Journal of Rehabilitation Medicine最新文献

Objective: To compare the muscular activity and metabolic response between a novel handle-based wheelchair drive (KURT) and conventional push rim propulsion in a simulated daily mobility circuit.

Design: Single-group comparative study between 3 wheelchair configurations.

Participants: 22 healthy individuals without prior wheelchair experience.

Methods: Participants completed a multi--movement circuit including ramps, obstacle avoidance, and directional changes using KURT and 2 push-rim wheelchairs with different wheel sizes (small wheels, SW; large wheels, LW). Electromyographic data were collected bilaterally from 7 upper body muscles, and cardiopulmonary variables were -continuously monitored.

Results: Biceps brachii activity was significantly higher with KURT than with SW and LW for both arms (all p < 0.001), while triceps brachii and pectoralis major activity were significantly lower (all p < 0.001). Other monitored muscles showed smaller relative differences between configurations, often resulting in limited or no statistically significant effects. Metabolic demand was lower with KURT: heart rate, oxygen consumption, and carbon dioxide production were reduced compared with LW (all p < 0.05), while respiratory exchange ratio was unchanged and respiratory frequency was higher than with SW (p < 0.05).

Conclusion: KURT appears to be a promising, more energy-efficient alternative to push-rim wheelchairs, reducing upper limb muscle demand and metabolic cost. These findings motivate studies in regular wheelchair users and longer-term use in daily living scenarios.

Objective: To assess changes in bowel function and quality of life over time in adults with spinal cord injury.

Design: Retrospective cohort study linking clinical registry data with patient-reported outcomes.

Subjects: 236 adults with spinal cord injury in Sweden; 157 had both baseline and follow-up data.

Methods: Data from the Swedish National Quality Registry for Rehabilitation Medicine were merged with responses from the 2024 Swedish International Spinal Cord Injury Community Survey. Bowel dysfunction was assessed using the Spinal Cord Injury Secondary Conditions Scale, Constipation Scoring System, and St. Mark's Incontinence Score. Quality of life was measured using the 3L EQ-5D questionnaire at baseline and the 5L version at follow-up, converted to a common scale. Group differences were analysed using χ2 and Mann-Whitney U tests. Logistic regression identified predictors of bowel outcomes; linear regression assessed factors associated with quality-of-life scores.

Results: At baseline, 70% had bowel dysfunction and a mean quality-of-life score of 0.33. Bowel dysfunction was the only independent predictor of lower baseline quality of life. At follow-up, severe incontinence and high bowel burden predicted lower scores. Incomplete injury predicted improvement.

Conclusion: Bowel dysfunction is common and closely linked to reduced quality of life after spinal cord injury. Early and sustained management is essential.

Objective: The aim of this observational study was to describe the real-world use of botulinum toxin-A in patients with a stroke in the Netherlands.

Methods: This study used longitudinal insurance claims data between 2012 and 2016 with 30% nationwide coverage and included patients with both stroke-related and botulinum toxin-A claims. All analyses were descriptive and displayed as summary statistics.

Results: 60,222 patients with a stroke were identified, of whom 18,141 (30.1%) were treated in a rehabilitation centre or hospital and 1.7% (1,036 patients) were treated with botulinum toxin-A. A total of 2,855 botulinum toxin-A claims from 890 patients were included in the analysis (1.5% of all patients in the database). Mean age was 63.4 (SD ± 14.0) years at index injection cycle, with a median follow-up of 3.7 years (interquartile range [IQR] 2.2-4.5 years). Patients received up to 16 injection cycles with a median of 2 injection cycles (IQR 1-5 cycles). The median Time-To-Next-Injection-Cycle was 17 weeks (IQR 13-25 weeks). The total number of injection cycles was 604 for abobotulinumtoxinA (22.1%) and 2,251 (78.8%) for onabotulinumtoxinA. Doses per cycle ranged from 200-660 for abobotulinumtoxinA and 101-400 units for onabotulinumtoxinA.

Discussion: Claims data from a national healthcare insurance fund in the Netherlands showed that only 1.7% of patients with post-stroke spasticity received botulinum toxin-A. Botulinum toxin-A treatment doses and intervals varied widely across patients and most patients received only 1 or 2 botulinum toxin-A injection cycles. Our results suggest undertreatment of spasticity with botulinum toxin-A and suboptimal treatment adherence in Dutch clinical practice.

