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

Impact of Therapeutic Exercises Versus General Conservative Modalities and Brace on the Progression of Adolescent Idiopathic Scoliosis: Systematic Review and Meta-analysis 治疗性运动与一般保守模式和支具对青少年特发性脊柱侧凸进展的影响：系统回顾和荟萃分析。

IF 3.7 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2025-12-01 DOI: 10.1016/j.apmr.2025.06.021

Rodrigo Mantelatto Andrade MS , Ana Paula Ribeiro PhD , Milene Eloise Callegari Ferreira MS , Larissa Calvo Piras MS , Maria de Lourddes de Moura Partika MS , Nelson Carvas Junior MS , Henry Dan Kiyomoto MS , Silvia Maria Amado João PhD

Objective

To compare the effects of therapeutic exercises in preventing Cobb angle progression in adolescent idiopathic scoliosis (AIS) compared with other conservative treatments.

Data Sources

Systematic searches were conducted in MEDLINE via PubMed, Embase, centralized database (CENTRAL), Physiotherapy Evidence Database (PEDro), and cumulative index to nursing and allied health literature up to December 14, 2023, and registered in PROSPERO (CRD42020156639).

Study Selection

Randomized controlled trials involving adolescents aged 10-18 years with AIS and a Cobb angle >10° were included.

Data Extraction

Two reviewers independently extracted study data, assessed the risk of bias using the PEDro scale, and the certainty of evidence—using the Grading of Recommendations, Assessment, Development and Evaluation approach.

Data Synthesis

Nineteen studies involving 832 participants met our selection criteria. The PEDro scale score ranged from 3 to 8 points (0-10). The results on Cobb angle progression showed no significant difference in Cobb angle reduction between therapeutic exercises and minimal intervention in the short term (mean difference [MD]=−1.33; 95% confidence interval [CI], −4.87 to 2.22). The specific therapeutic exercises showed greater Cobb angle reduction compared with general exercises in the short term (MD=−2.57; 95% CI, −4.56 to −0.59) and long term (MD=−6.00; 95% CI, −6.88 to −5.12). No significant difference was observed between therapeutic exercise and brace use in the short term (MD=0.20; 95% CI, −1.74 to 2.14); however, bracing was more effective in the long term (MD=2.66; 95% CI, 0.18-5.14). Therapeutic exercises with bracing significantly reduced Cobb angle in the short term compared with bracing alone (MD=2.25; 95% CI, −3.86 to −0.63).

Conclusions

This systematic review and meta-analysis suggest that therapeutic exercises can be effective in preventing Cobb angle progression in AIS. Specifically, targeted therapeutic exercises led to a greater reduction in Cobb angle compared with general exercises both in the short and long term. Although no significant difference was found between therapeutic exercises and minimal intervention in the short term, combining therapeutic exercises with bracing demonstrated a significant short term advantage over bracing alone. In the long term, bracing was found to be more effective than therapeutic exercises in preventing Cobb angle progression. Given the varied outcomes across different interventions and time frames, further high-quality trials are needed to establish optimal treatment protocols for managing AIS.

目的：比较治疗性运动在预防青少年特发性脊柱侧凸（AIS）的Cobb角进展方面与其他保守治疗的效果。检索平台：截至2023年12月14日，通过PubMed， Embase， CENTRAL， PEDro和CINAHL在MEDLINE中进行系统检索，并在PROSPERO中注册（CRD42020156639）。研究选择：纳入10 - 18岁患有AIS且Cobb角大于10度的青少年的随机对照试验。数据提取：两位审稿人独立提取研究数据，使用PEDro量表评估偏倚风险，使用GRADE方法评估证据的确定性。数据综合：19项涉及832名参与者的研究符合我们的选择标准。佩德罗量表得分范围从3到8分（0-10）。Cobb角进展的结果显示，治疗性运动与最小干预在短期内Cobb角减小方面无显著差异(MD= -1.33；95% CI -4.87至2.22)。与一般运动相比，特殊治疗运动在短期内显示出更大的Cobb角降低(MD = -2.57；95% CI -4.56至-0.59)和长期(MD = -6.00；95% CI -6.88至-5.12)。治疗性运动与支具使用在短期内无显著差异(MD = 0.20；95% CI: -1.74至2.14)；然而，支具在长期内更有效(MD = 2.66；95% CI: 0.18 ~ 5.14)。治疗性运动加支具较单独支具在短期内显著降低Cobb角(MD = 2.25；95% CI: -3.86 ~ -0.63)。结论：本系统综述和荟萃分析表明，治疗性锻炼可有效预防青少年特发性脊柱侧凸（AIS）的Cobb角进展。具体来说，与一般运动相比，有针对性的治疗性运动在短期和长期内都能更大程度地降低科布角。虽然在短期内治疗性运动和最小干预之间没有发现显著差异，但将治疗性运动与支具结合显示出明显优于单独支具的短期优势。长期来看，支具在预防Cobb角进展方面比治疗性运动更有效。考虑到不同干预措施和时间框架的不同结果，需要进一步的高质量试验来建立管理AIS的最佳治疗方案。

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引用次数: 0

Enhancing Interpretability of Patient Reported Outcome Measurement Information System (PROMIS) and Related Measures in Rehabilitation Populations: A Systematic Review of Clinical and Research Applications. 增强康复人群中患者报告结果测量信息系统（PROMIS）和相关措施的可解释性：临床和研究应用的系统综述。

IF 3.7 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2025-12-01 DOI: 10.1016/j.apmr.2025.11.017

Rehab Alhasani, Rebecca Ataman, Zanib Nafees, Anita Luong, Line Auneau-Enjalber, Adria Quigley, Henry Ukachukwu Michael, Sara Ahmed

Objective: To evaluate and synthesize interpretability metrics, including minimal important change (MIC), minimal important difference (MID), and minimal detectable change (MDC), across PROMIS and related systems (Neuro-QoL, TBI-QoL, SCI-QoL) in rehabilitation populations.

