Archives of rehabilitation research and clinical translation最新文献

Objectives

Design

Setting

Participants

Interventions

Main Outcome Measures

Results

Conclusions

Objective

Design

Setting

Participants

Interventions

Main Outcome Measures

Results

Conclusions

Objective

To evaluate the relationships between baseline nutritional status, medical events (MEs), and rehabilitation outcomes in individuals undergoing inpatient rehabilitation (IR).

Design

A retrospective single center cohort study.

Setting

An IR ward.

Participants

This study included 409 patients (mean age, 80 years; men, 170 [42%]) undergoing IR for hospital-associated deconditioning, neurologic disorders, or musculoskeletal diseases. Participants were grouped according to the Controlling Nutritional Status score at admission: normal nutrition (NN): 0 to 1, mild malnutrition (MM): 2 to 4, and moderate/severe malnutrition (M/SM): 5 to 12.

Interventions

None.

Main Outcome Measures

The primary outcomes included MEs leading to death or acute illness requiring transfer to other hospitals for specialized treatments. The secondary outcomes were the rehabilitation efficiency scores (changes in Functional Independence Measure [FIM] score divided by length of stay) for motor function (FIM-M) and cognitive function (FIM-C).

Results

Among the 409 participants, 300 (73%) were malnourished at admission. The adjusted hazard ratios (95% confidence interval) for MEs in the MM and M/SM groups relative to the NN group were 1.48 (0.67-3.27) and 0.98 (0.34-2.81), respectively. No significant differences were observed among the 3 groups in FIM-M efficiency scores (mean ± SD, NN: 0.49±0.51 vs MM: 0.41±0.57 vs M/SM: 0.44±1.06, P=.7) or FIM-C efficiency scores (0.04±0.06 vs 0.04±0.06 vs 0.08±0.4, P=0.1). Analysis of covariance showed no significant association between MM or M/SM group and FIM-M efficiency score (beta coefficient = -0.038, P=.6; beta coefficient = 0.15, P=.1, respectively) or FIM-C efficiency score (beta coefficient = 0.004, P=.8; beta coefficient = 0.047, P=.08, respectively).

Conclusion

No significant associations were observed between the baseline nutritional status and MEs, FIM-M efficiency score, or FIM-C efficiency score in individuals undergoing IR.

Objective

To perform a systematic review of the effects of Pilates on common body postures.

Data sources

Web of Science, PubMed, Scopus, Science Direct, Springer Link, and CNKI. The search year is set from January 1, 2019, to November 15, 2023.

Study Selection

Quasi-experimental studies, randomized controlled trials, randomized clinical trials, and nonrandomized controlled trials investigating the effects of Pilates on body posture.

Data Extraction

The Physiotherapy Evidence Database scale was used to evaluate the quality of studies that met the inclusion requirements. Studies were independently assessed by 2 reviewers who read through the full text and labeled as “low quality,” “moderate quality,” “good quality,” and “excellence quality.” Disagreements were resolved by the third reviewer. The Cochrane Risk of Bias (RoB 2.0) tool was used to assess the risk of bias for each study.

Data Synthesis

Of the 492 studies screened, 13 met the inclusion criteria involving a total of 783 trial participants. Six studies (46%) were of high quality or above, with main limitation related to the internal validity of the study design. The research outcomes focused primarily on effects of Pilates on body posture; cervical, thoracic, and lumbar spine; and followed by quality of life and pain.

Conclusions

The findings of this systematic review provided valuable evidence for the role of Pilates in improving body posture problems. Pilates is a boon to patients suffering from postural disorders, and it is suggested that Pilates can be widely used as a complementary therapy. Nonetheless, more detailed studies are necessary in the future.

Objective

To assess the relationship between 2-minute walk test (2MWT) distance, employment status, and median household income in adult dysvascular amputee patients after a 6-week rehabilitation program.

Design

Retrospective cohort study.

Setting

Amputation rehabilitation program.

Participants

In total, 505 patients were included in the analysis. Most (71.1%) were men and had below-knee amputations (78.3%); the average age was 65.3±11.6 years.

Interventions

Not applicable.

Main Outcome Measures

2MWT distance at discharge.

