Disability and Rehabilitation最新文献

Purpose: Physical activity at home is vital after hospital or rehabilitation admission to support recovery and participation in society. This study aimed to identify determinative factors for physical activity at home during the first year post-discharge from the patient's perspective.

Materials and methods: Narrative storytelling was used to explore the underlying emotions and motivations behind physical activity behavior among orthopedic and neurological patients during the first year post-discharge. Analysis included extracting multiple real-life stories from each interview, followed by reflexive thematic analysis.

Results: Fourteen participants (9 orthopedic, 5 neurological) were interviewed. Across the extracted stories, 45 topics were identified and grouped into 4 main themes and 9 subthemes. Findings underscore that long-term physical activity requires rehabilitation to be rooted in patients' life roles, values, and priorities, enhancing autonomy and opportunities for personal functional activities in supportive clinical and home environments. Positive reinforcement and involvement of significant others, provided with practical strategies, were seen as essential for sustaining activity at home. Across neurological and orthopedic subgroups, shared determinative factors included focusing on daily life participation and fostering patients' responsibility and resilience.

Conclusions: Emphasizing participation in personal environments and fostering self-management, autonomy, and resilience may enhance physical activity at home.

Purpose: This study explored the 2-year impacts of the Family Engagement in Research (FER) Course on researchers' and family members' engagement in neurodevelopmental disability and child health research.

Materials and methods: A qualitative study was conducted with graduates from the first six cohorts of the FER Course. Data were collected through semi-structured interviews and focus groups two years after taking the course. Thematic analysis was used to analyze qualitative data from transcripts.

Results: Twenty-six learners (family members and researchers) participated in the 2-year follow-up interview or focus group. The majority (85%) reported increased involvement in FER since they completed the course, which included (i) engaging in research and (ii) advocating and championing FER. Learners reported how the course supported their research engagement, which included: (i) feeling confident and empowered; (ii) acquiring new knowledge and skills; (iii) embracing new perspectives; and (iv) growing a network for FER.

Conclusions: The FER Course is a training initiative that enables and sustains research engagement over time. Training for both researchers and family members is essential for building capacity in FER in neurodevelopmental disability and child health research.

Purpose: Return-to-work (RTW) following road traffic accidents (RTAs) is essential for better health and financial outcomes. The Motor Vehicle Accident Fund (MVAF) Botswana assists loss-of-income (LOI) claimants with medical assistance, LOI compensation and facilitates RTW. Claimants' experiences affect RTW. This qualitative study investigated barriers to and facilitators of RTW for LOI claimants at the MVAF Botswana.

Materials and methods: Eleven LOI claimants were purposively sampled and participated in two focus group discussions. They benefited from LOI compensation between 2015 and 2020. Thematic analysis and a hybrid inductive and deductive approach were used to analyze the data via the ecological case management model.

Results: The main themes were health care, personal, workplace and legislation and insurance systems, which were further classified into eight subthemes related to barriers and facilitators. The combined top facilitators were (1) vocational rehabilitation, (2) medical assistance, and (3) effective case management, whilst top barriers were (1) severe injuries, (2) insufficient LOI funds, and (3) ineffective RTW case management.

Conclusion: Effective medical case management and coordinated RTW processes are vital for RTW; equally, the severity of injury affects RTW success.

Contribution: Understanding barriers and facilitators of RTW can inform personalized RTW interventions.

Purpose: Upper extremity function is crucial for daily living activities. This study aimed to validate the Persian version of the 10-item Arm Function in Multiple Sclerosis Questionnaire-Short Form (AMSQ-SF) in individuals with multiple sclerosis (MS).

Materials and methods: In this cross-sectional study involving 201 individuals with MS, the AMSQ-SF was evaluated for reliability (test-retest in 50 participants) and construct validity against a battery of established performance-based and patient-reported outcome measures. Spasticity and disability levels were employed to evaluate the questionnaire's ability to differentiate between various subgroups.

