Archives of physical medicine and rehabilitation最新文献

{"title":"Neurophysiological Effects of Dry Needling: A Systematic Review and Meta-analysis","authors":"Gabriel Rabanal-Rodríguez PT, MSc ,&nbsp;Marcos José Navarro-Santana PT, PhD ,&nbsp;Juan Antonio Valera-Calero PT, PhD ,&nbsp;Guido Fabián Gómez-Chiguano PT, PhD ,&nbsp;Magdalena Kocot-Kępska MD, PhD, EDPM ,&nbsp;César Fernández-de-las-Peñas PT, PhD ,&nbsp;Gustavo Plaza-Manzano PT, PhD","doi":"10.1016/j.apmr.2025.08.019","DOIUrl":"10.1016/j.apmr.2025.08.019","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the neurophysiological effects associated with dry needling. This review evaluates the influence of dry needling on pain-related biomarkers, conditioned pain modulation, and temporal summation to clarify the potential mechanisms underlying its therapeutic effects.</div></div><div><h3>Data Sources</h3><div>A literature search across the Physiotherapy Evidence Database, Web of Science, PubMed, Cochrane Library, and Scopus databases until October 2024 was conducted.</div></div><div><h3>Study Selection</h3><div>Studies were included if they assessed the neurophysiological effects of dry needling in animal or human models. Fourteen results were included in the qualitative synthesis (n=4 in animals, n=10 in humans) and 4 in the quantitative analysis. Selection was performed independently by 2 reviewers.</div></div><div><h3>Data Extraction</h3><div>Data were extracted independently by 2 reviewers using a standardized form. Neurophysiological outcomes included levels of biomarkers (eg, substance P [SP], cortisol, interleukins, calcitonin gene-related peptide , serotonin, and tumor necrosis factor-α) as well as measures of conditioned pain modulation and temporal summation. The methodological quality was assessed using the Physiotherapy Evidence Database, Cochrane Risk of Bias-2, and Risk of Bias in Nonrandomized Studies of Interventions scales.</div></div><div><h3>Data Synthesis</h3><div>Dry needling showed increases in microRNA-939, microRNA-25, β-endorphin, interleukin-2 (IL-2), tumor necrosis factor-α, inducible isoform of nitric oxide synthases, hypoxia-inducible factor-1α, cyclooxygenase-2, vascular endothelial growth factor, inflammatory cells, IL-6, and acetylcholinesterase, whereas decreases were observed in Myozenin 2, SP, calcitonin gene-related peptide, acetylcholine, and acetylcholine receptor. The effects on neurophysiological variables related to pain processing are limited, leading to small improvements in conditioned pain modulation (standardized mean differences, 0.36; 95% CI, 0.05-0.67) and no apparent changes in temporal summation (standardized mean difference, −0.08; 95% CI, −0.44 to 0.27).</div></div><div><h3>Conclusions</h3><div>The application of dry needling can induce significant changes in pain-related biomarker levels in animal and human studies, providing insights into its underlying mechanisms of action and potential clinical effects.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 2","pages":"Pages 299-314"},"PeriodicalIF":3.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022777","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":"Inspiratory Muscle Training Enhances Functional Sitting Balance More Than Usual Care in Individuals With Spinal Cord Injury: A Randomized Controlled Trial","authors":"Kanishka Gambhir MPT ,&nbsp;Shambhovi Mitra PhD ,&nbsp;Anne E. Palermo PhD","doi":"10.1016/j.apmr.2025.09.017","DOIUrl":"10.1016/j.apmr.2025.09.017","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the effect of inspiratory muscle training (IMT) on functional sitting balance (FSB) in individuals with spinal cord injury (SCI).</div></div><div><h3>Design</h3><div>Rater-masked, parallel, 2-group randomized clinical trial.</div></div><div><h3>Setting</h3><div>Tertiary care SCI rehabilitation hospital.</div></div><div><h3>Participants</h3><div>Forty-four participants (N=44) (aged 18-60) with C4-T6 injuries (American Spinal Injury Association Impairment Scale A-C) (cervical-SCI=25, thoracic-SCI=19, American Spinal Injury Association Impairment Scale A=33, B=11, C=0) in their first SCI-specific inpatient rehabilitation were randomly assigned into experimental and control groups.</div></div><div><h3>Interventions</h3><div>Both groups received standard respiratory care and physiotherapy. The experimental group received additional flow-resistive IMT sessions over 6 weeks.