Clinical Rehabilitation最新文献

{"title":"Reliability and Optimal Cut-Off Points of the Test for Upper Limb Apraxia (TULIA) for Spanish-Speaking Post-Stroke Patients.","authors":"Laura Sánchez-Bermejo, Pedro Jesús Milla-Ortega, José Manuel Pérez-Mármol","doi":"10.1177/02692155241305250","DOIUrl":"10.1177/02692155241305250","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the reliability, identify the optimal cut-off points, and determine the diagnostic accuracy of the TULIA Apraxia test in a sample of Spanish-speaking post-stroke patients.</p><p><strong>Design: </strong>Cross-sectional.</p><p><strong>Setting: </strong>Public primary care.</p><p><strong>Participants: </strong>201 post-stroke patients.</p><p><strong>Main measures: </strong>Reliability was assessed using Cronbach's alpha. Cut-off points were identified for each TULIA Apraxia sub-test and stratified for age (≤65 years, > 65 years) using ROC curve analysis, area under the curve, and Youden index. Diagnostic accuracy was evaluated using sensitivity, specificity, and predictive values.</p><p><strong>Results: </strong>Cronbach's alpha of the sub-tests varied from 0.716 (95% CI 0.653-0.772) for pantomime intransitive to 0.824 (95% CI 0.784-0.858) for imitation non-symbolic. Cut-off points ranged from ≤25 to ≤35 points. For individuals aged ≤65 years, the cut-offs that best balanced sensitivity and specificity were ≤25 points for detecting alterations in imitation transitive and ≤33 points for pantomime non-symbolic. For individuals over 65 years, the imitation transitive cut-off (≤26 points) presented the most adjusted balance. The minimum positive predictive value was 0.667 (95% CI 0.542-0.777), indicating that the TULIA Apraxia tests correctly classified more than 67% of patients with apraxia. The minimum negative predictive value was 0.763 (95% CI 0.644-0.859), showing that the test accurately identified more than 76% of patients without apraxia.</p><p><strong>Conclusions: </strong>The TULIA Apraxia test is reliable in Spanish-speaking post-stroke patients. Optimal cut-off points, along with their respective sensitivity and specificity values, exhibit adequate test accuracy. Predictive values indicate that the test correctly identifies individuals with and without apraxia.</p>","PeriodicalId":10441,"journal":{"name":"Clinical Rehabilitation","volume":" ","pages":"202-213"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The health economic analysis of surgery versus rehabilitation in non-traumatic musculoskeletal shoulder disorders: A systematic review of trial-based studies.","authors":"Thomas Lathiere, Anouck Jaubert, Jeremy Lewis, Sandra David-Tchouda, David Beard, Nicolas Pinsault","doi":"10.1177/02692155241300121","DOIUrl":"10.1177/02692155241300121","url":null,"abstract":"<p><strong>Objective: </strong>Non-traumatic musculoskeletal shoulder disorders are common. Their treatment, surgical or non-surgical, is associated with a considerable financial burden to health systems. The aim of this study was therefore to investigate the cost-effectiveness of surgical or rehabilitative treatments in this population.</p><p><strong>Data sources: </strong>PubMed, Embase, NHS Economic Evaluation Database, Cost-Effectiveness Analysis registry, PEDro Database, Cochrane Library, and Google Scholar.</p><p><strong>Review methods: </strong>Trial-based economic evaluations assessing nonoperative and/or operative interventions for the management of non-traumatic shoulder disorders, published from January 2000 to October 2024, were searched. The selection process, data extraction and quality assessment (carried out with the Quality of Health Economic Studies instrument) were independently conducted by two reviewers.</p><p><strong>Results: </strong>Four studies (883 patients) were included in the review. Subacromial decompression for rotator cuff-related shoulder pain was found not to be cost-effective when compared with physiotherapy. Although it was not as cost-effective, Physiotherapy could be a socially beneficial alternative to mobilisation under anaesthesia in the early management of a frozen shoulder, due to lower costs and the delays in accessing surgical management in the pain-predominant phase. Productivity loss was the main driver of costs. It was not possible to determine the cost-effectiveness of other shoulder-related disorders due to sparsity of evidence.</p><p><strong>Conclusion: </strong>Priority should be given to interventions that reduce productivity loss and facilitate patients' return to work as soon as possible. There is a definite need for multiplication and standardization of high-quality economic studies (and the trials they are based on) regarding the management of non-traumatic musculoskeletal shoulder disorders.