Archives of physical medicine and rehabilitation最新文献

{"title":"Effects of a Hybrid Telerehabilitation Model on Mobility and Functional Capacity in Patients With Multiple Sclerosis: A Single-Blind Randomized Controlled Study","authors":"Guzin Kaya Aytutuldu PT, PhD ,&nbsp;Duygu Yalcınkaya PT, MSc ,&nbsp;Buket Akinci PT ,&nbsp;Hikmet Ucgun PT ,&nbsp;Rabia Gokcen Gozubatik Celik MD ,&nbsp;Mesude Tutuncu MD","doi":"10.1016/j.apmr.2025.09.034","DOIUrl":"10.1016/j.apmr.2025.09.034","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the effects of hybrid telerehabilitation (Hybrid TR), telerehabilitation (TR-only), and clinic-based rehabilitation on gait speed (primary outcome: Timed 25-Foot Walk Test), as well as on fatigue, functional capacity, mobility, quality of life, and muscle activation in patients with multiple sclerosis (MS).</div></div><div><h3>Design</h3><div>A single-blind randomized controlled trial with assessments conducted at baseline, mid-treatment (wk 4), and post-treatment (wk 8).</div></div><div><h3>Setting</h3><div>Rehabilitation settings included hybrid (combination of telerehabilitation, clinic-based interventions), only telerehabilitation, and clinic-based environments.</div></div><div><h3>Participants</h3><div>A total of 44 participants (N=44) diagnosed with MS (Expanded Disability Status Scale scores ranging from 0 to 4) were randomly assigned into 3 groups: Hybrid TR (Group A), TR-only (Group B), and clinic-based rehabilitation (Group C). Participants underwent an 8-week intervention program. Selection was based on specific eligibility criteria, and random allocation methods were applied.</div></div><div><h3>Interventions</h3><div>Participants engaged in an 8-week program consisting of breathing exercises, aerobic training, and strengthening exercises delivered through Hybrid TR, TR-only, or clinic-based rehabilitation.</div></div><div><h3>Main Outcome Measures</h3><div>Primary outcome was mobility assessed by the Timed 25-Foot Walk. Secondary outcomes included functional capacity assessed by 2-Minute Walk Test, and mobility assessed by timed Up and Go; fatigue assessed by the Modified Fatigue Impact Scale; quality of life assessed by the Multiple Sclerosis International Quality of Life questionnaire; and muscle activation measured by surface electromyography of the rectus femoris muscle.</div></div><div><h3>Results</h3><div>Significant within group improvements in mobility, fatigue, functional capacity, quality of life, and EMG parameters were observed by week 8 across all groups. However, statistically significant between-group differences were not observed, and effect sizes were small to moderate (η²_p=0.01-0.07).</div></div><div><h3>Conclusions</h3><div>Hybrid TR appears to be a feasible and potentially beneficial approach for individuals with MS, with clinical outcomes that may be comparable with those of clinic-based rehabilitation in terms of mobility, fatigue, functional capacity, quality of life, and muscle activation.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 1","pages":"Pages 11-20"},"PeriodicalIF":3.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145312322","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":"TBI Disability, Health Beliefs, and Workforce Capacity Are Top Barriers to Chronic Pain Guideline-Based Nonpharmacologic Interventions","authors":"Risa Nakase-Richardson PhD ,&nbsp;Jolie Haun PhD ,&nbsp;Mitch Sevigny MS ,&nbsp;Aaron Martin PhD ,&nbsp;Robin Hanks PhD ,&nbsp;Flora Hammond MD ,&nbsp;Georgia Kane MD ,&nbsp;Jessica Ryan PhD ,&nbsp;Natalie Gilmore PhD ,&nbsp;Rebecca Campbell-Montalvo PhD ,&nbsp;Jeanne Hoffman PhD","doi":"10.1016/j.apmr.2025.06.002","DOIUrl":"10.1016/j.apmr.2025.06.002","url":null,"abstract":"<div><h3>Objective</h3><div>To examine determinants of evidence-based, nonpharmacologic treatments for chronic pain among patients with traumatic brain injury (TBI) using an access to care lens.</div></div><div><h3>Design</h3><div>Convenience sample of respondents to an online survey directed to rehabilitation professionals.</div></div><div><h3>Setting</h3><div>Civilian and VA-based centers with TBI providers.</div></div><div><h3>Participants</h3><div>US based providers (N=145) (63% civilian; 34% VA, 3% DOD).