Archives of physical medicine and rehabilitation最新文献

{"title":"Minimal Important Changes of Common Outcome Measures of Physical Function in Individuals With Knee Osteoarthritis: A Prospective Clinical Study","authors":"Rebecca B. Ramalho PT ,&nbsp;Thais C. Chaves PhD ,&nbsp;Berend Terluin PhD ,&nbsp;Luiz F.A. Selistre PhD","doi":"10.1016/j.apmr.2025.04.016","DOIUrl":"10.1016/j.apmr.2025.04.016","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the minimal important change (MIC) for the 40-meter Fast Paced Walk Test (40m FPWT), 30-second Chair Stand Test (30s CST), 11-step Stair Climb Test (SCT), and Western Ontario and McMaster Universities Osteoarthritis Index – Physical Function subscale (WOMAC-PF) in individuals with knee osteoarthritis according to 3 methods described in the literature.</div></div><div><h3>Design</h3><div>A prospective clinical study.</div></div><div><h3>Setting</h3><div>Department of Physiotherapy at the Federal University of São Carlos (Brazil).</div></div><div><h3>Participants</h3><div>A total of one hundred and seven (N=107) participants.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Performance-based tests and WOMAC-PF were applied. After 6 months, the Global Perceived Effect (GPE) scale was used to evaluate changes in physical function. A GPE cutoff score was established to categorize participants as improved or not improved. The MIC_mean, MIC_{receiver operating characteristic (ROC)}, and MIC_adjusted were calculated. Anchor reliability was assessed through longitudinal confirmatory factor analysis.</div></div><div><h3>Results</h3><div>Of the 80 study participants, 19 were in the improved group. The MIC_mean of the subgroups ranged from 0.07 to 0.29 m/s for the 40m FPWT, 2.07 to 5.29 stands for the 30s CST, 2.14 to 5.58 seconds for the 11-step SCT, and 4.21 to 27 for the WOMAC-PF. The MIC_ROC values were 0.14 m/s for the 40m FPWT, 1.5 stands for the 30s CST, 1.79 seconds for the 11-step SCT, and 4.5 for the WOMAC-PF. The MIC_adjusted values were 0.10 m/s for the 40m FPWT, 0.7 stands for the 30s CST, 4.0 seconds for the 11-step SCT, and 12.8 for the WOMAC-PF.</div></div><div><h3>Conclusions</h3><div>The MIC_adjusted method considers both the proportion of improved patients and the reliability of transition ratings, making it preferable to MIC_mean and MIC_ROC. However, more high-quality studies are needed to assess its performance in samples with floor or ceiling effects.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 12","pages":"Pages 1829-1836"},"PeriodicalIF":3.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Utility of Remote Teleassessment of Motor Performance in Individuals With Neurologic Disabilities: A COSMIN Systematic Review","authors":"Andrea Baroni PhD ,&nbsp;Gabriele Perachiotti PT ,&nbsp;Andrea Carpineto PT ,&nbsp;Giulia Fregna MSc ,&nbsp;Annibale Antonioni MD ,&nbsp;Maria E. Flacco PhD ,&nbsp;Sofia Straudi PhD","doi":"10.1016/j.apmr.2025.07.013","DOIUrl":"10.1016/j.apmr.2025.07.013","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the feasibility and measurement properties of measurement tools for remote evaluation of motor performance in people with neurologic conditions requiring only synchronous or asynchronous video conferencing without sensors or other complex technological tools.</div></div><div><h3>Data Sources</h3><div>A systematic search was conducted in PubMed, Embase, the Cumulative Index for Nursing and Allied Health Literature (CINHAL), and ScienceDirect. The search strategy included keywords related to any neurologic population, telerehabilitation, and motor performance outcome measure; papers in Italian or English language on adults were included, without time restrictions.</div></div><div><h3>Study Selection</h3><div>We included studies reporting data of at least one measurement property between reliability, validity, feasibility, or acceptability of measurement tools for remote motor assessment in neurologic disorders. We excluded studies that used wearable technologies, smartphones, or mobile applications. After duplicate removal, 2530 records were screened. Of the 461 remaining papers, 26 met the inclusion criteria and were included in the systematic review.