Archives of physical medicine and rehabilitation最新文献

{"title":"Optimizing Cancer Rehabilitation: Policy Implications 1137","authors":"Patricia Geels","doi":"10.1016/j.apmr.2025.01.045","DOIUrl":"10.1016/j.apmr.2025.01.045","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the impact of the current inpatient rehabilitation facility (IRF) admission criteria, specifically the “60% rule,” on access to rehabilitation services for patients with cancer. It seeks to assess potential modifications to the criteria to better align with the needs of this patient population.</div></div><div><h3>Design</h3><div>Using Bardach's Eightfold Path for Policy Analysis, this research conducts a comprehensive evaluation of the existing IRF admission criteria and their implications for cancer patients’ access to rehabilitation services. A literature review was conducted to gather evidence on the historical context, policy development, and current challenges related to IRF admission criteria.</div></div><div><h3>Setting</h3><div>The study focuses on the United States health care system, particularly Medicare's reimbursement policies for IRFs under the Prospective Payment System.</div></div><div><h3>Participants</h3><div>The participants include patients with cancer who may require postacute rehabilitation services, policymakers, health care providers, and stakeholders involved in the development and implementation of IRF admission criteria.</div></div><div><h3>Interventions</h3><div>The interventions assessed in this study include potential modifications to the existing IRF admission criteria, such as reducing the 60% rule threshold, expanding the list of compliant conditions to include cancer, or restricting the criteria to Medicare and Medicaid beneficiaries.</div></div><div><h3>Main Outcome Measures</h3><div>The main outcome measure is the impact of proposed modifications to the IRF admission criteria on access to rehabilitation services for patients with cancer. This includes assessing changes in admission rates, functional outcomes, health care utilization, and patient satisfaction.</div></div><div><h3>Results</h3><div>The analysis reveals that the current IRF admission criteria, particularly the 60% rule, present barriers to access for patients with cancer despite evidence of functional improvement with rehabilitation services. Proposed modifications, such as expanding the list of compliant conditions to include cancer, have the potential to increase access and improve outcomes for this patient population.</div></div><div><h3>Conclusions</h3><div>Modifications to the IRF admission criteria are necessary to better meet cancer patients’ rehabilitation needs. Expanding eligibility criteria and aligning policies with initiatives such as the Cancer Moonshot can enhance access to rehabilitation services and improve the quality of life for individuals with cancer.</div></div><div><h3>Disclosures</h3><div>I am employed as an assistant professor in the Vera Z. Dwyer College of Health Sciences at Indiana University South Bend. I have no other financial or nonfinancial disclosures to report.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages e17-e18"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761113","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":"Evaluating Hand Motor Coordination of Chronic Stroke Survivors Through the Combination of Features Extracted From a High-density EMG Sleeve 4361","authors":"Nicholas Tacca,&nbsp;Bryan Schlink,&nbsp;Philip Putnam,&nbsp;Michael Darrow,&nbsp;Sam Colachis,&nbsp;Collin Dunlap,&nbsp;Lauren Wengerd,&nbsp;David Friedenberg,&nbsp;Eric Meyers","doi":"10.1016/j.apmr.2025.01.037","DOIUrl":"10.1016/j.apmr.2025.01.037","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To investigate whether hand motor coordination of stroke survivors can be explained through a combination of features extracted from a high-density electromyography (HD-EMG) sleeve.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Standardized clinical assessments were evaluated in participants with stroke and scored by a licensed occupational therapist. Assessments included the upper extremity section of the Fugl-Meyer and the Modified Ashworth Scale test to assess finger and wrist spasticity. After clinical assessments, subjects performed 12 functional hand and wrist movements while HD-EMG was recorded using a wearable sleeve. Movements were visually evaluated based on an observed movement score (0=no movement, 1=visible movement, 2=incomplete movement, and 3=normal movement). After data collection, a variety of HD-EMG features, or views, were calculated from EMG, namely cocontraction, muscle correlation, muscle synergies, and motor unit firing coherence.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;This study was performed at Battelle Memorial Institute.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;This study enrolled able-bodied adults (n=7) and chronic stroke subjects with upper limb hemiparesis (n=7). Participants with stroke had hand impairment that interferes with their ability to perform activities of daily living and were classified as stage 1-6 on the hand subscale of the Chedoke McMaster Stroke assessment.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;Not applicable.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;Main outcome measures include the correlation of HD-EMG features, or a combination of features, with the upper extremity section of the Fugl-Meyer and Modified Ashworth Scale scores.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Stroke subjects had higher cocontraction and reduced muscle coupling when attempting to open their hand and actuate their thumb. Muscle synergies decomposed in the stroke population were relatively preserved. Alterations in synergy composition demonstrated reduced coupling between digit extensors and muscles that actuate the thumb, as well as an increase in flexor activity in the stroke group. Average synergy activations during movements revealed differences in coordination, highlighting overactivation of antagonist muscles and compensatory strategies. Motor units decomposed in the stroke population had a lower firing coherence across movements, demonstrating reduced neural drive to muscles. When combining features using canonical correlation analysis, the first latent component was correlated with upper extremity section of the Fugl-Meyer hand subscore (&lt;em&gt;R&lt;/em&gt;&lt;sup&gt;2&lt;/sup&gt;=0.85). Latent component weightings revealed interpretable measures of motor coordination and muscle coupling alterations.