Archives of physical medicine and rehabilitation最新文献

Objective: To evaluate the reliability, construct validity, responsiveness, and interpretability of the PSEQ-10 in individuals with chronic shoulder pain.

Design: Measurement properties study.

Setting: Outpatient rehabilitation.

Participants: A total of 105 individuals with chronic shoulder pain were included.

Interventions: Not applicable.

Main outcome measures: At baseline, participants completed the PSEQ-10, CPSS, SPADI, and NPRS. After a 7- to 10-day interval, a second assessment was performed in which all participants completed the PSEQ-10 and NPRS. After eight weeks of clinical intervention, 89 individuals were reassessed using the PSEQ-10, CPSS, SPADI, NPRS, and GPE to analyze responsiveness and interpretability.

Results: The PSEQ-10 demonstrated excellent internal consistency (α = 0.89), acceptable intra-rater reliability (ICC = 0.70), a standard error of measurement (SEM) of 6.56 points, and a minimal detectable change (MDC) of 18.2 points. Moderate correlations with the CPSS (r = 0.62) and SPADI (r = -0.42) supported construct validity. The questionnaire showed an effect size of 0.98, AUC of 0.71 (95% CI: 0.578-0.853), and a minimal important change (MIC) of 1.5 points based on the GPE (AUC = 0.77; 95% CI: 0.645-0.897) and 5.5 points based on the CPSS (AUC = 0.67; 95% CI: 0.539-0.803), as well as 3.5 points with the SPADI.

Conclusions: The PSEQ-10 is a reliable and valid tool for point-in-time assessment of self-efficacy in individuals with chronic shoulder pain. Future research should investigate the stability of this construct and refine clinically meaningful change thresholds in this population.

Objective: To compare the effects of Functional Inspiratory Muscle Training (FIMT) with Inspiratory Muscle Training (IMT) in individuals with chronic stroke.

Design: Prospective, randomized controlled, double-blinded trial SETTING: Department of Physiotherapy and Rehabilitation PARTICIPANTS: Forty-two individuals with chronic stroke (mean age 62.9 years, 36.4% female for FIMT group; mean age 60.3±8.3 years, 40.9% female for IMT group) completed the study.

Intervention: Both groups received Neurodevelopmental Therapy (NDT) three times per week for eight weeks. The FIMT group performed inspiratory muscle training simultaneously with NDT-based functional exercises (e.g., bridging, kneeling, weight transfer), while the IMT group performed inspiratory training separately, combined with NDT in the same session. All participants also completed a home-based IMT program twice weekly.

Main outcome measures: The primary outcomes were the Trunk Impairment Scale (TIS) and maximal inspiratory pressures (MIP). Secondary outcomes included Trunk Control Test (TCT), maximal expiratory pressures (MEP), respiratory endurance (Incremental Threshold Loading Test), spirometry values (FEV₁,FVC), balance (Berg Balance Scale), gait (Timed Up and Go, 10-Meter Walk Test), core muscle activity (PRONE test), functional capacity (6-Minute Walk Test), and independence (Barthel Index).

Results: Both groups showed significant improvement in most outcome measures following training. However, the FIMT group demonstrated notably greater gains in trunk control (TIS, TCT), respiratory muscle strength and endurance (MIP, MEP, ITL), balance, walking speed, and transversus abdominis activity (p<0.05). The mean between-group difference in TIS change was 2.62 points (95%CI 1.67-3.57), with the lower bound of the confidence interval exceeding the smallest worthwhile effect (0.31). FIMT also yielded superior improvements in MIP (7.48 cmH₂O, 95%CI 2.43-12.52). No significant differences were observed between groups in 6MWT distance, spirometry results, or Barthel Index scores.

Conclusions: FIMT produced greater improvements than IMT in trunk control, respiratory muscle function, balance, and gait speed in individuals with chronic stroke, suggesting it as a promising rehabilitation approach.

Objective: To investigate the efficacy of an innovative physical therapy program targeting mobility.

Design: Single blinded randomized controlled trial SETTING: Outpatient care VA regional tertiary care center PARTICIPANTS: Community-dwelling middle aged and older Veterans with slow walking speed.

Interventions: Live Long Walk Strong (LLWS) is an 8-week 10 (1-hour/session) session outpatient physical therapy program. It was designed to enhance mobility by targeting impairments linked to mobility decline. It was compared to participants within a waitlist control group.

Main outcome measure(s): Walking speed (primary outcome) and secondary outcomes included the Short Physical Performance Battery (SPPB), Activity Measure for Post Acute Care (AM-PAC), leg power, trunk extensor muscle endurance, gait coordination, and exercise self-efficacy.

