Archives of physical medicine and rehabilitation最新文献

{"title":"Effects of Virtual Reality Intervention on Motor Function and Activities of Daily Living of Children and Adolescents with Cerebral Palsy: A Systematic Review and Meta-analysis of Randomized Controlled Trials: VR AND MOTOR FUNCTION & ADL.","authors":"Fang-Bo Li, Wei-Feng Pan, Jia-Fu Huang, Liang-Hao Zhu, Xue-Cheng Li","doi":"10.1016/j.apmr.2025.06.001","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.06.001","url":null,"abstract":"<p><strong>Objective: </strong>To explore the impact of virtual reality (VR) intervention on motor function (MF) and activities of daily living (ADL) in children and adolescents with cerebral palsy (CP), and to identify effective VR intervention strategies.</p><p><strong>Data sources: </strong>Searches were conducted in PubMed, Wiley online Library, Embase, Cochrane Library, and Web of Science (all collections).</p><p><strong>Study selection: </strong>All randomized controlled trials of VR intervention on motor function and ADL of children and adolescents with cerebral palsy.</p><p><strong>Data extraction: </strong>We conducted dual data abstraction, quality assessment, and strength of evidence. Outcomes include gait, balance, gross motor function, ADL, and hand function.</p><p><strong>Data synthesis: </strong>This review encompassed 41 randomized controlled trials (RCTs) focusing on the use of VR intervention in children and adolescents with CP. The effect of VR intervention on gait (SMD=0.52; 95% CI: 0.18, 0.85) and gross motor function (SMD=0.76; 95% CI: 0.17, 1.34) has a moderate effect, while the balance (SMD=1.1; 95% CI: 0.61, 1.59), ADL (SMD=1.46; 95% CI: 0.71, 2.2) and hand function (SMD=1.08; 95% CI: 0.17, 2) has great effect. Subgroup analysis reveals the influence of different intervention parameters on different functions. For example, balance is related to the intervention duration of more than 10 weeks, the frequency of 1-2 times per week, Nintendo Wii platform and non-immersive VR.</p><p><strong>Conclusion: </strong>Although the results show that VR intervention has a positive impact on MF and ADL, the high heterogeneity limits the stability of the conclusion. Future research needs to further explore the mechanism of VR intervention and try to set a reliable personalized intervention model.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293259","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":"What is Mild Cognitive Impairment (MCI)? A Guide for Patients, Families, and Caregivers.","authors":"Patricia C Heyn, Monika Gross, Urvashy Gopaul, Elisa Ogawa, Catherine Diaz-Asper, Hannes Devos, Elizabeth A Terhune, J Taylor Harden","doi":"10.1016/j.apmr.2025.05.007","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.05.007","url":null,"abstract":"","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265174","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":"Prevalence of Sports Injuries Among Athletes with Disabilities: A Meta-Analysis.","authors":"Tongnian Yang","doi":"10.1016/j.apmr.2025.05.018","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.05.018","url":null,"abstract":"<p><strong>Objectives: </strong>To synthesize the prevalence and risk factors of sports injuries in athletes with disabilities through a meta-analysis.</p><p><strong>Data sources: </strong>Web of Science, PubMed, EBSCO, SpringerLink, China National Knowledge Infrastructure (CNKI), and Wanfang Data.</p><p><strong>Study selection: </strong>We selected cross-sectional studies on the prevalence of sports injuries in athletes with disabilities published between 2006 and 2024.</p><p><strong>Data extraction: </strong>Two researchers independently performed literature screening, data extraction, and literature quality assessment. The Joanna Briggs Institute Prevalence Critical Appraisal Tool was selected for the study to assess the methodological quality of the included studies. Literature publication bias was assessed using funnel plots, Begg's, and Egger's tests in Stata 17.0 software.</p><p><strong>Data synthesis: </strong>A total of 20 studies were included (n=25683). The meta-analysis revealed a 30.9% [95% CI (26.9%, 34.9%)] prevalence of sports injuries in athletes with disabilities. Subgroup analyses showed a higher prevalence of acute traumatic injuries than chronic traumatic injuries and acute chronic traumatic injuries, a higher prevalence of upper extremity injuries than lower extremity injuries, trunk and head and neck injuries, and a higher prevalence of athletic injuries in sample sizes < 1000 than in sample sizes ≥ 1000 (P < 0.001).