Archives of physical medicine and rehabilitation最新文献

Objective: This study examined changes in satisfaction with and ability to participate in social roles and activities over 3 years for people who were aging with long-term physical disability. The goal was to understand the impact of physical health, function, depression, fatigue, and pain on participation.

Design: A 3-wave longitudinal cohort survey study was completed from 2019 to 2022.

Setting: The general community.

Participants: The study included 323 respondents who participated all 3 years. Purposive sampling recruited individuals aged 45-64 with at least 5 years of disability history through community partners, advertisements, and social media.

Interventions: Not applicable.

Main outcome measures: Patient-Reported Outcome Measurement Information System (PROMIS) Adult Ability to Participate in Social Roles and Activities and PROMIS Satisfaction with Participation in Social Roles.

Results: Univariate repeated measures analysis of variance models indicated that satisfaction with participation did not change over time, and ability to participate slightly increased (means T0 44.4, T2 45.5, P=.045). Linear mixed models indicated that greater physical function was associated with greater satisfaction (β=0.21, 95% confidence interval [CI]: 0.14-0.28) and ability to participate (β=0.19, 95% CI: 0.13-0.26). Greater levels of depression, fatigue, and pain were associated with decreased satisfaction (depression β=-0.21, 95% CI: -0.28 to -0.14; fatigue β=-0.18, 95% CI: -0.26 to -0.11; pain β=-0.14, 95% CI: -0.21 to -0.07) and decreased ability to participate (depression β=-0.23, 95% CI: -0.29 to -0.17; fatigue β=-0.19, 95% CI: -0.25 to -0.12; pain β=-0.12, 95% CI: -0.18 to -0.06).

Conclusions: This longitudinal study demonstrated that satisfaction with and ability to participate in social roles fluctuated little over 3 years but were influenced by physical and mental health variables. Findings suggest that decreasing aging-with-disability symptoms and improving health and function may sustain social participation over time. Interventions to address social participation decline are available; however, further exploration into individual differences and external socioeconomic factors is warranted to understand the variance in social participation.

Objective: To characterize the extent and contexts in which the Rehabilitation Treatment Specification System (RTSS) and its predecessor, the Rehabilitation Treatment Taxonomy (RTT), have been applied in the field of rehabilitation.

Data sources: Electronic databases (eg, PubMed, Cumalative Index to Nursing and Allied Health Literature [CINAHL]) were searched. All articles were collated in the Covidence database.

Study selection: To be included in this scoping review, the studies had to be specific to rehabilitation and mention the RTT or RTSS and/or a combination of concepts of RTT/RTSS such as ingredients, targets, and mechanisms of action. Reviewers screened the titles, abstracts and full-text articles for eligibility. A total of 1929 sources were identified, and 71 full text articles were included.

Data extraction: Random pairs of reviewers used a data extraction form to collect information about each article. Any discrepancies were resolved through discussion by the 2 reviewers, a third reviewer, or with additional reviewers until agreement was achieved.

Data synthesis: Results revealed that less than half of the 71 included publications applied the RTSS to specify rehabilitation treatments. A variety of relevant study characteristics were reported, including RTSS contexts of its application (eg, disciplines of authors, use of key terms/concepts, target clinical conditions).

Conclusions: The RTSS has reached a global audience, but many of the references to the RTSS in the literature cite concepts from the RTSS without performing actual specifications of treatments. There remains considerable work to be done in terms of quality and comprehensiveness of intervention specifications as well as RTSS application across different areas of rehabilitation practice.

Objective: To determine whether specific ultrasound (US) measures and cutoff scores from a new point-based scoring system were able to confirm the findings of the videofluoroscopic swallow study (VFSS) in diagnosing swallowing disorders (SDs).

Design: A cross-sectional, single-center study from March 2021 to March 2023. Initial SD screening on the Penetration Aspiration Scale and subsequent evaluation on the VFSS were administered to confirm SD. Additionally, a US study examined tongue thickness, tongue movement, hyoid bone displacement, and suprahyoid muscles. A scoring system based on these US measures was developed, and cutoff scores for the presence/absence of SDs were determined from the US and VFSS findings.

