Journal of Rehabilitation Medicine最新文献

Objective: To evaluate the usefulness of electromyography at a polio clinic in identifying unperceived muscle denervation. Second, to compare people who perceived themselves as weak in 1 or both legs with those who did not.

Design: Cross-sectional study.

Subjects: The study included 542 persons with late effects of polio in Sweden. Mean age 58 at the first visit, 312 were female. Data used are from a clinical quality registry.

Methods: At the first visit patients answered sent-out questionnaires. They underwent an electromyography test, walk test, and muscle strength assessment.

Results: Electromyography identified signs of chronic neurogenic changes in lower limb muscles (n = 260) where the patient reported no previous involvement, comprising 239 of the participants. Significant differences in values shows that the group who did not perceive themselves as weak exhibited better performance, demonstrating greater speed, strength, and reduced reliance on wheelchairs.

Conclusion: Electromyography can identify signs of muscle denervation in association with weakness in people with late effects of polio who perceived themselves as healthy. This comparison suggests that those that do not perceive weakness may unknowingly overuse their muscles. These findings contribute to our understanding of the late effects of polio and importance of early detection and rehabilitation.

Objectives: To investigate the relationship between physical activity and depressive symptoms in stroke survivors.

Design: A cross-sectional study utilizing National Health and Nutrition Examination Survey (NHANES) 2007-2018 data, employing propensity score matching to control for confounders.

Patients: 1,140 stroke survivors from NHANES, assessing depressive symptoms through the Patient Health Questionnaire-9 (PHQ-9) conducted via family interview or a mobile examination centre examination.

Methods: PA was surveyed concurrently with the PHQ-9, categorized into vigorous, moderate, and moderate-to-vigorous intensities. Propensity score matching was used to match participants based on their activity levels, and the relationship between physical activity and depressive symptoms was analysed by logistic regression.

Results: Among all the subjects, 225 individuals had significant depressive symptoms. If vigorous-intensity PA duration is longer than 75 min (odds ratio [OR] = 0.41, 95% CI 0.21-0.75) or longer than 150 min (OR = 0.42, 95% CI 0.19-0.85), and moderate-intensity physical activity duration is longer than 150 min (OR = 0.59, 95% CI 0.38-0.90) or between 150 and 300 min (OR = 0.36, 95% CI 0.15-0.77), and moderate-to-vigorous PA duration is greater than 150 min (OR = 0.61, 95% CI 0.40-0.91) or exceeding 300 min (OR = 0.50, 95% CI 0.31-0.78), this might be associated with lower depressive symptoms.

Conclusion: Regular physical activity, particularly of moderate or higher intensity, is associated with milder depressive symptoms in stroke survivors, suggesting the potential for non-pharmacological intervention.

Objective: To map existing knowledge on screening and rehabilitation outcomes for co-occurring traumatic brain injury among people with traumatic spinal cord injury (SCI).

Methods: Articles focusing on screening and rehabilitation outcomes in participants sustaining co-occurring traumatic brain injury and traumatic spinal cord injury (all ages) were identified in Ovid, Scopus, Web of Science, CINAHL, and ProQuest Dissertations and Theses electronic databases. There were no limitations on study design, date, or geographical location. Articles were excluded if they were not available in English. Data were extracted into the Rayyan online collaboration platform and summarized descriptively.

Results: Twenty-five studies were included, with a mix of retrospective, case-control, and prospective cohort designs. Screening under-estimated traumatic brain injury incidence when approaches relied on inconsistently collected traumatic brain injury indicators, especially for mild traumatic brain injury. Rehabilitation outcomes included length of stay, functional outcomes, cognitive functioning, complication rates, and employment. Although mixed, outcomes among persons with moderate to severe co-occurring traumatic brain injury especially, appeared poorer than those with spinal cord injury alone.

Conclusions: Multivariable approaches to traumatic brain injury ascertainment and greater consistency in documenting acute traumatic brain injury indicators may improve reliability of capturing traumatic brain injury and traumatic brain injury severity among persons with traumatic spinal cord injury. Impacts of co-occurring traumatic brain injury appear greater relative to SCI alone but few studies analysed outcomes based on traumatic brain injury severity.

