Archives of physical medicine and rehabilitation最新文献

Objective: The aim of this study was to conduct a meta-analysis to investigate the effect of virtual reality (VR)-based rehabilitation on the mental health and quality of life of stroke patients.

Data sources: The search strategy was conducted in five databases (PubMed, Scopus, Web of Science, Embase, and Cochrane Library databases) from inception to December 2023.

Study selection: Randomized controlled trials (RCTs) comparing the effectiveness of standard rehabilitation and VR-based rehabilitation for stroke patients.

Data extraction: Data from the included articles were extracted independently by two authors, with any disagreements resolved through consultation with a third author. The extracted data included the first author's name, country/region, publication year, sample size, mean/median age of participants, gender distribution (the proportion of males), VR type, duration of rehabilitation, comparison, intervention, and assessment of outcome.

Data synthesis: A total of 29 studies involving 1,561 stroke patients were included. The results showed that compared with standard rehabilitation, VR-based rehabilitation remarkably reduced anxiety symptoms [SMD=-0.97 (95% CI [-1.84, -0.09], P <0.0001)], depression symptoms [SMD=-0.94 (95% CI [-1.46, -0.42], P <0.001)], and improved quality of life [SMD=0.94 (95% CI [0.42, 1.45], P <0.001)] of stroke patients. Subgroup analysis showed that immersive VR was particularly effective in reducing anxiety and depression symptoms compared to non-immersive VR. The longer the duration of VR intervention, exceeding 6 weeks, the more significant the effect of improving anxiety and depression symptoms. Meanwhile, VR-based rehabilitation significantly improved the psychological state and quality of life of European patients.

Conclusions: VR-based rehabilitation significantly reduces anxiety and depression symptoms and enhances the quality of life in stroke patients compared to standard rehabilitation. The most notable improvements were observed with immersive VR-based rehabilitation programs over six weeks in duration, particularly among European patients.

Objective: To explore the feasibility and effectiveness of face recognition-driven video game (FR-VG) swallowing training for stroke patients with dysphagia.

Design: A single-blind pilot randomized controlled trial.

Setting: A rehabilitation center.

Participants: Stroke patients with dysphagia (N=26).

Interventions: Participants in the intervention group were trained using FR-VG, while the control group used the conventional method (i.e. lip exercise, tongue exercise, and lower jaw exercise). The training was conducted five days a week over four weeks.

Outcome measures: The swallowing function and swallowing-related quality of life between the two groups were observed before and after the intervention. The acceptance of FR-VG in the intervention group and the adherence of the patients in the two groups after the intervention were analyzed.

Results: A total of 26 stroke patients with dysphagia were included. The results showed that after the intervention, both groups exhibited significant improvements in swallowing function and swallowing-related quality of life compared to the pre-intervention (p < 0.05). Patients in the intervention group demonstrated better swallowing function than the control group on the Gugging swallowing screen (p = 0.015) and functional oral intake scale (p = 0.004). The intervention group had high acceptance of the FR-VG training and had significantly better adherence compared to the control group (p = 0.032).

Conclusions: FR-VG rehabilitation training can help improve swallowing function, swallowing-related quality of life, and training adherence in stroke patients with dysphagia. Patients have a high acceptance of FR-VG rehabilitation training, which can be used as an adjunctive method to conventional rehabilitation.

Objectives: To summarize current reports in the literature on disparities in rehabilitation following stroke; identify gaps in our understanding of rehabilitation disparities; and make recommendations for future research.

Data sources: A Health Sciences librarian developed a search string based on an a priori protocol and searched MEDLINE (Ovid) Embase (Elsevier), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL, EBSCO).

Study selection: A two-step screening process of titles and abstracts followed by full-text review was conducted. Primary observational studies conducted in the United States that reported on disparities in rehabilitation (i.e., physical, occupational, or speech therapy) among adults following stroke were retained. Eligible disparity populations included racial minorities; ethnic minorities; sex and gender minorities; older population; socioeconomically disadvantaged populations; and geographic minorities (inner city/rural).

Data extraction: Data extracted from retained articles included: aims/objectives; data source; sample characteristics, rehabilitation outcomes examined; types of disparities examined; statistical methods used; and disparity findings.

Data synthesis: 7,853 titles and abstracts were screened, and 473 articles underwent full-text review. 49 articles were included for data extraction and analysis. Many articles examined more than one disparity type with most examining disparities in race and/or ethnicity (n=43, 87.7%), followed by sex (n=25, 53.0%), age (n=23, 46.9%), socioeconomic status (n=22, 44.9%), and urban/rural status (n=8, 16.3%). Articles varied widely by sample characteristics, data sources, rehabilitation outcomes, and methods of examining disparities.

Conclusions: While we found some consistent evidence of disparities in rehabilitation for older individuals, non-White races, and individuals of lower socioeconomic status, the variability in methods made synthesis of findings challenging. Further work, including additional well-designed studies and systematic reviews and/or meta-analyses of current studies are needed to better understand the extent of rehabilitation disparities following stroke.

Objectives: To i) compare baseline clinical and demographic characteristics of post-acute stroke inpatients who were diagnosed with first-time urinary tract infection (UTI) vs inpatients who were not ii) compare rehabilitation outcomes between both groups and iii) examine associations between time to UTI event and risk factors.

Design: Retrospective observational cohort study SETTING: Institution for inpatient neurological rehabilitation.

Participants: Inpatients (n=1683) admitted within 3 months post-stroke to a rehabilitation facility between 2005 and 2023.