</p><p><strong>Conclusions: </strong>The prevalence of sports injuries in athletes with disabilities was 30.9%, with a higher prevalence of acute traumatic injuries and upper extremity injuries. Preventive measures for acute trauma and upper limb injuries include increasing cushioning coverage in site design, introducing dynamic electromyography monitoring techniques, developing injury risk prediction systems, etc. In interpreting the results of these studies, the large heterogeneity among the source studies is taken into account, which may limit the generalizability of the pooled estimates. Future studies should use standardized injury surveillance protocols (e.g., consensus definitions, exposure time reporting) and stratify analyses by disability type and sport to develop more targeted injury prevention strategies.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257274","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":"Neurofeedback: An Introductory Guide for Patients.","authors":"David Cantor, Heather Mastrianno, Matt Erb, Erin Conway, Sonya Kim","doi":"10.1016/j.apmr.2025.04.020","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.04.020","url":null,"abstract":"","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246105","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":"Reductions in therapy provision in skilled nursing facilities after Medicare payment reform and during the COVID-19 pandemic: An interrupted time series analysis.","authors":"Rachel A Prusynski, Harsha Amaravadi, Cait Brown, Natalie E Leland, Debra Saliba, Bianca K Frogner, Janet Freburger, Tracy M Mroz","doi":"10.1016/j.apmr.2025.05.020","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.05.020","url":null,"abstract":"<p><strong>Objective: </strong>To examine how rehabilitation service provision (i.e., physical therapy [PT], occupational therapy [OT], and speech language pathology [SLP]) changed in skilled nursing facilities (SNFs) after Medicare implemented the Patient-Driven Payment Model (PDPM) and the COVID-19 pandemic began, while comprehensively accounting for changes in patient clinical characteristics.</p><p><strong>Design: </strong>Secondary interrupted time series analysis of 100% Medicare data from January 2018 through September 2021 with interruptions for PDPM implementation (October 2019) and COVID-19 (March 2020).</p><p><strong>Setting: </strong>U.S. SNFs.</p><p><strong>Participants: </strong>All SNF stays for fee-for-service Medicare beneficiaries admitted to SNF within 3 days of hospitalization with complete data from SNF assessments and hospital claims. Stratified analyses included stays with facility data on ownership status and rural versus urban location.</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcome measure(s): </strong>Average total minutes of therapy per day (MTD) provided by assistants or therapists, and MTD by discipline (i.e., PT, OT, SLP).</p><p><strong>Results: </strong>For 3,917,261 SNF stays, PDPM implementation was associated with a decline of 28.9 total MTD, representing a relative reduction of 23.7%, compared to pre-PDPM averages. PT declined by 12.8 MTD (-23.5%), OT by 12.9 MTD (-24.3%), and SLP by 3.1 MTD (-21.7%). PDPM-associated declines were larger in for-profit SNFs versus not-for-profit and government-owned SNFs and in rural versus urban SNFs. Compared to what would have occurred if post-PDPM negative trends continued, COVID-19 was associated with a 15.3-minute (15.9%) increase in total MTD, a 5.4-minute (12.8%) increase for PT, a 5.1-minute (12.3%) rebound for OT, and a 4.5-minute (38.9%) increase for SLP, with greater relative increases in urban and for-profit SNFs.</p><p><strong>Conclusions: </strong>Even when accounting for changing patient characteristics over time, PDPM implementation was associated with substantial declines in therapy provision, particularly in for-profit and rural SNFs. After COVID-19, these steep declines stabilized, with a slight recovery for SLP, but lower levels of PT and OT MTD persisted well into the pandemic.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246106","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":"Muscle synergy analysis for clinical characterization of upper limb motor recovery after stroke.","authors":"Giorgia Pregnolato, Giacomo Severini, Lorenza Maistrello, Daniele Rimini, Tiziana Lencioni, Ilaria Carpinella, Maurizio Ferrarin, Johanna Jonsdottir, Vincent C K Cheung, Andrea Turolla","doi":"10.1016/j.apmr.2025.05.019","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.05.019","url":null,"abstract":"<p><strong>Objective: </strong>To characterize individuals with stroke who responded or did not respond to upper limb motor treatment by analyzing muscle synergy patterns (similarity, merging and fractionation).