Archives of physical medicine and rehabilitation最新文献_第4页

Time to Navigate: A Practical Objective Clinical Measure for Freezing of Gait Severity in People With Parkinson Disease 导航时间（TTN）：用于冻结帕金森病患者步态严重程度的实用客观临床测量方法。

IF 3.6 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2025-02-01 DOI: 10.1016/j.apmr.2024.09.003

Aileen Eugenia Scully PhD , Dawn May Leng Tan ClinDoc PT , Beatriz Ito Ramos de Oliveira PhD , Keith David Hill PhD , Ross Clark PhD , Yong Hao Pua PhD

Objectives

To provide an easy-to-use measure, as existing objective assessments for freezing of gait (FOG) severity may be unwieldy for routine clinical practice, this study explored time taken to complete the recently validated FOG severity tool and its components.

Design

A cross-sectional study.

Setting

Outpatient clinics of a tertiary hospital.

Participants

People with Parkinson disease who could independently ambulate 8-meters, understand instructions, and without co-morbidities affecting gait were consecutively recruited. Thirty-five participants were included (82.9% [n=29] male; median [IQR]: age of 73.0 [11.0] years and disease duration of 4.0 [4.5] years).

Interventions

Not applicable.

Main Outcome Measures

Participants were assessed with the FOG severity tool in a test-retest design, with time taken for each component recorded using a stopwatch during video-analysis. Validity of total FOG severity tool time, time taken to complete its turning and narrow-space components (i.e., time to navigate [TTN]), and an adjusted TTN were examined through correlations with validated FOG severity outcomes. To facilitate clinical interpretation, the TTN cut-off was determined using scatterplot smoothing regression, whereas minimal important change was calculated using predictive modeling.

Results

The FOG severity tool time, TTN, and adjusted TTN similarly demonstrated moderate correlations with the FOG questionnaire and percentage-FOG, and very high correlations with FOG severity tool–revised. The TTN was nonlinearly related to FOG severity, with a positive relationship observed in the first 300 seconds and plateauing after. minimal important change for TTN was 15.4 seconds reduction in timing (95% CI, 3.2-28.7).

Conclusions

The TTN is a feasible, interpretable, and valid test of FOG severity. In busy clinical settings, TTN can provide a viable alternative when use of existing objective FOG measures is (often) unfeasible.

研究目的：由于现有的步态冻结（FOG）严重程度客观评估对于常规临床实践而言可能过于笨重，为了提供一种易于使用的测量方法，本研究探讨了完成最近通过验证的 FOG 严重程度工具及其组成部分所需的时间：设计：横断面设计：横断面研究场景：一家三甲医院的门诊部参与者：能够进行自我评估的帕金森病患者：连续招募能够独立行走八米、理解指令且无影响步态的并发症的帕金森病患者。共纳入 35 名参与者[82.9%（n=29）为男性；中位数（IQR）：年龄 - 73.0（11.0）岁；病程 - 4.0（4.5）年]：主要结果测量：在视频分析过程中使用秒表记录每个部分的时间。通过与经过验证的 FOG 严重程度结果的相关性，对 FOG 严重程度工具的总时间、完成转弯和窄空间部分所需的时间（即导航时间，TTN）以及调整后的 TTN 的有效性进行了检验。为便于临床解释，采用散点图平滑（LOESS）回归法确定 TTN 临界值，同时采用预测建模法计算最小重要变化（MIC）：结果：FOG 严重程度工具时间、TTN 和调整后的 TTN 与 FOG 问卷和 FOG 百分比呈中度相关，与 FOG 严重程度工具修订版呈高度相关。TTN 与 FOG 严重程度呈非线性关系，在最初的 300 秒内呈正相关，之后则趋于平稳。TTN的MIC值为时间缩短15.4秒（95%CI为3.2至28.7）：结论：TTN 是一种可行、可解释且有效的 FOG 严重程度测试方法。在繁忙的临床环境中，当使用现有的客观 FOG 测量方法（通常）不可行时，TTN 可以提供一种可行的替代方法。

{"title":"Time to Navigate: A Practical Objective Clinical Measure for Freezing of Gait Severity in People With Parkinson Disease","authors":"Aileen Eugenia Scully PhD , Dawn May Leng Tan ClinDoc PT , Beatriz Ito Ramos de Oliveira PhD , Keith David Hill PhD , Ross Clark PhD , Yong Hao Pua PhD","doi":"10.1016/j.apmr.2024.09.003","DOIUrl":"10.1016/j.apmr.2024.09.003","url":null,"abstract":"<div><h3>Objectives</h3><div>To provide an easy-to-use measure, as existing objective assessments for freezing of gait (FOG) severity may be unwieldy for routine clinical practice, this study explored time taken to complete the recently validated FOG severity tool and its components.</div></div><div><h3>Design</h3><div>A cross-sectional study.</div></div><div><h3>Setting</h3><div>Outpatient clinics of a tertiary hospital.</div></div><div><h3>Participants</h3><div>People with Parkinson disease who could independently ambulate 8-meters, understand instructions, and without co-morbidities affecting gait were consecutively recruited. Thirty-five participants were included (82.9% [n=29] male; median [IQR]: age of 73.0 [11.0] years and disease duration of 4.0 [4.5] years).</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Participants were assessed with the FOG severity tool in a test-retest design, with time taken for each component recorded using a stopwatch during video-analysis. Validity of total FOG severity tool time, time taken to complete its turning and narrow-space components (i.e., time to navigate [TTN]), and an adjusted TTN were examined through correlations with validated FOG severity outcomes. To facilitate clinical interpretation, the TTN cut-off was determined using scatterplot smoothing regression, whereas minimal important change was calculated using predictive modeling.</div></div><div><h3>Results</h3><div>The FOG severity tool time, TTN, and adjusted TTN similarly demonstrated moderate correlations with the FOG questionnaire and percentage-FOG, and very high correlations with FOG severity tool–revised. The TTN was nonlinearly related to FOG severity, with a positive relationship observed in the first 300 seconds and plateauing after. minimal important change for TTN was 15.4 seconds reduction in timing (95% CI, 3.2-28.7).</div></div><div><h3>Conclusions</h3><div>The TTN is a feasible, interpretable, and valid test of FOG severity. In busy clinical settings, TTN can provide a viable alternative when use of existing objective FOG measures is (often) unfeasible.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 2","pages":"Pages 247-254"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279801","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}

引用次数: 0

Usefulness and Safety of a Wearable Transcutaneous Electrical Nerve Stimulation Device for Promoting Exercise Therapy in Patients With Chronic Knee Pain: A Randomized Controlled Trial 可穿戴经皮神经电刺激装置在促进慢性膝关节疼痛患者运动疗法方面的实用性和安全性：随机对照试验

IF 3.6 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2025-02-01 DOI: 10.1016/j.apmr.2024.08.021

Keisuke Yamada MS , Hiroki Shimizu PT, MS , Naoki Doi PT, MS , Keiko Harada MS , Mami Ishizuka-Inoue PT, MS , Reika Yamashita PT, MS , Shozo Takamatsu MS , Saki Hayashi-Nishiyama MS , Yukihiro Okamoto MD , Tomoki Aoyama MD, PhD

Objective

To investigate the effect of transcutaneous electrical nerve stimulation (TENS) in reducing barriers to the implementation of exercise therapy and promoting exercise therapy, focusing on physical activity (PA).

