Archives of physical medicine and rehabilitation最新文献_第5页

Relationship Between Step Count and the Timed Up and Go and L Test of Functional Mobility Among Adults With Transtibial Amputation 成人经胫截肢患者步数与上、下时间及功能活动能力的关系。

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.2025.04.007

Kyle R. Leister PhD, CPO , Tiago V. Barreira PhD

Objective

To explore the relationship between daily steps measured by the activPAL 3 and Fitbit Inspire 3 accelerometers and performance on the Timed Up and Go test (TUG) and L Test of Functional Mobility (L test) in adults with transtibial amputation.

Design

Observational design.

Setting

Six outpatient prosthetic clinics located in the United States and the participant’s home environment.

Participants

Adults (n=96) with unilateral transtibial amputation.

Interventions

Not applicable.

Main Outcome Measures

Each participant wore the activPAL and Fitbit concurrently for 7 days. Pearson correlation was used to assess the relationship between daily steps from each device and TUG and L test completion times. Regression was employed to control for sex, body mass index, age, and type 2 diabetes status.

Results

Moderate negative correlations were observed between daily steps recorded by the activPAL and TUG (r=−.52) and L test (r=−.51) times. Moderate negative correlations were also found between daily steps from the Fitbit Inspire 3 and TUG (r=−.55) and L test (r=−.56) times. These relationships remained statistically significant with minimal influence by the included covariates.

Conclusions

Participants who performed well on the TUG and L test tend to have higher daily step counts, highlighting a meaningful association between clinical mobility performance and free-living physical activity. This finding provides evidence that TUG and L test completion times may reflect both functional capacity in a clinical setting and real-world ambulatory behavior. Although step counts and clinical performance measures are not interchangeable, together they offer complementary insights that can enhance the evaluation and monitoring of mobility in individuals with transtibial amputation.

目的：探讨activPAL 3和Fitbit Inspire 3加速度计测量的日步数与成人胫骨截肢患者的Timed Up and Go Test （TUG）和功能活动能力L-test （L-test）的关系。设计：观察性设计。环境：位于美国的六个义肢门诊诊所，以及参与者的家庭环境。参与者：96例单侧胫骨截肢的成人。干预：不适用。主要结果测量：每个参与者同时佩戴activPAL和Fitbit 7天。使用Pearson相关性来评估每个设备的每日步数与TUG和L-test完成时间之间的关系。采用回归控制性别、体重指数、年龄和2型糖尿病状况。结果：激活pal与TUG记录的日步数呈中等负相关（r=-0.52）， l检验记录的日步数呈中等负相关（r=-0.51）。Fitbit Inspire 3和TUG的每日步数（r=-0.55）和L-test次数（r=-0.56）之间也存在中度负相关。这些关系在统计上仍然显著，受纳入协变量的影响最小。结论：在TUG和l测试中表现良好的参与者倾向于有更高的每日步数，突出了临床流动性表现和自由生活体力活动之间有意义的关联。这一发现提供了证据，表明TUG和L-test完成时间可以反映临床环境中的功能能力和现实世界中的动态行为。虽然步数和临床表现测量不能互换，但它们一起提供了互补的见解，可以加强对胫骨截肢患者活动能力的评估和监测。

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引用次数: 0

Comparing the Impact of Intermittent Blood Flow Restriction Training and High-Load Resistance Training in Individuals With Patellofemoral Pain: A Randomized Controlled Trial 比较间歇性血流限制训练和高负荷阻力训练对髌骨痛患者的效果：一项随机对照试验。

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.2025.06.003

Weiya Kong PhD , Ziru Wang PhD , Qiang Zhou MS , Xinyi Yan MS , Jinyu Li MS , Yangyang Zhao MS , Xinran Wang BS , Haonan Wang PhD , Guoxin Ni PhD

Objective

To compare the effectiveness of intermittent blood flow restriction (iBFR) training with that of high-load resistance training in improving patellofemoral pain (PFP).

Design

Double-blind randomized trial.

Setting

A college rehabilitation center.

Participants

Individuals with PFP (N=42).

Interventions

Participants were randomly assigned to 2 groups: iBFR group and control group. iBFR group performed low-load resistance training at 30% of 1 RM under individualized limb occlusion pressure (LOP) at 80% of their individualized LOP. Control group engaged in high-load resistance training with a sham BFR at 70% of 1 RM, using a BFR cuff inflated to 20 mm Hg. Training sessions were conducted 3 times per week for 8 weeks, with follow-up assessments at 8 and 24 weeks.

Main Outcome Measures

Pain and self-report function assessed at baseline, postintervention, and 24-week follow-up. Quadriceps muscle strength and thickness assessed at baseline and postintervention. All adverse events were recorded during the trial.

Results

Both iBFR and standard exercise resulted in significant improvements, but between-group comparisons indicated no conclusive difference in the primary outcomes [P=.163; mean difference, –8.75 (95% confidence interval, –21.18 to 3.69)]. Muscle strength and thickness increased similarly in both groups, with no significant differences observed. However, patients from the iBFR group had higher adherence and fewer adverse events, highlighting its safety and tolerability.

Conclusions

iBFR combined with low-load resistance training was found to be not statistically significant different from high-load resistance training in terms of pain relief and function improvement in PFP patients, with fewer adverse events, indicating that it may be a safer and more patient-friendly rehabilitation option that is sutiable for tailored treatment based on individual preferences and tolerance levels.

