Disability and Rehabilitation最新文献

Purpose: The aim of the study was to examine the reliability and validity of the Groningen Meander Walk Test (GMWT).

Materials and methods: Forty-six people with Parkinson's disease (PwPD) and 32 controls were included. Reliability was determined using intraclass correlation coefficients (ICC) and the minimal detectable change (MDC). Correlations between the completion time (CT) and overstep score (OS) of the GMWT and the other balance and disease severity specific tools were used to assess validity. The CT and OS of the GMWT were also compared between fallers and non-fallers among PwPD.

Results: The GMWT times demonstrated excellent test-retest reliability (ICC = 0.964) while overstep scores had good test-retest reliability (ICC = 0.757). The MDC was 1.72 s for CT and 1.64 s for OS. The CT of the GMWT showed moderate to strong correlations with the other measures (correlation coefficients ranged from 0.530 to 0.847, p < 0.05 for all), while the OS showed fair to moderate correlations (correlation coefficients ranged from -0.361 to 0.660, p < 0.05 for all). Significant differences in the GMWT were found between PwPD and healthy controls and between fallers and non-fallers with PwPD (p < 0.05).

Conclusion: The GMWT is a reliable and valid tool for quantifying the advanced walking skills of PwPD.Implications for RehabilitationThe Groningen Meander Walk Test is a reliable, valid, and easy-to-administer clinical assessment tool in people with Parkinson's disease.The Groningen Meander Walk Test can be used for assessing advanced walking ability in people with Parkinson's disease.The Groningen Meander Walk Test can detect fallers and freezers with Parkinson's disease.

Purpose: Adoption of rehabilitative interventions for dementia care is limited in India and is attributed to a poor understanding of dementia among caregivers. Conventional interventions target the primary caregiver and overlook the broader family unit. The study aimed to develop an education program for caregivers and families of persons with dementia.

Materials and methods: A focused literature review informed the preliminary draft of the program. Fourteen panelists participated in the modified Delphi that included semi-structured interviews in Round 1 and survey questionnaires in subsequent rounds.

Results: The preliminary program was based on available literature from developed countries with individualistic cultures. In Round 1, panelists raised concerns that the program's instructional content, high reading demands and didactic approach may not be suitable for India's diverse family systems, collectivistic values and resource constrained settings. The program was modified by incorporating case vignettes representing different culturally appropriate care scenarios and family living arrangements. The delivery was modified to be more personalized, interactive and conversational with activities and guided practice tasks. In Round 2, consensus was achieved (S-CVI/Ave = 0.96) for the modified program.

Conclusion: The developed culturally appropriate family-centered education program may be a meaningful, feasible, and promising approach to support dementia rehabilitation.

Purpose: To systematically review and synthesize qualitative evidence on therapists' perceptions, attitudes, and lived experiences with lower limb robotic exoskeletons in stroke rehabilitation settings.

Methods: Seven databases (PsycINFO, Embase, Scopus, Web of Science, PubMed, MEDLINE, CINAHL) were searched from inception to March 2025. Study quality was assessed using the Critical Appraisal Skills Program (CASP) checklist. Thematic synthesis was employed with confidence assessed using GRADE-CERQual.

Results: Ten studies met inclusion criteria, representing 157 therapists across nine countries. Four major themes emerged: (1) Clinical benefits and therapeutic potential - including significant reduction in physical demands and enhanced treatment capabilities (40-fold increase in step repetitions); (2) Implementation challenges and barriers - notably time constraints (15-40 min setup), prohibitive costs ($33,000-$250,000 USD), and restrictive patient eligibility; (3) Professional adaptation and identity - encompassing role tensions and competency development; (4) Integration into rehabilitation practice - with universal consensus that exoskeletons should complement rather than replace conventional therapy. High confidence was found in 60% of key findings.

Conclusions: While therapists recognize substantial benefits of lower limb robotic exoskeletons, significant barriers limit routine implementation. Successful integration requires comprehensive training, adequate resources, organizational support, and preservation of clinical reasoning.

Prospero registration: CRD42024602812.

