American Journal of Physical Medicine & Rehabilitation最新文献

Objective: To guide efforts in reducing discharge opioid prescribing, we aimed to investigate the rate of discharge with opioids for opioid-naïve older adults in inpatient orthopedic rehabilitation and to identify factors associated with this outcome.

Design: This is a single-center case-control study of opioid-naïve older adults participating in inpatient orthopedic rehabilitation, with patients grouped based on whether they received an opioid prescription upon discharge. Patient data were collected through the electronic health record. Logistic regression was used to assess for variables that were associated with discharge with an opioid prescription.

Results: Three hundred ninety-one patients were included, with 238 (60.9%) discharged with an opioid prescription. Factors predicting receiving an opioid prescription included longer acute care length of stay, admission for knee replacement, higher pain scores, higher opioid dose, a shorter rehab length of stay, and the absence of a dementia diagnosis. Rates were highest in patients aged 65-74 (77.17%) and lowest in patients aged 85+ (49.59%); however, age was not an independent predictor when all other factors were considered.

Conclusions: A large proportion of older patients were discharged from inpatient orthopedic rehabilitation with an opioid prescription, which may be linked to intrinsic and extrinsic patient factors that influence opioid prescribing.

Objective: The aim of the study was to evaluate the efficacy of laser therapy (high-intensity vs. low-level) in treating tennis elbow.

Design: PubMed, Scopus, Embase, and Web of Science were systematically searched for randomized controlled trials up to February 2025. Cochrane risk-of-bias tool was used for quality assessment. Data were analyzed via RevMan 5.4.

Result: Twelve randomized controlled trials were included. Laser therapy demonstrates significant improvements in pain, grip strength, and functional outcomes for tennis elbow patients. Subgroup analysis reveals that both high-intensity laser therapy ( P = 0.01) and low-level laser therapy ( P < 0.00001) effectively reduce pain versus baseline with comparable efficacy, although high-intensity laser therapy shows nonsignificant improvement versus placebo ( P = 0.07). Regarding functional improvement, high-intensity laser therapy is similar to low-level laser therapy (both significant, P < 0.05). For grip strength, both modalities show significant improvement ( P < 0.05), with high-intensity laser therapy exhibiting superior effects. Further analysis of combination therapies showed that laser combined with bandage demonstrates more significant pain relief and functional improvement.

Conclusions: High-intensity laser therapy and low-level laser therapy are both effective modalities for improving symptoms of tennis elbow (pain, function, and grip strength). Low-level laser therapy demonstrates more consistent significance in pain relief, while high-intensity laser therapy shows greater advantages in enhancing grip strength. More importantly, laser therapy combined with bandage produces synergistic effects, highlighting its value as a key complementary component within multimodal rehabilitation programs.

Objective: The aim of the study was to establish the physiologic baseline (person's physiologic state when their health is stable) for vital signs and urine lab measurements after spinal cord injury.

Design: This case-control study using outpatient data from the national Veteran's Health Administration Corporate Data Warehouse included 2000 veterans with spinal cord injury (cases) and 2000 Veterans without spinal cord injury (controls) between 2018-2019. Cases and controls were randomly selected, and frequency matched for age, sex, race, ethnicity, and Deyo Comorbidity Index.

Results: Spinal cord injury patients had lower temperature, heart rate, respiratory rate, and systolic and diastolic blood pressures than non-spinal cord injury ( P < 0.05). Pyuria and hematuria were higher in spinal cord injury patients, with approximately 73% of tetraplegic and paraplegic patients having urine white blood cells above 10 high power field. Tetraplegic patients had lower heart rate, systolic blood pressure, and diastolic blood pressure than both paraplegic patients and non-spinal cord injury patients ( P < 0.001).

Conclusions: Baseline vital signs were lower in spinal cord injury patients compared with non-spinal cord injury patients. Lower systolic blood pressure, diastolic blood pressure, and heart rate were associated with higher levels of spinal cord injury. Tetraplegic and paraplegic patients had baseline pyuria above 10 high power field suggesting the criteria for pyuria as a positive indicator of urinary tract infection should be different in patients with spinal cord injury than those without spinal cord injury.

