American Journal of Physical Medicine & Rehabilitation最新文献

Objective: This study aimed to determine repetitive transcranial magnetic stimulation, transcranial direct current stimulation, and cranial nerve noninvasive neuromodulation affect functional balance, gait speed, and walking cadence in stroke patients.

Methods: We searched PubMed, Embase, Cochrane, and Scopus (June 22, 2022) for randomized controlled trials. Three reviewers independently performed data extraction and assessed the risk of bias. Network and pairwise meta-analyses were performed to assess indirect and direct comparisons.

Results: We included 34 studies ( N = 915 patients). Sixty percent had moderate-to-high methodological quality. The meta-analyses showed positive effects of repetitive transcranial magnetic stimulation combined with rehabilitation therapy compared with sham on gait speed, walking cadence, and balance function with weighted mean differences and 95% confidence interval of 0.08 (0.03 to 0.13), 7.16 (3.217 to 11.103), and 3.05 (0.52 to 5.57), respectively. Transcranial direct current stimulation showed improvement on the time up and go test (-0.88 [-1.68 to -0.08]). From the surface under the cumulative ranking analyses, repetitive transcranial magnetic stimulation is the best ranked treatment for gait speed and functional balance improvement compared with transcranial direct current stimulation and sham interventions. There were not enough studies to include cranial nerve noninvasive neuromodulation in the meta-analysis.

Conclusions: Walking cadence and speed, functional balance significantly improved after repetitive transcranial magnetic stimulation with short-term effects, which were superior to that of transcranial direct current stimulation and sham treatments. Transcranial direct current stimulation showed short-term beneficial effects on the Time Up and Go test.

Objective: The aim of the study is to investigate the efficacy of targeted scapular stabilization exercise in shoulder pain.

Design: This is an evaluator-blinded, multicenter, randomized controlled trial. The scapular stabilization exercise group ( n = 45) received scapular stabilization exercise based on the type of scapular dyskinesis for 6 wks; the conventional exercise group ( n = 45) received pendulum, wall climbing and stick exercises for 6 wks. Constant-Murley score, numerical rating scale, range of motion, type of scapular dyskinesis, lateral scapular sliding test, pectoralis minor index, scapular index, and satisfaction were assessed at baseline, 2-, 4-, and 6-wk treatment as well as a 6-wk follow-up.

Results: After a 6-wk intervention, the improvement of Constant-Murley score was greater in the scapular stabilization exercise group than in the conventional exercise group, and improvement continued at the 6-wk follow-up ( F = 15.39, P < 0.001, partial η 2 = 0.17). The results were also significant for numerical rating scale during activity, lateral scapular sliding test, pectoralis minor index, type of scapular dyskinesis, and satisfaction in favor of the scapular stabilization exercise group ( P < 0.05).

Conclusions: Targeted scapular stabilization exercise is an effective intervention program that might be applied to the rehabilitation of shoulder pain.

Abstract: This review presents a comprehensive summary and critical evaluation of intention-to-treat analysis, with a particular focus on its application to randomized controlled trials within the field of rehabilitation. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a methodological review that encompassed electronic and manual search strategies to identify relevant studies. Our selection process involved two independent reviewers who initially screened titles and abstracts and subsequently performed full-text screening based on established eligibility criteria. In addition, we included studies from manual searches that were already cataloged within the first author's personal database. The findings are synthesized through a narrative approach, covering fundamental aspects of intention to treat, including its definition, common misconceptions, advantages, disadvantages, and key recommendations. Notably, the health literature offers a variety of definitions for intention to treat, which can lead to misinterpretations and inappropriate application when analyzing randomized controlled trial results, potentially resulting in misleading findings with significant implications for healthcare decision making. Authors should clearly report the specific intention-to-treat definition used in their analysis, provide details on participant dropouts, and explain upon their approach to managing missing data. Adherence to reporting guidelines, such as the Consolidated Standards of Reporting Trials for randomized controlled trials, is essential to standardize intention-to-treat information, ensuring the delivery of accurate and informative results for healthcare decision making.

Abstract: Postherpetic neuralgia results from varicella-zoster virus reactivation post-chickenpox infection, manifesting as persistent and severe pain lasting a minimum of 3-mo post-herpes zoster onset. Traditional postherpetic neuralgia management comprises antiviral, analgesic medications, corticosteroids, and various agents. Ultrasound-guided nerve blocks have recently emerged as a promising postherpetic neuralgia treatment. In a case involving a 58-year-old man with severe thoracic herpes zoster lesions, the serratus posterior superior intercostal plane block was employed under ultrasound guidance, significantly reducing pain scores and enhancing quality of recovery. This study underscores serratus posterior superior intercostal plane block's secure, effective role in managing thoracic herpes zoster, and mitigating postherpetic neuralgia risk. This case report represents the pioneering application of serratus posterior superior intercostal plane block for postherpetic neuralgia, offering a promising avenue for relieving patients suffering from this condition.

