Journal of rehabilitation medicine. Clinical communications最新文献

Objective: To assess practice patterns and attitudes of Canadian physiatrists, given their expertise in pain management and spasticity, conditions in which medical cannabis (MC) should be considered.

Design: A 24-item, survey questionnaire was sent to physiatrists across Canada.

Subjects: One hundred and nine physiatrists responded.

Methods: A structured web-based survey distributed to members of Canadian Association of Physical Medicine and Rehabilitation. Inferential statistical analysis was conducted.

Results: A majority of respondents acknowledged the medicinal value of MC, with 61% of respondents feeling comfortable discussing it, whereas only 31% felt comfortable authorizing MC. Years of work experience did not impact comfort regarding discussions of MC, but those with 21+ years of experience authorized MC more frequently. A significant relationship was observed between subspecialty and MC prescribing; most prescriptions authorized for neuropathic pain, musculoskeletal pain and spasticity. Most respondents agreed that medical school and residency programs provided insufficient education on MC, and that governmental and institutional guidelines remained unclear.

Conclusion: Addressing cannabinoids in medical school and residency is important to improve the therapeutic and counselling aspects of patient care in addressing safety and preventing misuse. With clearer guidelines and more research on MC efficacy, physiatrists will be more knowledgeable and better able to improve patient lives.

Objective: To assess the effects of higher-intensity aerobic training (AET) and lower-intensity rapid-resisted exercise training (RET) on fitness, cognition, balance, mobility, and quality of life in sedentary adults with chronic traumatic brain injury.

Design: Participants were randomized to AET, RET, or waitlist control later randomized to AET or RET.

Participants: Nine adults, 25 to 65 years, completed elliptical training (AET = 4; RET = 5). Follow-up data were available for 4 AET and 2 RET.

Methods: Exercise groups trained for 12 weeks. Outcomes were assessed at 0, 12, and 24 weeks.

Results: Main effects from exercise included improvements in the Brief Visuospatial Memory Test, Limits of Stability excursion, fast elliptical cadence, and self-reported cognitive abilities. Improved fitness was related strongly to improved memory, balance, and quality of life. Similar fitness gains across groups indicate high individual variability in response to exercise intensity. Continuing to exercise during follow-up was associated with more cognitive benefits.

Conclusion: Exercise had positive effects on multiple aspects of functioning well after traumatic brain injury and should be advocated. Differences based on exercise intensity were not identified in this small sample. Inconsistent recommendations across studies on optimal exercise parameters are likely obscured by individual differences, suggesting a personalized approach is warranted.

Objective: Nelarabine is an antineoplastic agent used in the treatment of acute T-cell lymphoblastic lymphoma with inadequate clinical response to prior chemotherapeutic treatments. While the most common side effects are mild to moderate haematologic events, there are known severe neurologic side effects including induced myelopathy. Due to the sparsity of cases, there is a lack of literature to guide inpatient rehabilitation programs for patients with neurological toxicity.

Design: Case report.

Patient: A 30-year-old woman with a history of T-cell lymphoblastic lymphoma presenting with tetraplegia after treatment with nelarabine and treated with intravenous immunoglobulin and plasma exchange therapy.

Methods: After medically stabilized, she was admitted to acute inpatient rehabilitation centre with therapy program incorporating strengthening and endurance training, robot-assisted training and respiratory muscle strength training.

Results: The patient demonstrated marked improvement in functional independence and manual motor testing on discharge. With ongoing participation in out-patient therapies, she achieved full independence with bed mobility and activities of daily living at a 6-month follow-up. She continues to use a wheelchair in the community, demonstrates modified independence with ambulation and is capable of climbing stairs at home.

Conclusion: This case report details the functional improvements following intensive rehabilitation of a patient with severe nelarabine-associated neurotoxicity.

Objective: To evaluate psychometric properties of newly developed hand and wrist proprioception tests.

Design: Cross-sectional and test-retest comparisons.