目的：比较间歇性血流量限制（iBFR）训练与高负荷阻力训练在改善髌股疼痛（PFP）方面的效果。设计：双盲随机试验。环境：大学康复中心。参与者：PFP患者（N=42）。干预措施：参与者随机分为2组：iBFR组和对照组。iBFR组在个体化肢体闭塞压力（LOP）为个体化LOP的80%的情况下，以30%的1 RM进行低负荷阻力训练。对照组进行高负荷阻力训练，假BFR为1 RM的70%，使用充气至20 mmHg的BFR袖带。每周进行3次培训，持续8周，并在8周和24周进行随访评估。主要结果测量：基线、干预后和24周随访时评估疼痛和自我报告功能。在基线和干预后评估股四头肌力量和厚度。在试验期间记录所有不良事件。结果：iBFR和标准运动均有显著改善，但组间比较显示主要结局无决定性差异(p=0.163；平均差值为-8.75[95%置信区间，-21.18至3.69])。两组的肌肉力量和厚度增加相似，没有观察到显著差异。然而，iBFR组患者有更高的依从性和更少的不良事件，突出了其安全性和耐受性。结论：iBFR联合低负荷阻力训练与高负荷阻力训练在PFP患者的疼痛缓解和功能改善方面无统计学差异，不良事件较少，提示iBFR联合低负荷阻力训练可能是一种更安全、更人性化的康复选择，适合根据个体偏好和耐受水平进行个性化治疗。

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引用次数: 0

Effectiveness of Thoracic Spine Manual Therapy in Treating Subacromial Impingement Syndrome: A Systematic Review and Meta-analysis 胸椎推拿疗法治疗肩峰下撞击综合征的有效性：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.2025.07.008

Shiya Yu BS , Shuqi Chen MSc , Zhimo Yang MM , Xixi Ma MSc , Jielei Huang BS , Lin Yang MD

Objective

To determine the effects of thoracic spine manual therapy (TSMT) in managing shoulder impingement syndrome (SIS) through a systematic review and meta-analysis.

Data Sources

Five databases (Medline, Embase, Web of science, Physiotherapy Evidence Database, and Cochrane Central) were searched from inception to October 2024.

Study Selection

Randomized controlled trials evaluating TSMT combined with other physiotherapy versus physiotherapy alone, or TSMT versus placebo, in individuals with SIS were included. Outcomes included pain, disability, and range of motion.

Data Extraction

Two authors independently performed data extraction, risk of bias assessment, and evidence quality evaluation.

Data Synthesis

A total of 10 randomized controlled trials involving 444 participants were included. Pooled mean difference and standardized mean difference (SMD) with 95% confidence interval (CI) were calculated. Four studies examined TSMT as an adjunct to exercise; 6 used placebo comparators. Pain was commonly assessed using Numeric Pain Rating Scale or Visual Analog Scale in 7 studies; disability was measured by Shoulder Pain And Disability Index or Disabilities of Arm, Shoulder, and Hand in 6 studies. High-quality evidence showed large effect size in favor of TSMT at short terms (2-6 wk after baseline) (SMD [95% CI]=−0.94 [−1.23 to −0.65]) and at intermediate-term (4-6 wk after intervention completion) (SMD [95% CI]=−0.83 [−1.26 to −0.40]) follow-up. Disability improved significantly at intermediate-term follow-up (SMD [95% CI]=−0.82 [−1.25 to −0.38]), supported by high-quality evidence. Subgroup analysis revealed that significant disability reduction in TSMT groups compared with placebo with a moderate effect size (SMD [95% CI]=−0.75 [−1.18 to −0.32]), supported by high-quality evidence. Furthermore, moderate evidence also supported improved internal rotation (SMD [95% CI]=0.61 [0.21-1.02]) and external rotation (SMD [95% CI] = 0.58 [0.17-1.00]).

Conclusions

The TSMT is effective in reducing pain, disability, and improving range of motion in individuals with SIS over short terms.

目的：通过系统回顾和荟萃分析，确定胸椎推拿疗法（TSMT）治疗肩撞击综合征（SIS）的效果。数据来源：检索自成立至2024年10月的5个数据库（Medline、Embase、WOS、PEDro和CENTRAL）。研究选择：纳入了评估TSMT联合其他物理治疗与单独物理治疗或TSMT与安慰剂在SIS患者中的作用的随机对照试验（RCTs）。结果包括疼痛、残疾和活动范围（ROM）。数据提取：两位作者独立进行数据提取、偏倚风险评估和证据质量评估。资料综合：纳入10项随机对照试验，共444名受试者。计算95% CI的合并平均差和标准化平均差（SMD）。四项研究将TSMT作为运动的辅助手段；其中6人使用安慰剂对照。在7项研究中，通常使用数字疼痛评定量表或视觉模拟量表评估疼痛；在六项研究中，残疾是通过肩痛和残疾指数或手臂、肩膀和手的残疾来衡量的。高质量的证据显示，在短期（基线后2-6周）（SMD [95% CI] = -0.94[-1.23,-0.65]）和中期（干预完成后4-6周）（SMD [95% CI] = -0.83[-1.26,-0.40]）随访中，TSMT具有较大的效应。在中期随访中，残疾显著改善（SMD [95% CI] = -0.82[-1.25,-0.38]），得到高质量证据的支持。亚组分析显示，与安慰剂相比，TSMT组显著减少了残疾，具有中等效应（SMD [95% CI] = -0.75[-1.18,-0.32]），这得到了高质量证据的支持。此外，中度证据也支持改善内旋（SMD [95% CI] = 0.61[0.21,1.02]）和外旋（SMD [95% CI] = 0.58[0.17,1.00]）。结论：TSMT在短期内有效减轻SIS患者的疼痛、残疾和改善ROM。

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引用次数: 0

Effect Size Guidelines for Individual and Group Differences in Physiotherapy 物理治疗中个体和群体差异的效应量指南。

IF 3.7 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2025-12-01 DOI: 10.1016/j.apmr.2025.05.013

Grzegorz Zieliński PT, PhD, MBA

Objective

To investigate the distribution of effect sizes in individual and group differences within physiotherapy to provide standardized estimates of effect sizes in the field.

