Archives of physical medicine and rehabilitation最新文献

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 non-pharmacological intervention for both motor and non-motor 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 (PDMD) 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.

Objective: To describe the process and results of tailoring the Recovery Ruler, a novel data visualization tool for patients in disorders of consciousness at 4 postacute rehabilitation programs.

Design: Descriptive, participatory, qualitative approach. We conducted iterative design sessions (DSs) with rehabilitation practitioners to tailor the Recovery Ruler for postacute care workflows.

Setting: Four postacute rehabilitation programs.

Participants: Sixteen rehabilitation practitioners.

Intervention: Not applicable.

Main outcome measure: Transcripts from DSs, research team notes, and correspondences to describe the process of tailoring the Recovery Ruler.

Results: Practitioners identified 3 core functions of the Recovery Ruler: (1) communicating Coma Recovery Scale-Revised (CRS-R) results to family care partners; (2) guiding interpretation of CRS-R scores; and (3) providing context for CRS-R results. Revisions to the tool aligned with these functions, including emphasizing the 0-100 equal-interval scale for clarity, replacing solid lines with dashed lines to represent score ranges, and adding fields for clinical notes and test completion codes. Practitioners perceived that tailoring the Recovery Ruler enhanced comprehensibility, efficiency, and alignment with program workflows.

Conclusions: The Recovery Ruler was tailored to meet the diverse needs of 4 postacute disorders of consciousness programs, emphasizing person-centered principles of transparency, comprehensibility, and perceptions of holistic communication. Practitioners' input guided revisions to enhance family communication, facilitate CRS-R interpretation, and contextualize patient data, while maintaining adaptability to varied clinical workflows. Future research should focus on extended usability testing and tailored implementation strategies to optimize integration into practice.

Objective: To identify factors influencing the use, intention to use, satisfaction, attitudes, experience, and preferences regarding group-based interventions in physiotherapy, from the perspectives of patients and physiotherapists.

Data sources: PubMed, Embase, Web of Science, Cochrane, and EBSCO CINAHL databases were searched from inception to September 6, 2024.

Study selection: Included studies used quantitative, qualitative, or mixed-method designs; involved adult patients or physiotherapy professionals; and reported on determinants influencing the use, intention to use, satisfaction, attitudes, experiences, or preferences regarding group-based interventions in physiotherapy.

Data extraction: A data-based convergent synthesis approach was adopted. Two independent reviewers extracted data using a data extraction form, treating findings from all studies, regardless of methodological design, as qualitative data. Quantitative results were transformed into textual descriptions to enable integration with qualitative data. All findings were entered into a data matrix and then inductively grouped into common themes.

Data synthesis: Fifty studies met the inclusion criteria, out of 10,421 identified references. The review identified 32 distinct determinants, which were mapped to 9 of the 14 domains of the Theoretical Domains Framework. Key Theoretical Domains Framework domains included "Social influence," "Environmental context and resources," "Emotion," and "Beliefs about capabilities." Of the included studies, 38 focused on patients, 4 on physiotherapists, and 8 on both groups. Determinants of experience were the most frequently reported. From the patients' perspective, access to peer support, encouragement, and being among others facing similar challenges were the most frequently cited determinants of a positive experience, each mentioned in 23 studies. From the physiotherapists' perspective, group size was the most frequently cited determinant of experience, mentioned in 4 studies, with a suggested optimal size between 6 and 8 participants.

Conclusions: These findings can help guide physiotherapy services and policy to better align interventions with the needs and contexts of both groups.