PM&R最新文献

{"title":"Prioritization and multilevel mapping of implementation strategies for a cancer rehabilitation navigation program.","authors":"Nicole L Stout, Shana E Harrington, Ashley Perry, Meryl J Alappattu, Mindi R Manes","doi":"10.1002/pmrj.13301","DOIUrl":"https://doi.org/10.1002/pmrj.13301","url":null,"abstract":"<p><strong>Background: </strong>Although determinants and strategies for implementing a cancer rehabilitation navigation (CRNav) program have been described, defining specific implementation interventions could improve uptake in oncology care delivery. This manuscript shares prioritized implementation interventions using a multilevel framework.</p><p><strong>Methods: </strong>We convened interdisciplinary stakeholders from two CRNav programs to participate in an implementation mapping focus group. Using a multilevel framework that considered provider-, clinic-, and system-level interventions, the focus group discussion guide sought participant input on specific interventions that needed to occur at each level to facilitate implementation. The focus group transcript was analyzed using deductive thematic coding to identify program implementation interventions at each level. The interventions were then shared with all stakeholders to seek agreement and prioritization using a modified Delphi process. A priori a 70% threshold was established to define agreement. Two rounds of Delphi were conducted.</p><p><strong>Results: </strong>Fifteen stakeholders were recruited and nine participated in the focus group. The implementation mapping exercise identified 19 different interventions within the following Expert Recommendations for Implementing Change domains by level: provider level-use evaluative and iterative strategies, provide interactive assistance, train and educate stakeholders, support clinicians; clinic level-change infrastructure, support clinicians, adapt and tailor to context, use evaluative and iterative strategies; and system level-develop stakeholder interrelationship, use financial strategies, change infrastructure. Seven of 15 individuals completed both rounds of the Delphi. Fourteen interventions achieved agreement for high importance. Highest prioritized implementation interventions were develop a core champion team, develop a rationale for program justification, agree upon outcomes measures for the program, and examine and contextualize barriers that will influence the program.</p><p><strong>Conclusion: </strong>Clinical implementation of an innovative care delivery model requires attention to specific interventions that affect various levels within a health care system. These findings will inform future research and clinical efforts in the implementation of CRNav programs.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971781","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":"Physical function and perceived pain following inpatient intensive interdisciplinary pain treatment for children and adolescents.","authors":"Mayank Seth, Kate Vieni, Kathryn Hottinger, Katherine Bentley","doi":"10.1002/pmrj.13325","DOIUrl":"https://doi.org/10.1002/pmrj.13325","url":null,"abstract":"<p><strong>Background: </strong>Chronic pain among children and adolescents negatively impacts overall functioning and quality of life. Although Intensive Interdisciplinary Pain Treatment (IIPT) programs aim to reduce functional impairment and perceived pain, overall evidence is limited and restricted by small sample sizes and limited diversity in pain diagnoses.</p><p><strong>Objective: </strong>To determine whether children and adolescents with chronic pain participating in an inpatient IIPT program experience improvements in their physical function and perceived pain.</p><p><strong>Design: </strong>Cross-sectional, secondary analysis.</p><p><strong>Setting: </strong>Inpatient acute rehabilitation.</p><p><strong>Participants: </strong>Children and adolescents with chronic pain (n = 258; females/males = 204/54; age = 16.5 ± 2.6) admitted to a 4-week inpatient IIPT program from November 2011 to January 2023.</p><p><strong>Intervention: </strong>Participants attended individual and group sessions involving physical therapy, occupational therapy, aquatic therapy, cognitive behavioral therapy, school-related tasks, and meditation. The sessions focused on improving strength, endurance, and function, while helping participants modify physical sensations, catastrophic thinking, and maladaptive behaviors.