Archives of physical medicine and rehabilitation最新文献

{"title":"Home, but Homebound After Traumatic Brain Injury: Risk Factors and Associations With Nursing Home Entry and Death","authors":"Raj G. Kumar PhD, MPH ,&nbsp;Mary Louise Pomeroy PhD, MPH ,&nbsp;Katherine A. Ornstein PhD, MPH ,&nbsp;Shannon B. Juengst PhD ,&nbsp;Amy K. Wagner MD ,&nbsp;Jennifer M. Reckrey MD ,&nbsp;Kirk Lercher MD ,&nbsp;Laura E. Dreer PhD ,&nbsp;Emily Evans PhD, DPT ,&nbsp;Nicola L. de Souza PhD ,&nbsp;Kristen Dams-O'Connor PhD","doi":"10.1016/j.apmr.2024.09.012","DOIUrl":"10.1016/j.apmr.2024.09.012","url":null,"abstract":"<div><h3>Objective</h3><div>To examine risk factors associated with homeboundness 1-year after traumatic brain injury (TBI) and to explore associations between homebound status and risk of future mortality and nursing home entry.</div></div><div><h3>Design</h3><div>Secondary analysis of a longitudinal prospective cohort study.</div></div><div><h3>Setting</h3><div>TBI Model Systems centers.</div></div><div><h3>Participants</h3><div>Community-dwelling TBI Model Systems participants (n=6595) who sustained moderate-to-severe TBI between 2006 and 2016, and resided in a private residence 1-year postinjury.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Homebound status (leaving home ≤1-2d per week), 5-year mortality, and 2- or 5-year nursing home entry.</div></div><div><h3>Results</h3><div>In our sample, 14.2% of individuals were homebound 1-year postinjury, including 2% who never left home. Older age, having less than a bachelor's degree, Medicaid insurance, living in the Northeast or Midwest, dependence on others or special services for transportation, unemployment or retirement, and needing assistance for locomotion, bladder management, and social interactions at 1-year postinjury were associated with being homebound. After adjustment for potential confounders and an inverse probability weight for nonrandom attrition bias, being homebound was associated with a 1.69-times (95% confidence interval, 1.35-2.11) greater risk of 5-year mortality, and a nonsignificant but trending association with nursing home entry by 5 years postinjury (RR=1.90; 95% confidence interval, 0.94-3.87). Associations between homeboundness and mortality were consistent by age subgroup (±65y).</div></div><div><h3>Conclusions</h3><div>The negative long-term health outcomes among persons with TBI who rarely leave home warrants the need to re-evaluate home discharge as unequivocally positive. The identified risk factors for homebound status, and its associated negative long-term outcomes, should be considered when preparing patients and their families for discharge from acute and postacute rehabilitation care settings. Addressing modifiable risk factors for homeboundness, such as accessible public transportation options and home care to address mobility, could be targets for individual referrals and policy intervention.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages 517-526"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387470","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":"Interpreting Variations in Fugl-Meyer Assessment Protocols: Results and Recommendations From a Nominal Group Consensus Process","authors":"Susan E. Fasoli OT, ScD, OTR ,&nbsp;Julia Mazariegos MS, OTR/L ,&nbsp;Kelly Rishe MSOT, OTR/L ,&nbsp;Sarah Blanton PT, DPT ,&nbsp;Julie A. DiCarlo MS ,&nbsp;David Lin MD ,&nbsp;Veronica T. Rowe PhD, OTR/L","doi":"10.1016/j.apmr.2024.10.004","DOIUrl":"10.1016/j.apmr.2024.10.004","url":null,"abstract":"<div><h3>Objective</h3><div>To identify variations among administration and scoring instructions of 6 upper extremity Fugl-Meyer Assessment (FMA-UE) protocols and to achieve consensus regarding optimal administration procedures.</div></div><div><h3>Design</h3><div>Nominal group consensus technique comprised of iterative independent reviews of protocol content, anonymous voting, and group consensus meetings.</div></div><div><h3>Setting</h3><div>Clinicians working in clinical practice and research settings participated in virtual meetings via Zoom.</div></div><div><h3>Participants</h3><div>Ten experts in stroke rehabilitation and administration of the FMA-UE contributed to the interprofessional consensus group.