Vitamin B12 deficiency is a well-established cause of spinal cord dysfunction, often manifesting as subacute combined degeneration. However, in young adults, especially those with a history of substance use, this diagnosis can be delayed or misattributed to other causes. We present the case of a 26-year-old woman with a history of nitrous oxide and ketamine use who developed significant functional decline and was ultimately diagnosed with B12 deficiency-related spinal cord injury. Despite normal spinal magnetic resonance imaging, she exhibited profound bilateral lower extremity weakness and neuropathic pain. Intensive inpatient rehabilitation resulted in significant functional improvement. This case underscores the importance of early recognition and a multidisciplinary approach to recovery, even in radiographically silent presentations.
{"title":"Functional Recovery in a Young Adult With Spinal Cord Injury Secondary to Vitamin B12 Deficiency and Substance Use: A Case Report","authors":"Fereshteh Kargar Bafrani MD , Nozima Akbarova MD , Paul Rutkowski MD","doi":"10.1016/j.arrct.2025.100531","DOIUrl":"10.1016/j.arrct.2025.100531","url":null,"abstract":"<div><div>Vitamin B12 deficiency is a well-established cause of spinal cord dysfunction, often manifesting as subacute combined degeneration. However, in young adults, especially those with a history of substance use, this diagnosis can be delayed or misattributed to other causes. We present the case of a 26-year-old woman with a history of nitrous oxide and ketamine use who developed significant functional decline and was ultimately diagnosed with B12 deficiency-related spinal cord injury. Despite normal spinal magnetic resonance imaging, she exhibited profound bilateral lower extremity weakness and neuropathic pain. Intensive inpatient rehabilitation resulted in significant functional improvement. This case underscores the importance of early recognition and a multidisciplinary approach to recovery, even in radiographically silent presentations.</div></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"7 4","pages":"Article 100531"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145739227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-10-11DOI: 10.1016/j.arrct.2025.100534
Joon Sin Ser MBBS, MMed, MRCP , Kee Jin Loh MBBS, MRCP , Sing Mei Chung MBBS , Mei Xian Tan BSc , Evangeline Jia Yun How BASc , San San Tay MBBS, MMed, MRCP
Opsoclonus-Myoclonus-Ataxia Syndrome (OMAS) is a rare inflammatory neurologic condition predominantly described in pediatric populations. Adult-onset OMAS presents significant rehabilitation challenges because of limited literature and established treatment protocols. We report a middle-aged man with postinflammatory OMAS who underwent intensive inpatient rehabilitation using both conventional therapy and adjunct interventions, including robot-assisted gait training and hydrotherapy. The patient presented with characteristic opsoclonus, truncal ataxia, and bilateral dysmetria after an upper respiratory tract infection. After 22 days of intensive rehabilitation, the patient demonstrated remarkable functional improvement with a FIM efficiency of 1.77 and effectiveness of 0.84. Berg Balance Scale scores improved from 25 of 56 to 53 of 56, and the patient achieved modified independence in activities of daily living. While recovery occurred during rehabilitation, causality cannot be established, as improvement may also reflect the natural disease trajectory. Nevertheless, this case demonstrates the potential efficacy of combining conventional rehabilitation with targeted adjunct therapies for adult-onset OMAS, providing a rationale for a treatment strategy in rare neurologic conditions.
{"title":"A Dual Approach to Rehabilitation of an autoimmune ataxia : A case study involving the Adult-Onset Opsoclonus-Myoclonus-Ataxia Syndrome","authors":"Joon Sin Ser MBBS, MMed, MRCP , Kee Jin Loh MBBS, MRCP , Sing Mei Chung MBBS , Mei Xian Tan BSc , Evangeline Jia Yun How BASc , San San Tay MBBS, MMed, MRCP","doi":"10.1016/j.arrct.2025.100534","DOIUrl":"10.1016/j.arrct.2025.100534","url":null,"abstract":"<div><div>Opsoclonus-Myoclonus-Ataxia Syndrome (OMAS) is a rare inflammatory neurologic condition predominantly described in pediatric populations. Adult-onset OMAS presents significant rehabilitation challenges because of limited literature and established treatment protocols. We report a middle-aged man with postinflammatory OMAS who underwent intensive inpatient rehabilitation using both conventional therapy and adjunct interventions, including robot-assisted gait training and hydrotherapy. The patient presented with characteristic opsoclonus, truncal ataxia, and bilateral dysmetria after an upper respiratory tract infection. After 22 days of intensive rehabilitation, the patient demonstrated remarkable functional improvement with a FIM efficiency of 1.77 and effectiveness of 0.84. Berg Balance Scale scores improved from 25 of 56 to 53 of 56, and the patient achieved modified independence in activities of daily living. While recovery occurred during rehabilitation, causality cannot be established, as improvement may also reflect the natural disease trajectory. Nevertheless, this case demonstrates the potential efficacy of combining conventional rehabilitation with targeted adjunct therapies for adult-onset OMAS, providing a rationale for a treatment strategy in rare neurologic conditions.</div></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"7 4","pages":"Article 100534"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145739173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-08-21DOI: 10.1016/j.arrct.2025.100506
Na Yoon Yoo MD , Hyoung Seop Kim MD, PhD
Objective
To analyze ultrasonographic findings associated with subacromial impingement syndrome and adhesive capsulitis in patients with unrestricted shoulder joint motion and positive impingement signs during physical examinations, and assess pain improvement after intraarticular steroid injections to verify the potential presence of early-stage adhesive capsulitis.
Outpatient clinic of the Department of Physical Medicine and Rehabilitation at a single general hospital.
Participants
Twenty-seven patients (N=27) presenting with unilateral shoulder pain and no limitation in joint motion.
