Frontiers in rehabilitation sciences最新文献

Functional impairment refers to limitations in performing basic activities necessary for independent living, mobility, communication or social participation. Meeting the needs of people with functional impairments is an essential part of strengthening India's health system. Present article is an attempt to cover the individuals with functional impairments under proposed Health Policy on AT, which otherwise have inadequate attention in existing public health policies, acts, and laws. Assistive technologies (AT), such as wheelchairs, white canes, hearing aids, spectacles, prosthetic limbs, communication boards, memory aids, adapted writing tools, and self-care devices, play a vital role in improving functionality, enhancing quality of life, and enabling participation in education, employment, and community activities. Based on wide range of articles reviewed from the countries with best provisioning models on AT, present health policy article proposes recommendations for a comprehensive inclusive National AT Policy for India. The policy considerations emphasize legal entitlements, sustainable financing, equitable access, integration into health systems, digital inclusion, localized manufacturing, and cross-sector collaboration. Implementing assistive technology policy is not only essential to improve public health outcomes, but also for achieving the Sustainable Development Goals by 2030 and realizing India's vision of "Viksit Bharat" by 2047.

Introduction: The Post-COVID-19 Functional Status (PCFS) scale was quickly adopted into COVID-19 research and clinical practice worldwide to monitor functional status and recovery. The scale has been translated into Danish, and three different administration methods have been employed. However, clinicians have expressed concerns about the scale's ability to capture work-related functional limitations. Therefore, the purpose of this study was to evaluate the construct validity of three different administration methods of the Danish version of the PCFS scale.

Methods: This cross-sectional study included patients with long COVID who completed three versions of the PCFS scale: a questionnaire-based version, a flowchart-based version, and an interview-based version. The construct validity was evaluated following the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines by testing predefined hypotheses that compared the PCFS scale with sick leave and EuroQoL Five-dimensions Five level (EQ-5D-5l).

Results: A total of 437 patients, with a mean age 48 years, 75% female, and 59% on sick leave, were included in this study. Statistically significant differences between the three administration methods were found. Of the 234 patients on sick leave, only 50%-54% had a PCFS grade ≥3 which was below our predefined hypothesis. Furthermore, correlations between the PCFS scale and EQ-5D-5l was lower than hypothesized.

Conclusion: None of the three administration methods effectively captured work-related functional limitations associated with being on part-time or full-time sick leave. Additionally, correlations with quality of life were lower than expected. Overall, the construct validity of the PCFS scale was only partially supported.

Background: This paper presents the participative research undertaken to adapt and pilot the Early Positive Approaches to Support (E-PAtS) program, originally developed and evaluated in English for use in the United-Kingdom, for implementation within Québec's public health and social services. E-PAtS supports family carers of young children with developmental disabilities by promoting their well-being and adjustment early in their services trajectory.

Method: The program was translated into French and iteratively adapted based on feedback from six pilot cohorts conducted across four diverse clinical settings: a rural service center, an urban center, a specialized pediatric hospital, and a diagnostic clinic. These sites were selected to ensure demographic and geographic representativity of Québec's population, and participating families also reflected a range of backgrounds. The adaptation process was grounded in community-based participatory research principles, actively involving parents, practitioners, managers, and researchers. Changes to the program's content and delivery were made according to partner recommendations. Evaluation focused on social validity, effectiveness, feasibility, and fidelity of implementation.

Results: Participating parents completed questionnaires and interviews, reporting improved well-being and greater confidence in self-care, indicating the program's relevance and positive impact. Fidelity of implementation was assessed using the E-PAtS fidelity checklist, and feasibility was evaluated through session attendance logs. Both indicators were considered strong, despite the challenges posed by the COVID-19 pandemic.

Conclusion: Findings support the adapted E-PAtS program's suitability for Québec's public services, with further refinements recommended for broader dissemination. This study highlights the value of participatory approaches in adapting evidence-based interventions across cultural and service delivery contexts.

Introduction: Integrated Practice Units are whole-person models of care designed to deliver a comprehensive range of treatment strategies centered around a patient's preferences, values, and needs. The purpose of this study was to assess the efficacy of a virtual IPU (V-IPU) for employees of two large health systems experiencing back, neck or joint pain. Specifically, we evaluated improvements in pain interference, physical health, and user satisfaction/experience.

Methods: This was a prospective cohort study with a total of 167 employees from two health systems who were recruited through e-mail outreach and completed a brief health assessment, including patient reported outcome measures (PROMs) for physical, emotional, and pain health. Upon sign-up, employees began a 12-week multidisciplinary program consisting of musculoskeletal (MSK) physician telehealth treatment and oversight, supervised one-to-one physical therapy, registered dietitian counseling, health coaching, and platform to in-person specialty services when clinically appropriate. National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS) scores for physical health, mental health, and pain interference were assessed at intake, 6-weeks, and 12-weeks after program initiation. Net promoter score (NPS) was measured to evaluate participant experience and satisfaction with the program.