</div></div><div><h3>Intervention</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>A 10-item survey examining barriers to nonpharmacologic evidence-based therapies, informed by the robust Levesque Access to Care framework, which includes supply and demand characteristics. Six of the items described patient and community abilities to access care and 4 focused on health care system or infrastructure critical in access. On the basis of their professional experience, participants were asked to separately rate the frequency of the 10 barriers for each of the 3 specific guideline-endorsed interventions for chronic pain: behavioral health therapies, comprehensive chronic pain programs, and substance use disorder treatment.</div></div><div><h3>Results</h3><div>Across all 3 interventions, morbidity associated with TBI (ie, cognitive, physical disabilities), patient lack of understanding, trust, or beliefs about efficacy of intervention, and lack of qualified providers who can deliver the intervention were the most frequently endorsed barriers to delivering NP-EBTs for chronic pain. Subgroup analyses found higher frequency of barriers in civilian versus VA settings particularly related to patient ability to afford (58%-70% difference) and insurance coverage (54%-61%) of interventions.</div></div><div><h3>Conclusions</h3><div>Findings have implication for policy and practice to address health care inequities that persons with TBI-related disability experience in accessing high-quality, evidence-based treatments.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 1","pages":"Pages 32-41"},"PeriodicalIF":3.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301020","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":"Predicting Suicidality in Veterans/Service Members Over 5 Years After TBI: A VA Model Systems Study","authors":"Bani Malhotra PhD ,&nbsp;Jessica M. Ketchum PhD ,&nbsp;Daniel W. Klyce PhD ,&nbsp;Jacob A. Finn PhD ,&nbsp;Lauren B. Fisher PhD ,&nbsp;Kelli G. Talley PhD ,&nbsp;Shannon B. Juengst PhD ,&nbsp;Elizabeth C. Pasipanodya PhD ,&nbsp;Janet P. Niemeier PhD ,&nbsp;Paul B. Perrin PhD","doi":"10.1016/j.apmr.2025.07.009","DOIUrl":"10.1016/j.apmr.2025.07.009","url":null,"abstract":"<div><h3>Objective</h3><div>To examine demographic and injury-related predictors of suicide attempt (SA) and suicidal ideation (SI) during the 5 years after traumatic brain injury (TBI) among Veterans and Service Members (V/SMs) enrolled in the Department of Veterans Affairs (VA) Polytrauma Rehabilitation Center (PRC) TBI Model Systems study.</div></div><div><h3>Design</h3><div>Multicenter, longitudinal observational cohort study.</div></div><div><h3>Setting</h3><div>Inpatient rehabilitation at one of the VA’s 5 PRCs.</div></div><div><h3>Participants</h3><div>A sample of 812 V/SMs with TBI enrolled within 14 months of injury and survived to at least the year 1 data collection.</div></div><div><h3>Main Outcome Measures</h3><div>Past year SA and past-2-week SI were assessed at follow-ups.</div></div><div><h3>Results</h3><div>SA prevalence rate across the years varied between 2.2% and 2.5%, with 4.8% of the sample reporting SA at least once. SI rates were higher and varied between 13.2% and 14.3%, with 21.7% reporting SI at least once. After controlling for other predictors, V/SMs aged &lt;30 years had 5.32 times greater odds of SA post-TBI compared with those aged ≥50 years. Those with a preinjury history of mental health treatment or psychiatric hospitalization had 3.89 times greater odds of SA over time. Nonviolent TBI etiologies increased SI odds by 1.94 times. Preinjury history of mental health treatment or psychiatric hospitalization increased SI odds by 1.69 times; and those with a preinjury history of SA had 2.86 times greater SI odds.</div></div><div><h3>Conclusions</h3><div>These rates, though high, are likely underestimates of 5-year post-TBI suicidality among V/SMs with TBI. V/SMs with TBI should be screened regularly for suicidality—even years after injury. Future research should explore the contributions of the identified risk factors to inform targeted screening and appropriate mental health referral to prevent, assess, monitor, and treat SA and SI.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 1","pages":"Pages 59-67"},"PeriodicalIF":3.