Journal of Rehabilitation Medicine最新文献

Objective: The aim of this study is to evaluate the effectiveness of immersive technologies in the rehabilitation of patients with non-specific neck pain and identify any potential side effects associated with their use.

Design: Systematic review.

Subjects/patients: Individuals with non-specific neck pain.

Methods: A systematic literature search of randomized controlled trials was conducted using Medline (PubMed), Embase (Ovid), Scopus, Cochrane Database of Systematic Reviews, WHO, Pedro, and ClinicalTrials.gov. Risk of bias was assessed with Cochrane Risk of Bias tool.

Results: Five studies with a total of 203 participants (129 women, 74 men) were included in the review. In most studies, both the virtual reality (VR) and control groups demonstrated improvement in pain, functioning related to neck pain, and range of motion. Two cases found the virtual reality group to demonstrate greater improvements in pain and range of motion (for some movements), but not in function. The studies analysed lack much information regarding the applicability of VR therapy.

Conclusion: The data are promising and suggest that VR therapy may have benefits in the rehabilitation of patients with non-specific neck pain. Data on the safety of therapy and adverse events are insufficient to draw any conclusions.

Objective: To determine the impact of mobilization training time during the first postoperative week on the length of hospital stay for postoperative patients admitted to an intensive care unit.

Design: A retrospective cohort study.

Patients: Consecutive patients who underwent elective surgery and stayed in the intensive care unit of a university hospital for more than 48 h between July 2017 and August 2020 were enrolled.

Methods: The total duration of mobilization training during the first postoperative week and clinical variables, including demographic information, were collected from medical records. Multivariable regression analysis was used to investigate the impact of mobilization training time on the length of hospital stay, adjusting for potentially confounding variables.

Results: In total, 773 patients (504 males; median age, 70 years) were enrolled. Multivariable regression analysis showed that an increase in mobilization training time during the first postoperative week was associated with a shorter length of hospital stay (β = -0.067, 95% confidence interval: -0.120, -0.017, p = 0.010), with each 1-h increase in training time associated with a 4.02-day reduction in the length of hospital stay.

Conclusion: Increased mobilization training during the first postoperative week significantly reduced the length of hospital stay in postoperative patients.

Introduction: Functioning is the reason to be of rehabilitation as it is essential to the lives of people who suffer from a disease. The International Classification of Functioning, Disability and Health (ICF) can help in designing a functioning profile of a patient, identifying needs for rehabilitation plans and measuring the results of an intervention.

Objective: To identify the outcome measurement instruments reported in clinical studies in muscular dystrophies (MDs) and provide an ICF content analysis.

Method: A systematic literature review was conducted until October 2022, using Medline, PubMed, and Scopus databases. Papers assessing outcomes related to functioning in patients with MDs were included.

Results: A total of 116 papers were included and all identified outcome measures were linked to the ICF. Inter-researcher agreement for the linking process was 0.82. The analysed instruments focused mainly on aspects of body functions, followed by activities and participation. General scales were more comprehensive than specific.

Conclusions: The application of ICF in this research enhances the understanding of functioning of patients with MDs and the need to develop more specific but comprehensive scales tailored to the needs of MD patients, and can guide clinicians in a assessing patients through a biopsychosocial perspective.

Objective: This study focuses on how patients experience the time following amputation after primary limb salvage surgery due to musculoskeletal malignancies. Limb salvage is state of the art in the treatment of musculoskeletal tumours. Nonetheless, in some cases, limb salvage can become problematic over time, resulting in poorer limb function and septic outcomes. This raises the question of whether amputation is indicated sooner rather than later. Patients who have undergone secondary amputation might retrospectively prefer a different approach.

Design: Interview study.

Subjects/patients: Patients who underwent primary limb salvage surgery followed by later ablative sarcoma treatment.