</p><p><strong>Main outcome measures: </strong>Collected at admission and discharge: pain intensity (Numerical Pain Rating Scale; scale: 0-10), lower extremity function (Lower Extremity Functional Scale [LEFS]; scale: 0-80), upper extremity function (Upper Extremity Functional Index [UEFI]; scale: 0-80), motor proficiency (Bruininks-Oseretsky Test of Motor Proficiency, Second Edition short form [BOT-2 SF]; scale: 0-70), and occupational performance and satisfaction (Canadian Occupational Performance Measure [COPM]; scale: 0-10 for both).</p><p><strong>Results: </strong>Overall, participants reported significant improvements (p < .05) in median LEFS (median change [MC] = +30.5; 25th, 75th percentile range [PR] = 19, 42), UEFI (MC = +21; PR = 12.8, 31), BOT-2 SF (MC = +9; PR = 5, 15), COPM performance (MC = +4; PR = 2.8, 5.4), and COPM satisfaction (MC = +5.6; PR = 3.8, 7.2). Moreover, participants reported significant reduction (p < .05) in median pain intensity (MC = -3; PR = 1, 5). For a majority of participants, MC surpassed previously reported minimally clinical important difference thresholds.</p><p><strong>Conclusions: </strong>Findings highlight the relevance of inpatient IIPT programs in enhancing physical function and reducing perceived pain in children and adolescents with chronic pain.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142953779","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":"Multicomponent telerehabilitation program for veterans with multimorbidity: A randomized controlled feasibility study.","authors":"Michelle R Rauzi, Lauren M Abbate, Laura Churchill, Alexander J Garbin, Jeri E Forster, Cory L Christiansen, Jennifer E Stevens-Lapsley","doi":"10.1002/pmrj.13299","DOIUrl":"10.1002/pmrj.13299","url":null,"abstract":"<p><strong>Background: </strong>Older veterans with multimorbidity experience physical and social vulnerabilities that complicate receipt of and adherence to physical rehabilitation services. Thus, traditional physical rehabilitation programs are insufficient to address this population's heterogenous clinical presentation.</p><p><strong>Objective: </strong>To evaluate the feasibility and acceptability of a MultiComponent TeleRehabilitation (MCTR) program for older veterans with multimorbidity.</p><p><strong>Design: </strong>Randomized controlled cross-over feasibility study.</p><p><strong>Setting: </strong>Telehealth from Veterans Affairs Medical Center to participants' homes.</p><p><strong>Participants: </strong>Fifty U.S. military veterans, age ≥60 years (mean ± SD; 69.2 ± 6.7) with ≥3 comorbidities (6.0 ± 1.9), and impaired physical function were randomized and allocated equally to two groups.</p><p><strong>Intervention: </strong>The MCTR program consisted of high-intensity rehabilitation, coaching, social support, and technologies. Physical therapists delivered 12 individual and 20 group telerehabilitation sessions/participant. Participants in the education group started the MCTR program after 12 weeks.</p><p><strong>Main outcome measures: </strong>The primary outcome was combined adherence (>75% of participants attending ≥80% sessions). Acceptability was measured by the Acceptability of Intervention Measure. Secondary outcomes included safety, participant surveys, and physical function. Patient-level outcomes were collected at baseline, 12 (primary time point), and 24 weeks.</p><p><strong>Results: </strong>Of 50 participants, 39 adhered to total session attendance (0.78 [95% confidence interval: 0.64-0.88], p = .76), 45 adhered to individual sessions (0.90 [95% confidence interval: 0.78-0.97], p = .01), and 48 rated the program as acceptable (0.96 [95% confidence interval: 0.85-0.99], p < .001). Thirty-five participants reported 78 safety events, and 12 (15%) had some degree of relatedness to the protocol. Most patient-level outcomes were similar between groups at 12-weeks.</p><p><strong>Conclusions: </strong>The MCTR program was feasible based on high adherence to individual sessions and high acceptability. Adherence results were consistent with previous exercise studies in older adults. Most in-session safety events were related to underlying medical conditions and consistent with in-person physical rehabilitation safety events. These results can inform use of telerehabilitation for similar populations.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142953847","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 role of the rock climbing Treadwall as a novel therapy tool in physical rehabilitation.","authors":"Kathryne Bartolo, Katelyn Prais, Ella D'Amico, Ghaith J Androwis, Jenfu Cheng, Hannah Aura Shoval","doi":"10.1002/pmrj.13283","DOIUrl":"https://doi.org/10.1002/pmrj.13283","url":null,"abstract":"<p><strong>Background: </strong>Rock climbing offers numerous health benefits, but accessibility and safety concerns limit its therapeutic use, especially for individuals with disabilities. No prior studies have explored the potential benefits of integrating the Treadwall, a rotating climbing wall with improved accessibility and safety, into rehabilitation protocols.