</p>","PeriodicalId":10441,"journal":{"name":"Clinical Rehabilitation","volume":" ","pages":"139-152"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between postoperative dietary intake and walking ability among older adults with hip fractures: A retrospective study.","authors":"Hikaru Kobayashi, Koutatsu Nagai, Yasuhiro Shimamura, Masami Hidaka, Akiko Mori, Kaoru Sakuma, Tomoyuki Ogino","doi":"10.1177/02692155241307504","DOIUrl":"10.1177/02692155241307504","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to determine whether total dietary intake assessed in the acute phase after hip fracture surgery is associated with walking ability.</p><p><strong>Design: </strong>The retrospective observational study.</p><p><strong>Setting: </strong>A single institution.</p><p><strong>Participants: </strong>Patients with hip fractures aged ≥65 years.</p><p><strong>Main measures: </strong>Dietary intake was recorded daily on an 11-point scale using visual plate waste. The primary outcome was walking ability, which was assessed using functional ambulation categories at discharge. We categorised the patients into those with improved walking ability (functional ambulation categories score ≥3) and those without (<3). Cox proportional hazard models were used to estimate hazard ratios and 95% confidence intervals for functional ambulation categories according to total dietary intake during acute hospitalisation.</p><p><strong>Results: </strong>In total, 182 patients were included with a median age of 85 years; 73.6% were women. The median dietary intake during the first week after surgery, the second postoperative week, and throughout the postoperative period were 24.5, 28.4, and 27.1 kcal, respectively. After adjusting for potential confounders, high total dietary intake (hazard ratio, 1.05; 95% confidence intervals, 1.02-1.09; <i>P</i> = .006) and high dietary intake after the second week (hazard ratio, 1.04; 95% confidence intervals, 1.01-1.08; <i>P</i> = .017) were associated with walking ability.</p><p><strong>Conclusions: </strong>Total dietary intake was associated with walking ability at discharge during the acute postoperative period after hip fracture. Dietary intake following the second postoperative week may play a significant role in the recovery of walking ability.</p>","PeriodicalId":10441,"journal":{"name":"Clinical Rehabilitation","volume":"39 2","pages":"259-267"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of acetic acid shockwave phonophoresis on spur morphology, foot pain and function in patients with calcaneal spur: A randomised controlled trial.","authors":"Nabil Mahmoud Abdel-Aal, Fatma Seddek Amen, Ahmad Hamdi Azzam, Mostafa Ali Elwan","doi":"10.1177/02692155241306072","DOIUrl":"10.1177/02692155241306072","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effect of acetic acid shockwave phonophoresis on spur morphology, foot pain, and function in patients with calcaneal spurs.</p><p><strong>Design: </strong>A double-blinded, randomised clinical trial.</p><p><strong>Setting: </strong>Outpatients physical therapy clinics.</p><p><strong>Participants: </strong>One hundred forty-seven patients with calcaneal spurs, 18-65 years old, were randomly allocated to three equal groups.</p><p><strong>Intervention: </strong>The study group (A) received acetic acid shockwave phonophoresis plus conventional physical therapy. The study group (B) received shockwave therapy plus conventional physical therapy. The control group received conventional physical therapy programme only. Interventions were applied twice a week for 3 weeks.</p><p><strong>Outcome measures: </strong>Calcaneal spur width, calcaneal spur length, pain intensity level, pain pressure threshold and foot and ankle ability measure activities of daily living subscale were measured at baseline, after 3 weeks of interventions and after 4 weeks of follow-up with no intervention.</p><p><strong>Results: </strong>Between-group differences were observed for calcaneal spur width and length, pain intensity, pain pressure threshold and function after 3 weeks favouring Group A (<i>p</i> < 0.001). Mean differences (95% CI) between study groups were -1.11 mm (-1.46, -0.77) for spur width; -1.34 mm (-1.67, -1.01) for spur length; -20.71 mm (-24.66, -16.77) for pain; 1.45 kg/cm² (1.05, 1.85) for pain pressure threshold; and 12.16 points (9.24, 15.09) for function after 3 weeks.