Archives of physical medicine and rehabilitation最新文献

Objective: To describe and explain the impact of the COVID-19 pandemic and its related measures on return-to-work (RTW) outcomes following multimodal medical rehabilitation for musculoskeletal disorders.

Design: Retrospective cohort study SETTING: Three cohorts: reference (rehabilitation and RTW pre-pandemic), pandemic 1 (rehabilitation pre-pandemic, RTW during pandemic), pandemic 2 (rehabilitation and RTW during pandemic).

Participants: Individuals who underwent multimodal medical rehabilitation for musculoskeletal disorders through the German Pension Insurance system between January 2018 and December 2021 (N = 688,127).

Main outcome measure: A successful and stable RTW was operationalized as having employment subject to social insurance contributions in the ninth to twelfth month following rehabilitation.

Results: Descriptive analysis revealed a RTW rate of 67.2% in the reference cohort, a slight decline in pandemic cohort 1 (66.3%) and a more pronounced decrease in pandemic cohort 2 (63.1%). In contrast, average marginal predictions from a logistic model including various covariates showed that both pandemic cohorts (63.8%, 64.4%) exhibited similarly reduced predicted probabilities of RTW compared to the reference cohort (66.5%). Individuals with sick leave durations exceeding 6 months, compared to those with shorter sick leaves, were more negatively affected by pandemic cohort 1; however, this effect recovered in pandemic cohort 2. The interaction between cohort and income did not show any amplifying effect of the pandemic.

Conclusion: The logistic model revealed no differences in predicted probabilities of RTW between pandemic cohort 2 and pandemic cohort 1, suggesting that orthopedic rehabilitation remained robust in maintaining RTW outcomes despite pandemic-related challenges. The findings offer mixed evidence regarding the question whether the pandemic amplified pre-existing barriers to RTW.

Objective: To derive and evaluate an alternative equation to estimate maximal HR in PwPD in the absence of structured exercise testing using observed maximal HR data from a maximal cardiopulmonary exercise test (CPET) and basic demographic and clinical data.

Design: Baseline data from a randomized clinical trial SETTING: Academic medical center PARTICIPANTS: Eighty-two persons with mild-moderate PD who completed a CPET INTERVENTION: Not applicable MAIN OUTCOME MEASURES: A linear regression model was fit to maximal HR from CPET using the relaxed least absolute shrinkage and selection operator (lasso) and seven readily clinically accessible candidate covariables. Model fit was assessed by leave-one-out cross-validation. Maximal HRs from the CPET were compared with estimates from the regression model and from two traditional age-based maximal HR estimators, (220-age) and [208 - (0.7*age)].

Results: The regression-based HR estimator was [166 - (1.15 * age) + (0.60 * resting HR)] and most closely fit the observed maximal HR from the CPET. The (220-age) and [208 - (0.7*age)] equations overestimated maximal HR for 88% and 94% of the participants, respectively. The mean square error of the regression-based estimator was 63% and 75% lower than those of the two traditional age-based estimators, respectively.

Conclusion: Overestimating maximal HR generates prescribed target HR zones that are likely unachievable during aerobic exercise. The proposed regression-based maximal HR estimator most closely fit observed maximal HRs from the CPET. Adoption of this estimator, based upon both age and resting HR, may improve estimated maximal HR accuracy and thus provide more appropriate and achievable exercise HR zones for PwPD in the absence of a CPET.

Objective: To compare the effects of physical activity behavior change intervention (PABC) on durations (total time and bouts of sitting, standing, and stepping) and free-living walking cadence patterns for people recovering from unilateral total knee arthroplasty (TKA).

Design: Secondary analysis of an RCT.

Setting: Veterans Affairs Medical Center.

Participants: 92 U.S. military Veterans.

Interventions: Standardized rehabilitation for 12 weeks following TKA plus random assignment to either a physical activity behavior change intervention (PABC) or attention-control intervention (CTL).

Main outcome measures: Sitting, standing, and stepping patterns (daily total time and bouts) and free-living walking cadence patterns were measured using thigh-mounted triaxial accelerometry (activPAL3; Glasgow, UK) for 10 consecutive days. Outcomes were analyzed with a linear mixed model that estimated mean between-group differences within 2-4 weeks pre-TKA and post-TKA at 8, 14, and 38 weeks.

Results: No between-group differences were observed at any time point for sitting, standing, or stepping total times or average bout durations. The PABC group spent significantly more time walking at a brisk cadence compared to CTL (p<0.001) with the largest group difference noted at 38 weeks, which was 24 weeks after intervention end (∆ = 8.36 mins, 95% CI = 4.83, 11.88).

Conclusion: The study suggests that PABC helped Veterans after TKA increase and sustain the duration of daily brisk cadence walking. Future investigations should incorporate the PABC to explore potential interventions to reduce sedentary behavior and assess how improvements in the duration of daily brisk cadence post-TKA impact long-term mobility, functional, and pain outcomes.