PM&R最新文献

{"title":"Toward personalizing prosthesis prescription: A take-home study of three microprocessor-controlled prosthetic knees: A randomized crossover study.","authors":"Kinsey Herrin, Sujay Kestur, Sixu Zhou, Gwyn O'Sullivan, Teresa Snow, Walter Lee Childers, Aaron Young","doi":"10.1002/pmrj.70028","DOIUrl":"https://doi.org/10.1002/pmrj.70028","url":null,"abstract":"<p><strong>Background: </strong>Previous studies on microprocessor-controlled prosthetic knees (MPKs) often investigate benefits of MPKs as a class of knees rather than clinically relevant differences between specific knees, despite their distinct features.</p><p><strong>Objectives: </strong>To systematically evaluate and report outcomes associated with three commercially available MPKs following a standardized real-world use period.</p><p><strong>Design: </strong>Randomized crossover study.</p><p><strong>Setting: </strong>Research laboratory and community environment.</p><p><strong>Participants: </strong>Ten patients with transfemoral amputation.</p><p><strong>Interventions: </strong>Three MPKs were fitted, trained, and worn for a 1-week period including C-Leg 4.0 (Ottobock, Duderstadt, Germany), Rheo Knee-Model RM7 (Össur, Reykjavik, Iceland), and Power Knee-PKA01 (Össur, Reykjavik, Iceland).</p><p><strong>Main outcome measures: </strong>Primary outcomes were the 10-meter walk test (10-mwt), the 2-minute walk test (2-mwt), and the Prosthesis Evaluation Questionnaire (PEQ). Secondary outcomes were stance time asymmetry, physiological cost index, stair and ramp speeds, the narrowing beam walking test, and community ambulation monitoring.</p><p><strong>Results: </strong>Participants walked 11% faster in Rheo than Power Knee during the 10-mwt (95% confidence interval [CI]: 0.046-0.184, p = .015). In the 2-mwt, participants walked 12% faster in C-Leg (95% CI: 0.034-0.241, p = .003) and 9% faster in Rheo (95% CI: 0.031, 0.163, p = .027) than in Power Knee. On the PEQ, participants reported greater satisfaction with C-Leg compared to Power Knee (p = .006). Ramp ascent speed was 8% faster in Rheo than Power Knee (95% CI: 0.026-0.130, p = .024). No significant differences were found for other secondary outcomes. Notably, 10 of 12 outcomes showed individuals performing their best by a defined difference on an MPK different from the cohort's best-performing MPK.</p><p><strong>Conclusions: </strong>Participants walked faster in C-Leg and Rheo than Power Knee and reported greater satisfaction with C-Leg. Consideration of patient needs and characteristics may allow more individualized MPK prescription and thereby improve rehabilitation outcomes.</p><p><strong>Database registration: </strong>NCT06399471.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145355906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of referral source and acute care transfers from inpatient rehabilitation among patients with brain injury and stroke.","authors":"Steven Bou, Heide Klumpp, Burke Crawford, William Chang","doi":"10.1002/pmrj.70041","DOIUrl":"https://doi.org/10.1002/pmrj.70041","url":null,"abstract":"<p><strong>Background: </strong>Logistics of admissions to inpatient rehabilitation facilities have been reported to affect patient outcomes. One aspect that has not been previously assessed is the impact of referral source on outcomes.</p><p><strong>Objective: </strong>The primary aim was to determine whether there is an association between referral source and the prevalence of acute care transfers. The secondary aim was to explore whether there is an association between referral source and functional improvement achieved with inpatient rehabilitation.</p><p><strong>Design: </strong>Retrospective chart review.</p><p><strong>Setting: </strong>Rehabilitation unit at a Veterans Affairs hospital.</p><p><strong>Patients: </strong>Veterans with a diagnosis of stroke or brain injury who were initially admitted to the rehabilitation unit from 2019 to 2023 were included. Veterans were placed into the external referral group or the internal referral group.</p><p><strong>Main outcome measures: </strong>Admission functional status measurement with Functional Independence Measure (FIM) scores and comorbidity measurement with Charlson Comorbidity Index (CCI) scores were submitted to independent t-tests to examine potential baseline differences between the two groups. To evaluate frequency of discharge outcomes, chi-square analysis was performed. To evaluate functional improvement during inpatient rehabilitation, FIM effectiveness was submitted to independent t-tests.</p><p><strong>Results: </strong>177 veterans were included, with 97 (54.8%) from external referrals and 80 (45.2%) from internal referrals. There were no baseline differences between the two groups in terms of admission FIM and CCI scores (p > .05). Although acute care transfer rates were higher for admissions from external referrals (17.5%) compared to those from internal referrals (11.3%), this difference was not statistically significant (p = .45). FIM effectiveness during inpatient rehabilitation was similar between the two groups.