Design

Meta-analysis of effect sizes extracted from published studies in physiotherapy.

Setting

Data were collected from 6 physiotherapy journals with the highest H-index.

Participants

A total of 111 meta-analyses (N=111) were analyzed, yielding 3374 extracted effect sizes.

Interventions

Not applicable.

Main Outcome Measures

Effect sizes were categorized as diagnostic methods, kinesiotherapy, manual therapy, and a group labeled "laser therapy, magnetic therapy, electrotherapy, etc." Hedges’ g effect sizes were determined, and percentiles were calculated to establish thresholds for small, medium, and large effects.

Results

For individual differences (Pearson’s r), the 25th, 50th, and 75th percentiles were 0.33, 0.45, and 0.62, respectively. For group differences (Hedges’ g), these values were 0.13, 0.35, and 0.79, respectively. In kinesiotherapy, small, medium, and large effect sizes were determined as 0.1, 0.3, and 0.7, respectively. For physiotherapy diagnostics, the thresholds were 0.2, 0.5, and 1.0, respectively. For physical treatments such as laser therapy, magnetic therapy, and electrotherapy, the corresponding values were 0.1, 0.4, and 1.1. For manual therapy, the thresholds were 0.1 for small effects, 0.3 for medium effects, and 0.8 for large effects.

Conclusions

For individual differences (Pearson’s r), small, medium, and large effect sizes should be considered 0.3, 0.5, and 0.6, respectively. For group differences (Cohen's d or Hedges’ g), small, medium, and large effect sizes should correspond to 0.1, 0.4, and 0.8, respectively. These findings provide standardized effect size estimates for various physiotherapy interventions, aiding in the interpretation of research outcomes.

目的：研究物理治疗中个体和群体差异的效应量分布，以提供该领域效应量的标准化估计。设计：荟萃分析从已发表的物理治疗研究中提取的效应量。背景：数据收集自h指数最高的6种物理治疗期刊。参与者：共分析了111项荟萃分析，产生了3374个提取的效应量。干预措施：不适用。主要结果测量：效应大小分为诊断方法、运动疗法、手工疗法和一组标记为“激光疗法、磁疗、电疗等”的疗法。确定对冲的效应大小，并计算百分位数以建立小、中、大效应的阈值。结果：个体差异（Pearson’s r），第25、50、75百分位分别为0.33、0.45、0.62。对于组差异（Hedges’g），这些值分别为0.13、0.35和0.79。在运动疗法中，小、中、大效应量分别为0.1、0.3和0.7。对于物理治疗诊断，阈值分别为0.2、0.5和1.0。对于物理治疗，如激光治疗、磁疗和电疗，相应的值分别为0.1、0.4和1.1。手工治疗的阈值为：小效果为0.1，中等效果为0.3，大效果为0.8。结论：对于个体差异（Pearson’s r），应考虑小、中、大效应量分别为0.3、0.5和0.6。对于组差异（Hedges’g），小、中、大效应量应分别对应于0.1、0.4和0.8。这些发现为各种物理治疗干预提供了标准化的效应量估计，有助于解释研究结果。

{"title":"Effect Size Guidelines for Individual and Group Differences in Physiotherapy","authors":"Grzegorz Zieliński PT, PhD, MBA","doi":"10.1016/j.apmr.2025.05.013","DOIUrl":"10.1016/j.apmr.2025.05.013","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the distribution of effect sizes in individual and group differences within physiotherapy to provide standardized estimates of effect sizes in the field.</div></div><div><h3>Design</h3><div>Meta-analysis of effect sizes extracted from published studies in physiotherapy.</div></div><div><h3>Setting</h3><div>Data were collected from 6 physiotherapy journals with the highest H-index.</div></div><div><h3>Participants</h3><div>A total of 111 meta-analyses (N=111) were analyzed, yielding 3374 extracted effect sizes.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Effect sizes were categorized as diagnostic methods, kinesiotherapy, manual therapy, and a group labeled \"laser therapy, magnetic therapy, electrotherapy, etc.\" Hedges’ <em>g</em> effect sizes were determined, and percentiles were calculated to establish thresholds for small, medium, and large effects.</div></div><div><h3>Results</h3><div>For individual differences (Pearson’s <em>r</em>), the 25th, 50th, and 75th percentiles were 0.33, 0.45, and 0.62, respectively. For group differences (Hedges’ <em>g</em>), these values were 0.13, 0.35, and 0.79, respectively. In kinesiotherapy, small, medium, and large effect sizes were determined as 0.1, 0.3, and 0.7, respectively. For physiotherapy diagnostics, the thresholds were 0.2, 0.5, and 1.0, respectively. For physical treatments such as laser therapy, magnetic therapy, and electrotherapy, the corresponding values were 0.1, 0.4, and 1.1. For manual therapy, the thresholds were 0.1 for small effects, 0.3 for medium effects, and 0.8 for large effects.</div></div><div><h3>Conclusions</h3><div>For individual differences (Pearson’s <em>r</em>), small, medium, and large effect sizes should be considered 0.3, 0.5, and 0.6, respectively. For group differences (Cohen's <em>d</em> or Hedges’ <em>g</em>), small, medium, and large effect sizes should correspond to 0.1, 0.4, and 0.8, respectively. These findings provide standardized effect size estimates for various physiotherapy interventions, aiding in the interpretation of research outcomes.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 12","pages":"Pages 1844-1849"},"PeriodicalIF":3.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144339856","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