Design

A single-center, participant-blinded, randomized controlled trial with a pre-post design.

Setting

Orthopedic clinic at a single institution,.

Participants

Participants (N=63, aged ≥50y) who had knee pain for ≥3 months were randomly assigned to the TENS (N=21), exercise (N=23), or combined (N=19) groups.

Interventions

Participants were provided with 4 weeks of intervention: the TENS group using a wearable TENS device, exercise group performing designated exercises, and combined group performing activities from the TENS and exercise groups.

Main Outcome Measures

The primary outcome measure was PA. The secondary outcome measures were 6-minute walk test (6MWT); timed Up and Go (TUG) test; stair climbing; knee pain using the visual analog scale at 6MWT, TUG test, and stair climbing; and patient-reported changes in knee pain over time.

Results

At pre- and postintervention, light-intensity PA time (minutes per day) in the TENS, exercise, and combined groups was 735.62±68.82 vs 714.21±73.06 (P=.061), 733.05±103.90 vs 700.31±90.33 (P=.057), and 710.09±62.98 vs 685.22±58.35 (P=.049), respectively, with a significant decrease in the combined group. Significant improvement in knee pain and stair climbing was observed in all groups pre- and postintervention.

Conclusions

The group using TENS showed improved effects of early reduction in knee pain and when combined with exercise therapy, a reduction in time spent in light-intensity activities such as sedentary behavior. Thus, the use of TENS in combination with conventional exercise therapy has the potential to reduce psychological barriers to the introduction of exercise therapy. It also promotes and ensures the safe implementation and continuation of exercise therapy.

目的：研究经皮神经电刺激（TENS）在减少运动疗法实施障碍和促进运动疗法方面的效果：研究经皮神经电刺激（TENS）在减少运动疗法实施障碍和促进运动疗法方面的效果，重点关注体力活动：设计：单项参与者盲法随机对照试验（RCT），采用前后对照设计：参与者：膝关节疼痛至少 3 年的参与者：参与者膝关节疼痛至少3个月（63人，年龄≥50岁），随机分配到TENS组（21人）、运动组（23人）或联合组（19人）：参与者接受为期 4 周的干预：使用可穿戴 TENS 设备的 TENS 组、进行指定运动的运动组，以及进行 TENS 组和运动组活动的联合组：主要结果测量：主要结果测量为体力活动（PA）。次要结果指标包括：6 分钟步行测试（6MWT）；定时上下楼测试（TUG）；爬楼梯；6MWT、TUG 和爬楼梯时膝关节疼痛的视觉模拟量表；以及患者报告的膝关节疼痛随时间的变化：干预前后，TENS组、运动组和联合组的轻强度PA时间（LPA）分别为735.62±68.82 vs. 714.21±73.06（P=0.061）、733.05±103.90 vs. 700.31±90.33（P=0.057）和710.09±62.98 vs. 685.22±58.35（P=0.049），联合组的轻强度PA时间显著减少。所有组别在干预前后的膝关节疼痛和爬楼梯能力均有明显改善：结论：使用 TENS 的组别在早期减轻膝关节疼痛方面显示出更好的效果，当与运动疗法相结合时，减少了久坐等轻强度活动所花费的时间。因此，结合传统运动疗法使用 TENS 有可能减少运动疗法的心理障碍。它还能促进和确保运动疗法的安全实施和持续进行。

{"title":"Usefulness and Safety of a Wearable Transcutaneous Electrical Nerve Stimulation Device for Promoting Exercise Therapy in Patients With Chronic Knee Pain: A Randomized Controlled Trial","authors":"Keisuke Yamada MS , Hiroki Shimizu PT, MS , Naoki Doi PT, MS , Keiko Harada MS , Mami Ishizuka-Inoue PT, MS , Reika Yamashita PT, MS , Shozo Takamatsu MS , Saki Hayashi-Nishiyama MS , Yukihiro Okamoto MD , Tomoki Aoyama MD, PhD","doi":"10.1016/j.apmr.2024.08.021","DOIUrl":"10.1016/j.apmr.2024.08.021","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the effect of transcutaneous electrical nerve stimulation (TENS) in reducing barriers to the implementation of exercise therapy and promoting exercise therapy, focusing on physical activity (PA).</div></div><div><h3>Design</h3><div>A single-center, participant-blinded, randomized controlled trial with a pre-post design.</div></div><div><h3>Setting</h3><div>Orthopedic clinic at a single institution,.</div></div><div><h3>Participants</h3><div>Participants (N=63, aged ≥50y) who had knee pain for ≥3 months were randomly assigned to the TENS (N=21), exercise (N=23), or combined (N=19) groups.</div></div><div><h3>Interventions</h3><div>Participants were provided with 4 weeks of intervention: the TENS group using a wearable TENS device, exercise group performing designated exercises, and combined group performing activities from the TENS and exercise groups.</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome measure was PA. The secondary outcome measures were 6-minute walk test (6MWT); timed Up and Go (TUG) test; stair climbing; knee pain using the visual analog scale at 6MWT, TUG test, and stair climbing; and patient-reported changes in knee pain over time.</div></div><div><h3>Results</h3><div>At pre- and postintervention, light-intensity PA time (minutes per day) in the TENS, exercise, and combined groups was 735.62±68.82 vs 714.21±73.06 (<em>P</em>=.061), 733.05±103.90 vs 700.31±90.33 (<em>P</em>=.057), and 710.09±62.98 vs 685.22±58.35 (<em>P</em>=.049), respectively, with a significant decrease in the combined group. Significant improvement in knee pain and stair climbing was observed in all groups pre- and postintervention.</div></div><div><h3>Conclusions</h3><div>The group using TENS showed improved effects of early reduction in knee pain and when combined with exercise therapy, a reduction in time spent in light-intensity activities such as sedentary behavior. Thus, the use of TENS in combination with conventional exercise therapy has the potential to reduce psychological barriers to the introduction of exercise therapy. It also promotes and ensures the safe implementation and continuation of exercise therapy.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 2","pages":"Pages 167-176"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279803","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}

引用次数: 0

Psychosocial Responses to a Cardiovascular Exercise Randomized Controlled Trial: Does Intensity Matter for Individuals Post-Stroke?