Data sources: Comprehensive searches of electronic databases (MEDLINE, EMBASE, PsycINFO, HaPI, CINAHL, Cochrane Library, Web of Science) and clinical trial registries (ISRCTN Registry, ClinicalTrials.gov) were conducted from inception through March 23, 2024, in consultation with an information specialist.

Study selection: Eligible studies assessed interpretability metrics in rehabilitation populations using PROMIS, Neuro-QoL, TBI-QoL, or SCI-QoL. Studies of pediatric or non-rehabilitation populations, abstracts, posters, or consensus statements were excluded. A total of 202 studies met inclusion criteria.

Data extraction: Two independent reviewers extracted study characteristics, interpretability metrics, and analytic methods following COnsensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines.

Data synthesis: MIC, MID, and MDC values varied widely across populations and domains. PROMIS mental health domains (e.g., depression, anxiety, fatigue) demonstrated relatively consistent estimates, whereas physical function domains were more variable, particularly in chronic and geriatric groups. PROMIS Computer Adaptive Testing (CAT) measures showed fewer floor and ceiling effects than short forms, indicating enhanced sensitivity to change. Limited data were available for SCI-QoL and TBI-QoL.

Conclusions: Standardizing interpretability metrics and expanding research on SCI-QoL and TBI-QoL are critical to improving the clinical utility of these measures in rehabilitation. Future work should incorporate response-shift considerations and establish population-specific cut-points to support patient-centered care and evidence-based practice.

目的：评价和综合康复人群中PROMIS及相关系统（neuroqol、TBI-QoL、SCI-QoL）的可解释性指标，包括最小重要变化（MIC）、最小重要差异（MID）和最小可检测变化（MDC）。数据来源：综合检索电子数据库（MEDLINE， EMBASE, PsycINFO, HaPI， CINAHL, Cochrane Library, Web of Science）和临床试验注册（ISRCTN Registry, ClinicalTrials.gov），从成立到2024年3月23日，与信息专家协商。研究选择：符合条件的研究使用PROMIS、neuroqol、TBI-QoL或SCI-QoL评估康复人群的可解释性指标。排除了儿童或非康复人群的研究、摘要、海报或共识声明。共有202项研究符合纳入标准。数据提取：两名独立审稿人根据基于共识的健康测量工具选择标准（COSMIN）指南提取研究特征、可解释性指标和分析方法。数据综合：MIC、MID和MDC值在人群和领域之间差异很大。PROMIS的心理健康领域（如抑郁、焦虑、疲劳）显示出相对一致的估计，而身体功能领域则更加多变，特别是在慢性和老年群体中。PROMIS计算机自适应测试（CAT）的测量结果显示，与短格式相比，下限和上限效应更少，表明对变化的敏感性增强。SCI-QoL和TBI-QoL资料有限。结论：标准化可解释性指标和扩大SCI-QoL和TBI-QoL的研究对提高这些指标在康复中的临床应用至关重要。未来的工作应纳入响应转移的考虑，并建立特定人群的切入点，以支持以患者为中心的护理和循证实践。

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引用次数: 0

Clinical Characterization of Hip Subgroups in Geriatric Chronic Low Back Pain 老年慢性腰痛髋部亚群的临床特征。

IF 3.7 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2025-12-01 DOI: 10.1016/j.apmr.2025.04.018

Jenifer M. Pugliese PT, DPT , Jaclyn Megan Sions PT, DPT, PhD , Patrick J. Knox PT, DPT, PhD , Ryan T. Pohlig PhD , Gregory E. Hicks PT, PhD

Objective

To investigate and compare the clinical profiles of 3 previously established hip-based subgroups of older adults with chronic low back pain (LBP) using data from multiple domains.

Design

Cross-sectional analysis of baseline cohort study data.

Setting

Clinical research laboratory.

Participants

Two hundred fifty (n=250) community dwelling older adults with chronic LBP.

Interventions

Not applicable.

Main Outcome Measures

Clinical profiles of the previously derived subgroups were established. Pain quality and dispersion were captured with the McGill Pain Questionnaire. Self-efficacy was measured using the Low Back Activity Confidence Scale. Catastrophic thoughts about LBP were captured with the Pain Catastrophizing Scale. Trunk mobility was measured with an inclinometer. Trunk muscle function was captured through standardized muscle endurance testing and ultrasound measures of muscle activity. One-way analysis of variance was used to analyze between-group differences.

Results

Each chronic LBP subgroup was named based on the level of hip strength and hip symptoms: weak and symptomatic, weak and nonsymptomatic, and strong and nonsymptomatic. The weak and symptomatic subgroup had distinctly worse levels of pain quality, dispersion, catastrophizing and self-efficacy, compared with the other 2 subgroups. In contrast, the strong and nonsymptomatic subgroup, as compared with the other subgroups, had greater thoracolumbar flexion, greater trunk muscle endurance and better psychological profiles.

