Archives of physical medicine and rehabilitation最新文献

Objective: To investigate the recovery processes of pusher behavior (PB) and unilateral spatial neglect (USN) based on the severity of PB and USN, and to determine the relationship between activities of daily living (ADL) independence levels.

Design: This retrospective study aimed to examine the temporal changes and their association with ADL independence levels based on the severity of PB and USN.

Setting: Recovery ward of Moriyama Neurological Center Hospital between March 2017 and October 2022.

Participants: We included all patients with cerebrovascular disease admitted to the recovery ward of Moriyama Neurological Center Hospital between March 2017 and October 2022. A total of 174 patients with PB and USN were classified into 4 groups as follows: severe PB and severe USN (Group A), severe PB and mild USN (Group B), mild PB and severe USN (Group C), and mild PB and mild USN (Group D).

Interventions: Not applicable.

Main outcome measures: Kaplan-Meier survival analysis was used to determine whether the time to recovery from PB or USN (SCP: ≤1.75 points; Catherine Bergego Scale: 0 points) differed between groups. In addition, group differences in functional independence measure (FIM) scores and efficiencies were examined.

Results: There were significant differences among Groups A and B, and Groups A and C, as determined by the log-rank test (P<.05), and recovery was prolonged when both PB and USN were severely impaired. Similarly, FIM scores and efficiencies were lower in Group A (P<.05). When PB and USN were severely impaired, ADL was adversely affected, and the recovery process was prolonged. In addition, when 1 of the 2 symptoms was severe and the other was mild, each recovery course tended to show improvement, suggesting that they exerted a mutual influence on each other.

Conclusions: These findings indicate that severity classification may help to determine functional prognosis in patients with PB and USN.

Objective: To identify variations among administration and scoring instructions of six upper extremity Fugl-Meyer Assessment (FMA-UE) protocols and to achieve consensus regarding optimal administration procedures.

Design: Nominal group consensus technique comprised of iterative independent reviews of protocol content, anonymous voting, and group consensus meetings.

Setting: Clinicians working in clinical practice and research settings participated in virtual meetings via Zoom.

Participants: Ten experts in stroke rehabilitation and administration of the FMA-UE contributed to the interprofessional consensus group.

Interventions: not applicable.

Main outcome measure: Qualitative reviews of each FMA-UE protocol and rater responses (agree/disagree) regarding variations in general administration instructions (i.e., instructions that could affect the scoring of many individual test items) were discussed and analyzed during a three-phase consensus process. An a priori target of 80% or greater agreement was used to determine group consensus.

Results: Consensus was attained for 7/10 general administration instructions. Recommendations from our consensus group summarize "best practice" general instructions for researchers and clinicians. A case example, in which we found up to a 21-point difference between highest and lowest FMA-UE scores, highlights the potential impact of these protocol variations.

Conclusions: Variations among FMA-UE administration protocols during stroke rehabilitation studies can lead to discrepancies in the interpretation and translation of research findings across institutions and limit the perceived value and uptake of standardized assessments for evidenced-based practice. Results of this nominal group consensus provide a first step toward developing cohesive FMA-UE recommendations for wider dissemination and review.

Objectives: To conduct a systematic review of clinical guidelines, guidance documents and consensus statements regarding physical activity (PA) promotion by healthcare providers (HCPs) to people with multiple sclerosis (MS), and to assess the methodological quality, and actionability of the recommendations. The protocol was registered with Prospero (CRD42023495137).

Data sources: Clinical guidelines, guidance documents and consensus statements (hereafter guidelines) published in English between 2013-2023 were identified through extensive grey and scientific literature searches, and through contacting relevant HCP organisations in English speaking countries.

Study selection: Two researchers independently screened titles and abstracts of the 939 identified records and included 19 guidelines which were developed for PA promotion as part of MS clinical management, and for which the target user was HCPs.

Data extraction: Two researchers independently extracted data and appraised the methodological quality using the Appraisal of Guidelines for Research and Evaluation (AGREE-II). Behavioural actionability was analysed using the Actor, Action, Context, Target and Time (AACTT) framework.

