Annals of Physical and Rehabilitation Medicine最新文献

Background

Comorbidities are common in older people with back pain but little is known about the influence of comorbidities on outcomes.

Objectives

To explore the influence of the most prevalent comorbidities, and the number of comorbidities, on short (at 3 months) and long-term (at 12 months) outcomes of back pain in older people.

Methods

We analyzed data from the ‘Back Complaints in the Elders’ Dutch study cohort (BACE-D) and included participants aged >55 years. We used the modified Self-Administered Comorbidities Questionnaire (SCQ), the Numeric Rating Scale (NRS) and the Roland–Morris Disability Questionnaire (RMDQ) to assess the number of comorbidities, pain intensity and back-related physical functioning, respectively. We conducted separate linear regression models to analyze the association between comorbidities and outcomes including potential confounders of age, sex, body mass index, smoking and alcoholic drinking status, back pain history, and baseline NRS and RMDQ scores.

Results

Our study included 669 participants with a mean age of 66.5 (SD 7.7) years of whom 394 were female. More comorbidities were positively associated with higher pain intensity (3-month regression coefficient (β) =0.27, 95% CI 0.14–0.39; 12-month β = 0.31, 95% CI 0.17–0.45) and worse physical functioning (3-month β = 0.54, 95% CI 0.31–0.77; 12-month β = 0.64, 95% CI 0.37–0.92). Four of the 5 commonest comorbidities were musculoskeletal problems. Older participants with musculoskeletal comorbidities had higher pain intensity (3-month β = 0.89 95% CI 0.41–1.37; 12-month β = 1.17, 95% CI 0.65–1.69), and worse physical functioning (3-month β = 1.61, 95% CI 0.71–2.52; 12-month β = 1.85, 95% CI 0.82–2.89, P-value < 0.001) compared to participants without musculoskeletal comorbidities.

Conclusions

More comorbidities are associated with worse back pain outcomes in older adults. Participants with musculoskeletal comorbidities had worse back pain outcomes than those without.

Background

Non-pharmacological interventions, such as rehabilitation, are crucial for the treatment of people with peripheral arterial disease (PAD). Although several studies have shown rehabilitation is effective in improving the functional prognosis of PAD, there is currently insufficient evidence regarding its effect on readmission rates.

Objectives

To examine the impact of rehabilitation on readmission rates for people with PAD.

Methods

A retrospective analysis of the JMDC hospital database was performed on data from two groups of people aged ≥20 years who were hospitalized between 2014 and 2020 with PAD, as based on a previous diagnosis. Participants were divided according to whether they did, or did not, receive any form of rehabilitation as part of their treatment in hospital. The primary outcome was readmission rates at 30, 60, 90, and 180 days after initial admission. A one-to-one propensity score matching was used to compare readmission rates between rehabilitation and non-rehabilitation groups.

Results

We included 13,453 people with PAD, of whom 2701 pairs (5402 subjects) were selected after being matched in the rehabilitation and non-rehabilitation groups. The rehabilitation group participants had significantly lower mortality and readmission rates at 30, 60, 90, and 180 days. The odds ratios (95% confidence interval) for both groups were 0.79 (0.69–0.91; 30 days), 0.81 (0.71–0.91; 60 days), 0.78 (0.69–0.88; 90 days), and 0.79 (0.71–0.88; 180 days).

Conclusions

This large, nationwide study found that rehabilitation treatment during hospitalization was associated with lower readmission rates and mortality for people following hospitalization with PAD and supports its inclusion as a standard PAD treatment.

Background

Resistance training (RT) effectively promotes functional independence after stroke.

Objectives

To investigate the effect of lower limb RT on body structure and function (muscle strength, postural balance), activity (mobility, gait) and participation (quality of life, impact of stroke on self-perceived health) outcomes in individuals with chronic stroke.

Methods

Six databases were searched from inception until September 2022 for randomized controlled trials comparing lower limb RT to a control intervention. The random-effects model was used in the meta-analyses. Effect sizes were reported as standardized mean differences (SMD). Quality of evidence was assessed using the GRADE approach.

Results

Fourteen studies were included. Significant improvements were found in body structure and function after lower limb RT: knee extensors (paretic side – SMD: 1.27; very low evidence), knee flexors (paretic side – SMD: 0.51; very low evidence; non-paretic side – SMD: 0.52; low evidence), leg press (paretic side – SMD: 0.83; very low evidence) and global lower limb muscle strength (SMD: -1.47; low evidence). No improvement was found for knee extensors (p = 0.05) or leg press (p = 0.58) on the non-paretic side. No improvements were found in the activity domain after lower limb RT: mobility (p = 0.16) and gait (walking speed-usual: p = 0.17; walking speed-fast: p = 0.74). No improvements were found in the participation domain after lower limb RT: quality of life (p > 0.05), except the bodily pain dimension (SMD: 1.02; low evidence) or the impact of stroke on self-perceived health (p = 0.38).

