Journal of Rehabilitation Medicine最新文献

Objective: To investigate the combined effect of transcranial magnetic stimulation (TMS) and transcranial direct current stimulation on improving lower limb function in stroke patients.

Design: Randomized controlled trial.

Subjects/patients: Subacute stroke patients.

Methods: 169 post-stroke hemiplegia patients were randomly divided into 4 groups (control, transcranial direct current stimulation, transcutaneous auricular vagus nerve stimulation, and transcutaneous auricular vagus nerve stimulation combined with transcranial direct current stimulation) and evaluated using the Fugl-Meyer Assessment-Lower Extremity (FMA-LL), Timed Up-and-Go (TUG) test, Modified Barthel Index (MBI), Berg Balance Scale (BBS), gait parameters, and surface electromyography (sEMG).

Results: Significant improvements in FMA-LL, MBI, BBS, TUG, gait parameters, and sEMG were noted in the intervention groups compared with the control, with the transcutaneous auricular vagus nerve stimulation combined with transcranial direct current stimulation group showing the most pronounced improvements. Differences in some outcomes were also notable between the transcutaneous auricular vagus nerve stimulation and transcranial direct current stimulation groups.

Conclusion: The combination of transcutaneous auricular vagus nerve stimulation and transcranial direct current stimulation effectively enhances gait, balance, and daily living activities in subacute stroke patients. These benefits are likely due to transcutaneous auricular vagus nerve stimulation activating the solitary and trigeminal nuclei and transcranial direct current stimulation stimulating the motor cortex. Wearable gait analysis systems and electromyography are valuable in clinical gait assessment for these patients.

Objective: To develop models for predicting postoperative ambulation recovery at 3 months following fragility hip fracture surgery.

Design: Cross-sectional study.

Subjects: Fragility hip fracture patients aged ≥ 50 years who underwent operative treatment and completed a 3-month follow-up.

Methods: Potential predictors were collected from eligible patients, while ambulation at 3 months after injury was assessed using the modified functional ambulation classification. These factors were used to develop the Hip Fracture Short-Term Ambulation Prediction, consisting of 2 models: Model 1 for postoperative ambulation and Model 2 for preinjury status recovery.

Results: Among the 275 patients, 55 (20.0%) achieved good ambulation, and 59 (21.5%) returned to their preinjury status at 3 months. Age, preinjury ambulatory status, and discharge ambulatory status were identified as significant predictors of 3-month postoperative ambulation. The tool presented (Models 1 and 2) showed strong performance (area under the curve of 0.86 and 0.85, respectively) and good internal validity.

Conclusions: Age, preinjury ambulatory status, and discharge ambulatory status significantly predict postoperative ambulation and preinjury status recovery at 3 months after fragility hip fracture surgery. The tool presented may aid clinicians in identifying patients who could benefit from targeted rehabilitation interventions during this crucial period.

Objective: The present scoping review aimed to summarize and determine the accuracy of the variables and cutoff values reported to date for identifying fall risk in patients with stroke and identify the commonalities, limitations, and clinical implications.

Methods: Articles published by the end of 2023 were searched using PubMed, Cumulative Index of Nursing and Allied Health Literature, and Scopus electronic databases. Two reviewers created a search formula, searched the databases, and conducted primary and secondary screenings.

Results: This review included 21 articles. The most commonly used individual indicator for identifying fall risk after stroke was the Berg Balance Scale; the cutoff values were relatively consistent, ranging between 46.5 and 50.5 points (area under the curve: 0.72-0.81). For the Timed Up and Go test and Falls Efficacy Scale-International, the cutoff values were in the range of 15-19 s and 27-29 points, respectively, and were relatively consistent across the articles. However, the area under the curve values were low (0.66-0.70 and 0.68-0.71, respectively).

Conclusion: Among various assessments, the Berg Balance Scale is the most extensively studied tool, with established cutoff values associated with falls risk. It serves as a reliable indicator for detecting fall risk, especially in community-dwelling individuals with chronic stroke.