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717351","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":"Intimate Partner Violence and Traumatic Brain Injury: A Commentary","authors":"Angela Colantonio PhD, OT Reg. (Ont.),&nbsp;Flora Nikolaou PhD (Clinical Psychology),&nbsp;Denise Gobert PT MEd, PhD,&nbsp;Brooke Holt PhD, CCC-SLP","doi":"10.1016/j.apmr.2025.09.029","DOIUrl":"10.1016/j.apmr.2025.09.029","url":null,"abstract":"","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 1","pages":"Pages 143-144"},"PeriodicalIF":3.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145312309","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":"Primary Care and Brain Injury Physician Utilization for Individuals Living With Chronic Brain Injury","authors":"Flora M. Hammond MD ,&nbsp;Kurt Kroenke MD ,&nbsp;John D. Corrigan PhD ,&nbsp;Angelle M. Sander PhD ,&nbsp;Ross Zafonte DO ,&nbsp;Robert C. Brunner MD ,&nbsp;Joseph T. Giacino PhD ,&nbsp;Jeanne M. Hoffman PhD ,&nbsp;Dmitry Esterov DO ,&nbsp;David X. Cifu MD ,&nbsp;Kathleen Bell MD ,&nbsp;David C. Mellick PhD","doi":"10.1016/j.apmr.2025.06.018","DOIUrl":"10.1016/j.apmr.2025.06.018","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the use of primary care (PCP) and brain injury physicians in the years after a traumatic brain injury (TBI) and the perceived reasons for lack of utilization.</div></div><div><h3>Design</h3><div>Prospective, observational cohort study of persons who received inpatient brain injury rehabilitation under the care of a brain injury rehabilitation physician.</div></div><div><h3>Setting</h3><div>Fifteen TBI Model System centers.</div></div><div><h3>Participants</h3><div>Participants in the TBI Model Systems (N=1520) cohort who experienced TBI 1-35 years previously.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>The proportion of participants under the care of a PCP and/or a brain injury physician, and if applicable, the reasons not cared for by a physician; and what type of physician the participant would see if they had 8 common brain injury conditions.</div></div><div><h3>Results</h3><div>Most participants (85%) reported having a PCP, and 35% reported active care from a brain injury physician. More than 90% have visited their physician in the past 1-2 years. Factors independently associated with not having either a PCP or a brain injury physician were being younger, men, black, unmarried, having fewer health conditions, and having a more rapid initial recovery from their TBI. The most frequent reasons for not having a specific type of physician were a lack of perceived need or their physician taking care of most of their health care problems. The PCP was most often the first contact for 8 common health conditions.</div></div><div><h3>Conclusions</h3><div>Most individuals in this longitudinal cohort of TBI survivors report having a PCP. Demographic and clinical characteristics identified subgroups who may lack regular contact with primary care or brain injury specialty care. While all participants were cared for by a brain injury physician during their initial rehabilitation, only a minority had ongoing care from a brain injury physician years later.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 1","pages":"Pages 42-50"},"PeriodicalIF":3.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590338","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 Preliminary Examination of a Fidelity Assessment for the Spinal Cord Injury Movement Index","authors":"Nicole M. Gerhardt OTD ,&nbsp;Rachel Y. Kim OTD ,&nbsp;Maclain Capron MS ,&nbsp;M.J. Mulcahey PhD","doi":"10.1016/j.apmr.2025.06.010","DOIUrl":"10.1016/j.apmr.2025.06.010","url":null,"abstract":"<div><h3>Objective</h3><div>The study aimed to describe the development and refinement of a fidelity assessment for a novel performance-based item pool, the Spinal Cord Injury Movement Index (SCI-MovIn), and report on its interrater agreement.</div></div><div><h3>Design</h3><div>Guidance for the development of intervention fidelity assessments was adapted to create a framework for the development of an assessment fidelity checklist. An initial draft of the SCI-MovIn fidelity checklist was drafted. The set-up and administration fidelity criteria were exposed to iterative modified Delphi surveys with individuals knowledgeable about the SCI-MovIn. Interrater agreement was then assessed through field-testing of the fidelity assessment by fidelity raters who viewed the same video-recorded SCI-MovIn testing sessions.</div></div><div><h3>Setting</h3><div>Academic institution in an urban area.