Archives of physical medicine and rehabilitation最新文献

Objective: To quantify physical and psychosocial impacts of falls by age and Gross Motor Classification System (GMFCS) level in ambulatory individuals with cerebral palsy (CP).

Design: Cross-sectional survey.

Setting: Tertiary specialty hospital and online CP communities.

Participants: Ambulatory individuals with CP (N=201 adults; 18-76 years old) or the caregivers of minors (N=180; 5-17 years old).

Main outcome measure(s): Participants completed online surveys to report fall frequency, fall characteristics, injuries, concern about falling (Short Falls Efficacy Scale-International), activity avoidance due to concern about falling (Short Falls Efficacy Scale-International Avoidance Behavior), and psychosocial constructs related to perceived consequences of falling (Consequences of Falling-Damage to Identity subscale).

Results: Most participants fell in the past 12 months (86%). Fall frequency in the past 12 months differed by age (P<.001) and GMFCS level (P=.021). Individuals aged 5-12 years or GMFCS level II reported the most falls. The percentage of participants who experienced a past serious fall-related injury (eg, head/face stitches, concussion, fractures) increased with age (P<.001), affecting 80% of ≥50-year olds. Falls often occurred in the forward direction, when wearing shoes, and during ambulation. Uneven surfaces and fatigue were notable causes. Concern about falling and associated activity avoidance scores differed by age and GMFCS level (all P<.01), both of which were highest for ≥50-year olds and GMFCS level III. Although psychosocial consequences of falls (eg, embarrassment, lost confidence) were elevated across all groups, they did not differ by age or GMFCS level (P=.130, P=.083). Nearly everyone (88%) wished they fell less.

Conclusions: Falls are common for ambulatory children and adults with CP. Physical and psychosocial consequences of falls were frequent and impacted behavior. Differences observed by age and GMFCS level should be considered in care delivery. Clinically tracking and discussing falls and their repercussions across the lifespan will aid in addressing this under-researched and under-resourced concern of people with CP.

Objective: To analyze the reliability of the estimated 1-repetition maximum (e1RM) through the repetition to fatigue method in 4 unilateral resistance training exercises performed using weight machines (ie, leg press, calf raises, leg extension, seated leg curl), and their relationship to gait-related tests.

Design: Cross-sectional study.

Setting: University sports complex.

Participants: Twenty-four participants with multiple sclerosis (N=24) completed 3 testing sessions. They performed 3 testing sessions that were integrated into a long-term multimodal exercise regime comprising strength, balance, and functional mobility exercises, conducted twice a week in 90-minute sessions.

Main outcome measures: The first session consisted in the assessment of the gait-related tests (ie, timed up and go test [TUG], timed 25-foot walk test [T25FW], 6-minute walk test [6MW]). Two testing sessions were dedicated to the assessment of the e1RM in the aforementioned exercises.

Results: Intraclass correlation coefficients (ICC_2.1) of absolute e1RM ranged from 0.92 to 0.97 and they were slightly higher than those relative to the body mass (0.85

Conclusions: The results suggest that e1RM can be safely and reliably performed to quantify single-leg strength and to control the training load in these exercises. Knee flexors and ankle extensors strength, especially of the weaker leg, along with their asymmetry, seem to be the most relevant factors to consider in the strength assessment and training of this population.

Objective: To validate a universal measurement scale and unit for gross motor development across multiple instruments.

Design: Retrospective cohorts SETTING: Community and clinic PARTICIPANTS: Item difficulty calibrations were extracted from three published studies. 4,445 children from Brazil and Taiwan between the ages of 0 to 77 months with similar percentages of males and females were included. Majority were typically developing children with 655 having atypical development due to a variety of medical conditions.

Intervention: None MAIN OUTCOME MEASURES: Gross Motor Units (GMU) and observed item difficulty calibrations for items on the Peabody Developmental Motor Scales-2 locomotor and stationary subscales and the Denver II gross motor subscale.

Results: There was a strong linear association between observed item difficulty for a sample of children with typical development and a mixed sample of typical and atypical development for the PDMS-2 locomotor and stationary subscales, respectively (locomotor subscale, disattenuated r = 0.97; stationary subscale, disattenuated r = 0.98). GMUs had strong linear associations with observed difficulty for items on the PDMS-2 locomotor and stationary subscales (disattenuated r = 0.88-1.00) for each scale when correcting for measurement error. A similar linear association was found between GMUs and observed difficulty for items on the Denver II gross motor subscale (r = 0.90).

Conclusions: The results of this study found that GMUs have a strong linear association with observed difficulty for gross motor development items from the PDMS-2 locomotor and stationary subscales and Denver II gross motor subscale. The strong association between observed item difficulties for children with typical and atypical development, across multiple scales suggests the GMU and construct specification equation can provide a means for consolidating all gross motor development items onto the same scale.

Objective: The overarching goal of the patient-reported outcomes measurement information system (PROMIS) is to standardize patient-reported outcomes across settings and health conditions globally. Following this purpose, the Reha-Toolbox study aimed to link item subsets of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), the Indicators of Rehabilitation Status (IRES-3), and the Hamburg Modules for the Assessment of Psychosocial Health (HEALTH-49) to the standardized metrics provided by PROMIS.

