American Journal of Physical Medicine & Rehabilitation最新文献

Objective: The study was designed to explore the effect of proprioceptive training in contrast to conventional training among individuals following anterior cruciate ligament reconstruction (ACLR). It includes joint position sense (JPS), subjective functional outcomes (Cincinnati, Knee injury Osteoarthritis Outcome Score, International Knee Documentation Committee knee form), muscle strength, pain, and kinesthesia.

Methods: PubMed, EMBASE, The Cochrane Library, and Web of Science databases were searched. Quality assessment was performed through the Cochrane Risk of Bias tool and GRADE system. The standardized mean deviation (SMD) was selected as the effect size.

Results: Fifteen studies and 537 participants were included. Compared with conventional training, proprioceptive training may significantly enhance passive JPS (SMD = -1.87 [95%CI: -2.39 to -1.34]) and single-leg hop function test performance (SMD = 0.29 [95%CI 0.04 to 0.54]). Data also indicated that proprioceptive training can moderately improve subjective functional outcomes (SMD = 0.61 [95%CI, 0.23 to 0.99]). However, there were no significant effects on active JPS, muscle strength and VAS.

Conclusion: Proprioceptive training has the potential to yield beneficial effects on knee passive JPS, hop functional test and subjective functional outcomes in patients after ACLR. However, its impact on enhancing knee active JPS and kinesthesia may not be statistically significant.

Objective: Retrospective studies suggest quality indicators (QI) are associated with falls in inpatient rehabilitation facilities (IRFs), but this claim has not yet been validated prospectively. The aim of this study was to analyze the associations between QI codes and falls in a prospective sample.

Design: For this prospective observational cohort study, we followed 658 patients from 4 IRFs who were consecutively admitted and discharged over a 6-month period. On admission, we collected patients' QI codes, and then, tracked whether they fell during their IRF stay.

Results: Univariable logistic regressions revealed that most individual QI items for communication, self-care, and mobility were significantly associated with falls. In a multivariable model with 6 different QI items, only patients' performance going up and down 1 step was significantly associated with falls. To explain this finding, we investigated the relationships between these QI items and found 3 of them to be highly correlated.

Conclusions: Most individual QI items appear prospectively associated with falls. Patients with lower QI codes are more likely to fall. Combining QI items (such as expression and toileting) may improve fall-risk assessment, but some QI items may be too interrelated to use together.

Abstract: To enhance engagement and educational outcomes, game-based learning has been introduced into undergraduate and graduate medical education programs. Using a free website, "PM&R Connections", a serious game, was created to provide trainees with an alternative method of reviewing content to identify knowledge gaps to direct studying. The game was used by 19/33 trainees and 92.3% of users required <10 minutes to complete a puzzle. 76.9% of users found the tool helpful, 69.2% recommended the game, and 92.3% desired more puzzles to be developed. Confusion on how to play and intimidation were the most reported barriers to play, and only 46% of users changed their study habits. The positive feedback and desire for more puzzles to be developed provide a foundation to further develop the game.

Objective: To investigate whether adding diaphragmatic release to corrective exercise could improve the Cobb angle and pulmonary function more than corrective exercise alone in hyperkyphotic adolescent girls.

Design: Single-blinded, randomized, controlled trial.

Methods: 118 adolescent hyperkyphotic girls were allocated randomly into two equal groups. Control group received only corrective exercise, while study group received diaphragmatic release in addition to corrective exercise. Primary outcome was Cobb angle, assessed by lateral radiographs. Secondary outcomes were pulmonary function testing, assessed by computerized spirometery. Outcomes were assessed pre- and post-treatment, after three months of interventions, in both groups.

Results: Two-way ANOVA revealed that both Cobb angle and pulmonary function testing significantly improved after treatment in both groups (p < 0.001). Time*group interaction revealed that the study group had a superior improvement in Cobb angle and pulmonary function testing compared to the control group (p < 0.003 and p < 0.001, respectively).

Conclusion: Adding diaphragmatic release to three months of multimodal corrective exercise program showed superior improvements in Cobb angle and pulmonary function testing than corrective exercise alone in hyperkyphotic adolescent girls within a shorter timeframe compared to previous studies. These results strengthen the hypothesis of its potential as a beneficial addition to the treatment of thoracic hyperkyphosis.

Objective: The study aimed to evaluate the effectiveness of mobile phone-based support in improving exercise adherence and outcomes in knee OA.

Designs: A prospective comparative cohort study was conducted with a follow-up at 3, 6, and 12 weeks, involving 210 participants allocated into intervention and control groups. The intervention group received knee exercise flyers and mobile phone-based adherence support, while the control group received only standard instructions after physiotherapy. Outcome measures included Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores, numeric rating scale pain scores, and quality of life assessments at baseline and follow-ups at 3, 6 and 12 weeks.

Results: The intervention group exhibited significant reductions in WOMAC scores, pain scores and improvement in quality of life over the 12-week follow-up compared to baseline. The intervention group exhibited significantly greater improvements in the outcomes as compared to control group.

Conclusion: A combined intervention of knee exercises leaflets and SMS/phone-call adherence support led to significant improvements in pain, functional outcomes and quality of life among individuals with knee OA. These findings underscore the potential of mobile phone-based interventions as effective adjuncts to traditional therapies for knee OA.

Objective: This study explored the interaction among ACTN3 R577X polymorphism, muscle damage, and post-exercise inflammatory response by assessing changes over time in serum creatine kinase and interleukin-6 levels.

Design: Ninety-five active Japanese participants (50 men and 45 women: 22.2 ± 2.3 years) who did not perform daily upper limb strength exercises were enrolled. Participants executed five sets of six maximal eccentric elbow flexion exercises. The exercise duration was 9 min, including rest between sets (90 s). Maximum voluntary isometric contraction, range of motion, muscle soreness, and serum creatine kinase and interleukin-6 levels were assessed pre and post and 1, 2, 3, and 5 d after exercise. Genotype groups were classified as RR + RX and XX based on the absence of ACTN3 expression.

Results: A significant time and group interaction (p = 0.045) on creatine kinase levels was observed between the groups, indicating that the absence of ACTN3 significantly affects creatine kinase changes. Conversely, no significant interaction on change in interleukin-6, maximum voluntary isometric contraction, range of motion, and muscle soreness was observed between groups.

Conclusion: The results highlight an interaction on creatine kinase activity post-exercise by ACTN3 R577X polymorphism, with elevated activity in the XX genotype.

Objective: The aim of this study was to compare overall performance and performance within the individual disciplines (e.g., swim) in elite paratriathlon between the ambulatory classes PTS2-5 in men and women.

Design: Data were acquired from the official results of 31 International paratriathlon competitions between 2018 and 2021. 1094 results (men N = 774; women N = 320) were analyzed. One-way analysis of variance was used to compare overall performance time, absolute time spent in each discipline, and percentage of performance time spent in each discipline between sports classes. Pearson's correlation between segment times and overall times were explored.

Results: Overall time was significantly quicker in PTS5 than PTS4 and PTS3 (p < 0.05), and between PTS4 and PTS3 (p < 0.05), but no differences were found between PTS3 and PTS2. PTS5 was also quicker than PTS4 and PTS3 (p < 0.05) across most of the individual discipline times. Cycling comprised the highest percentage of race time in all classes (47.1-49.6%) and was strongly correlated to overall performance (r = 0.72-0.91).

Conclusion: Hierarchy in performance times was demonstrated between the less impaired paratriathlon classes, but not between the most impaired PTS2 and PTS3 classes. It may be appropriate for PTS2 and PTS3 to compete together.