Archives of physical medicine and rehabilitation最新文献

Objective: To compare the effects of high-intensity telerehabilitation, high-intensity face-to-face rehabilitation, and moderate-intensity face-to-face rehabilitation on cardiovascular function, gait ability, and lipid profiles in chronic stroke.

Design: Randomized controlled trial.

Setting: Hospital and community settings.

Participants: Forty-five enrolled; after one moderate-intensity dropout, 44 analyzed (HIT 15; HIF 15; MIF 14).

Interventions: All groups trained 3 × /week for 6 weeks.

Hit/hif: 40-min HIIT (5-min warm-up; six 1-min bouts at 80-100% HRmax with 4-min active recovery <60% HR reserve; 5-min cool-down) plus 30-min conventional therapy; delivered remotely with Apple Watch (HIT) or face to face with ECG telemetry (HIF). MIF: 40-min continuous training at 60-80% HRmax with the same warm-up/cool-down, then 30-min conventional therapy, face to face with ECG telemetry.

Main outcome measures: Primary: maximal oxygen consumption (VO₂max). Secondary: maximal heart rate (HRmax), heart rate while walking (HW), 6-Minute Walk Test (6MWT), 10-Meter Walk Test (10MWT), Timed Up-and-Go (TUG), and lipids (LDL, HDL, triglycerides).

Results: VO₂max showed a significant Group × Time interaction (F=17.209, p<.001, partial η²=0.456). HIT and HIF improved more than MIF (p<.001), with no difference between HIT and HIF (p=.742). Gait improved within groups; no significant between-group effects. LDL and triglycerides decreased and HDL increased in high-intensity groups (p<.05). No serious adverse events; only mild soreness.

Conclusion: High-intensity telerehabilitation yielded cardiovascular, gait, and lipid benefits comparable to face-to-face care. Both high-intensity modalities were superior to moderate-intensity training for VO₂max. Telerehabilitation with wearables is a safe, feasible option for intensive stroke rehabilitation.

Objective: To examine relationships of depression symptoms to demographic factors and different types of stroke-related disability and impairment in adults with chronic left-hemisphere stroke and a history of aphasia.

Design: Cross-sectional study SETTING: General community PARTICIPANTS: A convenience sample of 92 chronic left-hemisphere stroke survivors (> 6 months) with a history of aphasia and 70 neurologically healthy controls participated.

Interventions: Not applicable MAIN OUTCOME MEASURES: The Beck Depression Inventory-II (BDI-II) measured depression symptoms. The Stroke Impact Scale 3.0 (SIS) assessed stroke-related disability in Cognitive, Physical, and Social Participation domains, as well as self-perceived Recovery. The Western Aphasia Battery Aphasia Quotient and the NIH Stroke Scale total motor score measured language and motor impairment. Spearman correlations examined bivariate relationships between variables. Regression Model 1 examined group differences in BDI-II scores, accounting for demographic factors, including age, education, race, sex, socioeconomic status and antidepressant medication status. Regression Model 2 examined the disability and impairment measures above that predicted BDI-II scores, accounting for the same demographic factors included in Model 1, plus time-since-stroke.

Results: BDI-II scores were on average 3.4 points higher in stroke survivors than controls. Model 1 confirmed that this difference was significant, and found that age was inversely related to BDI-II scores. Bivariate correlations demonstrated that higher BDI-II scores were related to lower SIS Cognitive, Social Participation, and Recovery scores. Model 2 found that these three measures independently predicted BDI-II scores.

Conclusion: In the chronic phase of LH stroke with aphasia, cognitive and communication disabilities, social participation, and self-perceived recovery are the primary correlates of depression symptoms. These findings highlight the importance of assessing for depression even long after left hemisphere stroke and suggest potential targets to improve psychological intervention and rehabilitation.

Objective: To investigate whether a positive perception of one's neighborhood improves social connections among persons with disabilities and this relationship is moderated by disability acceptance.

Design: Individual level longitudinal.

Setting: Community in South Korea.

Participants: A total of 5165 individuals with disabilities.

Interventions: Not applicable.

Main outcome measures: The number and frequency of contacts participants maintain with friends and neighbors.