Results: The average age was 50.56 years, and a large majority of responders were female (89.2%). There were clinically meaningful improvements for PROMIS measures of physical health, mental health and pain interference (5.6, 4.4 and 6.9 points, respectively). The Net Promoter Score was 85 for engaged individuals. Additionally, the V-IPU was successful in connecting employees to additional surgical-avoiding services offered by the employer and which complemented the digital participation of the V-IPU.

Conclusion: The V-IPU improves health outcomes and care coordination for health system employees. These findings support the use of virtual multidisciplinary models to enhance access and outcomes in employer-based health initiatives.

Background: Whiplash syndrome is one of the most frequent consequences of traumatic pathology caused traffic accidents. The acceleration-deceleration mechanism of energy transmitted to the neck causes abnormal maneuvers in the area and muscle pain. The most common form of muscle pain in the neck and head is myofascial pain syndrome, caused by myofascial trigger points, these being clinically defined as painful, sensitive and hyperirritable nodules that are located on tense muscle bands. These painful nodules are treated with different physiotherapy techniques, there being no international consensus regarding their diagnosis and recommended interventions.

Objective: The primary objective of this study is to evaluate the effectiveness of percutaneous intratissue electrolysis (EPI) on intrafibrillar blood flow and muscle fiber elasticity compared to deep dry needling (DN) and standard physiotherapy. Secondary objectives include the assessment of perceived pain, disability, and clinical outcomes at follow-up.

Methods: This single-blind randomized clinical trial will be conducted in patients residing in Melilla with whiplash syndrome due to traffic accidents. Participants will receive interventions targeting the sternocleidomastoid and/or levator scapulae muscles. Assessments will be conducted at baseline, after four weeks of intervention, and at three months post-intervention to evaluate medium-term effects. Our hypothesis is that EPI will produce greater improvements in the study variables compared to DN and standard physiotherapy.

Discussion: Percutaneous electrolysis has shown positive clinical effects in various musculoskeletal pathologies; however, its impact on intrafibrillar blood flow and muscle fiber elasticity remains unexplored. This study aims to provide reference clinical data on these physiological outcomes and compare the effects of invasive vs. standard physiotherapy interventions, supporting the development of evidence-based protocols for whiplash-associated disorders.

Clinical trial registration: NCT06938425.

Background: Post-acute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID, are characterized by persistent symptoms such as fatigue, dyspnea, and reduced functional capacity. Pulmonary rehabilitation (PR) is recommended for chronic respiratory conditions, but its effectiveness in PASC, particularly across different delivery modes, remains uncertain.

Objective: To assess the impact of PR, including telerehabilitation and in-person modalities, on physical function, dyspnea, pulmonary function, fatigue, and quality of life in patients with PASC.

Methods: We conducted a systematic search of PubMed, Embase, the Cochrane Library, and Web of Science from inception to March 25 for controlled clinical trials assessing the effects of PR in PASC patients. Two independent reviewers performed study selection and data extraction. The risk of bias was assessed using the Cochrane Risk of Bias Tool, and data were analyzed using Review Manager (RevMan) 5.4.1. Effect sizes were reported as mean differences (MD) or standardized mean differences (SMD) with 95% confidence intervals (CI).

Results: Ten randomized controlled trials involving 673 participants were included. Most studies were judged to have a moderate risk of bias. Compared with usual care, PR significantly improved six-minute walk distance (MD: 76.85 meters; 95% CI: 57.35-96.36; p < 0.001), maximal inspiratory pressure (MD: 17.63 cmH₂O; 95% CI: 4.50-30.76; p = 0.009), fatigue (SMD: -1.15; 95% CI: -1.83 to -0.48; p < 0.001), and quality of life (SMD: 1.73; 95% CI: 0.56-2.91; p = 0.004). No statistically significant improvement was found for dyspnea (MD: -0.41; 95% CI: -1.51 to -0.68; p = 0.46). Subgroup analyses showed no significant differences between telerehabilitation and in-person PR across all outcomes, including exercise capacity (p = 0.84), dyspnea (p = 0.86), fatigue (p = 0.93), and quality of life (p = 0.44).

Conclusions: PR improves physical and functional outcomes in patients with PASC. Telerehabilitation offers a clinically equivalent alternative to in-person PR, supporting its broader implementation.