Setting: A single tertiary referral center providing both ambulatory and inpatient care.

Participants: One hundred nineteen adults (N=119) consecutively admitted to the SDs unit with suspected SDs. Exclusion criteria included total laryngectomy, health conditions preventing standard evaluation (eg, dyspnea, musculoskeletal disorders), and prior evaluation in the unit.

Interventions: Not applicable.

Main outcome measures: The SDs was able to be confirmed on the US-based score. The US cutoff scores were related to the presence or absence of SDs based on the findings of the VFSS.

Results: The SDs diagnosed in 75 (63%) based on VFSS and corroborated with main US features seen during swallowing. The logistic model developed included tongue movement, hyoid bone displacement, geniohyoid thickness at rest, and sex (area under the curve=0.83; 95% CI, 0.75-0.91). The US scoring system developed ranges from 0 to 5, with 0 indicating no dysphagia and 3-5 indicating SDs. The optimal cutoff to rule out SDs was ˂1, with a negative likelihood ratio of 0.04 and a negative posttest probability of 6%. To rule in SDs, the optimal cutoff was ≥3, with a positive likelihood ratio of 5.1 and a positive posttest probability of 90%.

Conclusions: The US-based scoring system is a promising, easy-to-use assessment tool with good diagnostic accuracy and useful posttest probabilities for SDs assessment. Further research is needed before clinical adoption.

Objective: To evaluate the feasibility and preliminary effects of remotely delivered metacognitive strategy training (MCST) to address cancer-related cognitive impairment (CRCI) in breast cancer survivors.

Design: Single-blinded, pilot randomized controlled trial.

Setting: University research laboratory and community.

Participants: Women (N=42) with self-reported CRCI, aged 40-80 years, who completed chemotherapy for breast cancer between 6 months and 3 years prior were recruited from a local cancer center and community support groups.

Methods: Outcome data were gathered before and after intervention. Participants (N=42) were randomized to either a 10-session Cognitive Orientation to daily Occupational Performance (CO-OP; ie, a type of MCST) group or an attention + education control group. All study procedures were conducted via secure videoconferencing.

Interventions: Ten, 45-minute weekly sessions of remotely delivered MCST or an attention + education control group.

Main outcome measures: The primary aim of this study was to evaluate feasibility.

Results: The study demonstrated strong feasibility, with a 41% recruitment rate and a 91.3% retention rate. Participants rated the CO-OP intervention and its remote delivery as highly feasible, appropriate, and acceptable. The intervention group showed small to medium positive effects on trained activity performance goals, cognition in daily life, and executive function measures compared with the control group. The control group showed a small positive effect on quality-of-life outcomes compared with the intervention group.

Conclusions: Breast cancer survivors found the remotely delivered CO-OP intervention to be suitable and practical. The positive effects of CO-OP on activity performance and cognitive outcomes support the need for further research on efficacy.

Objective: To describe the prevalence, interference, and intensity of subtypes of pain (at-level and below-level neuropathic pain [NeuP] and axial and limb musculoskeletal [MSK] pain) and the prevalence of nonpainful sensations (NPSs; unpleasant and nonunpleasant) experienced during the first 12 months after spinal cord injury (SCI).

Design: A prospective cohort study with clinician assessment of pain and survey administration at 3 timepoints SETTING: Four academic SCI rehabilitation centers.

Participants: A total of 189 individuals (N=189), English-speaking and aged 18 years or older, with complete and incomplete acute traumatic SCI, with or without pain were included.

Interventions: Not applicable.

Main outcome measure: International SCI Pain Basic Data Set.

