Journal of Rehabilitation Medicine最新文献

Objective: Perform a cost-utility analysis for return-to-work interventions with missing health-related quality-of-life (HRQoL) data while transparently demonstrating the impact of different methods of handling missing data on outcomes.

Methods: The costs and quality-adjusted life-years over a 2-year period were estimated for 2 return-to-work interventions, inpatient multimodal occupational rehabilitation (I-MORE) and outpatient acceptance and commitment therapy (O-ACT), using a healthcare perspective and a limited societal perspective. Four methods were used to handle the missing HRQoL data: complete case analysis, single imputation, multiple imputation, and linear mixed models. The cost-effectiveness outcomes were expressed as incremental net monetary benefit.

Results: The average incremental quality-adjusted life-years comparing I-MORE with O-ACT ranged between -0.001 and 0.330 depending on missingness method. From a healthcare perspective, I-MORE was consistently not cost-effective (incremental net monetary benefits ranged from -€7,094 to -€9,363) while from a limited societal perspective, I-MORE was consistently cost-effective (incremental net monetary benefits ranged from €1,293 to €16,277).

Conclusion: While cost-effectiveness findings remained consistent within each analytical perspective, the choice of different missingness methods led to variations in incremental quality-adjusted life-years. Multiple imputation is recommended to handle missing HRQoL data as it is transparent and flexible. How-ever, a thorough investigation of the missing data mechanism should still be conducted.

Objective: To investigate the effects of motor imagery on psychological and physical outcomes during acute-phase rehabilitation following total knee arthroplasty.

Design: A single-blind, randomized controlled trial.

Subjects/patients: Forty patients who underwent total knee arthroplasty and scored ≥37 on the Tampa Scale of Kinesiophobia were enrolled and randomly allocated to either a motor imagery group or a control group.

Methods: Both groups received the same 2-week standard rehabilitation programme beginning within 48 h post-surgery. The motor imagery group additionally performed structured motor imagery sessions prior to exercise. Outcomes included kinesiophobia, pain catastrophizing, self-efficacy, exercise adherence, pain intensity, knee range of motion, and quadriceps strength. Assessments were performed by blinded evaluators before and after the intervention.

Results: Both groups showed significant improvements in all outcome measures (p < 0.05), with the motor imagery group achieving significantly greater gains in psychological variables, pain reduction, and physical function compared with the control group (p < 0.05).

Conclusion: Motor imagery is an effective adjunct to early rehabilitation after total knee arthroplasty. Its use enhances psychological resilience, supports adherence, and accelerates functional recovery, indicating its value in comprehensive, multidimensional rehabilitation strategies.

Objective: To explore the mediating role of exercise self-efficacy in the relationship between pain catastrophizing, kinesiophobia, and exercise adherence in patients post-cardiovascular surgery.

Design: Cross-sectional study.

Subjects/patients: A total of 278 adult patients who underwent elective cardiovascular surgeries between March 2023 and February 2025 at a tertiary hospital in China.

Methods: Participants completed standardized instruments measuring pain catastrophizing, kinesiophobia, exercise self-efficacy, and exercise adherence. Statistical analysis was performed using SPSS 29.0, R 4.4.5, and Zstats 1.0, including mediation analysis.

Results: Pain catastrophizing significantly negatively correlated with exercise self-efficacy (r = -0.830, p<0.001) and adherence (r = -0.953, p < 0.001), while positively correlating with kinesiophobia (r = 0.295, p < 0.001). Kinesiophobia negatively correlated with self-efficacy (r = -0.252, p < 0.001) and adherence (r = -0.277, p<0.001). Exercise self-efficacy positively correlated with adherence (r = 0.699, p<0.001). Mediation analysis revealed that self-efficacy partially mediated the relationship between pain catastrophizing and adherence (β = -1.11, p<0.001) and between kinesiophobia and adherence (β = -0.30, p < 0.001).

Conclusion: Exercise self-efficacy is a critical mediator in how psychological factors like pain catastrophizing and kinesiophobia influence exercise adherence post-cardiovascular surgery. Enhancing self-efficacy may improve rehabilitation outcomes.

Objective: To evaluate the safety, adherence, and efficacy of self-administered balance and resistance exercise using the Borg scale in patients with chronic kidney disease, and to examine relationships between exercise intensity or duration and baseline measures, and relationships between change in physical performance and baseline measures, intensity, or duration.