Subjects/patients: Twenty-six individuals (mean age 40 years) with wrist disability (> 3 months) due to traumatic injury or general instability.

Methods: Pointing acuity (with eyes open and closed), active joint position sense (in extension, flexion, radial- and ulnar deviation) and grip force reproduction were measured by 1 rater on 2 occasions, 1 week apart. The mean absolute error was calculated for each test. Discriminative validity (affected vs non-affected hand/wrist) was evaluated by paired t-test and test-retest reliability with Intraclass Correlation Coefficient (ICC).

Results: The pointing acuity test with eyes closed gave higher errors for the affected hand/wrist (p = 0.08) and good ICCs (0.80-0.85), while the test with eyes open had poor discriminative ability (p = 0.32) and test-retest reliability (ICC 0.13-0.16). The active joint position sense test showed higher error in flexion for the affected wrist (p = 0.03), and the ICC was moderate (0.51). The remaining joint directions and the grip force reproduction test had poor discriminative ability (p = 0.21-0.94) and poor to moderate ICCs (0.00-0.65).

Conclusion: The pointing acuity test with eyes closed and the active joint position test in flexion show-ed promising results but need further evaluation in larger samples.

Objective: Evaluate study design, procedure, and measurements for future study of early rehabilitation after mild traumatic brain injury.

Design: A randomized controlled study was conducted.

Subjects/patients: Patients from a county hospital emergency department, diagnosed with mild Traumatic Brain Injury were contacted 2 weeks post-trauma.

Methods: Patients who met the inclusion criteria were randomized into 2 groups (n=28). The intervention group received early rehabilitation from a team consisting of physio- and occupational therapists. The control group received usual care. Patient-reported outcomes for measures were fatigue, anxiety and depression, health-related quality of life, physical and activity levels, and sleep after trauma. Data were collected 3 and 16 weeks after trauma.

Results: Patient-reported outcomes measures showed improvement in both groups for symptoms, physical and activity levels, sleep quality and quantity. Also, improvement in the sub-scales of fatigue and health- related quality of life but worsening for general fatigue and general health at post-test in both groups. Neither group showed improvement for anxiety or depression: the intervention group rated depression higher, and the control group rated anxiety higher, post-test.

Conclusion: Design, procedures, measurements and interventions were feasible but need refinement for a full-scale study.

Objective: To study whether there were differences in terms of change in the level of physical activity and functional exercise capacity between 1 month and 3 months of training after surgical aortic valve replacement.

Design: A feasibility study of a randomized controlled trial.

Subjects: After drop-out, a total of 30 patients with aortic stenosis participated in the 2 interventions.

Methods: Group A received 1 month and group B 3 months of cardiac rehabilitation after surgical aortic valve replacement. Feasibility was measured in terms of recruitment, adherence and retention rate, adverse events and the ability to collect primary and secondary outcome measurements.

Results: Regarding feasibility, the recruitment rate was low (55%), but the adherence and retention rates were good (group A 81%/94%, group B 64%/79%). The outcome assessment collection was good, and there was only 1 adverse event. Significant differences were found regarding physical activity and self-perceived health in favour of group B.

Conclusion: This feasibility study showed that although the recruitment rate was low, other measures were satisfactory. Results indicate that a shorter supervised programme may be sufficient and possibly facilitate more effective use of resources.

Objective: People who have experienced stroke are at a high risk for falls, fractures, and osteoporosis. Bone health post-stroke is often overlooked. The goal of this study was to understand current practice perspectives and barriers to bone health care post-stroke among physiatrists.

Methods: We conducted an online survey of English-speaking stroke physiatrists practicing in Canada from October 2023 to April 2024. We recruited participants through the Canadian Association of Physical Medicine and Rehabilitation newsletter and direct contact via hospital or university email. The survey included demographic and multiple-choice questions as well as open-ended queries. Data were summarized using frequencies and percentages, and open-ended questions were assessed qualitatively for themes.

