Journal of Rehabilitation Medicine最新文献

Objective: This study explored the effects of home-based transcranial direct current stimulation combined with exercise on motor and sensory function, spasticity, functional and transfer performance, and quality of life.

Design: A prospective, double-blind, randomized, sham-controlled trial.

Subjects and methods: Thirty individuals with SCI were allocated to receive either active transcranial direct current stimulation or sham transcranial direct current stimulation, followed by the same tele-rehabilitation programme, for 12 sessions over 4 weeks (3 sessions/week). Each session included 20 min of transcranial direct current stimulation followed by 1 h of tele-supervised exercise. Primary outcome was the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). Secondary outcomes included (i) the upper limb muscle strength evaluated by hand-held dynamometer, (ii) spasticity evaluated by H reflex and modified-Modified Ashworth Scale, (iii) functional performance assessed by the spinal cord independence measure III, (iv) transfer performance assessed by the transfer assessment instrument, and (v) quality of life assessed by WHOQOL-BREF. Outcomes were assessed at baseline, post-intervention, and 1-month follow-up.

Results: Two-way mixed ANOVA revealed an interaction effects between group and time (F(1,18)=4.49, p=0.043) and main effects of time (F(1,18)=7.82, p=0.009). Bonferroni post-hoc analysis showed a significant improvement only within the active group at 1-month follow-up (p=0.002) for the upper extremity motor scores (UEMS). No significant differences were observed for any of the secondary outcomes.

Conclusion: The effect of 12 sessions of home-based transcranial direct current stimulation combined with exercise was limited to improved upper limb motor recovery, with after-effect at 1-month post-intervention as compared with exercise alone. No improvements were found in sensory function, spasticity, functional and transfer performance, and quality of life. However, this intervention appeared to be feasible, safe, and well-adhered to and provides insight into the use of transcranial direct current stimulation as a tool for tele-rehabilitation in a spinal cord injury outpatient population.

Objective: To ensure wider use of the internationally recommended Fugl-Meyer Assessment (FMA) of sensorimotor function for people with stroke, official translations of the scale are needed. This study aimed to perform a translation and cross-cultural adaptation/validation of the FMA into the Czech language.

Design: Translation and cross-cultural adaptation/validation.

Subjects/patients: Five clinical experts and 1 external expert participated as reviewers; 11 individuals with stroke in the early subacute phase were included in the pilot testing.

Methods: A standardized process using forward-backward translations, expert panel reviews, and pilot testing between and within the raters (inter- and intra-rater reliability) were employed to ensure conceptual, semantic, and operational validity of the new Czech FMA. Agreement between raters was assessed in 11 individuals with stroke on 2 consecutive days at University Hospital Olomouc by using Svensson's rank-based statistics.

Results: Percentage of agreement between and within raters ranged between 70-100% and 55-100%, respectively. Systematic disagreements, found in 7 out of 96 FMA items, were discussed and revised in the final version.

Conclusion: The Czech FMA offers a more unified and standardized assessment of sensorimotor impairment in clinical and research settings. This will improve stroke rehabilitation care and allow for wider international collaboration.

Objective: Aquatic exercise therapy has gained recognition as a valuable non-pharmacological intervention for managing musculoskeletal disorders. Despite the growing body of evidence supporting its efficacy, research on aquatic exercise therapy remains fragmented, with limited understanding of key trends, influential studies, and evolving themes within the field. This study aims to conduct a comprehensive bibliometric analysis to identify publication trends, key authors, and the evolution of research themes in aquatic exercise therapy for musculoskeletal disorders.

Methods: A total of 117 articles were selected based on predefined search terms and inclusion criteria, resulting in 3,985 citations, with an average of 35.9 citations per article and an H-index of 37.

Results: Publications surged between 2013 and 2024, accounting for 88.3% of total output. Peaks occurred in 2019 (n = 14) and 2022 (n = 368 citations). Key contributors include Mariana Arias Avila and Basia Belza, with journals such as BMC Musculoskeletal Disorders and Arthritis & Rheumatism-Arthritis Care & Research playing pivotal roles. Research trends shifted from disease-specific studies to broader quality-of-life outcomes, with keywords such as "rheumatoid arthritis", "balneotherapy", and "quality of life" emerging as focal points.

Conclusion: The findings underscore the growing importance of aquatic exercise therapy in clinical rehabilitation and suggest that future research should focus on long-term outcomes, underrepresented populations, and the integration of aquatic exercise therapy with emerging rehabilitation technologies.

Objective: Evaluate cost, effectiveness and cost-effectiveness of cognitive behavioural therapy for sleep and fatigue (CBT-SF) vs health education (HE) and of CBT-SF vs treatment as usual (TAU) for sleep disturbance and fatigue in acquired brain injury.