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Qualitative reviews of each FMA-UE protocol and rater responses (agree/disagree) regarding variations in general administration instructions (ie, instructions that could affect the scoring of many individual test items) were discussed and analyzed during a 3-phase consensus process. An a priori target of 80% or greater agreement was used to determine group consensus.</div></div><div><h3>Results</h3><div>Consensus was attained for 7 of 10 general administration instructions. Recommendations from our consensus group summarize “best practice” general instructions for researchers and clinicians. A case example, in which we found up to a 21-point difference between the highest and lowest FMA-UE scores, highlights the potential effect of these protocol variations.</div></div><div><h3>Conclusions</h3><div>Variations among FMA-UE administration protocols during stroke rehabilitation studies can lead to discrepancies in the interpretation and translation of research findings across institutions and limit the perceived value and uptake of standardized assessments for evidence-based practice. The results of this nominal group consensus provide a first step toward developing cohesive FMA-UE recommendations for wider dissemination and review.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages 573-579"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142493673","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":"Mobility Simulation: An IPL Opportunity 4349","authors":"Andrea Frederick,&nbsp;Mindy Fabbro","doi":"10.1016/j.apmr.2025.01.051","DOIUrl":"10.1016/j.apmr.2025.01.051","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To evaluate the impact of interprofessional simulation on student perception of interprofessional collaborative competencies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;The interprofessional simulation learning activity took place. The recruitment script/consent was read. They had access to a QR code link to the Interprofessional Collaborative Competencies Attainment Survey (ICCAS) through Microsoft Forms available on the SVSU OneDrive. Participants were asked to identify their professional program of study (Nursing or Occupational Therapy). No other demographic information was collected. The tool selected was the Interprofessional Collaborative Competency Attainment Scale (ICCAS). The ICCAS was developed by MacDonald, C., Archibald, D., Trumpower, D., Casimiro, L., Cragg, B., &amp; Jelly, W. (2010). The ICCAS is a 20 item retrospective pre/post designed self-assessment. Participants complete the tool only once at the conclusion of the simulation event. All items are positively worded and the participant is asked to rate their ability before and after activity with a score from 1 (strongly disagree) to 7 (strongly agree). The University of Ottawa's methodology for administering the ICCAS was used. Data were analyzed using SPSS. Paired &lt;em&gt;t&lt;/em&gt; tests were performed on presimulation and postsimulation responses for each item of the ICCAS to evaluate perceived changes to interprofessional competencies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;This study was conducted at a public university in the United States.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;Thirty-nine nursing students and 32 occupational therapy students completed the ICCAS tool after the simulation activity.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;The 3 simulations were designed using Society for Simulation in Healthcare best practices guidelines. Nursing and Occupational Therapy faulty had equal voice in planning and setting the objectives for the simulations. Objectives were reviewed with all participants. Participants were given presimulation information. Participants had time to ask questions and permission to step out of the simulation activity if they became stressed. Participants rotated to all 3 simulations, a newborn with a 100% brachial plexus injury, a 65-year-old ventilator dependent patient, and a home care patient with posttraumatic stress disorder. Participants participated in debriefing after each simulation activity.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;The outcome of the study was to evaluate the effectiveness of an interprofessional simulation to improve student interprofessional collaboration and teamwork.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Using the ICCAS data, all 20 mean post simulation item scores were greater than preprogram counterparts. All students and each preprofessional group reported improved levels of interprofessional collaborative competence.