Interventions
Not applicable.
Main Outcome Measures
At the initial visit, ultrasonography was performed to measure supraspinatus tendon thickness and evaluate for bicipital groove fluid collection and subacromial bursitis. All patients received sonography-guided intraarticular steroid injections. Pain and functional status were assessed using the Visual Analog Scale (VAS) and the Korean version of the Shoulder Pain and Disability Index (SPADI) at baseline and at a 2-week follow-up. Positive impingement signs were confirmed via the painful arc, Neer, Hawkins–Kennedy, Paxinos, and horizontal adduction tests.
Results
There was no significant difference in supraspinatus tendon thickness between the painful and nonpainful shoulders. However, VAS scores showed a significant decrease at follow-up. Both SPADI total disability scores and total SPADI scores demonstrated statistically significant improvement.
Conclusions
Patients with preserved shoulder range of motion but positive impingement signs, often diagnosed as subacromial impingement syndrome, may in fact represent early-stage adhesive capsulitis. Ultrasonography and steroid injection response may help differentiate these conditions in clinical practice.
{"title":"Ultrasonographic Validity of Clinical Shoulder Impingement Signs in Patients Without Limitation of Motion","authors":"Na Yoon Yoo MD , Hyoung Seop Kim MD, PhD","doi":"10.1016/j.arrct.2025.100506","DOIUrl":"10.1016/j.arrct.2025.100506","url":null,"abstract":"<div><h3>Objective</h3><div>To analyze ultrasonographic findings associated with subacromial impingement syndrome and adhesive capsulitis in patients with unrestricted shoulder joint motion and positive impingement signs during physical examinations, and assess pain improvement after intraarticular steroid injections to verify the potential presence of early-stage adhesive capsulitis.</div></div><div><h3>Design</h3><div>Prospective, noninterventional, observational study.</div></div><div><h3>Setting</h3><div>Outpatient clinic of the Department of Physical Medicine and Rehabilitation at a single general hospital.</div></div><div><h3>Participants</h3><div>Twenty-seven patients (N=27) presenting with unilateral shoulder pain and no limitation in joint motion.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>At the initial visit, ultrasonography was performed to measure supraspinatus tendon thickness and evaluate for bicipital groove fluid collection and subacromial bursitis. All patients received sonography-guided intraarticular steroid injections. Pain and functional status were assessed using the Visual Analog Scale (VAS) and the Korean version of the Shoulder Pain and Disability Index (SPADI) at baseline and at a 2-week follow-up. Positive impingement signs were confirmed via the painful arc, Neer, Hawkins–Kennedy, Paxinos, and horizontal adduction tests.</div></div><div><h3>Results</h3><div>There was no significant difference in supraspinatus tendon thickness between the painful and nonpainful shoulders. However, VAS scores showed a significant decrease at follow-up. Both SPADI total disability scores and total SPADI scores demonstrated statistically significant improvement.</div></div><div><h3>Conclusions</h3><div>Patients with preserved shoulder range of motion but positive impingement signs, often diagnosed as subacromial impingement syndrome, may in fact represent early-stage adhesive capsulitis. Ultrasonography and steroid injection response may help differentiate these conditions in clinical practice.</div></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"7 4","pages":"Article 100506"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145739178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-07-24DOI: 10.1016/j.arrct.2025.100499
Stacy Schantz Wilkins PhD , Jin J. Zhou PhD , Rebecca J. Melrose PhD , Mia Delgadillo PhD , Elisa F. Ogawa PhD , Steven C. Castle MD , Megan Pearson MA , Rebekah Harris PT, DPT, PhD , Jonathan Wanagat MD, PhD , Jamie Giffuni MA , Neil Alexander MD , Adam D. Gepner MD , Lauren M. Abbate MD, PhD , Daniel E. Forman MD , Odessa Addison DPT, PhD , Monica C. Serra PhD , Katherine S. Hall PhD , Cathy C. Lee MD
Objective
To evaluate cognition at entry into the Gerofit program and its association with physical function.
Gerofit outpatient clinical exercise programs at multiple Veterans Affairs Medical Centers from 2021 to 2023.
Participants
New enrollees (N=1172) completed measures of lower and upper extremity strength, balance, cardiovascular endurance, and measures of global cognition (telephone Montreal Cognitive Assessment, tMoCA) and cognitive set shifting (Oral Trail Making Test B). Dementia diagnosis in the medical record was exclusionary.
Interventions
Not applicable.
Main Outcome Measures
Relationship between physical and cognitive function, self-rated memory change, and demographics were evaluated by linear regression.
Results
Mean age was 75 years. 78% of participants were White and 20% Black; 88% were men. Mean tMoCA score was 17.39. tMoCA and Oral Trail Making Test B scores were significantly associated with lower extremity strength (P<.001), and tMoCA score was significantly associated with endurance. tMoCA score was significantly associated with self-rated memory.
Conclusions
Global cognitive functioning was below the cutoff for normal cognition in 61% of participants, suggesting mild cognitive impairment is common in older exercise program enrollees. Lower cognitive scores were related to both reduced strength and endurance.
