American Journal of Physical Medicine & Rehabilitation最新文献

Objective: This systematic review and meta-analysis evaluated the effectiveness of fully immersive virtual reality (IVR) and fully immersive virtual environment (IVE) in improving balance, motor function, cognitive performance, and quality of life in individuals with Parkinson's disease (PD), compared to conventional treatment (CT).

Design: PubMed, Cochrane Library, and Web of Science were searched up to April 2025. Of the 983 studies screened, 13 studies met the inclusion criteria, following the PRISMA guidelines. Individuals with PD receiving fully IVR/IVE rehabilitation were included compared to CT. The meta-analysis only included RCTs and was conducted using RevMan 5.4.1 with a random-effects model and 95% confidence intervals.

Results: Fully IVR/IVE significantly improved dynamic balance TUG(s) test and motor function (UPDRS-III) with low heterogeneity, and quality of life (PDQ-39) with high heterogeneity (I2 > 50%) compared to CT. No significant changes were found for the static balance (BBS), Tinetti scale (TS), and Falls Efficacy Scale-International (FES-I).

Conclusion: Rehabilitation integrating fully IVR/IVE showed greater effectiveness than conventional treatment in improving dynamic balance, motor function, and quality of life in individuals with PD. Future RCTs with larger samples and extended follow-up are necessary to strengthen the evidence.

Abstract: The 7th edition update of the Rehabilitation, Recovery and Community Participation module is presented in three parts. Part Three of the series reflects the current research evidence focused on person-centered care, optimizing an individual's return to their community and engaging in active and meaningful participation. Emphasis is placed on regular healthcare follow-up, maximizing secondary prevention strategies, assessment, diagnosis, and management of mood disorders and cognitive status, sleep health, and post-stroke fatigue. Personal issues that are important and meaningful to individuals with stroke are addressed, including returning to driving, vocational roles, relationships, sexuality, life roles, leisure, social participation, advance care planning, and palliative care. This module highlights the need for coordinated and seamless systems of care that extend beyond the first few months after stroke, building on progress achieved during the initial recovery, to support seamless longer-term recovery. The main goal of these recommendations is to help individuals with stroke achieve as much independence as possible in meaningful life roles and leisure activities. Successful planning across transitions requires integrated and coordinated people-centered efforts by all stroke team members and the broader community. Active engagement of the individual and family at all stages of planning and goal setting is essential.

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.