Journal of Rehabilitation Medicine最新文献

Objective: Assessing functional abilities in stroke rehabilitation is essential, combining subjective self-reports with objective clinical evaluations.

Methods: This study aimed to compare self-reported impairments from stroke patients with rehabilitation team evaluations using the ICF stroke core set at 3 time points: 1 month post-discharge, after 6 months, and 12 months post-diagnosis. Additionally, the study sought to identify ICF subdomains most impacting health-related quality of life (HRQOL) as measured by EQ-5D. This longitudinal, retrospective observational study included consecutive 118 stroke patients at the Satahospital Rehabilitation Unit (2021-2022).

Results: Results showed that, 1 month after discharge, patients rated their functioning higher than team assessments, particularly in cognitive domains. By 12 months, patients' self-reports indicated lower functioning than team evaluations, with discrepancies diminishing over time. Objective assessments revealed significant improvements in mobility, self-care, and cognitive functions, while patients reported progress in life activities and social interactions but little change in physical or cognitive domains. Depression levels and self-care ability (washing) were the strongest predictors of improved HRQOL.

Conclusion: These findings reveal that patients initially overestimate their abilities, influenced by a lack of awareness and emotional factors, while rehabilitation teams provide more objective evaluations and individualized rehabilitation. Integrated assessment frameworks combining subjective and objective perspectives are crucial to optimizing rehabilitation outcomes.

Objective: To assess the correlation between controlled-pressure provocative test duration and electrodiagnostic severity in carpal tunnel syndrome.

Design: Cross-sectional correlational study.

Patients: Patients with clinical symptoms consistent with carpal tunnel syndrome were recruited from the electrodiagnosis clinic of the Department of Rehabilitation Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, between September 2023 and July 2024.

Methods: Patients underwent electrodiagnostic studies, and the severity of carpal tunnel syndrome was classified as mild, moderate, or severe according to the 2011 criteria of the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM). Each participant subsequently received a controlled-pressure provocative test. The time to symptom provocation was recorded, with a maximum duration of 30 s. Spearman's rank correlation was used to assess the association between test duration and electrodiagnostic severity.

Results: In 124 hands, 31, 45, and 48 hands were categorized by the degree of electrodiagnostic severity as mild, moderate and severe, respectively. There was no correlation (ρ = -0.16, p-value = 0.074) between controlled-pressure provocative test duration and electrodiagnostic severity.

Conclusions: There was no correlation between controlled-pressure provocative test duration and electrodiagnostic severity in patient with carpal tunnel syndrome.

Background: Tachycardia after mild activity or during rest is a common complaint among people with post-COVID-19 condition (PCC). Understanding the relationships between heart rate (HR) and physical activity (PA) in this population is crucial for developing appropriate rehabilitation protocols.

Objective: To investigate the associations between HR and PA in individuals with PCC, accounting for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) symptoms.

Design: Observational study.

Subjects: Sixteen adults with PCC (81% females, mean age 51 ± 12 years).

Methods: Participants were instructed to use 2 wearable devices (Garmin smartwatch and ActiGraph accelerometer) during waking hours over 4 days while performing daily activities. Average HR, percentage of time in tachycardia (time with HR > 100 bpm), and daily step count were assessed. The accelerometer counts per minute was used to categorize daily PA as sedentary, light intensity, and moderate-to-vigorous (MVPA).

Results: Participants wore the watches and accelerometers for a mean of 11.36 ± 2.60 and 12.51 ± 1.94 h per day, respectively. Average daily HR increased with increasing PA levels from sedentary to MVPA. However, the percentage of time in tachycardia was significantly lower during periods of MVPA compared with sedentary periods, even after adjusting for ME/CFS symptoms.

Conclusion: Individuals with PCC in our study experienced more tachycardia during periods of minimal physical activity compared with periods categorized as MVPA.

Objective: Post-stroke limitations in arm-hand activities are prevalent, yet a system for categorizing these limitations like the Functional Ambulation Categories (FAC) is lacking. The Arm-Hand-Activities-Scale (AHAS) was developed and psychometric properties of this classification were investigated.

Design: Mixed methods to examine comprehensibility, inter-rater reliability, correlations with the Fugl-Meyer Assessment (FMA) and the Action Research Arm Test (ARAT), and sensitivity to change.

Subjects/patients: 76 professionals answered a comprehensibility questionnaire and 85 professionals an inter-rater reliability questionnaire.

Methods: For comprehensibility and inter-rater reliability, standardized video sequences of each category were assessed. Cut-off values were identified by comparing the AHAS categories with the FMA (n = 10) and the ARAT (n = 71). For sensitivity-to-change studies, 71 stroke patients were followed for 4 weeks of inpatient rehabilitation. Spearman correlation coefficients were calculated to examine the relationship between AHAS, FMA, and ARAT outcomes. A Wilcoxon signed-rank test was applied for sensitivity to change.

Results: The results on comprehensibility of the AHAS categories and the FMA cutoff values were highly consistent. Inter-rater reliability was good to excellent. A significant and strong correlation was found between ARAT and AHAS. The Wilcoxon signed-rank test for sensitivity to change was also significant.

Conclusion: The AHAS provides a quick and simple classification system to assess the severity of arm-hand activity limitations after stroke This may help in selecting appropriate treatment strategies.

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.