European journal of physical and rehabilitation medicine最新文献

{"title":"Prevalent vertebral fractures and the diabetic bone paradox in women who sustain a hip fracture: a cross-sectional study.","authors":"Marco Di Monaco, Carlotta Castiglioni, Francesca Bardesono, Marco A Minetto, Chiara Busso, Giuseppe Massazza","doi":"10.23736/S1973-9087.25.08894-X","DOIUrl":"10.23736/S1973-9087.25.08894-X","url":null,"abstract":"<p><strong>Background: </strong>Patients with type 2 diabetes mellitus (T2DM) have enhanced fracture risk despite high bone mineral density (BMD), a phenomenon known as the diabetic bone paradox. Consistently with the paradox, hip fractures occur at higher BMD in women with T2DM than in controls. However, no studies have addressed BMD in women with T2DM who have prevalent vertebral fractures at the time of their first hip fracture.</p><p><strong>Aim: </strong>The aim of this study was to test the hypothesis that BMD levels could be higher in the hip-fracture women with versus without T2DM in the absence but not in the presence of prevalent vertebral fractures.</p><p><strong>Design: </strong>This was a cross-sectional study.</p><p><strong>Setting: </strong>The research took place in a rehabilitation ward.</p><p><strong>Population: </strong>The study involved women who were undergoing inpatient rehabilitation following a subacute hip fracture.</p><p><strong>Methods: </strong>We investigated hip-fracture women with and without prevalent vertebral fractures, consecutively admitted to our rehabilitation ward. At a median of 19 days after the hip fracture we assessed femoral BMD by dual-energy X-ray absorptiometry and prevalent vertebral fractures by X-ray examination.</p><p><strong>Results: </strong>The study sample included 504 women. One hundred eighty-five of the 504 had no vertebral fractures whereas 319 had at least one spine fracture. The 185 women without vertebral fractures had BMD higher in the presence (N.=29) than in the absence (N.=156) of T2DM (mean T-score difference was 0.67, 95% confidence interval (CI) from 0.31 to 1.03, P<0.001). After adjustment for 8 potential confounders, the odds ratio to have densitometric osteoporosis for a woman without T2DM was 3.21 (95% CI from 1.10 to 9.33, P=0.032). On the contrary, in the 319 women with vertebral fractures T2DM was not associated with BMD.</p><p><strong>Conclusions: </strong>At the time of an original hip fracture, we found a BMD gap between women with and without T2DM in the absence but not in the presence of prevalent vertebral fractures.</p><p><strong>Clinical rehabilitation impact: </strong>Adjustments of fracture risk calculation in T2DM have been authoritatively suggested, because high BMD levels may falsely lead to risk underestimation. Our data suggests that no adjustments may be needed for the risk estimation in patients with prevalent vertebral fractures. Further data from longitudinal studies are needed to define the role of both prevalent vertebral fractures and BMD in fracture risk of patients with T2DM.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":"543-550"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12409357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625660","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":"Brain Injury Sense of Self Scale: psychometric development of a new measure of strength of self-identity after traumatic brain injury.","authors":"Emily J Thomas, William J Taylor, Richard J Siegert, William M Levack","doi":"10.23736/S1973-9087.25.08721-0","DOIUrl":"10.23736/S1973-9087.25.08721-0","url":null,"abstract":"<p><strong>Background: </strong>There is growing awareness that traumatic brain injury (TBI) can have a significant and troublesome impact of a person's self-identity, yet few measurement tools exist to clinically evaluate this.</p><p><strong>Aim: </strong>The aim of this paper was to develop a patient-reported measure of strength of self-identity after TBI - the Brain Injury Sense of Self Scale (BISOSS).</p><p><strong>Design: </strong>Measurement development and validation.</p><p><strong>Setting: </strong>UK and New Zealand communities.</p><p><strong>Population: </strong>One hundred and thirty-six people with TBI (68.4% [93/136]) male; mean age 47.9 years, SD 13.0 years; mean time post-TBI 11.2 years, SD 11.1 years; 74.3% (101/136) moderate to severe TBI).</p><p><strong>Methods: </strong>Preliminary measurement items were generated from prior qualitative research, a concept analysis, and cognitive interviewing with survivors of TBI. Administration of the draft BISOSS, the Glasgow Outcome Scale, and the Sense of Coherence Scale to participants - with factor analysis, Rasch analysis, and construct validity testing to refine and test the draft BISOSS.