American Journal of Physical Medicine & Rehabilitation最新文献

Purpose: The aim of the study was to review the current literature on the accuracy and efficacy of ultrasound- and landmark-guided intra-articular knee injections.

Methods: A systematic review was performed following the Cochrane process from April 2023 to August 2023 utilizing PubMed, Embase, Web of Science, and Scopus. Branched logic was used to include articles containing terms regarding the knee AND ultrasound AND injections. Two authors screened studies for eligibility, and any disagreement was resolved through discussion with a third reviewer. Risk-of-bias assessments were performed.

Results: A total of 13 studies were included in the review. Cumulative accuracies amounted to 95.4% (356/373) versus 82.0% (268/327) for ultrasound-guided and landmark-guided intra-articular knee injections/aspirations, respectively. All but one study looking at efficacy showed significantly improved outcomes in the ultrasound-guided injection/aspiration groups.

Conclusions: This systematic review provides data to support that ultrasound-guided intra-articular knee injections/aspirations are more accurate and efficacious than landmark-guided intra-articular knee injections/aspirations.

Level of evidence: Level I - systematic review.

Objective: Stroke is a major cause of disability, impacting mobility worldwide. Overground robotic-assisted gait training uses wearable exoskeletons to improve walking. This systematic review and meta-analysis assess its effectiveness versus conventional gait training in enhancing gait velocity and balance in poststroke patients.

Design: Our search was conducted in the Pubmed, Cochrane, ScienceDirect, Scopus, and PEDro electronic databases for English journal articles about human randomized controlled trials of the last two decades, investigating overground robotic-assisted gait training effects on gait parameters of poststroke patients compared with conventional gait training.

Results: A comprehensive literature search identified seven randomized controlled trials with a total of 288 participants. Meta-analysis results indicated that overground robotic-assisted gait training significantly improved after intervention gait velocity (summary mean difference: 0.09 m/sec, 95% confidence interval 0.02-0.17), while other gait parameters, such as stride length and cadence, showed no statistically significant differences. The intervention was well-tolerated, with no major adverse events reported.

Conclusions: Despite the positive impact on gait speed, challenges remain, including high device costs and the need for further research to optimize training parameters. These findings support the potential of overground robotic-assisted gait training as an effective tool for gait rehabilitation in stroke survivors, highlighting the need for larger studies with long-term follow-up to refine its clinical application.

Abstract: The Canadian Stroke Best Practice Recommendations 7 th edition update of the Rehabilitation, Recovery and Community Participation module is presented in three parts. This publication, Part One of the series, reflects the growing and changing body of research evidence available to guide planning, ongoing screening and assessment, management, education, and support of individuals with stroke, their families, and caregivers. This module provides guidance for the planning and delivery of coordinated and seamless systems of care from acute stroke onset to return to community settings by an interdisciplinary team of healthcare providers with expertise in stroke. These recommendations were developed with active involvement of people with lived experience of stroke at all phases. These recommendations are intended to support the progress achieved during the initial recovery stages and enable individuals with stroke to resume life roles and leisure activities as best as possible, to achieve optimal recovery goals. Evidence for effective rehabilitation therapies and support for individuals with stroke and their families continues to emerge and gaps in knowledge should drive future research.

Objective: This study compared the effects of continuous theta burst stimulation and low-frequency repetitive transcranial magnetic stimulation on cortical activity modulation and upper limb motor recovery in subacute stroke patients.

Design: A total of 105 subacute stroke patients with unilateral upper limb impairment were randomly divided into the following three groups: continuous theta burst stimulation, low-frequency repetitive transcranial magnetic stimulation, and sham. Main outcomes included upper extremity Fugl-Meyer score and modified Barthel Index scores at baseline, 4 wks (posttreatment), and 12 wks (follow-up). Secondary outcomes evaluated cortical activation via functional near-infrared spectroscopy.

Results: Among 103 recruited participants, 98 completed follow-up. Both continuous theta burst stimulation and low-frequency repetitive transcranial magnetic stimulation groups showed significantly greater upper extremity Fugl-Meyer improvement than the sham group at 4 and 12 wks ( P < 0.05), while modified Barthel Index scores did not differ significantly. Functional near-infrared spectroscopy revealed that active treatments suppressed contralesional primary motor cortex activation, with continuous theta burst stimulation additionally inhibiting premotor and supplementary motor areas.

Conclusions: Continuous theta burst stimulation and low-frequency repetitive transcranial magnetic stimulation effectively enhanced upper limb motor motricity in stroke patients compared to sham stimulation, suggesting their potential as noninvasive neuromodulatory therapies for poststroke rehabilitation.

Objective: Nerve and tendon transfer surgery has restored upper extremity function in cervical spinal cord injury but is not universally accessible to all eligible individuals. The purpose of this exploratory qualitative study was to understand the healthcare provider factors that are associated with access to nerve transfer surgery for people with spinal cord injury.

Design: Semistructured interviews explored healthcare provider knowledge and practices regarding nerve and tendon transfer surgery to improve upper extremity function in cervical spinal cord injury. An inductive, iterative, constant comparative process involving descriptive and interpretive data analyses was used to identify themes, guided by the Consolidated Framework for Implementation Research.

