Archives of physical medicine and rehabilitation最新文献

Objective: To compare the different physiotherapy treatments and determine the most effective treatment to reduce the non-specific low back pain (NSLBP) intensity in children and adolescents.

Data sources: Eight databases (Cochrane Library, MEDLINE, PEDro, Web of Science, LILACS, IBECS, PsycINFO and SCOPUS), and two health-specialized journals (BMJ and Spine) were searched from inception to May 2023, with no language restriction.

Study selection: Individuals aged 6 to 18 years with NSLBP were selected, and physical therapy treatments were considered. Studies were required to be controlled clinical trials with pretest and posttest evaluations, and to report pain intensity.

Data extraction: Data extraction and risk of bias assessment were performed independently by two reviewers.

Data synthesis: A meta-analysis of 11 controlled trials with 827 participants found that physiotherapy treatments effectively reduced NSLBP intensity on posttest measurement (d₊ = 0.75, 95% CI= 0.30-1.20) and six-month follow-up (d₊ = 0.35, 95% CI= -0.72-1.40). Network meta-analysis showed both therapeutic exercise (d₊ = 1.11, 95% CI= 0.48-1.74) and a combination of therapeutic exercise and manual therapy (d₊ = 1.45, 95% CI= 0.40-2.49) were effective compared to no treatment. There were no significant differences between therapeutic exercise and the combination of therapeutic exercise and manual therapy.

Conclusion: Physical exercise has proven to be the most effective treatment for addressing the intensity of NSLBP in children and adolescents. While combining it with manual therapy may yield even better results, it is crucial to emphasize that physical exercise should serve as the cornerstone in the physiotherapeutic approach to managing NSLBP intensity in this age group.

Objective: To examine the correlations amongst center of pressure (COP) trajectories, foot morphology and knee symptoms in older women with medial knee deformity.

Design: This was a cross-sectional study.

Setting: Participants were recruited from two local orthopedic clinics.

Participants: Eighty-four female patients with medial knee deformity (Kellgren Lawrence grade ≥1) aged 60 years or older.

Interventions: Not applicable.

Main outcome measures: COP trajectories during comfortable gait were obtained using a plantar pressure distribution platform. As foot morphology metrics, hallux valgus angle, navicular/foot ratio, and leg-heel alignment were measured. The knee society scoring system was used to evaluated knee symptom severity. We used statistical parametric mapping for COP trajectory analysis to reduce the bias caused by data extraction. Multiple linear regression in statistical parametric mapping was used to determine the correlations amongst foot morphology, knee symptom severity and COP trajectories.

Results: There was a correlation between higher navicular/foot ratio and medial shift on COP at initial contact (0〜3.0% stance phase, p<0.05) and at toe-off (95.3〜100% stance phase, p=0.04). Also, higher navicular/foot ratio was associated with lateral shift of COP during single leg stance phase (8.3〜80.1% stance phase, p<0.01). We also found a significant correlation between lateral shift of COP during loading response phase (6.8〜19.0% stance phase) and knee symptom severity (p=0.03).

Conclusion: Our results indicated that patients with severe knee symptoms may benefit from intervention to modify the foot arch and to medially shift the COP, which may be capable of relieving knee symptoms. Although our results do not directly show pain reduction, a medial COP shift could indeed reduce pain in cases where knee adduction moment is responsible for pain. These findings may contribute to the further development of conservative intervention, which focus on knee OA patients' foot morphology.

Objective: To systematically review Randomized Controlled Trials (RCTs) of post-stroke upper extremity (UE) motor rehabilitation interventions to identify the outcome measures used in studies in low-to-middle-income countries (LMICs) and high-income countries (HICs) and describe the differences in the context of the International Classification of Functioning Disability and Health (ICF).

Data sources: Five databases "Embase, PubMed, CINAHL, Scopus and Web of Science" were searched from 1960 to April 1, 2021.

Study selection: Studies were included if they were: 1) RCTs or RCT crossovers in English; 2) with ≥50% participants affected by ischemic/hemorrhagic stroke; 3) participants ≥18 years old, 4) used an intervention for the hemiparetic UE as the primary objective of the study.

Data extraction: Title and abstract screening and full-text studies were reviewed, and data for included studies were extracted by two independent investigators. The study quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. Data analyses were performed using SPSS (V29.0).

