Disability and Rehabilitation最新文献

Purpose: To identify characteristics of participants, intervention features and outcomes in studies examining aquatic exercise for adolescents and adults with cerebral palsy (CP).

Materials and methods: Four electronic databases were systematically searched on 15 August 2024. Studies that included people with a diagnosis of CP (mean age ≥15 years), and an intervention that involved an aquatic based activity were considered for inclusion. Quantitative and qualitative results were reported using narrative syntheses.

Results: Database searches yielded 299 studies of which 11 met inclusion criteria with 66 participants in total. Eight studies used a non-experimental quantitative design. Three studies included participants with greater disability (Gross Motor Function Classification System Level V); four studies included participants older than 30 years. Aquatic program components were variable. Reporting of parameters such as intensity, adverse events, and safety measures was generally poor. Participation outcomes were included in only three studies. No study formally gathered participant experiential data.

Conclusions: Aquatic programs for individuals with CP appear predominantly focused on younger people and those with mild to moderate disability. Poor reporting of program design has led to non-reproducible studies and inconsistent approaches to aquatic exercise for adolescents and adults with CP. Participant, carer, and clinician perspectives on aquatic programs remain unknown.

Purpose: The National Clinical Guideline for Stroke for the United Kingdom and Ireland was published in 2023 with an increased focus and detail regarding cardiorespiratory training. This study aimed to explore physiotherapists' perspectives into the feasibility of implementing cardiorespiratory training for people with stroke as per this new guideline.

Materials and methods: A qualitative descriptive study was conducted using semi-structured interviews with professionally registered physiotherapists, who had worked with stroke patients in the past two years. Data was inductively analysed using reflexive thematic analysis.

Results: Fifteen physiotherapists participated in interviews from a variety of healthcare settings and geographical locations across the Republic of Ireland. Three themes were constructed: 1) How cardiorespiratory training is prioritised, 2) Current practices of cardiorespiratory training and the challenges faced, and 3) Creative and resourceful solutions to improving cardiorespiratory implementation. Facilitating factors included one-to-one support, accessibility/inclusivity of services, education, promotion, and developing a stroke-specific rehabilitation programme.

Conclusions: These findings inform on current practices and challenges to implementation of cardiorespiratory training in stroke rehabilitation. Physiotherapists had innovative ideas and solutions that could enhance the delivery and implementation of cardiorespiratory training for people with stroke.

Purpose: With the increasing prevalence of early onset Parkinson's disease (EOPD) world-wide, there is a need to understand consumer views on the benefits and barriers to community exercise programs for people with this progressive condition.

Materials and methods: A physiotherapist-led, 1:1 strength training program was implemented in adults with EOPD by exercise trainers who were educated and supervised to ensure safe exercise delivery. We applied a qualitative descriptive approach to collect and thematically analyse data from two groups of consumers: (i) people ≤ 50 years with EOPD (ii) exercise trainers.

Results: Interviews from 16 participants were transcribed and inductively coded with three main themes emerging: (i) a community gym program was acceptable and of benefit in individuals with EOPD (ii) exercise delivery was safe and feasible provided that exercise trainers were educated about PD and supported (iii) challenges to regular exercise participation included work and family commitments, gym access and matching exercise times to PD medication cycles.

Conclusions: Adults with EOPD valued participating in a community gymnasium program and exercise trainers reported benefits of being educated and supervised in exercise delivery. Physiotherapists play a key role in the design, supervision, and modification of exercise programs to optimise safety and benefit.

Purpose: The aim was to examine disease-related challenges and rehabilitation needs among adults with Myasthenia Gravis (MG) to target future support initiatives.

Materials and methods: The study involved a cross-sectional questionnaire based on patient-reported outcomes within 11 domains/95 items, covering potential challenges and needs in living with MG. Data were compared against the subgroups gender, age, and years with MG.

