Archives of physical medicine and rehabilitation最新文献

{"title":"Behavioral fluctuation in disorders of consciousness: a retrospective analysis.","authors":"Alice Barra, Yelena G Bodien, Can Ozan Tan, Geraldine Martens, Christopher Malone, Joseph T Giacino","doi":"10.1016/j.apmr.2025.03.038","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.03.038","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the frequency of behavioral fluctuations in patients with prolonged disorders of consciousness (DoC), characterize the stability of consciousness ratings, and characterize the stability of behavioral signs of consciousness.</p><p><strong>Design: </strong>Prospective observational analysis.</p><p><strong>Setting: </strong>Specialized DoC Program in an inpatient rehabilitation facility and a long-term acute care hospital.</p><p><strong>Participants: </strong>Patients in vegetative state/unresponsive wakefulness state (VS/UWS), minimally conscious state and emerged from MCS followed weekly on the Coma Recovery Scale- Revised (CRS-R) between 28 and 90 days post-injury (N=241).</p><p><strong>Main outcome measure: </strong>Change in CRS-R subscale scores and consciousness ratings.</p><p><strong>Results: </strong>Behavioral fluctuation was observed in more than 80% of patients, and was most common on the CRS-R Motor subscale and least common on the Communication subscale (83% and 54% of patients experienced ≥1 fluctuation over the 3-week study period, respectively, with a 1-point change observed most frequently). Among patients who were conscious on baseline assessment, 25% were subsequently rated as unconscious at least once. Localization to pain and object manipulation were the most stable signs of consciousness, recurring at least 3 times after the first occurrence in ≥ 97% of the sample. Reproducible command-following and intelligible verbalization were the least stable, recurring at least 3 times after the first occurrence in ≤ 27% of the sample.</p><p><strong>Conclusions: </strong>Patients with prolonged DoC who undergo serial assessment demonstrate a high rate of fluctuation in behavioral signs of consciousness. These findings highlight that repeated assessments are essential in this population, both to capture the highest level of consciousness and to help distinguish spontaneous fluctuation from response to treatment in interventional studies.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shear-Wave Elastography for Measuring the Stiffness of Latent Trigger Points and Surrounding Areas in the Infraspinatus Muscle: Intra- and Inter-Examiner Reliability Analysis.","authors":"Mateusz D Kobylarz, Juan Antonio Valera-Calero, Sandra Sánchez-Jorge, Jorge Buffet-García, María José Díaz-Arribas, Ricardo Ortega-Santiago, Sebastian Klich","doi":"10.1016/j.apmr.2025.03.036","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.03.036","url":null,"abstract":"<p><strong>Objective: </strong>To explore the intra- and inter-examiner reliability of shear-wave elastograhy (SWE), (an objective alternative to highly subjective procedures with poor inter-rater reliability such as manual palpation) in measuring the stiffness of latent Myofascial trigger points (MTrPs) and healthy surrounding areas in the infraspinatus muscle, pressure pain threshold (PPT), inter-examiner reliability and mean differences in SWE and PPTs between MTrPs and control points DESIGN: Longitudinal observational study: Intra- and inter-examiner reliability study.</p><p><strong>Setting: </strong>A University lab.</p><p><strong>Participants: </strong>Forty participants with latent MTrPs within the infraspinatus muscle.</p><p><strong>Interventions: </strong>None.</p><p><strong>Main outcome measures: </strong>One experienced examiner identified and classified latent MTrPs and selected an asymptomatic control point within the infraspinatus muscle. Later, 2 blinded examiners assessed once the PPTs (blinded to the scores) and acquired 2 SWE images of each location. Reliability estimates were calculated for assessing PPT inter-examiner reliability and SWE intra- and inter-examiner reliability. PPT and SWE scores were compared by location (MTrP and control) and gender (male/female).</p><p><strong>Results: </strong>PPTs were significantly lower in MTrPs compared with control points in males (p=0.003) and females (p=0.006), and lower in females compared with males (MTrP p<0.001; control point p=0.001). Good inter-examiner reliability was found for PPTs (ICC>0.84) and SWE (ICC>0.82). Intra-examiner reliability for SWE was excellent (ICC>0.95) in both the novice and experienced examiners.</p><p><strong>Conclusion: </strong>This study demonstrated excellent SWE intra-examiner reliability (ICCs>0.9) and good inter-examiner reliability (ICCs>0.82). Although PPT scores indicated significant differences in hyperirritability between latent MTrPs and control points, SWE measurements revealed no significant differences in muscle stiffness.