Archives of rehabilitation research and clinical translation最新文献

{"title":"The Immediate Effects of Different Types of Augmented Feedback on Fast Walking Speed Performance and Intrinsic Motivation After Stroke","authors":"Saleh M. Alhirsan PT, MSc, PhD ,&nbsp;Carmen E. Capó-Lugo PT, PhD ,&nbsp;Christopher P. Hurt PhD ,&nbsp;Gitendra Uswatte PhD ,&nbsp;Haiyan Qu PhD ,&nbsp;David A. Brown PT, PhD","doi":"10.1016/j.arrct.2023.100265","DOIUrl":"10.1016/j.arrct.2023.100265","url":null,"abstract":"<div><h3>Objective</h3><p>To examine the immediate effects of different types of augmented feedback on walking speed and intrinsic motivation post-stroke.</p></div><div><h3>Design</h3><p>A within-subjects repeated-measures design.</p></div><div><h3>Setting</h3><p>A university rehabilitation center.</p></div><div><h3>Participants</h3><p>Eighteen individuals with chronic stroke hemiparesis with a mean age of 55.67±13.63 years and median stroke onset of 36 (24, 81) months (N=18).</p></div><div><h3>Interventions</h3><p>Not applicable.</p></div><div><h3>Primary outcome</h3><p>Fast walking speed measured on a robotic treadmill for 13 meters without feedback and 13 meters with augmented feedback on each of the 3 experimental conditions: (1) without virtual reality (VR), (2) with a simple VR interface, and (3) with VR-exergame. Intrinsic motivation was measured using the Intrinsic Motivation Inventory (IMI).</p></div><div><h3>Results</h3><p>Although the differences were not statistically significant, fast-walking speed was higher in the augmented feedback without VR (0.86±0.44 m/s); simple VR interface (0.87±0.41 m/s); VR-exergame (0.87±0.44 m/s) conditions than in the fast-walking speed without feedback (0.81±0.40 m/s) condition. The type of feedback had a significant effect on intrinsic motivation (<em>P</em>=.04). The post hoc analysis revealed borderline significance on IMI-interest and enjoyment between the VR-exergame condition and the without-VR condition (<em>P</em>=.091).</p></div><div><h3>Conclusion</h3><p>Augmenting feedback affected the intrinsic motivation and enjoyment of adults with stroke asked to walk fast on a robotic treadmill. Additional studies with larger samples are warranted to examine the relations among these aspects of motivation and ambulation training outcomes.</p></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0b/38/main.PMC10258376.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9623616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the Effectiveness of Exercise Therapy for Adults With Knee Osteoarthritis: A Pragmatic Randomized Controlled Trial (BEEP Trial)","authors":"Nadine E. Foster DPhil ,&nbsp;Elaine Nicholls PhD ,&nbsp;Melanie A. Holden PhD ,&nbsp;Emma L. Healey PhD ,&nbsp;Elaine M. Hay MD ,&nbsp;The BEEP trial team","doi":"10.1016/j.arrct.2023.100266","DOIUrl":"10.1016/j.arrct.2023.100266","url":null,"abstract":"<div><h3>Objective</h3><p>To investigate whether knee osteoarthritis (OA) related pain and function can be improved by offering enhanced physical therapist-led exercise interventions.</p></div><div><h3>Design</h3><p>Three-arm prospectively designed pragmatic randomized controlled trial.</p></div><div><h3>Setting</h3><p>General practices and National Health Service physical therapy services in England.</p></div><div><h3>Participants</h3><p>514 adults (252 men, 262 women) aged ≥45 years with a clinical diagnosis of knee osteoarthritis (N=514). Mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores at baseline were 8.4 for pain and 28.1 for function.</p></div><div><h3>Interventions</h3><p>Participants were individually randomized (1:1:1 allocation) to usual physical therapy care (UC control: up to 4 sessions of advice and exercise over 12 weeks), individually tailored exercise (ITE: individualized, supervised, and progressed lower limb exercises, 6-8 sessions over 12 weeks), or targeted exercise adherence (TEA: transitioning from lower limb exercise to general physical activity, 8-10 contacts over 6 months).</p></div><div><h3>Main Outcome Measures</h3><p>Primary outcomes were pain and physical function measured by the WOMAC at 6 months. Secondary outcomes were measured at 3, 6, 9, 18, and 36 months.