IF 3.6 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2025-01-31 DOI: 10.1016/j.apmr.2025.01.468

Lynden Rodrigues, Kevin Moncion, Sotiria Anna Angelopolous, Bernat De Las Heras, Shane Sweet, Janice J Eng, Joyce Fung, Marilyn MacKay-Lyons, Ada Tang, Marc Roig

Objective: This study compared the effect of cardiovascular high-intensity interval training (HIIT) vs. moderate-intensity continuous training (MICT) on psychosocial responses to exercise, motivation and enjoyment, in individuals with chronic stroke.

Design: A secondary analysis of motivation and enjoyment outcomes collected from a randomized controlled trial (NCT03614585) comparing 12-weeks of HIIT vs MICT in participants with chronic stroke (6-60 months post-stroke) was conducted.

Setting: General community.

Participants: Seventy-one individuals with chronic stroke (mean ± SD, age: 65.5 ± 8.4 years, 19.4 ± 13.4 months post-stroke, 38% female) and mild disability (median ± IQR, NIH Stroke Scale score 1 ± 2).

Interventions: Twelve-week, 3x/per week progressive cardiovascular HIIT or MICT program conducted on NuStep recumbent steppers.

Main outcome measures: Motivation (Behavioral Regulation in Exercise Questionnaire-3) was measured at week 1, 6 and 12. Enjoyment outcomes comprised of affective response (Feeling Scale) assessed at each training session, and post-exercise enjoyment (Physical Activity Enjoyment Scale) assessed at week 6 and 12. Linear mixed models, examining group, time and group × time point interactions in motivation constructs and composite scores, mean affective response per session, and post-exercise enjoyment were used to compare the effect of HIIT vs. MICT.

Results: HIIT elicited a lower affective response (mean difference [95% CI]: -1.18 [-1.90, -0.47]; p = 0.002), that also progressively declined during sessions, in contrast to MICT (group × time point interaction: F [2,63.5] = 3.99, p = 0.02). HIIT and MICT did not elicit any significant difference between groups or change over time for post-exercise enjoyment or any motivation constructs (p>0.05).

Conclusions: Despite lower affective response during exercise, HIIT and MICT elicit equivalent motivation and post-exercise enjoyment. This study provides further support for the implementation of HIIT in stroke rehabilitation by demonstrating sustained responses of motivation and post-enjoyment. Future studies should consider potential strategies that positively reinforce these important psychosocial responses to implement HIIT in post-stroke rehabilitation.

{"title":"Psychosocial Responses to a Cardiovascular Exercise Randomized Controlled Trial: Does Intensity Matter for Individuals Post-Stroke?","authors":"Lynden Rodrigues, Kevin Moncion, Sotiria Anna Angelopolous, Bernat De Las Heras, Shane Sweet, Janice J Eng, Joyce Fung, Marilyn MacKay-Lyons, Ada Tang, Marc Roig","doi":"10.1016/j.apmr.2025.01.468","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.01.468","url":null,"abstract":"<p><strong>Objective: </strong>This study compared the effect of cardiovascular high-intensity interval training (HIIT) vs. moderate-intensity continuous training (MICT) on psychosocial responses to exercise, motivation and enjoyment, in individuals with chronic stroke.</p><p><strong>Design: </strong>A secondary analysis of motivation and enjoyment outcomes collected from a randomized controlled trial (NCT03614585) comparing 12-weeks of HIIT vs MICT in participants with chronic stroke (6-60 months post-stroke) was conducted.</p><p><strong>Setting: </strong>General community.</p><p><strong>Participants: </strong>Seventy-one individuals with chronic stroke (mean ± SD, age: 65.5 ± 8.4 years, 19.4 ± 13.4 months post-stroke, 38% female) and mild disability (median ± IQR, NIH Stroke Scale score 1 ± 2).</p><p><strong>Interventions: </strong>Twelve-week, 3x/per week progressive cardiovascular HIIT or MICT program conducted on NuStep recumbent steppers.</p><p><strong>Main outcome measures: </strong>Motivation (Behavioral Regulation in Exercise Questionnaire-3) was measured at week 1, 6 and 12. Enjoyment outcomes comprised of affective response (Feeling Scale) assessed at each training session, and post-exercise enjoyment (Physical Activity Enjoyment Scale) assessed at week 6 and 12. Linear mixed models, examining group, time and group × time point interactions in motivation constructs and composite scores, mean affective response per session, and post-exercise enjoyment were used to compare the effect of HIIT vs. MICT.</p><p><strong>Results: </strong>HIIT elicited a lower affective response (mean difference [95% CI]: -1.18 [-1.90, -0.47]; p = 0.002), that also progressively declined during sessions, in contrast to MICT (group × time point interaction: F [2,63.5] = 3.99, p = 0.02). HIIT and MICT did not elicit any significant difference between groups or change over time for post-exercise enjoyment or any motivation constructs (p>0.05).</p><p><strong>Conclusions: </strong>Despite lower affective response during exercise, HIIT and MICT elicit equivalent motivation and post-exercise enjoyment. This study provides further support for the implementation of HIIT in stroke rehabilitation by demonstrating sustained responses of motivation and post-enjoyment. Future studies should consider potential strategies that positively reinforce these important psychosocial responses to implement HIIT in post-stroke rehabilitation.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078250","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}

引用次数: 0

Peripheral electrical stimulation on motor function and activities of daily living after stroke: A systematic review and network meta-analysis.

IF 3.6 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2025-01-30 DOI: 10.1016/j.apmr.2025.01.466

Yihao Zhou, Siyu Yang, Dongxia Li, Wenqiang Li, Chen Yang, Hong Huo, Shaojie Cai, Xingyan Zhu, Ruwen Zheng, Xu Dong, Dongyan Wang

Objective: To compare the effects of different peripheral electrical stimulation protocols and current frequencies for post-stroke motor function and activities of daily living (ADL).

Data sources: Seven databases (PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, VIP Database, Wan-Fang Database and Chinese Biomedical Database) were searched from inception to August 2024.

Study selection: Two reviewers independently performed the literature selection. The included studies were randomized controlled trials providing peripheral electrical stimulation for patients with stroke.

Data extraction: Two reviewers independently extracted data following a pre-developed Excel data collection sheet, including trial characteristics, intervention and comparator details, and outcome data. Risk of bias was evaluated by RoB2, PRISMA guidelines were followed for reporting.

