Archives of physical medicine and rehabilitation最新文献

{"title":"Reliability and Construct Validity of Three Self-report Questionnaires Assessing Dual-Task Difficulties in People With Multiple Sclerosis: An International Study","authors":"Zuhal Abasıyanık PhD ,&nbsp;Ludovico Pedullà PhD ,&nbsp;Turhan Kahraman PhD ,&nbsp;Mieke D'Hooge MSc ,&nbsp;Carme Santoyo-Medina MSc ,&nbsp;Bernardita Soler MD, PhD ,&nbsp;Andrea Tacchino PhD ,&nbsp;Renee Veldkamp PhD ,&nbsp;Edwin-Roger Meza-Murillo MD ,&nbsp;Areen Omar MSc ,&nbsp;Ethel Ciampi MD ,&nbsp;Serkan Özakbaş MD ,&nbsp;Daphne Kos PhD ,&nbsp;Alon Kalron PhD ,&nbsp;Peter Feys PhD","doi":"10.1016/j.apmr.2024.08.024","DOIUrl":"10.1016/j.apmr.2024.08.024","url":null,"abstract":"<div><h3>Objective</h3><div>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).</div></div><div><h3>Design</h3><div>Multicenter, cross-sectional study</div></div><div><h3>Setting</h3><div>Persons with multiple sclerosis (pwMS) were recruited from 7 multiple sclerosis centers across 6 countries (Belgium, Chile, Italy, Israel, Spain, and Turkey).</div></div><div><h3>Participants</h3><div>A total of 356 pwMS (mean age 47.5±11.5y, expanded disability status scale, 3.79±1.83) were enrolled.</div></div><div><h3>Interventions</h3><div>Not applicable</div></div><div><h3>Main Outcome Measures</h3><div>The reliability (internal consistency, test-retest, and measurement error) and construct validity (structural and convergent) were assessed.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 2","pages":"Pages 230-238"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Inadequate Response to Ultrasound-Guided Subacromial Corticosteroid Injection in Shoulder Impingement Syndrome: Treatment Failure or Central Sensitization?: Central Sensitization in Injection Response.","authors":"Büşra Şirin Ahisha, Nurdan Paker, Nur Kesiktaş, Nazlı Derya Buğdayci, Yiğit Can Ahisha","doi":"10.1016/j.apmr.2025.01.469","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.01.469","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether central sensitization (CS), pain catastrophizing, and psychological factors are associated with inadequate response to ultrasound-guided subacromial corticosteroid injection (SCI) in patients with chronic shoulder impingement syndrome (SIS).</p><p><strong>Design: </strong>This study was designed as a prolective observational study, combining analytical cross-sectional and prospective elements to evaluate associations and treatment responses.</p><p><strong>Setting: </strong>Secondary care outpatient clinic.</p><p><strong>Participants: </strong>A total of 72 patients aged 18-75 years with SIS and at least 6 months of shoulder pain, planned to undergo ultrasound-guided SCI, were included in the study.</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcome measure(s): </strong>Treatment response was defined as a ≥50% reduction in pain (VAS) at 4 weeks post-injection. The presence of central sensitization was assessed using the Central Sensitization Inventory (CSI) and Pressure Pain Threshold (PPT) via algometry (ipsilateral deltoid, contralateral deltoid, and contralateral vastus lateralis). Negative thoughts related to pain were evaluated with the Pain Catastrophizing Scale (PCS), and mood status was assessed using the Hospital Anxiety and Depression Scale (HADS).</p><p><strong>Results: </strong>48 patients (responders) experienced ≥50% VAS reduction, while 24 (non-responders) did not. Non-responders had significantly higher CSI (p=0.000), HADS-depression (p=0.001), and HADS-anxiety (p=0.000) scores. PPT values were significantly lower in non-responders at ipsilateral deltoid (p=0.030), contralateral deltoid (p=0.045), and contralateral vastus lateralis (p=0.036). CSI was significantly correlated with PPT at ipsilateral deltoid (r=-0.400, p=0.001), contralateral deltoid (r=-0.354, p=0.002), and contralateral vastus lateralis (r=-0.442, p=0.000); PCS total score (r=0.449, p=0.000); HADS-depression score (r=0.572, p=0.000); and HADS-anxiety score (r=0.618, p=0.000). CSI was the most predictive factor for non-response (AUC=0.755, 95% CI: 0.635-0.875). Multivariate analysis identified CSI as an independent predictor (p=0.022), with a predictive accuracy of 72.2%.</p><p><strong>Conclusions: </strong>Inadequate response to SCI in chronic SIS is strongly associated with CS, psychological distress, and altered pain perception. Integrating CS-targeted interventions into treatment strategies may improve outcomes.