</p><p><strong>Conclusions: </strong>Acetic acid shockwave phonophoresis combined with exercise clinically and statistically improves calcaneal spur width, length, pain intensity, pain pressure threshold and foot function more than shockwave therapy alone or conventional physical therapy. This method might be considered an effective, feasible, safe, non-invasive and locally applicable treatment for heel spurs.</p>","PeriodicalId":10441,"journal":{"name":"Clinical Rehabilitation","volume":" ","pages":"187-201"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptions of digitally supported home exercise for people with Parkinson's disease: A qualitative study.","authors":"Jenny Sedhed, Hanna Johansson, Elisabet Åkesson, Erika Franzén, Breiffni Leavy","doi":"10.1177/02692155241298859","DOIUrl":"10.1177/02692155241298859","url":null,"abstract":"<p><strong>Background: </strong>Digitally supported home exercise offers the potential to expand accessibility to rehabilitation. However, little is known about how people with Parkinson's disease experience performing home exercise programs using digital delivery.</p><p><strong>Objective: </strong>To explore and describe how people with Parkinson's disease perceive digital home-based exercise that is not supported in real-time, and how it affected their everyday lives.</p><p><strong>Methods: </strong>This study was qualitative in nature, using qualitative content analysis with an inductive approach. In-depth, individual, semi-structured interviews were held with 14 participants with Parkinson's disease.</p><p><strong>Results: </strong>Two overarching themes were formed: \"Active agency in the face of uncertainty\" and \"The home - safe space or disability on display\". The overarching themes were formed by four themes: 1) resisting the disease - a hope and a burden, 2) interpreting mixed messages, 3) home exercise - consideration and responsibility, and 4) the social context - judgement and support. Participants with Parkinson's disease believe that home exercise enables them to actively counter the disease, and this belief serves as both a source of hope but also a burden. Although perceived as advantageous, digitally supported home exercise may also incur becoming vulnerable to exposing one's disability.</p><p><strong>Conclusions: </strong>People with Parkinson's disease struggle to reconcile their beliefs about exercise with that which is encouraged or discouraged by those around them. Exercise in the home involves a dynamic interplay between achieving self-directed goals while trying to balance social consideration and maintaining integrity of identity.</p>","PeriodicalId":10441,"journal":{"name":"Clinical Rehabilitation","volume":" ","pages":"268-278"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost consequences analysis of early vocational rehabilitation compared with usual care for stroke survivors.","authors":"Sarah Pyne, Tracey H Sach, Rory Cameron, Helen Risebro, Alexandra Wright-Hughes, Ellen Thompson, Dame Caroline Watkins, Audrey Bowen, Judith Stevens, Amanda J Farrin, Christopher McKevitt, John D Murray, Rory J O'Connor, Julie Phillips, Kate A Radford","doi":"10.1177/02692155241299372","DOIUrl":"10.1177/02692155241299372","url":null,"abstract":"<p><strong>Objective: </strong>To compare costs and consequences of Early Stroke Specialist Vocational Rehabilitation (ESSVR) with usual care in working age, stroke survivors over 12 months.</p><p><strong>Design: </strong>An economic evaluation nested within the pragmatic, multi-centre, randomised, controlled RETurn to work After stroKE (RETAKE) study.</p><p><strong>Setting: </strong>Twenty-one English and Welsh National Health Service (NHS) hospital-based stroke units. A UK NHS and Personal Social Services perspective was taken in the base-case and a wider perspective (participant, family, employer and other public services) in a secondary analysis.</p><p><strong>Participants: </strong>A total of 583 stroke survivors age ≥18 years (mean 54.0 years, 69% male).</p><p><strong>Interventions: </strong>Participants were randomised to ESSVR, an early, individually tailored (in content, dose, intensity and duration) intervention, plus usual care or usual care alone.</p><p><strong>Main measures: </strong>Disease-specific resource-use data and EQ-5D-5L (health-related quality of life) collected at baseline, 3, 6 and 12 months. Resource-use items were valued using unit costs in UK£ 2021/22. EQ-5D-5L was used to estimate Quality-adjusted life-years (QALYs). If ESSVR was found effective, an incremental cost-utility analysis was planned, otherwise a cost-consequence analysis.