Introduction: Duchenne muscular dystrophy management often results in tracheostomies or palliative care deaths.

Methods: Two centers, A in the US and B in Japan, report 486 with Duchenne muscular dystrophy, including 263 dependent on continuous noninvasive ventilatory support, and mechanical in-exsufflation. When needing intubation, all were extubated to continuous noninvasive ventilatory support and mechanical in-exsufflation whether ventilator weanable or not.

Results: Of 320 noninvasive ventilatory support users, 263 extended it to continuous noninvasive ventilatory support without hospitalization or acute respiratory failure. Another 57 were extubated to, and 15 decannulated to continuous noninvasive ventilatory support. Of 223 noninvasive ventilatory support users in Center A, 197 eventually required continuous noninvasive ventilatory support over 10.1 ± 6.3 yrs with 91 surviving to at least age 35.4 ± 9.0 (21-58) yrs; 106 died or were lost to follow-up at 34.3 ± 9.0 (18-58) yrs of age. Center B had 97 noninvasive ventilatory support/continuous noninvasive ventilatory support users; 31 died at 36.4 ± 8.1 (17-46) yrs of age. Sixty-six became continuous noninvasive ventilatory support dependent from age 24.3 with 35 now 38.2 ± 6.7 (29-51) yrs of age. The centers had 14 over age 50, 57 over age 40. Three underwent tracheotomies for chronic lung disease.

Conclusions: The facts that 263 became continuous noninvasive ventilatory support dependent without hospitalization, that 15 using trach ventilations were decannulated to continuous noninvasive ventilatory support, and that only three of 486 apparently required tracheotomies suggest that airway tubes are unnecessary for these patients without severe chronic lung disease.

Abstract: Patient participation in therapy sessions during inpatient rehabilitation is essential to maximize recovery. While specific reasons for missed therapies have not been studied in the brain injury population, individuals with brain injuries are often medically complex, which may impact participation. This quality improvement study aimed to deepen the understanding of reasons for missed therapy and design an intervention to improve therapy participation in an inpatient brain injury rehabilitation unit. Over two consecutive years, data on missed therapies were collected in a rehabilitation unit. Preintervention analysis established three categories of missed therapy, including medical complications (67.4%), routine medical testing (20.9%), and nursing care (11.6%). Therapy was commonly missed on Mondays (21%) and often missed for the entire day (35%). An intervention was designed and implemented to improve communication of weekend medical events, aimed at reducing missed therapies on Mondays. After implementation, there was a statistically significant decrease in missed or rescheduled therapies on Mondays ( P = 0.017) and in the number of "all-day" missed sessions ( P = 0.018). This quality improvement study provides valuable data on trends in missed therapy sessions for individuals with brain injury during inpatient rehabilitation, as well as a successful intervention.

Objectives: Chronic ankle instability is prevalent among physically active individuals and leads to significant functional limitations, yet the neuroplastic mechanisms underlying this condition remain poorly understood. This study examines alterations in brain network connectivity related to chronic ankle instability and explores how these changes associate with postural control deficits.

Methods: This cross-sectional study included 29 patients with chronic ankle instability and 29 controls without ankle sprain history. All participants underwent resting-state functional magnetic resonance imaging. The connectivity between the sensorimotor network and other brain networks were compared between groups, and their correlations with the postural control outcomes were also explored.

Results: Patients with chronic ankle instability exhibited significantly higher functional connectivity between the sensorimotor network and the ventral attention network, central executive network, and default mode network. A significant negative correlation between sensorimotor network-central executive network functional connectivity and postural sway area was observed in chronic ankle instability patients (r = -0.380, P = 0.042).

Conclusions: These results suggest that large-scale brain network reorganization may occur in chronic ankle instability, which could be associated with postural control deficits. The identified relationship between functional connectivity and center of pressure trajectories offers insights into neurobiological changes.