Design: Cross-sectional, single-group linking study.

Setting: Online survey.

Participants: Experts (N=5) mapped items from the 3 rehabilitation measures to PROMIS scales. Data were collected online from a general population sample (N=1000). Items from the rehabilitation measures and their corresponding PROMIS short forms were administered to facilitate item linkage.

Interventions: Not applicable.

Main outcome measures: WHODAS 2.0, IRES-3, HEALTH-49, and PROMIS scales.

Results: Overall, 96 of 171 outcome items (56%) from the legacy measures and 1 additional IRES-3 item were mapped to 9 PROMIS domains, including pain interference, physical function, dyspnea, fatigue, depression, anxiety, cognitive function, ability to participate in social roles and activities, and satisfaction with participation in social roles and activities. Ninety-five items fulfilled the linking assumptions of construct similarity, unidimensionality, and measurement invariance. The legacy items were successfully calibrated on the corresponding PROMIS metrics using graded-response models. The range and precision of the measures varied, depending on the number of items in each domain. Domains that were assessed with 4 or more items achieved sufficient reliability for group-based analyses. Crosswalk tables were created for each measure and domain. We discussed the reasons for and implications of the fact that the rehabilitation measures were only partially linked to the PROMIS metrics.

Conclusions: The study achieved robust linking between subsets of WHODAS 2.0, IRES-3, HEALTH-49 items, and 9 PROMIS scales.

Objective: To review and synthesize the effectiveness of exercise interventions on mobility, postural control, and falls in older adults with mild cognitive impairment (MCI).

Data sources: This review was registered with PROSPERO (CRD42023453320) and adhered to the PRISMA guidelines. The PubMed, Embase, APA PsycInfo, Cochrane Library, Web of Science, CINAHL, and SPORTDiscus were searched from inception until September 2024.

Study selection: Randomized controlled trials (RCTs) examining the effectiveness of exercise interventions on mobility, postural control, and falls in older adults with MCI.

Data extraction: Data extraction included author names, publication years, participant characteristics, intervention details, outcomes, key results, and attrition rates. Data accuracy was verified by 2 reviewers, with discrepancies resolved through consultation with a third reviewer.

Data synthesis: Thirty-two RCTs met the criteria for qualitative systematic review, with 22 RCTs included in the pairwise meta-analysis and network meta-analysis. Aerobic exercise (AE) (SMD 1.07 [95% CI, 0.62-1.52]), multicomponent exercise (SMD 0.46 [95% CI, 0.18-0.74]), and simultaneous cognitive-motor training (SMD 0.56 [95% CI, 0.23-0.89]) significantly improved gait speed during single task (P<.05). AE was the most effective intervention for single-task walking performance (99.3%), whereas Exergaming was the most effective for timed Up and Go performance (100.0%) according to the surface under the cumulative ranking. Paddling exercise (SMD 0.42 [95% CI, 0.16-0.68]) effectively increased handgrip strength (P<.05). However, network meta-analyses revealed no intervention demonstrating significant effects on postural control performance (Berg Balance Scale and Functional Reach Test scores). The effect of exercise on falls remained inconclusive because of the limited number of studies.

Conclusions: AE, multicomponent exercise, and combined cognitive-motor training significantly enhance gait speed and functional performance in older adults with MCI. However, the effect of exercise on fall risk remains unclear. These findings underscore the potential of tailored exercise interventions to improve physical function in this vulnerable population.

Objective: To examine racial disparities in lower limb prosthesis (LLP) prescription practices between White and Black veterans across different geographic levels within the United States Veterans Health Administration (VHA) and explore how racial disparities in LLP prescription practices differ by amputation level.

Design: Retrospective cohort study.

Setting: VHA facilities across the United States.

Participants: A total of 12,143 White and 4711 Black veterans who underwent major lower limb amputation between 2010 and 2022 in a VHA facility, including 4885 with transfemoral amputations (TFA) and 11,969 with transtibial amputations (TTA).

Interventions: Not applicable.

Main outcome measures: Age-standardized percentage point (pp) differences in LLP prescriptions between White and Black veterans within 12 months post-amputation, analyzed at national, regional, and Veterans Integrated Service Network (VISN) levels. A positive pp difference indicates a racial disparity, meaning a higher proportion of White veterans were prescribed LLPs compared with Black veterans.

Results: Nationally, 54.5% of veterans received an LLP prescription within 12 months post-amputation, with the age-standardized pp difference in LLP prescriptions favoring White veterans by 5.06 pp (95% confidence limits [CLs], 2.51,7.61). Regional analysis revealed variations, with the Continental region showing the largest disparity (9.10 pp; 95% CLs: 4.48, 13.71) and the Pacific region the smallest (3.27 pp; 95% CLs: -3.87,10.42). The VISN-level analysis uncovered greater variations, ranging from -9.26 to 14.54 pp. Disparities were more pronounced for veterans with TFA (5.25 pp; 95% CLs: 1.91, 8.59) compared with TTA (4.52 pp; 95% CLs: 1.54, 7.50).

