Archives of physical medicine and rehabilitation最新文献

Objective: To determine whether hip flexion (HF), extension (HE), abduction (HA), knee flexion (KF) and extension (KE), and ankle plantarflexion (APF) and dorsiflexion maximum voluntary contraction (MVC) differentiates between nonfall and fall history in persons with multiple sclerosis (PwMS) after accounting for age, gender, fatigue, disability, and disease duration.

Design: Secondary analysis of a cross-sectional study.

Setting: Community-based comprehensive MS center.

Participants: A total of 172 PwMS who completed a 1-time visit.

Interventions: Not applicable.

Main outcome measures: Lower limb (LL) MVC was measured for each muscle group as isometric peak torque (Newton-meter: Nm) of both limbs (Strongest: S; Weakest: W) using a Biodex Dynamometer and normalized by body weight (Nm/kg). Falls in the past 6 months were retrospectively collected and participants were classified as nonfall history (0 falls [nonfallers]; n=78) or fall history (≥1 falls [fallers]; n=94). Fall history was further categorized as occasional (1-2 falls [occasional fallers]; n=51) and recurrent (≥3 falls [recurrent fallers]; n=43).

Results: Overall differences between participants with and without a fall history were noted on both limbs, with post-hoc analyses showing that those with a fall history had significantly lower strength (P<.05) on all LL-W and HF-S, HE-S, HA-S, KF-S, and APF-S. When separated out by fall frequency, recurrent fallers had diminished strength on all LL-W and HF-S, HE-S, HA-S, and APF-S, whereas occasional fallers exhibited reductions on HA-W, KE-W, and KF-W compared with nonfallers. Recurrent and occasional fallers differed on HE-W.

Conclusion: All LL-W and aspects of LL-S differentiated between fallers and nonfallers, with further differences observed when fall history was separated by frequency. These findings provide the necessary information to clinicians to inform their plans of care to address falls in MS and provide education on the importance of maintaining LL strength.

Objective: To describe 24-hour physical activities (sleep and physical activity) in adults with cerebral palsy (CP), explore potential influencing factors, and compare 24-hour physical activities with controls.

Design: Cross-sectional, observational internet study involving adults with CP and a convenience sample of adults without CP.

Setting: Individuals residing in the Netherlands.

Participants: A total of 110 adults with CP (median age: 42, range: 28-77 years; 64 [58%] ambulant; 40% men) and 89 adult controls (median age; 43, range: 18-78 years; 29% men).

Main outcome measures: Sleep quantity and quality measured by the Pittsburgh Sleep Quality Index, physical activity measured using the International Physical Activity Questionnaire- Short Form, and health status using the 5-level EuroQol-5D.

Results: Most recurrent sleep problems for adults with CP included falling asleep, waking up, needing the toilet, having nightmares, and experiencing pain during the night. Sleep quality was significantly worse for adults with CP than controls. A total of 64% of adults with CP met the physical activity guidelines. Total physical activity was similar between adults with CP who are ambulatory and controls. A total of 44% of adults with CP, compared with 51% controls, met both sleep and physical activity guidelines. No factors influencing the 24-hour activities were found for level of severity, age, sex, pain/discomfort, and anxiety/depression.

Conclusions: Given the prevalence of worse sleep quality and modest adherence to the 24-hour movement guideline, this study emphasizes the importance for clinicians to assess problems in physical activities during clinical encounters with adults with CP.

Objective: To test the efficacy of a randomized control trial low-touch mobile health intervention designed to promote care partner self-awareness and self-care.

Design: This randomized controlled trial included a baseline assessment of self-report surveys of health-related quality of life (HRQOL), care partner-specific outcomes, and the functional/mental status of the person with traumatic brain injury (TBI), as well as a 6-month home monitoring period that included 3 daily questions about HRQOL, monthly assessments of 12 HRQOL domains, and the use of a Fitbit to continuously monitor physical activity and sleep. HRQOL surveys were repeated at 3 and 6 months post-home monitoring.

Setting: Two academic medical centers.

Participants: A total of 254 TBI care partners.

Interventions: The CareQOL app, a mobile health app designed to promote care partner self-awareness (through self-monitoring) and self-care (through personalized self-care push notifications).

Results: Care partners were randomly assigned to self-monitoring alone (n=128) or self-monitoring plus self-care push notifications (n=126). Although we neither saw improvements in HRQOL outcomes, nor in physical activity or sleep, we found that across all the different measures, approximately 1/3 of the participants showed clinically meaningful improvements, 1/3 stayed the same, and 1/3 got worse; care partners who reported engagement in the intervention were more likely to show improvements than those who were not engaged. There was preliminary support for factors that being male, caring for a person with posttraumatic stress symptoms, living in the same household as the person with TBI, being a spousal care partner, working, and being diagnosed with COVID-19 during the study were associated with increased risk for negative outcomes.

