American Journal of Physical Medicine & Rehabilitation最新文献

Objective: A Paralympic sport classification system aims to minimize the impact of the athlete's impairment on performance, thus contributing to a fair competition. The aim of this study was to investigate consensus among an expert panel regarding statements on recent scientific findings and their implications for handcycling classification.

Design: Three rounds of online questionnaires were sent to an international panel ( N = 53) consisting of para-cyclists, para-cycling coaches and team managers, classifiers, and researchers within para-sport or Paralympic classification. The second and third questionnaire rounds were based on insights gathered from the previous round.

Results: Consensus was reached on the inclusion of upper-limb function, shoulder function, and lower-limb function in the classification assessment of athletes competing in recumbent handcycling positions. In contrast, topics related to the role of trunk function, hand function, and equipment settings did not achieve consensus within the panel.

Conclusions: The future of handcycling classification requires consideration of these recent findings and consensus. Nevertheless, to continuously develop its system toward an evidence-based classification, the handcycling sport should further research the remaining questions and controversial topics to rely less on subjective decisions.

Purpose: The aim of this umbrella review is to assess the effectiveness of exercise interventions in preventing and managing cancer-related cognitive impairment among cancer survivors, providing an evidence-based foundation for clinical practice.

Methods: The umbrella review was preregistered on PROSPERO. It included systematic reviews that assessed any exercise interventions aimed at improving cognition in cancer patients. The overview adhered to gold standard guidelines and recommendations. We utilized AMSTAR 2 to evaluate the quality of the literature and to synthesize the consistency of the evidence in order to formulate recommendations.

Results: Based on 28 systematic reviews, four subtypes of exercise interventions were identified. High-quality evidence consistently demonstrates that aerobic exercise significantly improves performance on specific neuropsychological tests. The Hopkins Verbal Learning Test shows a score improvement (standardized mean difference (SMD) = 0.65, 95% confidence interval (CI) = 0.42, 0.88); The Trail Making Test Part A shows a reduction (SMD = -0.61, 95% CI = -0.92, -0.30). Mind-body exercises also have notable effects on alleviating subjective cognitive complaints, indicated by an improvement in the Functional Assessment of Cancer Therapy-Cognitive Function score (SMD = 0.82, 95% CI = 0.49, 1.15). However, the evidence for objective cognitive improvement is limited and inconsistent. Combined training presents preliminary evidence of synergistic effects in enhancing global cognitive function, with an average effect across multiple cognitive domains (SMD = 0.45, 95% CI = 0.20, 0.70). Currently, resistance training lacks robust, high-quality evidence, and more studies are needed to determine its effects on specific objective cognitive domains.

Conclusions: This review highlights exercise intervention as a key nonpharmacological approach for managing Cancer-Related Cognitive Impairment. Urgent priorities for future research include the following: (1) conducting high-quality randomized controlled trials to validate exercise tolerability in patients undergoing active treatment; (2) developing multimodal assessment frameworks that integrate neuroimaging and blood-based biomarkers; and (3) establishing personalized exercise guidelines tailored to specific cancer types and treatment phases. Additionally, future studies should focus on clarifying the biological mechanisms that underpin the cognitive improvements associated with exercise. This will help create a stronger evidence base for precision exercise prescription.

Abstract: As endorsed by leading endocrine societies, a fragility fracture of the hip or spine warrants a diagnosis of osteoporosis, irrespective of bone mineral density. A fragility fracture occurs from a force equal to or less than a fall from standing height, an event unlikely to cause a fracture in healthy bone. Physiatrists often manage patients with such fractures, including fractures stabilized by surgery. However, many patients are not diagnosed with osteoporosis during their acute hospitalization or rehabilitation admission, leading to suboptimal care and an increased risk of repeat fractures. This project involves a 6-mo retrospective review of 77 patients with fragility fractures at an acute inpatient rehabilitation facility, which found that none of the 77 patients were diagnosed with osteoporosis either at the time of admission or during their stay. To address this, the authors developed an educational flowchart for admitting providers and a "smart-phrase" shortcut within the electronic health record that automatically entered a diagnosis of osteoporosis into the patient's record. After intervention, 93% of patients (56/60) admitted with fragility fractures over 6 mos had osteoporosis documented in their rehabilitation medical record. Additionally, 66% of patients discussed or received osteoporosis management during outpatient primary follow-up appointments.

Objective: Lee Silverman Voice Treatment is an exercise program developed for patients with Parkinson's disease. This systematic review and meta-analysis evaluate the benefits of Lee Silverman Voice Treatment on motor function in these patients.

Design: A comprehensive search was conducted in Embase, PubMed, Cochrane Library, Scopus, MEDLINE, ScienceDirect, and PEDro up to October 2024. Two investigators reviewed studies comparing Lee Silverman Voice Treatment with other interventions on motor function outcomes. Study quality was assessed using the Cochrane Risk of Bias tool, and certainty of the evidence was evaluated using Grading of Recommendations Assessment, Development, and Evaluation methodology.

Results: The search identified 827 studies, with 6 included in the systematic review and 5 in the meta-analysis. Lee Silverman Voice Treatment significantly improved walking speed, as measured by the 10-Meter Walk Test mean difference (MD) -0.60, (95% confidence interval (CI) = -1.17, -0.02, P = 0.04). No significant improvement was found in quality of life (Parkinson's Disease Questionnaire-39 items, MD -2.79, 95% CI = -7.38, 1.80, P = 0.23). Sensitivity analysis revealed significant improvement in motor function (Unified Parkinson's Disease Rating Scale Part III, MD -5.52, 95% CI = -7.72, -3.32, P < 0.05). The certainty of evidence ranged from moderate to low.