</p><p><strong>Objective: </strong>To evaluate the safety and feasibility of implementing a Treadwall climbing intervention as a novel therapy tool for children with hemiplegic cerebral palsy. Additionally, we seek to explore potential functional benefits derived from the Treadwall intervention.</p><p><strong>Design: </strong>This prospective, observational, single-site study assessed Treadwall training in a cohort of children with hemiparetic cerebral palsy while attending a 3-week intensive therapy program.</p><p><strong>Setting: </strong>The study was conducted at the BECOME Program in Children's Specialized Hospital, Mountainside, NJ.</p><p><strong>Participants: </strong>A total of 10 participants, aged 4 to 9 years, diagnosed with hemiparesis, were enrolled, with nine completing the intervention.</p><p><strong>Interventions: </strong>The intervention involved 15 10-minute climbing sessions during the 3-week intensive therapy program. Participants' climbing distance, intensity, and active mobility rate were recorded.</p><p><strong>Main outcome measure(s): </strong>Primary outcome measures included climbing distance, intensity, and active mobility rate. Secondary measures, the Assisting Hand Assessment (AHA) and Melbourne Assessment of Unilateral Upper Limb Function, were collected to assess upper limb function.</p><p><strong>Results: </strong>The study demonstrated significant improvements in distance climbed (p < .01), intensity (p < .05), and active mobility rate (p < .05). Participants showed enhanced upper limb function, indicated by improved AHA and Melbourne Assessment scores (p < .01). Qualitative therapist reports showed positive feedback regarding the Treadwall's potential benefits.</p><p><strong>Conclusions: </strong>The study supports the feasibility and safety of using the rock climbing Treadwall as a novel therapy tool for children with hemiplegic cerebral palsy. The intervention showed promising results in improving climbing skills, motor learning, and coordination. Future investigations should explore dosing and long-term outcomes to fully assess the Treadwall's therapeutic potential.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142922622","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":"Differences in content of care and outcomes between a clinical practice guideline adherent program and usual care for patellofemoral pain: A retrospective pilot study.","authors":"Shawn Farrokhi, Sara Gorczynski, Emma Beisheim-Ryan, Sara R Piva, Daniel I Rhon, Richard W Willy, Marisa Pontillo","doi":"10.1002/pmrj.13298","DOIUrl":"https://doi.org/10.1002/pmrj.13298","url":null,"abstract":"<p><strong>Background: </strong>Patellofemoral pain (PFP) is a common knee condition in young and active individuals that is managed with highly variable treatment strategies.</p><p><strong>Objective: </strong>To determine whether the length, number of visits, and content of physical therapy care for patients with PFP differ between a Clinical Practice Guidelines (CPG) adherent program and usual care. Additionally, the percentage of patients reporting clinically important improvements in patient-reported outcomes in each group was evaluated as an exploratory aim.</p><p><strong>Design: </strong>Retrospective analysis of clinical data.</p><p><strong>Setting: </strong>Military outpatient physical therapy clinics.</p><p><strong>Patients: </strong>Thirty-two patients who received CPG-adherent care and 46 patients who received usual care.</p><p><strong>Interventions: </strong>Patients in the CPG-adherent group were classified into overuse/overload, movement coordination deficits, muscle performance deficits, or mobility impairments subcategories based on CPG-recommended examination procedures and received the CPG-recommended interventions. Patients in the usual care group received interventions based on clinical expertise and organizational practice standards.</p><p><strong>Main outcomes measures: </strong>Length of care, number of visits, and intervention content were used as primary outcomes. The Anterior Knee Pain Scale (AKPS), Defense and Veterans Pain Rating Scale (DVPRS), and Global Rating of Change (GROC) scores were used as secondary outcomes. These scores were extracted from routinely collected health data available in medical records; as a result, not all patients completed these outcomes during the follow-up time points because they were optional.