PM&R最新文献

{"title":"Impact of animal-assisted intervention on therapy engagement in hospitalized children with traumatic brain injuries.","authors":"Miranda Yelvington, Beverly Spray, Frank Bregy, Amy Ramick, Austin Lovenstein, Marlene Walden","doi":"10.1002/pmrj.13335","DOIUrl":"https://doi.org/10.1002/pmrj.13335","url":null,"abstract":"<p><strong>Background: </strong>Individuals who sustained traumatic brain injuries in childhood may experience global challenges including disorders of consciousness, motor dysfunctions, and sensory impairments. Occupational and physical therapy are important parts of recovery from an acute brain injury, addressing deficits that directly affect functional recovery and return to age-appropriate activities of daily living. Difficulty with active engagement in therapy tasks can limit the effectiveness of therapeutic interventions. Therapists search for methods to increase patient engagement to bolster patient progress.</p><p><strong>Objective: </strong>To examine the effect of animal-assisted interventions on patient engagement and therapy participation in children with traumatic brain injuries.</p><p><strong>Design: </strong>Prospective, crossover design observational study with each patient serving as their own control.</p><p><strong>Setting: </strong>This study was conducted in a pediatric acute rehabilitation unit.</p><p><strong>Participants: </strong>Nine participants completed all study sessions.</p><p><strong>Intervention: </strong>Study participants completed four visits, two with animal-assisted intervention and two without animal-assisted intervention.</p><p><strong>Outcomes and measures: </strong>The Pediatric Rehabilitation Intervention Measure of Engagement, length of session, breaks needed.</p><p><strong>Results: </strong>The use of animal-assisted intervention resulted in significantly greater mean engagement scores and significantly greater affective and behavioral engagement scores. No significant differences were found with cognitive engagement score, length of session tolerated, or number of breaks required. No participants had decreased engagement when animal-assisted intervention was used.</p><p><strong>Conclusions: </strong>Animal-assisted intervention has the potential to increase therapy engagement in acute rehabilitation with children recovering from traumatic brain injuries.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415034","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":"Identifying malaligned knee screw during ultrasound examination.","authors":"Pelin Türkekul, Jakub Jačisko, Filip Jevič, Alena Kobesova, Levent Özçakar","doi":"10.1002/pmrj.13344","DOIUrl":"https://doi.org/10.1002/pmrj.13344","url":null,"abstract":"","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415033","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":"Prevalence and treatment outcomes of persistent postural-perceptual dizziness after traumatic brain injury.","authors":"Brandon Johnson, Nathaniel Johnson, Jeffrey Staab, Dmitry Esterov","doi":"10.1002/pmrj.13339","DOIUrl":"https://doi.org/10.1002/pmrj.13339","url":null,"abstract":"<p><strong>Background: </strong>Persistent postural-perceptual dizziness (PPPD) is a chronic functional vestibular disorder that is a potential sequela of traumatic brain injury (TBI). Currently, little is known about how patients with TBI associated PPPD respond to typical PPPD treatment modalities.</p><p><strong>Objective: </strong>To investigate the prevalence of TBI as a precipitant for PPPD and assess outcomes of usual treatment.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Electronic medical records from a tertiary care center.</p><p><strong>Participants: </strong>Patients ≥18 years of age diagnosed with PPPD secondary to TBI between January 2015 and December 2022 who underwent 6 months of treatment with at least one return clinic visit.</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcome measure(s): </strong>Patients' best clinical global impression-improvement scale (CGI-I) score following 6 months of treatment were collected and then compared with previously published literature, with CGI-I scores of 1or 2 (indicating the patient was \"very much\" or \"much\" improved, respectively) considered treatment responders.</p><p><strong>Results: </strong>In total, 134 (8.9%) of 1503 patients had a TBI as the triggering event for PPPD. The mean age of this cohort was 47.6 years with most of these cases occurring after a mild TBI (85.8%). The proportion of females with post-TBI PPPD (58.2%) was significantly lower than the proportion with PPPD due to all causes (p < .037). The most common treatment prescribed was vestibular therapy (82.2%), and 53.3% of patients were considered treatment responders after 6 months. Patients with TBI-induced PPPD had a significantly worse mean CGI-I score (2.49 ± 1.1) when compared to prior literature (1.71 ± 0.83) (p < .001).