Data synthesis: Seventy-eight recommendations from 19 guidelines were identified. Two guidelines had high methodological quality. Actor, Action, Context, Target and Time was clearly specified in 57 (73%), 45 (58%), 0 (0%), 51 (65%), and 24 (31%) of the 78 recommendations, respectively. Guidelines with the highest methodological quality did not always score well on actionability, and vice-versa.

Conclusions: Our comprehensive analysis of guidelines for PA promotion in MS reveals the need for more actionable recommendations and better reporting of guideline development, which has the potential to improve the translation of evidence into practice.

Objective: To examine the effects of a sport-based exercise therapy (ET) program combined with usual care (sET+UC) compared with usual care (UC) alone on health-related quality of life, upper limb motor control, functional capacity, mobility, balance, and physical activity participation in ambulant adults with acquired brain injury (ABI).

Design: Single-blind, parallel-group, randomized controlled trial.

Setting: Rehabilitation center.

Participants: Twenty-three adults with ABI (82.6% stroke; 17 men; mean age of 59.6±10.3y).

Intervention: Participants received either sET+UC (n=11) or UC (n=12). The sET+UC group received sixteen 60-minute sessions of a sport-based ET program in addition to sixteen 60-minute sessions of UC, whereas the UC group attended UC only.

Main outcome measures: Primary outcome measures were health-related quality of life (Short Form-36 [SF-36]) and upper limb motor control (Fugl-Meyer Upper Extremity [FM-UE]), whereas the secondary included functional capacity (6-minute walk test and 10-meter walk test), mobility (timed Up and Go Test), balance (Berg Balance Scale), and physical activity participation (Global Physical Activity Questionnaire).

Results: Significant differences were found in all outcome analyses at postintervention when comparing between groups. The sET+UC group showed significant improvements in both the physical (P=.027, r=.46) and mental component summary (P=.001, r=.71) of the SF-36 as well as FM-UE (P=.004, r=.60), with large effect sizes. In turn, all secondary outcomes were also significantly improved in this group (all P<.05 r>.05). In contrast, the UC group showed slight improvements in postintervention scores but did not reach significance in any of these measures.

Conclusions: This study shows that a sport-based ET program combined with UC can effectively improve all the aforementioned outcomes measures in ABI population. Further research with larger sample sizes and follow-up assessments is crucial to gain a more comprehensive understanding of the long-term effects of the intervention in this specific population.

Objective: To examine the length of time to complete wheelchair repairs and the relationship between negative outcomes and the factors that prevented or determined who performed the repairs.

Design: Survey, cross-sectional.

Setting: Nine spinal cord injury (SCI) Model Systems Centers.

Participants: Wheelchair users with SCI reporting at least 1 repair (N=301).

Interventions: Not applicable.

Main outcome measures: Prevalence of adverse consequences associated with wheelchair repairs, repairs completed of those needed, and time elapsed before wheelchair repair.

Results: Of the participants, 76% reported all necessary repairs were completed, 7% indicated that some repairs were addressed, and 14% reported none of the repairs were completed. The most common reason for incomplete repairs (30%) was the vendor's failure to complete the repair after being contacted. Among the repairs that were successfully completed, 56% were performed by vendors. The median time elapsed before repair was 14 days, with no significant difference observed in the time taken for repairs across different components. The most common consequences were being forced to use a backup wheelchair or being confined at home. A greater percentage of participants experienced each type of consequence, except injury, for repairs completed by vendors.

Conclusions: The high percentage of uncompleted wheelchair repairs poses a significant risk to users, and this risk is compounded by prolonged time taken by vendors to address breakdowns. Unsatisfactory vendor service was common, with a significantly larger proportion of participants experiencing consequences for repairs that required a vendor. This seems to indicate structural inadequacies within the repair process and the need for interventions to address these issues.

Objective: To evaluate a 6-week sub-symptom threshold aerobic exercise protocol (AEP) vs a stretching protocol (SP) on symptom burden and quality of life (QoL) in adults with persisting post-concussive symptoms (PPCS).

Design: The Aerobic exercise for treatment of Chronic symptoms following mild Traumatic Brain Injury (ACTBI) Trial was a randomized controlled trial with two groups.

Setting: Outpatient brain injury, pain and physiotherapy clinics.