</p><p><strong>Design: </strong>This study is a secondary analysis of a multicentre randomized controlled trial.</p><p><strong>Setting: </strong>Inpatients of two specialised neurorehabilitation hospitals.</p><p><strong>Participants: </strong>We enrolled 62 individuals with a unilateral first-event ischemic or haemorrhagic stroke and severe-to-mild upper limb motor impairment (Fugl-Meyer Assessment Upper Extremity score of 5 to 61, out of 66). We excluded people with untreated seizure, severe cognitive or verbal comprehension impairment.</p><p><strong>Interventions: </strong>After randomization, individuals were allocated to conventional, virtual reality or robot-assisted treatment groups (20 sessions, 1h/day, 5d/week, 4 weeks).</p><p><strong>Main outcome measures: </strong>A blinded assessor performed assessments both before and after the intervention. Surface electromyography recordings from 16 muscles during reaching tasks were collected pre- and post-treatment. We extracted muscle synergy patterns (similarity, merging, and fractionation) of the stroke-affected and unaffected upper limb of each subject.</p><p><strong>Results: </strong>Overall, individuals improved upper limb motor function (Fugl-Meyer Assessment Upper Extremity change score = 7.14 ± 7.46, p< 0.001). We identified 34 responders to treatment showing clinically significant improvement (over the Minimal Clinically Important Difference of 5 points on the Fugl-Meyer Assessment-Upper Extremity). The responders showed decreased merging of synergies (p=0.016) as compared with the non-responders (p=0.025), who conversely showed improved similarity of synergies (p=0.006).</p><p><strong>Conclusions: </strong>In individuals with stroke undergoing upper limb motor rehabilitation, changes in the synergy merging pattern may serve as a potential marker to distinguish responders from non-responders.</p><p><strong>Trial registration: </strong>The trial is registered in ClinicalTrial.gov, identifier number NCT03530358 (https://clinicaltrials.gov/study/NCT03530358).</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246104","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 role of Blended Learning in Enhancing Self-Efficacy and Medication Adherence in Cardiac Rehabilitation for Patients Undergoing Coronary Artery Bypass Surgery: A Randomised Control Trial: Blended learning in cardiac rehabilitation.","authors":"Ghazal Veisi, Fatemeh Pakrad, Robbert Gobbens, Younes Mohammadi, Lobat Majidi","doi":"10.1016/j.apmr.2025.05.011","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.05.011","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the effectiveness of a traditional cardiac rehabilitation (CR) program compared to an augmented program that integrates traditional cardiac rehabilitation with face-to-face training sessions and remote assistance facilitated through an application based on the Knowledge, Attitude, and Practice (KAP) model for individuals undergoing coronary artery bypass graft (CABG) surgery.</p><p><strong>Design: </strong>A randomized controlled trial with a blinded outcome assessment was used (IRCT20230902059333N1).</p><p><strong>Setting: </strong>A major heart center in a middle-income country.</p><p><strong>Participants: </strong>Of the 80 patients referred to the cardiac rehabilitation program during the study, 70 patients were successfully enrolled, reaching the target sample size. Participants were randomly assigned in a 1:1 ratio, resulting in 35 patients per group.</p><p><strong>Intervention: </strong>In addition to traditional cardiac rehabilitation, patients participated in four in-person training sessions throughout the rehabilitation process and received three months of follow-up support via the app after completing the program.</p><p><strong>Main outcome measures: </strong>Medication adherence and self-efficacy were assessed before the initiation of cardiac rehabilitation (CR), immediately following the completion of CR, and three months post-completion of CR.</p><p><strong>Results: </strong>There were no significant demographic differences between the intervention and control groups. However, throughout the study, significant differences emerged in favor of the 3 group concerning medication adherence and self-efficacy (p<0.001). The intervention group showed substantial and continuous improvements in medication adherence and self-efficacy scores, which were evident from the first month and persisted over time.</p><p><strong>Conclusion: </strong>Implementing a blended learning approach in cardiac rehabilitation has demonstrated benefits in medication adherence and self-efficacy, highlighting the necessity for further research and clinical application.