Conclusions: Significant geographic variations exist in racial disparities for LLP prescriptions across the VHA, with most areas favoring White veterans. Disparities were more pronounced for veterans with transfemoral amputations, highlighting the need for targeted interventions to improve equity in access to prosthetic care, especially for veterans with more proximal amputations and in regions and VISNs with the largest disparities.

Objective: To identify sex- and gender-based variables associated with immediate and delayed recall in individuals with stroke.

Design: This was a secondary analysis of data from the National Health and Aging Trends Study (NHATS) using general linear models with a standard stepwise approach.

Setting: Community.

Interventions: Not applicable.

Participants: Participants were eligible for the current analysis if they had a self-reported history of stroke at NHATS Round 1 (2011) and data available on our variables of interest. The final analyses included 366 participants for the immediate recall model and 365 participants for the delayed recall model.

Main outcome measures: Independent variables of interest included sex- (8 variables, for example biological sex, depression and anxiety, and comorbidities) and gender-related factors (14 variables, for example education, income, and independence with banking). The dependent variables of interest were the 10-word immediate and delayed recall tests, respectively.

Results: Higher immediate recall scores were associated with younger age, female biological sex, independence with banking, higher income, giving financial gifts, not requiring assistance with activities of daily living, and higher education (P<.001-.04). Higher delayed recall scores were associated with younger age, higher body mass index, higher education, placing importance in socializing, and independence with banking (P<.001-.04).

Conclusions: We conducted the largest analysis to date of sex- and gender-based factors associated with cognition in individuals with stroke. Stroke rehabilitation scientists and clinicians may consider both biological and sociodemographic factors associated with cognitive function, which may guide holistic poststroke assessments and interventions.

Objective: To explore the prevalence, trajectories, and predictors of poststroke fatigue in older adults after a first ischemic stroke.

Design: A longitudinal observational cohort study.

Setting: Two hospitals.

Participants: A total of 381 patients aged ≥65 years with their first ischemic stroke were included. The mean (standard deviation) age was 71.1 (4.27) years, with 96 patients (25.2%) being women and 285 (74.8%) being men.

Interventions: Not applicable.

Main outcome measures: Patients were assessed using the Fatigue Severity Scale at admission, 3 months, and 12 months. Growth mixture models were used to identify distinct fatigue trajectories, and baseline variables were analyzed to determine their association with these trajectories.

Results: The prevalence of clinical fatigue was 39.11%, 33.33%, and 22.31% at admission, 3 months, and 12 months, respectively. Five distinct fatigue trajectories were identified: persistently low fatigue (class 1, 49.1%), persistently high fatigue (class 2, 21.5%), initial high but early decreasing fatigue (class 3, 15.0%), initial high but late decreasing fatigue (class 4, 8.7%), and increasing-then-decreasing fatigue (class 5, 5.8%). Multinomial logistic regression analysis revealed that several factors were significantly associated with high and persistent fatigue (class 2), including older age, lower social support, decreased physical activity, higher depression and anxiety scores, cognitive impairment, and greater stroke severity.

Conclusions: These findings indicate significant variability in the progression of fatigue among stroke survivors. Further research is necessary to determine the outcomes linked to these fatigue trajectory subgroups and to identify the most effective treatment strategies tailored to each specific subgroup.

Objective: To determine which statistical techniques enhance our ability to predict ambulation and transfer ability in people with spina bifida (SB).

Design: Retrospective cohort study.

Setting: Thirty-five US outpatient SB clinic sites.

Participants: Individuals (n=4589) with SB aged 5-73 years (median age=13.59y).

Intervention: Not applicable.

Main outcome measures: Ambulation ability, which consisted of the following categories: community ambulators, household ambulators, therapeutic ambulators, and nonambulators.

Secondary outcome: Wheelchair transfer ability, as defined by the ability to transfer in and out of a wheelchair unassisted.

Results: A recurrent neural network (RNN) using a multilayer perceptron discarded 76 cases during case processing, resulting in 4513 that were run through the RNN. The predictions in the resulting testing dataset were 83.22% accurate. Recall was 93.21% for community ambulators, 10.00% for household ambulators, 23.96% for therapeutic ambulators, and 76.70% for nonambulators. Precision was 85.34% for community ambulators, 16.05% for household ambulators, 16.67% for therapeutic ambulators, and 93.47% for nonambulators. Total predictions included 68.39% for community ambulators, 2.25% for household ambulators, 3.83% for therapeutic ambulators, and 25.53% for nonambulators. Correspondingly, the model accurately classified 70% of wheelchair transfers while correctly identifying 97.3% of those able to transfer unassisted.

Conclusions: RNN models hold promise for the prediction of functional outcomes such as ambulation and transfer ability in people with SB, particularly for community ambulators and nonambulators. Compared with the previous work using traditional logistic regression approaches which misclassified 16% of cases, the RNN resulted in greater prediction accuracy with fewer than 7% of cases misclassified.