Results: We experienced a 25% dropout rate, which was in part due to the COVID-19 pandemic shutdowns of human research. We observed significantly faster (p<.05) walking speed (mean 0.08 +/- .02 m/s) after 8 weeks among LLWS participants. Similarly, there were significant improvements SPPB (.95 +/- .32) and AM-PAC (2.1 +/-0.8) among LLWS participants. We also observed significantly greater improvements in leg power and self-efficacy among LLWS participants. No significant differences were observed for trunk muscle endurance or gait coordination, however significantly greater improvement in gait coordination was observed within sensitivity analyses.

Conclusions: Our study demonstrates that LLWS enabled statistically significant and clinically meaningful gains in mobility among middle aged and older adult Veterans with slow walking speed. Future analyses of this clinical trial will be able to evaluate long term outcomes and be better powered to evaluate changes in the attributes LLWS targets.

Objective: The study goals were to 1) identify the typical time from a concussion injury to initial physical therapy (PT) evaluation, and 2) explore concussion subtypes (complexity) across time (diagnosis visit versus PT evaluation). We anticipated the median time from concussion to PT evaluation would be 61 days, and that greater time from injury to PT evaluation would be associated with greater symptom complexity. We also explored demographics and referral patterns to PT.

Design: Retrospective chart review.

Setting: Academic medical center.

Participants: A convenience sample of patients seen in PT for concussion from 3/1/2023 to 12/31/2024 with no hospitalization from concussion and no skull fracture. Two hundred and four charts were reviewed and 100 met inclusion criteria. Patients were 46.0 (±15.0) years old and 67% percent female. The most common mechanism of injury was motor vehicle accident (43%).

Interventions: Not applicable.

Main outcome measure(s): Days from concussion injury to initial PT evaluation, number of concussion subtypes (range 0-7) at diagnosis and PT evaluation, departments diagnosing concussion and referring to PT, and mechanism of injury.

Results: The median [range] time from injury to diagnosis was 5 [0-64] days, and median time to PT evaluation was 58 [5-339] days. The mean number of subtypes at diagnosis was 3.24 (±1.59), which was significantly less than at PT evaluation which was 4.32 (±1.36). There was no association between number of subtypes and days to PT evaluation. Primary Care provided the most diagnoses and referrals to PT, followed by Emergency Department (diagnosis) and Sports Medicine (referrals).

Conclusions: The time to PT evaluation was similar to that found in other studies conducted prior to publication of recent concussion guidelines. This continued delay in being seen by PT may be due to lack of awareness of concussion guidelines by non-specialty providers, and limited availability of concussion specialist therapists contributing to long appointment wait times.

Objective: to investigate whether dextrose prolotherapy (DPT) injections to the anterior talofibular ligament (ATFL) improves Chronic ankle instability (CAI).

Design: A 52-week, two-arm, parallel, superiority, triple-blinded randomized-controlled trial.

Setting: The study was performed at a university-affiliated primary care clinic.

Participants: 114 participants with CAI were randomly assigned to DPT and normal saline (NS) group in a 1:1 ratio.

Interventions: The DPT group and the NS group and received 5 ml of 15 % dextrose (D15) and 5 ml of normal saline injection to the ATFL on week 0, 4, 8, and 16, respectively.

Main outcome measure: Primary outcome was the Cumberland Ankle Instability Tool (CAIT 0-30 points) at 52 weeks. Secondary outcomes included the Star Excursion Balance Test (SEBT), number of ankle re-sprains, health-related quality of life (measured by EQ-5D) and treatment satisfaction. All outcomes were assessed at baseline, 16, 26 and 52 weeks.

Results: Randomization produced two groups of 57 participants, (57 % female; 49.9±14.8 years). Although no statistically significant between-group difference was detected for CAIT, DPT participants demonstrated a statistically significant improvement in SEBT compared to NS, with a difference-in-difference estimate of 4.46 points (confidence interval [CI] 0.51 to 8.41, P=0.027) at 26 weeks, and 4.27 points (CI 0.26 to 8.29, P=0.037) at 52 weeks. Participants in the DPT group had a lower risk of re-sprains (adjusted odds ratio 2.88 (CI 1.21 to 6.89, P=0.017). No procedure-related adverse events were reported.

Conclusion: DPT is superior than NS injections in improving postural dynamic balance at 26 and 52 weeks, and experienced fewer re-sprains at 52 weeks.

Objective: To evaluate the effectiveness of therapeutic interventions on gait, balance, functional independence, and balance confidence in individuals with lower limb amputation. Additionally, to examine effects by intervention type and determine their clinical significance.

