Disability and Rehabilitation最新文献

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: To assess the efficacy of pulmonary rehabilitation (PR) on fatigue in patients with post-COVID-19 syndrome (PCS).

Methods: A systematic review and a meta-analysis were performed until 21 October 2024 in 4 databases (CINAHL, Medline, Scopus and Web of Science). Inclusion criteria: Population: patients (≥18 years) with PCS; Intervention: PR; Comparison: control group (CG) vs. placebo; Outcome: fatigue assessed before and after the intervention; Study: randomized clinical trials. Methodological quality was assessed with Downs and Black scale and risk of bias with Cochrane risk-of-bias tool. Meta-analysis was conducted with RevMan 5.4.

Results: Thirteen studies were included in the systematic review and 10 in the meta-analysis. The meta-analysis showed a moderate effect size (SMD = -0.59, 95% CI = -0.89, -0.28; p = 0.0002, n = 973) in favor of PR compared to CG for fatigue, with significant differences. Compared to CG, fatigue in patients with PCS was reduced to a greater extent in PR group (both center-based PR and home-based PR, and both <12 weeks of PR and ≥12 weeks of PR), with significant differences.

Conclusion: This review demonstrates the efficacy of PR as a promising intervention for alleviating fatigue in patients with PCS, revealing a significantly greater reduction in fatigue in PR group compared to CG.

Prospero registration number: CRD42022310791.

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.

Purpose: This scoping review aims to give an overview of the literature describing medical complications in children from 2 to 17 years, arising in the subacute and chronic phases after pediatric CNS injury, and to identify knowledge gaps on the subject.

Methods: Our scoping review of publications in databases Embase and Medline follows the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA).

Results: We identified 11,497 articles published from 2000 to 2024. Initial screening reduced these to 1,220, which were reviewed in full-text, resulting in inclusion of 373 publications. Acquired brain injury was the most common CNS injury, with neoplastic etiology as the dominating subgroup. The majority of the articles were retrospective studies and case studies. Most publications reported one complication, and comprehensive approaches were scarce. Epilepsy and endocrine disturbances were the most frequently reported complications in brain injury patients, and scoliosis and pressure ulcers predominated in the spinal cord injury group.

Conclusion: Despite a broad literature on the current topic, more longitudinal studies are needed, especially studies with a comprehensive approach to the medical complications that can occur after the acute phase in children with CNS injury.

Background: Health care providers face many challenges with delivering care in rural areas. However, little is known about their experiences of providing care to marginalized populations, such as children with disabilities. The purpose of this study was to explore the experiences of health care providers serving rural children with disabilities.

Methods: We conducted a scoping review following the Joanna Briggs Institute methodology and an inductive thematic approach involving eight international databases (Embase, CINAHL, JBI EBP, Healthstar, Ovid Medline, PsycINFO, Scopus, Web of Science). Of the 2631 screened articles, 31 met the inclusion criteria.

Results: The studies spanned across seven countries over a 24-year period. Our findings involved the following themes: (1) training and knowledge of childhood-onset disabilities (i.e., lack of training; adequate training); (2) communication (i.e., communication concerns; effective communication and rapport building with local communities); and (3) lack of resources, services and supports (i.e., staff shortages; travel and accessibility issues; challenges of intersectional needs of rural patients).

Conclusions: Our findings emphasize the extent of the challenges that rural health care providers encounter in delivering care to children with disabilities. There is a critical need for further supports, resources and targeted interventions to recruit and retain rural health care providers.

Purpose: Children with incomplete recovery from Brachial Plexus Birth Injury (BPBI) experience varying degrees of upper limb impairment, and 20-30% require interventions to optimize function. A psychometrically validated measure of upper limb activity capacity is essential to guide shared clinical decisions for surgical and rehabilitation interventions.

Materials and methods: Following the Joanna Briggs Institute Manual for Evidence Synthesis, this systematic review included studies on the measurement properties of the Brachial Plexus Outcome Measure (BPOM) - Activity Scale, a performance-based outcome measure of upper limb activity capacity in children with BPBI. Three databases were searched from inception to October 2023. Methodological quality was assessed and summarized using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN)'s Risk of Bias checklist.

Results: Of 11 screened, 6 studies were included. The quality of measurement property studies was very good (27%, n = 4), adequate (7%, n = 1), doubtful (20%, n = 3) and inadequate (47%, n = 7). The BPOM - Activity Scale demonstrated strong internal consistency, with good reliability and construct validity. Additional evidence on its content validity and reliability is necessary.

Conclusions: Overall, the BPOM - Activity Scale has the potential to provide evidence-based information to support the rehabilitation of children with BPBI.

Purpose: To identify and prioritise key activities to promote functional independence and reduce the risk of hospital-associated deconditioning for older adults admitted to our acute care wards.

Materials and methods: A local, stand-alone evaluation and planning project using group concept mapping methodology. Multidisciplinary healthcare workers took part in a statement generation activity, individually sorted these statements into themes, and rated each statement for perceived importance and current success. Applying multidimensional scaling and hierarchical cluster analysis to the sorted data produced visual representations of the statements (concept maps), and rating scores enabled identification of agreed priorities for improvement.

Results: Seventy-eight participants took part in ideas generation, 25 in sorting, and 86 in rating. An eight-item cluster map was agreed upon, with the following named clusters: optimising nutrition and hydration; facilitating independence, especially at mealtimes; creating an enabling 'rehabilitative' culture; get up, get dressed, get moving; inclusion and engagement for patient wellbeing; understanding and managing risk; working together, preparing for home; and organisation of care in an acute hospital setting.

Conclusion: The findings from this group concept mapping project highlight the importance of adopting a multidimensional approach to promoting functional independence and reducing the risk of hospital-associated deconditioning for hospitalised older adults.