Objective: This study aimed to explore the effect of three-dimensional rehabilitation potential on the activity of daily living (ADL) among patients with stroke in rehabilitation wards.

Design: Prospective longitudinal study.

Setting: Two rehabilitation wards situated within a nationally recognized referral centre in Northern Taiwan, followed by subsequent discharge.

Participants: A total of 101 participants were admitted due to either a primary or recurring incident of infarction or haemorrhagic stroke, subsequently being transferred to the rehabilitation ward of a medical centre.

Interventions: Not applicable.

Main outcome measures: Rehabilitation potential included biological (swallowing ability, muscle power, and urinary incontinence), psychological (rehabilitation motivation and cognitive function), and social (social support) dimensions. The rehabilitation treatment outcome was activities of daily living measured using the Barthel Index. Time-variant variables, including swallowing ability, rehabilitation motivation, social support, and ADL, were collected at the time of transfer to the rehabilitation ward, 1-3 days before discharge, and 1 month after discharge.

Results: The results of the generalized estimating equations model revealed that poor swallowing ability, lower muscle power, and urinary incontinence in the biological dimension, along with lower rehabilitation motivation and moderate cognitive impairment in the psychological dimension, are significant indicators of rehabilitation potential among stroke patients. When the different dimensional rehabilitation potential was considered overall, both biological and psychological indicators can still predict ADL outcomes during and after inpatient rehabilitation therapy. Of these indicators, swallowing ability and rehabilitation motivation were positively correlated with ADL over time. Further, increased rehabilitation motivation enhanced the protective effect of swallowing ability on ADL.

Conclusion: Important indicators of rehabilitation potential, which can predict ADL outcomes, were identified for stroke patients in the rehabilitation ward. Policymakers can design appropriate intervention plans to enhance the rehabilitation potential and improve the effectiveness of inpatient rehabilitation treatment for stroke patients.

Objective: This study investigated the weight of different cognitive disorders on patient behaviour influencing the risk of falls after recent stroke.

Design: Survey and retrospective monocentric study.

Subjects/patients: 74 professionals/108 patients.

Methods: Survey of professionals to ask for their thoughts concerning the weight of different cognitive disorders on the risk of falls and a retrospective study of patients post-stroke to determine whether these cognitive deficits could distinguish fallers from non-fallers. Univariate and multivariate logistic regression analyses were conducted.

Results: In part 1, major cognitive disorders identified were anosognosia, confusion, inattention, precipitation, and unilateral spatial neglect. In part 2, 25 patients (23%) were fallers. After adjustment for length of rehabilitation stay and disease severity, on multivariate analysis, the cognitive disorders significantly associated with risk of falls were anosognosia (odds ratio 16), precipitation (13.3), inattention (8.3), and perseveration (4.9). Unilateral spatial neglect was not independently associated. Aphasia did not play a role.

Conclusion: Some cognitive disorders, easily identified before any neuropsychological assessment, strongly modify patient behaviour in terms of risk of falls. It is proposed that these disorders should not be considered as an additional factor along with physical and general factors but rather as a multiplying factor applied to the others.

Purpose: To investigate the impact of chemoradiotherapy on the physical fitness of patients with oesophageal cancer, and the clinical factors influencing it.

Method: A total of 67 participants successfully completed the study, with 18 of them engaging in supervised, in-hospital aerobic training at moderate intensity for a minimum of 20 sessions. Cardiopulmonary exercise testing, hand grip strength, body composition assessed via bioelectrical impedance analysis, patient-generated subjective global assessment, albumin, and the Functional Oral Intake Scale (FOIS) were evaluated before chemoradiotherapy and 6-8 weeks after its completion.

Result: Among the participants, cardiopulmonary fitness, hand grip strength, and phase angle of BC-BIA declined during chemoradiotherapy. Before and after chemoradiotherapy, V̇O2peak was 19.6 ± 4.4 and 17.4 ± 3.9 mL/min/kg respectively. The improvement in FOIS during chemoradiotherapy showed a positive correlation with changes in aerobic capacity. Additionally, exercise training was associated with attenuating the decline in aerobic capacity.

