Disability and Rehabilitation最新文献

Purpose: Communication Partner Training (CPT) improves communication between people with aphasia and their families and friends, but there is considerable variation in practice. We evaluated the outcomes of an implementation package on speech pathologists' delivery of CPT to familiar partners of people with aphasia, and factors influencing outcomes.

Methods: 12-month pilot stepped wedge cluster non-randomised controlled trial and process evaluation involving three health services. Implementation package included online training, workshops, resources, and support. Data were collected through audits, clinician behaviour-change surveys, training logs, checklists, questionnaires, and focus groups.

Results: Thirty-six clinicians participated, and 113 patient files were audited. Post-implementation, there was a 26% increase in familiar partners being offered CPT and an 18% increase in those provided CPT. Significant improvements were recorded between immediate pre/post implementation time-points (offering CPT: p = 0.004; providing CPT: p = 0.021), and more comprehensive CPT practice was provided, but change was not sustained. Total behaviour-change scores increased (p < 0.001), with a higher intervention effect for targeted domains (p < 0.001). Clinicians reported valuing and intending to implement CPT, but organisational barriers and patient-partner dynamics impacted outcomes.

Conclusion: Short-term improvements in CPT practice were observed, but change was not sustained. Longer-term support and CPT tailored to readiness and stage of recovery is needed.

Purpose: The Graded Repetitive Arm Supplementary Program (GRASP) is used widely to reduce arm impairment from stroke. Evidence for its effectiveness in chronic stroke survivors is based on studies that used clinical measures and different treatment lengths. This study aimed to examine whether GRASP changes movement quality by conducting a biomechanical analysis of chronic stroke survivors' movements prior to, during and after GRASP; assess whether changes in kinematic and clinical measures are associated and an intervention duration shorter eight-weeks could be similarly effective.

Materials and methods: Chronic stroke survivors (n = 27) completed the baseline measures, GRASP for eight weeks and post-measures. They practiced one-hour daily at home for six days/week and visited the University weekly, where arm movements were recorded.

Results: There were significant GRASP related improvements in movement duration and smoothness in the affected arm. Significant improvements in arm function, self-efficacy and quality of life were also observed, but these did not consistently significantly correlate with kinematic changes. There was no evidence to support shortening the program.

Conclusion: Kinematic changes in movement patterns were evident across the GRASP program as were benefits on clinical measures, but additional research is needed to determine the benefits of GRASP for chronic stroke rehabilitation.

Purpose: Therapist feedback regarding the patient's performance, behavior or personal development constitutes an effective interventional technique in the context of psychotherapy. Due to the extensive patient-therapist interaction during exercise therapy in medical rehabilitation, this study evaluated the effects of multidimensional exercise therapy feedback on the patient-related treatment outcome and satisfaction with rehabilitation.

Materials and methods: The study was conducted as a two-armed, mono-center, randomized controlled trial with three measuring points: start of three-week inpatient rehabilitation (T0), end of three-week inpatient rehabilitation (T1), 12-week follow-up (T2), and included patients with chronic neck, shoulder and/or lumbar spine disorders. The intervention group received multidimensional exercise therapy feedback during the initial and final physical therapist examination as well as short therapist feedbacks during group-based exercise therapy. The control group received usual care.

Results: 109 (69%) participants completed the study. Although patients and exercise therapists regarded the intervention as conducive for patient-therapist interaction, no significant differences were found at T1 or T2 between the intervention and control group in terms of average pain intensity, impairment or satisfaction with rehabilitation.

Conclusion: While multidimensional exercise therapy feedback is appreciated by patients, it does not improve patient-related outcomes in the context of medical rehabilitation.

Trial registration: This trial was registered with the German Clinical Trial Register (DRKS) (https://www.drks.de/search/de/trial/DRKS00027263/details) under the registration number DRKS00027263 (Date of registration: 25/Mar/2022).

Purpose: This study aims to investigate the efficacy and safety of foot orthoses (FO) in improving pain and function among patients with plantar fasciitis.