IF 3.7 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2025-11-27 DOI: 10.1016/j.apmr.2025.11.007

Vanessa K Noonan, Apichana Kovindha, Brigitte Perrouin-Verbe, Angela Cristina Yánez Corrales, Abderrazak Hajjioui, Conran Joseph, Mohit Arora, Diana Pacheco Barzallo

Objective: People with spinal cord injury/disease (SCI/D) have high healthcare needs. Using data from the second International Spinal Cord Injury (InSCI) community survey, the objective of this study is to determine the performance of healthcare systems for people with SCI/D. Specifically, health utilities for people with SCI/D and the country's healthcare system performance relative to other countries with comparable economic profiles will be examined.

Design: A cross-sectional, multi-national, observational cohort study.

Setting: Community setting with participants from 31 countries across six World Health Organization regions.

Participants: Of the 15,051 participants completing the survey between May 2022 and October 2024, 72% were male with a median age of 54 years, 55% having an incomplete injury and 64% having paraplegia.

Interventions: Not applicable MAIN OUTCOME MEASURES: Health-related quality of life was assessed by reporting health utilities using the EQ-5D-5L. Sixteen healthcare system performance indicators for five domains were derived by mapping the InSCI survey items to the Commonwealth Fund domains.

Results: Health utility values ranged from 0.75 for Finland, a high-income country, to -0.01 for Iran, an upper-middle income country. All 31 countries have strengths and areas for improvement across sixteen indicators. High-income countries generally had higher health utility ratings and better rankings for their healthcare system performance. However, the healthcare systems in many of the upper-middle and lower-middle-income countries performed well, and efficiently utilized limited resources.

Conclusion: To optimize health and participation in the community, the healthcare system must be responsive and meet the needs for people living with SCI/D. Results from this study provide evidence on the link between healthcare policies, resources and health outcomes for people with SCI, which can inform policy change.

目的：脊髓损伤/疾病（SCI/D）患者具有较高的医疗保健需求。利用来自第二次国际脊髓损伤（InSCI）社区调查的数据，本研究的目的是确定医疗保健系统对SCI/D患者的表现。具体而言，将审查SCI/D患者的卫生设施以及该国相对于其他具有可比经济概况的国家的卫生保健系统绩效。设计：横断面、多国、观察性队列研究。环境：社区环境，参与者来自世界卫生组织六个区域的31个国家。参与者：在2022年5月至2024年10月期间完成调查的15051名参与者中，72%是男性，中位年龄为54岁，55%有不完全性损伤，64%有截瘫。干预措施：不适用主要结局测量：健康相关生活质量通过使用EQ-5D-5L报告健康效用来评估。通过将InSCI调查项目映射到英联邦基金领域，得出了五个领域的16个医疗保健系统绩效指标。结果：高收入国家芬兰的健康效用值为0.75，中高收入国家伊朗的健康效用值为-0.01。所有31个国家在16项指标上都有优势和有待改进的领域。高收入国家通常有更高的医疗效用评级和更好的医疗系统绩效排名。然而，许多中上和中低收入国家的医疗保健系统表现良好，有效地利用了有限的资源。结论：为了优化社区健康和参与，医疗保健系统必须响应并满足SCI/D患者的需求。本研究的结果为脊髓损伤患者的医疗政策、资源和健康结果之间的联系提供了证据，这可以为政策的改变提供信息。

{"title":"Health-related quality of life and healthcare systems in people with spinal cord injury: A cross-country comparison from the second InSCI community survey.","authors":"Vanessa K Noonan, Apichana Kovindha, Brigitte Perrouin-Verbe, Angela Cristina Yánez Corrales, Abderrazak Hajjioui, Conran Joseph, Mohit Arora, Diana Pacheco Barzallo","doi":"10.1016/j.apmr.2025.11.007","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.11.007","url":null,"abstract":"<p><strong>Objective: </strong>People with spinal cord injury/disease (SCI/D) have high healthcare needs. Using data from the second International Spinal Cord Injury (InSCI) community survey, the objective of this study is to determine the performance of healthcare systems for people with SCI/D. Specifically, health utilities for people with SCI/D and the country's healthcare system performance relative to other countries with comparable economic profiles will be examined.</p><p><strong>Design: </strong>A cross-sectional, multi-national, observational cohort study.</p><p><strong>Setting: </strong>Community setting with participants from 31 countries across six World Health Organization regions.</p><p><strong>Participants: </strong>Of the 15,051 participants completing the survey between May 2022 and October 2024, 72% were male with a median age of 54 years, 55% having an incomplete injury and 64% having paraplegia.</p><p><strong>Interventions: </strong>Not applicable MAIN OUTCOME MEASURES: Health-related quality of life was assessed by reporting health utilities using the EQ-5D-5L. Sixteen healthcare system performance indicators for five domains were derived by mapping the InSCI survey items to the Commonwealth Fund domains.</p><p><strong>Results: </strong>Health utility values ranged from 0.75 for Finland, a high-income country, to -0.01 for Iran, an upper-middle income country. All 31 countries have strengths and areas for improvement across sixteen indicators. High-income countries generally had higher health utility ratings and better rankings for their healthcare system performance. However, the healthcare systems in many of the upper-middle and lower-middle-income countries performed well, and efficiently utilized limited resources.</p><p><strong>Conclusion: </strong>To optimize health and participation in the community, the healthcare system must be responsive and meet the needs for people living with SCI/D. Results from this study provide evidence on the link between healthcare policies, resources and health outcomes for people with SCI, which can inform policy change.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145628156","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

