Pub Date : 2025-09-30DOI: 10.1016/j.rehab.2025.102017
Louis Jacob , John Castro , Camille Heslot , Nada Andelic , Olli Tenovuo , CENTER-TBI Participants and Investigators (Appendix) , Philippe Azouvi
Background
Most of the prior research on absence from work after a mild traumatic brain injury (mTBI) was of a small sample size and had a limited number of follow-up assessments.
Objectives
Therefore, this study investigated the prevalence of absence from work, trajectories, and associated factors in the 12 months following mTBI in Europe.
Methods
Data from a European cohort (CENTER-TBI) were used. Absence from work was assessed at 2 weeks, 3 months, 6 months, and 12 months after mTBI. Associated factors included sociodemographic factors, current psychoactive substance use, pre-injury medical history, injury-related factors, medical care, complications, and discharge, and 2-week follow-up questionnaires. Inferential analyses relied on generalized estimating equations.
Results
This study included 1080 adults with mTBI who were working at the time of the injury (median [IQR] age, 46.0 [23.0] years; 69 % men). Absence from work decreased from 32 % at 2 weeks to 20 % at 12 months after the injury (P < 0.001). Around 76 % of adults returned to work within the first 3 months, whereas > 43 % of those absent from work at 3 months remained absent at 12 months. The 3 factors with the strongest association with absence from work were admission to hospital wards (OR = 2.57) or intensive care units (OR = 4.76), the presence of a pre-injury psychiatric disorder (OR = 2.55), and older age (OR = 1.61).
Conclusions
One-fifth of workers with mTBI were absent from work 12 months after the injury. Early identification of those at particular risk for not returning to work should be a clinical priority.
{"title":"Absence from work in the 12 months following mild traumatic brain injury in Europe: a CENTER-TBI cohort study","authors":"Louis Jacob , John Castro , Camille Heslot , Nada Andelic , Olli Tenovuo , CENTER-TBI Participants and Investigators (Appendix) , Philippe Azouvi","doi":"10.1016/j.rehab.2025.102017","DOIUrl":"10.1016/j.rehab.2025.102017","url":null,"abstract":"<div><h3>Background</h3><div>Most of the prior research on absence from work after a mild traumatic brain injury (mTBI) was of a small sample size and had a limited number of follow-up assessments.</div></div><div><h3>Objectives</h3><div>Therefore, this study investigated the prevalence of absence from work, trajectories, and associated factors in the 12 months following mTBI in Europe.</div></div><div><h3>Methods</h3><div>Data from a European cohort (CENTER-TBI) were used. Absence from work was assessed at 2 weeks, 3 months, 6 months, and 12 months after mTBI. Associated factors included sociodemographic factors, current psychoactive substance use, pre-injury medical history, injury-related factors, medical care, complications, and discharge, and 2-week follow-up questionnaires. Inferential analyses relied on generalized estimating equations.</div></div><div><h3>Results</h3><div>This study included 1080 adults with mTBI who were working at the time of the injury (median [IQR] age, 46.0 [23.0] years; 69 % men). Absence from work decreased from 32 % at 2 weeks to 20 % at 12 months after the injury (<em>P</em> < 0.001). Around 76 % of adults returned to work within the first 3 months, whereas > 43 % of those absent from work at 3 months remained absent at 12 months. The 3 factors with the strongest association with absence from work were admission to hospital wards (OR = 2.57) or intensive care units (OR = 4.76), the presence of a pre-injury psychiatric disorder (OR = 2.55), and older age (OR = 1.61).</div></div><div><h3>Conclusions</h3><div>One-fifth of workers with mTBI were absent from work 12 months after the injury. Early identification of those at particular risk for not returning to work should be a clinical priority.</div></div><div><h3>Study registration</h3><div>NCT02210221 (<span><span>https://clinicaltrials.gov/</span><svg><path></path></svg></span>).</div></div>","PeriodicalId":56030,"journal":{"name":"Annals of Physical and Rehabilitation Medicine","volume":"68 8","pages":"Article 102017"},"PeriodicalIF":4.6,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-29DOI: 10.1016/j.rehab.2025.102029
Huijing Zhang , Yuhang Yang , Fei Li , Linya Ma , Amanguli Abudureyimu , Ling Jie Cheng , Kun Li , Xi Vivien Wu
Background
Social participation is a core indicator of long-term recovery, but it significantly decreases after a stroke. Diverse single-, bi-, or multi-dimensional interventions showed differing effects on improving stroke survivors’ participation.
Objectives
To compare the effectiveness of current interventions based on the social ecological model in improving social participation among stroke survivors.
Methods
Ten electronic databases were searched from their inception to April 2024, and additional searches were conducted in ProQuest, Google Scholar, and the reference lists of relevant reviews. Randomized controlled trials of interventions with the primary aim of improving social participation for stroke survivors aged 18 years and older were included. Pairwise meta-analysis and network meta-analysis were conducted. The intervention hierarchy was evaluated using the surface under the cumulative ranking curve (SUCRA) values.
Results
A total of 32 articles with 3211 participants were included, and 29 articles were eligible for meta-analysis. Pairwise meta-analysis indicated that different interventions were effective in improving social participation compared to control groups at post-intervention, but not at 3, 6, and 12 months after the intervention. The network meta-analysis showed that personal-physical environmental dimensional interventions were the most effective in improving social participation between baseline and post-intervention (SUCRA 86 %, SMD 0.72, 95 % CI 0.20–1.25), followed by personal-interpersonal-physical environmental dimensional interventions (SUCRA 85 %, SMD 0.75, 95 % CI 0.23–1.27) compared to control groups.