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Results support that simulatio","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Page e20"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761244","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":"Eight Days of Mild Intermittent Hypoxia Improves Mitochondrial Capacity and Autonomic Dysfunction in Individuals Living with Incomplete Spinal Cord Injury","authors":"Gino Panza,&nbsp;Fei Zhao,&nbsp;Alexandra Soltesz,&nbsp;Haya Javaid","doi":"10.1016/j.apmr.2025.01.067","DOIUrl":"10.1016/j.apmr.2025.01.067","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the effects of mild intermittent hypoxia (MIH) on mitochondrial capacity at rest, oxygen extraction during hypoxia, and autonomic dysfunction in individuals with motor incomplete spinal cord injury (iSCI).</div></div><div><h3>Design</h3><div>Two-arm parallel design.</div></div><div><h3>Setting</h3><div>Research Laboratory.</div></div><div><h3>Participants</h3><div>Four individuals with motor iSCI (C4, C7/T5, C5, and C4/C7) aged 46±1.4 years (3 males, 1 female).</div></div><div><h3>Interventions</h3><div>Eight days of MIH consisting of twelve 2-minute bouts of hypoxia interspersed with 2 minutes of normoxic recovery. Slight hypercapnia (+3mmHg) was maintained throughout.</div></div><div><h3>Main Outcome Measures</h3><div>A full thigh arterial occlusion is administered with a tourniquet inflated to 300 mmHg. During occlusion and hypoxia, a near infrared spectroscopy device is used to measure muscle oxygen saturation of the lateral gastrocnemius muscle of dominant leg. The amplitude of oxygen extraction during occlusion is a measure of mitochondrial capacity. During hypoxia, the amplitude desaturation, compared with normoxia, was calculated for the 1st, 2nd, 11th, and 12th hypoxic bouts as a measure of oxygen extraction. The first 2 and last 2 hypoxic bouts were then averaged (ie, initial and final). Systolic and diastolic blood pressure responses are obtained during occlusion and a sit-up test for assessing autonomic dysreflexia (AD) and orthostatic hypotension (OH), respectively.</div></div><div><h3>Results</h3><div>Mitochondrial extraction improved from 55±10% to 89±9% after 8 days of MIH (<em>P</em>=.07). On day 1, oxygen extraction increased from 4.70±1.62 to 4.78±2.14%, respectively. On day 8, the amplitude of oxygen extraction was 2.94%±1.25% and 3.55%±0.76% during initial and final bouts, respectively. Notably, on day 8, the amplitude in oxygen extraction was lower across all bouts compared with day 1. However, the amplitude changes from initial to final bouts were smaller on day 1 (17%±29%) than day 8 (56%±42%). After the 8-day MIH, systolic blood pressure and diastolic blood pressure changes during AD improved by 44%±8% (<em>P</em>&lt;.01) and 43%±5% (<em>P</em>=.01) as OH improved by 88%±21% (<em>P</em>=.01) and 128±50% (<em>P</em>=.02).</div></div><div><h3>Conclusions</h3><div>Eight days of MIH improved mitochondrial capacity coupled with the reduced oxygen extraction during hypoxia on day 8, suggests an increased oxygen reserve. Likewise, these improvements in mitochondrial function were concurrent with improvements in AD and OH, suggesting that mitochondrial function may be a potential mechanism impacting autonomic function.</div></div><div><h3>Disclosures</h3><div>none.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Page e26"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761260","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":"Executive Function and Daily Living Skills in Young Women with Stroke","authors":"Michelle Scheffler,&nbsp;Asha Vas","doi":"10.1016/j.apmr.2025.01.068","DOIUrl":"10.1016/j.apmr.2025.01.068","url":null,"abstract":"<div><h3>Objectives</h3><div>To examine cognitive challenges in young women poststroke, using a standardized survey.</div></div><div><h3>Design</h3><div>Survey.</div></div><div><h3>Setting</h3><div>General community/virtual setting.</div></div><div><h3>Participants</h3><div>Eight women aged 21-54 years old who had experienced a stroke. Population-based snowball sampling was used.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Daily Living Questionnaire.