{"title":"Cognitive Impairment Highly Prevalent and Associated With Reduced Physical Function in Older Veteran Clinical Exercise Program","authors":"Stacy Schantz Wilkins PhD , Jin J. Zhou PhD , Rebecca J. Melrose PhD , Mia Delgadillo PhD , Elisa F. Ogawa PhD , Steven C. Castle MD , Megan Pearson MA , Rebekah Harris PT, DPT, PhD , Jonathan Wanagat MD, PhD , Jamie Giffuni MA , Neil Alexander MD , Adam D. Gepner MD , Lauren M. Abbate MD, PhD , Daniel E. Forman MD , Odessa Addison DPT, PhD , Monica C. Serra PhD , Katherine S. Hall PhD , Cathy C. Lee MD","doi":"10.1016/j.arrct.2025.100499","DOIUrl":"10.1016/j.arrct.2025.100499","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate cognition at entry into the Gerofit program and its association with physical function.</div></div><div><h3>Design</h3><div>Retrospective observational cross-sectional design.</div></div><div><h3>Setting</h3><div>Gerofit outpatient clinical exercise programs at multiple Veterans Affairs Medical Centers from 2021 to 2023.</div></div><div><h3>Participants</h3><div>New enrollees (N=1172) completed measures of lower and upper extremity strength, balance, cardiovascular endurance, and measures of global cognition (telephone Montreal Cognitive Assessment, tMoCA) and cognitive set shifting (Oral Trail Making Test B). Dementia diagnosis in the medical record was exclusionary.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Relationship between physical and cognitive function, self-rated memory change, and demographics were evaluated by linear regression.</div></div><div><h3>Results</h3><div>Mean age was 75 years. 78% of participants were White and 20% Black; 88% were men. Mean tMoCA score was 17.39. tMoCA and Oral Trail Making Test B scores were significantly associated with lower extremity strength (<em>P</em><.001), and tMoCA score was significantly associated with endurance. tMoCA score was significantly associated with self-rated memory.</div></div><div><h3>Conclusions</h3><div>Global cognitive functioning was below the cutoff for normal cognition in 61% of participants, suggesting mild cognitive impairment is common in older exercise program enrollees. Lower cognitive scores were related to both reduced strength and endurance.</div></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"7 4","pages":"Article 100499"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145739174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To evaluate the effects of isokinetic eccentric training (ECC) in hemiparesis on plantar flexor muscle structure and function.
Design
Randomized controlled trial.
Setting
Neurorehabilitation unit.
Participants
Twenty adult (N=20) community-dwelling outpatients with chronic stroke-induced hemiparesis (>6 mo) were recruited (n=10/group); median age: 59 (interquartile range [IQR], 55-64) years, sex: 15 men, 5 women; median time since lesion: 63 (IQR, 50-104) months.
Interventions
Subjects were randomized into two 8-week rehabilitation programs: ECC group, involving 3 sessions/wk of plantar flexor ECC training, and a conventional group, with continuation of usual rehabilitation.
Main Outcome Measures
(1) Fascicle length and thickness of medial gastrocnemius (MG) and soleus (SOL), knee extended, at 80% maximal clinical extensibility of gastrocnemius in an isokinetic ergometer; (2) The MG and SOL agonist and antagonist electromyographic activity normalized to the amplitude of the maximum motor response during maximal isometric torques in plantar flexion and dorsiflexion; and (3) maximal barefoot 10-m ambulation speed. Parameters were collected by blinded evaluators at day 1 and week 8.
Results
At week 8, significant between-group differences were observed for the ECC group, including: SOL fascicle length, +11.1 mm (P=.004, Rank-ANCOVA); SOL thickness: +1.9 mm (P=.007); MG thickness: +1.0 mm (P=.002); increased MG agonist recruitment: +0.015 (P=3 × 10−4); and decreased MG cocontraction: −0.003 (P=.007). No between-group difference in ambulation speed, maximal torque, or neural command to SOL were observed.
Conclusions
In individuals with chronic hemiparesis, ECC training of plantar flexors is feasible and may improve their spastic myopathy, and command to gastrocnemius.
目的探讨等速偏心训练对偏瘫患者足底屈肌结构和功能的影响。设计随机对照试验。SettingNeurorehabilitation单位。参与者：招募20例（N=20）慢性脑卒中性偏瘫（6个月）的成年社区门诊患者（N= 10/组）；中位年龄：59岁（四分位间距[IQR]， 55-64岁），性别：男性15人，女性5人；中位发病时间：63 （IQR, 50-104）个月。受试者被随机分为两个为期8周的康复计划：ECC组，包括3次/周的足底屈肌ECC训练，以及传统组，继续常规康复。(1)腓肠肌内侧肌（MG）和比目鱼肌（SOL）的肌束长度和厚度，膝关节伸直，在等速测力仪中腓肠肌最大临床伸直80%；(2) MG和SOL激动剂和拮抗剂肌电图活动归一化到足底屈曲和背屈最大等距扭矩时的最大运动反应幅度；(3)最大赤脚10米行走速度。参数由盲法评估者在第1天和第8周收集。结果第8周，ECC组间差异显著，SOL束长+11.1 mm (P= 0.004, Rank-ANCOVA)；SOL厚度：+1.9 mm (P= 0.007)；MG厚度：+1.0 mm (P= 0.002)；MG激动剂招募增加：+0.015 (P=3 × 10−4)；MG收缩减少：- 0.003 （P=.007）。在行走速度、最大扭矩或对SOL的神经指令方面，组间无差异。结论对慢性偏瘫患者进行足底屈肌ECC训练是可行的，可改善其痉挛性肌病，对腓肠肌有一定的控制作用。
