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Response to Letter to the Editor: Rehabilitation of Social Communication Skills in Patients With Acquired Brain Injury With Intensive and Standard Group Interactive Structured Treatment: A Randomized Controlled Trial 对 "通过强化和标准小组互动结构化治疗康复后天性脑损伤患者的社交沟通技能:随机对照试验"。
IF 3.6 2区 医学 Q1 REHABILITATION Pub Date : 2025-01-01 DOI: 10.1016/j.apmr.2024.09.009
Silje Merethe Hansen Ingebretsen PhD, Melanie Kirmess PhD, Jan Stubberud PhD
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引用次数: 0
Should You Tell Others That You Live With Brain Injury? Things to Consider About Brain Injury and Disclosure 您是否应该告诉他人您患有脑损伤?关于脑损伤和信息披露的注意事项。
IF 3.6 2区 医学 Q1 REHABILITATION Pub Date : 2025-01-01 DOI: 10.1016/j.apmr.2024.09.018
Lisa Engel PhD, MSc OS/OT, Wendy Waldman BSW, CBIST, Laurie Rippon MA Ed, HD, Elaheh Keshavarz MSc Rehab
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引用次数: 0
Archives Supplements
IF 3.6 2区 医学 Q1 REHABILITATION Pub Date : 2025-01-01 DOI: 10.1016/S0003-9993(24)01392-3
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引用次数: 0
Effects of Exercise Therapy in Axial Spondyloarthritis: A Systematic Review, Meta-analysis, and Meta-regression of Randomized Trials 运动疗法对轴向脊柱关节炎的影响:随机试验的系统回顾、荟萃分析和荟萃回归。
IF 3.6 2区 医学 Q1 REHABILITATION Pub Date : 2025-01-01 DOI: 10.1016/j.apmr.2024.06.005
Meng Zhang PhD , Zhide Liang MD , Liang Tian MD , Yaqi Han MD , Xu Jiang , Yali Li , Zhaoxi Su MD , Tao Liu PhD

Objective

This study aimed to assess the effectiveness of exercise therapy for patients with axial spondyloarthritis (axSpA).

Data Sources

We searched MEDLINE (via PubMed), Cochrane Library, Embase, Web of Science, Scopus, and SPORTDiscus for all relevant publications from database inception to March 2024, without language restriction.

Study Selection

We included randomized controlled trials (RCTs) of patients with axSpA in which ≥1 group received exercise therapy.

Data Extraction

Two independent reviewers assessed the quality of the literature using the Cochrane Collaboration Risk of Bias Tool 2.0. The outcomes were ankylosing spondylitis (AS) disease activity score (ASDAS), Bath AS disease activity index (BASDAI), Bath AS functional index (BASFI), Bath AS metrology index (BASMI), 6-minute walk test (6MWT), chest expansion capacity, peak oxygen consumption (VO2peak), pain, fatigue, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR).

Data Synthesis

A total of 20 RCTs, including 1670 patients, were included in this study. Compared with the control group, exercise therapy improved BASFI (weighted mean difference [WMD], −0.49; 95% confidence interval [CI], −0.65 to −0.32; I2=3.4%; P=.414), BASMI (WMD, −0.49; 95% CI, −0.87 to −0.11; I2=71.9%; P=.679), BASDAI (WMD, −0.78; 95% CI, −1.08 to −0.47; I2=55.9%; P=.021), ASDAS (WMD, −0.44; 95% CI, −0.64 to −0.24; I2=0.0%; P=.424), VO2peak (WMD, 3.16; 95% CI, 1.37-4.94; I2=0.0%; P=.873), 6MWT (WMD, 27.64; 95% CI, 12.04-43.24; I2=0.0%, P=.922), pain (standardized mean difference [SMD], −0.47; 95% CI, −0.74 to −0.21; I2=66.0%, P=.046), and fatigue (SMD, −0.49; 95% CI, −0.71 to −0.27; I2=0.0%; P=.446). However, no significant benefit was found in chest expansion, CRP, and ESR outcomes.

