Archives of physical medicine and rehabilitation最新文献

{"title":"Effects of Functional Inspiratory Muscle Training in Individuals with Obesity: A Randomized Controlled Trial.","authors":"Safak Yigit, Alihan Oral, Buket Akinci","doi":"10.1016/j.apmr.2026.09.017","DOIUrl":"https://doi.org/10.1016/j.apmr.2026.09.017","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate effects of functional inspiratory muscle training (FIMT) on functional capacity as primary outcome and on cardiometabolic markers, body composition, peripheral muscle strength, ventilatory responses, pulmonary function, respiratory muscle performance, and physical activity as secondary outcomes in individuals with obesity, compared to aerobic and resistance exercise (ARE) and control group.</p><p><strong>Design: </strong>Single-blind, prospective, randomized controlled.</p><p><strong>Setting: </strong>University-based rehabilitation unit.</p><p><strong>Participants: </strong>51 individuals with obesity (mean age 44.93±9.73 years; mean body mass index 34.45±3.02 kg/m²) were randomly assigned to three groups: ARE Group (AREG), FIMT Group (FIMTG), and Control Group (CG).</p><p><strong>Interventions: </strong>AREG performed aerobic and resistance exercises. FIMTG performed resistance exercise and FIMT, in which IMT was integrated into aerobic exercise. Both exercise programs were performed three times per week for 10 weeks. CG received no exercise intervention.</p><p><strong>Main outcome measures: </strong>The primary outcome was functional capacity.Secondary outcomes included cardiometabolic markers, body composition, peripheral muscle strength, pulmonary function, respiratory muscle performance, ventilatory responses, and physical activity.</p><p><strong>Results: </strong>The mean between-group difference in the 6MWD was 57.33 m (95% CI:27.98 to 86.64; p<0.001) in favour of AREG compared with CG, and 64.20 m (95% CI:34.84 to 93.55; p<0.001) in favour of FIMTG compared with CG. However, there was no significant difference between FIMTG and AREG (6.87 m; 95% CI:-22.48 to 36.21). For most secondary outcomes, both exercise groups showed similar improvements compared to CG in cardiometabolic markers, body composition, peripheral and expiratory muscle strength, physical activity. FIMTG showed favor in ventilation (VE), peak ventilation (VEpeak), peak breathing reserve (BRpeak), peak expiratory flow (PEF) and FEF25-75%, inspiratory muscle performance compared to AREG and CG (p<0.05).</p><p><strong>Conclusion: </strong>Both exercise programs similarly improved functional capacity and most secondary outcomes in obesity. FIMT provided additional benefits in ventilatory responses and inspiratory muscle performance. FIMT may be considered a feasible approach for integration into exercise programs for obesity.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149332167","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":"Comparative Effects of Neurostimulation- and Technology-Augmented Robot-Assisted Training on Upper-Limb Motor Recovery After Stroke: A Systematic Review and Network Meta-Analysis.","authors":"Lin Wang, Zhitao Zhu, Yue Liu, Junjie Qu, Ning Li, Haitao Liu, Lei Cao, Zhenjiang Ma, Hao Wu, Jinwu Wang","doi":"10.1016/j.apmr.2026.10.014","DOIUrl":"https://doi.org/10.1016/j.apmr.2026.10.014","url":null,"abstract":"<p><strong>Objective: </strong>To compare robot-assisted training (RAT) alone with neurostimulation- or technology-augmented RAT for poststroke upper-limb recovery.</p><p><strong>Data sources: </strong>PubMed, Embase, Web of Science, Scopus, Cochrane Library, CNKI, and Wanfang were searched through August 1, 2026.</p><p><strong>Study selection: </strong>Randomized trials evaluated RAT alone or RAT combined with virtual reality, a brain-computer interface, low-frequency electrical stimulation (LFES), transcranial direct current stimulation, or repetitive transcranial magnetic stimulation (rTMS).</p><p><strong>Data extraction: </strong>Two reviewers independently selected studies and extracted data; risk of bias and certainty of evidence were assessed with Cochrane and GRADE methods.</p><p><strong>Data synthesis: </strong>Of 103 trials (5,251 participants), 84 (4,277 participants) entered restricted Fugl-Meyer Assessment for Upper Extremity (FMA-UE) Model E. Compared with usual care (UC), mean differences (MDs) were 9.56 points (95% CI, 7.18-11.93) for rTMS plus RAT, 7.52 (95% CI, 4.48-10.57) for LFES plus RAT, and 3.83 (95% CI, 2.69-4.97) for RAT alone. Heterogeneity was substantial (τ=2.79); global inconsistency was not detected (χ²(9)=3.64; P=.934). rTMS plus RAT ranked first (SUCRA, 96.2%), but its probability of being best decreased from 77.8% to 56.0% after predictive uncertainty was incorporated. Signals for stroke stage (P=.030) and total duration (P=.040) did not meet the multiplicity-adjusted threshold (P<.01).