Journal of Rehabilitation Medicine最新文献

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.

Objective: To study the rehabilitation of Ukrainian war trauma patients abroad, focusing on 5 areas of particular interest: communication, cultural differences, infection isolation, psychosocial load, and the rehabilitation process.

Design: Observational study.

Subjects: (i) 14 Ukrainian patients who underwent rehabilitation at Sunnaas Rehabilitation Hospital, Norway; (ii) 15 members of multidisciplinary teams providing war trauma rehabilitation.

Methods: Combined methods.

Patients: medical file review, Client Satisfaction Questionnaire 8, custom questionnaire on the 5 focal areas. Hospital staff: focus-group interviews.

Results: Patients preferred professional interpreters, while multilingual staff served an additional role in providing psychological support and cultural mediation. All patients experienced infection isolation, and health professionals worried about the added psychological strain this entailed. Patients reported high trust in the therapists and high satisfaction with rehabilitation. Although war and infection isolation were negative influences, patients reported overall good mood. Health professionals reported becoming more skilled at facilitating rehabilitation under these conditions.

Conclusion: Despite challenges within the 5 areas assessed, providing rehabilitation to patients evacuated from a country at war is feasible and valuable for patients and health professionals. Both patients and health professionals showed willingness to adapt to foreign concepts, perhaps aided by multilingual health professionals acting as cultural mediators.

Background: The impact of delayed inpatient rehabilitation on the functional outcomes of stroke patients has not been reported in regional Australia.

Objective: This study examined the impact of delayed inpatient rehabilitation following acute stroke on functional outcomes (Relative Functional Gain and Functional Independence Measure efficiency) and length of stay in rehabilitation at a regional Australian hospital.

Methods: Rehabilitation initiated > 24 h after a patient was deemed clinically ready was considered delayed. Associations between delayed inpatient rehabilitation and functional outcomes were investigated with mixed effects linear regression while length of stay was modelled using a negative binomial regression.

Results: Of a total 487 patients, 301 (61.8%) experienced delayed inpatient rehabilitation, with a median delay of 2 days (interquartile range: 1-4 days). Multivariate regressions showed delayed inpatient rehabilitation was negatively associated with Relative Functional Gain (Beta: -0.07, 95% confidence interval [CI]: -0.11, -0.02, p = 0.009) and Functional Independence Measure efficiency (Beta: -0.18, 95% CI: -0.32, -0.04, p = 0.014), but positively associated with length of stay in rehabilitation wards (incidence rate ratio: 1.11, 95% CI: 1.02, 1.21, p = 0.021). Bed unavailability was the leading cause of delay.

Conclusion: Delayed inpatient rehabilitation is associated with poorer functional outcomes in stroke patients. Timely access to rehabilitation is crucial for optimising recovery.

Objective: To investigate whether motor and balance assessments predict independent ambulation in patients with subacute stroke.

Design: Retrospective observational study.

Subjects/patients: 109 patients admitted for inpatient rehabilitation within 3 months of stroke onset.

Methods: Independent ambulation was defined as a Functional Ambulation Category score of 4 or higher on discharge. The Fugl-Meyer Assessment for Lower Limb and Berg Balance Scale were administered on admission. Associations with walking independence on both admission and discharge were examined using binary logistic regression, adjusted for age, sex, and Korean Mini-Mental State Examination scores. Discriminative ability was assessed using receiver operating characteristic curve analysis.

Results: On admission, both the Fugl-Meyer -Assess-ment for Lower Limb (B = 0.42, p < 0.001, odds ratio = 1.52) and the Berg Balance Scale (B = 0.31, p < 0.001, odds ratio = 1.37) were significantly -associated with walking independence. Both assessments also significantly predicted independence in ambulation on discharge. The Berg Balance Scale showed excellent discriminative performance (area under the curve = 0.97 on admission, 0.88 on discharge), and the Fugl-Meyer Assessment also performed well (area under the curve = 0.89 and 0.82).

Conclusion: Admission motor and balance assessments are significant predictors of walking independence in subacute stroke patients and may inform early rehabilitation decisions.

Objective: To develop an official translation of the original Fugl-Meyer Assessment of upper and lower extremity sensorimotor function into Japanese by following a standardized cross-cultural adaptation process to ensure conceptual, linguistic, and semantic validity.

Design: Cross-cultural translation/validation.

Subjects/patients: Seven Japanese clinical experts and an external expert developed the translation. The pilot study included 10 participants with stroke.

Methods: Following the Translation and Cross-Cultural Adaptation of Objectively Assessed Outcome Measures, the Fugl-Meyer Assessment was forward and backward translated and reviewed by an expert group and an external expert familiar with the original scale. The translation was tested in a pilot study with 10 patients with hemiparetic stroke to identify problematic items in intra- and inter-rater agreements.

Results: Sufficient intra- and inter-rater agreements (> 70% agreement) were reached for all items, and only 2 sensation items showed systematic disagreement. These results were incorporated to refine the translation and ensure conceptual, semantic, and linguistic equivalence with the original Fugl-Meyer Assessment.

