Archives of physical medicine and rehabilitation最新文献

Objective: To describe the effects of cognitive rehabilitation provided to patients with lingering cognitive difficulties or "brain fog" after COVID-19.

Design: Retrospective cohort study SETTING: Outpatient rehabilitation setting PARTICIPANTS: Seventy consecutive patients with Long COVID that were referred from a Neuro-COVID clinic and evaluated and treated by speech-language pathologists INTERVENTIONS: Usual care cognitive rehabilitation MAIN OUTCOME MEASURES: Patients completed the Quality of Life in Neurological Disorders (NeuroQoL) Cognition Function Short Form and the Rivermead Behavioral Memory Test Story Recall assessments before and after treatment. Demographics, goals, treatment frequency/duration, and interventions were analyzed to determine treatment outcomes and patterns of care.

Results: Of 70 patients, 83% were never hospitalized for COVID-19, the average age was 46.5 years, 77% were female and 69% were white. There were no differences in demographics, race, ethnicity or objective cognitive measures prior to starting treatment between the 50 individuals who completed their plan of care (POC) versus the 20 who did not. However, patients who did not complete their POC reported higher anxiety prior to treatment. Patients with higher anxiety prior to treatment demonstrated less improvement in cognitive quality of life measures following treatment. Of the 50 patients who completed their POC, 45 (90%) met all short-term goals. There was a significant increase in NeuroQoL Cognition Function scores from pre- to post cognitive rehabilitation in 36 patients tested, but no significant differences in objective measures of memory in 23 patients tested.

Conclusion: Cognitive rehabilitation resulted in self-reported improvement in functional cognition. However, anxiety limited the favorable impact of treatment and should be addressed in conjunction with cognitive therapy to maximize outcomes.

Objective: To determine if performance on symptom, cognitive, balance, fatigue, physical activity, and quality of life outcomes at 4-weeks post-injury in children with concussion differs based on acute 5P risk classification.

Design: Prospective cohort.

Setting: Laboratory.

Patients: Sixty-two children (age: 13.27 ± 2.50 years; 29 (46.7%) females) with diagnosed concussion.

Interventions: Not applicable.

Main outcome measures: Patient demographics and post-injury assessments were completed within 72 hours of concussion and used to classify patients as "high", "moderate", or "low" PPCS risk. Children then completed a multi-modal assessment battery at 4-weeks post-concussion. Kruskal-Wallis assessments analyzed whether study outcomes differed between 5P risk groups.

Results: Significant group differences were observed in symptom (χ²(2)= 9.76, p=0.008), fatigue (χ²(2)= 14.60, p<0.001), physical activity (χ²(2)= 15.76, p<0.001), and quality of life (χ²(2)= 7.82, p=0.02) outcomes. The low-risk group had fewer symptoms and less fatigue but increased physical activity levels and quality of life compared to the high-risk group. No significant differences in cognitive or balance outcomes were observed (p>0.05).

Conclusion: The 5P rule provides clinicians with valuable prognostic information related to PPCS and self-reported outcomes 4-weeks post-concussion, but not objective cognitive or balance outcomes. This information may help clinicians prioritize treatment resources to children most at-risk of prolonged concussion recovery.

Objective: The aim of this systematic review was to determine the extent to which sex and gender are considered in the design and reporting of DRF rehabilitation RCTs.

Data source: PubMed, Embase, CINAHL and Pedro databases were searched in March 2022, and an updated search was conducted in July 2023.

Study selection: All RCTs with a rehabilitation intervention and any comparison were included.

Data extraction: We extracted information on the study characteristics and sex and gender reporting in the articles. We extracted whether the studies complied with the SAGER guidelines and a reporting tool for sex and gender.

Data synthesis: A total of 77 studies were included in this review. All studies were published between 1987 and 2021. Two were in children, and the rest were in adults. This systematic review found that sex and gender were adequately considered in only six of the 77 RCTs investigating rehabilitation interventions post-DRF. Three of those studies were published before the SAGER guidelines were published in 2016, and three were published after 2016.

