Archives of physical medicine and rehabilitation最新文献

Objectives: To investigate the effects of a 9-month online bone-strengthening exercise intervention on the femoral neck areal bone mineral density (aBMD) Z-score and other bone health parameters.

Design: Assessor-blinded randomized controlled trial with 2 parallel arms.

Setting: Sport and Health University Research Institute (iMUDS).

Participants: A total of 116 pediatric cancer survivors aged 6-18 years (12.1 ± 3.3 years; 42% girls).

Interventions: Before intervention, all participants received dietary counseling on calcium and vitamin D intake. The exercise group performed a 9-month periodized video-recorded bone-strengthening exercise intervention based on squats and jumps (3-4 days/week for 10-20 min/session) at home.

Main outcome measures: Primary (femoral neck aBMD [g/cm²]) and secondary outcomes (aBMD and bone mineral content [BMC, g]) were measured using dual-energy X-ray absorptiometry at the hip regions (femoral neck and total hip), total body, and lumbar spine (mean of L1-L4) at baseline and 9-month post-intervention.

Results: No between-group differences in femoral neck aBMD Z-score (Cohen's d = -0.08, P = .706) and aBMD Z-score outcomes were observed post-intervention. However, the intervention showed small effect sizes on the total hip, with a borderline non-significant improvement in aBMD Z-score (Cohen's d = 0.35, P = .054) and a significant improvement in BMC Z-score (Cohen's d = 0.38, P = .039).

Conclusions: The 9-month online bone-strengthening exercise intervention did not increase the femoral neck aBMD Z-score; however, it improved the overall BMC Z-score at the hip in young pediatric cancer survivors.

Objective: To compare knee osteoarthritis in people with unilateral transtibial (UTT) limb loss (LL) between (i) intact- and amputation-side knees, and (ii) ∼8-years and ∼11-years post-LL, and report knee osteoarthritis in reference population.

Design: Inception cohort SETTING: UK military PARTICIPANTS: Volunteers with UTT LL (n=36) and matched controls (n=36).

Interventions: N/a.

Main outcome measures: Kellgren-Lawrence (KL; 0-4 [none-severe]) score and Knee injury and Osteoarthritis Outcome Score (KOOS; 100-0 [no problems-severe problems]) for Pain and Symptoms.

Results: At Baseline, ∼8-years after LL, mean age was 32.9±4.2-years. Participants used dynamic-passive prosthetic limbs for daily activities and exercise. At Baseline, KL was not different between intact- and amputation-side knees (p=0.220). At Follow-up, KL was worse on the amputation-side compared to intact-side knee (p=0.021). Rank biserial correlation indicated that, for a randomly chosen pair, the amputation-side knee was 67% more likely to have a higher KL score than the intact-side knee. On both the intact- and amputation-side knees, KL was not different between Baseline and Follow-up (p=0.706 and p=0.138). KOOS Pain and Symptoms were not different between intact- and amputation-side knees at Baseline (Pain: median 100.0 vs. 100.0, p=0.253; Symptoms: median 90.0 vs. 86.5 p=0.573) or Follow-up (Pain: median 94.4 vs. 97.2, p=0.291; Symptoms: median 90.0 vs. 90.0 p=0.247). KOOS Pain (p=0.619 and p=0.557) and Symptoms (p=0.664 and p=0.580) were not different between Baseline and Follow-up for the intact- and amputation-side knees.

Conclusions: For the first time, we have compared osteoarthritis of the intact- and amputation-side knee of people with UTT LL. Contrary to current opinion, radiographic osteoarthritis was worse on the amputation-side knee 11-years post-LL. Modern military populations may be unique in their access to rehabilitation and prosthetic technology, resulting in different patterns of osteoarthritis. Clinical care should focus on the intact- and amputation-side knee of people with UTT LL.