Conclusions
Addressing personal and physical environmental barriers, or additionally incorporating interpersonal relationships improvement techniques, appears to be most effective in enhancing social participation among stroke survivors. Findings highlight the need for more rigorous multi-dimensional interventions to provide robust evidence.
社会参与是长期康复的核心指标，但中风后显著下降。不同的单、双或多维干预对改善中风幸存者的参与表现出不同的效果。目的比较目前基于社会生态模型的干预措施在提高脑卒中幸存者社会参与方面的有效性。方法检索自建库至2024年4月的10个电子数据库，并在ProQuest、谷歌Scholar和相关综述的参考文献中进行检索。纳入了以改善18岁及以上中风幸存者社会参与为主要目的的干预措施的随机对照试验。两两荟萃分析和网络荟萃分析。采用累积排序曲线（SUCRA）值下曲面评价干预等级。结果共纳入32篇文献，3211名受试者，其中29篇纳入meta分析。两两荟萃分析表明，与对照组相比，不同的干预措施在干预后有效地改善了社会参与，但在干预后的3、6和12个月则没有效果。网络荟萃分析显示，与对照组相比，个人-物理环境维度干预在改善基线和干预后的社会参与方面最有效（SUCRA 86%, SMD 0.72, 95% CI 0.20-1.25），其次是个人-人际-物理环境维度干预（SUCRA 85%, SMD 0.75, 95% CI 0.23-1.27）。结论：解决个人和物理环境障碍，或额外结合人际关系改善技术，似乎是提高中风幸存者社会参与最有效的方法。研究结果强调需要更严格的多维干预措施来提供有力的证据。
{"title":"Comparative effects of social participation interventions for stroke survivors: a network meta-analysis using a social ecological model","authors":"Huijing Zhang , Yuhang Yang , Fei Li , Linya Ma , Amanguli Abudureyimu , Ling Jie Cheng , Kun Li , Xi Vivien Wu","doi":"10.1016/j.rehab.2025.102029","DOIUrl":"10.1016/j.rehab.2025.102029","url":null,"abstract":"<div><h3>Background</h3><div>Social participation is a core indicator of long-term recovery, but it significantly decreases after a stroke. Diverse single-, bi-, or multi-dimensional interventions showed differing effects on improving stroke survivors’ participation.</div></div><div><h3>Objectives</h3><div>To compare the effectiveness of current interventions based on the social ecological model in improving social participation among stroke survivors.</div></div><div><h3>Methods</h3><div>Ten electronic databases were searched from their inception to April 2024, and additional searches were conducted in ProQuest, Google Scholar, and the reference lists of relevant reviews. Randomized controlled trials of interventions with the primary aim of improving social participation for stroke survivors aged 18 years and older were included. Pairwise meta-analysis and network meta-analysis were conducted. The intervention hierarchy was evaluated using the surface under the cumulative ranking curve (SUCRA) values.</div></div><div><h3>Results</h3><div>A total of 32 articles with 3211 participants were included, and 29 articles were eligible for meta-analysis. Pairwise meta-analysis indicated that different interventions were effective in improving social participation compared to control groups at post-intervention, but not at 3, 6, and 12 months after the intervention. The network meta-analysis showed that personal-physical environmental dimensional interventions were the most effective in improving social participation between baseline and post-intervention (SUCRA 86 %, SMD 0.72, 95 % CI 0.20–1.25), followed by personal-interpersonal-physical environmental dimensional interventions (SUCRA 85 %, SMD 0.75, 95 % CI 0.23–1.27) compared to control groups.</div></div><div><h3>Conclusions</h3><div>Addressing personal and physical environmental barriers, or additionally incorporating interpersonal relationships improvement techniques, appears to be most effective in enhancing social participation among stroke survivors. Findings highlight the need for more rigorous multi-dimensional interventions to provide robust evidence.</div></div>","PeriodicalId":56030,"journal":{"name":"Annals of Physical and Rehabilitation Medicine","volume":"69 1","pages":"Article 102029"},"PeriodicalIF":4.6,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145181433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-29DOI: 10.1016/j.rehab.2025.102030
Deborah Wareham , Joel Fuller , Petra Graham , Eoin Doyle , Mark Hancock
Background
Swimming is anecdotally suggested as a suitable exercise for chronic low back pain. However, swimming involves different strokes that require different movement patterns and, therefore, may impact low back pain symptoms differently. The extent to which different swimming strokes impact chronic low back pain differently is currently unknown.
Objectives
This study compares and describes the intensity of pain experienced during and immediately after different swimming strokes in individuals with chronic low back pain.
Methods
We recruited 30 adults with chronic low back pain. Participants swam 100 m of freestyle, breaststroke, and backstroke in a balanced, randomized sequence. The primary outcome was pain intensity during swimming, measured as average and worst pain (0–10 Numeric Pain Rating). Secondary outcomes included pain after swimming while standing and while completing an aggravating movement. Pain scores were compared between strokes using linear mixed-effects models that included a fixed effect of stroke and period, and a random effect for participant. Carry-over effects were investigated via a stroke-by-period interaction.
Results
There was no evidence of carry-over effects for any outcome measure (P >0.15). Backstroke had lower average pain compared to breaststroke (mean difference, MD −0.63; 95% CI: −1.17 to −0.10) but was not different to freestyle (MD −0.27; 95% CI: −0.80 to 0.27), and lower worst pain compared to breaststroke (MD −1.10; 95% CI: −1.77 to −0.43) but was not different to freestyle (MD −0.60; 95% CI: −1.27 to 0.07). Standing pain had a similar pattern to the primary outcomes, but pain with an aggravating movement showed no statistically significant differences.
