PM&R最新文献

{"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}

{"title":"A dearth of disability-related competencies in Accreditation Council for Graduate Medical Education's Milestones 2.0.","authors":"Amy J Houtrow, Max B Hurwitz","doi":"10.1002/pmrj.13257","DOIUrl":"10.1002/pmrj.13257","url":null,"abstract":"<p><strong>Background: </strong>Despite the high prevalence of disability and the frequency with which people with disabilities encounter the health care system, physicians report inadequate knowledge regarding caring for their patients with disabilities.</p><p><strong>Objective: </strong>To determine the number and type of disability-related competencies in the Accreditation Council for Graduate Medical Education's Milestones 2.0.</p><p><strong>Design: </strong>Cross-sectional analysis of publicly available data to identify, via key word search, the presence of disability-related competencies using disability-related terms derived from the World Health Organization's International Classification of Functioning Disability and Health.</p><p><strong>Setting: </strong>Accreditation Council for Graduate Medical Education's Milestones 2.0.</p><p><strong>Participants: </strong>N/A INTERVENTIONS: N/A MAIN OUTCOME MEASURE: Presence of disability-related competencies.</p><p><strong>Results: </strong>Over one-third (37.5%) of specialties had zero disability-related competencies. Nineteen (59.4%) included an Interpersonal and Communication Skills Milestone that mentions disability as a potential barrier to communication. No specialties had Systems-Based Practice or Practice-Based Learning and Improvement disability-related competencies. Physical medicine and rehabilitation (PM&R) had six disability-related competencies, preventive medicine occupational and environmental medicine had three, and otolaryngology and transition year each had two.</p><p><strong>Conclusions: </strong>A minority of medical and surgical specialties had disability-related competencies outside of the Interpersonal and Communication domain. With the rising prevalence of disability and the lack of physicians with expertise in the care of people with disability, the time is now to integrate disability competencies into residencies, especially for the primary care specialties.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"195-199"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142036669","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 systematic review and meta-analysis of Nordic walking for chronic heart failure with low left ventricular ejection fraction.","authors":"Aulia Syavitri Dhamayanti, Rahmad Rahmad, Samiah Rachmawati, Yoga Waranugraha","doi":"10.1002/pmrj.13254","DOIUrl":"10.1002/pmrj.13254","url":null,"abstract":"<p><strong>Background: </strong>Nordic walking (NW) has been reported to be beneficial in various chronic diseases.</p><p><strong>Objective: </strong>To determine whether NW improves function in patients with heart failure (HF) with low left ventricular ejection fraction more than conventional cardiac rehabilitation or usual care.</p><p><strong>Methods: </strong>Systematic literature searches in PubMed, ScienceDirect, and Web of Science were conducted. According to patient, intervention, comparison, and outcome (PICO) principles, a stepwise selection process was completed to identify eligible studies. Only randomized controlled trials (RCTs) were included in this systematic review and meta-analysis. Pooled effects were determined using a random effect analysis model for the meta-analysis.</p><p><strong>Results: </strong>A total of 282 participants from four RCTs were included. The improvement of peak oxygen consumption (peak VO₂) was greater in the NW group than in the control group (mean difference [MD] = 2.18 mL/kg/min; 95% confidence interval [CI] = 1.35-3.01; p < .01). The improvement of the 6-minute walk test (6MWT) distance was also greater in the NW group than in the control group (MD = 16.51 meters; 95% CI = 3.23-29.80; p = .01).</p><p><strong>Conclusion: </strong>This systematic review highlights the benefits of NW training in patients with chronic HF, particularly those with systolic dysfunction. Specifically, NW walking was associated with increased peak VO₂ and 6MWT improvement compared to conventional cardiac rehabilitation or usual care. These results suggest that NW may be a useful component of cardiac rehabilitation. However, additional larger studies with a wider range of patients are needed.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"210-221"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142111224","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":"Movement disorders in pediatric stroke survivors: A case series.","authors":"Rafaello Ibrado, Annie M Abraham, Jared Stowers, Melissa Fleming","doi":"10.1002/pmrj.13209","DOIUrl":"10.1002/pmrj.13209","url":null,"abstract":"","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"238-239"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141088372","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":"Racial disparities in prosthesis abandonment and mobility outcomes after lower limb amputation from a dysvascular etiology in a veteran population.","authors":"Max Hurwitz, Joseph Czerniecki, David Morgenroth, Aaron Turner, Alison W Henderson, Beth Halsne, Daniel Norvell","doi":"10.1002/pmrj.13240","DOIUrl":"10.1002/pmrj.13240","url":null,"abstract":"<p><strong>Background: </strong>Non-Hispanic Black (NHB) individuals have higher rates of amputation and increased risk of a transfemoral amputation due to dysvascular disease than non-Hispanic White (NHW) individuals. However, it is unclear if NHB individuals have differences in prosthesis use or functional outcomes following an amputation.