</p><p><strong>Conclusions: </strong>rTMS plus RAT yielded the largest FMA-UE estimate, followed by LFES plus RAT. Sparse head-to-head evidence, heterogeneity, and very low-to-moderate certainty preclude a definitive hierarchy and warrant comparative trials.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149317448","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":"Real-Time Ultrasound-Assisted Laryngeal Electromyography Using an In-Plane Trajectory View: A Prospective Feasibility Study.","authors":"Yong Jae Na, Don-Kyu Kim, Sung Joon Park, Yookyung Lee","doi":"10.1016/j.apmr.2026.10.017","DOIUrl":"https://doi.org/10.1016/j.apmr.2026.10.017","url":null,"abstract":"<p><strong>Objective: </strong>To assess the feasibility, safety, and procedural performance of a real-time ultrasound-assisted laryngeal electromyography (LEMG) protocol that uses a single dedicated in-plane trajectory view for needle guidance, without electromagnetic tracking equipment.</p><p><strong>Design: </strong>Prospective single-arm feasibility study performed by two physicians using an identical standardized technique.</p><p><strong>Setting: </strong>Single-center university hospital, department of rehabilitation medicine.</p><p><strong>Participants: </strong>Sixteen consecutive adult patients (N=16; 14 men, 2 women; mean age 69.5±10.9 years) referred for LEMG for suspected neuromuscular laryngeal dysfunction.</p><p><strong>Interventions: </strong>Following anatomic survey with three orientation views, a single in-plane lateral oblique trajectory was used to sample thyroarytenoid (TA) and cricothyroid (CT) muscles.</p><p><strong>Main outcome measures: </strong>(i) Electromyography-confirmed muscle sampling success; (ii) complete real-time needle visualization; (iii) per-structure ultrasound visualization rates; and (iv) procedure-related adverse events.</p><p><strong>Results: </strong>Forty-four muscles (31 TA, 13 CT) were sampled. EMG-confirmed sampling was achieved in 100% (44/44). Complete real-time needle visualization was achieved in 4/31 TA muscles (12.9%) and 13/13 CT muscles (100%); thyroid cartilage calcification (87.5%) was the principal limiting factor for TA. TA and CT muscles were visualized in 100%; arytenoid and vocal cords in 30/32 (93.8%). Transient cough occurred in 3/44 muscle examinations (6.8%); none required termination. No bleeding, hematoma, or infection occurred.</p><p><strong>Conclusions: </strong>A real-time, in-plane ultrasound-assisted LEMG protocol using a single dedicated trajectory view was feasible and showed a favorable short-term safety profile in this single-arm cohort, performed using commodity ultrasound equipment without electromagnetic tracking. In elderly patients with frequent thyroid cartilage calcification, ultrasound primarily provided trajectory guidance and vascular avoidance; the EMG signal remained the targeting reference. A comparative study against conventional landmark-based LEMG is warranted to establish its additive value.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149317450","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":"Multidomain Benefits of Exergaming for Sarcopenia Management in Institutionalized Older Adults: Physical, Psychological, and Social Outcomes","authors":"Tzu-Pei Yeh PhD,&nbsp;Yen-Kuang Lin PhD,&nbsp;Dorothy Bai PhD,&nbsp;Fang-Lin Kuo PhD,&nbsp;Pi-Ju Liu PhD,&nbsp;I-Hui Chen PhD","doi":"10.1016/j.apmr.2026.06.018","DOIUrl":"10.1016/j.apmr.2026.06.018","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the effectiveness of a 12-week exergaming intervention (Nintendo Switch Ring Fit Adventure) on physical, psychological, and social outcomes in institutionalized older adults with sarcopenia. We hypothesized that exergaming would produce concurrent improvements across physical, psychological, and social domains.</div></div><div><h3>Design</h3><div>Pragmatic quasi-experimental study with a pre-post design and matched facility pairs, following the Transparent Reporting of Evaluations with Nonrandomized Designs guidelines.</div></div><div><h3>Setting</h3><div>Six long-term care facilities in Taiwan (3 intervention and 3 comparison).