American Journal of Physical Medicine & Rehabilitation最新文献

Objective: The aim of this retrospective cohort study was to evaluate and compare the effectiveness of Spiral Stabilization (SPS) and core stabilization exercises in adolescents with idiopathic scoliosis (AIS).

Design: Data from AIS were analyzed, dividing by clinical decision and treatment availability into SPS (n = 24, age 10.75 ± 2.57 years) and core stabilization (n = 24, age 11.71 ± 1.99 years). Baseline characteristics, including sex, BMI, and Risser stage, were comparable (all P > 0.05).Each intervention consisted of supervised, active sessions twice weekly for 5 weeks (30 minutes/session), followed by a 6-month home program.Outcomes included Cobb angle (primary) and pain (VAS), trunk rotation (ATR), clavicle angle, pelvic obliquity, trunk aesthetics(TRACE), quality of life(SRS-22), and joint hypermobility (Beighton Score), all assessed pre- and post-intervention.

Results: Both groups improved significantly in Cobb angle, trunk aesthetics, and clinical outcomes(All P<0.05). The SPS group demonstrated significantly greater improvements in Cobb angle, trunk rotation, clavicle angle, pelvic obliquity, and self-image(SRS-22) compared to core stabilization(All P<0.05). Beighton Score correlated positively with Cobb angle correction (ρ = 0.31, P = 0.033), indicating flexibility may modestly influence outcomes.

Conclusion: SPS was more effective than core stabilization in improving spinal alignment, aesthetics, and self-image. Flexibility appears to influence treatment.

Objective: Patients with tetraplegia experience significant limitations in upper extremity function, restricting the performance of activities of daily living (ADL). Herein, we evaluated the effects of upper extremity training using an exoskeleton robot device, in the form of mobile arm support (MAS), on functional recovery and ADL performance.

Design: This preliminary study employed a one-group pre-post-test design and used a Wilmington robotic exoskeleton for training. The training comprised six sessions conducted three times per week over a 2-week period. Assessments were conducted using the manual muscle test, range of motion (ROM), upper extremity functional index (UEFI), and efficiency of assistive technology and services (EATS-6D). Twenty participants were enrolled.

Results: The participants demonstrated significant improvements in muscle strength across shoulder and elbow flexion. Regarding ROM, significant improvements were observed in all areas except for shoulder internal rotation and elbow flexion. The UEFI results indicated no significant differences in the difficulty of performing most tasks. The EATS-6D showed some improvement in task performance difficulty; however, they were not significant.

Conclusion: A gravity-balanced exoskeleton robot effectively improved the upper extremity muscle strength and ROM in patients with tetraplegia. MAS devices can be utilized to assist in upper extremity function and training in patients with tetraplegia.

Abstract: Homelessness significantly hinders access to inpatient rehabilitation (IPR) services, particularly for individuals with complex medical and functional needs. This case series presents three persons experiencing homelessness (PEH) with disabilities-due to amputation, functional neurological disorder, and stroke-who require coordinated rehabilitation care. Each case illustrates the compounded barriers PEH face, including lack of stable housing, limited access to follow-up care, and fragmented healthcare and social service systems. Through interdisciplinary collaboration involving physiatrists, outreach occupational therapists, and social workers, each patient successfully accessed IPR and continued rehabilitation post-discharge despite persistent challenges. The cases underscore the importance of low-barrier, community-based care models and policy changes that view housing as a critical component of healthcare. Recommendations include adopting an expanded Housing First (+) model, improving medical respite programs, and integrating social services into rehabilitation planning. These strategies can improve health outcomes and community reintegration for PEH, highlighting the need for systemic reform to ensure equitable access to rehabilitation services.

Objective: To analyze the most current evidence to evaluate the effectiveness of physiotherapy interventions in improving post-surgical functional outcomes in patients who had undergone reverse total shoulder arthroplasty (RTSA).

Design: This systematic review was conducted by searching the PubMed and Embase databases and selecting studies including subjects who had undergone post-surgical rehabilitation after RTSA.

Results: Nine studies were selected with a total sample size of 394 patients followed during a period that varies between 3 and 24 months. All studies indicated substantial functional improvement in patients after a physiotherapy program. Regarding the American Shoulder and Elbow Surgeons scale, the multimodal physiotherapy intervention based on kinesiotherapy plus strengthening showed a small to moderate effect size (d Cohen = 0.47 - 0.56). This clinical relevance was very strong (d Cohen = 2.35) in the only study that included a detailed load progression together with functional activities. Furthermore, early intervention has been demonstrated to be effective with a moderate effect size (d Cohen = 0.52).

Conclusion: The current evidence may confirm that an intervention based on early motion and strength exercise seems to be beneficial in functionality and range of motion in patients with reverse total shoulder arthroplasty.

Objective: Neuropsychological tests of executive function often rely on reading, writing, and/or calculation, introducing educational bias. ReacStick uses a rapid go/no-go paradigm (within a 390 millisecond window) to assess attention, processing speed, inhibition, and working memory without requiring proficiency in reading, writing, or calcuation.

