Advances in rehabilitation science and practice最新文献

Background and rationale: Paired vagus nerve stimulation (VNS) has emerged as a safe and effective therapy to reduce upper limb (UL) motor deficits and improve motor function in individuals with chronic ischemic stroke with moderate-to-severe arm impairment. VNS paired with rehabilitation motor tasks led by an occupational or physical therapist is typically done in-clinic during initial treatment. Attending regular outpatient sessions can be difficult for individuals with limited mobility/transportation.

Objectives: The primary objective of the VNS-REHAB At-Home study is to assess the feasibility, safety, compliance, and therapist/patient acceptance of delivering up to 36 hours of therapist-activated VNS paired with UL rehabilitation in a home setting. Secondary objectives include evaluating improvements in UL impairment and function.

Trial design: The acute stage is therapist-activated VNS therapy paired with at home rehabilitation in 1- to 2-hour sessions up to 5 times per week for up to 18 weeks, with a maximum of 36 total hours of therapist visit duration. The long-term stage is a follow-up period of up to 2 years during which participants continue self-activated VNS at home using a magnet during functional tasks.

Study setting: Therapist-activated Paired VNS will be done in the participant's home.

Eligibility criteria: Participants implanted or scheduled to be implanted commercially with the Vivistim Paired VNS System and assessed as able to receive therapist-activated VNS in the home setting.

Interventions: The study will use mobile therapists in the participant's home instead of a clinic for the initial treatment phase. Paired VNS will be done according to the manufacturer's instructions for use.

Outcomes: The primary endpoint is the number of individuals who complete at least 24 hours of therapy provided in the home setting by a therapist within an 18-week period. Secondary endpoints are change from baseline in assessment measures and patient-reported outcomes.

Sample size: Up to 150 participants.

Introduction: Percutaneous tenotomy is an emerging, minimally-invasive procedure to treat muscle and tendon contractures, including those resulting from spasticity. Such contractures often cause pain, functional impairment, impact quality of life and may not respond to conservative or medical therapy. Further, spastic contractures typically affect frail, older patients unsuitable for management with open surgical procedures. We undertook the first PRISMA-compliant systematic review exploring use of percutaneous tenotomy to manage contractures occurring in the context of spasticity in adults.

Methods: We searched 6 databases for primary research papers featuring an entirely adult sample undergoing percutaneous tenotomy, published in either English or French. Quality assessment was performed using the Oxford Centre for Evidence-Based Medicine Scale and the Methodological Index for Non-Randomized Studies. Synthesis of included study data was performed where possible.

Results: Six studies were included, reporting 160 patients undergoing more than 430 tenotomies to 27 different tendons. All were low quality. Synthesis of evidence across studies indicated that percutaneous tenotomy has a low complication rate and may support patients to obtain a range of post-operative goals, including improved skin hygiene, ease of patient care and joint range. However, synthesis across studies was limited by heterogenous patient assessment and poor reporting.

Conclusion: This review found some evidence supporting the safety and efficacy of percutaneous tenotomy in adults with contracture, but higher-quality studies are required. Further work should standardise the approach and reporting of these procedures to facilitate evidence synthesis and to develop best practice.

Background: Cardiac rehabilitation (CR) improves exercise capacity and is strongly recommended in clinical guidelines. However, no established scoring system exists to predict improvements in exercise capacity following CR.

Objective: This study aimed to assess whether the CHA₂DS₂-VASc score could serve as a predictive scoring system for improvements in exercise capacity after CR.

Methods: Of the 99 patients with cardiovascular disease who participated in the hospital-based CR, those who were ineligible were excluded. The remaining patients were stratified into 2 groups based on the median CHA₂DS₂-VASc score. Changes in peak oxygen uptake (peak VO₂) and clinical parameters from baseline to follow-up were compared between the groups.

Results: A total of 46 patients (median age, 74 years; 72% male) were stratified according to the median CHA₂DS₂-VASc score of 4. Patients in the high-score group (CHA₂DS₂-VASc score ⩾ 4) were older, more likely to be female, and had elevated B-type natriuretic peptide levels compared with those in the low-score group (CHA₂DS₂-VASc score <4). The prevalence of comorbidities was similar between the groups. The low-score group showed a significantly greater improvement in peak VO₂ from baseline to follow-up compared with that of the high-score group (2.8 [1.3-4.7] vs 0.4 [-1.0 to 2.4] mL/kg/min, P < 0.01). Spearman's rank correlation analysis showed a significant negative correlation between CHA₂DS₂-VASc scores and the change in peak VO₂ between baseline and follow-up (r = -0.37, P = .01). A CHA₂DS₂-VASc score <4 was independently associated with an increase in peak VO₂ (β = 0.50, 95% confidence interval 0.23-2.14, P = .01) in the multivariate analysis using multiple linear regression.

