American Journal of Physical Medicine & Rehabilitation最新文献

Objective: This study aimed to investigate the feasibility of a neurorehabilitation pipeline and develop an algorithm to automatically select the appropriate treatment for individuals with upper extremity motor paralysis after stroke in the chronic phase.

Design: In experiment 1, eight post-stroke participants in the chronic phase who underwent treatment sustaining two to three phases were assessed before and after treatment. In experiment 2, a decision tree analysis was performed in which the dependent variable was set as the treatment option determined by a board-certified physiatrist for 95 poststroke participants; the independent variables were only motor function scores or both motor function scores and electromyogram variables.

Results: In experiment 1, the clinical assessment scores were improved significantly after treatment. Experiment 2 showed that the agreements of the model with only motor function scores as the independent variable and with motor function scores and electromyogram variables as the independent variables were 75.8% and 82.1%, respectively.

Conclusions: This novel treatment package is feasible for improvement of motor function in poststroke individuals with severe motor paralysis. The study also established an automated algorithm for selecting appropriate treatments for upper extremity motor paralysis after stroke, identifying standard values of key variables, including electromyography variables.

Objective: This study investigated whether the origin (acquired or congenital) and type of impairment affect the participation and likelihood of winning a medal in different sports at the Paralympic Games.

Design: We analyzed competition data and athlete biographies web scraped from the International Paralympic Committee's website ( www.Paralympic.org ).

Results: In some sports, athletes with one origin or type of impairment were overrepresented. For example, 76% of Para-snowboarders had an acquired impairment. Furthermore, mixed effects logistic regression analyses showed that the origin of impairment had no effect on the likelihood of winning a medal in most sports. However, athletes with a congenital impairment had a significantly higher likelihood of winning a medal compared to those with an acquired impairment in Para-athletics, Para-alpine skiing, and Para-biathlon (odds ratio: 1.71, P < 0.01, odds ratio: 3.69, P = 0.002, and odds ratio: 3.70, P = 0.016, respectively). Athletes with a given origin-type of impairment combination also may have an advantage or disadvantage in some sports. For example, athletes with an acquired spinal cord injury win proportionally fewer medals in Para-powerlifting.

Conclusions: Understanding potential effects of the origin and type of impairment on participation and medaling chances in Paralympic sports can help shape the development of Para-sports and support talent identification.

Objective: The aim of the study is to review the literature regarding the current state and clinical applicability of machine learning models in prognosticating the outcomes of patients with mild traumatic brain injury in the early clinical presentation.

Design: Databases were searched for studies including machine learning and mild traumatic brain injury from inception to March 10, 2023. Included studies had a primary outcome of predicting post-mild traumatic brain injury prognosis or sequelae. The Prediction model study Risk of Bias for Predictive Models assessment tool was used for assessing the risk of bias and applicability of included studies.

Results: Out of 1235 articles, 10 met the inclusion criteria, including data from 127,929 patients. The most frequently used modeling techniques were support vector machine and artificial neural network and area under the curve ranged from 0.66 to 0.889. Despite promise, several limitations to studies exist such as low sample sizes, database restrictions, inconsistencies in patient presentation definitions, and lack of comparison to traditional clinical judgment or tools.

Conclusions: Machine learning models show potential in early stage mild traumatic brain injury prognostication, but to achieve widespread adoption, future clinical studies prognosticating mild traumatic brain injury using machine learning need to reduce bias, provide clarity and consistency in defining patient populations targeted and validate against established benchmarks.

Introduction: Intubated, ventilator unweanable patients with ventilatory pump failure can be extubated to continuous noninvasive positive pressure ventilatory support; however, delays may result in untoward effects on speech and swallowing.

Methods: This is a retrospective chart review of ventilatory pump failure patients to determine need for postextubation gastrostomy tubes and consequences on speech for intubations less than (short) versus greater than (long) 3 wks.

Results: One hundred sixty-five patients were intubated for a mean 20.7 ± 23.5 (range = 1-240) days. All recovered prehospitalization speech status within 2 hrs to 3 days. One hundred four of the short group were intubated 1.6 ± 1.3 (range = 1-9) times for 9.9 ± 5.1 (range = 1-20) days versus 61 of the long group intubated 2.4 ± 3.3 (range = 1-26) times for 39.0 ± 30.5 (range = 21-210) days, 10.6% vs. 8.2%, respectively, required postextubation gastrostomy tubes indefinitely.

Discussion: There was no difference in untoward effects on speech or swallowing from short- versus long-term intubation. Had the patients undergone tracheotomies, the majority would have had gastrostomy tubes placed permanently and suffer morbidity and mortality from the tubes. Thus, an option is to permit patients to remain intubated and, even if unweanable, extubate them to continuous noninvasive positive pressure ventilatory support rather than tracheotomy.