Inclusion of Young Adults With Intellectual Disabilities in Their Transition to Employment: Designing the Vocational Fit Assessment- Self-report. 青年智障人士在转业过程中的包容：设计职业契合度评估-自我报告。

IF 3.7 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2025-11-26 DOI: 10.1016/j.apmr.2025.10.028

Cristina C Parsons, Margaret Gibson, Marisa Thum, Dennis S Cleary, Andrew C Persch

Objective: To engage young adults with intellectual disabilities (ID) in redesigning the Vocational Fit Assessment (VFA), an algorithm-based assessment to support customized employment decisions for people with ID, toward an accessible self-report tool, the VFA Self-Report (VFA-SR).

Design: A mixed-methods, competency-based approach to assessment and technology design for young adults with ID. We conducted cross-sectional cognitive interviews to collect qualitative and quantitative data on the interpretability of 102 candidate items and tool accessibility. Participants learned the VFA-SR rating scale, answered items while describing performance, and responded to Likert-style usability questions.

Setting: Community.

Participants: Eleven young adults (N=11; aged 19-23y) with mild/moderate ID.

Interventions: Not applicable.

Main outcome measures: Not applicable.

Results: Five items on the VFA-SR were modified based on qualitative data from interviews. Participants were highly likely to answer "Yes" to items that described their performance positively, with an average alignment between "Yes" selections and positive performance of 97% (SD, 5%). All participants either "agreed" or "strongly agreed" that the VFA-SR was easy to use, and 9 reported feeling confident using it.

Conclusions: Overall, young adults with mild/moderate ID felt the current iteration of the VFA-SR was easy to use and responded to the rating scale items as intended. We gained valuable insights into how to present information to young adults with ID, specific improvements to the items, and considerations for accessibility in subsequent iterations of the tool. Our study developed a version of the VFA that incorporates person-centered measurement principles (eg, Patient-Driven, Transparent, Comprehensible, and Timely) by encompassing young adults' goals, preferences, and priorities in employment planning decisions.

目的：让有智力障碍的年轻人（ID）重新设计职业适合度评估（基于算法的评估，以支持有智力障碍的人定制的就业决策），以实现一个可访问的自我报告工具，职业适合度评估-自我报告（VFA-SR）。设计：一种混合方法，基于能力的方法来评估和技术设计与年轻的成年人身份证。我们使用横断面认知访谈来获得102个候选项目的可解释性和工具可及性的定性和定量数据。参与者学习了VFA-SR评定量表，回答了描述性能的项目，并回答了李克特式的可用性问题。社区参与者：11名患有轻度/中度ID的年轻人（19-23岁）。结果：根据访谈的定性数据，对VFA-SR中的五个项目进行了修改。参与者极有可能对他们积极描述自己表现的项目回答“是”，“是”选择和积极表现之间的平均一致性计算为97%（±5%）。所有参与者都“同意”或“强烈同意”VFA-SR易于使用，其中9人报告说他们对使用它很有信心。结论：总体而言，患有轻度/中度自我认知障碍的年轻成年人认为VFA-SR的当前版本易于使用，并且他们对使用评定量表的项目做出了预期的反应。我们获得了一些有价值的见解，包括如何向具有ID的年轻人展示信息、对项目的具体改进以及在该工具的后续迭代中对可访问性的考虑。我们的研究生成了一个VFA版本，通过将年轻人的目标、偏好和就业计划决策的优先级纳入其中，结合了以人为本的测量原则（例如，患者驱动、透明、可理解和及时）。

{"title":"Inclusion of Young Adults With Intellectual Disabilities in Their Transition to Employment: Designing the Vocational Fit Assessment- Self-report.","authors":"Cristina C Parsons, Margaret Gibson, Marisa Thum, Dennis S Cleary, Andrew C Persch","doi":"10.1016/j.apmr.2025.10.028","DOIUrl":"10.1016/j.apmr.2025.10.028","url":null,"abstract":"<p><strong>Objective: </strong>To engage young adults with intellectual disabilities (ID) in redesigning the Vocational Fit Assessment (VFA), an algorithm-based assessment to support customized employment decisions for people with ID, toward an accessible self-report tool, the VFA Self-Report (VFA-SR).</p><p><strong>Design: </strong>A mixed-methods, competency-based approach to assessment and technology design for young adults with ID. We conducted cross-sectional cognitive interviews to collect qualitative and quantitative data on the interpretability of 102 candidate items and tool accessibility. Participants learned the VFA-SR rating scale, answered items while describing performance, and responded to Likert-style usability questions.</p><p><strong>Setting: </strong>Community.</p><p><strong>Participants: </strong>Eleven young adults (N=11; aged 19-23y) with mild/moderate ID.</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcome measures: </strong>Not applicable.</p><p><strong>Results: </strong>Five items on the VFA-SR were modified based on qualitative data from interviews. Participants were highly likely to answer \"Yes\" to items that described their performance positively, with an average alignment between \"Yes\" selections and positive performance of 97% (SD, 5%). All participants either \"agreed\" or \"strongly agreed\" that the VFA-SR was easy to use, and 9 reported feeling confident using it.</p><p><strong>Conclusions: </strong>Overall, young adults with mild/moderate ID felt the current iteration of the VFA-SR was easy to use and responded to the rating scale items as intended. We gained valuable insights into how to present information to young adults with ID, specific improvements to the items, and considerations for accessibility in subsequent iterations of the tool. Our study developed a version of the VFA that incorporates person-centered measurement principles (eg, Patient-Driven, Transparent, Comprehensible, and Timely) by encompassing young adults' goals, preferences, and priorities in employment planning decisions.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145628154","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