</div></div><div><h3>Participants</h3><div>Three individuals participated in the modified Delphi survey (purposeful sample). Three individuals served as fidelity raters for interrater agreement testing.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>The modified Delphi technique was completed iteratively until 100% agreement among respondents was reached that every criterion on the fidelity assessment was relevant, clear, specific, and in alignment with the response scale. Descriptive statistics were used to examine exact percent interrater agreement for the ratings on the SCI-MovIn fidelity assessment across 3 raters.</div></div><div><h3>Results</h3><div>Four survey rounds were iteratively completed until 100% agreement among respondents was reached that fidelity criteria were relevant, clear, specific, and aligned with the fidelity response scale. Across 21 sessions (394 items), raters’ total absolute exact percent agreement on scores of fidelity was 79.33%. Nine of 13 criteria had &gt;75% agreement.</div></div><div><h3>Conclusions</h3><div>The SCI-MovIn fidelity assessment was developed using a framework modified from guidance for intervention fidelity assessments. It was refined over 4 rounds of a modified Delphi process and then exposed to field-testing for rater agreement.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 1","pages":"Pages 68-76"},"PeriodicalIF":3.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625304","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":"Understanding Brain Injury in Intimate Partner Violence: A Guide for Frontline Professionals Working With IPV in Shelters","authors":"Flora Nikolaou PhD,&nbsp;Brooke Holt PhD,&nbsp;Iro Michael MSc,&nbsp;Fofi Constantinidou PhD,&nbsp;Eve Valera PhD,&nbsp;Denise Gobert PhD,&nbsp;Angela Colantonio PhD,&nbsp;American Congress of Rehabilitation Medicine Girls and Women with Acquired Brain Injury Task Force","doi":"10.1016/j.apmr.2025.06.007","DOIUrl":"10.1016/j.apmr.2025.06.007","url":null,"abstract":"","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 1","pages":"Pages 147-149"},"PeriodicalIF":3.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641619","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":"Correction: Late Breaking Research Poster 2905855","authors":"","doi":"10.1016/j.apmr.2025.09.022","DOIUrl":"10.1016/j.apmr.2025.09.022","url":null,"abstract":"","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 1","pages":"Page 145"},"PeriodicalIF":3.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145852230","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":"Virtual Reality in Training of Sustained Attention, Processing Speed, and Working Memory After Traumatic Brain Injury: A Randomized Controlled Trial","authors":"Truls Johansen MPhil, PhD ,&nbsp;Martin Matre PhD ,&nbsp;Marianne Løvstad PhD ,&nbsp;Alexander Olsen PhD ,&nbsp;Anne Lund PhD ,&nbsp;Anne-Catrine Trægde Martinsen PhD ,&nbsp;Frank Becker PhD ,&nbsp;Cathrine Brunborg PhD ,&nbsp;Albert Rizzo PhD ,&nbsp;Jacoba M. Spikman PhD ,&nbsp;Dawn Neumann PhD ,&nbsp;Jennie Ponsford PhD ,&nbsp;Sveinung Tornås PhD","doi":"10.1016/j.apmr.2025.07.005","DOIUrl":"10.1016/j.apmr.2025.07.005","url":null,"abstract":"<div><h3>Objective</h3><div>The study aimed to evaluate the effect of playing a commercially available virtual reality (VR)-game on sustained attention as primary outcome, and processing speed and working memory as secondary outcomes, after traumatic brain injury (TBI).</div></div><div><h3>Design, Setting, and Participants</h3><div>The study was a parallel-group randomized controlled trial with 1:1 allocation to VR training or an active control condition. One hundred participants aged 18-65 years with complicated mild-to-severe TBI and consequently impaired sustained attention, processing speed, and/or working memory were enrolled. Participants were assessed at baseline, after intervention, and 16 weeks postbaseline.</div></div><div><h3>Intervention</h3><div>The intervention arm played Beat Saber, a VR game requiring sustained attention and processing speed, 30 minutes per day, 5 days per week for 5 weeks. The control arm received information about everyday activities that might impact cognition.</div></div><div><h3>Outcome Measures</h3><div>Primary outcome was sustained attention measured by Connors Continuous Performance Test-third edition (CPT-3). Secondary outcomes included processing speed (CPT-3 hit reaction time), working memory (digit span backward and sequencing from Wechsler Adult Intelligence Scale-fourth edition), and self-report measures: Behavior Rating Inventory of Executive Function-Adult Version, Patient Competency Rating Scale, Fatigue Severity Scale, and Quality of Life after BRain Injury.