Archives of rehabilitation research and clinical translation最新文献

{"title":"Exploring the Efficacy of the Effortful Swallow Maneuver for Improving Swallowing in People With Parkinson Disease—A Pilot Study","authors":"Pooja Gandhi PhD ,&nbsp;Melanie Peladeau-Pigeon MHSc ,&nbsp;Michelle Simmons MHSc ,&nbsp;Catriona M. Steele PhD","doi":"10.1016/j.arrct.2023.100276","DOIUrl":"10.1016/j.arrct.2023.100276","url":null,"abstract":"<div><h3>Objectives</h3><p>To determine the immediate (compensatory) and longer term (rehabilitative) effect of the effortful swallow (ES) maneuver on physiological swallowing parameters in Parkinson disease.</p></div><div><h3>Design</h3><p>Virtual intervention protocol via Microsoft Teams with pre- and post-videofluoroscopic swallowing studies.</p></div><div><h3>Setting</h3><p>Outpatient hospital setting, with intervention performed virtually.</p></div><div><h3>Participants</h3><p>Eight participants (median age 74 years [63-82])with Parkinson disease (years post onset 3-20) with a Hoehn and Yahr scale score between 2 and 4 (N=8).</p></div><div><h3>Interventions</h3><p>ES maneuver, initiated using a maximum effort isometric tongue-to-palate press, with biofeedback provided using the Iowa Oral Performance Instrument. The protocol included 30 minute sessions twice daily, 5 days/week for 4 weeks.</p></div><div><h3>Main Outcome Measures</h3><p>Penetration-Aspiration Scale scores, time-to-laryngeal-vestibule-closure, total pharyngeal residue, and pharyngeal area at maximum constriction as seen on lateral view videofluoroscopy.</p></div><div><h3>Results</h3><p>No consistent, systematic trends were identified in the direction of improvement or deterioration across Penetration-Aspiration Scale scores, time-to-laryngeal-vestibule-closure, pharyngeal area at maximum constriction, or total pharyngeal residue.</p></div><div><h3>Conclusions</h3><p>Heterogeneous response to the ES as both a compensatory and rehabilitative technique. Positive response on the compensatory probe was predictive of positive response after rehabilitation.</p></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"5 3","pages":"Article 100276"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10517353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41174806","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":"“The Days Are Long But the Nights Are Even Longer”: A Mixed-Method Study of Sleep Disturbances Among Patients in an Inpatient Rehabilitation Program","authors":"Miia Rahja PhD ,&nbsp;Kate Laver PhD ,&nbsp;Dylan A. Mordaunt BHB, MB, ChB, PGDip (Data Science), FRACP, FAIDH ,&nbsp;Nurul Adnan BNurs ,&nbsp;Andrew Vakulin PhD ,&nbsp;Nicole Lovato PhD ,&nbsp;Maria Crotty PhD, MPH","doi":"10.1016/j.arrct.2023.100275","DOIUrl":"10.1016/j.arrct.2023.100275","url":null,"abstract":"<div><h3>Objective</h3><p>To assess sleep quality of patients on a rehabilitation ward and to identify staff practices and beliefs about management of sleep disturbance.</p></div><div><h3>Design</h3><p>Mixed-methods design including patient surveys and staff interviews.</p></div><div><h3>Setting</h3><p>Inpatient rehabilitation ward in a tertiary teaching hospital in Adelaide, Australia.</p></div><div><h3>Participants</h3><p>Of the 345 screened inpatients who had been in a mixed post-acute rehabilitation ward for at least 5 days, 120 (43% women) were included. The mean age was 67.7 years and the main admission reason was functional decline (40%). Patients with stroke or traumatic brain injury were excluded. Eleven (n = 11) staff (a mix of doctors, nurses, and allied health) were interviewed.</p></div><div><h3>Main Outcome Measures</h3><p>The surveys comprised of the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, the Flinders Fatigue Scale, and the Sleep Inertia Questionnaire. The survey results were compared with functional outcomes using the functional independence measure (FIM). Staff interviews delved into barriers to good sleep, ward practices, and knowledge about sleep hygiene.</p></div><div><h3>Results</h3><p>43% of the surveyed patients reported having healthy amount of sleep. Sleep quality was not significantly correlated with rehabilitation outcomes (assessed using FIM). Staff reported having a good awareness of sleep hygiene; however, acknowledged limitations about the environment and routine which were not conducive to healthy sleep. They identified several actions which could be taken to improve patients’ sleep hygiene.