Conclusion
Backstroke was the least painful swimming stroke during and immediately after swimming when compared to breaststroke, and to a lesser extent, freestyle. The average differences were typically small but may be important to the long-term effects. Swimming stroke should be considered by health professionals when prescribing an individualized swimming program.
Trial registration: This study was registered in the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12624000263594).
{"title":"The immediate effect of swimming stroke on pain in people with chronic low back pain: a crossover study","authors":"Deborah Wareham , Joel Fuller , Petra Graham , Eoin Doyle , Mark Hancock","doi":"10.1016/j.rehab.2025.102030","DOIUrl":"10.1016/j.rehab.2025.102030","url":null,"abstract":"<div><h3>Background</h3><div>Swimming is anecdotally suggested as a suitable exercise for chronic low back pain. However, swimming involves different strokes that require different movement patterns and, therefore, may impact low back pain symptoms differently. The extent to which different swimming strokes impact chronic low back pain differently is currently unknown.</div></div><div><h3>Objectives</h3><div>This study compares and describes the intensity of pain experienced during and immediately after different swimming strokes in individuals with chronic low back pain.</div></div><div><h3>Methods</h3><div>We recruited 30 adults with chronic low back pain. Participants swam 100 m of freestyle, breaststroke, and backstroke in a balanced, randomized sequence. The primary outcome was pain intensity during swimming, measured as average and worst pain (0–10 Numeric Pain Rating). Secondary outcomes included pain after swimming while standing and while completing an aggravating movement. Pain scores were compared between strokes using linear mixed-effects models that included a fixed effect of stroke and period, and a random effect for participant. Carry-over effects were investigated via a stroke-by-period interaction.</div></div><div><h3>Results</h3><div>There was no evidence of carry-over effects for any outcome measure (<em>P</em> >0.15). Backstroke had lower average pain compared to breaststroke (mean difference, MD −0.63; 95% CI: −1.17 to −0.10) but was not different to freestyle (MD −0.27; 95% CI: −0.80 to 0.27), and lower worst pain compared to breaststroke (MD −1.10; 95% CI: −1.77 to −0.43) but was not different to freestyle (MD −0.60; 95% CI: −1.27 to 0.07). Standing pain had a similar pattern to the primary outcomes, but pain with an aggravating movement showed no statistically significant differences.</div></div><div><h3>Conclusion</h3><div>Backstroke was the least painful swimming stroke during and immediately after swimming when compared to breaststroke, and to a lesser extent, freestyle. The average differences were typically small but may be important to the long-term effects. Swimming stroke should be considered by health professionals when prescribing an individualized swimming program.</div><div><strong>Trial registration:</strong> This study was registered in the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12624000263594).</div></div>","PeriodicalId":56030,"journal":{"name":"Annals of Physical and Rehabilitation Medicine","volume":"69 1","pages":"Article 102030"},"PeriodicalIF":4.6,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145181434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-29DOI: 10.1016/j.rehab.2025.102026
Anne Boissel , Florian Leblond , Philippe Petit , François Tasseau , Brice Gouvernet , Fabrice Sebbe , Eric Vérin
{"title":"Daily life of persons with chronic disorders of consciousness: advice of families and healthcare professionals","authors":"Anne Boissel , Florian Leblond , Philippe Petit , François Tasseau , Brice Gouvernet , Fabrice Sebbe , Eric Vérin","doi":"10.1016/j.rehab.2025.102026","DOIUrl":"10.1016/j.rehab.2025.102026","url":null,"abstract":"","PeriodicalId":56030,"journal":{"name":"Annals of Physical and Rehabilitation Medicine","volume":"69 1","pages":"Article 102026"},"PeriodicalIF":4.6,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145181435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-26DOI: 10.1016/j.rehab.2025.102023
Gijs P.G. Lemmers , René J.F. Melis , Sophie Pagen , Robin Hak , Miriam L. Haaksma , Gert P. Westert , Philip J. van der Wees , J.Bart Staal
Background
People with low back pain are a heterogeneous group with diverse symptoms and recovery patterns, highlighting the need for a better understanding of trajectories toward either rapid resolution or chronicity with persistent disease burden.
Objectives
The aim of this study is to identify clustering of pain and disability trajectories and predictors thereof in adults seeking physical therapy care for low back pain.
Methods
People (n=347) were followed for 12 months in a prospective cohort. Growth classes were identified using growth mixture modeling (GMM) separately for pain and disability. Pseudo-class method was used to calculate the odd ratios between the assigned growth class for pain and disability.
Results
The best-fitting GMM identified two growth classes in both the pain and disability courses. One trajectory with people with moderate pain/disability at first visit that recovered and a second trajectory with people with moderate pain/disability at first visit that did not recover. People in the worst class for disability had higher odds of being the worst class for pain as well (OR 6.8, 95% CI 1.69-9.28). Predictors of class membership for the worst classes in pain and disability were longer duration of complaints (OR 1.24, 95% CI 1.02-1.46) for pain and higher baseline NPRS score (OR 1.31, 95% CI 1.09-1.52) and higher baseline STarT Back Screening Tool (SBST) score (OR 5.49, 95% CI 1.69-9.28).
Conclusion
The odds are high for people in the non-recovery class for disability to also be in the worst recovery class for pain. Longer duration of complaints, higher pain scores, and presence of more psychosocial factors were identified as predictors of slower recovery trajectories. People might benefit from tailored treatment based on these prognostic factors.