Interventions: Not applicable.

Main outcome measures: Functional Independence Measure (FIM), Functional Ambulation Categories (FAC) at admission. Cox proportional hazards models analyzed the association between UTI event timing and risk factors.

Results: Of the (n=1683) included patients, 196 (11.6%) experienced a UTI. In 32.1% of cases, the UTI occurred during the first week after admission to rehabilitation and 47.9% of UTIs occurred during the first two weeks. Median (IQR) time to UTI was 16 (5-37) days since admission. Most common germs were Escherichia coli (40.5%), Klebsiella pneumoniae (23.7%) and Pseudomonas aeruginosa (6.4%). Patients who acquired a UTI had older age, higher stroke severity, higher proportion of dysphagia, hypertension, neglect, bilateral affectation, atrial fibrillation, hemiplegia, lower levels of functional independence and lower FAC. We identified no differences in sex, type of stroke (ischemic or hemorrhagic), time to admission, aphasia, diabetes, dyslipidemia, chronic obstructive pulmonary disease, dominant side affected and educational level between both groups. Patients with UTI presented significantly poorer rehabilitation outcomes including lower discharge FIM and FAC, larger LOS, lower FIM efficiency and decreased FIM effectiveness. Multivariable Cox proportional hazards identified hypertension HR=1.60(1.13-2.27), admission FIM HR=0.98(0.97-0.99), admission BMI HR=0.96(0.93-0.99) and admitted with catheter HR= 1.80(1.22-2.64) as significant predictors of time to first UTI event (Concordance-index = 0.754).

Conclusions: UTIs identification, characterization, and predictive factors can support post-acute stroke mitigation strategies to minimize UTI-related complications and optimize rehabilitation outcomes.

Objectives: To (1) compare physical activity variability between individuals with patellofemoral pain (PFP) and pain-free individuals and (2) evaluate the relationships of physical activity variability with pain severity, symptom duration, disability, and pain catastrophizing in PFP cohorts.

Design: Cross-sectional case-control study.

Setting: University research laboratory.

Participants: Individuals with PFP (N=34) and pain-free individuals (N=34) aged 18 to 40 years.

Interventions: Not applicable.

Main outcome measures: We assessed physical activity (daily steps and moderate-to-vigorous physical activity [MVPA]) over a period of 14 consecutive days using a triaxial accelerometer. Variability (coefficient of variation) for daily steps and MVPA was calculated, where higher CV values indicate greater physical activity variability. We evaluated pain severity (numeric pain rating scale), symptom duration (months), disability (Knee Injury and Osteoarthritis Outcome Score-Patellofemoral subscale), and pain catastrophizing (Pain Catastrophizing Scale). Independent t-tests or Mann-Whitney U tests evaluated group differences in physical activity variability. Spearman ρ correlation coefficients were calculated to determine the relationships of physical activity variability with pain severity, symptom duration, disability, and pain catastrophizing in PFP cohorts. Correlation coefficients were interpreted as weak (<0.40), moderate (0.40-0.70), and strong (>0.70).

Results: Age, height, and mass did not differ between individuals with PFP and pain-free individuals (P>.05). Individuals with PFP displayed greater variability in daily steps (P<.001) and MVPA (P=.001) compared to pain-free individuals. In individuals with PFP, greater variability in daily steps was moderately related to higher pain severity (ρ=0.41, P=.016), while greater variability in MVPA was weakly related to higher pain severity (ρ=0.36, P=.037).

Conclusions: Individuals with PFP demonstrated greater physical activity variability compared to pain-free individuals, which positively related to more severe pain. Future PFP research may explore the underlying factors contributing to increased physical activity variability and their potential implications for pain management.

Objectives: To investigate the effect of telerehabilitation-based graded motor imagery (MI,GMI) training on pain and pain-related factors in people with multiple sclerosis (MS).

Design: Randomized controlled, assessor-blind pilot trial with repeated measure design.

Setting: Neurology outpatient clinic.

Participants: Thirty-two people with MS were randomly allocated to intervention (n=16) and control (n=16) groups.

Interventions: During 8-week GMI training period, the first 2-weeks involved implicit MI training while 6-weeks explicit MI training were conducted.

Main outcome: The primary outcome was the general pain intensity over the past two days, assessed with Visual Analogue Scale, with a minimum clinically important difference (MCID) of 23 mm. Secondary outcomes included general pain and specific body parts' pain intensity over the past seven days, neuropathic pain intensity, MI ability, fatigue, depression, anxiety, quality of life, sleep quality, daytime sleepiness and cognitive functions scores. Assessments were conducted at baseline, at weeks 8 (post-treatment) and 12 (follow-up).

Results: The intervention group demonstrated a significant reduction in pain intensity over the past two days compared to control group (p<0.05). Furthermore, at the 8-week assessment, the intervention group surpassed the MCID in pain intensity over the past 2 and 7 days (p<0.05), whereas no significant change was observed in the control group (p>0.05). Significant effects were observed post-treatment on general pain over the past seven days, neuropathic pain, MI ability, fatigue, depression, quality of life, processing speed, and visuospatial memory within intervention group compared to control group (p<0.05). However, the impact on anxiety, sleep quality, daytime sleepiness, and verbal memory between groups were not significant (p>0.05).

Conclusion: Telerehabilitation-based GMI training stands out as viable for management of chronic pain and pain-related psychosocial symptoms for people with MS.