</p><p><strong>Conclusions: </strong>This study found a 9% prevalence of PPPD following TBI in the largest cohort studied to date. Patients who developed PPPD following TBI did not respond as well to standard treatments as patients with other causes of the disorder, and thus may require closer clinical follow-up to assess treatment efficacy.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415036","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":"Telerehabilitation of patients with stroke: Initial program theories for successful implementation.","authors":"Mohamed M Hasan, Miriam R Rafferty, Elliot Roth, Sarah Abunaser, Justin D Smith, Lisa R Hirschhorn, Donna Woods","doi":"10.1002/pmrj.13322","DOIUrl":"https://doi.org/10.1002/pmrj.13322","url":null,"abstract":"<p><strong>Purpose: </strong>Telerehabilitation has proven effective for stroke survivors, yet it is slowly implemented. We developed Initial Program Theories (IPTs) that focus on the telerehabilitation of stroke survivors in the United States to uncover the possible causal relationship between implementation strategies and outcomes.</p><p><strong>Methods: </strong>We created a conceptual framework to steer the development of IPTs. Then, we extracted concepts from theoretical frameworks reported in telemedicine implementation literature combined with feedback meetings with stakeholders with relevant experience.</p><p><strong>Results: </strong>We developed a framework for implementing telerehabilitation that includes implementation levels, contextual domains, telerehabilitation technology, implementation phases, actors, targets, mechanisms, and outcomes. We created 27 IPTs that specify telerehabilitation interventions, implementation strategies, actors, targets, context, implementation mechanisms, and outcomes. The IPTs were refined and validated through feedback meetings.</p><p><strong>Conclusions: </strong>This study adds to the relatively scarce literature on IPT development. For each IPT, we elaborated on the implementation mechanism and how it could facilitate or hinder telerehabilitation implementation, an essential insight for researchers and professionals to plan successful implementation strategies. Understanding causal mechanisms helps identify implementation strategies that will work in the U.S. context and improve weak implementation strategies that are potentially significant or commonly used.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374659","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":"Etiological factors and clinical outcomes in extracapsular and intracapsular hip fractures among older adults: A gender-specific analysis.","authors":"Radcliffe Lisk, Keefai Yeong, David Fluck, Jonathan Robin, Christopher H Fry, Thang S Han","doi":"10.1002/pmrj.13326","DOIUrl":"https://doi.org/10.1002/pmrj.13326","url":null,"abstract":"<p><strong>Background: </strong>Compared to patients with intracapsular fractures (ICFs), those with extracapsular fractures (ECFs) had worse outcomes. However, most studies of risk factors for these fractures lacked relevant potential reasons, particularly nutritional status, and adjustment for confounding factors. Furthermore, less is known about their effects on clinical outcomes.</p><p><strong>Objective: </strong>To conduct a gender-specific analysis of community-dwelling individuals admitted with hip fractures to examine the association of clinical risk factors and health care measures.</p><p><strong>Design: </strong>Monocentric cross-sectional study.</p><p><strong>Setting: </strong>Orthopedic trauma department.</p><p><strong>Participants: </strong>A total of 787 women and 318 men of similar mean age (±SD): 83.1 years (±8.6) and 82.5 years (±9.0), respectively.</p><p><strong>Main outcome measures: </strong>Multivariable logistic regression analyzed risk factors including age, gender, dementia, stroke, ischemic heart disease, diabetes, prefracture mobility, alcohol consumption, American Society of Anesthesiologists grades, drug history, and nutrition status for assessing risk factors and outcomes associated with ECFs and ICFs.</p><p><strong>Results: </strong>Compared to ICFs, for each additional year of age, women had a 3% and men 4% greater association with ECFs. Among women only, ECFs were associated with risk of malnutrition: odds ratio [OR] = 1.70 (95% CI, 1.17-2.48) or malnourishment: OR = 1.93 (95% CI, 1.06-3.52), stroke: OR = 1.85 (95% CI, 1.16-2.97), and diabetes: OR = 1.92 (95% CI, 1.21-3.06). Women with ECFs were less likely to be discharged to their own homes: OR = 0.56 (95% CI, 0.38-0.83); but more likely to be discharged to a rehabilitation unit: OR = 1.81 (95% CI, 1.21-2.71) and readmitted to hospital within 30 days of discharge ≥1 time: OR: 2.39 (95% CI, 1.27-4.50) or ≥2 times: OR = 3.48 (95% CI, 1.05-11.57): they did not differ in discharge to residential or nursing care or in-hospital mortality. Among men, there were no differences in discharge destinations or readmissions between types of fractures.