</p><p><strong>Conclusions: </strong>Preliminary findings showed that referral source may not be a factor in acute care transfer frequency or functional improvement. It will be important for a multicenter study to replicate findings before drawing conclusions.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145346766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on \"Racial disparities in patients with amputation in an acute care setting in the immediate postoperative period\".","authors":"Majid Khalilizad, Mostafa Javanian, Mohammad Barary, Romina Hamzehpour, Soheil Ebrahimpour","doi":"10.1002/pmrj.70044","DOIUrl":"https://doi.org/10.1002/pmrj.70044","url":null,"abstract":"","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145346808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Considerations of race and ethnicity within rehabilitation studies for post COVID-19 condition: A scoping review.","authors":"Nadine Akbar, Siona Phadke, Sumaya Mehelay, Abdul Kareem Pullattayil, Afolasade Fakolade, Monica Busse","doi":"10.1002/pmrj.70027","DOIUrl":"https://doi.org/10.1002/pmrj.70027","url":null,"abstract":"<p><p>Post COVID-19 condition (PCC) or long COVID disproportionately affects racial and ethnic minority communities. There are a growing number of rehabilitation studies for PCC, however, it has yet to be determined whether existing studies take race and ethnicity into account in their study designs and whether existing rehabilitative approaches are equally effective across diverse racial and ethnic groups. The objective of this study was to describe the extent to which rehabilitation studies of PCC consider race and ethnicity in defining eligibility criteria, planning recruitment strategies, designing intervention delivery and adherence promoting approaches, selecting outcome measures, and reporting results. Of the 4845 studies screened, 23 met eligibility criteria and were included in this review. The most common reason for exclusion was a lack of mention of race or ethnicity anywhere within the article. Among the 23 studies included, 13 studies provided data on the race and/or ethnicity characteristics of their sample, with 88% of participants across all of these studies being White. Less than 25% of studies described the incorporation of race and/or ethnicity in their recruitment strategies (n = 3, 13%) or data analysis (n = 5, 22%). Greater racial and ethnic diversity is needed within rehabilitation studies for PCC as there is currently a significant underrepresentation of racial and ethnic minorities in existing studies. Overall, more PCC rehabilitation studies need to incorporate race and ethnicity into their study designs as it is not well understood whether existing rehabilitation strategies are equally effective across different racial and ethnic groups.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiple eumenorrheic cycles are necessary to observe a significant increase in estrogen exposure and ovulation in exercising women with functional hypothalamic oligo/amenorrhea undergoing a nutritional intervention: Insights from the REFUEL study.","authors":"Rebecca J Mallinson, Nancy I Williams, Emily A Ricker, Heather C M Allaway, Mary Jane De Souza","doi":"10.1002/pmrj.70024","DOIUrl":"https://doi.org/10.1002/pmrj.70024","url":null,"abstract":"<p><strong>Background: </strong>Due to consequences of energy-related oligo-/amenorrhea (Oligo/Amen) among exercising females, recovery of menses (ROM) is a priority. ROM is inconsistently defined and rarely reported with reproductive hormone (estrogen, progesterone) data, making it difficult to know when females achieve adequate recovery.</p><p><strong>Objective: </strong>The purpose of this secondary analysis of the REFUEL randomized controlled trial was to explore the ovarian hormone environment and quality of menstrual recovery among varying ROM definitions.</p><p><strong>Methods: </strong>ROM was assessed in exercising females with Oligo/Amen (n = 33) who participated in a 12-month intervention of increased energy intake. Four ROM definitions (onset of menses, 1 menstrual cycle <36 days, 2 cycles <36 days, or 3 cycles <36 days) demonstrating advancing degrees of recovery were evaluated. Urinary metabolites of estrogen (estrone-1-glucuronide) and progesterone (pregnanediol glucuronide) were measured daily in a baseline and recovery menstrual cycle; the change in ovarian hormone exposure from baseline to recovery menstrual cycle was analyzed for each ROM definition. The proportion of ovulatory versus anovulatory recovery cycles and the proportion of exercising females who experienced a relapse of Oligo/Amen post recovery were calculated.