Conclusions: The CHA₂DS₂-VASc score may be a useful tool for predicting potential improvements in exercise capacity after CR.

Introduction: Growth affects prosthetic provision in children, leading to socket fit issues and prosthetic length discrepancy. Despite increasing numbers of paediatric amputations, no studies have systematically analysed clinical casefiles or interviewed prosthetists to identify growth-related challenges and mitigation strategies, particularly in low-resource environments where polypropylene (PP) technology is used. This study addresses this gap by interviewing prosthetists and analysing clinical casefiles.

Methods: This study combined qualitative interviews with Cambodian prosthetists and analysis of 62 clinical casefiles. Casefile analysis documented growth-related issues, adjustment methods, and time between interventions. Thematic analysis was applied to interviews.

Results: Five themes were identified, highlighting that: sockets and their use can account for growth through careful oversizing and using liners/socks; handcrafted adjustments that rely on thermoplastic technology can also accommodate for growth; lack of adjustment increases waste and clinical attendance; poor socket fit causes pain and residual limb problems; and growth issues result in universal problems of socket fit issues and prosthetic length discrepancy.

Discussion: This study is the first to interview paediatric prosthetists to assess growth-related challenges, identify mitigation strategies, and combine these qualitative findings with hard clinical evidence. PP prosthetic systems offer cost-effectiveness and increased adjustability compared to modular components and carbon fibre sockets. However, this adjustability is still limited, leading to waste of resources and increased clinical time. Finally, longer-than-recommended replacement timelines are concerning, and more research is necessary to understand these longer delays. Addressing these limitations is crucial, particularly in low-resource environments, to improve accessibility and prevent secondary impairments.

Background: Sickle cell disease (SCD), the most common monogenetic childhood disorder, imposes a significant psychosocial and financial burden on caregivers of affected children. Despite the availability of community-based support programs, few are tailored to the specific identified needs of caregivers managing SCD. This study presents a comprehensive program evaluation of a community-partnered caregiver retreat hosted by the St. Louis Sickle Cell Association (SCA).

Methods: Researchers collaborated with the SCA to evaluate their annual weekend-long retreat. Year 1 employed a cross-sectional design using the General Self-Efficacy Scale. Year 2 implemented a pre-post design using the Family Empowerment Scale. In Year 3, a mixed-methods design included the Social Support Survey Instrument, 2 focus groups, and 6 interviews. Data were analyzed using descriptive and inferential statistics and thematic analysis.

Results: Findings revealed no significant group-level empowerment changes in Year 2, though individual improvements were noted. In Year 3, caregivers reported strong emotional and social support but low tangible support. Thematic analysis identified 5 themes: SCD awareness gaps, caregiving burden, psychological toll, support variability, and caregiver-identified solutions. Caregivers emphasized a need for peer connection, mental health support, practical advocacy training, and expanded access to retreat programming.

Discussion: This program evaluation demonstrates the meaningful support provided by community-based caregiver retreats while highlighting areas for enhancement. The findings underscore the value of systematic evaluation in identifying program strengths and opportunities for improvement to better serve caregiver needs.

Conclusion: Community-based partnerships can enhance support for caregivers of children with SCD. This evaluation identifies essential program components and demonstrates how systematic assessment can inform program development to better address unmet caregiver needs and advance health equity.

Background: Most individuals with inflammatory bowel diseases (IBD) do not engage in optimum levels of physical activity (PA). This study aimed to identify important factors to consider when promoting PA participation among individuals with quiescent or mildly active IBD.

Methods: In this qualitative description study, we purposively enrolled 15 Manitobans with quiescent IBD. Data was collected via semi-structured interviews conducted on Zoom. Using the Capability, Opportunity, Motivation, and Behaviour (COM-B) model, we elicited factors that influence PA behaviour. We performed thematic analysis of transcribed interviews using NVivo.