</div></div><div><h3>Data Extraction</h3><div>Two independent reviewers extracted data from the included records, evaluated the risk of bias of the studies using the Consensus-based Standards for the selection of health Measurement Instruments tool, and applied the criteria for good measurement properties and clinical utility. Discordance was solved through discussion with a third reviewer.</div></div><div><h3>Data Synthesis</h3><div>Twenty-nine measurement tools were identified, and a narrative synthesis was conducted because of the heterogeneity of the included studies. The Fugl-Meyer Assessment for the Lower and Upper Extremity and the Tinetti Performance-Oriented Mobility Assessment Balance were suggested for the remote evaluation of people with stroke, whereas the Five Times Sit-to-Stand Test, the Nine-Hole Peg Test, and the Timed 25-Foot Walk Test were suggested for people with multiple sclerosis.</div></div><div><h3>Conclusions</h3><div>Several measurement tools have been identified for remote evaluation of motor performance in people with neurologic disorders, but few of them can be suggested for clinical and scientific purposes. A higher methodological quality of studies would support the use of these tools in clinical practice.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 12","pages":"Pages 1899-1911"},"PeriodicalIF":3.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ed Board page","authors":"","doi":"10.1016/S0003-9993(25)01008-1","DOIUrl":"10.1016/S0003-9993(25)01008-1","url":null,"abstract":"","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 12","pages":"Page A10"},"PeriodicalIF":3.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moderating Effects of Clinical and Social Factors on Fatigue Improvement After an Online Peer-Led Fatigue Self-management Intervention in People With Systemic Sclerosis: A Secondary Analysis of a Randomized Controlled Trial","authors":"Yen T. Chen PhD ,&nbsp;Nirali Shah PhD ,&nbsp;Afton L. Hassett PsyD ,&nbsp;Suiyuan Huang MPH ,&nbsp;Dinesh Khanna MD, MSc ,&nbsp;Susan L. Murphy ScD","doi":"10.1016/j.apmr.2025.05.002","DOIUrl":"10.1016/j.apmr.2025.05.002","url":null,"abstract":"<div><h3>Objective</h3><div>To examine moderators of intervention effects in fatigue from a randomized controlled trial comparing an online peer-led fatigue self-management intervention to a waitlist control in people with systemic sclerosis (SSc).</div></div><div><h3>Design</h3><div>Secondary analysis of a 12-week, parallel, single-blind randomized controlled trial.</div></div><div><h3>Setting</h3><div>Community.</div></div><div><h3>Participants</h3><div>Adults with SSc with moderate to severe fatigue (N=173) recruited from SSc specialty centers, a registry, and social media.</div></div><div><h3>Interventions</h3><div>A 12-week, online, peer-led fatigue self-management intervention was randomized in a 2:1 ratio: intervention (n=115) and waitlist control (n=58).</div></div><div><h3>Main Outcome Measures</h3><div>The outcome measure was change in the Functional Assessment of Chronic Illness Therapy-Fatigue scale assessed at baseline, week 6, and week 12. Potential moderators assessed at baseline included demographic, clinical, psychological, and social variables.</div></div><div><h3>Results</h3><div>Baseline levels of informational support moderated the treatment effect to predict change in fatigue at week 12 (<em>P</em>=.015). Participants who had average to high levels of informational support at baseline reported greater improvements in fatigue at week 12 compared with their counterparts in both treatment groups, whereas the between-moderator difference in the intervention group is significantly larger than in the waitlist control. No other variables were found to significantly moderate the outcomes.</div></div><div><h3>Conclusions</h3><div>Participants with baseline average to high informational support experienced greater improvements in fatigue at week 12 compared with their counterparts, particularly in the intervention group. This suggests that higher informational support may enhance coping and emotional reassurance. Future research could tailor fatigue interventions based on baseline informational support to optimize treatment efficacy in diverse SSc populations.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 12","pages":"Pages 1807-1814"},"PeriodicalIF":3.