</div></div><div><h3>Results</h3><div>Results suggested that the cognitive skills most affected in this sample of young women after stroke are executive functions and executive function monitoring. Furthermore, the most frequently challenging tasks chosen from 52 daily activities included expressing thoughts and screening out background noises. Strong positive correlations were noted between 3 groups of variables: (a) between challenges in participants’ need and participants’ want to complete tasks in daily life, (b) between changes in participants’ responsibilities within their households and within their community/work, and (c) between changes in participants’ responsibilities within their households and general life changes since stroke.</div></div><div><h3>Conclusions</h3><div>This preliminary study brings to light the need to address cognitive challenges, especially executive function, in young women after stroke. This preliminary study builds the case for larger studies of a similar nature with more participants. It highlights a potential emerging area of occupational therapy practice that could become integral in traditional rehabilitation settings.</div></div><div><h3>Disclosures</h3><div>none.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages e26-e27"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761261","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":"Utilization of Occupational Therapy Services for Patients with Cancer in an Acute Care Setting and Effects on Readmission","authors":"Christine McNichols,&nbsp;Alicia Peterson,&nbsp;Stacey Reynolds","doi":"10.1016/j.apmr.2025.01.071","DOIUrl":"10.1016/j.apmr.2025.01.071","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate if patients with cancer diagnoses who received occupational therapy (OT) services in an acute care setting had a lower likelihood of readmission within 30 days status post discharge than patients who did not receive OT services. To identify if patients with cancer diagnoses who received OT services in an acute care setting had a lower likelihood of readmission within 30 days status post discharge than patients who did not receive occupational therapy services after adjusting for sex, race, ethnicity, age, admitting diagnosis, cancer type, cancer stage, discharge location, living situation, pain levels, and insurance type.</div></div><div><h3>Design</h3><div>This was a retrospective observational study. Secondary data from patient medical records from a 5-year period (January 1, 2015, to January 1, 2020) were analyzed.</div></div><div><h3>Setting</h3><div>The data was analyzed from a NCI Comprehensive Cancer Center, Massey, located in Richmond, Virginia, a part of the Virginia Commonwealth University (VCU) Health system. Massey is a large, urban, academic medical center providing inpatient and outpatient services.</div></div><div><h3>Participants</h3><div>There were 6614 patients analyzed in an unadjusted logistic regression and 1920 patients analyzed in an adjusted logistic regression. Complete case analysis was used. Inclusion criteria consisted of: patients with a cancer diagnosis, persons aged ≥18 years, residing in a housing environment, and having an inpatient hospital stay.</div></div><div><h3>Interventions</h3><div>The study analyzed the effect of OT services on readmission status with OT services identified by the billing of at least one OT CPT code in the patient's chart.</div></div><div><h3>Main Outcome Measures</h3><div>The study analyzed the likelihood of a hospital readmission within 30 days of discharge.</div></div><div><h3>Results</h3><div>Patients who received OT services had a statistically significant decrease in their risk of a 30-day hospital readmission compared with patients with cancers who did not receive OT services. Patients with cancer who had OT services were 33.5% less likely to readmit within 30 days compared with a patient who did not have OT services in the unadjusted logistic regression. After adjusting for patient health-related factors, patients with cancer who had OT services were 22.2% less likely to readmit to a hospital when compared with a patient who did not have OT services.</div></div><div><h3>Conclusions</h3><div>The results are intended to contribute to the body of knowledge on the benefits of OT services on both individual and health systems-based levels for hospitalized patients with cancer diagnoses.</div></div><div><h3>Disclosures</h3><div>none.