Data synthesis: A total of 106 trials with 7,513 participants were included. Meta-analysis showed that neuromuscular electrical stimulation (NMES) could be the optimal electrical stimulation protocol for improving the Fugl-Meyer Assessment (FMA) score (SMD = 1.67, 95% CI (1.14, 2.21)) and improving the Modified Barthel Index (MBI) score (SMD = 1.73, 95% CI (1.10, 2.37)). Results showed that different frequencies of electrical stimulation ranked the top five in descending order for improving FMA scores as 20-30Hz_NMES (SUCRA = 87.5%) > 100Hz_NMES (SUCRA = 75.4%) > 100Hz_functional electrical stimulation (FES) (SUCRA = 70.9%) > 20/35Hz_transcutaneous electrical acupoint stimulation (TEAS) (SUCRA = 69.8%) > 1-4Hz_electrical acupuncture (EA) (SUCRA = 69.6%), and ranked the top five in descending order for improving MBI scores as 100Hz_transcutaneous electrical nerve stimulation (TENS) (SUCRA = 77.3%) > 5/15Hz_NMES (SUCRA = 68.3%) > 100Hz_TEAS (SUCRA = 65.6%) > 35-50Hz_FES (SUCRA = 64.8%) > 1-4Hz_EA (SUCRA = 60.0%).

Conclusions: Adding electrical stimulation on the basis of routine rehabilitation training can improve the motor dysfunction and ADL of patients with stroke. Specifically, NMES with 20-30 Hz improves motor function best, while 100 Hz TENS improves ADL best.

{"title":"Peripheral electrical stimulation on motor function and activities of daily living after stroke: A systematic review and network meta-analysis.","authors":"Yihao Zhou, Siyu Yang, Dongxia Li, Wenqiang Li, Chen Yang, Hong Huo, Shaojie Cai, Xingyan Zhu, Ruwen Zheng, Xu Dong, Dongyan Wang","doi":"10.1016/j.apmr.2025.01.466","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.01.466","url":null,"abstract":"<p><strong>Objective: </strong>To compare the effects of different peripheral electrical stimulation protocols and current frequencies for post-stroke motor function and activities of daily living (ADL).</p><p><strong>Data sources: </strong>Seven databases (PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, VIP Database, Wan-Fang Database and Chinese Biomedical Database) were searched from inception to August 2024.</p><p><strong>Study selection: </strong>Two reviewers independently performed the literature selection. The included studies were randomized controlled trials providing peripheral electrical stimulation for patients with stroke.</p><p><strong>Data extraction: </strong>Two reviewers independently extracted data following a pre-developed Excel data collection sheet, including trial characteristics, intervention and comparator details, and outcome data. Risk of bias was evaluated by RoB2, PRISMA guidelines were followed for reporting.</p><p><strong>Data synthesis: </strong>A total of 106 trials with 7,513 participants were included. Meta-analysis showed that neuromuscular electrical stimulation (NMES) could be the optimal electrical stimulation protocol for improving the Fugl-Meyer Assessment (FMA) score (SMD = 1.67, 95% CI (1.14, 2.21)) and improving the Modified Barthel Index (MBI) score (SMD = 1.73, 95% CI (1.10, 2.37)). Results showed that different frequencies of electrical stimulation ranked the top five in descending order for improving FMA scores as 20-30Hz_NMES (SUCRA = 87.5%) > 100Hz_NMES (SUCRA = 75.4%) > 100Hz_functional electrical stimulation (FES) (SUCRA = 70.9%) > 20/35Hz_transcutaneous electrical acupoint stimulation (TEAS) (SUCRA = 69.8%) > 1-4Hz_electrical acupuncture (EA) (SUCRA = 69.6%), and ranked the top five in descending order for improving MBI scores as 100Hz_transcutaneous electrical nerve stimulation (TENS) (SUCRA = 77.3%) > 5/15Hz_NMES (SUCRA = 68.3%) > 100Hz_TEAS (SUCRA = 65.6%) > 35-50Hz_FES (SUCRA = 64.8%) > 1-4Hz_EA (SUCRA = 60.0%).</p><p><strong>Conclusions: </strong>Adding electrical stimulation on the basis of routine rehabilitation training can improve the motor dysfunction and ADL of patients with stroke. Specifically, NMES with 20-30 Hz improves motor function best, while 100 Hz TENS improves ADL best.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073763","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}

引用次数: 0

Caregiver Resilience through the First Two Years after Traumatic Brain Injury: A Traumatic Brain Injury Model Systems Study.

IF 3.6 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2025-01-28 DOI: 10.1016/j.apmr.2025.01.464

Daniel W Klyce, Jennifer H Marwitz, Robert A Perera, Laura E Dreer, Stephanie D Agtarap, Katherine Abbasi, Dawn M Neumann, Flora M Hammond, Thomas F Bergquist, Jean Lengenfelder

Objective: To examine: (1) the trajectory of caregiver resilience over two years following onset of a care recipient's moderate-to-severe traumatic brain injury (TBI), (2) caregiver-related outcomes associated with resilience, and (3) changes in associations between caregiver resilience, other caregiver characteristics, and care-recipient variables across time.

Design: Prospective cohort.

Setting: TBI Model Systems (TBIMS) centers.

Participants: TBIMS participants (care-recipients) were approached to enroll in this study and identify a caregiver. 258 care-recipient and caregiver dyads were enrolled.

Interventions: N/A MAIN OUTCOME MEASURES: Caregiver data included demographics, health history, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Zarit Burden Interview (ZBI), Family Needs Questionnaire-Revised (FNQ-R), and Connor-Davidson Resilience Scale 10 (CD-RISC-10). All caregiver data were self-reported via phone interview or mailed surveys at 6 months, 12 months, and 24 months post-injury. At all 3 time points, care-recipients with TBI also completed their own CD-RISC-10, PHQ-9, GAD-7, and Disability Rating Scale (DRS).

Results: Linear mixed-effects models indicated that the trajectory of resilience was stable within caregivers over two years post-injury. There were significant, positive associations for all caregiver FNQ-R subscales (all p<0.001) with care-recipient and caregiver CD-RISC-10 scores (p=0.001), indicating that more caregiving needs endorsed as "met" corresponded with higher resilience. Caregiver PHQ-9 and ZBI scores were found to be negatively associated with resilience (both p<0.001). When all covariates were included in the multivariable model, met emotional needs was positively associated with caregiver resilience (p<0.0001). Negative associations with caregiver resilience included higher caregiver PHQ-9 scores (p = 0.001) and perceptions of caregiving burden (p=0.003).

