Journal of Rehabilitation Medicine最新文献

Background: The Motricity Index (MI) is a commonly used method of measuring muscle strength in post-stroke hemiparesis. This study aimed to produce the MI Italian version (MI-IT) and assess its reliability in subjects with stroke.

Methods: Phase-1: stepwise approach to MI-IT production and pilot-testing with 10 health professionals to ensure clarity of each item and instructions for administration and scoring. Phase-2: evaluation of MI-IT reliability on stroke subjects, each independently assessed by 2 raters randomly selected from a group of 10 physiotherapists; the first rater re-administered the MI-IT 1-3 days later. Intraclass correlation coefficients, Spearman's rho and, limited to the more affected side, non-parametric limits of agreement (LOA) were computed for total MI-IT scores, squared weighted kappa and percentage of observed agreement for individual item scores.

Results: The back-translated versions showed no discrepancies with original MI, but 3 items were revised after pilot-testing. Complete data on 50 (test-retest) and 51 (inter-rater) participants demonstrated excellent reliability of all MI-IT total scores on the more affected side (Spearman's rho range: test-retest 0.953-0.975; inter-rater: 0.965-0.970), with LOA ranging from 9-25%), but poor inter-rater reliability for some scores on the less affected side (Spearman's rho range: test-retest, 0.816-0.976; inter-rater: 0.508-0.721). Moderate to almost perfect agreement was found for all individual item scores, except for 2 items on the less affected side.

Conclusions: The MI-IT is sufficiently reliable to evaluate motor impairment of the more affected side after stroke, with acceptable measurement error for all scores.

Objective: Patients with therapy-refractory chronic spinal pain after spinal surgery experience increased disability, resulting in substantial loss of employment and consequently lower quality of life. Despite findings that rehabilitation improves socio-economic outcomes in other chronic pain conditions, evidence for patients with chronic spinal pain after spinal surgery is limited. A systematic review was conducted to provide an overview of rehabilitation interventions and their effectiveness to improve work participation for patients with chronic spinal pain after spinal surgery.

Methods: MEDLINE (via PubMed), Scopus, Embase, and Web of Science, were systematically searched. Risk of bias was assessed using the modified Downs and Black checklist and GRADE was used to assess certainty of evidence. The review protocol was prospectively registered on PROSPERO (CRD42022346091).

Results: The search yielded 1,289 publications. Full-text screening of 48 articles resulted in the inclusion of 6 publications. The included interventions comprised multiple treatment components, consisting of back school, self-care, functional restoration, multidisciplinary rehabilitation, physiotherapy, and digital care programmes to improve work participation.

Conclusion: Rehabilitation to improve return to work for patients with chronic spinal pain after spinal surgery was supported only by low-certainty evidence. Rehabilitation therapies that are personalized and that integrate the patient's work seem most suitable.

Objectives: To measure the potential effects of an overground exoskeleton-assisted walking programme on upper limb strength and mass, as well as on wheelchair propulsion performances and abilities in individuals with chronic spinal cord injury.

Design: Prospective, single-group, pre-post intervention study.

Participants: Ten individuals with chronic (≥ 18 months) spinal cord injury who use a wheelchair as their primary mode of locomotion and who had little-to-no motor function in the lower limbs.

Methods: Individuals completed a progressive 16-week exoskeleton-assisted walking programme (34 × 1-h sessions, 1-3 sessions/week). Upper limb muscle strength was measured with dynamometers (isokinetic, Jamar). Upper limb lean mass (dual-energy X-ray absorptiometry) was used to calculate relative strength. Field tests (20-m wheelchair propulsion, and slalom test) and the Wheelchair Skills Test Questionnaire determined performances and abilities. Wilcoxon signed-rank tests were used with the following criteria: p < 0.1, effect size ≥ 0.5, and relative variation > 5%.

Results: Only natural velocity during the 20-m wheelchair propulsion test (i.e., fundamental wheelchair ability) changed following the intervention (p = 0.01, effect size = 0.82, relative variation = +14.5%).

Conclusion: Overall, upper limb muscle function did not significantly and meaningfully change following the exoskeleton-assisted walking programme in this population. Additional research is needed to verify how changes in training volume would affect strength and advanced wheelchair-related abilities and performance, as well as the response in individuals who are deconditioned or novices to wheelchair use (e.g., subacute spinal cord injury).

Objective: This study explores the effectiveness of using the International Classification of Functioning, Disability and Health (ICF) as a coding framework to document work-related disability information in sick leave certificates, focusing on depression and fibromyalgia in Sweden.

