Disability and Rehabilitation最新文献

Purpose: This qualitative evidence synthesis aimed to identify and integrate findings where adults with fibromyalgia discussed how they managed their pain, and their perceptions of prescribed treatments from healthcare professionals.

Materials and methods: A comprehensive search strategy was implemented in PubMed, Scopus, ISI Web of Science, and Cinahl Plus databases. The GRADE-CERQual framework was used to evaluate the findings confidence. The findings were analyzed using an inductive thematic analysis approach.

Results: A total of 35 studies (N = 728) were included. The confidence in the findings ranged from high to low confidence. Patients with fibromyalgia often do not benefit from seeking medical attention due to provider stigma, and have varying views on medication effectiveness commonly reporting feeling like "walking chemists." They find mixed effects from exercise, and consider psychological support essential, although the benefits of cognitive-behavioral therapy were controversial. Combining cognitive-behavioral therapy with physical exercise appears more effective, while natural and complementary therapies have short-term benefits and high costs.

Conclusions: Pain management is a source for frustration and an unmet need for patients with fibromyalgia. The current findings provide crucial insight for providers and researchers; and support the need for fibromyalgia phenotyping and precision medicine approaches to pain management.Implications for RehabilitationChronic widespread pain is the defining feature of fibromyalgia, yet pain reduction is often an unmet need for these individuals.The lack of effective treatments resulting in long-term relief proves frustrating for patients and healthcare providers.Rehabilitation professional should consider the unique insight into this complex, heterogeneous condition that this qualitative synthesis provides to better understand their patient's perspective on pain management.Given the differing perspectives on pain treatment approaches individuals with fibromyalgia report, providers should discuss with each patient their current strategies and take a patient-centered, individualized approach to form an effective treatment plan.

Purpose: Narrative Medicine complements the clinically centered approach, which focuses on the analytical and sanitary aspects, with the illness- and disorder- centered models, which deal respectively, with personal coping and social perception of a condition. Hypermobile Ehlers- Danlos Syndrome and Behçet's Disease are two rare multisystemic chronic disease experienced a myriad of clinical symptoms, psychological distress, and poor quality of life. The purpose of this report is to describe application of a multidisclipinary rehabilitation intervention according to the narrative medicine.

Case description and intervention: a 35-year-old woman with a 23-year history of Hypermobile Ehlers-Danlos Syndrome and Behçet's Disease was admitted. A multimodal rehabilitation approach was implemented and described through the patient's feelings and expected short-, medium-, and long- terms goals. Moreover, she reported her feeling with periodical interview by her therapist.

History patient: The patient was seen for 32 weeks. A decreased pain, as well as improved function was recorded immediately post-intervention.

Conclusion: Narration is not just an interpretation of the illness experience, but the result of reshaping the interpretations of the story that both patient and health professional. This discipline provides enrichment of care, especially when combined with rehabilitation in chronic disease, by paying attention to and using even in the therapeutic phase the stories of patients, family and health care personnel, giving the opportunity to define a tailored effectiveness rehabilitation approach at the light of the different points of view of the subjects.

Purpose: This study aimed to vet the measurement properties of Brief-BESTest scores in children, adolescents, and youth with visual impairment and blindness (YVI). Methods: A cross-sectional sample of YVI (N = 101) completed the Brief-BESTest, a modified version of the Y-Balance Test, the 360-degree turn test, bipedal quiet stance, and Activity-Specific Balance Confidence Scales. Thirty-seven YVI completed test-retest of the Brief-BESTest using a one-year interval. Using classical test theory, various forms of total and item-level Brief-BESTest score reliability and validity were investigated in YVI. Results: All inter-rater reliability coefficients were ≥ .80. When considering the eight items of the Brief-BESTest, 27 of the 28 possible correlations were statistically significant (p<.05). Various internal consistency and item difficulty results were strong. When taking total Brief-BESTest scores and their association with the complementary balance tasks/metrics into account, 11 of 13 associations were statistically significant (p<.05) providing strong convergent validity evidence. Being multimorbid and degree of vision significantly predicted total Brief-BESTest scores (p<.001) suggesting construct (i.e. known groups) validity. Numerous test-retest results (e.g. coefficients, limits of agreement) following the one-year interval were indicative of score stability. Conclusion: Practitioners and researchers should have confidence in, and consider adopting, the Brief-BESTest to examine multidimensional balance in YVI.