Results: The association between neighborhood perception and the number of friends and neighbors participants keep in contact with is stronger when individuals have higher levels of disability acceptance. Similar results were found for the frequency of informal relationships.

Conclusions: This study provides an understanding of how neighborhood perception is associated with social connections among persons with disability.

Objective: To examine the effects of occupational therapy (OT) services on patient discharge outcomes.

Design: This is a retrospective cohort study. We developed decision tree algorithms to investigate how 3 measures of OT service delivery-(1) the total number of completed OT visits, (2) the total minutes of all completed OT visits, and (3) the proportion of hospitalized days that included an OT visit (frequency)-affect outcomes.

Setting: Acute care settings.

Participants: The target population was patients admitted to and discharged from the Cleveland Clinic between 2017 and 2021, who received at least 1 OT session and stayed in the hospital for <30 days, with an orthopedic physician designated as the primary treating provider (N=36,300).

Interventions: Not applicable.

Main outcome measures: Reduced 30-day readmission rates, increased rates of home discharge, and improved daily activity abilities after hospital discharge.

Results: Our prediction models for predicting our outcomes showed good to excellent performance metrics (accuracy, 0.69-0.91). Our model demonstrated that variations in the total number, minutes, or frequency of OT sessions are associated with the likelihood of readmission within 30 days after hospital discharge and minimal detectable improvements in daily activities for subgroups of patients with orthopedic conditions.

Conclusions: Our study suggests that the effective use of limited OT services may require prioritizing certain subgroups of patients for providing more frequent OT sessions to optimize the impact of OT services on patient outcomes.

This clinical practice guideline (CPG) provides evidence-informed recommendations on the use of methylphenidate hydrochloride (MPH) in adults with cognitive and noncognitive neuropsychiatric symptoms in the subacute or chronic periods after traumatic brain injury (TBI). The CPG was developed by an American Congress of Rehabilitation Medicine multidisciplinary author panel with expertise in brain injury rehabilitation and included professionals in physical medicine and rehabilitation, basic/translational science, neurology, behavioral neurology and neuropsychiatry, nursing, and neuropsychology. Rationales and recommendations were written based on evidence from an accompanying systematic review. The generation and finalization of CPG recommendations followed procedures in the 2017 American Academy of Neurology Guideline Development and Process Manual. Clinicians should establish a therapeutic alliance and apply principles of pharmacotherapy in persons with TBI to identify indications for and contraindications to MPH use, facilitate treatment adherence, and optimize outcomes. MPH should be offered to improve sustained attention and processing speed performance and may be offered to improve selective attention performance among adults with TBI. MPH should be offered to improve depressive symptoms among adult patients with TBI in whom rapid resolution of depressive symptoms and/or treatment of co-occurring cognitive impairments are clinical priorities. MPH should not be offered to improve performance in executive functioning or working memory among adults with TBI. Although MPH is usually well tolerated among adults with TBI, clinicians should follow standard assessment, education, dosing, and monitoring recommendations when prescribing MPH to optimize its safety and tolerability. A summary of all recommendations on the use of MPH in TBI is available at the end of the CPG.

Objective: To compare the effects of asynchronous versus conventional synchronous neuromuscular electrical stimulation (NMES) on evoked torque, fatigability, discomfort, and training-induced strength gains.

Data sources: A systematic search was conducted in six electronic databases (PubMed, EMBASE, PEDro, LILACS, SciELO, and Web of Science) for studies published up to April 2025. Guided by a PICOT framework, we combined terms for the population (humans), intervention (electrical stimulation), comparator (synchronous, asynchronous, spatially distributed sequential, conventional), and outcomes (torque, muscle strength, fatigue, discomfort, evoked contraction).

Study selection: We included cross-sectional, repeated-measures or randomized controlled trials of adult or elderly participants (healthy or clinical) receiving electrically induced isometric or dynamic contractions without voluntary effort. Comparisons involved synchronous vs. asynchronous current delivery. Outcomes were maximal evoked torque, fatigability, perceived discomfort, and strength adaptations. A total of 22 studies were included from 11,043 records.

Data extraction: Two independent reviewers extracted participant demographics, stimulation parameters, electrode configurations, and outcomes. Study quality was assessed with the PEDro scale and evidence quality via GRADE.