Methods: Semi-structured interviews and the standardized "Prosthetic Limb Users Survey of Mobility" questionnaire were conducted. Interviews were analysed according to Mayring content analysis method.

Results: Amputation is perceived as an improvement after a long course of illness with little quality of life. By enhancing the amputation environment and providing detailed information regarding quality of life afterwards, emotional pressure could be reduced and patient satisfaction improved.

Conclusion: Surgical options for ablation should be openly communicated earlier when consulting patients experiencing recurrent complications that might eventually lead to amputation. Supporting factors that subsequently may help to improve quality of life after amputation were further identified.

Objective: To compare inpatient rehabilitation outcomes after total knee arthroplasty (TKA) between groups with different baseline scores.

Design: A retrospective observational study.

Subjects: Patients with knee osteoarthritis who have previously undergone unilateral TKA.

Methods: Patients participated in 3-week inpatient rehabilitation following TKA and were assessed for patient-reported outcome measures (PROMs), which included the Numeric Pain Rating Scale (NPRS), the Health Assessment Questionnaire (HAQ), the European Quality of Life 5 Dimensions 5 Level Version (EQ-5D-5L), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Furthermore, mobility scores for the range of motion (ROM) and the Timed Up and Go (TUG) test were recorded at the beginning and the end of rehabilitation. Patients were divided into quartile groups based on their initial examination scores.

Results: 329 patients were enrolled in the study. The study population consisted mostly of female patients (63.8% vs 36.2%) with a mean age of 68.25 (SD 9.24) years. The personalized 21-day in rehabilitation programme was safe for all patients and had no dropouts. Patients with better PROMs scores at T1 did not have the same potential for improvement in PROMs but showed effective improvement in mobility (η² = 0.103 for changes in the WOMAC vs η²=0.502 for changes in the TUG test).

Conclusion: Regardless of the baseline scores, all patients presented significant improvements in both subjective and objective measures. Age and baseline PROMs or mobility scores did not have a significant effect on score development.

Objective: To evaluate existing evidence from published systematic reviews for the effectiveness and safety of rehabilitation interventions in adult patients with colorectal cancer.

Methods: A comprehensive literature search was conducted using medical/health science databases up to October 2024. Bibliographies of pertinent articles, journals, and grey literature were searched. Three reviewers independently selected potential reviews, assessed methodological quality, and graded the quality of evidence for outcomes using validated tools.

Results: Sixty systematic reviews (761 randomized controlled trials) evaluated 5 categories of rehabilitation interventions. Over half of the included reviews (n = 31) were of moderate-high quality. The findings suggest: moderate-quality evidence for exercise interventions for improving physical fitness and quality of life; high-quality evidence for nutritional interventions in reducing postoperative infections; high-quality evidence for multimodal prehabilitation for improved preoperative functional capacity; moderate-quality evidence for nutritional interventions for improving humoral immunity, reducing inflammation, and length of stay; moderate-quality evidence for acupuncture in improving gastrointestinal functional recovery; psychosocial interventions in improving short-term quality of life and mental health, and lifestyle interventions for improved quality of life.

Conclusion: Rehabilitation interventions yielded positive effects across multiple outcomes. However, high-quality evidence is still needed to determine the most effective rehabilitation approaches for patients with colorectal cancer.

Study design: Systematic scoping review.

Objectives: The aim was to identify and synthesize empirical studies exploring outdoor experiences, activities, and interventions in people with spinal cord injury (SCI).

Methods: Systematic searches were performed in 7 bibliometric databases. Unique records were independently screened by 2 authors. Peer-reviewed studies on outdoor experiences, activities, or interventions in adults with SCI were included. This was supplemented by Google Scholar searches and citation tracking. Data from included studies were extracted and analysed in a narrative synthesis.

Results: A total of 89 studies were included. Study findings were catalogued into 9 categories and grouped into 3 themes. Theme 1 covered findings related to the experiences and outcomes of outdoor recreational activities and nature exposure. Theme 2 covered findings on facilitators and barriers related to outdoor recreational activities and nature exposure. Theme 3 covered findings related to outdoor testing of equipment and tools.

