Archives of physical medicine and rehabilitation最新文献

英文中文

Depression Mediates the Association Between Burden and Quality of Life in Informal Caregivers of Stroke Survivors: Meta-analytic Structural Equation Modeling 抑郁对中风幸存者非正式照顾者的负担与生活质量之间的关系起中介作用：元分析结构方程模型

IF 3.6 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2024-10-01 DOI: 10.1016/j.apmr.2024.01.022

Objective

This study aims to use Meta-analytical structural equation modeling (MASEM) to clarify the relationship between burden, depression, and quality of life in informal caregivers of stroke survivors.

Data Sources

The databases of PubMed, Cochrane Library, Embase, China Knowledge Resource Integrated Database, Wan Fang Database, and Chinese Biomedical Database were comprehensively searched before January 16, 2023.

Study Selection

Two researchers performed an independent initial search by using a unified search strategy. Observational studies investigating the relation between burden, depression, and quality of life in informal caregivers of stroke survivors were included. The studies that met the inclusion criteria were appraised by “Quality Assessment and Validity Tool for Correlational Studies”.

Data Extraction

PRISMA guidelines were used for this study. Data extraction was performed independently by 2 researchers. The following data were extracted: study author, year of publication, country, language, sample size, age, sex (%women), the caregivers’ relation with stroke survivor, measures, type of outcome reported in the study, study design, and main conclusion.

Data Synthesis

The analysis included 18 articles that reported 23 effect sizes (N=3284). The MASEM findings showed that caregiver burden was positively associated with caregiver depression (β=0.474, 95% CI [0.398, 0.550]), caregiver depression was negatively associated with caregiver quality of life (β=-0.316, 95% CI [-0.545, -0.087]). Furthermore, the association between caregiver burden and quality of life was completely mediated by caregiver depression (β=-0.150, 95% CI [-0.271, -0.041]).

Conclusions

Using the MASEM approach, we observed that caregiver depression completely mediated the relation between burden and quality of life in informal caregivers of stroke survivors. Although the results did not allow for causal inference, this result suggested that for burdened stroke survivors’ informal caregivers efforts should be made to their mental health to eliminate the internal barriers, then eventually improve their quality of life.

数据来源在 2023 年 1 月 16 日之前，对 PubMed、Cochrane Library、Embase、中国知识资源综合数据库、万方数据库和中国生物医学数据库进行了全面检索。研究筛选两位研究人员采用统一的检索策略进行了独立的初步检索，纳入了调查脑卒中幸存者非正式照护者的负担、抑郁和生活质量之间关系的观察性研究。符合纳入标准的研究由 "相关研究质量评估和有效性工具 "进行评估。数据提取由两名研究人员独立完成。提取的数据包括：研究作者、发表年份、国家、语言、样本量、年龄、性别（女性占比）、照护者与卒中幸存者的关系、测量方法、研究中报告的结果类型、研究设计和主要结论。MASEM 研究结果显示，护理者负担与护理者抑郁呈正相关（β=0.474，95% CI [0.398，0.550]），护理者抑郁与护理者生活质量呈负相关（β=-0.316，95% CI [-0.545，-0.087]）。此外，照顾者负担与生活质量之间的关系完全由照顾者抑郁介导（β=-0.150，95% CI [-0.271，-0.041]）。结论使用 MASEM 方法，我们观察到照顾者抑郁完全介导了中风幸存者非正式照顾者负担与生活质量之间的关系。尽管这一结果无法进行因果推断，但它表明，对于负担沉重的脑卒中幸存者的非正式照顾者来说，应努力改善他们的心理健康，消除内部障碍，最终提高他们的生活质量。

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引用次数: 0

Effectiveness of Balance Exercise and Brisk Walking on Alleviating Nonmotor and Motor Symptoms in People With Mild-to-Moderate Parkinson Disease: A Randomized Clinical Trial With 6-Month Follow-up 平衡运动和快走对缓解轻度至中度帕金森病患者的非运动症状和运动症状的效果：一项为期 6 个月的随机临床试验。

IF 3.6 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2024-10-01 DOI: 10.1016/j.apmr.2024.05.031

Objective

To investigate the effects of balance exercise and brisk walking on nonmotor and motor symptoms, balance and gait functions, walking capacity, and balance confidence in Parkinson disease (PD) at posttraining and 6-month follow-up.