Data synthesis: Meta-analysis showed asynchronous NMES produced greater isometric evoked torque than synchronous NMES (p<0.01; SMD 95% CI: 0.245, 0.957), especially when using larger electrodes (p=0.042, β=0.0023). No difference was found in dynamic evoked torque (p=0.95; 95% CI: -1.44, 1.35). Fatigability was significantly lower with asynchronous NMES for both isometric (p<0.01; SMD 95% CI: 0.49, 1.21) and dynamic contractions (p<0.01; SMD 95% CI: 0.61, 2.76). Discomfort and strength data were insufficient for firm conclusions.

Conclusions: Asynchronous NMES effectively reduces muscle fatigability compared to synchronous stimulation. These findings may help clinicians and researchers in optimizing NMES protocols and support the development of asynchronous NMES solutions for clinical use.

Objective: To determine the efficacy and cost-effectiveness of telerehabilitation compared to face-to-face rehabilitation for patients after open reduction and internal fixation (ORIF) for ankle fractures.

Design: A randomized controlled trial was conducted.

Setting: The trial was conducted at the largest trauma center in Shanghai.

Participants: A total of 468 patients who underwent ORIF for ankle fractures participated in the study. Participants were randomly assigned to either the telerehabilitation group (TELE group) or the face-to-face rehabilitation group (PT group), with 234 patients in each group.

Interventions: The TELE group received a 12-week home-based rehabilitation program, which included video instructions on a tablet and remote coaching. The PT group received standard face-to-face rehabilitation with the assistance of a physical therapist for 12 weeks.

Main outcome measures: Effectiveness was measured using the Olerud and Molander Ankle Score (OMAS) and the EQ-5D-5L, with assessments at baseline, 12 weeks, and 24 weeks postoperatively. The incremental cost-effectiveness ratio (ICER) was calculated using bootstrapping methods.

Results: At the 12-week follow-up, the difference in OMAS scores between the TELE and PT groups was negligible, with a coefficient of -0.477 (p = 0.086). At 24 weeks post-surgery, the OMAS difference was -0.050 (p = 0.857). The EQ-5D-5L Utility score had a coefficient of -0.008 (p = 0.146), and the EQ-5D-5L VAS score showed a coefficient of 0.312 (p = 0.058) at 12 weeks, indicating no significant difference between the groups at 12 weeks. Total 12-week costs per patient were 15% lower in the TELE group compared to the PT group.

Conclusion: Telerehabilitation for patients following ORIF for ankle fracture was found to be cost-effective, with no significant difference in clinical outcomes compared to face-to-face rehabilitation.

Objective: To determine the association of self-reported dual-task ability with fear of falling and recurrent falls in individuals with multiple sclerosis (MS).

Design: Cross-sectional study.

Setting: Individuals with MS were recruited from the general community in the US.

Participants: A total of 1083 people (N=1083) with MS were enrolled. The sample was predominantly women (80.52%). Of the total, 262 participants (24.19%) were classified as recurrent fallers. Patient Determined Disease Steps scores ranged from 0 to 6, with 563 participants (52.00%) reporting mild disability (Patient Determined Disease Steps=0-2).

Interventions: Not applicable.

Main outcome measures: A Dual-Task Impact on Daily Life Activities Questionnaire (DIDA-Q) and its subdomains of motor-motor interference (MMI) and cognitive-motor interference (CMI) were assessed. The total, MMI, and CMI scores were expressed in a 5-point interval scale for ease of interpretation. The total score of the Fall Efficacy Scale-International was dichotomized into low and high fear of falling based on a cutoff score of 35.5. Fall status was categorized as nonfall or single fall (≤1 fall) and recurrent falls (>1 fall) within the past 3 months.

Results: Every 5-point increase in the DIDA-Q was significantly associated with fear of falling (odds ratio [OR], 1.71; 95% CI, 1.56-2.88), as were the CMI (OR, 2.05; 95% CI, 1.80-2.34) and MMI (OR, 3.48; 95% CI, 2.80-4.34). The DIDA-Q total score (OR, 1.14; 95% CI, 1.07-1.21), CMI (OR, 1.19; 95% CI, 1.09-1.29), and MMI (OR, 1.42; 95% CI, 1.21-1.66) were significantly associated with increased likelihood of recurrent falls.