Conclusion: Overall, sex and gender were inadequately defined, and poorly addressed in the study design, conduct, and interpretation. Unfortunately, there was no evidence of improvement after 2016 when the SAGER guidelines became available.

The aim of this commentary is to highlight the contributions of Ziebert and colleagues regarding sex and gender reporting in randomized clinical trials of distal radial fractures. While increasingly more research funding agencies are requiring the consideration of sex and gender in research designs, this is not consistently being carried out in the reporting phase. Their research quantifies the extent to which this is occurring in randomized clinical trials, considered the most rigorous of study designs which inform clinical practice guidelines.

Objectives: The objectives are: 1) to conduct cluster analysis to explore patterns of outpatient prescription medications during the first year following combat-related amputations, and 2) to analyze patient characteristics associated with prescription medication clusters.

Design: Retrospective study of Department of Defense casualty records and outpatient prescription medications during the first year postinjury. Hierarchical cluster analysis of American Hospital Formulary Service (AHFS) medication classes.

Setting: Military amputation rehabilitation program.

Participants: 1,651 US service members who sustained major limb amputations in Operations Iraqi and Enduring Freedom (OIF/OEF), 2001-2017, and had outpatient prescription medications.

Interventions: n/a.

Main outcome measures: Prescription medication clusters, patient characteristics.

Results: Cluster analysis identified three prescription medication profiles: Cluster 1) Baseline (n = 682) consisted of six AHFS classes: cathartic/laxatives, anticonvulsants, semisynthetic opioids, antidepressants, NSAIDs, combination opioid analgesics. These six classes were part of all three profiles (i.e., baseline medications). Cluster 2) Baseline plus Insomnia (B+I) (n = 502): atypical antipsychotics, anxiolytics/sedatives, methadone, benzodiazepines, analgesics/antipyretics and baseline medications. Cluster 3) Baseline plus Severe Injury (B+SI) (n = 467): anticoagulants, 5-HT 3 receptor antagonist, multivitamins, anxiolytic/sedatives, analgesic/antipyretics and baseline medications. The Baseline cluster was characterized by early injury years (85%, 2001-2008), moderate/serious injuries (85%), single amputation, chronic pain, and posttraumatic stress disorder. Cluster B+I was characterized by early injury years (62%), minor injuries (16%), low rates of traumatic amputations, and postinjury complications. Cluster B+SI was characterized by later injury years (88%, 2009-2017), serious/severe injuries (62%), multiple amputation (42%), TBI (43%), high rates of complications, and prescriptions.

Conclusions: Cluster analysis identified three outpatient prescription medication profiles during the first year postinjury. All profiles included analgesics and psychotherapeutics but differed on specific insomnia medications, multivitamins, and anticoagulants. Medication profiles had significant associations with injury years, injury severity, and postinjury complications. The results inform future research and prescription medication practices.

Objective: to evaluate if a novel intervention involving individualized behaviour change strategies delivered by physiotherapists has an effect on physical activity levels in people with MS who were previously inactive compared with usual care.

Design: prospective, assessor-blinded, parallel-group, randomised controlled trial.

Setting: Community settings across Saskatchewan, Canada PARTICIPANTS: Individuals diagnosed with MS, >18 years of age, and able to walk with or without aids were invited to participate from an MS Saskatchewan database.

Intervention: The intervention group received individualized physical activity behavioural coaching for 12 months compared to a usual care control group. There were three consistent features of the intervention: behaviour change techniques, recommendations for physical activity, and ongoing physiotherapist support. However, these components were tailored to each participant.

Main outcome measures: The primary outcome was change in physical activity levels at 12 months on the Godin Leisure Time Exercise Questionnaire (GLTEQ). Secondary measures included MS symptoms (MSIS-29), confidence with managing MS (MSSE) and exercise self-efficacy (EXSE).

