Archives of physical medicine and rehabilitation最新文献

Objective: To compare the functional (daytime) use to the nightly use of an orthosis for patients affected by trapeziometacarpal osteoarthritis (OA).

Design: Randomized, controlled single-blind trial.

Setting: The rheumatology outpatient clinic of the University.

Participants: Sixty participants diagnosed with trapeziometacarpal OA.

Interventions: Participants were randomly assigned into 2 groups: a functional group that used a functional hand-based thumb immobilization orthosis during activities of daily living and a night-time group that used the same orthosis at night.

Main outcomes measures: The patients were evaluated at baseline and after 45, 90, 180, and 360 days considering: pain at the base of the thumb and in the hand, range of motion of the thumb, grip, and pinch strength, manual dexterity, and hand function.

Results: The groups were homogeneous at the beginning of the trial. No statistically significant difference was observed between groups over time for trapeziometacarpal pain (P=.646). For general hand pain, no statistically significant difference was found between groups over time (P=.594). Although both groups improved from baseline, there were no statistically significant differences between the groups in the vast majority of the assessed parameters. Statistically significant differences between the groups were found only in the following outcomes: thumb palmar abduction of the right hand (P=.023), pick-up test with closed eyes of the right hand (P=.048), and tripod grip strength of the right hand (P=.006).

Conclusions: Both groups showed improvement in pain and function from baseline to the end of the intervention. However, there were no reported differences in these outcomes after a 1-year follow-up between the functional (daytime) and night-time use of orthosis in patients with trapeziometacarpal OA. This suggests that both types of usage can be offered to patients.

Objective: To identify the relations of 3 frequently used prescription opioids (hydrocodone, oxycodone, tramadol) with unintentional injuries, including fall-related and non-fall-related injuries among adults with chronic, traumatic spinal cord injury (SCI).

Design: Cross-sectional cohort study.

Setting: Community setting; Southeastern United States.

Participants: Adult participants (N=918) with chronic traumatic SCI were identified from a specialty hospital and state population-based registry and completed a self-report assessment.

Interventions: Not applicable.

Main outcome measures: Self-reported fall-related and non-fall-related unintentional injuries serious enough to receive medical care in a clinic, emergency room, or hospital within the previous 12 months.

Results: Just over 20% of participants reported ≥1 unintentional injury in the past year, with an average of 2.16 among those with ≥1. Overall, 9.6% reported fall-related injuries. Only hydrocodone was associated with any past-year unintentional injuries. Hydrocodone taken occasionally (no more than monthly) or regularly (weekly or daily) was related to 2.63 (95% confidence interval [CI], 1.52-4.56) or 2.03 (95% CI, 1.15-3.60) greater odds of having ≥1 unintentional injury in the past year, respectively. Hydrocodone taken occasionally was also associated with past-year non-fall-related injuries (OR, 2.20; 95% CI, 1.12-4.31). Each of the 3 opioids was significantly related to fall-related injuries. Taking hydrocodone occasionally was associated with 2.39 greater odds of fall-related injuries, and regular use was associated with 2.31 greater odds. Regular use of oxycodone was associated with 2.44 odds of a fall-related injury (95% CI, 1.20-4.98), and regular use of tramadol was associated with 2.59 greater odds of fall-related injury (95% CI, 1.13-5.90).

Conclusions: Injury prevention efforts must consider the potential effect of opioid use, particularly hydrocodone. For preventing fall-related injuries, each of the 3 opioids must be considered.

Objective: To determine the prevalence and co-occurrence of common geriatric syndromes in geriatric rehabilitation inpatients.

Design: Restoring Health of Acutely Unwell Adults (RESORT) and Enhancing Muscle Power in Geriatric Rehabilitation (EMPOWER-GR) are observational, longitudinal cohorts.

Setting: Geriatric rehabilitation.

Participants: Geriatric rehabilitation inpatients (N=1890 and N=200).

Interventions: Not applicable.