Conclusion: The culturally validated upper and lower extremity Fugl-Meyer Assessment supports the Japanese rehabilitation field and promotes international collaboration by improving the unified assessment of sensorimotor function in individuals with stroke.

Objective: To map studies that use ultrasonography to assess shoulder soft-tissue injuries in stroke survivors and identify the methods and soft-tissue injury locations.

Design: Scoping review.

Methods: A literature search was performed through PubMed and ICHUSI from 1966 to May 2023 using the terms "stroke", "shoulder soft-tissue injury", and "ultrasonography". Original articles that used ultrasonography to evaluate shoulder soft-tissue injuries in patients with stroke were selected. Extracted data included study design, phase, sample size, ultrasonographic methods (probe, evaluation position, frequency, and assessment site), and soft-tissue injury location.

Results: Among 249 articles identified, 10 met the inclusion and exclusion criteria. In ultrasonographic methods, over half the studies used linear transducer probes, evaluated participants in a sitting position, and applied frequencies of 5-7 MHz. Common assessment sites were the supraspinatus tendon, long head of the biceps tendon, subscapularis tendon, infraspinatus tendon, and subacromial-subdeltoid bursa. The most common locations of shoulder soft-tissue injuries were the long head of the biceps tendon (effusion/tendinitis) and the supraspinatus tendon (tear/tendinitis).

Conclusion: This study identified ultrasonographic methods and hemiplegic shoulder soft-tissue injury locations. These findings may help facilitate evaluations and enable proper assessment of shoulder soft-tissue injuries in patients with stroke using ultrasonography in clinical practice.

Objective: First, to describe a clinical sample with persisting post-concussion symptoms after a mild injury to the head. Second, to explore whether patients who sustained a mild traumatic brain injury differed from those with a minimal head injury (no loss of consciousness, no post-traumatic amnesia, no neuroimaging findings).

Design: Cross-sectional clinic-referred sample.

Subjects: 178 adult patients with persisting post-concussion symptoms referred to outpatient rehabilitation.

Methods: Main outcome measures were Rivermead Post-Concussion Symptoms Questionnaire, Glasgow Outcome Scale-Extended, and Return-to-work status.

Results: In the total sample, previous health problems, daily headaches, fatigue, and depressive symptoms were frequent. Most had functional disability on the Glasgow Outcome Scale-Extended and had not returned to full-time work. The mean Rivermead Post-Concussion Symptoms Questionnaire total score was 29. Only 5 patients had intracranial traumatic injuries. Some 45% had sustained a minimal head injury. Patients with minimal head injury and mild traumatic brain injury had different causes of injury and acute care but were comparable regarding symptom burden and functional limitations.

Conclusion: Clinicians treating persisting post-concussion symptoms may need to target physiological, psychological, and social factors. Many had an injury too mild to meet criteria for a traumatic brain injury, but the clinical phenotype was similar, supporting further research on the mildest head injuries.

Introduction: Brain injuries are the leading cause of disorders of consciousness and are often complicated by swallowing disorders. The aim of this study was to determine whether a correlation existed between swallowing and level of consciousness in patients with acquired brain injury.

Methods: This pilot and observational study was conducted in the post intensive care coma arousal rehabilitation on 10 patients with acquired brain injury with disorder of consciousness and swallowing disorder evaluated with the Coma Recovery Scale-Revised (CRS-R) CRS-R evaluation or WHIM scale and a SWallowing Disorders in Disorders of Consciousness (SWADOC) assessment, both conducted in the same timeline frame. Swallowing function was assessed using the SWADOC scale. The level of consciousness was evaluated with the CRS-R and the Wessex Head Injury Matrix (WHIM). A Pearson correlation analysis was performed to examine the potential relationship between swallowing capacity and level of consciousness.

Results: A strong correlation was identified between the CRS-R and WHIM scales with the SWADOC evaluation. Indeed, the correlation between SWADOC and CRS-R reached 0.70, while the correlation between SWADOC and WHIM was above 0.60.

Conclusion: These findings highlight the importance of integrating swallowing evaluation within the multimodal assessment of consciousness recovery.

Objective: First, to investigate whether the 6 aspects of executive functions assessed by the Frontal Assessment Battery have different components and, if so, to extract those components using principal component analysis. Second, to identify patient groups based on their characteristics using cluster analysis.

Design: A cross-sectional study.

Subjects: Seventy-eight patients with stroke.

Methods: The Frontal Assessment Battery, Mini-Mental State Examination, Trail Making Test, and Stroop Color Word Test were performed within 5 days.

Results: Based on principal component analysis, the Frontal Assessment Battery was classified into cognitive control (subscales 1-3, 5) and behavioural control (subscales 4 and 6). Two clusters that reflect these components (cluster 1, n = 68; cluster 2, n = 10) were identified. The between-group comparison showed that compared with cluster 1, cluster 2 had lower scores on Frontal Assessment Battery subscales 4 and 6, the Frontal Assessment Battery total scores, and other executive functions scores. The Mini-Mental State Examination scores had no significant differences.

Conclusions: The Frontal Assessment Battery can be classified into 2 components, and the impairment of Frontal Assessment Battery subscales 4 and 6 identified a specific group of patients with stroke with severe executive dysfunction.