Results: At baseline, at-level NeuP and axial neck and upper back MSK pain were most reported, whereas at 12 months, at-level and below-level NeuP were reported, with the percentage of participants with at-level NeuP remaining stable from baseline to 12 months. During the year, the percentage of participants reporting below-level NeuP steadily increased, whereas the percentage with all types of MSK pain decreased. Electrical- and stabbing-related and thermal-related descriptors were used more frequently to describe pain than to describe NPS, whereas numbness and tingling-related descriptors were the most frequently used for both pain and NPS. Pain intensity and interference were variable throughout the year.

Conclusions: At-level NeuP remains consistent, and MSK pain resolves over the first year for most people. However, more people develop below-level NeuP as the first year progresses. Pain intensity and interference are variable, presenting without a clear pattern during this time period.

Objectives: To explore the early efficacy of building emotional self-awareness teletherapy (BEST) at reducing alexithymia and improving emotional functioning in civilians and military service members and veterans with mild traumatic brain injury (TBI).

Design: Nonrandomized, pretest-posttest design and a 3-month follow-up.

Setting: Community.

Participants: Forty participants with mild TBI (20 civilians and 20 service members and veterans) and elevated alexithymia and emotion dysregulation. On average, participants were 40 years old and 13 years post-TBI.

Intervention: BEST is an 8-session, remotely delivered intervention that trains emotional insight.

Main outcome measures: Toronto Alexithymia Scale-20, Levels of Emotional Awareness Scale, Difficulty with Emotion Regulation Scale, Brief Resilience Scale, Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety and Anger, Patient Health Questionnaire-9 (depression), Posttraumatic stress disorder Checklist for DSM-5 (PCL-5), Positive and Negative Affect Schedule, and Patient Global Impression of Change.

Results: Thirty-six participants completed the study (90% retention). Compared with baseline, participants had significant improvements immediately and 3 months after treatment on the Toronto Alexithymia Scale-20, Levels of Emotional Awareness Scale, Difficulty with Emotion Regulation Scale, Brief Resilience Scale, Positive and Negative Affect Schedule negative affect scale, PROMIS Anxiety and Anger, Patient Health Questionnaire-9, and PCL-5. All P values were <.001, except Positive and Negative Affect Schedule negative affect at immediate posttest (P=.001), PROMIS Anxiety at both posttreatment time points (P=.009 and P=.006, respectively), and PROMIS anger at 3-month follow-up (P=.001). At posttest, 75%, 70%, and 60% of participants improved by ≥½ SD on the Toronto Alexithymia Scale-20, Levels of Emotional Awareness Scale, and Difficulty with Emotion Regulation Scale, respectively. On the Patient Global Impression of Change, 83% of participants reported noticeable positive changes in their emotional functioning.

Conclusions: Findings support the preliminary efficacy of BEST at improving psychological health in civilian and military participants with mild TBI who have elevated alexithymia and emotion dysregulation. However, larger trials with more rigorous designs are necessary to determine the true impact of BEST.

Objective: To identify specific pain qualities associated with body perception disturbances in patients with musculoskeletal pain, using machine learning interpretability methods.

Design: A cross-sectional study using self-reported questionnaires and SHapley Additive exPlanation (SHAP) analysis within a random forest model.

Setting: Multicenter clinical settings where patients with musculoskeletal pain received physical therapy.

Participants: A total of 179 patients with musculoskeletal pain, without restrictions on pain location or duration. Patients with cognitive impairment or difficulty completing questionnaires were excluded.

Interventions: None.

Main outcome measure(s): Pain qualities assessed using the Short-Form McGill Pain Questionnaire-2 (SFMPQ-2) and body perception disturbances assessed using the Fremantle Body Awareness Questionnaire (FreBAQ). SHAP values were calculated to quantify the relationship between individual pain qualities and body perception disturbances.

Results: SHAP-based importance ranked "cramping pain" among the top contributors, whereas bivariate correlations with FreBAQ were strongest for "gnawing pain" (r=.90, P<.001), indicating convergence on kinesthesia-related descriptors.