</p><p><strong>Results: </strong>During the intervention, 58% percent (19/33) of females satisfied at least one ROM definition. There was no change in average ovarian hormone exposure from baseline to the recovery cycle until females experienced three consecutive cycles <36 days, when estrogen exposure significantly increased (+154.7 ng/mL*day, +32.5%, p < .04). As females achieved more consecutive cycles <36 days, the number of ovulatory cycles increased (ROM-1: 31% ovulatory vs. ROM-2 and ROM-3: 54% and 44% ovulatory, respectively) and the occurrence of relapse after recovery decreased (ROM-1 relapse: 53% vs. ROM-2 and ROM-3 relapse: 15% and 22%, respectively).</p><p><strong>Conclusion: </strong>Multiple eumenorrheic cycles may be necessary to observe a significant increase in estrogen exposure, ovulation, and a decrease in relapse after recovery.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145302730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of wrist extensor muscle recovery following acute traumatic spinal cord injury: A model systems replication study.","authors":"Brandon M Johnson, Nathaniel K Johnson, Yan Li, Ronald K Reeves, Steven Kirshblum, Ryan Solinsky","doi":"10.1002/pmrj.70038","DOIUrl":"https://doi.org/10.1002/pmrj.70038","url":null,"abstract":"<p><strong>Background: </strong>After high-level spinal cord injury (SCI), motor recovery of wrist extensors has significant functional consequences as it can facilitate grasp through tenodesis. A small seminal study from 1993 established widely used prognostic rules for wrist extensor recovery, though these have not been replicated with larger, real-world samples since inception.</p><p><strong>Objective: </strong>To determine the prognostic value of initial C5 sharp-dull discrimination, C5 motor strength, and C6 motor strength on predicting 1-year ipsilateral wrist extensor motor recovery for patients with SCI with neurological level of C4 or C5.</p><p><strong>Design: </strong>Retrospective cohort replication study.</p><p><strong>Setting: </strong>SCI Model Systems.</p><p><strong>Participants: </strong>35,675 total individuals with acute traumatic SCI with 219 cases of initial wrist extensor weakness (0/5-2/5) meeting inclusion criteria.</p><p><strong>Intervention: </strong>Not applicable.</p><p><strong>Main outcome measure: </strong>Recovery of wrist extensor strength to ≥3/5 at 1 year.</p><p><strong>Results: </strong>The positive predictive and negative predictive values were 57% (95% CI, 47.4%-66.1%) and 66% (56.0%-75.1%) if initial C5 sharp-dull discrimination was present, 61% (52.7%-69.3%) and 82% (71.4%-89.7%) if initial C5 myotome strength was at least antigravity, and 74% (63.7%-82.5%) and 74% (65.5%-81.4%) if initial C6 myotome strength was at least a 1/5 or 2/5. Synthesizing these three rules, an updated branched nomogram for functional wrist extensor recovery prediction was created.</p><p><strong>Conclusions: </strong>In isolation, none of the previously established wrist extensor motor recovery predictive rules had as high of a prognostic value when using a larger dataset. As such, singular reliance on these prediction rules to identify who will gain 1-year antigravity wrist extension should be approached with decreased certainty. The best positive and negative predictors were trace C6 strength and absent C5 strength, respectively. An updated nomogram provides more nuanced prognostic information to guide clinical care following acute SCI.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145286747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gluteal aponeurotic fascial injury and proximal iliotibial band syndrome: Lateral hip pain in female runners.","authors":"Elizabeth L Roux, Violet E Sullivan, Katrina I Coogan, F Joseph Simeone, Adam S Tenforde","doi":"10.1002/pmrj.70030","DOIUrl":"https://doi.org/10.1002/pmrj.70030","url":null,"abstract":"","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adductor-related groin injury: Prevalence and etiology during NCAA football games on artificial and natural grass surfaces.","authors":"Jarrett L Mitton, Michael C Meyers, Irene van Woerden, Ryan P Lindsay, James C Sterling, Shad K Robinson","doi":"10.1002/pmrj.70023","DOIUrl":"https://doi.org/10.1002/pmrj.70023","url":null,"abstract":"<p><strong>Background: </strong>Groin injuries can be detrimental to an athlete's health and performance. Prior studies evaluating musculoskeletal injuries on artificial turf versus natural grass have resulted in equivocal findings; however, few studies have compared the occurrence of groin trauma between the two surfaces.</p><p><strong>Objective: </strong>To quantify the incidence and etiology of groin trauma during college football games across artificial and natural grass surfaces.</p><p><strong>Design: </strong>Prospective Cohort.</p><p><strong>Setting: </strong>University.