Conclusion: Physical fitness deteriorated in patients with oesophageal cancer following chemoradiotherapy. Improvement in dysphagia helps maintain aerobic capacity. Additionally, exercise training has the potential to mitigate the decline. This discovery can serve as a reference for enhancing holistic care for patients with oesophageal cancer.

Objective: The primary aim of this study was to evaluate the safety and efficacy of early mobilization in patients with aneurysmal subarachnoid haemorrhage.

Design: Systematic review with meta-analysis of randomized controlled studies and observational studies.

Patients: Patients with aneurysmal subarachnoid haemorrhage.

Methods: PubMed, Embase, CINAHL, Web of Science, Pedro, and the Cochrane Library databases were searched. A systematic review and meta-analysis were performed. Screening and data extraction were performed by 2 independent reviewers.

Results: Sixteen studies involving 1,757 patients were included. Meta-analysis of the data estimated that early mobilization improved mRS score at discharge (mean difference -1.39, 95% CI -2.51 to -0.28, I2 = 86%) and at 3 months (mean difference -1.10, 95% CI -1.54 to -0.66, I2 = 7%). Early mobilization was associated with a reduction in cerebral vasospasm rate, both radiological (OR 0.66, 95% CI 0.45 to 0.96, I2 = 7%) and clinical (OR 0.44, 95% CI 0.27 to 0.72, I2 = 8%); 6% of mobilization sessions involved adverse events, mostly haemodynamic changes.

Conclusion: This review found moderate-quality evidence supporting the safety and effectiveness of early mobilization in patients with SAH. Further randomized controlled trials are needed to identify the appropriate mobilization strategy and confirm these results.

Objective: To assess (i) the impact of self-reported fatigue on functioning in daily life, and (ii) the association with sociodemographics, physical capacity, and work ability among people with post-COVID-19.

Design: A cross-sectional study.

Subjects: Adults reporting post-COVID-19 symptoms for at least 2 months.

Methods: Participants were recruited through social media and responded to an online survey between October 2021 and February 2022 regarding sociodemographics, COVID-19 symptoms, comorbidities, physical and mental fatigue, aerobic capacity, and work ability. Descriptive statistics and logistic regression analyses were used.

Results: A total of 614 participants (88% women, mean age 47 years, on average 13 months of symptoms) were included. A majority (≥ 84%) reported both physical fatigue and mental fatigue, according to the Fatigue Severity Scale and Mental Fatigue Scale. The fatigue impacted motivation, physical functioning, work, family, or social life, and increased sensitivity to stress and concentration difficulties. Among the factors, work ability had the strongest association with both physical fatigue and mental fatigue; odds ratio: 0.650 and 0.473, p < 0.001, respectively.

Conclusion: This study found that self-reported fatigue is common among people with post-COVID-19, and negatively impacts functioning in daily life. To achieve a sustainable life and work situation, support and targeted rehabilitation interventions may be important.

Background: The standard posture described in Kendall's manual is commonly used for postural assessment. However, no bibliographic reference was provided to support its use.

Objective: To identify the original source and the procedure followed for the design of that posture and to compare it with current literature on the subject.

Methods: In accordance with the PRISMA Extension for Scoping Reviews recommendations, PubMed and Scopus were searched using the terms "standing posture", "plum line," and "gravity line". Publications in English, French, German, or Spanish that referred to posture in adults without pathology were included.

Results: Six articles and 3 books were included in the final analysis. An identical posture to that described in Kendall's manual was identified in an early 19th-century work carried out with the unrealistic objective of maintaining static bipedal standing without muscular support, and including several anatomical misconceptions. Furthermore, the "ideal alignment" described in Kendall's manual does not correspond to the actual line of gravity, the comfortable posture, or natural postural compensations due to age, gender, or race.

Conclusion: The utilization of this standard to ascertain postural deficiencies is not supported by current evidence and may result in numerous false positives, particularly in the elderly.