</p><p><strong>Results: </strong>After iterative refinements using the Rasch model to help guide item adjustments, BISOSS was comprised of three subscales (egocentric self, sociocentric self, and relational self), each which fit the Rasch model and demonstrated unidimensionality, adequate precision, absence of differential item functioning and adequate person separation index. BISOSS scores correlated well with employment status, leisure activities and positive family relationships. Participants' responses supported the notion that problems with self-identity were commonplace after TBI, with 40% of respondents self-reporting such problems.</p><p><strong>Conclusions: </strong>BISOSS is a valid measure, which conforms to measurement expectations for an interval scale and is in grounded in the language of people with TBI. It is now available as a validated tool for assessing self-identity issues post-TBI. Further work is required to assess whether the scale can change over time or is responsive to interventions targeted at strengthening self-identity.</p><p><strong>Clinical rehabilitation impact: </strong>Change in self-identity is a commonplace problem following TBI but is seldomly evaluated in clinical practice. BISOSS can be used to explore patient experiences of problems with self-identity after TBI and will help further our understanding of this phenomenon.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":"472-481"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980416","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":"Prevalence and risk factors of neck pain among middle-aged and older adults in China: a cross-sectional study from the CHARLS cohort.","authors":"Yi-Wen Bai, Yu-Chen Wang, Xue Jiang, Xia Bi, Wen-Yuan Xing, Le Tang, Pei-Jie Chen, Xue-Qiang Wang","doi":"10.23736/S1973-9087.25.08492-8","DOIUrl":"10.23736/S1973-9087.25.08492-8","url":null,"abstract":"<p><strong>Aim: </strong>To investigate neck pain prevalence and risk factors pain in China.</p><p><strong>Design: </strong>Cross-sectional analysis using data from the China Health and Retirement Longitudinal Study.</p><p><strong>Setting: </strong>Nationwide study conducted in China.</p><p><strong>Population: </strong>Adults aged 45 years or older.</p><p><strong>Methods: </strong>The data for the study were from the China Health and Retirement Longitudinal Study. A total of 19816 representative subjects were selected by multi-stage stratified sampling method. Univariable and multivariable logistic regression analyses were conducted to identify potential risk factors for neck pain.</p><p><strong>Results: </strong>The estimated prevalence of neck pain among Chinese people over 45 was 18.93% (95% CI 18.32-19.55). Neck pain prevalence significantly differed according to sex, with an overall rate of 12.26% in men and 25.04% in women (P<0.001 for sex difference). Risk factors for neck pain included female (odds ratio [OR] 1.83, 95% CI 1.61-2.08), depression (1.23, 1.06-1.42), short sleep time (1.48,1.31-1.68), more than one chronic condition (1.18, 1.04-1.35), headache (4.83, 4.28-5.47), poor health status (2.93, 2.18-3.92), limitation of physical activity (1.37,1.21-1.57) and activity of daily living (1.48, 1.31-1.68). A lower risk of neck pain was associated with age over 75 and illiterate.</p><p><strong>Conclusions: </strong>The Prevalence of neck pain in China is relatively high. These results may help to develop proper prevention and treatment measures for patients with neck pain.</p><p><strong>Clinical rehabilitation impact: </strong>Our study provides insights for rehabilitating neck pain in adults aged 45 or older, aiding targeted interventions and preventive measures.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":"509-519"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607818","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":"Explore the Overall Benefit Index and its correlation with item difficulty among dysphagia-related syndromes in the ICF framework.","authors":"Ya-Cen Wu, Yan-Qun Luo, Feng Lin, Chun Feng","doi":"10.23736/S1973-9087.25.08862-8","DOIUrl":"10.23736/S1973-9087.25.08862-8","url":null,"abstract":"<p><strong>Background: </strong>Individuals with dysphagia typically experience multiple co-occurring symptoms, whose interrelationships can vary in strength. The significance and impact of each symptom within dysphagia also differ. However, the intricate web of connections among these symptoms remains poorly understood, making it challenging to assess the importance of individual symptoms from a relational perspective.