</p></div><div><h3>Conclusions</h3><p>Sleep disturbance is common for patients in rehabilitation. Rehabilitation wards should address this often-neglected critical component of rehabilitation to improve patient experience and potential participation in therapy. Introducing a systematic approach for assessing sleep during admission, establishing clear roles regarding sleep assessment and intervention among staff, and ensuring that patients and staff are aware of good sleep hygiene practices may promote better sleep during inpatient rehabilitation.</p></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"5 3","pages":"Article 100275"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/62/66/main.PMC10517360.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41159039","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":"PROClass: The Development and Validation of a Novel Prosthetic Component Sophistication Classification System","authors":"Daniel C. Norvell PhD ,&nbsp;Wayne T. Biggs CPO ,&nbsp;Jeffrey Bott ,&nbsp;Alison W. Henderson PhD ,&nbsp;Kathryn P. Moore PhD ,&nbsp;Joseph M. Czerniecki MD","doi":"10.1016/j.arrct.2023.100273","DOIUrl":"10.1016/j.arrct.2023.100273","url":null,"abstract":"<div><h3>Objective</h3><p>To develop a lower limb prosthesis (LLP) sophistication classification system that categorizes prosthetic component prescriptions into “basic,” “intermediate,” and “advanced” and assess its content validity, reliability, and accuracy.</p></div><div><h3>Design</h3><p>Classification development and validation study.</p></div><div><h3>Setting</h3><p>The Veterans Affairs (VA) Corporate Data Warehouse database and National Prosthetics Patient Database were used to identify patients undergoing their first amputation at the transtibial or transfemoral level due to diabetes or peripheral artery disease and to identify the associated codes for each LLP.</p></div><div><h3>Participants</h3><p>An expert panel of 6 nationally recognized certified prosthetists, a national expert in VA prosthetics data and coding, a physical medicine and rehabilitation physician, and an epidemiologist developed an LLP classification system (<em>PROClass</em>) using 30 transfemoral and transtibial lower limb amputees.</p></div><div><h3>Main Outcome Measures</h3><p>The expert panel reviewed 20 consecutive participants meeting study criteria for the development of the <em>PROClass</em> system and a subsequent 30 consecutive cases for assessing the inter- and intra-rater reliability and accuracy.</p></div><div><h3>Results</h3><p>The interrater and intrarater reliability was almost perfect with Gwet's AC1 values ranging from .82 to .96 for both expert panel members and research assistants. The accuracy of the research assistant's classifications to the “criterion standard” was excellent with Gwet's AC1 values ranging between .75 and .92.</p></div><div><h3>Conclusions</h3><p><em>PROClass</em> is a pragmatic, reliable, and accurate prosthetic classification system with strong face validity that will enable the classification of prosthetic components used for large data set research aimed at evaluating important clinical questions such as the effects of sophistication on patient outcomes.</p></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"5 3","pages":"Article 100273"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/06/ca/main.PMC10517350.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41143384","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":"Comprehensive Assessment of the Activity Level of the ICF Using Both Capacity and Performance Measures: A Case Report","authors":"Carey L. Holleran MPT, DHS, NCS ,&nbsp;Marghuretta D. Bland DPT, NCS ,&nbsp;Catherine E. Lang PT, PhD","doi":"10.1016/j.arrct.2023.100277","DOIUrl":"10.1016/j.arrct.2023.100277","url":null,"abstract":"<div><p>Individuals with neurologic conditions seek physical therapy services to improve mobility in their daily lives. While clinicians commonly track activity capacity, measurement of activity performance in daily life is an emerging yet unstandardized practice within routine clinical physical therapy. The purpose of this case report is to (1) provide an example of the structure, clinical reasoning, and implementation of both activity capacity and activity performance level assessments across an episode of outpatient physical therapy and (2) to describe how objective activity performance in daily life tracking supported the physical therapy intervention and education plan.