</p><p><strong>Results: </strong>The number of physical therapy visits and percentage of patients receiving knee-targeted exercises, soft tissue mobility interventions, neuromuscular reeducation, patient education, patellar taping, and foot orthoses were greater in the CPG-adherent group compared to usual care (p < .05). Additionally, most patients in the CPG-adherent group reported clinically meaningful improvements in secondary outcomes: AKPS (1 month: 13/23; 3 months: 11/16), DVPRS (1 month: 11/20; 3 months: 8/14), and GROC (1 month: 14/22; 3 months: 11/16). In contrast, fewer than half of the patients in the usual care group reached clinically meaningful thresholds: AKPS (1 month: 1/17; 3 months: 3/8), DVPRS (1 month: 3/15; 3 months: 3/7), and GROC (1 month: 2/12; 3 months: 2/7).</p><p><strong>Conclusion: </strong>The content of the CPG-adherent care was significantly different versus usual care and associated with meaningful changes in outcomes. Several CPG-recommended interventions appeared to be underused in usual care, underscoring the value of further CPG adoption.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142922618","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":"Self-reported physical activity more than 1 year after stroke and its determinants in relation to the WHO recommendations.","authors":"Maria Kähler, Hanna M Nilsson, Lina Rosengren, Lars Jacobsson, Jan Lexell","doi":"10.1002/pmrj.13297","DOIUrl":"https://doi.org/10.1002/pmrj.13297","url":null,"abstract":"<p><strong>Background: </strong>Physical activity (PA) after stroke has significant health benefits if it is conducted regularly, with sufficient intensity and duration. Because of the health benefits, it is important to identify those below the World Health Organization (WHO) recommended level of PA. However, few studies have assessed the level of PA after stroke in relation to the WHO recommendations and which sociodemographic factors and stroke characteristics are associated with those below the WHO recommendations.</p><p><strong>Objective: </strong>To assess survivors of stroke at least 1 year after onset and (1) describe their self-reported level of PA; (2) explore the association between PA, sociodemographics, and stroke characteristics, and (3) determine the characteristics of those below the WHO recommended level of PA.</p><p><strong>Design: </strong>Cross-sectional descriptive survey.</p><p><strong>Setting: </strong>Community settings.</p><p><strong>Participants: </strong>Data were collected from 160 survivors of stroke (mean age 73 years, 46% women, mean time since stroke onset 35 months).</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcome measures: </strong>The Swedish National Board of Health and Welfare Physical Activity Questionnaire and the following sociodemographics and stroke characteristics: gender, age, marital status, vocational situation, need for home help, use of mobility devices, time since stroke onset, first-time stroke, type of stroke, location of stroke, and stroke treatment.</p><p><strong>Results: </strong>Two thirds (66.3%) of the participants were below the WHO recommendations. The hierarchical regression analysis explained 13% of the variance in PA with need for home help as a single significant contributor. Those who did not meet the WHO recommendations were significantly older, more likely to live alone, and in need of home help and mobility devices.</p><p><strong>Conclusions: </strong>A majority of survivors of stroke do not meet the WHO recommended level of PA. Future studies should assess how other factors characterize those who are physically inactive. This knowledge could help rehabilitation professionals to target interventions and self-management programs to promote PA among survivors of stroke.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142922551","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":"Posttraumatic osteoarthritis after athletic knee injury: A narrative review of diagnostic imaging strategies.","authors":"Alexandra E Fogarty, Michael C Chiang, Stephanie Douglas, Lauren H Yaeger, Fabrisia Ambrosio, Christian Lattermann, Cale Jacobs, Joanne Borg-Stein, Adam S Tenforde","doi":"10.1002/pmrj.13217","DOIUrl":"10.1002/pmrj.13217","url":null,"abstract":"<p><p>Intraarticular knee injuries and subsequent posttraumatic arthritis (PTOA) are common in athletes. Unfortunately, PTOA may significantly affect performance and overall function, but this condition remains difficult to characterize. In this review, we provide an overview of imaging modalities used to evaluate PTOA among athletes and physically active individuals following