</p><p><strong>Results: </strong>The clinical study found no evidence of a between-group difference in the proportion of participants returning to work at 12 months. This, and the level of missing data, means a cost-consequence analysis is reported. Using imputed data, ESSVR plus usual care is estimated to be more expensive with slightly higher QALYs compared with usual care.</p><p><strong>Conclusions: </strong>Early Stroke Specialist Vocational Rehabilitation is unlikely to be considered cost-effective over 12 months, which fits with the clinical finding of no between-group difference in return-to-work rates post-stroke.</p><p><strong>Clinical trial registration information: </strong>The ISRCTN registry: ISRCTN12464275 https://doi.org/10.1186/ISRCTN12464275.</p>","PeriodicalId":10441,"journal":{"name":"Clinical Rehabilitation","volume":" ","pages":"161-173"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to letter to the editor \"Standardizing blood flow restriction research-the crucial role of identifying apparatus methodology and analysis\".","authors":"Stuart A Warmington, Matthew J Clarkson","doi":"10.1177/02692155241296131","DOIUrl":"10.1177/02692155241296131","url":null,"abstract":"","PeriodicalId":10441,"journal":{"name":"Clinical Rehabilitation","volume":" ","pages":"130-131"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Letter to the Editor: \"Effect of a Transitional Tele-Rehabilitation Programme on Quality of Life of Adult Burn Survivors: A Randomised Controlled Trial\".","authors":"Jonathan Bayuo, Frances Kam Yuet Wong, Loretta Yuet Foon Chung","doi":"10.1177/02692155241309196","DOIUrl":"10.1177/02692155241309196","url":null,"abstract":"","PeriodicalId":10441,"journal":{"name":"Clinical Rehabilitation","volume":" ","pages":"134-136"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standardizing blood flow restriction research-the crucial role of identifying apparatus in methodology and analysis: A letter to the editor.","authors":"Nicholas Rolnick, Jim McEwen, Victor De Queiros, Tim Werner","doi":"10.1177/02692155241293247","DOIUrl":"10.1177/02692155241293247","url":null,"abstract":"","PeriodicalId":10441,"journal":{"name":"Clinical Rehabilitation","volume":" ","pages":"128-129"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wrist Stabilising Exercise Versus Hand Orthotic Intervention for Persons with Hypermobility - A Randomised Clinical Trial.","authors":"Lindholm Susanne, Claesson Lisbeth","doi":"10.1177/02692155241293265","DOIUrl":"10.1177/02692155241293265","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effectiveness of wrist stabilisation exercises compared to conventional intervention, whether it reduces pain and/or paraesthesia in the hand, as well as how the interventions affected activity ability, health-related quality of life and effects on hand function and grip strength in people with Hypermobility Diagnosis.</p><p><strong>Design: </strong>A randomised controlled trial.<b>Setting</b>: Units of Occupational therapy in Primary Care, Kalmar County Council, SwedenParticipants: The study included 169 participants' data randomised to the Exercise group (n = 83) or the Control group (n = 86). The samples consisted of adults in diagnosed Hypermobility Spectrum Disorders or hypermobility Ehlers Danlos Syndrome with symptoms of pain and/or paraesthesia in the hands in the last three years.<b>Interventions</b>: The Exercise group trained according to structured progressive exercises and weights programme. The Control group used the hand orthosis during selected activities. Both groups performed randomised intervention for 12 weeks.<b>Main measures</b>: The primary outcome was the Disabilities of Arm, Shoulder, and Hand questionnaire. Secondary outcomes were the Grip Ability Test, the Jamar dynamometer and the EuroQol EQ-5D.</p><p><strong>Results: </strong>There were 116 subjects who completed the intervention. There were no statistically significant difference between the wrist stabilisation exercise and the conventional intervention in terms of activity ability, health-related quality of life, hand function, grip strength, pain or paraesthesia in people with Hypermobility Spectrum Disorders or hypermobility Ehlers Danlos Syndrome.</p><p><strong>Conclusion: </strong>There is no statistically significant difference between the Exercise group and the Control group regarding activity ability after 12 weeks intervention period.</p>","PeriodicalId":10441,"journal":{"name":"Clinical Rehabilitation","volume":" ","pages":"47-57"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11776353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}