</p><p><strong>Objective: </strong>To determine if there are racial disparities in prosthesis abandonment and mobility outcomes in veterans who have undergone their first major unilateral lower extremity amputation (LEA) due to diabetes and/or peripheral artery disease.</p><p><strong>Design: </strong>National cohort study that identified individuals retrospectively through the Veterans Affairs (VA) Corporate Data Warehouse (CDW) from March 1, 2018, to November 30, 2020, then prospectively collected their self-reported prosthesis abandonment and mobility. Multiple logistic regression was used to control for potential confounders and identify potential effect modifiers.</p><p><strong>Setting: </strong>The VA CDW, participant mailings and phone calls.</p><p><strong>Participants: </strong>Three hundred fifty-seven individuals who underwent an incident transtibial or transfemoral amputation due to diabetes and/or peripheral arterial disease.</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcomes measures: </strong>(1) Self-reported prosthesis abandonment. (2) Level of mobility assessed using the Locomotor Capabilities Index.</p><p><strong>Results: </strong>Rurally located NHB individuals without a major depressive disorder (MDD) had increased odds of abandoning their prosthesis (adjusted odds ratios [aOR] = 5.3; 95% confidence interval [CI]: [1.3-21.1]). This disparity was nearly three times as large for rurally located NHB individuals with MDD diagnosis, compared with other races from rural areas and with MDD (aOR = 15.8; 95% CI, 2.5-97.6). NHB individuals living in an urban area were significantly less likely to achieve advanced mobility, both with MDD (aOR=0.16; 95% CI: [0.04-7.0]) and without MDD (aOR = 0.26; 95% CI: [0.09-0.73]).</p><p><strong>Conclusions: </strong>This study demonstrated that health care disparities persist for NHB veterans following a dysvascular LEA, with increased prosthesis abandonment and worse mobility outcomes.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"137-146"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11804270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889943","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":"Changes in walking speed following resistance training in people with multiple sclerosis: A systematic review and meta-analysis.","authors":"Connor McManaman, Brianna Novak, Lorna Paul, Scott Rooney","doi":"10.1002/pmrj.13255","DOIUrl":"10.1002/pmrj.13255","url":null,"abstract":"<p><strong>Background: </strong>Reduced walking ability, especially decreased gait speed, is one of the most common and disabling impairments reported by people with multiple sclerosis (MS). Considering the impact of muscle strength on walking ability, resistance training may have the potential to improve walking speed in MS. Therefore, this systematic review and meta-analysis aims to evaluate the effect of lower limb resistance training on walking speed in people with MS.</p><p><strong>Methods: </strong>Seven databases (CINAHL, MEDLINE, The Allied and Complimentary Medicine Database, Web of Science, Physiotherapy Evidence Database [PEDro], PsycINFO, and Sports Medicine and Education Index) were searched in March 2024 for studies that met the following eligibility criteria: randomized controlled trials investigating the effects of resistance training interventions on objective measures of walking speed in people with MS. Risk of bias was assessed using the PEDro scale. Meta-analysis was performed to quantify intervention effect using a random effects model.</p><p><strong>Results: </strong>Twelve randomized controlled trials were included, reporting data on 425 individuals with MS. Participants had mostly relapsing-remitting MS (85%) and a mild-moderate level of disability (Expanded Disability Status Score 1.0-6.0). Results of the meta-analysis (based on 7 of the included studies) indicated a significant yet variable improvement in walking speed in favor of the intervention (0.10 m/s, 95% confidence interval 0.01-0.19, p < .05). Sensitivity analysis indicates that larger improvements in walking speed were found over tests covering shorter distances.</p><p><strong>Conclusions: </strong>Resistance training was found to significantly improve walking speed in people with MS. However, variability in results were noted across studies; accordingly, future research should determine how variables-particularly related to resistance training prescription-influence the intervention effect.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"222-237"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142293738","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":"Departments.","authors":"","doi":"10.1002/pmrj.13362","DOIUrl":"https://doi.org/10.1002/pmrj.13362","url":null,"abstract":"","PeriodicalId":20354,"journal":{"name":"PM&R","volume":"17 2","pages":"E1-E9"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415038","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":"The relationship of hip strength to walking and balance performance in unilateral lower limb prosthesis users differs by amputation level.","authors":"Andrew Sawers, Stefania Fatone","doi":"10.1002/pmrj.13245","DOIUrl":"10.1002/pmrj.13245","url":null,"abstract":"<p><strong>Background: </strong>Safe and efficient locomotion is a frequently stated goal of lower limb prosthesis users, for which hip strength may play a central yet poorly understood role. Additional research to identify associations between hip strength, balance, and mobility among transtibial and transfemoral prosthesis users is required.