Journal of Rehabilitation Medicine最新文献

Objective: To reach consensus on statements of best practice for ways of working to deliver orthotic interventions after stroke among expert professionals in the UK involved in the delivery of orthotic intervention to patients after stroke.

Design: A 2-round modified electronic Delphi exercise (eDelphi).

Subjects: Thirty-two orthotic professionals with 2 years' or more experience of delivering orthotic intervention within stroke rehabilitation, from varied geographical locations and experience levels participated in the eDelphi.

Methods: For the eDelphi exercise, 65 statements of best practice were assessed by participants. A 7-point Likert scale was used to determine agreement with statements. A consensus threshold of 75% was pre-determined in line with other studies.

Results: After the first round, consensus was reached for 62 of the statements. All statements had 75% or above agreement. An 87.5% retention rate was maintained between rounds. After the second round 64 statements of best practice achieved 75% consensus.

Conclusion: Overall consensus 94.3% was achieved on the first UK-wide professionally agreed statements of best practice detailing the optimal ways of working when delivering orthotic interventions to enhance rehabilitation outcomes and reduce complications for stroke survivors.

Objective: To determine whether changes in physical and psychological outcomes occurred in the 12 months following completion of a randomized controlled trial comparing a 4-week pulmonary telerehabilitation programme with a control group of usual care in people with respiratory post-acute sequelae of COVID.

Methods: This was a prospective, observational, multi-site, assessor-blinded study.

Primary outcome: 1-minute sit-to-stand test.

Secondary outcomes: 5-repetition sit-to-stand test; Montreal Cognitive Assessment; COVID-19 Yorkshire Rehabilitation Scale; COPD Assessment Test; 36-Item Short-Form Health Survey; Hospital Anxiety and Depression Scale; Fatigue Severity Scale; and the Kessler Psychological Distress Scale. All outcomes were assessed at baseline and 12 months following randomized controlled trial participation. All participants were analysed as a single group at 12 months, given there were no significant differences in the randomized controlled trial.

Results: Of 50 participants enrolled in the randomized controlled trial, 29 (58%) participated in the 12-month follow-up. Compared with baseline, at the 12-month follow-up there was no statistically significant improvement in the primary outcome of the 1-min sit-to-stand test (1.5 points, CI: -1.3 to 4.2), yet statistically significant differences in the 5-repetition sit-to-stand test (-1.4 seconds CI: -2.7 to -0.1), COPD Assessment Test (-4.1 points CI: -6.8 to -1.4), and some domains of SF-36 and COVID-19 Yorkshire Rehabilitation Scale.

Conclusion: This study demonstrated that people reporting respiratory post-acute sequelae of COVID experienced some recovery at 12 months, despite not improving initially during a 4-week pulmonary telerehabilitation programme or control period.

Objective: To investigate rehabilitation settings, exercise modalities, and assessments provided post-discharge to older adults with hip fracture with and without signs of cognitive impairment.

Design: National cross-sectional e-survey.

Subjects: Rehabilitation managers and development physiotherapists from all 98 Danish municipalities.

Methods: Information was collected on rehabilitation after discharge across four settings: 24-h-care, home-based care, outpatient-healthcare-centers, and nursing-home-facilities.

Results: Ninety municipalities (92%) responded. About half used standardized screening tools to guide rehabilitation, but only 4% screened for cognitive impairment. Rehabilitation was typically delivered by physiotherapists 1-2 times/week, lasting 5-12 weeks, with 24-h-care and nursing-home facilities settings offering shorter but more frequent sessions. Common exercise modalities included strengthening, balance, and functional tasks, where these were more used in hip fracture than hip fracture with signs of cognitive impairment. Patient-Reported-Outcome-Measures (PROMs) were infrequently used; the Patient-Specific-Functional-Scale and Numerical-Rating-Scale were most often used. Cognitive PROMs were rarely applied, except the Montreal-Cognitive-Assessment at 24-h-care. Performance-based tests were more widely used, particularly the 30s-sit-to-stand and Timed Up&Go tests.

Conclusion: The survey had a high response rate. Few municipalities used cognitive screening tests and pain scales whereas performance-based testing was more predominant. The preferred exercise modality was functional exercise, used more often for patients with hip fracture than those with hip fracture and signs of cognitive impairment.

Objective: Robot-assisted therapy (RAT) has shown promise in post-stroke motor recovery. However, its effects on non-motor outcomes remain unclear. This systematic review evaluated RAT impact on post-stroke quality of life (QoL), cognition, and psychosocial functioning.

Methods: Following PRISMA guidelines, electronic searches were performed from Web of Science, PubMed, Cochrane Library, CINAHL, Embase, and PsycINFO. Risk of bias was assessed using NIH Quality Assessment Tools. Data on study design, participants, intervention characteristics, outcomes, and results were extracted and synthetized descriptively.

Results: A total of 90 studies met the inclusion criteria. Considerable heterogeneity was found in participants' characteristics, intervention duration (2-52 weeks), and dosage (20-240 min/session). Most studies reported significant RAT effects on QoL (emotional, physical, cognitive, social subdomains), cognition (attention, executive functions, memory, language, visuo-spatial abilities, intelligence), and psychosocial outcomes (anxiety, depression, self-efficacy, fear of falling, motivation, coping). Some studies also showed greater improvements compared with conventional training controls. Longitudinal effects were generally absent, except for QoL variations observed up to 12 months. Cognitive and psychological factors were also identified as moderators/predictors of RAT response.

Conclusion: Despite variability across studies, findings suggest RAT may have a broad impact beyond motor recovery. Future large-scale, standardized, longitudinal trials are recommended to confirm these results.

Objective: To predict treatment response of a family intervention and investigate its cost-effectiveness from a healthcare payer perspective.

Design: Explorative predictor analyses and trial-based economic evaluation.

Subjects/patients: Participants (n=157) were enrolled 4 months to 2 years after discharge from a specialized neurorehabilitation unit.

Methods: Injury type, time since injury, delivery format, and relationship (individual with injury vs family member) were explored as predictors of effect using linear mixed-effect regression. Cost-effectiveness was analysed from a healthcare payer perspective, with incremental cost based on delivery. Incremental health effect was reported for measures on mental health and anxiety and depression symptoms.

Results: The 4 predictors had negligible to small effects on the treatment response. Incremental cost for the family intervention was estimated at €798.16 (CI: €700.9; €895.5). Incremental health effect was estimated at 5.64 (CI: 2.71, 8.56) points on the Mental Component Summary at 2 months' follow-up. At a willingness-to-pay threshold of €300, the probability of the intervention being cost-effective was 99.8% for the Mental Component Summary.

Conclusion: The predictors showed no or little effect on the treatment response, and the cost-effectiveness analysis showed the probabilities of the intervention being cost-effective from a health payer perspective.

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.