PM&R最新文献

{"title":"Academy News - October 2024 PM&R.","authors":"","doi":"10.1002/pmrj.13288","DOIUrl":"https://doi.org/10.1002/pmrj.13288","url":null,"abstract":"","PeriodicalId":20354,"journal":{"name":"PM&R","volume":"16 10","pages":"1168-1169"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392671","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 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":"https://doi.org/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":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcranial Doppler ultrasonography can predict inpatient rehabilitation functional outcome in patients with stroke.","authors":"Nina Navalkar, Kristen Sandefer, Hely Nanavati, Chen Lin","doi":"10.1002/pmrj.13161","DOIUrl":"10.1002/pmrj.13161","url":null,"abstract":"<p><strong>Background: </strong>Despite advances in imaging techniques and treatment modalities, tools to predict recovery after stroke remain limited.</p><p><strong>Objective: </strong>To determine if transcranial Doppler (TCD) mean flow velocities were predictive of functional recovery following ischemic stroke.</p><p><strong>Methods: </strong>Data were collected from patients with stroke admitted to an academic tertiary care facility in the southeastern region of the United States between 2012 and 2019 who had a middle cerebral artery distribution ischemic stroke, TCD, and were discharged to our inpatient rehabilitation facility. Mean flow velocities were categorized as low (<40 cm/s), normal (40-80 cm/s), or high (>80 cm/s). Functional Independence Measure (FIM) scores were collected on admission to and discharge from inpatient rehabilitation. Multiple linear regression models were used to assess the differences in mean FIM score changes by categories of mean flow velocities.</p><p><strong>Results: </strong>We enrolled 57 patients, mean age 60 years, 73.7% male. Compared to the normal velocity group, those with abnormally low velocities had a significantly smaller change in their FIM score (adjusted β = -8.42; p = .01). Compared to the normal velocity group, those with abnormally high velocities experienced a greater change in FIM score, but this association was not statistically significant (beta = 1.12; p = .77).</p><p><strong>Conclusions: </strong>In this limited population, we found that low mean flow velocity as measured by TCD ultrasonography after a middle cerebral artery stroke is associated with poorer functional recovery following inpatient rehabilitation. Our results suggest that the value of TCD ultrasonography as a tool to predict motor recovery after stroke warrants further investigation.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"1072-1078"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11436487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140306690","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":"Virtual reality training versus conventional rehabilitation for chronic neck pain: A systematic review and meta-analysis.","authors":"Jie Hao, Zhengting He, Ziyan Chen, Andréas Remis","doi":"10.1002/pmrj.13158","DOIUrl":"10.1002/pmrj.13158","url":null,"abstract":"<p><strong>Objective: </strong>To identify, critically appraise, and quantitatively synthesize current randomized controlled trials to compare the effects of virtual reality and dose-matched conventional exercises in patients with chronic neck pain.</p><p><strong>Literature search: </strong>PubMed, Embase, CINAHL, PsycINFO, and Scopus were searched for studies published prior to April 15, 2023. The search strategies combined controlled vocabularies and title/abstract keywords on search themes of virtual reality and neck pain.</p><p><strong>Methods: </strong>A systematic review and meta-analysis of randomized controlled trials was conducted. Two independent reviewers conducted study selection, data extraction, and quality assessment. Methodological quality was assessed using the Physiotherapy Evidence Database scale. Meta-analyses were performed using random-effects models.</p><p><strong>Synthesis: </strong>Six randomized controlled trials including 243 participants with chronic neck pain met the inclusion criteria. Four studies were evaluated as good quality and two as fair. Pooled analysis revealed that virtual reality demonstrated significantly better improvements in the Neck Disability Index in both the short term (mean difference [MD] = -2.16; 95% confidence interval [CI]: -3.50 to -0.82) and long term (MD = -2.95; 95% CI: -4.93 to -0.97), and pain intensity in the short term (MD = -0.94, 95% CI: -1.31 to -0.58). No significant between-group differences were found in pain in the long term and kinesiophobia.</p><p><strong>Conclusions: </strong>Virtual reality is a promising intervention to address disability and pain in patients with chronic neck pain. This review supports the clinical significance of augmenting conventional exercise with virtual reality as part of conservative management of chronic neck pain.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"1143-1153"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140306691","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":"Toward a person-centered ethics framework for autonomy in spinal cord injury research and rehabilitation.","authors":"Anna Nuechterlein, Alexandra Olmos Pérez, Fabio Rossi, Jody Swift, Andrea Townson, Judy Illes","doi":"10.1002/pmrj.13146","DOIUrl":"10.1002/pmrj.13146","url":null,"abstract":"<p><p>In this paper, we explore how the concepts of autonomy and autonomous choice are understood in the context of spinal cord injury in the academic literature, both in reporting on research results and more broadly on outcomes and quality of life. We find inconsistent, framework-absent portrayals of autonomy as well as an absence of discourse that draws upon ethical constructs and theory. In response, we advance a person-centered framework for spinal cord injury research that combines both lived experience and a disability ethics approach to fill this gap.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"1154-1161"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140194409","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":"Mental health screening in pediatric lower limb deficiency population.","authors":"Emily Marshall, Eileen Shieh, Jeanne M Franzone, Paul T Enlow","doi":"10.1002/pmrj.13156","DOIUrl":"10.1002/pmrj.13156","url":null,"abstract":"<p><strong>Background: </strong>Youth with lower limb deficiency (LLD) may be at increased risk for mental health difficulties. However, guidelines around psychosocial screening are not well established.