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144092738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of a Prognostic Model for Independent Walking in Children With Cerebral Palsy Based on Machine Learning","authors":"Wang Yiwen MD,&nbsp;Yang Yonghui MD","doi":"10.1016/j.apmr.2025.05.006","DOIUrl":"10.1016/j.apmr.2025.05.006","url":null,"abstract":"<div><h3>Objective</h3><div>To develop and validate machine learning-based models for predicting independent walking ability in children with cerebral palsy (CP).</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>Data were collected from a national CP registry platform and follow-up assessments were conducted through telephone interviews.</div></div><div><h3>Participants</h3><div>Children with CP (n=807) registered between January 2016 and December 2020, with follow-up data collected from October 2022 to March 2023.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome was independently walking before the age of 6 years.</div></div><div><h3>Results</h3><div>Among the 807 participants, 561 (69.5%) achieved independent walking. Univariate Cox regression identified several predictive factors, including neonatal asphyxia, bilirubin encephalopathy, Gross Motor Function Classification System level before age of 2 years, age of independent sitting, type of CP, magnetic resonance imaging classification, Gross Motor Function Measure-88 scores, epilepsy, intellectual disability, early preterm birth, and very low birth weight (<em>P</em>&lt;.05). Machine learning models demonstrated excellent predictive performance, with logistic regression achieving the highest area under the curve (AUC=0.947), followed by XGBoost (AUC=0.946) and multilayer perceptron (AUC=0.945). Cox proportional hazard models identified key predictors for the timing of independent walking, with a nomogram constructed for clinical application. Internal validation confirmed model reliability, although calibration curves indicated potential overestimation for ages 5-6 years.</div></div><div><h3>Conclusions</h3><div>Machine learning models accurately predict independent walking ability in children with CP, although calibration analyses indicated potential overestimation for children aged 5-6 years. The proposed nomogram provides clinicians with an interpretable tool for personalized prognosis. Although internal validation demonstrated excellent performance, future external validation in multicenter cohorts will be critical to confirm generalizability.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 12","pages":"Pages 1850-1858"},"PeriodicalIF":3.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validity and Reliability of Interview and Online Self-Report Versions of Motor and Sensory Components of a Neurological Exam for Classifying Spinal Cord Injury (One-SCI)","authors":"Thomas N. Bryce MD ,&nbsp;Laiba Afzal MS ,&nbsp;Stephen P. Burns MD ,&nbsp;Marcel P. Dijkers PhD ,&nbsp;Steven Kirshblum MD ,&nbsp;Ralph J. Marino MD ,&nbsp;Jayme O’Connor BS ,&nbsp;Arianny Ramirez BA ,&nbsp;Brittany Snider DO ,&nbsp;Lisa Spielman PhD ,&nbsp;Chung-Ying Tsai PhD","doi":"10.1016/j.apmr.2025.05.016","DOIUrl":"10.1016/j.apmr.2025.05.016","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the feasibility, validity, and reliability of the Online Neurological Exam for Spinal Cord Injury (One-SCI), a patient-reported outcome measure of the motor and sensory components needed for classifying spinal cord injury (SCI) according to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI).</div></div><div><h3>Design</h3><div>Repeat administration (1wk interval) of either an online self-administered or an interviewer-administered survey (both supported by extensive computer-provided illustrations and animations) followed by an in-person ISNCSCI examination after an additional week.</div></div><div><h3>Setting</h3><div>Academic free standing rehabilitation center and medical center.</div></div><div><h3>Participants</h3><div>A total of 67 individuals (N=67) with chronic SCI with complete or incomplete injuries representing 6 groups based upon neurologic level of injury (C1-4, C5-6, C7-T1, T2-T6, T7-T12, and L1-S5) who were English-speaking and aged ≥18 years.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>ISNCSCI neurologic levels and American Spinal Injury Association Impairment Scale (AIS) grade.