American Journal of Physical Medicine & Rehabilitation最新文献

Objective: The aim of the study is to examine the changes in the burden of secondary health conditions and their risk factors among newly injured individuals with spinal cord injury after discharge from inpatient rehabilitation to community living.

Design: This is a prospective cohort study.

Results: Among 280 included persons, the majority were men with traumatic spinal cord injury and paraplegia. The most common secondary health conditions at discharge from rehabilitation and in the community setting were pain (60.8% vs. 75.9%), urinary tract infections (27.8% vs. 47.6%), and pressure sores (9.9% vs. 27.5%). There was also a significant increase in reported heart disease (9.3% vs. 14.8%) and diabetes (0% vs. 4.2%). The odds of experiencing pain, pressure sores, depression and urinary tract infections increased after discharge from rehabilitation, whereas the odds of respiratory problems decreased significantly during the observation period. Factors such as sex, injury severity, activity limitations, and duration of follow-up were identified as potential risk factors influencing secondary health condition occurrence.

Conclusions: Our study emphasizes a significant rise in secondary health conditions after the transition to community living. Future research should prioritize development of targeted intervention programs tailored to address the unique needs of affected individuals at this pivotal stage in the continuum of spinal cord injury care.

Objective: The objective of this study was to describe the use of digital health tools by people with spinal cord injury and associated factors.

Design: Cross-sectional data from the 2022 Swiss Spinal Cord Injury Cohort Study (SwiSCI) were analyzed. Descriptive statistics summarized data regarding sociodemographic characteristics, self-management, health, and digital health usage. Multiple logistic regression analysis examined the association of digital health use with reasons of use, concerns, confidence, sociodemographic characteristics, self-management, and comorbidities.

Results: Among 961 participants, 69% used digital health tools. Females were 1.79 times more likely to adopt them. People aged 60-70 had 3.84 times higher usage rates than 18-30 yrs old. Longer spinal cord injury duration increased usage by 0.98 times/year. Confidence using digital tools and positive health attitudes predicted usage. Comorbidities were positively correlated with usage. Concerns about digital health utilization had no significant impact.

Conclusions: Our study provides one of the first comprehensive descriptions of digital health utilization in spinal cord injury. Its findings shed light on the intricate factors influencing digital health utilization, contribute to a deeper understanding of this patient population, and pave the way for more targeted and effective digital tools and strategies for their uptake.

Objective: The aim of the study is to provide a population-based evaluation of vaccination coverage to prevent respiratory complications from SARS-COV-2, influenza, and pneumococcus, among community-dwelling persons with spinal cord injury/disease.

Design: This is a cross-sectional survey conducted in 2022, utilizing questionnaires administered to persons with spinal cord injury/disease living in Switzerland. Main outcomes were ever-vaccination rates for SARS-COV-2, influenza, and pneumococcus. Secondary outcomes included demographics, lesion and education levels, as well as respiratory and cardiovascular conditions. Vaccine hesitancy was additionally assessed for all three vaccines in nonvaccinated persons through questions on reasons for not getting vaccinated.

Results: A total of 1158 persons participated in this survey. Overall vaccination rates were highest for SARS-COV-2 86.5% (95% CI = 84.4-88.3), followed by influenza 44.6 (41.7-47.6) and pneumococcus: 7.5% (6.0-9.3). The most prominent reasons for not being vaccinated were doubt on effectiveness (72.7%) and potential side effects (60%) for SARS-COV-2, patients did not feel at risk for influenza (57%) and insufficient information from the physician (52.4%) for pneumococcus vaccination.

Conclusions: In individuals with spinal cord injury/disease, vaccination coverage is notably low for influenza and especially pneumococcus. Vaccine hesitancy varies between vaccination types and is associated with vaccine-specific reasons. These findings underscore the imperative for updated clinical vaccination guidelines, improved public health information, and targeted intervention programs for specific patient groups.

Objective: The aim of the study is to model the health indicator of functioning for persons with spinal cord injury or disorder living in Switzerland in the long-term context, considering chronological age, time since injury, and age at injury.

Design: This is a longitudinal analysis of three waves of a community survey. An interval-scaled functioning metric was constructed using modern test theory. Random effects within-between mixed models were used to investigate trends in functioning over time.

Results: Persons with complete injuries have lower levels of functioning than persons with incomplete injuries, and persons with complete tetraplegia have the lowest levels of functioning. The person's age when injured, the level and completeness of the injury, the presence of secondary health conditions, and various combinations of these factors significantly influenced how functioning changed over time.