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages e27-e28"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761265","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":"Housing and Disability: Social Determinants of Health Utilizing a National Geospatial Analysis 8264","authors":"Raeda Anderson,&nbsp;Chloe Sellers,&nbsp;Daniel Pasciuti","doi":"10.1016/j.apmr.2025.01.023","DOIUrl":"10.1016/j.apmr.2025.01.023","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To demonstrate the macro dynamics of housing and disablement by comparing pressures on a broad range of issues related to housing and disablement across states.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Examination of US Census Data, American Community Survey, using statistical hypothesis testing.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;Data for this nationally representative study are from the American Community Survey, with state-level aggregated measures from the Annual Disability Statistics Compendium.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;Approximately 3,500,000 US adults via the American Community Survey with state-level aggregated measures from the Annual Disability Statistics Compendium.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;No interventions, this is a natural experiment.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;Housing issues are measured at a state-level percent of community living adults by disability status across 6 housing metrics: lacks a complete kitchen, lacks complete plumbing, overcrowded home environment, housing cost burden, poor housing, and old housing. Housing type is measured by the state-level percent of US community living adults living in houses, apartments, and mobile homes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Disabled adults are more likely to live in old housing (&lt;em&gt;t&lt;/em&gt;=−16.777, &lt;em&gt;P&lt;/em&gt;&lt;.001) but less likely to experience all other housing issues: lacks a complete kitchen (&lt;em&gt;t&lt;/em&gt;=10.3181, &lt;em&gt;P&lt;/em&gt;&lt;.001), lacks complete plumbing (&lt;em&gt;t&lt;/em&gt;=5.2579, &lt;em&gt;P&lt;/em&gt;&lt;.001), high housing cost burden (&lt;em&gt;t&lt;/em&gt;=30.6175, &lt;em&gt;P&lt;/em&gt;&lt;.001), and poor housing (&lt;em&gt;t&lt;/em&gt;=27.0892, &lt;em&gt;P&lt;/em&gt;&lt;.001). The percent of housing with incomplete plumbing per state is strongly positively associated with housing with incomplete kitchens per state (&lt;em&gt;r&lt;/em&gt;=0.802, &lt;em&gt;P&lt;/em&gt;&lt;.001). States with higher rates of overcrowding have higher housing cost burden (&lt;em&gt;r&lt;/em&gt;=0.439, &lt;em&gt;P&lt;/em&gt;=.002) and higher rates of poor housing (&lt;em&gt;r&lt;/em&gt;=0.496, &lt;em&gt;P&lt;/em&gt;&lt;.001). States with high housing cost burden have higher rates of poor housing (&lt;em&gt;r&lt;/em&gt;=0.878, &lt;em&gt;P&lt;/em&gt;&lt;.001). States that have a high housing cost burden have lower rates of people living in older housing (&lt;em&gt;r&lt;/em&gt;=−0.329, &lt;em&gt;P&lt;/em&gt;=.017). States with a high rate of poor housing also have a high rate of overcrowded homes (&lt;em&gt;r&lt;/em&gt;=0.496, &lt;em&gt;P&lt;/em&gt;&lt;.001) and high rate of housing cost burden (&lt;em&gt;r&lt;/em&gt;=0.878, &lt;em&gt;P&lt;/em&gt;&lt;.001), however, they have lower rates of old housing (&lt;em&gt;r&lt;/em&gt;=−0.323, &lt;em&gt;P&lt;/em&gt;=.019). States with high rates of old housing have lower housing cost burden (&lt;em&gt;r&lt;/em&gt;=−0.329, &lt;em&gt;P&lt;/em&gt;=.017) and lower rates of poor housing (&lt;em&gt;r&lt;/em&gt;=−0.323, &lt;em&gt;P&lt;/em&gt;=.019).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Housing issues disproportionately affect disabled adults in the United States. We argue that the multidimensional nature of housing, through cost burdens, upkeep and maintenance, renting","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Page e9"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761284","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":"Clinical Course of Metastatic Brachial Plexopathy in Patients With Breast Cancer","authors":"So Ra Han,&nbsp;Jae Yong Jeon","doi":"10.1016/j.apmr.2025.01.076","DOIUrl":"10.1016/j.apmr.2025.01.076","url":null,"abstract":"<div><h3>Objectives</h3><div>To track the clinical courses of metastatic brachial plexopathy (MBP) in patients with breast cancer. MBP is a late complication of breast cancer that results in significant functional impairments such as pain and muscle weakness. However, there have been exceedingly rare studies of MBP that are limited to breast cancer or tracking the clinical course of MBP.