Results: The Persian AMSQ-SF demonstrated excellent reliability (ICC_(2,1) = 0.94) and internal consistency (α = 0.95). Its strong construct validity was evidenced by correlations in the hypothesized directions with measures of grip strength, quality of life, self-reported function, dexterity, and fatigue. It differentiated patients with and without spasticity and various disability levels (p < 0.001). Clinically useful cutoff scores were established to classify impairment severity (mild ≥16, moderate ≥20, severe ≥26) with high sensitivity (70-81%) and specificity (85-95%).

Conclusions: The AMSQ-SF demonstrates strong validity and reliability as a questionnaire for individuals with MS, suitable for use in both research and rehabilitation settings.

Purpose: Assessing postural stability before and after total knee arthroplasty (TKA) is crucial for monitoring recovery and guiding rehabilitation. This study evaluated postural stability and the Romberg quotient in individuals with knee osteoarthritis (OA) before and after TKA, compared with healthy controls.

Materials and methods: This prospective, longitudinal single-center study included 77 individuals with primary knee OA scheduled for TKA and 77 age- and sex-matched controls. Postural stability was assessed using a Win-Track force platform under eyes-open and eyes-closed conditions preoperatively and postoperatively. Parameters included center of pressure (CoP) length, area, average sway speed, and sway deviations and the Romberg quotient. Between-group and within-group comparisons were done.

Results: Individuals with knee OA exhibited significantly impaired postural stability compared to controls. Following TKA, progressive improvement was observed, with significant reductions in CoP area and sway deviations. At 12-month post-TKA, postural stability parameters were comparable to controls during eyes-open, with minimal differences during eyes-closed. Romberg quotient showed no statistically significant differences across time points or between groups.

Conclusions: TKA significantly improves postural stability in individuals with knee OA. Despite improvements, subtle deficits in postural control may persist postoperatively. Rehabilitation should emphasize neuromuscular reeducation and sensory integration to optimize balance and reduce fall risk.

Purpose: To assess French- and Dutch-speaking physiotherapists' knowledge, practices, and acceptance of immersive virtual reality (VR) in clinical settings.

Materials and methods: A cross-sectional online survey (NCT06252363) was conducted from February to July 2024, targeting French- and Dutch-speaking physiotherapists via non-probability sampling methods. Data were analyzed descriptively.

Results: A total of 155 physiotherapists from eight countries participated, mostly from Belgium. Most (75.5%) had never used immersive VR, while 12.25% were current users and 12.25% past users. Physiotherapists generally demonstrated satisfactory knowledge of immersive VR. Key facilitators and barriers to usage, reasons for discontinuation, and factors contributing to nonuse were identified. Half of the never-users showed interest in future use, a minority of past users planned to resume, and nearly all current users intended to continue. Attitudes toward immersive VR were mostly positive, though concerns about cost and value for money were noted. Immersive VR was generally perceived as clinically useful and not overly complex. Social influence did not appear to be a key factor in its adoption.

Conclusions: These findings provide insights into the perspectives of French- and Dutch-speaking physiotherapists regarding the use of immersive VR in clinical settings and may help inform the development of implementation strategies targeting physiotherapists.

Purpose: Although the COVID-19 pandemic has ended, long-term effects persist. Exercise training (ET) supports recovery, but evidence on optimal modalities is limited. This study evaluated the effects of different ET modalities in post-COVID-19 individuals.

Methods: A systematic search identified randomized controlled trials (RCTs) up to 23 September 2025, involving adults with COVID-19. Studies compared ≥4-week interventions-aerobic training, high-intensity interval training (HIIT), or combined training (aerobic plus resistance training)-with usual care (UC). Risk of bias and certainty of evidence were assessed using RoB 2.0 and GRADE.

Results: Eighteen RCTs (N = 1171) were included. Interventions varied in intensity and duration. Most studies had "some concerns" regarding bias, and overall certainty of evidence was low to very low. Overall, ET modalities were associated with improvements in functional capacity (VO₂peak or six-minute walk distance) and muscle strength, although not all studies showed significant differences vs. UC. HIIT demonstrated the greatest VO₂peak gain (mean difference: 6.17 ml.kg^-1.min^-1). Effects on quality of life, anxiety, and depression were inconsistent. Most cardiopulmonary parameters (VE/VCO₂ slope, OUES) showed no significant changes, with mixed results for O₂ pulse and ventilation.

