American Journal of Physical Medicine & Rehabilitation最新文献

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.

Abstract: Obstacles and barriers in real-world settings can limit community participation for mobility device users. Effective training requires foundational device skills and realistic scenarios to help mobility device users anticipate and respond in real time. The HERL-Town is an educational board game designed to provide training on community transportation for mobility device users and other stakeholders. This study aimed to validate two game elements: transportation scenarios and a series of response options, respectively representing real-life transportation barriers and corresponding strategies to address these challenges. Through a nationwide online survey, Item-level Content Validity Index of 60 scenarios and preference for each of the four response options per scenario were rated by mobility device users and travel companions. A total of 126 individual participated in the study. Two scenarios did not satisfy the Item-level Content Validity Index standard (i.e., 0.78) were removed and 58 were retained. While most preferred (i.e., 1 st ranking) and least preferred (i.e., 4 th ranking) answers were consistent across participants, preference for the middle rankings (i.e., 2 nd and 3 rd tended to vary). Finalized scenarios and ranked response options can be applicable as game elements that simulate transportation barriers and facilitate discussions on safe and independent community mobility of mobility device users.

Objective: To systematically evaluate the effects of noninvasive brain stimulation (NIBS) on pain intensity, psychological symptoms, and quality of life in patients with central poststroke pain (CPSP).

Design: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted. Databases including PubMed, Embase, Cochrane Library, Web of Science, and CNKI were searched through April 2025. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated, and subgroup analyses were performed by stimulation target and modality.

Results: Thirteen RCTs involving 430 participants were included. Compared with sham stimulation, NIBS significantly reduced pain intensity (SMD = -0.64, 95% CI: -1.24 to -0.05, p = 0.035). Subgroup analyses showed greater pain reduction when stimulation targeted the primary motor cortex (M1) (SMD = -1.07, 95% CI: -1.62 to -0.52) and when using transcranial direct current stimulation (tDCS) (SMD = -1.08, 95% CI: -1.99 to -0.17). However, no significant effects were observed on depression, anxiety, or quality of life.

Conclusion: NIBS, particularly M1 stimulation and tDCS, may provide analgesic benefits for CPSP but appears ineffective for psychosocial outcomes. Larger, well-designed trials are required to validate stimulation-specific efficacy and clarify the broader therapeutic role of NIBS in CPSP.

Objective: To compare the effects of two nutritional supplementation strategies Amendcor® (Creatine, D-ribose, coenzyme Q10, and vitamin E) vs. Ubiquinol+D-ribose, combined with a 12-wk group-based high-intensity aerobic interval training (GB-HIAIT) on functional exercise capacity (FEC), health-related quality of life (HRQoL), left ventricular ejection fraction (LVEF), and perceived exertion (PE), in patients with heart failure with reduced ejection fraction (HFrEF).

Design: 68 patients with HFrEF were randomly assigned to a Creatine + D-ribose + CoQ10 + Vit. E) (n = 35) or a Ubiquinol + D-ribose group (n = 33) and performed GB-HIAIT. The primary outcome was FEC, assessed via the 6-minute walk test (6MWT), peak VO₂, and peak respiratory exchange ratio (RER). Secondary outcomes included HRQoL, LVEF, and PE.

Results: Study participants supplemented with Creatine + D-ribose + CoQ10 + Vit. E demonstrated significantly greater improvements in FEC (6MWT: +19.88%, VO₂ peak: +25.46%, PE: -38.53%), HRQoL: -25.64%, LVEF: +40.94%, compared with subjects supplemented with Ubiquinol + D-ribose (P < 0.05).

Conclusions: Patients with HFrEF who received multi-ingredient supplementation combined with GB-HIAIT demonstrated superior improvements in FEC, HRQoL, LVEF, and PE, compared with those supplemented with Ubiquinol + D-ribose.