Archives of physical medicine and rehabilitation最新文献

Objective: To primarily assess neuroanatomical changes following CTS surgical release and their association with patient symptoms and functional status; secondarily, to determine the optimal time point for evaluating therapeutic outcomes.

Design: Prospective quasi-experimental study with a follow-up period of 6 months.

Setting: Physical medicine and rehabilitation institutional practice in an outpatient setting.

Participants: 34 patients diagnosed with moderate-to-severe CTS by ultrasound, who underwent surgical release between May 2022 and July 2023.

Interventions: Median nerve surgical release.

Main outcome measures: Ultrasound was used to assess the cross-sectional area (CSA) and flattening ratio (FR) of the median nerve before surgery and at 15 days, three months, and six months postoperatively. The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) was administered to assess symptom severity and functional status.

Results: Of the participants, 73.6% were women, with a median age of 48.8 years (42.5-53.3). Before surgery, CSA at the carpal tunnel inlet measured 14.3 mm² (IQR 13-17) and at the outlet 10 mm² (IQR 9-11); the FR was 3.1 (2.5; 3.7). The CSA at the inlet was the only parameter to show consistent improvement at all follow-up points: 15 days (p=0.001), three months (p<0.001), and six months (p<0.001). BCTQ scores for symptom severity and functional status showed significant reduction at three and six months (p<0.001).

Conclusion: A reduction in the elevated CSA of the median nerve was observed following CTS surgical release, with the optimal evaluation point being three months postoperatively. This anatomical improvement was associated with decreased symptom severity and improved functional status.

Objective: To investigate the associations between step counts (step volume; steps/day) and peak step cadence (step intensity; steps/min) with total body fat, abdominal fat, and visceral adipose tissue (VAT) in community-dwelling older adults.

Design: Cross-sectional study.

Setting: Community-based setting.

Participants: A total of 158 older adults (N=158) (mean age, 66.2±4.5y) were included. All participants wore an accelerometer and completed body composition assessment using dual-energy x-ray absorptiometry.

Interventions: Not applicable.

Main outcome measures: Steps/day and 30-minute peak cadence were measured by hip-worn accelerometer for 1 week. Total body fat, abdominal fat, and VAT were measured by dual-energy x-ray absorptiometry. Generalized linear models were used for data analyses with adjustments for known cardiovascular risk factors.

Results: Each additional 1000 steps/day was associated with lower values of total body fat (β=-575 g, P=.006), abdominal fat (β=-55 g, P=.038), and VAT mass (β=-47 g, P=.016) and volume (β=-50 cm³, P=.016). Each additional 10 steps/min in peak 30-minute cadence was associated with lower values of total body fat (β=-864 g, P=.002), abdominal fat (β=-93 g, P=.008), and VAT mass (β=-78 g, P=.002) and volume (β=-83 cm³, P=.002). All associations persisted after adjusting for body mass index (P<.05).

Conclusions: Both step volume and intensity were inversely associated with obesity-related markers in older adults. Our findings suggest that walking more or faster may be associated with lower obesity-related markers in community-dwelling older adults.

Objective: To evaluate the safety and efficacy of very early mobilization (VEM) after acute stroke through a comprehensive meta-analysis of cohort studies and randomized controlled trials.

Data sources: A systematic literature search was conducted in PubMed, Cochrane Library, Embase, Web of Science, Google Scholar, and Semantic Scholar from inception to May 2024.

Study selection: Studies were included if they compared VEM with standard care in adult patients with stroke and reported outcomes related to functional recovery, mortality, or medical complications. Both randomized controlled trials and observational cohort studies were eligible.

Data extraction: Two independent reviewers extracted study and participant characteristics, intervention details, comparator information, and outcome measures (functional recovery, complications, mortality, and length of stay). Discrepancies were resolved through discussion. Effect sizes (risk ratios, standardized mean differences) with 95% confidence intervals were calculated, and methodological quality was assessed using the Cochrane Risk of Bias tool for randomized controlled trials and the Newcastle-Ottawa Scale for cohort studies.

