Archives of physical medicine and rehabilitation最新文献

Objective: Post-stroke rehabilitation provides skilled services that target motor impairments to improve function and maximize independence after stroke. Our objectives are to first describe functional outcomes for those who participated in rehabilitation services, then to identify race/ethnic disparities in rehabilitation services after stroke and characterize the independent association of race/ethnicity to functional recovery post-stroke.

Design: Observational data were extracted from the American Heart Association's Get-With-The-Guidelines-Stroke dataset. Rehabilitation services, and modified Rankin Scale were recorded at hospital discharge and via follow up phone calls at 30- and 90-days after.

Setting: Large, comprehensive stroke centers PARTICIPANTS: Stroke survivors throughout the state of Florida.

Interventions: Not applicable.

Outcomes: Descriptive statistics characterize functional change in those who received rehabilitation services. Logistic regression models adjusted for potential confounders were used to determine: 1) race/ethnic differences in rehabilitation services received; and 2) race/ethnic differences in functional change from discharge to 30- and 90-days, respectively.

Results: Of 1,083 individuals, 43% were female, 54% were Non-Hispanic White (NHW), 23% Non-Hispanic Black (NHB), and 23% Hispanic. At a short-term (30-days) follow up after hospital discharge, 14% of individuals who received rehabilitation services showed functional gains, 68% no change in function, and 18% functional decline. Yet, 30-days is likely inadequate for the full functional benefit of rehabilitation efforts. At 90-days after hospital discharge, 26% showed functional improvements, 58% no change, and 16% functional decline. Irrespective of type of rehabilitation services received, there were no differences in functional change between NHW and NHB individuals, yet Hispanic individuals were less likely to improve [aOR=0.647, 95%CI (0.425,0.983)] compared to NHW. Additionally, Hispanic individuals were significantly less likely to receive any rehabilitation services [aOR=0.626, 95%CI (0.442,0.886)] and were half as likely to receive outpatient services [aOR=0.543, 95%CI (0.368,0.800)] as compared to NHW.

Conclusions: Rehabilitation is key to functional improvement after stroke. We are making strides in health equity between NHW and NHB individuals, yet there remain disparities in functional outcomes and in rehabilitation services particularly for Hispanic individuals after stroke.

Objective: To examine whether cognitive symptoms, an indicator of need, was associated with the likelihood that Veterans with mild traumatic brain injury (mTBI) received a cognitive rehabilitation referral in the Veterans Health Administration (VHA). We also examined whether non-clinical factors modified the relationship between cognitive symptoms and receipt of a referral.

Design: Retrospective cohort study of VHA medical record data. Modified Poisson regression was used to model the likelihood of receiving a cognitive rehabilitation referral based on cognitive symptom severity and non-clinical predisposing (e.g., race/ethnicity) and enabling (e.g., drive time) factors. Discipline-specific models were specified to explain a referral to occupational therapy (OT); speech-language pathology (SLP) services, and neuropsychology. Statistical interactions determined whether non-clinical factors modified the relationship between cognitive symptoms and receipt of a referral.

Setting: VHA.

Participants: Veterans with a mTBI, determined using the Comprehensive Traumatic Brain Injury (TBI) Evaluation database (n=77,001).

Interventions: N/A.

Main outcome measure: Cognitive rehabilitation referrals (no/yes), identified using a validated algorithm.

Results: Only 26% received a cognitive rehabilitation referral, with SLP services being the most common discipline (19%), followed by neuropsychology (6%) and OT (3%). Veterans with more severe cognitive symptoms were more likely to receive a referral, and this relationship was stable in discipline-specific models. However, many Veterans without a referral reported severe cognitive challenges, indicating unmet need. Moreover, non-clinical factors-including Hispanic ethnicity, employment status, rurality, drive time, neighborhood disadvantage, and VHA enrollment priority group (e.g., requiring a co-pay)-modified the relationship between cognitive symptom severity and receipt of a referral.

Conclusions: These results suggest that while cognitive rehabilitation services tend to be allocated to those in need, significant gaps in access exist. Findings lay the foundation for developing strategies that expand access to beneficial cognitive rehabilitation among Veterans with mTBI, reducing their cognitive symptoms and enhancing their daily function.

Objective: This study aims to investigate the effects of deep transcranial magnetic stimulation (dTMS) on the treatment of dysphagia to reduce aspiration episodes in patients with infratentorial stroke (IS).

Design: A prospective, double-blinded, sham-controlled, single-center clinical trial.

Setting: A tertiary hospital rehabilitation center.