Preliminary Effect of Person-Centered Stroke Telerehabilitation That Combines Rasch Analysis Keyform Mapping With Cognitive Strategy Training. 结合Rasch分析键形映射与认知策略训练的以人为中心的脑卒中远程康复的初步效果。

IF 3.7 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2025-11-26 DOI: 10.1016/j.apmr.2025.11.009

Michelle L Woodbury, Stephanie Garner, Emerson Hart, Patty Finetto, Kelly Rishe, Julianne Laura, Corey Morrow

Objective: To test the preliminary effect of an innovative, in-home person-centered stroke telerehabilitation program combining Rasch keyform mapping with metacognitive strategy training.

Design: Single-group pre-/posttest quasi-experimental design.

Setting: University research laboratory and in-home telerehabilitation.

Participants: Thirty (N=30) stroke survivors with a mean age ± SD of 59.7±16 years, 3.92 years poststroke (SD, 5.76), and with arm/hand hemiparesis.

Interventions: The Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) keyform, derived from Rasch analysis, maps personalized motor skill levels to the likelihood of successfully performing home/community activities of varying difficulty. Scored keyforms were made available to participants. Participants/therapists co-created an in-home telerehabilitation program (nine 1-h sessions over 6 wks) to address participants' self-identified home activity goals through individualized cognitive strategy training using a metacognitive strategy training approach.

Main outcome measures: Activity performance using the Patient-Specific Functional Scale (PSFS); self-efficacy using the Stroke Self-Efficacy Questionnaire; skill generalization using the Performance Quality Rating Scale (PQRS); and paretic arm motor ability using the telerehabilitation-specific FMA-UE (tFMA-UE). Pre-to-post mean score differences were compared using the Wilcoxon signed-rank test (P<.05), and Cohen's d indicated effect size.

Results: Ninety percent of participants completed the intervention. The mean pre-to-post score differences ± SD were as follows: PSFS: pre: 2.30±1.67, post: 5.76±1.99, P<.001, d=1.73; Stroke Self-Efficacy Questionnaire: pre: 87.93±18.24, post: 99.96±12.92, P<.001, d=1.12; PQRS Completeness: pre: 9.19±1.00, post: 9.33±1.75, P=.13; PQRS Quality: pre: 4.04±2.09, post: 5.72±2.24, P<.001, d=1.25; telerehabilitation-specific FMA-UE: pre: 22.11±9.12, post: 23.74±9.43, P=.01, d=0.55.

Conclusions: Pre-to-post comparisons were significant, and effect sizes for all measures were medium/large. Combining keyform mapping with strategy training during stroke telerehabilitation may facilitate the co-creation of personalized intervention plans. The combined intervention may improve paretic upper extremity motor skills and increase activity performance, self-efficacy, and skill generalization.

目的：检验一种创新的、以人为中心的居家脑卒中远程康复方案的初步效果，该方案将Rasch键形映射与元认知策略训练相结合。设计：单组测试前/后准实验设计。设置：大学研究实验室和家庭远程康复。参与者：30例（n=30）中风幸存者，年龄59.7岁（SD 16），中风后3.92年（SD 5.76），手臂/手偏瘫。干预：Fugl-Meyer上肢评估（FMA-UE）键表，通过Rasch分析得出，将个性化的运动技能水平映射到成功执行不同难度的家庭/社区活动的可能性。得分的关键表格提供给参与者。参与者/治疗师共同创建了一个家庭远程康复计划（9个一小时的课程/6周），通过使用元认知策略训练方法进行个性化认知策略训练，解决参与者自我确定的家庭活动目标。主要结果测量：通过患者特定功能量表（PSFS）进行活动表现；卒中自我效能问卷（SSEQ）；通过绩效质量评定量表（PQRS）进行技能概括；通过远程康复特异性FMA-UE （tFMA-UE）检测患儿手臂运动能力。将前后平均得分差异与Wilcoxon Signed rank进行比较(结果：90%的参与者完成了干预。前后平均（SD）评分差异如下：PSFS前2.30(1.67)，后5.76 (1.99)，p结论：前后比较具有显著性，所有测量的效应量均为中/大。在中风远程康复过程中，将键形映射与策略训练相结合，可以促进个性化干预计划的共同制定。联合干预可改善父母UE运动技能，提高活动表现、自我效能感和技能泛化。

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引用次数: 0

Open Notes in Brain Injury Rehabilitation Part 2: Provider and Patient Preferences for Artificial Intelligence Solutions. 脑损伤康复开放笔记第二部分：人工智能解决方案的提供者和患者偏好。

IF 3.7 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2025-11-26 DOI: 10.1016/j.apmr.2025.11.016

Natalie V Covington, Scott E Friedman, Caitlin Klukas, Natalie Becker, Olivia Vruwink, Katy H O'Brien

Objective: To characterize opinions and experiences related to use of artificial intelligence (AI) in the context of patient-accessible electronic medical records in rehabilitation (PAEHR or "open notes").

Design: Rehabilitation providers and patients with acquired brain injury (ABI) completed a web-based survey.

Setting: Provider participants were recruited via publicly-available email lists published by licensure boards and via internal listservs within a large Midwestern healthcare system. Patient participants were recruited via medical records search within the same healthcare system.

