Journal of Rehabilitation Medicine最新文献

Objective: The objective of this study was to investigate a more accurate and efficient technique for assessing spasticity in stroke patients via surface electromyography (sEMG).

Methods: 45 hemiplegic individuals were recruited and spasticity was assessed via the modified Ashworth scale (MAS). Multichannel sEMG data were collected from 3 muscles: the long head of the biceps brachii (LB), the short head of the biceps brachii (SB), and the brachioradialis (BR). Both time-domain and frequency-domain features were extracted. A K-nearest neighbour (k-NN) classifier was used to develop a new feature vector consisting of multichannel sEMG features. Finally, a model using this new feature was constructed and evaluated for classification accuracy.

Results: Data from 40 patients were analysed, revealing significant correlations between MAS scores and sEMG features. Specifically, MAS exhibited strong positive correlations with 3 time-domain features: root mean square (RMS), integral sEMG (iEMG), and envelope area (EA) (r > 0.7). In contrast, frequency-domain features were negatively correlated with the MAS score (r < -0.7). A single-channel model and a single-feature model were developed as baselines. A k-NN classifier using a novel feature vector - -integrating single-channel and single-feature data - enabled automatic spasticity grading, surpassing the performance of the baseline models. The proposed multichannel sEMG feature fusion model achieved an average accuracy of 78.7%, significantly outperforming both the single-channel model (LB: 66.0%, SB: 64.3%, BR: 70.4%) and the single-feature model (RMS 70.8%, iEMG 71.4%, and EA 63.4%).

Conclusions: Compared with single-channel and single-feature models, the k-NN model, which uses multichannel sEMG features, has superior accuracy in spasticity assessments and is a reliable tool for objective evaluation. This approach holds promise for enhancing rehabilitation strategies by enabling precise and data-driven efficacy assessments, ultimately improving patient outcomes.

Objective: This study aimed to compare the long-term effects of soft robotic gloves (SRGs) and mirror therapy on hand function and motor recovery in post-stroke patients.

Methods: A single-blinded, randomized controlled comparative study was conducted on 49 patients with chronic stroke assigned randomly to either the SRGs or mirror therapy group. Both groups underwent an 8-week intervention alongside conventional rehabilitation. The Box and Block Test (BBT), hand grip strength, and Fugl-Meyer Assessment-Upper Extremity (FMA-UE), were assessed at baseline, post-intervention, and 6-month follow-up.

Results: Post-intervention, the SRGs group demonstrated significantly greater improvements in all outcome measures compared with the mirror therapy group (p = 0.004, 0.011, and 0.021, respectively). These improvements were sustained at follow-up (p < 0.001, < 0.001, and 0.003, respectively). Within-group comparisons showed significant post-intervention improvements in both groups; however, the mirror therapy group exhibited no significant changes between post-intervention and follow-up (p = 0.197, 0.125, and 0.317, respectively), whereas the SRGs group maintained significant gains (p = 0.003, 0.012, and 0.005, respectively).

Conclusion: Findings suggest that SRGs provide superior improvements in hand function and motor recovery compared with mirror therapy in post-stroke rehabilitation. The long-term benefits highlight the potential of SRGs as an effective intervention for promoting functional independence in stroke survivors.

Objective: This study aimed to compare the effectiveness of telerehabilitation to traditional face- to-face physical therapy for patients with degenerative meniscal tears in Shanghai, China.

Design: A two-arm, single-blinded, randomized controlled trial was conducted across two hospitals in Shanghai, China Subjects/Patients: Participants with clinically diagnosed degenerative meniscal tears were randomly assigned to either the telerehabilitation group or the face-to-face physical therapy group.

Methods: Both groups underwent a 12-week intervention. Participants in telerehabilitation group used a digital platform for remote physical therapy, while participants in physical therapy group received traditional clinic-based rehabilitation. A predefined non-inferiority margin of 10 points on the Knee Injury and Osteoarthritis Outcome Score (KOOS) was applied to determine clinical equivalence between the interventions.

Results: Both groups demonstrated significant improvements in knee function and quality of life, with no significant differences in the KOOS, SF-36, or functional tests at any time point (p > 0.05). Both groups had high adherence rates, with no significant differences in exercise completion or satisfaction scores. The TELE group had a significantly lower total cost compared to the PT group (p < 0.001), demonstrating greater cost-effectiveness.

