Archives of physical medicine and rehabilitation最新文献

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.

Objective: To examine the dose-response relationship between time spent in gait training and gait independence in individuals with nonambulatory subacute hemiparetic stroke in a rehabilitation ward.

Design: Retrospective cohort study.

Setting: A rehabilitation ward in Japan.

Participants: Nonambulatory individuals with subacute hemiparetic stroke who were admitted and discharged from the ward between January 2018 and December 2021 (N=326).

Interventions: Gait training using orthoses, canes, robotic technology, and/or manual assistance by the therapist as needed.

Main outcome measures: Functional Independence Measure walk score.

Results: In total, 326 individuals (mean age [SD], 70.4 [14.7] years; men, 205) were included in the study. The cumulative rates of achieving gait independence (Functional Independence Measure walk score ≥6), estimated by the Kaplan-Meier method with total gait training time during hospitalization as the time scale, were 50.6% (95% confidence interval [CI], 45.3-56.2), 61.7% (95% CI, 56.4-66.9), 65.0% (95% CI, 59.9-70.2), and 65.9% (95% CI, 60.5-70.8), at 2000, 4000, 6000, and 8000 minutes, respectively. When participants were categorized according to the severity of lower limb motor impairment assessed by the Stroke Impairment Assessment Set motor function in lower extremity total score at admission, the cumulative rates of gait independence were significantly different among the 4 groups, with complete paralysis being the lowest, followed by severe, moderate, and mild paralysis (P<.001). Stratifying by gait training time per day, the higher the gait training time per day, the higher the cumulative rate of achieving gait independence in complete and severe cases, and the lower rate in mild cases (P<.001).

Conclusions: A dose-response relationship with a plateau relationship was found between gait training time and achieving gait independence for nonambulatory individuals with subacute hemiparetic stroke. The relationships differ by the degree of severity of lower limb motor impairment and by training intensity.

Objective: To develop and pilot-test a choice-based conjoint (CBC) tool using discrete choice methodology to assess risk-benefit trade-offs in prosthetic device selection among individuals with upper limb amputation or difference (ULA/D) and explore how user-complexity influences prosthetic preferences.

Design: A survey-based study utilizing a CBC tool with a full-profile, balanced-overlap experimental design. The tool presented participants with different combinations of prosthetic attributes to evaluate selection preferences.

Setting: Research setting involving remote interviews and online survey participation.

Participants: Six individuals with ULA/D and eight content experts participated in qualitative one-on-one interviews to inform prosthetic attribute selection and refinement. A total of 54 individuals, recruited from Hanger Clinic, with ULA/D completed the CBC tool for pilot testing.

Interventions: N/A MAIN OUTCOME MEASURE(S): The mains outcomes include the development of the CBC tool and the analysis of prosthetic attribute selection frequencies, including variations by user-complexity level and shifts in preferences when cost was introduced as an attribute. User-complexity is the conceptual framework underlying our CBC preference choice tool and is defined as the user's individual capability to function and adapt to different levels of technological device complexities.

Results: Eight key attributes were identified: three benefits (functional usefulness, life goals, and noticeability) and five risks (weight/comfort, durability/repairs, concentration/energy required, body connection, and training). A secondary version of the CBC tool, included in the same survey, incorporated cost as a ninth attribute. Among participants (N=54), the highest preference for functional usefulness of device was for precision control via implanted electrodes (62.1%). Highly durable devices with minimal repairs (56.0%) were preferred over delicate options (41.3%). In paired device choice comparisons, preferences varied across user-complexity levels, with participants choosing moderate-complexity devices (hook/shoulder harness) 70% of the time over low-complexity (passive) devices (30%), and 56% of the time over moderate/high-complexity devices (hybrid harness/myoelectric), and 63% of the time over high-complexity (fully myoelectric) options.

Conclusions: The CBC tool captured user preferences, allowing individuals to weigh risk-benefit trade-offs in prosthesis selection. Preliminary findings aligned with expected patterns, highlighting the tool's potential application in guiding personalized prosthetic decision-making based on user-complexity levels.

Objective: To compare the effects of intermittent Theta Burst Stimulation (iTBS), continuous TBS (cTBS), and sham stimulation of the right cerebellum on language function, cognitive function, and quality of life in post-stroke aphasia (PSA) patients.

Design: Randomized controlled trial.

Setting: Department of Rehabilitation, The First Affiliated Hospital of Jinan University, Guangzhou, China.