Conclusions: Caregiver levels of resilience were generally stable over two years post-TBI. Caregivers' resilience was positively associated with perceptions of their needs being met and negatively associated with caregiving burden and emotional distress. Further research is needed to develop and evaluate the utility and feasibility of interventions to enhance resilience, meet family needs, and improve long-term outcomes following brain injury.

{"title":"Caregiver Resilience through the First Two Years after Traumatic Brain Injury: A Traumatic Brain Injury Model Systems Study.","authors":"Daniel W Klyce, Jennifer H Marwitz, Robert A Perera, Laura E Dreer, Stephanie D Agtarap, Katherine Abbasi, Dawn M Neumann, Flora M Hammond, Thomas F Bergquist, Jean Lengenfelder","doi":"10.1016/j.apmr.2025.01.464","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.01.464","url":null,"abstract":"<p><strong>Objective: </strong>To examine: (1) the trajectory of caregiver resilience over two years following onset of a care recipient's moderate-to-severe traumatic brain injury (TBI), (2) caregiver-related outcomes associated with resilience, and (3) changes in associations between caregiver resilience, other caregiver characteristics, and care-recipient variables across time.</p><p><strong>Design: </strong>Prospective cohort.</p><p><strong>Setting: </strong>TBI Model Systems (TBIMS) centers.</p><p><strong>Participants: </strong>TBIMS participants (care-recipients) were approached to enroll in this study and identify a caregiver. 258 care-recipient and caregiver dyads were enrolled.</p><p><strong>Interventions: </strong>N/A MAIN OUTCOME MEASURES: Caregiver data included demographics, health history, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Zarit Burden Interview (ZBI), Family Needs Questionnaire-Revised (FNQ-R), and Connor-Davidson Resilience Scale 10 (CD-RISC-10). All caregiver data were self-reported via phone interview or mailed surveys at 6 months, 12 months, and 24 months post-injury. At all 3 time points, care-recipients with TBI also completed their own CD-RISC-10, PHQ-9, GAD-7, and Disability Rating Scale (DRS).</p><p><strong>Results: </strong>Linear mixed-effects models indicated that the trajectory of resilience was stable within caregivers over two years post-injury. There were significant, positive associations for all caregiver FNQ-R subscales (all p<0.001) with care-recipient and caregiver CD-RISC-10 scores (p=0.001), indicating that more caregiving needs endorsed as \"met\" corresponded with higher resilience. Caregiver PHQ-9 and ZBI scores were found to be negatively associated with resilience (both p<0.001). When all covariates were included in the multivariable model, met emotional needs was positively associated with caregiver resilience (p<0.0001). Negative associations with caregiver resilience included higher caregiver PHQ-9 scores (p = 0.001) and perceptions of caregiving burden (p=0.003).</p><p><strong>Conclusions: </strong>Caregiver levels of resilience were generally stable over two years post-TBI. Caregivers' resilience was positively associated with perceptions of their needs being met and negatively associated with caregiving burden and emotional distress. Further research is needed to develop and evaluate the utility and feasibility of interventions to enhance resilience, meet family needs, and improve long-term outcomes following brain injury.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063447","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}

引用次数: 0

Dual-Task Resistance Training Improves Strength and Reduces Pain More Than Resistance Exercise Alone in Elbow Fracture Rehabilitation: A Randomized Controlled Trial.

IF 3.6 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2025-01-20 DOI: 10.1016/j.apmr.2025.01.419

Carlos Cruz-Montecinos, Laura López-Bueno, Rodrigo Núñez-Cortés, Rubén López-Bueno, Luis Suso-Martí, Guillermo Mendez-Rebolledo, Antoni Morral, Lars Louis Andersen, Joaquín Calatayud

Objective: To examine the effects on strength, pain intensity, range of motion (ROM), and functionality of a 12-week dual-task resistance exercise program in patients undergoing rehabilitation from elbow fractures.

Design: Randomized controlled trial.

Setting: Rehabilitation hospital.

Participants: Individuals undergoing elbow fracture rehabilitation (N=32).

Intervention: Randomization was performed sequentially using numbered envelopes containing assignments to either an intervention group (dual-task resistance training using a mathematical task with self-regulation, N=18) or a control group (traditional resistance training, N=14) for 12 weeks.

Main outcome measures: The primary outcomes were muscle strength for elbow flexors and extensors and pain assessed by the visual analog scale from 0 to 100 mm. The secondary outcomes were kinesiophobia assessed by the Tampa Scale-11 and disability using the Disabilities of the Arm, Shoulder, and Hand questionnaire and passive ROM.

Results: Dual-task resistance training improved strength and reduced pain more than resistance training alone (P<.05), and only the dual-task group improved in kinesiophobia (P<.05). The linear regression showed a significant negative association between kinesiophobia and increased elbow strength in the dual-task group (flexion, r=-0.53, P=.024; extension, r=-0.65, P=.004) but not in the control group (P>.05). No significant differences were observed between the group for disability and passive ROM (P>.05).

Conclusions: Dual-task resistance training and traditional resistance training both enhance strength, reduce pain, improve functionality, and increase ROM after 12 weeks of elbow fracture rehabilitation. However, dual-task resistance training is superior to resistance training alone in enhancing strength and reducing pain.

{"title":"Dual-Task Resistance Training Improves Strength and Reduces Pain More Than Resistance Exercise Alone in Elbow Fracture Rehabilitation: A Randomized Controlled Trial.","authors":"Carlos Cruz-Montecinos, Laura López-Bueno, Rodrigo Núñez-Cortés, Rubén López-Bueno, Luis Suso-Martí, Guillermo Mendez-Rebolledo, Antoni Morral, Lars Louis Andersen, Joaquín Calatayud","doi":"10.1016/j.apmr.2025.01.419","DOIUrl":"10.1016/j.apmr.2025.01.419","url":null,"abstract":"<p><strong>Objective: </strong>To examine the effects on strength, pain intensity, range of motion (ROM), and functionality of a 12-week dual-task resistance exercise program in patients undergoing rehabilitation from elbow fractures.</p><p><strong>Design: </strong>Randomized controlled trial.</p><p><strong>Setting: </strong>Rehabilitation hospital.</p><p><strong>Participants: </strong>Individuals undergoing elbow fracture rehabilitation (N=32).</p><p><strong>Intervention: </strong>Randomization was performed sequentially using numbered envelopes containing assignments to either an intervention group (dual-task resistance training using a mathematical task with self-regulation, N=18) or a control group (traditional resistance training, N=14) for 12 weeks.</p><p><strong>Main outcome measures: </strong>The primary outcomes were muscle strength for elbow flexors and extensors and pain assessed by the visual analog scale from 0 to 100 mm. The secondary outcomes were kinesiophobia assessed by the Tampa Scale-11 and disability using the Disabilities of the Arm, Shoulder, and Hand questionnaire and passive ROM.</p><p><strong>Results: </strong>Dual-task resistance training improved strength and reduced pain more than resistance training alone (P<.05), and only the dual-task group improved in kinesiophobia (P<.05). The linear regression showed a significant negative association between kinesiophobia and increased elbow strength in the dual-task group (flexion, r=-0.53, P=.024; extension, r=-0.65, P=.004) but not in the control group (P>.05). No significant differences were observed between the group for disability and passive ROM (P>.05).</p><p><strong>Conclusions: </strong>Dual-task resistance training and traditional resistance training both enhance strength, reduce pain, improve functionality, and increase ROM after 12 weeks of elbow fracture rehabilitation. However, dual-task resistance training is superior to resistance training alone in enhancing strength and reducing pain.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021995","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}