Conclusion: Telerehabilitation was found to be clinically non-inferior to face-to-face physical therapy for improving knee function, pain, and quality of life in patients with degenerative meniscal tears. It offered significant cost savings, making it a cost-effective alternative to traditional in-person rehabilitation.

Objective: To evaluate the effect and safety of serial interferential current stimulation on postoperative pain and wound healing after sternotomy in cardiac rehabilitation.

Design: Prospective, randomized, double-blinded, sham-controlled clinical trial.

Subjects/patients: 200 patients undergoing open-heart surgery via sternotomy were enrolled during inpatient cardiac rehabilitation, 8 to 12 days postoperatively.

Methods: Patients were randomized into an intervention group receiving interferential current stimulation over the sternum (six sessions across 21 days) or a control group receiving sham stimulation. All participants underwent the same standardized cardiac rehabilitation program. The primary outcome was pain reduction over 21 days. Secondary outcomes included analgesic use, inflammatory cytokine levels, pulmonary function, wound healing, and adverse events.

Results: Interferential current stimulation significantly reduced pain scores compared to sham treatment. Analgesic use decreased more in the intervention group. A greater reduction in tumor necrosis factor alpha and interleukin 6 levels was observed. Pulmonary function and quality of life improved in both groups without significant between-group differences. No adverse effects or wound infections occurred in the intervention group.

Conclusion: Serial interferential current stimulation is a safe, effective non-pharmacological therapy for reducing post-sternotomy pain and analgesic use in cardiac rehabilitation. The effect may be mediated by modulation of inflammatory cytokines.

Objective: This study aimed to evaluate the effectiveness of a 12-month relapse prophylaxis following a 4-week interdisciplinary multimodal pain therapy approach for patients with back pain. The study examined whether the intervention reduced days of incapacity to work (primary outcome) and improved functional capacity and health-related quality of life (secondary outcomes) compared with interdisciplinary multimodal pain therapy alone.

Design: A randomized controlled trial was conducted. The recruitment period was 24 months.

Subjects/patients: The study comprised 297 employed patients from a rural region in north-west Germany, diagnosed with back pain in different regions of the spine.

Methods: The analyses were based on quantitative data: claims data and questionnaire data.

Results: The results showed a mean of 70.07 days of incapacity to work after the interdisciplinary multimodal pain therapy for the control group and a lower mean of 56.41 days for the intervention group. The group difference was not significant (p = 0.259). Analysis of change scores revealed statistically significant larger improvements of functional capacity and health-related quality of life in the intervention group.

Conclusion: Findings of this study show improvements in the secondary outcomes. The results indicate that further studies are needed to determine how to sustainably reduce days off work due to back pain.

Objective: To classify Koreans with spinal cord injury into groups with similar levels of life satisfaction and analyse the differences in life satisfaction between the groups, and identify the factors influencing their quality of life.

Design: A cross-sectional study was conducted.

Subjects: The International Spinal Cord Injury Survey of 711 persons with traumatic or non-traumatic spinal cord injury was used.

Methods: The latent profiles were classified according to the sub-items of quality of life, and variables influencing the latent profiles were identified. The Mplus 8.0 program was used for the main analysis. Logistic regression analysis was performed to examine how the predictors were associated with latent profile membership.

Results: The factors associated with a higher likelihood of belonging to the high quality of life group included marital status; having less bowel dysfunction and muscle spasms or spasticity; receiving vocational rehabilitation services and currently engaging in paid work; and negative social attitude and problematic financial status.

Conclusion: Enhancing the quality of life of individuals with spinal cord injury necessitates providing medical care for bowel dysfunction or spasticity, providing vocational rehabilitation services, enabling successful return to work, improving negative perceptions regarding people with disabilities, and implementing policies to guarantee them an income.

Objective: To investigate whether low-back-pain patients classified based on the risk of pain chronification (low, medium, high) differ in psychosocial and physical function measures, and whether these subgroup differences are moderated by age, gender, and body mass index.

Methods: In this cross-sectional study, 595 Austrian patients with chronic low back pain (68% female; mean age: 53 ± 6.7 years) completed the STarT Back screening tool, visual analogue scale, Roland Morris Disability Questionnaire, Pain Disability Index, 5-level European Quality of Life Questionnaire, Hospital Anxiety and Depression Scale, and Avoidance-Endurance fast screen. Physical function tests assessed maximum trunk strength, trunk range of motion, and hand grip strength, while multivariate analyses of variance evaluated differences among the risk groups.

