Journal of Rehabilitation Medicine最新文献

Objective: To determine whether early cognitive function in amyotrophic lateral sclerosis patients predicts future cognitive function and the decision to cease driving.

Design: Observational study.

Subjects: Patients with amyotrophic lateral sclerosis.

Methods: Subjects underwent baseline assessments of cognitive function and driving ability within 4 months of diagnosis, with follow-up evaluation conducted 4 months thereafter. Two hypotheses were tested: (H1) cognitive status remains stable between baseline and follow-up, (H2) patients with baseline cognitive impairment cease driving earlier than those without cognitive changes. Data were analysed using t-tests and regression analysis, with visual inspection of the results.

Results: Of 31 subjects tested at baseline, 5 were under 60 years old, 11 were female, 11 were cognitively impaired, and 61% were driving. Over the 4-month period, cognitive function of the subjects (n = 21) did not change significantly. There was no significant association between baseline cognitive function and follow-up driving status.

Conclusion: Early cognitive function assessment in amyotrophic lateral sclerosis predicts future cognitive function but not currently the decision to cease driving. Cognitive impairment occurs early in the disease, highlighting the importance of early evaluation and implementation of safety measures related to driving.

Background: Knee osteoarthritis is the most common form of arthritis in adults and a leading cause of years lived with disability. Knee osteoarthritis is a significant burden on health systems worldwide.

Objective: This study evaluated the impact of transcranial pulse stimulation in pain intensity on a case series of 8 patients with refractory pain due to primary knee osteoarthritis.

Design: Prospective before-and-after case series.

Setting: Tertiary rehabilitation outpatient clinic at a university hospital.

Methods: Transcranial pulse stimulation was delivered in 6 sessions per participant on 8 patients, diagnosed with knee osteoarthritis using the American College of Rheumatology and the Kellgren-Lawrence radiographic grading criteria, with a nominal weekly interval but an adaptive schedule that accommodated individual and logistical constraints. Overall adherence to the programme, the effect on pain level on the Visual Analogue Scale and side effects were assessed.

Results: In total, 8 female patients were evaluated for the visual analogue scale score before and after therapy. Their ages ranged from 63 to 77 years, with an average of 69.3 (± 5.3) years. The mean initial (before therapy) Visual Analogue Scale score for the right knee was 6.4 (± 2.5) across the patients, and that score reduced to an average of 1.1 (± 1.6) by the end of the therapy. Similarly, the average for the left knee reduced from 7.2 (± 1.4) to 1.4 (± 1.8). This resulted in an average reduction in pain of 5.3 points for the right knee and of 5.8 points for the left knee. All patients improved their scores. Proper adherence and tolerance to the transcranial pulse stimulation protocol was observed, with no severe side effects.

Conclusion: Transcranial pulse stimulation reduced pain in patients with refractory pain due to primary knee osteoarthritis. It may be considered as an intervention for knee osteoarthritis patients with chronic disabling pain.

Objective: To evaluate the implementation and feasibility of the Neuropsychological Digital Care Pathway (NP-DCP), a novel, professional-guided web-based rehabilitation programme for the rehabilitation of cognitive and emotional symptoms following stroke and to identify factors associated with adherence and user experience.

Design: Retrospective registry study.

Subjects: 133 stroke patients (≥ 18 years) with mild to moderate cognitive impairment at the Neurocenter, Helsinki University Hospital, Finland, referred to the NP-DCP between April 2019 and April 2020.

Methods: The NP-DCP adherence data (completers, dropouts, non-starters) and feedback from programme completers were analysed along with demographic and clinical characteristics.

Results: Of the referred patients, 114 (86%) started the programme; of these, 79 (68%) completed it. The average completion time was 82.3 days. Referral on discharge from acute care was associated with higher adherence (p = 0.019). Women were more likely to start the programme than men (p = 0.012). Usability and content were rated good to excellent (mean 4.1-4.4/5), with participants with basic education more satisfied than those with higher education (p = 0.033).

Conclusion: The NP-DCP demonstrated high engagement and user satisfaction, suggesting it is a feasible tool for stroke rehabilitation, thus adding a promising new method to existing services. Early referral may improve adherence.

Objective: To examine whether muscle stiffness -changes occur after botulinum toxin A treatment measured with shear wave elastography over a 3-month period and whether these changes are associated with walking function, active and passive ankle dorsiflexion, and participants' goal achievements.

