American Journal of Physical Medicine & Rehabilitation最新文献

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.

Objectives: The aim of this study was to investigate the effect of diaphragmatic breathing exercise with biofeedback on respiratory function in incomplete cervical spinal cord injury (SCI) patients.

Design: Forty SCI patients (mean age: 32.67 ± 5.08 years) were randomly entered into two groups including the control group (n = 20) and the intervention group (n = 20). Forced Expiratory Volume in 1 second (FEV1), Functional Vital Capacity (FVC), Maximum Voluntary Ventilation (MVV) tests were performed to measure pulmonary function and Nijmegen Questionnaire (NQ) was used to evaluate severity of respiratory dysfunction before, immediately after intervention, and one month after the intervention.

Results: The mean of pulmonary function tests in the intervention group was increased after the intervention (p < 0.001) and at one-month after intervention (p < 0.001).In addition, the control group indicated no change in these variables. The NQ score also decreased significantly in both groups (control group = p < 0.001, intervention group=, p < 0.001). The change of NQ score significantly differed between the groups (F = 4.67, p = 0.03); also, significant difference was observed after intervention (p < 0.001) and one month follow-up (p < 0.001).

Conclusion: The application of visual biofeedback during breathing exercise can improve pulmonary function and mechanism may make the NQ improve as a reflection of lowered dyspnea.

Objective: To assess oral sensory deficits and their correlation with mastication and swallowing in patients with stroke.

Design: This prospective observational study was conducted in the stroke unit of a rehabilitation hospital. The inclusion criterion was first occurrence of stroke with a unilateral lesion. Patients underwent oral sensory tests, including tactile sensation (light touch, two-point discrimination) and proprioception, along with mastication and swallowing assessments via videofluoroscopic swallowing study (VFSS) and Test of Masticating and Swallowing Solids (TOMASS).

Results: Among 36 patients, contralesional sides exhibited reduced oral sensory function (light touch, two-point discrimination, and proprioception of lips) compared with ipsilesional sides (p = 0.003, p = 0.001, p = 0.046, respectively). Oral proprioception was negatively correlated with mastication and swallowing. Proprioception of tongue showed negative correlation with mastication (p = 0.035), while combined value of proprioception of teeth, lip, and tongue showed negative correlation with time per swallow. Contralesional light touch and two-point discrimination influenced swallow items in TOMASS and pharyngeal phase items in VFSS.

Conclusion: Patients with stroke demonstrated contralesional oral sensory deficits, which were associated with impaired mastication and swallowing. Oral proprioception was correlated with mastication and swallowing, whereas tactile sensation correlated with the pharyngeal phase.

Objective: Spurling's test (ST) is commonly used to diagnose cervical radiculopathy (CR); however, its diagnostic accuracy varies across studies. This systematic review and meta-analysis aim to evaluate the diagnostic performance of ST for CR.

Design: A systematic search of PubMed, ClinicalTrials.gov, Cochrane Library, and Physiotherapy Database was conducted following PRISMA guidelines. Studies assessing ST against imaging or electrodiagnostic tests were included. A bivariate random-effects model calculated pooled sensitivity, specificity, likelihood ratios (LR), and log diagnostic odds ratios.

Results: Eight studies met the inclusion criteria. The pooled sensitivity of ST was 0.53 (95% confidence interval [CI]: 0.29-0.78), higher with imaging (0.67) than with electrodiagnostic testing (0.31). Combining neck rotation or extension increased sensitivity to 0.67, compared to 0.31 without. The pooled specificity was 0.92 (95% CI: 0.88-0.96), 0.93 with imaging and 0.91 with electrodiagnostic testing. The pooled positive LR was 3.28, negative LR was 0.28, and the log diagnostic odds ratio was 2.74.

Conclusions: ST is highly specific but has low sensitivity for CR diagnosis, making it better suited for confirmation than screening. Sensitivity may improve with added maneuvers and imaging as a reference.

Objective: A concomitant traumatic brain injury (TBI) is often seen in patients with acute traumatic spinal cord injury (TSCI). Unfortunately, the exact epidemiology of concomitant TBI-TSCI remains unknown. Our objective was to determine the incidence of concomitant TBI-TSCI and identify clinical factors associated with its occurence.

Design: A prospective cross-sectional study of 476 TSCI patients was conducted. In all patients, baseline characteristics were routinely collected and the presence of a TBI was sought prospectively by a specialized neurosurgeon using standardized diagnostic criteria based on clinical and radiological variables.

Results: Out of the 476 included patients, 250 (53%) had isolated TSCI and 226 (47%) had concomitant TBI-TSCI. Almost 85% of diagnosed TBI were mild. At the univariate level, patients with concomitant TBI-TSCI were more likely to present a history of drug/alcohol abuse (p = 0.014), be involved in a motor vehicle accident (p < 0.001), sustain a high energy mechanism (p < 0.001) or present tetraplegia rather than paraplegia(p = 0.021). These factors all remained significant at the multivariate level.

Discussion: A concomitant TBI can be found in around 50% of TSCI individuals. There are several clinical variables that should increase clinical suspicion of underlying TBI and warrant further investigation to facilitate prompt identification and treatment of affected patients.

Objective: To comprehensively survey the impact of botulinum neurotoxin (BoNT) on muscle volume or mass in treating lower limb spasticity in individuals with spastic cerebral palsy (CP).

Design: We searched PubMed, Embase, Web of Science, and the Cochrane Library up to May 15, 2024. We focused on changes in the volume or mass of the gastrocnemius, triceps surae, or entire distal lower limb muscles at various follow-up periods. Meta-regression analysis was conducted to assess the moderating effects of age and gross motor function classification system (GMFCS) level.

Results: Our analysis included 11 cohort studies. A significant decrease in gastrocnemius muscle volume or mass was observed 2 to 3 months post-BoNT treatment (SMD -0.496, 95% CI [-0.810, -0.181]) but not at earlier (SMD -0.134, [-0.397, 0.129]) or later (SMD -0.223, [-1.199, 0.752]) periods. The triceps surae and entire distal lower limb muscles showed no changes. Older patients (P = 0.026) and those with GMFCS I-II levels (P = 0.0191) had more pronounced decreases.

Conclusion: The present study showed a decrease in muscle volume or mass of the BoNT-injected gastrocnemius after a short follow-up period but not in the triceps surae or the distal lower limb in individuals with spastic CP.