Archives of physical medicine and rehabilitation最新文献

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 US survey that combines in-home interviews and standardized physical examinations conducted in mobile examination centers.

Participants: A total of 1312 adult stroke survivors were included, representing a weighted population of 6617,365 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 because of CVD. Sitting ≥8 h/d was associated with higher risks of all-cause mortality (hazard ratio [HR], 1.73; 95% confidence interval [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=.006). Participants with both prolonged sitting and <150 min/wk 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 ≥150min/wk and sitting time <4h/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).

Conclusions: This study of US 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.

Objective: To investigate the categories of Mainstream Smart Home technology (MSHT) that are commonly owned by individuals with spinal cord injury and disease (SCI/D), their perceived benefits, and barriers to obtaining or using.

Design: Cross-sectional.

Setting: Spinal Cord Injury (SCI) Model Systems.

Participants: Individuals (N=417) aged ≥18 years enrolled in a participating SCI Model Systems Center between October 2022 and May 2025.

Interventions: Not applicable.

Main outcome measures: Participants were surveyed on 18 categories of MSHT and indicated for each ownership status, perceived benefit of owning (yes, no, and unsure), acquisition method, satisfaction, and barriers to ownership or use.

Results: The median number of MSHT categories owned per participant was 4 (interquartile range, 2-6), with 7 (interquartile range, 3-10) categories perceived as beneficial but not owned. Most devices (88.4%) were acquired through self-pay. Common barriers to ownership were cost (63.6%) and installation difficulty (35.2%). Individuals with greater upper extremity (UE) impairment were significantly more likely to perceive benefit from voice assistants, smart plugs, smart bed controls, and smart televisions. Multivariate logistic regression identified higher education (odds ratio, 1.97; P=.03), higher income (odds ratio, 2.25; P<.01), and greater UE impairment (odds ratio, 1.75; P=.03) as significant predictors for owning ≥4 categories of MSHT.

Conclusion: MSHT was highly valued among individuals with SCI/D, although the rate of ownership of MSHT was low, especially for costlier or more complex devices. Barriers stem largely from affordability and limited support for installation and training. Integrating MSHT training into rehabilitation programs and improving funding, education, and service delivery could enhance access and autonomy for people with SCI/D.

Objective: To explore the trajectories of combined healthy lifestyle index (HLI), and to examine the association between HLI at a single point, HLI trajectories, and new-onset functional disability among middle-aged and older adults.

Design: A longitudinal cohort study. Group-based trajectory modeling and binomial logistic regression analysis were used to explore HLI trajectories and their associations with functional disability.

Setting: Data were obtained from the China Health and Retirement Longitudinal Survey (2011-2020), a nationally representative assessment of community-dwelling middle-aged and older adults spanning 150 counties across 28 provinces.

Participants: A total of 5985 community-dwelling individuals aged ≥45 years were included for cross-sectional analysis, 3213 of whom were women. In addition, 3888 individuals without functional disability at baseline were eligible for the longitudinal analysis.

Interventions: Not applicable.

Main outcome measures: Activities of daily living (ADLs) disability and instrumental activities of daily living (IADLs) disability.

Results: Three distinct HLI trajectories were identified: persistently high-level then declining group (n=742, 19.08%), persistently moderate-level then declining group (n=2416, 62.14%), and persistently low-level group (n=730, 18.78%). In comparison with persistently low-level group, persistently high-level then declining group was associated with a lower risk of ADL disability (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.23-0.67) and IADLs disability (OR, 0.51; 95% CI, 0.36-0.73), whereas persistently moderate-level then declining group only had a lower risk of ADL disability (OR, 0.70; 95% CI, 0.50-1.00).

Conclusions: The healthy lifestyle was stable and not susceptible to prolonged change without external influences. Sustaining the high level of healthy lifestyle benefited functional capacity in middle-aged and older adults. Future research needs to focus on improving the overall lifestyle intervention to maximize the effectiveness of the intervention.

Objective: To investigate the prevalence of chronic lower extremity pain in ambulatory individuals post-stroke, the location of pain with respect to joints and limbs, and how people with and without chronic pain report levels of mobility, functional status, and quality of life.

Design: Cross-sectional survey.

Setting: Outpatient stroke rehabilitation clinic and community-based stroke support groups.

Participants: 122 individuals with a history of stroke, 89 with unilateral weakness. Mean age 64 years; 71.3% White, 19.7% Black.

Interventions: Not applicable.

Main outcome measures: Brief Pain Inventory-Short Form, Functional Ambulation Category, General Practice Activity Questionnaire, Stroke Impact Scale-Mobility and Participation Subsections, Patient Health Questionnaire-9.

Results: Chronic lower extremity pain was more prevalent on the paretic side (hip: 19.1% vs. 6.7%, p<0.01; knee: 21.3% vs. 9.0%, p=0.01; foot: 20.2% vs. 7.9%, p<0.01). Participants with chronic pain had significantly lower Stroke Impact Scale scores for mobility (62.5 vs. 77.8, p<0.01) and participation (53.0 vs. 69.3, p<0.01), lower estimated recovery (52.5% vs. 65.3%, p<0.01), slower perceptions of gait speed (67.6% slow vs. 33.3%, p<0.01), and increased use of assistive devices (49.3% vs. 21.6%, p<0.01).