{"title":"Impact of a 2-Month Program of Eccentric Training on Plantar Flexor Structure and Function in Hemiparesis After Stroke","authors":"Maud Pradines PT, PhD , François Jabouille PT, MSc , Marjolaine Baude MD, PhD , Jean-Michel Gracies MD, PhD , Karine Gros PhD , Waël Maktouf PhD , Marina Guihard PhD","doi":"10.1016/j.arrct.2025.100496","DOIUrl":"10.1016/j.arrct.2025.100496","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the effects of isokinetic eccentric training (ECC) in hemiparesis on plantar flexor muscle structure and function.</div></div><div><h3>Design</h3><div>Randomized controlled trial.</div></div><div><h3>Setting</h3><div>Neurorehabilitation unit.</div></div><div><h3>Participants</h3><div>Twenty adult (N=20) community-dwelling outpatients with chronic stroke-induced hemiparesis (>6 mo) were recruited (n=10/group); median age: 59 (interquartile range [IQR], 55-64) years, sex: 15 men, 5 women; median time since lesion: 63 (IQR, 50-104) months.</div></div><div><h3>Interventions</h3><div>Subjects were randomized into two 8-week rehabilitation programs: ECC group, involving 3 sessions/wk of plantar flexor ECC training, and a conventional group, with continuation of usual rehabilitation.</div></div><div><h3>Main Outcome Measures</h3><div>(1) Fascicle length and thickness of medial gastrocnemius (MG) and soleus (SOL), knee extended, at 80% maximal clinical extensibility of gastrocnemius in an isokinetic ergometer; (2) The MG and SOL agonist and antagonist electromyographic activity normalized to the amplitude of the maximum motor response during maximal isometric torques in plantar flexion and dorsiflexion; and (3) maximal barefoot 10-m ambulation speed. Parameters were collected by blinded evaluators at day 1 and week 8.</div></div><div><h3>Results</h3><div>At week 8, significant between-group differences were observed for the ECC group, including: SOL fascicle length, +11.1 mm (<em>P</em>=.004, Rank-ANCOVA); SOL thickness: +1.9 mm (<em>P</em>=.007); MG thickness: +1.0 mm (<em>P</em>=.002); increased MG agonist recruitment: +0.015 (<em>P</em>=3 × 10<sup>−4</sup>); and decreased MG cocontraction: −0.003 (<em>P</em>=.007). No between-group difference in ambulation speed, maximal torque, or neural command to SOL were observed.</div></div><div><h3>Conclusions</h3><div>In individuals with chronic hemiparesis, ECC training of plantar flexors is feasible and may improve their spastic myopathy, and command to gastrocnemius.</div></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"7 4","pages":"Article 100496"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-08-21DOI: 10.1016/j.arrct.2025.100516
Ferdinand Prüfer MSc , Alexander Kautzky PhD , Alexandra Unger PhD , Špela Matko MSc , Michael J. Fischer PhD , Ralf Harun Zwick MD , Vincent Grote PhD
Objective
To evaluate and compare rehabilitation outcomes in patients with post-COVID syndrome (post-COVID) vs those with pulmonary, cardiovascular, metabolic, and orthopedic conditions.
Individualized, multidisciplinary outpatient rehabilitation (6-10wk, total 3.000min, minimum 3sessions/wk, and 2-3h/session) including strength/endurance training, physiotherapy, psychological support, and nutritional counseling.
Main Outcome Measures
Physical function was assessed with the 6-minute walking test (6MWT), and quality of life (QOL) with the 5-level EuroQol 5-dimensional questionnaire were measured at admission and discharge of outpatient rehabilitation. Differences within and between groups were analyzed using the analysis of variance, and the effect of baseline values on the outcome’s performance was modeled.
Results
The Post-COVID group was younger (44.7±12.6y), and the percentage of women (75.4%) was higher than in other outpatient rehabilitation groups. All groups improved significantly during rehabilitation. Patients with post-COVID showed the lowest baseline and discharge QOL scores. Baseline-adjusted scores demonstrated that, despite overall improvements, the post-COVID group reported significantly lower QOL than other outpatient rehabilitation groups, except the COPD group. In contrast, the post-COVID group achieved the highest physical function gains in 6MWT (+60.4m, P<.001). Baseline-adjusted scores indicated the highest physical function in patients with post-COVID (6MWT, PC = 632.4 m vs ALL = 603.4 m), outperforming all other outpatient rehabilitation groups. Baseline and change scores were negatively correlated, highlighting the need for baseline adjustment.
Conclusions
Although outpatient rehabilitation was associated with improvements in physical function in patients with post-COVID, QOL deficits persist, discordant with other common outpatient rehabilitation indications. Targeted rehabilitation strategies addressing mental health and fatigue are needed to optimize post-COVID recovery.