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Efficacy of 5% Dextrose and Corticosteroid Injections in Carpal Tunnel Syndrome: A Systematic Review and Meta-analysis","authors":"Min Woo Oh MD ,&nbsp;Ji-in Park MD ,&nbsp;Ga Yang Shim MD, PhD ,&nbsp;Hyun-Ho Kong MD, PhD","doi":"10.1016/j.apmr.2024.07.005","DOIUrl":"10.1016/j.apmr.2024.07.005","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to assess the effectiveness of 5% dextrose (D5W) in comparison to corticosteroids for treating carpal tunnel syndrome (CTS).</div></div><div><h3>Data Sources</h3><div>A comprehensive systematic search was conducted across MEDLINE (PubMed), Embase, and the Cochrane Central Register of Controlled Trials on November 13, 2023. These were supplemented by manual searches using Google Scholar.</div></div><div><h3>Study Selection</h3><div>Two independent authors reviewed the literature, resolving any discrepancies through detailed discussions and consultation with a third author.</div></div><div><h3>Data Extraction</h3><div>Data on primary outcomes (pain assessment) and secondary outcomes (symptom severity and functional status using the Boston Carpal Tunnel Questionnaire, electrophysiologic measures, cross-sectional area, and adverse effects) were extracted independently by the 2 authors (M.W. and H.H.).</div></div><div><h3>Data Synthesis</h3><div>The analysis included 4 randomized controlled trials and 1 quasi-experimental study, encompassing a total of 212 patients (220 hands) with mild to moderate CTS.</div></div><div><h3>Results</h3><div>Within 3 months, the D5W injections showed a statistically significant improvement in functional status compared to the corticosteroids with a standard mean difference of −0.34 (95% CI, −0.62 to −0.05). D5W was associated with fewer adverse incidents than corticosteroids (risk ratio, 0.13; 95% CI: 0.03-0.51). No difference was observed between the 2 treatments in other areas.</div></div><div><h3>Conclusions</h3><div>For patients with mild to moderate CTS, D5W injections were more effective than corticosteroid injections in improving functional status and demonstrated fewer adverse effects. D5W injections also paralleled corticosteroids in pain reduction, symptom severity, electrodiagnostic measures, and cross-sectional area of nerve, recommending D5W as a preferred treatment for mild to moderate CTS.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 2","pages":"Pages 300-310"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uphill Treadmill Running and Joint Mobilization Improve Dynamic Stability and Ankle Dorsiflexion Range of Motion in Young Adults With Chronic Ankle Instability: A Four-Arm Randomized Controlled Trial","authors":"Yongjie Lao BSc ,&nbsp;Zimei Zeng PT, BSc ,&nbsp;Zhenni Yu BSc ,&nbsp;Yu Gu BSc ,&nbsp;Yixiao Jia BSc ,&nbsp;Jianxiu Liu PhD ,&nbsp;Bing Ruan PT, MSc","doi":"10.1016/j.apmr.2024.08.025","DOIUrl":"10.1016/j.apmr.2024.08.025","url":null,"abstract":"<div><h3>Objective</h3><div>To observe the effect of uphill running and the combined effect of uphill running plus joint mobilizations on dynamic stability and ankle dorsiflexion in young adults with chronic ankle instability (CAI).</div></div><div><h3>Design</h3><div>Four-arm randomized controlled trial.</div></div><div><h3>Setting</h3><div>A college rehabilitation center.</div></div><div><h3>Participants</h3><div>Individuals with CAI (N=73).</div></div><div><h3>Interventions</h3><div>Participants were randomly assigned to 4 groups: combined uphill running and joint mobilization (URJM), uphill running alone (UR), joint mobilization alone (JM), and control group. The URJM and UR groups received 20-minute running sessions, and the URJM and JM groups received ankle joint mobilizations, all 3 times a week for 4 weeks.</div></div><div><h3>Main Outcome Measures</h3><div>Cumberland Ankle Instability Tool (CAIT) and Y-balance test (YBT) in anterior, posteromedial (PM), and posterolateral (PL) directions for dynamic stability; weight-bearing lunge test and non-weight-bearing ankle dorsiflexion degree using a goniometer (NWBG) for dorsiflexion.</div></div><div><h3>Results</h3><div>The UR group showed significant improvements in CAIT, YBT-PL, YBT-PM, and NWBG compared to the control group. The URJM group demonstrated large treatment effects in NWBG compared to both UR and JM groups. Responder analysis indicated that the UR, JM, and URJM groups had a higher likelihood of achieving clinically significant changes (exceeding minimal detectable change or minimal clinically important difference) in CAIT, YBT-PM, YBT-PL, and NWBG compared with the control group. Additionally, the combination of UR and JM was superior to either intervention alone for NWBG, with success rates 1.55 times greater than UR alone and 2.08 times greater than JM alone.