Objective: To compare the Physiological Cost Index (PCI) across stroke, traumatic brain injury (TBI), and non-TBI groups; evaluate within-group changes in PCI during inpatient rehabilitation; assess agreement between PCI derived from the 2-minute and 6-minute walk tests; and estimate a distribution-based minimal clinically important difference (MCID).

Design: Retrospective cohort study.

Setting: Hospital.

Participants: Two hundred twenty-seven adults undergoing inpatient neurorehabilitation, including individuals with stroke (n = 117), traumatic brain injury (n = 71), and non-traumatic brain injury neurological conditions (n = 39).

Interventions: None MAIN OUTCOME MEASURE(S): Physiological Cost Index (PCI; beats·m⁻¹) derived from the 2MWT and 6MWT at admission and discharge.

Results: Individuals with non-TBI showed higher admission 6MWT-derived PCI than individuals with stroke and TBI (global p = 0.0012; ε² = 0.073; post-hoc: non-TBI>stroke (p=0.015); non-TBI>TBI (p=0.002). Stroke improved from admission to discharge (2MWT Δ -0.13 ± 0.41; 6MWT Δ -0.17 ± 0.59), while TBI/non-TBI changes were small/non-significant. Across groups and timepoints, PCI was higher for 2MWT than 6MWT; Bland-Altman mean bias +0.35 (admission) and +0.26 (discharge) beats·m⁻¹.

Conclusions: The 2MWT yields systematically higher PCI values than the 6MWT; likely reflecting non-steady-state cardiovascular responses inherent to shorter-duration walking. Stroke patients demonstrated clinically meaningful efficiency gains approaching an exploratory, distribution-based MCID (∼0.2 beats·m⁻¹); anchor-validated thresholds require larger, diagnosis-specific cohorts.

Individuals with spinal cord injury (SCI) face a disproportionate burden of obesity and cardiometabolic disease, yet evidence to guide pharmacologic treatment is minimal. Mainstay diet and exercise recommendations often yield modest, unsustainable results for those with SCI. In the general population, glucagon-like peptide-1 receptor agonists and dual agonists (GLP-1s) have emerged as potent therapies for obesity and related cardiometabolic disorders. Initially developed for type 2 diabetes mellitus, GLP-1s improve glycemic control, promote substantial weight loss, and reduce other cardiometabolic risk factors. While robust data from the general population show weight-dependent and independent benefits, evidence specific to SCI is limited to case presentations. These reports suggest the potential for significant reductions in body fat and improvements in cardiometabolic risk. However, concerns remain regarding potential complications, including worsened gastrointestinal dysfunction, reduced muscle mass with a proclivity to develop pressure injuries, and further compromises in bone density. This special communication draws on evidence from the general population and limited SCI-specific evidence to examine the relevance of GLP-1s for individuals with SCI and provides commentary on key clinical considerations for navigating their use in this population.

Objective: To examine the associations of specific physical activity (PA) patterns-intensity, frequency, and duration-with the risk of post-stroke cognitive impairment (PSCI) and long-term cognitive trajectories in Chinese stroke survivors.

Design: Observational cohort study (cross-sectional and longitudinal analyses) using CHARLS data.

Setting: Community-based nationwide survey in China (China Health and Retirement Longitudinal Study [CHARLS], 2011-2020).

Participants: Cross-sectional: 1502 stroke survivors (2011-2020). Longitudinal: 170 stroke survivors with PSCI at baseline (MMSE-defined) and 10-year cognitive follow-up.

Interventions: Not applicable.

Main outcome measure(s): PSCI status (education-adjusted Mini-Mental State Examination [MMSE] criteria) and cognitive trajectory group over 10 years.