Participants: 677 providers and 270 patients with ABI completed the survey. Providers (physical therapy, occupational therapy, speech-language pathology) were working in settings that utilize electronic health records. Adults with ABI had received rehabilitative care between 2021 and 2024.

Interventions: Not Applicable.

Main outcome measures: Participants responded to multiple choice, Likert-scale, and open-response questions about their experiences with and opinions about AI in the context of clinical documentation in rehabilitation.

Results: Both groups reported little experience with AI in daily life or healthcare contexts. Both groups reported concerns regarding AI accuracy and privacy. Most providers expressed interest in AI tools for supporting clinical documentation; patients with ABI expressed more hesitancy. Both groups agreed that a patient-directed summary would be helpful for improving the utility of open notes. Both groups rated Goals, Progress, Activities, and Home Exercise Programs as the most important note components for patients to understand.

Conclusions: Rehabilitation providers and patients with ABI agree that patient-directed note summaries may be one way to improve open notes. Generative AI provides one potential pathway for creating such a summary without undue clinician burden, but both providers and patients express significant concerns about accuracy and privacy. Future work should continue to evaluate the potential of AI solutions for improving patient-provider communication in the open notes era, while mitigating potential drawbacks.

目的：描述在患者可访问的康复电子病历（PAEHR或“开放式笔记”）背景下与使用人工智能（AI）相关的意见和经验。设计：康复提供者和获得性脑损伤（ABI）患者完成了一项基于网络的调查。设置：提供者参与者通过执照委员会发布的公开电子邮件列表和中西部大型医疗保健系统的内部列表来招募。患者参与者是通过同一医疗保健系统内的医疗记录搜索招募的。参与者：677名提供者和270名ABI患者完成了调查。提供者（物理治疗、职业治疗、语言病理学）在使用电子健康记录的环境中工作。患有ABI的成年人在2021年至2024年间接受了康复治疗。干预措施：不适用。主要结果测量：参与者回答多项选择、李克特量表和开放式回答问题，以了解他们在康复临床文献背景下对人工智能的体验和看法。结果：两组人都报告在日常生活或医疗环境中很少有人工智能的经历。这两个群体都对人工智能的准确性和隐私表示担忧。大多数供应商表示对支持临床文档的人工智能工具感兴趣；ABI患者表现出更多的犹豫。两组都同意，以病人为导向的总结将有助于提高开放式笔记的效用。两组都认为目标、进展、活动和家庭锻炼计划是患者理解的最重要的笔记组成部分。结论：康复提供者和ABI患者一致认为，以患者为导向的笔记摘要可能是改善开放式笔记的一种方法。生成式人工智能为创建这样的摘要提供了一种潜在的途径，而不会给临床医生带来不必要的负担，但提供者和患者都对准确性和隐私表示了严重的担忧。未来的工作应该继续评估人工智能解决方案在开放式笔记时代改善医患沟通的潜力，同时减轻潜在的缺点。

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引用次数: 0

Long-term Progress of Functional Independence of Patients With Prolonged Disorders of Consciousness Who Emerge From the Minimally Conscious State. 从最低意识状态出现的长期意识障碍患者功能独立性的长期进展。

IF 3.7 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2025-11-26 DOI: 10.1016/j.apmr.2025.11.012

Ana Sierra, Alice Barra, María Dolores Navarro, Joan Ferri, Enrique Noé, Roberto Llorens

Objective: To investigate the long-term functional independence of individuals with prolonged disorders of consciousness (DOC) who emerge from the minimally conscious state (MCS).

Design: Retrospective cohort study. Follow-up assessments were conducted at 6 and 12 months after emergence.

Setting: Long-term neurorehabilitation center.

Participants: We conducted a retrospective analysis of 62 individuals with prolonged DOC who emerged from MCS and completed 6- and 12-month follow-up assessments. Individuals were predominantly men (79%), with a median age of 35 years (interquartile range [IQR]: 25.9-49.4), and most had sustained a traumatic brain injury (74%). At admission, 21% of individuals were in an unresponsive wakefulness state and 79% in MCS (44% MCS- and 56% MCS+).

Interventions: Not applicable.

Main outcome measures: Functional independence was evaluated using the Disability Rating Scale (DRS), the Barthel Index (BI), the Functional Independence Measure (FIM), and the Functional Assessment Measure (FAM). Descriptive statistics and categorical analyses were used to evaluate changes across timepoints.

Results: At 6 months after emergence, individuals showed severe functional dependence, with most of the sample categorized as extremely or severely disabled. Median scores indicated poor independence across all scales (DRS: 16/29 [IQR=8.25-18]; BI: 10/100 [IQR=0.25-31]; FIM: 29.5/126 [IQR=20-46.75]; FIM+FAM: 52 [IQR=36.26-80]). By 12 months, slight but nonsignificant improvements were observed (DRS: 14 [IQR=8-18]; BI: 20.5 [IQR=2.25-52.5]; FIM: 32 [IQR=23-63.25]; FIM+FAM: 60 [IQR=37.25-107]), with only a minority transitioning to less severe disability categories. Most remained highly dependent in motor, cognitive, and daily living activities.

Conclusions: Individuals with prolonged DOC generally show limited functional recovery after emerging from MCS, with only minimal group-level improvements during the first year. These findings highlight the persistence of severe disability after emergence from prolonged DOC and the importance of long-term care strategies.