Participants: Forty-eight patients were enrolled and allocated to three groups: high-frequency (HF) group, low-frequency (LF) group, or sham stimulation group.

Interventions: DTMS targeting the bilateral insular cortex was performed using the H-coil. LF (1 Hz) was delivered in 20 trains (50 pulses/train, 50s duration) with 15s inter-train intervals, and HF (10 Hz) consisted of 34 trains (30 pulses/train, 3s duration) .

Main outcome measures: The primary outcomes of the study included the respiratory-swallow coordination (RSC) parameters and Penetration Aspiration Scale (PAS) scores. Secondary outcomes comprised Functional Oral Intake Scale (FOIS) scores, with assessments performed at baseline, immediately post-intervention (day 0), and at 1- and 2-month follow-ups.

Results: The swallow apnea duration (SAD) in the treatment group was significantly prolonged compared to the sham group (p<0.05), and the change in SAD in both the HF and LF groups was significantly greater than that in the sham group (p<0.05). Although a reduction in the swallow-inhale RSC pattern was observed only in the HF group following the intervention, this change did not achieve statistical significance (p>0.05). The FOIS scores in the HF and LF groups demonstrated significant effects of time and intervention (F=2.48, p<0.001). At 0 day post-intervention, the improvement in FOIS scores was significantly greater in the HF group compared to the sham group (p<0.05); additionally, the PAS scores in the HF group showed a notable reduction.

Conclusion: The study demonstrated that both HF dTMS and LF dTMS influenced the SAD values, RSC patterns did not change significantly. Notably, the HF group showed more pronounced improvements in both aspiration reduction and overall swallowing function. These findings support the clinical application of dTMS in this patient population.

Objective: To characterize childhood cancer survivor (CCS) and caregiver barriers and facilitators to participating in rehabilitation therapies, specifically physical therapy, occupational therapy and speech-language pathology, following a new pediatric cancer diagnosis.

Design: Multi-site qualitative study.

Setting: Two US academic medical centers in the Midwest and Mountain West regions.

Participants: Thirteen CCS diagnosed with cancer before age 19 with a rehabilitation referral and 33 caregivers of CCS meeting eligibility criteria.

Interventions: Not applicable.

Main outcome measure(s): Not applicable.

Results: We identified five key themes: (1) consistency in care; (2) unique needs of CCS; (3) access to local rehabilitation services in home communities; (4) caregiver engagement; and (5) costs and insurance coverage. Receiving routine care from consistent providers helped CCS feel comfortable participating in and challenging themselves in therapy. Organizational and provider supports helped families navigate transitions between rehabilitation settings. Participants reported challenges related to finding care that met CCS' unique needs in their home communities and identifying providers who were knowledgeable of these needs. Patient safety and comfort were influenced by factors such as rehabilitation setting and sanitized to reflect the needs of immunocompromised CCS. Organizational and provider supports helped families with associated care cost barriers, including insurance coverage.

Conclusions: CCS and caregiver experiences with rehabilitation services are influenced by supports and challenges at multiple levels, including individual, community, and organizational levels. These findings can inform current and future pediatric oncology rehabilitation program multi-level implementation and promote patient and family participation. Contextual factors that influence these efforts should be a focus of future research.

Objective: This study examined changes in satisfaction with and ability to participate in social roles and activities over 3 years for people who were aging with long-term physical disability. The goal was to understand the impact of physical health, function, depression, fatigue, and pain on participation.

Design: A 3-wave longitudinal cohort survey study was completed from 2019-2022.

Setting: The general community.

Participants: The study included 323 respondents who participated all 3 years. Purposive sampling recruited individuals aged 45-64 with at least 5 years of disability history through community partners, advertisements, and social media.

Interventions: Not applicable MAIN OUTCOME MEASURES: Patient-Reported Outcome Measurement Information System (PROMIS) Adult Ability to Participate in Social Roles and Activities and PROMIS Satisfaction with Participation in Social Roles.

Results: Univariate repeated measures analysis of variance models indicated that satisfaction with participation did not change over time, and ability to participate slightly increased (means T0 44.4, T2 45.5, P=0.045). Linear mixed models indicated that greater physical function was associated with greater satisfaction (β=0.21, 95% CI 0.14 to 0.28) and ability to participate (β=0.19, 95% CI 0.13 to 0.26). Greater levels of depression, fatigue, and pain were associated with decreased satisfaction (depression β=-0.21, 95% CI -0.28 to -0.14; fatigue β=-0.18, 95% CI -0.26 to -0.11; pain β=-0.14, 95% CI -0.21 to -0.07) and decreased ability to participate (depression β=-0.23, 95% CI -0.29 to -0.17; fatigue β=-0.19, 95% CI -0.25 to -0.12; pain β=-0.12, 95% CI -0.18 to -0.06).