Data synthesis: Twenty-three studies, including 84,936 patients in the VEM group and 32,753 in the standard care group, were analyzed. VEM significantly improved functional independence, as measured by the Barthel Index (a validated scale for activities of daily living; standardized mean difference [SMD]=0.61; 95% CI, 0.25-0.98; P<.01) and the modified Rankin Scale (mRS; a disability scale, with scores of 0-2 indicating functional independence; risk ratio [RR]=1.14; 95% CI, 1.03-1.27). It also reduced the length of hospital stay (SMD=-2.53; 95% CI, -4.45 to -0.60; P<.01), pulmonary infection (RR=0.75; 95% CI, 0.57-0.99; P=.04), and urinary tract infection (RR=0.76; 95% CI, 0.71-0.82; P<.01). No significant effects were observed in National Institutes of Health Stroke Scale (a stroke severity scale) scores, mortality, deep vein thrombosis, neurologic deterioration, or falls.

Conclusions: VEM is safe and effective in enhancing functional recovery, reducing complications, and shortening hospitalization after acute stroke. Further high quality studies are needed to optimize timing and dosage of mobilization, particularly considering stroke severity and subtype.

Objective: To compare three delivery formats of a rehabilitation intervention in reducing fatigue: 1) synchronous group sessions via audio-only teleconference, 2) asynchronous group sessions delivered online, and 3) synchronous one-to-one sessions delivered in-person or videoconference. The primary hypothesis was that group-based teleconference and internet formats would be non-inferior to the one-to-one format.

Design: Decentralized, randomized, non-inferiority trial with assessments at baseline, 2, 3, and 6 months.

Setting: Community-based adults in Midwestern United States PARTICIPANTS: 590 adults with multiple sclerosis (MS) INTERVENTIONS: An occupational therapist-led intervention aimed at supporting self-management of fatigue.

Main outcome measure: Generalized estimating equations tested the primary hypothesis using a 10-point non-inferiority margin on the Fatigue Impact Scale (FIS). Moderation and mediation analyses explored the effects of demographic, health, and psychosocial factors.

Results: GEE analysis showed that the teleconference format had higher (worse) estimated FIS scores compared to the one-to-one format, with values of 5.96 (1.80, 10.12) at 2 months, 8.73 (4.52, 12.94) at 3 months, and 4.89 (0.67, 9.12) at 6 months. The internet format also had higher FIS scores, with estimates of 9.94 (5.68, 14.20) at 2 months, 9.09 (4.80, 13.38) at 3 months, and 6.12 (1.81, 10.44) at 6 months. Moderation analysis indicated that participants from racial and ethnic minority groups, those with lower education levels, and individuals experiencing more anxiety, sleep disturbance, or comorbidities derived better improvements in FIS from the one-to-one format. The number of logins significantly mediated fatigue improvements in the internet format, while outcome expectations significantly mediated the teleconference format.

Conclusions: The upper bound CI for teleconference and internet formats exceeded the non-inferiority margin at most time points, indicating the hypothesis was neither supported nor rejected. While teleconference and internet formats may offer broader accessibility, potential effectiveness trade-offs should be considered, especially for individuals needing intense, personalized care.

Objective: To evaluate the efficacy of transcranial direct current stimulation (tDCS) in treating naming disorders in patients with poststroke aphasia through a meta-analysis.

Data sources: This systematic review includes randomized controlled trials (RCTs) retrieved from 4 databases: Web of Science, Cochrane Library, EMBASE, and PubMed, with the search period extending from database inception to July 22, 2024.

Study selection: We included RCTs examining the effects of tDCS on naming ability in patients with poststroke aphasic. Two authors independently searched and screened the literature and assessed studies for compliance with the inclusion and exclusion criteria by reviewing titles, abstracts, and full texts. Any disagreements were resolved by consultation with the other authors.

Data extraction: Two reviewers independently extracted relevant data (sociodemographic characteristics, clinical information, study characteristics, stimulus parameters, and outcome indicators) from eligible studies and assessed risk of bias using the Cochrane Risk of Bias Tool II. When discrepancies arose, they were resolved by another experienced researcher.