knee injury, with the goal to discuss the strengths and limitations of their application in this population. A literature search was performed to identify clinical studies focusing of knee injuries in athletes and athletic persons, specifically using imaging for diagnosis or monitoring disease progression. A total of 81 articles were identified, and 23 were included for review. Studies on plain radiographs (n = 8) and magnetic resonance imaging (MRI) assessed arthritic burden (n = 13), with MRI able to depict the earliest cartilage changes. Few studies (n = 2) leveraged ultrasound. Challenges persist, particularly regarding standardization and reliability across different radiographic grading systems. Additionally, further research is needed to establish the clinical significance of techniques to assess cartilage composition on MRI, including ultrashort echo-time enhanced T2*, T1rho and T2 imaging. Addressing these challenges through standardized protocols and intensified research efforts will enhance the diagnostic utility of imaging modalities in musculoskeletal medicine and enable high-quality prospective studies.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"96-106"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11733860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141856247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of self-esteem and quality of life in patients with transtibial amputations using an exoskeletal prosthesis.","authors":"S Varuni, Sridevi Gnanasekaran, Ravi Gaur, Akhil Dhanesh Goel, Pankaj Bhardwaj, Akshay Chavan, Vinoth Rajendran","doi":"10.1002/pmrj.13191","DOIUrl":"10.1002/pmrj.13191","url":null,"abstract":"<p><strong>Background: </strong>Lower limb amputation can have profound physical, psychological, and social effects on individuals. Assistive aids like prosthetic lower limbs can help an individual regain mobility and thereby affect their self-esteem and quality of life.</p><p><strong>Objective: </strong>To assess self-esteem and quality of life in patients with transtibial amputations who are using a transtibial prosthesis and explore the association between sociodemographic and amputation-related factors with self-esteem and prosthesis-related quality of life measures.</p><p><strong>Design: </strong>A cross-sectional study.</p><p><strong>Setting: </strong>An orthotics and prosthetics center (Bhagwan Mahaveer Viklang Sahayata Samiti) in Jaipur, Rajasthan.</p><p><strong>Participants: </strong>Patients with transtibial amputations using exoskeletal prostheses between July and September 2022, in Jaipur, Rajasthan.</p><p><strong>Main outcome measures: </strong>The study used Rosenberg self-esteem questionnaire and Prosthesis Evaluation Questionnaire (PEQ) for self-esteem and quality of life assessment, respectively. Descriptive analysis was used to present the demographic details, and nonparametric tests examined the relationship between PEQ dimensions and sociodemographic variables.</p><p><strong>Results: </strong>The study included 138 participants, primarily <40 years old (45.7%) and mostly engaged in high-activity occupations. Self-esteem mean score (SD) was 19.9 (3.9), with 89.1% exhibiting normal self-esteem. Prosthesis-related quality of life, showed high satisfaction across various domains, including ambulation, appearance, frustration, perceived response, residual limb health, social burden, sounds, utility, and well-being. No significant associations were found between sociodemographic factors, amputation-related variables, and self-esteem. However, PEQ scales showed associations with gender, age, occupation, type of amputation, and years of prosthesis use.</p><p><strong>Conclusion: </strong>These results highlight the potential advantages of exoskeletal prostheses in improving the standard of living for people with transtibial amputations. Further research is essential to develop targeted interventions for improving their overall quality of life.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"37-44"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141081118","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":"Establishment of regression-based isometric strength reference values for the upper limb in persons with multiple sclerosis.","authors":"Heather M DelMastro, Abigail Robson, Elizabeth S Gromisch, Marc Campo, Laura B Simaitis, Albert C Lo, Zaenab Dhari, Jennifer A Ruiz","doi":"10.1002/pmrj.13234","DOIUrl":"10.1002/pmrj.13234","url":null,"abstract":"<p><strong>Background: </strong>Muscle weakness is common and significantly affects persons with multiple sclerosis (PwMS), with dysfunction in upper limb (UL) muscle groups occurring in approximately 60% of PwMS.