Journal of Rehabilitation Medicine最新文献

Objective: To investigate validity and reliability of the Danish version of the Resilience Scale for Adults among individuals with acquired brain or spinal cord injury, and their family members.

Design: Cross-sectional study.

Subjects/patients: Adults with acquired brain or spinal cord injury, and their family members.

Methods: Unidimensionality, floor/ceiling effects, and internal consistency of the 6 subscales were analysed using confirmatory factor analysis. A series of models were estimated to investigate structural validity, and construct validity was analysed using correlations.

Results: Family cohesion, Planned future, and Perception of self showed good reliability (ω = 0.79-0.83) and good model fit (Comparative fit index: 0.986-1.000). Social resources and Social competence demonstrated adequate reliability (ω = 0.81 and 0.75) and good fit, accounting for local dependency. Structured style had poor reliability (ω = 0.53) and model misfit. The Resilience Scale for Adults was best represented by a 6-factor correlated model, compared with a single first- or second-order factor, but all models showed inadequate fit. All scale scores correlated negatively with scores of anxiety and depression.

Conclusion: All but 1 subscale demonstrated good psychometric properties. The Resilience Scale for Adults can be used to measure different aspects related to resilience for this mixed population.

Objective: To develop data-driven functional staging cutoff scores for the Clinical Functioning Information Tool (ClinFIT) total raw score to stratify patients according to rehabilitation provision and intensity.

Methods: This observational study included adult inpatients (n = 270) admitted to a tertiary rehabilitation unit. ClinFIT total scores at admission were analysed alongside the Therapy Disciplines domain of the Rehabilitation Complexity Scale to represent rehabilitation intensity. Receiver Operating Characteristic analysis was used to identify optimal cutoff points distinguishing between levels of rehabilitation intensity. Subgroup analyses were conducted by age, sex, and diagnosis.

Results: Participants were predominantly male (54.1%), with a mean age of 62.9 ± 14.3 years. ClinFIT total raw scores improved significantly across all health conditions at discharge compared with admission (p < 0.001), reflecting substantial functional recovery during inpatient rehabilitation. Two ClinFIT total score cutoffs were identified: 135 (light vs moderate) and 192 (moderate vs high intensity), with acceptable discriminatory performance (AUCs: 0.720, 0.748, respectively). Subgroup analyses supported the robustness of this 3-level staging system across demographic and diagnostic groups.

Conclusion: This study provides evidence-based cutoff scores for ClinFIT, supporting its clinical use for stratifying rehabilitation provision and intensity. These findings may enhance clinical decision-making, optimize resource allocation, and promote wider adoption of the ClinFIT. Further validation in external and diverse populations is warranted.

Objective: To (i) quantify elbow flexor and extensor strength and stiffness in people with stroke; (ii) compare affected and unaffected sides; (iii) compare stroke survivors and healthy older adults; and (iv) examine correlations between muscle properties, motor control, and ADLs.

Design: Cross-sectional study.

Participants: 65 stroke survivors and 31 healthy older adults.

Methods: Elbow muscle strength and stiffness (biceps and triceps) were assessed bilaterally by Myoton PRO. Stroke participants also completed the Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), Disabilities of the Arm, Shoulder and Hand (DASH), and Oxford Participation and Activity Questionnaire (OxPAQ).

Results: Stroke participants had significantly weaker elbow muscles on the affected side (p < 0.001) than the unaffected side, but stiffness did not differ significantly. Compared with healthy adults, stroke participants showed reduced strength but similar stiffness. Weak to moderate correlations were found between muscle strength and FMA-UE, ARAT, and DASH (ρ = 0.336-0.613), but not with OxPAQ. Weak negative correlations were found between biceps stiffness and motor function (FMA, ARAT) (ρ = -0.343 to -0.397), and a weak negative correlation between triceps stiffness and OxPAQ emotional well-being (ρ = -0.313).

Conclusion: Stroke survivors have reduced elbow strength but similar stiffness compared with the healthy elderly. Strength correlates moderately with upper limb function; stiffness shows inconsistent associations.

Background: Intensive care unit-acquired weakness (ICU-AW) affects 25-50% of critically ill patients, resulting in prolonged hospitalization and impaired functional recovery. Despite recognition of its clinical importance, effective prevention and treatment strategies remain limited.

Objective: To evaluate the efficacy of a comprehensive evidence-based intervention programme on ICU-AW incidence and functional outcomes compared with standard care.

Methods: This retrospective analysis conducted between May 2021 and December 2023 included 420 critically ill patients allocated to either an evidence-based intervention group (n = 200) receiving a structured programme incorporating early mobilization, respiratory rehabilitation, swallowing training, psychological support, and nutritional optimization, or a standard care group (n = 220). Primary outcomes included ICU-AW incidence and hospital length of stay. Secondary outcomes comprised MRC muscle strength scores, nutritional status (Subjective Global Assessment), and functional independence (Barthel Index).

