Journal of Rehabilitation Medicine最新文献

Background: Rehabilitation is vital for optimizing recovery following neurological injuries. However, much of what is done for the paediatric population relies heavily on the adult literature or is based on expert opinion. No previous attempt has been made to collate high-quality evidence pertaining to the subacute period.

Objectives: To summarize and appraise the evidence from systematic reviews regarding the efficacy of inpatient neurorehabilitation interventions for paediatric patients in the 6 months immediately following neurological injury.

Method: A systematic search was conducted of PubMed, Ovid Medline, Cumulative Index to Nursing and Allied Health Literature, Embase, and Cochrane databases, as well as using Google Scholar. Selection required an appraisal of efficacy of an inpatient rehabilitation intervention delivered within 6 months of injury.

Results: 1,250 papers were found. Titles and abstracts were compared against the selection criteria, with 52 papers being selected for full-text review. None of these met the selection criteria. Exclusions were often due to setting and chronicity.

Conclusions: This review reveals a critical lack of systematically reviewed evidence within the scope investigated. There is a pressing need for evaluation of current interventions. In the future, alternative approaches to identifying and appraising different forms of available evidence could be considered.

Objective: This study aimed to compare the impact of sarcopenia on gait recovery using the Sarcopenia Special Interest Group of the International Society of Physical and Rehabilitation Medicine (ISarcoPRM) and the Asian Working Group for Sarcopenia 2019 (AWGS2019) algorithms in older orthopaedic patients.

Design: A prospective observational study.

Patients: A total of 153 orthopaedic patients (78.4% women; average age 79.3 ± 6.7 years) were included during hospitalization.

Methods: Sarcopenia was defined using the ISarcoPRM and AWGS2019 algorithms on admission. Functional ambulation categories assessed gait independence before admission and on discharge. The impact of sarcopenia on worsened gait independence on discharge was evaluated using multivariate logistic regression analysis.

Results: Sarcopenia based on the ISarcoPRM algorithm (prevalence=56.2%) was significantly associated with worsened gait independence (odds ratio: 3.94, 95% confidence interval: 1.51-10.25, p = 0.005), unlike sarcopenia based on AWGS2019 (prevalence=36.6%).

Conclusion: Sarcopenia assessed using the ISarcoPRM algorithm was associated with worsened gait independence on discharge in older orthopaedic patients.

The ongoing war in Ukraine has led to a significant rise in combat-related polytrauma injuries, including high-level multiple amputations, delayed evacuations, infectious complications, and limited access to rehabilitation services. This clinical case demonstrates a comprehensive, patient-centred approach to the rehabilitation of a 25-year-old serviceman with triple amputations caused by a mine-blast injury. The patient progressed through pre-prosthetic and prosthetic rehabilitation stages, achieved independent mobility with prosthetics, transitioned to the K3 functional level, and adapted to his independent life. The success of this case underscores the importance of a multidisciplinary approach, modern technologies, and adherence to evidence-based rehabilitation practices. The leading role of the physical and rehabilitation medicine physician was pivotal in coordinating and adjusting the rehabilitation process, ensuring the optimal use of available resources, and aligning the patient's care with clinical goals. Challenges such as delays in rehabilitation initiation and limited resources highlight the need to expand inpatient rehabilitation capacity and standardize protocols. A coordinated bio-psycho-social rehabilitation model must be the framework for increasing the effectiveness of rehabilitation services and optimizing functioning and quality of life after severe injuries. Implementing multidisciplinary approaches tailored to wartime settings is crucial for combatants' effective recovery and reintegration.

Objective: Investigating the role of telerehabilitation in aiding recovery and societal reintegration for COVID-19 survivors, this study aims to identify distinct subphenotypes among survivors and assess their responsiveness to telerehabilitation.

Design: A secondary analysis of a multicentre, parallel-group randomized controlled trial from April 2020 through to follow-up in 2021.

Subjects/patients: The study included 377 COVID-19 survivors (47.1% male), with a mean age of 56.4 years.

Methods: Data from the Telerehabilitation Programme for COVID-19 (TERECO) were analysed using Latent Class Analysis to identify subphenotypes based on baseline characteristics. Clinical outcomes were compared between subphenotypes and treatment groups.

