Archives of physical medicine and rehabilitation最新文献

Objective: To determine if axillary recess capsular edema on MRI is associated with heterogeneity in rehabilitation response for adhesive capsulitis and to explore its implications for a stratified treatment strategy.

Design: Retrospective cohort study.

Setting: Department of Rehabilitation Medicine at a tertiary medical center.

Participants: Thirty patients with adhesive capsulitis were stratified into two groups based on baseline MRI findings: a capsular edema negative (CE-) group (n=15) and a capsular edema positive (CE+) group (n=15).

Interventions: All patients received a standardized 2-week conventional rehabilitation program.

Main outcome measures: Primary outcomes included the Shoulder Pain and Disability Index (SPADI), Visual Analog Scale (VAS) for pain, and active Range of Motion (ROM). Treatment efficacy was defined as achieving the minimal clinically important difference (MCID ≥14.88) in the total SPADI score.

Results: At baseline, the CE+ group demonstrated significantly worse VAS, ROM, and SPADI scores (P<0.05). Although both groups showed significant post-treatment improvements in all outcomes (P<0.001), the CE+ group exhibited significantly smaller improvements in SPADI and ROM (P<0.05). The MCID attainment rate was significantly lower in the CE+ group (53.33%) compared to the CE- group (93.33%). In an exploratory multivariate analysis, CE+ status was associated with a markedly lower odds of achieving the MCID (OR=0.043; 95%CI: 0.003 to 0.577; P=0.018).

Conclusion: The presence of axillary recess capsular edema (CE+) on MRI is associated with more severe baseline dysfunction and a diminished early response to conventional rehabilitation in adhesive capsulitis. This MRI finding may identify a distinct patient phenotype. Our findings suggest a potential rationale for stratifying management: CE+ patients might benefit from augmented anti-inflammatory interventions, whereas CE- patients may be well-suited to standard adhesion-focused rehabilitation. This hypothesis warrants validation in prospective trials.

Objective: The aim of this study was to investigate the effect of surgical correction of pes equinovarus on personalized goal attainment and balance and gait capacity.

Design: In this prospective observational cohort study, outcome measures were assessed before and twelve months after surgery. For a subgroup of participants, a 4-month baseline period with repeated assessments was used.

Setting: Participants were recruited between 2019 and 2023 at a tertiary referral center.

Participants: Adults with pes equinovarus deformity following chronic stroke.

Interventions: All participants underwent reconstructive surgery for pes equinovarus, involving tarsal arthrodesis as principal procedure, often combined with a form of Achilles tendon lengthening.

Main outcome measures: Personalized goal attainment, balance capacity, and gait capacity were assessed with the Canadian Occupational Performance Measure (COPM), the Mini Balance Evaluation Systems Test (Mini-BESTest), and barefoot three-dimensional instrumented gait analysis, respectively.

Results: Forty-six participants were included. No changes in COPM, Mini-BESTest, and gait speed were observed during the 4-month baseline period. Following surgery, significant improvements were found in personalized goal attainment, with COPM-performance increasing by 3.5±1.7 points (p<0.001) and COPM-satisfaction increasing by 3.9±1.8 points (p<0.001). Balance capacity also showed significant improvement after surgery (Mini-BESTest: +5.1±5.4, p<0.001). The vast majority of participants who were unable to walk barefoot prior to surgery were able to do so post surgery (19/24 participants). Furthermore, improvements in barefoot gait speed after surgery were found in participants with low pre-surgical gait speeds.

Conclusions: Improvements in personalized goal attainment and balance and gait capacity after reconstructive surgery for pes equinovarus were clinically relevant. Therefore, reconstructive surgery for pes equinovarus, with tarsal arthrodesis as principal procedure, can be considered as a valuable treatment in people with chronic stroke. Our findings provide guidance for optimal pre-operative counseling.

Objective: The primary objective was to quantify the effect of interventions involving voluntary walking on gait function (i.e., velocity, distance, step length, stride length, and cadence) in people with Parkinson's disease (pwPD) compared to non-active or active controls. A secondary objective was to quantify the effect of voluntary walking interventions on functional mobility, disease severity, and health-related quality of life.