Conclusions

The unique clinical profile of each subgroup underscores how important it is to consider the heterogeneous nature of chronic LBP in the geriatric population when developing treatment approaches. The clinical characterization of these subgroups across multiple rehabilitation-focused domains may optimize the development of tailored interventions for each subgroup.

目的：利用来自多个领域的数据，调查和比较三个先前建立的基于髋关节的老年慢性腰痛（LBP）亚组的临床概况。设计：基线队列研究数据的横断面分析。单位：临床研究实验室。参与者：250名社区居住的慢性下腰痛老年人。干预措施：不适用。主要结果测量：建立了先前衍生亚组的临床概况。用McGill疼痛问卷记录疼痛质量和分散度。自我效能用腰背活动信心量表测量。关于腰痛的灾难性想法用疼痛灾难性量表来记录。用倾斜仪测量躯干活动度。通过标准化肌肉耐力测试和超声测量肌肉活动来捕获躯干肌肉功能。组间差异分析采用单因素方差分析。结果：每个慢性腰痛亚组根据髋关节力量和髋关节症状的水平命名：弱/有症状（WS）、弱/无症状（WNS）和强/无症状（SNS）。与其他两个亚组相比，WS亚组的疼痛质量、离散度、灾难化和自我效能感水平明显较差。相比之下，SNS亚组与其他亚组相比，有更大的胸腰椎屈曲，更大的躯干肌肉耐力和更好的心理特征。结论：每个亚组的独特临床特征强调了在制定治疗方法时考虑老年人群慢性腰痛异质性的重要性。这些亚组跨越多个康复重点领域的临床特征可以优化每个亚组量身定制的干预措施的发展。

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引用次数: 0

Effectiveness, Feasibility, Acceptability, and Safety of Digital Interventions in Post-Stroke Rehabilitation: A Systematic Review and Meta-analysis of Randomized Controlled Trials 数字干预在脑卒中后康复中的有效性、可行性、可接受性和安全性：随机对照试验的系统回顾和荟萃分析。

IF 3.7 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2025-12-01 DOI: 10.1016/j.apmr.2025.07.004

Shuangyue Liu MD , Min Li MD , Jilin Ding MD , Qipei Ji MD , Yanning Niu MD , Xiao Yang MD , Shuangchun Ai PhD , Siyuan Li PhD

Objective

To assess the effects of digital interventions on cognition, emotion, and activities of daily living (ADL) in stroke survivors, alongside evaluating feasibility, acceptability, and safety metrics.

Data Sources

We systematically searched 11 English databases for eligible studies published between 2000 and May 2025.

Study Selection

Randomized control trials that focused on poststroke digital therapeutics were included. Experimental groups received digital interventions, while control groups underwent standard therapies or placebo. The outcomes included cognition, emotion, ADL, feasibility, acceptability, and safety.

Data Extraction

Two researchers independently extracted key data from eligible studies. Risk and methodology were assessed using the Cochrane Risk of Bias v2.0 and the PEDro scale. The meta-analysis was conducted using CMA v3.7, following the PRISMA 2020 guidelines.

Data Synthesis

Sixty-three studies (3297 participants) demonstrated significant improvements in overall cognition (g=0.46; 95% CI, 0.24-0.67; P<.001), ADL (g=0.38; 95% CI, 0.19-0.57; P<.001), and specific domains (global cognition, language, visuospatial; all P<.05). Exergaming and computer cognitive training significantly improved overall cognition and memory compared to other digital interventions. Medical sites-based interventions significantly enhanced overall/global cognition versus home-based protocols. Shorter sessions (≤30min) demonstrated superior efficacy in overall cognition to longer durations. Robot-assisted and computer cognitive training maximized ADL gains. Despite significant between-subgroup heterogeneity in emotion outcomes, no within-subgroup efficacy emerged for any digital interventions. Results showed varied recruitment (4.97%-100%) and retention (mostly >75%) across digital interventions. Adherence and attendance were generally high, while safety profiles were mostly favorable with mild adverse events like fatigue or dizziness in some cases.

Conclusions

Digital interventions significantly enhance cognition when delivered via clinic-based exergaming or computer cognitive training (≤30min/session), while maximizing ADL improvements through robot-assisted or computer cognitive training in stroke patients. Robust feasibility, acceptability, and favorable safety supports clinical integration.