</div></div><div><h3>Participants</h3><div>N=72 institutionalized older adults (n=36 intervention group and n=36 comparison group) with confirmed sarcopenia per the Asian Working Group for Sarcopenia (AWGS) 2019 criteria, aged ≥65 years, with adequate cognitive capacity.</div></div><div><h3>Interventions</h3><div>The intervention group received thrice-weekly 50-minute exergaming sessions over 12 weeks, with intensity maintained at a Borg rating of perceived exertion (RPE) of 13-14 (6-20 scale). The comparison group continued routine care.</div></div><div><h3>Main Outcome Measures</h3><div>Sarcopenia indicators (muscle mass index, grip strength, gait speed), functional performance (sit-to-stand, timed Up and Go), and psychosocial outcomes (Geriatric Depression Scale, University of California Los Angeles Loneliness Scale, Pittsburgh Fatigability Scale, State-Trait Anxiety Inventory, Pittsburgh Sleep Quality Index).</div></div><div><h3>Results</h3><div>Significant time-by-group interactions (groups changed differently over time) occurred across all domains. In the physical domain, sarcopenia prevalence decreased from 100% to 41.7% (intervention group) vs 100% to 94.4% (comparison group) (<em>P</em>&lt;.001); grip strength increased by 26.9% (intervention group) vs −7.4% (comparison group); and muscle mass index increased by 14.3% (intervention group) vs −5.2% (comparison group). In the psychological domain, depression decreased by 44% vs an increase of 31%; anxiety decreased by 14% vs an increase of 15%. In the social domain, loneliness decreased by 9% vs an increase of 6%. Adherence reached 94.4% with no adverse events.</div></div><div><h3>Conclusions</h3><div>Exergaming demonstrated clinically meaningful improvements across physical, psychological, and social domains, with exceptional adherence, suggesting gaming’s unique potential to address the interconnected biopsychosocial nature of sarcopenia—a critical advantage for holistic geriatric care in institutional settings.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 11","pages":"Pages 3137-3145"},"PeriodicalIF":4.0,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148350376","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":"Apraxia in Individuals With Cognitive Impairment: Evidence From Familiar Tool Use","authors":"Taoran Tang MS,&nbsp;Jinni Wang MD,&nbsp;Jingxin Wei MS,&nbsp;Ben Chen MD,&nbsp;Qiang Wang MD,&nbsp;Danyan Xu MD,&nbsp;Xinyu Zhang BS,&nbsp;Mingyong Zeng BM,&nbsp;Yue Li BM,&nbsp;Xiaoran Zhu BS,&nbsp;Wenjie Tang BS,&nbsp;Hang Gong MS,&nbsp;Dongping Rao MM,&nbsp;Xiaomei Zhong MD,&nbsp;Xiaoyan Liao MD,&nbsp;Yuping Ning MD,&nbsp;Lili Zhang MD","doi":"10.1016/j.apmr.2026.06.016","DOIUrl":"10.1016/j.apmr.2026.06.016","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the action selection, production, and execution of familiar tool use in patients with cognitive impairment, and to report the prevalence of Familiar Tool-Use Impairment (FTUI) and its association with cognitive impairment and functional disability.</div></div><div><h3>Design</h3><div>Cross-sectional, observational study.</div></div><div><h3>Setting</h3><div>The outpatient memory clinic in a tertiary care hospital.</div></div><div><h3>Participants</h3><div>A total of 66 patients with mild cognitive impairment and 80 patients with dementia were consecutively recruited, along with 85 healthy controls.</div></div><div><h3>Intervention</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Familiar tool test (FTT) and their association with multiple cognitive domains and basic activity of daily living in patients with cognitive impairment.</div></div><div><h3>Results</h3><div>Early signs of FTUI were observed in the mild cognitive impairment stage, with an FTUI rate of 6.0%. The prevalence of FTUI increased significantly from the healthy controls to the dementia group to approximately 65.0% (<em>P</em>&lt;.001). Canonical correlation analysis (r=0.529, <em>P</em>=.006) indicated that semantic and visuospatial impairment contributed substantially to the canonical variables and showed a prominent association with the Selection Scale in FTT deficits. Multiple linear regression analyses revealed that tool selection was associated with the degree of bathing dependency (R²=0.471; 95% CI, −0.49 to −0.13) and dressing (R²=0.429; 95% CI, −0.35 to −0.05).</div></div><div><h3>Conclusions</h3><div>This study characterized the prevalence of FTUI in patients with cognitive impairment and its underlying cognitive factors, based on the FTT. The findings provided a new perspective for understanding the cognitive impairment and functional disability, suggesting that FTUI may serve as an early warning indicator of functional decline, and offer a practical clinical tool for individualized cognitive rehabilitation in apraxia.