Results

Men (68.3±32.6m) and below-knee amputation amputees (70.9±32.0m) walked significantly further than women (58.8±30.0m; P=.003) and above-knee amputees (47.2±25.7m; P<.001), respectively. A significant negative correlation was found between 2MWT distance and age (r=−.32; P<.001) as well as time from consultation to admission (r=−.23; P<.001). An unadjusted general linear model (GLM) revealed that employment status (F_2,446=17.47; P<.001) but not income (F_4,446=.714; P=.58) was statistically significantly associated with 2MWT distance. An adjusted (age, sex, time from consult to admission, and amputation level) GLM revealed employment status remained significant (F_2,434=5.59; P=.004) and income remained insignificant (F_4,434=.43; P=.784). Differences in 2MWT distance between employment and income groups did not meet clinical significance.

Conclusions

Preamputation employment appears to be associated with postrehabilitation outcomes.

Objective

To evaluate the effectiveness of 2 interventions for caregivers of patients with acquired brain injury (ABI) transitioning home after inpatient rehabilitation, to prepare them for the role of caregiving and reduce stress and depression.

Design

Controlled trial with participants randomly assigned to (1) usual care (UC), (2) clinician-delivered Problem-Solving Training (PST), or (3) peer-led Building Better Caregivers (BBC) training; both experimental interventions initiated during the inpatient rehabilitation stay, delivered virtually, of similar intensity (six 60-minute sessions), and focused on managing stress and building skills related to caregiving.

Setting

Nonprofit rehabilitation hospital specializing in care of persons with acquired brain and spinal cord injuries.

Participants

Caregivers (n=169) of patients with ABI (54 stroke; 115 other ABI) admitted for rehabilitation whose discharge location was home with care provided by family members (caregivers: 83% women, 62% White, age [mean ± SD]: 51±11.5 y). Participants were recruited from February 2021 to November 2022, when COVID-19 restrictions were in place.

Interventions

Noted above.

Main Outcome Measures

Caregiver-reported stress, depressive symptoms, and caregiving self-efficacy; patient unplanned hospital readmissions and emergency department visits 30 days post discharge.

Results

Only 61% of participants in the 2 intervention groups completed 3 or more of 6 intervention sessions and only 53% completed all data collection surveys. Statistically significant improvements between UC and PST groups were noted for caregiver stress (p=.039). Positive differences in caregiver self-efficacy found between UC and the BBC intervention groups approached significance at 30 days after discharge (p=.054). Patient unplanned hospital readmissions and days hospitalized were also higher, albeit not statistically significant, for UC participants than both intervention groups.

Conclusions

Although positive findings were noted, results were negatively affected by study limitations including low enrollment and limited engagement (intervention completion and follow-up outcomes assessment). These limitations resulted, in part, from restrictions put into place during the COVID-19 pandemic, which limited contact with study participants and required alterations to the BBC intervention likely influencing its effectiveness. Despite limitations noted, the encouraging findings suggest the need for further research.

Objective

To investigate the relationship between patient perception of lower extremity function and a home-based virtual clinician assessment of mobility in lower limb prosthesis clients.

Design

Descriptive observational study using a clinician-administered functional mobility survey and timed Up and Go test to assess lower extremity function under supervision.

Setting

Health Insurance Portability and Accountability Act-compliant online virtual platform.

Participants

Twelve lower limb loss clients currently using prostheses, aged ≥19 years, not pregnant, and with no stroke, seizure disorder, or cancer.

Interventions

Not applicable.

Main Outcome Measures

Main outcomes were mobility survey scores and mean timed Up and Go duration.

Results

Most participants reported significant ease of completing basic indoor ambulation and toileting tasks (66%-75%) and significant difficulty in running or prolonged ambulation activities (83%) requiring use of lower limb prosthesis. Timed Up and Go test was faster (11.0±2.9 s) than the reference range for transtibial prosthesis users and negatively associated with self-reported lower extremity functional status (r=−.70, P=.02).

Conclusions

Self-reported movement with lower limb prostheses at home and evaluation of mobility via a virtual platform is a feasible assessment modality that may reduce the frequency of therapy visits, defray some rehabilitation costs, and minimize the travel burden to distant prosthetic clinics.