引用次数: 0

The Clinical Efficacy of Extracorporeal Shock Wave Therapy Combined With Platelet-Rich Plasma and Exercise for Lateral Epicondylitis: Prospective Randomized Sham-Controlled Ultrasonographic Study.

IF 3.6 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2025-01-20 DOI: 10.1016/j.apmr.2025.01.420

Ali İzzet Akçin, Nuran Eyvaz, Ümit Dündar, Hasan Toktaş, Hilal Yeşil, Selma Eroğlu, Sevda Adar

Objectives: To evaluate the combined effect of 2 different regenerative therapies, extracorporeal shock wave therapy (ESWT) and platelet-rich plasma (PRP), along with therapeutic exercise, in patients with lateral epicondylitis (LE).

Design: Prospective, randomized, sham-controlled trial.

Settings: Outpatient clinic.

Participants: Ninety-one patients (N=91) with LE for >3 months were randomly allocated into 3 groups.

Interventions: Participants were assigned to PRP+ESWT, Sham PRP+ESWT, or ESWT only treatment group. All groups received exercise therapy.

Main outcome measures: The primary outcome was the visual analog scale (VAS) pain score. Secondary outcomes included handgrip strength, Patient-rated Tennis Elbow Evaluation (PRTEE), Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH), Short Form 36, ultrasonographic assessments (common extensor tendon [CET] measurement and total ultrasonography scale score [TUSS]), and isokinetic evaluation. Participants were evaluated 3 times: pre-treatment (T0), after 4 weeks (T1), and after 12 weeks (T2).

Results: The PRP group showed superiority over other groups in terms of VAS (activity and night) scores at follow-ups. With regard to the secondary outcomes, in the short term, the PRP group demonstrated a statistically significant difference in the PRTEE-function. In the 12th week, PRP outperformed only against ESWT in all PRTEE parameters, and also showed superior Quick DASH scores to the other groups. In handgrip strength, the PRP group demonstrated superiority over the Sham PRP group at T1 and over both groups at T2. In the isokinetic evaluation, PRP group showed superiority over the Sham PRP group in both wrist flexion/extension peak torque scores during follow-ups. No significant differences were found in any of the ultrasonographic parameters, including CET thickness and TUSS scores, between the groups at the 4th and 12th week.

Conclusions: The combined application of ESWT and PRP in the management of LE has demonstrated superior efficacy, as evidenced by significant improvements in clinical parameters.

{"title":"The Clinical Efficacy of Extracorporeal Shock Wave Therapy Combined With Platelet-Rich Plasma and Exercise for Lateral Epicondylitis: Prospective Randomized Sham-Controlled Ultrasonographic Study.","authors":"Ali İzzet Akçin, Nuran Eyvaz, Ümit Dündar, Hasan Toktaş, Hilal Yeşil, Selma Eroğlu, Sevda Adar","doi":"10.1016/j.apmr.2025.01.420","DOIUrl":"10.1016/j.apmr.2025.01.420","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the combined effect of 2 different regenerative therapies, extracorporeal shock wave therapy (ESWT) and platelet-rich plasma (PRP), along with therapeutic exercise, in patients with lateral epicondylitis (LE).</p><p><strong>Design: </strong>Prospective, randomized, sham-controlled trial.</p><p><strong>Settings: </strong>Outpatient clinic.</p><p><strong>Participants: </strong>Ninety-one patients (N=91) with LE for >3 months were randomly allocated into 3 groups.</p><p><strong>Interventions: </strong>Participants were assigned to PRP+ESWT, Sham PRP+ESWT, or ESWT only treatment group. All groups received exercise therapy.</p><p><strong>Main outcome measures: </strong>The primary outcome was the visual analog scale (VAS) pain score. Secondary outcomes included handgrip strength, Patient-rated Tennis Elbow Evaluation (PRTEE), Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH), Short Form 36, ultrasonographic assessments (common extensor tendon [CET] measurement and total ultrasonography scale score [TUSS]), and isokinetic evaluation. Participants were evaluated 3 times: pre-treatment (T0), after 4 weeks (T1), and after 12 weeks (T2).</p><p><strong>Results: </strong>The PRP group showed superiority over other groups in terms of VAS (activity and night) scores at follow-ups. With regard to the secondary outcomes, in the short term, the PRP group demonstrated a statistically significant difference in the PRTEE-function. In the 12th week, PRP outperformed only against ESWT in all PRTEE parameters, and also showed superior Quick DASH scores to the other groups. In handgrip strength, the PRP group demonstrated superiority over the Sham PRP group at T1 and over both groups at T2. In the isokinetic evaluation, PRP group showed superiority over the Sham PRP group in both wrist flexion/extension peak torque scores during follow-ups. No significant differences were found in any of the ultrasonographic parameters, including CET thickness and TUSS scores, between the groups at the 4th and 12th week.</p><p><strong>Conclusions: </strong>The combined application of ESWT and PRP in the management of LE has demonstrated superior efficacy, as evidenced by significant improvements in clinical parameters.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021997","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}

引用次数: 0

Functional Capacity at Rehabilitation Discharge Predicts Physical Activity Characteristics 24 Weeks Later for People With Total Knee Arthroplasty: A Secondary Analysis of a Randomized Controlled Trial. 康复出院时的功能能力预测全膝关节置换术患者24周后的身体活动特征：一项随机对照试验的二次分析。

IF 3.6 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2025-01-16 DOI: 10.1016/j.apmr.2025.01.416

Paul W Kline, Shawn L Hanlon, Vanessa L Richardson, Rashelle M Hoffman, Edward L Melanson, Elizabeth Juarez-Colunga, Jennifer E Stevens-Lapsley, Cory L Christiansen

Objective: To determine the association between performance-based and patient-reported functional capacity at the conclusion of 12-week rehabilitation with average daily step counts and peak walking cadence 38 weeks after total knee arthroplasty (TKA).