Design: Economic evaluation from Australian health system and societal perspectives based on data from a June 2017 to October 2023 randomized controlled trial.

Subjects: Community-dwelling Australian adults with sleep disturbance and fatigue following acquired brain injury (n = 126).

Methods: Incremental health system costs based on cost of delivery and health service utilization since last follow-up. Incremental effectiveness based on participant-reported sleep quality, fatigue, and quality of life at each timepoint. Productivity gains/losses based on a 1-week activity diary at each timepoint.

Results: Reductions in health service utilization from CBT-SF (-A$777, 95% CI: -A$4,232, A$2,678) offset higher delivery costs (A$333, 95% CI: A$109, A$556) relative to HE, with improvements in quality of life at 2 months post-treatment (0.02, 95% CI: -0.01, 0.05) and an additional 3.37 quality-adjusted life days per participant (95% CI: -4.18, 10.92). CBT-SF dominates HE (less costly and more effective) and is likely more cost-effective than HE (66-76%). CBT-SF is cost-effective relative to TAU under realistic assumptions.

Conclusions: CBT-SF after acquired brain injury improved clinical and economic outcomes and was more likely to be cost-effective than HE. Further research is required to precisely estimate the cost-effectiveness of CBT-SF vs TAU and to demonstrate generalizability to routine practice and other settings. ANZCTR Trial registration numbers: 1261700087830; 12617000879369.

Objective: To define long-term changes in subjective symptoms among polio survivors in Japan.

Design: Prospective cohort study.

Patients: Sixty-five polio survivors.

Methods: Surveys were conducted on subjective symptoms including muscle weakness and limb atrophy during 2007 and 2021. The results of manual muscle tests of the upper and lower limbs on both sides during 2007 were summed and scored, and the side with lower scores was defined as the poor side. The participants were classified as younger or older groups based on the median age at the first survey (i.e., 58 years old) and the subjective symptoms were compared between the two groups.

Results: As a whole, muscle atrophy and weakness progressed in the lower and upper limbs while fatigue was reduced. Muscle weakness progressed especially in the lower limbs on the poor side in the younger group, and in the older group it progressed in the lower limbs on the good side and the upper limbs on the poor side.

Conclusion: The timing of progressive muscle weakness differed between the upper and lower limbs of younger and older polio survivors.

Objective: To explore the experiences of 8-week thrice-weekly supervised intense cardiorespiratory interval training at home in people with post-stroke fatigue.

Design: Qualitative, using semi-structured individual interviews.

Methods: Eleven people with post-stroke fatigue were recruited from a study investigating the effects of supervised intense cardiorespiratory interval training. The interviews were conducted 1-2 weeks after the intervention period and analysed inductively with qualitative content analysis.

Results: The theme "Supervised cardiorespiratory interval training at home was perceived as feasible and safe, reducing fatigue and contributing to enhanced self-efficacy in both exercise and everyday life" was based on 4 main categories: "Experiences of performing the intervention and testing, "Perceived impact of the intervention on fatigue", "Perceived impact of the intervention on self-efficacy", and "The reinforcing experiences of exercise transfer to everyday life". The informants reported that participating in the intervention made them feel physically and mentally stronger and no longer restricted by a lack of confidence in performing activities that increased their heart rate.

Conclusions: Participating in supervised intense cardiorespiratory interval training provided a model on how to train, which was transferable to other contexts in everyday life. The training improved exercise self-efficacy and gave the informants the confidence to challenge themselves in everyday life.

Objective: To present a radically interdisciplinary research approach to ill-defined symptoms, with a focus on fatigue as a major symptom of post COVID-19 condition, where multiple and, to date, rarely combined approaches may yield a fuller understanding of these symptoms.

Design: Protocol for a mixed-methods study comprising an interdisciplinary cross-analysis.

Patients: 35 persons with post COVID-19 condition and severe fatigue were included, and 35 age-, sex-, and educationally matched controls who recovered from COVID-19 without post COVID-19 condition.

Methods: Participants were assessed by a multidisciplinary research team as follows: physician assessment; blood and urinalysis; spirometry and physical performance tests; neuropsychological tests; structural and functional magnetic resonance imaging; extended immunological tests (cytokines); and qualitative phenomenological analysis of interviews. Data will be analysed in accordance with established methods in each of these research fields and by a cross-analysis methodology developed from within an enactive framework. This framework encompasses a focus on neuroscientific, physiological, and experiential aspects of the person as a living being in their sociocultural world.

Conclusion: The biopsychosocial model needs to be implemented in research according to methods that allow radically different research paradigms, typically seen as incommensurable, to inform each other in a non-reductionist manner. One application of such an approach is therefore described.

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.