Design: Post-hoc analysis of a randomized controlled trial.

Patients: 151 patients, mean age 66 (14) years, measured glomerular filtration rate 22 (8) mL/min/1.73 m2.

Methods: 12 months balance or resistance exercise, Borg 13-17, combined with aerobic exercise. Berg Balance scale, Functional Reach, isometric quadriceps strength and 30 s sit-to-stand were assessed at baseline and after 12 months. Intensity and duration were recorded in an exercise diary.

Results: No injuries occurred. Patients reported high adherence, median intensity 14 (13-15). Both groups maintained/improved physical performance by 2-18%, within a wide duration, mean 56 (range 3-194) min/week. No significant relationships were found between intensity or duration and baseline measures, or between improved physical performance and baseline measures, intensity, or duration.

Conclusion: Twelve months' self-administered balance and resistance exercise were safe and adhered to, using the Borg scale, in patients with chronic kidney disease. Physical performance improved, showing that even short weekly durations can be efficacious when prescribed intensity is maintained.

Objective: To evaluate the test-retest reliability and agreement of kinematic variables measured with an optical motion capture system during a standardized drinking task in adults with unilateral cerebral palsy (CP).

Design: Test-retest.

Subjects/patients: 25 subjects (12 males) with spastic unilateral CP, aged 18-60 years.

Methods: Kinematic variables were collected while participants performed a drinking task with the affected upper limb on 2 consecutive days. Inter-session reliability and agreement were estimated using the intra-class correlation coefficient (ICC) 2.1, and standard error of measurement (SEM).

Results: Reliability was excellent for all investigated variables (ICCs: 0.90-0.99). Agreement for elbow flexion/extension, shoulder flexion, and abduction: SEM ≤ 3.1 degrees, max trunk displacement during reaching: SEM = 9.9 mm, number of stops/starts during total movement: SEM = 2.1 movement units, total movement time: SEM = 1.0 s.

Conclusion: Optical motion capture of a standardized drinking task was reliable for evaluating upper limb movements in adults with spastic unilateral CP. The method may be used as an outcome measure to evaluate the effect of treatments of upper limb function, as well as to follow the function over time.

Objectives: To describe the prevalence of -shoulder pain and associations with patient characteristics and activities of daily living in individuals with spinal cord injury (SCI) and to identify pain--relieving strategies. This paper presents questionnaire results from a larger study that also includes clinical and ultrasound assessments.

Design: Cross-sectional study.

Participants: Individuals with SCI for at least 1 year.

Methods: A questionnaire including patient characteristics, shoulder-loading activities, and pain prevalence was distributed. Those with shoulder pain were asked additional pain-related questions.

Results: One hundred participants were included (mean age = 54 years, 79 male, time since SCI = 13.8 years, wheelchair users = 56). Shoulder pain prevalence was 34% during the last week, with higher rates after tetraplegia AIS A-D. Mode of ambulation did not affect pain ratings; however, wheelchair users experienced more bilateral pain. Pharmacological use specific for shoulder pain was low; non-pharmacological treatments included exercise, massage, and TENS.

Conclusions: This study confirms a high prevalence of shoulder pain in persons with chronic SCI, with small differences across subgroups. This suggests that shoulder attention is equally important among individuals with incomplete SCI and ambulatory individuals as it is for wheelchair users. The majority with shoulder pain experienced onset of pain over 1 year ago.

Objective: Gait symmetry is an important assessment indicator in patients with stroke and is classified into temporal and kinematic types. This study aimed to clarify the clinical assessments and ability characteristics of subtypes by gait symmetry through clustering analysis using symmetry indices.

Design: Retrospective, cross-sectional, observational study.

Participants: Fifty-nine patients with chronic stroke who could walk independently without aids during measurement, including those who habitually used an assistive device.

Methods: Gait was analysed with a 3-dimensional motion analysis system and force plates. Temporal symmetry was assessed using the swing-time ratio; kinematic symmetry was assessed by the normalized cross-correlation of left-right knee angle waveforms; k-means clustering used the 2 indices; and clinical measures and comfortable gait speed were compared across subtypes.

Results: Four subtypes were identified. Subtypes with high kinematic but low temporal symmetry had moderate motor paralysis, moderate gait speed, and high paretic-side propulsion, whereas subtypes with high temporal but low kinematic symmetry showed moderate motor paralysis, higher muscle tone, moderate gait speed, and lower paretic-side propulsion.