Results: In total, 197 participants responded. The median number of challenges across all domains was 15 out of 95 with a higher prevalence in women than men and with no differences in relation to age or years with MG. The most prominent challenges were muscle strength, physical tiredness, and mental fatigue. The median number of total rehabilitation needs was three out of 95 with a higher prevalence in women than men, but with no differences between age and years with MG. The most prominent rehabilitation needs were physical tiredness, mental fatigue, and knowledge on existing interventions. Many participants reported unmet psychological needs, especially women, participants from 40 years of age, and participants who had lived with MG for more than five years.

Conclusions: MG significantly impacts on everyday functioning and activities. Disease-related challenges and rehabilitations needs manifested differently across genders. A profound difference was found between the number of challenges and rehabilitation needs reported.

Purpose: To examine the effectiveness of Pilates on fatigue, quality of life and physical function in persons with chronic conditions and explore potential intervention moderators.

Materials and methods: PubMed, SPORTDiscus, AMED and CINAHL were systematically searched from database inception to September 2024, to identify relevant studies. Two independent reviewers screened and selected the articles and evaluated methodological quality. Studies were included if they were randomised controlled trials of Pilates to improve fatigue in persons with chronic conditions.

Results: Eighteen studies involving 812 participants were included. Pilates had a significant effect on fatigue, quality of life and physical function. Meta-analyses showed Pilates had significant effect on physical function [Hedge's g = 0.85 (95% CI: 0.30; 1.40), p = 0.01] but the effects on fatigue [Hedge's g = -0.43 (95% CI: -0.96; 0.11), p = 0.12] and quality of life [Hedge's g = 0.49 (95% CI: -0.40; 1.37), p = 0.28] were not significant. Interventions with smaller duration (6-8 weeks) influenced Pilates effect on fatigue. The type of chronic condition and control did not influence effect.

Conclusions: Pilates has beneficial effects on physical function and may help reduce fatigue and improve quality of life in persons with chronic conditions. Pilates exercises used in rehabilitation settings can influence health outcomes.

Purpose: Cognitive reserve and neuropsychological test results are linked to outcomes after acquired brain injury (ABI), but their interaction and their impact on different types of outcomes remains to be explored. This study aimed to explore how cognitive reserve, measured by education, is related to neuropsychological outcomes, return-to-work and life satisfaction after ABI.

Methods: Long term follow-up of 83 patients with ABI, 5-15 years after specialized brain injury rehabilitation. Logistic regression was used to analyze the relationship between independent variables and outcomes (return-to-work and life satisfaction).

Results: Return-to-work was associated with cognitive reserve (OR = 1.31, p = 0.024), age (OR = 0.95, p = 0.042), general fatigue (OR = 0.77, p = 0.034), and Cognitive Profiency Index (measures of working memory and processing speed, OR = 1.06, p = 0.037). Verbal and spatial abilities were related to education, but not to return-to-work. General fatigue was related to satisfaction with mental health in both univariate (OR = 0.78, p = 0.008) and multivariate analyses (OR = 0.8, p = 0.037), but no other variables were significantly associated with life satisfaction in multivariate analyses.

Conclusion: Patients with lower cognitive reserve paired with slower processing speed and poor working memory may need additional support for successful return-to-work, while life satisfaction appears to depend more on other factors.

Purpose: To synthesize the evidence for: (1) outcome measures and components of postural stability evaluated in people after total hip arthroplasty (THA) for osteoarthritis (OA), and (2) the effectiveness of exercise interventions delivered within the first three months post-THA for OA on short-term and long-term postural stability.

Methods: MEDLINE, Embase, CENTRAL and CINAHL (inception to December 2024) were searched for randomized trials examining exercise interventions within three months post-THA for postural stability. Outcome measures and components of postural stability were identified using the Systems Framework for Postural Stability. Exercise intervention details were extracted using a modified TIDieR checklist, and trial quality was assessed with the PEDro scale.

Results: Of 16 trials, 15 were high quality (PEDro = 6-8), and one was low quality (PEDro = 4). The Timed Up and Go Test, assessing motor systems, anticipatory postural control, and dynamic stability was the most frequently used outcome measure (n = 9). Adding balance-challenging exercises to standard rehabilitation improved short-term postural stability more than standard rehabilitation alone. Long-term effects remain unclear.