</div></div><div><h3>Design</h3><div>This study retrospectively reviewed medical records of breast cancer patients with confirmed MBP who visited the Department of Rehabilitation Medicine at Seoul Asan Medical Center from January 2009 to September 2023.</div></div><div><h3>Setting</h3><div>This study retrospectively reviewed medical records of breast cancer patients with confirmed MBP who visited the Department of Rehabilitation Medicine at Seoul Asan Medical Center from January 2009 to September 2023.</div></div><div><h3>Participants</h3><div>A total of 29 participants (N=29) available with over 1 year of follow-up data were ultimately selected.</div></div><div><h3>Interventions</h3><div>Data on demographic, breast cancer–related, and MBP-related characteristics were collected.</div></div><div><h3>Main Outcome Measures</h3><div>Changes in clinical symptoms were investigated at both 1-year and 2-year follow-up timepoints.</div></div><div><h3>Results</h3><div>Of the total 29 subjects, the mean age was 54.3±11.6 years, and the duration from breast cancer diagnosis to the MBP diagnosis averaged 7.3±7.2 years. At the time of MBP diagnosis, accompanying symptoms included upper limb muscle weakness (96.0%), pain (82.8%), shoulder joint limited range of motion (LROM) (47.8%), and malignant lymphedema (58.3%). Among those experiencing pain, 91.6% reported moderate to severe pain. All participants with shoulder LROM showed limited abduction. Regarding clinical course follow-up, upper limb weakness displayed diverse courses at 1-year and remained relatively stable at 2-year. In the case of pain, most participants showed no significant changes at 1 year (21 out of 28), but a tendency toward maintenance or worsening was noted at 2 years (13 out of 14). Shoulder LROM remained stable or worsened at 1 year (18 out of 22), with no significant changes observed at 2-year follow-up. All participants with lymphedema, except one, received rehabilitation therapy and most of them showed either improvement or maintenance (16 out of 19) at 1 year. This tendency persisted at 2-year follow-up.</div></div><div><h3>Conclusions</h3><div>This study comprehensively analyzed the clinical courses of various symptoms accompanying breast cancer MBP. Our findings are expected to ultimately contribute to understand and predict the course of individual breast cancer MBP patients in future clinical practice.</div></div><div><h3>Disclosures</h3><div>none.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages e29-e30"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761333","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":"Multisite Musculoskeletal Pain Are Associated with Long-term Declined Physical Quality of Life and Knee-related Quality of Life in Older Adults Knee OA 8266","authors":"Badr Alqahtani,&nbsp;Aqeel Alenazi,&nbsp;Mohammed Alshehri","doi":"10.1016/j.apmr.2025.01.059","DOIUrl":"10.1016/j.apmr.2025.01.059","url":null,"abstract":"<div><h3>Objectives</h3><div>To examine the longitudinal impact of multisite musculoskeletal pain (MMP) on the physical and mental health-related quality of life (HRQOL) in individuals with or at risk of experiencing knee osteoarthritis (OA).</div></div><div><h3>Design</h3><div>Longitudinal study.</div></div><div><h3>Setting</h3><div>Multiple sites.</div></div><div><h3>Participants</h3><div>This study employed a prospective longitudinal design with over 8 years of follow-up. Data from 4796 participants aged 45-79 years were obtained from the OA initiative.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>This research mainly focused on assessing the HRQOL, which was measured using the Medical Outcomes Study Short-Form 12 (SF-12) at various times over 7 visits across a period of up to 96 months. We employed the knee injury and osteoarthritis outcome score (KOOS) for knee-related QOL. The KOOS, a self-reported measure of knee outcomes, included 42 items. The KOOS covers 5 subscales: pain, symptoms, activities of daily living function, sport and recreation function, and knee-related QOL. This study employed the KOOS for knee-related QOL subscale. It consisted of 4 items. This subscale was normalized into a 0-100 score, with a higher score indicating better health status. Multisite pain was examined using a self-report questionnaire at 20 sites.