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144232981","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":"Validity and Reliability of Interview and Online Self-Report Versions of Motor and Sensory Components of a Neurological Exam for Classifying Spinal Cord Injury (One-SCI).","authors":"Thomas N Bryce, Laiba Afzal, Stephen P Burns, Marcel P Dijkers, Steven Kirshblum, Ralph J Marino, Jayme O'Connor, Arianny Ramirez, Brittany Snider, Lisa Spielman, Chung-Ying Tsai","doi":"10.1016/j.apmr.2025.05.016","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.05.016","url":null,"abstract":"<p><strong>Objective: </strong>To examine the feasibility, validity, and reliability of the Online Neurological Exam for Spinal Cord Injury (One-SCI), a patient-reported outcome measure of the motor and sensory components needed for classifying spinal cord injury (SCI) according to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) DESIGN: Repeat administration (one week interval) of either an online self-administered or an interviewer-administered survey (both supported by extensive computer-provided illustrations and animations) followed by an in-person ISNCSCI examination after an additional week SETTING: Academic free standing rehabilitation center and medical center PARTICIPANTS: 67 individuals with chronic SCI with complete or incomplete injuries representing six groups based upon neurological level of injury (C1-4, C5-6, C7-T1, T2-T6, T7-T12, and L1-S5) who were English-speaking and aged 18 or older INTERVENTIONS: Not applicable MAIN OUTCOME MEASURE: ISNCSCI neurological levels and American Spinal Injury Association Impairment Scale (AIS) grade RESULTS: Overall test-retest agreement was substantial, with kappas ranging from 0.69 to 0.84 for all the neurological levels and AIS grades. Overall agreement between the neurological levels and AIS grades derived from the first administration of One-SCI (participant survey responses) and the ISNCSCI examinations was moderate to substantial, with kappas ranging from 0.55 to 0.71. The median time needed to complete the interview and online versions of One-SCI the first time was 51 minutes.</p><p><strong>Conclusions: </strong>Findings generally support the reliability and validity of both interview and online versions of One-SCI. One-SCI does take nearly one hour to complete, which possibly will limit its widespread use. The results should be replicated in larger samples.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224154","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":"Effects of Noninvasive or Minimally Invasive Neuromodulation Techniques on Neurogenic Lower Urinary Tract Dysfunction After Spinal Cord Injury: A Network Meta-analysis","authors":"Zifu Yu MM ,&nbsp;Xiaoxia Yang MNS ,&nbsp;Tiantian Ma MM ,&nbsp;Fang Qin MM ,&nbsp;Lili Ren MM ,&nbsp;Shiai Gao MM ,&nbsp;Jinhui Chen MM ,&nbsp;Xihua Liu MD","doi":"10.1016/j.apmr.2024.12.016","DOIUrl":"10.1016/j.apmr.2024.12.016","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the available evidence of noninvasive or minimally invasive neuromodulation therapies in improving urodynamic outcomes, voiding diaries, and quality of life in patients with neurogenic lower urinary tract dysfunction (NLUTD) after spinal cord injury (SCI).</div></div><div><h3>Data Sources</h3><div>A comprehensive search of 10 databases from inception until August 30, 2023, was conducted.</div></div><div><h3>Study Selection</h3><div>Randomized controlled trials (RCTs) assessing the effects of conventional treatment (CT) and CT combined with sham stimulation, transcranial magnetic stimulation (TMS), sacral nerve magnetic stimulation (SNMS), TMS+SNMS, sacral pulsed electromagnetic field therapy (SPEMFT), sacral transcutaneous electrical nerve stimulation (STENS), sacral dermatomal transcutaneous electrical nerve stimulation, bladder &amp; STENS, transcutaneous tibial nerve stimulation (TTNS), transcutaneous electrical acupoint stimulation, pelvic floor electrical stimulation, or pelvic floor biofeedback therapy on postvoid residual volume (PVR), maximum cystometric capacity (MCC), number of voids per 24 hours (V24), mean urine volume per micturition, (MUV), maximum urinary flow rate (Qmax), maximum detrusor pressure (MDP), maximum voiding volume, number of leakages per 24 hours (L24), lower urinary tract symptoms score, and SCI-quality of life (SCI-QoL) score in patients with NLUTD after SCI were included.</div></div><div><h3>Data Extraction</h3><div>Two researchers independently extracted data on study characteristics and outcomes following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The Cochrane risk of bias tool (2.0) was used to assess the quality of RCTs.