Archives of physical medicine and rehabilitation最新文献

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.

Objective: To investigate the effect of activity engagement on current and future pain in individuals after stroke.

Design: Prospective observational study using a smartphone-based ecological momentary assessment (EMA) as a real-time measurement for monitoring post-stroke pain and activity engagement in natural contexts.

Setting: Home and Community PARTICIPANTS: Persons with mild-to-moderate stroke (N = 202) completed the study protocol, with the EMA completion rate of at least 30%. Participants (mean age = 59.7 years; SD = 11.7) were primarily men (55%), White (55%), married (52%), unemployed (57%), and had an ischemic stroke (90%).

Interventions: Not applicable.

Main outcome measures: Participants completed EMA surveys five times per day for two weeks, reporting their pain and activity engagement. EMA-measured pain was characterized by its level of severity. EMA-measured activity engagement was characterized by daily functioning metrics, including the location, company, and activity in which they engaged. We employed multilevel models to investigate concurrent and time-lagged relationships between pain and activity engagement.

Results: In concurrent models, engagement in physical activities (β = 0.088), time spent with care providers (β = 0.249), and hospitalizations (β = 0.667) or outpatient clinic visits (β = 0.137) were associated with increased pain. In contrast, spending time with coworkers (β = -0.092), friends (β = -0.046), and spouses (β = -0.068) was associated with decreased pain. In time-lagged models, participating in physical activities (β = -0.052) and activities of daily living (ADL; β = -0.038) were associated with reduced subsequent pain, whereas spending time with care providers (β = 0.102) and in hospitals (β = 0.520) were associated with increased subsequent pain.

Conclusion: EMA provides new insights into understanding the impact of activity engagement on post-stroke pain in daily contexts. Strategies promoting social interaction may reduce current pain, and physical activity and ADL participation may reduce subsequent pain.

Objective: Examine the association and temporal relationship between weight-loss and participant characteristics in a sample of community-dwelling adults with acquired brain injury (ABI), including cerebral vascular accident (CVA) and traumatic brain injury (TBI).

Design: Secondary data analysis of a wait-list control assessor-blinded randomized control trial (RCT) and parallel-group assessor-blinded RCT.

Setting: Community-based interventions through in-person and telehealth delivery.

Participants: 69 participants (45 CVA; 24 TBI) with 12-month follow-up assessments.

Interventions: The diabetes prevention program group lifestyle balance (DPP-GLB) program is a theoretically-grounded self-management intervention adapted for people with CVA (GLB-CVA) and TBI (GLB-TBI). Both interventions shared program goals of losing body weight through decreased caloric intake and increased physical activity (150 minutes/week).

Main outcome measures: Assessments for body weight completed at baseline, 3, 6, and 12 months, in addition to a range of biopsychosocial factors (demographic, injury-related, physiological, fitness-related, and self-reported outcomes).

Results: Race and private/public insurance had statistically significant associations with change in weight. Associations between baseline measures, biomarkers, walk scales, self-report outcomes, and corresponding weight change from baseline to 12-months showed a significant association for 6-minute walk test (6MWT). Regression analysis demonstrated variables with a P < .05, including 8-year diabetes risk (8YDR) and 6MWT showed a positive relationship with weight change.

Conclusions: Factors related to racial background and private/public insurance may correspond with weight-loss and further change after injury. Greater body weight associated with higher scores on 6MWT and/or 8YDR emphasize the need to examine associations between dimensions of fitness, diabetes predictors, and GLB outcomes.

Objective: To determine the effect of 12 weeks of twice daily albuterol repetabs on pulmonary function in persons with chronic spinal cord injury.

Design: 12-week prospective, double-blinded, placebo-controlled trial SETTING: Research laboratories PARTICIPANTS: 32 individuals with chronic spinal cord injury INTERVENTION: Albuterol repetabs or placebo, twice daily, for twelve weeks.

Main outcome measure(s): Pulmonary function tests and maximum inspiratory and expiratory pressures RESULTS: Interaction effects were found for expiratory reserve volume and forced expiratory volume. Improvements in the drug group were found for total lung capacity, vital capacity, expiratory reserve volume, and maximal inspiratory pressure. Forced expiratory volume in 1 second did not change in the drug group but trended towards a significant decrease in the placebo group.