背景腰痛患者是一个异质性群体，具有不同的症状和恢复模式，强调需要更好地了解快速解决或慢性持续疾病负担的轨迹。目的：本研究的目的是确定寻求下腰痛物理治疗护理的成人疼痛和残疾轨迹的聚类及其预测因素。方法对347名前瞻性队列患者进行为期12个月的随访。使用生长混合模型（GMM）分别确定疼痛和残疾的生长类别。采用伪类法计算疼痛和残疾指定生长类之间的奇比。结果最合适的GMM在疼痛和残疾过程中都确定了两个生长类别。一条轨迹是第一次就诊时患有中度疼痛/残疾的人康复了第二条轨迹是第一次就诊时患有中度疼痛/残疾的人没有康复。残疾程度最差的人也有更高的几率成为疼痛程度最差的人（OR 6.8, 95% CI 1.69-9.28）。最严重疼痛和残疾类别成员的预测因子是疼痛的投诉持续时间较长（OR 1.24, 95% CI 1.02-1.46），较高的基线NPRS评分（OR 1.31, 95% CI 1.09-1.52）和较高的基线STarT Back Screening Tool （SBST）评分（OR 5.49, 95% CI 1.69-9.28）。结论残疾患者在疼痛方面处于非康复阶段的概率较高。较长的抱怨持续时间、较高的疼痛评分和更多的社会心理因素被确定为较慢的恢复轨迹的预测因素。人们可能会受益于基于这些预后因素的量身定制的治疗。伦理委员会RadboudUMC 2020-6295
{"title":"Low back pain and disability trajectories in primary care: a growth mixture modeling analysis","authors":"Gijs P.G. Lemmers , René J.F. Melis , Sophie Pagen , Robin Hak , Miriam L. Haaksma , Gert P. Westert , Philip J. van der Wees , J.Bart Staal","doi":"10.1016/j.rehab.2025.102023","DOIUrl":"10.1016/j.rehab.2025.102023","url":null,"abstract":"<div><h3>Background</h3><div>People with low back pain are a heterogeneous group with diverse symptoms and recovery patterns, highlighting the need for a better understanding of trajectories toward either rapid resolution or chronicity with persistent disease burden.</div></div><div><h3>Objectives</h3><div>The aim of this study is to identify clustering of pain and disability trajectories and predictors thereof in adults seeking physical therapy care for low back pain.</div></div><div><h3>Methods</h3><div>People (<em>n</em>=347) were followed for 12 months in a prospective cohort. Growth classes were identified using growth mixture modeling (GMM) separately for pain and disability. Pseudo-class method was used to calculate the odd ratios between the assigned growth class for pain and disability.</div></div><div><h3>Results</h3><div>The best-fitting GMM identified two growth classes in both the pain and disability courses. One trajectory with people with moderate pain/disability at first visit that recovered and a second trajectory with people with moderate pain/disability at first visit that did not recover. People in the worst class for disability had higher odds of being the worst class for pain as well (OR 6.8, 95% CI 1.69-9.28). Predictors of class membership for the worst classes in pain and disability were longer duration of complaints (OR 1.24, 95% CI 1.02-1.46) for pain and higher baseline NPRS score (OR 1.31, 95% CI 1.09-1.52) and higher baseline STarT Back Screening Tool (SBST) score (OR 5.49, 95% CI 1.69-9.28).</div></div><div><h3>Conclusion</h3><div>The odds are high for people in the non-recovery class for disability to also be in the worst recovery class for pain. Longer duration of complaints, higher pain scores, and presence of more psychosocial factors were identified as predictors of slower recovery trajectories. People might benefit from tailored treatment based on these prognostic factors.</div></div><div><h3>Registration</h3><div>Clinicaltrials.gov 109643; Ethics committee RadboudUMC 2020-6295</div></div>","PeriodicalId":56030,"journal":{"name":"Annals of Physical and Rehabilitation Medicine","volume":"68 8","pages":"Article 102023"},"PeriodicalIF":4.6,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145157468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-26DOI: 10.1016/j.rehab.2025.102020
José García Cancela , Orlando Conde Vázquez , Santiago Navarro Ledesma , Leo Pruimboom
Background
Chronic non-specific low back pain (CNLBP) affects millions worldwide and is a major contributor to disability and healthcare costs. Pain neuroscience education (PNE) aims to improve understanding of pain mechanisms, reduce maladaptive beliefs, and promote active coping strategies.
Objective
To evaluate the effectiveness of pain neuroscience education (PNE) on pain intensity, frequency, disability, and quality of life in adults with chronic non-specific low back pain (CNLBP).
Design
Umbrella review (UR) (PROSPERO, CRD42023382825).
Literature search
A comprehensive search was conducted in 8 databases, covering April 2014 to April 2024.
Study selection criteria
Inclusion: adults with CNLBP, PNE interventions provided by healthcare professionals, and systematic reviews (SRs) of randomized controlled trials (RCTs). Exclusion: studies focusing solely on psychological or physical aspects.
Data synthesis
Data on pain intensity, pain frequency, disability, and quality of life measured using validated scales were extracted. The results were shown according to the type of intervention and the period evaluated (short or long-term).
Results
Nineteen SRs with 5200 participants were included. Five studies (1120 participants) showed significant short-term pain reductions with PNE alone but inconsistent long-term effects. Four studies (860 participants) showed enhanced pain reduction with PNE combined with physiotherapy or exercise. Ten studies (3220 participants) indicated that combining PNE with other educational and biopsychosocial interventions led to more sustained pain reductions. Six studies were included in a quantitative review assessing PNE combined with exercise, with MD (mean difference) for pain, -1.11 (95 % CI, -1.57 to -0.66). For disability, SMD (standardized mean difference) was -0.42 (95 % CI, -1.09 to 0.24).
Conclusions
PNE decreases pain intensity in CNLBP, with improved outcomes when combined with physiotherapy, exercise, or additional educational and biopsychosocial strategies. A multidisciplinary approach, including PNE, is recommended. Further research using standardized tools and diverse populations is needed to enhance the efficacy and generalizability of PNE interventions.