</div></div><div><h3>Results</h3><div>The results showed that participants with one painful site (Beta [<em>B</em>]=−0.92, <em>P</em>=.01), 2 painful sites (<em>B</em>=−1.94, <em>P</em>&lt;.001), and multiple painful sites (≥3) (<em>B</em>=−4.68, <em>P</em>&lt;.001) were significantly associated with decreased composite score for the physical HRQOL over time compared with those with no painful site at baseline after adjusting for covariates. However, there was no significant association with the decline in mental HRQOL over time. All multisite pain categories were associated with worse overtime symptoms in knee-related QOL using KOOS including one painful site (<em>B</em>=−6.97, <em>P</em>&lt;.001), 2 painful sites (<em>B</em>=−9.96, <em>P</em>&lt;.001), and multiple painful sites (≥3) (<em>B</em>=−17.56, <em>P</em>&lt;.001) after controlling for covariates.</div></div><div><h3>Conclusions</h3><div>This study revealed that baseline MMP was linked to declining physical QOL and knee-related QOL among individuals with or at risk of experiencing knee OA. Moreover, baseline multisite pain and 2 painful sites were associated with a decline in physical QOL and KOOS of QOL, whereas mental HRQOL was not significantly associated with multisite pain. Therefore, it is imperative for primary health care settings to prioritize the assessment of MMP and develop interventions aimed at preserving and enhancing physical HRQOL in people with or at risk of experiencing OA.</div></div><div><h3>Disclosures</h3><div>none.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Page e23"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761288","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":"Traumatic Brain Injury in US Veterans: Prevalence and Associations With Physical, Mental, and Cognitive Health","authors":"Justin E. Karr PhD ,&nbsp;Colton S. Rippey MS ,&nbsp;Troy J. Hubert MS ,&nbsp;Murray B. Stein MD, MPH ,&nbsp;Thomas G. Adams PhD ,&nbsp;Robert H. Pietrzak PhD, MPH","doi":"10.1016/j.apmr.2024.11.010","DOIUrl":"10.1016/j.apmr.2024.11.010","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the prevalence of traumatic brain injury (TBI) in the US veteran population, and physical, mental, and cognitive health conditions associated with TBI.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>A nationally representative sample of US military veterans surveyed in 2019-2020.</div></div><div><h3>Participants</h3><div>Veterans with probable TBI (n=943; M=58.8 years, SD=16.4; 75.9% non-Hispanic White) and without probable TBI (n=3,033; M=63.3 years, SD=15.3; 78.6% non-Hispanic White) were categorized based on a 2-item modified Veterans Health Administration TBI screen or self-reported health professional diagnoses of concussion/TBI.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measure(s)</h3><div>Self-reported health professional-diagnosed physical and cognitive health conditions, disability with basic and instrumental activities of daily living (ADLs), positive screens for posttraumatic stress disorder (PTSD), major depressive disorder, anxiety disorder, alcohol use disorder, or drug use disorder, and current suicidal ideation or prior suicide attempts.</div></div><div><h3>Results</h3><div>Among the full sample, 24.5% (95% confidence interval: 22.7, 26.3) had probable TBI. In adjusted analyses, probable TBI was independently associated with greater odds of rheumatoid arthritis (odds ratio [OR]=2.06), chronic pain (OR=1.87), kidney disease (OR=1.81), pulmonary disease (OR=1.74), arthritis (OR=1.65), migraine (OR=1.59), sleep disorders (OR=1.57), and osteoporosis or osteopenia (OR=1.51). Veterans with probable TBI also had higher odds of mild cognitive impairment (OR=4.53) and disability with ADLs (OR=2.18) and instrumental ADLs (OR=1.98), although ADL disability was explained by other physical health conditions. Probable TBI was associated with higher odds of probable current anxiety disorder (OR=2.82), major depressive disorder (OR=2.17), suicidal ideation (OR=1.78), PTSD (OR=1.72), drug use disorder (OR=1.54), and alcohol use disorder (OR=1.47).</div></div><div><h3>Conclusions</h3><div>Nearly 1-in-4 US veterans screen positive for probable TBI, which was associated with several physical and mental health conditions that adversely affect health and functioning. Results underscore the importance of multidisciplinary interventions that concurrently target the unique physical, mental, cognitive, and functional health needs of this population.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages 537-547"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754502","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}