Results: Participants' (N = 15) ages ranged between 20 and 37 years, majority were female (n = 8), and most had a diagnosis of ulcerative colitis (UC) (n = 10). None was a current smoker. Thematic analysis identified persistent symptoms, PA engagement prior to IBD diagnosis, PA routine, coping strategies and determination as themes that influenced 'capability' for PA participation. Social support, type of employment, bathroom access, and finances influenced 'opportunity'. Awareness of the benefits of PA on IBD, relevant knowledge, social support, and personal goals promoted 'motivation' for PA participation. Sex differences were noted in participants' perspectives related to safety concerns and the social context of workout spaces.

Conclusion: Using the COM-B model, we elicited barriers (including IBD-related persistent symptoms, lack of knowledge of PA) and facilitators (social support, coping strategies, ability to track PA progress) that influence PA behaviour among adults with quiescent IBD. These factors are important considerations when promoting PA participation among individuals with IBD.

Purpose: The COVID-19 pandemic disrupted in-person healthcare and accelerated the adoption of telemedicine, for which most low- and middle-income countries were unprepared. This study describes the population, service delivery, and therapeutic outcomes of telerehabilitation in Cali, Colombia, during the pandemic, and identifies factors influencing its feasibility to guide future implementation in similar low-resource settings.

Methods: We conducted a retrospective cohort study using medical records from 2 rehabilitation centers in Cali, Colombia, including patients who received synchronous telerehabilitation between January 2020 and December 2021. Data on demographics, diagnoses (grouped as mental health, neurological, chronic, post-traumatic, or unspecified), and outcomes (recovery, dropout, continued care) were collected using a structured form and analyzed with descriptive statistics and non-parametric tests (Wilcoxon, Kruskal-Wallis, chi-square, or Fisher's exact), with significance set at p < .05.

Results: We analyzed 1572 patients receiving telerehabilitation. Most were women (65.4%), aged 36 to 64 (46.5%), with trauma sequelae (32.8%) and mental health conditions (26.3%) as common diagnoses. Main services were physiatry (32%), psychosocial therapy (29%), and physiotherapy (27%). Most sessions were by phone (67.5%) and completed successfully (90%). Recovery was reported in 6.4% of cases; 13.3% completed treatment, 72.3% required ongoing care, and 3% dropped out. Completion was more common in older patients (p < .05).

Conclusions: The COVID-19 pandemic underscored telerehabilitation's vital role in Latin America, revealing access gaps and the need for further research to address socioeconomic, educational, and digital barriers affecting vulnerable populations. The patterns of telerehabilitation utilization varied notably by age, sex, and diagnosis, highlighting the necessity of strengthening and adapting these services to improve health outcomes and ensure equitable access. Gaps remain in areas of telerehabilitation such as, mental health, cardiovascular diseases and ophthalmology, underscoring the need for broader implementation and integration across specialties.

Background: A key stroke in tennis is the serve. It is the most strenuous stroke in the game and has the greatest potential for injury. The serve has been broken down into a number of key stages to allow analysis of the movements involved.

Objective: The aim of this study was to conduct a systematic review of all injuries related to the stages of the tennis serve and to assess their relative impact on the risk of injury using a meta-analysis.

Methods: A systematic search was conducted across 8 electronic databases, supplemented with searches of grey literature. Eligible studies presented data from injured (injury group) and uninjured (control group) tennis players in a form that allowed further analysis of each risk factor for comparison. All results were presented as effect sizes (Cohen's d) to allow comparison of each risk factor and to identify the most important risk factors associated with injury. Overall study quality was assessed using an adapted Downs and Blacks checklist.

Results: A total of 29 studies were included in the meta-analysis, identifying 130 risk factors. 36 risk factors had an effect size suggesting a large or significant association with injury in tennis players (d ⩾ 0.8 or ⩽-0.8). These were divided into general risk factors and those associated with the preparation, acceleration and follow-through phases of the tennis serve. Seven of the risk factors were from 3 or more studies allowing meta-analysis, 3 were from 2 studies and 26 were from a single study. Downs and Black checklist scores ranged from fair to good for the studies included in this review. There was no evidence of publication bias.

Conclusion: Meta-analysis identified dominant shoulder rotation strength, internal rotation range of movement, weekly tennis volume, age, body mass and height as risk factors for injury in the tennis serve.