Design

Two-arm, assessor-blinded randomized controlled trial

Setting

University research laboratory and the community

Participants

Ninety-nine eligible individuals with mild-to-moderate PD

Interventions

Participants were randomized to balance and brisk walking group (B&B, n=49) or active control group (n=50). B&B received ten 90-minute sessions of balance exercises and brisk walking supervised by physical therapists for 6 months (week 1-6: weekly, week 7-26: monthly), whereas control practiced whole-body flexibility and upper limb strength exercise at same dosage (180 min/wk). Both groups performed unsupervised home exercises 2-3 times/wk during intervention and continued at follow-up.

Main Outcome Measures

Primary outcomes were Movement Disorder Society Unified Parkinson Disease Rating Scale nonmotor (MDS-UPDRS-I) and motor (MDS-UPRDS-III) scores. Secondary outcomes were mini-Balance Evaluation Systems Test (mini-BEST) score, comfortable gait speed (CGS), 6-minute walk test (6MWT), dual-task timed-Up-and-Go (DTUG) time, and Activities-Specific Balance Confidence Scale score.

Results

Eighty-three individuals completed the 6-month intervention with no severe adverse effects. The mean between-group (95% CI) difference for the MDS-UPDRS nonmotor score was 1.50 (0.19-2.81) at 6 months and 1.09 (−0.66 to 2.85) at 12 months. The mean between-group (95% CI) difference for the MDS-UPDRS motor score was 3.75 (0.69-6.80) at 6 months and 4.57 (1.05-8.01) at 12 months. At 6 and 12 months, there were significant between-group improvements of the B&B group in mini-BEST score, CGS, 6MWT, and DTUG time.

Conclusions

This combined balance and brisk walking exercise program alleviates nonmotor and motor symptoms and improves walking capacity, balance, and gait functions posttraining, with positive carryover effects for all except nonmotor outcomes, at 6-month follow-up in mild-to-moderate PD.

目的调查帕金森病（PD）患者在训练后和6个月随访期间，平衡锻炼和快走对非运动症状和运动症状、平衡和步态功能、行走能力以及平衡信心的影响：设计：双臂、评估者盲法随机对照试验：参与者：99 名符合条件的帕金森病患者：99 名符合条件的轻度至中度帕金森病患者：参与者被随机分配到平衡和快走组（B&B，49 人）或积极对照组（CON，50 人）。B&B组在理疗师的监督下进行10次90分钟的平衡练习和快走，为期6个月（第1-6周：每周一次，第7-26周：每月一次），而CON组则以相同的剂量（180分钟/周）进行全身柔韧性和上肢力量练习。在干预期间，两组患者均在无人监督的情况下进行家庭锻炼，每周 2-3 次，并在随访时继续进行：主要结果和测量方法：主要结果为运动障碍协会统一帕金森病评分量表非运动性（MDS-UPDRS-I）和运动性（MDS-UPRDS-III）评分。次要结果为迷你平衡评估系统测试（Mini-BEST）得分、舒适步态速度（CGS）、六分钟步行距离（6MWD）、双任务定时起立行走（DTUG）时间和特定活动平衡信心量表（ABC）得分：83人完成了为期6个月的干预，未出现严重不良反应。6 个月时，MDS-UPDRS 非运动评分的组间平均差异（95% CI）为 1.50（0.19-2.81），12 个月时为 1.09（-0.66-2.85）。6 个月时，MDS-UPDRS 运动评分的组间平均差异（95% CI）为 3.75（0.69-6.80），12 个月时为 4.57（1.05-8.01）。在 6 个月和 12 个月时，B&B 组在 Mini-BEST 评分、CGS、6MWD 和 DTUG 时间方面均有显著的组间改善：这种平衡与快走相结合的锻炼计划可减轻轻度至中度帕金森病患者的非运动症状和运动症状，提高训练后的行走能力、平衡能力和步态功能，并在6个月的随访中对除非运动外的所有结果产生积极的延续性影响。

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引用次数: 0

Self-management Programs Within Rehabilitation Yield Positive Health Outcomes at a Small Increased Cost Compared With Usual Care: A Systematic Review and Meta-analysis 与常规护理相比，康复项目中的自我管理计划只需增加少量成本就能产生积极的健康效果：系统回顾和荟萃分析。

IF 3.6 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2024-10-01 DOI: 10.1016/j.apmr.2024.05.007

Objective

To determine if self-management programs, supported by a health professional, in rehabilitation are cost effective.

Data Sources

Six databases were searched until December 2023.