</div></div><div><h3>Conclusions</h3><div>A 4-week UR program improves the subjective feeling of instability, dynamic postural control, and ankle dorsiflexion in young adults with CAI. Compared to UR or JM alone, their combined application can better improve the non-weight-bearing ankle dorsiflexion range of motion.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 2","pages":"Pages 177-186"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Aerobic Exercise on Symptom Burden and Quality of Life in Adults With Persisting Post-concussive Symptoms: The ACTBI Randomized Controlled Trial","authors":"Leah J. Mercier PhD ,&nbsp;Samantha J. McIntosh BHSc ,&nbsp;Chloe Boucher BSc ,&nbsp;Julie M. Joyce MSc ,&nbsp;Julia Batycky BHSc ,&nbsp;Jean-Michel Galarneau PhD ,&nbsp;Michael J. Esser MD, PhD ,&nbsp;Kathryn J. Schneider PT, PhD ,&nbsp;Sean P. Dukelow MD, PhD ,&nbsp;Ashley D. Harris PhD ,&nbsp;Chantel T. Debert MD, MSc","doi":"10.1016/j.apmr.2024.10.002","DOIUrl":"10.1016/j.apmr.2024.10.002","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate a 6-week sub-symptom threshold aerobic exercise protocol (AEP) versus a stretching protocol (SP) on symptom burden and quality of life (QoL) in adults with persisting post-concussive symptoms (PPCS).</div></div><div><h3>Design</h3><div>The Aerobic exercise for treatment of Chronic symptoms following mild Traumatic Brain Injury (ACTBI) Trial was a randomized controlled trial with 2 groups.</div></div><div><h3>Setting</h3><div>Outpatient brain injury, pain, and physiotherapy clinics.</div></div><div><h3>Participants</h3><div>A total of 210 participants were screened. A consecutive sample of 52 adults with PPCS and exercise intolerance after mild traumatic brain injury were enrolled. No participants withdrew because of the adverse effects of the intervention.</div></div><div><h3>Interventions</h3><div>Participants were randomized to a 6-week AEP (n=27) or 6-week SP (n=25).</div></div><div><h3>Main Outcome and Measures</h3><div>The Rivermead Post Concussion Symptoms Questionnaire was the primary outcome. Secondary outcomes included QoL using the QoL After Brain Injury Questionnaire, in addition to measures of mood, anxiety, functional impact of headache, fatigue, dizziness, exercise tolerance, and sleep.</div></div><div><h3>Results</h3><div>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 the Rivermead Post Concussion Symptoms Questionnaire, but QoL After Brain Injury Questionnaire between-group difference was significant (mean change=5.024; 95% Cl, 0.057-9.992; <em>P</em>=.047) from baseline to 6 weeks. In the intention-to-treat analysis, between-group changes in primary and secondary outcomes were not significant.</div></div><div><h3>Conclusions</h3><div>This trial provides preliminary data to support the prescription of aerobic exercise for adults with PPCS. Despite presenting with exercise intolerance, participants were able to engage in subsymptom threshold exercise with QoL benefits.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 2","pages":"Pages 195-205"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of a 6-Week Treadmill Training With and Without Virtual Reality on Frailty in People With Multiple Sclerosis","authors":"Tobia Zanotto PhD ,&nbsp;Irina Galperin MP ,&nbsp;Danya Pradeep Kumar PhD ,&nbsp;Anat Mirelman PhD ,&nbsp;Shahar Yehezkyahu BPT ,&nbsp;Keren Regev MD ,&nbsp;Arnon Karni MD ,&nbsp;Tanja Schmitz-Hübsch MD ,&nbsp;Friedemann Paul MD ,&nbsp;Sharon G. Lynch MD ,&nbsp;Abiodun E. Akinwuntan PhD ,&nbsp;Jianghua He PhD ,&nbsp;Bruce R. Troen MD ,&nbsp;Hannes Devos PhD ,&nbsp;Jeffrey M. Hausdorff PhD ,&nbsp;Jacob J. Sosnoff PhD","doi":"10.1016/j.apmr.2024.09.010","DOIUrl":"10.1016/j.apmr.2024.09.010","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the effects of a cognitive-motor rehabilitation program consisting of treadmill training (TT) augmented by virtual reality (TT+VR) on frailty in people with multiple sclerosis (pwMS).</div></div><div><h3>Design</h3><div>Secondary analysis from a multicenter randomized controlled trial investigating the effects of TT+VR, compared with TT only, on measures of mobility and cognitive function in pwMS.</div></div><div><h3>Setting</h3><div>Four university research laboratories in 3 countries.