Results: Twenty-two physiatrists completed the survey. Female physiatrists made up 45.5% of respondents, and 36.4% were in their first 5 years of practice. Most worked in an academic hospital (81.8%). The majority (81.9%) of respondents felt there is a need for post-stroke bone health guidelines. Important themes that emerged from open-ended questions included a lack of awareness, research, and resources.

Conclusions: In this study of Canadian physiatrists, most respondents feel post-stroke bone health guidelines would be beneficial. More research and resources focused upon bone health in this population is needed.

Objective: Acetabular fractures are among the most severe injuries in trauma surgery. In younger patients, they typically result from high-energy trauma and are often associated with polytrauma. Treatment complexity and rehabilitation outcomes are influenced by overall injury severity. This study aimed to evaluate return to work (RTW) after acetabular fracture in relation to the overall injury severity score (ISS).

Design/subjects/patients: A retrospective study included 22 patients treated for acetabular fractures at a Level I Trauma Centre spanning a period from January 2009 - December 2020.

Methods: Patients completed a questionnaire assessing work-related factors and workload before (PRE) and after (POST) trauma (median [MD] = 126.4 ± 46.4 months POST). Based on ISS, patients were categorized as < 16 = "no polytrauma" (n = 8) and ≥ 16 = "polytrauma" (n = 14).

Results: The RTW rate was 75% in both groups. However, descriptively the median workload reduction was greater in the "polytrauma" group (-50%) compared to the "no polytrauma" group (-33.3%). A shift toward sedentary work was seen in both groups, more prominently in the "polytrauma" subgroup (+40%) compared to the "no polytrauma" group (+11.4%).

Conclusion: Possible workload was reduced after acetabular fracture. Despite similar RTW rates, polytrauma patients descriptively returned to less physically demanding work. Thus, ISS significantly predicts the outcome of the rehabilitations process after acetabular fractures.

Objective: The aim of this report is to describe the aggregated insights and key findings from a Swedish need assessment project. The project comprised 3 parallel studies identifying [a] needs to be met, [b] research questions, and [c] knowledge translation gaps related to enhancing the lives of people with spinal cord injury (SCI).

Methods: The project included people living with SCI, their relatives, health professionals, and personal care assistants. Analyses were conducted with the aim of identifying commonalities and connections between the results of the 3 individual studies.

Results: The aggregated insights and key findings from this project can be summarized into 3 themes. First, a well-functioning healthcare, rehabilitation, and supporting system must have a holistic perspective on what it means to live with SCI. Second, aging is about living with the SCI and getting old with the SCI. Third, when family members receive their own support, they can provide good support to the person living with SCI.

Conclusion: New evidence from the Swedish needs assessment project reveals the needs that currently have the greatest impact on improving the lives of people with SCI, which can guide researchers, healthcare providers, and knowledge translators.

Objective: Long-term mobility impairment is a sequel of stroke victims which requires intensive medical and physiotherapeutic care. Detailed assessment of therapeutic success is relevant to achieving efficacy, but requires expert knowledge, since mobility disorders are complex. Increasing shortage of qualified staff and larger numbers of patients are thus major problems in this field. To meet these challenges, we show that machine learning algorithms can reproduce expert mobility assessment from gait data with acceptable accuracy, supporting poststroke evaluation while giving intelligible feedback into how the assessments were generated.

Methods: A total of 100 hemiparetic stroke patients received clinical examinations followed by instrumented gait analysis and were assigned a Stroke Mobility Score by an interdisciplinary expert board. From each measured stride pair, 680 features were extracted. After removing non-discriminating features, two regression models were trained: a decision tree and a multilayer perceptron artificial neural network.

Results: The models yielded good to very good (Cohen) coefficients of determination. The interpretable decision-trees and the explanations obtained from the neural network unveiled key features supporting the mobility assessments.

Conclusion: The automated assessments agree well with those of the experts. Synergistic interactions between system, and experts via the computed key features may improve quality in diagnosis and objectify therapeutic targets.