Participants: A total of 210 participants were screened. A consecutive sample of 52 adults with PPCS and exercise intolerance following mild traumatic brain injury were enrolled. No participants withdrew due to adverse effects of intervention.

Interventions: Participants were randomized to a 6-week AEP (n=27) or 6-week SP (n=25).

Main outcomes and measures: The Rivermead Post Concussion Symptoms Questionnaire (RPQ) was the primary outcome. Secondary outcomes included QoL using the Quality of Life After Brain Injury Questionnaire (QOLIBRI), in addition to measures of mood, anxiety, functional impact of headache, fatigue, dizziness, exercise tolerance and sleep.

Results: Participants were a mean (SD) of 43.0 (10.9) years old (75% female) and 24.7 (14.0) months post-injury. In per protocol analysis, between group difference (AEP vs SP) was not significant for RPQ, but QOLIBRI between group difference was significant (mean change=5.024, 95% Cl [0.057, 9.992], p=0.047) from baseline to 6-weeks. In intention to treat analysis, between group change in primary and secondary outcomes were not significant.

Conclusions: This trial provides preliminary data to support prescription of aerobic exercise for adults with PPCS. Despite presenting with exercise intolerance, participants were able to engage in sub-symptom threshold exercise with QoL benefits.

Objective: To evaluate the effect of individualized exercises based on movement fault (MF) control on pain intensity and disability in subjects with chronic subacromial pain syndrome (SAPS).

Design: Randomized Controlled Trial (IRCT20221126056621N1) SETTING: Rehabilitation clinics PARTICIPANTS: Thirty-eight participants with chronic SAPS (aged 52.23(8.47), 60 %woman).

Interventions: The participants were randomly allocated to one of the intervention groups (individualized exercises based on MFs control test designed to target specific movement faults) or the control group (commonly prescribed general scapular stabilization exercises). Both groups received exercise sessions twice a week for four weeks.

Main outcome measures: The primary outcome measures were pain intensity at rest (PR) and during arm raising (PAR) using a visual analog scale. Disability was assessed as a key secondary outcome, including the disabilities of the arm, shoulder, and hand (DASH) questionnaire and the Shoulder Pain and Disability Index (SPADI).

Results: Following completion of all exercise sessions, PAR was significantly lower in the intervention group compared to the control group (mean [CI]: 9.17 [0.31 to 18.03], p=0.04), with a large effect size [0.68]. The reduction of PAR remained significantly lower in the intervention group than in the control group after four months of follow-up (mean [CI]: 18.29 [9.09 to 27.48], p=0.00) with a large effect size [1.27]. Disability significantly decreased at two month (mean=14.58, p=0.002 on SPADI index; mean=10.26, p=0.006 on DASH index) and four month (mean=19.85, p=0.00 on SPADI index; mean=12.09, p=0.001 on DASH index) follow ups in the intervention group compared to the control group.

Conclusion: Individualized exercises based on MFs control of the shoulder region was accompanied by decreased PAR and disability in subjects with SAPS.

Objective: To evaluate the reliability and validity of the dual-tasking questionnaire (DTQ), dual-task screening list (DTSL), and dual-task impact on daily life activities questionnaire (DIDA-Q).

Design: Multicenter, cross-sectional study SETTING: Persons with multiple sclerosis (pwMS) were recruited from 7 multiple sclerosis centers across 6 countries (Belgium, Chile, Italy, Israel, Spain, and Turkey).

Participants: A total of 356 pwMS (mean age 47.5±11.5y, expanded disability status scale, 3.79±1.83) were enrolled.

Interventions: Not applicable MAIN OUTCOME MEASURES: The reliability (internal consistency, test-retest, and measurement error) and construct validity (structural and convergent) were assessed.

Results: The DTQ, DTSL, and DIDA-Q demonstrated excellent test-retest reliability (intraclass correlation coefficients [95% CI], 0.84 [0.80-0.87] to 0.90 [0.87-0.92]) and internal consistency (Cronbach α: 0.86-0.96). As hypothesized, the 3 questionnaires showed a strong correlation with each other, moderate-to-strong correlations with other self-report questionnaires (perceived walking difficulties, fatigue, and fear of falling), and low-to-moderate correlations with cognitive information processing speed, manual dexterity, and dual-task walking performance (walking with word list generation task), showing convergent validity. The DIDA-Q exhibited systematically superior properties. These results were also verified in subsets from 6 different countries. In the structural validity analysis, all questionnaires displayed 2 main factors, allocated as "motor-driven" and "cognitive-driven" subscales.