Study Selection

Randomized controlled trials with adults completing a supported self-management program while participating in rehabilitation or receiving health professional input in the hospital or community settings were included. Self-management programs were completed outside the structured, supervised therapy and health professional sessions. Included trials had a cost measure and an effectiveness outcome reported, such as health-related quality of life or function. Grading of Recommendations, Assessment, Development, and Evaluations was used to determine the certainty of evidence across trials included in each meta-analysis. Incremental cost-effectiveness ratios were calculated based on the mean difference from the meta-analyses of contributing health care costs and quality of life.

Data Extraction

After application of the search strategy, two independent reviewers determined eligibility of identified literature, initially by reviewing the title and/or abstract before full-text review. Using a customized form, data were extracted by one reviewer and checked by a second reviewer.

Data Synthesis

Forty-three trials were included, and 27 had data included in meta-analyses. Where self-management was a primary intervention, there was moderate certainty of a meaningful positive difference in quality-of-life utility index of 0.03 units (95% confidence interval, 0.01-0.06). The cost difference between self-management as the primary intervention and usual care (comprising usual intervention/therapy, minimal intervention [including education only], or no intervention) potentially favored the comparison group (mean difference=Australian dollar [AUD]90; 95% confidence interval, −AUD130 to AUD310). The cost per quality-adjusted life year (QALY) gained for self-management programs as a stand-alone intervention was AUD3000, which was below the acceptable willingness-to-pay threshold in Australia per QALY gained (AUD50,000/QALY gained).

Conclusions

Self-management as an intervention is low cost and could improve health-related quality of life.

目标：确定由医疗专业人员支持的康复自我管理计划是否具有成本效益：确定在医疗专业人员支持下的康复自我管理计划是否具有成本效益：研究选择：随机对照试验：包括在医院或社区环境中，成人在参与康复治疗或接受医疗专业人员指导的同时完成自我管理计划的试验。自我管理计划是在有组织、有监督的治疗和医疗专业课程之外完成的。纳入的试验均有成本衡量标准和有效性结果报告，如与健康相关的生活质量或功能。推荐、评估、发展和评价分级法（GRADE）用于确定每项荟萃分析所纳入试验的证据确定性。根据医疗成本和生活质量荟萃分析的平均差异计算增量成本效益比（ICERS）：采用检索策略后，由两名独立审稿人确定已识别文献的资格，首先审阅标题和/或摘要，然后再审阅全文。一名审稿人使用定制的表格提取数据，并由另一名审稿人进行检查：共纳入 43 项试验，27 项试验的数据被纳入荟萃分析。在以自我管理为主要干预措施的情况下，生活质量效用指数的有意义正差异为 0.03 个单位（95% CI 0.01 至 0.06），这一点已基本确定。将自我管理作为主要干预措施与常规护理（包括常规干预/治疗、最小干预（仅包括教育）或无干预）之间的成本差异可能有利于对比组（MD 90 澳元，95% CI - 130 澳元至 310 澳元）。作为一项独立干预措施，自我管理项目每获得一个质量调整生命年（QALY）的成本为3000澳元，低于澳大利亚每获得一个质量调整生命年可接受的支付意愿阈值（50000澳元/质量调整生命年）：自我管理作为一种干预措施成本较低，可改善与健康相关的生活质量：CRD42021275472。

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引用次数: 0

Letter to the Editor: The Effects of Near-Infrared Phototherapy Preirradiation on Lower-Limb Muscle Strength and Injury After Exercise 致编辑的信，主题为 "近红外光疗照射前对下肢肌肉力量和运动后损伤的影响"。

IF 3.6 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2024-10-01 DOI: 10.1016/j.apmr.2024.05.036

João Vitor Ferlito MSc, Thiago De Marchi PhD

引用次数: 0

Letter to Editor: Effect of Psychomotricity in Combination With 3 Months of Active Shoulder Exercises in Individuals With Chronic Shoulder Pain: Primary Results From an Investigator-Blinded, Randomized, Controlled Trial 致编辑的信，主题为 "心理治疗与 3 个月积极肩部锻炼相结合对慢性肩部疼痛患者的影响：一项研究者盲法随机对照试验的初步结果"。

IF 3.6 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2024-10-01 DOI: 10.1016/j.apmr.2024.05.034

Samruddhi Kendhe, Anmol Bhatia, Thiagarajan Subramanian PhD

引用次数: 0

Archives Manuscript Reviewers 档案馆审稿人

IF 3.6 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2024-09-30 DOI: 10.1016/j.apmr.2024.09.001