</div></div><div><h3>Main Outcome Measures</h3><div>FSB was measured using the Function in Sitting Test-SCI, and respiratory function was assessed via maximal inspiratory pressure, sustained maximal inspiratory pressure, and Fatigue Index Test score at baseline, 4 weeks and 6 weeks. Data were analyzed using repeated measures general linear model framework in IBM SPSS version 21.</div></div><div><h3>Results</h3><div>Analysis showed significant improvements in FSB for both groups (<em>P</em>&lt;.001). Sustained maximal inspiratory pressure, maximal inspiratory pressure, and Fatigue Index Test scores improved only for the experimental group (<em>P</em>&lt;.05). Post-hoc analyses of interaction effects showed significantly greater improvements in all variables in the experimental group.</div></div><div><h3>Conclusions</h3><div>This study is the first to show that FSB improves more with addition of IMT to standard care in individuals with SCI.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 2","pages":"Pages 178-187"},"PeriodicalIF":3.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211485","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":"Health Care Utilization in Veterans With Tetraplegia in the First Year After Cervical Spinal Cord Injury: Identifying Opportunities for Dissemination of Treatment Information","authors":"Katharine Tam MD ,&nbsp;Daniel Eaton MPH ,&nbsp;Amanda Mayo MD ,&nbsp;Aimee James PhD, MPH ,&nbsp;Candace Tefertiller PT, DPT, PhD, NCS ,&nbsp;Katherine C. Stenson MD ,&nbsp;Catherine Curtin MD ,&nbsp;Doug Ota MD ,&nbsp;Flora Laurent BA ,&nbsp;Michael J. Berger MD, PhD ,&nbsp;Jana Dengler MD, MASc, MHSc ,&nbsp;Ida K. Fox MD","doi":"10.1016/j.apmr.2025.07.011","DOIUrl":"10.1016/j.apmr.2025.07.011","url":null,"abstract":"<div><h3>Objective</h3><div>To describe Veterans Affairs (VA) utilization patterns by Veterans with tetraplegia during the first year after cervical spinal cord injury (SCI) and explore differences among subpopulations. A secondary objective of this study was to develop a process map to guide targeted clinician education about upper limb treatment information.</div></div><div><h3>Design</h3><div>Retrospective cohort study using the Veterans Health Administration (VHA) Spinal Cord Injury and Disorders (SCI/D) Registry and the VHA Corporate Data Warehouse.</div></div><div><h3>Setting</h3><div>Outpatient setting in the VHA.</div></div><div><h3>Participants</h3><div>Veterans (N=884) with traumatic, C5-C8 neurologic level of injury, and American Spinal Injury Association Impairment Scale A-C classification who received care at a regional VA SCI/D Center between October 1, 2012, and September 30, 2019.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>VA health care utilization as defined by ≥1 VA outpatient visit within the first year of SCI using VHA administrative data. We also examined predictors of care interactions using multivariate logistic regression models.</div></div><div><h3>Results</h3><div>In total, 489 Veterans (55%) had ≥1 VA outpatient visit in the first year after SCI whereas 395 Veterans (45%) did not receive outpatient VA care within their first year after SCI. Veterans who used VA health care received a median of 41 outpatient visits in the first year after SCI. Veterans had the highest median number of visits and shortest time interval from SCI to initial visit with therapists (physical, occupational, and recreational) compared to other health care providers. No significant predictors of care were identified with adjusted and unadjusted multivariate logistic regression.</div></div><div><h3>Conclusions</h3><div>Health care utilization patterns of Veterans with tetraplegia identified physical, occupational, and recreational therapists as the health care providers who had visits early and often with these Veterans. Therapists are uniquely positioned in health care systems to facilitate communication of treatment opportunities to persons with tetraplegia.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 2","pages":"Pages 270-278"},"PeriodicalIF":3.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774560","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":"Cancer Incidence and Risk in Children and Adolescents With Intellectual Disability in South Korea","authors":"Hyun Jung Lee MD, PhD ,&nbsp;Jae Young Kim MS ,&nbsp;Sung Wook Song MD ,&nbsp;Shin-Young Yim MD, PhD","doi":"10.1016/j.apmr.2025.04.023","DOIUrl":"10.1016/j.apmr.2025.04.023","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate cancer risk and identify distinctive cancer patterns in children and adolescents with intellectual disability (ID) in South Korea, where comprehensive research in this population remains limited.