Methods: Seven databases were searched from the time of construction to February 2025. Include randomized controlled trials (RCTs) evaluating the effects of foot orthoses on pain and function in patients with plantar fasciitis for data extraction, quality assessment, meta-analysis, and subgroup analysis. A random-effects model was used to calculate the pooled effect size and its 95% confidence interval (CI), with pain and foot function as the primary outcome measures.

Results: Eight RCTs involving 391 patients were analyzed. Meta-analysis revealed that compared with the control group, the experimental group demonstrated significant efficacy in alleviating pain in patients with plantar fasciitis (p = 0.0003). However, no significant differences were observed in foot function (p = 0.23) or walking ability (p = 0.44). No adverse events related to foot orthoses (FO) were reported in the studies.

Conclusion: FO effectively alleviates pain symptoms in patients with plantar fasciitis, but no clinically meaningful statistical differences were observed in functional improvement. Further high-quality, large-sample, multicenter randomized controlled trials are needed to confirm these findings.

Purpose: To explore the experiences of physiotherapy students and people living with pain regarding their participation in a novel partnered learning activity.

Materials and methods: A concurrent mixed method design integrating quantitative and open-ended survey questions with focus group discussions was used. The activity included a one-on-one interaction between physiotherapy students and people living with chronic pain to explore the multidimensional impact of pain. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using a qualitative description approach.

Results: Twenty-five students and 42 people living with pain consented to participate. For students, three overarching themes were identified: (1) the activity was perceived as a transformative learning experience; (2) first-hand interactions, the learning tools, and the environment contributed to learning; and (3) some challenges fostered learning, while others impeded it. For people living with pain, three themes emerged: (1) translating lived experience into an empowering contribution; (2) the complex role of compensation; and (3) engagement driven by purpose and trust.

Conclusion: The partnered learning activity served as a transformative learning experience for students and empowered people living with pain through meaningful contributions of their lived experience. Future research should explore the impact of partnered activities on student learning outcomes.

Purpose: To map somatosensory impairments in the more-impaired and less-impaired upper limb of children with unilateral cerebral palsy (uCP) compared to typically developing children (TDC), using clinical and robotic assessments. Additionally, we explored which subgroups of children with uCP are more likely to experience somatosensory impairments.

Materials and methods: This cross-sectional study included 49 children with uCP (11y11m ± 2y10m, 26 males) and 49 age- and sex-matched TDC (11y10m ± 2y10m). Tactile registration (Semmes-Weinstein monofilaments), tactile perception (stereognosis, two-point discrimination), and proprioception (clinical movement sense, ETH MIKE robot, and Kinarm exoskeleton) were assessed. Differences between groups and across manual ability levels and brain lesion types were analyzed using generalized estimating equation models.

Results: Children with uCP exhibited tactile impairments in both hands (more-impaired: 27-43%; less-impaired: 12-16%) and worse proprioception bilaterally compared to TDC (p ≤ 0.003). Lower manual ability was related to worse tactile perception (p ≤ 0.001) and proximal proprioception (p ≤ 0.045). Predominant grey matter lesions were correlated with worse tactile registration (p = 0.016), perception (p ≤ 0.009), and distal proprioception (p = 0.009).

Conclusions: Our results underline the importance of including clinical and robotic assessments in the follow-up of children with uCP to identify bilateral somatosensory impairments. An international consensus on clinically relevant and well-defined assessment protocols is needed to enhance clinical translation.

Purpose: To investigate the agreement between a graded exercise test (GXT) and a 45-second sit-to-stand test and prediction equation to predict cardiorespiratory fitness (CRF) in people with stroke.

Methods: People with ischaemic stroke admitted to subacute outpatient rehabilitation at Epworth HealthCare were screened for eligibility and invited to participate. Participants completed two tests of CRF: 1) a 45-second sit-to-stand test, and 2) a GXT with measurement of gas exchange. Both tests were completed within seven days of each other, with the order of test administration randomised. Heart rate response during and after the sit-to-stand test was input into a prediction equation to obtain predicted maximal volume of oxygen consumption (VO_2max). Concurrent validity was determined by calculating Lin's concordance correlation coefficients (CCC).