Conclusions: Despite heterogeneous protocols and low certainty of evidence, structured ET appears beneficial for post-COVID-19 recovery. Multiple ET approaches may be effective rather than a single "optimal" approach.

Purpose: To determine the effectiveness of manual therapy with or without exercise therapy in chronic ankle instability (CAI).

Materials and methods: MEDLINE, Pubmed, Scopus, PEDro, EBSCOhost and Cochrane CENTRAL were searched from January 2000 to 13^th of January 2025 for studies on the manual therapy in the treatment of CAI. The studies with primary outcome measures of ankle range of motion (ROM), pain and self-perceived function were included. A minimal clinically important difference (MCID) was used for each outcome measure to define smallest meaningful change. Meta-analysis with random-effect model was performed for studies with similar outcome measures and GRADE analysis for performed for certainty of evidence. Manual therapy interventions were compared with exercise therapy, sham therapy or control group.

Results: The final review included 13 randomized clinical trials and a total of 497 patients. Meta-analysis of ROM, FAAM and CAIT included four, four and five studies, respectively, of which ROM and CAIT were significantly effective compared to comparison groups.

Conclusions: Manual therapy is effective for ankle ROM and self-perceived function (CAIT), although effectiveness remained below the MCID values and certainty of evidence was low.

Background: Children with disabilities (CWD) experience greater obstacles than those without disabilities, including increased poverty, reduced healthcare opportunities, minimal educational resources, and stigma. This research explored the impact of community interventions on reducing stigma and discrimination toward children with disabilities.

Methods: A repeated cross-sectional survey design (2019/2021) was implemented with community members in three low-resource compounds in Lusaka, Zambia, regarding stigma related to disability and participation in sensitization events via Kusumala+, a community-based intervention designed to improve quality of life for households with CWD. The analysis included descriptive statistics and linear regression assessing group mean change over time.

Results: Participants included N = 259 (2019) and N = 1037 (2021). Subscales of stigma were identified: attitudes (t = 9.7, p < 0.001) and discrimination (t = 4.1, p < 0.001), which both significantly changed from baseline to follow-up. The effect size for the change in discrimination was d = 0.28 (95% CI 0.15-0.42) (weak to moderate effect) and for attitudes was d = 0.67(95% CI 0.53-0.81) (strong effect). Attitudes improved if event attendance occurred and increased with each additional event. In contrast, discrimination improved only when one event attendance occurred, not with each additional event change, in adjusted or unadjusted models.

Conclusion: Sensitization activities and events show promise as targeted interventions to reduce stigma and discrimination and create supportive community environments for CWD and their families.

Purpose: Currently available methods may not reliably assess language comprehension in children with significant speech and motor limitations. The Computer-Based instrument for Low motor Language Testing (C-BiLLT) is a standardized assessment designed for children with cerebral palsy that allows them to participate using various alternative response methods. This study aimed to understand speech-language pathologists' and occupational therapists' perceived facilitators and barriers to implementing the Canadian C-BiLLT (C-BiLLT-CAN).

Materials and methods: Six focus groups were conducted with 30 clinicians. Transcripts were analyzed using a semi-deductive thematic analysis. The Consolidated Framework for Implementation Research was used to guide the identification of clinicians' perceived facilitators and barriers.

Results: Clinicians unanimously reported interest in implementing the C-BiLLT-CAN. Facilitators and barriers were classified into five primary themes. Key facilitators related to the test's evidence-based design, standardized nature, and potential flexibility. Key barriers related to Internet connectivity, the need to expand customization and response options to meet a greater breadth of needs, privacy policies, lack of resources, and perceived costs associated with equipment, training, and time.

Conclusions: Many perceived barriers aligned with previous European and Canadian C-BiLLT implementation research. However, findings elucidated unique considerations that will inform adaptations to the C-BiLLT-CAN and development of training/educational materials.