Frontiers in rehabilitation sciences最新文献

Introduction: This study investigated the effects of a mobile app-based biofeedback breathing exercise program on handgrip strength, respiratory muscle activity, and pulmonary function in healthy young adults.

Methods: Forty-eight participants were randomly assigned to an experimental group (n = 22), which performed app-based biofeedback breathing exercises, or a control group (n = 26), which performed traditional breathing exercises. Both groups completed three to four sessions per week for four weeks. Handgrip strength, respiratory muscle activity measured using surface electromyography, and pulmonary function assessed by spirometry were evaluated before and after the intervention.

Results: The experimental group showed a significant within-group improvement in handgrip strength (p < 0.05), although between-group differences were not significant. Significant reductions in external intercostal and rectus abdominis activity were observed in the experimental group (p < 0.05), whereas the control group demonstrated reduced external oblique activity (p < 0.05). Both groups improved in forced expiratory volume in one second (FEV₁) and in the FEV₁/forced vital capacity (FVC) ratio (p < 0.05), with a greater improvement in FEV₁/FVC observed in the experimental group.

Discussion: These findings suggest that mobile app-based biofeedback breathing exercises may enhance respiratory efficiency and optimize muscle activation patterns in healthy young adults, supporting their potential use as an accessible adjunct tool in pulmonary rehabilitation.

Objectives: To explore the overall effectiveness of the Post-Acute Care-Cerebrovascular Diseases (PAC-CVD) program in Taiwan, which was implemented in 2014.

Data sources: A systematic search of databases, namely PubMed and Google Scholar, was conducted. Eligible studies published between Jan 2014 and June 2023 were included.

Study selection: Studies included those that explored stroke care, involved post-acute care, were conducted in Taiwan, focused on an inpatient model of the PAC-CVD program, and had either a quantitative or qualitative design. In total, 23 articles were identified and included for narrative synthesis after complete examination.

Data extraction: Multiple observers independently extracted the research articles, with their objectives focused on topics such as patient outcomes, quality of care, the influence of referral systems, cost-effectiveness, or outcome prediction for the PAC-CVD program.

Data synthesis: The PAC groups showed significantly better performance in most functional outcome, quality of care, and cost-effectiveness indicators than the non-PAC groups. Patients with intra-hospital referrals or in partner hospitals had better outcomes. Younger age, ischemic stroke, and better baseline condition, especially in balance function, were strong predictive factors for stroke prognosis in the PAC program.

Conclusions: The PAC-CVD program, implemented in Taiwan through the establishment of an integrated healthcare system and a change in payment systems, not only enhanced functional recovery and quality of life of acute stroke patients but also improved the quality of health care. The program also offered a more efficient and effective care model for acute stroke patients by reducing medical expenditures. However, the PAC program has also increased the workload of clinical healthcare professionals. The successful PAC-CVD implementation indicates the possibility of a standard rehabilitative care model for acute stroke patients, with expansion to other diseases or conditions possible after adjustments to the payment structure and workload.

Background: Universal Health Coverage (UHC) cannot be achieved without equitable access to assistive technology (AT). Wheelchairs are among the most needed AT products worldwide, yet service provision is hindered by limited workforce capacity, inadequate training, and fragile supply systems, challenges that become critical in conflict and emergency settings.

Objective: This study aimed to evaluate the effectiveness of a World Health Organization (WHO)- supported wheelchair service training program in Ukraine, developed in partnership with the International Society of Wheelchair Professionals (ISWP), in improving theoretical knowledge, wheelchair skills performance and confidence, among rehabilitation professionals.

Methods: A five-day, 40 h training program based on the WHO Wheelchair Service Training Package-Basic Level (WSTPb) was delivered to 39 rehabilitation professionals in Ukraine. Training combined theoretical instruction, hands-on skill practice, and adapted educational strategies, including group-based ISWP testing, to overcome infrastructure constraints. Pre- and post-training assessments were conducted using the Wheelchair Skills Test-Questionnaire (WST-Q).

Results: All participants achieved certification in basic wheelchair service provision. Statistically significant improvements were observed in both performance (from 42.72 ± 21.89 to 68.08 ± 14.22; mean increase 25.36%) and confidence (from 40.72 ± 21.63 to 67.72 ± 12.88; mean increase 27.00%) domains of the WST-Q (p < 0.01). Importantly, rehabilitation assistants demonstrated the largest relative improvement, reducing pre-training disparities with occupational and physical therapists.

Conclusion: The findings highlight how targeted educational interventions can expand the AT workforce, promote equitable skill acquisition across professional cadres, and strengthen AT integration into UHC, even in the context of armed conflict. The Ukrainian experience illustrates both the clinical challenges, such as mastering advanced wheelchair skills, and the educational challenges including addressing diverse professional backgrounds and limited infrastructure, that are inherent in AT service provision. This model can inform future workforce capacity-building strategies for AT in both emergencies and routine health system strengthening efforts.

