Archives of physical medicine and rehabilitation最新文献

Objective: To determine the prevalence of substance abuse disorders (SUDs) in patients with stroke, acquired brain injury (ABI), and other conditions; compare patient demographic and clinical characteristics by SUD status; and determine how SUDs are related to discharge disposition following inpatient rehabilitation for stroke, ABI, or other conditions.

Design: Retrospective cohort study SETTING: Single inpatient rehabilitation facility PARTICIPANTS: A total of 8,235 patients with stroke (n=2,609), ABI (n=874) or other conditions (n=4,752) discharged from an inpatient rehabilitation facility between April 2020 and April 2025 INTERVENTIONS: NA MAIN OUTCOME MEASURE: Discharge disposition RESULTS: Patient history and physical exams, conducted at the inpatient rehabilitation facility and preceding acute care facilities, identified 18.7% of patients as having a SUD, with the highest prevalence in patients admitted for stroke and ABI (24% each). Nicotine use disorders (NUDs) were most common (15%), particularly in patients with stroke (21%). Alcohol use disorders (AUDs) were documented in 5.5% of patients overall, with the highest prevalence in patients with ABI (9.8%). In adjusted models, SUDs were associated with a reduced odds of home discharge, independent of rehabilitation diagnosis (OR: 0.72, 95% CI: 0.60-0.87, P < 0.001). Interaction analyses found that the relationships between SUDs and home discharge were most pronounced in patients with ABI (OR: 0.48, 95% CI: 0.28-0.81, P = 0.006). NUDs, AUDs and other SUDs were each associated with lower odds of home discharge overall (OR: 0.72, 0.60, 059, respectively). A significant interaction between AUDs and patients with ABI was observed (OR: 23, 95% CI: 0.10, 0.50, P < 0.001).

Conclusions: Substance use disorders were associated with reduced odds of home discharge following inpatient rehabilitation. Patients with AUD and ABI were disproportionately affected, highlighting the need for tailored discharge planning, extended institutional support, and caregiver assistance for patients with these co-occurring conditions.

Objective: To develop and provide evidence supporting content validity for the Pediatric Appraisals of Disability Primary and Secondary Scale (PedsADAPSS), a self-report measure designed to assess appraisals of disability related to spinal cord injury (SCI) in children and adolescents.

Design: A mixed-methods, multi-phase instrument development study guided by the Stress, Appraisal, and Coping (SAC) framework.

Setting: Pediatric rehabilitation hospitals and outpatient settings in the United States.

Participants: A multidisciplinary expert panel, an international sample of 72 SCI clinicians/researchers, and 15 caregiver-youth dyads of children and adolescents with SCI aged 9-17 years.

Interventions: Not applicable.

Main outcome measures: Item clarity, relevance, and developmental appropriateness as determined by structured expert review, modified Delphi consensus (≥90%), and iterative cognitive interviews.

Results: Item generation drew from 42 measures and the adult ADAPSS. Through a binning and winnowing process and expert review, a refined item pool underwent a modified Delphi survey. Cognitive interviews with caregiver-youth dyads informed three waves of item revision. The finalized PedsADAPSS comprises 37 items across four domains: Harm/Loss, Threat, Challenge, and Coping Potential.

Conclusions: The PedsADAPSS was developed using a rigorous, stakeholder-informed process to assess appraisals of disability in youth with SCI. This tool fills a critical gap in pediatric rehabilitation by offering a developmentally appropriate measure that can support early identification of at-risk youth and inform targeted psychological interventions to improve long-term outcomes.

