Disability and Rehabilitation最新文献

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.

Purpose: To evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) on gait and brain alteration in cerebral palsy (CP) children.

Materials and methods: MEDLINE, Scopus, Google Scholar, Web of Science, and Cochrane were searched in February 2024 and updated in 9 October 2025. Randomized controlled trials (RCTs) with CP participants under 18, rTMS or tDCS intervention, and gait assessment were included. The risk of bias was assessed, and a meta-analysis was conducted using random-effect models.This review was registered in PROSPERO (ID: CRD42024555049).

Results: 21 studies met the inclusion criteria. tDCS led to significant improvements in velocity (MD = 0.17, 95% CI = 0 to 0.35), gross motor function measure (GMFM), and functional independence. However, changes in other parameters such as step length, and cadence were not statistically significant and showed high heterogeneity. rTMS also improved overall motor function and walking performance in several studies, though data variability prevented meta-analysis. Both methods were safe and well-tolerated.

Conclusion: Both interventions showed promise for improving velocity and GMFM in children with CP. However, due to inconsistent findings across other gait parameters and substantial heterogeneity, further large-scale, standardized RCTs with neuroimaging assessments are needed.

Purpose: To determine the implementation considerations for an online mindfulness-based intervention (MBI) tailored to individuals with spinal cord injury (SCI) and determine whether the identified preferences vary by demographic and clinical characteristics.

Materials and methods: This study was a cross-sectional, online survey using an integrated knowledge translation (iKT) approach. Adults with SCI across Canada and the United States participated in this study. Participants stated their preferences and importance of different aspects of the program (e.g. delivery format, session structure). The survey content was informed by an earlier qualitative study and the Template for Intervention Description and Replication (TIDieR) framework.

Results: 361 adults with SCI (225 males, mean age 36 (SD 8.61)) completed the survey. Prerecorded webinars were the most preferred format for an online MBI. The preferred duration and frequency of the program were 6-8 weeks and 2 sessions per week, respectively. The preferred session length was 30-45 min. Participants preferred having the program be introduced during inpatient SCI rehabilitation.

Conclusions: This study identified the preferred adaptations for an online MBI for individuals with SCI in Canada and the United States. Survey results will inform the development and implementation of a tailored online MBI that is relevant and meaningful to individuals with SCI.

Purpose: To explore the scope of the methodologies reported for Audit & Feedback (A&F) in rehabilitation settings.

Method: The keyword search strategy was validated by a specialized librarian and conducted in the PubMed and CINAHL databases. Two reviewers screened the studies using Covidence software, and conflicts were resolved by a third person. The inclusion criteria were 1) to take place in a physical rehabilitation setting, 2) to use the A & F, and 3) to be written in English or French. Data were extracted into an Excel grid, and descriptive analyses were conducted to summarize the characteristics of the studies and A&F methodologies.

Results: Sixty studies were included. A&F are primarily used in the context of implementing a new program/intervention (40.0%), or to ensure adherence to guidelines and recommendations (55.5%). Principal data collection methods are audit of medical files (51.7%) and observations (6.7%). Nineteen studies (31.7%) provided both written and verbal feedback, yet thirteen studies (21.7%) did not clarify the feedback recipients (e.g. managers, clinicians). Research gaps identified included a lack of guiding frameworks for A&F reported in the studies and the absence of a detailed feedback procedure.

Conclusion: Our study reflects the importance of thorough reflections on best practices.