Main outcome measures: Geriatric syndromes included polypharmacy, multimorbidity (Cumulative Illness Rating Scale), cognitive impairment, depression (Hospital Anxiety and Depression Scale/Geriatric Depression Scale), malnutrition (Global Leadership Initiative on Malnutrition), functional limitation (Katz index), falls, physical frailty (Fried), and sarcopenia (European Working Group on Sarcopenia in Older People 2).

Results: Inpatients in RESORT (R) (N=1890, 56% females) had a median age of 83.4 years (interquartile range [IQR], 77.6-88.4) and in EMPOWER-GR (E) (N=200, 57% females) of 79.8 years (IQR, 75.0-85.9). Polypharmacy (R, 82.2%; E, 84.0%), multimorbidity (R, 90.4%; E, 85.5%), functional limitation (R, 96.0%; E, 76.5%), and frailty (R, 91.8%; E, 92.2%) were most prevalent. Most inpatients had ≥5 geriatric syndromes at admission in both cohorts (R, 70.0%; E, 72.4%); few inpatients had only 1 (R, 0.4%; E, 1.5%) or no geriatric syndrome (R, 0.2%; E, 0.0%). Geriatric syndromes did not occur in isolation (without other syndromes), except for multimorbidity (R, 1%; E, 5%), functional limitation (R, 3%; E, 2%), falls (R, 0%; E, 4%), and frailty (R, 2%; E, 5%), which occurred in isolation in some inpatients; sarcopenia did not.

Conclusions: Geriatric syndromes are highly prevalent at admission to geriatric rehabilitation, with a median of 5 co-occurring syndromes. Implications for diagnosis and intervention potential should be further addressed.

Objectives: To retrospectively evaluate the comparative effect of 2 wheelchair seating systems, Custom-Contoured Wheelchair Seating (CCS) and Modular Wheelchair Seating (MWS), on scoliosis progression in children with neuromuscular and neurologic disorders and to determine any predictors for scoliosis progression.

Design: Longitudinal, retrospective cohort study.

Setting: A national health service regional posture and mobility service.

Participants: Nonambulant pediatric wheelchair users with neuromuscular and neurologic disorders (N=75; 36 men, 39 women; mean age at seating intervention, 10.50±3.97y) issued CCS and MWS by the South Wales Posture and Mobility Service from 2012-2022.

Interventions: Two specialized wheelchair seating systems, CCS and MWS.

Main outcome measures: A generalized least squares model was used to estimate the effect of seat type on Cobb angle over time.

Results: Of the 75 participants enrolled, 51% had cerebral palsy. Fifty were issued CCS and 25 were issued MWS. Baseline Cobb angle was 32.9±18.9° for the MWS group and 48.0±31.0° for the CCS group. The generalized least squares model demonstrated that time since seating intervention (χ²=122, P<.0001), seating type (χ²=52.5, P<.0001), and baseline scoliosis severity (χ²=41.6, P<.0001) were predictive of scoliosis progression. Condition was not a strong predictor (χ²=9.96, P =.0069), and sex (χ²=5.67, P=.13) and age at intervention (χ²=4.47, P=.35) were not predictive. Estimated contrasts of medical condition with seat type over time demonstrated smaller differences between MWS and CCS over time. Predicted scoliosis velocity was found to attenuate with use of CCS over time compared with MWS, although scoliosis deteriorated regardless of intervention.

Conclusions: Our findings showed pediatric wheelchair users with neurologic and neuromuscular disorders prescribed CCS showed greater mitigation of scoliosis progression over time compared with those issued MWS.

Objective: To investigate the association of quadriceps strength with the presence of knee pain.

Design: This cross-sectional study was based on data from the 1999-2000 to 2001-2002 National Health and Nutrition Examination Survey.

Setting: This was a community-based study.

Participants: This study included 2619 adults with complete data for knee pain, quadriceps strength, and covariates.

Intervention: Not applicable.

Main outcome measures: Self-reported knee pain.