</p><p>A 42-year-old woman presented to outpatient neurologic physical therapy with a rare autoimmune-mediated disorder with primary goals of independently caring for her youngest child and grandchild, walking without limitations in the home and community, participating in exercise, and returning to work due to deconditioning and dizziness. The patient participated in 12 visits across a span of 4.5 months targeting performance in daily life (steps per day), aerobic conditioning, and vestibular habituation. Activity capacity measurement served as a standardized assessment of what the patient was able to do in the clinic, and activity performance in daily life tracking via a Samsung wrist worn consumer-grade device provided a quantitative assessment of real-world daily stepping activity. Tracking of activity performance in daily life was an essential component of physical therapy management that provided an objective quantification of daily stepping activity to identify barriers and facilitators to increasing daily performance in an individual with a medical diagnosis of Susac syndrome.</p></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"5 3","pages":"Article 100277"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ab/11/main.PMC10517369.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41156995","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":"A Case Report of Cryoneurolysis for Dorsal Foot Pain and Toe Clawing in a Patient With Multiple Sclerosis","authors":"Fraser MacRae BSc ,&nbsp;Abby Speirs BSc ,&nbsp;Andrei Bursuc MD ,&nbsp;Mahdis Hashemi MD ,&nbsp;Paul Winston MD","doi":"10.1016/j.arrct.2023.100286","DOIUrl":"10.1016/j.arrct.2023.100286","url":null,"abstract":"<div><p>Toe clawing in patients with upper motor neuron disorders is often attributed to the flexor digitorum longus (FDL) and is a common presentation among patients with multiple sclerosis (MS). This movement may be painful because of the altered pressure distribution and may increase the risk of falls, heighten energy expenditure during gait, and lower gait speed. Cryoneurolysis is a minimally invasive treatment that may be beneficial for pain and focal muscle hypertonicity. An ambulatory patient with MS was treated bilaterally with cryoneurolysis to the superficial fibular nerves for pain on the dorsum of the foot, and to the intramuscular tibial nerve motor branch to FDL for toe clawing. The patient felt that toe clawing was immediately reduced during gait and noted the ability to voluntarily spread their toes. The patient stated that the neuropathic pain on the dorsum of the foot was fully eliminated immediately post procedure. The patient reported improved confidence in their gait, maintained independence, and reduced toe clawing during a structured interview 12 weeks after treatment. The effects lasted for 5.5 months before symptoms returned. Retreatment at 6 months reproduced the benefits<strong>.</strong> The patient reported a positive experience with cryoneurolysis for toe clawing and dorsal foot pain.</p></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"5 3","pages":"Article 100286"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10517354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41166640","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":"An Initial Assessment of the Decline With Age for the 6-minute Walk Test (6MWT) in Chinese Older Adults With Chronic Obstructive Pulmonary Disease (COPD)","authors":"Tiffany Ching Man Choi DHSc ,&nbsp;Hin Cheung Tsang MSc ,&nbsp;Sweetie R. Lui BSc ,&nbsp;Tsz Fung Yam BSc ,&nbsp;Yuen Shan Lee BSc ,&nbsp;Yuk Ling To MSc ,&nbsp;Kah Lin Choo BMBS","doi":"10.1016/j.arrct.2023.100262","DOIUrl":"10.1016/j.arrct.2023.100262","url":null,"abstract":"<div><h3>Objective</h3><p>To establish an initial assessment of the decline with age for the 6-minute walk test (6MWT) in patients with chronic obstructive pulmonary disease (COPD) in Chinese older adults.</p></div><div><h3>Design</h3><p>It was an observational analytical study.</p></div><div><h3>Setting</h3><p>The study was conducted in a local acute hospital.</p></div><div><h3>Participants</h3><p>From January 2017 to January 2021, a total of 525 patients (431 men, 94 women; mean age 73.4±7.9; N=525) with COPD were studied.</p></div><div><h3>Main Outcome Measures</h3><p>Information including sex, age, Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages, and 6-minute walk distance (6MWD) were collected.