Design: Prospective cohort study.

Subjects/patients: 25 first stroke survivors with disabling spasticity and reduced walking function (mean age 52.6).

Methods: Botulinum toxin A was administered in relevant calf muscles. Muscle stiffness measurements with shear wave elastography and clinical tests such as spasticity test (Modified Ashworth scale), maximal active and passive dorsiflexion of the ankle, and 10 m walk test were conducted at baseline, after 6 weeks, and after 3 months. Medial gastrocnemius muscle stiffness was measured in both the affected and the unaffected leg. The Goal Attainment Scale was used to evaluate therapy goal achievements.

Results: Significantly reduced muscle stiffness was found at 6 weeks on the affected side, but not at 3 months, and no changes were present on the unaffected side. A moderate positive correlation between muscle stiffness and Goal Attainment Scale score was observed.

Conclusion: Shear wave elastography could evaluate the effect of botulinum toxin A on muscle stiffness in stroke patients over a 3-month period. The correlation between muscle stiffness changes, goal attainment, and function need further longitudinal studies.

Objective: This study aimed to describe the long-term changes in walking function, fatigue, and pain in adults with cerebral palsy.

Design: A 16-year follow-up study with paired comparisons.

Subjects: Adults with spastic cerebral palsy (n = 29) from a baseline study in 2008.

Methods: The mean age at follow-up was 50 (standard deviation 10) years.

Primary outcomes: Gait Deviation Index, 6 Minute Walk Test, Timed-Up-and-Go test, walking speed, Fatigue Severity Scale, and bodily pain (visual analogue scale, 0-100). Paired samples t-test (Wilcoxon signed rank test for non-parametric data) was used to assess differences between baseline and follow-up. Between-group differences were analysed using an independent samples t-test (Mann-Whitney U test for non-parametric data).

Results: Mean gait pattern deviations significantly (p-value = < 0.001) increased at follow-up compared with baseline for the full cohort. Walking speed decreased for the full cohort (-0.08 m/sec, p-value = 0.022), due to the bilateral group (-0.13 m/sec, p-value = 0.006). Walking capacity was maintained for the full cohort but decreased (mean diff: -84m, p-value = 0.035) for the bilateral group. Fatigue remained stable (p-value = 0.888). Pain decreased (p-value = 0.025) for the whole group, primarily due to the unilateral group (mean diff: 14 points on visual analogue scale, p-value = 0.031).

Conclusions: Gait pattern deviations increased for adults with cerebral palsy during this 16-year follow-up. Walking speed and capacity decreased for the bilateral group but were maintained for the unilateral group. Fatigue symptoms were high at baseline but did not change across this follow-up. Pain decreased, similar to the general population.

Objective: To systematically review and meta-analyse the effects of Nordic Walking in patients with respiratory diseases.

Design: Systematic review and meta-analysis.

Subjects/patients: People with respiratory diseases.

Methods: A systematic review from 9 databases and 1 trial register was conducted. Randomized controlled trials and quasi-experimental studies involving children or adults with respiratory diseases participating in Nordic Walking were included. A qualitative synthesis was conducted. When feasible, a meta-analysis was performed.

Results: Thirteen studies were included, involving 514 participants. The qualitative synthesis suggested that Nordic Walking has benefits in exercise tolerance, physical activity, physical fitness, dyspnoea, lung function, and mood status. Meta-analysis was only possible for exercise tolerance, through a 6-minute walking test assessed in 7 studies, which indicated that Nordic Walking had similar effect to other interventions (mean difference 4.4; 95% confidence interval -88.1-96.9 m, p = 0.93).

Conclusion: This systematic review demonstrates potential benefits of Nordic Walking in terms of exercise tolerance, physical activity, physical fitness, and dyspnoea, in people with respiratory diseases, comparable to other exercise forms. Further evidence is needed, particularly in studies analysing a structured Nordic Walking intervention with individually prescribed intensity.

Objective: To assess the efficacy of pharyngeal electrical stimulation in improving dysphagia post-stroke.

Design: A randomized, sham-controlled, blinded multicentre clinical trial.

Subjects/patients: Seventeen patients with acute ischaemic or haemorrhagic stroke experiencing dysphagia, indicated by a penetration aspiration scale score of 4-8 on videofluoroscopy.