Results: In the cross-sectional analysis, vigorous physical activity (VPA) performed three days per week for 2-4 hours (OR=0.51, 95% CI 0.27-0.95; p=0.034), and moderate physical activity (MPA) six days per week for 10-30 minutes (OR=0.32, 95% CI 0.18-0.57; p<0.001), were significantly associated with lower PSCI risk. VPA showed greater benefits in participants with hypertension, liver disease, or kidney disease, whereas MPA was more protective in older adults and those without dyslipidemia. The longitudinal analysis identified four distinct cognitive trajectories ("high-stable," "low-declining," "moderate high-stable," and "moderate low-declining"). MPA significantly improved cognitive function over time in PSCI patients (p=0.022).

Conclusion(s): Our results strongly support regular moderate physical activity for reducing PSCI risk and preserving long-term cognitive function. The role of vigorous activity appears promising but requires further confirmation. Thus, moderate-intensity exercise is recommended as the cornerstone of cognitive protection after stroke, with the benefits of vigorous exercise to be more firmly established in future studies.

Objective: To evaluate AI-based transtibial prosthetic socket shapes in a rural, low-income setting.

Design: This prospective cohort study evaluates AI-designed prosthetic sockets. Baseline and ten-week follow-up assessments were conducted to evaluate satisfaction, functionality, and quality of life.

Setting: The study was conducted at the 3D laboratory of Masanga Hospital in rural Sierra Leone.

Participants: 34 participants with a transtibial amputation without a functional prosthesis were enrolled. At follow-up, 27 participants completed the assessments.

Interventions: Local coworkers with limited prosthetic experience autonomously produced transtibial sockets using user-friendly software powered by an AI algorithm trained on expert data.

Main outcome(s) and measure(s): Baseline and ten-week follow-up assessments included: (1) satisfaction with the device and service using the adapted Orthotics and Prosthetics User's Survey (OPUS); (2) functioning by quantifying prosthetic wear time and step count (before and after receiving the prosthesis) with activity sensors and the Lower Extremity Functional Status (LEFS) using the adapted OPUS survey (range: 0-60); (3) disease-specific Health-Related Quality of Life (D-HRQoL) using the adapted OPUS survey (range: 0-36) and Generic Health-Related Quality of Life (G-HRQoL) using the EQ-5D-3L and the VAS score; (4) participants' personal goals were evaluated.

Results: The activity sensors confirmed that all participants used the prosthesis. Median prosthetic wear time was 9.3 (1.6-11.4) hours per day, with a median of 3978 (1746-6545) steps per day, of which 39% (16-76%) were with the prosthesis. Median scores indicated a significant improvement in OPUS LEFS from 45 (39-49) to 52 (47-54) and OPUS D-HRQoL from 25 (20-30) to 31 (25-35). EQ-5D-3L and the VAS score did not significantly change; 56% achieved their desired activity goal.

Conclusion and relevance: This study shows that easy-to-use software and AI can support socket design in areas with limited access to skilled prosthetists.

Objective: To investigate the dose-response relationship of virtual reality training (VRT) on overall motor function (UPDRS-III), functional mobility (TUG), and balance confidence (ABC) in Parkinson's disease (PD) to optimize rehabilitation protocols.

Data sources: A comprehensive literature search was performed across six electronic databases-PubMed, Embase, Cochrane Library, Web of Science, EBSCOhost, and CNKI-from their inception to August 3, 2025.

Study selection: A systematic search identified 31 randomized controlled trials (RCTs) (n=1,110) evaluating the effects of VRT on balance capabilities and functional gait in patients with PD.

Data extraction: Data were extracted into three categories: bibliographic details, participant characteristics, and intervention specifics, alongside quantitative data for TUG, UPDRS-III, and ABC scores. Data extraction was independently conducted by two reviewers, followed by cross-verification and adjudication.

Data synthesis: Weighted mean differences (WMD) and univariate meta-regression were analyzed following PRISMA guidelines. VRT significantly improved TUG (WMD = -3.69) and ABC (WMD = 11.80), both achieving the minimal clinically important difference (MCID). VRT alone improved TUG but missed the MCID. No significant improvement was observed for UPDRS-III overall. Optimal TUG parameters were identified as 21-40 minutes/session, 4-7 sessions/week, for 6-8 weeks. High-frequency training (≥4 sessions/week) was required for UPDRS-III benefits. Commercial and specialized platforms showed comparable efficacy.

