Journal of Rehabilitation Medicine最新文献

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.

Objective: To test the equivalence of the 6-minute walk test and the 2-minute walk test in stroke survivors in a multicultural setting, focusing on reliability, performance, and associations with clinical and anthropometric factors.

Design: Cross-sectional observational study.

Subjects/patients: 238 participants (119 stroke survivors and 119 healthy individuals matched for age and sex).

Methods: Participants were assessed using the 6-minute walk test and the 2-minute walk test in Belgium and Vietnam. Stroke survivors were assessed in the acute and subacute phases (17 days post-stroke) and reassessed after 1-3 days.

Results: The 6-minute walk test and the 2-minute walk test showed high test-retest reliability (ICC > 0.96). The difference between the two tests was not significant in terms of walking distance reduction in stroke survivors relative to healthy participants (1.4%), not clinically meaningful for walking speed (0.026 m/s), and not significant in chronotropic response (1.6 bpm). The correlation between the 2 tests in stroke survivors was high (r = 0.93) and walking distance was moderately related to height, weight, and phase, and type of stroke (p < 0.05).

Conclusion: The 6-minute walk test and the 2-minute walk test exhibited similar results in measuring the impact of stroke on walking performance. The similarity between Belgium and Vietnam further supports the clinical equivalence of both tests among acute and subacute stroke survivors.

Objective: This study examines the dose-response relationship between physical activity (PA) and all-cause mortality across different severities of airflow limitation, identifying threshold effects that yield new insights into the PA-mortality association.

Design: A prospective cohort study with a 5-year follow-up (2018-2023), employing multivariate Cox models and penalized spline smoothing to assess non-linear associations.

Subjects/patients: A total of 2,975 individuals from a cohort categorized by airflow limitation severity (normal, GOLD 1-4).

Methods: PA levels were quantified in metabolic equivalent hours per week (MET·h/week). Cox proportional hazards models were used to evaluate PA-mortality associations, with penalized spline analysis detecting threshold effects.

Results: Identified thresholds were 41.50 MET·h/week (95% CI: 23.03-64.22) for normal lung function and 13.21 MET·h/week (95% CI: 9.67-16.14) for GOLD 1. Below these thresholds, higher PA levels were associated with a significant reduction in mortality risk (HR = 0.66, HR = 0.41, respectively). In GOLD 2, PA levels below the threshold were associated with a lower mortality risk (HR=0.85), whereas PA exceeding the threshold was associated with a higher mortality risk (HR = 1.23). No significant associations were observed in GOLD 3-4.

Conclusion: PA demonstrates a non-linear, threshold-dependent association with mortality. These findings underscore the importance of individualized PA recommendations for optimizing health outcomes in individuals with chronic respiratory conditions.

Objective: The aim of the study was to investigate postural balance and functional muscle strength over 1 year following hospital discharge due to COVID-19 and identify possible differences depending on age, sex, and level of hospital care.

Design: A prospective longitudinal study.

Subjects: A total of 164 participants were included.

Methods: Postural balance, functional leg strength, and functional hand strength were evaluated. Change over time and differences between groups were investigated.

Results: At the 1-year follow-up postural balance was improved (p = 0.001), as well as strength in the hands (p = 0.001), and legs (p = 0.001). Participants treated at an intensive care unit (ICU) had impaired functional muscle strength in the hands but not in the legs 1 year after discharge. Functional muscle strength in dominant hand on discharge, age, and previous level of physical activity were associated with having more impaired functional muscle strength in the dominant hand 1 year after discharge.

Conclusion: Functional muscle strength and postural balance after COVID-19 improved significantly from discharge to the 1-year follow-up although nearly half of the patients still had impaired functional muscle strength 1 year after COVID-19 hospitalization.

Trial registration: FoU i Sverige (Research & Development in Sweden, Registration number: 274476, registered 2020-05-28).

Objective: The primary aim of this study is to compare the effectiveness of early active limb movement facilitated by virtual reality technologies with conventional exercise therapy in enhancing patient recovery in the Respiratory Intensive Care Unit. The follow-up period covers 1 week.

Methods: In this prospective randomized controlled trial, patients were allocated to either a control group, which received standard exercise therapy, or a virtual reality group, which utilized virtual reality software and equipment for active exercises. Patients were followed for 1 week. The study compared compliance, safety, and rehabilitative outcomes between these groups. Data were analysed using a linear mixed-effects model.

Results: Patients in the virtual reality-based exercise group exhibited significantly higher levels of average daily exercise time, out-of-bed exercise time, and overall exercise compliance compared with the control group (p < 0.05). There were no reports of adverse events related to exercise in either group. Notably, within the first week of intervention, the virtual reality-based exercise group showed significant improvements in various parameters, including muscle strength, grip strength, body mass index, and the Barthel Index, outperforming the control group in these areas (all p < 0.05).

Conclusion: Based on 1 week of follow-up data, the study confirms that virtual reality-based exercise modalities are more efficacious than traditional exercise approaches in enhancing exercise duration, compliance, and various health outcomes in Respiratory Intensive Care Unit patients. This approach also contributes to reducing Respiratory Intensive Care Unit stay duration. The system's effectiveness could be further increased by integrating more varied and engaging rehabilitation games and features tailored to the needs of ICU patients.

Trial registration: Chictr.org: ChiCTR1900021452.

Objective: This study aims to identify characteristic gait patterns in people with multiple sclerosis, to describe their key characteristics, and to identify their potential underlying causes.

Design: a 3-round Delphi study.

Participants: An international panel of 20 experts, including physiotherapists, a neurologist, rehabilitation physicians, biomechanical engineers, and movement scientists with expertise in multiple sclerosis or gait analysis.

Methods: A comprehensive list of gait characteristics and underlying impairments was compiled and analysed to identify common gait patterns and their primary features and potential causes. Consensus was defined as 67% agreement.

Results: Consensus was reached on 6 gait patterns in multiple sclerosis: (i) drop foot; (ii) insufficient push-off; (iii) stiff knee during swing; (iv) knee hyperextension during stance; (i) knee flexion in midstance; and (vi) enhanced gait variability. At least 69% agreement was achieved on the naming of the final gait patterns, their key characteristics, and the potential causes of each pattern.

Conclusion: Consensus was achieved on 6 gait patterns, their characteristics, and potential underlying causes. The identification of these gait patterns may support clinical decision-making regarding diagnostic and treatment measures, and deepen understanding of impairments that underlie walking problems in people with multiple sclerosis.