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>Nationwide population-based data from the National Health Insurance Service-National Health Information Database (NHIS-NHID) in South Korea (2004-2021).</div></div><div><h3>Participants</h3><div>This study included individuals (N=75,491) with ID aged 2-18 years and 917,699 age- and sex-matched controls without ID (1:10 matching ratio to maximize statistical power).</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Cancer incidence and associated risk factors, including comorbidities, demographic characteristics, and socioeconomic status, analyzed using Cox proportional hazard models.</div></div><div><h3>Results</h3><div>Children and adolescents with ID had a significantly higher overall cancer incidence and risk compared to the control group (adjusted hazard ratio [HR]: 1.1; 95% confidence interval [CI]: 1.005-1.204). Those with medical comorbidities faced an even greater risk (adjusted HR: 1.96; 95% CI, 1.75-2.194). Significant risk factors included older age (16-≤18y vs 2-&lt;6y: HR 3.529; 95% CI, 3.321-3.749) and lower socioeconomic status (medical aid vs high-income: HR 0.863; 95% CI, 0.788-0.945). The top 5 cancer sites in the ID group were renal pelvis and ureter; heart, mediastinum, and pleura; acute lymphoblastic leukemia; brain; and ovary.</div></div><div><h3>Conclusions</h3><div>Children and adolescents with ID in South Korea exhibit a distinct cancer risk profile, with elevated cancer incidence compared to the control group. Tailored cancer prevention, early detection strategies, and health care utilization policies are essential to address these needs of this vulnerable group.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 2","pages":"Pages 279-286"},"PeriodicalIF":3.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967904","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":"Association of Sleep Quality With Activity and Participation in Older Adults","authors":"Jessie M. VanSwearingen PhD, PT ,&nbsp;Caitlan A. Tighe PhD ,&nbsp;Subashan Perera PhD ,&nbsp;Daniel E. Forman MD ,&nbsp;Daniel J. Buysse MD ,&nbsp;Jennifer S. Brach PhD, PT","doi":"10.1016/j.apmr.2025.05.010","DOIUrl":"10.1016/j.apmr.2025.05.010","url":null,"abstract":"<div><h3>Objective</h3><div>To explore the relation of self-reported sleep quality with the International Classification of Functioning domains of activity (eg, physical functioning) and participation (eg, disability).</div></div><div><h3>Design</h3><div>Descriptive, secondary, cross-sectional data analysis</div></div><div><h3>Setting</h3><div>General community</div></div><div><h3>Participants</h3><div>Community-dwelling older adults, volunteers, n=249</div></div><div><h3>Interventions</h3><div>Not applicable</div></div><div><h3>Main Outcome Measures</h3><div>The Pittsburgh Sleep Quality Index, self-reported measures of activity and participation by the Late-Life Function and Disability Instrument, the Modified Gait Efficacy Scale for confidence in walking, and performance-based measures of physical functioning (gait speed, 6-minute Walk Test, Figure-of-8 Walk Test, and Short Physical Performance Battery). Measures of function were regressed on sleep quality adjusted for age, sex, and comorbidities.</div></div><div><h3>Results</h3><div>Older adults with good (Pittsburgh Sleep Quality Index ≤5) compared with poor (&gt;5) sleep quality reported better function and disability across almost all considered domains (<em>P</em>&lt;.05). Effect sizes for self-reported and performance-based measures were comparable and in the small to moderate range.</div></div><div><h3>Conclusions</h3><div>Among older adults with mild to moderate functional limitations and disability, self-reported sleep quality related broadly to activity and participation. Experimental studies are needed to assess the effects of sleep interventions on activity and participation and understand if sleep quality may represent a novel treatment target in future intervention trials to improve function in older adults.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 2","pages":"Pages 207-214"},"PeriodicalIF":3.