Objective: To evaluate the effects of interactive cognitive-motor training on balance, mobility and cognition in people with chronic stroke.

Design: A systematic search of the Medline, EMBASE, Cochrane Library, and PsycINFO databases from inception to 11 June 2025 to identify relevant randomized controlled trials. Trials investigating the effects of cognitive-motor training interventions with balance, mobility, and cognition outcomes in chronic stroke survivors.

Results: Forty-four trials involving 1,422 people with chronic stroke were included. The meta-analyses revealed interactive cognitive-motor training significantly improved mobility (Timed Up and Go Test and Dynamic Gait Index), gait speed, and dynamic balance (Berg Balance Scale and Functional Reach Test), but not postural sway, lower limb motor function (Fugl-Meyer Assessment of Lower Extremity) or executive function (Trail Making Test-B). No subgroup differences were observed with respect to intervention type, dose, or duration.

Conclusions: Interactive cognitive-motor training represents a promising approach for improving balance, mobility, and gait speed in people with chronic stroke. However, the optimal intervention dose and long-term effects remain unclear. Standardized protocols, increased accessibility, and further research on home-based interventions are necessary to optimize clinical applications and improve long-term outcomes for stroke rehabilitation.

Abstract: Diagnostic nerve blocks are emerging as valuable tools for assessing and guiding spasticity management, yet their clinical application remains variable and underexplored. This scoping review systematically maps the current literature on the use, efficacy, and safety of diagnostic nerve blocks across diverse neurological conditions. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews guidelines, a comprehensive search of PubMed, Embase, and Web of Science was conducted, identifying 15 studies involving 504 patients with spasticity due to stroke, cerebral palsy, spinal cord injury, traumatic brain injury, and other etiologies. Diagnostic nerve blocks were predominantly applied to the lower limbs, targeting spastic equinovarus foot and stiff knee gait. Reported outcomes included spasticity scales, joint range of motion, gait kinematics, electromyographic changes, and functional mobility tests. Across studies, diagnostic nerve blocks consistently supported clinical decision making including decisions on botulinum toxin dosages, neurolysis, and neurectomy. Their use was also associated with improved goal attainment rates. Adverse effects were infrequent and transient. While most studies were of fair quality, limitations included small sample sizes, absence of blinding or powered calculations. Overall, diagnostic nerve blocks represent a safe and valuable tool, enhancing diagnostic precision and facilitating personalized, patient-centered spasticity management. Future high-quality studies are needed to establish standardized protocols and strengthen the evidence for their use in clinical practice.

Objective: The purpose of this study was to evaluate the effect of transforaminal epidural steroid injection (TFESI) for patients with lumbosacral radiculopathy secondary to a lumbosacral herniated nucleus pulposus.

Design: A retrospective review of adult patients who received a fluoroscopically guided transforaminal epidural steroid injections for a herniated nucleus pulposus was performed. Patient-Reported Outcome Measurement Information System domains of physical function, pain interference, and depression were collected at baseline and postprocedure short-term (1-3 mos after procedure) and long-term follow-up (6-12 mos after procedure).

Results: Patient-Reported Outcome Measurement Information System physical function at short- and long-term follow-up statistically improved by 1.9 ( P = 0.02) and 4.6 ( P = 0.01) points, respectively. Patient-Reported Outcome Measurement Information System-pain interference at short- and long-term follow-up statistically improved by 3.7 ( P < 0.001) and 5.9 ( P = 0.002) points, respectively. Depression scores improved by 2.7 ( P = 0.04) at short-term follow-up, but long-term follow-up scores did not significantly differ from baseline scores. Ninety-one (85%) of patients did not elect for spine surgical consultation.

Conclusions: Our study demonstrated that lumbosacral transforaminal epidural steroid injection was associated with a long-term improvement in function and pain for patients with lumbosacral radiculopathy due to a herniated nucleus pulposus as measured by Patient-Reported Outcome Measurement Information System-physical function and pain interference survey and obviated the need for spine surgery at long-term follow-up.