Purpose: HAND-Q Life Impact Scale assesses how hand conditions affect quality of life, and it has not yet been translated nor validated for the Portuguese population. The aim is to translate, culturally and linguistically adapt, and pilot validate the HAND-Q Life Impact Scale for the Portuguese population.

Materials and methods: Multicenter study involving translation, cultural and linguistic adaptation following International Society for Pharmacoeconomics and Outcomes Research guidelines (ISPOR) and pilot psychometric properties testing, at Physiatry and Occupational Therapy departments in rehabilitation centers in Portugal. 15 patients with hand conditions for cognitive interviews, 7 experts reviewed the scale, and 30 patients for pilot validation study.

Results: The HAND-Q Life Impact Scale demonstrated excellent internal consistency (α = 0.891) with most items showing good item-total and inter-item correlations. A good degree of agreement was obtained among the experts. Significant correlations with upper limb disability and health related quality of life supported its validity.

Conclusion: The Portuguese version of the HAND-Q Life Impact Scale appears to be reliable and valid for assessing the impact of hand conditions on quality of life, but further studies should confirm the findings. This research introduces the first validated Portuguese version of the HAND-Q Life Impact Scale.

Purpose: The International Parkinson and Movement Disorder Society Modified Unified Parkinson's Disease Rating Scale (MDS-UPDRS) is the gold standard evaluation of Parkinson's Disease (PD), but there is inter-rater variability. Wearable biosensors are a novel tool to quantify neurodegenerative symptoms in PD. This project aimed to use XSens sensors to assess PD patients during motor tasks and identify differences compared to controls.

Methods: Participants with PD (n = 6) exhibiting freezing of gait (FOG) were compared to controls meeting inclusion criteria (n = 5). Participants donned inertial motion capture sensors and underwent motor assessments. Data was analyzed using MATLAB and Prism.

Results: Using XSens, we found stride length in PD patients is reduced compared to controls (0.58 m vs. 0.97 m, p = 0.0028). Wrist rotational area is reduced in PD patients compared to controls (445mm² vs. 2731 mm², p < 0.01). When following the beat of a metronome, PD patients exhibited an increased standard deviation in beats per minute compared to controls (0.072 vs. 0.040, p = 0.024).

Conclusion: We identified novel clinical tests of wrist rigidity and rhythmicity, which identified significant differences between groups. This exploratory study indicates accelerometry is a promising biomarker for remote monitoring and screening of PD, which needs to be substantiated with large-scale clinical studies.

Purpose: This study examines the impact of EksoNR robotics exoskeleton training on gait performance in individuals with progressive and non-progressive neurological impairments and compares the gait effectiveness outcomes between these groups over fifteen therapy sessions.

Materials and methods: Sixteen participants (n = 8 progressive; n = 8 non-progressive) were enrolled in a community-based exoskeleton program at Dublin City University. Each completed 15 sessions (approximately once per week). Gait outcomes included (i) exoskeleton assistance level, (ii) walking efficiency (walk time and step count), and (iii) session efficiency (ratios of walk time and step count to up time).

Results: The non-progressive group showed a significant reduction in exoskeleton assistance (79.9% to 66.4%), while no significant change was observed in the progressive group. Both groups demonstrated significant improvements in walk time (566 s to 1268 s), step count (322 to 703), and session efficiency (step count ratio: 31.1% to 31.6%; walk time ratio: 20.0% to 21.1%).

Conclusions: Community-based EksoNR training significantly improves gait performance in both progressive and non-progressive neurological conditions. In non-progressive cases, reducing robotic assistance may enhance recovery, while walking and session efficiency metrics better reflect progress in progressive conditions.

Purpose: This study aimed to investigate the effectiveness of digital combined decongestive therapy (CDT) in individuals with lower extremity lymphedema (LEL) and to determine its impact on limb volume and functional outcomes in short- and long-term follow-up.

Materials and methods: This prospective single-arm clinical trial with follow-up included individuals with LEL. Limb circumferences were recorded at baseline (V0), post-treatment (V1), and 12-week follow-up (V2). Functional status and participation were evaluated with the Lymphedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphedema (LYMPH-ICF-LL). All participants received one weekly therapist-led CDT session over 4 weeks, supplemented by digitally guided self-management, followed by compression garment use during the follow-up phase.