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141211","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":"Quality and Outcomes of Acute Stroke Care for People With and Without Aphasia","authors":"Marissa Stone BHlthSc ,&nbsp;Sarah J. Wallace PhD ,&nbsp;David A. Copland PhD ,&nbsp;Dominique A. Cadilhac PhD ,&nbsp;Kelvin Hill BAppSC ,&nbsp;Tara Purvis PhD ,&nbsp;Megan Reyneke BCom ,&nbsp;Monique F. Kilkenny PhD","doi":"10.1016/j.apmr.2025.07.007","DOIUrl":"10.1016/j.apmr.2025.07.007","url":null,"abstract":"<div><h3>Objective</h3><div>The study aimed to investigate whether the presence of aphasia was associated with differences in acute stroke care quality and to describe in-hospital outcomes.</div></div><div><h3>Design</h3><div>Observational cohort study of cross-sectional data from the biennial Stroke Foundation National Stroke Audit of Acute Services (2017, 2019, and 2021). Descriptive statistics and multivariable regression models were used to compare quality of care and in-hospital outcomes by aphasia status (care adjusted for hospital variation; outcomes adjusted for age, sex, prior function, stroke type, stroke severity indicators, and hospital variation).</div></div><div><h3>Setting</h3><div>Acute hospital services in Australia.</div></div><div><h3>Participants</h3><div>Patients with stroke and aphasia status recorded (n=11,613) were included in the study. A total of 3122 (26.9%) patients had aphasia documented in clinical notes (aphasia 51% male; median age 78 y; no aphasia 58% male; median age 74 y).</div></div><div><h3>Main Outcome Measures</h3><div>Quality of care indicators aligned with national evidence-based guidelines. In-hospital outcomes included complications, level of independence, survival, and discharge destination.</div></div><div><h3>Results</h3><div>Patients with aphasia were less likely to be assessed for mood impairment (23% vs 30%; adjusted odds ratio [aOR], 0.73; 95% confidence interval [CI], 0.65-0.81), receive risk factor education (59% vs 70%; aOR, 0.55; 95% CI, 0.48-0.64), or be involved in care plan development (83% vs 95%; aOR, 0.22; 95% CI, 0.18-0.28). Patients with aphasia were more likely to have a more severe stroke and had more in-hospital complications (aOR, 1.46; 95% CI, 1.30-1.63) and in-hospital deaths (aOR, 2.86; 95% CI, 2.36-3.49). They were less independent at discharge (aOR, 0.48; 95% CI, 0.42-0.56), less often discharged home (aOR, 0.63; 95% CI, 0.56-0.72), and more likely to be discharged to residential care (aOR, 1.52; 95% CI, 1.08-2.15). They were more likely to receive inpatient rehabilitation (aOR, 1.15; 95% CI, 1.01-1.30).</div></div><div><h3>Conclusions</h3><div>Important differences exist in the quality of acute stroke care received by patients with aphasia. Targeted quality improvement in mood screening and risk factor education is needed.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 2","pages":"Pages 188-197"},"PeriodicalIF":3.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673855","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":"Dysphagia Screening in Acute Stroke: Adaptation and Validation of the Modified Volume-Viscosity Swallowing Test With International Dysphagia Diet Standardization Initiative Standards","authors":"Muhammed Salman MSc, SLP ,&nbsp;Preetie Shetty Akkunje PhD ,&nbsp;Radish Kumar Balasubramanium PhD ,&nbsp;Zulkifli K. Misri MD","doi":"10.1016/j.apmr.2025.06.006","DOIUrl":"10.1016/j.apmr.2025.06.006","url":null,"abstract":"<div><h3>Objective</h3><div>To adapt and validate the modified Volume-Viscosity Swallowing Test (MV-VST), aligned with the International Dysphagia Diet Standardization Initiative (IDDSI) framework, and to enhance its applicability in diverse dietary contexts, particularly in lower-middle-income countries.</div></div><div><h3>Design</h3><div>A cross-sectional study.</div></div><div><h3>Setting</h3><div>The research was carried out at an acute care tertiary hospital.</div></div><div><h3>Participants</h3><div>Seventy patients (N=70) with acute stroke, aged ≥18 years, with a standard education level and no sensory deficits, were included in the study.