Conclusions: The DTQ, DTSL, and DIDA-Q have good-to-excellent measurement properties, with the highest properties observed in DIDA-Q. The use of these self-reported questionnaires can be used in research and clinical practice to assess the effect of dual-task difficulties on the daily life of ambulatory pwMS.

Objective: To examine robotic interventions for upper limb rehabilitation poststroke, focusing on geographic distribution, stroke chronicity, outcome measures, outcomes of robotic interventions, and publication trends in low- and middle-income countries (LMICs) compared with high-income countries (HICs).

Data sources: Using Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines, PubMed, CENTRAL, Embase, CINAHL, and PEDro databases were searched for studies on upper extremity rehabilitation with robotics poststroke.

Study selection: This review focused on randomized controlled trials (RCTs) published between 2012 and 2024 that examined rehabilitation robots for upper limb impairments caused by stroke. The studies included adults aged ≥18 years in the acute, subacute, or chronic recovery phases. Eligible trials involved using robotic devices, independently or combined with other interventions. Only RCTs with 2 or more arms were considered, and all included studies were published in English.

Data extraction: Reviewers independently extracted data on study characteristics, stroke chronicity, outcome measures, outcomes of robotic interventions, and temporal trends.

Data synthesis: Of 129 articles meeting the criteria, 107 were from HICs, and 22 were from LMICs. Major contributors from HICs included Italy, Taiwan, and the USA, whereas China was a significant contributor among LMICs. Most studies focused on patients with chronic stroke, with varying assessment tools, the most common being the Fugl-Meyer Upper Extremity Evaluation. Positive outcomes were reported across studies, and recent research activity has increased in both settings.

Conclusions: This review underscores the expanding research on robotic therapy for upper limb rehabilitation in patients with stroke, primarily from HICs with limited input from low- and middle-income nations. Although positive outcomes were frequently observed, disparities between high-income and low-and middle-income countries were clear. The growing research indicates rising interest and advancements in this domain.

Objective: To investigate the risk factors relating to the need for mechanical ventilation (MV) in isolated patients with cervical spinal cord injury (cSCI) and to construct a nomogram prediction model.

Design: Retrospective analysis study.

Setting: National Spinal Cord Injury Model System Database (NSCID) observation data were initially collected during rehabilitation hospitalization.

Participants: A total of 5784 patients (N=5784) who had a cSCI were admitted to the NSCID between 2006 and 2021.

Interventions: Not applicable.

Main outcome measure(s): A univariate and multivariate logistic regression analysis was used to identify the independent factors affecting the use of MV in patients with cSCI, and these independent influencing factors were used to develop a nomogram prediction model. The area under the receiver operating characteristic curve (AUROC), calibration curve, and decision curve analysis (DCA) were used to evaluate the efficiency and the clinical application value of the model, respectively.

Results: In a series of 5784 included patients, 926 cases (16.0%) were admitted to spinal cord model system inpatient rehabilitation with the need for MV. Logistic regression analysis demonstrated that associated injury, American Spinal Cord Injury Association Impairment Scale (AIS), the sum of unilateral optimal motor scores for each muscle segment of upper extremities (sUEM), and neurologic level of injury (NLI) were independent predictors for the use of MV (P<.05). The prediction nomogram of MV usage in patients with cSCI was established based on the above independent predictors. The AUROC of the training set, internal verification set, and external verification set were 0.871 (0.857-0.886), 0.867 (0.843-0.891), and 0.850 (0.824-0.875), respectively. The calibration curve and DCA results showed that the model had good calibration and clinical practicability.

Conclusions: The nomograph prediction model based on sUEM, NLI, associated injury, and AIS can accurately and effectively predict the risk of MV in patients with cSCI, to help clinicians screen high-risk patients and formulate targeted intervention measures.