</div></div><div><h3>Participants</h3><div>A total of 124 pwMS were randomized into the parent trial. Here, we studied a subset of n = 83 participants (mean age, 49.4±9.3y; 73.5% female; expanded disability status scale range, 2.0-6.0), who completed the intervention and had complete preintervention and postintervention frailty data.</div></div><div><h3>Interventions</h3><div>Participants were randomly allocated to TT+VR (n=44) or TT (n=39). Both groups trained 3 times a week for 6 weeks.</div></div><div><h3>Main Outcome Measures</h3><div>Frailty was assessed using a 40-item frailty index (FI) through standard validated procedures and represented the primary study outcome. Two exploratory frailty indices were also computed by isolating health-related deficits involving the cognitive (FI-physical) or physical (FI-cognitive) domains from the main FI. The assessments were performed at baseline and after 6 weeks, upon intervention completion.</div></div><div><h3>Results</h3><div>The mean FI of study participants at baseline was 0.33±0.13, indicating a moderate average level of frailty. FI scores improved in both TT+VR and TT groups participants (pooled mean ΔFI, 0.024; 95% CI, 0.010-0.038; F=10.49; <em>P=</em>.002; η_p²=0.115), without any group-by-time interaction (F=0.82; <em>P=</em>.367; η_p²=0.010<em>)</em>. However, a significant group-by-time interaction was found for pretraining and posttraining changes in FI-cognitive (F=5.74; <em>P=</em>.019; η_p²=0.066), suggesting a greater improvement for TT+VR group participants than for TT group participants.</div></div><div><h3>Conclusions</h3><div>TT with or without virtual reality can reduce frailty levels in pwMS. While both TT and TT+VR had a positive effect on overall frailty, only TT+VR improved cognitive aspects of frailty and may represent an appropriate strategy for counteracting frailty in pwMS.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 2","pages":"Pages 187-194"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142340048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Objectively Measured Physical Activity in Children With Developmental Coordination Disorder: A Systematic Review and Meta-analysis","authors":"Huynh-Truc Tran MS ,&nbsp;Wen-Chao Ho PhD ,&nbsp;Li-Wei Chou PhD ,&nbsp;Yao-Chuen Li PhD","doi":"10.1016/j.apmr.2024.06.002","DOIUrl":"10.1016/j.apmr.2024.06.002","url":null,"abstract":"<div><h3>Objective</h3><div>To conduct a systematic review and meta-analysis to understand the difference in objectively measured physical activities (PAs) between children with and without developmental coordination disorder (DCD).</div></div><div><h3>Data Sources</h3><div>A systematic literature search of 4 databases (PubMed, Science Direct, Web of Science, and Cochrane library) was conducted in July 2023.</div></div><div><h3>Study Selection</h3><div><span>Studies that met the following criteria were considered classified children with DCD based on </span><em>Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition</em> (DSM-IV), DSM-IV-Text Revision, or DSM-V diagnosis criteria, evaluated PA using objective measurements and provided the amount of time spent in PA and/or sedentary behavior, included a control group of typically developing children, and written in English.</div></div><div><h3>Data Extraction</h3><div>Data extracted from all included studies were: first author's surname and publication year, study design, country, total sample size, the measure of PA, the intensity of PA, categories of PA level, and main finding(s).</div></div><div><h3>Data Synthesis</h3><div>Twelve articles met the inclusion criteria for the systematic review, 10 of which were included in the meta-analysis. The overall mean difference in moderate-to-vigorous PA (MVPA) between 2 groups was −0.17 (95% CI, −0.25 to −0.09), (<em>I</em>²=48.7%, <em>P</em>=.029). A subgroup analysis by age (ie, school-aged vs. preschool) showed a significant pooled effect size with no heterogeneity in school-aged children (ie, 6-14y) (standardized mean difference=−0.27, 95% CI, −0.38 to −0.16, <em>I</em>²=43.1%, <em>P</em>=.08).</div></div><div><h3>Conclusions</h3><div>Children with DCD spent significantly less time participating in MVPA, particularly those aged between 6 and 14 years. These findings highlight the need for increased awareness among parents and physicians regarding insufficient participation in PA among children with DCD.