</p><p><strong>Aim: </strong>The aim of this study was to: 1) construct a correlation map that identifies the risk associations within dysphagia-related syndromes; and 2) rank syndromes according to the Overall Benefit Index (OBI) of a specific functional intervention, which varies in their impact on the overall functional status.</p><p><strong>Design: </strong>This study has a cross-sectional design.</p><p><strong>Setting: </strong>The setting of this study was a tertiary hospital in Hunan Province, China.</p><p><strong>Population: </strong>Population considered in this study included patients with non-esophageal dysphagia.</p><p><strong>Methods: </strong>Adopting convenience sampling, we recruited 150 patients with dysphagia to assess their health-related quality of life through the dysphagia-specific International Classification of Functioning, Disability and Health (ICF) Scale. A network structure of 50 second-level or third-level ICF categories was investigated by the Ising model. The Bayesian model was applied to determine the probability of the existence of the connection among ICF functional categories.</p><p><strong>Results: </strong>The resulting network consisted of 50 nodes and 64 connections. 48 functional categories demonstrated a significant OBI, with \"d9102 Ceremonies\" (OBI=1.00) achieving the highest OBI. \"d9204 Hobbies\" (OBI=0.862), and \"d9205 Socializing\" (OBI=0.847) were another top two categories with the 2^nd and 3^rd highest OBI. There was a significant correlation between network parameters, OBI, and item difficulty. Specifically, item difficulty showed a positive correlation with OBI (P<0.001, rPearson=0.712), indicating that more challenging items tend to correspond with higher OBIs.</p><p><strong>Conclusions: </strong>The Ising model is a powerful tool that can assist rehabilitation clinicians in better understanding the complex functional network and guide specific rehabilitation interventions for patients with dysphagia.</p><p><strong>Clinical rehabilitation impact: </strong>Cooperating the item difficulties from the Item Response Theory (IRT) into the OBI from the Ising model could guide individualized clinical decisions based on item difficulties and importance.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":"61 3","pages":"363-375"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12405946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947782","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":"Effects of lower limb botulinum toxin injections on gait functional outcomes in stroke survivors: a systematic review and meta-analysis.","authors":"Chiara De Santis, Stefano Doronzio, Maria A Szczepanska, Gemma Lombardi, Giovanna Cristella, Chiara Castagnoli, Teresa Barretta, Michele Piazzini, Marco Baccini, Francesca Cecchi","doi":"10.23736/S1973-9087.25.08995-6","DOIUrl":"10.23736/S1973-9087.25.08995-6","url":null,"abstract":"<p><strong>Introduction: </strong>Spasticity is a relatively common complication of stroke. In the lower limb, it generally involves the ankle and the foot, often leading to equinovarus deformity. Botulinum toxin (BoNT) injections are commonly used to manage spasticity, both in the subacute and chronic phase after stroke; however, their effects on function, particularly gait, are uncertain. This systematic review aims to update the current evidence on the effects of BoNT treatment on gait function in stroke survivors.</p><p><strong>Evidence acquisition: </strong>This systematic review follows the PRISMA guidelines. We searched five databases (PubMed, Embase, Scopus, CINAHL, Web of Science) for Randomized Controlled Trials (RCTs) published in English that investigated the effects of BoNT injections on gait in individuals with stroke compared to any other treatment or no treatment. Two reviewers independently selected the studies, assessed the risk of bias using the PEDro scale, and extracted the results. Standardized mean differences were calculated and, when possible, meta-analyses were performed, using random effects models.