目的：评估数字干预对脑卒中幸存者认知、情绪和日常生活活动（ADL）的影响，同时评估可行性、可接受性和安全性指标。数据来源：我们系统地检索了11个英文数据库，检索了2000年至2025年5月间发表的符合条件的研究。研究选择：纳入了关注脑卒中后数字治疗的随机对照试验。实验组接受数字干预，而对照组则接受标准治疗或安慰剂。结果包括认知、情绪、ADL、可行性、可接受性和安全性。数据提取：两位研究者独立地从符合条件的研究中提取关键数据。采用Cochrane风险偏倚v2.0和PEDro量表评估风险和方法。meta分析使用CMA v3.7进行，遵循PRISMA 2020指南。数据综合：63项研究（3297名参与者）显示，总体认知（g = 0.46,95% CI 0.24-0.67, p < 0.001）、ADL （g = 0.38,95% CI 0.19-0.57, p < 0.001）和特定领域(全球认知、语言、视觉空间；p < 0.05)。与其他数字干预相比，游戏和计算机认知训练显著改善了整体认知和记忆。与基于家庭的方案相比，基于医疗站点的干预措施显著增强了整体/全局认知。较短的疗程（≤30分钟）在整体认知方面优于较长的疗程。机器人辅助和计算机认知训练使ADL收益最大化。尽管情绪结果在亚组之间存在显著的异质性，但没有出现任何数字干预的亚组内疗效。结果显示，在数字干预措施中，招聘人数（4.97-100%）和保留人数（大部分为75%）各不相同。依从性和出勤率普遍较高，而安全性主要是有利的，在某些情况下有轻微的不良事件，如疲劳或头晕。结论：通过临床练习或计算机认知训练（≤30分钟/次）提供数字干预可显著增强认知能力，而通过机器人辅助或计算机认知训练可最大限度地改善脑卒中患者的ADL。强大的可行性，可接受性和良好的安全性支持临床整合。

{"title":"Effectiveness, Feasibility, Acceptability, and Safety of Digital Interventions in Post-Stroke Rehabilitation: A Systematic Review and Meta-analysis of Randomized Controlled Trials","authors":"Shuangyue Liu MD , Min Li MD , Jilin Ding MD , Qipei Ji MD , Yanning Niu MD , Xiao Yang MD , Shuangchun Ai PhD , Siyuan Li PhD","doi":"10.1016/j.apmr.2025.07.004","DOIUrl":"10.1016/j.apmr.2025.07.004","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the effects of digital interventions on cognition, emotion, and activities of daily living (ADL) in stroke survivors, alongside evaluating feasibility, acceptability, and safety metrics.</div></div><div><h3>Data Sources</h3><div>We systematically searched 11 English databases for eligible studies published between 2000 and May 2025.</div></div><div><h3>Study Selection</h3><div>Randomized control trials that focused on poststroke digital therapeutics were included. Experimental groups received digital interventions, while control groups underwent standard therapies or placebo. The outcomes included cognition, emotion, ADL, feasibility, acceptability, and safety.</div></div><div><h3>Data Extraction</h3><div>Two researchers independently extracted key data from eligible studies. Risk and methodology were assessed using the Cochrane Risk of Bias v2.0 and the PEDro scale. The meta-analysis was conducted using CMA v3.7, following the PRISMA 2020 guidelines.</div></div><div><h3>Data Synthesis</h3><div>Sixty-three studies (3297 participants) demonstrated significant improvements in overall cognition (<em>g</em>=0.46; 95% CI, 0.24-0.67; <em>P</em><.001), ADL (<em>g</em>=0.38; 95% CI, 0.19-0.57; <em>P</em><.001), and specific domains (global cognition, language, visuospatial; all <em>P</em><.05). Exergaming and computer cognitive training significantly improved overall cognition and memory compared to other digital interventions. Medical sites-based interventions significantly enhanced overall/global cognition versus home-based protocols. Shorter sessions (≤30min) demonstrated superior efficacy in overall cognition to longer durations. Robot-assisted and computer cognitive training maximized ADL gains. Despite significant between-subgroup heterogeneity in emotion outcomes, no within-subgroup efficacy emerged for any digital interventions. Results showed varied recruitment (4.97%-100%) and retention (mostly >75%) across digital interventions. Adherence and attendance were generally high, while safety profiles were mostly favorable with mild adverse events like fatigue or dizziness in some cases.</div></div><div><h3>Conclusions</h3><div>Digital interventions significantly enhance cognition when delivered via clinic-based exergaming or computer cognitive training (≤30min/session), while maximizing ADL improvements through robot-assisted or computer cognitive training in stroke patients. Robust feasibility, acceptability, and favorable safety supports clinical integration.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 12","pages":"Pages 1912-1932"},"PeriodicalIF":3.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717350","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

Psychometric Properties of Free-Living Step-Based Metrics (Daily Steps and Peak Cadence) in Multiple Sclerosis 多发性硬化症患者自由生活步数指标（每日步数和峰值节奏）的心理测量学特征。

IF 3.7 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2025-12-01 DOI: 10.1016/j.apmr.2025.05.005

Peixuan Zheng PhD, Robert W. Motl PhD

Objective

We examined the reliability, precision, and clinically detectable change of step-based metrics (daily steps, peak 30-min cadence [Peak-30_CAD], and peak 1-min cadence [Peak-1_CAD]) over 6 months in the absence of intervention and evaluated the construct validity through correlations with laboratory-assessed walking and gait performance among persons with multiple sclerosis (MS).

Design

Cross-sectional study.

Setting

University-based laboratory.

Participants

Seventy-eight ambulatory adults (18-64y) with MS.

Interventions

Not applicable.

Main Outcome Measures

Free-living physical activity (via ActiGraph GT3X accelerometer), the Timed 25-Foot Walk, 6-minute walk, gait assessment (gait velocity, step length, and time), and disability status (the 12-item MS Walking Scale, Patient-Determined Disease Steps, and Self-Report Expanded Disability Status Scale) were measured before and after 6 months without any intervention.