</div></div><div><h3>Results</h3><div>Overall test–retest agreement was substantial, with kappas ranging from 0.69 to 0.84 for all the neurologic levels and AIS grades. Overall agreement between the neurologic levels and AIS grades derived from the first administration of One-SCI (participant survey responses) and the ISNCSCI examinations was moderate to substantial, with kappas ranging from 0.55 to 0.71. The median time needed to complete the interview and online versions of One-SCI the first time was 51 minutes.</div></div><div><h3>Conclusions</h3><div>Findings generally support the reliability and validity of both interview and online versions of One-SCI. One-SCI does take nearly 1 hour to complete, which possibly will limit its widespread use. The results should be replicated in larger samples.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 12","pages":"Pages 1821-1828"},"PeriodicalIF":3.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Therapeutic Exercises Versus General Conservative Modalities and Brace on the Progression of Adolescent Idiopathic Scoliosis: Systematic Review and Meta-analysis","authors":"Rodrigo Mantelatto Andrade MS ,&nbsp;Ana Paula Ribeiro PhD ,&nbsp;Milene Eloise Callegari Ferreira MS ,&nbsp;Larissa Calvo Piras MS ,&nbsp;Maria de Lourddes de Moura Partika MS ,&nbsp;Nelson Carvas Junior MS ,&nbsp;Henry Dan Kiyomoto MS ,&nbsp;Silvia Maria Amado João PhD","doi":"10.1016/j.apmr.2025.06.021","DOIUrl":"10.1016/j.apmr.2025.06.021","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the effects of therapeutic exercises in preventing Cobb angle progression in adolescent idiopathic scoliosis (AIS) compared with other conservative treatments.</div></div><div><h3>Data Sources</h3><div>Systematic searches were conducted in MEDLINE via PubMed, Embase, centralized database (CENTRAL), Physiotherapy Evidence Database (PEDro), and cumulative index to nursing and allied health literature up to December 14, 2023, and registered in PROSPERO (CRD42020156639).</div></div><div><h3>Study Selection</h3><div>Randomized controlled trials involving adolescents aged 10-18 years with AIS and a Cobb angle &gt;10° were included.</div></div><div><h3>Data Extraction</h3><div>Two reviewers independently extracted study data, assessed the risk of bias using the PEDro scale, and the certainty of evidence—using the Grading of Recommendations, Assessment, Development and Evaluation approach.</div></div><div><h3>Data Synthesis</h3><div>Nineteen studies involving 832 participants met our selection criteria. The PEDro scale score ranged from 3 to 8 points (0-10). The results on Cobb angle progression showed no significant difference in Cobb angle reduction between therapeutic exercises and minimal intervention in the short term (mean difference [MD]=−1.33; 95% confidence interval [CI], −4.87 to 2.22). The specific therapeutic exercises showed greater Cobb angle reduction compared with general exercises in the short term (MD=−2.57; 95% CI, −4.56 to −0.59) and long term (MD=−6.00; 95% CI, −6.88 to −5.12). No significant difference was observed between therapeutic exercise and brace use in the short term (MD=0.20; 95% CI, −1.74 to 2.14); however, bracing was more effective in the long term (MD=2.66; 95% CI, 0.18-5.14). Therapeutic exercises with bracing significantly reduced Cobb angle in the short term compared with bracing alone (MD=2.25; 95% CI, −3.86 to −0.63).</div></div><div><h3>Conclusions</h3><div>This systematic review and meta-analysis suggest that therapeutic exercises can be effective in preventing Cobb angle progression in AIS. Specifically, targeted therapeutic exercises led to a greater reduction in Cobb angle compared with general exercises both in the short and long term. Although no significant difference was found between therapeutic exercises and minimal intervention in the short term, combining therapeutic exercises with bracing demonstrated a significant short term advantage over bracing alone. In the long term, bracing was found to be more effective than therapeutic exercises in preventing Cobb angle progression. Given the varied outcomes across different interventions and time frames, further high-quality trials are needed to establish optimal treatment protocols for managing AIS.