Conclusion

Lower limb RT led to significant improvements in the body structure and function domain (knee extensors and flexors, leg press, global lower limb muscle strength) in individuals with chronic stroke. No improvements were found in the activity (mobility, gait [walking speed]) or participation (quality of life, impact of stroke on self-perceived health) domains.

PROSPERO registration number

CRD42021272645.

Background

Despite clinical guidelines recommending an interdisciplinary approach to persisting post-concussion symptom (PPCS) management, evaluations of interdisciplinary interventions remain scant.

Objectives

This pilot study aimed to explore the feasibility and preliminary efficacy of an interdisciplinary intervention for PPCSs.

Method

A single-case experimental design with randomisation to multiple baselines (2, 4, or 6 weeks) was repeated across 15 participants (53% female) with mild traumatic brain injury (mean age 38.3 years, SD 15.7). The 12-week treatment incorporated psychology, physiotherapy, and medical interventions. Feasibility outcomes included recruitment and retention rates, adverse events, treatment adherence and fidelity. Patient-centred secondary outcomes included the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), assessed 3 times per week during the baseline and treatment phases, and at the 1- and 3-month follow-ups. Other secondary outcomes included measures of mood, sleep and fatigue, physical functioning, health-related quality of life, illness perceptions, and goal attainment. Changes in PPCSs were evaluated using systematic visual analysis and Tau-U. Clinically significant changes in secondary outcomes were explored descriptively.

Results

16/26 individuals assessed for eligibility were enroled (61% recruitment rate); 15 completed the post-treatment follow-ups, and 13 completed the 1- and 3-month follow-up assessments (81% retention rate). High treatment adherence and competence in delivering treatments was observed. Moderate-large effect sizes for reducing PPCSs were observed in 12/15 cases, with 7/15 reaching statistical significance. Improvements were maintained at the 1- and 3-month follow-ups and were accompanied by reductions in fatigue, sleep difficulties, and mood symptoms, and changes in illness perceptions. All participants had clinically significant improvements in at least 1 outcome, with 81% of individual therapy goals achieved.

Conclusions

This pilot study provided preliminary support for a subsequent randomised controlled trial (RCT), with satisfactory recruitment, retention, treatment compliance, and treatment fidelity. Improvement was evident on participant outcomes including symptom reduction and goal attainment, suggesting that progressing to a phase-II RCT is worthwhile. Findings highlight the potential benefit of individualized interdisciplinary treatments.

Background

Recent studies have tested models of resilience and caregiver adjustment in individuals with traumatic brain injury (TBI) or spinal cord injury (SCI). Few studies have examined the role of adaptive variables over time.

Objective

Conduct a longitudinal study to test a model of caregiver resilience with caregiver outcomes at 2- and 5-years post-injury.

Method

Caregivers of relatives with TBI or SCI were surveyed at 2 years (Time 1) and 5 years (Time 2) post-injury. Stability of the resilience model across the 2 time-points was tested using structural equation modeling with multi-group analysis. Measures included resilience related variables (Connor-Davidson Resilience Scale, General Self-Efficacy Scale, Herth Hope Scale, Social Support Survey) and outcome variables (Caregiver Burden Scale, General Health Questionnaire-28, Medical Outcome Study Short Form -36 [SF-36] and Positive and Negative Affect Scale).

Results

In total, 100 caregivers were surveyed at both 2 and 5 years (TBI =77, SCI =23). Scores for resilience (Time 1, 75.9 SD 10.6; Time 2, 71.5 SD 12.6) and self-efficacy (Time 1, 32.51 SD 3.85; Time 2, 31.66 SD 4.28) showed significant minor declines, with other variables remaining stable. The resilience model for the pooled responses (Time 1+ Time 2) demonstrated a good fit (Goodness of Fit Index [GFI] = 0.971; Incremental Fit Index [IFI] = 0.986; Tucker-Lewis Index [TLI] = 0.971; Comparative Fit Index [CFI] = 0.985 and Root Mean Square Error of Approximation [RMSEA] = 0.051). Multi-group analysis then compared Time 1 to Time 2 responses and found that a variant (compared to invariant) model best fitted the data, with social support having stronger associations with mental health and positive affect at Time 2 than Time 1. Hope reduced from Time 1 to Time 2.

Conclusions

The model suggests that resilience-related variables can play an important role in positive caregiver adjustment over time.

Background

Physiotherapy (PT) is important to optimize functional recovery in geriatric rehabilitation. The dose of PT received by inpatients during geriatric rehabilitation and the determinants of dose are unknown.

Objectives

Describe PT dose in terms of total number of sessions, frequency, duration and type of sessions, and inpatient characteristics determining the frequency of PT in geriatric rehabilitation.