Conclusions: Findings suggest that engagement with the app, even when it is confined to self-monitoring alone, is associated with small improvements in HRQOL.

Objective: The Cognitive and Linguistic Scale (CALS) was developed to serially monitor cognitive recovery of children and young people after severe acquired brain injury, during inpatient rehabilitation. The CALS can be used to derive Cognitive Ability Estimates (CAE), which are Rasch-propertied (unidimensional, interval-scale) and therefore may be ideally applied for use in research including within the context of clinical trials. Here, we used established statistical distribution-based and expert consensus-based methods to estimate the minimal clinically important difference (MCID) for CAE derived from the CALS.

Design: Retrospective study.

Setting: Pediatric inpatient rehabilitation hospital.

Participants: 252 patients consecutively admitted for inpatient rehabilitation after acquired brain injury (46% traumatic brain injury); age at injury ranging from 1.9 to 21.6 years (median, 11.8 years).

Interventions: Not applicable.

Main outcome measures: MCID estimates.

Results: Together, results suggest a MCID of approximately 4-7 CAE units.

Conclusions: These data can be used to aid in the design and interpretation of clinical studies proposing to use the CALS CAE as an outcome measure.

Objective: To identify predictors of adherence in supervised and self-administered exercise interventions for individuals with low back pain.

Design: Cohort study.

Setting: Rehabilitation.

Participants: This preplanned reanalysis within the Medicine in Spine Exercise Network included 1511 participants with low back pain (57% female, mean age 40.9 years, SD ±14 years).

Interventions: Participants underwent an initial 3-week supervised phase of sensorimotor exercises, followed by a 9-week self-administered phase.

Main outcome measures: Biological, psychological, and social factors potentially impacting training adherence were evaluated. During the supervised phase, adherence was tracked through a standardized training log. During the self-administered phase, adherence was monitored via a diary, with adherence calculated as the percentage of scheduled versus completed sessions. Adherence was analyzed both as an absolute percentage and as a dichotomized variable (adherent vs nonadherent, with a 70% adherence cut-off). Predictors for adherence were identified using Gradient Boosting Machines and Random Forests (R package caret). Seventy percent of the observations were used for training, whereas 30% were retained as a hold-out test-set.

Results: The average overall adherence was 64% (±31%), with 81% (±28%) adherence during the supervised phase and 58% (±39%) in the self-administered phase. The root mean square error for the test-set ranged from 36.2 (R²=0.18, self-administered phase) to 19.3 (R²=0.47, supervised phase); prediction accuracy for dichotomized models was between 64% and 83%. Predictors of low to intermediate adherence included poorer baseline postural control, decline in exercise levels, and fluctuations in pain intensity (both increases and decreases).

Conclusion: Identified predictors could aid in recognizing individuals at higher risk for nonadherence in low back pain exercise therapy settings.

Objective: To validate a universal neuropsychological model that suggests that disorders of the self are best conceptualized as disintegrated neuropsychological processes (ie, sensations, mental experiences) that lack a sense of relationship to the unified experience/sense of self.

Design: Cross-sectional observational study.

Setting: Rehabilitation hospital outpatient clinics.

Participants: A total of 73 individuals including 33 with acquired brain injury and 40 with multiple sclerosis.

Intervention: Not applicable.

Main outcome measures: On the basis of the Cambridge Depersonalization Scale, a measure of general disintegration of sensations and mental experiences, a team of rehabilitation clinicians and researchers proposed 6 clinically derived indices of specific disintegrated neuropsychological inputs (ie, sensations), outputs (ie, mental experiences), and experiences of disintegration (ie, space, time, context).

Results: As hypothesized (1) a confirmatory factor analysis supported the proposed factors including disintegrated bodily sensations (root mean square error of approximation [RMSEA]=0.193, P=.009; comparative fit index [CFI]=0.909; Tucker-Lewis index [TLI]=0.819), disintegrated context (RMSEA=0.143, P=.129; CFI=0.970; TLI=0.911), disintegrated emotions (RMSEA=0.090, P=.266; CFI=0.967; TLI=0.902), disintegrated cognition (RMSEA=0.091, P=.210; CFI=0.963; TLI=0.939), disintegrated smell/taste, and disintegrated spatial perception (measures of model fit for these last 2 factors could not be determined given they included only 2 items); and (2) Pearson correlations indicated that all 7 Cambridge Depersonalization Scale indices were negatively correlated with a measure associated with right hemisphere functioning, with 5 achieving/approaching statistical significance.

Conclusion: The results suggest that (1) neuropsychological abilities should be conceptualized in terms of relatively singular neuropsychological domains (ie, affect, behavior, cognition, sensation) and the experience of relationship that is created when they are integrated, and (2) disorders of the self are best conceptualized as disorders of disintegration that are associated with decreased relationship between specific neuropsychological processes and the unified experience/sense of self.