Introduction: The German vocational rehabilitation and participation system is highly complex due to fragmented legal responsibilities and institutional structures. To address this and improve labor market inclusion for people with severe disabilities, Single Contact Points for Employers [Einheitliche Ansprechstellen für Arbeitgeber (EAA)] were established in 2022. The EAA are legally mandated, provider-independent entities that support employers in hiring and retaining employees with disabilities. The article analyzes the network structure of the EAA within the vocational rehabilitation and participation system, how the structure is evaluated, and which partners are most relevant to the EAA.

Methods: A network analysis was conducted through egocentric network maps (N = 20) with EAA consultants, online surveys of EAA consultants (N = 18), and their key network partners (N = 123). Additionally, N = 7 guided expert interviews (5 with employers, 2 with EAA supervisors) and three focus groups of 3-6 people each (1 with EAA consultants, 1 with EAA supervisors, and 1 with network partners) were analyzed using qualitative content analysis to assess the structure and quality of cooperation.

Results: The EAA work closely with policy actors from the vocational rehabilitation and participation system who provide advice and services for participation in work, such as Integration Services, Employment Agencies, and Specialist Agencies. These collaborations are characterized by mutual information exchange and generally positive cooperation. Actors from the economy, civil society, and academic sector are underrepresented in the EAA's overall network. Employers' associations were rarely named as key partners, and civil society organizations were absent.

Discussion: The EAA's strong integration into policy networks underscores their institutional relevance. However, their limited ties to economic and civil entities suggest a constrained capacity for innovation. This pattern reflects both the strengths of their legal mandate and the challenges of acting independently within a highly structured system. Expanding their relational scope could foster more holistic solutions for inclusive employment.

Background: Lumbar paraspinal muscles (LPM), which belong to lumbar extensor muscles, play a key role in stabilising the lumbar spine and maintaining spine health. Although chronic non-specific low back pain (CNLBP) represents a major health problem worldwide, there is a knowledge gap regarding the function, morphology of LPM, and the effect of regular exercise on them in patients with CNLBP. The purpose of the study was to evaluate functional and quantitative MRI (qMRI) parameters of LPM in CNLBP patients, compare them to matched healthy volunteers (HV), and assess the effect of exercise therapy on these parameters in CNLBP patients.

Methods: The first part of the study was cross-sectional, observational, and comparative; the second was prospective and interventional. Based on physiological parameters, 43 matched pairs of CNLBP patients and HV were formed. All participants underwent MRI of the LPM using a 6-point Dixon gradient-echo sequence to assess qMRI parameters: fat fraction, total muscle volume, and functional muscle volume (FMV). Maximal isometric lumbar extensor muscle strength (MILEMS), lumbar extensor muscle endurance (LEME), MILEMS to LPM FMV ratio, pain, and disability were assessed. Each group's parameters were compared and effect size evaluated. The total of 29 patients entered an 18-week hybrid guided daily home-based exercise programme, which was completed by 27 CNLBP patients. The study was registered, trial registration number is ISRCTN11556477.

Results: CNLBP patients had significantly lower MILEMS, LEME (both P < 0.001), and MILEMS to LPM FMV ratio (P = 0.006) compared to matched HV. These parameters, as well as pain and disability, improved significantly after exercise (each P < 0.001). The qMRI parameters did not differ between CNLBP patients and HV, nor did they change after exercise therapy.

Conclusions: The significant LPM dysfunction and poorer muscle quality in CNLBP patients were reversible with exercise. Our study does not support the use of qMRI parameters as objective and reliable biomarkers of LPM dysfunction in a cohort of CNLBP with mild clinical impairment.

Healthcare systems worldwide face mounting challenges, including shortages of primary and specialty care providers, escalating direct and indirect medical costs, and limited access to high-quality diagnostic and interventional services-burdens that disproportionately affect patients in rural or medically underserved areas. Because timely, reliable, and affordable diagnostic and interventional services are essential to comprehensive, lifelong care, the expanding role of physiotherapists as autonomous, first-contact providers represents a critical and timely innovation. This article underscores the value of electrodiagnostic (EDX) testing and ultrasound imaging (USI) as instrumented point-of-care diagnostic tools available to physiotherapists through recognized pathways of training and credentialing and argues for their greater integration into contemporary practice. The authors contend that expanding training opportunities in both entry-level physiotherapy curricula and post-graduate programs will increase physiotherapist utilization of these technologies, strengthen the evidence-based rationale for physiotherapy as a primary care profession, and solidify the discipline's role as an indispensable member of the interdisciplinary healthcare team. By broadening access to EDX testing and USI, physiotherapists can deliver timely and cost-effective diagnostic and interventional services, mitigate barriers created by provider shortages, and help modernize healthcare systems to better meet the demands of strained populations worldwide.