</p></div><div><h3>Results</h3><p>Participants receiving UC, ITE, and TEA all experienced moderate improvement in pain and function. There were no significant differences between groups at 6 months (adjusted mean differences (95% confidence intervals): pain UC vs ITE, -0.3 (-1.0 to 0.4), UC vs TEA, -0.3 (-1.0 to 0.4); function UC vs ITE, 0.5 (-1.9 to 2.9), UC vs TEA, -0.9 (-3.3 to 1.5)), or any other time-point.</p></div><div><h3>Conclusions</h3><p>Patients receiving UC experienced moderate improvement in pain and function; however, ITE and TEA did not lead to superior outcomes. Other strategies for patients with knee osteoarthritis to enhance the benefits of exercise-based physical therapy are needed.</p></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10258382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9629730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Duration of Electro-Dry Needling Does Not Change the Pain Response After Repeated Nociceptive Thermal Stimuli in Asymptomatic Individuals: A Randomized Intervention Study","authors":"Max Jordon DPT, PhD,&nbsp;Matthew Grubb DPT,&nbsp;Frank Tudini DPT, DScPT","doi":"10.1016/j.arrct.2023.100267","DOIUrl":"10.1016/j.arrct.2023.100267","url":null,"abstract":"<div><h3>Objective</h3><p>To assess the effects of 5 different durations of electro-dry needling (EDN) on asymptomatic individuals’ pain response after repeated noxious thermal stimuli.</p></div><div><h3>Design</h3><p>Randomized, non-controlled intervention trial.</p></div><div><h3>Setting</h3><p>University laboratory.</p></div><div><h3>Participants</h3><p>Asymptomatic participants (N=50) were recruited for the study and randomized into 5 groups. There were 33 women with an average age of 26.8 (±4.8) years. To participate in the study, individuals had to be between the ages of 18 and 40, free of any musculoskeletal injury which prevented participation of daily activities, and not pregnant or trying to become pregnant.</p></div><div><h3>Interventions</h3><p>Participants were randomly assigned to receive 5 different durations of EDN: 10, 15, 20, 25, and 30 minutes. To perform the EDN, 2 monofilament needles were inserted lateral to the lumbar spinous processes of L3 and L5 on the right. Needles were left in situ with electrical stimulation at a frequency of 2 Hz and an amplitude which resulted in a 3 to 6 out of 10 intensity pain rating by the participant.</p></div><div><h3>Main Outcome Measures</h3><p>The change in the magnitude of pain in response to repetitive heat-pulses before and after the EDN procedure.</p></div><div><h3>Results</h3><p>There was a significant reduction in the magnitude of pain in response across the groups after EDN (<em>F</em>_(1,42)=94.12<em>, P&lt;</em>.001, ƞ_p²=.691). However, the interaction between time and group was not significant (<em>F</em>_(4,42)=1.019, <em>P</em>=.409, ƞ_p²=.088), indicating that no duration of EDN was superior to another in reducing temporal summation.</p></div><div><h3>Conclusions</h3><p>This study suggests that in asymptomatic individuals, performing EDN beyond 10 minutes does not provide any additional benefits in the reduction of the magnitude of pain in response to thermal nociceptive stimuli. Additional study in symptomatic populations is required for generalizability in clinical settings.</p></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f3/5e/main.PMC10258375.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9623618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peak Quadriceps Muscle Torque and Electromyographic Output in Patients With Chronic Respiratory Disorders: Effects of Pulmonary Rehabilitation","authors":"Gregory Grandio MD ,&nbsp;Guadalupe Yetter DPT ,&nbsp;Spencer Briglio BA ,&nbsp;Kimberly Ong PT ,&nbsp;Joel Froding DPT ,&nbsp;Jimmy Kim PT ,&nbsp;Juan Cortez NP ,&nbsp;Ahmet Baydur MD","doi":"10.1016/j.arrct.2023.100259","DOIUrl":"10.1016/j.arrct.2023.100259","url":null,"abstract":"<div><h3>Objective</h3><p>To assess the change in relation of the peak quadriceps electromyographic signal to the peak torque produced during a train of 5 isokinetic knee extensions (from 90 degrees below horizontal at a constant speed of 60 degrees/s) at baseline, and at 4 and 8 weeks of pulmonary rehabilitation.