Results: Eighty-two patients with LEL (129 affected limbs; mean age 56.5 ± 18.3 years; 63 female/19 male; 47 bilateral/35 unilateral LEL; 37 primary/45 secondary LEL) were enrolled. Mean limb volume significantly decreased from 5027.7 ± 1826.0 mL at baseline to 4682.3 ± 1746.0 mL post-treatment (p < 0.001), and further to 4310.5 ± 1380.2 mL at follow-up (p < 0.001). Improvements were also observed in total and domain-specific LYMPH-ICF-LL scores at both time points (all p < 0.001).

Conclusions: Digital CDT reduces extremity volume and improves functionality in LEL patients, demonstrating short and long-term efficacy. It provides an alternative to conventional CDT, enhancing accessibility and adherence.

Purpose: Disabled people are less likely to be employed than those without disabilities. Research on the relationship between accessibility and the employment of physically disabled people has focused primarily on accessibility concerns within workplaces, neglecting challenges associated with travel to and within work, or 'work mobility'. Those few researchers who have addressed work mobility largely deal either with people with nonwork-related disabilities or with the return-to-work experiences of injured workers. Both literatures pay insufficient attention to the potential role of policy and practice in helping workers navigate work mobility challenges. This paper presents findings from a qualitative study of work disability policies that affect the work mobility of disabled people, with both work and nonwork-related physical disabilities, in the Canadian context.

Materials and methods: Findings are based on a combination of document analysis of policy texts related to work injury and disability support programs in two Canadian provinces, and semi-structured interviews with key informants (N = 6) and disabled people (N = 6).

Results: Important weaknesses in both workers' compensation and general disability policies negatively influence employment options and enhance reliance on informal support.

Conclusions: Work mobility challenges contribute to unemployment and poverty among disabled people. Ways to better support work mobility are identified.

Purpose: This systematic review aimed to evaluate the effectiveness of yoga interventions in individuals with intellectual disabilities (ID), a population vulnerable to physical and mental health issues and in need of accessible, holistic therapies.

Methods: Following PRISMA guidelines, a systematic search was conducted in Web of Science, PubMed, SPORTDiscus, and Scopus up to March 2025. Study quality was assessed using PEDro and MINORS tools.

Results: Ten studies involving 518 participants met inclusion criteria. Yoga interventions (ranging from five weeks to 10 months) showed significant within-group improvements in balance, anthropometric measures, pulmonary and cardiovascular parameters. Between-group differences favored yoga over no intervention, although benefits were often comparable to other exercise modalities. Methodological quality was mostly "good" for RCTs, but lower for comparative studies.

Conclusions: Yoga appears to be a promising strategy for improving balance, anthropometric parameters, and pulmonary function in individuals with ID.

Purpose: To explore how a brief reframing intervention influences physical activity (PA) behaviors and cognitive biases in individuals with Multiple Sclerosis (MS).

Materials and methods: In this mixed-method, single-arm study, 22 individuals with MS received a one-on-one, ∼15-min reframing session targeting negative exercise-related thinking patterns. Participants completed surveys at four time points (pre-, post-, 1-week, and 4-weeks post-intervention) assessing cognitive errors and PA. A follow-up interview at 1 week explored individual experiences and perceived changes. Interview data were analyzed using inductive content analysis; Repeated Measures ANOVA assessed changes in outcomes.

Findings: Cognitive errors decreased from pre-reframing (M = 5.32) to 1-week post reframing (M = 4.52, p = 0.013, partial eta = 0.258). Light PA significantly increased from pre-reframing (M = 2.26) to 1-week post reframing (M = 3.14, p = 0.029, partial eta = 0.218). While moderate-vigorous PA significantly increased from pre reframing (M = 2.76) to 4-weeks post reframing (M = 5.76, p = < 0.01, partial eta = 0.460). Changes to PA at all levels were sustained at the 4-week follow-up. Interviews contextualized these changes, revealing shifts in motivation and self-talk.

Conclusion: Reframing may be an effective strategy to increase physical activity and decrease cognitive biases for individuals with MS. Findings provide preliminary support for a future randomized pilot trial to evaluate efficacy.