</div></div><div><h3>Data Synthesis</h3><div>Fifty-two RCTs with 2884 participants were included. CT+TMS was able to remarkably decrease PVR (mean difference [MD], −132.14; 95% confidence interval [CI], −230.97 to −33.31) and increase MUV (MD, 147.79; 95% CI, 64.51-231.06). CT+SNMS ranked high in improving V24 (MD, 2.76; 95% CI, 1.26-4.25) and reducing L24 (MD, −2.73; 95% CI, −4.46 to −1.01); CT+TMS+SNMS maximized the reduction of SCI-QoL scores (MD, −1.52; 95% CI, −2.97 to −0.25) and ranked second in both reducing PVR and improving MCC; CT+SPEMFT had a significant advantage in improving MCC (MD, 83.31; 95% CI, 39.73-126.88) and increasing Qmax (MD, 5.91; 95% CI, 2.99-8.84). Improvement in MDP was highly ranked by CT+TTNS (MD, 9.46; 95% CI, 2.15-16.76).</div></div><div><h3>Conclusions</h3><div>CT combined with magnetic stimulation therapy provided more benefits than its combination with electrical stimulation. TMS+SNMS seemed to be a promising noninvasive neuromodulation technique in managing NLUTD after SCI. High-quality RCTs should be conducted in the future to validate these findings.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 6","pages":"Pages 961-972"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906314","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":"Functional Capacity at Rehabilitation Discharge Predicts Physical Activity Characteristics 24 Weeks Later for People With Total Knee Arthroplasty: A Secondary Analysis of a Randomized Controlled Trial","authors":"Paul W. Kline PT, DPT, PhD ,&nbsp;Shawn L. Hanlon PhD, ATC ,&nbsp;Vanessa L. Richardson MS ,&nbsp;Rashelle M. Hoffman PT, DPT, PhD ,&nbsp;Edward L. Melanson PhD ,&nbsp;Elizabeth Juarez-Colunga PhD ,&nbsp;Jennifer E. Stevens-Lapsley PT, PhD ,&nbsp;Cory L. Christiansen PT, PhD","doi":"10.1016/j.apmr.2025.01.416","DOIUrl":"10.1016/j.apmr.2025.01.416","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the association between performance-based and patient-reported functional capacity at the conclusion of 12-week rehabilitation with average daily step counts and peak walking cadence 38 weeks after total knee arthroplasty (TKA).</div></div><div><h3>Design</h3><div>Secondary analysis of a randomized controlled trial.</div></div><div><h3>Setting</h3><div>Veterans Affairs Medical Center.</div></div><div><h3>Participants</h3><div>A total of 87 US military Veterans (age: 67±7y, 87% male).</div></div><div><h3>Interventions</h3><div>Twelve-week rehabilitation beginning 2 weeks post-TKA plus random assignment to either a telehealth-based physical activity behavior change intervention or control group.</div></div><div><h3>Main Outcome Measures</h3><div>Performance-based (timed Up-and-Go [TUG], 30-second sit-to-stand) and patient-reported measures (Western Ontario and McMaster Universities Osteoarthritis Index, Veterans RAND 12-Item Health Survey [VR-12]) were assessed at rehabilitation discharge (14wk post-TKA). Physical activity was measured using thigh-mounted accelerometry 38 weeks post-TKA. Relationships between participant characteristics (age, sex, body mass index, group assignment), functional capacity at discharge, and long-term physical activity outcomes (average daily step count and peak walking cadence) were evaluated using single- and multiple-variable linear and logistic regressions.</div></div><div><h3>Results</h3><div>Univariate analyses: TUG time (<em>r</em>=−0.33, <em>P=</em>.002) and VR-12 physical health subscore (<em>r</em>=0.23, <em>P=</em>.036) were correlated with average daily step count at week 38. TUG time (<em>r</em>=−0.31, <em>P=</em>.006) was correlated with peak walking cadence. Multivariate analyses: multiple linear regression controlling for age, sex, and body mass index identified TUG (B=−301.25, <em>P=</em>.039) and VR-12 physical health (B=93.1, <em>P=</em>.049) as predictors of daily step count. TUG time (B=−1.5, <em>P=</em>.012) and assignment to physical activity behavior change intervention (B=13.7, <em>P</em>&lt;.001) predicted peak walking cadence. No significant predictors of attaining a 7500 steps per day threshold were identified.</div></div><div><h3>Conclusions</h3><div>Functional capacity at discharge is related to physical activity characteristics 38 weeks post-TKA. Although behavior change interventions are needed to address physical activity deficits postoperatively, the link between functional capacity and activity suggests additional need to address functional capacity limitations during TKA rehabilitation.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 6","pages":"Pages 845-852"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999136","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}