereas the FNMES group received stimulation during STS. Interventions were delivered three times weekly for eight weeks. Kinematic parameters were assessed using optoelectronic motion capture, and pain and disability using the Visual Analog Scale and Oswestry Disability Index.

Results: At baseline, CNLBP groups showed reduced range of motion and angular velocity during the flexion phase of STS. After the intervention, the FNMES group demonstrated significant improvements in spine, pelvis, and hip kinematics (p < 0.05), while only spine angular velocity improved in the CNMES group. Both NMES groups demonstrated significant reductions in pain and disability levels (p < 0.05).

Conclusion: FNMES was more effective than CNMES in improving movement patterns during the flexion phase of STS, demonstrating its potential as a phase-specific rehabilitation approach for individuals with CNLBP.

Purpose: Compare telerehabilitation with in-person therapy for work-related injuries in Italian routine care using the STRF as the primary outcome.

Materials and methods: A 29-month retrospective cohort included sub-acute patients treated by telerehabilitation (n = 107) or in-person therapy (n = 117). Post-treatment STRF was analyzed by ANCOVA adjusted for baseline STRF, age, sex, anatomical site, surgical status, and calendar period. Secondary outcomes were responder status (ΔSTRF ≥1; adjusted logistic regression) and pain (NPRS; ANCOVA adjusted for baseline NPRS). Sensitivity analyses excluded surgical cases; an exploratory treatment × period interaction was tested. The STRF, developed and validated in Italy, was used as a context-specific measure.

Results: Adjusted models showed no between-group differences for post-treatment STRF or NPRS. Responder odds did not differ, and patterns suggesting slower early recovery among patients with low baseline STRF in unadjusted summaries attenuated after adjustment. Magnetotherapy was not independently associated with outcomes. Sensitivity analyses were consistent.

Conclusion: In Italian routine care for work-related injuries, telerehabilitation and in-person therapy showed no adjusted differences in functional or pain outcomes at discharge. These findings should be interpreted given the retrospective, nonrandomized design, period effects, surgical imbalance, and the Italy-specific validation of STRF. Prospective studies with cross-cultural validation and longer-term (including return-to-work) outcomes are warranted.

Purpose: Digital transformation and integration of eHealth solutions into chronic pain management faces significant challenges that have not yet been met. The objective of this study is to explore the challenges, barriers, needs, and solutions experienced by patients and general practitioners (GPs) in the context of an eHealth solution designed for chronic pain management in general practice.

Materials and methods: The study used action-research as a methodological framework. We conducted two future workshops involving eight patients living with chronic pain and seven GPs with clinical experience in managing chronic pain. Through case vignettes and inspiration cards, the workshops stimulated discussions and shared construction of knowledge. Data were analyzed using reflexive thematic analysis, separated by the groups, and were synthesized via a matrix analysis.

Results: The analysis revealed five content summary themes: Theme 1-patients' experience of challenges in life with pain; Theme 2-challenges in treating patients with chronic pain; Theme 3-patients' suggestions for the structure of the eHealth solution; Theme 4-GP' suggestions for the structure of the eHealth solution; and Theme 5-differences and similarities: Visions for an eHealth solution.

Conclusions: Our study represents a significant advancement in developing personalized and innovative eHealth solutions for general practice, addressing key clinical challenges.

Purpose: Conduct a systematic review aimed to identify and synthesise evidence describing how walking impairment impacts the way persons with multiple sclerosis (MS) participate in activities within their homes and communities. Further, we assessed the sensitivity of the International Classification of Functioning, Disability and Health (ICF) framework to the lived walking experience for persons with MS.

Methods: Seven electronic databases were searched for peer-reviewed articles on the walking experience of persons with MS. Qualitative articles were included if they included quotes from persons with MS regarding community walking. Qualitative data were synthesised using a hybrid inductive and deductive thematic analysis, guided by the ICF framework and quality was appraised using the CASP tool.

Results: We included 90 eligible studies (214 quotes, 1813 participants). Study quality was high in 54% of studies. Four themes were identified: (1) adapting to physical barriers; (2) navigating society; (3) emotion and mindset; and (4) personal relationships.

Conclusions: The impact of walking impairment on community participation is perceived by persons with MS as negative and the cause of disconnect from those around them. Barriers are largely perceived as extrinsic to the self. Caution should be exercised when conceptualising walking experiences with MS using the ICF framework alone.

Purpose: Lower limb dysfunction following a stroke substantially hinders mobility and independence. Cerebellar noninvasive brain stimulation (NIBS) has exhibited potential in enhancing lower limb functionality post-stroke. Our study aims to evaluate the effects from both statistical and clinical significance based on the International Classification of Functioning, Disability, and Health (ICF).

Materials and methods: We systematically searched PubMed, Embase, Web of Science, and Cochrane Library. With meta-analyses and network meta-analyses conducted. Data extraction and analyses based on Cochrane Handbook and ICF.

Results: Fifteen studies (n = 579 patients) were enrolled. Cerebellar NIBS revealed statistically significant differences in "Activity" components, including the Berg Scale (MD = 4.37), Timed Up and Go Test (TUG; MD = 3.32), and Barthel index (BI; MD = 8.01). However, no significant differences were noted in "Body" Functions (FMA-LL; MD = 2.97), with high-dose intermittent theta-burst stimulation indicating a potentially large effect size (MD = 5.26 vs. 0.68). The post-hoc network meta-analysis showed no statistical difference between electrical and magnetic cerebellar NIBS in "Activity" components.

Conclusions: As per the low-to-moderate level evidence, cerebellar NIBS demonstrated statistically significant improvements in the "Activity" components (Berg, TUG, and BI), albeit these improvements did not translate into clinically meaningful differences, except for BI.

Purpose: This descriptive qualitative study explored knowledge users' perspectives on precision rehabilitation concepts, barriers, facilitators, and future directions as part of a convergent mixed methods scoping review.

Materials and methods: Sixteen clinicians, administrators, and researchers from three North American tertiary care rehabilitation centers were recruited using convenience and snowball sampling to participate in individual semi-structured interviews. Conventional qualitative content analysis followed a deductive thematic approach based on predetermined categories.

Results: Analyses revealed three main themes: (1) Although precision rehabilitation shares foundational concepts with precision medicine, there are certain elements, such as personalization, that are uniquely expressed; (2) Rehabilitation-specific facilitators to precision approaches include the use of unobtrusive technology to collect large amounts of data in real-world contexts, while barriers include rehabilitation's typically small, heterogeneous sample sizes; and (3) The future of precision rehabilitation will require collaborative data-sharing to focus on determining care trajectories that enhance functional outcomes.

Conclusion: Findings provide the first qualitative synthesis of knowledge users perspectives to complement quantitative evidence and inform the emerging field of precision rehabilitation.