Data synthesis: We used Review Manager 5.4 software for data analysis. Standardized mean difference (SMD) and 95% CI were used for meta-analysis. This study is registered with PROSPERO (CRD42024586289). A total of 12 studies involving 400 subjects were included. tDCS significantly improved the naming abilities of participants with poststroke aphasia (SMD=0.25; 95% CI=[0.05-0.45], P=.01), particularly in those with chronic stroke (SMD=0.48, 95% CI=[0.10-0.86], P=.01). Anodal tDCS stimulation demonstrated a statistically significant effect on the recovery of naming functions (SMD=0.25, P =.02).

Conclusions: Anodal tDCS could positively impact the naming abilities of patients with poststroke aphasia, particularly those with chronic stroke. Because of the methodological limitations of the included studies, it is worthwhile to further evaluate the value of tDCS in RCTs in future research.

Objectives: To describe the employment of people with spinal cord injury/disease (SCI/D) and identify employment-associated factors among participating countries in the International Spinal Cord Injury 2024.

Design: Cross-sectional, multinational, observational cohort study.

Setting: Community setting with participants from 31 countries representing all 6 World Health Organization regions.

Participants: A total of 11,170 working age people (N=11,170) with SCI/D were analyzed.

Interventions: Not applicable.

Main outcome measures: International Spinal Cord Injury (InSCI) Community Survey.

Results: The majority were men (72.4%), most persons had paraplegia (65.6%), incomplete (57.2%), and traumatic as cause of injury (77.5%). The median age was 45.5 years, the median time since injury was 11 years, and the median total years of education was 12 years. A third of the respondents were engaged in paid work (33.1%). Participants from lower middle-income countries had 59% lower odds (OR=0.413; 95% CI, 0.363-0.469; P<.001) of employment compared with high-income countries. Modifiable factors that positively influence employment included education and receiving vocational rehabilitation.

Conclusions: A major finding of this study is the difference in employment rates and employment factors for people with an SCI/D in high-income countries versus low income countries. Although employment can powerfully facilitate wellbeing in this population, it is heavily influenced by broader socioeconomic factors that vary across countries. Efforts can be targeted toward addressing education and vocational rehabilitation to improve employment of people post-SCI/D.

Objective: To compare the effects of low-volume high-intensity interval training (HIIT) with moderate-intensity continuous training (MICT) on physical performance, muscle strength, and exercise enjoyment in older adults with possible sarcopenia.

Design: A 2-arm, assessor-blind randomized controlled trial.

Setting: Community-based.

Participants: Thirty older adults (N=30) with possible sarcopenia (mean ± SD age, 66.0±3.7y, 67% women).

Interventions: Participants were randomized to either a 15-minute HIIT protocol (5×1-min cycling at 77%-90% maximum heart rate or 15-17 ratings of perceived exertion interspersed with 1-min recovery; n=15) or 25-minute MICT protocol (cycling at 65%-76% maximum heart rate or 12-14 ratings of perceived exertion; n=15), performed for 3 days per week for 7 weeks.

Main outcome measures: The primary outcome was the 5 times sit to stand test. Secondary outcomes included comfortable walking speed, handgrip strength, and functional reach test. Exploratory outcomes were exercise enjoyment assessed using the Physical Activity Enjoyment Scale and the Exercise Enjoyment Scale.

Results: The HIIT group showed greater improvements in 5 times sit to stand test compared with the MICT group postintervention (Δ-0.57s [95% CI, -1.10 to -0.04]; P=.04; η²=0.15), at 1-month (Δ-0.58s [95% CI, -1.13 to -0.04]; P=.04; η²=0.15), and 3-month follow-ups (Δ-0.58s [95% CI, -1.13 to -0.02]; P=.04; η²=0.14). Both groups demonstrated significant improvements over time in 5 times sit to stand test time (P<.001; η²=0.77), comfortable walking speed (P<.001; η²=0.79), handgrip strength (P<.001; η²=0.88), and functional reach test (P<.001; η²=0.78). Participants in the HIIT group reported significantly higher scores on the Physical Activity Enjoyment Scale and the Exercise Enjoyment Scale compared with those in the MICT group.

Conclusions: HIIT provides superior and sustained improvements in physical performance, as well as greater exercise enjoyment, over MICT in older adults with possible sarcopenia.