Results: The evidence-based intervention group demonstrated significantly lower ICU-AW incidence (32.5% vs 57.3%, p < 0.001) and shorter hospital stays (18.4 ± 6.2 days vs 25.7 ± 7.8 days, p < 0.001) compared with standard care. Post-intervention MRC scores were significantly higher in the evidence-based intervention group (50.4 ± 5.9 vs 44.2 ± 7.1, p < 0.001), representing a mean improvement of 7.3 points (95% CI: 6.2-8.4) compared with 1.9 points (95% CI: 1.2-2.6) in standard care. Nutritional status improved by at least one SGA grade in 56% of evidence-based intervention patients vs 28.6% of standard care patients (p < 0.001). Barthel Index scores increased substantially more in the evidence-based intervention group (32.3-point increase vs 13.4-point increase, p < 0.001), with 41% achieving scores > 75 compared with 16% in standard care (p < 0.001).

Conclusion: A comprehensive evidence-based intervention programme significantly reduces ICU-AW incidence and improves muscle strength, nutritional status, and functional outcomes in critically ill patients. This multimodal strategy offers promise for alleviating ICU-AW's burden and warrants broader clinical adoption.

Objective: Pre-dialysis exercise training may benefit haemodialysis patients, but the effects of structured aerobic and resistance training remain unclear. This study evaluated the effects of a 6-month training performed 1-2 h before haemodialysis on muscle strength, cardiorespiratory fitness, quality of life, and systemic inflammation.

Design: A 3-phase self-controlled design: 3-month control, 6-month aerobic and resistance training (72 sessions) and nutrition counselling, and 3-month follow-up.

Patients: Haemodialysis patients > 3 months.

Methods: Assessments were performed every 3 months at 5 time points. Outcomes included physical fitness (dual-energy X-ray absorptiometry, isokinetic dynamometry, and cardiopulmonary exercise testing), Kidney Disease QOL questionnaire, International Physical Activity Questionnaire, nutrition, and plasma pro- and anti-inflammatory cytokines.

Results: Of 118 patients screened, 29 entered training and 22 completed 72 sessions (92% compliance). Pre-dialysis exercise training improved muscle mass, cardiorespiratory fitness, quadriceps strength, physical and mental components, and disease-specific quality of life; cardiorespiratory fitness and strength declined at 3-month follow-up, but muscle mass remained. Cytokine levels were unchanged, suggesting minimal pro- or anti-inflammatory effects.

Conclusion: A 6-month pre-dialysis exercise programme improved cardiorespiratory fitness, strength, muscle mass, and quality of life with high compliance. It may be viable for haemodialysis patients, though maintenance is needed to sustain benefits.

Clinicaltrials: gov ID: NCT05649657.

Objective: This study aimed to explore physical activity and sedentary time in adults with post-COVID-19 condition, and to identify associated factors.

Design: Cross-sectional, observational study.

Subjects/patients: Adults with post-COVID-19 condition.

Methods: Physical activity and sedentary time were measured using activity monitors alongside assessment of potential associated factors.

Results: Among 159 participants (mean age: 50 years, women: 64%), 36% took < 5,000 steps, 60% spent < 22 min in brisk walking, and 57% spent ≥ 8 h sedentarily daily. Additionally, 29% exhibited low activity combined with prolonged sedentary time. Postural orthostatic tachycardia syndrome and palpitations were associated with taking fewer steps, while paraesthesia, greater distance in the 6-min walk test, previous activity levels, and self-rated health were associated with taking more steps. Palpitations were associated with less brisk walking, whereas greater distance in the 6-min walk test and lung function were associated with more brisk walking. Postural orthostatic tachycardia syndrome was associated with increased sedentary time and with exhibiting low activity combined with prolonged sedentary time.

Conclusion: A substantial proportion of individuals with post-COVID-19 condition exhibit low physical activity and prolonged sedentary behaviour, posing potential health risks. The associated factors underscore the importance of comprehensive assessments to inform safe, individualized interventions.

Objective: Kinematic assessment of the drinking task offers objective metrics of upper limb recovery following neurological injury. The rehabilitation research community's increased interest has led to consensus standardization efforts. These efforts inherently depend on fidelity of the activity protocol underlying drinking task kinematics. This study's objective is to investigate whether differences in the drinking task protocol, as observed in prior literature, impact common kinematic metrics.

Design: Incomplete block design with repeated-measures.

Subjects/patients: Six neurotypical participants.

Methods: Seating position, cup start position, and target definition for cup return were varied. Mixed effects linear models analysed the impact of protocol variants on validated kinematic metrics used in stroke rehabilitation research.