Conclusions: 12-weeks of albuterol treatment improved overall pulmonary function and ventilatory muscle strength, compared to placebo, in those living with spinal cord injury.

Objective: To examine the frequency of falls during recovery in older patients with orthopedic conditions in a sub-acute rehabilitation setting and to evaluate the association between mobility and fall risk.

Design: Observational retrospective cohort study.

Setting: Single sub-acute rehabilitation hospital.

Participants: Patients with orthopedic conditions aged ≥65 years admitted between April 1, 2023, and November 30, 2024.

Interventions: Not applicable.

Main outcome measures: Incidence of first fall after admission.

Results: Of the 845 participants, 65 (7.7%) experienced a fall during follow-up (median: 42 days [interquartile range: 23-64 days]). The fall rate per 1,000 person-days increased immediately after admission, peaking at 2.41 during weeks 5-6, then declining. The Cox proportional hazards model assessing the association between mobility and fall risk showed no significant difference based on mobility at admission. However, repeated assessments showed a significantly higher hazard ratio (2.65; 95% confidence interval, 1.16-6.04) during light assistance or supervision, defined as requiring minimal physical contact or supervision by a caregiver, compared with independent status.

Conclusions: Repeated assessments of mobility as a time-dependent exposure factor revealed that fall risk was highest during periods requiring light assistance or supervision and was most frequent during weeks 5-6 of the sub-acute rehabilitation setting. These findings indicate that evaluating mobility only at admission is inadequate for assessing fall risk, underscoring the importance of continuous reassessment throughout the sub-acute rehabilitation.

Objective: To evaluate the scientific evidence on the diagnostic accuracy, reliability, and feasibility of synchronous physiotherapy tele-assessment via videoconferencing compared with in-person evaluation in individual's post-stroke.

Data sources: A systematic search was performed in 5 electronic databases (MEDLINE, Scopus, Web of Science, CINAHL, and Physiotherapy Evidence Database).

Study selection: Studies were eligible if they compared synchronous tele-assessment with in-person physiotherapy evaluation in adult stroke patients, reporting outcomes on diagnostic accuracy, interrater reliability, or feasibility. Seven studies met the inclusion criteria for the systematic review; 6 studies (n=270 stroke patients) provided sufficient data to be included in the meta-analysis.

Data extraction: Two independent reviewers extracted data on study characteristics, outcomes, and assessment tools. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and Quality Appraisal Tool for Studies of Diagnostic Reliability. Discrepancies were resolved through consensus by the research team.

Data synthesis: A random-effects meta-analysis was conducted. Tele-assessment showed strong agreement with in-person evaluation for balance outcomes (Hedges' g=0.03; 95% CI, -0.26 to 0.32; I²=0%). Sensorimotor outcomes demonstrated high heterogeneity (g=-0.02; 95% CI, -0.56 to 0.51; I²=94.2%). Functional capacity showed a small, nonsignificant effect in favor of tele-assessment (g=0.21; 95% CI, -0.76 to 1.18; I²=98.8%).

Conclusions: Synchronous tele-assessment via videoconferencing appears to be a valid, reliable, and feasible alternative to in-person physiotherapy evaluation in stroke patients, particularly for balance assessment. These findings support the integration of tele-assessment protocols into rehabilitation services, especially when face-to-face access is limited. Further studies are needed to standardize protocols and validate their effectiveness across a broader range of functional outcomes.

Objective: This meta-analysis aimed to systematically evaluate the effects of vagus nerve stimulation (VNS) on limb motor function, activities of daily living (ADL), swallowing capacity, and emotional status in patients with stroke.

Data sources: The search was performed in electronic databases EMBASE, Cochrane Library, and PubMed from inception to December 19, 2025.

Study selection: All randomized controlled trials (RCTs) that used VNS plus rehabilitation for stroke were included.

Data extraction: Two researchers independently extracted data after a predeveloped Excel data collection sheet, including basic information, research design, patient demographic characteristics, the intervention details for the experimental group and the control group, time of measurement, and evaluation of relevant results. The risk of bias was evaluated by the risk of bias 2 tool, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for reporting. A random-effects model was used to pool the data from individual studies. Data were analyzed using Stata 18.0 software.