</p><p><strong>Evidence synthesis: </strong>From a total of 1238 records, 8 studies met the inclusion criteria, all but one study enrolling participants with chronic stroke. Sample sizes ranged from 16 to 468 subjects, for a total of 434 in the experimental groups and 568 in the control groups.. Gait function was assessed using a variety of gait tests, including instrumental gait analysis. Meta-analyses showed no significant effects of BoNT on gait speed, step frequency or step length. One small, underpowered study, with high risk of bias, reported significant improvements of gait speed in individuals with subacute stroke. Other gait-related variables were measured in single small trials, most often finding no differences between BoNT and control interventions.</p><p><strong>Conclusions: </strong>Our findings indicate that current evidence shows no effects of BoNT treatment on gait speed, and insufficient evidence on its effects on other gait parameters. Adequately-powered, high-quality trials are needed to verify whether BoNT treatment, beyond reducing spasticity, can positively impact functional outcomes other than gait speed in individuals with chronic post-stroke lower limb spasticity and/or during early stroke recovery.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":"61 3","pages":"449-461"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12405947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947877","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":"Individual and combined applied robotic hand rehabilitation and conventional rehabilitation for post-stroke hemiplegia: a prospective three-arm randomized study.","authors":"Betül Başar, Berrin Hüner, Erva Kahraman","doi":"10.23736/S1973-9087.25.08609-5","DOIUrl":"10.23736/S1973-9087.25.08609-5","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Conventional rehabilitation (CR) and robotic hand rehabilitation (RR) are effective rehabilitation options for post-stroke hemiplegia. Combining these two rehabilitation protocols may positively affect the results.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To compare the effectiveness of individual and combined applications of CR and RR on hand and upper extremity function, spasticity, grip and tip pinch strength in the treatment of post-stroke hemiplegia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;A three-arm, prospective randomized controlled trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Multidisciplinary rehabilitation facility.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Population: &lt;/strong&gt;Sixty-six patients with post-stroke hemiplegia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Participants were randomized into three groups: RR, CR, and combined conventional and robotic hand rehabilitation (CR-RR). For the RR group, a passive and active finger motion program (40 minutes a day), along with a home-based rehabilitation program, was administered using the robotic device. For the CR group, traditional manual therapy techniques were used to improve activities of daily living and to achieve isometric contractions in weak muscles (60 minutes a day). For the CR-RR group, 60 minutes of conventional rehabilitation was followed by 40 minutes of hand rehabilitation using the robotic device. The patients in all groups were rehabilitated for 1 month, 5 days a week. The Fugl-Meyer Upper Extremity Assessment Scale was used as primary outcome measure for evaluating the upper extremity function. The secondary outcome was evaluated based on hand function, upper extremity and hand motor function, activities of daily living (ADLs), upper extremity spasticity, and hand strength.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;CR-RR was significantly more effective than both CR and RR in improving upper extremity function, hand function, and ADLs. The only group that had no effect on upper extremity function was RR. All three rehabilitation protocols were ineffective in treating shoulder adductor and elbow flexor spasticity. While all three protocols effectively reduced spasticity in the wrist, fingers, and thumb flexors, CR was significantly less effective compared to the other groups. Although the CR-RR and RR groups had similar results in reducing wrist and finger flexor spasticity, the CR-RR group was significantly more effective than the RR group in reducing thumb spasticity. CR did not influence grip and tip pinch strength, whereas both CR-RR and RR led to significant improvements.