Results: 120 participants (mean age 53 years, 78% female, average disease duration 14.7 years) were enrolled and 117 completed primary outcome. At month 12 the mean (95% CI) difference between intervention and control group for GLTEQ was 15.9 (12.5 to 28.4). This improvement occurred regardless of age, gender, if on an MS drug, time since relapse, or co-morbidity history. In the intervention group, 33.9% were sufficiently active for substantial health benefits compared to 6.9% in the control group at month 12 (p<0.001). At baseline, these proportions were 3.4 % and 4.9% respectively. Improvement occurred on the MSSE and EXSE at 12 months in favor of the intervention group.

Conclusion: Physical activity levels and exercise self-efficacy improved clinically and significantly with neurophysiotherapist led individualized coaching.

Objective: Report chronic health conditions are common among adults with disabilities to inform prevention and management efforts in public health.

Design and setting: This article reports on secondary analysis of 2022 Behavioral Risk Factor Surveillance Survey.

Participants: Cases with a disability within the BRFSS 2022 dataset were identified by selecting any case that answered "yes" to any of the ACS-6. The BRFSS only includes non-institutionalized individuals 18 years or older.

Main outcome measures: Statistics reported include weighted unadjusted prevalence of any chronic health condition among adults with a disability by type of disability and other selected demographic characteristics, weighted unadjusted prevalence estimates for individuals with chronic health conditions by age group and disability type, and prevalence ratios across groups.

Results: Review of the proportions between disability types within demographic strata revealed those with self-care and those with independent living disabilities consistently had the highest, and those with hearing and those with vision-related disabilities had the lowest prevalence of any chronic health condition. Across all age and disability groups, arthritis and depression were among the most common chronic health conditions. Prevalence differences among racial groups in younger age groups were not present among the 65+ age group.

Conclusion: These prevalence estimates can inform health education and chronic health management efforts to support targeted prevention and intervention programs.

Objective: To evaluate longitudinal cost outcomes of initial treatment strategies for new neck pain (NP) episodes among Medicare beneficiaries.

Design: Retrospective cohort study using Medicare Part A, B, and D claims data.

Setting: Not applicable.

Participants: Medicare beneficiaries aged 65-99 years, continuously enrolled in Parts A, B, and D from 2018 to 2021, who experienced a new NP episode in 2019.

Interventions: Three cohorts were developed based on the index visit provider: chiropractic (spinal manipulative therapy [SMT]), primary care with prescription analgesics (PCP [+A]), and primary care without analgesics (PCP [-A], reference group).

Main outcome measures: Medicare allowed costs for total and NP-related claims (Parts A and B), and medication claims (Part D) over 24 months from the index visit.

Results: Among 291,604 older adults with NP, most were White women with few comorbidities. Compared to PCP (-A), the SMT cohort had 6% (cost ratio, 0.94; 95% CI, 0.93-0.95) lower total Medicare Part A costs, whereas the PCP (+A) cohort showed no difference. For NP-related Part A claims, PCP (+A) had 7% (0.93; 95% CI, 0.88-0.98) lower costs, whereas SMT showed no difference. The SMT cohort had 6% (0.94; 95% CI, 0.94-0.95) lower total Medicare Part B costs and 36% (0.64; 95% CI, 0.64-0.65) lower NP-related costs, whereas PCP (+A) had 2% (1.02; 95% CI, 1.01-1.02) higher total costs. The SMT had 2% (0.98; 95% CI, 0.98-0.99) lower nonanalgesic and 13% (0.87; 95% CI, 0.87-0.88) lower analgesic Part D costs; the PCP (+A) had 13% (1.13; 95% CI, 1.12-1.14) higher nonanalgesic but 14% (0.86; 95% CI, 0.86-0.87) lower analgesic costs. Propensity weighting balanced covariates among cohorts.

Conclusions: For older adults with new NP episodes, initial SMT was associated with lower health care costs, particularly for Part A total and NP-related claims, with a less pronounced effect on Part B and D claims than PCP-related strategies. These findings suggest potential for health care savings based on the initial treatment choice.