American Journal of Physical Medicine & Rehabilitation最新文献

Objectives: The primary repair of the anterior cruciate ligament (ACL) has re-emerged as a treatment for acute ruptures. While numerous studies have investigated rehabilitation after ACL reconstruction, few have focused on primary repair. We aimed to describe the rehabilitation protocols for primary ACL repair, and to identify knowledge gaps and differences between primary ACL repair and reconstruction.

Design: A scoping review design was selected due to the descriptive and exploratory nature, aiming to identify and map available research evidence from various databases relevant to the research question. Evaluation of study quality and risk of bias is not required in scoping reviews.

Results: A comprehensive search of PubMed, Embase, Cochrane Library, and Web of Science identified a total of 66 studies involving over 3,100 participants. No randomized controlled trials directly comparing postoperative rehabilitation protocol were identified. Eight items of the rehabilitation protocols were analyzed, based on existing clinical practice guidelines for ACL reconstruction. This review highlights the inadequacy and heterogeneity of the available data.

Conclusions: This review revealed a lack of consistent evidence and call for the development of standardized, technique-specific rehabilitation guidelines after primary ACL repair. Clinical trials and transparent reporting are needed to establish validated protocols.

Objective: Recently, extracorporeal shock wave therapy (ESWT) has emerged as a novel and noninvasive approach for alleviating spasticity and pain, improving motor dysfunction after stroke. To determine the effectiveness of ESWT and the effects of shock wave parameters in relieving spasticity, pain, and motor dysfunction following stroke.

Design: We conducted a systematic search of PubMed, EBSCOhost, Embase, Cochrane Library, and Web of Science databases for randomized controlled trials on ESWT for limb dysfunction after stroke from inception until February 1, 2023. Two researchers independently searched and screened articles identified from each database, used RevMan v.5.4 analyzing data.

Results: This review included nine articles and 327 patients. ESWT improved the spasticity, pain, and motor function following stroke. They also improved the passive range of motion in the lower limbs. The treatment effect was highest when the shock wave frequency was <8 Hz and pressure was <2 bar. However, the effect was not significantly affected by treatment duration. Compared to focused extracorporeal shock waves, released extracorporeal shock waves were associated with better outcomes.

Conclusion: The treatment outcomes are optimal when a shock wave frequency < 8 Hz, pressure < 2 bar, and released extracorporeal shock waves are used.

Objective: To investigate whether the impacts of height increase on gastrocnemius muscle (GM) stiffness are greater in children with spastic cerebral palsy (CP) than in those with typical development (TD).

Design: This one-year cohort study enrolled children (CP, 23; TD, 23) who underwent two measurements conducted at entry and after one year. Lateral and medial GM-strain ratios representing muscle stiffness were obtained using elastography.

Results: All regression equations (dependent variable, rate of change [RoC] of height; independent variable, RoC of the GM-strain ratios) were significant and all R2s in children with CP (all p < 0.001; lateral GM's R2 = 0.81; medial GM's R2 = 0.74) were greater than those in children with TD (p < 0.001 and R2 = 0.49; medial GM's R2 = 0.49). The coefficients of equations in children with CP were significantly larger than those in TD (p < 0.05).

Conclusion: The greater R2 values in CP than TD could explain how the variation in height predicts the variations in GM stiffness more accurately in CP than in TD. GM stiffness worsens more in children with CP than that in TD.

Objective: This study investigated the effects of a single dose injection of mesenchymal stem cells (MSCs) under ultrasound guidance for knee osteoarthritis (KOA).

Design: The study included 30 subjects in the intervention group, who received the MSC injection and 27 in the control group who received triamcinolone. Various outcome measures, including pain levels, range of motion (ROM), and MRI parameters, were evaluated before the intervention and at different time points after treatment.

Result: The results showed that the MSC group experienced more effective improvements in outcome measures compared to the control group. Pain improvement was significantly different in the MSC group at 2 weeks, 4 weeks, and 24 weeks after the treatment. ROM in extension improved significantly in the MSC group after 4 weeks. Physical function improved significantly in both groups at different time points. Furthermore, the MSC group showed some positive changes in MRI parameters, but it can't be said definitively that they led to an increase in cartilage thickness.

Conclusion: In conclusion, the study suggests that a single dose injection of MSCs is safe and holds promise for long-term treatment of KOA. No significant negative effects were reported in either group as a result of the study.

Objective: To explore the relationship between daily activity counts and knee osteoarthritis (OA) progression.