引用次数: 0

Letter to the Editor: Rehabilitation of Social Communication Skills in Patients With Acquired Brain Injury With Intensive and Standard Group Interactive Structured Treatment: A Randomized Controlled Trial. 致编辑的信，主题为 "通过强化和标准小组互动结构化治疗康复后天性脑损伤患者的社交沟通技能：随机对照试验"。

IF 3.6 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2024-09-27 DOI: 10.1016/j.apmr.2024.06.025

Parneet Kaur, Anmol Bhatia, Geetanjali Saggar

引用次数: 0

Response to Letter to the Editor: Rehabilitation of Social Communication Skills in Patients With Acquired Brain Injury With Intensive and Standard Group Interactive Structured Treatment: A Randomized Controlled Trial. 对 "通过强化和标准小组互动结构化治疗康复后天性脑损伤患者的社交沟通技能：随机对照试验"。

IF 3.6 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2024-09-27 DOI: 10.1016/j.apmr.2024.09.009

Silje Merethe Hansen Ingebretsen, Melanie Kirmess, Jan Stubberud

引用次数: 0

Comparison of the Efficacy of 2 Different Botulinum Toxin Injection Techniques in Gastrocnemius Muscle Spasticity in Hemiplegic Patients: A Randomized Double-Blind Controlled Study. 比较两种不同的肉毒毒素注射技术对偏瘫患者腓肠肌痉挛的疗效：随机双盲对照研究。

IF 3.6 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2024-09-27 DOI: 10.1016/j.apmr.2024.09.011

Savaş Karpuz, Ramazan Yılmaz, Halim Yılmaz

Objective: To compare the efficacy of the innervation zone-targeted injection technique (EUROMUSCULUS/USPRM (Ultrasound Study Group of the International Society of Physical and Rehabilitation Medicine) spasticity approach) and the injection technique along the muscle length.

Design: A double-blind randomized controlled trial.

Setting: Department of rehabilitation medicine of a medical center.

Participants: One hundred patients with stroke experiencing ankle plantar flexor spasticity.

Interventions: In addition to conventional rehabilitation, eligible patients were randomly assigned to 2 groups. The experimental group was injected with botulinum toxin along the length of the muscle, whereas the control group was injected with the same dose and volume of botulinum toxin 25%-35% proximal to the medial head and 20%-30% proximal to the lateral aspect of the head of the gastrocnemius muscle.

Main outcome measures: Modified Ashworth scale, modified Tardieu scale, ankle range of motion measurement, and 10-meter walk test were used before and 1 month after injection.

Results: The study was completed by 60 participants with a mean age of 59.96±12.15 years. Both injection methods were found to be effective on range of motion, spasticity level, ambulation, and walking speed. There was no statistically significant difference between injection methods.

Conclusions: Both injection methods of botulinum toxin A produce similar clinical effects.

目的比较神经支配区靶向注射技术（EUROMUSCULUS/USPRM痉挛方法）和沿肌肉长度注射技术的疗效：双盲随机对照试验：参与者： 100 名患有踝关节足底痉挛的中风患者：100 名患有踝关节跖屈痉挛的中风患者：在注射前和注射后一个月使用改良阿什沃特量表、改良Tardiue量表、踝关节活动范围测量和10米步行测试：除常规康复治疗外，符合条件的患者被随机分配到两组。实验组沿肌肉长度方向注射肉毒杆菌毒素，而对照组则在腓肠肌内侧头近端25%-35%处和外侧头近端20%-30%处注射相同剂量和体积的肉毒杆菌毒素：60名参与者完成了研究，平均年龄为（59.96±12.15）岁。两种注射方法对活动范围、痉挛程度、活动能力和行走速度均有效。结论：两种 A 型肉毒毒素注射方法产生的临床效果相似。

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引用次数: 0

United States Veterans' Utilization of Spinal Cord Injuries and Disorders Annual Evaluation Services. 美国退伍军人利用脊髓损伤和失调年度评估服务的情况。

IF 3.6 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation

Pub Date : 2024-09-27 DOI: 10.1016/j.apmr.2024.09.008

Jennifer Sippel, Bella Etingen, Kevin Stroupe, Charlesnika Evans, Zhiping Huo, Belinda Frazier, Manosha Wickremasinghe, Bridget Smith

Objective: To evaluate Veterans' engagement in spinal cord injury and disorder (SCI/D) specialty annual evaluations (AEs).