Objective: This study investigates the impact of different rehabilitation approaches on functional recovery and health-related quality of life (HRQoL) in stroke patients.

Design: A longitudinal retrospective observational study.

Subjects: The study included all 538 consecutive stroke patients treated in Satakunta County, Finland, between January 2021 and January 2022.

Methods: Functional recovery was assessed using the modified Rankin Scale (mRS), WHODAS 2.0, and HRQoL using the EQ-5D. Outcomes were evaluated at 1, 3, 6, and 12 months. Patients were categorized into 3 groups: no rehabilitation, primary care (PC) rehabilitation, and multidisciplinary (MD) rehabilitation. Longitudinal changes in mRS, WHODAS, and EQ-5D were further assessed at a 3-year follow-up.

Results: MD rehabilitation resulted in significantly greater improvements in HRQoL and functional recovery compared with PC rehabilitation and no rehabilitation. Female patients reported lower HRQoL and poorer functioning than males; however, rates of improvement were similar between the sexes. Dependency (mRS > 2) was associated with lower HRQoL, although changes over the 1-year follow-up were comparable between dependent and independent patients. Depression emerged as the strongest predictor of HRQoL improvements. Substantial correlations were observed among mRS, EQ-5D, and WHODAS 2.0 scores, with the strength of these correlations increasing over time. At the 3-year follow-up, stroke survivors continued to exhibit decreasing HRQoL and functional status.

Conclusions: Multidisciplinary rehabilitation substantially enhances functional recovery and HRQoL during the first year after stroke compared with primary care or no rehabilitation. Although women and patients with greater dependency report lower HRQoL, their rates of improvement are similar to those of other groups. Depression is a key determinant of HRQoL gains, underscoring the importance of integrating mental health support into rehabilitation pathways. The persistently low HRQoL observed 3 years post-stroke highlights the long-term burden of stroke and the need for sustained, comprehensive follow-up and rehabilitation strategies to address ongoing functional limitations.

Objective: To examine stroke survivors' satisfaction with hospital-based outpatient rehabilitation and its association with life satisfaction and health-related quality of life (HRQoL), and whether sex and age affect possible associations.  Design: A longitudinal national register study.  Methods: Data from the Swedish national quality register were used and included 1,068 patients with stroke performing outpatient rehabilitation. Self-reported questionnaires collected on admission, discharge, and at 1-year follow-up were analysed. Regression analyses were used to assess possible associations between patient satisfaction and life satisfaction (Life Satisfaction Questionnaire, LiSat-11) and HRQoL (EuroQol Five Dimensions questionnaire, EQ-5D).

Results: Over 71% of the included patients were satisfied with their rehabilitation process on discharge. Satisfied patients also reported higher scores on global LiSat-11 and higher EQ-5D values. Older patients (> 58 years) satisfied with their rehabilitation process were more likely to be satisfied with global LiSat-11. Women dissatisfied with the rehabilitation process had lower EQ-5D values on discharge.

Conclusion: Patient satisfaction with hospital-based outpatient rehabilitation was associated with life satisfaction and HRQoL. Potential differences linked to sex and age support the importance of individually tailored rehabilitation strategies. Evaluating self-reported outcomes and experiences over time is essential for improving long-term recovery and for further development of person-centred stroke rehabilitation.

Objective: To review the literature on whether sleep impacts mobility in adults.

Methods: Ovid Medline, Web of Science, Embase, and CINAHL databases were searched. Citations were randomly divided so that each was screened separately by 2 authors. Data were extracted from included articles independently by 2 reviewers.

Results: The search strategy generated 8,772 references, 697 articles underwent full-text screening, and 108 eligible articles were included in the scoping review. Most studies (n = 69; 64%) included only self-reported sleep, and "walking" was the most common mobility category (n = 99). Most studies (n = 60; 56%) reported a positive association between sleep and mobility, indicating better sleep was associated with better mobility or worse sleep was associated with worse mobility. Most studies, including people with cardiovascular, kidney, metabolic, mental health, neurological, and pulmonary conditions, reported a positive association between sleep and mobility.