Results

Step-based metrics were stable with no significant changes across time (P>.05) and demonstrated good test–retest reliability (intraclass correlation coefficients: 0.80-0.85) and acceptable precision (SEM%s:14.4%∼24.3%). The minimal detectable changes at 95% CIs (MDC₉₅) values for Peak-30_CAD, Peak-1_CAD, and daily steps were 25.6 steps/min, 31.0 steps/min, and 2909.2 steps/d, respectively. There were consistent, strong associations between peak cadence with walking tests, gait parameters, and disability status at both time points (|r_s|=.52-.79), even after controlling for daily steps (|pr_s|=.25-.58; P<.05).

Conclusions

Walking represents an important clinical endpoint in people with MS, yet it is often measured in controlled settings using performance-based tests that might not reflect real-world status. Our findings support step-based metrics via accelerometry as reliable and valid measures of free-living ambulatory performance and may inform the inclusion of these metrics in clinical trials among people with MS.

目的：在没有干预的情况下，我们检验了六个月内基于步数的指标（每日步数、30分钟步频峰值[peak - 30cad]和1分钟步频峰值[peak - 1cad]）的可靠性、精确性和临床可检测的变化，并通过与多发性硬化症（MS）患者实验室评估的步行和步态表现的相关性来评估结构效度。设计：横断面研究。设置：校本实验室。参与者：78名患有ms的成人（18-64岁）。干预措施：不适用。主要结果测量：在没有任何干预的情况下，在六个月前和六个月后测量自由生活体力活动（通过ActiGraph GT3X加速度计），25英尺步行，6分钟步行，步态评估（步态速度，步长和时间）和残疾状态（12项MS步行量表，患者确定的疾病步骤和自我报告扩展残疾状态量表）。结果：基于步骤的指标稳定，没有随时间的显著变化（p>0.05），并表现出良好的重测信度（ICCs: 0.80-0.85）和可接受的精度（SEM%s:14.4% ~ 24.3%）。Peak-30CAD、Peak-1CAD和daily steps的MDC95值分别为25.6 steps/min、31.0 steps/min和2909.2 steps/day。在两个时间点，峰值节奏与步行测试、步态参数和残疾状态之间存在一致的强关联（|rs|=0.52-0.79），即使在控制了每日步数(|prs|=0.25-0.58；结论：行走是多发性硬化症患者的一个重要临床终点，但它通常是在对照环境中使用基于性能的测试来测量的，而这些测试可能不能反映现实世界的状态。我们的研究结果支持通过加速度计的基于步骤的指标作为自由生活动态表现的可靠和有效的衡量标准，并可能为将这些指标纳入MS患者的临床试验提供信息。

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引用次数: 0

Does Orthosis Improve Outcomes of Conservative Treatment in Trigger Fingers? A 3-Arm Prospective Randomized Controlled Trial 矫形器能改善扳机指保守治疗的效果吗？一项三组前瞻性随机对照试验。

IF 3.7 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2025-12-01 DOI: 10.1016/j.apmr.2025.05.015

Kathryn Minkhorst MD, MSc , Alexandra Munn MD , Joy MacDermid PhD , Ruby Grewal MD, MSc

Objective

To evaluate whether the addition of an orthosis improved the efficacy of cortisone injection for the nonoperative management of trigger finger.

Design

Block randomized controlled trial.

Setting

Outpatient hand clinic.

Participants

Individuals presenting to our center with Green severity grade 1-3 trigger finger, aged 18-80, were eligible for inclusion (N=226). Exclusion criteria were previous treatment with either a splint or cortisone injection, trigger thumb, >2 digits involved, grade 4 trigger, or an allergy to cortisone (N=118).

Interventions

Patients’ hands were randomized to nighttime extension orthosis, cortisone injection, or combined treatment, stratified by the Green severity score and comorbid diabetes.

Main Outcome Measures

Patient-reported outcome measures and the number of triggering occurrences with 10 repeated grips were collected at 6 weeks and 3, 6, and 12 months.

Results

The study included 104 patients representing 122 trigger fingers in 115 hands, with an average follow-up of 29 months. At 6 weeks, there was no significant difference in the incidence of triggering, symptom relief, or the Patient-Reported Wrist and Hand Evaluation score between injection or combined treatment groups. The overall success rate with conservative treatment was high, with 68.9% experiencing resolution or improvement of their symptoms. Grade 3 trigger fingers had a significantly higher rate of surgical release compared with lower-grade trigger fingers (39.1% vs 22.4%, P=.05).

Conclusions

Our study shows no significant benefit of adding an orthosis to cortisone injection in all trigger grades. Overall success with conservative treatment was high (68.9%) in this cohort. Conservative management of grade 1 and 2 triggers is successful in about 75% of patients, regardless of whether treatment is an orthosis, injection, or both, compared with a 60% success rate for grade 3.