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 11","pages":"Pages 3152-3161"},"PeriodicalIF":4.0,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148337541","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":"Retrospective Analysis of the Relationship Between Poststroke Fatigue and Aphasia Severity","authors":"Ellyn A. Riley PhD,&nbsp;Yina M. Quique PhD,&nbsp;Katarina L. Haley PhD,&nbsp;Adam Jacks PhD,&nbsp;Jessica D. Richardson PhD","doi":"10.1016/j.apmr.2026.07.002","DOIUrl":"10.1016/j.apmr.2026.07.002","url":null,"abstract":"<div><h3>Objectives</h3><div>To characterize poststroke fatigue in people with aphasia and to investigate the relationship between aphasia severity and fatigue.</div></div><div><h3>Design</h3><div>Cross-sectional observational design.</div></div><div><h3>Setting</h3><div>University labs or clinic setting at 3 institutions in the United States, occasionally in participants’ homes.</div></div><div><h3>Participants</h3><div>Adults with chronic poststroke aphasia (N=73), with English reported as their primary language before stroke onset (mean age=59.4y; 61.6% men; mean time postonset=44.4mo). Aphasia severity, as measured by the Western Aphasia Battery—Revised (WAB-R), ranged from severe to very mild (scores of 14.7-100), with the majority (over 68%) presenting with mild-to-moderate impairment (scores 76-100).</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>The WAB-R was used to measure aphasia severity (Aphasia Quotient). The Multidimensional Assessment of Fatigue measured poststroke fatigue using the Global Fatigue Index, consisting of 4 dimensions: severity, distress, interference, and timing.</div></div><div><h3>Results</h3><div>Participants reported moderate ratings of fatigue across all Multidimensional Assessment of Fatigue dimensions, with substantial individual variability. Bayesian regression showed that higher WAB-R scores were associated with greater fatigue (β=0.31; 95% credible interval, 0.06-0.55), but age and sex were not.</div></div><div><h3>Conclusions</h3><div>Participants with milder aphasia reported greater poststroke fatigue than those with more severe impairments. These findings suggest that compensatory cognitive demands and elevated communication expectations that are associated with milder language deficits may contribute to increased fatigue burden. Results emphasize the need for routine fatigue screening across all aphasia severity levels and support reconceptualizing mild aphasia as potentially involving substantial hidden costs.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 11","pages":"Pages 3232-3239"},"PeriodicalIF":4.0,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148444176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Benefits of Ultrasound-Guided Percutaneous Electrical Nerve Stimulation for Chronic Lateral Elbow Pain: A Randomized Controlled Trial","authors":"Daniel Albert-Lucena PT, PhD,&nbsp;Gabriel Rabanal-Rodríguez PT,&nbsp;Marcos José Navarro-Santana PT, PhD,&nbsp;Guido Fabián Gómez-Chiguano PT, PhD,&nbsp;Ángel González-de-la-Flor PT, PhD,&nbsp;Carlos Romero-Morales PT, PhD,&nbsp;Gustavo Plaza-Manzano PT, PhD","doi":"10.1016/j.apmr.2026.07.006","DOIUrl":"10.1016/j.apmr.2026.07.006","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the mid and long-term benefits of percutaneous electrical nerve stimulation applied to the radial nerve (RN), combined with exercise, in patients with chronic lateral elbow pain, focusing on pain intensity, pain-related disability, psychological outcomes, and self-perceived change.</div></div><div><h3>Design</h3><div>A randomized, double-blinded, sham-controlled clinical trial.</div></div><div><h3>Setting</h3><div>University facilities.</div></div><div><h3>Participants</h3><div>Forty-nine participants (N=49) with lateral elbow pain were randomly assigned to percutaneous electrical nerve stimulation or sham percutaneous electrical nerve stimulation groups.</div></div><div><h3>Interventions</h3><div>A 4-week exercise program with 1 weekly session of percutaneous electrical nerve stimulation or sham percutaneous electrical nerve stimulation targeting the RN in patients with chronic lateral elbow pain.</div></div><div><h3>Main Outcome Measures</h3><div>Numeric Pain Rating Scale for pain, Patient-Rated Tennis Elbow Evaluation for disability, and psychological and self-perceived outcomes, including the Tampa Scale of Kinesiophobia (11-item version), Pain Catastrophizing Scale, and Global Rating of Change, assessed over 1 year.