Conclusions: Chronic lower extremity pain is associated with poorer perceptions of functional outcomes in ambulatory stroke survivors. Pain is more prevalent on the paretic side and is significantly associated with lower perceived mobility, participation in physical activity, and recovery. Comprehensive pain assessment and management should be prioritized in post-stroke rehabilitation.

Parkinson's disease (PD) is a neurological disorder that Veteran populations are at a disproportionately higher risk for developing compared to the general population. There is a growing appreciation of the efficacy of nonpharmacological intervention for both motor and nonmotor symptoms of PD, particularly the relationship between rehabilitation interventions and positive outcomes. PD care by a multidisciplinary team (MDT) in particular can enhance outcomes and improve quality of life throughout the PD journey. To date, the literature is replete with guidelines and considerations for MDT PD care, but very few papers describe how an established integrated program functions. This paper describes an expanded, rehabilitation-focused MDT caring for Veterans with PD at the Minneapolis Veterans Affairs Healthcare System (MVAHCS). The Parkinson's disease and movement disorders program at MVAHCS uniquely provides neurorehabilitation-focused care via a lifelong, shared care model between neurology and rehabilitation medicine, with consultation to neurosurgery as indicated. The MDT at MVAHCS is further enhanced by referrals to specialized, neuro-based rehabilitation therapies (physical, occupational, and speech therapy) and other ancillary services (geropsychiatry, rehabilitation psychology, social work) and programs (Caregiver Support Program, Comprehensive Pain Center). Conclusions: This network of disciplines and providers maximize the Veteran's quality of life through a cohesive, integrated, team approach.

Objective: To investigate neural plasticity changes in patients with subacute stroke during single motor task and dual-task execution.

Design: Case-control study.

Setting: Rehabilitation department in a single hospital.

Participants: Twenty patients with subacute stroke (mean age, 63.8±10.4y; Mini-Mental State Examination score >20) and 20 age- and sex-matched healthy controls (mean age, 60.95±9.5y) recruited via convenience sampling.

Interventions: Not applicable.

Main outcome measure(s): A functional near-infrared spectroscopy (fNIRS) system was used to evaluate hemodynamic responses in prefrontal, motor, and occipital regions during single motor task and motor-cognitive dual-task conditions, and functional connectivity (FC) was calculated for each task state.

Results: Healthy controls showed widespread activation increases during dual-task versus single motor task (P<.05), whereas patients with stroke exhibited enhanced activation only in ipsilesional prefrontal cortex (P=.041) and contralesional supplementary motor area (P=.045). Controls demonstrated significantly higher sensorimotor activation than patients with stroke during dual-task (P=.001). FC analysis revealed increased prefrontal-premotor connectivity in controls (P=.027), whereas patients with stroke showed enhanced bilateral prefrontal (P=.032), premotor (P=.034), and occipital (P=.043) connectivity. In patients with stroke, premotor area activation is negatively correlated with pace (ρ=-0.53, P=.025), heel-strike angle (ρ=-0.73, P=.029), and swing phase (ρ=-0.56, P=.015), but positively with support phase (ρ=0.56, P=.015).

Conclusion: This study confirms that motor-cognitive dual task paradigms effectively induce activation in the ipsilesional cortex of patients with stroke while enhancing interhemispheric FC, demonstrating significant neuromodulatory effects of dual-task training in stroke rehabilitation; simultaneously, it validates the feasibility of utilizing fNIRS combined with motor paradigms for real-time assessment of neuroplasticity changes.

Objective: To increase our understanding of the transition experiences and care gaps of young adults with cerebral palsy (CP) who recently transitioned to adult-based care.

Design: Qualitative descriptive study using semistructured interviews.

Setting: Adult-based CP specialty clinic.

Participants: Eligible adults with CP were between the ages of 18 and 40 years, English speaking, and seen in the adult CP clinic at least once. Caregivers were eligible if they were the primary support person for an adult with CP who met study criteria and were English speaking. Participants were purposefully sampled to promote diversity of demographic background and level of functional mobility. The total number of participants in our study was N=27.

Interventions: Not applicable.

Main outcome measures: Themes associated with participants' transition and care gap experiences.

Results: Of the 21 interviews completed, there were 7 adult with CP interviews, 9 caregiver interviews (1 with 2 caregivers), and 5 dyadic interviews with both adult with CP and caregiver (27 participants total). Adults with CP who participated or were represented by their caregiver(s) (N=21) ranged between 20 and 37 years old with relatively equal men and women, as well as functional level, representation. This included 6 participants who identified as non-White (29%), 5 who identified as Hispanic (24%), and 2 from rural communities (10%). We identified 4 major themes related to transition and care gap experiences (1) the value of transition preparation and discussion; (2) the need for supportive, coordinated care; (3) struggling through gaps in care during the transition; and (4) the importance of and challenges to ensuring lifespan care.

Conclusions: Young adults with CP face complex challenges in the transition to adulthood, including inadequate preparation and a lack of adult-based services to meet their needs. Adults with CP who have successfully established adult-based CP care and their caregivers value support in transferring to adult care and access to CP-specific care throughout the lifespan.