Data sources: Seven databases (AMED, APA PsycInfo, MEDLINE, CINAHL, PubMed, Scopus, Web of Science) were searched up to May 26, 2025. Reference lists of included studies and related systematic reviews were also screened.

Study selection: Studies were included if they evaluated a therapeutic intervention in adults with lower limb amputation, had evidence of reliability, validity, and responsiveness in people with limb amputation, and had a PEDro score ≥6. Twenty-one studies met inclusion criteria; 18 were included in the meta-analysis.

Data extraction: Studies were divided across six reviewers, who then independently extracted data using a standardized form (participant characteristics, intervention type and duration, outcome measures, and results). Study quality was reported using the PEDro scale.

Data synthesis: Twenty-one studies (654 participants) contributed 34 gait outcomes (13 studies), 26 balance outcomes (10 studies), 11 functional independence outcomes (8 studies), and five balance confidence outcomes (5 studies). A three-level random-effects meta-analysis showed that therapeutic interventions statistically significantly improved gait (Standardized mean difference (SMD) = 0.54), balance (SMD = 0.68), and functional independence (SMD = 0.30), with smaller effects on balance confidence (SMD = 0.27). Cognitive training had the largest effect on gait, exercise on balance, virtual reality on balance confidence, and proprioceptive neuromuscular facilitation on functional independence. All effects were statistically significant except virtual reality on balance confidence. Only seven of 54 outcomes met minimal clinically important difference or minimal detectable change thresholds.

Conclusions: Therapeutic interventions improve functional outcomes in individuals with a lower limb amputation, though clinical significance was limited. Future research should tailor interventions and standardize outcome measures to better align with meaningful patient improvements.

Objective: Post-stroke rehabilitation provides skilled services that target motor impairments to improve function and maximize independence after stroke. Our objectives are to first describe functional outcomes for those who participated in rehabilitation services, then to identify race/ethnic disparities in rehabilitation services after stroke and characterize the independent association of race/ethnicity to functional recovery post-stroke.

Design: Observational data were extracted from the American Heart Association's Get-With-The-Guidelines-Stroke dataset. Rehabilitation services, and modified Rankin Scale were recorded at hospital discharge and via follow up phone calls at 30- and 90-days after.

Setting: Large, comprehensive stroke centers PARTICIPANTS: Stroke survivors throughout the state of Florida.

Interventions: Not applicable.

Outcomes: Descriptive statistics characterize functional change in those who received rehabilitation services. Logistic regression models adjusted for potential confounders were used to determine: 1) race/ethnic differences in rehabilitation services received; and 2) race/ethnic differences in functional change from discharge to 30- and 90-days, respectively.

Results: Of 1,083 individuals, 43% were female, 54% were Non-Hispanic White (NHW), 23% Non-Hispanic Black (NHB), and 23% Hispanic. At a short-term (30-days) follow up after hospital discharge, 14% of individuals who received rehabilitation services showed functional gains, 68% no change in function, and 18% functional decline. Yet, 30-days is likely inadequate for the full functional benefit of rehabilitation efforts. At 90-days after hospital discharge, 26% showed functional improvements, 58% no change, and 16% functional decline. Irrespective of type of rehabilitation services received, there were no differences in functional change between NHW and NHB individuals, yet Hispanic individuals were less likely to improve [aOR=0.647, 95%CI (0.425,0.983)] compared to NHW. Additionally, Hispanic individuals were significantly less likely to receive any rehabilitation services [aOR=0.626, 95%CI (0.442,0.886)] and were half as likely to receive outpatient services [aOR=0.543, 95%CI (0.368,0.800)] as compared to NHW.

Conclusions: Rehabilitation is key to functional improvement after stroke. We are making strides in health equity between NHW and NHB individuals, yet there remain disparities in functional outcomes and in rehabilitation services particularly for Hispanic individuals after stroke.

Objective: To examine whether cognitive symptoms, an indicator of need, was associated with the likelihood that Veterans with mild traumatic brain injury (mTBI) received a cognitive rehabilitation referral in the Veterans Health Administration (VHA). We also examined whether non-clinical factors modified the relationship between cognitive symptoms and receipt of a referral.

Design: Retrospective cohort study of VHA medical record data. Modified Poisson regression was used to model the likelihood of receiving a cognitive rehabilitation referral based on cognitive symptom severity and non-clinical predisposing (e.g., race/ethnicity) and enabling (e.g., drive time) factors. Discipline-specific models were specified to explain a referral to occupational therapy (OT); speech-language pathology (SLP) services, and neuropsychology. Statistical interactions determined whether non-clinical factors modified the relationship between cognitive symptoms and receipt of a referral.

Setting: VHA.