目的评价和比较新冠肺炎后综合征（post-COVID）患者与合并肺部、心血管、代谢和骨科疾病患者的康复效果。设计单中心比较队列前后研究。门诊康复中心。连续抽取597例门诊康复患者（N=597）（新冠肺炎后227例；骨科疾病147例；心血管疾病84例；代谢疾病83例；慢性阻塞性肺疾病[COPD] 35例；哮喘24例），年龄50.3±12.7岁，女性54.6%。干预措施：个体化、多学科门诊康复（6-10周，总计3000分钟，最少3次/周，2-3小时/次），包括力量/耐力训练、物理治疗、心理支持和营养咨询。主要观察指标采用6分钟步行测试（6MWT）评估患者身体功能，采用5级EuroQol 5维问卷测量患者入院和出院时的生活质量（QOL）。使用方差分析分析组内和组间差异，并对基线值对结果表现的影响进行建模。结果新型冠状病毒感染后患者年龄较轻（44.7±12.6岁），女性比例（75.4%）高于其他门诊康复组。两组在康复期间均有显著改善。新冠肺炎后患者的基线和出院生活质量评分最低。基线调整得分表明，尽管总体上有所改善，但covid后组的生活质量明显低于除COPD组外的其他门诊康复组。相比之下，新冠肺炎后组在6MWT时获得了最高的身体功能增益（+60.4m, P< 0.001）。基线调整得分显示，新冠肺炎后患者的身体功能最高（6MWT, PC = 632.4 m vs ALL = 603.4 m），优于所有其他门诊康复组。基线和变化得分呈负相关，突出了基线调整的必要性。结论尽管门诊康复与covid - 19后患者身体功能改善相关，但生活质量仍然存在缺陷，与其他常见门诊康复指征不一致。需要有针对性的康复战略，解决心理健康和疲劳问题，以优化covid - 19后的恢复。
{"title":"Post-COVID Rehabilitation Outcomes: A Comparative Cohort Study","authors":"Ferdinand Prüfer MSc , Alexander Kautzky PhD , Alexandra Unger PhD , Špela Matko MSc , Michael J. Fischer PhD , Ralf Harun Zwick MD , Vincent Grote PhD","doi":"10.1016/j.arrct.2025.100516","DOIUrl":"10.1016/j.arrct.2025.100516","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate and compare rehabilitation outcomes in patients with post-COVID syndrome (post-COVID) vs those with pulmonary, cardiovascular, metabolic, and orthopedic conditions.</div></div><div><h3>Design</h3><div>Monocentric comparative cohort pre-post study.</div></div><div><h3>Setting</h3><div>Outpatient rehabilitation center.</div></div><div><h3>Participants</h3><div>Consecutive sample of 597 outpatient rehabilitation patients (N=597) (post-COVID, 227; orthopedic disorder, 147; cardiovascular disorder, 84; metabolic disorder, 83; chronic obstructive pulmonary disease [COPD], 35; asthma, 24) aged 50.3±12.7 years, 54.6% women.</div></div><div><h3>Interventions</h3><div>Individualized, multidisciplinary outpatient rehabilitation (6-10wk, total 3.000min, minimum 3sessions/wk, and 2-3h/session) including strength/endurance training, physiotherapy, psychological support, and nutritional counseling.</div></div><div><h3>Main Outcome Measures</h3><div>Physical function was assessed with the 6-minute walking test (6MWT), and quality of life (QOL) with the 5-level EuroQol 5-dimensional questionnaire were measured at admission and discharge of outpatient rehabilitation. Differences within and between groups were analyzed using the analysis of variance, and the effect of baseline values on the outcome’s performance was modeled.</div></div><div><h3>Results</h3><div>The Post-COVID group was younger (44.7±12.6y), and the percentage of women (75.4%) was higher than in other outpatient rehabilitation groups. All groups improved significantly during rehabilitation. Patients with post-COVID showed the lowest baseline and discharge QOL scores. Baseline-adjusted scores demonstrated that, despite overall improvements, the post-COVID group reported significantly lower QOL than other outpatient rehabilitation groups, except the COPD group. In contrast, the post-COVID group achieved the highest physical function gains in 6MWT (+60.4m, <em>P</em><.001). Baseline-adjusted scores indicated the highest physical function in patients with post-COVID (6MWT, PC = 632.4 m vs ALL = 603.4 m), outperforming all other outpatient rehabilitation groups. Baseline and change scores were negatively correlated, highlighting the need for baseline adjustment.</div></div><div><h3>Conclusions</h3><div>Although outpatient rehabilitation was associated with improvements in physical function in patients with post-COVID, QOL deficits persist, discordant with other common outpatient rehabilitation indications. Targeted rehabilitation strategies addressing mental health and fatigue are needed to optimize post-COVID recovery.</div></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"7 4","pages":"Article 100516"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145739179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-07-13DOI: 10.1016/j.arrct.2025.100494
Mazen A. Basheikh MD, Adnan A. Badahdah MD
Objectives
Stroke survivors face a significant burden of disability, necessitating regular activity to improve their functional abilities, well-being, and quality of life. We conducted this systematic review and meta-analysis to assess the feasibility and effectiveness of professionally supervised, home-based rehabilitation in stroke survivors.
Data Sources
A comprehensive search of PubMed, Scopus, and Web of Science was carried out from inception until December 2023.
Study Selection
We included randomized controlled trials assessing the effectiveness of home-based rehabilitation under professional supervision (intervention) for stroke patients compared with hospital-based, unsupervised home exercise, or no therapy (control).
Data Extraction
We extracted and analyzed the mean difference (MD) between groups in improvements using various rehabilitation assessment scales: Fugl-Meyer Assessment (FMA), Barthel Index (BI), Modified Barthel Index, Berg Balance Scale, 6-minute walk test, and Modified Ashworth Scale.
Data Synthesis
Seventeen articles were eligible for meta-analysis. The intervention group showed significantly higher BI scores in both early (MD, 2.71; 95% CI, 0.14-5.28; P=.04) and late stages (MD, 4.53; 95% CI, 1.67-7.4; P=.002) compared with controls. The Modified Barthel Index was also significantly higher in the home-based group (MD, 5.12; 95% CI, 1.63-8.62; P=.004). For FMA, significant differences were observed only after 3 months (MD, 3.99; 95% CI, 2.87-5.11; P<.0001) favoring the intervention group. Similarly, the 6-minute walk test results favored the intervention group (MD, 27.5; 95% CI, 14.72-40.29; P<.0001). No significant differences were observed in the Berg Balance Scale and Modified Ashworth Scale between groups. Subgroup analysis confirmed the superior effectiveness of home-based rehabilitation compared with both center-based rehabilitation and unsupervised home exercise in improving BI and FMA scores.
Conclusions
This systematic review and meta-analysis of randomized controlled trials suggests that home-based rehabilitation under professional supervision among stroke survivors facilitates more rapid and substantial improvements relative to hospital-based rehabilitation and unsupervised home exercise.