</p><p><strong>Objective: </strong>To describe the implementation and results of a mental health screening process in a multidisciplinary prosthetics clinic.</p><p><strong>Design: </strong>Survey.</p><p><strong>Setting: </strong>Outpatient specialty care clinic located within a children's hospital.</p><p><strong>Patients: </strong>All patients ages 0-18 years with LLD seen at a monthly multidisciplinary prosthetics clinic between September 2019 and January 2023 (n = 75).</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcomes measures: </strong>Quality of life was measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) pediatric proxy survey. Psychological functioning was measured using the Strengths and Difficulties Questionnaire (SDQ).</p><p><strong>Results: </strong>Descriptive statistics were used to determine the proportion of patients who endorsed clinically significant concerns. Of the 75 clinic visits during the study time frame, the psychosocial screeners were completed at 38 (51%). A total of 25 unique patients completed the screeners; 12 patients completed the screener more than once. The most commonly endorsed concerns on the PROMIS were issues with physical mobility (65%) and upper extremity function (40%). The SDQ revealed that a majority (62.5%) of the screened patients had an overall score above the clinical cutoff, indicating psychosocial distress in more than one area. The most commonly reported mental health concern was peer problems (62.5%). Post hoc analysis of repeat screenings indicated that most problems identified during the first screening persisted at follow-up screenings.</p><p><strong>Conclusions: </strong>Clinically significant psychological concerns were common among the sample, indicating the need to address this aspect of patients' well-being. Preliminary data on repeat screenings suggest that clinically significant concerns may not self-resolve. Routine psychosocial screening is critical for early identification of mental health problems and timely referral to evidence-based psychological interventions.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"1095-1104"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140176118","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":"Exploratory analysis of spontaneous versus paced breathing on heart rate variability in veterans with combat-related traumatic injury.","authors":"Rabeea Maqsood, Susie Schofield, Alexander N Bennett, Ahmed Khattab, Anthony M J Bull, Nicola T Fear, Christopher J Boos","doi":"10.1002/pmrj.13164","DOIUrl":"10.1002/pmrj.13164","url":null,"abstract":"<p><strong>Background: </strong>Respiration is a crucial determinant of autonomic balance and heart rate variability (HRV). The comparative effect of spontaneous versus paced breathing on HRV has been almost exclusively explored in healthy adults and never been investigated in an injured military cohort.</p><p><strong>Objective: </strong>To examine the effect of spontaneous versus paced breathing on HRV in veterans with combat-related traumatic injury (CRTI).</p><p><strong>Design: </strong>Observational cohort study.</p><p><strong>Setting: </strong>ArmeD serVices trAuma rehabilitatioN outComE (ADVANCE) study, Stanford Hall, UK.</p><p><strong>Participants: </strong>The sample consisted of 100 randomly selected participants who sustained CRTI (eg, amputation) during their deployment (Afghanistan 2003-2014) and were recruited into the ongoing ADVANCE prospective cohort study.</p><p><strong>Intervention: </strong>Not applicable.</p><p><strong>Main outcome measure: </strong>HRV was recorded using a single-lead ECG. HRV data were acquired during a sequential protocol of 5-minute spontaneous breathing followed immediately by 5 minutes of paced breathing (six cycles/minute) among fully rested and supine participants. HRV was reported using time domain (root mean square of successive differences), frequency domain (low frequency and high frequency) and nonlinear (sample entropy) measures. The agreement between HRV during spontaneous versus paced breathing was examined using the Bland-Altman analysis.</p><p><strong>Results: </strong>The mean age of participants was 36.5 ± 4.6 years. Resting respiratory rate was significantly higher with spontaneous versus paced breathing (13.4 ± 3.4 vs. 7.6 ± 2.0 breaths/minute; p < .001), respectively. Resting mean heart rate and root mean square of successive differences were significantly higher with paced breathing than spontaneous breathing (p < .001). Paced breathing significantly increased median low frequency power than spontaneous breathing (p < .001). No significant difference was found in the absolute power of high frequency between the two breathing protocols. The Bland-Altman analysis revealed poor agreement between HRV values during spontaneous and paced breathing conditions with wide limits of agreement.</p><p><strong>Conclusion: </strong>Slow-paced breathing leads to higher HRV than spontaneous breathing and could overestimate resting \"natural-state\" HRV.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"1079-1087"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140863769","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":"Departments.","authors":"","doi":"10.1002/pmrj.13287","DOIUrl":"https://doi.org/10.1002/pmrj.13287","url":null,"abstract":"","PeriodicalId":20354,"journal":{"name":"PM&R","volume":"16 10","pages":"E1-E8"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392672","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":"Delayed diagnosis of cervical myelopathy in an adult with Weaver syndrome.","authors":"Yvette Ysabel Yao, Ranita Harpreet Kaur Manocha","doi":"10.1002/pmrj.13162","DOIUrl":"10.1002/pmrj.13162","url":null,"abstract":"","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"1162-1164"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140288875","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":"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":"https://doi.org/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":""},"PeriodicalIF":2.2,"publicationDate":"2024-09-27","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}