Archives of physical medicine and rehabilitation最新文献

Objective: To identify specific pain qualities associated with body perception disturbances in patients with musculoskeletal pain, using machine learning interpretability methods.

Design: A cross-sectional study utilizing self-reported questionnaires and SHapley Additive exPlanation (SHAP) analysis within a random forest model.

Setting: Multicenter clinical settings where patients with musculoskeletal pain received physical therapy.

Participants: A total of 179 patients with musculoskeletal pain, without restrictions on pain location or duration. Patients with cognitive impairment or difficulty completing questionnaires were excluded.

Main outcome measure(s): Pain qualities assessed using the Short-Form McGill Pain Questionnaire-2 (SFMPQ-2), and body perception disturbances assessed using the Fremantle Body Awareness Questionnaire (FreBAQ). SHAP values were calculated to quantify the relationship between individual pain qualities and body perception disturbances.

Interventions: none.

Results: SHAP-based importance ranked "cramping pain" among the top contributors, whereas bivariate correlations with FreBAQ were strongest for "gnawing pain" (r = 0.90, p < 0.001), indicating convergence on kinesthesia-related descriptors.

Conclusions: Multiple pain-quality descriptors were associated with body perception disturbances. While the analytic metrics differed in how they ranked individual descriptors, both SHAP-based importance and correlation analyses converged on kinesthesia-related qualities. These results indicate a prominent association between such descriptors and disturbed body perception, potentially informing sensorimotor-focused assessment and intervention strategies.

Objective: to determine the association of sleep duration and disturbances with physical and mental health-related quality of life (HRQoL) in stroke survivors.

Design: cross-sectional analysis of the REasons for Geographic And Racial Differences in Stroke (REGARDS) second in-home visit (May 2013-Dec 2016).

Setting: population-based national study, United States.

Participants: Individuals with adjudicated incident stroke.

Intervention: Not Applicable MAIN OUTCOME MEASURES: Physical and Mental HRQoL based on the 12-item Short-Form. Sleep measures included sleep duration, difficulty initiating sleep, difficulty maintaining sleep, nonrestorative sleep, and a combined measure based on the latent class model. Logistic regression models were employed to investigate the association between sleep variables and HRQOL adjusting for demographic factors, socioeconomic factors, behavioral factors, and co-morbidities.

Results: This study included 368 non-Hispanic Black and White stroke survivors. The mean age was 76.0 years (SD=7.9) and 52.7% were males. Stroke survivors with short sleep duration were more likely to have poor physical HRQoL (OR: 2.87, 95% CI=1.46-5.62) compared to stroke survivors with adequate sleep duration after adjusting for confounding. Similarly, stroke survivors with nonrestorative sleep were 3 times more likely to have poor physical HRQoL (OR: 3.11, 95% CI=1.28-7.55) compared to stroke survivors with restorative sleep.

Conclusion: sleep quantity and quality were associated with physical HRQoL in stroke survivors. These findings suggest that sleep health is associated with stroke rehabilitation.

Objective: It is unknown how the United States (U.S.) opioid epidemic influenced the integration of nonpharmacologic pain treatments in cancer survivors. We described annual trends and predictors of using opioids alone, nonpharmacologic treatments alone, multimodal treatments (opioid + nonpharmacologic), and neither treatment.

Design: A serial cross-sectional design.

Setting: Ambulatory.

Participants: Noninstitutionalized U.S. adults with prevalent cancer and pain in the Medical Expenditure Panel Survey (2011-2020).

Interventions: Not applicable.

Main outcome measures: Period prevalence of self-reported and pharmacy-verified use of opioids alone, nonpharmacologic treatments alone, both, or neither. Nonpharmacologic treatments included physical therapy, occupational therapy, chiropractic care, massage therapy, and acupuncture.

Results: Respondents with cancer and pain represented a total of 41,064,668 adults from 2011 to 2020. Most adults with cancer pain were >65 years of age (66.6%), women (52.1%), White (91.4%), non-Hispanic (95.8%), had a high school diploma (42.2%), had an income of 400% of the federal poverty line (46.6%), and lived in the U.S. South (37.7%). Compared with 2011, the prevalence of multimodal treatments increased from 4% (95% confidence interval [CI], 2%-6%) to 10% (95% CI, 6%-14%) in 2019, while the prevalence of using neither pain treatment decreased from 62% (95% CI, 55%-68%) to 46% (95% CI, 40%-52%). Compared with using neither treatment, the adjusted relative risk ratio (RRR) for using nonpharmacologic treatments was stable from 2011 to 2015 (RRR=1.00; 95% CI, 0.93-1.08), but increased from 2016 to 2019 (RRR=1.22; 95% CI, 1.02-1.46) until 2020 (RRR=0.68; 95% CI, 0.43-1.46). Both unadjusted and adjusted analyses found that pain treatments varied based on income, educational attainment, race, and geographic region.

Conclusions: Nonpharmacologic and multimodal pain treatments increased from 2011 to 2020; however, most cancer pain survivors remained untreated. Pain treatment varied based on sociodemographic and socioeconomic factors.