Archives of physical medicine and rehabilitation最新文献

Objective: Our objectives to examine whether Strolll - an individually-tailored gamified augmented-reality gait-and-balance therapy for people with Parkinson's disease - meets intensity thresholds to also qualify as aerobic exercise were to: 1) quantify exercise intensity of a representative 30 active-minutes Strolll gait-and-balance therapy session at home and 2) examine if Strolll exercise settings (type of gamified exercise and its difficulty level and duration) could influence exercise intensity.

Design: Within-subject experimental design.

Setting: Home environment.

Participants: A convenience sample of fifteen individuals with Parkinson's Disease (Hoehn & Yahr stages 1-3, 12/3 males/females, 46-84 years of age) familiar with Strolll exercises.

Intervention: On separate days, participants completed a representative 30 active-minutes gait-and-balance therapy session at home and performed the five different gait-and-balance exercise types at various difficulty levels and durations.

Main outcome measures: Exercise intensity was expressed as percentage heart rate reserve (%HRR) and Rate of Perceived Exertion (RPE).

Results: The 30 active-minutes gait-and-balance therapy session reached moderate-to-vigorous exercise-intensity levels for 9 (%HRR) and 14 (RPE) of the 15 participants. Exercise intensity varied over the five gamified exercise types. Varying the level and duration of exercise types had a smaller influence on exercise intensity.

Conclusions: Strolll, designed to target aspects of gait, balance and fall risk, showed potential to be applied as a moderate-to-vigorous exercise-intensity program (meeting intensity levels for most participants). Exercise settings to (further) influence exercise intensity levels of augmented-reality exercises were identified. With the proper exercise settings prescribed, Strolll may also qualify as moderate-or-higher intensity aerobic exercise, creating opportunities for multimodal therapy facilitating multiple rehabilitation targets simultaneously in the future.

Objective: To investigate supraspinatus tendon thickness (SST), acromiohumeral distance (AHD), and occupation ratio (OR) in manual wheelchair (MWC) users with spinal cord injury, comparing symptomatic and asymptomatic shoulders versus able-bodied controls at rest, 60° abduction, and during weight-relief raises (WRRs).

Design: Cross-sectional study.

Setting: University rehabilitation center.

Participants: The study included 63 participants (N = 63): 34 MWC users with spinal cord injury (mean age, 42.8±14.9y; 67.6% men; body mass index, 25.8±4.37kg/m²; 67.6% with T7 to T12 level injuries; 60.79±53.46mo after injury) and 29 able-bodied controls matched for age, sex, and body mass index.

Interventions: Not applicable.

Main outcome measures: Sonographic measurements of SST and AHD were performed in 3 positions, and OR was calculated by dividing SST by AHD. Clinical outcomes were assessed using the Shoulder Pain and Disability Index and Wheelchair User's Shoulder Pain Index (WUSPI).

Results: No significant between-group differences were found in AHD. SST was significantly greater in both symptomatic (ΔMean=+1.57 mm; 95%CI, 0.92-2.22 mm; P<.001) and asymptomatic (ΔMean=+1.40 mm; 95% CI, 0.75-2.04 mm; P<.001). Positional changes significantly influenced SST, with lower thickness at 60° abduction compared with WRR in symptomatic (ΔMean=-0.66 mm; P=.003) and asymptomatic (ΔMean=-0.57 mm; P=.015) groups, but not in controls. MWC users compared with able-bodied controls, and this was accompanied by a higher OR. Regression analysis showed that higher OR in the WRR position, greater Shoulder Pain and Disability Index scores, and longer MWC use significantly predicted WUSPI-assessed shoulder pain, with each 10% increase in OR linked to an average 3.41-point rise in WUSPI scores.

Conclusions: OR may be more responsive to posture changes than AHD, suggesting that dynamic ultrasonographic assessment could serve as a practical tool to support clinical evaluations and inform targeted rehabilitation strategies for MWC users.

Objective: To examine the association between the daily count of sedentary bouts ≥60 minutes and activities of daily living (ADL) recovery in nonambulatory patients with subacute stroke.

Design: A prospective observational cohort study.

Setting: Convalescent rehabilitation wards in 11 inpatient facilities across Japan.

Participants: Patients with subacute stroke admitted between February 2022 and February 2025 who were unable to walk independently at admission but had been independent in ADL before stroke onset (N = 626). A total of 588 participants were analyzed.

Interventions: Not applicable.

Main outcome measures: Outcome measurement was the motor subscale of the functional independence measure assessed longitudinally at admission, 1 month after admission, and at discharge. The exposure was the mean daily count of ≥60-minute sedentary bouts measured by triaxial accelerometry during the first week after admission. Linear mixed-effects models were used to examine associations between the mean daily count of ≥60-minute sedentary bouts at admission and the motor subscale of the functional independence measure change over time, adjusting for covariates, including total sedentary time. Exploratory age-stratified analyses (≥65 vs ≤64y) were also conducted.

