Frontiers in rehabilitation sciences最新文献

Purpose: To investigate how perceived recovery influences perspectives on successful community reintegration, from the point of view of persons with spinal cord injury (PWS) and their support persons (SP).

Methods: Our mixed methods approach included qualitative interviews conducted with civilians and Veterans with spinal cord injury (SCI) and their designated SP at three time points across the first year after SCI: during inpatient rehabilitation, 6 months, and 12 months. Participants with SCI completed measures of independence [Spinal Cord Injury Independence Measure III (SCIM-III)] and self-efficacy (Moorong Self-Efficacy Scale) during inpatient rehabilitation and at 12 months postinjury. Data analysis was informed by the Transformative Framework and International Classification of Functioning, Disability, and Health (ICF).

Results: Regarding perceptions of how recovery influences community reintegration, PWS most often reported themes related to slow recovery whereas SPs expressed concerns about psychological impacts on PWS. While some participants were equally satisfied with rate of recovery and rate of community reintegration, several deviated from that expected trajectory. Associations between satisfaction with community reintegration and independence or self-efficacy were variable.

Conclusions: Successful community reintegration cannot be predicted solely on clinical measures. Inclusion of perspectives of PWS and their support systems is critical to inform successful societal participation after SCI.

The growing demand for healthcare services and development of healthcare present an opportunity for expanding physical therapy roles into internal medicine. This perspective discusses the potential benefits and limitations of establishing a formal internal medicine specialization for physical therapists (PTs). While PTs already contribute significantly to chronic disease prevention and treatment, their current scope of practice lacks structured training in internal medicine domains such as metabolic, autoimmune, renal, and systemic inflammatory disorders. Integrating internal medicine into PT education and clinical practice could enhance early identification of red flags, embrace interdisciplinary collaboration, and improve non-pharmacological interventions for various internal medicine-related diseases. Nevertheless, this expansion must be approached with caution, ensuring clear scope definitions, adequate training, and collaborative implementation to mitigate risks such as role ambiguity or misdiagnosis. Drawing on global experiences from advanced practice models and emerging literature, this paper calls for a discussion on the feasibility, safety, and value of internal medicine specialization in physical therapy practice. The goal of this perspective is not to replace medical professionals but to augment chronic disease management through targeted evidence-based rehabilitation strategies and preventative approaches.

Background: Adolescent Idiopathic Scoliosis (AIS) is a common spinal deformity affecting 1%-3% of adolescents aged 10-18, characterized by a lateral curvature with a Cobb angle ≥10°. Current treatments, including bracing and surgery, have limitations in patient compliance and invasiveness, highlighting the need for effective non-surgical alternatives.

Methods: This retrospective cohort study included five prepubescent patients (age 10-14 years, Tanner Stage 1-2) with moderate AIS (Cobb angle 20°-40°). The intervention combined Schroth exercises with core exercises, performed 3-4 times daily over six months. Cobb angles were measured from standing full-spine radiographs at baseline and six months, while quality of life was assessed using the Scoliosis Research Society-22 (SRS-22) questionnaire.

Results: The mean Cobb angle significantly reduced from 24.12° ± 4.80° at baseline to 12.68° ± 8.11° post-intervention (p = 0.012). Quality of life improved across all SRS-22 domains, with statistically significant gains in pain (p < 0.001), function (p = 0.011), mental health (p < 0.001), and self-image (p < 0.001). These findings suggest that the combined intervention effectively addresses spinal alignment and muscle strength, leading to improved clinical outcomes.

Conclusion: This preliminary study demonstrates that combining Schroth exercises with core exercises is a promising non-surgical intervention for prepubescent AIS patients, significantly reducing Cobb angles and improving quality of life. Future research should include larger cohorts and longer follow-up periods to validate these findings and explore the long-term benefits of this combined approach.

Introduction: Lower limb amputation is a life-altering event that affects multiple dimensions of quality of life (QoL), including physical functioning, emotional well-being, and social participation. Despite the clinical importance of QoL assessment in prosthetic rehabilitation, few studies have examined the multidimensional impact of amputation and prosthesis use in the Jordanian context. This study aimed to evaluate the QoL of lower-limb prosthetic users in Jordan and examine potential differences based on gender, and amputation level.

