American Journal of Physical Medicine & Rehabilitation最新文献

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: 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.

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.

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.