Objective: The aim of the study is to investigate the effectiveness of an 8-wk cardiopulmonary rehabilitation program on cardiorespiratory fitness (VO 2 peak) and key cardiopulmonary exercise test measures, quality of life, and symptom burden in individuals with long COVID.

Design: Forty individuals with long COVID (mean age 53 ± 11 yrs), were randomized into two groups: (1) rehabilitation group: center-based individualized clinical rehabilitation program (8 wks, 3 sessions per week of aerobic and resistance exercises, and daily inspiratory muscle training) and (2) control group: individuals maintained their daily habits during an 8-wk period.

Results: There was a significant difference between groups in mean VO 2 peak improvement ( P = 0.003). VO 2 peak improved significantly in the rehab group (+2.7 mL.kg.min; 95% CI = +1.6 to +3.8; P < 0.001) compared to the control group (+0.3 mL.kg.min; 95% CI = -0.8 to +1.3 P = 0.596), along with VE/VCO 2 slope ( P = 0.032) (-2.4; 95% CI = -4.8 to +0.01; P = 0.049 and +1.3; 95% CI = -1.0 to +3.6; P = 0.272, respectively) and VO 2 at first ventilatory threshold ( P = 0.045). Furthermore, all symptom impact scales improved significantly in the rehabilitation group compared to the control group ( P < 0.05).

Conclusions: An individualized and supervised cardiopulmonary rehabilitation program was effective in improving cardiorespiratory fitness, ventilatory efficiency, and symptom burden in individuals with long COVID. Careful monitoring of symptoms is important to appropriately tailor and adjust rehabilitation sessions.

Abstract: The purpose of this study was to provide an evidence map for explaining research trends and gaps. Four databases and clinical practice guidelines-related Websites were searched up to March 2022. Basic information, methodological quality, reporting quality of clinical practice guidelines, and similar stroke recommendations were extracted. The methodological and reporting quality of stroke clinical practice guidelines were evaluated using the Appraisal of Guidelines Research and Evaluation (second version) instrument and the Reporting Items for Practice Guidelines in Healthcare checklist. The bubble plot format of the evidence map helped visualize the overall quality. Data management and analysis were performed using Excel 2013 and SPSS 22.0 software. A total of 12 clinical practice guidelines, published between 1997 and 2020, were included for in-depth analysis. The identified clinical practice guidelines had a mixed quality and scored poorly in the developmental rigor and applicability domains by Appraisal of Guidelines Research and Evaluation (second version). According to the Reporting Items for Practice Guidelines in Healthcare checklist, field four (clarity of expression) showed the highest (79.2%), and field three (rigor of formulation) secured the lowest (28%) reporting rates. The stroke rehabilitation recommendations primarily focused on organizational management, timing and intensity, rehabilitation and nutritional management of dysphagia, return to work, communication, speech, and language function. This would promote improvement in developing trustworthy clinical practice guidelines for stroke rehabilitation.

Objective: The aim of the study is to determine the effectiveness of a medial off-loader brace with sensor monitoring capabilities and associated phone application in improving outcomes for individuals with knee osteoarthritis.

Methods: This is a randomized clinical trial of participants with knee osteoarthritis, aged 40-75 with two groups: 1) brace-only and 2) brace+sensor (sensor providing walking time, knee range of motion, and 7-day activity streak). Both groups received a prefabricated custom-fitted medial off-loader brace and 12-wk self-guided exercise therapy program. Baseline and postintervention assessments included subjective and objective outcomes.

Results: Sixty participants were recruited ( n = 30/group). The brace+sensor group demonstrated higher study retention (88.89%) compared with the brace-only group (73.33%). Significant improvement in Knee Injury and Osteoarthritis Outcome Survey knee pain and other Knee Injury and Osteoarthritis Outcome Survey subscores compared with baseline was observed for both groups. However, only the brace+sensor group improved beyond the established minimal clinically important difference for Knee Injury and Osteoarthritis Outcome Survey pain (11.31 ± 13.87). Knee Injury and Osteoarthritis Outcome Survey activities of daily living was also significantly improved in the brace+sensor group compared with brace-only group ( P = 0.049). Both treatment groups had significant improvement in functional outcomes (10-m walk, 5× sit-to-stand, P < 0.05). Only the brace+sensor group had significant improvements in the 6-min walk test ( P = 0.02) and reduction in participant weight ( P = 0.01) at 12 wks.

Conclusions: Incorporating wearable technology in standard bracing for individuals with knee osteoarthritis has potential in improving clinical outcomes.