</p></div><div><h3>Design</h3><p>In this prospective observational study, isokinetic contractions were recorded during the extensions from the knee bent at 90 degrees to the horizontal plane against graded resistance. Peak quadriceps torque signal (Tq) and peak electromyographic signal (Eq) were recorded by dynamometry and surface electrodes placed at designated locations over the muscle group, respectively.</p></div><div><h3>Setting</h3><p>Physical therapy department in a tertiary care medical center.</p></div><div><h3>Participants</h3><p>Eighteen patients (9 restrictive lung disease, 6 chronic airflow limitation, 3 non-ILD restrictive; N=18) were compared with 11 healthy control subjects.</p></div><div><h3>Interventions</h3><p>Patients underwent an 8-week pulmonary rehabilitation program.</p></div><div><h3>Main Outcome Measures</h3><p>Comparisons of Tq, Eq, and Tq/Eq ratio among patients and controls were by analysis of variance. Associations between physiological variables were determined by multivariable Pearson's correlation.</p></div><div><h3>Results</h3><p>Compared with patients, controls exhibited a 22% higher baseline mean peak Eq (<em>P</em>&lt;.05) and 76% higher mean peak Tq (<em>P</em>=.02) during knee extensions. Patients’ peak Eq/Tq was twice as high as in the controls (<em>P</em>=.02); at 4 weeks, Eq/Tq in patients decreased by 44% (<em>P</em>&lt;.04) with no further decline at 8 weeks; changes in Eq/Tq of 5 of 6 patients paralleled changes in their respective St George's Respiratory Questionnaire scores. There was no change in Tq or Eq/Tq over time among the control cohort.</p></div><div><h3>Conclusions</h3><p>Eight weeks of pulmonary rehabilitation result in a decrease in Eq/Tq, indicating improvement in force generation of limb muscles, with the change occurring in the first 4 weeks.</p></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/10/da/main.PMC10258385.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9629729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Activity and Participation, Bimanual Function, and Prosthesis Satisfaction are Strong Predictors of General Well-Being Among Upper Limb Prosthesis Users","authors":"Phillip M. Stevens MEd ,&nbsp;Dwiesha L. England MS ,&nbsp;Amy E. Todd MS ,&nbsp;Stephen A. Mandacina CP ,&nbsp;Shane R. Wurdeman PhD","doi":"10.1016/j.arrct.2023.100264","DOIUrl":"10.1016/j.arrct.2023.100264","url":null,"abstract":"<div><h3>Objective</h3><p>To determine the role of multiple factors on general well-being for upper limb prosthesis users.</p></div><div><h3>Design</h3><p>Retrospective cross-sectional observational design.</p></div><div><h3>Setting</h3><p>Prosthetic clinics across the United States.</p></div><div><h3>Participants</h3><p>At the time of analysis, the database consisted of 250 patients with unilateral upper limb amputation seen between July 2016 and July 2021.</p></div><div><h3>Intervention</h3><p>Not applicable.</p></div><div><h3>Main Outcomes Measures</h3><p>Dependent variable: well-being (Prosthesis Evaluation Questionnaire- Well-Being). Independent variables included in analysis: activity and participation (Patient Reported Outcomes Measurement Information System [PROMIS] Ability to Participate in Social Roles and Activities), bimanual function (PROMIS-9 UE), prosthesis satisfaction (Trinity Amputation and Prosthesis Experience Scales-Revised; TAPES-R), PROMIS pain interference, age, gender, average daily hours worn, time since amputation, and amputation level.</p></div><div><h3>Results</h3><p>A multivariate linear regression model using a forward enter method was applied. The model included 1 dependent variable (well-being) and 9 independent variables. Within the multiple linear regression model, the strongest predictors of well-being were activity and participation (β=0.303, <em>P</em>&lt;.0001), followed by prosthesis satisfaction (β=0.257, <em>P</em>&lt;.0001), pain interference (β=-0.187, <em>P</em>=.001), and bimanual function (β=0.182, <em>P</em>=.004). Age (β=-0.036, <em>P</em>=.458), gender (β=-0.051, <em>P</em>=.295), time since amputation (β=0.031, <em>P</em>=.530), amputation level (β=0.042, <em>P</em>=.385), and hours worn (β=-0.025, <em>P</em>=.632) were not significant predictors of well-being.</p></div><div><h3>Conclusion</h3><p>Reducing pain interference and improving clinical factors such as prosthesis satisfaction and bimanual function with their associated effects on activity and participation will positively affect the well-being of individuals living with upper limb amputation/congenital deficiency.