Conclusions: Our study shows that chronological age is not necessarily the best time variable for understanding the aging process of people with spinal cord injury in terms of changes in functioning over time and that modeling functioning over time since injury provides important insights into how functioning of people with complete or incomplete injuries declines with increasing time living with the injury.

Abstract: Unloader braces are a treatment modality for medial compartment knee osteoarthritis. The functional mechanisms involved are not yet fully understood. Therefore, this two-part systematic review examines the following research questions: How is muscle activation altered by medial compartment knee osteoarthritis, and do medial tibio-femoral compartment unloader braces alter muscle activation? If so, could this alteration be part of the unloading mechanism by affecting the altered muscle activity in medial compartment knee osteoarthritis?A systematic literature search was conducted using PubMed, LIVIVO, Web of Science, Google Scholar, and CENTRAL for articles published until August 2023. The first systematic review, examining neuromuscular alterations, identified 703 articles, with a final inclusion of 20. The second systematic review, which evaluated the neuromuscular effects of unloader braces, identified 123 articles with the final inclusion of 3. Individuals with medial compartment knee osteoarthritis demonstrated increased activity and co-contraction of the periarticular knee muscles, whereas medial tibio-femoral compartment unloader braces seemed to reduce activity and co-contraction. In contrast to the belief that unloader braces result in muscle weakness as they decrease muscle activity and co-contraction, our limited insights indicate that they rather might reduce the pathological increase. This may result in joint load reduction due to lower compressive forces. However, further investigation is required.

Abstract: Pectoralis major injuries are uncommon, typically affecting young male athletes engaging in high-intensity activities like weightlifting. A 62-yr-old man, who previously suffered a stroke leading to left hemiparesis, hemisensory loss, and spasticity, exhibited a left chest swelling during a rehabilitation clinic visit. Subsequent inquiries revealed his recent incorporation of a home-based pulley system for stretching exercises. On examination, the swelling was diffuse, firm, and nontender, located at the midclavicular line of his left chest, with a positive dropped nipple sign and loss of the left anterior axillary fold sign. An ultrasound confirmed a low-grade injury to the left pectoralis major tendon. Spastic muscle ruptures are extremely rare, with only three published reports linked to traumatic brain injury, multiple sclerosis, and spinal cord injury. Spasticity increases muscle vulnerability due to structural and mechanical changes to the skeletal muscles. This is the first report of a spastic pectoralis major tendon rupture and the first after a stroke. This case highlights the need for optimized multimodal spasticity management and reinforces the importance of comprehensive patient education on the safe execution of home-based stretching exercises.

Objectives: This study aims to examine the change in mental health from the clinical to community setting in persons with spinal cord injury and to identify the role of psychosocial resources for this transition.

Design: Longitudinal survey self-report data from N = 240 persons with spinal cord injury from the Swiss Spinal Cord Injury Cohort study.

Results: Latent profile analysis identified three profiles for each the clinical and the community setting: low, medium, and high mental health load. Latent transition analysis revealed that persons with spinal cord injury were most likely to stay in the same profile from discharge of initial rehabilitation to community, followed by a decrease from a high mental health load to a medium mental health load and an increase from a low mental health load to a medium mental health load. Individuals staying in the low mental health load profile showed significantly higher levels of psychosocial resources compared to individuals increasing to the medium mental health load profile, whereas individuals who stayed in the high mental health load profile showed lower levels of psychosocial resources compared to individuals decreasing to the medium mental health load profile.

Conclusions: This study highlights a positive role of psychosocial resources on mental health transitions, underlining the need for strengthening psychosocial resources beyond initial rehabilitation.

Abstract: Introduction: Intubated, ventilator unweanable patients with ventilatory pump failure (VPF) can be extubated to continuous noninvasive positive pressure ventilatory support (CNVS), however, delays may result in untoward effects on speech and swallowing.Methods: Retrospective chart review of VPF patients to determine need for post-extubation gastrostomy tubes (GTs) and consequences on speech for intubations less than (short) vs. greater than (long) three weeks.Results: 165 patients were intubated for a mean 20.7 ± 23.5 (range = 1 to 240) days. All recovered pre-hospitalization speech status within two hours to 3 days. 104 of the short group were intubated 1.6 ± 1.3 (range = 1 to 9) times for 9.9 ± 5.1 (range = 1 to 20) days vs. 61 of the long group intubated 2.4 ± 3.3 (range = 1 to 26) times for 39.0 ± 30.5 (range = 21 to 210) days. 10.6% vs. 8.2%, respectively, required post-extubation GTs indefinitely.Discussion: There was no difference in untoward effects on speech or swallowing from short vs. long-term intubation. Had the patients undergone tracheotomies, the majority would have had GTs 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 CNVS rather than tracheotomy.