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Pre-injury Psychiatric Difficulties on Caregiving Needs and Post-injury Emotional Distress in Care Partners of Persons with TBI.","authors":"Fedora Biney, Jennifer Marwitz, Yue Zhang, Richard Kennedy, Flora M Hammond, Katherine Abbasi","doi":"10.1016/j.apmr.2025.03.035","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.03.035","url":null,"abstract":"<p><strong>Objective: </strong>To examine differences in post-injury needs in traumatic brain injury (TBI) care partners with and without a pre-injury psychiatric history (PH+ vs. PH-).</p><p><strong>Design: </strong>A multi-site, prospective, observational cohort study.</p><p><strong>Setting: </strong>Community.</p><p><strong>Participants: </strong>258 care partners for persons with TBI meeting these criteria: ≥18 years old; non-paid caregiver; TBI care recipient criteria: ≥ 16 years old at time of injury, TBI requiring inpatient rehabilitation; acute hospitalization/admission at TBIMS-approved inpatient rehabilitation site.</p><p><strong>Interventions: </strong>Not applicable, Main Outcome Measures: Family Needs Questionnaire-Revised (FNQ-R) assessed proportion of emotional (ES), instrumental (IS), professional (PS), and community (CS) support needs met at 6-months post-injury.</p><p><strong>Secondary outcome measures: </strong>Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) assessed care partner depression and anxiety at 6, 12, and 24-months post-injury.</p><p><strong>Results: </strong>At 6-months post-injury, care partners reported more met needs for community support relative to instrumental support needs (Estimates; 95% CI: 7.30; 3.91-10.69, p<.001). PH+ care partners did not differ from PH- care partners in the percentage of met needs across any need category. Number of psychiatric diagnoses (0 vs. 1 vs. 2 vs. 3+) was not associated with differences in met needs. PH+ care partners endorsed more depression and anxiety symptoms than PH- care partners from 6 to 24-months post-injury (Estimates; 95% CI: depression: 3.78; 2.55-5.00 p<.001; anxiety: 2.91; 1.58-4.24, p<.001).</p><p><strong>Conclusions: </strong>PH+ TBI care partners do not appear have differing needs than PH- care partners at 6 months post-injury, but do experience persistent emotional distress. Evaluating care partners' psychiatric history is warranted to identify caregivers vulnerable to developing post-TBI emotional distress.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trajectories of Global Functioning over the 10 Years after Traumatic Brain Injury in Black Individuals: A Model System Study.","authors":"Chimdindu Ohayagha, Bridget Xia, Shawn C T Jones, Daniel W Klyce, Juan Arango-Lasprilla, Paul B Perrin","doi":"10.1016/j.apmr.2025.03.034","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.03.034","url":null,"abstract":"<p><strong>Objective: </strong>This study examined: (a) longitudinal global functioning trajectories over the 10 years after traumatic brain injury (TBI) in a group of Black individuals, and (b) demographic and injury-related predictors of those trajectories.</p><p><strong>Design: </strong>Participants completed follow-up data collections at 1, 2, 5, and 10 years after TBI and being discharged from acute rehabilitation.</p><p><strong>Setting: </strong>TBI Model System (TBIMS) hospitals.</p><p><strong>Participants: </strong>This study included a subsample of 2,523 Black individuals in the TBIMS National Database who had a completed global functioning scores at one or more follow-up time points.</p><p><strong>Interventions: </strong>None MAIN OUTCOME MEASURE: Glasgow Outcome Scale-Extended (GOS-E).</p><p><strong>Results: </strong>GOS-E scores across the full sample tended to increase slightly between years 1 and 2 and then plateaued for the successive years such that a quadratic, or U-shaped, trend that best fit the data. Younger age (p < .001), higher level of education (p < .001), private insurance (p = .007), and shorter posttraumatic amnesia (PTA) duration (p < .001) were significant predictors of higher GOS-E trajectories. There was also a significant time²*age effect (p < .001), such that younger adults improved slightly over the first 5 years and plateaued between years 5 and 10 relative to a general decline for older adults.</p><p><strong>Conclusions: </strong>These findings suggest that age, education, insurance status, and PTA are important predictors of long-term global functional outcomes for Black individuals with TBI. Identifying baseline risk factors for Black individuals who may experience lower global functioning trajectories can inform development of targeted interventions and be a first step in working to reduce health disparities in functional outcomes in this group.