Conclusions

Exercise therapy is an effective strategy for improving disease control and symptom relief in patients with axSpA.
研究目的本研究旨在评估轴性脊柱关节炎(axSpA)患者运动疗法的有效性:从数据库建立之初到 2024 年 3 月,我们检索了 PubMed(通过 Medline)、Cochrane Library、Embase、Web of Science、Scopus 和 SPORTDiscus 的所有相关出版物,没有任何语言限制:我们纳入了针对axSpA患者的随机对照试验(RCT),其中至少有一组接受了运动疗法:两名独立审稿人使用 Cochrane 协作偏倚风险工具 2.0 评估了文献质量。研究结果包括强直性脊柱炎(AS)疾病活动度评分(ASDAS)、巴斯强直性脊柱炎疾病活动度指数(BASDAI)、巴斯强直性脊柱炎功能指数(BASFI)、巴斯强直性脊柱炎计量指数(BASMI)、6分钟步行距离(6MWT)、胸廓扩张能力、峰值耗氧量(VO2peak)、疼痛、疲劳、C反应蛋白(CRP)和血沉(ESR):本研究共纳入了 20 项 RCT,包括 1,670 名患者。与对照组相比,运动疗法改善了 BASFI(加权平均差 [WMD]:-0.49,95% 置信区间 [CI]:-0.65 至 -0.32,I2= 3.4%,P=0.414), BASMI (WMD: -0.49, 95% CI: -0.87 to -0.11, I2= 71.9%, P=0.679), BASDAI (WMD: -0.78, 95% CI: -1.08, -0.47, I2=55.9%, P=0.021), ASDAS (WMD: -0.44, 95% CI: -0.64至-0.24,I2=0.0%,P=0.424)、VO2peak(WMD:3.16,95% CI:1.37至4.94,I2=0.0%,P=0.873)、6MWT(WMD:27.64,95% CI:12.04至43.24,I2=0.0%,P=0.922)、疼痛(标准化平均差 [SMD]:-0.47,95% CI:-0.74 至 -0.21,I2= 66.0%,P=0.046)和疲劳(SMD:-0.49,95% CI:-0.71 至 -0.27,I2= 0.0%,P=0.446)。然而,在胸廓扩张、CRP和ESR结果方面没有发现明显的益处:运动疗法是改善axSpA患者疾病控制和症状缓解的有效策略。
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引用次数: 0
Does Terminology Matter? Perspectives From People With Limb Difference, Clinicians, and Researchers 术语是否重要?肢体残障人士、临床医生和研究人员的观点。
IF 3.6 2区 医学 Q1 REHABILITATION Pub Date : 2025-01-01 DOI: 10.1016/j.apmr.2024.07.019
M.G. Finco PhD, CPO, MS , Cody L. McDonald PhD, CPO, MPH , Sarah C. Moudy PhD, MSc

Objective

To elicit the preferred terminology among people with limb difference as well as health care and/or research professionals.

Design

Cross-sectional survey.

Setting

Online.

Participants

A convenience sample of N=122 individuals (people with limb difference, n=65; health care and/or research professionals, n=57) completed an online survey. People were included if they (1) were aged ≥18 years; (2) self-identified as having limb difference (regardless of etiology) or as a health care or research professional (with experience working with people with limb difference); and (3) lived in the United States for most of the time in their selected role.

Interventions

Not applicable.

Main Outcome Measures

Importance of terminology, preference toward person-first or identity-first terms, preferred terms, and individual perspectives on terminology preferences.

Results

Most participants identified as White (92.6%). Age significantly differed between groups (people with limb difference, 49.9±15.4y; professionals, 41.0±14.3y; P=.001). Approximately 50% of people with limb difference stated terminology was very or extremely important, compared to 70% of professionals (χ2=16.6, P=.002). While 73.7% of professionals reported a preference for person-first terminology, the sample of people with limb difference were more evenly split, as 42.9% reported a preference for identity-first terminology and 50.8% reported a preference for person-first terminology. The most frequently selected limb and population terms, respectively, were residual limb and individual/person with limb difference; however, many people with limb difference indicated they preferred “amputee” when speaking about a population.