Methods: A cross-sectional study was conducted with 293 adults with lower limb amputations, using prostheses. Participants completed the Arabic version of the RAND 36-Item Health Survey (SF-36). Data were collected from public and private rehabilitation centers across Jordan. Eight QoL subscales were scored on a 0-100 scale. Descriptive statistics, group comparisons (gender and age group), and multiple linear regression were conducted to assess predictors of QoL.

Results: The highest domain scores were observed in Emotional Well-being (median = 77.0, IQR 55.0-90.0) and Social Functioning (median = 100.0, IQR 62.5-100.0), while the lowest were in Role Physical (median = 50.0, IQR 0.0-100.0) and General Health (median = 41.7, IQR 33.3-58.3). Group comparisons revealed significant differences by amputation level in Role Physical, Role Emotional, and Composite QoL scores, with individuals with more proximal amputations reporting lower outcomes. Regression analyses showed that older age significantly predicted poorer Physical Functioning (β = -0.75, p < 0.001), and male participants scored higher than females in the same domain (β =  + 8.67, p = 0.0227). Amputation level was significantly associated with QoL in select domains in group comparisons, though it was not a significant predictor in multivariable regression. Education level was not a significant factor in either analysis. The models explained a modest proportion of variance, with R² values ranging from 0.03 to 0.19 across SF-36 domains.

Conclusions: Lower limb prosthetic users in Jordan experience moderate impairments in physical QoL domains, particularly among older adults. Emotional and social domains were relatively preserved. Demographic factors, especially age and gender were associated with differences in specific QoL outcomes and should be considered in the development of personalized rehabilitation strategies.

We present the first documented case of vascular Ehlers-Danlos syndrome (vEDS) associated with muscle injury in a spastic muscle following a stroke, which occurred during physical therapy. The patient was a 46-year-old male with a family history of subarachnoid hemorrhage (SAH) and aortic dissection, who presented with sudden headache, dysarthria, and left hemiparesis, leading to transport to a nearby hospital. He was diagnosed with arterial dissection and subsequent SAH and cerebral infarction in the right hemisphere using brain computed tomography (CT) and magnetic resonance imaging (MRI). He received treatment with antihypertensive and antiplatelet medications. After five weeks, he was admitted for rehabilitation with moderate left-sided hemiparesis and spasticity. Twenty-six weeks post-onset, while participating in passive hamstring stretching, he experienced sudden pain and swelling in his left thigh. Imaging confirmed hematomas in the biceps femoris and semitendinosus muscles, indicating muscle injury. Clopidogrel was discontinued due to progressive anemia, and the hematoma resolved within five days. He quickly resumed ambulation with increasing independence. One month after the injury, he was discharged home, and subsequent genetic testing at another institution confirmed the diagnosis of vEDS with a pathogenic variant in COL3A1. Patients with vEDS are at an increased risk for injuries due to tissue fragility. A stroke can lead to limb spasticity, making spastic muscles more susceptible to injury during sudden stretching, such as passive stretching. This report highlights the need for clinicians to exercise caution when rehabilitating vEDS patients, especially in the absence of established guidelines. Further case reports and clinical evidence are essential to develop comprehensive rehabilitation standards for vEDS.

Background: Virtual reality (VR) rehabilitation represents a promising technological approach in post-stroke neurorehabilitation, offering immersive, engaging therapy environments. However, limited data exist on patient satisfaction and tolerance in clinical practice, particularly during the subacute phase of stroke recovery.

Objective: To evaluate patient satisfaction and tolerance of VR rehabilitation in patients with subacute ischemic stroke and assess physiotherapist perceptions of treatment outcomes compared to conventional rehabilitation.

Methods: A prospective pilot study was conducted from January 1, 2024, to December 31, 2024, at the Department of Neurology, University Hospital Ostrava, Czech Republic. Patients in the subacute phase of ischemic stroke (≤2 weeks post-stroke) underwent VR rehabilitation using the MDR-certified VR Vitalis® Pro system. Patient satisfaction was measured using the User Satisfaction Evaluation Questionnaire (USEQ) with individual question analysis. Physiotherapists assessed treatment outcomes on a 5-point scale compared to conventional rehabilitation. Vital signs were monitored pre- and post-intervention.