目的：探讨从最低意识状态（MCS）出现的延长性意识障碍（DOC）患者的长期功能独立性。设计：回顾性队列研究。在出现后6和12个月进行随访评估。地点：长期神经康复中心。参与者：我们对62名从MCS出现的延长DOC患者进行了回顾性分析，并完成了6个月和12个月的随访评估。个体以男性为主（79%），中位年龄为35岁（IQR: 25.9-49.4），大多数患有创伤性脑损伤（74%）。入院时，21%的患者处于无反应清醒状态，79%处于MCS状态（44%为MCS-， 56%为MCS+）。干预措施：不适用主要结果测量：功能独立性采用残疾评定量表（DRS）、Barthel指数（BI）、功能独立性测量（FIM）和功能评估测量（FAM）进行评估。使用描述性统计和分类分析来评估不同时间点的变化。结果：在出现后6个月，个体表现出严重的功能依赖，大多数样本被归类为极度或严重残疾。中位数得分表明所有量表的独立性较差(DRS: 16/29 (IQR=8.25-18)；Bi: 10/100 (iqr =0.25-31)；胶片：29.5/126 (iqr =20-46.75)；film + fam: 52 (iqr =36.26-80))。12个月时，观察到轻微但不显著的改善(DRS: 14 (IQR=8-18)；Bi: 20.5 (iqr =2.25-52.5)；胶片：32 (iqr =23-63.25)；FIM+FAM: 60 (IQR=37.25-107))，只有少数过渡到较轻的残疾类别。大多数患者在运动、认知和日常生活活动方面仍然高度依赖。结论：患有长期DOC的个体在MCS出现后通常表现出有限的功能恢复，在第一年只有最小的组水平改善。这些发现强调了长期DOC出现后严重残疾的持久性和长期护理策略的重要性。

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引用次数: 0

Open Notes in Brain Injury Rehabilitation Part 1: Contrasting Perspectives of Patients and Providers. 脑损伤康复的开放笔记第一部分：患者和提供者的对比观点。

IF 3.7 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2025-11-26 DOI: 10.1016/j.apmr.2025.11.015

Natalie V Covington, Scott E Friedman, Natalie Becker, Caitlin Klukas, Olivia Vruwink, Katy H O'Brien

Objective: To characterize opinions and experiences related to patient-accessible electronic health records in rehabilitation (or "open notes") in patients with a history of acquired brain injury (ABI) and rehabilitation providers.

Design: Patients with ABI and rehabilitation providers completed a web-based survey.

Setting: Patients were identified and recruited from medical records in a large Midwestern health care system. Providers were recruited through internal listservs within the same health care system as well as publicly available state licensure board email lists.

Participants: Patients with ABI (N=284) and rehabilitation providers (N=740) participated in the study. Adults with ABI had received rehabilitative care between 2021 and 2024, and rehabilitation providers (physical therapy, occupational therapy, speech-language pathology) were working in settings that use electronic health records. Primary analyses were conducted with responses from the 149 patients who reported reading at least 1 rehabilitation note in an electronic health record and 390 providers who reported that a patient had read one of their notes.

Interventions: Not applicable.

Main outcome measures: Participants responded to multiple choice, Likert scale, and open-response questions about their experiences with and opinions about open notes in rehabilitation.

Results: Patients with ABI were enthusiastic about open notes in rehabilitation, with a large majority agreeing that access to open notes reinforces their rehabilitative care and improves their connection to their providers. Patients with ABI were unconcerned about the potential for notes to be confusing, offensive, or upsetting. In contrast, providers were ambivalent about open note access, with a majority expressing concerns that patients might misunderstand or be offended by their notes. Rehabilitation providers also expressed significant burden surrounding clinical documentation and reported that patient access to notes increased this burden and disagreed that it improved patient-provider communication.

Conclusions: Results suggest significant tensions between patient and provider perspectives surrounding open rehabilitation notes. Future work should examine methods for increasing the utility of open notes in supporting improved patient-provider communication while minimizing provider documentation burden.

目的：探讨有获得性脑损伤（ABI）病史的患者和康复服务提供者对患者可获取的康复电子健康记录（PAEHR或“开放式笔记”）的看法和经验。设计：ABI患者和康复提供者完成一项基于网络的调查。环境：从中西部大型医疗保健系统的医疗记录中确定并招募患者。提供者是通过同一医疗保健系统内的内部列表以及公开的州执照委员会电子邮件列表招募的。参与者：284例ABI患者和740名康复提供者参与了这项研究。患有ABI的成年人在2021年至2024年间接受了康复治疗，康复提供者（物理治疗、职业治疗、言语语言病理学）在使用电子病历的环境中工作。对149名报告在电子病历中至少阅读了一份康复记录的患者和390名报告患者阅读了他们的一份记录的提供者的反应进行了初步分析。干预措施：不适用。主要结果测量：参与者回答多项选择、李克特量表和开放式回答问题，以了解他们在康复过程中对开放式笔记的经历和看法。结果：ABI患者对康复中的开放式笔记很感兴趣，绝大多数人同意开放笔记可以加强他们的康复护理，并改善他们与提供者的联系。ABI患者不关心笔记可能令人困惑、冒犯或不安。相比之下，提供者对开放笔记访问持矛盾态度，大多数人表示担心患者可能会误解或被他们的笔记冒犯。康复服务提供者也表达了围绕临床文件的重大负担，并报告说患者访问笔记增加了这种负担，并不同意它改善了患者与提供者的沟通。结论：结果表明围绕开放康复记录的患者和提供者观点之间存在显著的紧张关系。未来的工作应该研究如何增加开放笔记的效用，以支持改善患者与提供者的沟通，同时最大限度地减少提供者的文档负担。

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引用次数: 0