Perspective
This umbrella review (UR) demonstrates that PNE can effectively reduce pain intensity and disability in CNLBP, especially when combined with physiotherapy, exercise, or biopsychosocial approaches, and it launches new hypotheses about how PNE may work. Adding PNE to different interventions may enhance participant outcomes and support more sustained pain relief.
{"title":"The effectiveness of pain neuroscience education in people with chronic non-specific low back pain: An umbrella review with meta-analysis","authors":"José García Cancela , Orlando Conde Vázquez , Santiago Navarro Ledesma , Leo Pruimboom","doi":"10.1016/j.rehab.2025.102020","DOIUrl":"10.1016/j.rehab.2025.102020","url":null,"abstract":"<div><h3>Background</h3><div>Chronic non-specific low back pain (CNLBP) affects millions worldwide and is a major contributor to disability and healthcare costs. Pain neuroscience education (PNE) aims to improve understanding of pain mechanisms, reduce maladaptive beliefs, and promote active coping strategies.</div></div><div><h3>Objective</h3><div>To evaluate the effectiveness of pain neuroscience education (PNE) on pain intensity, frequency, disability, and quality of life in adults with chronic non-specific low back pain (CNLBP).</div></div><div><h3>Design</h3><div>Umbrella review (UR) (PROSPERO, CRD42023382825).</div></div><div><h3>Literature search</h3><div>A comprehensive search was conducted in 8 databases, covering April 2014 to April 2024.</div></div><div><h3>Study selection criteria</h3><div>Inclusion: adults with CNLBP, PNE interventions provided by healthcare professionals, and systematic reviews (SRs) of randomized controlled trials (RCTs). Exclusion: studies focusing solely on psychological or physical aspects.</div></div><div><h3>Data synthesis</h3><div>Data on pain intensity, pain frequency, disability, and quality of life measured using validated scales were extracted. The results were shown according to the type of intervention and the period evaluated (short or long-term).</div></div><div><h3>Results</h3><div>Nineteen SRs with 5200 participants were included. Five studies (1120 participants) showed significant short-term pain reductions with PNE alone but inconsistent long-term effects. Four studies (860 participants) showed enhanced pain reduction with PNE combined with physiotherapy or exercise. Ten studies (3220 participants) indicated that combining PNE with other educational and biopsychosocial interventions led to more sustained pain reductions. Six studies were included in a quantitative review assessing PNE combined with exercise, with MD (mean difference) for pain, -1.11 (95 % CI, -1.57 to -0.66). For disability, SMD (standardized mean difference) was -0.42 (95 % CI, -1.09 to 0.24).</div></div><div><h3>Conclusions</h3><div>PNE decreases pain intensity in CNLBP, with improved outcomes when combined with physiotherapy, exercise, or additional educational and biopsychosocial strategies. A multidisciplinary approach, including PNE, is recommended. Further research using standardized tools and diverse populations is needed to enhance the efficacy and generalizability of PNE interventions.</div></div><div><h3>Perspective</h3><div>This umbrella review (UR) demonstrates that PNE can effectively reduce pain intensity and disability in CNLBP, especially when combined with physiotherapy, exercise, or biopsychosocial approaches, and it launches new hypotheses about how PNE may work. Adding PNE to different interventions may enhance participant outcomes and support more sustained pain relief.</div></div><div><h3>Registration</h3><div>PROSPERO, CRD42023382825.</div></div>","PeriodicalId":56030,"journal":{"name":"Annals of Physical and Rehabilitation Medicine","volume":"68 8","pages":"Article 102020"},"PeriodicalIF":4.6,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145157467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-18DOI: 10.1016/j.rehab.2025.102022
YuanLiang Zhu , Francois Quesque , Daisuke Nishida , Sophie Jacquin-Courtois , Jacques Luaute , Eric Chabanat , Gilles Rode , Yves Rossetti
Background
Although prism adaptation (PA) has been applied in spatial neglect (SN) for 27 years, its efficacy remains controversial and lacks consistency.
Objective
The first aim was to assess the immediate and long-term effects of PA on SN via meta-analysis of randomized controlled trials (RCTs). The second aim was to identify potential effect modifiers of PA efficacy.
Methods
We searched four databases up to March 2025 for RCTs comparing PA, or PA+conventional vs. shamPA, or shamPA+conventional, or only conventional in participants with SN, and assessing behavioral or neuropsychological tests (such as Catherine Bergego scale (CBS) and behavioral inattention test (BIT)). Cochrane risk-of-bias assessment tool and random-effects meta-analysis were used, and effect size was reported as Weighted Mean Difference (WMD) with 95 % CI.
Results
Only 10 RCTs (356 participants) could be included, eight of them reporting CBS data and six for BIT. Immediate PA effects on SN showed a significant improvement for CBS between the PA group (PA/PA+conventional) and control group (shamPA/ shamPA+conventional/only conventional), all studies with prism shift ≥10°, (WMD = −2.13, 95% CI −3.93 to 0.33; P = 0.020), but non-significance for conventional BIT (BIT-C). Long-term benefit was not significant for CBS, while it was significant for BIT-C when the prism shift was ≥10° (n = 2; WMD = 12.37, 95% CI 0.53 to 24.21; P = 0.041). Linear regressions showed non-significant effect modifiers among the participant characteristics or PA intervention parameters. Subgroup analyses for CBS showed a significant immediate improvement in the larger total quantity of prism exposure (number of total trials × prism shift) subgroup (WMD = −2.73, 95% CI −5.01 to −0.44; P = 0.019), whereas the subgroup with smaller total exposure showed no significant difference.