Conclusions: This longitudinal study demonstrated that satisfaction with and ability to participate in social roles fluctuated little over 3 years but were influenced by physical and mental health variables. Findings suggest that decreasing aging-with-disability symptoms and improving health and function may sustain social participation over time. Interventions to address social participation decline are available; however, further exploration into individual differences and external socioeconomic factors is warranted to understand the variance in social participation.

Objective: To characterize the extent and contexts in which the Rehabilitation Treatment Specification System (RTSS) and its predecessor, the Rehabilitation Treatment Taxonomy (RTT), have been applied in the field of rehabilitation.

Data sources: Electronic databases (e.g. PubMed and CINAHL) were searched. All articles were collated in the Covidence database.

Study selection: To be included in this scoping review, the studies had to be specific to rehabilitation and mention the RTT or RTSS and/or a combination of concepts of RTT/RTSS such as ingredients, targets, and mechanisms of action. Reviewers screened the titles, abstracts and full-text articles for eligibility. 1,929 sources were identified, and 71 full text articles were included.

Data extraction: Random pairs of reviewers used a data extraction form to collect information about each article. Any discrepancies were resolved through discussion by the two reviewers, a third reviewer, or with additional reviewers until agreement was achieved.

Data synthesis: Results revealed that less than half of the 71 included publications applied the RTSS to specify rehabilitation treatments. A variety of relevant study characteristics were reported, including RTSS contexts of its application (e.g., disciplines of authors, use of key terms/concepts, and target clinical conditions).

Conclusion: The RTSS has reached a global audience, but many of the references to the RTSS in the literature cite concepts from the RTSS without performing actual specifications of treatments. There remains considerable work to be done in terms of quality and comprehensiveness of intervention specifications as well as RTSS application across different areas of rehabilitation practice.

Objective: To determine whether specific ultrasound (US) measures and cut-off scores from a new point-based scoring system were able to confirm the findings of the Videofluoroscopic swallow study (VFSS) in diagnosing swallowing disorders (SD).

Design: Cross-sectional, single-center study from March 2021 to March 2023. Initial SD screening on the Penetration Aspiration Scale (PAS) and subsequent evaluation on the VFSS were administered to confirm SD. Additionally, an US study examined tongue thickness, tongue movement, hyoid bone displacement, and suprahyoid muscles. A scoring system based on these US measures was developed and cut-off scores for presence/absence of SD were determined from the US and VFSS findings.

Setting: Single tertiary referral center providing both ambulatory and inpatient care.

Participants: 119 adults consecutively admitted to the SD unit with suspected SD. Exclusion criteria included total laryngectomy, health conditions preventing standard evaluation (e.g., dyspnoea, musculoskeletal disorders) and prior evaluation in the unit.

Interventions: Not applicable.

Main outcome: SD was able to be confirmed on the US-based score. The US cut-off scores were related to the presence or absence of SD based on the findings of the VFSS.

Results: SD diagnosed in 75 (63%) based on VFSS; and corroborated with main US features seen during swallowing. The logistic model developed included tongue movement, hyoid bone displacement, geniohyoid thickness at rest and sex (Area Under the Curve = 0.83, 95% CI 0.75-0.91). The ultrasound scoring system developed range from 0 to 5; with 0 indicating no dysphagia and 3-5 indicating SD. The optimal cut-off to rule out SD was ˂1, with a negative likelihood ratio of 0.04 and a negative post-test probability of 6%. To rule in SD, the optimal cut-off was ≥3, with a positive likelihood ratio of 5.1 and a positive post-test probability of 90%.

Conclusions: The ultrasound-based scoring system is a promising, easy-to-use assessment tool with good diagnostic accuracy and useful post-test probabilities for SD assessment. Further research is needed before clinical adoption.

Objective: To evaluate the feasibility and preliminary effects of remotely delivered metacognitive strategy training (MCST) to address CRCI in breast cancer survivors.

Design: Single-blind, pilot randomized controlled trial SETTING: University research laboratory and community PARTICIPANTS: Women with self-reported CRCI, aged 40-80 years, who completed chemotherapy for breast cancer between six months and three years prior were recruited from a local cancer center and community support groups.