Conclusions

Most of the participants indicated terminology was very or extremely important, and both groups tended to prefer the terms residual limb (limb term) and individual/person with limb difference (population term). However, this study was not intended to recommend terminology, but rather help inform terminology choices that are centered around people with limb difference. Individuality and context should be considered when deciding terminology. Future studies should include more participants from racially/ethnically minoritized groups and people with limb difference who have dysvascular and/or congenital etiologies.
目的了解肢体残障人士以及医疗保健和/或研究专业人员的首选术语:横断面调查:参与者方便抽样调查:122 人(肢体残障人士 65 人;医疗保健和/或研究专业人员 57 人)完成了在线调查。参与调查的人员必须具备以下条件1)年满 18 周岁;2)自我认定为肢体残障人士(无论病因)或医疗保健或研究专业人士(具有与肢体残障人士打交道的经验);3)在所选角色的大部分时间内居住在美国:不适用 主要结果测量指标:术语的重要性、对 "个人优先 "或 "身份优先 "术语的偏好、首选术语以及个人对术语偏好的看法:大多数参与者为白人(92.6%)。各组之间的年龄存在明显差异(肢体残障人士=49.9 ± 15.4;专业人士=41.0 ± 14.3;P=0.001)。与肢体残障者(约 30%)相比,较少专业人士(5.3%)表示术语对他们来说稍微重要或根本不重要(χ2=16.6,p=0.002)。73.7%的专业人士表示偏好 "以人为本 "的术语,而肢体残障人士的样本则较为平均,42.9%的人表示偏好 "身份第一 "的术语,50.8%的人表示偏好 "以人为本 "的术语。最常选择的肢体和人群术语分别是残肢和个人/肢体残缺者,但许多肢体残缺者表示,在谈论人群时,他们更喜欢 "截肢者":结论:大多数参与者表示术语非常重要或极其重要,两个群体都倾向于使用残肢(肢体术语)和肢体残缺者(人群术语)。然而,本研究并不打算推荐术语,而是帮助人们选择以肢体残缺者为中心的术语。在决定术语时,应考虑到个体性和背景。未来的研究应包括更多来自少数种族/族裔群体的参与者,以及有血管障碍和/或先天性病因的肢体差异患者。
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引用次数: 0
Model of Care for Chronic Brain Injury 慢性脑损伤护理模式。
IF 3.6 2区 医学 Q1 REHABILITATION Pub Date : 2025-01-01 DOI: 10.1016/j.apmr.2024.08.001
John D. Corrigan PhD , Flora M. Hammond MD , Angelle M. Sander PhD , Kurt Kroenke MD
There is growing evidence that long-term outcomes after traumatic brain injury (TBI) are more dynamic than stable. People continue to change, both improving and declining, many years postinjury. Research, practice, and medical education have not yet fully embraced the implications of TBI as a chronic, dynamic condition. In 2020, the National Institute on Disability Independent Living and Rehabilitation Research funded the BeHEALTHY project to develop a model for long-term support of persons with chronic brain injury. Based on initial reviews of the available evidence and expert input from researchers, clinicians, and persons with lived experience, the BeHEALTHY model was proposed. Among existing chronic disease treatment models, Wagner's Chronic Care Model was selected as a starting point, with several critical refinements. The BeHEALTHY model endorses a person-centered approach, recognizing the individual with brain injury, and their social support system, as the primary source of goals in care planning. The model also acknowledges the critical importance of self-management and the need for health care programs to actively promote self-direction by the person using their social supports. The model also recognizes that outcomes are not determined solely by the person and the injury incurred but also by the environment in which a person lives and recovers. The importance of integrating health care with community resources is underscored by embracing environmental influences as a shared responsibility of the community and the health care system. This article recounts the impetus for developing the BeHEALTHY model and describes those it is intended to serve and its structural features and core components.
越来越多的证据表明,创伤性脑损伤(TBI)后的长期疗效与其说是稳定的,不如说是动态的。人在受伤后多年仍在不断变化,既有改善,也有衰退。研究、实践和医学教育尚未充分认识到创伤性脑损伤是一种慢性、动态的疾病。2020 年,美国国家残疾人独立生活和康复研究所资助了 BeHEALTHY 项目,以开发一种为慢性脑损伤患者提供长期支持的模式。根据对现有证据的初步审查以及来自研究人员、临床医生和有生活经验者的专家意见,提出了 BeHEALTHY 模式。在现有的慢性病治疗模式中,我们选择了瓦格纳的慢性病护理模式作为起点,并对其进行了一些重要的改进。BeHEALTHY 模式支持以人为本的方法,承认脑损伤患者及其社会支持系统是护理规划目标的主要来源。该模式还承认自我管理的极端重要性,以及医疗保健计划需要积极促进患者利用其社会支持进行自我指导。该模式还认识到,治疗效果不仅取决于患者本人和所受的伤害,还取决于患者的生活和康复环境。将环境影响作为社区和医疗保健系统的共同责任,强调了将医疗保健与社区资源相结合的重要性。本文叙述了开发 BeHEALTHY 模式的动机,并介绍了该模式的服务对象、结构特征和核心组成部分。
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引用次数: 0
A Directed Content Analysis for Greatest Problems Among People With and Without Traumatic Brain Injury 针对脑损伤患者和非脑损伤患者最大问题的定向内容分析。
IF 3.6 2区 医学 Q1 REHABILITATION Pub Date : 2025-01-01 DOI: 10.1016/j.apmr.2024.08.008
Emily Dudek BS , Michael W. Williams PhD , Chung Lin (Novelle) Kew PhD , Annalyn DeMello PhD, MPH, RN , Brittany Wright PhD , Alexandra B. Holland LMSW , Alyssa Day-Gorman MA , Alexa S. Gonzalez MS , Luis Leon Novelo PhD , Xiangyi Liu MS , Shannon B. Juengst PhD, CRC

