Disability and Rehabilitation最新文献

Purpose: To use the "three delays model" as a framework to identify and synthesise qualitative literature that identifies barriers to accessing and utilising P&O services in low-middle-income countries from the perspective of individuals with disabilities and clinicians.

Methods: A systematic search of four databases was used to identify research exploring user and clinician experiences in accessing P&O services in LMICs. Selected search terms and combinations identified through an adapted version of the SPIDER tool were used to identify studies. All retrieved articles were critically appraised using the CASP tool. Data were extracted, and themes were synthesised using a deductive thematic approach guided by the three-delays model.

Results: Ten key themes were generated and linked to the three-delays model. Fear of perceived financial implications, transportation, and respectful care were some of the themes affecting accessibility in the first, second, and third delays, respectively. The findings suggest that the delays are interconnected components that might have a cascading effect on access to P&O services as a whole. Minimising delays can improve the accessibility of P&O services in low-middle-income countries.

Purpose: To conduct an environmental scan of known peer support programs implemented for adults with chronic health conditions and/or their caregivers in Ontario, Canada and synthesize these results, to inform future efforts to co-design peer support programs with and for adults with special health care needs (ASCN).

Materials and methods: A systematic online search was performed, to identify peer support programs for individuals with chronic health conditions and their caregivers in Ontario. Relevant program details were extracted from peer support group webpages and where possible peer support program coordinators were contacted for additional information.

Results: Twenty programs met inclusion criteria. There was considerable variation in the type of peer support programs offered across Ontario. Despite this heterogeneity, the environmental scan identified several important trends across program offerings. Key amongst these are inclusive programming for both patients and family, and individualized/flexible service delivery. Program and outcome evaluation was lacking across programs.

Conclusions: Peer support programs in Ontario used diverse strategies but shared the goal of creating safe spaces for individuals with similar lived experiences to connect. Future research on peer support programs for people with chronic health conditions should assess short- and long-term outcomes to evaluate their impact on populations served.

Purpose: To review research on mobility development in children, adolescents and young adults with cerebral palsy (CP).

Methods: This scoping review included longitudinal studies on mobility development of children and young people (19-21 years) with CP. Findings were reported considering mobility capacity and performance of individuals with CP, observed in low- and middle- or high-income countries. The results were analyzed by two physicians and a mother of a child with CP, using Patient and Public Involvement (PPI) strategy.

Results: Eleven studies included 3,047 individuals with CP. Lower Gross Motor Function Classification Measure (GMFCS) levels were associated with better mobility capacity and performance. Additionally, the lower the GMFCS level, the more stability is achieved at older ages. Ten studies in high-income countries showed that mobility capacity stabilized before performance. The only study conducted in a low-income country showed a decline in mobility capacity in early adolescence.

Interpretations: The development of mobility capacity and performance may be related to the presence of different contextual factors in socioeconomically diverse countries. The findings of this review are important for sharing, discussing, and managing mobility development patterns with family members.

Purpose: To investigate experiences and perspectives of caregivers of people with adult-onset myotonic dystrophy type 1 (DM1) on living and coping with DM1 to inform future targeted rehabilitation services.

Materials and methods: Qualitative study using the Interpretive Description methodology and Herbert Blumer's Symbolic Interactionism as the theoretical lens. Data was generated through four focus group interviews and two individual interviews, with a total of 13 caregivers.

Results: The analysis identified three categorical themes and five subthemes on how caregivers understand living and coping with adult-onset DM1: 'Continuous reflections on everyday life as a caregiver', 'Being a part of the disease trajectory', and 'Changes in social relations when living with a person with DM1'. The findings provided insights into how caregivers found meaning in and handled everyday life, which might be influenced by social interactions when living with a person with adult-onset DM1.

Conclusion: The progressive changes in functioning caused by DM1 led the caregivers to make constant adaptations to their everyday lives. The findings illustrate how caregivers can play an important role in their close ones' disease trajectory when addressing biopsychosocial needs that arise in everyday life.

Purpose: To investigate the use of static posturography as a tool to distinguish between non-recurrent and recurrent Parkinson's disease (PD) fallers based on a 1-year follow-up.

Materials and methods: This prospective cohort study included 48 participants (35 men and 13 women) from different PD associations. Data collected included fall history, sociodemographic and clinical information, balance tests, and static posturography. Group comparisons were conducted using Chi-square, T-test, Mann-Whitney U, and Hedge's (g) effect size. Pearson's correlation assessed associations between posturographic parameters and clinical tests. A two-step binary logistic regression was used to identify predictors of future falls. Discriminative ability was analyzed using a ROC curve, with the optimal cutoff determined by the Youden index.

Results: The mean speed of the center of pressure (eyes-open condition), along with the Hoehn and Yahr and the history of falls, was identified as a significant predictor of recurrent fallers, reporting excellent discrimination values (area under the ROC curve = 0.81) and a cutoff point of 18.1 mm/s. Logistic regression modeling accurately classified 88.2% of participants.

Conclusions: Static posturography, specifically the mean speed of the center of pressure (eyes-open condition), demonstrated excellent discriminative ability in identifying PD patients at risk of recurrent falls in this study.

Purpose: This study explores the impact of foot orthoses (FO) on pain and disability in low back pain (LBP) patients, providing new treatment evidence.

Methods: A systematic search was conducted across PubMed, Cochrane Library, Scopus, Web of Science, Embase, Medline, CNKI, and Wanfang Database for randomized controlled trials (RCTs) on FO for LBP treatment, from database inception to July 12, 2025. Data extraction, quality assessment, subgroup analysis, and meta-analysis were performed.