Conclusion: This study provides new insights into gait symmetry in stroke and may help lay the groundwork for future studies on gait classification and rehabilitation.

Objectives: Explore exercise intolerance with the Buffalo Concussion Treadmill Test (BCTT) in adult patients with persisting post-concussion symptoms (PCS). Examine the association between exercise intolerance and persistent post-concussion symptom burden. Explore factors associated with the BCTT symptom threshold.

Design: Cross-sectional study.

Patients: 100 patients (mean age 36.9 [SD 10.6] years; 58% women) with mild traumatic brain injury and persistent PCS.

Methods: Exercise intolerance was assessed using descriptive statistics and group comparisons. Regression models were applied testing the association between exercise intolerance and symptom burden, and to explore factors associated with symptom threshold.

Results: 81% tested positive for exercise intolerance. Patients with exercise intolerance were younger, had a shorter time since injury, more symptoms, and poorer quality of life. Higher symptom burden was associated with increased odds for exercise intolerance (OR: 1.07, 95%CI: 1.01 to 1.13, p = 0.023). Higher heart rate at start of BCTT was associated with a higher symptom threshold (B: 0.34, 95%CI: 0.17 to -0.50, p  <  0.001), while greater anxiety symptoms were associated with lower symptom threshold (B: -0.86, 95%CI: -1.6 to -0.12, p < 0.023) with R2 = 0.21.

Conclusion: Exercise intolerance was confirmed in over 80% of the patients. Assessments of exercise intolerance might contribute to a broader understanding and improved rehabilitation of these patients.

Objective: To evaluate the impact of gait-synchronized functional electrical stimulation during exoskeleton-assisted ambulation on cardiorespiratory demand in individuals with incomplete spinal cord injury.

Design: Cross-sectional study employing a randomized crossover arrangement of measurements.

Participants: Convenience sample of 11 individuals with chronic incomplete spinal cord injury and partial walking ability.

Methods: Participants completed 2 x 6-min walking tests (6MWTs) with the EksoNR, 1 with and 1 with-out gait-synchronized functional electrical stimulation targeting gait-related muscles in a randomized order. Cardiorespiratory and metabolic parameters were measured breath-by-breath via ergospirometry. The primary outcome was oxygen consumption (V̇O2/kg). Secondary outcomes included further cardiovascular and metabolic parameters. Data from the final 2 min of each 6MWT were analysed using linear mixed-effect models.

Results: V̇O2/kg increased by 6% with functional electrical stimulation compared with exoskeleton-assisted ambulation alone (15.07 ± 4.11 vs 14.21 ± 3.61 mL·min-¹·kg-¹, p = 0.02). Heart rate, ventilation, and energy expenditure were also elevated (p < 0.05), while breathing frequency, respiratory exchange ratio, distance, and perceived exertion remained unchanged. Inter-individual differences in V̇O2/kg were not explained by stimulation amplitude (r = 0.36, p = 0.27).

Conclusion: Adding functional electrical stimulation to exoskeleton-assisted gait therapy consistently increased cardiorespiratory demand, potentially enhancing training intensity. Further research assessing long-term clinical impact is required.

Objective: To assess rehabilitation professionals' perspectives on unmet rehabilitation needs in patients with traumatic injuries and how to bridge the gap between met and unmet needs.

Design: Semi-structured focus-group interviews analysed using a reflexive thematic approach.

Methods: Eighteen strategically sampled health professionals (67% female, aged 27-56 years) from specialist and community-based rehabilitation services in Northern and South-Eastern Norway were interviewed regarding their perspectives on alignment of current rehabilitation services with patient needs, reasons for misalignment, and potential service improvements.

Results: Care continuity and multidisciplinary collaboration was identified as essential for high-quality rehabilitation services. Unmet needs were noted in community-based services for cognitive and mental health support, as well as financial assistance for patients. Health professionals faced challenges prioritizing patient needs and expressed frustration with not being able to provide legally mandated services. Contributing factors included insufficient resources, lack of competency standards, and weak organizational structure. Suggested improvements were early rehabilitation assessments and stronger collaboration between specialist and community services.

Conclusions: Strengthening community-based rehabilitation for traumatic injuries requires establishing professional competency standards, stronger coordination across care levels, and greater integration of psychosocial support. Advancing these dimensions calls for critical reflection on clinical practice, service organization, and health policy.