Conclusions: Multiple pain quality descriptors were associated with body perception disturbances. Although the analytic metrics differed in how they ranked individual descriptors, both SHAP-based importance and correlation analyses converged on kinesthesia-related qualities. These results indicate a prominent association between such descriptors and disturbed body perception, potentially informing sensorimotor-focused assessment and intervention strategies.

Objective: To determine the association of sleep duration and disturbances with physical and mental health-related quality of life (HRQoL) in stroke survivors.

Design: Cross-sectional analysis of the REasons for Geographic And Racial Differences in Stroke second in-home visit (May 2013-Dec 2016).

Setting: Population-based national study in US.

Participants: Individuals with adjudicated incident stroke (N=368).

Interventions: Not applicable.

Main outcome measures: Physical and mental HRQoL based on the 12-item Short Form. Sleep measures included sleep duration, difficulty initiating sleep, difficulty maintaining sleep, nonrestorative sleep, and a combined measure based on the latent class model. Logistic regression models were used to investigate the association between sleep variables and HRQoL, adjusting for demographic factors, socioeconomic factors, behavioral factors, and comorbidities.

Results: This study included 368 non-Hispanic Black and White stroke survivors. The mean age was 76.0 years (SD=7.9), and 52.7% were men. Stroke survivors with short sleep duration were more likely to have poor physical HRQoL (OR, 2.87; 95% CI, 1.46-5.62) compared with stroke survivors with adequate sleep duration after adjusting for confounding. Similarly, stroke survivors with nonrestorative sleep were 3 times more likely to have poor physical HRQoL (OR, 3.11; 95% CI, 1.28-7.55) compared with stroke survivors with restorative sleep.

Conclusions: Non-optimal sleep duration and nonrestorative sleep were associated with higher odds of poor physical HRQoL in stroke survivors. These findings highlight the importance of considering sleep health in post-stroke care.

Objective: It is unknown how the United States (U.S.) opioid epidemic influenced the integration of nonpharmacologic pain treatments in cancer survivors. We described annual trends and predictors of using opioids alone, nonpharmacologic treatments alone, multimodal treatments (opioid + nonpharmacologic), and neither treatment.

Design: A serial cross-sectional design.

Setting: Ambulatory.

Participants: Noninstitutionalized U.S. adults with prevalent cancer and pain in the Medical Expenditure Panel Survey (2011-2020).

Interventions: Not applicable.

Main outcome measures: Period prevalence of self-reported and pharmacy-verified use of opioids alone, nonpharmacologic treatments alone, both, or neither. Nonpharmacologic treatments included physical therapy, occupational therapy, chiropractic care, massage therapy, and acupuncture.

Results: Respondents with cancer and pain represented a total of 41,064,668 adults from 2011 to 2020. Most adults with cancer pain were >65 years of age (66.6%), women (52.1%), White (91.4%), non-Hispanic (95.8%), had a high school diploma (42.2%), had an income of 400% of the federal poverty line (46.6%), and lived in the U.S. South (37.7%). Compared with 2011, the prevalence of multimodal treatments increased from 4% (95% confidence interval [CI], 2%-6%) to 10% (95% CI, 6%-14%) in 2019, while the prevalence of using neither pain treatment decreased from 62% (95% CI, 55%-68%) to 46% (95% CI, 40%-52%). Compared with using neither treatment, the adjusted relative risk ratio (RRR) for using nonpharmacologic treatments was stable from 2011 to 2015 (RRR=1.00; 95% CI, 0.93-1.08), but increased from 2016 to 2019 (RRR=1.22; 95% CI, 1.02-1.46) until 2020 (RRR=0.68; 95% CI, 0.43-1.46). Both unadjusted and adjusted analyses found that pain treatments varied based on income, educational attainment, race, and geographic region.

Conclusions: Nonpharmacologic and multimodal pain treatments increased from 2011 to 2020; however, most cancer pain survivors remained untreated. Pain treatment varied based on sociodemographic and socioeconomic factors.