Objective

To characterize the greatest problem or need among individuals with a history of traumatic brain injury (TBI), as compared with individuals with a history of other neurologic conditions, mental health conditions, and no history of neurologic or mental health conditions.

Design

A directed content analysis of open-text responses to a single online survey question using a framework guided by the Mayo-Portland Adaptability Inventory-4.

Setting

Community.

Participants

A total of 2861 community-dwelling adults (n=274 with TBI; n=289 with other neurologic conditions besides TBI; n=454 with mental health conditions but no neurologic conditions; and n=1844 controls).

Interventions

Not applicable.

Main Outcome Measures

Open-text responses to the survey prompt: “What was your greatest problem or need over the past 2 weeks?

Results

The Participation index comprised the greatest proportion of responses across all 4 participant groups. A quarter (25.4%) of controls reported None (no problem/need), whereas only 7.9%-10.7% of participants in all other groups reported None. Among all groups, individuals with TBI reported the greatest proportion of problems in the Adjustment and Ability indices. Among people with TBI, Money Management (19.7%), None (10.6%), and Anxiety (7.7%) were the 3 most frequently reported problems. Compared with individuals with mild TBI (mTBI), individuals with moderate-to-severe TBI (msTBI) reported a higher proportion of problems in the Ability and Adjustment indices. Among individuals with msTBI, the Adjustment index accounted for the greatest proportion of problems.