Access to justice is a determinant of the realisation of all other rights, including the right to health, employment, and education. As persons with disabilities experience increased discrimination and social exclusion and are at higher risk of violence than people without disabilities, it is crucial to ensure access to justice in both the civil and criminal legal spheres for people with disabilities. However, persons with disabilities experience multiple barriers at the macro/structural and individual levels to accessing justice. In light of the significance of access to justice for people with disabilities, and the multiple barriers to accessing justice experienced by those with disabilities, this perspective examines the importance of assistive technology in fulfilling the right to access justice. To fulfill the right of access to the justice system, assistive technologies must be more effectively harnessed to provide equitable access to justice for persons with disabilities.

Traumatic brain injury (TBI) remains a leading cause of long-term morbidity and disability worldwide. Individuals with moderate to severe TBI often experience persistent neurocognitive deficits, including short-term memory loss, executive dysfunction, and slowed cognitive processing for which there are currently no FDA-approved treatments. This case series investigates the synergistic use of guanfacine, N-acetylcysteine (NAC), and donepezil (GND) administered alongside ongoing cognitive rehabilitation, with treatment effects evaluated through pre- and post-intervention Montreal Cognitive Assessment (MoCA) scores. The guanfacine/NAC combination has previously been reported to improve working memory and executive function in individuals with mild TBI, suggesting its potential applicability to more severe TBI cases. Guanfacine, an alpha-2A agonist approved for ADHD, enhances prefrontal cortical function; Donepezil, a cholinesterase inhibitor, is widely used to treat cognitive symptoms in mild cognitive impairment and early dementia; and NAC, a potent antioxidant and glutamate modulator, has demonstrated neuroprotective effects across a range of clinical contexts, including TBI. Each of these agents has a well-established safety profile. The encouraging outcomes observed in this case series underscore the potential of the GND regimen as a multimodal pharmacologic approach to target the complex neurochemical disruptions following TBI. These preliminary findings warrant further investigation in larger, placebo-controlled trials in order to more rigorously assess the safety, efficacy, and translational potential of this intervention for mitigating chronic cognitive sequelae in individuals with moderate to severe TBI.

Introduction: Body weight support (BWS) treadmill training, commonly utilized to improve gait, has inconsistent evidence of effectiveness across disorders.

Methods: We aimed to comprehensively evaluate its scientific rationale by comparing immediate effects of two weight support levels (20%, 40%) to unsupported (0%) treadmill walking on neural and biomechanical measures in children with unilateral cerebral palsy (CP) and typical development (TD). We hypothesized BWS would demonstrate positive effects only in CP. Participants included 10 with TD and 8 with CP (mean age = 14.6 and 15.4 years, respectively).

Results: Minimal or no group differences or BWS effects were found for synergy number, structure or Walk-DMC, whereas the Gait Deviation Index (GDI) showed a significant interaction with 20% BWS where the dominant side in CP improved with 20% BWS while both sides in TD worsened. Beta band EEG activation from 0% to 20% BWS showed a significant triple interaction increasing in the non-dominant and decreasing in the dominant hemisphere in TD, while increasing in both in CP. A worsening trend was seen with 40% BWS in all measures except z scores.

Conclusion: BWS has beneficial effects on kinematics in CP supporting the basic premise for use in neurorehabilitation at the body structure level.

Background: Total knee arthroplasty (TKA) is a common and effective treatment for advanced knee osteoarthritis, yet it imposes significant demands on primary caregivers throughout the perioperative and rehabilitation phases. Understanding caregivers' evolving needs is critical for optimizing patient outcomes and sustaining caregiver well-being. This study aimed to explore the dynamic care experiences and changing needs of primary caregivers of TKA patients across three distinct phases: the diagnosis period, discharge transition, and rehabilitation phase, and to construct a comprehensive journey map of caregiving needs.

Methods: A longitudinal qualitative study was conducted using purposive sampling. Sixteen primary caregivers of patients undergoing unilateral TKA were recruited from a tertiary hospital in Henan, China. Semi-structured interviews were conducted at three time points: preoperative (T1), pre-discharge (T2), and one month post-discharge (T3), resulting in 43 interviews. Data were analyzed using content analysis and synchronized temporal mapping to identify themes and subthemes along the caregiving timeline.

Results: Four major themes and 27 subthemes were identified: care tasks, emotional experiences, caregiving barriers, and support systems. Caregivers' responsibilities evolved from pre-surgical information gathering to intensive post-surgical care and long-term rehabilitation support. Emotional burdens shifted from anxiety and helplessness to fatigue and psychological strain. Major barriers included knowledge deficits, skill limitations, and inadequate systemic support. The caregiver support network transitioned from hospital-based to community and family-based systems over time. A visual journey map was developed to represent these findings.

Conclusion: Primary caregivers of TKA patients face complex and changing needs across different stages of care. A caregiver-centered, multidisciplinary, and phase-specific support framework is essential to improve the quality of postoperative care and reduce caregiver burden.