目的：本试验的目的是评估矫形器的增加是否提高可的松注射在非手术治疗扳机指的疗效。设计：分组随机对照试验。环境：门诊手部诊所。参与者：年龄在18岁至80岁之间，到我们中心就诊的绿色严重等级1-3级扳机指患者符合入选条件。既往使用夹板或可的松注射治疗，触发拇指，大于两个手指受累，4级触发或可的松过敏是排除标准。干预措施：患者手部随机接受夜间伸展矫形器、可的松注射或联合治疗，根据格林严重程度评分和合并症糖尿病进行分层。主要。结果：测量：收集患者报告的结果测量值和10次重复抓握的触发次数，分别为6周、3个月、6个月和12个月。结果：该研究包括104例患者，代表115只手的122个扳机指，平均随访29个月。6周时，注射组和联合治疗组在触发发生率、症状缓解或PRWHE评分方面无显著差异。保守治疗的总体成功率高，68.9%的患者症状得到缓解或改善。3级扳机指的手术释放率明显高于低级别扳机指（39.1%比22.4%,p=0.05）。结论：我们的研究显示，在所有触发级别的可的松注射中添加矫形器没有显著的益处。在这个队列中，保守治疗的总体成功率很高（68.9%）。1级和2级触发因素的保守管理在75%的病例中是成功的，无论治疗是矫形器、注射还是两者兼而有之，相比之下，3级触发因素的成功率为60%。

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引用次数: 0

Development of Interview and Online Self-report Versions of Motor and Sensory Components of a Neurological Exam for Classifying Spinal Cord Injury (One-SCI) 脊髓损伤分类的神经学检查中运动和感觉成分的访谈和在线自我报告版本的开发。

IF 3.7 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2025-12-01 DOI: 10.1016/j.apmr.2024.10.021

Thomas N. Bryce MD , Laiba Afzal MS , Stephen P. Burns MD , Marcel P. Dijkers PhD , Steven Kirshblum MD , Ralph J. Marino MD , Jayme O’Connor BS , Arianny Ramirez BA , Brittany Snider DO , Lisa Spielman PhD , Chung-Ying Tsai PhD

Objective

To develop a patient-reported outcome (PRO) survey measure of the motor, sensory, and anorectal components needed for classifying spinal cord injury (SCI) according to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI).

Design

Questionnaire development through an iterative process of review, feedback provision, and consensus revision incorporating 2 rounds of cognitive interviewing (CI).

Setting

Community.

Participants

Individuals with SCI (N=34) who were English-speaking and aged ≥18 years were recruited nationally through social media and advertisements to complete CI. Purposive sampling was used to ensure participants with complete and incomplete injuries in 6 cohorts based upon neurological level of injury (C1-4, C5-6, C7-T1, T2-T6, T7-T12, and L1-S5) were enrolled.

Interventions

Not applicable.

Main Outcome Measures

Online Neurological Exam for Spinal Cord Injury (One-SCI).

Results

A group of SCI clinicians, a graphic artist, ISNCSCI experts, researchers with expertise in questionnaire development, cognitive interviewing, and statistics, and a person with SCI who has lived experience with SCI developed the initial One-SCI questionnaire. A CI script with predetermined verbal probing questions was developed, designed to assess language appropriateness, vocabulary, concept simplicity, grammar, question structure, visual aids, emotional and mental burden both in the instructions and in the questions and available responses. Participants completed an online or interview version of the survey during 2 rounds of CI. After each round, changes were made to the instructions, questions, responses, and graphics. The final survey has a minimum of 154 and a maximum of 210 items, depending on branching logic driven by previous answers.

Conclusions

One-SCI allows online or interviewer-administered self-report documentation of the motor and sensory components of a neurologic examination for classifying SCI. Developed using an in-depth CI process, it may allow remote assessments of the elements required by an individual trained to interpret ISNCSCI examination findings to determine neurological status and classify SCI when an in-person ISNCSCI examination is not obtainable.

目的：根据国际脊髓损伤神经学分类标准（ISNCSCI），开发一种患者报告的结果（PRO）调查方法，测量脊髓损伤（SCI）分类所需的运动、感觉和肛肠成分。设计：通过回顾、反馈提供和共识修订的迭代过程开发问卷，包括两轮认知访谈（CI）。通过社交媒体和广告在全国范围内招募了34名说英语且年龄在18岁及以上的SCI患者来完成CI。采用有目的的抽样方法，根据神经损伤程度（C1-4、C5-6、C7-T1、T2-T6、T7-T12和L1-S5），将完整和不完整损伤的参与者纳入6个队列。干预措施：不适用主要结果测量：脊髓损伤在线神经学检查（One-SCI）结果：一组脊髓损伤临床医生，一名图形艺术家，ISNCSCI专家，具有问卷开发，认知访谈和统计学专业知识的研究人员；一位有SCI经历的SCI患者开发了最初的One-SCI问卷。开发了一个带有预先确定的口头探究问题的CI脚本，旨在评估语言的适当性、词汇量、概念的简单性、语法、问题结构、视觉辅助、指导、问题和可用回答中的情感和精神负担。参与者在两轮CI中完成了在线或访谈版本的调查。每一轮后，对说明、问题、回答和图形进行更改。最后的调查至少有154项，最多有210项，这取决于之前的答案所驱动的分支逻辑。结论：One-SCI允许在线或访谈者自我报告记录神经学检查的运动和感觉成分，用于分类SCI。使用深度CI流程开发，当无法进行现场ISNCSCI检查时，它可以允许接受培训的个人对ISNCSCI检查结果进行远程评估，以确定神经系统状态并对SCI进行分类。