Results: Latent Class Analysis identified 2 phenotypes: Phenotype 1 (52.9%) characterized by impaired lung function and Phenotype 2 (47.1%) with better lung function. Among those receiving corticosteroids, only Phenotype 1 showed significant benefits from the TERECO intervention. Discrimination accuracy using forced expiratory volume in 1 s (FEV1) and peak expiratory flow was high (AUC = 0.936).

Conclusion: Two distinct phenotypes were identified in COVID-19 survivors, suggesting potential improvements in clinical trial design and personalized treatment strategies based on initial pulmonary function. This insight can guide more targeted rehabilitation approaches, enhancing recovery outcomes for specific survivor groups.

Objective: Maintaining long-term physical activity after a stroke is challenging. "The Stroke School", a standardized physical exercise programme, was developed and patients' and healthcare professionals' experiences of participating were explored.

Design: Qualitative study.

Methods: Eight patients with minor stroke or transient ischaemic attack (TIA) completed a feasibility study on The Stroke School intervention in conjunction with their supervising municipal physiotherapists (n = 5). All informants were invited for semi-structured focus-group interviews, during which they were asked to reflect on their experience attending The Stroke School. Audio recordings from 3 focus-group interviews lasting 90 min each were transcribed to text verbatim and analysed with qualitative content analysis.

Results: Thirteen informants attended 3 focus-group interviews. Five categories were identified (i-iii representing the patients' perspective and iv-v the physiotherapists' perspectives): (i) window of opportunity, (ii) benefits of participating in the study, (iii) strengths and pitfalls of transitioning from the hospital to the municipalities, (iv) effective communication across sectors, and (v) empowering patients to continue exercising independently.

Conclusion: The Stroke School intervention was feasible, provided patient safety throughout the study, and resulted in effective communication and collaboration across sectors. However, identifying factors that facilitate life-long exercise behaviour changes is still warranted.

Objective: This work aimed to investigate the effects of prism adaptation on unilateral spatial neglect following right hemispheric stroke.

Design: Systematic review and meta-analysis of randomized controlled trials (RCTs).

Patients: Patients with unilateral spatial neglect following right hemispheric stroke.

Methods: RCTs comparing prism adaptation with placebo therapy were systematically searched across 4 databases (PubMed, Web of Science, CINAHL, and Cochrane Library). Screening, data extraction, and quality assessment were performed by 2 independent reviewers.

Results: A total of 7 RCTs, involving 227 participants, satisfied the eligibility criteria. The results showed significant short-term effects of prism adaptation on neglect outcomes (SMD: 0.49 [95% CI: 0.07 to 0.92], p = 0.02) but not on the Catherine Bergego Scale (CBS) (SMD: -0.38 [95% CI: -1.27 to 0.51], p = 0.40). Subgroup analyses revealed that larger prism angles (exceeding 10°) had greater prism adaptation effects on both neglect outcomes and CBS (SMD: 0.71 [95% CI: 0.30 to 1.12], p = 0.0007 and SMD: -0.77 [95% CI: -1.51 to -0.02], p = 0.04, respectively).

Conclusion: This study demonstrated that larger prism angle with greater than 10° was identified as a crucial factor in eliciting prism adaptation effects. These findings support the use of prism adaptation with angles exceeding 10° as a therapeutic approach for unilateral spatial neglect.

Objective: This study aimed to assess and compare changes in pain, balance, functional status, and health-related quality of life between adolescents with patellofemoral pain syndrome undergoing 12 weeks of monochromatic infrared energy application as an adjuvant to physical rehabilitation and those receiving physical rehabilitation alone.

Design: Randomized controlled trial.

Patients: Adolescents aged 15-18.

Methods: 46 adolescents were randomly assigned to receive either a standard physical therapy programme or monochromatic infrared energy plus the standard programme. Pain intensity, dynamic postural control, functional status, and health-related quality of life were evaluated pre- and post-intervention.