{"title":"Efficacy of Home-Based Physical Exercise in Stroke Survivors: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","authors":"Mazen A. Basheikh MD, Adnan A. Badahdah MD","doi":"10.1016/j.arrct.2025.100494","DOIUrl":"10.1016/j.arrct.2025.100494","url":null,"abstract":"<div><h3>Objectives</h3><div>Stroke survivors face a significant burden of disability, necessitating regular activity to improve their functional abilities, well-being, and quality of life. We conducted this systematic review and meta-analysis to assess the feasibility and effectiveness of professionally supervised, home-based rehabilitation in stroke survivors.</div></div><div><h3>Data Sources</h3><div>A comprehensive search of PubMed, Scopus, and Web of Science was carried out from inception until December 2023.</div></div><div><h3>Study Selection</h3><div>We included randomized controlled trials assessing the effectiveness of home-based rehabilitation under professional supervision (intervention) for stroke patients compared with hospital-based, unsupervised home exercise, or no therapy (control).</div></div><div><h3>Data Extraction</h3><div>We extracted and analyzed the mean difference (MD) between groups in improvements using various rehabilitation assessment scales: Fugl-Meyer Assessment (FMA), Barthel Index (BI), Modified Barthel Index, Berg Balance Scale, 6-minute walk test, and Modified Ashworth Scale.</div></div><div><h3>Data Synthesis</h3><div>Seventeen articles were eligible for meta-analysis. The intervention group showed significantly higher BI scores in both early (MD, 2.71; 95% CI, 0.14-5.28; <em>P</em>=.04) and late stages (MD, 4.53; 95% CI, 1.67-7.4; <em>P</em>=.002) compared with controls. The Modified Barthel Index was also significantly higher in the home-based group (MD, 5.12; 95% CI, 1.63-8.62; <em>P</em>=.004). For FMA, significant differences were observed only after 3 months (MD, 3.99; 95% CI, 2.87-5.11; <em>P</em><.0001) favoring the intervention group. Similarly, the 6-minute walk test results favored the intervention group (MD, 27.5; 95% CI, 14.72-40.29; <em>P</em><.0001). No significant differences were observed in the Berg Balance Scale and Modified Ashworth Scale between groups. Subgroup analysis confirmed the superior effectiveness of home-based rehabilitation compared with both center-based rehabilitation and unsupervised home exercise in improving BI and FMA scores.</div></div><div><h3>Conclusions</h3><div>This systematic review and meta-analysis of randomized controlled trials suggests that home-based rehabilitation under professional supervision among stroke survivors facilitates more rapid and substantial improvements relative to hospital-based rehabilitation and unsupervised home exercise.</div></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"7 4","pages":"Article 100494"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145739019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-10-28DOI: 10.1016/j.arrct.2025.100542
Angela Benfield PhD, OTR , Mark V. Johnston PhD , Cheryl Miller DrOT, OTR/L , Alexandra E. Harper PhD, OTR/L, CPHQ , Minmei Shih PhD, OTR/L , Elizabeth R. Skidmore PhD, OTR/L
Objective
To explore relationships between therapists’ recurrent, self-regulated evidence-related activities and antecedent factors that may influence these habits.
Design
Secondary analysis of survey data using multivariate regression/correlations analyses.
Setting
Representative sample of 30 inpatient rehabilitation clinics across the United States.
Participants
163 rehabilitation therapists (N=163), specifically physical and occupational therapists and speech-language pathologists.
Interventions
Not applicable.
Main Outcome Measures
Evidence-informed professional thinking, which is comprised of measures of recurrent, self-regulated evidence-informed practice (EIP) and reflective critical clinical reasoning (CCR) activities by therapists.
Results
Scores indicate infrequent engagement in EIP activities (mean=4.22, SD=0.93), with somewhat greater engagement in CCR (mean=5.00, SD=0.920). Therapists generally had positive attitudes toward evidence-based practice (EBP) on the Evidence-Based Practice Attitude Scale-36. The EIP and CCR were highly related (r=.651, P=.001). Even after linear controls for other possible predictors, beliefs that EBPs lead to greater Job Security predicted greater engagement in both EIP and CCR (P<.001). Openness was also independently related to engagement in EIP (P<.001) and to CCR (P<.011), apparently mediated by Feedback, Professional Education, and awareness of Limitations (of EBP). Specialty certification was clearly related to EIP (P<.016), but many common educational and experience background variables had weak or nonsignificant relationships with therapists’ EIP or CCR habits.
Conclusions
Self-regulated engagement in EIP and CCR are predicted by identifiable but somewhat complex antecedents. CCR was more strongly related to EIP than any other variable. Results suggest that implementation strategies that engage therapists’ reflective critical clinical reasoning will be more successful at increasing therapists’ engagement in self-regulated EBP habits than in strategies that do not.