Introduction: Individuals with hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorders (HSD) often experience chronic pain, leg fatigue and/or pain, which may contribute to a higher metabolic cost of walking. How these subjective measures may manifest in an elevated metabolic cost of transport and perceived pain at varying walking speeds remains to be evaluated.

Methods: We recruited 11 HSD/hEDS participants (33 ± 14 yrs, 170 ± 6. cm, weight 71 ± 11 kg) and 11 age- and sex-matched controls. Self-reported subjective outcome measures of health-related quality of life, fatigue severity, and foot function were evaluated prior to treadmill walking using the 36-Item Short Form Health Survey (SF-36) and the Fatigue Severity Scale (FSS). Participants also rated their self-perceived leg pain/fatigue following 3 x 6 min of treadmill walking at 80%, 100% and 120% of preferred walking speed (PWS). Cost of transport (CoT) was calculated from indirect calorimetry.

Results: CoT was significantly higher in HSD/hEDS compared to CON at all speeds (p = 0.034). CoT was significantly higher at 80% PWS compared to both 100% and 120% PWS in HSD/hEDS. HSD/hEDS reported significantly poorer health outcomes across all SF-36 domains (p < 0.05), significantly poorer foot function (p < 0.001) and significantly higher fatigue severity (p < 0.001) prior to walking. Despite similar PWS (1.1 ± 0.3 m⸱s^-1), Leg pain/fatigue immediately following walking was significantly higher in HSD/hEDS compared to CON (group main effect p < 0.001) and increased with speed in HSD/hEDS (p = 0.011). The physical function domain was significantly related post-walking leg pain/fatigue, and perceived energy prior to walking (all r > 0.69, p < 0.001).

Discussion: These results have important implications for exercise prescription in individuals with HSD/hEDS whose CoT is higher during walking, which may exacerbate already elevated symptoms of pain and fatigue.

Introduction: Rehabilitation is integral for solid organ transplant (SOT) candidates and recipients, and aims to build physical capacity for surgery, facilitate post-operative recovery, and mitigate long-term complications. Prior to the COVID-19 era, in-person programs were the primary delivery model in Canadian SOT rehabilitation programs, but there are several knowledge gaps with the current delivery models. The aims of this study were to: 1) assess the characteristics and current practices of SOT rehabilitation programs in Canada, and 2) identify key facilitators and barriers to providing rehabilitation for the SOT population.

Methods: An electronic survey was administered to 17 adult Canadian SOT rehabilitation programs utilizing REDCap in April 2024. The survey examined types of exercise training and supervision practices, clinical outcome measures, delivery models, safety considerations, facilitators, and barriers. Survey measures were summarized using descriptive statistics.

Results: The response rate was 59% (10/17). Post COVID-19, there has been a shift in program delivery, with majority (60%) of SOT rehabilitation programs now using a hybrid approach comprised of both in-person and virtual components. There is heterogeneity among programs with respect to clinical assessments, safety measures, and virtual rehabilitation platforms. The most common barriers were limitations in funding and healthcare personnel.

Conclusion: This study provides a better understanding of the current landscape and variability of SOT rehabilitation programs. Most programs have transitioned to hybrid models post-COVID-19, which may facilitate greater access. Future research can leverage findings from this survey to optimize SOT rehabilitation programs and improve clinical outcomes.

Objective: Psychosocial rehabilitation for children and adolescents with physical illnesses remains underdeveloped and poorly defined. This systematic review and meta-analysis aimed to consolidate current research findings.

Design: We searched Medline, PsycINFO, Scopus, Web of Science, and a guideline registry, with the last search conducted on August 30, 2023.

Subjects/patients: Children and adolescents with physical indications.

Methods: Eligible studies reported time-limited rehabilitation programs conducted in dedicated facilities, excluding those focused on psychiatric conditions.

Results: In all, 18 studies were eligible (N = 2,933). Meta-analysis (k = 4, i = 11, N = 418) revealed a moderate, statistically significant effect size (d = 0.48) for psychosocial rehabilitation in improving quality of life, mood, and anxiety. However, research in this field proved scattered and inconsistent, as few controlled trials were available, and there was little agreement regarding research designs, procedures, and outcome measures.

Conclusion: Psychosocial rehabilitation shows promising effects, but stronger evidence is needed to validate its efficacy. The lack of standardized definitions and procedures hinders progress. Future research should focus on randomized controlled trials and larger samples to optimize rehabilitation practices and improve outcomes for young patients with somatic conditions, resulting in evidence-based guidelines.

Systematic review registration: https://doi.org/10.17605/OSF.IO/AM2Z9.