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing sensor-derived features from a wrist-worn wearable device as indicators of upper extremity function in individuals with cervical spinal cord injury.","authors":"Tessa C Johnson, Cole Hagen, Donna L Coffman, Melissa Nunn, Mary Schmidt-Read, Kelly M Heath, Ralph J Marino, Shivayogi V Hiremath","doi":"10.1016/j.apmr.2025.03.003","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.03.003","url":null,"abstract":"<p><strong>Objective: </strong>To assess the relationship between sensor-derived features and upper extremity function in individuals with acute and chronic cervical spinal cord injury (cSCI) and to assess the reproducibility of these features in chronic cSCI.</p><p><strong>Design: </strong>Prospective, longitudinal study. Participants completed the Capabilities of Upper Extremity Test (CUE-T) - a measure of upper extremity function - at two time points, four weeks apart, while wearing a wrist-worn inertial measurement unit (IMU) device on their most-used upper extremity. The IMU recorded 3-axis accelerometer and gyroscope data from which metrics (features) were derived. Distance correlations (dCorr) assessed associations between features and CUE-T hand and arm function scores. Intraclass correlation coefficients (ICCs) assessed the reproducibility of CUE-T scores and features in the chronic subgroup.</p><p><strong>Setting: </strong>Inpatient rehabilitation facility (acute cSCI) and community (chronic cSCI).</p><p><strong>Participants: </strong>Forty adults with cSCI were enrolled, and 33 provided data.</p><p><strong>Intervention: </strong>None.</p><p><strong>Main outcome measures: </strong>Correlations between CUE-T scores and features; ICCs of CUE-T scores and features (chronic group).</p><p><strong>Results: </strong>At Time 1, two features showed strong correlations with CUE-T hand score (dCorr=0.53-0.58), while nine showed strong correlations with CUE-T arm score (dCorr=0.54-0.62). At Time 2, three features showed strong correlations with CUE-T hand score (dCorr=0.53-0.57), while 29 showed strong correlations with CUE-T arm score (dCorr=0.50-0.72). Types of features were distinct for hand and arm conditions. For the chronic subgroup, CUE-T scores showed excellent reproducibility (ICC=0.94-0.99), and 16 features demonstrated moderate to good reproducibility (ICC=0.50-0.77).</p><p><strong>Conclusions: </strong>Sensor-derived features can indicate upper extremity function in cSCI, supporting their use for monitoring recovery and functional outcomes. Future research should focus on validating features of upper extremity function to support digital biomarker development and clinical adoption.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Randomized Trial Assessing Prospective Surveillance and Exercise for Preventing Breast Cancer-Related Lymphedema in High-Risk Patients.","authors":"Karol Ramírez-Parada, Cesar Sánchez, Irene Cantarero-Villanueva, Álvaro Reyes, Mauricio P Pinto, M Loreto Bravo, Denise Montt-Blanchard, Francisco Acevedo, Benjamín Walbaum, Margarita Alfaro-Barra, Margarita Barra-Navarro, Scarlet Muñoz-Flores, Constanza Pinto, Sabrina Muñiz, Felipe Contreras-Briceño, Tomás Merino, Gina Merino","doi":"10.1016/j.apmr.2025.03.002","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.03.002","url":null,"abstract":"<p><strong>Objective: </strong>to evaluate if combining prospective surveillance model (PSM) with a supervised multimodal exercise program prevents breast cancer-related lymphedema (BCRL) and its impact on the functional capacity and quality of life (QoL) of high-risk breast cancer (BC) patients undergoing treatment.</p><p><strong>Design: </strong>two-arm parallel superiority randomized controlled trial.</p><p><strong>Setting: </strong>outpatient physical therapy service in a public hospital.</p><p><strong>Participants: </strong>116 adult women (≥18-year-old) diagnosed with stage I-III BC were enrolled. Inclusion criteria included recent surgery and indication for adjuvant chemotherapy. Exclusion criteria were significant arm volume difference, previous cancer, exercise contraindications, and extreme BMI values.</p><p><strong>Interventions: </strong>participants were randomized into experimental (n=61) or control groups (n=55) in a 1:1 ratio. The experimental group received PSM with a supervised multimodal exercise program for 12 weeks. The control group received PSM alone.</p><p><strong>Main outcome measures: </strong>arm volume, grip strength, 6-minute walk test, and QoL were blindly assessed at baseline, 3, 6, and 9 months.</p><p><strong>Results: </strong>the combination of PSM with a supervised multimodal exercise program significantly reduced arm volume and body weight and improved grip strength, functional capacity, and the QoL of patients.