Archives of physical medicine and rehabilitation最新文献

Objectives: To (1) detect distinct trajectories of symptoms and quality of life (QoL) over the first 4 years after mild traumatic brain injury (mTBI); (2) assess the relationship between symptom trajectory membership and QoL trajectory membership; and (3) identify participant characteristics associated with QoL trajectory membership.

Design: Prospective longitudinal cohort study. Assessments occurred at 4, 8, 12, 24, 36, and 48 months after mTBI.

Setting: Recruitment occurred in Level 1 Trauma Centers; follow-up was completed in the community.

Participants: Participants were 143 adults (aged 18-65y) who sustained an mTBI and were hospitalized (≥24h) at a Level 1 Trauma Center.

Interventions: Not applicable.

Main outcome measures: Fatigue Severity Scale, Hospital Anxiety and Depression Scale, Insomnia Severity Index, Medical Outcomes Study Cognitive Functioning Scale, Quality of Life after Brain Injury questionnaire, presence/absence of headaches or dizziness.

Results: Group-based trajectory modeling revealed relatively stable symptom and QoL trajectories over time. Considerable percentages of participants were classified in trajectories of clinically significant symptoms throughout the full follow-up period: 62% for subjective cognitive issues, 54% for fatigue, 44% for anxiety, 43% for insomnia, 27% for depression, 23% for headaches, and 17% for dizziness. Sixty-six percent of participants belonged to trajectories of persistently poor QoL. For all symptoms, trajectories of greater severity were associated with trajectories of poorer QoL. None of the sociodemographic or injury-related variables examined were associated with QoL trajectory membership.

Conclusions: A substantial proportion of individuals hospitalized after mTBI experiences clinically significant persistent symptoms ≤4 years after injury, and those with more severe symptoms have poorer QoL. Further research is required to better understand the factors leading to symptom persistence and poor QoL.

Objective: To assess rehabilitation clinicians' viewpoints regarding a multicomponent implementation program aimed at promoting high-intensity resistance rehabilitation (HIR), as well as practical implications for its use in skilled nursing facility (SNF) rehabilitation.

Design: Prospective convergent mixed-method design.

Setting: Eight rural SNFs within the Department of Veterans Affairs.

Participants: Physical rehabilitation clinicians (physical and occupational therapists, physical and occupational therapy assistants, recreational therapists, and kinesiotherapists) who engaged with the implementation program (n=38).

Interventions: Clinicians engaged with the multicomponent implementation program to promote the use of HIR in clinical practice. The program components included clinician training (i.e., virtual didactic modules with synchronous case discussions), provision of resources (e.g., equipment, job aids), and facilitated implementation (e.g., external implementation facilitator support, distributed tips and tricks).

Main outcome measures: Acceptability of Intervention Measure, Training Acceptability Rating Scale, study-specific questionnaires, and qualitative focus groups exploring perceived acceptability, feasibility, and effect on work experience.

Results: Questionnaires revealed high levels of implementation program acceptability and perceived effect, alongside moderate levels of feasibility. Focus group themes supported these findings, explaining high acceptability and effect through differentiation from other trainings and prolonged engagement. Feasibility results were explained qualitatively by facilitatory factors (i.e., team participation, reduced caseloads, training characteristics) and inhibitory factors (i.e., training timing, self-paced scheduling logistics, lack of protected time and space). There was no reported negative effect on clinician work experience.

Conclusions: According to SNF clinician perspectives, a positive HIR implementation experience may be enhanced through implementation programs that provide prolonged engagement and a self-paced structure with built-in accountability. Leadership and organizational support appear important to protect time and space for clinicians who experience competing priorities to successfully facilitate evidence uptake. Future work can evaluate the applicability across various contexts beyond rural VA SNFs.

Objective: To generate crosswalk equations and tables for 4 pain impact measures: the Impact Stratification Score (ISS), Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), and the Pain, Enjoyment of Life and General Activity Scale (PEG).

Design: Cross-sectional survey assessing demographics and pain impact. Crosswalks were developed using item-response theory (IRT) cocalibrations and linear regressions between the ISS, ODI, RMDQ, and PEG.

Setting: Online panel.

Participants: Population-based sample of United States adults aged 18 and older. Eligibility criteria were reporting current back pain, not reporting 2 fake health conditions, and having data for 2 or more pain measures (N=1530; 37% of sample). Crosswalks were developed (n=1030) and cross-validated in a subsample of 500 participants (n=125 randomly sampled from each ISS quartile).

Interventions: Not applicable.

Main outcome measures: ISS, ODI, RMDQ, and the PEG.