Design: A qualitative ICF linking study was conducted, mapping information from 200 certificates per diagnosis to ICF.

Methods: ICF linking rules were followed strictly. The coverage of ICF and ICF Core Sets was evaluated, proposing additional ICF categories when relevant categories were not included. Saturation of ICF categories was considered achieved if no new categories appeared in the last 5 certificates.

Results: The study found high ICF coverage (85% for depression, 78% for fibromyalgia) in capturing work-related disability information. However, there was limited coverage in ICF Core Sets due to an excess of ICF categories in the Core Sets. Also, 2 additional relevant ICF categories for depression and 3 for fibromyalgia were identified.

Conclusion: This study confirms that the International Classification of Functioning, Disability and Health is suitable for coding work-related disability in sick leave certificates. However, the identified limitations in ICF Core Sets highlights the need for context-specific subsets to enhance their relevance for depression and fibromyalgia in work-related disability.

Objectives: To implement and evaluate a rehabilitation-inclusive service delivery model at a tertiary cancer hospital.

Methods: The "Rehab-Toolkit", a structured assessment tool comprising validated functional measures, was introduced in an inpatient cancer service. Consecutive inpatients were enrolled, and a Reach, Effectiveness, Adoption, Implementation, and Maintenance framework guided the analysis of barriers and facilitators for subacute care at clinic and system levels.

Results: The implementation of the Rehab-Toolkit was incorporated into routine inpatient care. Major pre-implementation barriers included: absence of routine standardized functional assessment tools, limited coordination amongst acute and subacute care providers, low awareness of rehabilitation medicine amongst patients and professionals, and insufficient engagement of subacute care with interdisciplinary stakeholders in clinical decision-making. Following the intervention, there was a notable increase in awareness and the contributory role of subacute rehabilitation services, rehabilitation "needs" assessment, and referral pathways. Recommendations for process change included: development of clinical pathways, establishment of subacute referral systems and discharge coordinator roles, inclusion of subacute rehabilitation services in acute interdisciplinary team meetings, enhanced staff education and knowledge.

Conclusion: Integration of rehabilitation services into cancer care can proactively manage functional morbidity. While the implementation process proved feasible and effective, robust process evalu-ation and longer term follow-up are necessary for sustained success.

Objective: To estimate the effectiveness and costs of Rehabilitation for Life (RFL) compared with usual rehabilitation and care after hip fracture to determine which course offered the most value for money.

Design: Cost-utility analysis.

Patient: Community-dwelling patients aged 65+ after hip fracture.

Method: 123 intervention and 122 control patients were included. Data was collected at 5 points from discharge to 1-year follow-up. Cost analysis included expenses to hospital, general practice, specialist services, medications, rehabilitation, home and informal care, transport, and waiting times. The primary outcome was the incremental cost per quality-adjusted life year (QALY).

Results: The intervention group experienced a statistically significant mean QALY gain of 0.02 -compared with the control group. The intervention was more costly by €4,224, resulting in an incremental cost of €159,990 per QALY gained. Two municipalities had several patients in respite care, yielding an imbalance. A subanalysis excluding these patients demonstrated QALY gain at 0.03 and the cost difference of €2,586 was not statistically significant.

Conclusion: The intervention demonstrated a slight improvement in effectiveness over the control but was costly. For patients not requiring respite care, the intervention effect was slightly higher, and the cost differences statistically insignificant. In total 91% received informal care and the economic contribution of informal care exceeded the municipal home care services.

Objective: To identify the factors associated with the pain-related functional interference level in people with chronic low back pain.

Design: Cross-sectional.

Subjects/patients: Chronic low back pain patients.

Methods: Sociodemographic data, pain intensity, pain-related functional interference, physical functioning and fitness, sleep quality, anxiety and depression, social support, and health-related quality of life were recorded. Descriptive and bivariate analyses were performed. A linear regression model was carried out to identify the factors associated with the pain-related functional interference level.

Results: 99 participants were involved (mean age: 54.37 SD: 12.44; women: 67.7%). 37.4%, 27.3%, and 35.4% were classified into low, moderate, and high pain-related functional interference level groups, respectively. Higher pain-related functional interference was associated with higher pain intensity (β: 0.724; p = 0.026), worse sleep quality (β: 0.077; p = 0.012), worse quality of life (physical (β: -0.539; p < 0.001) and mental (β: -0.289; p < 0.001), and lower consumption of weak opioids (β: -3.408; p = 0.037).