Conclusions: The study indicates that self-reported dual-task difficulty was associated with fear of falling and recurrent falls in persons with MS. Considering that current in-lab dual-task assessments are insufficient to predict falls, the self-reported dual-task questionnaire can be an effective alternative for screening fall risk in this population.

Objective: To investigate ethnic differences in poststroke rehabilitation between Mexican American (MA) and non-Hispanic White (NHW) stroke patients.

Design: Prospective cohort study.

Setting: Community-based (December 2019 to August 2024).

Participants: Of 1453 stroke patients (N=1453), the median age was 66 years, 46% were women, and 66% were MA.

Interventions: Not applicable.

Main outcome measures: Stroke patients or their proxies were contacted every 2 weeks for 90 days after stroke to identify their rehabilitation provider: inpatient rehabilitation facility (IRF), skilled nursing facility, home health agency (HHA), or outpatient rehabilitation. Binomial regression was used to model the association of ethnicity (MA vs NHW) with IRF as the first rehabilitation provider. Sequential modeling and propensity-score adjustment were used to investigate demographic and clinical variables impacting ethnic disparities.

Results: Rehabilitation services were received by 974 patients in the 90 days after stroke; 34% of patients received no rehabilitation for the first 2 calls. The most common transitions between the first 2 providers were HHA to home without rehabilitation (14%), IRF to HHA (10%), and IRF to home without rehabilitation (7%). NHW patients had higher IRF usage as the first provider compared with MA patients (NHW vs MA risk difference=7.4%, 95% CI, 0.8-14.0). This difference remained after adjustment for patient and clinical factors (risk difference=6.5%, 95% CI, -0.1 to 13.0) and was attenuated by 74.6% after further adjustment for socioeconomic status (risk difference=1.9%, 95% CI, -5.2 to 9.0). Propensity-score methods implemented in a separate model confirmed a smaller, nonsignificant effect (risk difference=2%, 95% CI, -6 to 9) given observed covariates.

Conclusions: MA stroke patients are less likely to receive rehabilitation in an IRF as the first provider after stroke compared with NHW stroke patients. This difference is largely explained by socioeconomic status.

Objective: To evaluate the efficacy of mixed norepinephrine and dopamine reuptake inhibitors (NDRI) on cognitive and non-cognitive neuropsychiatric outcomes following traumatic brain injury (TBI), and to describe their safety/tolerability.

Data sources: A literature search using MEDLINE® and a reference title search were conducted from inception to August 17 2023.

Study selection: Studies were retained based on prespecified, PICO framework criteria: (1) participants were aged 18 years or older with mild, moderate or severe TBI; (2) an NDRI class medication was studied [e.g. methylphenidate hydrochloride (MPH)]; (3) the research design included a comparison group; (4) the treatment sample size was ≥9; and (5) cognition, emotion, behavior, or safety/tolerability was an outcome.

Data extraction: Trained methodologists extracted information. Each study's scientific quality was classified using procedures in the 2017 American Academy of Neurology Guideline Development and Process Manual; articles with Class I-III evidence ratings were retained. Thirteen articles from 442 identified publications met review criteria.

Data synthesis: Sufficient evidence was available to evaluate MPH. Meta-analysis generated pooled effects and 95% confidence intervals for outcome domains. MPH improved performance on objective measures of processing speed (k = 9, d = 0.39 [95% CI: 0.17, 0.60), selective attention (k = 5, d = 0.33 [95% CI: 0.04, 0.61]), and sustained attention (k = 4, d = 0.45 [95% CI: 0.11, 0.79]). MPH reduced clinician-evaluated depressive symptoms (k = 2, d = 1.06 [95% CI: 0.47, 1.64). MPH did not produce adverse events or clinically significant autonomic dysfunction. There was little evidence that time since injury and injury severity moderated MPH effects.

Conclusions: Among adults with TBI, MPH has medium effects on selective attention, sustained attention, and processing speed, and large effects on depressive symptoms. These effects are consistent with MPH's biological mechanisms and are not moderated by injury severity or time since injury.