Results: Associations of the ISS with the PEG and ODI met the criteria for IRT cocalibration. Other measure pairs were crosswalked using regression. Associations were strongest between the PEG and the ISS (r=0.87, normalized mean absolute error [NMAE]=0.38) and between the ODI and the ISS (r=0.85, NMAE=0.39). Associations were weakest between the PEG and the RMDQ (r=0.69, R²=0.48, NMAE: 0.55-0.58). Regression equations and IRT accounted for 48%-64% of the variance (NMAE: 0.38-0.58) in corresponding pain measures in the cross-validation sample.

Conclusions: The crosswalks between the ISS and common legacy pain measures created in this study of a nationally representative sample of United States adults with back pain can be used to estimate 1 pain impact measure from another. Further evaluation in clinical samples is recommended.

Objective: To examine the effects of a cognitive-motor rehabilitation program consisting of treadmill training (TT) augmented by virtual reality (TT+VR) on frailty in people with multiple sclerosis (pwMS).

Design: Secondary analysis from a multicenter randomized controlled trial investigating the effects of TT+VR, compared with TT only, on measures of mobility and cognitive function in pwMS.

Setting: Four university research laboratories in 3 countries.

Participants: A total of 124 pwMS were randomized into the parent trial. Here, we studied a subset of n = 83 participants (mean age, 49.4±9.3y; 73.5% female; expanded disability status scale range, 2.0-6.0), who completed the intervention and had complete preintervention and postintervention frailty data.

Interventions: Participants were randomly allocated to TT+VR (n=44) or TT (n=39). Both groups trained 3 times a week for 6 weeks.

Main outcome measures: Frailty was assessed using a 40-item frailty index (FI) through standard validated procedures and represented the primary study outcome. Two exploratory frailty indices were also computed by isolating health-related deficits involving the cognitive (FI-physical) or physical (FI-cognitive) domains from the main FI. The assessments were performed at baseline and after 6 weeks, upon intervention completion.

Results: The mean FI of study participants at baseline was 0.33±0.13, indicating a moderate average level of frailty. FI scores improved in both TT+VR and TT groups participants (pooled mean ΔFI, 0.024; 95% CI, 0.010-0.038; F=10.49; P=.002; η_p²=0.115), without any group-by-time interaction (F=0.82; P=.367; η_p²=0.010). However, a significant group-by-time interaction was found for pretraining and posttraining changes in FI-cognitive (F=5.74; P=.019; η_p²=0.066), suggesting a greater improvement for TT+VR group participants than for TT group participants.

Conclusions: TT with or without virtual reality can reduce frailty levels in pwMS. While both TT and TT+VR had a positive effect on overall frailty, only TT+VR improved cognitive aspects of frailty and may represent an appropriate strategy for counteracting frailty in pwMS.

Objective: To describe staff-perceived barriers to progressive patient mobilization.

Design: Cross-sectional staff survey.

Setting: Ten internal medicine wards in 4 hospitals in a large health service.

Participants: Nursing, medical, and allied health staff (n=208).

Interventions: Not applicable.

Main outcome measures: Patient Mobilization Attitudes and Beliefs Survey. An overall barriers score and subscale scores for knowledge, attitudes, and behaviors were calculated and compared between hospitals, discipline, and years of clinical experience.

Results: The survey was completed by 208 participants (123 nurses, 27 medical, 58 allied health), of whom 104 (50%) had <5 years of experience. The greatest perceived barriers included nursing workload, medical orders not being in place, and patient and family resistance to mobilization. Overall barrier scores differed between hospitals, discipline (mean nursing score ± SD 50±7; mean medical score ± SD, 51±7; mean allied health score ± SD, 43±7), and years of clinical experience (<5y mean score ± SD, 50±7; 5-9y mean score ± SD, 47±7; ≥10y mean score ± SD, 46±8); significant differences by hospital and discipline persisted in multivariate analysis. The behavior subscale had the highest barriers score and knowledge the lowest across all subgroups.

Conclusions: Staff-perceived nursing workload, lack of medical orders, and patient and family resistance to be the greatest barriers to patient mobilization. Barrier scores differed between disciplines, experience levels, and across hospitals within a single health service. Lower scores on the knowledge subscale highlight the need for multicomponent strategies beyond education that address culture and systems; education may particularly benefit medical staff.

Objective: To investigate the feasibility of creating an artificial intelligence (AI) algorithm to enhance prosthetic socket shapes for transtibial prostheses, aiming for a less operator-dependent, standardized approach.

Design: The study comprised 2 phases: first, developing an AI algorithm in a cross-sectional study to predict prosthetic socket shapes. Second, testing the AI-predicted digitally measured and standardized designed (DMSD) prosthetic socket against a manually measured and designed (MMD) prosthetic socket in a 2-week within-subject cross-sectional study.