</p><p><strong>Conclusions: </strong>Compared to ICFs, a greater number of risk factors associated with ECFs were identified more often in women than in men, and ECFs also have greater influences on clinical outcomes in women.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190265","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":"Successful treatment of chronic medial plantar nerve entrapment syndrome with hypertrophy of the abductor hallucis muscle using botulinum toxin injection.","authors":"Joffrey Drigny, Anaëlle Calmès, Grégoire Prum","doi":"10.1002/pmrj.13330","DOIUrl":"https://doi.org/10.1002/pmrj.13330","url":null,"abstract":"","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080868","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":"A case of neuralgic amyotrophy presenting with multiple lower cranial neuropathies with delayed onset of symptoms.","authors":"Takashi Kasahara, Takeshi Kimachi, Mitsuhiko Kodama, Katsuhiro Mizuno","doi":"10.1002/pmrj.13334","DOIUrl":"https://doi.org/10.1002/pmrj.13334","url":null,"abstract":"","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080867","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":"Peripheral neuropathy prevalence and effect on mobility 12 months after prosthesis prescription among individuals with dysvascular lower extremity amputation.","authors":"Daniel C Norvell, Elizabeth G Halsne, Alison W Henderson, Aaron P Turner, Wayne T Biggs, Joseph Webster, Joseph M Czerniecki, David C Morgenroth","doi":"10.1002/pmrj.13253","DOIUrl":"10.1002/pmrj.13253","url":null,"abstract":"<p><strong>Objective: </strong>To determine the prevalence of peripheral neuropathy (PN) and its effect on mobility in patients who were prescribed a lower limb prosthesis (LLP) after an incident dysvascular transtibial (TT) or transfemoral (TF) lower extremity amputation (LEA). We also sought to determine if the effect of PN on mobility was modified by amputation level or depression.</p><p><strong>Design: </strong>Participants were identified retrospectively through the Veterans Affairs (VA) Corporate Data Warehouse (CDW) from March 1, 2018, to November 30, 2020, then were contacted prospectively to obtain their self-reported mobility. Multiple logistic regression was used to control for potential confounders and identify potential effect modifiers.</p><p><strong>Setting: </strong>The VA CDW, the National Prosthetics Patient Database, participant mailings and phone calls.</p><p><strong>Participants: </strong>Three hundred fifty-seven individuals who underwent a TT or TF amputation due to diabetes and/or peripheral arterial disease and were fitted with a qualifying LLP.</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcomes measures: </strong>The Locomotor Capabilities Index basic and advanced mobility subscale scores.</p><p><strong>Results: </strong>Two-hundred thirty seven participants (66%) had a diagnosis of PN prior to prosthesis prescription. The detrimental effect of PN on achieving basic and advanced mobility was significant after adjusting for potential confounding factors (adjusted odds ratio [aOR], 0.53; 95% confidence interval [CI], 0.30-0.94; p = .03 and aOR, 0.43; 95% CI, 0.24-0.77; p = .005, respectively). The detrimental effect of PN was more pronounced in patients with depression, especially for advanced mobility (aOR, 0.36; 95% CI, 0.14-0.95; p = .04) versus no depression (aOR, 0.53; 95% CI, 0.27-1.0; p = .07).</p><p><strong>Conclusions: </strong>PN is common in patients who have undergone an LEA due to diabetes and/or vascular disease and patients with this diagnosis should be carefully evaluated. Targeted rehabilitation programs to mitigate its potential detrimental effects on mobility are important and should specifically include mental health assessment and treatment.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"159-169"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11828668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142111225","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":"A randomized, double-blind, placebo-controlled trial of DaxibotulinumtoxinA for Injection for the treatment of upper limb spasticity in adults after stroke or traumatic brain injury.","authors":"Atul T Patel, Michael C Munin, Ziyad Ayyoub, Gerard E Francisco, Rashid Kazerooni, Todd M Gross","doi":"10.1002/pmrj.13258","DOIUrl":"10.1002/pmrj.13258","url":null,"abstract":"<p><strong>Background: </strong>Intramuscular injection of botulinum toxin type A is a first-line pharmacotherapy for adults with upper limb spasticity (ULS). However, reemergence of symptoms within 12 weeks of treatment is common and longer-lasting treatments are needed.