</div></div><div><h3>Results</h3><div>Percutaneous electrical nerve stimulation significantly outperformed sham treatment across all primary and secondary outcomes. The percutaneous electrical nerve stimulation group demonstrated large and sustained improvements in pain (Numeric Pain Rating Scale: −25.5 points), function (patient-rated tennis elbow evaluation: −25.4 points; disabilities of the arm, shoulder, and hand: −24.5 points), Tampa Scale of Kinesiophobia (11-item version), and Pain Catastrophizing Scale, with all differences exceeding minimal clinically important differences. More than 90% of participants receiving percutaneous electrical nerve stimulation reported moderate to large perceived improvement (Global Rating of Change of ≥4) at 1-year follow-up. No serious adverse events were reported.</div></div><div><h3>Conclusions</h3><div>Ultrasound-guided percutaneous electrical nerve stimulation targeting the RN, when combined with exercise, appears to produce significant, clinically meaningful, and sustained improvements in pain, function, and psychological health in individuals with chronic lateral elbow pain. These findings may support integrating percutaneous electrical nerve stimulation into evidence-based physiotherapy for this condition.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 11","pages":"Pages 3279-3289"},"PeriodicalIF":4.0,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148454528","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":"Challenging a “Gold Standard” in Rehabilitation Research: The Limits of Outcome-Centered Trials in Pain Science","authors":"Marcelo de França Moreira PhD,&nbsp;Marco Aurelio Pinho Oliveira PhD","doi":"10.1016/j.apmr.2026.05.005","DOIUrl":"10.1016/j.apmr.2026.05.005","url":null,"abstract":"<div><div>Randomized controlled trials (RCTs) hold a privileged position in evidence hierarchies and are widely regarded as the most rigorous design for evaluating rehabilitation intervention efficacy. However, their conventional structure, which focuses on group-level average treatment effects assessed at sparse time points and abstains from a deeper inquiry into individual differences (ie, outcome-centered), presents critical limitations when applied to complex phenomena such as chronic pain. These limitations are often under recognized, reinforcing a narrow view of causality that discourages methodological pluralism and constrains the advancement of rehabilitation-oriented pain science. To address this gap, this article examines what outcome-centered trial designs can and cannot tell us in pain research, and how other approaches can contribute. The article discusses the historical and theoretical foundations of the model’s widespread adoption, then examines its practical and inferential shortcomings through common design and analytical choices, and finally explores how alternative designs and modeling strategies offer distinct contributions in clarifying the sources and patterns of variation in intervention effects. Rather than treating RCTs as inherently superior, this article advocates judging them by how well methods match the research question and phenomenon studied. Advancing more precise, theory-informed, and clinically relevant evidence requires recognizing both the capacities and limitations of each methodological approach, including large-sample outcome-centered RCTs, and moving beyond rigid hierarchies that rank designs independently of context.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 11","pages":"Pages 3428-3440"},"PeriodicalIF":4.0,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147970093","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":"Early Self-Efficacy Predicts Short- and Long-Term Pain and Functional Outcomes Following Surgically Treated Lower Extremity Fracture","authors":"Joshua J. Van Wyngaarden PT, DPT, PhD,&nbsp;Brian Noehren PT, PhD,&nbsp;Curtis Auterson DPT,&nbsp;Ben James DPT,&nbsp;Matteson Demers DPT,&nbsp;Quinn Romasko DPT,&nbsp;William M. Charlton MD,&nbsp;Paul E. Matuszewski MD","doi":"10.1016/j.apmr.2026.06.011","DOIUrl":"10.1016/j.apmr.2026.06.011","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to identify which early psychosocial measures are most predictive of pain severity, pain interference, physical function, and chronic pain throughout recovery from lower extremity fractures (LEF).</div></div><div><h3>Design</h3><div>Prospective cohort study.</div></div><div><h3>Setting</h3><div>Level 1 trauma center.