Results: Higher daily count of ≥60-minute sedentary bouts was significantly associated with poorer ADL recovery (β=-1.53; 95% CI]: -2.31 to -0.76; P<.001), independent of total sedentary time. Age-stratified analyses revealed that this association was significant in older adults (β=-1.52; 95% CI: -2.46 to -0.57; P=.002) but not in younger patients (β=-0.73; 95% CI -2.05 to 0.59; P=.278).

Conclusions: In nonambulatory patients with subacute stroke, frequent prolonged sedentary bouts during early rehabilitation were independently associated with poorer ADL recovery, particularly in older adults. Interrupting extended sitting periods may represent a simple, low-cost intervention to support functional recovery in stroke rehabilitation.

Objective: To examine the differences in last-resort behavioral health care (LRBH) utilization for mental health and substance use between individuals with spina bifida (SB) and matched non-SB controls.

Design: We analyzed data from the California Department of Health Care Access and Information (2005-2017) to compare inpatient and emergency department (ED) behavioral health utilization between individuals with SB and non-SB controls (1:5 ratio). Multivariable logistic regression was used to assess the likelihood of LRBH use, adjusting for demographic, socioeconomic, and clinical variables.

Setting: ED and inpatient hospitalizations across all practice types in a large health care system.

Participants: We queried the California Department of Health Care Access and Information database from 2005 to 2017, (N=116,364). We created a cohort by frequency-matching those with SB 1:5 by birth year and facility (inpatient or ED) to a randomly generated control sample without SB.

Interventions: Not applicable.

Main outcome measures: Encounters per patient with a primary behavioral health diagnosis.

Results: The cohort included 19,394 individuals with SB and 96,970 controls. Individuals with SB had a higher mean Charlson Comorbidity Index (2.0 vs 1.1) and more LRBH encounters (5.1 vs 2.7 per patient). SB was independently associated with increased risk of ≥1 encounter (adjusted odds ratio [aOR], 1.49; 95% CI, 1.42-1.56). Within the SB group, increased Charlson Comorbidity Index (aOR, 1.04), women (aOR, 1.12), and nonprivate insurance (aOR, 2.48) predicted higher utilization. Asian/Pacific Islander race (aOR, 0.32), Hispanic ethnicity (aOR, 0.41), and those residing in lower socioeconomic advantage areas (aOR, 0.92) were associated with decreased odds of behavioral health care encounters.

Conclusions: Individuals with SB are at significantly higher risk of LRBH utilization compared with non-SB controls. SB independently predicted nearly 50% increased odds of requiring such services. Our analysis identifies significant sociodemographic predictors of LRBH care within the SB population, which should be further explored as potential targets for preventive behavioral health intervention.

Objective: To determine sex-based differences in: (1) enrolment, adherence, and satisfaction in telerehabilitation programs for individuals with stroke in Canada; (2) adherence and satisfaction outcomes in exercise and self-management intervention subgroups.

Design: Cross-sectional study.

Setting: Telerehabilitation for community-dwelling individuals with stroke.

Participants/main outcome measures: Enrolment (n (%) men, women), adherence (# sessions completed/total # sessions), and program satisfaction (5-point Likert scale program satisfaction survey administered) were used from 3 telerehabilitation trials. Wilcoxon rank-sum tests were used to determine sex differences in exercise-based (participants included in analyses: n=57 adherence; n=54 satisfaction total participants included in analyses) or self-management (n=87 adherence; n=77 satisfaction) programs.

Interventions: Not applicable.

Results: Enrolment for men was more than 2-fold higher than that for woman across all studies (n=149 [67.4%] vs 72 [32.6%]). Adherence was similar between men and women with most participants completing 100% [interquartile range, 0] of sessions for the total sample (P=.13, Z=1.52), and for exercise (P=.16, Z=1.41) and self-management subgroups (P=.13, Z=1.52). Overall satisfaction with the telerehabilitation programs were similar between sexes for the total sample (P=.46, Z=0.75), and in exercise (P=.82, Z=0.23) and self-management (P=.49, Z=0.69) subgroups.

Conclusions: Enrolment among men outnumbered women more than 2-fold, despite the similar number of stroke events between sexes. There were no sex differences for adherence or satisfaction across programs or with different areas of intervention foci. Emphasis should be placed on promoting recruitment of women with stroke. We provided potential strategies based on observations in the current study.

Objective: To investigate the impact of leisure-time physical activity (PA) on all-cause and cause-specific mortality risk in individuals with chronic obstructive pulmonary disease (COPD).

Design: Retrospective cohort study.

Setting: Baseline information on leisure-time PA of the patients with COPD was gathered from the National Health Interview Survey (conducted in 2001, 2005, 2009, and 2013). Comorbidities were identified from the National Health Insurance dataset (2000-2021).

