Journal of Rehabilitation Medicine最新文献

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.

Objective: This study aimed to investigate the relationship between brain lesions and trunk function impairment in stroke patients.

Design: Retrospective cohort study.

Subjects/patients: One hundred fifty-six first-time stroke patients admitted for rehabilitation between August 2021 and October 2023.

Methods: Trunk function was assessed using the Trunk Control Test. Brain lesions were detected using magnetic resonance imaging scans. Support vector regression lesion-symptom mapping was used to identify brain lesions associated with trunk function on admission and discharge, adjusted for lesion volume, age, and lower limb motor impairment.

Results: After adjusting for age, admission trunk function was linked to lesions in the right corticospinal tract, superior longitudinal fasciculus, superior thalamic radiation, and putamen. Further adjustment for lower limb motor impairment revealed associations not only with all aforementioned regions, but also with lesions in the right supplementary motor area and premotor cortex. For trunk function on discharge, no suprathreshold regions were found.

Conclusion: Early post-stroke trunk control impairment was associated with lesions in the right hemisphere, which is involved in motor function, motor control, and sensory integration. These findings provide insights into trunk dysfunction mechanisms, and suggest that targeted rehabilitation could improve trunk control and independence in daily activities for stroke patients.

is missing (Corrigendum) This Corrigendum relates to the following article: https://doi.org/10.2340/jrm.v56.40055.

Objective: The feasibility, safety, and efficacy of automated multi-channel functional electrical stimulation-assisted gait training was assessed in individuals with chronic incomplete spinal cord injury, using an electrical stimulation suit with built-in surface electrodes and motion capture sensors (Teslasuit).

Design: 10-week functional electrical stimulation-assisted gait training, twice weekly for 30 min.

Subjects/patients: Five individuals with chronic incomplete spinal cord injury (≥ 12 months post-injury, ASIA C/D, minimal Walking Index Spinal Cord Injury II ≥ 9).

Methods: The quadriceps, gluteii, hamstrings, tibialis anterior, and gastrocnemius muscles were stimulated bilaterally during gait. Feasibility and safety were evaluated via questionnaires, session adherence, and adverse events. Gait function was assessed using a 10 m walk test, Walking Index Spinal Cord Injury II, and Hoffer classification at baseline, post-intervention, and follow-up. Surface electromyography and spatiotemporal parameters (walking speed, step length and width, cadence) were recorded during the 10 m walk test.

Results: All participants completed the training (91% adherence) with no serious adverse events. Temporary skin redness, muscle soreness, and fatigue were reported by participants. Post-intervention, 4 participants increased their walking speed, step length, and cadence, with 2 maintaining and 2 further improving at follow-up. No consistent changes were found in muscle activity post training.

Conclusion: Automated multi-channel functional electrical stimulation-assisted gait training was feasible, safe, and well received. Preliminary findings suggest that gait improved in most participants, though individual responses varied. The results highlight the potential of multi-channel functional electrical stimulation-assisted gait training as a valuable tool for enhancing gait recovery.

Objective: To determine the time course of longitudinal changes in the independence level of toileting-related subtasks in post-stroke patients.

Design: Single-institution, prospective cohort study.

Subjects/patients: A total of 101 consecutive patients with stroke admitted to subacute rehabilitation wards who urinated/defecated in bathrooms using wheelchairs upon admission.

Methods: Occupational therapists assessed the independence level of patients in each of the 24 toileting subtasks on a 3-level rating scale using the Toileting Tasks Assessment Form every 2-4 weeks from admission to the endpoint (achieving independent toileting or discharge). Patients were classified based on admission and endpoint assessment form scores using a two-step cluster analysis.

Results: Patients were classified into Cluster 1 (30 patients who exhibited a greater independence level in all subtasks upon admission [46.7-100% of patients performed each subtask independently] to the endpoint [73.3-100%]), Cluster 2 (41 patients who showed less independence upon admission [0-26.8%] but gained greater independence at the endpoint [34.1-73.2%]), and Cluster 3 (30 patients whose independence levels remained low in many subtasks from admission [0-26.7%] to the endpoint [3.3-26.7%]).

Conclusion: Changes in toileting independence levels could be classified into 3 time courses. Effective intervention strategies may differ between each group.