</p><p><strong>Conclusion: </strong>combining PSM and physical exercise reduces arm volume, prevents BCRL, and improves physical performance and QoL in high-risk patients. The combination of PSM and STRONG-B was superior to PSM alone, validating the study's superiority design.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reliability and Validity of Instrumented Timed Up and Go Test in Typical Adults and Elderly: A Systematic Review.","authors":"Jinyu Zhou, Qihang Yao, Ruihua Han, Patrick De Bock, Gabrielle Vassard-Yu, Ann Hallemans, Lien Van Laer","doi":"10.1016/j.apmr.2025.03.001","DOIUrl":"10.1016/j.apmr.2025.03.001","url":null,"abstract":"<p><strong>Objective: </strong>To summarize the available literature investigating the reliability and validity of the instrumented Timed Up and Go (iTUG) in typical adults and elderly.</p><p><strong>Data sources: </strong>Data were collected from PubMed, Web of Science, and hand searching up until July 15, 2024.</p><p><strong>Study selection: </strong>English-language studies investigating the reliability and validity of the 3-meter version of the iTUG in typical adults and elderly were included. Eligibility was blindly reviewed by 2 reviewers.</p><p><strong>Data extraction: </strong>Data on demographics, settings, reliability, and validity of the iTUG were independently extracted by 2 reviewers. The methodological quality was blindly assessed by 2 reviewers using the Consensus-Based Standards for the Selection of Health Status Measurement Instruments tools, and the certainty of evidence was evaluated by the modified Grading of Recommendations Assessment, Developement and Evaluation (GRADE) approach.</p><p><strong>Data synthesis: </strong>Nineteen studies were included investigating 1729 participants, of which 334 were typical adults and 1395 typical elderly. For intrarater reliability (n=1 study), intraclass correlation coefficient ranged from 0.39 (95% CI, 0.30-0.50) to 0.97 (95% CI, 0.95-0.98), test-retest reliability (n=2 studies) from 0.27 (95% CI, -0.47 to 0.63) to 0.89 (95% CI, 0.78-0.95), and interrater reliability (n=1 study) generally sufficient from 0.929 to 0.99 (CI not reported). One study on criterion validity showed sufficient agreement (intraclass correlation coefficient >0.7) with the criterion standard for most outcome measures, except for 3 outcome measures measuring time of turn. Moreover, 12 studies used iTUG to predict cognitive decline (area under the curve [AUC] = 0.80), maximal mobility performance (R²=0.278), physical function (AUC ≤0.75), or falls [(AUC ≤0.853 (95% CI, 0.759-0.948)].</p><p><strong>Conclusions: </strong>iTUG can be a reliable and valid tool for assessing mobility in adults and elderly. However, the complexity and nonstandardization of outcome measures reduce the reliability and validity of iTUG, which needs to be addressed in future research.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pneumonia Prolongs Rehabilitation Length of Stay and Induces Excess Costs in Adults With Acute Spinal Cord Injury: A Causal Inference Study Using Prospective Multicenter Data.","authors":"Sven Mostberger, Martin W G Brinkhof, Boris Polanco, David J Berlowitz, David Gobets, Margret Hund-Georgiadis, Xavier Jordan, Karin Postma, Anja M Raab, Martin Schubert, Gabi Mueller","doi":"10.1016/j.apmr.2025.02.014","DOIUrl":"10.1016/j.apmr.2025.02.014","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the causal effect of pneumonia on the length of stay (LOS) and associated costs during inpatient rehabilitation following an acute spinal cord injury (SCI).</p><p><strong>Design: </strong>Prospective multicenter cohort study using a causal inference framework.</p><p><strong>Setting: </strong>Ten centers specialized in SCI rehabilitation in high-income countries.</p><p><strong>Participants: </strong>Newly injured SCI patients with complete or incomplete lesions at cervical or thoracic levels (C1-T12) admitted for inpatient rehabilitation. The study included adults (N=486), predominantly men (76.1%), with a median age of 55 years, who were roughly evenly divided between paraplegia (46.5%) and tetraplegia (53.5%).</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcome measures: </strong>Additional rehabilitation LOS and associated excess costs because of pneumonia.</p><p><strong>Results: </strong>Experiencing at least 1 episode of pneumonia was associated with an 11% increase in rehabilitation LOS on average. The resulting excess LOS was 21.3 days (95% confidence interval (CI), 18.9-23.7). The additional LOS because of pneumonia costs, on average, $41,812.57 (standard deviation 20,909.73) per patient. Patients with motor complete tetraplegia had the longest rehabilitation LOS, both with and without pneumonia (256.0d; 95% CI, 226.7-285.2 vs 228.9d; 95% CI, 201.6-256.2) and subsequential higher costs.