Data synthesis: Of 5,408 records, 1,276 RCTs were eligible, 298 RCTs were conducted in LMICs and 978 in HICs. A higher percentage of RCTs in LMICs employed body structure and function outcome measures for central nervous system (e.g. Fugl Meyer Assessment) and tone and range of motion (e. g. modified Ashworth Scale) as well as activity outcome measures for general activities of daily living (e.g. Barthel Index). In HICs, a higher percentage of RCTs utilized body structure and function outcome measures assessing strength (e.g. Motricity index), activity outcome measures examining motor specific activity (e. g. Action Research Arm Test, Wolf Motor Function Test) and dexterity (e.g. Box and Block Test), as well as participation outcome measures (e. g. Stroke Impact Scale).

Conclusions: There were significant differences in the outcome measures chosen for assessing post stroke UE rehabilitation interventions by researchers in LMICs and HICs. This suggests that there might be potential resource and expertise as well as timing constraints that influences the choice of outcome measures in RCTs between HICs and LMICs and highlights the need for investigating the availability of resources, infrastructure, and expertise and their impact on the feasibility and practicality of employing different outcome measures in different countries.

Objective: To identify and compare interventions for upper extremity (UE) motor recovery post stroke in randomized controlled trials (RCTs) conducted in high-income countries (HICs) and low-to-middle income countries (LMICs).

Data source: Systematic searches were conducted for RCTs published in English in five databases (CINAHL, Embase, PubMed, Scopus, and Web of Science) up to April 2021, in line with PRISMA guidelines.

Study selection: RCTs, including crossover design, were included if they were in English and evaluated an intervention for post-stroke UE motor rehabilitation, in an adult population (≥18yr) diagnosed with stroke.

Data extraction: Data on country of origin and type of intervention in each RCT were extracted using a data extraction template in Covidence software. Study screenings and data extraction were performed by two independent reviewers.

Data synthesis: A total of 1,276 RCTs met inclusion criteria, with 978 RCTs conducted in HICs and 298 in LMICs. A significantly larger proportion of RCTs evaluating robotics and task specific training interventions were conducted in HICs, compared to LMICs (p<0.009). In contrast, a higher proportion of RCTs conducted in LMICs examined acupuncture (p<0.001) and rTMS (p=0.001) when compared to HICs.

Conclusions: Post-stroke rehabilitation in LMICs is conducted in a lower resource environment when compared to HICs. Some differences exist in the use of UE motor rehabilitation interventions between LMICs and HICs such as robotics, task-specific training, rTMS, and acupuncture; however, there was no significant difference between HICs and LMICs for most interventions.

Objective: To evaluate the impact of lifestyle and behavioral interventions on anthropometric indices and body composition in individuals with spinal cord injury (SCI).

Data sources: MEDLINE, EMBASE, Web of Science, and Cochrane Library were searched from inception to January 22, 2024.

Study selection: Randomized clinical trials (RCTs), non-randomized clinical trials and pre-post studies on the effectiveness of lifestyle and/or behavioral interventions in improving body composition (including body mass index, waist circumference, fat mass and lean mass) were eligible.

Data extraction: Study design characteristics, number of participants, interventions/controls characteristics, and outcomes were extracted.

Data synthesis: Sixty-one interventional studies were included in the systematic review, among which five RCTs contributed to meta-analysis. Exercise, alone or combined with functional electrical stimulation (FES), supplements, or educational sessions, was the most studied intervention across the identified studies, accounting for 75% of studies. Exercise regimen compared to the usual activities yielded a decrease in BMI (MD -0.38 kg/m² [95% CI: -0.57 to -0.19, I²: 0%, p_q: 0.45]) and waist circumference (MD -2.93 cm [95% CI: -3.98 to -1.88, I²: 0%, p_q: 0.59]). No significant differences were observed when comparing changes in total body fat percentage nor lean body mass between the two groups. Exercise with FES and testosterone, exercise and personalized diet, high protein diet, and alpha-lipoic acid supplementation were mapped as other potentially beneficial interventions, while studies targeting behavioral changes were inconclusive.

Conclusion: Exercise-based interventions alone or combined with FES or standardized/personalized dietary regimens show promise as effective strategies for improving anthropometric indices and body composition among individuals with SCI, emphasizing the potential benefit of weight management programme. The present findings may not be applicable to individuals with high SCI lesion. Further research to evaluate the effectiveness of a more complex lifestyle and / or behavioral interventions in individuals with SCI is warranted.

Objective: To examine the test-retest reliability, responsiveness, and clinical utility of the machine learning-based short-form of the Berg Balance Scale (BBS-ML) in persons with stroke.

Design: Repeated measures design.

Setting: A department of rehabilitation in a medical center.

Participants: This study recruited two groups: 50 persons who were more than 6 months post-stroke to examine the test-retest reliability, and 52 persons who were within 3 months post-stroke to examine the responsiveness. Test-retest reliability was investigated by administering assessments twice at a 2-week interval. Responsiveness was investigated by gathering data at admission and discharge from hospital.