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>The study consisted of 2 phases. In phase 1, the MV-VST was adapted using IDDSI guidelines with varied viscosities and volumes and validated by 5 experienced swallow specialists. In phase 2, the test was used to screen swallowing safety, swallowing efficacy, and temporal parameters across different consistencies and volumes. In addition, clinical assessment was performed using standardized test batteries (Functional Oral Intake Scale [FOIS] and Eating Assessment Tool [EAT-10]), and a subset of participants underwent a videofluoroscopic swallow study (VFSS). The primary outcome of MV-VST measured parameters were defined as clinical indicators that predict potential deficits, and their correlations with FOIS, EAT-10, and VFSS. Furthermore, the study examined the reliability and validity of the adapted swallowing screening tool, MV-VST.</div></div><div><h3>Results</h3><div>Of the 70 participants, 62.8% experienced dysphagia. The MV-VST demonstrated significant correlations with clinical assessments (FOIS and EAT-10), showing high test–retest and interrater reliability (Cronbach’s α=0.994). Sensitivity and specificity were 87.5% and 100% for EAT-10, respectively, and 75% and 100% for VFSS, respectively. The tool demonstrated its ability to predict potential deficits in swallowing safety, efficacy, and temporal aspects, with significant differences observed between participants based on MV-VST outcomes.</div></div><div><h3>Conclusions</h3><div>The adapted MV-VST, using IDDSI standards, is a reliable and valid tool for the early identification of poststroke dysphagia, facilitating timely intervention. Despite limitations like the single-center design and small sample size, the study underscores the potential of the MV-VST in diverse dietary practices. Future research should focus on larger, multicenter studies and integrating advanced technologies for more precise assessments.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 2","pages":"Pages 215-224"},"PeriodicalIF":3.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144339797","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":"Concussion Recognition: A Guide for Parents and Coaches","authors":"Ruairi Connolly MD,&nbsp;Ann Guernon BS, MS, PhD,&nbsp;Jaclyn Stephens BA, MS, PHD,&nbsp;John Leddy MD,&nbsp;Aoife Murray MD,&nbsp;Julia Drattell LAT, ATC, CES,&nbsp;Jacob McPherson PT, DPT, PhD,&nbsp;Karen McCulloch PT, PhD, MS,&nbsp;Quratulain Khan PhD,&nbsp;Akuadasuo Ezenyilimba PhD,&nbsp;Zainab Al Lawati MD,&nbsp;Will Panenka MD, MSc,&nbsp;Samir Belagaje MD, PhD,&nbsp;Tracey Wallace MS,&nbsp;Noemi Lansang MS,&nbsp;Jennifer Wethe PhD","doi":"10.1016/j.apmr.2025.09.012","DOIUrl":"10.1016/j.apmr.2025.09.012","url":null,"abstract":"","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 2","pages":"Pages 365-368"},"PeriodicalIF":3.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145450461","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":"Safety and Efficacy of Very Early Mobilization in Acute Stroke: A Systematic Review and Meta-analysis","authors":"Xiaoyan Li BS ,&nbsp;Yali Kong BS","doi":"10.1016/j.apmr.2025.10.021","DOIUrl":"10.1016/j.apmr.2025.10.021","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the safety and efficacy of very early mobilization (VEM) after acute stroke through a comprehensive meta-analysis of cohort studies and randomized controlled trials.</div></div><div><h3>Data Sources</h3><div>A systematic literature search was conducted in PubMed, Cochrane Library, Embase, Web of Science, Google Scholar, and Semantic Scholar from inception to May 2024.</div></div><div><h3>Study Selection</h3><div>Studies were included if they compared VEM with standard care in adult patients with stroke and reported outcomes related to functional recovery, mortality, or medical complications. Both randomized controlled trials and observational cohort studies were eligible.</div></div><div><h3>Data Extraction</h3><div>Two independent reviewers extracted study and participant characteristics, intervention details, comparator information, and outcome measures (functional recovery, complications, mortality, and length of stay). Discrepancies were resolved through discussion. Effect sizes (risk ratios, standardized mean differences) with 95% confidence intervals were calculated, and methodological quality was assessed using the Cochrane Risk of Bias tool for randomized controlled trials and the Newcastle-Ottawa Scale for cohort studies.