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 2","pages":"Pages 269-279"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141431233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Falls Among Hospitalized Medical Patients – A Systematic Review and Meta-analysis","authors":"Jeannelle Heinzmann MB ,&nbsp;Michael L. Rossen MMed ,&nbsp;Orestis Efthimiou PhD ,&nbsp;Christine Baumgartner MD, MSc ,&nbsp;Maria M. Wertli MD, PhD ,&nbsp;Nicolas Rodondi MD, MAS ,&nbsp;Carole E. Aubert MD, MSc ,&nbsp;Fabian D. Liechti MD, PhD","doi":"10.1016/j.apmr.2024.06.015","DOIUrl":"10.1016/j.apmr.2024.06.015","url":null,"abstract":"<div><h3>Objective</h3><div>To identify and quantify risk factors for in-hospital falls in medical patients.</div></div><div><h3>Data Sources</h3><div>Six databases (MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, and Google Scholar) were systematically screened until April 11, 2023, to identify relevant articles.</div></div><div><h3>Study Selection</h3><div>All titles and abstracts of the retrieved articles were independently screened by 2 researchers who also read the full texts of the remaining articles. Quantitative studies that assessed risk factors for falls among adult patients acutely hospitalized were included in the review. Publications that did not capture internal medicine patients or focused on other specific populations were excluded.</div></div><div><h3>Data Extraction</h3><div>Information on study characteristics and potential risk factors were systematically extracted. Risk of bias was assessed using the Quality in Prognosis Studies tool. Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analyses of Observational Studies in Epidemiology guidelines were followed for reporting.</div></div><div><h3>Data Synthesis</h3><div>The main outcome was any in-hospital falls. Using a random-effects meta-analysis model, association measures for each risk factor reported in 5 or more studies were pooled. Separate analyses according to effect measure and studies adjusted for sex and age at least were performed. Of 5067 records retrieved, 119 original publications from 25 countries were included. In conclusion, 23 potential risk factors were meta-analyzed. Strong evidence with large effect sizes was found for a history of falls (odds ratio [OR], 2.54; 95% confidence interval [CI], 1.63-3.96; I², 91%), antidepressants (pooled OR, 2.25; 95% CI, 1.92-2.65; I², 0%), benzodiazepines (OR, 1.97; 95% CI, 1.68-2.31; I², 0%), hypnotics–sedatives (OR, 1.90; 95% CI, 1.53-2.36; I², 46%), and antipsychotics (OR, 1.61; 95% CI, 1.33-1.95; I², 0%). Furthermore, evidence of associations with male sex (OR, 1.22, 95% CI, 0.99-1.50; I², 65%) and age (OR, 1.17, 95% CI, 1.02-1.35; I², 72%) were found, but effect sizes were small.</div></div><div><h3>Conclusions</h3><div>The comprehensive list of risk factors, which specifies the strength of evidence and effect sizes, could assist in the prioritization of preventive measures and interventions.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 2","pages":"Pages 292-299"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and External Validation of a Motor Intention–Integrated Prediction Model for Upper Extremity Motor Recovery After Intention-Driven Robotic Hand Training for Chronic Stroke","authors":"Chengpeng Hu MSc ,&nbsp;Chun Hang Eden Ti PhD ,&nbsp;Xiangqian Shi MSc ,&nbsp;Kai Yuan PhD ,&nbsp;Thomas W.H. Leung MD ,&nbsp;Raymond Kai-Yu Tong PhD","doi":"10.1016/j.apmr.2024.08.015","DOIUrl":"10.1016/j.apmr.2024.08.015","url":null,"abstract":"<div><h3>Objective</h3><div>To derive and validate a prediction model for minimal clinically important differences (MCIDs) in upper extremity (UE) motor function after intention-driven robotic hand training using residual voluntary electromyography (EMG) signals from affected UE.</div></div><div><h3>Design</h3><div>A prospective longitudinal multicenter cohort study. We collected preintervention candidate predictors: demographics, clinical characteristics, Fugl-Meyer assessment of UE (FMAUE), Action Research Arm Test scores, and motor intention of flexor digitorum and extensor digitorum (ED) measured by EMG during maximal voluntary contraction (MVC). For EMG measures, recognizing challenges for stroke survivors to move paralyzed hand, peak signals were extracted from 8 time windows during MVC-EMG (0.1-5s) to identify subjects’ motor intention. Classification and regression tree algorithm was employed to predict survivors with MCID of FMAUE. Relationship between predictors and motor improvements was further investigated.</div></div><div><h3>Setting</h3><div>Nine rehabilitation centers.</div></div><div><h3>Participants</h3><div>Chronic stroke survivors (N=131), including 87 for derivation sample, and 44 for validation sample.