The growing relevance of rehabilitation in healthcare to address increasing patient needs necessitates robust Physical and Rehabilitation Medicine (PRM) integration into medical education and practice. Academic PRM, rooted in medical faculties, is vital for developing the medical speciality as an academic discipline across Europe, where it faces challenges, including limited representation in medical schools and competition for resources with established disciplines. This commentary advocates establishing a representative organization for academic PRM in Europe. Currently, no organization adequately represents academic PRM at the European level. The lack of academic chairs and departments in some countries undermines PRM's credibility and visibility, making it less attractive to students and prospective academics. An organized effort could provide a platform for knowledge exchange, policy formulation, and advocacy, ultimately strengthening the discipline's presence in medical faculties. Immediate action is crucial, particularly in light of the WHO's call for action 2030 and its 2023 resolution emphasizing the need for rehabilitation within health systems. A representative European academic PRM organization could advocate for education on rehabilitation across all medical specialities and enhance the understanding of functioning as a health indicator. It would also support the development of national academic organizations across Europe and facilitate collaboration with other stakeholders, including patient organizations, rehabilitation professionals, and funding agencies. Critical considerations for creating this organization include defining core activities, establishing governance principles focused on representativity and inclusion, and fostering relationships with existing national, European, and international organizations of PRM and academic medicine. By leveraging successful models like the Association of Academic Physiatrists in the United States, Europe can develop a robust and credible voice for academic PRM. This initiative is timely and necessary to capitalize on the current momentum and ensure the future of academic PRM in Europe.

Objective: Evaluate efficacy of cognitive behavioural therapy for sleep and fatigue adapted for brain injury relative to health education control in alleviating sleep disturbance and fatigue after acquired brain injury.

Design: Parallel groups randomized controlled trial.

Subjects: 126 community dwelling adults with stroke or traumatic brain injury.

Methods: Participants were randomized 2:1 to receive 8-weeks of cognitive behavioural therapy for sleep and fatigue (n = 86) or health education (n = 40). The Pittsburgh Sleep Quality Index was assessed pre- and post-treatment, and 2 and 4-months post-treatment, with secondary measures of insomnia, fatigue, sleepiness, mood, quality of life, activity levels, self-efficacy, and actigraphy.

Results: Both groups showed improved sleep by 4-month follow-up. However, cognitive behavioural therapy for sleep and fatigue had significantly larger and more rapid improvements than health education immediately post-treatment (β = -1.50, p < 0.001, 95% confidence interval -2.35 to -0.64). There were no significant between-groups differences in fatigue; however, cognitive behavioural therapy for sleep and fatigue showed within-group gains on both fatigue measures immediately post-treatment and over time (β = -0.29, p = 0.047, 95% confidence interval -0.58 to -0.01). Health education had delayed improvements at 4-month follow-up on 1 fatigue measure.

Conclusions: Both cognitive behavioural therapy for sleep and fatigue and health education led to improvement in sleep and fatigue; however, effects were larger and more rapid for cognitive behavioural therapy for sleep and fatigue immediately post-treatment. This supports the efficacy of cognitive behavioural therapy for sleep and fatigue in acquired brain injury but also highlights that health education may result in delayed improvements in symptoms. ANZCTR Trial registration numbers: 1261700087830; 12617000879369.

Objective: To investigate if eye tracking can support detection of covert voluntary eye movements and to compare these findings with a simultaneously performed clinical assessment according to the Coma Recovery Scale manual regarding visual stimuli.

Design: Observational case series.

Subjects: Twelve outpatients with prolonged disorders of consciousness recruited from the rehabilitation clinic of a regional rehabilitation unit.

Method: Eye movements were recorded with a wearable eye tracker while performing 4 test items from the Coma Recovery Scale Revised. The clinical assessment and recorded eye movement responses were analysed for agreement.

Results: Response data was obtained from 238 out of 288 trials. Eye-tracking data were obtained in median 89.6% of the trials (37.5-100%). The eye tracking assessment judged a significantly higher percentage of trials as a response (46.2%) compared with the clinical assessment (18.1%), mainly in test items "visual pursuit" and "visual fixation".

Conclusion: Eye tracking showed potential to be more effective in the detection of putative voluntary eye movements compared with conventional examination. Based on the findings in this and previous studies, eye tracking may serve as a useful complementary tool when examining patients with prolonged disorders of consciousness.

Background/objective: A systematic review was conducted on the association between ethnicity and health-related quality of life in post-stroke populations.

Methods: In February 2024, a comprehensive search was conducted across several databases. Studies were included when they had at least 2 distinct ethnic post-stroke groups for comparison, along with the utilization of validated questionnaires to measure health-related quality of life. Two authors independently screened, selected, and evaluated studies, while 1 author extracted outcome data. When possible, effect sizes were calculated using raw data from included studies.

Results: Eleven studies were included, comprising 12,430 patients. All but 1 study found ethnic disparities in post-stroke health-related quality of life. In 8 studies, patients from minority ethnic groups had lower health-related quality of life after stroke compared with the predominant ethnic group in a country. In 2 studies, the minority group (Asians and non-Hispanic blacks, respectively) showed better outcomes compared with the majority group. In 1 study no differences were observed. In 6 studies the effect size was calculable, and ranged from small to moderate.