</div></div><div><h3>Data Synthesis</h3><div>Twenty-three studies, including 84,936 patients in the VEM group and 32,753 in the standard care group, were analyzed. VEM significantly improved functional independence, as measured by the Barthel Index (a validated scale for activities of daily living; standardized mean difference [SMD]=0.61; 95% CI, 0.25-0.98; <em>P</em>&lt;.01) and the modified Rankin Scale (mRS; a disability scale, with scores of 0-2 indicating functional independence; risk ratio [RR]=1.14; 95% CI, 1.03-1.27). It also reduced the length of hospital stay (SMD=−2.53; 95% CI, −4.45 to −0.60; <em>P</em>&lt;.01), pulmonary infection (RR=0.75; 95% CI, 0.57-0.99; <em>P</em>=.04), and urinary tract infection (RR=0.76; 95% CI, 0.71-0.82; <em>P</em>&lt;.01). No significant effects were observed in National Institutes of Health Stroke Scale (a stroke severity scale) scores, mortality, deep vein thrombosis, neurologic deterioration, or falls.</div></div><div><h3>Conclusions</h3><div>VEM is safe and effective in enhancing functional recovery, reducing complications, and shortening hospitalization after acute stroke. Further high quality studies are needed to optimize timing and dosage of mobilization, particularly considering stroke severity and subtype.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 2","pages":"Pages 333-352"},"PeriodicalIF":3.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534291","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":"Dual-Site Transcranial Direct Current Stimulation Combined With Exercising Improves Fatigue and Sleep Quality in People With Fibromyalgia: A Randomized Sham-Controlled Clinical Trial","authors":"Rafael Velasco-Velasco MSc ,&nbsp;Juan Avendaño-Coy PhD ,&nbsp;Elena Labrador-García PT ,&nbsp;Elisabeth Bravo-Esteban PhD ,&nbsp;Rubén Arroyo-Fernández PhD","doi":"10.1016/j.apmr.2025.07.022","DOIUrl":"10.1016/j.apmr.2025.07.022","url":null,"abstract":"<div><h3>Objective</h3><div>The study aimed to evaluate the effectiveness of a combined program of unihemispheric concurrent dual-site anodal-transcranial direct current stimulation (UHCDS a-tDCS) + therapeutic exercise (TE) on fatigue and sleep quality in people with fibromyalgia syndrome (FMS).</div></div><div><h3>Design</h3><div>Double-blind, randomized, sham-controlled trial.</div></div><div><h3>Setting</h3><div>Primary health care center.</div></div><div><h3>Participants</h3><div>A total of 90 volunteers diagnosed with fibromyalgia. Nine participants dropped out of the study.</div></div><div><h3>Intervention</h3><div>Participants were randomly allocated in a 1:1:1 ratio to active UHCDS a-tDCS+TE, sham UHCDS a-tDCS+TE, or control receiving TE. The intervention was delivered in 10 sessions over 6 weeks.</div></div><div><h3>Outcome Measures</h3><div>Fatigue, sleep quality, and quality of life.</div></div><div><h3>Results</h3><div>Fatigue score decreased significantly in the active group compared with the sham (−9.8 points; 95% CI, −18.9 to −0.8; <em>P</em>=.028) and control groups (−9.9 points; 95% CI, −18.9 to −0.9; <em>P</em>=.027) at posttreatment and compared with the control group at follow-up (−11.5 points; 95% CI, −20.8 to −2.1; <em>P</em>=.01). Sleep quality improved in active group compared with sham and control groups at posttreatment (sham: −14.4 points; 95% CI, −24.2 to −4.5; <em>P</em>=.002; control: −19.5 points; 95% CI, −29.4 to −9.7; <em>P</em>&lt;.001) and at follow-up (sham: −11.2 points; 95% CI, −21.1 to −1.3; <em>P</em>=.02; control: −15.5 points; 95% CI, −25.3 to −5.6; <em>P</em>&lt;.001). Quality of life enhanced in the active group compared with the other groups, both at posttreatment (sham: −15.2 points; 95% CI, −26.6 to −3.9; <em>P</em>=.005; control: −13.7 points; 95% CI, 25.0 to −2.3; <em>P</em>=.012) and at follow-up (sham: −14.5 points; 95% CI, −25.2 to −3.7; <em>P</em>=.004; control: −17.4 points; 95% CI, −28.1 to −6.6; <em>P</em>&lt;.001). Effect sizes for intergroup comparisons were medium across all outcomes: fatigue (η²=0.10; <em>P</em>=.01), sleep quality (η²=0.12; <em>P</em>&lt;.01), and quality of life (η²=0.13; <em>P</em>&lt;.01). No intergroup differences in any outcome were found between the sham and control groups.</div></div><div><h3>Conclusions</h3><div>Combining UHCDS a-tDCS with TE can result in clinically significant improvements in fatigue, sleep disorders, and quality of life in people with FMS.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 2","pages":"Pages 153-161"},"PeriodicalIF":3.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862067","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}