American Journal of Physical Medicine & Rehabilitation最新文献

Abstract: Knee osteoarthritis leads to pain, functional limitations, and muscle weakness. This study compared the efficacy and safety of blood flow restriction training with high- and low-intensity resistance training in knee osteoarthritis patients. Randomized controlled trials comparing these interventions were identified through database searches. Primary outcomes included knee pain, function, muscle strength, safety, and quality of life. A network meta-analysis estimated treatment effects, ranked interventions, and assessed risk of bias (Cochrane tool) and network consistency. Fourteen randomized controlled trials involving 866 participants were included. Blood flow restriction significantly reduced knee pain (mean difference: -1.72; 95% confidence interval: [-2.44, -1.00]), improved function (mean difference: 7.12; 95% confidence interval: [2.21, 12.02]), and increased muscle strength (mean difference: 0.89; 95% confidence interval: [0.18, 1.20]) compared to low-intensity resistance training. Compared to high-intensity resistance training, blood flow restriction yielded comparable or slightly better outcomes in pain (mean difference: -0.43; 95% confidence interval: [-2.26, 1.40]) and strength (mean difference: 0.54; 95% confidence interval: [0.39, 1.48]), with fewer adverse effects. Funnel plots and rankograms showed no major publication bias or inconsistency. Blood flow restriction training seems to be a safe and effective alternative to high- and low-intensity resistance training for improving pain, strength, and function in knee osteoarthritis patients, especially those intolerant to high-intensity exercise.

Objective: The current study explored the association between knee extensor strength asymmetry and the risk of total knee arthroplasty in individuals with or at risk of knee osteoarthritis.

Design: This longitudinal cohort study analyzed data from the Osteoarthritis Initiative, including 3860 individuals with or at risk for knee osteoarthritis. Participants were categorized as having symmetrical or asymmetrical knee extensor strength based on a 10% difference between limbs. Kaplan-Meier curves and Cox regression assessed the risk of total knee arthroplasty over 10 yrs, adjusting for age, sex, body mass index, baseline Kellgren-Lawrence grade, absolute weakness, and baseline pain.

Results: Participants with asymmetrical knee extensor strength had a 30% greater risk of undergoing total knee arthroplasty over 10 yrs compared to those with symmetrical strength (hazard-ratio: 1.30, 95% CI [1.05,1.62]). Limb-specific analyses revealed that a 10% reduction in right and left knee extensor strength were associated with a 40% and 80% increased risk of right and left total knee arthroplasty, respectively.

Conclusions: Knee extensor strength asymmetry was associated with the risk of total knee arthroplasty in individuals with or at risk for knee osteoarthritis. Findings support the need to further examine if an intervention targeted at quadriceps strengthening aimed at achieving and maintaining strength symmetry can reduce total knee arthroplasty risk.

Objective: This study aims to compare the long-term results of continuous intrathecal baclofen therapy rehabilitation against those of conventional treatment for intractable spasticity in children with cerebral palsy using the International Classification of Functioning, Disability and Health of Children and Youth.

Design: This is a 5-yr single-center retrospective cohort study.

Results: The International Classification of Functioning, Disability and Health of Children and Youth data from 24 patients with cerebral palsy of Gross Motor Function Classification System levels IV-V (aged between 8 and 18 yrs) were retrospectively analyzed for 5 yrs. The results show different trends between the 12 patients who received continuous intrathecal baclofen therapy and the 12 who were excluded because of contraindications.The continuous intrathecal baclofen therapy group improved spasticity, pain, and body mass index z-scores over 12 mos and during the 5-yr follow-up with a continuous simple Baclofen administration at a maximum of 140 μg/d at a concentration of 2000 μg/mL.

Conclusions: Continuous intrathecal baclofen therapy improves structure and function, autonomy, and participation in both short and long term. Overall, the continuous intrathecal baclofen therapy group, with its characteristics of initially greater pain and hypertonia, benefited significantly from the efficacy of intrathecal Baclofen treatment compared with the control group, which continued to receive conventional treatment.The International Classification of Functioning, Disability and Health of Children and Youth outcome measures demonstrated an interrelationship between spasticity and weakness and disease progression over childhood to adolescence.Follow-up will be vital for effective personalized treatment, quality of life, and research.Long-term International Classification of Functioning, Disability and Health of Children and Youth data collection is key to comparing treatment outcomes.

Abstract: This report describes a case of stretching-induced gastrocnemius muscle rupture in a patient with lower limb spastic paresis. To the best of our knowledge, this is the first reported case of such an injury in this patient population. After 6 mins of progressive stretching of the gastrocnemius muscle, the patient experienced localized pain at the medial gastrocnemius musculotendinous junction. Ultrasonography confirmed a partial rupture of the medial gastrocnemius. In addition to presenting this clinical case, we propose a potential treatment approach based on recent evidence-based physiotherapy methods.

Objective: While cycling and walking are different motor tasks, both require the rapid reciprocal activation and relaxation of lower extremity muscles in a synergistic manner, promoting coordination patterns similar to walking. The aim of this secondary analysis was to examine the effects of forced-rate cycling on gait biomechanics after stroke.

Design: A randomized controlled trial was conducted investigating the neuroplastic effects of forced-rate cycling on upper extremity motor recovery in individuals ( n = 60) after stroke. In this secondary analysis, a subset of participants ( N = 45) completed biomechanical gait assessment at baseline and postintervention.

Results: Gait velocity increased in the cycling group by 0.08 m/sec and in the control group by 0.02 m/sec, though a group difference was not observed ( P = 0.195). Walking capacity (6-min walk test) significantly improved by 53.3 m for the cycling group versus 15.6 m for the control group ( P = 0.0036). Improvements in spatiotemporal characteristics in the cycling group included increased step length, cadence, and time spent in single-limb support, in addition to paretic limb kinetics.

Conclusions: Improvements in gait velocity after forced-rate cycling were accompanied by normalization of gait biomechanics rather than exaggerated compensatory strategies, supporting the use of aerobic cycling as a viable and safe intervention to improve locomotor control after stroke.

Abstract: In this clinical vignette, we report the case of a 22-yr-old division I collegiate wrestler who presented with chronic left foot and ankle weakness, tightness, and a burning sensation extending from the midlateral calf to the dorsum of the foot. Initial magnetic resonance imaging completed of the left knee 1 yr before presentation was unremarkable. He was given a diagnosis of exertional compartment syndrome and he was medically cleared to compete. However, after sustaining an unrelated left knee injury during a match 4 wks later, a repeat magnetic resonance imaging revealed a multiloculated cystic lesion along the popliteal artery, consistent with adventitial cystic disease. The patient underwent surgical resection of the cyst and had worsening dorsiflexion weakness following the procedure. This was despite careful intraoperative preservation of the common peroneal nerve, suggesting the rare occurrence of intraarticular extension and possible nerve involvement. This case highlights the complex nature of adventitial cystic disease, drawing parallels to intraneural ganglion cysts. We detail the importance of early recognition through high-resolution imaging and electromyography to assess for intraarticular and neural involvement preoperatively. Additionally, patient counseling should address the potential risk of foot drop as a complication of both adventitial cystic disease progression and surgical intervention.