</p><p><strong>Objective: </strong>To test whether residual and/or intact limb isometric hip strength was associated with lower limb prosthesis users' walking speed, endurance, and balance.</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Setting: </strong>Research laboratory.</p><p><strong>Participants: </strong>Convivence sample of 14 transtibial and 14 transfemoral prosthesis users.</p><p><strong>Methods: </strong>Multiple linear regression was used to evaluate the relationship between isometric measures of residual and intact limb hip strength and walking and balance performance.</p><p><strong>Main outcome measurements: </strong>Measures of isometric hip muscle strength, including peak torque, average torque, torque impulse, and torque steadiness (i.e. consistency with which an isometric torque can be sustained) were derived from maximum voluntary hip flexion, extension, abduction and adduction torque signals collected with a motor-driven dynamometer. Walking speed, endurance, and balance were assessed by administering the 10-meter walk test, 2-minute walk test, Four Square Step Test, and Narrowing Beam Walking Test, respectively.</p><p><strong>Results: </strong>Residual limb hip extensor max torque and abductor torque steadiness explained between 51% and 69% of the variance in transtibial prosthesis users' walking speed, endurance, and balance. In contrast, intact limb hip abductor torque impulse explained between 33% and 48% of the variance in transfemoral prosthesis users' walking speed, endurance, and balance.</p><p><strong>Conclusions: </strong>Our results suggest that unilateral transtibial and transfemoral prosthesis users' walking and balance performance may depend on different hip muscles, and different facets of hip strength. Amputation level-specific hip strength interventions may therefore be required to improve walking and balance performance in unilateral transtibial and transfemoral prosthesis users. The \"intact leg strategy\" adopted by transfemoral prosthesis users may be due to a variety of prosthesis and biomechanical factors that limit the efficiency with which transfemoral prosthesis users can exploit the strength of their residual limb hip muscles while walking.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"147-158"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141907499","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":"Mobilization with movement is effective for improving ankle range of motion and walking ability in individuals after stroke: A systematic review with meta-analysis.","authors":"Lucas R Nascimento, Augusto Boening, Isabella Ribeiro, Maria Eduarda Dos Santos, Marcelo Benevides, Cíntia H Santuzzi","doi":"10.1002/pmrj.13259","DOIUrl":"10.1002/pmrj.13259","url":null,"abstract":"<p><strong>Background: </strong>Mobilization with movement has been recommended to improve foot mobility in people with ankle impairments and could improve walking after stroke.</p><p><strong>Objective: </strong>To examine the effects of the addition of mobilization with movement to commonly used exercises in physiotherapy for improving ankle range of motion and walking in people who have had a stroke.</p><p><strong>Design: </strong>Systematic review of randomized controlled trials.</p><p><strong>Settings: </strong>Not applicable.</p><p><strong>Participants: </strong>Ambulatory adults at any time after stroke.</p><p><strong>Intervention: </strong>The experimental intervention was exercises plus ankle mobilization with movement, in comparison with exercises alone.</p><p><strong>Main outcome: </strong>Ankle range of motion.</p><p><strong>Measurements: </strong>Walking parameters (ie., walking speed, cadence, step length).</p><p><strong>Results: </strong>Six trials, involving 160 participants, were included. The mean PEDro score of the trials was 6 (range 4 to 7). Mobilization with movement in addition to exercises improved range of motion by 4° (95% CI 2 to 6), walking speed by 0.08 m/s (95% CI 0.05 to 0.11), cadence by 9 steps/min (95% CI 7 to 12), and step length by 5 cm (95% CI 3 to 7) more than exercises alone. The quality of evidence was low for range of motion and moderate for walking outcomes.</p><p><strong>Conclusion: </strong>This systematic review provided evidence that the addition of mobilization with movement to commonly used exercises in neurological rehabilitation increases ankle dorsiflexion, and benefits are carried over to improving walking speed, cadence, and step length in moderately disabled individuals with chronic stroke.</p><p><strong>Review registration: </strong>PROSPERO (CRD42023405130).</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"200-209"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142352492","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":"Basal cell carcinoma on amputated limb following radiation therapy for heterotopic ossification.","authors":"Gabriela Pinero-Crespo, Meredith E Thomley, Aashish Bhatt, Jeffrey Heckman, Thomas Beachkofsky","doi":"10.1002/pmrj.13336","DOIUrl":"https://doi.org/10.1002/pmrj.13336","url":null,"abstract":"","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075295","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}