Setting: The study was done at the rehabilitation department of the Radboud University Medical Center in Nijmegen, the Netherlands.

Participants: The AI algorithm was developed using retrospective data from 116 patients from a Dutch orthopedic company, OIM Orthopedie, and tested on 10 randomly selected participants from Papenburg Orthopedie.

Interventions: Utilization of an AI algorithm to enhance the shape of a transtibial prosthetic socket.

Main outcome measures: The algorithm was optimized to minimize the error in the test set. Participants' socket comfort score and fitting ratings from an independent physiotherapist and prosthetist were collected.

Results: Predicted prosthetic shapes deviated by 2.51 mm from the actual designs. In total, 8 of 10 DMSD and all 10 MMD-prosthetic sockets were satisfactory for home testing. Participants rated DMSD-prosthetic sockets at 7.1 ± 2.2 (n=8) and MMD-prosthetic sockets at 6.6 ± 1.2 (n=10) on average.

Conclusions: The study demonstrates promising results for using an AI algorithm in prosthetic socket design, but long-term effectiveness and refinement for improved comfort and fit in more deviant cases are necessary.

Objective: To observe the effect of uphill running and the combined effect of uphill running plus joint mobilizations on dynamic stability and ankle dorsiflexion in young adults with chronic ankle instability (CAI).

Design: Four-arm randomized controlled trial.

Setting: A college rehabilitation center.

Participants: Individuals with CAI (N=73).

Interventions: Participants were randomly assigned to 4 groups: combined uphill running and joint mobilization (URJM), uphill running alone (UR), joint mobilization alone (JM), and control group. The URJM and UR groups received 20-minute running sessions, and the URJM and JM groups received ankle joint mobilizations, all 3 times a week for 4 weeks.

Main outcome measures: Cumberland Ankle Instability Tool (CAIT) and Y-balance test (YBT) in anterior, posteromedial (PM), and posterolateral (PL) directions for dynamic stability; weight-bearing lunge test and non-weight-bearing ankle dorsiflexion degree using a goniometer (NWBG) for dorsiflexion.

Results: The UR group showed significant improvements in CAIT, YBT-PL, YBT-PM, and NWBG compared to the control group. The URJM group demonstrated large treatment effects in NWBG compared to both UR and JM groups. Responder analysis indicated that the UR, JM, and URJM groups had a higher likelihood of achieving clinically significant changes (exceeding minimal detectable change or minimal clinically important difference) in CAIT, YBT-PM, YBT-PL, and NWBG compared with the control group. Additionally, the combination of UR and JM was superior to either intervention alone for NWBG, with success rates 1.55 times greater than UR alone and 2.08 times greater than JM alone.

Conclusions: A 4-week UR program improves the subjective feeling of instability, dynamic postural control, and ankle dorsiflexion in young adults with CAI. Compared to UR or JM alone, their combined application can better improve the non-weight-bearing ankle dorsiflexion range of motion.

Objectives: To provide an easy-to-use measure, as existing objective assessments for freezing of gait (FOG) severity may be unwieldy for routine clinical practice, this study explored time taken to complete the recently validated FOG severity tool and its components.

Design: A cross-sectional study.

Setting: Outpatient clinics of a tertiary hospital.

Participants: People with Parkinson disease who could independently ambulate 8-meters, understand instructions, and without co-morbidities affecting gait were consecutively recruited. Thirty-five participants were included (82.9% [n=29] male; median [IQR]: age of 73.0 [11.0] years and disease duration of 4.0 [4.5] years).

Interventions: Not applicable.

Main outcome measures: Participants were assessed with the FOG severity tool in a test-retest design, with time taken for each component recorded using a stopwatch during video-analysis. Validity of total FOG severity tool time, time taken to complete its turning and narrow-space components (i.e., time to navigate [TTN]), and an adjusted TTN were examined through correlations with validated FOG severity outcomes. To facilitate clinical interpretation, the TTN cut-off was determined using scatterplot smoothing regression, whereas minimal important change was calculated using predictive modeling.

Results: The FOG severity tool time, TTN, and adjusted TTN similarly demonstrated moderate correlations with the FOG questionnaire and percentage-FOG, and very high correlations with FOG severity tool-revised. The TTN was nonlinearly related to FOG severity, with a positive relationship observed in the first 300 seconds and plateauing after. minimal important change for TTN was 15.4 seconds reduction in timing (95% CI, 3.2-28.7).

Conclusions: The TTN is a feasible, interpretable, and valid test of FOG severity. In busy clinical settings, TTN can provide a viable alternative when use of existing objective FOG measures is (often) unfeasible.