Methods: Sites enrolled 3 open-label roll-in participants and then randomized subsequent participants to either stimulation or sham treatment. Study interventions were delivered for 10 min daily over 3 consecutive days. Prior to data lock the primary outcome was modified to the change in dysphagia severity rating scale from pre-treatment to end of follow-up period. Secondary outcomes included penetration-aspiration scale score assessed via videofluoroscopy 48 h after final treatment and functional oral intake scale, measured at 7, 14, and 83 days post-randomization.

Results: The trial was halted early due to low recruitment, with 15 participants receiving active stimulation and 2 receiving sham treatment. Active stimulation significantly reduced dysphagia severity at day 83 (difference: -4, p = 0.027). Improvements were observed in diet and supervision subscales, and functional oral intake scores. Of those treated, 67% were discharged home, with no serious adverse events attributable to the intervention noted in either group.

Conclusion: Pharyngeal electrical stimulation was safe and associated with reduced dysphagia severity in stroke patients, warranting further validation in larger studies.

Rehabilitation is increasingly recognized as a key component of health systems worldwide. To meet the growing demand for rehabilitation services, it is essential to strengthen academic capacity in Physical and Rehabilitation Medicine within universities. Academic structures are critical for training future physicians and professionals, and for advancing research and innovation in rehabilitation. In response to this need, a new European organization has been established: the European Organization of University Physical and Rehabilitation Medicine. This organization aims to unite and support university-based educators and researchers in the field, fostering excellence in teaching, research, clinical care, and academic leadership. The initiative has been developed through collaboration with major European and international rehabilitation bodies and is grounded in the values of representativity, inclusiveness, and collaboration. The organization invites current and future university professors in Physical and Rehabilitation Medicine to join as founding members and contribute to shaping its mission, structure, and strategic direction. By building a strong academic network across Europe, this initiative seeks to reinforce the foundations of rehabilitation in health systems and promote the development of a skilled and innovative workforce. This commentary outlines the rationale, development, and goals of the new organization and calls for broad participation from the academic community.

Objective: To study the biopsychosocial model of chronic low back pain in the workplace and the role of sex in it.

Design: Cross-sectional nationwide survey in a service company.

Patients: 256 workers (women 64.1%) reporting chronic low back pain.

Methods: Variables on biometry, job description, physical activity, pain severity/interference, neuropathic features, and questionnaire-based cognitive and affective parameters were collected. Within each sex group, the interrelationships between variables by Multiple Correspondence Analysis were analysed, followed by cluster analysis.

Results: In the overall sample, neuropathic features were reported by 28.9% of the patients; the cluster including the high pain disorder modalities (i.e., severity and interference) also included high pain catastrophizing and fear/avoidance towards work, as well as neuropathic features. However, in men, the modalities neighbouring high pain disorder were high anxiety and depression, and low mental quality of life, while in women, they were kinesiophobia, high fear/avoidance towards physical activity and stress at work, and low physical quality of life.

Conclusion: As there is now a major demand for defining chronic low back pain patients based on their biopsychosocial profile to improve care and prognosis, this study's results indicate the relevance of conducting such phenotyping at an early stage in a working environment, and that it is preferable to construct predictive models for each sex group.

Objective: To assess well-being and unmet needs among participants, and examine differences between patients and their next of kin.

Subjects: Cancer patients pre-adjuvant chemotherapy (n = 231) in rural northern Sweden, and their next of kin (n = 204).

Methods: Well-being and unmet needs were assessed using the Edmonton Symptom Assessment System (ESAS), Functional Assessment of Cancer Therapy-General (FACT-G), Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp-12), Hospital Anxiety and Depression Scale (HADS), and Cancer Survivors' (Partners') Unmet Needs measure (CaSUN)/(CaSPUN). Descriptive methods summarized sociodemographic, cancer-specific, and psychosocial data. Non-parametric statistical tests examined the differences between patients and next of kin.

Results: The HADS indicated that one-quarter of patients and one-third of next of kin possibly/probably had anxiety, and one-seventh of participants possibly/probably had depression. One-third of participants experienced no/minimal impact of cancer on well-being. The CaSUN identified unmet needs in all domains, but mostly in information and psychosocial domains. At least 15% of patients/next of kin reported unmet needs in 12/26 items. For most items, next of kin reported unmet needs at a similar/higher frequency than patients (10-25%).

Conclusion: These findings underscore the importance of assessing well-being and rehabilitative needs in patients and their next of kin before chemotherapy, to identify those who may benefit from early professional support.