Conclusion: Limited number of outcome measures were used, assessing a few components of postural stability. Early postoperative exercise interventions improve postural stability, but greater clarity is needed to identify optimal assessments and exercise interventions.

Purposes: To investigate item-level agreement between children with neurodevelopmental disorders (NDD) and their primary caregivers regarding perceived participation attendance and involvement, and identify differences in their selections of the important activities to children.

Materials and methods: The participants included 143 children with NDD aged 6 to 12 years and their primary caregivers (n = 130). Each completed the Picture My Participation (PmP) separately. Weighted Kappa coefficients and absolute agreement/disagreement were calculated to assess agreement between child-primary caregiver dyads in attendance and involvement ratings. Frequencies of items selected as one of the three most important activities were analyzed.

Results: Slight to moderate agreement was found between children and primary caregivers in perceived attendance (κ = 0.10 - 0.47, p < 0.05) and involvement (κ = 0.12 - 0.48, p < 0.05) at the item level. Children more frequently identified social activities, caregiving for others or animals, personal care, and school learning as important compared to their primary caregivers.

Conclusions: The relatively low agreement between children with NDD and their primary caregivers highlights the importance of including children's perspectives in collaborative goal-setting. Clinicians should tailor tools and strategies to address children's and caregivers' differences in perceived participation and important activities to facilitate the co-construction of participation goals.

Purpose: To explore and understand the experiences and perceptions of rest among adults experiencing fatigue alongside a long-term condition (LTC) and healthcare professionals (HCPs).

Methods: This qualitative study used convenience and snowball sampling. Semi-structured interviews were conducted with 23 adults with LTCs experiencing fatigue and four HCPs. Data were audio-recorded, transcribed, and analysed using thematic analysis with inductive approach.

Results: Four themes were identified: (1) operationalisation of rest, (2) rest as a practiced skill, (3) rest as a tool for optimising functioning, and (4) barriers. Both participants with lived experience and HCPs viewed rest as reducing activities, connecting with nature, and disengaging from responsibilities. Both groups valued rest for managing energy, symptoms, and activities. Barriers included impact of expectations on persons with LTC, environmental, and interpersonal factors, as well as responsibilities and lack of resting skills. Lived-experience participants noted physical symptoms, while HCPs highlighted "all-or-nothing" thinking as a significant barrier.

Conclusion: Rest in chronic fatigue management involved reducing activity, restorative practices, connecting with nature, and disengaging from responsibilities. Identifying truly restorative activities was challenging. Both adults with LTC and HCPs recognised effective rest as a strategic tool for energy management, symptom control, and activity participation.

Purpose: Young and middle-aged women engage in distinct occupations, facing unique post-stroke challenges that complicate their recovery. However, little is known about their experiences with occupational engagement following a stroke. This qualitative systematic review aimed to explore the post-stroke experiences of women aged 18-65 from an occupational perspective of health.

Methods: A comprehensive search of five databases identified qualitative studies on post-stroke experiences of women aged 18-65. Two reviewers independently appraised the methodological quality of eligible studies. Data were extracted and synthesised using the Joanna Briggs Institute (JBI) method of meta-aggregation.

Results: Seven studies were included. From 103 extracted findings, 18 aggregated categories and six synthesised findings emerged, relating to impacts on (1) daily life, domestic roles, self-efficacy and identity (2) work (3) relationships (4) health and recovery (5) adjustment and coping, and (6) experiences with healthcare.

Conclusion: Post-stroke occupational engagement in young and middle-aged women was disrupted across various life domains, reflecting its dynamic and intersectional nature with individual experiences of doing, being, belonging and becoming. Systematic barriers and societal attitudes posed additional challenges to recovery. These findings underscore the need for equitable, person-centred interventions to facilitate occupational engagement for health and well-being in this population.