</p><p><strong>Participants: </strong>Athletic trainers from 41 Football Bowl Subdivision universities evaluated injuries sustained by collegiate football athletes while competing on artificial or natural grass surfaces. The universities were selected based on the availability of both playing surfaces during the competitive season, consistent sport skill level, and the presence of a full-time certified athletic trainer. Artificial surfaces included in the study were limited to heavyweight infill systems (≥9.0 lbs/ft²) to minimize infill system weight influences on trauma.</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcome measure(s): </strong>Adductor injury severity, classification, category, primary type, mechanism and situation, player position, skill position, cleat design, field conditions, environmental conditions, imaging and surgical procedures, and turf age. Injury incidence rates were calculated using injuries per 10 games = [(number of injuries ÷ number of games) × 10].</p><p><strong>Results: </strong>Of the 2243 games documented, 1061 (47.3%) were played on artificial turf and 1182 games (52.7%) on natural grass. In sum, of 9360 total injuries, 111 (1.2%) adductor-related groin injuries were recorded with 48 (43.2%) occurring on artificial turf, and 63 (56.8%) on natural grass. Multivariate analyses of variance indicated no significant surface effect by any outcomes of interest. Cases occurred most frequently as minor muscle strains (87%), during defensive play (41%) and noncontact sprinting (39%).</p><p><strong>Conclusion: </strong>Regarding adductor-related groin trauma, heavyweight artificial turf is as safe as natural grass. Focus should be placed on early detection and understanding long-term health outcomes rather than surface influence. An athlete who sustains such an injury may benefit from engaging in a structured resistance training program that progresses from general lower-body development in the days after injury to adductor-specific training in the weeks following. The results of this study are generalizable only to this level of competition.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence versus physical medicine and rehabilitation residents: Can ChatGPT compete in clinical exam performance?","authors":"Aylin Ayyıldız, Selda Çiftci İnceoğlu, Banu Kuran, Kadriye Öneş","doi":"10.1002/pmrj.70032","DOIUrl":"https://doi.org/10.1002/pmrj.70032","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence has begun to replace human power in many areas today.</p><p><strong>Objective: </strong>To assess the performance of Chat Generative Pretrained Transformer (ChatGPT) on examinations administered to physical medicine and rehabilitation (PM&R) residents.</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Setting: </strong>Tertiary-care training and research hospital, department of physical medicine and rehabilitation.</p><p><strong>Participants: </strong>ChatGPT-4o and PM&R residents.</p><p><strong>Intervention: </strong>ChatGPT was presented with questions from the annual nationwide in-training exams administered to PM&R residents at different postgraduate years. The exam is a national requirement for the majority of PM&R residents in Turkey and is administered annually.</p><p><strong>Main outcome measures: </strong>The responses to these multiple-choice questions were evaluated as correct or incorrect, and ChatGPT's performance was then compared to that of the residents of each postgraduate year (PGY) term. The time taken by ChatGPT to answer each question was also recorded. Additionally, its learning ability was assessed by reasking the questions it initially answered incorrectly, this time providing the correct answers to evaluate improvement.</p><p><strong>Results: </strong>ChatGPT received a score of 88 out of 100 points in the PGY1 exam, 84 points in the PGY2 exam, 78 points in the PGY3 exam, and 80 points in the PGY4 exam. When compared with the performance distribution of residents, ChatGPT ranked in the 40th-50th percentile for PGY1, 70th-80th percentile for PGY2, 30th-40th percentile for PGY3, and 40th-50th percentile for PGY4. It has been demonstrated that ChatGPT has achieved a learning rate of 65%.</p><p><strong>Conclusion: </strong>Despite the potential of ChatGPT to surpass PM&R physicians in terms of learning capabilities and extensive knowledge network, several functional limitations remain. In its current form, it is not capable of replacing a physician, especially in the field of PM&R, where clinical examination and patient interaction play a critical role.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the use of dalfampridine (4-aminopyridine) for treatment of ataxia in cerebellar stroke.","authors":"Arjun Kotwal, Prashant Yadav, Veyola Rezkalla, Alison Mautner, Gilbert Siu","doi":"10.1002/pmrj.70036","DOIUrl":"https://doi.org/10.1002/pmrj.70036","url":null,"abstract":"","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}