Data sources: PubMed and EMBASE were searched for relevant studies.

Study selection: Eligibility criteria were: 1) randomized controlled trials (RCTs) or pilot RCTs, 2) participants diagnosed with Parkinson's disease (PD), 3) evaluation of any voluntary structured walking intervention (>3 weeks and/or >6 training sessions), and 4) pre- and post-intervention walking assessments.

Data extraction: Post-mean data of short and long walking tests, Timed-Up and Go (TUG) test, Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale III (MDS-UPDRS III), and Parkinson's Disease Questionnaire-39 were extracted and analyzed.

Data synthesis: Fifteen studies (11 RCT, 4 pilot-RCT) were included covering 590 pwPD (mean age 65.7 (±7.5) years; 208 women). Meta-analyses showed positive effects of voluntary walking on gait speed (i.e., short walking tests, standardized mean difference ((SMD) = 0.59 [0.26; 0.93]), gait distance (i.e., long walking tests, SMD = 0.83 [0.55; 1.10]), step length (SMD = 0.72 [0.35; 1.10]), stride length (SMD = 0.57 [0.07; 1.07]), MDS-UPDRS III (SMD = -0.39 [-0.62; -0.16]), and TUG (SMD = -0.38 [-0.73; -0.04]).

Conclusion: Voluntary walking interventions improved gait and mobility function and lowered disease severity in pwPD. These results support the use of voluntary walking in PD rehabilitation.

Objective: To examine and compare trends in the discharge rates from inpatient rehabilitation to nursing homes (NHs) in persons with traumatic spinal cord injury (tSCI) from 1970 to 2019.

Design: Retrospective analysis of existing data from the national Spinal Cord Injury Model Systems (SCIMS) database in the United States.

Participants: Persons admitted to a SCIMS center between 1970 and 2019 (N=33,379).

Interventions: Not applicable.

Main outcome measures: Discharge disposition to an NH after inpatient rehabilitation for incident tSCI.

Results: The rate of NH discharge increased from 3.6% in the 1970s to 9.5% in 2010-2019, plateauing over the last two decades despite parallel increases in the average age at injury and the shorter durations of rehabilitation length of stay (LOS) over time. Older age, male sex, not being employed or married, complete tetraplegia, bladder dysfunction, ventilator dependence, and longer LOS were factors associated with higher odds of NH discharge.

Conclusion: Although the rate of NH discharges has been higher in the past 20 years compared to the 1970s, the rate has stabilized at approximately 9.5% over the past two decades, despite the changing demographics of the tSCI population and shorter rehabilitation LOS. Age, injury severity, functional limitations, and social factors remain key predictors of NH placement, emphasizing the need for individualized discharge planning focused on patient function and independence, and continued investment in community-based supports to promote independence and reduce institutionalization among individuals with SCI.

Objectives: To investigate: (1) the number of hospital admissions, discharges, and transfers; and (2) the principal diagnoses, length of stay (LOS), and mortality rates among patients with spinal cord injuries (SCI) in rural Australia.

Design: Descriptive Study SETTING: Forty-one hospitals in Western New South Wales Local Health District (WNSWLHD), Australia PARTICIPANTS: Patients at least 18 years of age with SCI who have at least one hospital admission documented in electronic medical records within the rural WNSWLHD between 2014 and 2019 INTERVENTIONS: N/A MAIN OUTCOME MEASURES: Number and LOS of hospital admissions, discharges and transfers, principal diagnoses, and mortality outcomes RESULTS: One hundred and five patients, with an average age of 52 ± 16, and the majority being male (83%), had 455 hospital admissions. Twenty out of forty-one (49%) hospitals had at least one admission for patients with SCI. Three hundred and forty-four (76%) admissions were discharged home, whilst 32 (7%) admissions were transferred to metropolitan tertiary hospitals. Out of the 105 patients, 49 (47%) were transferred to another NSW health facility at least once. A total of 4,727 bed days (MD=4.0, IQR=1.0-10.0) were attributed to patients with SCI. Patients spent a median of 22 bed days (IQR= 6.0-60.5) in hospital. Genitourinary conditions had the greatest number of admissions with a total of 156 admissions and 585 bed days (MD=1.0, IQR=1.0-4.0). Rehabilitation had the highest number of bed days, with 26 admissions and 901 bed days (MD=23.5, IQR=14.0-40.5). 11 (10%) patients died during their admission.