Results: All considered factors have a significant impact on at least 1 kinematic metric. Seating position impacts movement time (p  =  0.035) and trunk displacement (p = 0.017), cup starting position impacts trunk displacement (p = 0.001), and target definition impacts movement time (p = 0.036). Of note, none of the factors significantly altered the number of movement units.

Conclusion: Further refinement and adherence to a standardized protocol for the drinking task activity may reduce between-study effects and promote the successful uptake of upper limb kinematic assessment in the rehabilitation research community.

Objective: This study investigated the effectiveness of deep oscillation therapy on early rehabilitation outcomes and inflammatory markers in 60 patients (32.7 ± 6.5 years) following anterior cruciate ligament reconstruction.

Design: A randomized controlled study was undertaken.

Methods: Patients were randomly allocated into a deep oscillation therapy group (n = 30) receiving a physiotherapy protocol plus deep oscillation therapy, and a control group (n = 30) receiving a physiotherapy protocol alone. Outcomes assessed over 4 weeks included pain (algesimeter), knee circumference (swelling), active range of motion for flexion and extension (goniometer), and biomarkers: C-reactive protein (inflammation) and D-dimer (thromboembolic risk) blood tests.

Results: Results showed significantly (p < 0.01) higher pressure pain threshold (i.e., increased tolerance of pressure-evoked pain), swelling reduction, and improved knee flexion and extension range of motion in the deep oscillation therapy compared with the control group after 2 and 4 weeks. The deep oscillation therapy achieved full extension by week four. Deep oscillation therapy also led to a more dynamic and pronounced decrease in C--reactive protein and D-dimer levels in the deep oscillation therapy compared with the control group (p < 0.01), with the deep oscillation therapy exhibiting significantly lower levels after 2 and 4 weeks. Correlations were observed in the deep oscillation therapy between reduced inflammatory markers and improved mobility and swelling.

Conclusions: These findings suggest that deep oscillation therapy can significantly enhance early rehabilitation outcomes and reduce inflammation in patients after anterior cruciate ligament reconstruction.

Objectives: This study aimed to examine the clinical relevance and usability of the digital self-report version of the Mayo-Portland Adaptability Inventory - fourth edition, MPAI-4 (MPAI-4-S-dig). In its paper version, MPAI-4 is well validated for patients with acquired brain injuries (ABIs) and neurological disorders (NDs), but time consuming. An additional aim was to investigate whether MPAI-4-S-dig is reliable for repeated measurements.

Setting: Community neurorehabilitation in Stockholm, Sweden.

Methods: MPAI-4-S-dig was administered to 40 patients with ABI or ND 2 weeks apart. Test-retest reliability was assessed using the intraclass correlation coefficient (ICC); clinical relevance of data was assessed through Pearson's Correlation Coefficient with Montreal Cognitive Assessment (MoCA), the Community Integration Questionnaire - Revised (CIQ-R), and Hospital Anxiety and Depression Scale (HADS).

Results: ICC values ranged from 0.86 to 0.93 for total and subscales. Significant correlations were found between MPAI-4-S-dig participation and CIQ-R Total, social integration and home integration and MoCA naming, MPAI-4-S-dig adjustment and CIQ-R Social integration, MPAI-4-S-dig Total and all subscale scores and HADS Anxiety score, MPAI-4-S-dig Total, abilities and participation and HADS Depression.

Conclusion: The demonstrated reliability and clinical relevance of MPAI-4-S-dig for patients undergoing neurorehabilitation permits the implementation of digital data capture in patients with mild acquired cognitive impairment.

Objective: This study aimed to develop the Italian version of the modified Barthel Index and assess its reliability within stroke survivors.

Design: Single-centre, prospective observational study for measure validation.

Subjects/patients: To pre-test the pre-final scale, stroke survivors, caregivers, and health professionals were enrolled. For reliability, only stroke survivors were enrolled. Inclusion of stroke survivors: adults presenting ADL limitation; exclusion: severe visual/hearing impairment, Mini-Mental State Examination <21; severe language disorder, clinical instability.

Methods: The Italian modified Barthel Index was developed through forward-and-back translation, and interdisciplinary review. Clarity was evaluated by a sample of all participants. Inter-rater reliability was assessed by 2 independent physiotherapists, and test-retest examined 1-3 days later. Intraclass correlation coefficient (ICC), Spearman's correlation, quadratic weighted Kappa, and agreement percentages were calculated.

Results: Clarity was evaluated with 30 participants (10 per group); minor semantic adjustments were made. Reliability was assessed within 51 stroke survivors, showing Spearman's correlation of 0.990 (test-retest) and 0.985 (inter-rater). ICCs were 0.990 and 0.987, respectively. Weighted Kappa values ranged from 0.76 to 0.98.

Conclusion: The Italian Modified Barthel Index showed high reliability, supporting its use in Italian-speaking stroke populations. The validation of its other psychometric properties needs further research.