Interventions: Not applicable.

Main outcome measures: Mortality was confirmed using the National Death Registration.

Results: A total of 6584 adults aged >18 years with COPD were enrolled in this survey. Among them, 3360 (51.0%) were men, with a mean (SD) age of 57.3 (17.7) years. During the 20 years of follow-up, 1760 (26.7%) deaths were observed. Kaplan-Meier survival curves showed a significant survival rate among the 3 groups (log-rank P<.001). After controlling for potential confounders, subjects with leisure-time PA of 0

Conclusions: This study demonstrated the benefits of leisure-time PA in individuals with COPD. Engaging in at least 800 MET-minutes of PA per week was associated with a significantly reduced risk of death from all causes, especially cardiovascular and cancer-related deaths.

Objective: This study aimed to 1) replicate pain/depression clusters among individuals with spinal cord injury (SCI) as found by Wilson et al.¹; 2) examine demographic differences among pain/depression clusters one (Y1) and five (Y5) years post-injury; 3) predict evolution to chronic pain syndrome (CPS) subgroup at Y5.

Design: Observational; longitudinal SETTING: Data from the Spinal Cord Injury Model Systems (SCIMS) National Database PARTICIPANTS: Persons with traumatic SCI Y1 (n = 5,924) and Y5 (n = 3,349) post-injury INTERVENTIONS: none MAIN OUTCOME MEASURES: Pain/depression clusters based on pain intensity (NRS), pain interference (MOS-SF-12 item), and depression (PHQ-9) RESULTS: A four-subgroup solution consistent with prior literature was retained at Y1 and Y5 given its clinical relevance: Low Pain (low pain intensity, interference, and depression), Positive Adaptation to Pain (high pain intensity, low pain interference and depression), Minimal Distress (high pain intensity and interference, low depression), and CPS (high pain intensity, interference, and depression). The proportion in the CPS cluster increased from Y1 (11%) to Y5 (16%). Those with Black/African American race, less than high school education, or violent injury etiology were overrepresented in the CPS subgroup at Y5. Higher Y1 depression (OR: 1.69, 95% CI: 1.36, 2.08) and incomplete injury (OR: 2.07, 95% CI: 1.46, 2.96) were associated with increased odds of evolving to CPS at Y5; Y1 pain intensity and interference were not associated with odds of evolving to CPS at Y5 (p's > .1).

Conclusions: The pain/depression subgroups identified by Wilson et al. (2005) remain clinically relevant in a contemporary SCI sample. Depression, even at subclinical levels, is a stronger predictor of future development of CPS than pain intensity or interference. Findings highlight the importance of early depression screening among individuals with SCI.

Objective: To establish the reliability and validity of measures from the Traumatic Brain Injury-Caregiver Quality of Life (TBI-CareQOL) measurement system in care partners of individuals with comorbid traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) and to compare health-related quality of life (HRQOL) between care partners of individuals with TBI with and without PTSD.

Design: Survey study.

Setting: Two academic medical centers.

Participants: A total of 246 care partners of individuals with TBI.

Interventions: Not applicable.

Main outcome measures: Psychometric qualities of Quality of Life In Neurological Disorders (Neuro-QoL) TBI-CareQOL Caregiver Strain and Caregiver-Specific Anxiety, Patient-Reported Outcomes Measurement Information System (PROMIS) short form assessments of Anger, Anxiety, Depression, Fatigue, Ability to Participate in Social Roles and Activities, and Sleep-Related Impairment, National Institutes of Health Toolbox assessments of Perceived Stress and Self-Efficacy, Neuro-QoL Positive Affect and Well-Being.

Results: Our results provide evidence for the internal consistency reliability for all TBI-CareQOL measures (α≥0.70), which were also devoid of ceiling and floor effects, excluding a slightly elevated floor effect (23%) for PROMIS Depression. Convergent and discriminant validity were established by demonstrating moderate-to-high correlations between similar constructs, and minimal-to-low correlations between dissimilar constructs. Known groups validity was established by demonstrating significantly worse HRQOL for care partners of individuals with both TBI and PTSD compared with care partners for individuals with TBI alone. Caring for an individual with PTSD was associated with elevated impairment rates in comparison with the general population and care partners of individuals without PTSD. We also demonstrate significant negative correlations between measures of care partner HRQOL and posttraumatic stress disorder checklist for DSM-5 score, and provide evidence that PTSD significantly predicts Caregiver Strain above and beyond functional impairment in the care recipient and time spent caregiving.

Conclusions: We provide evidence for the clinical utility of TBI-CareQOL measures in care partners of individuals with both TBI and PTSD. Our data also suggest that caring for individuals with both PTSD and TBI is associated with lower HRQOL and higher impairment.