Results: The study group showed a greater reduction in pain intensity (p < 0.001; η2 = 0.36), improvement in dynamic postural control, towards the anterior (p = 0.002; η2 = 0.20), posteromedial (p = 0.009; η2 = 0.14), posterolateral (p = 0.018; η2 = 0.12) directions, and composite postural control (p = 0.001; η2 = 0.24), and enhancement of functional status (p = 0.013; η2 = 0.13) from the pre- to post-treatment occasion than the control group. Moreover, the study group reported better quality of life: physical health (p = 0.035; η2 = 0.10), psychosocial health (p = 0.005; η2 = 0.17), and overall (p = 0.001; η2 = 0.21).

Conclusion: Monochromatic infrared energy is likely beneficial in adolescents with patellofemoral pain syndrome.

Objective: To support data-driven healthcare, digital applications of patient and outcome information bundled in dashboards can be used in daily care. This study investigated the usage, user-friendliness, and added value of patient and outcome information applications from a clinician's perspective.

Design: We used a mixed-methods design, including surveys (n = 56 clinicians), interviews (n = 16 clinicians), and eye-tracking experiments (n = 8 clinicians) across 3 different settings: a specialized clinic, a rehabilitation centre, and a general hospital. The applications, bundled in dashboards, include visual representations of patient information, individual treatment goals, screening tools for mental health, pain, and physical function, individual predictions of recovery and treatment effect, visuals of treatment outcome information, and identification of extreme values that fall outside the expected values.

Results: Applications were used for managing patient expectations, treatment selection, goal setting, and treatment evaluation. While usage frequency varied between applications and clinicians generally reported positive experiences with outcome information, a complex interaction of factors influenced use in clinical practice. The value of each application depends on its clinical actionability and clinicians' confidence.

Conclusion: From clinicians' perspectives, the applications provide meaningful conversation starters, can lead to a more targeted conversation, and allow for better patient-clinician connection.

Objective: To explore perceived barriers to and facilitators of behaviour change towards a more active lifestyle in people with neuromuscular diseases.

Design: A qualitative study.

Subjects: Nineteen subjects (63% females, age range 28-73 years), representing 4 different neuromuscular diseases.

Methods: Data from a randomized controlled trial were used. Subjects followed a physical activity programme including coaching sessions using motivational interviewing techniques. All sessions were audio-recorded, and thematic analyses were conducted on a random selection of 29 audio recordings, using the International Classification of Functioning, Disability and Health as a framework.

Results: Barriers and facilitators were identified in the following domains: body functions and structures (i.e., neuromusculoskeletal, sensory and mental functions), activities and participation (i.e., undertaking multiple tasks and complex interpersonal interactions), environmental factors (i.e., products and technology for personal use in daily living, design/construction of buildings for public and private use, financial assets, climate, natural events, support and relationships) and personal factors (i.e., satisfaction with life, attitude toward health and disease, attitude toward intervention, exercise habits and methodical skills).

Conclusion: Identified barriers and facilitators could guide healthcare professionals to facilitate the discussion of physical activity behaviour and to address them in a personalized way during neuromuscular rehabilitation treatment.

Spasticity is characterized by increased muscle tone, which can result in pain, contractures, impaired hygiene, and deformities. Stroke is a leading cause of paresis, and nearly 40% of stroke patients will develop spasticity.

Objective: To assess trends in upper and lower extremity spasticity-reducing surgery and botulinum toxin A (BoNT-A) treatment.

Design: A national cohort register study.

Methods: Upper and lower extremity spasticity-reducing surgery and BoNT-A treatment in Swedish stroke patients over a 12-year period was assessed using the National Patient Register.

Results: A total of 6,258 patients were treated during this period; their mean age was 58, and the majority were male. In both upper and lower extremities, tenotomy was the most common surgical procedure, followed by tendon lengthening. The need for BoNT-A injections was significantly reduced after surgery compared with before surgery. The total number of BoNT-A treatments increased during the study period, and ultrasound guidance of injections became more common.

Conclusion: The frequency of BoNT-A treatments was significantly reduced in patients who underwent surgery. Even though no causative association can be established due to the nature of these registry data, this may indicate that surgery reduces the need for further BoNT-A treatments.