Participants: Veterans with a mTBI, determined using the Comprehensive Traumatic Brain Injury (TBI) Evaluation database (n=77,001).

Interventions: N/A.

Main outcome measure: Cognitive rehabilitation referrals (no/yes), identified using a validated algorithm.

Results: Only 26% received a cognitive rehabilitation referral, with SLP services being the most common discipline (19%), followed by neuropsychology (6%) and OT (3%). Veterans with more severe cognitive symptoms were more likely to receive a referral, and this relationship was stable in discipline-specific models. However, many Veterans without a referral reported severe cognitive challenges, indicating unmet need. Moreover, non-clinical factors-including Hispanic ethnicity, employment status, rurality, drive time, neighborhood disadvantage, and VHA enrollment priority group (e.g., requiring a co-pay)-modified the relationship between cognitive symptom severity and receipt of a referral.

Conclusions: These results suggest that while cognitive rehabilitation services tend to be allocated to those in need, significant gaps in access exist. Findings lay the foundation for developing strategies that expand access to beneficial cognitive rehabilitation among Veterans with mTBI, reducing their cognitive symptoms and enhancing their daily function.

Objective: This study aims to investigate the effects of deep transcranial magnetic stimulation (dTMS) on the treatment of dysphagia to reduce aspiration episodes in patients with infratentorial stroke (IS).

Design: A prospective, double-blinded, sham-controlled, single-center clinical trial.

Setting: A tertiary hospital rehabilitation center.

Participants: Forty-eight patients were enrolled and allocated to three groups: high-frequency (HF) group, low-frequency (LF) group, or sham stimulation group.

Interventions: DTMS targeting the bilateral insular cortex was performed using the H-coil. LF (1 Hz) was delivered in 20 trains (50 pulses/train, 50s duration) with 15s inter-train intervals, and HF (10 Hz) consisted of 34 trains (30 pulses/train, 3s duration) .

Main outcome measures: The primary outcomes of the study included the respiratory-swallow coordination (RSC) parameters and Penetration Aspiration Scale (PAS) scores. Secondary outcomes comprised Functional Oral Intake Scale (FOIS) scores, with assessments performed at baseline, immediately post-intervention (day 0), and at 1- and 2-month follow-ups.

Results: The swallow apnea duration (SAD) in the treatment group was significantly prolonged compared to the sham group (p<0.05), and the change in SAD in both the HF and LF groups was significantly greater than that in the sham group (p<0.05). Although a reduction in the swallow-inhale RSC pattern was observed only in the HF group following the intervention, this change did not achieve statistical significance (p>0.05). The FOIS scores in the HF and LF groups demonstrated significant effects of time and intervention (F=2.48, p<0.001). At 0 day post-intervention, the improvement in FOIS scores was significantly greater in the HF group compared to the sham group (p<0.05); additionally, the PAS scores in the HF group showed a notable reduction.

Conclusion: The study demonstrated that both HF dTMS and LF dTMS influenced the SAD values, RSC patterns did not change significantly. Notably, the HF group showed more pronounced improvements in both aspiration reduction and overall swallowing function. These findings support the clinical application of dTMS in this patient population.

Objective: To characterize childhood cancer survivor (CCS) and caregiver barriers and facilitators to participating in rehabilitation therapies, specifically physical therapy, occupational therapy and speech-language pathology, following a new pediatric cancer diagnosis.

Design: Multi-site qualitative study.

Setting: Two US academic medical centers in the Midwest and Mountain West regions.

Participants: Thirteen CCS diagnosed with cancer before age 19 with a rehabilitation referral and 33 caregivers of CCS meeting eligibility criteria.

Interventions: Not applicable.

Main outcome measure(s): Not applicable.

Results: We identified five key themes: (1) consistency in care; (2) unique needs of CCS; (3) access to local rehabilitation services in home communities; (4) caregiver engagement; and (5) costs and insurance coverage. Receiving routine care from consistent providers helped CCS feel comfortable participating in and challenging themselves in therapy. Organizational and provider supports helped families navigate transitions between rehabilitation settings. Participants reported challenges related to finding care that met CCS' unique needs in their home communities and identifying providers who were knowledgeable of these needs. Patient safety and comfort were influenced by factors such as rehabilitation setting and sanitized to reflect the needs of immunocompromised CCS. Organizational and provider supports helped families with associated care cost barriers, including insurance coverage.

Conclusions: CCS and caregiver experiences with rehabilitation services are influenced by supports and challenges at multiple levels, including individual, community, and organizational levels. These findings can inform current and future pediatric oncology rehabilitation program multi-level implementation and promote patient and family participation. Contextual factors that influence these efforts should be a focus of future research.