Results: A total of 30 people with stroke (males n = 23, mean ± standard deviation age 67.1 ± 9.9 years) were recruited. Predicted mean VO_2max based on the sit-to-stand test was 36.2 ml.kg^-1.min^-1, while the GXT mean VO_2max was 28.0 ml.kg^-1.min^-1. There was poor agreement between the two fitness tests (CCC 0.11, 95% CI -0.07 to 0.28).

Conclusion: Predicted VO_2max based on a 45-second sit-to-stand test does not appear to be a valid test of CRF in people with stroke.

Purpose: Understand and describe the rehabilitation needs of adults with cerebral palsy (CP) who recently established adult-based physiatric care, and how these needs have changed over time.

Materials and methods: In this convergent mixed-methods study, qualitative data were collected using semi-structured interviews with adults with CP, caregivers, and dyads of adults with CP and caregivers to explore the rehabilitation needs of adults with CP. Quantitative data were collected through retrospective review of electronic health record data from patients with CP aged ≥18 years who had been seen in the adult CP clinic at least once since April 2022.

Results: We conducted 21 interviews with 27 participants (7 adults with CP, 10 caregivers, 5 dyads) and included 73 adults with CP in quantitative data extraction. We identified three qualitative themes and integrated these with quantitative findings related to rehabilitation and healthcare needs. Themes identified included: 1) The importance of therapy access throughout the lifespan; 2) Changes in and variety of equipment needs in adulthood; and 3) Evolving rehabilitation needs and goals.

Conclusions: Rehabilitation professionals play an important role in the ongoing care of adults with CP, including ensuring access to rehabilitative therapies, evaluating changing equipment needs, and supporting changing health-related goals.

Purpose: Patients with acquired brain injuries (ABI) and severe traumatic injuries face many persisting and overlapping injury-related consequences. Despite a growing number of self-management (SM) interventions targeting these conditions, no comprehensive reviews exist. This scoping review aims to map the existing SM interventions across these injury populations.

Materials and methods: Five databases (MEDLINE, EMBASE, PsycINFO, CINAHL, PubMed) were systematically searched. Studies were included if they adhered to the operational definition by Jonkman et al. and targeted adults with ABI and traumatic injuries.

Results: A total of 43 studies were included. Most interventions targeted stroke and spinal cord injuries. The key ingredients were psychoeducation, goal setting, and training in self-management skills. Most interventions were conducted in hospitals by healthcare personnel in the chronic post-injury phase. A considerable variation of reported effects was observed. Additionally, Bandura's social cognitive theory was frequently applied as a theoretical background.

Conclusions: A significant lack of SM interventions for multiple/major trauma and burns was identified. Many studies were poorly described and did not indicate how the interventions were tailored to the patients, and the effects were inconsistent. However, the findings suggest that SM ingredients are applicable to both ABI and traumatic injury populations in clinical settings.

Purpose: Engaging in meaningful social and community activities may be an option for promoting sustainable post-stroke physical activity participation. This research aimed to co-design an intervention to help people re-engage in meaningful activities and lead an active life after stroke.

Methods: A four-stage co-design methodology using an Integrated Knowledge Translation (IKT) approach was used to design a post-stroke intervention and resources: Stage one: research team planning, stage two: knowledge-user content development, stage three: research team intervention and resource development, stage four: knowledge-user review and research team adaptation and finalisation. The research team included four clinical researchers with expertise in stroke and/or physical activity, two stroke clinicians, and one stroke survivor. Knowledge-user informants were recruited to participate (Stages 2 and 4) and included eight stroke survivors (four female), median age 67 years (IQR 55-74); and 11 health professionals (10 allied-health and one registered nurse).

Results: An intervention and resources aiming to facilitate physical activity was successfully developed. It comprises a patient-facing booklet (including secondary-stroke prevention education, structured meaningful activity identification, and goal setting) and a health professional resource (including education, upskilling information, and resources).

Conclusions: This study successfully co-designed an intervention and resources which are ready for feasibility and acceptability testing.