Conclusions: Lee Silverman Voice Treatment could be more effective than general exercise in improving gait speed and motor function in patients with mild to moderate Parkinson's disease. However, because of the variability in study quality and the limited number of participants, these findings should be interpreted with caution.

Objective: The aim of the study was to determine the effects of age on inflammatory markers and histological features in the injured mouse tail intervertebral disc.

Design: Inflammatory marker gene (e.g., Cxcl1 , Il6 , Adam8 , and Tipe2 ) expression and morphological changes (histological score and % red in Safranin O staining) in the injured intervertebral discs are recorded in 3-, 10-, and 18-mo-old mice 1 wk after injury.

Results: The injured intervertebral discs had higher histological scores (more degenerative) than intact discs at all ages post injury ( P < 0.01). However, there was no significant difference among the histological scores of injured intervertebral discs from mice of three ages ( P > 0.05). Expression of inflammatory marker genes (e.g., Cxcl1 and Il6 ) was elevated in the injured compared with intact discs in mice of all ages ( P < 0.01). The injury-induced increase in gene expression was greater in 10-mo and 18-mo-old mouse discs than in the 3-mo-old mice ( P < 0.01).

Conclusions: The intervertebral discs responded to injuries similarly, regardless of age. Because of the modest age-related differences in injury effects, using mice of the same age in experiments is essential, unless one aims to examine age-related differences. Given the costs of maintaining an aged mouse colony, the necessity of using old animals may need justification.

Objective: The aim of the study was to report on real-world use of a powered exoskeleton for outpatient gait training in multiple sclerosis.

Design: We conducted a retrospective chart review on 21 patients with multiple sclerosis who completed physical therapy gait training sessions using a powered exoskeleton. Training descriptors, powered exoskeleton parameters, adverse events, and performance on mobility tests without powered exoskeleton were compared between first and last session.

Results: The median number of gait training sessions was 11. There was a statistically significant increase in walk time ( P = 0.008), number of steps ( P = 0.011), and programmed step length ( P < 0.001) while using powered exoskeleton. Three patients exhibited a greater than 20% increase in walking speed on the Timed 25 Foot Walk. The time to complete the Timed Up and Go increased ( P = 0.029), although patients who did not use a wheelchair outdoors showed a smaller mean increase in Timed Up and Go time (0.59 secs vs. 8.69 secs, P = 0.050). Five patients had one mild adverse event without impact on training participation.

Conclusions: Our findings suggest that gait training with a powered exoskeleton is safe and feasible in individuals with multiple sclerosis. Changes in mobility outcomes without powered exoskeleton were highly variable between patients. Further research is needed to establish the value of powered exoskeleton gait training and predictors of response to gait training.

Abstract: This study aimed to measure how many physical medicine and rehabilitation residencies include a disability awareness program, investigate the format and content of existing programs, understand barriers to including a disability awareness program, and evaluate receptiveness to adopting provided disability awareness resources. A Qualtrics survey was distributed through the physical medicine and rehabilitation residency program director listserv to all 112 accredited physical medicine and rehabilitation residencies in the US. Fifty-three program directors completed surveys (47%), and 52 responses were analyzed. Fifty-eight percent of physical medicine and rehabilitation residencies included a disability awareness program. Frequently utilized formats included didactic courses/lectures (82%), adaptive sports experiences (64%), and panels of individuals with disability (or their caregivers) (46%). Physical disabilities were most commonly covered in the curriculum (96%), followed by intellectual (61%) and sensory disabilities (50%). There was minimal curriculum coverage of the Alliance for Disability in Health Care Education's Core Competencies on Disability. For residencies without a disability awareness program, barriers included lack of faculty expertise in disability advocacy education (55%), insufficient resources for curriculum development (50%), and limited faculty time (41%). The majority (59%) of residencies reported they would likely or very likely adopt a provided disability awareness program. This study identifies a demand for a comprehensive, standardized disability awareness curriculum for physical medicine and rehabilitation residency programs.

Objective: The aim of the study was to identify the self-care and mobility functional response in patients with and without COVID-19 who were admitted to inpatient rehabilitation.

Design: Cross-sectional retrospective multisite study using data collected from routine care data from the Rehabilitation Registry of COVID-19 patients within 12 inpatient rehabilitation facilities across the United States from March 1 through December 31, 2020, was used.

Results: Data included 11,734 patients admitted to one of the participating hospitals. Of the patients admitted, 868 had active or had recently recovered from COVID-19 before their admission to the rehabilitation hospital. Patients with active or who had recently recovered from COVID-19 were younger with a mean age 65.74 yrs, over half being male (60.0%) and White (64.4%), with significance seen in the African American population. Fewer patients with COVID returned home, and the majority in both groups had neurological diagnoses, longer lengths of stay, fewer minutes of therapy, and a lower functional response in the self-care domain.

Conclusions: This study demonstrates patients with active and recovered COVID-19 who received inpatient rehabilitation made significant gains in self-care and mobility. These findings suggest that a structured inpatient rehabilitation program may provide benefit in patients with active and recovered COVID-19.