Conclusions

This study employed a person-centered approach to understanding the greatest needs among individuals with TBI. Qualitative differences were observed between individuals with and without TBI, between people with mTBI and msTBI, and across genders among people with TBI. These findings can help guide research and policy toward addressing challenges perceived as highly important by people living in the community with TBI.
目标:将有脑外伤(TBI)病史的人与有其他神经系统病史、精神健康病史以及无神经系统病史或精神健康病史的人进行比较,找出他们最大的问题或需求:设计:采用 Mayo-Portland Adaptability Inventory-4 框架,对单个在线调查问题的开放文本回复进行定向内容分析:参与者:2861 名居住在社区的成年人(n = 274 名患有创伤性脑损伤;n = 289 名患有创伤性脑损伤以外的其他神经系统疾病;n = 454 名患有精神疾病但无神经系统疾病;n = 1844 名对照组):主要结果测量:对调查提示的开放文本回答:"结果:"在过去两周内,您最大的问题或需求是什么?在所有四个参与者组别中,参与指数所占比例最大。四分之一(25.4%)的对照组参与者表示 "无"(没有问题/需求),而所有其他组别中仅有 7.9 -10.7% 的参与者表示 "无"。在所有组别中,患有创伤性脑损伤的人在适应和能力指数中报告的问题比例最高。在有创伤性脑损伤的人中,"理财"(19.7%)、"无"(10.6%)和 "焦虑"(7.7%)是最常报告的三个问题。与轻度创伤性脑损伤(mTBI)患者相比,中重度创伤性脑损伤(msTBI)患者在能力指数和适应指数中报告的问题比例更高。在msTBI患者中,适应指数所占的问题比例最大:本研究采用了以人为本的方法来了解创伤性脑损伤患者的最大需求。在患有和未患有创伤性脑损伤的个体之间、患有 mTBI 和 msTBI 的个体之间,以及不同性别的创伤性脑损伤患者之间,都观察到了质的差异。这些发现有助于指导研究和政策,以应对生活在社区中的创伤性脑损伤患者认为非常重要的挑战。
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引用次数: 0
Mixed-Method Evaluation to Understand Clinician Perspectives of a Program to Implement High-Intensity Resistance Rehabilitation Into Skilled Nursing Facilities 通过混合方法评估了解临床医生对在专业护理机构实施高强度阻力康复计划的看法。
IF 3.6 2区 医学 Q1 REHABILITATION Pub Date : 2025-01-01 DOI: 10.1016/j.apmr.2024.09.006
Lauren A. Hinrichs-Kinney PT, DPT, PhD, OCS , Janell Pisegna PhD, OTR/L, CSRS , Mattie E. Pontiff PT, DPT, PhD, OCS , Emma H. Beisheim-Ryan PT, DPT, PhD , Rebecca Altic PT, DPT , Heather Coats PhD, APRN-BC , Jennifer E. Stevens-Lapsley PT, PhD, FAPTA

Objective

To assess rehabilitation clinicians’ viewpoints regarding a multicomponent implementation program aimed at promoting high-intensity resistance rehabilitation (HIR), as well as practical implications for its use in skilled nursing facility (SNF) rehabilitation.

Design

Prospective convergent mixed-method design.

Setting

Eight rural SNFs within the Department of Veterans Affairs.

Participants

Physical rehabilitation clinicians (physical and occupational therapists, physical and occupational therapy assistants, recreational therapists, and kinesiotherapists) who engaged with the implementation program (n=38).

Interventions

Clinicians engaged with the multicomponent implementation program to promote the use of HIR in clinical practice. The program components included clinician training (i.e., virtual didactic modules with synchronous case discussions), provision of resources (e.g., equipment, job aids), and facilitated implementation (e.g., external implementation facilitator support, distributed tips and tricks).

Main Outcome Measures

Acceptability of Intervention Measure, Training Acceptability Rating Scale, study-specific questionnaires, and qualitative focus groups exploring perceived acceptability, feasibility, and effect on work experience.

Results

Questionnaires revealed high levels of implementation program acceptability and perceived effect, alongside moderate levels of feasibility. Focus group themes supported these findings, explaining high acceptability and effect through differentiation from other trainings and prolonged engagement. Feasibility results were explained qualitatively by facilitatory factors (i.e., team participation, reduced caseloads, training characteristics) and inhibitory factors (i.e., training timing, self-paced scheduling logistics, lack of protected time and space). There was no reported negative effect on clinician work experience.