</p></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d0/c8/main.PMC10258372.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9623617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing and Testing Implementation Strategies to support the Centers for Disease Control and Prevention's Initiative for Falls Risk Management in Outpatient Physical Therapy: A Protocol","authors":"Jennifer L. Vincenzo PhD, MPH, PT ,&nbsp;Jennifer S. Brach PhD, PT ,&nbsp;Jonathan Bean MD, MS, MPH ,&nbsp;Geoffrey M. Curran PhD","doi":"10.1016/j.arrct.2023.100268","DOIUrl":"10.1016/j.arrct.2023.100268","url":null,"abstract":"<div><h3>Objectives</h3><p>To develop and test implementation strategies to support implementing the Centers for Disease Control and Preventions’ Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative for falls prevention and falls risk management in a novel setting, outpatient physical therapy.</p></div><div><h3>Design</h3><p>A feasibility implementation study engaging key partners involved in or affected by the implementation throughout the study.</p></div><div><h3>Setting</h3><p>Five outpatient physical therapy clinics embedded in a health system.</p></div><div><h3>Participants</h3><p>Key partners (physical therapists, physical therapist assistants, referring physicians, administrative clinic staff, older adults, and caregivers) involved in or affected by the implementation (N=48) will participate in surveys and interviews to identify barriers and facilitators prior to implementation and post implementation. Twelve key partners representing at least 1 of each group will participate in evidence-based quality improvement panels to identify which barriers and facilitators are most important and feasible to address and to assist in choosing and designing implementation strategies to support the uptake of STEADI in outpatient rehabilitation. STEADI will be implemented in 5 outpatient physical therapy clinics as a standard of care for the ∼1200 older adults attending those clinics annually.</p></div><div><h3>Outcomes</h3><p>Primary outcomes include clinic- and provider-level (physical therapists and physical therapist assistant) adoption and fidelity to STEADI screening, multifactorial assessment, and falls risk interventions for older adults (65 years or older) attending outpatient physical therapy. Key partners’ perceived feasibility, acceptability, and appropriateness of STEADI in outpatient physical therapy will also be measured using validated implementation science questionnaires. Exploratory clinical outcomes of older adults’ falls risk pre- and post rehabilitation will be investigated.</p></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/57/a0/main.PMC10258383.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9629732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prism Adaptation Treatment for Right-Sided and Left-Sided Spatial Neglect: A Retrospective Case-Matched Study","authors":"Timothy J. Rich PhD, OTR/L ,&nbsp;Marinos Pylarinos ,&nbsp;Devan Parrott PhD ,&nbsp;Peii Chen PhD","doi":"10.1016/j.arrct.2023.100263","DOIUrl":"10.1016/j.arrct.2023.100263","url":null,"abstract":"<div><h3>Objective</h3><p>To compare the effectiveness of prism adaptation treatment (PAT) between patients with right- and left-sided spatial neglect (SN).</p></div><div><h3>Design</h3><p>Retrospective case-matched design.</p></div><div><h3>Setting</h3><p>Inpatient rehabilitation hospitals and facilities.</p></div><div><h3>Participants</h3><p>A total of 118 participants were selected from a clinical dataset of 4256 patients from multiple facilities across the United States. Patients with right-sided SN (median age: 71.0 [63.5-78.5] years; 47.5% female; 84.8% stroke, 10.1% traumatic/nontraumatic brain injury) were matched 1:1 with patients with left-sided SN (median age: 70.0 [63.0-78.0] years; 49.2% female; 86.4% stroke, 11.8% traumatic/nontraumatic brain injury) based on age, neglect severity, overall functional ability at admission, and number of PAT sessions completed during their hospital stay.</p></div><div><h3>Intervention</h3><p>Prism adaptation treatment.