Results: The intensity of physical and psychosocial problems differed significantly among the pain chronification risk groups. Physical function also varied across subgroups, with the high-risk group exhibiting the weakest muscle strength and the greatest stiffness. Gender significantly moderated the association between pain risk group and trunk strength.

Conclusion: In people of working age with chronic low back pain, the STarT risk of pain chronification was correlated with physical and psychosocial variables. Moreover, this screening tool can be used irrespective of personal factors such as age, gender, and BMI.

Objective: Hand dysfunction is one of the main factors contributing to daily activity limitations in children with cerebral palsy (CP). As a latent -variable, manual ability is not easily measurable, especially in young children. This study aimed to develop ABILHAND-Kids Young CP, a Rasch-built manual ability measure in young children with CP.

Design: Prospective study/questionnaire develop-ment.

Subjects/patients: 107 CP children aged 2 to 7 (59% unilateral CP).

Methods: Responses of children's parents to an 80-item experimental questionnaire were analyzed using RUMM2020 software to select items presenting the best psychometric qualities.

Results: ABILHAND-Kids Young CP includes 17 items with well-discriminated response categories and defines a valid, unidimensional, and linear scale. It presents high measurement precision (R  =  0.94) and is invariant allowing the measurement of young children with CP whatever their age, gender, clinical form, and Manual Ability Classification System (MACS) levels. Its measures are significantly related to age (r = 0.22), school education, clinical form, MACS (r = -0.63) and Pediatric Evaluation of Disability Inventory (r = 0.74) (all p < 0.001, except age at p = 0.023).

Conclusion: ABILHAND-Kids Young CP is a unidimensional and linear scale specifically developed to measure manual ability in young children with CP. Its psychometric properties show promising potential in monitoring children's evolution related to neurorehabilitation.

Objective: to report on the development and global testing of the COVID-19 version of the International Classification of Functioning, Disability and Health-based Clinical Functioning Information Tool called "ClinFIT COVID-19" to collect functioning data of rehabilitation patients across the care continuum to establish an interval-scaled functioning score.

Design: Multicentre, cross-sectional observational study.

Subjects/patients: Rehabilitation patients in acute, post-acute, and long-term settings.

Methods: Three context-specific versions (13-16 ICF categories) of ClinFIT-COVID-19 were administered to collect information on patient functioning. Rasch analysis examined psychometric properties and generated conversion tables from ordinal raw scores to a 0-100 interval metric.

Results: Twenty-six study centres in 17 countries across the globe collected data from 1,747 patients. Problems in exercise tolerance functions were most frequently reported in the acute and post-acute settings (74.2%; 87.6%), while long-term care patients most frequently reported pain as problematic (71.1%). With a testlets approach and item splitting, all 3 ClinFIT COVID-19 versions satisfied Rasch model expectations (item-trait χ² p > 0.05; PSI 0.742-0.812), making it feasible to develop respective transformation tables.

Conclusion: This study found the psychometric properties of ClinFIT COVID-19 acceptable. Future studies are needed to validate the use of the transformation tables to monitor functioning and evaluate intervention impact.

Objective: To evaluate the effects of different exercise training modalities on maximal and sub-maximal physical fitness in chronic stroke patients and determine the optimal training dosage.

Design: Systematic review and meta-analysis of 38 randomized controlled trials.

Methods:  A comprehensive search was conducted across seven databases (MedLine, Embase, ScienceDirect, Cochrane Library, CINAHL, and SPORTSDiscus) up to March 31, 2024. Maximal fitness was measured by VO2 max/peak, and sub-maximal fitness by the 6- or 12-minute walk test (6MWT) Results: Aerobic and mixed training significantly improved VO2 max/peak (MD = 3.16 [2.83, 3.49], p < 0.00001; I² = 22%). Only aerobic training significantly enhanced 6MWT performance (MD = 34.30 [25.08, 43.53], p < 0.00001; I² = 25%). Sensitivity analysis revealed that VO2 max/peak gains were greater with moderate-to-high intensity, while moderate intensity sufficed for 6MWT improvement. The optimal regimen was 45-minute sessions of moderate-to-high intensity aerobic training, at least three times weekly for a minimum of eight weeks.

Conclusion:  Moderate-to-vigorous aerobic training enhances physical fitness in chronic stroke. High-intensity and mixed training programs yield greater maximal fitness improvements, while moderate intensity benefits sub-maximal capacity. Targeted, intensity-monitored exercise programs of ≥45 minutes, three times weekly over ≥8 weeks, are recommended for significant fitness gains.