Purpose: To investigate the effects of mirror therapy (MT) and therapeutic exercise (TE) with the unaffected hand, on pain, sensitivity and functionality in individuals with unilateral carpal tunnel syndrome (CTS).

Material and methods: A randomized controlled trial was carried out. Thirty-nine adults with unilateral CTS were included and randomly allocated to a six-week training programme based on MT (n = 20) or TE (n = 19). Visual Analogue Scale, Semmes-Weinstein monofilament test, Two-point discrimination (2PD), Disabilities of the Arm, Shoulder and Hand (DASH) and Boston Carpal Tunnel Questionnaire (BCTQ) were assessed before (T0) and after the intervention (T1), and at one-month follow-up (T2).

Results: At T1, MT and TE showed significant improvements in pain (p = 0.001 and p = 0.03, respectively), however, only MT maintained the achieved effects at T2 (p = 0.01). In addition, 2PD significantly improved in MT in the first (p = 0.04) and fourth fingers (p = 0.02) at T1. The DASH score decreased at T1 in MT (p < 0.001) and TE (p = 0.01). Additionally, the BCTQ score improved in MT (p < 0.001), and TE (p < 0.001) at T1. The effects were maintained at T2 for DASH and BCTQ scores.

Conclusions: Training of the unaffected hand resulted in a significant improvement of the affected hand in both groups; nevertheless, MT achieved a longer duration of the effects.

Purpose: This review aimed to characterise and map: (1) what type of evidence and what dominant study characteristics are available regarding acquired brain injury (ABI) survivors' experience of occupation and activity in hospital? (2) How are occupation and activity conceptualised in the literature? (3) How are ABI survivors experiencing occupation and activity while in hospital? (4) What factors create barriers or opportunities for engagement in occupations or activity in hospital? (5) Are there any knowledge gaps identified?

Materials and methods: A scoping review was conducted examining literature published between 2017 and 2022. Relevant studies were systematically retrieved from electronic databases.

Results: Thirty-four publications were included. There were more quantitative studies (n = 18). Much of the research has been conducted outside of the UK. The populations studied were principally stroke (n = 22). The concept of activity rather than occupation predominates. Patients spend their time alone and inactive. Structural and contextual barriers for engaging in activity are identified. Qualitative study designs exclude ABI survivors with communication or cognitive impairment.

Conclusions: There is a paucity of research with ABI survivors in hospitals in the UK. Alternative methodological approaches such as ethnography would ensure those with communication or cognitive impairment are not excluded from research. Implications for rehabilitationRehabilitation professionals, especially occupational therapists, need to lead acquired brain injury (ABI) research in acute hospital settings in the UK.Conceptualisation of meaningful activity and occupation needs a clearer focus in ABI research.Qualitative studies frequently exclude participants with cognitive or communication impairments so methodologies that are more inclusive and representative of brain injury survivors are needed.

Purpose: To evaluate the efficacy of transcranial direct current stimulation (tDCS) in pain management in subjects with oncologic process.

Material and methods: Several databases were searched in December 2023. Randomized Controlled Trials that evaluated the application of tDCS on pain in adults with oncologic process were selected. Random-effects meta-analysis with 95%CI were used to quantify the change scores in pain between tDCS and control groups.

Results: Six trials with 482 participants were included. There were significant differences in favor of tDCS in pain intensity in surgical oncology patients compared to sham stimulation (p < 0.001). Non-surgical patients showed no significant effect. Meta-regression analysis in this group of patients showed that the timing of the evaluation moderated the effect of tDCS on pain (p= .042), with longer time after tDCS being associated with greater pain reduction.

Conclusions: The application of a-tDCS for at least 20 min, with a current density higher than 0.057 mA/cm2, applied over M1, left DLPFC, or the insula area, between 2-5 sessions appears to be an effective and safe treatment of pain in surgical oncology patients compared to sham. The tDCS appears to be more effective for high-intensity pain, and in the long term.

Purpose: After traumatic brain injury (TBI), individuals may face challenges in their social participation, self-awareness, and self-identity. However, positive life changes can also be experienced (i.e., post-traumatic growth). This study aimed to characterize the social participation, self-awareness, and self-identity of individuals with TBI displaying post-traumatic growth.