</p><p><strong>Conclusions: </strong>Our findings indicate that pneumonia increases the average rehabilitation length of stay by 21 days and incurs additional costs exceeding $41,000 per patient in individuals with acute SCI. Early screening and prevention are essential to manage these impacts, especially in patients with motor complete tetraplegia.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technology-Based Physical Rehabilitation for Balance in Patients With Multiple Sclerosis: A Systematic Review and Meta-analysis.","authors":"Cristina Lirio-Romero, Sara Reina-Gutiérrez, Purificación López-Muñoz, Elisabeth Bravo-Esteban, Ana Torres-Costoso, María José Guzmán-Pavón","doi":"10.1016/j.apmr.2025.02.011","DOIUrl":"10.1016/j.apmr.2025.02.011","url":null,"abstract":"<p><strong>Objective: </strong>To synthesize the current evidence on technology-based physical rehabilitation for balance in people with multiple sclerosis and to compare its effectiveness with that of conventional physical therapy.</p><p><strong>Data sources: </strong>A comprehensive search of databases including CENTRAL Scopus, CINAHL, PsycINFO, PubMed, and PEDro was conducted up to March 2024.</p><p><strong>Study selection: </strong>Studies were selected based on predefined inclusion criteria.</p><p><strong>Data extraction: </strong>Data extraction and quality assessment were performed independently by 2 reviewers. Statistical analyses were conducted using a random effects model.</p><p><strong>Data synthesis: </strong>A total of 24 studies involving 985 participants were included. The meta-analysis revealed that compared with conventional physical therapy, technology-based physical rehabilitation significantly improved balance outcomes by 0.16 (95% CI, 0.04- 0.29; P=.027) with moderate heterogeneity (I²=39.1%). Subgroup analyses were performed by intervention modality (robotic assistive gait training, exergaming, and telerehabilitation), and only exergaming interventions had a medium effect on balance in this population of 0.29 (95% CI, 0.08-0.251; P=.03).</p><p><strong>Conclusions: </strong>Among technology-based physical rehabilitation approaches, exergaming interventions have shown promising effectiveness in improving balance in people with multiple sclerosis. Despite the moderate heterogeneity, the findings support the use of exergaming as a viable option. Further high-quality randomized controlled trials are needed to confirm these results.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a Multidimensional, Multigroup Measure of Cognitive-Communication for Inpatient Rehabilitation.","authors":"Julia Carpenter, Caitlin Deom, Andrew Bodine, Allen W Heinemann, Richard L Lieber, James Sliwa","doi":"10.1016/j.apmr.2025.02.007","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.02.007","url":null,"abstract":"<p><strong>Objective: </strong>To develop a comprehensive, repeatable measure of cognitive-linguistic function for use in inpatient rehabilitation facility (IRF) settings using contemporary methods and to compare the sensitivity of this measure to the FIM cognitive items.</p><p><strong>Design: </strong>Retrospective analysis of clinician-reported assessment data collected as part of routine clinical operations.</p><p><strong>Setting: </strong>Free-standing inpatient rehabilitation facility in the Midwestern United States.</p><p><strong>Participants: </strong>A convenience sample of 12,245 inpatients with motor speech, voice, aphasia and/or cognitive-communicative diagnoses, 18 years of age and older who were admitted to an IRF.</p><p><strong>Interventions: </strong>Standard of care rehabilitation services.</p><p><strong>Main outcome measure: </strong>Cognitive-Communication Ability Quotient (AQ) composed of 10 standard measures used by speech-language pathologists.</p><p><strong>Results: </strong>Confirmatory factor analysis resulted in good-fitting models (root-mean-square errors of approximation ≤0.08, comparative fit indices, and non-normed fit indices ≥0.95) for 5 groups defined by primary communication impairment (Aphasia, Cognitive-Communication Disorder, Brain Injury, Right Hemisphere Dysfunction, Motor Speech/Voice). Re-estimation as a multigroup, MIRT model yielded scores more sensitive to change compared to the FIM cognitive score. True score equating analysis demonstrated a higher ceiling and lower floor for the Cognitive-Communication AQ compared to the FIM.</p><p><strong>Conclusions: </strong>We constructed 5 forms of a novel cognitive-communication measure, the Cognitive-Communication AQ, that demonstrates superior measurement characteristics compared to the FIM cognition score with a lower floor and higher ceiling. The AQ can detect changes in cognitive-communicative function that typically occur during an IRF stay. Repeated measurement during the IRF stay allows clinicians to monitor patients' progress and modify rehabilitation plans accordingly.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143565867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}