Objective To evaluate the safety and efficacy of transcutaneous auricular vagus nerve stimulation (taVNS) paired with exercise training on upper limb motor function and activities of daily living in stroke patients through a meta-analysis. Data Sources A systematic literature search was conducted in PubMed, Cochrane Library, Embase, Web of Science, CINAHL, CNKI, and Wanfang Database from inception to November 2025. Study Selection Randomized controlled trials were included to evaluate the effects of taVNS paired with exercise training in stroke patients. Data Extraction Two researchers independently extracted relevant data ( socio-demographic characteristics, study characteristics, stimulus parameters, and outcome indicators ). The methodological quality of the included studies was assessed using the Cochrane Risk of Bias 2.0 tool (ROB 2.0). Any discrepancies were resolved through discussion or consultation with a third researcher. Data Synthesis Sixteen original studies involving a total of 708 stroke patients were included. The results showed that patients receiving taVNS paired with exercise training had significant improvements in upper limb motor function, as assessed by the FMA-UE (SMD = 1.27; 95% CI = 0.89 - 1.66; P < 0.01), WMFT (SMD = 1.46; 95% CI = 0.74 - 2.17; P < 0.01) and ARAT (SMD = 4.51; 95% CI = 2.73 - 6.29; P < 0.01). TaVNS paired with exercise also exhibited beneficial effects on ADL (SMD = 1.42; 95% CI = 0.70-2.14; P < 0.01). Subgroup analysis indicated that an intervention frequency of ≥ 4 sessions per week had a significant effect on upper limb motor function (SMD = 1.36; 95% CI = 0.90-1.82; P < 0.01). Conclusion TaVNS paired with exercise training can effectively improve upper limb motor function and activities of daily living, with a significant effect when the intervention frequency is ≥ 4 sessions per week. Further research is needed to determine the optimal stimulation parameters and exercise protocols.

Objective: To assess the validity of digital palpation in evaluating pelvic floor muscle (PFM) tone by: (1) examining the association between palpation scale and both dynamometry and ultrasound imaging measures, and (2) determining whether the palpation scale levels can be distinguished when compared with dynamometry and ultrasound imaging measures.

Design: Cross-sectional validation study.

Setting: Two research laboratories.

Participants: Women aged 18-45 (n=528) with provoked vestibulodynia (n=209) and urinary incontinence (n=319).

Interventions: Not applicable.

Main outcome measures: Digital palpation, dynamometry and transperineal 3D/4D ultrasound imaging. PFM tone was evaluated by 34 physiotherapists via vaginal digital palpation at the 6 o'clock position using the Reissing scale, ranging from -3 (no resistance) to +3 (very firm resistance). Dynamometry evaluation included assessment of passive forces and passive elastic stiffness (vaginal aperture of 15 mm), as well as flexibility (distance between the dynamometric speculum branches at the maximal tolerated aperture). Transperineal ultrasound imaging was used to measure the levator hiatus area and anteroposterior diameter at rest.

Results: All dynamometric and ultrasound measurements were significantly correlated with the Reissing scale (Spearman's rank correlation |r_s|=0.28-0.53; p<0.05). A Kruskal-Wallis test indicated that all dynamometry and ultrasound measurements significantly differed across palpation score levels (p<0.05, η² 0.08-0.28, medium to large effect sizes). While physiotherapists could discriminate between several levels of palpation scale, the ability to distinguish between adjacent scale levels was lower, particularly for the negative scores of the scale (decreased tone scores).

Conclusions: PFM tone assessed with digital palpation using the Reissing scale is associated with objective measurements using dynamometry and ultrasound imaging. Digital palpation may serve as a valid tool for providing an estimated assessment of PFM tone in clinical practice. However, the considerable variability and overlap in values across palpation scores highlight some limitations, hindering precise assessment and limiting its suitability for research purposes.

Objective: This study aims to examine the most frequently pursued goals among individuals with cervical spinal cord injury (cSCI) undergoing posterior deltoid-to-triceps transfer, and to assess the extent to which these goals are represented in existing questionnaires and assessments.

Design: Retrospective observational study SETTING: Spinal cord Injury rehabilitation centre in Switzerland PARTICIPANTS: 47 participants (37 male, 10 female) with cSCI, levels of injury C4-C6, mean age of 33.4 years (SD 10.7 years), 4.8 years (SD 6.7 years) between injury and surgical reconstruction.

Interventions: In total, 307 goals were consolidated into 32 activities of daily living (ADLs). The goals were additionally categorized according to the Activity and Participation component of the International Classification of Functioning, Disability and Health (ICF), and by three functional workspaces (below, at and above shoulder level). The frequency of each ADL, ICF category, and workspace was determined across all goals and stratified by levels of injury. The 15 most most frequently ADLs were compared with the items from existing questionnaires and assessments.

Main outcome measure: Not applicable.

