Advances in rehabilitation science and practice最新文献

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.

Background: Spasticity is a motor phenomenon occurring in disorders of the central nervous system that impacts on active and passive function, and quality of life. Pharmacological, physical and surgical management options are available, each of which have limitations. Cryoneurolysis is a technique developed for the treatment of pain which involves the controlled freezing and thawing of peripheral nerves. Recent case reports and series have suggested it may offer a novel treatment approach for pain associated with spasticity.

Objectives: To report on the evaluation of cryoneurolysis in the first cohort of patients treated in a UK spasticity clinic.

Methods: Eight patients with a variety of neurological conditions (aged 25-75 years) underwent cryoneurolysis. Each had been receiving regular botulinum toxin injections and had ongoing treatment goals. All patients first underwent diagnostic nerve blocks with local anaesthetic to determine their appropriateness for the treatment. Cryoneurolysis was then performed with ultrasound and nerve stimulator guidance. Assessments included goal attainment, Modified Ashworth Scale (MAS), ArmA, LegA and the patient reported impact of spasticity scale (PRISM), alongside patient satisfaction and side effect questionnaires. Assessments were at baseline and at regular intervals over 9 to 12 months.

Results: All patients attained at least one of their goals, with sustained effect for more than 6 months. MAS demonstrated mixed or modest improvements. Functional outcome measures (ArmA/LegA) showed several meaningful improvements, particularly in passive function. There was an indication of an improvement in PRISM across domains, which plateaued at 6 months. Post-procedure pain was the most common side effect but subsided in all affected patients by 3 months. Patient satisfaction was positive.

Conclusions: Our findings contribute to a growing base of case reports and series suggesting that cryoneurolysis could be a potentially useful treatment modality for spasticity. Future controlled studies should aim to evaluate cost-effectiveness and compare with existing treatments.

Objective: To present the rehabilitation considerations in prehabilitation and the rehabilitation phase post spinal cord stimulator implantation; and to evaluate the efficacy of synergistic combination of epidural spinal cord stimulation (SCS) with motor imagery, trunk rehabilitation, robotic and overground gait training in improving mobility in persons with sensorimotor complete spinal cord injury (SCI).

Design: A non-controlled before-after clinical trial.

Methods: Epidural spinal cord stimulators were implanted into 3 participants with complete thoracic SCI (Thoracic 4, Thoracic 2 and Thoracic 10 respectively). They underwent 1 month of prehabilitation, followed by 7 months of daily rehabilitation post-implantation, consisting of SCS, motor imagery, trunk rehabilitation, robotic therapy and overground gait training. Pre-post assessments include the American Spinal Injury Association Impairment Scale (AIS) examination, Spinal Cord Independence Measure version III (Mobility subscale) (SCIM-III), Walking Index for Spinal Cord Injury II (WISCI-II), Trunk Assessment Scale for Spinal Cord Injury (TASS), Five Times Sit-to-Stand (5×STS) and 2-minute Walk Test (2mWT).

Results: Post rehabilitation, there were improvements in WISCI-II, TASS, 5×STS and 2mWT in all 3 participants; and no change in AIS sensory scores. Only participants 2 and 3 exhibited slight improvement in SCIM-III. The WISCI-II of all participants improved, ranging from 3 levels to 9 levels, which was considered a clinically meaningful change. Furthermore, the change in TASS exceeded the minimal clinically important difference (MCID) of 4 points for two participants. The change in 5×STS exceeded the MCID of 2.27 seconds for all participants. These significant improvements translated into the participants' ability to perform sit-to-stand independently and ambulate with a rollator frame under supervision of a carer.

Conclusion: This clinical trial demonstrated proof-of-concept and promising findings that support our rehabilitation protocol in improving functional mobility of people with sensorimotor complete SCI, which may be replicated in future studies.*The study protocol was registered with Clinical-trials.gov (NCT05644171; Registered 13 November 2022. https://clinicaltrials.gov/ct2/show/NCT05644171).

Background: Setting goals and planning treatment to attain those goals is often integral to rehabilitation practice, particularly when managing spasticity following stroke or other brain injury. Optimal treatment planning and provision using an algorithm based on mapping goals and treatments, may improve outcome.

Methods: We analysed goal setting and treatment interventions through secondary analysis of goals and related treatments from (a) the Leg Activity measure study, (b) Ankle Contracture data set and (c) the Upper Limb International Spasticity-III study. Total 1207 participants. Goal categories were defined and identified based on a previously published framework: Pain, Involuntary Movement, Contracture Prevention, Active Function (self-performance of tasks), passive function (secondary performance of tasks or personal care). Treatment intervention was then identified per goal category.

Results: Arm spasticity goal categorisation: Pain 302 (22%), Involuntary Movement 166 (12%), Contracture Prevention 208 (15%), Active Function 174 (13%), passive function 501 (37%). Primary interventions identified per category: Pain (Positioning the limb, serial casting), Involuntary Movement (Position the limb, Splinting), Contracture Prevention (Positioning the limb, serial casting, Shoulder support and slings, Splinting), Active Function (Positioning the limb, serial casting, shoulder supports and splinting), passive function (Positioning the limb, serial casting, shoulder supports and splinting). Leg spasticity goal categorisation: Pain 117 (15%), Involuntary Movement 10 (1%), Contracture Prevention 139 (17%), Active Function 356 (44%), passive function 181 (22%). Primary interventions identified per category: Pain (Passive stretch, positioning), Involuntary Movement (Splinting), Contracture Prevention (Positioning, Orthotics, Task Practice), Active Function (Task Practice, Orthotics), passive function (Orthotics, Positioning).

Conclusions: Commonalities in goal categorisation were found in arm and leg. In these cohorts' task-practice interventions to improve active function (walking and transferring) were reported for leg but were not frequently reported for arm rehabilitation. It is suggested that improved treatment planning may result in greater and faster treatment goal attainment and better outcomes.

Objective: This study aimed to adapt and validate the Arabic version of the American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form for assessing shoulder disabilities in the Libyan-Arab population.

Methods: A cross-sectional study design was employed, involving 108 participants with shoulder conditions from rehabilitation centers in Misrata, Libya. The ASES form underwent translation and cultural adaptation following established guidelines, including forward translation, synthesis, back-translation, expert review, and pilot testing. Psychometric validation included assessments of reliability, convergent and discriminant validity, and agreement using Cronbach's α, Intraclass Correlation Coefficient (ICC), and Bland-Altman analysis.

Results: The Arabic ASES form demonstrated excellent internal consistency (Cronbach's α = .90) and high test-retest reliability (ICC = 0.95). Convergent validity was confirmed by significant correlations with the DASH (r = -.867, P < .001), ADL (r = .522, P < .001), VAS (r = -.480, P < .001), and SF-MPQ (r = -.554, P < .001). Discriminant validity was supported by weak, non-significant correlations with unrelated constructs such as self-efficacy, sleep quality, and stress. Bland-Altman analysis indicated minimal systematic bias between repeated measurements.

Conclusion: The Arabic ASES form is a reliable, valid, and culturally appropriate tool for evaluating shoulder disabilities in Arabic-speaking populations, particularly in Libya. Its cross-cultural validation supports broader applicability across diverse Arabic-speaking contexts, enhancing clinical and research utility.