Design: A cohort study using Osteoarthritis Initiative (OAI) data included 610 participants aged 45-79 years with knee OA or at risk. Daily activity counts were measured using ActiGraph GT1M accelerometers. OA progression was assessed via Kellgren-Lawrence (KL) grade and joint space narrowing (JSN) scores over two years. Cox proportional hazard and Restricted Cubic Spline models identified the dose-response relationship and optimal activity threshold.

Results: The average age of participants was 63.7 years, with 44.8% male. A U-shaped relationship was observed between daily activity counts and OA progression. Moderate activity levels could be associated with a reduced risk of KL-grade (adjusted HR: 0.33; 95% CI: 0.24-0.44) and JSN-score progression (HR: 0.31; 95% CI: 0.25-0.38) for activity below 3263.3 counts/min. However, higher activity levels may increase KL-grade (HR: 1.57; 95% CI: 1.40-2.75) and JSN-score progression risk (HR: 1.27; 95% CI: 1.13-1.43).

Conclusion: Moderate activity may protect against knee OA progression, while low and high levels may increase risk. Tailored activity recommendations are needed for individuals with or at risk for OA. Future research should investigate the mechanisms and refine activity thresholds for OA management.

Abstract: Neurogenic thoracic outlet syndrome is a chronic, focal lesion of the lower trunk of the brachial plexus or of the T1 and C8 anterior primary rami, often arising due to distortion of neural structures by a fibrous congenital band extending from a C7 transverse process or cervical rib. Accordingly, patients present with chronic weakness or atrophy of the hand, most prominently of the thenar eminence, which receives most innervation from the T1 root. We present clinical, electrophysiologic, and imaging findings in a case of neurogenic thoracic outlet syndrome presenting in an adult with a history most suggestive of congenital brachial plexus palsy, another pathology sharing the mechanism of nerve compression or injury within the supracostoclavicular space. The patient had new right thenar eminence atrophy and a lifelong history of medial forearm sensory deficit and she improved after first rib resection. The convergence of two disorders in the same patient arising in different phases of life illustrates how anatomic or structural variation in this space can predispose to lower brachial plexus injury.

Abstract: Predicting discharge destination for patients at inpatient rehabilitation facilities is important as it facilitates transitions of care and can improve healthcare resource utilization. This study aims to build on previous studies investigating discharges from inpatient rehabilitation by employing machine learning models to predict discharge disposition to home versus non-home and explore related factors. Fifteen machine learning models were tested. A total of 4922 patient encounters from 4401 patients undergoing inpatient rehabilitation at a Midwestern academic center's inpatient rehabilitation facilities were included. Input variables included demographic and hospital encounter-specific data. The total dataset contained 3687 discharges to home, and 1235 discharges to non-home destinations. A bagging classifier utilizing a decision tree base classifier utilizing random undersampling and without feature selection performed the best in terms of area under the receiver operating characteristic curve with a score of 0.722. Shapley value analysis suggested that length of stay, intravenous medication administration, urinary dysfunction, age, abnormalities white blood cell count or plasma sodium, and fatigue were the factors with the greatest impact on model output. Machine learning can help predict inpatient rehabilitation discharge disposition and identify factors associated with home or non-home discharges.

Objective: Fatigue and subjective sleep disturbance are elevated after mild traumatic brain injury (mTBI), raising the question of whether mTBI-specific factors contribute to the experience of fatigue and subjective sleep disturbance after mTBI.

Design: 110 premorbidly healthy individuals who had suffered a traumatic injury during an accident approximately 8 weeks prior were examined and assessed with subjective measures of fatigue and sleep disturbance, psychological distress and pain.

Results: Individuals with a traumatic injury reported significant elevations in most fatigue and all subjective sleep disruption components compared to community-based control participants (n = 45). After controlling for pain, psychological status, sex and premorbid intellectual functioning, those individuals experiencing a mTBI at time of traumatic injury (n = 64) had equivalent levels of fatigue and subjective sleep disruption as those who had experienced no head injury at time of traumatic injury (n = 46). Trauma group membership did not significantly predict fatigue or subjective sleep disturbance. In contrast, psychological distress consistently predicted fatigue and subjective sleep disturbance, with pain also inconsistently predicting some fatigue and subjective sleep disturbance variables.

Conclusion: This study suggests it is the experience of suffering traumatic injury, rather than mTBI-specific factors, that is associated with elevations in fatigue and subjective sleep disturbance, approximately 8 weeks after injury.