Results: The most frequently pursued ADLs were "performing a transfer" (15%), "taking an object from the shelf" (14%), followed by "operating a manual wheelchair" and "dressing upper body" (each 7%). These rankings remained consistent across different ICF categories and levels of injury. Most of the ADLs happen "below shoulder level" (47%), then "above shoulder level" (32%) and "at shoulder level" (21%). Among existing questionnaires and assessments, the Van Lieshout Test showed the highest overlap (33%) with the 15 most relevant ADLs.

Conclusion: An active elbow extension is crucial not only for overhead activities, but also for activities below shoulder level. Existing questionnaires and assessments insufficiently cover the most frequently pursued ADLs, emphasizing the need for a tailored tool for individuals with cSCI undergoing surgical reconstruction of active elbow extension.

Objective: To systematically assess tactile sensibility in children with right-sided Neonatal Brachial Plexus Palsy (NBPP) using a standardized approach, and to investigate whether (1) sensibility is reduced in the affected, non-dominant hand compared to the non-dominant hand of matched controls, (2) sensory thresholds correlate with electrophysiological findings (SNAP), and (3) diminished sensibility in digits 1-3 is associated with impaired hand motor performance.

Design: Cross-sectional study with a control group.

Setting: Tertiary university hospital NBPP care unit.

Participants: A total of 76 left-hand-dominant children aged 6-23 years: 31 with right-sided NBPP and 45 age- and sex-matched typically developing (TD) controls.

Interventions: All participants underwent Semmes Weinstein monofilament sensory testing (SWM), motor assessment (BOT-2, Purdue Pegboard Test). NBPP participants also underwent electrodiagnostic examination of sensory nerve action potential (SNAPs).

Results: NBPP participants demonstrated significantly impaired tactile sensibility in digits 1-5 of the affected hand compared to TD controls (p = .006-.040). Sensory thresholds in digits 2-5 were also significantly worse than in the contralateral hand. Although SNAP abnormalities increased with lesion severity, SWM and SNAP results were only weakly correlated (φ=-0.325 - +0.110), highlighting the complementary nature of perceptual and electrophysiological testing. Within the NBPP group, reduced tactile sensibility in digits 1-3 was significantly associated with lower scores on the BOT-2 manual dexterity subscale (β = -0.302, p = .030) and Purdue Pegboard Test (β = -0.309, p = .015).

Conclusion: Tactile sensory deficits are prevalent in children with right-sided NBPP and are functionally relevant, as reduced sensibility in digits 1 to 3 is associated with impaired fine motor performance. The partial dissociation between perceptual and electrophysiological findings highlights the complexity of sensory involvement and supports multimodal assessment. These results advocate for routine sensory evaluation to guide early neurorehabilitation and inform long-term management in NBPP.

Objective: To evaluate the effects of a 12-week blood flow restriction (BFR) training program on anxiety, depression, and quality of life in middle-aged individuals with multiple sclerosis (MS).

Design: A single-blind, randomized controlled trial.

Setting: University-based research facility in Spain.

Participants: Sixty-five adults (mean age 51.8 ± 7.5 years) with clinically diagnosed MS and Expanded Disability Status Scale (EDSS) scores below 7 were included. Participants were randomly assigned to an experimental BFR group (n = 32) or a control group (n = 33).

Interventions: The experimental group completed a supervised, low-load resistance training program with blood flow restriction twice weekly for 12 weeks (24 sessions total). Exercises targeted upper and lower limbs using individualized occlusion pressures to ensure safety and effectiveness. The control group continued their standard medical care without additional physical training.

Main outcome measure(s): The primary outcome was anxiety, assessed using the Hospital Anxiety and Depression Scale (HADS). Secondary outcomes included depression (HADS-D) and health-related quality of life, evaluated with the Multiple Sclerosis Quality of Life-54 (MSQOL-54).

Results: Participants in the BFR group showed clear reductions in anxiety and depression levels compared with the control group. Improvements were also observed in multiple quality-of-life domains, including emotional well-being, emotional limitations, cognitive functioning, and general health perception. No adverse events occurred, and adherence to the program was high.

Conclusions: BFR training is a safe, feasible, and effective intervention for enhancing emotional health and quality of life in people with multiple sclerosis. Its low mechanical demands and adaptability make it a valuable alternative for patients facing physical limitations or difficulties engaging in traditional exercise programs.