Methods: Outcome data were gathered pre- and post-intervention. Participants (n=42) were randomized to either a 10-session Cognitive Orientation to daily Occupational Performance (CO-OP; i.e., a type of MCST) group or an attention control + education group. All study procedures were conducted via secure videoconferencing.

Interventions: 10, 45-minute weekly sessions of remotely-delivered metacognitive strategy training or an attention + education control group MAIN OUTCOME MEASURES: The primary aim of this study was to evaluate feasibility RESULTS: The study demonstrated strong feasibility with a 41% recruitment rate and a 91.3% retention rate. Participants rated the CO-OP intervention and its remote delivery as highly feasible, appropriate, and acceptable. The intervention group showed small to medium positive effects on trained activity performance goals, cognition in daily life, and executive function measures compared to the control group. The control group showed a small positive effect on quality-of-life outcomes compared to the intervention group.

Conclusions: Breast cancer survivors found the remotely-delivered CO-OP intervention to be suitable and practical. The positive effects of CO-OP on activity performance and cognitive outcomes support the need for further research on efficacy.

Objective: To describe the prevalence, interference, and intensity of subtypes of pain (at-level and below-level neuropathic pain [NeuP] and axial and limb musculoskeletal [MSK] pain) and the prevalence of non-painful sensations (NPS; unpleasant and non-unpleasant) experienced during the first 12 months after spinal cord injury (SCI) DESIGN: A prospective cohort study with clinician assessment of pain and survey administration at three timepoints SETTING: Four academic SCI rehabilitation centers PARTICIPANTS: 189 individuals, English-speaking and aged 18 or older, with complete and incomplete acute traumatic SCI, with or without pain INTERVENTIONS: Not applicable MAIN OUTCOME MEASURE: : International SCI Pain Basic Data Set RESULTS: At baseline, at-level NeuP and axial neck and upper back MSK pain were most reported, while at 12 months, at-level and below-level NeuP were, with the percentage of participants with at-level NeuP remaining stable from baseline to 12 months. During the year, the percentage of participants reporting below-level NeuP steadily increased, while the percentage with all types of MSK pain decreased. Electrical and stabbing related and thermal related descriptors were used more frequently to describe pain as compared to describing NPS, while numbness and tingling related descriptors were the most frequently used descriptors for both pain and NPS. Pain intensity and interference were variable throughout the year.

Conclusions: At-level NeuP remains consistent and MSK pain resolves over the first year for most people. However, more people develop below-level NeuP as the first-year progresses. Pain intensity and interference are variable, presenting without clear pattern during this time-period.

Objectives: To explore the early efficacy of Building Emotional Self-awareness Teletherapy (BEST) at reducing alexithymia and improving emotional functioning in Civilians and military Service Members and Veterans (SM/V) with mild traumatic brain injury (mTBI).

Design: Non-randomized, pretest-posttest design and a 3-month follow-up.

Setting: Community.

Participants: Forty participants with mTBI (20 civilians and 20 SM/V) and elevated alexithymia and emotion dysregulation. On average, participants were 40 years-old and 13 years post-TBI.

Intervention: BEST is an 8-session, remotely delivered intervention that trains emotional insight.

Main outcome measures: Toronto Alexithymia Scale-20 (TAS-20); Levels of Emotional Awareness Scale (LEAS); Difficulty with Emotion Regulation (DERS); Brief Resilience Scale (BRS); PROMIS Anxiety and Anger; PHQ-9 (depression); Post-traumatic Stress Checklist-5 (PCL-5); Positive and Negative Affect Schedule (PANAS); and Patient Global Impression of Change (PGIC).

Results: Thirty-six participants completed the study (90% retention). Compared to baseline, participants had significant improvements immediately and 3-months after treatment on the TAS-20, LEAS, DERS, BRS, PANAS negative affect scale, PROMIS Anxiety and Anger, PHQ-9, and PCL-5. All p-values were <.001, except PANAS negative affect at immediate post-test (p=.001), PROMIS Anxiety at both post-timepoints (p=.009 and p=.006, respectively), and PROMIS anger at 3-month follow-up (p=.001). At post-test, 75%, 70%, and 60% of participants improved by ≥ ½ standard deviation (SD) on the TAS-20, LEAS, and DERS, respectively. On the PGIC, 83% of participants reported noticeable positive changes in their emotional functioning.

Conclusions: Findings support the preliminary efficacy of BEST at improving psychological health in civilian and military participants with mild TBI who have elevated alexithymia and emotion dysregulation. However, larger trials with more rigorous designs are necessary to determine the true impact of BEST.