</p></div><div><h3>Results</h3><p>The 6MWD was significantly decreased with increased age (<em>P</em>˂0.05). Mean 6MWD in the 61-65 years, 66-70 years, 71-75 years, 76-80 years, 81-85 years, and 86 years or above age groups were 301 m, 305 m, 274 m, 257 m, 260 m, and 215 m, respectively. The difference between the youngest and oldest age groups was 29%. The 6MWD was significantly lower in patients with more severe COPD (<em>P</em>˂0.05). The distance decreased from 317 m in GOLD 1, 306 m in GOLD 2, 259 m in GOLD 3 to 167 m in GOLD 4. The percentage dropped in 6MWD from GOLD 1 to GOLD 4 was 47%.</p></div><div><h3>Conclusion</h3><p>An initial assessment of the decline with age for 6MWT in Chinese older adults with COPD has been established. 6MWD decreases as age (in groups 66-75, 81-85, and 86 or above) and COPD severity increases, primarily because of the increased severity of dyspnea, decline in exercise capacity, and muscle changes in aging. Health care professionals in Chinese community can use these values to evaluate these patients’ functional capacity, assess treatment effect, and set treatment goals.</p></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"5 2","pages":"Article 100262"},"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/d3/af/main.PMC10258361.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9629731","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":"Effectiveness of CO-OP Approach for Children With Neurodevelopmental Disorders: A Systematic Review","authors":"Emmanuel Madieu MSc ,&nbsp;Sandrine Gagné-Trudel MSc ,&nbsp;Pierre Yves Therriault PhD ,&nbsp;Noémi Cantin PhD","doi":"10.1016/j.arrct.2023.100260","DOIUrl":"10.1016/j.arrct.2023.100260","url":null,"abstract":"<div><h3>Objective</h3><p>To examine the scientific evidence regarding the effectiveness of the Cognitive Orientation to Daily Occupational Performance (CO-OP) approach for children with neurodevelopmental disorders (NDDs).</p></div><div><h3>Data Sources</h3><p>Selected articles published between January 2001 and September 2020 and listed in CINAHL, MEDLINE, and PsycINFO on the EBSCO platform, or found searching with Scopus, Google Scholar, OTseekern Central Register of Controlled Trials in the Cochrane Library, WHO International Clinical Trials Registry Platform, Turning Research into Practice, and ProQuest Dissertations and Theses. An update was performed in March 2022.</p></div><div><h3>Study Selection</h3><p>Eligibility criteria included studies that assessed the effectiveness of the CO-OP approach on children (0-18 years) with NDDs. Unpublished results were excluded, as well as research published in a language other than English or French.</p></div><div><h3>Data Selection</h3><p>The first 2 authors independently reviewed the titles, abstracts, and full texts. Discrepancies were discussed and resolved by consensus. Included studies were quality appraised using the PEDro-P scale or using the risk of bias scale in N-of-1 trials (RoBiNT) according to experimental design.</p></div><div><h3>Data Synthesis</h3><p>Results were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Eighteen studies were initially included, with 2 additional studies added in the update. Three reached evidence level III (15%), 10 reached level IV (70%), and 5 reached level V (15%). All data collected on the activity-participation domain showed a significant improvement. Group therapy sessions show promising results for the improvement of activities or participation, as well as psychosocial dimensions such as self-esteem.</p></div><div><h3>Conclusions</h3><p>The scientific evidence analyzed shows that the CO-OP approach has a positive effect on children with NDDs, particularly in regard to their activities and participation. Future experimental studies should be designed in ways that allow determining effect sizes. Group therapy sessions appear relevant but require further research.</p></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"5 2","pages":"Article 100260"},"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/67/61/main.PMC10258384.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9635632","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":"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":"5 2","pages":"Article 100265"},"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":"5 2","pages":"Article 100266"},"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":"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":"5 2","pages":"Article 100259"},"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}