American Journal of Physical Medicine & Rehabilitation最新文献

Objective: To describe dropout rates, reasons, and factors associated with dropout during rehabilitation programs for patients with Long COVID.

Design: A search was conducted in PubMed, Embase, and Web of Science. Clinical trials were included that involved exercise programs lasting at least 4 weeks and focused on Long COVID patients aged 18 or older of both sexes, reporting on dropouts and their reasons. The TESTEX scale assessed study quality. Data on patients, interventions, and dropout rates were extracted and presented as frequencies.

Results: Twenty-three studies with 1,523 patients (mean age 53.0 ± 6.4 years, 51% female) were included. Overall, 14% (n = 216) of Long COVID patients dropped out. Reasons included health problems (23%), incomplete assessments (19%), loss of interest (16%), lack of adherence (7%), adherence to other interventions (4%), and 31% unreported. The dropout rate was significantly higher in 2020 compared to 2021 (p = 0.039), while no significant associations were observed between the dropout rate and other variables.

Conclusion: Exercise rehabilitation studies for Long COVID patients show a 14% dropout rate, with the most common reasons being health-related issues and incomplete assessments.

Abstract: The COVID-19 pandemic spurred global engagement with continuing medical education (CME). The Canadian Advances in Neuro-Orthopedics for Spasticity Consortium's free online platform offering interdisciplinary expert lectures on spasticity saw parallel growth. We analysed 1733 responses from 41 post-session surveys to assess the learner's perspectives of online CME using a convergent mixed-methods design. The qualitative analysis produced four themes: [1] event value and satisfaction (subthemes: quality and impact of speakers, accessibility of the online format, discussions and interactions, and the benefits of visual learning), [2] increased competence (subthemes: increased knowledge, intent to apply, and increased confidence), [3] inspiring collaboration (subthemes: need for multidisciplinary teams, international collaboration, and effective communication tools), [4] considerations and recommendations (subthemes: relevance to developing countries, technical aspects, and academic level of content). Quantitative analyses supported these findings, showing high levels of satisfaction and perceived gains in knowledge. Notably, 88% of participants indicated intent to apply their knowledge, and 84% stated that it would enhance their competence. These results underscore the importance of interaction in online education and highlights a need for communication skills training to facilitate multidisciplinary teamwork. The findings revealed disparities in perceptions of the academic difficulty of CME, which warrants investigation into participants' CME selection.

Abstract: This study examined preferences in interview type and signals among applicants interviewed by a non-surgical residency program during the 2023-2024 application cycle. A Qualtrics survey was sent to 88 interview applicants of a university-based Physical Medicine and Rehabilitation (PM&R) residency program. Main outcomes included interview type preference the applicants had with our PM&R program only and their interview type preference with multiple PM&R programs, and preferred number of signals. A resulting 38% of applicants completed the survey. The responders (n = 33) had a similar sex and race distribution compared to all interview applicants. Regarding preferred interview type for our single program, 42% favored in-person, while 40% favored virtual. Those geographically closer to our program had similar interview-type preferences compared to participants from other regions. For multiple program interviews, 52% preferred hybrid, 24% virtual, and 15% in-person format. For signal preferences, 70% of the applicants preferred more than five program signals. The program signaling preference was similar between those with more versus less interviews, for which the cut-off of 10 interviews during the 2023-2024 application cycle was used. Overall, respondents did not have a preferred interview format with a single program, strongly preferred the hybrid format when considering multiple programs, and preferred more program signals.

Objective: This cross-sectional study examined associations between wheelchair sprint and anaerobic power (measured in the lab) and wheelchair mobility performance (measured in the field) among two groups of wheelchair tennis players. Additionally, construct validity was assessed for both lab and field tests.

Design: Nine amateur and nine elite wheelchair tennis players performed a Sprint and Wingate test on a wheelchair ergometer in the lab and a Sprint, Illinois and Spider test in the field, with inertial measurement units on their wheelchairs. Associations were assessed using regression analyses, and construct validity was assessed with an independent t-test (elite vs. amateur).

Results: The strongest associations were observed between lab outcomes and field sprint power (R2 > 90%), followed by peak linear velocity and test duration (R2 = 77-85%), while peak rotational velocity showed the lowest associations with lab outcomes (R2 = 69-80%). The elite group outperformed the amateur group on all test outcomes.

Conclusion: Despite differences in lab- and field-testing methodologies (e.g., trunk influence, linear/rotational components), the strong associations indicate overlap in measured constructs. Field testing offers valuable insight into practical performance, whereas lab testing enables in-depth biomechanical and physiological analyses. All tests effectively discriminate between elite and amateur wheelchair tennis players.

Objectives: Many people with amyotrophic lateral sclerosis (ALS) develop cervical muscle weakness, often managed with cervical collars. Finding supportive and comfortable collars can be challenging. This study aimed to evaluate satisfaction with various collars and their impact on activities of daily living.

Design: This electronic survey study collected demographic information, clinical status, and participant experiences with commonly used cervical collars.

Results: Thirty-four participants (33 with ALS, 1 with primary lateral sclerosis) completed the survey, with 79% reporting neck weakness and 38% experiencing neck pain. Among those who tried cervical collars (65%), many had tried multiple options. The mean satisfaction across all collar types was 5.03 (SD = 2.92) out of 10.

Conclusion: These findings suggest current collars do not fully meet the needs of people living with ALS, emphasizing the importance of improved treatment options. Future research should explore innovative technologies to improve cervical support, function, and quality of life.

Objective: To assess the effects of neuromuscular electrical stimulation combined with lumbar stabilization exercises on lumbar multifidus muscle thickness, disability, pain, depression, anxiety, and fear-avoidance beliefs in patients with chronic low back pain; and to examine the correlation between ultrasound and magnetic resonance imaging of the lumbar multifidus.