Conclusion
Even with stringent inclusion criteria, significant effects of PA on SN were observed in the short-term CBS (all studies with prism shift ≥10°), mainly derived from studies with total exposure ≥11250°·trials. The total quantity of prism exposure (°·trials) may be an applicable effect modifier of PA efficacy.
背景：棱镜自适应（prism adaptation， PA）在空间忽视（spatial neglect， SN）中的应用已有27年，但其有效性仍存在争议，且缺乏一致性。目的：第一个目的是通过随机对照试验（rct）的荟萃分析来评估PA对SN的近期和长期影响。第二个目的是确定PA疗效的潜在效果调节剂。方法：我们检索了截至2025年3月的4个数据库，检索了在SN患者中比较PA、PA+常规与shamPA、shamPA+常规或仅常规的随机对照试验，以及评估行为或神经心理测试（如Catherine Bergego量表（CBS）和行为注意力不集中测试（BIT））的随机对照试验。使用Cochrane偏倚风险评估工具和随机效应荟萃分析，效应大小报告为加权平均差（WMD）， 95% CI。结果：仅纳入10项rct（356名受试者），其中8项报告CBS数据，6项报告BIT数据。即刻PA对SN的影响在PA组（PA/PA+常规）和对照组（shamPA/ shamPA+常规/仅常规）之间的CBS均有显著改善，所有研究中棱柱移位≥10°（WMD = -2.13, 95% CI = -3.93 ~ 0.33; P = 0.020），但对常规BIT （BIT- c）无显著性影响。CBS的长期获益不显著，而BIT-C在棱镜移位≥10°时显著（n = 2; WMD = 12.37, 95% CI 0.53 ~ 24.21; P = 0.041）。线性回归显示受试者特征或PA干预参数的影响不显著。CBS的亚组分析显示，较大的棱镜总曝光量（总试验数×棱镜位移）亚组（WMD = -2.73, 95% CI -5.01 ~ -0.44; P = 0.019）立即显著改善，而较小的总曝光亚组无显著差异。结论：即使采用严格的纳入标准，在短期CBS（所有棱镜移位≥10°的研究）中仍观察到PA对SN的显著影响，主要来源于总暴露≥11250°·试验的研究。棱镜总曝光量（°·试验）可能是一种适用于PA疗效的效果调节剂。试验注册：PROSPERO数据库（注册号：CRD420250650402）。
{"title":"Significant immediate and limited long-term benefit of prism adaptation on spatial neglect: a systematic review and meta-analysis of RCTs","authors":"YuanLiang Zhu , Francois Quesque , Daisuke Nishida , Sophie Jacquin-Courtois , Jacques Luaute , Eric Chabanat , Gilles Rode , Yves Rossetti","doi":"10.1016/j.rehab.2025.102022","DOIUrl":"10.1016/j.rehab.2025.102022","url":null,"abstract":"<div><h3>Background</h3><div>Although prism adaptation (PA) has been applied in spatial neglect (SN) for 27 years, its efficacy remains controversial and lacks consistency.</div></div><div><h3>Objective</h3><div>The first aim was to assess the immediate and long-term effects of PA on SN via meta-analysis of randomized controlled trials (RCTs). The second aim was to identify potential effect modifiers of PA efficacy.</div></div><div><h3>Methods</h3><div>We searched four databases up to March 2025 for RCTs comparing PA, or PA+conventional vs. shamPA, or shamPA+conventional, or only conventional in participants with SN, and assessing behavioral or neuropsychological tests (such as Catherine Bergego scale (CBS) and behavioral inattention test (BIT)). Cochrane risk-of-bias assessment tool and random-effects meta-analysis were used, and effect size was reported as Weighted Mean Difference (WMD) with 95 % CI.</div></div><div><h3>Results</h3><div>Only 10 RCTs (356 participants) could be included, eight of them reporting CBS data and six for BIT. Immediate PA effects on SN showed a significant improvement for CBS between the PA group (PA/PA+conventional) and control group (shamPA/ shamPA+conventional/only conventional), all studies with prism shift ≥10°, (WMD = −2.13, 95% CI −3.93 to 0.33; <em>P</em> = 0.020), but non-significance for conventional BIT (BIT-C). Long-term benefit was not significant for CBS, while it was significant for BIT-C when the prism shift was ≥10° (n = 2; WMD = 12.37, 95% CI 0.53 to 24.21; <em>P</em> = 0.041). Linear regressions showed non-significant effect modifiers among the participant characteristics or PA intervention parameters. Subgroup analyses for CBS showed a significant immediate improvement in the larger total quantity of prism exposure (number of total trials × prism shift) subgroup (WMD = −2.73, 95% CI −5.01 to −0.44; <em>P</em> = 0.019), whereas the subgroup with smaller total exposure showed no significant difference.</div></div><div><h3>Conclusion</h3><div>Even with stringent inclusion criteria, significant effects of PA on SN were observed in the short-term CBS (all studies with prism shift ≥10°), mainly derived from studies with total exposure ≥11250°·trials. The total quantity of prism exposure (°·trials) may be an applicable effect modifier of PA efficacy.</div></div><div><h3>Trial Registration</h3><div>PROSPERO database (registration number: CRD420250650402).</div></div>","PeriodicalId":56030,"journal":{"name":"Annals of Physical and Rehabilitation Medicine","volume":"68 7","pages":"Article 102022"},"PeriodicalIF":4.6,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-18DOI: 10.1016/j.rehab.2025.102025
Won Kee Chang , Yun-Sun Jung , Ji-Soo Choi , Won-Seok Kim , Min Kyun Sohn , Sungju Jee , Yong-Il Shin , Sung-Hwa Ko , Minsu Ock , Hyun Joo Kim , Nam-Jong Paik
Background
Early supported discharge (ESD) has shown benefits in post-acute stroke care in Western countries; however, its effectiveness in Asian healthcare systems remains unclear.