Design: Secondary analysis of a randomized controlled trial.

Setting: Veterans Affairs Medical Center.

Participants: A total of 87 US military Veterans (age: 67±7y, 87% male).

Interventions: Twelve-week rehabilitation beginning 2 weeks post-TKA plus random assignment to either a telehealth-based physical activity behavior change intervention or control group.

Main outcome measures: Performance-based (timed Up-and-Go [TUG], 30-second sit-to-stand) and patient-reported measures (Western Ontario and McMaster Universities Osteoarthritis Index, Veterans RAND 12-Item Health Survey [VR-12]) were assessed at rehabilitation discharge (14wk post-TKA). Physical activity was measured using thigh-mounted accelerometry 38 weeks post-TKA. Relationships between participant characteristics (age, sex, body mass index, group assignment), functional capacity at discharge, and long-term physical activity outcomes (average daily step count and peak walking cadence) were evaluated using single- and multiple-variable linear and logistic regressions.

Results: Univariate analyses: TUG time (r=-0.33, P=.002) and VR-12 physical health subscore (r=0.23, P=.036) were correlated with average daily step count at week 38. TUG time (r=-0.31, P=.006) was correlated with peak walking cadence. Multivariate analyses: multiple linear regression controlling for age, sex, and body mass index identified TUG (B=-301.25, P=.039) and VR-12 physical health (B=93.1, P=.049) as predictors of daily step count. TUG time (B=-1.5, P=.012) and assignment to physical activity behavior change intervention (B=13.7, P<.001) predicted peak walking cadence. No significant predictors of attaining a 7500 steps per day threshold were identified.

Conclusions: Functional capacity at discharge is related to physical activity characteristics 38 weeks post-TKA. Although behavior change interventions are needed to address physical activity deficits postoperatively, the link between functional capacity and activity suggests additional need to address functional capacity limitations during TKA rehabilitation.

目的：在全膝关节置换术（TKA）后38周的平均每日步数和峰值步行节奏中，确定基于表现和患者报告的12周康复结束时的功能能力之间的关系。设计：随机对照试验的二次分析。地点：退伍军人事务医疗中心。参与者：87名美国退伍军人（年龄：67±7岁，87%为男性）。干预措施：tka后两周开始为期12周的康复，随机分配到基于远程医疗的身体活动行为改变干预（PABC）或对照组。主要结果测量：在康复出院时（tka后14周）评估基于性能的（时间起-走（TUG）， 30秒坐-站）和患者报告的测量（西安大略省和麦克马斯特大学骨关节炎指数（WOMAC），退伍军人兰德12项健康调查（VR12））。tka后38周，使用大腿加速度计测量身体活动。使用单变量和多变量线性和逻辑回归评估参与者特征（年龄、性别、BMI、分组分配）、出院时的功能能力和长期身体活动结果（平均每日步数和峰值步行节奏）之间的关系。结果：单因素分析：TUG时间（r= -0.33, p=0.002）和VR12身体健康亚评分（r= 0.23, p=0.036）与第38周的平均每日步数相关。TUG时间（r= -0.31, p=0.006）与峰值步行节奏相关。多因素分析：控制年龄、性别和BMI的多元线性回归确定了TUG （B= -301.25, p=0.039）和VR12身体健康(B= 93.1；P =0.049)作为每日步数的预测因子。TUG时间（B= -1.5, p=0.012）和PABC干预分配（B= 13.7, p）结论：tka后38周出院时的功能能力与身体活动特征有关。虽然需要行为改变干预措施来解决术后身体活动缺陷，但功能能力和活动之间的联系表明，在TKA康复期间需要解决功能能力限制问题。

{"title":"Functional Capacity at Rehabilitation Discharge Predicts Physical Activity Characteristics 24 Weeks Later for People With Total Knee Arthroplasty: A Secondary Analysis of a Randomized Controlled Trial.","authors":"Paul W Kline, Shawn L Hanlon, Vanessa L Richardson, Rashelle M Hoffman, Edward L Melanson, Elizabeth Juarez-Colunga, Jennifer E Stevens-Lapsley, Cory L Christiansen","doi":"10.1016/j.apmr.2025.01.416","DOIUrl":"10.1016/j.apmr.2025.01.416","url":null,"abstract":"<p><strong>Objective: </strong>To determine the association between performance-based and patient-reported functional capacity at the conclusion of 12-week rehabilitation with average daily step counts and peak walking cadence 38 weeks after total knee arthroplasty (TKA).</p><p><strong>Design: </strong>Secondary analysis of a randomized controlled trial.</p><p><strong>Setting: </strong>Veterans Affairs Medical Center.</p><p><strong>Participants: </strong>A total of 87 US military Veterans (age: 67±7y, 87% male).</p><p><strong>Interventions: </strong>Twelve-week rehabilitation beginning 2 weeks post-TKA plus random assignment to either a telehealth-based physical activity behavior change intervention or control group.</p><p><strong>Main outcome measures: </strong>Performance-based (timed Up-and-Go [TUG], 30-second sit-to-stand) and patient-reported measures (Western Ontario and McMaster Universities Osteoarthritis Index, Veterans RAND 12-Item Health Survey [VR-12]) were assessed at rehabilitation discharge (14wk post-TKA). Physical activity was measured using thigh-mounted accelerometry 38 weeks post-TKA. Relationships between participant characteristics (age, sex, body mass index, group assignment), functional capacity at discharge, and long-term physical activity outcomes (average daily step count and peak walking cadence) were evaluated using single- and multiple-variable linear and logistic regressions.</p><p><strong>Results: </strong>Univariate analyses: TUG time (r=-0.33, P=.002) and VR-12 physical health subscore (r=0.23, P=.036) were correlated with average daily step count at week 38. TUG time (r=-0.31, P=.006) was correlated with peak walking cadence. Multivariate analyses: multiple linear regression controlling for age, sex, and body mass index identified TUG (B=-301.25, P=.039) and VR-12 physical health (B=93.1, P=.049) as predictors of daily step count. TUG time (B=-1.5, P=.012) and assignment to physical activity behavior change intervention (B=13.7, P<.001) predicted peak walking cadence. No significant predictors of attaining a 7500 steps per day threshold were identified.</p><p><strong>Conclusions: </strong>Functional capacity at discharge is related to physical activity characteristics 38 weeks post-TKA. Although behavior change interventions are needed to address physical activity deficits postoperatively, the link between functional capacity and activity suggests additional need to address functional capacity limitations during TKA rehabilitation.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999136","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}

引用次数: 0

External Validation and Update of Minimal Important Change in the 6-Minute Walk Test in Hospitalized Patients With Subacute Stroke. 亚急性脑卒中住院患者6分钟步行试验最小重要变化的外部验证和更新

IF 3.6 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2025-01-13 DOI: 10.1016/j.apmr.2025.01.002

Hiroki Kubo, Kazuhiro Miyata, Shuntaro Tamura, Sota Kobayashi, Masafumi Nozoe, Asami Inamoto, Akira Taguchi, Kazuki Kajimoto, Sota Nishihara, Nozomi Yamamoto, Tsuyoshi Asai, Shinichi Shimada

Objective: To investigate the external validation of the previously reported minimal important change (MIC) in the 6-minute walk test (6MWT) and update it for patients with subacute stroke hospitalized in rehabilitation unit.