</p><p><strong>Objective: </strong>To evaluate the efficacy and safety of three doses of DaxibotulinumtoxinA for Injection (DAXI) for treatment of ULS in adults with stroke or traumatic brain injury.</p><p><strong>Intervention: </strong>Intramuscular injections of placebo (N = 24), DAXI 250 U (N = 22), DAXI 375 U (N = 19), or DAXI 500 U (N = 18) to the suprahypertonic muscle (SMG) and other muscle groups.</p><p><strong>Design: </strong>Randomized, double-blind, placebo-controlled study.</p><p><strong>Setting: </strong>Twenty-six study centers across the United States.</p><p><strong>Participants: </strong>Eighty-three adult patients with ULS were randomly assigned to each treatment group and followed for up to 36 weeks.</p><p><strong>Outcome measures: </strong>Co-primary endpoints were the Modified Ashworth Scale (MAS) score change from baseline in the designated SMG and Physician Global Impression of Change (PGIC) at Week 6.</p><p><strong>Results: </strong>The mean changes from baseline in MAS score for the designated SMG for placebo and the DAXI 250 U, 375 U, and 500 U groups were -0.6, -0.9, -0.9, and -1.8, respectively, at Week 4 and -0.8, -0.9, -1.0, and -1.5, respectively, at Week 6. Statistically significant improvement in MAS score compared with placebo was reported only for the 500 U dose (Week 4: p < .001; Week 6: p = .049). Significant improvements in PGIC ratings compared with placebo were reported for DAXI 375 U (p = .015) and DAXI 500 U (p = .009) at Week 4 but not for any DAXI doses at Week 6. All DAXI doses were well tolerated with no trend toward more adverse events with increased dose.</p><p><strong>Conclusion: </strong>Results from this Phase 2 study indicate that DAXI 500 U is effective and well tolerated for treatment of adults with ULS.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"126-136"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142352491","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":"Effectiveness of early rehabilitation interventions in patients with traumatic brain injury using a large database.","authors":"Shota Hayashi, Tomohiko Kamo, Ryo Momosaki","doi":"10.1002/pmrj.13243","DOIUrl":"10.1002/pmrj.13243","url":null,"abstract":"<p><strong>Background: </strong>Rehabilitation is important for patients with moderate-to-severe traumatic brain injury (TBI). However, the timing of early rehabilitation initiation is ambiguous, and its safety and effectiveness are unknown.</p><p><strong>Objective: </strong>To examine the effectiveness and safety of early rehabilitation in patients with moderate-to-severe TBI using propensity score analysis and a large database.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>A large medical database (JMDC database) of tertiary care facilities was used to compare outcomes of early and delayed rehabilitation.</p><p><strong>Patients: </strong>Patients aged between 20 and 90 years who were diagnosed with TBI were admitted to acute care hospitals. Inclusion criteria were patients undergoing rehabilitation within 7 days of admission with a Glasgow Coma Scale score of 3 to 12 on admission. This study included 3074 patients with moderate-to-severe TBI.</p><p><strong>Interventions: </strong>Patients were classified into an early rehabilitation group (within 2 days of admission) or a delayed rehabilitation group (3 to 7 days postadmission), depending on when rehabilitation started after TBI. Rehabilitation was defined as any type or intensity of intervention provided by a physical, occupational, and/or speech/language therapist. Interventions were not controlled.</p><p><strong>Main outcome measure(s): </strong>The primary outcome was Barthel Index (BI) efficiency (BI gain/length of stay). Secondary outcomes included BI gain (discharge BI - admission BI), incidence of aspiration pneumonia complications during hospitalization, discharge to home, mortality, and length of stay.</p><p><strong>Results: </strong>After applying inverse probability weighting with propensity scores, the total was 6152 patients. 3074 (50.0%) patients received early rehabilitation. The early rehabilitation group showed no difference in inpatient mortality (p = .438), improved BI efficiency (β = 0.86, p < .001), and shorter length of stay (β = -5.00, p = .018).</p><p><strong>Conclusions: </strong>Early rehabilitation in patients with moderate-to-severe TBI is associated with more efficient functional improvement and reduced hospital stays without an increase in inpatient mortality.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"170-177"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141894109","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}