Conclusion: Most rural SCI patients residing within WNSWLHD were able to be managed locally for a broad range of medical and surgical care needs in a bespoke, pragmatic model of care.

Objective: Using the Canadian Longitudinal Study on Aging (CLSA), we tested the hypothesis that those with a TBI would have increased frailty compared to those without, and to test our secondary hypothesis that spending more time unconscious and/or requiring hospitalization following injury is associated with increased frailty.

Design: This observational, community-based cohort study uses data from the CLSA (comprehensive cohort).

Setting: NA.

Participants: Middle-and older-aged adults at baseline [Non-TBI=20 173 (63 ± 10 years, 54% female), TBI = 6499 (61 ± 9 years, 40% female)] and 3-year follow-up were included.

Interventions: NA.

Main outcome measures: Frailty was measured with a 43-item frailty index (derived from the 65-item CLSA frailty index) and determined as a ratio of deficit present to deficits measured. Participants self-reported TBI outcome information (e.g., cause, time unconscious, treatment). Covariate-adjusted linear regressions were conducted by cause of TBI to assess changes in frailty among individuals with a TBI. Time unconscious and treatment were analyzed separately within each cause-of-injury group, compared against those with a TBI who did not fall within the group of interest.

Results: Frailty was higher among the TBI group at baseline (Means±SD:0.10±0.06) and 3-year follow-up (0.12±0.07) compared to the non-TBI group at baseline (0.09±0.06) and 3-year follow-up (0.11±0.07; all, p<0.001). Those with a TBI demonstrated larger increases in frailty from baseline to 3-year follow-up compared with those who did not have a TBI (β=-0.33, p<0.001). There were no differences in frailty changes between TBI cause groups (i.e., vehicle, fall, sport), and no differences in frailty changes among these groups when stratified by time unconscious or treatment method.

Conclusion: Having a TBI is indicative of worsened frailty changes over a 3-year follow-up, regardless of the cause, time spent unconscious, or treatment method.

Objective: To investigate the current status of Cardiac rehabilitation (CR) in China by assessing its national availability, program characteristics, and key barriers to implementation.

Design: Cross-sectional nationwide survey.

Setting: Secondary and tertiary hospitals across 31 provinces in mainland China.

Participants: Data were collected from 568 hospitals, including 347 secondary hospitals and 221 tertiary hospitals.

Interventions: Not applicable.

Main outcome measures: National and regional availability of CR programs, operational models, staffing, equipment configuration, and perceived barriers to implementation.

Results: Only 22.9% of surveyed hospitals offered CR programs, with significant regional and hospital-level variations. Tertiary hospitals were more likely to provide CR than secondary hospitals. Regionally, the central region had the highest CR implementation rate (32.0%), followed by the eastern (22.5%) and western (16.3%) regions. Urban hospitals had greater CR availability (35.0%) than rural ones (13.8%). CR programs were predominantly managed by cardiology departments (65.4%), while only 13.8% had dedicated CR departments. Key barriers included limited equipment, insufficiently trained personnel, financial constraints, and low awareness among patients and healthcare providers.

Conclusions: The availability of CR in China is critically low nationwide, indicating a systemic national shortage rather than a problem confined to rural or western regions. Nonetheless, substantial disparities persist by hospital tier, region, and urban-rural location. These findings underscore the urgent need for national policies to address this widespread shortage, strengthen professional training, and increase funding. Expanding CR access is important for optimizing functional recovery and may contribute to reducing preventable non-communicable disease (NCD) mortality, mitigating the CVD burden, and achieving the goals of the 'Healthy China 2030' initiative.