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;RR has no effect on upper extremity functional results. CR has no effect on grip and pinch strength and only a limited effect on wrist, finger, and thumb flexor spasticity. Combining conventional rehabilitation with robotic rehabilitation in the CR-RR protocol yields better results in daily living activities, upper extremity function, hand function, wrist, finger, and thumb flexor spasticity, as well ","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":"61 3","pages":"437-448"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947874","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":"Psychometric properties of the German Stroke and Aphasia Quality of Life Scale 39 generic version.","authors":"Caterina Breitenstein, Katerina Hilari, Annette Baumgaertner, Tanja Grewe, Agnes Flöel, Wolfram Ziegler, Peter Martus, Erich B Ringelstein, Walter Huber, Karl G Haeusler, Stefanie Bruehl, Klaus Willmes","doi":"10.23736/S1973-9087.25.08963-4","DOIUrl":"10.23736/S1973-9087.25.08963-4","url":null,"abstract":"<p><strong>Background: </strong>The international expert consensus core outcome set for post-stroke aphasia recommends the Stroke and Aphasia Quality of Life Scale - 39/generic (SAQOL-39g) for assessing patient-reported health-related quality of life. Cultural adaptations of the SAQOL-39g are mandatory in stroke rehabilitation.</p><p><strong>Aim: </strong>We adapted the original English SAQOL-39g into German and evaluated its psychometric quality.</p><p><strong>Design: </strong>Evaluation of a self-report scale embedded in a prospective multicenter parallel group randomized waitlist-controlled trial on the effectiveness of intensive speech and language therapy.</p><p><strong>Setting: </strong>Nineteen in- and outpatient aphasia rehabilitation centers in Germany.</p><p><strong>Population: </strong>People with chronic post-stroke aphasia (N.=156) of all types and severity levels.</p><p><strong>Methods: </strong>We followed applicable guidelines for cross-cultural test adaptations and psychometric evaluations. Psychometric analyses are based on the assessment before three weeks of intensive speech and language therapy (acceptability, internal consistency, validity; N.=156), on the assessments before and after three weeks of waiting in the control group (test-retest reliability; N.=78), and on the assessments before and after three weeks of intensive speech and language therapy (responsiveness; N.=156).</p><p><strong>Results: </strong>The German SAQOL-39g was feasible across all aphasia severity grades (no missing data; no floor/ceiling effects). Internal consistency was excellent (Cronbach's α=0.90); test-retest reliability was moderate-to-good (intraclass-correlations: ICC=0.73 for single/0.85 for average measures). Both exploratory factor analyses and multidimensional scaling of proximity data/graphical network analysis supported the 3-dimensional structure (domains: physical, psychosocial, communication) of the English original version. Convergent (|r|=0.29 to 0.48) and discriminative (|r|=0.03 to 0.07) validities were acceptable. Responsiveness to intervention-induced change showed a small-to-medium treatment effect (group difference after intervention compared to waiting-list control: Cohen's d=0.34).</p><p><strong>Conclusions: </strong>The German SAQOL-39g is a reliable, valid and change-sensitive patient-reported outcome measure to assess the physical, communication and psychosocial quality of life in chronic post-stroke aphasia, with comparable psychometric properties and factorial structure to the original English version.</p><p><strong>Clinical rehabilitation impact: </strong>The German SAQOL-39g is an easy-to-administer and -score patient-reported scale that can be used in rehabilitation settings to measure health-related quality of life and support patient-centered goal setting in people with chronic post-stroke aphasia of different ages, stroke durations, severity and type of aphasia.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":"61 3","pages":"425-436"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947787","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":"Multicenter study on predictors of rehabilitation outcome and home discharge in people with non-traumatic spinal cord injuries.","authors":"Marco Franceschini, Carrie-Louise Thouant, Maurizio Agosti, Francesca Gimigliano, Salvatore Ferro, Jacopo Bonavita, Maria C Pagliacci, Giorgio Felzani, Sanaz Pournajaf","doi":"10.23736/S1973-9087.25.08777-5","DOIUrl":"10.23736/S1973-9087.25.08777-5","url":null,"abstract":"<p><strong>Background: </strong>Non-traumatic spinal cord injuries (NTSCI) represent an increasing public health concern, particularly in aging populations, yet there is limited literature on rehabilitation outcomes and key predictors of home discharge in this population.