Design: Longitudinal study.

Setting: Rehabilitation unit of a neurosurgical hospital.

Participants: One hundred and seven patients with subacute stroke.

Interventions: Not applicable.

Main outcome measures: The 6MWT, modified Rankin Scale (mRS), Functional Ambulation Categories (FAC), and Functional Independence Measure (FIM) were assessed at 30 (baseline) and 60 (follow-up) days after stroke onset. Patients were divided into 2 groups according to improvements of mRS by ≥1, FAC by ≥1, or FIM by ≥22. The change in the 6MWT between baseline and follow-up was calculated and patients were divided into 2 groups according to improvements of 6MWT by ≥71 m. External validation was performed using likelihood ratio (LR) between change of 6MWT by ≥71 m and improvement of mRS. An LR+ of >2.0 and LR- of <0.5 was considered valid. The new MIC of the 6MWT was calculated for the mRS, FAC, and FIM using the receiver operating characteristic curve (MIC_ROC) and adjusted predictive modeling method (MIC_adjusted).

Results: No external validation was achieved (LR+ of 1.41, LR- of 0.77). The MIC_ROC values for mRS, FAC, and FIM were 22.0, 69.0, and 22.0 m, respectively. The MIC_adjusted values for the mRS, FAC, and FIM were 68.7, 63.1, and 83.1 m, respectively. Only the MIC of the 6MWT for FAC was validated.

Conclusions: The previously reported MIC of the 6MWT was not suitable for patients with subacute stroke hospitalized in rehabilitation units; however, the newly determined MIC was useful.

目的：研究先前报道的6分钟步行试验（6MWT）最小重要变化（MIC）的外部验证，并对亚急性脑卒中住院康复患者进行更新。设计：纵向研究设置：：某神经外科医院康复科。研究对象：107例亚急性脑卒中患者。干预：不适用。主要结果测量：在卒中发作后30天（基线）和60天（随访）对6MWT、改良Rankin量表（mRS）、功能活动分类（FAC）和功能独立性测量（FIM）进行评估。根据mRS改善≥1、FAC改善≥1、FIM改善≥22分为两组。计算基线与随访期间6MWT的变化，根据6MWT改善≥71 m分为两组。采用6MWT变化≥71 m与mrs改善之间的似然比（LR）进行外部验证。采用LR+ bbb2.0和LR- roc)和调整后的预测建模方法（MICadjusted）。结果：未获得外部验证（LR+ = 1.41, LR- = 0.77）。mRS、FAC和FIM的MICROC值分别为22.0 m、69.0 m和22.0 m。mRS、FAC和FIM的mic校正值分别为68.7 m、63.1 m和83.1 m。仅对FAC的6MWT的MIC进行了验证。结论：先前报道的6MWT的MIC不适用于康复单位住院的亚急性脑卒中患者；然而，新确定的MIC是有用的。

{"title":"External Validation and Update of Minimal Important Change in the 6-Minute Walk Test in Hospitalized Patients With Subacute Stroke.","authors":"Hiroki Kubo, Kazuhiro Miyata, Shuntaro Tamura, Sota Kobayashi, Masafumi Nozoe, Asami Inamoto, Akira Taguchi, Kazuki Kajimoto, Sota Nishihara, Nozomi Yamamoto, Tsuyoshi Asai, Shinichi Shimada","doi":"10.1016/j.apmr.2025.01.002","DOIUrl":"10.1016/j.apmr.2025.01.002","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the external validation of the previously reported minimal important change (MIC) in the 6-minute walk test (6MWT) and update it for patients with subacute stroke hospitalized in rehabilitation unit.</p><p><strong>Design: </strong>Longitudinal study.</p><p><strong>Setting: </strong>Rehabilitation unit of a neurosurgical hospital.</p><p><strong>Participants: </strong>One hundred and seven patients with subacute stroke.</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcome measures: </strong>The 6MWT, modified Rankin Scale (mRS), Functional Ambulation Categories (FAC), and Functional Independence Measure (FIM) were assessed at 30 (baseline) and 60 (follow-up) days after stroke onset. Patients were divided into 2 groups according to improvements of mRS by ≥1, FAC by ≥1, or FIM by ≥22. The change in the 6MWT between baseline and follow-up was calculated and patients were divided into 2 groups according to improvements of 6MWT by ≥71 m. External validation was performed using likelihood ratio (LR) between change of 6MWT by ≥71 m and improvement of mRS. An LR+ of >2.0 and LR- of <0.5 was considered valid. The new MIC of the 6MWT was calculated for the mRS, FAC, and FIM using the receiver operating characteristic curve (MIC<sub>ROC</sub>) and adjusted predictive modeling method (MIC<sub>adjusted</sub>).</p><p><strong>Results: </strong>No external validation was achieved (LR+ of 1.41, LR- of 0.77). The MIC<sub>ROC</sub> values for mRS, FAC, and FIM were 22.0, 69.0, and 22.0 m, respectively. The MIC<sub>adjusted</sub> values for the mRS, FAC, and FIM were 68.7, 63.1, and 83.1 m, respectively. Only the MIC of the 6MWT for FAC was validated.</p><p><strong>Conclusions: </strong>The previously reported MIC of the 6MWT was not suitable for patients with subacute stroke hospitalized in rehabilitation units; however, the newly determined MIC was useful.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999135","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}

引用次数: 0

Cognitive Impairment After Stroke: Rehabilitation Strategies and SMART Goal Setting. 脑卒中后认知障碍：康复策略和SMART目标设定。

IF 3.6 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2025-01-11 DOI: 10.1016/j.apmr.2024.08.030

Urvashy Gopaul, Pooja Jethani, Nabila Enam, Anahita Amirpour, Olivia Crozier, Marina Charalambous, Mark Bayley

引用次数: 0