Design: Forty patients aged 18-65 years were randomized into two groups: Group 1: exercise and Group 2: exercise + neuromuscular electrical stimulation. The participants underwent 15-session electrical stimulation and/or exercise (3 days/week). All outcome measures assessed at baseline, post-treatment, and 3 months after. Multifidus cross-sectional area on magnetic resonance imaging was measured only at baseline.

Results: Multifidus thickness increased, and pain decreased significantly in both groups, more prominent in Group 2. Disability, depression, and fear-avoidance beliefs scores significantly decreased in both groups, while anxiety decreased only in Group 1. Both magnetic resonance and ultrasound measurements demonstrated excellent inter-rater reliability and statistically significant correlations.

Conclusion: Both groups improved in terms of pain, disability, psychological status and muscle thickness. Neuromuscular electrical stimulation adjunct to lumbar stabilization exercises demonstrated enhanced effectiveness in increasing lumbar multifidus thickness.

Objective: This cross-sectional study assesses the relationship between physical activity (PA) and crucial indicators of cognitive function in older adults with osteoarthritis and moderate-severe pain.

Design: Data were derived from the 9th wave of the Survey of Health, Ageing and Retirement in Europe (SHARE), conducted among older people in 27 European countries and Israel. Cognitive measures of verbal fluency, immediate recall, delayed recall, and numeracy were included, as well as self-reports of PA level. Multivariable linear regression analysis was applied to test associations, adjusted for various demographic and lifestyle factors.

Results: 7,429 participants were included. A positive association was found between performing moderate PA more than once a week and better verbal fluency (β = 2.16; 95%CI: 1.75-2.58), immediate recall (β = 0.51; 95%CI: 0.41-0.60), delayed recall (β = 0.45; 95%CI: 0.34-0.57) and numeracy (β = 0.43; 95%CI: 0.34-0.52) compared to hardly ever or never performing PA. Additionally, a positive but weaker association was found between performing vigorous PA once a week and better verbal fluency (β = 1.52, 95%CI: 1.02-2.02), immediate recall (β = 0.29, 95%CI: 0.18-0.41), delayed recall (β = 0.41, 95%CI: 0.27-0.54) and numeracy (β = 0.33, 95%CI: 0.23-0.44).

Conclusions: Regular PA, particularly moderate intensity, is positively associated with better cognitive measures of verbal fluency, immediate recall, delayed recall, and numeracy, with the strongest benefits observed for verbal fluency.

Objective: This study aimed to assess the influence of social determinants of health on discharge location after an acute care hospital admission due to stroke.

Design: Retrospective analyses assessed electronic medical records (EMR) from an acute facility in North Carolina dating from November 20, 2014, to December 29, 2019 (N = 4,603). All subjects were diagnosed with stroke and received at least one physical therapy session. Multinomial stepwise logistic regression assessed the clinical and demographic factors associated with being discharged to each home care with services, skilled nursing facilities, or inpatient rehabilitation in comparison to home care without services.

Results: After accounting for clinical variables, being younger, having a significant other, holding private insurance, being female, and being of Hispanic ethnicity were associated with a greater probability of being discharged to home care without services. Compared to White patients, Black patients were more likely to be discharged to home care with services than home care without services. Intraclass correlations indicated that zip code of residence may influence likelihood of being discharged to a skilled nursing facility.

Conclusion: This analysis demonstrates that social determinants of health are associated with discharge location.

Objective: To determine clinical effectiveness of an 8-week functional restoration program (FRP) compared with conventional medical management (CMM) in patients with chronic pain following work-related injury in the workers' compensation system.

Design: Observational retrospective chart review of 485 patients treated between January 1, 2020, and December 31, 2022. Included patients with chronic pain following work-related injury who participated in a multidisciplinary evaluation and were considered appropriate for FRP. Outcomes were analyzed for two groups: FRP group completed an 8-week program, and CMM group did not receive FRP treatment. The ordinary least squares regression model was used to control confounding factors, and an independent t-test was performed to assess FRP effectiveness.

Results: FRP graduates demonstrated improvements in depression, anxiety, self-efficacy, and physical function; CES-D (< 0.001), GAD-7 (p < 0.01), PSEQ (p < 0.001), NDI (p < 0.001), and ODI (p < 0.001) scores were statistically significant compared to CMM. The LEFS and QuickDASH scores did not show statistically significant improvement with FRP.

Conclusion: FRP offers a clinically effective treatment option to improve self-efficacy, anxiety, depression, and physical function in patients with chronic pain associated with work-related injury. Prospective, randomized control trials could be key in validating and identifying further variability in outcomes.

Objective: This study evaluated the characteristics of head injuries in male beach soccer players via video footage.

Design: Video recordings of all official beach soccer tournaments played by European national male beach soccer teams from 2018 to 2022 (n = 516) were analyzed retrospectively. The main collected variables were the injury mechanism, bleeding, the injured player action, whether the injury led to time-loss, and whether there were any video signs of possible concussion in an injury case.

Results: A total of 214 head injuries were documented, corresponding to 68.3 injuries/1000 player hours. The injury mechanism was apparent in 202 injuries. Of these injuries, 15.3% had video signs of suspected concussion, and 9.9% led to time-loss. The most common mechanism was opponent contact (74.8%, n = 151) and the most common submechanism was head-to-head contact (23.8%, n = 36), followed by foot-to-head contact (23.2%, n = 35). A total of 38.1% (n = 77) injuries were related to heading. Injuries with video signs of suspected concussion were 44.53 times more likely to result in time loss.

Conclusion: The findings revealed that head injury in beach soccer is an urgent problem that should be addressed. The authors strongly recommend future studies that include clinical assessments to better understand head injuries in beach-soccer.