{"title":"Development of Interview and Online Self-report Versions of Motor and Sensory Components of a Neurological Exam for Classifying Spinal Cord Injury (One-SCI)","authors":"Thomas N. Bryce MD , Laiba Afzal MS , Stephen P. Burns MD , Marcel P. Dijkers PhD , Steven Kirshblum MD , Ralph J. Marino MD , Jayme O’Connor BS , Arianny Ramirez BA , Brittany Snider DO , Lisa Spielman PhD , Chung-Ying Tsai PhD","doi":"10.1016/j.apmr.2024.10.021","DOIUrl":"10.1016/j.apmr.2024.10.021","url":null,"abstract":"<div><h3>Objective</h3><div>To develop a patient-reported outcome (PRO) survey measure of the motor, sensory, and anorectal components needed for classifying spinal cord injury (SCI) according to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI).</div></div><div><h3>Design</h3><div>Questionnaire development through an iterative process of review, feedback provision, and consensus revision incorporating 2 rounds of cognitive interviewing (CI).</div></div><div><h3>Setting</h3><div>Community.</div></div><div><h3>Participants</h3><div>Individuals with SCI (N=34) who were English-speaking and aged ≥18 years were recruited nationally through social media and advertisements to complete CI. Purposive sampling was used to ensure participants with complete and incomplete injuries in 6 cohorts based upon neurological level of injury (C1-4, C5-6, C7-T1, T2-T6, T7-T12, and L1-S5) were enrolled.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Online Neurological Exam for Spinal Cord Injury (One-SCI).</div></div><div><h3>Results</h3><div>A group of SCI clinicians, a graphic artist, ISNCSCI experts, researchers with expertise in questionnaire development, cognitive interviewing, and statistics, and a person with SCI who has lived experience with SCI developed the initial One-SCI questionnaire. A CI script with predetermined verbal probing questions was developed, designed to assess language appropriateness, vocabulary, concept simplicity, grammar, question structure, visual aids, emotional and mental burden both in the instructions and in the questions and available responses. Participants completed an online or interview version of the survey during 2 rounds of CI. After each round, changes were made to the instructions, questions, responses, and graphics. The final survey has a minimum of 154 and a maximum of 210 items, depending on branching logic driven by previous answers.</div></div><div><h3>Conclusions</h3><div>One-SCI allows online or interviewer-administered self-report documentation of the motor and sensory components of a neurologic examination for classifying SCI. Developed using an in-depth CI process, it may allow remote assessments of the elements required by an individual trained to interpret ISNCSCI examination findings to determine neurological status and classify SCI when an in-person ISNCSCI examination is not obtainable.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 12","pages":"Pages 1815-1820"},"PeriodicalIF":3.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144214774","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

Archives I/EP Guidelines 档案I/EP指南

IF 3.7 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2025-12-01 DOI: 10.1016/S0003-9993(25)01019-6

引用次数: 0

Real-Time Assessment of Resilience in Individuals With Spinal Cord Injury and Chronic Pain: A Feasibility, Reliability, and Validity Study 脊髓损伤和慢性疼痛患者恢复力的实时评估：可行性、信度和效度研究。

IF 3.7 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2025-12-01 DOI: 10.1016/j.apmr.2025.04.022

Duygu Kuzu PhD, Anna L. Kratz PhD

Objective

This observational study examined the feasibility, between-person reliability, and convergent and discriminant validity of an ecological momentary assessment (EMA) measure of resilience in individuals with spinal cord injury (SCI) and chronic pain.

Design

Participants completed self-report assessments of resilience twice a day for 7 days using a 6-item EMA measure adapted from the SCI Quality of Life (QOL) Resilience Item Bank. Data were collected via a smartphone.

Setting

General community.

Participants

Individuals with SCI and chronic pain (N=53; 54.7% men and 45.3% women).

Interventions

Not applicable.

Main Outcome Measures

Besides the 6-item EMA resilience measure, we included the full SCI-QOL Resilience Item Bank, the Connor-Davidson Resilience Scale, the Patient-Reported Outcomes Measurement Information System Depression Short Form, the SCI-QOL Anxiety Short Form, the National Institutes of Health Toolbox Perceived Stress Survey, the SCI-QOL Positive Affect and Well-Being Short Form, and the SCI-QOL Ability to Participate in Social Roles and Activities.

Results

Our results showed that the resilience EMA measure revealed high feasibility, with an overall response rate of 88%, and strong between-person reliability (>0.90). The measure also demonstrated good convergent validity with related constructs, such as depression, anxiety, and social participation, and good discriminant validity with unrelated factors, like age and injury level.

Conclusions

Our findings suggest that the EMA resilience measure is a reliable and valid tool for capturing the dynamic nature of resilience in real-time. Our study highlights the importance of the application of a real-time assessment, given that understanding daily functioning contributes to more person-centered rehabilitation interventions for individuals with SCI and chronic pain.

目的：本观察性研究考察了生态瞬时评估（EMA）在脊髓损伤（SCI）和慢性疼痛患者恢复力测量中的可行性、人间信度、收敛效度和判别效度。设计：参与者使用自SCI-QOL弹性题库改编的6项EMA测量方法，连续7天每天两次完成弹性自我报告评估。数据是通过智能手机收集的。设置：普通社区。参与者：患有脊髓损伤和慢性疼痛的个体（N=53，男性54.7%，女性45.3%）。干预措施：不适用。主要结果测量：除6项EMA弹性测量外，我们还包括完整的SCI-QOL弹性题库、康纳-戴维森弹性量表（CD-RISC）、PROMIS抑郁短表、SCI-QOL焦虑短表、NIH工具箱感知压力调查、SCI-QOL积极影响和幸福感短表、SCI-QOL参与社会角色和活动的能力。结果：我们的研究结果表明，弹性EMA测量显示出很高的可行性，总体反应率为88%，人与人之间的可靠性很强（高于0.90）。该量表与抑郁、焦虑、社会参与等相关构念具有良好的收敛效度，与年龄、损伤程度等无关因素具有良好的判别效度。结论：我们的研究结果表明，EMA弹性测量是实时捕捉弹性动态特性的可靠有效工具。我们的研究强调了实时评估应用的重要性，考虑到了解日常功能，有助于对脊髓损伤和慢性疼痛患者进行更多以人为本的康复干预。