Data synthesis: A total of 16 RCTs involving 819 patients were included. The results showed that patients receiving VNS had significant improvements in Fugl-Meyer Assessment Upper Extremity (FMA-UE) (mean difference=5.00; 95% confidence interval [CI], 2.10-7.89; P<.01) and Wolf Motor Function Test (WMFT) (standard mean difference [SMD]=1.02; 95% CI, 0.39-1.66; P<.01). VNS also exhibited beneficial effects on activity of daily living (SMD=0.91; 95% CI, 0.47-1.34; P<.01) and poststroke depression (SMD=-1.18; 95% CI: -1.91 to -0.44; P<.01).

Conclusions: VNS can significantly improve FMA-UE, WMFT, and ADL in patients with stroke. In addition, VNS demonstrated significant benefits in enhancing the Box and Block Test, Fugl-Meyer Assessment for Lower Limb, and alleviating depressive symptoms. Further large-scale RCTs are warranted to optimize treatment protocols by exploring key parameters.

Determinants of appointment completion in rehabilitative care: The Role of Insurance, Program Structure, and Access Barriers OBJECTIVE: Examine factors predicting healthcare appointment completion at Shepherd Center. Factors included sex, sex, race, ethnicity, geographic location, level of rurality of residence, state of residence, appointment lead time, type of healthcare insurance, patient classification, COVID-19 era, and telehealth as predictors to appointment completion.

Design: Bivariate analyses and binary logistic regressions were conducted on a dataset on patient visits. Data were retrieved from Shepherd Center's patient portals.

Participants: Patients with at least one healthcare appointment at Shepherd Center between March 19, 2020, and February 28, 2025 (N=19,453). Main unit of analysis was healthcare appointments (N=1,105,752).

Main outcome measure: Healthcare appointment completion.

Results: Insurance type and visit department significantly predicted appointment completion. Compared to private, public (B=-0.352), self-pay (B=-0.174), and other insurance types (B=-3.711) were associated with lower odds of completion (p<0.001). Medical visits had increased odds of appointment completion (B=1.301), while occupational therapy (B=-0.953), physical therapy (B=-0.703), speech-language pathology (B=-0.943), and psychology departments (B=-1.025) reduced odds for appointment completion (p<0.001). Telehealth occurred as a positive predictor of appointment completion in early models (B=0.328-0.426, p<0.001). However, when accounting for insurance and departments, it lowered completion odds. Sociodemographic variables did not strongly predict appointment completion (B=-0.962, p<0.001).

Conclusion: While sociodemographic factors were significant predictors of appointment completion, healthcare insurance type and appointment department emerged as the strongest predictors. Financial security and access to healthcare are foundational to patient engagement in rehabilitation settings. To improve appointment completion and promote equitable access to rehabilitation services, healthcare systems must adopt multifaceted strategies that address underlying financial, administrative, and accessibility challenges.

Objective: To determine the minimal detectable change (MDC) of the 10-Meter Walk Test (10MWT) and Timed Up and Go test (TUG) across different stages of Parkinson's disease (PD) severity as classified by the Hoehn & Yahr scale (H&Y).

Design: Cross-sectional observational study with a repeated-measures design. Subjects completed two trials of each test in a single session to assess reliability and MDC95.

Setting: Inpatient neuromodulation center at a general hospital.

Participants: A total of 80 patients with PD admitted to the Center for Neuromodulation, Kurashiki Heisei Hospital, categorized into H&Y stage II (n = 25), III (n = 31), and IV (n = 24).

Interventions: Not applicable.

Main outcome measure(s): The 10MWT and TUG were conducted twice in the "On" medication state. Intraclass correlation coefficients (ICC) and Bland-Altman analyses were used to assess reliability and systematic bias, and MDC95 values were calculated.

Results: Both tests demonstrated high reliability (ICC_1,1 > 0.92. MDC95 values for the 10MWT were 0.7 sec (stage II), 0.9 sec (stage III), and 1.4 sec (stage IV). MDC95 values for the TUG were 0.9 sec (stage II), 1.3 sec (stage III), and 2.7 sec (stage IV), indicating greater variability in advanced stages.

Conclusions: The MDC95 values of 10MWT and TUG increase with PD severity, highlighting the need for stage-specific criteria in clinical assessments. Utilizing severity-specific MDC values may improve the accuracy of treatment evaluations and clinical decision-making in patients with PD.