Conclusion: People with SCI mainly report positive experiences from engaging with the natural environment and pursuing outdoor activities, but also experienced a range of barriers that need to be considered in both research and clinical practice. Future studies need to explore the effects of outdoor-based rehabilitation, also employing high-quality methods.

Objective: To determine the strength of the association between residual limb neuropathic pain intensity and the number of neuromas, prosthetic, functional, and participation outcomes, and assess whether ultrasound (US) biomarkers of neuromas differ between pain intensities.

Design: Cross-sectional study.

Subjects: Twenty-two participants with a transtibial amputation for more than 12 months, with and without residual limb neuropathic pain.

Methods: Participants completed questionnaires (Numerical Pain Rating Scale, Pain Disability Index (PDI), Prosthetic Profile of the Amputee-Locomotor Capabilities Index), and had their residual limbs examined by US. Whenever a neuroma was diagnosed during US, images of the neuroma(s) were recorded and US biomarkers were computed.

Results: Of the 27 neuromas diagnosed, pain intensity was associated with no use of walking aid, less daily prosthesis wearing time, a higher PDI score, and a neuroma at the common fibular nerve. The cross-sectional area, the thickness ratio, or the thickness of the overlying tissues was not associated with pain intensity.

Conclusion: Though the results enrich currently available evidence on clinical variables potentially associated with the intensity of neuropathic pain in individuals living with a transtibial amputation, and on the limited value of US biomarkers studied to determine the association between neuroma(s) and pain intensity, future studies providing higher quality evidence remain needed.

Introduction: Despite the growing evidence for the effects of tailored internet-delivered cognitive behaviour therapy (ICBT) programmes for those receiving physical rehabilitation, there is a lack of implementation of these programmes in a clinical or community setting. The aim of the current study was to evaluate barriers and facilitators of implementing an ICBT programme into a physical medicine rehabilitation setting.

Methods: Stakeholders with expertise in physical medicine rehabilitation were recruited (n = 25) including: 16 clinicians, 4 administrators, 3 persons with lived experience, and 2 care partners. Individual semi-structured interviews were conducted based on the domains of the Consolidated Framework for Implementation Research (CFIR). Transcripts were analysed using a positivist approach, using deductive thematic content analysis. Themes were coded based on the domains of CFIR.

Results: Facilitators for implementation primarily fell under intervention characteristics including relative advantage, strong evidence and quality, and design quality. Perceived barriers for implementation were identified in the inner setting including leadership engagement, culture, and available resources.

Conclusions: The results from the current study provide insight on the factors that may contribute towards successful implementation of an ICBT programme in a physical medicine setting.

Objective: To understand patient, caregiver, and clinician perspectives on patient-reported outcome measures, critical functional domains, and disease-modifying therapies in adult spinal muscular atrophy.

Design: An exploratory qualitative single-site study.

Patients: Ten adults with spinal muscular atrophy and two clinicians participated in semi-structured interviews.

Methods: Semi-structured interviews were conducted virtually or in person with participants after they completed outcome measures at a routine clinic visit. Two researchers analysed transcripts concurrently using a thematic approach to determine themes.

Results: Ten themes were identified among partici-pants. Patient-reported outcome measure preference varied between functional groups and was under-responsive, although it captured meaningful data. Motor stability was most frequently expected with disease-modifying therapy, but participants also reported improved fatigue and respiratory status.

Conclusion: After considering patient goals, functional status, and preferences, patient-reported outcome measures represent a valuable adjunct to standard clinical and research tools. Optimal selection of patient-reported outcome measures requires careful consideration of multiple patient factors. Collaborative development of modified patient-reported outcome measures may yield a responsive, meaningful, and acceptable tool that can be used across a broad functional spectrum.