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引用次数: 0

Associations Between Obesity and Cardiometabolic, Physical, and Psychosocial Health in Chronic Traumatic Spinal Cord Injury. 慢性创伤性脊髓损伤中肥胖与心脏代谢、身体和心理健康之间的关系

IF 3.7 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2025-12-01 DOI: 10.1016/j.apmr.2025.11.018

Jesse S Brenman, Arthur S Berg, Allen W Heinemann, Yuying Chen, Elizabeth R Felix, Gary J Farkas

Objective: To examine the associations between obesity, defined using the spinal cord injury (SCI)-specific (>22 kg/m²) and the standard (≥30 kg/m²) body mass index (BMI) thresholds, and determine which index better discriminates against BMI-related cardiometabolic, physical, and psychosocial associations reported among the general population in chronic traumatic SCI (TSCI).

Design: Multicenter cross-sectional study.

Setting: Sixteen SCI Model System (SCIMS) sites.

Participants: Adults with TSCI (n=1523, 78.7% male, age 45.7±15.9 years, 56.7% tetraplegia, 8.5±10.5 years post-SCI). Participants were stratified into groups using BMI>22 (n=1,123) and BMI≥30 (n=376), based on available height and weight, follow-up data, and complete outcomes data from the 2016-2020 SCIMS database.

Interventions: Not applicable.

Main outcome measures: Prevalence and odds of self-reported cardiometabolic (diabetes, hypertension, hyperlipidemia), physical (arthritis, pressure injuries [PI], urinary tract infections [UTI], falls, rehospitalizations), and psychosocial (Patient Health Questionnaire-9, Resilience Short Form, Satisfaction with Life Scale, Self-perceived Health [SPH]) measures.

Results: Obesity prevalence was 73.7% using the SCI-specific threshold and 24.7% using the standard threshold. Individuals classified as obese by either definition had higher odds of diabetes, hypertension, and hyperlipidemia, with consistent findings across all neurological impairment categories. Arthritis was more prevalent among individuals with than without obesity, but increased odds were observed only for those with a BMI≥30. UTIs and PI were more common among participants with a BMI>22, while poorer SPH was associated with a BMI≥30. No significant associations with psychosocial outcomes were found using either threshold.

Conclusion: The SCI-specific BMI classified more persons as obese than the standard threshold, yet both thresholds were associated with cardiometabolic risk. Patterns diverged for other outcomes (arthritis, SPH at ≥30), suggesting common obesity-health risk patterns may not generalize to SCI. These findings highlight the complexity of obesity in SCI, suggesting that despite BMI's common use, more accurate, clinically accessible measures are needed to improve risk identification.

目的：研究用脊髓损伤（SCI）特异性（bb0 22 kg/m2）和标准（≥30 kg/m2）体重指数（BMI）阈值定义的肥胖之间的关系，并确定哪种指数能更好地区分慢性创伤性脊髓损伤（TSCI）普通人群中与BMI相关的心脏代谢、身体和社会心理关联。设计：多中心横断面研究。设置：16个SCI模型系统（SCIMS）站点。参与者：成人TSCI患者（n=1523, 78.7%为男性，年龄45.7±15.9岁，56.7%为四肢瘫痪，脊髓损伤后8.5±10.5年）。根据可用的身高和体重、随访数据和2016-2020年SCIMS数据库的完整结局数据，根据BMI指数bbbb22 （n= 1123）和BMI≥30 （n=376）将参与者分为两组。干预措施：不适用。主要结局指标：自我报告的心脏代谢（糖尿病、高血压、高血脂）、身体（关节炎、压伤[PI]、尿路感染[UTI]、跌倒、再住院）和心理社会（患者健康问卷-9、弹性短表、生活满意度量表、自我感知健康[SPH]）指标的患病率和几率。结果：肥胖患病率以sci特异性阈值为73.7%，以标准阈值为24.7%。被任何一种定义归类为肥胖的个体患糖尿病、高血压和高脂血症的几率更高，在所有神经损伤类别中都有一致的发现。关节炎在肥胖人群中比非肥胖人群更普遍，但仅在BMI≥30的人群中观察到风险增加。uti和PI在BMI≥22的参与者中更为常见，而较差的SPH与BMI≥30相关。使用这两种阈值均未发现与心理社会结局有显著关联。结论：与标准阈值相比，sci特异性BMI将更多的人归类为肥胖，但这两个阈值都与心脏代谢风险相关。其他结果（关节炎，≥30岁的SPH）的模式不同，表明常见的肥胖-健康风险模式可能不适用于脊髓损伤。这些发现强调了脊髓损伤中肥胖的复杂性，表明尽管BMI被普遍使用，但需要更准确、临床可及的测量方法来提高风险识别。

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引用次数: 0