Objectives
To investigate the efficacy and economic impact of ESD compared with conventional rehabilitation (CR) in Korean patients recovering from acute stroke.
Methods
The Korean Model for post-acute comprehensive rehabilitation (KOMPACT) study was a multicenter, single-blind, randomized controlled trial. Patients with mild-to-moderate stroke (modified Rankin Scale 1–3) were randomly assigned to the ESD or CR groups. ESD included 4 weeks of home-based rehabilitation and liaison services, including welfare applications and community care. Outcomes were assessed at baseline, 1 month after discharge, and 3 months after stroke. T-test, Chi-Square test, and Fisher’s exact test were used to compare the outcomes between two groups.
Results
Sixty-seven patients were enrolled, 61 (mean [SD] age, 66 [12] years, female n=13) of whom completed the study. No significant differences were found in the clinical outcomes, including functional dependence, between the groups. The ESD group (n=30) showed greater improvement in depressive symptoms from baseline to 3 months than the CR group (n=31) (p=0.025). Length of stay (17.8 days vs 18.3 days) and total deductible costs (2657.3 US dollars vs 2140.5 US dollars) did not significantly differ between the groups. However, one hospital site reported significantly lower rehabilitation costs for ESD. Patient and caregiver satisfaction were significantly higher in the ESD group in most domains.
Conclusion
ESD for Korean patients recovering from mild-to-moderate acute stroke showed clinical and economic outcomes comparable to those of CR, with potential benefits of mood improvement and higher patient satisfaction. These findings suggest that ESD could be a feasible transitional care model in the Korean healthcare system. Nonetheless, further research with larger sample sizes and more extended follow-up periods is needed to confirm ESD’s long-term effects.
{"title":"Pragmatic multicenter randomized controlled study on early supported discharge after stroke in Korea: the KOMPACT study","authors":"Won Kee Chang , Yun-Sun Jung , Ji-Soo Choi , Won-Seok Kim , Min Kyun Sohn , Sungju Jee , Yong-Il Shin , Sung-Hwa Ko , Minsu Ock , Hyun Joo Kim , Nam-Jong Paik","doi":"10.1016/j.rehab.2025.102025","DOIUrl":"10.1016/j.rehab.2025.102025","url":null,"abstract":"<div><h3>Background</h3><div>Early supported discharge (ESD) has shown benefits in post-acute stroke care in Western countries; however, its effectiveness in Asian healthcare systems remains unclear.</div></div><div><h3>Objectives</h3><div>To investigate the efficacy and economic impact of ESD compared with conventional rehabilitation (CR) in Korean patients recovering from acute stroke.</div></div><div><h3>Methods</h3><div>The Korean Model for post-acute comprehensive rehabilitation (KOMPACT) study was a multicenter, single-blind, randomized controlled trial. Patients with mild-to-moderate stroke (modified Rankin Scale 1–3) were randomly assigned to the ESD or CR groups. ESD included 4 weeks of home-based rehabilitation and liaison services, including welfare applications and community care. Outcomes were assessed at baseline, 1 month after discharge, and 3 months after stroke. T-test, Chi-Square test, and Fisher’s exact test were used to compare the outcomes between two groups.</div></div><div><h3>Results</h3><div>Sixty-seven patients were enrolled, 61 (mean [SD] age, 66 [12] years, female <em>n</em>=13) of whom completed the study. No significant differences were found in the clinical outcomes, including functional dependence, between the groups. The ESD group (<em>n</em>=30) showed greater improvement in depressive symptoms from baseline to 3 months than the CR group (<em>n</em>=31) (<em>p</em>=0.025). Length of stay (17.8 days vs 18.3 days) and total deductible costs (2657.3 US dollars vs 2140.5 US dollars) did not significantly differ between the groups. However, one hospital site reported significantly lower rehabilitation costs for ESD. Patient and caregiver satisfaction were significantly higher in the ESD group in most domains.</div></div><div><h3>Conclusion</h3><div>ESD for Korean patients recovering from mild-to-moderate acute stroke showed clinical and economic outcomes comparable to those of CR, with potential benefits of mood improvement and higher patient satisfaction. These findings suggest that ESD could be a feasible transitional care model in the Korean healthcare system. Nonetheless, further research with larger sample sizes and more extended follow-up periods is needed to confirm ESD’s long-term effects.</div></div><div><h3>Registrations</h3><div>URL: <span><span>https://www.clinicaltrials.gov</span><svg><path></path></svg></span>; Identifier: NCT04720820</div></div>","PeriodicalId":56030,"journal":{"name":"Annals of Physical and Rehabilitation Medicine","volume":"68 8","pages":"Article 102025"},"PeriodicalIF":4.6,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-17DOI: 10.1016/j.rehab.2025.102021
Marc Beaumont , Loic Péran , Anne Cécile Berriet , Catherine Le Ber , Emmanuelle Courtois-Communier , Francis Couturaud
Introduction
Patients with chronic obstructive pulmonary disease (COPD) often report an increase in dyspnea during activities involving the upper limbs. For this reason, pulmonary rehabilitation guidelines recommend upper limb training for these patients. However, the most effective training methods are unclear.
Objective
This study aimed to assess the relative effectiveness of upper limb endurance training vs force training in patients with COPD during pulmonary rehabilitation.