</p></div><div><h3>Main Outcome Measures</h3><p>Primary outcomes were pre–post change on the Kessler Foundation Neglect Assessment Process (KF-NAP) and the Functional Independence Measure (FIM). Secondary outcomes were whether the minimal clinically important difference was achieved for pre–post change on the FIM.</p></div><div><h3>Results</h3><p>We found greater KF-NAP gain for patients with right-sided SN than those with left-sided SN (<em>Z</em> = 2.38, <em>P</em>=.018). We found no differences between patients with right-sided and left-sided SN for Total FIM gain (<em>Z</em>=–0.204, <em>P</em>=.838), Motor FIM gain (Z=–0.331, <em>P</em>=.741), or Cognitive FIM gain (Z=–0.191, <em>P</em>=.849).</p></div><div><h3>Conclusions</h3><p>Our findings suggest PAT is a viable treatment for patients with right-sided SN just as it is for patients with left-sided SN. Therefore, we suggest prioritizing PAT within the inpatient rehabilitation setting as a treatment to improve SN symptoms regardless of brain lesion side.</p></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ab/99/main.PMC10258371.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9629728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remote Delivery of the Fugl-Meyer Assessment for the Upper Extremity: A Pilot Study to Assess Feasibility, Reliability, and Validity","authors":"Veronica Rowe PhD, OTR/L ,&nbsp;Sarah Blanton PT, DPT ,&nbsp;Dawn Aycock PhD, RN, ANP-BC ,&nbsp;Matthew J. Hayat PhD ,&nbsp;Syeda Zahra Ali MPH","doi":"10.1016/j.arrct.2023.100261","DOIUrl":"10.1016/j.arrct.2023.100261","url":null,"abstract":"<div><h3>Objective</h3><p>To develop a remote protocol for the upper extremity Fugl-Meyer Assessment (reFMA) and assess the reliability and validity with in-person delivery.</p></div><div><h3>Design</h3><p>Feasibility testing.</p></div><div><h3>Setting</h3><p>Remote/virtual and in-person in participants’ homes.</p></div><div><h3>Participants</h3><p>Three triads of therapists, stroke survivors, and carepartners (N=9) participated in Phases 1 and 2. Twelve different stroke survivors participated in Phase 3.</p></div><div><h3>Intervention</h3><p>The FMA was administered and received remotely using the instructional protocol (Phases 1 and 2). Pilot testing with the delivery of the reFMA remotely and the FMA in-person occurred in Phase 3.</p></div><div><h3>Main Outcome Measures</h3><p>Feedback for refinement and feasibility of obtaining the reFMA (including the System Usability Scale) and the FMA scores remotely and in-person to assess reliability and validity of the reFMA.</p></div><div><h3>Results</h3><p>The reFMA was refined to incorporate feedback and suggestions from users. Interrater reliability between 2 therapists evaluating the FMA remotely was found to be poor with little agreement. For criterion validity, only 1 out of 12 (8.3%) total scores were in agreement between the in-person and remote assessments.</p></div><div><h3>Conclusion</h3><p>Reliable and valid remote administration of the FMA is an important aspect of telerehabilitation for the upper extremity after stroke, but further research is needed to address current protocol limitations. This study provides preliminary support for the need for alternative strategies to improve appropriate implementation of the FMA remotely. Possible explanations for the poor reliability are explored and suggestions for improvement of the remote delivery of the FMA are provided.</p></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/14/d9/main.PMC10258373.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9629733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Choice After Referral to Physical Therapy for Lower Back Pain and Knee Osteoarthritis","authors":"Jason A. Sharpe DPT, PhD ,&nbsp;Abigail Shapiro MSPH ,&nbsp;Adam Goode DPT, PhD. ,&nbsp;Chelsea Whitfield MPH, CHES ,&nbsp;Jennifer Gierisch PhD, MPH ,&nbsp;Karen Goldstein MD, MSPH ,&nbsp;Kelli D. Allen PhD","doi":"10.1016/j.arrct.2022.100243","DOIUrl":"10.1016/j.arrct.2022.100243","url":null,"abstract":"<div><h3>Objective</h3><p>To assess factors influencing Veterans' decisions to initiate physical therapy (PT) after referral for low back pain (LBP) or knee osteoarthritis (OA).</p></div><div><h3>Design</h3><p>Qualitative study using individual semistructured telephone interviews.</p></div><div><h3>Setting</h3><p>Durham Veterans Health Administration Health Care System.