</div></div><div><h3>Interventions</h3><div>All participants underwent 20-session robotic hand training (40min/session, 3-5sessions/wk).</div></div><div><h3>Main Outcome Measures</h3><div>Prediction efficacies of models were assessed by area under the receiver operating characteristic curve (AUC). The best effective model was final model and validated using AUC and overall accuracy.</div></div><div><h3>Results</h3><div>The best model comprised FMAUE (cutoff score, 46) and peak activity of ED from 1-second MVC-EMG (MVC-EMG 4.604 times higher than resting EMG), which demonstrated significantly higher prediction accuracy (AUC, 0.807) than other time windows or solely using clinical scores (AUC, 0.595). In external validation, this model displayed robust prediction (AUC, 0.916). Significant quadratic relationship was observed between ED-EMG and FMAUE increases.</div></div><div><h3>Conclusions</h3><div>This study presents a prediction model for intention-driven robotic hand training in chronic stroke survivors. It highlights significance of capturing motor intention through 1-second EMG window as a predictor for MCID improvement in UE motor function after 20-session robotic training. Survivors in 2 conditions showed high percentage of clinical motor improvement: moderate-to-high motor intention and low-to-moderate function; as well as high intention and high function.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 2","pages":"Pages 206-215"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Related to the Quality and Stability of Partner Relationships After Stroke: A Systematic Literature Review","authors":"Brenda van den Broek MA ,&nbsp;Laura Verrijt MSc ,&nbsp;Sophie Rijnen PhD ,&nbsp;Caroline van Heugten PhD ,&nbsp;Boudewijn Bus MD, PhD","doi":"10.1016/j.apmr.2024.05.016","DOIUrl":"10.1016/j.apmr.2024.05.016","url":null,"abstract":"<div><h3>Objective</h3><div>To provide an overview of the current state of knowledge on factors related to relationship quality and relationship stability after stroke.</div></div><div><h3>Data Sources</h3><div>Cumulative Index to Nursing and Allied Health (CINAHL), Embase, MEDLINE, Psychology and Behavioral Sciences Collection, APA PsycINFO, and PubMed were searched on November 15, 2022, for literature on factors associated with (1) relation quality and (2) relation stability after stroke.</div></div><div><h3>Study Selection</h3><div>English quantitative and qualitative studies investigating factors associated with relation quality and/or stability after stroke were included. Three reviewers independently assessed eligibility. Consensus meetings were held in case of divergent opinions. A total of 44 studies were included.</div></div><div><h3>Data Extraction</h3><div>Information regarding study objectives and characteristics, participant demographics, independent and dependent variables, and main findings was extracted. Study quality was rated using the Joanna Briggs Institute Checklist for Analytical Cross-Sectional Studies and/or the Critical Appraisal Skills Programme Checklist for Qualitative Research. Both were administered by the lead reviewer and checked by the second reviewer. Identified factors are described and presented according to the domains of the International Classification of Functioning, Disability, and Health model.</div></div><div><h3>Data Synthesis</h3><div>Thirty-seven factors related to relationship quality after stroke were identified, covering the domains of body functions and structures (eg, cognitive problems), activities (eg, decrease in physical intimacy), participation (eg, being socially active), environment (eg, medication side effects), and personal factors (eg, hypervigilance). Eight factors related to relationship stability were identified, covering the domains of participation (agreement on reciprocal roles) and personal factors (eg, quality of prestroke relation).</div></div><div><h3>Conclusions</h3><div>Relationship quality and stability after stroke are related to a multitude of factors. Future research should confirm the relevance of factors found in a few studies of suboptimal quality; explore possible associations between relationship stability and factors falling in the domains of body functions and structure, activity, and environmental factors; and explicitly explore potential positive effects of stroke on relationships.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 2","pages":"Pages 255-268"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141079977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}