</div></div><div><h3>Participants</h3><div>A total of 240 patients (43±15y) with acute LEF.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>In this prospective cohort study, 240 adults with surgically treated LEFs completed psychosocial questionnaires 6 weeks after surgery. Pain severity, pain interference, and physical function outcomes were assessed longitudinally at 3, 6, 12, and 24 months, and the outcome of chronic pain at 12 and 24 months each using validated patient-reported outcome measures. Hierarchical regression analyses examined the predictive value of early psychosocial factors on outcomes over time.</div></div><div><h3>Results</h3><div>A total of 163 participants (67%) completed the study through 24 months. Pain catastrophizing was associated with pain interference across all time points through 24 months (<em>P</em>≤.049), whereas self-efficacy was associated at 3, 6, and 24 months (<em>P</em>≤.002). Self-efficacy was consistently associated with physical function across follow-up (<em>P</em>≤.01). Pain catastrophizing and self-efficacy were associated with chronic pain at 12 months (<em>P</em>≤.04), with self-efficacy remaining associated with chronic pain at 24 months (<em>P</em>=.017).</div></div><div><h3>Conclusion</h3><div>Although early pain catastrophizing and self-efficacy were associated with pain and disability-related outcomes throughout 24 months of recovery from a LEF, pain self-efficacy was most consistently associated with each outcome. Early assessment of self-efficacy may provide useful prognostic information regarding pain and functional outcomes following LEF.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 11","pages":"Pages 3119-3127"},"PeriodicalIF":4.0,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148293288","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":"Neurogenic Bowel Dysfunction in Multiple Sclerosis: Clinical Determinants and its Association With Bladder Dysfunction in a Multicenter Study","authors":"Yeşim Akkoç MD,&nbsp;Necmettin Yıldız MD,&nbsp;Hilal Adanur MD,&nbsp;Hakan Tunç MD,&nbsp;Ebru Alemdaroğlu MD,&nbsp;Selcen Kanyılmaz MD,&nbsp;Aysun Özlü MD,&nbsp;Haydar Gök MD,&nbsp;Belgin Erhan MD,&nbsp;Şenay Özdolap MD,&nbsp;Ayşe Nur Bardak MD,&nbsp;Hülya Şirzai MD,&nbsp;Murat Zinnuroğlu MD,&nbsp;Bedriye Karaman MD,&nbsp;Ayşe Nur Yüceyar MD,&nbsp;Özgül Ekmekçi MD,&nbsp;Levent Sinan Bir MD,&nbsp;Meltem Güneş Akıncı MD,&nbsp;Semra Mungan Öztürk MD,&nbsp;Zuhal Özişler MD,&nbsp;Helin Kökmen MD","doi":"10.1016/j.apmr.2026.06.017","DOIUrl":"10.1016/j.apmr.2026.06.017","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the prevalence and severity of neurogenic bowel dysfunction (NBD) in multiple sclerosis (MS) and to identify clinical factors associated with moderate-to-severe bowel dysfunction.</div></div><div><h3>Design</h3><div>Multicenter, prospective, cross-sectional study.</div></div><div><h3>Setting</h3><div>Twelve tertiary MS centers.</div></div><div><h3>Participants</h3><div>A total of 975 patients with MS.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Bowel dysfunction was assessed using the NBD score, and bladder symptoms were evaluated using the Neurogenic Bladder Symptom Score (NBSS). Moderate-to-severe NBD was defined as an NBD score ≥10. Associations between NBD and clinical variables were examined using univariate analyses and multivariable logistic regression.</div></div><div><h3>Results</h3><div>The mean age was 39.7±11.4 years, and 72.5% were women. Moderate-to-severe NBD was identified in 6.8% of patients. Higher NBD severity was associated with older age, longer disease duration, and greater disability (all <em>P</em>&lt;.01). In multivariable analysis, Expanded Disability Status Scale (odds ratio [OR], 1.35; 95% CI, 1.13-1.60; <em>P</em>=.001) and NBSS total score (OR, 1.08; 95% CI, 1.06-1.10; <em>P</em>&lt;.001) were independently associated with moderate-to-severe NBD, whereas age, sex, disease duration, and MS subtype were not.</div></div><div><h3>Conclusion</h3><div>Moderate-to-severe NBD affects a notable proportion of patients with MS and is independently associated with disability level and bladder dysfunction. These findings highlight the importance of integrated assessment of bowel and bladder symptoms and support routine screening, particularly in patients with higher disability.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 11","pages":"Pages 3146-3151"},"PeriodicalIF":4.0,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148337546","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}