Conclusions

According to SNF clinician perspectives, a positive HIR implementation experience may be enhanced through implementation programs that provide prolonged engagement and a self-paced structure with built-in accountability. Leadership and organizational support appear important to protect time and space for clinicians who experience competing priorities to successfully facilitate evidence uptake. Future work can evaluate the applicability across various contexts beyond rural VA SNFs.
目的:评估康复临床医生对旨在促进高强度阻力康复(HIR)的多组分实施计划的看法,以及该计划在加护病房(SNF)中使用的实际意义:评估康复临床医生对旨在促进高强度阻力康复(HIR)的多组分实施计划的观点,以及在专业护理机构(SNF)康复中使用该计划的实际意义:设计:前瞻性聚合混合方法设计:环境:退伍军人事务部下属的八家农村专业护理机构:参与实施计划的物理康复临床医生(物理和职业治疗师、物理和职业治疗助理、娱乐治疗师和运动治疗师)(38 人):干预措施: 临床医生参与多成分实施计划,以促进在临床实践中使用 HIR。项目内容包括临床医师培训(即虚拟教学模块与同步病例讨论)、资源提供(如设备、工作辅助工具)和促进实施(如外部实施促进者支持、分发提示和技巧):主要结果测量指标:干预措施可接受性测量、培训可接受性评分量表、特定研究问卷,以及探讨可接受性、影响、可行性和对工作经验的影响的定性焦点小组:调查问卷显示,实施计划的可接受性和可感知的影响程度较高,可行性也处于中等水平。焦点小组的主题支持这些结果,通过与其他培训的差异化和长期参与解释了高可接受性和影响。促进因素(即团队参与、工作量减少、培训特点)和抑制因素(即培训时间、自定进度的后勤安排、缺乏受保护的时间和空间)从质量上解释了可行性结果。没有报告称培训对临床医生的工作经验产生负面影响:根据 SNF 临床医生的观点,通过提供长期参与和自定进度结构以及内置问责制的实施计划,可以增强积极的 HIR 实施体验。领导和组织的支持对于保护临床医生的时间和空间似乎很重要,因为临床医生在成功促进证据吸收的过程中会遇到相互竞争的优先事项。未来的工作可以评估在农村退伍军人社区医疗机构以外的各种环境中的适用性。
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引用次数: 0
Influence of Aerobic Exercise on Functional Capacity and Maximal Oxygen Uptake in Patients With Parkinson Disease: A Systematic Review and Meta-analysis 有氧运动对帕金森病患者功能能力和最大摄氧量的影响:系统回顾和荟萃分析。
IF 3.6 2区 医学 Q1 REHABILITATION Pub Date : 2025-01-01 DOI: 10.1016/j.apmr.2024.09.013
Ricardo Augusto Barbieri PhD , Fabio Augusto Barbieri PhD , Nicolle Zelada-Astudillo MSc , Vinicius Christianini Moreno MSc , Carlos Augusto Kalva-Filho PhD , Antonio Roberto Zamunér PhD

Objective

To determine the effects of aerobic training in randomized controlled clinical trials on functional capacity, motor symptoms, and oxygen consumption in individuals with Parkinson disease (PD) through a systematic literature review and meta-analysis.

Data Sources

PUBMED, Web of Science, CINAHL, SciELO, and Medline databases were searched to identify published studies until September 2023.

Study Selection

Randomized controlled clinical trials that evaluated the long-term effect of aerobic exercise in individuals with PD were included.

Data Extraction

Two independent reviewers extracted the data and assessed the risk of bias and the Grading of Recommendation Assessment, Development, and Evaluation. In case of disagreement, a third reviewer was consulted.

Data Synthesis

Thirteen studies were included in the systematic review, and the number of participants was 588 with an average age of 66.2 years (57-73y). The study's exercise intervention lasted between 6 and 70 weeks, with most studies lasting 10-12 weeks, with 3 sessions per week and an average duration of 47 minutes per session. The meta-analysis revealed that aerobic exercise is effective in enhancing maximal oxygen uptake (standardized mean difference, SMD 0.42 [95% CI, 0.18, 0.66; P=.0007]) and functional capacity (SMD 0.48 [95% CI, 0.24−0.71; P<.0001]). In addition, aerobic exercise can reduce the motor-unified Parkinson disease rating scale (mean difference−2.48 [95% CI, −3.16 to −1.81; P<.00001]) score in individuals with PD.