Results: Interviews were conducted with healthcare providers ( n = 10 upper extremity surgeons, n = 10 spinal cord injury physiatrists/hospitalists, n = 6 occupational therapists, n = 6 physical therapists). The following nine themes were identified as barriers to accessing care: (1) lack of awareness; (2) lack of sufficient knowledge; (3) lack of buy-in as a priority; (4) lack of collaboration; (5) misperceptions; (6) lack of resources; (7) lack of evidence; (8) lack of ownership among rehabilitation specialists; and (9) hesitancy.

Conclusions: This study identified barriers limiting equitable access to nerve transfer surgery. These barriers highlight the need for a multimodal multidisciplinary approach to address individual-, provider-, and system-level barriers.

Objective: The metabolic syndrome is a growing health issue. This study evaluated the prevalence of metabolic syndrome and individual metabolic syndrome risk factors, in people with different neuromuscular diseases.

Design: We used baseline data of a randomized controlled trial on the efficacy of a physical activity program in neuromuscular diseases. Metabolic syndrome was defined as the presence of at least three out of five risk factors of the revised National Cholesterol Education Program Adult Treatment Panel III.

Results: The 84 participants (50 female, median age = 63 yrs, interquartile range = 48, 68 yrs) were diagnosed with post-polio syndrome ( n = 22), Charcot-Marie-Tooth disease ( n = 37) or other neuromuscular diseases ( n = 25). Metabolic syndrome was present in 18 participants (21%). The most common risk factors were hypertension (56%), central obesity (49%), and increased fasting blood glucose (33%). Logistic regression results showed that adjusted for age and muscle strength as confounders, participants with Charcot-Marie-Tooth disease (Exp(B) = 0.107, 95% confidence interval: 0.019-0.609) and other neuromuscular diseases (Exp(B) = 0.039, 95% confidence interval: 0.004-0.390) had significantly lower odds of metabolic syndrome compared with post-polio syndrome.

Conclusions: The metabolic syndrome prevalence that we found is comparable to the general Dutch population. However, a focus on the prevention of metabolic syndrome in neuromuscular rehabilitation is warranted, as certain neuromuscular diseases subgroups may be at increased risk of developing metabolic syndrome.

Background: Facet joint interventions are commonly performed procedures in patients with neck and back pain, including patients managed with anticoagulant/antiplatelet medications. Temporary cessation of anticoagulant/antiplatelet medications may increase the risk of thromboembolic complications, which may be unnecessary.

Objective: The aim of the study was to determine the risk of clinically relevant hemorrhagic complications in patients undergoing facet interventions.

Methods: Consecutive patients from September 19, 2009, to June 16, 2017, who were on anticoagulant/antiplatelet medication medications and scheduled for an any facet intervention in the cervical, thoracic, and lumbosacral spine were retrospectively audited for bleeding complications for a minimum of 90 days after procedure.

Results: Five hundred eighty-two procedures targeting the cervical, thoracic, or lumbosacral facet joints were performed on patients on anticoagulant or antiplatelet medications. One hundred twenty-eight patients ceased their anticoagulant/antiplatelet medications before the procedure and 454 maintained anticoagulant/antiplatelet medications. No clinically relevant epidural hematomas were noted in the patient cohort (0/582, 0%, 95% confidence interval = 0.0%-0.6%).

Discussion/conclusions: The risk of clinically relevant bleeding complications including epidural hematoma in properly performed facet interventions is low. This information is crucial in being able to quantitatively determine the risk of ceasing or maintaining anticoagulant/antiplatelet medications before cervical thoracic and lumbar facet interventions.

Objective: The aim of the study was to evaluate the predictive accuracy of the Global Fatty Degeneration Index for retear risk after rotator cuff repair.

Design: A single-cohort longitudinal study using historical data was conducted. Data on patient demographics, clinical comorbidities (e.g., diabetes mellitus), and preoperative rotator cuff fatty infiltration, quantified by the Global Fatty Degeneration Index from magnetic resonance imaging, were analyzed in patients undergoing primary rotator cuff repair between January 2014 and December 2018.

Results: Among 334 patients, 42 (12.6%) experienced retears. No significant differences were found in age, sex, or body mass index, except for diabetes mellitus, which was more prevalent in the retear group ( P = 0.012). The mean Global Fatty Degeneration Index was significantly higher in the retear group (2.3 ± 0.7 vs. 1.3 ± 0.5, P < 0.001). Receiver operating characteristic analysis demonstrated strong predictive capability (area under the curve = 0.866). A Global Fatty Degeneration Index of ≥1.875 yielded a sensitivity of 77.6% and specificity of 89.4%. Logistic regression showed an odds ratio of 18.059 for retears at Global Fatty Degeneration Index ≥1.875 ( P < 0.001), with significant associations for subscapularis (OR = 4.530, P = 0.019) and infraspinatus (odds ratio = 2.928, P = 0.043) Global Fatty Degeneration Index ≥3.

Conclusions: The Global Fatty Degeneration Index is a reliable quantitative predictor of retear after rotator cuff repair, with clinical relevance for risk assessment.