Design: Cross-sectional retrospective cohort study.

Setting: SCI/D System of Care, United States Department of Veterans Affairs (VA).

Participants: Veterans with SCI/Ds (N=14,662).

Interventions: Not applicable.

Main outcome measures: Receiving SCI/D AEs during the study period (fiscal years [FY] 2019 and 2020).

Results: A total of 14,662 Veterans with SCI/Ds were included in the sample; 32.8% (n=4811) received 2 AEs, 28.8% (n=4219) received 1 AE, and 38.4% (n=5632) received no AEs, with an average of 0.9 AEs per Veteran over the 2-year study timeframe (range, 0-2y). Black Veterans had an 8% higher number of AEs than White Veterans after adjusting for other variables (adjusted relative risk [RR], 1.08; 95% confidence interval [CI], 1.04-1.12). Veterans who lived ≥240 minutes away from a VA SCI/D System of Care Center had 45% fewer AEs than Veterans who lived within 30 minutes (adjusted RR, 0.55; 95% CI, 0.52-0.59). Veterans with more SCI/D specialty visits had 90% more AEs than those with fewer visits (adjusted RR, 1.90; 95% CI, 1.78-2.03), whereas Veterans with more outpatient visits in VA primary care had 28% fewer AEs (adjusted RR, 0.72; 95% CI, 0.69-0.76). Veterans with higher comorbidity scores had 9% more AEs than Veterans with lower scores (adjusted RR, 0.66; 95% CI, 0.61-0.70).

Conclusions: More than half (62%) of Veterans received ≥1 SCI/D AE during FY19-20. Veterans living closer to a VA SCI/D System of Care Center/Hub had more engagement in SCI/D AEs. Veterans with SCI/Ds who used VA primary care outside of the SCI/D System of Care had fewer AEs. There were no major racial, age-based, or sex disparities in SCI/D AE usage. Our findings suggest the need for targeted intervention efforts to promote AE use among Veterans.

目标：评估退伍军人参与脊髓损伤和疾病（SCI/D）专科年度评估的情况评估退伍军人参与脊髓损伤和失调（SCI/D）专科年度评估的情况设计：横断面回顾性队列研究横断面回顾性队列研究环境：（SCI/D 护理系统，美国退伍军人事务部 (VA) 参与者：14,662 名患有 SCI/D 的退伍军人14,662名患有SCI/D的退伍军人干预：主要结果测量：在研究期间（2019 和 2020 财年）接受 SCI/D 年度评估（AEs）结果：共有 14,662 名患有 SCI/D 的退伍军人被纳入样本；32.8%（n=4,811）的退伍军人接受了两次 AE；28.8%（n=4,219）的退伍军人接受了一次 AE；38.4%（n=5,632）的退伍军人接受了零次 AE，在为期两年的研究期间，平均每名退伍军人接受了 0.9 次 AE（范围：0-2）。调整其他变量后，黑人退伍军人的 AEs 数量比白人退伍军人高 8%（调整后 RR：1.08，95%CI：1.04 - 1.12）。与居住在 30 分钟以内的退伍军人相比，居住在距离退伍军人 SCI/D 系统护理中心 240 分钟或更远的退伍军人的 AE 减少了 45%（调整后 RR：0.55，95% CI：0.52 - 0.59）。与就诊 SCI/D 专科次数较少的退伍军人相比，就诊 SCI/D 专科次数较多的退伍军人的 AEs 增加了 90%（调整后 RR：1.90，95% CI：1.78 - 2.03），而就诊退伍军人初级保健门诊次数较多的退伍军人的 AEs 减少了 28%（调整后 RR：0.72，95% CI：0.69 - 0.76）。共病评分较高的退伍军人与评分较低的退伍军人相比，AEs 增加了 9%（调整后 RR：0.66，95% CI：0.61 - 0.70）：在 19 - 20 财年期间，超过一半（62%）的退伍军人至少接受了一次 SCI/D AE。居住在离退伍军人事务部 SCI/D 护理中心/枢纽系统较近的退伍军人参与 SCI/D AE 的次数较多。在SCI/D护理系统之外使用退伍军人事务部初级护理的SCI/D退伍军人的AE较少。在SCI/D AE的使用方面，并不存在重大的种族、年龄或性别差异。我们的研究结果表明，有必要采取有针对性的干预措施，促进退伍军人使用AE。

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