</p><p><strong>Aim: </strong>This study evaluates the impact of demographic and clinical characteristics on rehabilitation outcomes and home discharge rates in individuals with NTSCI.</p><p><strong>Design: </strong>Prospective observational cohort study.</p><p><strong>Setting: </strong>Thirty-one specialized SCI centers in 13 Italian regions.</p><p><strong>Population: </strong>Individuals with NTSCI.</p><p><strong>Methods: </strong>Demographic and clinical characteristics of 394 rehabilitation were recorded at admission (T1) and discharge (T2). The American Spinal Injury Association (ASIA) Scale and Spinal Cord Independence Measure (SCIM) were used to assess motor function and functional independence. Binary logistic regression was employed to develop a predictive model for home discharge, incorporating categorical and continuous variables. Two common metrics for this purpose are the Akaike Information Criterion (AIC) and the Bayesian Information Criterion (BIC). Predictive factors for home discharge were analyzed using logistic regression and ROC curves.</p><p><strong>Results: </strong>80% of participants were discharged home. Key predictors of home discharge included higher SCIM scores, younger age, and being married. The SCIM score at discharge was a stronger predictor of home discharge than at admission. Length of stay (LOS) was also a significant factor, with longer stays associated with better functional outcomes, particularly in individuals with severe impairments.</p><p><strong>Conclusions: </strong>SCIM scores at discharge, age, and marital status emerged as key predictors of home discharge, highlighting the importance of personalized rehabilitation strategies and structured discharge planning. Tailoring rehabilitation programs to maximize SCIM score improvements may enhance home discharge rates and long-term patient outcomes.</p><p><strong>Clinical rehabilitation impact: </strong>This study emphasizes the importance of continuous functional assessment using SCIM during rehabilitation, allowing clinicians to optimize treatment plans and improve home discharge likelihood. Additionally, considering demographic factors such as age and marital status in discharge planning may facilitate better reintegration into home environments. Longer rehabilitation stays for individuals with more severe injuries (ASIA A/B) can significantly enhance outcomes. By incorporating these predictors into everyday practice, rehabilitation clinics can better optimize patient care, increase home discharge rates, and improve overall quality of life post-rehabilitation.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":"482-495"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607817","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":"Specialized orthotic care to improve functioning in adults with neuromuscular disorders: results of an open-label blinded end-point randomized controlled trial.","authors":"Elza VAN Duijnhoven, Fieke S Koopman, Jana Tuijtelaars, Viola Altmann, Johanna M VAN Dongen, Manon Janse, Frans Nollet, Merel-Anne Brehm","doi":"10.23736/S1973-9087.25.08770-2","DOIUrl":"10.23736/S1973-9087.25.08770-2","url":null,"abstract":"<p><strong>Background: </strong>People with neuromuscular disorders (NMD) are often provided with lower limb orthoses to improve walking. Guideline-based provision of lower limb orthoses in expert settings (i.e. specialized orthotic care) may improve treatment outcomes by better matching the orthotic properties to address walking problems in neuromuscular disorders (NMD).</p><p><strong>Aim: </strong>We assessed the (cost)-effectiveness of specialized orthotic care compared to usual orthotic care in adults with NMD.</p><p><strong>Design: </strong>Randomized controlled trial with an economic evaluation.</p><p><strong>Setting: </strong>Outpatient rehabilitation settings.</p><p><strong>Population: </strong>Adults with plantar flexor and/or quadriceps weakness due to NMD with an indication for a lower limb orthosis.</p><p><strong>Methods: </strong>Participants were randomly assigned to specialized orthotic care (N.=31), or usual orthotic care (N.=30). Primary endpoints were personal goal attainment (at 24 weeks follow-up), and walking energy cost at comfortable speed (change from baseline to 24 weeks follow-up). Secondary endpoints included comfortable walking speed, spatiotemporal gait parameters, gait biomechanics, stability, physical functioning, (fear of) falling, fatigue and satisfaction.