Conclusion: Included studies show a large heterogeneity regarding included populations and reported outcomes. Racial/ethnic disparities in stroke patients exist in most studies from different countries. Further studies are needed to investigate the background of these disparities.

Objective: To evaluate the satisfaction, effectiveness, and usability of a telerehabilitation programme for Parkinson's disease (PD) patients.

Design: Prospective cohort study.

Subjects/patients: PD patients based on the diagnostic criteria for clinically established or probable PD published by the International Parkinson and Movement Disorder Society.

Methods: The telerehabilitation was conducted twice a week via a Zoom meeting platform, using pre-recorded rehabilitation contents shared during the sessions. In this study we administered several questionnaires, i.e., a self-report questionnaire on the effectiveness of telerehabilitation, the Parkinson's Disease Questionnaire-39 (PDQ-39), and the Telehealth Usability Questionnaire (TUQ), in order to evaluate the satisfaction, effectiveness, and usability of our telerehabilitation programme.

Results: Fifty-six PD patients were included in the analysis. After 6 months, 91.1% expressed satisfaction with the telerehabilitation and 91.9% reported telerehabilitation had helped them develop an exercise routine, but the PDQ-39 showed no significant improvement in quality of life. The TUQ showed higher scores for Usefulness (76.1%), Ease of Use and Learnability (73.5%), Interface Quality (75.4%), and Satisfaction and Future Use (82.2%).

Conclusion: Satisfaction with telerehabilitation was high, particularly with regard to positive effects on emotional well-being. Telerehabilitation usability was also found to be high.

Objectives: The conventional test to detect unilateral spatial neglect (USN) is the Bells Test performed in a paper-and-pencil format. While several studies showed immersive virtual reality (VR) tests may provide greater sensitivity in revealing the presence of USN using visual scanning tasks, none has investigated the Bells Test in VR. This study compares the Bells Test performed in paper-and-pencil format (PP) and in VR in conventional (CVR) and ecological (EVR) format, which differ by the size of the display, in stroke patients.

Design: Cross-sectional study.

Setting: Stroke patients.

Participants: A convenience sample of 32 stroke patients.

Interventions: VR assessments were performed using an immersive system with a head-mounted display. In CVR, the Bells Test is reproduced in the same format as PP (A4 sheet), while in EVR, the targets are displayed in a wider space corresponding to a hemisphere of 1-m radius.

Results: The number of cancelled targets out of 35 was 32.5 (3.5) for PP, 33 (4) for CVR, and 34 (2) for EVR (mean [SD]), with a significant difference between PP and EVR (p < 0.05). The time to complete the Bells Test was 186 (69) s for PP, 184 (65) s for CVR, and 170 (58) s for EVR, without differences between modalities (p > 0.05). Bells Tests in the 3 modalities revealed the presence of USN, except for 1 patient in EVR.

Conclusion: VR assessment of USN could be used in the same way as conventional cancellations tests. Moreover, VR could provide additional information on the type of USN through the different testing modalities available.

Objective: To identify factors associated with earlier independence in "real-life walking" during hospitalization in subacute stroke patients.

Design: Retrospective cohort study.

Subjects/patients: Two hundred and six hemiplegic patients.

Methods: Functional Independence Measure (FIM) walking items were measured biweekly from admission to discharge. Patients were grouped by achieving independent "real-life walking" (FIM-walking score ≥6). Time to independence, stratified by age, FIM motor score (FIM-M), FIM cognitive score (FIM-C), and Functional Ambulation Categories (FAC) scores were compared using Kaplan- Meier plots and log-rank tests. Hazard ratios were calculated via multivariable Cox proportional hazard models.

Results: The median time to independence was 4 weeks, with significant differences (p < 0.05) by age, FIM-M, FIM-C, and FAC stratification. Age ≤64 years (hazard ratio 1.92, 95% confidence interval 1.21-3.06), FIM-C ≥25 (hazard ratio 2.42, 95% confidence interval 1.52-3.86), and FAC ≥3 (hazard ratio 1.98, 95% confidence interval 1.22-3.21) significantly affected earlier walking independence (all p < 0.01). Impeding factors were FIM-M ≤38 (hazard ratio 0.23, 95% confidence interval 0.13-0.40; p < 0.01) and FAC = 0 (hazard ratio 0.184, 95% confidence interval 0.06-0.62; p < 0.01).

Conclusion: Early improvement in "real-life walking" was associated with younger age, greater cognitive function, and greater "test-setting walking" ability on admission. Low activities of daily living independence and "test-setting walking" ability hindered early progress.