Archives of physical medicine and rehabilitation最新文献

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: This meta-analysis aims 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 stroke patients DATA SOURCES: The search was performed in electronic databases EMBASE, Cochrane Library, PubMed from inception to December 19, 2025.

Study selection: All RCTs applied VNS plus rehabilitation in stroke were included.

Data extraction: Two researchers independently extracted data following a predeveloped Excel data collection sheet, including basic information, research design, patient demographic characteristic, 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 RoB2 tool, and the PRISMA guidelines were followed for reporting. A random-effects model was employed 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 FMA-UE (MD = 5.00; 95% CI = 2.10 - 7.89; P < 0.01) and WMFT (SMD = 1.02; 95% CI = 0.39 - 1.66; P < 0.01). VNS also exhibited beneficial effects on ADL (SMD=0.91; 95%CI=0.47-1.34; P < 0.01) and post-stroke depression(SMD=-1.18; 95% CI: -1.91∼-0.44; P < 0.01).

Conclusion: VNS can significantly improve FMA-UE, WMFT and ADL in stroke patients. Additionally, VNS demonstrated significant benefits in enhancing BBT, FMA-L and alleviating depressive symptoms. Further large-scale randomized controlled trials are warranted to optimize treatment protocols by exploring key parameters.

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

Data sources: A systematic search was performed in five electronic databases (MEDLINE, Scopus, Web of Science, CINAHL, and PEDro).

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; six 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 QUADAS-2 and QAREL tools. 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, 0.32]; I² = 0%). Sensorimotor outcomes demonstrated high heterogeneity (g = -0.02; 95% CI [-0.56, 0.51]; I² = 94.2%). Functional capacity showed a small, non-significant effect in favor of tele-assessment (g = 0.21; 95% CI [-0.76, 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.

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.

Objectives: To explore potential reference thresholds for individual and group differences in pain research. An additional objective was to examine possible variations in these thresholds across geographic regions and to provide indicative estimates of the sample sizes that may be required to detect given effect sizes at specified levels of statistical power.

Design: Data were exported from 6 key journals in the field of pain.

Setting: Data were collected from 6 journals with the highest H-index according to the Scimago Journal & Country Rank database in the category of Anesthesiology and Pain Medicine.

Participants: In total, 130 meta-analyses were identified, from which 5294 effect size measures were extracted, encompassing a total of 1,071,577 participants.

Interventions: Not applicable.

Main outcome measures: Empirically derived effect size thresholds intended to support more nuanced interpretation of individual and group differences in pain research, with consideration of potential regional variability across populations.

Results: Effect size thresholds were established based on percentiles, with small, medium, and large effects rounded to 0.10, 0.30, and 0.40 for correlations and 0.70 for group differences, respectively. Regional analyses revealed notable geographic variation, with the strongest large effects found in Asia and the weakest across studies conducted in North America.

Conclusions: Researchers may consider using approximate reference values of 0.10, 0.30, and 0.40 for individual differences (Pearson's r) and 0.10, 0.30, and 0.70 for group differences (Cohen's d or Hedges' g) as tentative interpretive guidelines for small, medium, and large effects in pain research, alongside appropriate sample size planning. For studies conducted within relatively homogeneous populations on individual continents, the following exploratory thresholds may be considered: Africa (0.10, 0.40, and 1.00); Asia (0.10, 0.40, and 1.40); Australia (0.20, 0.40, and 0.80); Europe (0.10, 0.30, and 0.70); North America (0.10, 0.20, and 0.50); South America (0.10, 0.40, and 0.80).

Objective: To assess the independent and joint effects of sitting time and moderate-to-vigorous intensity physical activity (MVPA) on mortality in stroke survivors.

Design: Retrospective study of prospective cohort data from the National Health and Nutrition Examination Survey (NHANES) 2007-2018.

Setting: NHANES, a nationally representative U.S. survey that combines in-home interviews and standardized physical examinations conducted in mobile examination centers.

Participants: A total of 1,312 adult stroke survivors were included, representing a weighted population of 6,617,365 individuals. Participants were followed for mortality outcomes through December 31, 2019.

Interventions: Not applicable.

Main outcome measures: All-cause and cardiovascular disease (CVD)-specific mortality ascertained from the National Death Index.

Results: Over a median follow-up of 4.85 years, there were 438 deaths, including 151 due to CVD. Sitting ≥8 h/day was associated with higher risks of all-cause mortality (HR, 1.73; 95% CI, 1.25-2.40) and CVD-specific mortality (HR, 1.97; 95% CI, 1.04-3.74). A statistically significant interaction between sitting time and MVPA was observed for all-cause mortality (P for interaction = 0.006). Participants with both prolonged sitting and <150 min/week of MVPA had significantly increased risks of all-cause mortality (HR, 3.86; 95% CI, 2.20-6.78), compared with stroke survivors who were sufficiently active and reported shorter sitting time (MVPA ≥150 min/week & sitting time <4 h/d). Importantly, the association between prolonged sitting and increased all-cause mortality was observed only among those with insufficient MVPA (HR, 1.04; 95% CI, 1.01-1.07), but not among those who were sufficiently active (HR, 1.00; 95% CI, 0.91-1.10).

Conclusion: This study of U.S. stroke survivors reveals that the combination of insufficient physical activity and prolonged sitting is associated with the highest mortality risk, and sufficient MVPA may attenuate the all-cause mortality risk associated with prolonged sitting.