</p><p><strong>Results: </strong>Personal goal attainment was significantly higher for specialized orthotic care (P=0.011). Walking energy cost did not differ between groups (P=0.140) but decreased significantly with -11.8% (-0.55 J/kg/m; 95% CI: -0.99 to -0.11) following specialized, but not following usual orthotic care (-0.08 J/kg/m; 95% CI: -0.32 to 0.26). Secondarily, changes in step length, walking speed, physical functioning, and satisfaction were in favor of specialized orthotic care (P≤0.042). Specialized orthotic care was likely cost-effective from a societal and healthcare perspective.</p><p><strong>Conclusions: </strong>Specialized orthotic care was beneficial in attaining personal goals, and likely cost-effective compared to usual orthotic care.</p><p><strong>Clinical rehabilitation impact: </strong>Guideline-based provision of lower limb orthoses in expert settings could enhance functioning of adults with NMD and generate societal cost savings.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":"61 3","pages":"496-508"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12405948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947827","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":"The effect of blood flow restricted aerobic exercise training on pain, functional status, quality of life and hormonal response to exercise in fibromyalgia patients: a randomized double-blind study.","authors":"Mert Zure, Mahir Topaloğlu, Sina Arman, Ayşegül Ketenci","doi":"10.23736/S1973-9087.25.08817-3","DOIUrl":"10.23736/S1973-9087.25.08817-3","url":null,"abstract":"<p><strong>Background: </strong>Fibromyalgia is a chronic pain condition with symptoms such as pain, fatigue, and decreased quality of life. Although aerobic exercise is an effective treatment for fibromyalgia, patients often struggle with exercise intolerance due to fatigue, limiting long-term adherence. Research on blood flow-restricted (BFR) exercise suggests it may provide benefits similar to traditional exercise with reduced intensity, but its effects on fibromyalgia-related symptoms remain underexplored.</p><p><strong>Aim: </strong>This study investigated the impact of a BFR aerobic exercise program on pain, functional status, quality of life, and hormonal response in women with fibromyalgia.</p><p><strong>Design: </strong>A prospective, randomized, double-blind, sham-controlled trial.</p><p><strong>Setting: </strong>Outpatient rehabilitation center.</p><p><strong>Population: </strong>Fifty women diagnosed with fibromyalgia were included in this study.</p><p><strong>Methods: </strong>Participants were randomly assigned to two groups receiving supervised aerobic exercise four times weekly for six weeks. The experimental group used blood flow restriction aid with elastic bandages at the groin level, while the control group received a sham restriction. Primary outcomes were assessed with the Fibromyalgia Impact Questionnaire (FIQ). Secondary outcomes included the Central Sensitization Index (CSI), Beck Depression Inventory (BDI), Visual Analogue Scale (VAS) for pain, Chronic Pain Acceptance Questionnaire-8 (CPAQ-8), and 24-hour urine levels of vanillyl mandelic acid (VMA) and 5-hydroxy indole acetic acid (5-HIAA). Evaluations were conducted before, immediately after, and three months post-intervention.</p><p><strong>Results: </strong>The mean age of participants was 43.2±7.2 years, with comparable baseline characteristics between groups. Both groups showed significant improvements across all outcomes, with the BFR group exhibiting superior improvements in FIQ (P<0.001), CSI, and BDI scores, as well as increased urine levels of VMA and 5-HIAA. Although both groups improved in pain and pain acceptance, these changes were not significantly different between groups.</p><p><strong>Conclusions: </strong>Patients with fibromyalgia who have limited exercise tolerance may find that BFR aerobic exercise improves pain, function, central sensitization, mood, and catecholamine-serotonin levels. Additional research is needed to further understand its effects and broaden the scope of this technique in the treatment of fibromyalgia.</p><p><strong>Clinical rehabilitation impact: </strong>BFR aerobic training could improve adherence to exercise therapy in fibromyalgia by offering a lower-intensity alternative with enhanced benefits, potentially leading to better symptom management in clinical settings.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":"564-571"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12405945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144156628","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}