Methods
In a randomised, open-label, monocentric controlled trial, the included patients were allocated to either upper limb force training (Force group) or endurance training (Endurance group). Evaluations were performed at baseline and after 4 weeks. The primary outcome was dyspnea, measured using the London Chest Activity of Daily Living questionnaire. Secondary outcomes included dyspnea, assessed using the MMRC Dyspnea Scale and Dyspnea-12 questionnaire; upper limb exercise capacity, measured using the 6-min peg board and ring test; maximal voluntary strength of the deltoid, biceps, and triceps brachii; quality of life, anxiety, and depression. All analyses were performed on an intention-to-treat basis.
Results
280 patients (FEV1[%]: force group: 45.9[19.2]; endurance group: 46.0[17.7]) were included. Dyspnea decreased in both groups. There was no difference in the improvement in dyspnea between both groups, and the minimum important difference of −3 points was not within the 95 % confidence interval (95% CI, −1.0 to 2.1). A significantly greater increase in biceps strength was found in the force group, N.m, 3.3 (6.3) vs 1.5 (6.2), (95% CI, 0.3 - 3.4), P < 0.017. A higher proportion of patients in the force group were unable to reach the required intensity because they found the program too difficult.
Conclusion
We found no significant difference between upper limb force training and upper limb endurance training in terms of changes in dyspnea, arm exercise capacity, quality of life, anxiety, or depression. We therefore suggest incorporating upper limb endurance training during pulmonary rehabilitation.
Trial registration
ClinicalTrials.gov (NCT03611036).
慢性阻塞性肺疾病（COPD）患者经常报告在上肢活动时呼吸困难增加。因此，肺康复指南建议对这些患者进行上肢训练。然而，最有效的训练方法尚不清楚。目的：本研究旨在评估上肢耐力训练与力量训练在COPD患者肺康复中的相对有效性。方法：在一项随机、开放标签、单中心对照试验中，纳入的患者被分配到上肢力量训练组（force组）或耐力训练组（endurance组）。在基线和4周后进行评估。主要终点是呼吸困难，使用伦敦日常生活胸活动问卷进行测量。次要结局包括呼吸困难，使用MMRC呼吸困难量表和呼吸困难-12问卷进行评估；上肢运动能力，采用6分钟钉板和环试验测量；三角肌、肱二头肌和肱三头肌的最大自主力量；生活质量，焦虑和抑郁。所有分析均以意向治疗为基础进行。结果：共纳入280例患者（FEV1[%]：用力组：45.9[19.2]；耐力组：46.0[17.7]）。两组呼吸困难均减轻。两组间呼吸困难的改善无差异，最小重要差异-3点不在95%置信区间内（95% CI, -1.0至2.1）。力量组肱二头肌力量明显增加，N.m, 3.3 (6.3) vs 1.5 (6.2), (95% CI, 0.3 - 3.4), P < 0.017。在强迫组中，更高比例的患者无法达到所需的强度，因为他们觉得这个项目太难了。结论：我们发现上肢力量训练和上肢耐力训练在呼吸困难、手臂运动能力、生活质量、焦虑或抑郁方面的变化无显著差异。因此，我们建议在肺康复过程中加入上肢耐力训练。试验注册：ClinicalTrials.gov （NCT03611036）。
{"title":"Effect of different forms of upper limb muscle training on dyspnea in chronic obstructive pulmonary disease: a randomised controlled trial","authors":"Marc Beaumont , Loic Péran , Anne Cécile Berriet , Catherine Le Ber , Emmanuelle Courtois-Communier , Francis Couturaud","doi":"10.1016/j.rehab.2025.102021","DOIUrl":"10.1016/j.rehab.2025.102021","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients with chronic obstructive pulmonary disease (COPD) often report an increase in dyspnea during activities involving the upper limbs. For this reason, pulmonary rehabilitation guidelines recommend upper limb training for these patients. However, the most effective training methods are unclear.</div></div><div><h3>Objective</h3><div>This study aimed to assess the relative effectiveness of upper limb endurance training vs force training in patients with COPD during pulmonary rehabilitation.</div></div><div><h3>Methods</h3><div>In a randomised, open-label, monocentric controlled trial, the included patients were allocated to either upper limb force training (Force group) or endurance training (Endurance group). Evaluations were performed at baseline and after 4 weeks. The primary outcome was dyspnea, measured using the London Chest Activity of Daily Living questionnaire. Secondary outcomes included dyspnea, assessed using the MMRC Dyspnea Scale and Dyspnea-12 questionnaire; upper limb exercise capacity, measured using the 6-min peg board and ring test; maximal voluntary strength of the deltoid, biceps, and triceps brachii; quality of life, anxiety, and depression. All analyses were performed on an intention-to-treat basis.</div></div><div><h3>Results</h3><div>280 patients (FEV1[%]: force group: 45.9[19.2]; endurance group: 46.0[17.7]) were included. Dyspnea decreased in both groups. There was no difference in the improvement in dyspnea between both groups, and the minimum important difference of −3 points was not within the 95 % confidence interval (95% CI, −1.0 to 2.1). A significantly greater increase in biceps strength was found in the force group, N.m, 3.3 (6.3) vs 1.5 (6.2), (95% CI, 0.3 - 3.4), <em>P</em> < 0.017. A higher proportion of patients in the force group were unable to reach the required intensity because they found the program too difficult.</div></div><div><h3>Conclusion</h3><div>We found no significant difference between upper limb force training and upper limb endurance training in terms of changes in dyspnea, arm exercise capacity, quality of life, anxiety, or depression. We therefore suggest incorporating upper limb endurance training during pulmonary rehabilitation.</div></div><div><h3>Trial registration</h3><div>ClinicalTrials.gov (NCT03611036).</div></div>","PeriodicalId":56030,"journal":{"name":"Annals of Physical and Rehabilitation Medicine","volume":"68 7","pages":"Article 102021"},"PeriodicalIF":4.6,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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