Conclusion: Beyond the pain experience and intensity among people with chronic low back pain, several biopsychosocial factors associated with this condition has been identified. Furthermore, higher pain intensity, worse sleep quality, worse quality of life, and weak opioids' consumption have been related to the pain-related functional interference of this population.

Objective: To examine factors associated with patient satisfaction with rehabilitation services received after traumatic brain injury.

Design: Cross-sectional study.

Subjects/patients: Persons with mild to severe traumatic brain injury (n = 1,375) registered in the "Oslo TBI Registry - Rehabilitation" quality register at Oslo University Hospital from 1 January 2018-31 July 2022.

Methods: Sociodemographics, injury-related variables, patient-reported outcome measures, global functioning, and rehabilitation-related variables were recorded at hospital outpatient visits. The patients reported satisfaction with services received at the outpatient clinic and in primary healthcare at the final follow-up. Multivariable logistic regression models were applied to examine factors associated with patient satisfaction.

Results:  Of 316 patients, 83% reported satisfaction with services received at the hospital outpatient clinic. Belief in recovery (odds ratio [OR] = 2.73), shorter time to follow-up (OR = 0.39), and lower symptom burden (OR = 0.96) significantly increased satisfaction. Among 283 patients, 62% reported satisfaction with services in primary healthcare, where belief in recovery (OR = 2.90), shorter time to follow-up (OR = 0.50), higher age (OR = 1.04), and higher number of rehabilitation services received in primary healthcare (OR =  1.32) significantly increased satisfaction.

Conclusion: Across service levels, the strongest associated factors for satisfaction were belief in recovery and shorter time to follow-up, suggesting that timely delivery of traumatic brain injury-related specialized services could increase overall satisfaction.

Background: Telerehabilitation is a practical option for individuals with multiple sclerosis (MS) to engage in sustained physical activity without -visiting a rehabilitation facility. The aim of this systematic review was to evaluate the feasibility, effectiveness, safety, and adherence of exercise-based telerehabilitation as compared with usual care for MS patients.

Methods: A comprehensive literature search adhering to PRISMA guidelines was conducted, focusing on studies published in English since 2000. The systematic review protocol was registered in PROSPERO. The selection process involved strict criteria, including studies focusing on people with MS, telerehabilitation centred on regular exercise, a control group receiving usual care, valid exercise testing, and adherence to randomized controlled trial principles. Methodological quality was assessed using the TESTEX tool, ensuring rigour in study design and reporting.

Results: Among the 281 records screened, 10 studies met the criteria. Telerehabilitation interventions varied in format and outcomes were assessed using diverse exercise tests and questionnaires. Despite variations, the studies collectively demonstrated promising feasibility and safety, with minimal withdrawals and minor adverse events. Effectiveness varied, with 5 out of 10 studies showing significant improvements in the intervention group. Adherence rates ranged from 38% to 100%.

Conclusion: In most of the assessed aspects, telerehabilitation is comparable to regular centre-based rehabilitation.

Objective: To corroborate findings suggesting that spinally targeted paired associative stimulation improves upper extremity motor function in chronic incomplete spinal cord injury.

Design: Prospective interventional study.

Subjects: Five adults with chronic tetraplegia.

Methods: Participants received paired associative stimulation, combining peripheral nerve stimulation and navigated transcranial magnetic stimulation towards 1 arm (16 1-h sessions during 4 consecutive weeks, targeting the 3 large nerves). Manual muscle testing (MMT) was performed in 23 muscles in each arm, at 3 time points (pre-stimulation, t0; the week following the stimulation period, t1; and 4-5 weeks post-stimulation, t2). Additionally, grip strength and changes in the Canadian Occupational Performance Measure were assessed.

Results: The mean improvement in manual muscle testing scores in the targeted extremity was +0.49 at t1 (p = 0.078) and +0.55 at t2 (p = 0.062). Grip strength in the stimulated extremity increased by 3.2 kg at t1 and 3.4 kg at t2, and in the non-targeted extremity by 2.2 and 3.6 kg, respectively. Performance and satisfaction increased by 2.1/2.4 points at t1, and by 2.0/1.9 points at t2.

Conclusion: Paired associative stimulation improved motor function: at the group level, MMT of the stimulated hand (p = 0.06) and non-stimulated hand (p = 0.04). Most participants achieved clinically relevant improvement. Thus, the results corroborate prior studies. The method may complement conventional rehabilitation for improving upper extremity function in incomplete tetraplegia.