Results: Nineteen patients (mean age 67.7 ± 11.2 years, 52.6% female) completed VR rehabilitation. The mean USEQ satisfaction score was 25.0 ± 6.8 points (range 7-30). High satisfaction (≥25 points) was achieved in 68.4% of patients, with only 5.3% reporting low satisfaction (<15 points). Individual question analysis revealed highest ratings for information clarity (4.63 ± 0.96) and perceived rehabilitation benefit (4.37 ± 1.12), with excellent tolerability as 63.2% reported no discomfort. Physiotherapists rated 31.6% of patients as showing better outcomes than expected with conventional therapy, while 52.6% showed similar outcomes and 15.8% showed worse outcomes. The mean number of VR sessions per patient was 4.2 ± 4.1. No serious adverse events were recorded.

Conclusions: VR rehabilitation demonstrated high patient satisfaction and excellent tolerance in subacute stroke patients. Individual USEQ analysis revealed particularly strong acceptance for system clarity and rehabilitation benefit. These findings support the feasibility and acceptability of VR rehabilitation in clinical stroke care.

Introduction: Spinal cord injury (SCI) presents a significant burden to patients, families, and the healthcare system. The ability to accurately predict functional outcomes for SCI patients is essential for optimizing rehabilitation strategies, guiding patient and family decision making, and improving patient care.

Methods: We conducted a retrospective analysis of 589 SCI patients admitted to a single acute rehabilitation facility and used the dataset to train advanced machine learning algorithms to predict patients' rehabilitation outcomes. The primary outcome was the Functional Independence Measure (FIM) score at discharge, reflecting the level of independence achieved by patients after comprehensive inpatient rehabilitation.

Results: Tree-based algorithms, particularly Random Forest (RF) and XGBoost, significantly outperformed traditional statistical models and Generalized Linear Models (GLMs) in predicting discharge FIM scores. The RF model exhibited the highest predictive accuracy, with an R-squared value of 0.90 and a Mean Squared Error (MSE) of 0.29 on the training dataset, while achieving 0.52 R-squared and 1.37 MSE on the test dataset. The XGBoost model also demonstrated strong performance, with an R-squared value of 0.74 and an MSE of 0.75 on the training dataset, and 0.51 R-squared with 1.39 MSE on the test dataset. Our analysis identified key predictors of rehabilitation outcomes, including the initial FIM scores and specific demographic factors such as level of injury and prehospital living settings. The study also highlighted the superior ability of tree-based models to capture the complex, non-linear relationships between variables that impact recovery in SCI patients.

Discussion: This research underscores the potential of machine learning models to enhance the accuracy of outcome predictions in SCI rehabilitation. The findings support the integration of these advanced predictive tools in clinical settings to better guide decision making for patients and families, tailor rehabilitation plans, allocate resources efficiently, and ultimately improve patient outcomes.

Introduction: Online community-based exercise (CBE) is a rehabilitation strategy that can promote health outcomes among people living with HIV. We aimed to describe experiences implementing a community-based exercise (CBE) intervention with adults living with HIV.

Methods: We conducted a longitudinal qualitative descriptive study involving interviews with adults living with HIV and persons implementing an online tele-coaching CBE intervention. Leveraging community-based research principles, the intervention aimed to improve physical activity engagement and health outcomes through online individualized coaching, online YMCA resources, and wearable fitness technology. We analyzed interviews with adults living with HIV and representatives involved in CBE implementation at baseline (month 0), end of intervention (6 months), and end of follow-up phase (12 months).

Results: Thirteen adults living with HIV and eight representatives involved in CBE implementation participated in the study (43 interviews total). Key themes included the "four Cs": Cost, Care, Comfort, and Convenience that encapsulated participants' perceptions of financial barriers, need for holistic healthcare integration, importance of stigma-free and emotionally supportive environments, and accessibility of health interventions.

Discussion: Results underscore the critical role of inclusive and adaptable exercise programs in addressing the complex needs of individuals with chronic, episodic conditions such as HIV, and the value of participatory, community-driven methodologies in designing effective and equitable health interventions.

Clinical trial registration: NCT05006391.