</p></div><div><h3>Participants</h3><p>A total of 44 Veteran patients (N=44) aged 26-85 were referred for LBP or knee OA between January and August 2021.</p></div><div><h3>Results</h3><p>Patient-level factors influencing PT initiation included confusion with navigating the health system, efficacy beliefs about PT, and thoughts about physical therapists' ability to diagnose their pain. At the provider level, discussion about PT care appeared to increase initiation of PT. At the system level, influences included wait times, availability of appointments outside business hours, and easy-to-access locations. Motivational themes included respondents' symptoms and functional limitations that drove them to initiate care. Respondents suggested that changes to wait times through same-day or rapid appointments, assistance and increased ease of the scheduling process, transportation support, convenient care locations, and information about PT, including its benefits, could improve PT care access.</p></div><div><h3>Conclusions</h3><p>This study of patient perceptions of initiating PT care after referral identified tangible barriers to care at patient, provider, and system levels for respondents with LBP or knee OA. Patient knowledge and system-level barriers, including how challenging the system is to navigate, are major factors that reduce patients' use of PT after referral. Health systems and physical therapists should address barriers to care through patient education, scheduling assistance, and changes to the health care system, including options for same-day appointments.</p></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/37/5e/main.PMC10036230.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9183342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic-Assisted Gait Training (RAGT) in Stroke Rehabilitation: A Pilot Study","authors":"Mariana Vita Milazzotto Neves MSc ,&nbsp;Leonardo Furlan PhD ,&nbsp;Felipe Fregni MD, PhD ,&nbsp;Linamara Rizzo Battistella MD, PhD ,&nbsp;Marcel Simis MD, PhD","doi":"10.1016/j.arrct.2023.100255","DOIUrl":"10.1016/j.arrct.2023.100255","url":null,"abstract":"<div><h3>Objective</h3><p>To compare the effects of 2 types of robotic-assisted gait training (RAGT) devices that have been used in stroke rehabilitation.</p></div><div><h3>Design</h3><p>Retrospective cohort.</p></div><div><h3>Setting</h3><p>Rehabilitation hospital.</p></div><div><h3>Participants</h3><p>24 community dwelling people with stroke (N=24).</p></div><div><h3>Interventions</h3><p>RAGT with either an <em>exoskeleton</em> (<em>Lokomat</em>) (mean age=53.8 years; 30% men; mean duration of stroke =17.8 months) or an <em>end-effector</em> (<em>G-EO</em>) (mean age=50.5 years; 77.8% men; mean duration of stroke =13.11) delivered 3 times per week (36 sessions total).</p></div><div><h3>Main Outcome Measures</h3><p>The following tests/scales were employed before and after RAGT: Functional Ambulation Categories (FACs), timed Up and Go (TUG), 10-Meter Walk Test (10MWT), 6-Minute Walk Test (6MWT), Trunk Impairment Scale, Dynamic Gait Index (DGI), Berg Balance Scale (BBS), and ability to climb stairs (time to climb 6 steps of 15 cm each; ability to climb stairs).</p></div><div><h3>Results</h3><p>There were 5 dropouts, all from the <em>G-EO</em> group. At the end, 10 participants in the <em>Lokomat</em> and 9 in the <em>G-EO</em> group completed the intervention. From pre- to post-RAGT, <em>G-EO</em> patients improved on all functional tests/scales, whereas <em>Lokomat</em> patients improved only on the TUG, DGI, and BBS. Most patients showed improvements above the relative smallest real difference in the TUG, 10MWT, and 6MWT.</p></div><div><h3>Conclusions</h3><p>Both <em>end-effectors</em> and <em>exoskeletons</em> may improve clinically relevant aspects of walking function. However, this study had a small sample, was retrospective, non-randomized, and had a significant number of drop-outs, therefore its findings should be interpreted carefully. Future studies are needed for investigating potential differences in clinical results, side effects, contraindications, and cost effectiveness between these 2 different types of RAGT.</p></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7d/ca/main.PMC10036220.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9559566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}