Journal of Rehabilitation Medicine最新文献

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.

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.