Abstract: The purpose of this retrospective study was to examine the use of virtual visits (telemedicine) at our cancer rehabilitation outpatient clinics from March 2020 to August 2021, when virtual visits became more widely available, and to identify any demographic and clinical variables making patients more likely to favor virtual over in-person visits. There were 3971 outpatient encounters (2020 virtual and 1951 in-person visits from a total of 1638 patients) in our cancer rehabilitation outpatient clinics during this time frame. Significant findings in both the univariate and multivariate analyses were race ( P < 0.001 and P = 0.006, respectively), cancer type ( P < 0.001 for both), and distance to the clinic ( P < 0.001 for both). Our research showed that virtual visits were accepted by patients with cancer, and that younger age (62 compared to 65), non-White race/ethnicity, solid tumor, and shorter distance to the clinic were associated with a preference for virtual over in-person visits.

Objective: The aim of the study was to compare the effectiveness of a telerehabilitation exercise program versus "wait-and-see" on physical exertion, quality of life, dyspnea severity, heart rate, and oxygen saturation in patients with post-COVID fatigue and dyspnea.

Design: Sixty-four patients were enrolled in this randomized clinical trial. A telerehabilitation program based on patient education, physical activity, airway clearing, and breathing exercise interventions was conducted. Self-perceived physical exertion during daily living activities, dyspnea severity, health-related quality of life and physiological outcomes, and the 6-min walking test were assessed at baseline, after the program and at 1- and 3-mo follow-up periods.

Results: The experimental group experienced greater improvements in self-perceived physical exertion during daily living activities, dyspnea severity, health-related quality of life, and 6-min walking test (all, P < 0.001). In addition, patients undergoing the telerehabilitation program reported lower exertion scores at rest and after the 6-min walking test (both, P < 0.001). Between-group oxygen saturation differences were found at rest ( P < 0.001), but not after the 6-min walking test ( P = 0.024). Finally, significant between-group differences were found for heart rate after the 6-min walking test ( P < 0.001).

Conclusions: Although both groups showed a significant improvement after 3 mos of follow-up, the group receiving the telerehabilitation program described a greater improvement compared with the group receiving no intervention.

Objective: The purpose of this study was to further previous research and gather additional information regarding the usage of motorized shopping scooters as well as feedback for improvements to an air-powered scooter.

Methods: Online surveys were used to assess individuals' shopping characteristics and experience using the motorized scooters and to gather feedback from store employees regarding their experience. K-Means clustering analysis was used to determine user demographics who chose to use the air-powered scooter versus the electric-powered scooter while shopping.

Results: A total of 127 individuals provided informed consent, 65 individuals from site 1 and 62 individuals from site 2. One hundred twenty participants met the inclusion criteria and completed the survey. K-Means clustering found that age, type of personal mobility device, shopping bill total, and frequency using a motorized shopping scooter to be significant factors in whether individuals chose to use an air-powered scooter or electric-powered scooter.

Conclusions: Motorized shopping scooters are in high demand and used by a wide variety of individuals, yet electric-powered scooters are commonly unavailable because of having dead batteries or all the devices being in use. Air-powered scooters may serve as a practical replacement for the current electric-powered scooters found in grocery and retail stores.

Abstract: Despite the growing popularity of physical medicine and rehabilitation as a specialty among medical students, meaningful experiences and mentorship can be challenging to obtain and may significantly vary depending on opportunities available to interact with physiatrists. This study explores the association between the geographic proximity of physical medicine and rehabilitation residency programs to medical schools and the match rate of medical students into physical medicine and rehabilitation from 2019 to 2021. Data on US medical schools, graduates, and physical medicine and rehabilitation residency programs were collected from publicly available sources, and a sample of 1193 physical medicine and rehabilitation residents from US medical schools was analyzed using a one-sample proportion test. The proportion of physical medicine and rehabilitation residents originating from medical schools with physical medicine and rehabilitation residency programs in the same metropolitan area was significantly greater than the corresponding proportion of expected residents based on medical school graduates, even when controlling for medical school affiliations with physical medicine and rehabilitation residency programs. These findings suggest that exposure and opportunities provided by physical medicine and rehabilitation residency programs may influence nearby medical students and that expanding residency programs into geographic regions without existing physical medicine and rehabilitation programs may foster interest and promote growth in the field of physiatry.