</div></div><div><h3>Results</h3><div>No statistically significant between-group effect was found for the primary outcome measure, sustained attention (<em>P</em>=.473). However, the VR group demonstrated a significant increase in processing speed (<em>P</em>=.035), which was accompanied by a reduction in the number of errors (<em>P</em>&lt;.001). No differences were observed for working memory. Self-reported executive functioning (<em>P</em>=.017) and quality of life (<em>P</em>=.039) were significantly improved in the VR group.</div></div><div><h3>Conclusion</h3><div>VR training did not improve sustained attention. However, a combination of prolonged reaction times and a decrease in errors in the VR group may indicate improved attentional control. In addition, the findings suggest that VR training might positively affect executive functioning. VR training may be used for cognitive training after TBI.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 1","pages":"Pages 21-31"},"PeriodicalIF":3.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717274","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 a Digitally Monitored Walking Program on Functional and Psychological Outcomes in Individuals With Mild Traumatic Brain Injury: A Randomized Controlled Trial","authors":"Hsin-Ya Tzeng MSc ,&nbsp;Cheng-Chiang Chang MD ,&nbsp;Sy-Jou Chen MD ,&nbsp;Dueng-Yuan Hueng MD ,&nbsp;Chi-Ming Chu PhD ,&nbsp;Hui-Hsun Chiang PhD","doi":"10.1016/j.apmr.2025.08.014","DOIUrl":"10.1016/j.apmr.2025.08.014","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the effects of a 12-week digital walking exercise program on functional capacity and psychological health in individuals with mild traumatic brain injury (mTBI) and the influence of exercise adherence.</div></div><div><h3>Design</h3><div>Randomized controlled trial with repeated measures.</div></div><div><h3>Setting</h3><div>Medical center-based recruitment with home-based intervention.</div></div><div><h3>Participants</h3><div>Fifty-two adults (N=52) (mean age ± SD, 43.98±14.94y; 57.7% women) diagnosed with mTBI (Glasgow Coma Scale score, 13-15) within 6 months postinjury.</div></div><div><h3>Interventions</h3><div>Participants were randomly assigned to either a digitally monitored walking program group (structured walking ≥30min/session, ≥3times/wk, supported by a wearable fitness tracker and personalized feedback) or an active control group receiving standard exercise education.</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome was functional capacity measured by the 6-minute walk test (6MWT). Secondary outcomes included depressive symptoms (Beck Depression Inventory-II) and quality of life (QoL; World Health Organization QoL-Brief Version). Assessments were conducted at baseline and at 4, 8, and 12 weeks. Generalized estimating equations assessed between-group differences. Subgroup analyses evaluated outcomes in participants with ≥80% adherence to moderate-intensity exercise.</div></div><div><h3>Results</h3><div>The intervention group demonstrated significantly greater improvements in 6MWT distance at 4 weeks (+41.65m, <em>P</em>=.02), 8 weeks (+61.31m, <em>P</em>=.001), and 12 weeks (+65.29m, <em>P</em>=.003) compared with controls. Between-group differences in depressive symptoms and psychological QoL were not statistically significant. However, in the high adherence subgroup (≥80%), significant improvements were observed in functional capacity, as measured by the 6MWT, as well as in depressive symptoms and overall QoL.</div></div><div><h3>Conclusions</h3><div>A 12-week digital walking exercise program significantly improved functional capacity in individuals with mTBI. Psychological health benefits were evident among those with high adherence to moderate-intensity walking. These findings support the integration of wearable technologies and remote monitoring tools into structured rehabilitation to promote functional recovery from mTBI.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 1","pages":"Pages 1-10"},"PeriodicalIF":3.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940354","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}