Participants: Sixty PSA patients were randomly assigned to three groups: iTBS (n=20), cTBS (n=20), and sham stimulation (n=20).

Interventions: Each patient received personalized speech training right after stimulation, five days a week, for two weeks. The iTBS, cTBS, and sham stimulation were applied to the right cerebellum.

Main outcome measure(s): Treatment effects were evaluated using the Chinese versions of the Western Aphasia Battery (WAB) for language function, the Non-Language-Based Cognitive Assessment (NLCA) for cognitive function, and the Stroke Aphasia Quality of Life Scale (SAQOL-39g) for quality of life.

Results: ANOVA revealed a significant interaction between time and group (P < 0.001). Post-hoc comparisons indicated that the cTBS group outperformed the iTBS and sham groups in language function, cognitive function, and quality of life scores post-treatment (p < 0.05). No significant differences were found between the iTBS and sham groups (p > 0.05).

Conclusions: cTBS stimulation of the right cerebellum significantly enhanced language cognitive function and quality of life in patients with aphasia, suggesting it as a promising target for neuromodulation treatment and offering new hope for rehabilitation strategies.

Objective: To examine the association between average weekly minutes of home-visit rehabilitation (HR) and 6-month changes in activities of daily living (ADL) for older adults.

Design: Retrospective cohort study using anonymized electronic health record data.

Setting: A total of 1525 home-visit nursing stations across Japan.

Participants: Adults aged ≥65 years who initiated HR after April 2021 and continued for ≥6 months.

Interventions: HR categorized by average weekly duration: ≤40 min/wk, >40 to ≤60 min/wk, >60 to ≤80 min/wk, and >80 to ≤120 min/wk.

Main outcome measure: Change in Barthel index (BI) score from baseline to 6 months.

Results: The analysis included 25,409 participants; the mean (SD) age was 82.9 (7.7) years, and 41.5% were male. The mean (SD) baseline BI was 68.7 (27.1). The proportion of HR duration was as follows: ≤40 min/wk (40.2%), >40-60 min/wk (25.6%), >60-80 min/wk (19.0%), and >80-120 min/wk (15.1%). Multivariable linear regression showed significant BI improvements in the >40-60 min/wk (0.30; 95% confidence interval [CI]: 0.05-0.54), >60-80 min/wk (1.05; 95% CI, 0.78-1.32), and >80-120 min/wk (1.06; 95% CI, 0.77-1.35) groups compared with the ≤40 min/wk group. Among participants with care-need level 1, no significant differences were observed across groups.

Conclusions: Increased average minutes per week of HR at 6 months is associated with an improvement in BI. This result suggests that an HR of 40 min/wk may be insufficient to improve ADL.

Objective: To describe the shoulder rotator muscle profiles across healthy, unstable, and athletic contexts and compare the usual peak torque (PT) method and the angular range (AR) method.

Design: Retrospective analysis of data collected cross-sectionally.

Setting: Hospital. Each participant participated in isokinetic evaluations of the shoulder rotator muscles at 60°/s (concentric/eccentric) for both shoulders.

Participants: A total of 239 participants with a mean age of 24.7 (7.5) years INTERVENTIONS: None.

Main outcome measures: We recorded the PT and AR mean torque by 10°, and we calculated the antagonist/agonist ratios. We used a 2-way repeated measures analysis of variance with a correction for multiplicity to compare laterality (ie, side-to-side) and contexts (ie, no-overhead sports healthy, no-overhead sports with unstable shoulder, overhead sports healthy, and overhead sports with unstable shoulder.

Results: Concentric PT of external rotators were significantly lower in no-overhead athletes with shoulder instability than healthy no-overhead athletes (P=.007) and healthy overhead athletes (P=.029). The AR highlighted significant (P<.05) lower concentric external and internal rotator muscles strength: (1) in no-overhead athletes with shoulder instability than in healthy no-overhead athletes; (2) in healthy overhead athletes than in healthy no-overhead athletes; and (3) in no-overhead athletes with shoulder instability than in healthy overhead athletes. No significant difference was observed in the eccentric modality or in the PT/AR ratios. Significant side-to-side differences (P<.05) between dominant and nondominant sides were reported by both PT and AR methods.

Conclusions: Only the concentric muscle profiles differed across context groups. The AR allowed for a more precise detection of shoulder muscle adaptations by identifying unique muscle signatures in the moment-angle relationship. These 10° AR measurements offer complementary information and enhance the clinical utility of isokinetic profiling compared to the traditional PT method.