Results: This study included 2619 individuals, 1287 (52.66%) of whom were women and 1543 (81.66%) identified as Non-Hispanic White. The mean ±standard deviation age was 62.48±9.71 years. After adjusting for covariates, the odds of knee pain decreased with every 20 N/m increase in quadriceps strength (odds ratio, 0.87; 95% confidence interval, 0.81-0.94). Individuals in the upper quartile of quadriceps strength had lower odds of knee pain than those in the lower quartile (Q4 vs Q1 [reference]: odds ratio, 0.28, 95% confidence interval, 0.15-0.52; P_trend=.006). Nonlinear analyses indicated L-shaped associations for knee pain. The subgroup analyses showed no significant interactions, except for sex (P_interaction=.046). The significance of the sex interaction indicated a correlation exclusively in women.

Conclusions: The results demonstrated an inverse association between quadriceps strength and the presence of knee pain. The subgroup analysis by sex showed that this inverse relationship was statistically significant in the women but not in the men subgroup.

Wearable devices have the potential to advance health care by enabling real-time monitoring of biobehavioral data and facilitating the management of an individual's health conditions. Individuals living with spinal cord injury (SCI) have impaired motor function, which results in deconditioning and worsening cardiovascular health outcomes. Wearable devices may promote physical activity and allow the monitoring of secondary complications associated with SCI, potentially improving motor function, sleep, and cardiovascular health. However, several challenges remain to optimize the application of wearable technologies within this population. One is striking a balance between research-grade and consumer-grade devices in terms of cost, accessibility, and validity. Additionally, limited literature supports the validity and use of wearable technology in monitoring cardio-autonomic and sleep outcomes for individuals with SCI. Future directions include conducting performance evaluations of wearable devices to precisely capture the additional variation in movement and physiological parameters seen in those with SCI. Moreover, efforts to make the devices small, lightweight, and inexpensive for consumer ease of use may affect those with severe motor impairments. Overcoming these challenges holds the potential for wearable devices to help individuals living with SCI receive timely feedback to manage their health conditions and help clinicians gather comprehensive patient health information to aid in diagnosis and treatment.

Objective: To analyze the psychometric properties of the Pictorial Pain Interference Questionnaire (PPIQ) for evaluating functional interference in the population with chronic low back pain (CLBP).

Design: Cross-sectional study.

Setting: Rehabilitation Unit in a hospital.

Participants: Ninety-nine patients with CLBP.

Interventions: Not applicable.

Main outcome measures: Functional interference was assessed using PPIQ. The following data were also collected: sociodemographic data; pain intensity (Numeric Pain Rating Scale [NPRS]); physical functioning (30-s arm curl, 30-s chair stand [30CST], and timed Up and Go [TUG] tests), fitness (International Physical Activity Questionnaire); quality of life (Short-Form 12 Health Survey version 1 [SF-12v1]); sleep quality (Spanish-validated 12-item Medical Outcomes Study Sleep scale [12-MOS Sleep]); anxiety and depression (Hospital Anxiety and Depression Scale [HADS]); and social support (Duke-UNK Functional Social Support Questionnaire). Internal consistency was analyzed using Cronbach's alpha, structural validity using exploratory factor analysis (EFA), and discriminant and convergent validity using bivariate analysis.

Results: Ninety-nine patients with CLBP were included (age [mean ± SD]: 54.37±12.44 y); women, 67.7%). The EFA extracted 2 factors: "physical function and "social and sleep," which explained 57.75% of the variance. Excellent internal consistency was observed for the overall PPIQ score (Cronbach's α=0.866). Convergent validity was observed between the PPIQ and other functional measures (ρ: 0.52 and -0.47 for the TUG and 30CST, respectively; P<.001) and with the following variables: physical and mental component summaries of the SF-12v1 (ρ: -0. 55 and -0.52, respectively (P<.001); anxiety and depression of the HADS (ρ: 0.47 and 0.59, respectively (P<.001); NPRS (ρ: 0.45; P<.001); and index 9 of the 12-MOS Sleep scale (r: 0.49; P<.001).

Conclusions: The PPIQ is a valid instrument with good psychometric properties for measuring functional interference in people with CLBP. This questionnaire appears to be a feasible alternative when language or communication barriers exist in CLBP population.