Conclusions: VRT significantly enhances TUG and ABC, particularly achieving clinical utility (MCID) when combined with physical therapy. While UPDRS-III effects are limited, high-frequency protocols show potential. A frequency of 4-7 sessions per week was associated with clinically important improvements in TUG. Additionally, patients aged 70 years and older showed no statistical heterogeneity in their response to the intervention (I²= 0%). However, this finding should be interpreted cautiously, as it is based on a small number of studies and may reflect limited statistical power rather than true clinical predictability.

Objective: To compare the prevalence of health-related social risks (e.g. food insecurity, unreliable transportation) among adults with and without hearing, speaking, and/or understanding difficulties (collectively called communication disabilities (CDs)).

Design: Cross-sectional study.

Setting: Pooled data from the 2020-2023 National Health Interview Survey (NHIS).

Participants: A nationally representative sample of community dwelling, US adults.

Interventions: Not applicable.

Main outcome measures: Self-reported experience of social risks in food, housing, transportation, and access to medical care due to costs. Separate multivariate logistic regressions with survey weighting were conducted for each social risk factor, adjusted for age, sex, race, ethnicity, health insurance, education, employment, and rurality.

Results: Of 118,158 adults, 18.1% reported having a CD including 14.8% with hearing difficulties, 5.3% with difficulty speaking or understanding others, and 2.0% who experienced both. One in three adults with CDs (33.2%) reported at least one social risk, compared to one in four (24.3%) among those without CDs. In adjusted analysis, adults with any CDs had significantly higher rates for all social risks (Risk Difference [RD]: 0.030 to 0.059, P<.001 in all cases).

Conclusion: One in three adults with CDs experienced social risks in food insecurity, housing instability, unreliable transportation, and financial barriers to medical care, at rates higher than adults without CDs. The consistency of these findings across multiple social risk domains suggest that structural barriers tied to CD may compound social vulnerability. Findings also underscore opportunities for rehabilitation providers to routinely incorporate social risks into treatment planning as a way to achieve equitable health outcomes for this population.

Objective: To investigate the effectiveness of diaphragmatic training interventions in adults with non-specific low back pain.

Data sources: PubMed (MEDLINE), Embase, Web of Science, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and China National Knowledge Infrastructure databases were systematically searched from inception to December 2024, with an updated search conducted through December 2025.

Study selection: Inclusion criteria included the following: (1) adults (≥18 years) with non-specific low back pain; (2) interventions involving diaphragmatic training, either as a standalone treatment or in combination with other therapies; (3) any comparator; (4) pain intensity and functional disability as primary outcomes, with diaphragmatic thickness as a secondary outcome; and (5) randomized controlled trial designs. Two reviewers independently screened the studies.

Data extraction: Data were extracted independently by two reviewers. The Cochrane Risk of Bias (RoB 1) assessment and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) certainty ratings were conducted by four reviewers.

Data synthesis: Thirteen studies (626 participants) were included. Diaphragmatic training likely reduced pain intensity compared with control interventions (SMD = -0.60; 95% CI = -0.86 to -0.34; 11 trials, n = 465; moderate-certainty evidence). It also likely improved functional disability (SMD = -0.71; 95% CI = -0.90 to -0.53; 9 trials, n = 469; moderate-certainty evidence). Evidence for changes in diaphragmatic thickness was of very low certainty. Subgroup analyses suggested that better pain outcomes typically occurred with 2-3 sessions per week.

Conclusion: Moderate-certainty evidence suggests that diaphragmatic training may be considered as an adjunct to rehabilitation to reduce pain intensity and improve functional disability in adults with non-specific low back pain. Prespecified trials with longer follow-up are needed to clarify effects on diaphragm thickness and the influence of training parameters.