Conclusions

Aerobic exercise training conducted 2-3 times a week, with different intensities (low to high), can be an effective intervention for enhancing functional capacity, maximizing oxygen uptake, and reducing the UPDRS scores in individuals with PD.
目的:通过系统性文献综述和荟萃分析,确定随机对照临床试验中的有氧训练对帕金森病患者的功能能力、运动症状和耗氧量的影响:检索了 PUBMED、Web of Science、CINAHL、SciELO 和 Medline 数据库,以确定截至 2023 年 9 月已发表的研究:研究选择:纳入评估有氧运动对帕金森病患者长期影响的随机对照临床试验:两名独立审稿人提取数据,评估偏倚风险和推荐评估、发展和评价分级(GRADE)。数据综合:13 项研究被纳入系统综述,参与者人数为 588 人,平均年龄为 66.2 岁(57 至 73 岁)。研究的运动干预持续时间为 6 至 70 周,大多数研究持续时间为 10 至 12 周,每周三次,每次平均持续时间为 47 分钟。荟萃分析显示,有氧运动能有效提高最大摄氧量(SMD 0.42 [CI95% = 0.18, 0.66; p = 0.0007])和功能能力(SMD 0.48 [CI95% = 0.24-0.71; p < 0.0001])。此外,有氧运动还能降低帕金森病患者的UPDRS III评分(平均差-2.48 [CI95% = -3.16,-1.81;p < 0.00001]):结论:每周进行2至3次不同强度(从低到高)的有氧运动训练可有效提高帕金森病(PD)患者的功能能力,最大限度地提高摄氧量,并降低UPDRS评分。
{"title":"Influence of Aerobic Exercise on Functional Capacity and Maximal Oxygen Uptake in Patients With Parkinson Disease: A Systematic Review and Meta-analysis","authors":"Ricardo Augusto Barbieri PhD ,&nbsp;Fabio Augusto Barbieri PhD ,&nbsp;Nicolle Zelada-Astudillo MSc ,&nbsp;Vinicius Christianini Moreno MSc ,&nbsp;Carlos Augusto Kalva-Filho PhD ,&nbsp;Antonio Roberto Zamunér PhD","doi":"10.1016/j.apmr.2024.09.013","DOIUrl":"10.1016/j.apmr.2024.09.013","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the effects of aerobic training in randomized controlled clinical trials on functional capacity, motor symptoms, and oxygen consumption in individuals with Parkinson disease (PD) through a systematic literature review and meta-analysis.</div></div><div><h3>Data Sources</h3><div>PUBMED, Web of Science, CINAHL, SciELO, and Medline databases were searched to identify published studies until September 2023.</div></div><div><h3>Study Selection</h3><div>Randomized controlled clinical trials that evaluated the long-term effect of aerobic exercise in individuals with PD were included.</div></div><div><h3>Data Extraction</h3><div>Two independent reviewers extracted the data and assessed the risk of bias and the Grading of Recommendation Assessment, Development, and Evaluation. In case of disagreement, a third reviewer was consulted.</div></div><div><h3>Data Synthesis</h3><div>Thirteen studies were included in the systematic review, and the number of participants was 588 with an average age of 66.2 years (57-73y). The study's exercise intervention lasted between 6 and 70 weeks, with most studies lasting 10-12 weeks, with 3 sessions per week and an average duration of 47 minutes per session. The meta-analysis revealed that aerobic exercise is effective in enhancing maximal oxygen uptake (standardized mean difference, SMD 0.42 [95% CI, 0.18, 0.66; <em>P</em>=.0007]) and functional capacity (SMD 0.48 [95% CI, 0.24−0.71; <em>P&lt;</em>.0001]). In addition, aerobic exercise can reduce the motor-unified Parkinson disease rating scale (mean difference−2.48 [95% CI, −3.16 to −1.81; <em>P&lt;</em>.00001]) score in individuals with PD.</div></div><div><h3>Conclusions</h3><div>Aerobic exercise training conducted 2-3 times a week, with different intensities (low to high), can be an effective intervention for enhancing functional capacity, maximizing oxygen uptake, and reducing the UPDRS scores in individuals with PD.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 1","pages":"Pages 134-144"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387471","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
Individualized Versus General Exercise Therapy in People With Subacromial Pain Syndrome: A Randomized Controlled Trial 肩峰下疼痛综合征患者的个性化运动疗法与普通运动疗法:随机对照试验
IF 3.6 2区 医学 Q1 REHABILITATION Pub Date : 2025-01-01 DOI: 10.1016/j.apmr.2024.08.027
Ghazaleh Momeni MSc , Abbas Tabatabaei PhD , Mehrnaz Kajbafvala PhD , Morteza Nakhaei Amroodi , Lincoln Blandford MRes