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 12","pages":"Pages 1874-1885"},"PeriodicalIF":3.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing Interpretability of Patient-Reported Outcomes Measurement Information System (PROMIS) and Related Measures in Rehabilitation Populations: A Systematic Review of Clinical and Research Applications.","authors":"Rehab Alhasani, Rebecca Ataman, Zanib Nafees, Anita Luong, Line Auneau-Enjalber, Adria Quigley, Henry Ukachukwu Michael, Sara Ahmed","doi":"10.1016/j.apmr.2025.11.017","DOIUrl":"10.1016/j.apmr.2025.11.017","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate and synthesize interpretability metrics, including minimal important change (MIC), minimal important difference (MID), and minimal detectable change (MDC), across Patient-Reported Outcomes Measurement Information System (PROMIS) and related systems (Quality of Life in Neurological Disorders [Neuro-QoL], Quality of Life in Traumatic Brain Injury [TBI-QoL], Quality of Life in Spinal Cord Injury [SCI-QoL]) in rehabilitation populations.</p><p><strong>Data sources: </strong>Comprehensive searches of electronic databases (MEDLINE, EMBASE, PsycINFO, HaPI, CINAHL, Cochrane Library, Web of Science) and clinical trial registries (ISRCTN Registry, ClinicalTrials.gov) were conducted from inception through March 23, 2024, in consultation with an information specialist.</p><p><strong>Study selection: </strong>Eligible studies assessed interpretability metrics in rehabilitation populations using PROMIS, Neuro-QoL, TBI-QoL, or SCI-QoL. Studies of pediatric or nonrehabilitation populations, abstracts, posters, or consensus statements were excluded. A total of 202 studies met inclusion criteria.</p><p><strong>Data extraction: </strong>Two independent reviewers extracted study characteristics, interpretability metrics, and analytical methods following COnsensus-based Standards for the Selection of Health Measurement Instruments guidelines.</p><p><strong>Data synthesis: </strong>MIC, MID, and MDC values varied widely across populations and domains. PROMIS mental health domains (eg, depression, anxiety, fatigue) demonstrated relatively consistent estimates, whereas physical function domains were more variable, particularly in chronic and geriatric groups. PROMIS Computer Adaptive Testing measures showed fewer floor and ceiling effects than short forms, indicating enhanced sensitivity to change. Limited data were available for SCI-QoL and TBI-QoL.</p><p><strong>Conclusions: </strong>Standardizing interpretability metrics and expanding research on SCI-QoL and TBI-QoL are critical to improving the clinical utility of these measures in rehabilitation. Future work should incorporate response-shift considerations and establish population-specific cut-points to support patient-centered care and evidence-based practice.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145666890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characterization of Hip Subgroups in Geriatric Chronic Low Back Pain","authors":"Jenifer M. Pugliese PT, DPT ,&nbsp;Jaclyn Megan Sions PT, DPT, PhD ,&nbsp;Patrick J. Knox PT, DPT, PhD ,&nbsp;Ryan T. Pohlig PhD ,&nbsp;Gregory E. Hicks PT, PhD","doi":"10.1016/j.apmr.2025.04.018","DOIUrl":"10.1016/j.apmr.2025.04.018","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate and compare the clinical profiles of 3 previously established hip-based subgroups of older adults with chronic low back pain (LBP) using data from multiple domains.</div></div><div><h3>Design</h3><div>Cross-sectional analysis of baseline cohort study data.</div></div><div><h3>Setting</h3><div>Clinical research laboratory.</div></div><div><h3>Participants</h3><div>Two hundred fifty (n=250) community dwelling older adults with chronic LBP.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Clinical profiles of the previously derived subgroups were established. Pain quality and dispersion were captured with the McGill Pain Questionnaire. Self-efficacy was measured using the Low Back Activity Confidence Scale. Catastrophic thoughts about LBP were captured with the Pain Catastrophizing Scale. Trunk mobility was measured with an inclinometer. Trunk muscle function was captured through standardized muscle endurance testing and ultrasound measures of muscle activity. One-way analysis of variance was used to analyze between-group differences.