Materials and methods: Fifteen participants (male = 10, mean age = 49.7 years) with moderate to severe TBI (average years post-injury = 15.2) were included in this mixed-methods study. Self-report questionnaires were used to assess social participation, self-awareness, and self-identity. Qualitative data, collected using semi-structured interviews, were used to categorize participants into two groups: higher (n = 8) and lower (n = 7) post-traumatic growth. Descriptive statistics were used to characterize participants in each group in terms of their social participation, self-awareness, and self-identity.

Results: Participants with higher post-traumatic growth had increased social participation, higher self-awareness, and fewer negative discrepancies between their pre- and post-injury self-identities, compared to participants with lower post-traumatic growth.

Conclusion: This study contributes to a more comprehensive understanding of post-traumatic growth through the use of both qualitative and quantitative data. These findings can inform future research and development of programs to promote post-traumatic growth post-TBI.

Purpose: This study aims to overcome the challenges experienced in the regional development and implementation of home-based stroke rehabilitation (HBSR) and to understand the change process needed.

Materials and methods: Using participatory action research (PAR), participants and researchers collaboratively produced knowledge and took action to improve the offered HBSR. Different methods for data generation and analysis were used, depending on the aim of the PAR phase and the participants' stages of change. The Consolidated Framework for Implementation Research (CFIR) was used to select implementation strategies and to evaluate the implementation process.

Results: Developing and implementing HBSR resulted in multiple products that promoted the implementation of a regional stroke network and affiliated work arrangements. Work arrangements were embodied in a stroke care pathway, follow-up tool, and expertise requirements. Evaluating the PAR process identified participants being able to take the lead, being facilitated by others, and making progress visible, as implementation facilitators. Collaborating within a primary care project can be challenging but is considered essential and has a positive impact on multiple levels. Also, the implementation of HBSR calls for multiple implementation strategies reflecting multiple CFIR constructs.

Conclusion: This study highlights the complexity and achievements of developing and implementing HBSR using PAR.

Purpose: To review existing research on psychosocial factors associated with athlete adaptation to acquired spinal cord injury (SCI).

Methods: A systematic review was conducted in February 2023. MEDLINE (Pubmed), PsycINFO, and SPORTDiscus databases were used, and peer-reviewed academic journal entries fully retrievable from the researcher's institution library or online were considered for inclusion. Publications were identified according to predetermined eligibility criteria, and 18 publications were included in the review.

Results: The results identified many psychosocial factors associated with adaptation to acquired SCI, including self-identity, emotions, coping strategies, sport involvement, social support, narratives, pain, participation, activity, self-efficacy, and sociability.

Conclusions: This review highlights the need for innovative methodologies and diverse perspectives and sampling in future investigations. Rehabilitation and sport and performance psychology practitioners working with athletes with acquired SCI are encouraged to gain a better understanding of the narratives framing and constraining athletes' life stories and rehabilitation experiences and consider using strategies such as narrative ambushing (Frank, 2010) to help athletes develop new ways of thinking about acquired SCI. Rehabilitation practitioners are also encouraged to discuss and facilitate opportunities to get involved in adaptive sports for athletes with acquired SCI as part of their rehabilitation plan.

Purpose: To understand the breadth of sensory dysregulation on participation in daily tasks for young people with tic disorders, as research identified that sensory dysregulation experiences are broader than the symptoms being assessed.

Methods: Eighteen semi-structured interviews were conducted with 16 families with children (5-16 years) with tic disorders. Interviews ranged from 45 to 120 min and were transcribed verbatim. Data collected from parents and young people were analysed and coded together. Thematic analysis using inductive and open coding methods was implemented using NVivo.

Results: The impact of sensory dysregulation on daily life may be understood through the higher-order theme: ''sensory, emotions and tics; it's a ticking time bomb'', and three subthemes: (1) we sacrifice and adapt to get daily activities done in the home, (2) my child's experience of the community environment hinders participation, and (3) sensory preferences impact our entire family.

Conclusion: Sensory dysregulation experiences impact the entire family's quality of life, yet patient-reported sensory measures do not adequately capture the impact on the family unit and breath of symptoms. A sensory-based measure for children with tics is needed to comprehensively assess sensory dysregulation sensitivities for this population, ensuring patients' needs and effectiveness of therapy can be measured.