Objective

To evaluate the effect of individualized exercises based on movement fault (MF) control on pain intensity, and disability in subjects with chronic subacromial pain syndrome (SAPS).

Design

Randomized controlled trial.

Setting

Rehabilitation clinics.

Participants

Thirty-eight participants with chronic SAPS (mean [SD] age, 52.23 (8.47); 60 % women).

Interventions

The participants were randomly allocated to 1 of the intervention groups (individualized exercises based on MFs control test designed to target specific movement faults) or the control group (commonly prescribed general scapular stabilization exercises). Both groups received exercise sessions twice a week for 4 weeks.

Main Outcome Measures

The primary outcome measures were pain intensity at rest (PR) and during arm raising (PAR) using a visual analog scale. Disability was assessed as a key secondary outcome, including the disabilities of the arm, shoulder, and hand (DASH) questionnaire and the Shoulder Pain and Disability Index (SPADI).

Results

Following completion of all exercise sessions, PAR was significantly lower in the intervention group compared to the control group (mean, 9.17; 95% confidence interval; 0.31-18.03; P=.04), with a large effect size (0.68). The reduction of PAR remained significantly lower in the intervention group than in the control group after 4 months of follow-up (mean, 18.29; 95% confidence intervals [CI], 9.09-27.48; P<.00) with a large effect size (1.27). Disability significantly decreased at 2-month (mean, 14.58, P=.002 on SPADI index; mean, 10.26, P=.006 on DASH index) and 4-month (mean, 19.85, P<.001 on SPADI index; mean, 12.09, P=.001 on DASH index) follow-ups in the intervention group compared to the control group.

Conclusion

Individualized exercises based on MFs control of the shoulder region was accompanied by decreased PAR and disability in subjects with SAPS.
目的评估基于运动过失(MF)控制的个性化锻炼对慢性肩峰下疼痛综合征(SAPS)患者疼痛强度和残疾程度的影响:随机对照试验(IRCT20221126056621N1):参与者:38名慢性SAPS患者(年龄52.23(8.47)岁,女性占60%):参与者被随机分配到干预组(根据 MFs 控制测试设计的针对特定运动障碍的个性化练习)或对照组(常用的一般肩胛骨稳定练习)。两组均接受每周两次、为期四周的锻炼:主要结果测量:采用视觉模拟量表测量休息时(PR)和举臂时(PAR)的疼痛强度。残疾评估是主要的次要结果,包括手臂、肩部和手部残疾(DASH)问卷和肩部疼痛与残疾指数(SPADI):结果:完成所有锻炼课程后,干预组的 PAR 明显低于对照组(平均值 [CI]:9.17 [0.31 至 18.03],P=0.04),效应大小较大 [0.68]。随访四个月后,干预组的 PAR 减少率仍明显低于对照组(平均值[CI]:18.29 [9.09 至 27.48],P=0.00),效应量较大[1.27]。与对照组相比,干预组在两个月(SPADI指数平均值=14.58,P=0.002;DASH指数平均值=10.26,P=0.006)和四个月(SPADI指数平均值=19.85,P=0.00;DASH指数平均值=12.09,P=0.001)的随访中残疾程度明显减轻:结论:基于中频运动控制肩部区域的个性化锻炼可降低 SAPS 患者的 PAR 和残疾程度。
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引用次数: 0
期刊
Archives of physical medicine and rehabilitation
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