{"title":"Engagement in Evidence-Based Practice Activities and Thinking by Rehabilitation Therapists: Predictive Factors","authors":"Angela Benfield PhD, OTR , Mark V. Johnston PhD , Cheryl Miller DrOT, OTR/L , Alexandra E. Harper PhD, OTR/L, CPHQ , Minmei Shih PhD, OTR/L , Elizabeth R. Skidmore PhD, OTR/L","doi":"10.1016/j.arrct.2025.100542","DOIUrl":"10.1016/j.arrct.2025.100542","url":null,"abstract":"<div><h3>Objective</h3><div>To explore relationships between therapists’ recurrent, self-regulated evidence-related activities and antecedent factors that may influence these habits.</div></div><div><h3>Design</h3><div>Secondary analysis of survey data using multivariate regression/correlations analyses.</div></div><div><h3>Setting</h3><div>Representative sample of 30 inpatient rehabilitation clinics across the United States.</div></div><div><h3>Participants</h3><div>163 rehabilitation therapists (N=163), specifically physical and occupational therapists and speech-language pathologists.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Evidence-informed professional thinking, which is comprised of measures of recurrent, self-regulated evidence-informed practice (EIP) and reflective critical clinical reasoning (CCR) activities by therapists.</div></div><div><h3>Results</h3><div>Scores indicate infrequent engagement in EIP activities (mean=4.22, SD=0.93), with somewhat greater engagement in CCR (mean=5.00, SD=0.920). Therapists generally had positive attitudes toward evidence-based practice (EBP) on the Evidence-Based Practice Attitude Scale-36. The EIP and CCR were highly related (<em>r</em>=.651, <em>P</em>=.001). Even after linear controls for other possible predictors, beliefs that EBPs lead to greater Job Security predicted greater engagement in both EIP and CCR (<em>P</em><.001). Openness was also independently related to engagement in EIP (<em>P</em><.001) and to CCR (<em>P</em><.011), apparently mediated by Feedback, Professional Education, and awareness of Limitations (of EBP). Specialty certification was clearly related to EIP (<em>P</em><.016), but many common educational and experience background variables had weak or nonsignificant relationships with therapists’ EIP or CCR habits.</div></div><div><h3>Conclusions</h3><div>Self-regulated engagement in EIP and CCR are predicted by identifiable but somewhat complex antecedents. CCR was more strongly related to EIP than any other variable. Results suggest that implementation strategies that engage therapists’ reflective critical clinical reasoning will be more successful at increasing therapists’ engagement in self-regulated EBP habits than in strategies that do not.</div></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"7 4","pages":"Article 100542"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145739124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To systematically evaluate the effects of noninvasive technology modalities, defined as externally applied stimulation or feedback devices, on lower-limb motor outcomes in individuals with spinal cord injury (SCI), addressing gaps in generalizability and classification to support evidence-based rehabilitation strategies.
Data Sources
We systematically searched PubMed, Web of Science, EMBASE, and the Cochrane Library for English-language articles from database inception to 2023 (initial search conducted in April 2024 and updated in January 2025).
Study Selection
We included randomized controlled trials involving adults with SCI that investigated noninvasive technology modalities applied to any body region and reported outcomes related to motor score, muscle performance, or walking ability. Of 2325 records screened, 22 full-text articles were independently evaluated by 2 reviewers, and 11 met the inclusion criteria and were included in the review.
Data Extraction
Two reviewers independently extracted data from eligible studies, with disagreements resolved through consensus with a third reviewer. The risk of bias (RoB) was assessed using the Cochrane RoB 2 tool by 2 reviewers.
Data Synthesis
Across the included studies (224 participants; mean age=44.9 y), interventions typically consisted of 30-minute sessions, 4 times weekly, over 6 weeks. Four studies applied transcranial stimulation, 4 used transspinal stimulation, and 3 targeted muscle stimulation. Outcomes were evaluated in 4 studies for motor score, 7 for muscle performance, and 7 for walking ability. Most interventions, combined with standard rehabilitation, showed improvements across these outcomes, although only a subset demonstrated statistically significant between-group effects. RoB was low in 6 studies, had some concerns in 3, and was high in 2.
Conclusions
Noninvasive modalities appear effective in enhancing lower-limb motor function in individuals with SCI. However, variability in intervention protocols and methodological quality limits the ability to draw definitive conclusions. Further studies should standardize protocols and minimize bias to strengthen the evidence for SCI rehabilitation strategies.
目的系统评估无创技术模式（定义为外部应用刺激或反馈装置）对脊髓损伤（SCI）患者下肢运动结果的影响，解决泛化和分类方面的差距，以支持循证康复策略。我们系统地检索了PubMed、Web of Science、EMBASE和Cochrane Library从数据库建立到2023年的英文文章（首次检索于2024年4月进行，更新于2025年1月）。研究选择我们纳入了随机对照试验，研究了非侵入性技术在任何身体区域的应用，并报告了与运动评分、肌肉表现或行走能力相关的结果。在筛选的2325篇文献中，22篇全文文章由2位审稿人独立评价，其中11篇符合纳入标准，被纳入本综述。数据提取两名审稿人独立地从符合条件的研究中提取数据，分歧通过与第三名审稿人达成一致来解决。偏倚风险（RoB）由2位评论者使用Cochrane RoB 2工具进行评估。在纳入的研究中（224名参与者，平均年龄=44.9岁），干预措施通常包括30分钟的疗程，每周4次，持续6周。4项研究采用经颅刺激，4项研究采用经脊髓刺激，3项研究采用靶向肌肉刺激。结果评估了4项研究的运动评分，7项研究的肌肉表现，7项研究的行走能力。大多数干预与标准康复相结合，显示出这些结果的改善，尽管只有一小部分组间效果具有统计学意义。在6项研究中，RoB较低，在3项研究中有所关注，在2项研究中较高。结论无创治疗可有效提高脊髓损伤患者的下肢运动功能。然而，干预方案和方法质量的可变性限制了得出明确结论的能力。进一步的研究应该规范方案，减少偏见，以加强脊髓损伤康复策略的证据。