Design: Secondary analyses using cross-sectional data examined the impact of years of education on Trails B, a gold-standard measure of executive function, and ReacStick parameters in healthy older adults (n = 139) and adults with hepatic cirrhosis (n = 118).

Results: Fewer years of education correlated with longer Trails B completion times (r = -0.214; p < 0.001) and accounted for 5.3% of Trails B variance when controlling for age, gender, and clinical group (cirrhosis vs. older) as covariates. In contrast, years of education showed no significant relationship with ReacStick accuracy parameters (On, Off, and All Accuracy). Similar results were obtained when years of education was dichotomized (≤ 12 vs. > 12 years).

Conclusion: ReacStick offers a quantifiable test of executive function with limited education bias, supporting its use in diverse population, including those with limited educational attainment or non-native English speakers.

Objective: To compare pre-injury and initial subacute clinical characteristics of adolescents with sport-related concussion (SRC) to those with non-sport-related concussion (non-SRC) who present to a specialty concussion clinic.

Design: Cross-sectional analysis of 136 adolescents 10-18 (Mean = 14.4 ± SD = 2.3) years presenting to a specialty concussion clinic 2-30 (M = 9.25 ± SD = 6.3) days post-injury. Main measures included 1) Clinical Interview, 2) Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), 3) Post-Concussion Symptom Scale (PCSS), 4) Vestibular/Ocular-Motor Screening (VOMS), 5) Screen for Child Related Anxiety Disorders - Child Version (SCARED-C), 6) Generalized Anxiety Disorder Assessment (GAD-7).

Results: 101 (74.3%) participants reported an SRC, and 35 (25.7%) reported a non-SRC. Adolescents presenting to the clinic with non-SRC were older, more likely to be female, presented to the clinic later, and reported headache/migraine and depression history (p < 0.05). These adolescents also reported a higher PCSS symptom severity and GAD-7 total score compared to their SRC counterparts (p < 0.01). Forward stepwise logistic regression revealed significant associations between non-SRC and headache/migraine history (adjusted [a]OR = 2.95, 95%CI = 1.17-7.47, p = 0.022), PCSS total score (aOR = 1.04, 95%CI = 1.02-1.06, p < 0.001), and days to clinic (OR = 1.08, 95%CI = 1.01-1.15, p = 0.029).

Conclusions: The most salient factors associated with non-SRC patients presenting to a specialty concussion clinic were a headache/migraine history, a longer time to clinic, and greater initial visit symptoms. These findings suggest that the factors that lead patients with SRC and Non-SRC to present to a specialty clinic differ, and that studies that are interested in differences in clinical characteristics based on mechanism of injury will need to address substantial referral differences between these two populations that would confound such findings.

Objective: The prevalence of burnout in Canadian physiatrists is unknown. This study describes the prevalence of burnout in Canadian physiatrists and explores predictors.

Design: This national cross-sectional web-based survey used convenience sampling, targeting Canadian physiatrists (staff, fellows, residents). The Checklist for Reporting Results of Internet E-Surveys was used to ensure reporting quality. Statistical analyses included descriptives, correlations, and logistic regressions. Survey items included personal and professional characteristics, and validated measures for burnout, relational compassion, emotion regulation, and moral injury.

Results: One hundred eighteen responses were collected from a possible 501 physiatrists across Canada. Majority were female (53%), White North American (55%), and working in an urban setting (93%). Forty-two percent ( n = 50) had burnout, 43% moral injury, and 40% difficulties regulating emotions. Burnout was more likely in females ( P = 0.0064; odds ratio 5.24, 95% confidence interval 1.60-17.3), and White respondents ( P = 0.0213; odds ratio 0.24, 95% confidence interval 0.07-0.81). Higher relational compassion conferred a lower risk of burnout ( P = 0.0006; odds ratio 0.80, 95% confidence interval 0.71-0.91); greater difficulty regulating emotions predicted higher risk of burnout ( P = 0.0406; odds ratio 1.06, 95% confidence interval 1.00-1.11), and moral injury ( P < 0.0001; 95% odds ratio 1.16, 95% confidence interval 1.09-1.24).

Conclusions: Burnout affects 4 in 10 Canadian physiatrists. Physiatrists who are female, White, and report greater difficulties regulating emotions are at greater risk.

Abstract: Education in quality improvement is linked to high-quality health care, and involving residents as key leadership in quality improvement projects ensures a level of engagement to reinforce principles in practice. Obtaining timely laboratory data in inpatient settings is critical to decision making. This resident-led group identified that the established forms of communication regarding uncollected laboratory draws at this inpatient rehabilitation facility were not standardized. There was significant variance in communication between phlebotomists and clinicians. Based on a root cause analysis, the quality improvement team concluded that a single unified email notifying clinicians about uncollected labs would be an effective and efficient communication method. A standardized email template was created and sent to the resident physicians and advanced practice providers during a 2-week feasibility pilot. After a successful pilot intervention, the communication email was expanded to include attending physicians. The standardized weekday email was distributed 100% of the time during both 2-week interventions. The residents leading the project gained a better understanding of the dynamics of interdisciplinary collaboration required within hospital operations to facilitate the success of a quality improvement intervention.