Objectives

To conduct a systematic review of the literature on the effect of virtual reality (VR) on biomechanical gait parameters (BGPs) in older adults. Specifically, the spatial-temporal parameters of gait, gait velocity, kinematics, and ground reaction forces, and examine how they are affected by VR interventions. To evaluate the effectiveness and validity of VR gait training and subsequently its potential integration into rehabilitation therapies. This review is a valuable contribution to the current literature as it does not limit its focus to a particular disease. By examining a wide range of studies, we sought to provide a comprehensive analysis of the effects of VR on the BGP in older adults. Our findings can inform future research on VR gait training and its potential role in rehabilitation for older adults.

Data Sources

Two authors independently conducted an electronic search from August 18, 2021, to December 17, 2021, using the PubMed, Scopus, and Web of Science databases, including articles published between January 1997 and July 2021.

Study Selection

The search yielded 1226 articles, and after exclusion, 16 articles were included in the analysis.

Data Extraction

The Joanna Briggs Institute appraisal tool for randomized controlled trials and experimental studies, and the Cochrane risk of bias tool, version 2, were used to assess the level of evidence and bias in the studies.

Data Synthesis

In our synthesis, we included data from 9 studies with a total of 217 subjects. The range of follow-up periods across these studies was 2-10 weeks, and 40% of the studies conducted the study in community-dwelling individuals. Of the randomized controlled trials, 9 had a low-risk level, whereas 1 study had moderate risk. All studies with control groups and low bias levels demonstrated a positive effect of VR intervention on the BGP in older adults.

Conclusions

Consistent evidence suggests that VR intervention has positive effects on gait performance in older adults.

Objective

To synthesize the evidence on conservative interventions for shoulder symptoms in hypermobile Ehlers-Danlos Syndrome (hEDS) and hypermobility spectrum disorder (HSD).

Data Sources

A literature search was conducted using data sources Medline, PEDro, CINAHL, AMED, Elsevier Scopus, and the Cochrane Library from January 1998 to June 2023.

Study Selection

The review included primary empirical research on adults diagnosed with hEDS or HSD who experienced pain and/or mechanical shoulder symptoms and underwent conservative interventions. Initially, 17,565 studies were identified, which decreased to 9668 after duplicate removal. After title and abstract screening by 2 independent authors, 9630 studies were excluded. The full texts of the remaining 38 were assessed and 34 were excluded, leaving 4 articles for examination.

Data Extraction

Two authors independently extracted data using a predefined extraction table. Quality assessment used the Joanna Briggs Institute checklists and the Template for Intervention Description and Replication.

Data Synthesis

The review covered 4 studies with a total of 7 conservative interventions, including exercise programs, kinesiology taping, and elasticized compression orthoses. Standardized mean differences were calculated to determine intervention effects over time. The duration of interventions ranged from 48 hours to 24 weeks, showing positive effect sizes over time in the Western Ontario Shoulder Instability Index, pain levels, improved function in activities of daily living, and isometric and isokinetic strength. Small to negligible effect sizes were found for kinesiophobia during completion of exercise programs.

Conclusions

Shoulder symptoms in hEDS/HSD are common, yet significant gaps in knowledge remain regarding conservative interventions, preventing optimal evidence-based application for clinicians. Further research is necessary to explore the most effective intervention types, frequencies, dosages, and delivery methods tailored to the specific requirements of this patient population.

Objective

To describe the development of a national Limb Loss and Preservation Registry (LLPR) designed to collect, standardize, and report patient outcomes data on limb loss and limb difference in the United States.

Design

Clinical Data Registry

Setting

The LLPR was developed through consensus of key stakeholders from academia, industry, patient advocacy, and payers as well as the available scientific evidence. Data are collected from multiple sources, including hospitals, providers, and patients.

Participants

Data are collected from all 50 states.

Interventions

Not applicable.

Main Outcome Measures

More than 1100 trigger codes are used to identify patients who have limb difference or have received a limb preservation or amputation procedure. Once a patient is identified, all subsequent episodes of care are collected for the life of the patient. An integrated model is used for collecting, validating, cleaning, transforming, aggregating, and storing the data received from all sources. The information contained is then provided in a thorough and easily comprehensible manner.

Results

To date, the LLPR has captured data from >435,000 patients and >11.5 million episodes of care.

Conclusions

The LLPR creates opportunities to apply large-data analytical methodologies to provides caregivers, researchers, manufacturers, payers, and policy makers the tools needed to improve the quality of clinical care, quantify patient-centric outcomes, develop clinical practice guidelines, assess patient quality of life, identify appropriate technology, and guide creation of national policies to allocate scarce sources appropriately.