Conclusions: Most studies reported a positive association between sleep and mobility. However, due to the variety of sleep and mobility outcomes used, it was challenging to compare studies and synthesize results. Further, due to a relatively small sample size and variety of health conditions, conclusions cannot be drawn, and further research is needed.

Objective: This study aimed to identify profiles of social participation among stroke survivors with limb dysfunction and explore the factors influencing these profiles.

Design: A convergent mixed-methods design.

Methods: The quantitative phase involved 499 participants recruited from 5 neurorehabilitation centres in Shanghai between December 2023 and June 2025. Participants completed measures including the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P), the Connor-Davidson Resilience Scale (CD-RISC-10), and the Modified Rankin Scale (mRS). Qualitative semi-structured interviews were performed with 16 participants to explore lived experiences of social participation.

Results: Latent profile analysis revealed 4 distinct social participation profiles: "Active Integration", "Contented Conservatism", "Cautious Conservatism", and "Alienated Disengagement". A multivariate analysis identified age, resilience, and physical function as significant predictors of profile membership. Qualitative findings uncovered 2 core emotional experiences (a sense of loss vs a sense of rebuilding) and 3 behavioural patterns (activist, conservative, alienated), which effectively explained the quantitative profiles' characteristics and their underlying mechanisms. The integration of data provided a nuanced person-centred framework depicting the heterogeneity in post-stroke social participation.

Conclusion: Social participation among stroke survivors is heterogeneous and can be classified into 4 distinct profiles shaped by the interplay of physical function, resilience, and sociodemographic factors. The findings underscore the necessity of implementing profile-specific, stepped-care interventions for effectively enhancing post-stroke social participation.

Purpose: To explore sex-specific differences in cardiac rehabilitation (CR) outcomes.

Methods: Aerobic capacity (6-Minute Walk Test), physical behaviour (accelerometer), cardiovascular risk profile (weight, blood pressure, cholesterol), and psychosocial well-being (questionnaires) were measured in patients after an acute coronary syndrome (147 women, 642 men) at CR start and completion, and 18 months' follow-up. Sex differences were studied using GEE models adjusted for age and differences in baseline characteristics. Additionally, whether men and women met targets associated with health risk reductions was assessed.

Results: Both sexes experienced similar CR benefits. Only for depressive symptoms did women show larger improvements (HADS score; ♀: -2.7 vs ♂: -1.1; p = 0.017). Nevertheless, long-term follow-up revealed women still lagged in meeting targets for physical activity (♀: 76.5% vs ♂: 93.1%; p < 0.001) and anxiety symptoms (♀: 75.5% vs ♂: 86.8%; p < 0.001), while men lagged in meeting aerobic capacity targets (♀: 71.3% vs ♂: 58.8%; p < 0.001).

Conclusion: Women experience similar CR benefits to men in aerobic capacity, physical behaviour, cardiovascular risk profile, anxiety, and quality of life, with greater improvement in depressive symptoms. However, target values were less often met by women in physical behaviour and psychosocial well-being, and by men in aerobic capacity. Tailored CR programmes may be needed to address the unique needs of women and men.

Objective: This longitudinal study evaluated acute-phase stroke patients, examining changes in skeletal muscle quantity and quality. The research aimed to determine when muscle quality deteriorates, its relationship with muscle quantity, and contributing factors.

Design: Prospective observational study.

Patients: Forty stroke patients.

Methods: Muscle quantity was assessed as the thickness of the anterior and lateral mid-thigh, while muscle quality was assessed by echo intensity of the rectus femoris and vastus lateralis. Measurements on paretic and non-paretic limbs were taken on the first day after stroke onset and on the 10th day.

Results: Muscle thickness of all regions of paretic and non-paretic limbs significantly decreased at 10 days, whereas echo intensity significantly increased only in the paretic limb. A significant negative correlation between changes in muscle thickness and echo intensity was observed in the paretic limb only. Multiple regression analysis revealed that the only variable that explains the changes in echo intensity was the changes in muscle thickness of the paretic limb.

Conclusion: Muscle quality begins to deteriorate as early as the acute phase of stroke. To prevent this deterioration, it is important to encourage skeletal muscle activity during the acute phase of immobilization and to minimise the reduction in muscle quantity.