</p><p><strong>Objective: </strong>To develop gender-specific regression-based prediction equations, with 95% confidence intervals for maximal bilateral UL isometric strength (shoulder abduction and adduction, wrist flexion and extension) and hand grip strength in PwMS.</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Setting: </strong>Comprehensive MS center.</p><p><strong>Participants: </strong>256 PwMS.</p><p><strong>Interventions: </strong>Not Applicable.</p><p><strong>Main outcome measures: </strong>Shoulder abduction and adduction and wrist flexion and extension isometric strength (Biodex System 4 Pro Dynamometer) and hand grip strength (Jamar handheld dynamometer) were measured. Disease characteristics (disability and disease duration) and demographics (age, height, and weight) were collected. Regression-based predictive equations were generated for the UL muscle groups for each gender and limb, using age, height, weight, disability, and disease duration as covariates. Variables were compared between genders using the Mann-Whitney U test. Maximal voluntary contraction (MVC) reference values (mean ± SD) were reported based on age (<30, 30-39, 40-49, 50-59, 60-69 years) and disability (mild, moderate, severe ambulant, and severe nonambulant) for each gender and limb.</p><p><strong>Results: </strong>Regression-based equations were developed for both genders' strongest and weakest limb, accounting for age, height, weight, disability, and disease duration. MVC was higher in men than women (p < .001) in all muscle groups. Overall, MVC was significantly related to age in 14, height in 5, weight in 6, disability in 14, and disease duration in none of the 20 models.</p><p><strong>Conclusion: </strong>This is the first study to provide regression-based prediction equations for strongest and weakest MVC of UL muscle groups and demonstrated an inverse relationship between MVC with disability and age. Regression-based reference strength values can help clinicians understand muscular strength along a spectrum of PwMS and can aid in goal setting and education for realistic outcomes.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"45-53"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141591187","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":"Narrative review and call to action on reporting and representation in orthobiologics research for knee osteoarthritis.","authors":"Alexander Sin, William Hollabaugh, Lauren Porras","doi":"10.1002/pmrj.13214","DOIUrl":"10.1002/pmrj.13214","url":null,"abstract":"<p><p>Osteoarthritis affects a significant portion of U.S. adults, and knee osteoarthritis contributes to 80% of disease burden. Previous data have shown that non-White patient populations often report worse symptoms and less favorable outcomes following arthroplasty, a definitive treatment for knee osteoarthritis. There is a lack of demographics data on race/ethnicity, as well as socioeconomic status (SES) and social determinants of health (SDOH), in knee osteoarthritis treatment guidelines and knee arthroplasty research. In addition, there is underrepresentation of non-White patient populations in the existing treatment guidelines for knee osteoarthritis. Over the past decade, orthobiologics have emerged as an alternative to surgical intervention. Our hypothesis is that there would be a similar lack of reporting of demographics data and underrepresentation of non-White populations in studies pertaining to orthobiologics, including evaluating differences in outcomes. This study reviewed U.S.-based research in orthobiologics as a treatment option for knee osteoarthritis. We identified a lack of demographics reporting in terms of race/ethnicity, and none of the studies reported SES or SDOH. Non-White populations were underrepresented; White patients contributed to 80% or more of all study populations that reported race/ethnicity. None studied the correlation between symptoms and outcome measures, and the race/ethnicity, SES, and SDOH of the patients. Based on a review of existing literature, we strongly advocate for ongoing research encompassing patients of all races/ethnicities, SES, and SDOH, and an exploration into potential variations in symptoms and outcomes among distinct population subgroups. Furthermore, SES barriers may influence health care delivery on orthobiologics for disadvantaged populations.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"88-95"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11733843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141545193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}