The second International Spinal Cord Injury (InSCI) community survey-a cross-sectional, multinational, observational cohort study-was conducted from 2022 to2024 in 31 countries, representing all 6 of the World Health Organization regions. The survey has produced a wealth of data, both about basic medical issues but also about the lived experience of spinal cord injury/disease (SCI/D). The InSCI survey is part of a larger project known as the Learning Health System for SCI Initiative and utilizes a 360° approach designed to collect information about all aspects of the experience of SCI/D and environmental factors that affect that experience. The objective of this article is, first, to summarize the uniqueness of the InSCI survey and its added value, both from the perspective of health research and human rights, and then to raise a challenge and an opportunity going forward. The first is the challenge of sustainability: although in the short and medium term, InSCI is on secure grounds, this cannot be guaranteed in the long term and a broader, more permanent governance structure and financial strategy must be developed. One suggestion for meeting this challenge is offered. The opportunity is to develop robust and effective implementation strategies by which the rich evidence that the InSCI community survey produces-in terms of intracountry comparisons and across settings from clinical practice to health systems management and national policy-are now being explored by countries participating in the survey. One of these strategies involving the use of national strategies for SCI/D is briefly described.

Objective: To describe the proportions of self-reported secondary health conditions, assess the overall health burden of these conditions, and examine their associations with age and time living with traumatic or nontraumatic spinal cord injury/disease (SCI/D) across participating countries in the second International Spinal Cord Injury survey.

Design: Cross-sectional, multinational, observational cohort study conducted in 2022-2024.

Setting: Community setting with participants from 31 countries representing all 6 World Health Organization regions.

Participants: Individuals with traumatic (n=11,882) and nontraumatic (n=3194) SCI/D aged ≥18 years and living in the community.

Interventions: Not applicable.

Main outcome measures: Proportions of secondary health conditions. A comorbidity index, based on a multicomponent approach-including the number of co-occurring health problems, their severity, and treatment status-was used as a proxy for overall health burden. Linear mixed model was conducted to examine the associations of age and time since injury with the comorbidity index.

Results: The most common secondary health problems worldwide were pain (81.5%), feeling depressed (79%), spasticity/muscle spasm (75.5%), and bowel dysfunction (70.5%). Higher comorbidity indices were observed with increasing age and duration of living with injury in individuals with traumatic SCI/D, but not in those with nontraumatic SCI/D.

Conclusions: Both individuals with traumatic and nontraumatic SCI/D worldwide experience high proportions of secondary health conditions. A significant association between overall health burden, increasing age, and time since injury was, however, observed only among those with traumatic injuries. This finding highlights the potential need for tailored interventions that account not only for the type of injury but also for the individual's age and duration of living with SCI/D.

Objective: To investigate plantar pressure (PP) distributions in patients with knee osteoarthritis (OA) and their correlations with foot morphology.

Design: This was a cross-sectional study.

Setting: Participants were recruited from 2 local orthopedic clinics.

Participants: Fifty-two women with symptomatic medial knee OA (Kellgren-Lawrence grade ≥2) and 38 adults without OA aged ≥60 years of age (total N = 90).

Interventions: Not applicable.

Main outcome measures: Hallux valgus angle, navicular/foot ratio, and calcaneus eversion angle were measured as foot morphology indices. PP distribution was recorded during comfortable walking using a PP distribution platform. Statistical parametric mapping analysis of variance was conducted to compare PP between patients with knee OA and those without knee OA. Statistical parametric mapping correlation analyses were performed to confirm the correlation between PP and foot morphology variables in knee OA group.

Results: Compared with the non knee OA group, peak PP values under the first metatarsophalangeal joint, lateral midfoot, and heel region were larger (all P<.01) in patients with knee OA, whereas under the toe and medial midfoot region, peak PP was not significantly different. Positive correlations were found between 1st metatarsophalangeal joint PP and the hallux valgus angle (P<.01), as well as between heel PP and both the navicular/foot ratio and calcaneus eversion angle (P<.01), whereas under the midfoot region, no significant correlation was observed.

Conclusions: Patients with knee OA showed increased localized PP during walking, as well as a potential association between the PP and foot morphology. These findings could contribute to the development of future treatment interventions for knee OA, including insoles or shoes modifying foot deformity and PP distribution.