{"title":"Therapeutic Effects of Noninvasive Technology Modalities on Lower-Limb Motor Function in Spinal Cord Injury: A Systematic Review","authors":"Siti Ainun Marufa MSc , Hung-Yen Chin MD , Bor-Shing Lin PhD , Hung-Chou Chen PhD , Tsung-Hsun Hsieh PhD , Wei-Lun Lo PhD , Chun-Wei Wu PhD , Yu-Ting Li PhD , Zidni Immanurohmah Lubis MSc , Nurul Aini Rahmawati MSc , Kurnia Putri Utami MSc , Chih-Wei Peng PhD","doi":"10.1016/j.arrct.2025.100536","DOIUrl":"10.1016/j.arrct.2025.100536","url":null,"abstract":"<div><h3>Objectives</h3><div>To systematically evaluate the effects of noninvasive technology modalities, defined as externally applied stimulation or feedback devices, on lower-limb motor outcomes in individuals with spinal cord injury (SCI), addressing gaps in generalizability and classification to support evidence-based rehabilitation strategies.</div></div><div><h3>Data Sources</h3><div>We systematically searched PubMed, Web of Science, EMBASE, and the Cochrane Library for English-language articles from database inception to 2023 (initial search conducted in April 2024 and updated in January 2025).</div></div><div><h3>Study Selection</h3><div>We included randomized controlled trials involving adults with SCI that investigated noninvasive technology modalities applied to any body region and reported outcomes related to motor score, muscle performance, or walking ability. Of 2325 records screened, 22 full-text articles were independently evaluated by 2 reviewers, and 11 met the inclusion criteria and were included in the review.</div></div><div><h3>Data Extraction</h3><div>Two reviewers independently extracted data from eligible studies, with disagreements resolved through consensus with a third reviewer. The risk of bias (RoB) was assessed using the Cochrane RoB 2 tool by 2 reviewers.</div></div><div><h3>Data Synthesis</h3><div>Across the included studies (224 participants; mean age=44.9 y), interventions typically consisted of 30-minute sessions, 4 times weekly, over 6 weeks. Four studies applied transcranial stimulation, 4 used transspinal stimulation, and 3 targeted muscle stimulation. Outcomes were evaluated in 4 studies for motor score, 7 for muscle performance, and 7 for walking ability. Most interventions, combined with standard rehabilitation, showed improvements across these outcomes, although only a subset demonstrated statistically significant between-group effects. RoB was low in 6 studies, had some concerns in 3, and was high in 2.</div></div><div><h3>Conclusions</h3><div>Noninvasive modalities appear effective in enhancing lower-limb motor function in individuals with SCI. However, variability in intervention protocols and methodological quality limits the ability to draw definitive conclusions. Further studies should standardize protocols and minimize bias to strengthen the evidence for SCI rehabilitation strategies.</div></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"7 4","pages":"Article 100536"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145739129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To investigate the relationship between the timing of functional recovery milestones and hospitalization-associated disability (HAD) in geriatric patients ≥70 years old.
Design
Retrospective cohort study.
Setting
A general acute care hospital.
Participants
A total of 195 patients (N=195) aged ≥70 years (mean age 81.7±7.4y; 48.2% women) who were hospitalized for acute medical conditions. Patients with baseline disability or missing key data were excluded.
Interventions
Not applicable.
Main Outcome Measures
The HAD was defined as a ≥5-point decline in the Barthel Index compared to baseline functioning 2 weeks before admission. The relationship between HAD and the number of days to initiation of sitting, wheelchair transfer, and ambulation was examined.
Results
The HAD occurred in 34.4% of patients. Those who developed HAD experienced significant delays in the initiation of sitting, wheelchair transfers, and ambulation. Multivariable logistic regression analysis showed that delayed initiation of wheelchair transfer and ambulation were independently associated with HAD, after adjusting for age, Barthel Index at admission, dementia, emergency admission, and total physical therapy time. Notably, the timing of ambulation initiation demonstrated moderate predictive ability for HAD (area under the curve=0.741; 95% CI, 0.656-0.825), with receiver operating characteristic analysis indicating a cut-off value of 1.5 days.
Conclusions
Delayed initiation of wheelchair transfer and ambulation was associated with increased risk of HAD in older hospitalized patients. Early initiation of ambulation may serve as a key target for HAD prevention strategies.
{"title":"Relationship between Hospitalization-Associated Disability and Functional Recovery","authors":"Haruka Adachi MSc , Wataru Kozuki PhD , Aki Gen PhD , Ryo Tsujinaka MSc , Tetsuya Ueda PhD , Yumi Higuchi PhD","doi":"10.1016/j.arrct.2025.100529","DOIUrl":"10.1016/j.arrct.2025.100529","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the relationship between the timing of functional recovery milestones and hospitalization-associated disability (HAD) in geriatric patients ≥70 years old.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>A general acute care hospital.</div></div><div><h3>Participants</h3><div>A total of 195 patients (N=195) aged ≥70 years (mean age 81.7±7.4y; 48.2% women) who were hospitalized for acute medical conditions. Patients with baseline disability or missing key data were excluded.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>The HAD was defined as a ≥5-point decline in the Barthel Index compared to baseline functioning 2 weeks before admission. The relationship between HAD and the number of days to initiation of sitting, wheelchair transfer, and ambulation was examined.</div></div><div><h3>Results</h3><div>The HAD occurred in 34.4% of patients. Those who developed HAD experienced significant delays in the initiation of sitting, wheelchair transfers, and ambulation. Multivariable logistic regression analysis showed that delayed initiation of wheelchair transfer and ambulation were independently associated with HAD, after adjusting for age, Barthel Index at admission, dementia, emergency admission, and total physical therapy time. Notably, the timing of ambulation initiation demonstrated moderate predictive ability for HAD (area under the curve=0.741; 95% CI, 0.656-0.825), with receiver operating characteristic analysis indicating a cut-off value of 1.5 days.</div></div><div><h3>Conclusions</h3><div>Delayed initiation of wheelchair transfer and ambulation was associated with increased risk of HAD in older hospitalized patients. Early initiation of ambulation may serve as a key target for HAD prevention strategies.</div></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"7 4","pages":"Article 100529"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145739128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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