Methods

The observational, longitudinal REStORing health of acutely unwell adulTs (RESORT) cohort consists of geriatric inpatients undergoing rehabilitation including PT (Melbourne, Australia). Ordinal regression was used to assess the determinants of PT frequency (total number of sessions divided by length of stay in weeks). Malnutrition, frailty and sarcopenia were diagnosed according to the Global Leadership Initiative on Malnutrition criteria, Clinical Frailty Scale and revised definition of the European Working Group on Sarcopenia in Older People respectively.

Results

Of the 1890 participants, 1799, median (quartile 1; quartile 3) age 83.4 (77.6; 88.4) years, 56% females received PT and were admitted for at least 5 days. Median total number of PT sessions was 15 (8; 24); median frequency was 5.2 sessions per week (3.0; 7.7); and duration was 27 (22; 34) minutes per session. Higher disease burden, cognitive impairment, delirium, higher anxiety and depression scores, malnutrition, frailty and sarcopenia were associated with a lower PT frequency. Older age, female sex, musculoskeletal reason for admission, greater independence in (instrumental) activities of daily living and handgrip strength were associated with a higher PT frequency.

Conclusions

PT frequency varied widely with a median of 1 session per working day. PT frequency was lowest in participants with poorest health characteristics.

Background

Objective physical performance-based outcome measures (PerBOMs) are essential tools for the holistic management of people who have had an amputation due to vascular disease. These people are often non-ambulatory, however it is currently unclear which PerBOMs are high quality and appropriate for those who are either ambulatory or non-ambulatory.

Research question

Which PerBOMs have appropriate clinimetric properties to be recommended for those who have had amputations due to vascular disease (‘vascular amputee’)?

Data sources

MEDLINE, CINAHL, EMBASE, EMCARE, the Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL) and Scopus databases were searched for the terms: “physical performance” or “function”, “clinimetric properties”, “reliability”, “validity”, “amputee” and “peripheral vascular disease” or “diabetes”.

Review methods

A systematic review of PerBOMs for vascular amputees was performed following COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology and PRISMA guidelines. The quality of studies and individual PerBOMs was assessed using COSMIN risk of bias and good measurement properties. Overall PerBOM quality was evaluated with a modified GRADE rating. Key clinimetric properties evaluated were reliability, validity, predictive validity and responsiveness.

Results

A total of 15,259 records were screened. Forty-eight studies (2650 participants) were included: 7 exclusively included vascular amputees only, 35 investigated validity, 20 studied predictive validity, 23 investigated reliability or internal consistency and 7 assessed responsiveness. Meta-analysis was neither possible nor appropriate for this systematic review in accordance with COSMIN guidelines, due to heterogeneity of the data. Thirty-four different PerBOMs were identified of which only 4 are suitable for non-ambulatory vascular amputees. The Amputee Mobility Predictor no Prosthesis (AMPnoPro) and Transfemoral Fitting Predictor (TFP) predict prosthesis use only. PerBOMs available for assessing physical performance are the One-Leg Balance Test (OLBT) and Basic Amputee Mobility Score (BAMS).

Conclusion

At present, few PerBOMs can be recommended for vascular amputees. Only 4 are available for non-ambulatory individuals: AMPnoPro, TFP, OLBT and BAMS.

Background: Phenotypic variability is a consistent finding in neurogenetics and therefore applicable to hereditary spastic paraparesis. Identifying reasons for this variability is a challenge. We hypothesized that, in addition to genetic modifiers, extrinsic factors influence variability.

Objectives: Our aim was to describe the clinical variability in hereditary spastic paraparesis from the person's perspective. Our goals were to identify individual and environmental factors that influence muscle tone disorders and derive interventions which could improve spasticity.

Methods: This study was based on self-assessments with questions on nominal and ordinal scales completed by participants with hereditary spastic paraparesis. A questionnaire was completed either in-person in the clinic or electronically via lay organization websites.

Results: Among the 325 responders, most had SPG4/SPAST (n = 182, 56%) with a mean age at onset of 31.7 (SD 16.7) years and a mean disease duration of 23 (SD 13.6) years at the time of participation. The 2 factors identified as improving spasticity for > 50% of the responders were physiotherapy (193/325, 59%), and superficial warming (172/308, 55%). Half of the responders (n = 164, 50%) performed physical activity at least once a month and up to once a week. Participants who reported physiotherapy as effective were significantly more satisfied with ≥ 3 sessions per week. Psychologically stressful situations (246/319, 77%) and cold temperatures (202/319, 63%) exacerbated spasticity for most participants.

Conclusion: Participants perceived that physiotherapy reduced spasticity and that the impact of physiotherapy on spasticity was much greater than other medical interventions. Therefore, people should be encouraged to practice physical activity at least 3 times per week. This study reported participants’ opinions: in hereditary spastic paraparesis only functional treatments exist, therefore the participant's expertise is of particular importance.