Interventions: Not applicable.

Main outcome measure: BBS-ML.

Results: The BBS-ML exhibited excellent test-retest reliability (intraclass correlation coefficient = 0.99), acceptable minimal random measurement error (minimal detectable change % = 13.6%), and good responsiveness (Kazis' effect size and standardized response mean values ≥ 1.34). On average, the participants completed the BBS-ML in around 6 minutes per administration.

Conclusions: Our findings indicate that the BBS-ML appears an efficient measure with excellent test-retest reliability and responsiveness. Moreover, the BBS-ML may be utilized as a substitute for the original BBS to monitor the progress of balance function in persons with stroke.

Objectives: To assess the feasibility of the Toolkit for Optimal Recovery after Concussion (TOR-C), the first mind-body program aiming to prevent persistent concussion symptoms among young adults with anxiety, and an active control (Health Enhancement after Concussion; HE-C). We also tested preliminary improvements in outcome measures and putative mechanistic targets.

Design: Single-blind, 2-arm, randomized controlled trial.

Setting: Academic medical center in the US Northeast.

Participants: Fifty young adults (ages 18-35) with a recent concussion (3-10 weeks prior) and anxiety (≥5 on the GAD7 questionnaire).

Interventions: Both interventions consisted of four 45-minute 1:1 sessions with a clinician over Zoom. TOR-C (n=25) taught mind-body, cognitive-behavioral, and return-to-activity skills. HE-C (n=25) taught health education (e.g., sleep, nutrition) without skills.

Main outcome measures: Primary: feasibility outcomes (e.g., recruitment, credibility, expectancy, acceptability, safety, feasibility of assessments, fidelity, satisfaction, TOR-C homework adherence) with a-priori-set benchmarks. Secondary: intervention outcomes were concussion symptoms (PCSS), physical function (WHODAS), anxiety (GAD7/HAD-A), depression (HADS-D) and pain (NRS). TOR-C mechanistic targets were pain catastrophizing (PCS), mindfulness (CAMS-R), fear avoidance (FAB-TBI), limiting behavior and all-or-nothing behavior (BRIQ).

Results: Both interventions met all feasibility benchmarks and were associated with significant improvements in outcomes (concussion symptoms, physical function, anxiety, depression and pain; d=0.44-1.21) and TOR-C mechanistic targets (pain catastrophizing, mindfulness, fear-avoidance, and limiting behavior; Cohen's d=0.41-1.24). Improvements in all-or-nothing behavior were only significant in TOR-C (d=0.52). Improvements in all mechanistic targets except all-or-nothing behavior following TOR-C were significantly associated with improvements in at least one outcome.

Conclusion: Findings provide strong support for the feasibility of TOR-C and HE-C, and preliminary evidence for improvements in mechanistic targets and outcomes. Findings inform a future fully-powered RCT testing efficacy of TOR-C vs. HE-C.

Objective: To examine how known causal factors (exercise self-efficacy, balance, walking capacity) affect outcomes (moderate intensity physical activity, community access) in people with Parkinson's disease (PD): through a direct pathway, indirectly through potential mediators (non-motor impairments), or through combined direct and mediated paths.

Design: Causal mediation analyses using baseline and three-month data from pooled treatment groups in a randomized controlled trial.

Setting: Data were collected at two university clinical research centers.

Participants: One hundred thirty-eight people with PD.

Interventions: Home and community-based walking and strength exercise program.

Main outcome measure(s): Exposures were exercise self-efficacy, walking ability, and balance. Potential mediators included pain, fatigue, mood (anxiety, depression, affect, apathy), stigma, and cognition (executive function and cognitive flexibility). Outcomes were physical activity and community access behaviour at three-month follow-up. Separate models were developed for each causal factor-mediator-outcome combination. To minimise bias, all models were adjusted for known confounders (comorbidities, freezing of gait, severity of motor impairments, and/or age) and baseline values of the outcomes.

Results: Self-efficacy of walking duration had a causal relationship with moderate intensity physical activity through direct and combined paths (p<.001). Walking capacity had a causal relationship with community access through direct (p=.03-.04) and combined (p=.02-.03) paths. Balance did not affect community access (p>.05). There were no significant mediation effects through indirect pathways for either outcome.

Conclusions: The effect of known causal factors on physical activity and community access was not mediated by non-motor impairments. Walking self-efficacy and walking capacity remain the primary intervention targets for improving physical activity and community access, respectively, in people with PD.