Results: Seven RCTs with 423 participants were analyzed. Most studies had low bias risk, though one had high risk. GRADE assessment indicated low evidence quality. The meta-analysis showed FO significantly reduced pain (p = 0.0006) and disability (p = 0.0004) compared to controls. This study did not find a significant effect of preformed FO on pain relief and leg length discrepancy (LLD) insole on disability dysfunction (p < 0.05). No studies reported adverse events related to FO.

Conclusion: FO is effective and safe for alleviating pain and disability in LBP patients. Conclusions should be interpreted cautiously due to the low quality and heterogeneity of the included studies. Future studies should concentrate on the long-term efficacy of FO and the identification of appropriate fabrication processes/materials for various LBP types.

Purpose: To analyse the predictive performance of Proactive Rehabilitation Screening (PReS) tool in identifying hospitalised patients who require formal inpatient multidisciplinary rehabilitation program.

Methods: A prospective observational cohort study was conducted in two Australian public hospitals. The aims were to (1) assess the original PReS tool's ability to predict rehabilitation needs and (2) develop and validate a modified PReS tool. Regression analysis was used to re-estimate predictor weights.

Results: In the development cohort (n = 1600), 272 patients (17%) received rehabilitation. Using multivariate regression analysis, we identified five key variables (age, number of allied health sessions received in 5 days, assistance required to mobilise, new personal care impairment and discharge barriers) to modify the original PReS tool. The modified PReS scores were stratified into likelihood of rehabilitation: low (0-4), medium (5-13) and high (14-20). Performance was improved for medium likelihood when a rehabilitation clinician was included in decision making. This was validated in an independent cohort of 800 patients demonstrating good predictive performance: sensitivity of 81.1%, specificity of 88.0%, total accuracy 86.9%.

Conclusion: The modified PReS tool can reliably identify patients at risk of needing rehabilitation using five easily obtained clinical variables, enabling timely evidence-based rehabilitation interventions to minimise disability.

Purpose: This randomized controlled trial examined the effects of a treatment program based on external focus of attention (EFA) and internal focus of attention (IFA) on spatiotemporal gait parameters and balance performance in children with unilateral cerebral palsy (uCP).

Methods: Twenty-four children with uCP, aged 6-12 years, were randomly assigned to EFA (n = 12) or IFA (n = 12) groups. Both groups received the same balance and gait exercises for six weeks, differing only in attentional focus instructions. Assessments included the C-Mill VR+ gait system, Single-Leg Stance Test, Pediatric Balance Scale (PBS), and Trunk Control Measurement Scale.

Results: After the intervention, the EFA group showed significantly greater improvements in cadence (+15.8 steps/min), affected limb stance phase (+4,17%), and PBS scores (+5 points) compared to the IFA group. Cadence and PBS changes suggest clinical relevance, though the stance phase increase may reflect compensation rather than functional improvement.

Conclusion: Both attentional focus and gait and balance parameters improved. EFA-based training was more effective than IFA in improving some parameters of gait and balance. These findings suggest that externally focused instructions can enhance motor learning in children with uCP, though further research is warranted to assess the clinical relevance of smaller differences.

Clinical trials: https://clinicaltrials.gov/study/NCT06170814.

Purpose: Cyberscams represent a significant global issue to which people with acquired brain injury (ABI) may be particularly vulnerable. Due to a lack of existing measures, The CyberAbility Scale was developed to measure cyberscam vulnerability for people with and without ABI. This study aimed to refine and validate The CyberAbility Scale.

Methods: The CyberAbility Scale was refined through assessment of scale response distribution, inter-item and item-total correlations, and exploratory factor analysis. Confirmatory and multiple-group confirmatory factor analyses and psychometric properties were evaluated.

Results: Participants with (n = 149) and without (n = 153) ABI completed a longer version of the scale, with 24 relevant and functional items retained. A four-factor model of risk included Past Scam Experience, Scam Knowledge, Trusted Supports, and Seeking Connection Online, alongside the ability to identify scams. The scale had appropriate model fit, internal consistency, test-retest reliability, and concurrent and construct validity.

Conclusions: Overall, The CyberAbility Scale is a brief, valid tool to screen online vulnerability for persons with and without ABI.

Purpose: This study aimed to evaluate the effects of high-intensity interval training on patients with chronic obstructive pulmonary disease and to synthesize the evidence into a Frequency, Intensity, Time, and Type framework for clinical application.

Materials and methods: We conducted a systematic review and meta-analysis of randomized controlled trials from PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) within the Cochrane Library through 14 July 2025. Trials evaluating structured high-intensity interval training programs in patients with chronic obstructive pulmonary disease were included. Two reviewers independently extracted data and assessed methodological quality.

Results: Sixteen trials were included, with data from 11 pooled for meta-analysis. Compared to moderate-intensity continuous training, high-intensity interval training significantly improved walking distance, peak workload, and quality of life. High-intensity interval training combined with resistance training also yielded greater improvements in exercise capacity than usual care. No serious adverse events were directly attributed to the training.

Conclusions: High-intensity interval training is a safe and superior strategy compared to continuous training for enhancing outcomes in patients with chronic obstructive pulmonary disease. This review successfully translates these findings into a practical Frequency, Intensity, Time, and Type framework, providing a scientific model to standardize clinical practice and guide future research.