</div></div><div><h3>Results</h3><div>Each chronic LBP subgroup was named based on the level of hip strength and hip symptoms: weak and symptomatic, weak and nonsymptomatic, and strong and nonsymptomatic. The weak and symptomatic subgroup had distinctly worse levels of pain quality, dispersion, catastrophizing and self-efficacy, compared with the other 2 subgroups. In contrast, the strong and nonsymptomatic subgroup, as compared with the other subgroups, had greater thoracolumbar flexion, greater trunk muscle endurance and better psychological profiles.</div></div><div><h3>Conclusions</h3><div>The unique clinical profile of each subgroup underscores how important it is to consider the heterogeneous nature of chronic LBP in the geriatric population when developing treatment approaches. The clinical characterization of these subgroups across multiple rehabilitation-focused domains may optimize the development of tailored interventions for each subgroup.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 12","pages":"Pages 1859-1865"},"PeriodicalIF":3.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness, Feasibility, Acceptability, and Safety of Digital Interventions in Post-Stroke Rehabilitation: A Systematic Review and Meta-analysis of Randomized Controlled Trials","authors":"Shuangyue Liu MD ,&nbsp;Min Li MD ,&nbsp;Jilin Ding MD ,&nbsp;Qipei Ji MD ,&nbsp;Yanning Niu MD ,&nbsp;Xiao Yang MD ,&nbsp;Shuangchun Ai PhD ,&nbsp;Siyuan Li PhD","doi":"10.1016/j.apmr.2025.07.004","DOIUrl":"10.1016/j.apmr.2025.07.004","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the effects of digital interventions on cognition, emotion, and activities of daily living (ADL) in stroke survivors, alongside evaluating feasibility, acceptability, and safety metrics.</div></div><div><h3>Data Sources</h3><div>We systematically searched 11 English databases for eligible studies published between 2000 and May 2025.</div></div><div><h3>Study Selection</h3><div>Randomized control trials that focused on poststroke digital therapeutics were included. Experimental groups received digital interventions, while control groups underwent standard therapies or placebo. The outcomes included cognition, emotion, ADL, feasibility, acceptability, and safety.</div></div><div><h3>Data Extraction</h3><div>Two researchers independently extracted key data from eligible studies. Risk and methodology were assessed using the Cochrane Risk of Bias v2.0 and the PEDro scale. The meta-analysis was conducted using CMA v3.7, following the PRISMA 2020 guidelines.</div></div><div><h3>Data Synthesis</h3><div>Sixty-three studies (3297 participants) demonstrated significant improvements in overall cognition (<em>g</em>=0.46; 95% CI, 0.24-0.67; <em>P</em>&lt;.001), ADL (<em>g</em>=0.38; 95% CI, 0.19-0.57; <em>P</em>&lt;.001), and specific domains (global cognition, language, visuospatial; all <em>P</em>&lt;.05). Exergaming and computer cognitive training significantly improved overall cognition and memory compared to other digital interventions. Medical sites-based interventions significantly enhanced overall/global cognition versus home-based protocols. Shorter sessions (≤30min) demonstrated superior efficacy in overall cognition to longer durations. Robot-assisted and computer cognitive training maximized ADL gains. Despite significant between-subgroup heterogeneity in emotion outcomes, no within-subgroup efficacy emerged for any digital interventions. Results showed varied recruitment (4.97%-100%) and retention (mostly &gt;75%) across digital interventions. Adherence and attendance were generally high, while safety profiles were mostly favorable with mild adverse events like fatigue or dizziness in some cases.</div></div><div><h3>Conclusions</h3><div>Digital interventions significantly enhance cognition when delivered via clinic-based exergaming or computer cognitive training (≤30min/session), while maximizing ADL improvements through robot-assisted or computer cognitive training in stroke patients. Robust feasibility, acceptability, and favorable safety supports clinical integration.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 12","pages":"Pages 1912-1932"},"PeriodicalIF":3.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}