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;These results demonstrate the feasibility of predicting motor function through features decomposed from a wearable HD-EMG sleeve, which could be leveraged to improve stro","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages e14-e15"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761188","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":"Impact of Accompaniment Music on Rehabilitation Compliance and Performance During Music-based Training in Stroke 8252","authors":"Yi-An Chen,&nbsp;Ella Atkinson,&nbsp;Alaina Nickerl,&nbsp;Dhruv Pargai,&nbsp;Gil Weinberg,&nbsp;Martin Norgaard,&nbsp;Molly Rowland,&nbsp;Annie Solomon,&nbsp;Sara Johnstone","doi":"10.1016/j.apmr.2025.01.039","DOIUrl":"10.1016/j.apmr.2025.01.039","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the impact of accompaniment music on patient compliance and performance during a 2-week in-home upper extremity music-based training (MBT) in stroke survivors.</div></div><div><h3>Design</h3><div>This is a within-subject feasibility study to understand how music influences participants’ engagement and performance during home training.</div></div><div><h3>Setting</h3><div>Participants’ home.</div></div><div><h3>Participants</h3><div>Community-dwelling individuals with chronic stroke and mild to moderate hemiplegia.</div></div><div><h3>Interventions</h3><div>During the 2-week MBT, participants were asked to exercise their upper extremities for at least 1 h/d with a piano keyboard and an iPad installed with a stroke-specific MBT app. The MBT included 2 training modes, nonmusic versus music, which were switched alternatively throughout the 2 weeks. Under the nonmusic mode, participants’ keystrokes were visually cued although they could hear the musical notes that they played on the keyboard. Under the music mode, accompaniment music with a steady pulse and visual guides cued key presses.</div></div><div><h3>Main Outcome Measures</h3><div>The app usage time (total and daily) and keynote press accuracy were measured to understand participants’ training compliance and performance, respectively. We compared the results between the 2 different modes to explore the impact of the accompaniment music on stroke survivors.</div></div><div><h3>Results</h3><div>We recruited 5 stroke survivors and observed the average total usage of 131 minutes for nonmusic mode and 142 minutes for music mode across all the participants. The average daily app usages were 22.9 min/d and 26.56 min/d under nonmusic and music modes, respectively. We also observed a difference in keynote press accuracy between the nonmusic mode (averaged 0.115s delay) and the music mode (averaged 0.097s delay).</div></div><div><h3>Conclusions</h3><div>Our preliminary results showed that stroke participants had greater use of the MBT app for rehab exercises under the music mode than the nonmusic mode. Participants’ keynote press accuracy was also more precise when they could hear the accompaniment music. These findings suggest that accompaniment music may play an important role in affecting not only participants’ engagement but also their performance. Data collection will be continued to demonstrate a robust result and explore the potential explanations for the observed differences.</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 e15"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761190","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":"Unpacking the Complexity of Implementing Robotic Technology for Multiple Disciplines: A Mixed Methods Study 4355","authors":"Julie Pryor,&nbsp;Louise Pearce,&nbsp;Jason Redhead,&nbsp;Cathie Sherrington,&nbsp;Leanne Hassett","doi":"10.1016/j.apmr.2025.01.040","DOIUrl":"10.1016/j.apmr.2025.01.040","url":null,"abstract":"<div><h3>Objectives</h3><div>To study the integration of robotic technologies across inpatient, outpatient and community rehabilitation services.</div></div><div><h3>Design</h3><div>Mixed methods over a 12-month period, using descriptive statistics to analyze device usage data and thematic analysis of semistructured clinician interviews.</div></div><div><h3>Setting</h3><div>A rehabilitation center in Australia.</div></div><div><h3>Participants</h3><div>Clinicians from physiotherapy, occupational therapy, recreational therapy, speech pathology and dietetics, and allied health assistants working in inpatient, outpatient and community services.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Device-specific usage and multidisciplinary experiences and perceptions of introducing robotic rehabilitation technologies.</div></div><div><h3>Results</h3><div>Device usage increased from 219 to 511 uses per month 11 months later, totaling 4262 uses across 25 different devices by 271 patients with a range of neurological conditions across the year. In about 20% of therapy sessions multiple devices were used. The 25 interviewed clinicians understood that the new technologies were additions to their clinical toolkit requiring them to think and practice differently, but they struggled with discipline-technology fit and were overwhelmed by the volume of training required for each device. Early on, clinicians from disciplines that typically target impairments found it easier to integrate technology than disciplines with a dominant participation focus, but this changed over time as evidenced in increasing diversity of session goals and the clinicians’ stories. Although technology was found to enhance patient engagement, it also required many clinicians to upskill to effectively navigate patients’ high expectations of robotic technologies. Key factors in successful implementation were clinician buy-in, a well-designed staff training model, real time on the ground support, and responsiveness to differences between inpatient, outpatient and community services.</div></div><div><h3>Conclusions</h3><div>Ultimately, clinicians came to embrace technology's role in rehabilitation but emphasized its use alongside traditional therapy methods, guided by strong clinical reasoning and clear goals. This study adds value by using implementation science and including multiple perspectives.</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 e16"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761191","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":"Coding, Tracking and Trending Injury Data to Improve Practice and Safety for Caregivers and Their Patients 1145","authors":"Teresa Boynton","doi":"10.1016/j.apmr.2025.01.050","DOIUrl":"10.1016/j.apmr.2025.01.050","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;(1) To describe how an employee injury coding project led to improved safety for caregivers and patients throughout a large hospital system. (2) To accurately investigate the underlying causes of employee injuries in order to implement effective injury prevention action plans including for rehabilitation units. (3) To understand the link between employee injury data, patient outcomes/NDNQI data and safe patient handling and mobility (SPHM) programs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Developed an injury coding system in order to accurately track data for 11 hospitals using over 15 years of workers’ compensation data. Accurate data led to implementing effective plans based on each category of cause of injury. Effective action plans led to significant decreases in frequency and severity of injuries, positive trending and sustainable programs. In addition to impacting caregiver safety, patient outcomes (eg, falls, pressure injuries) were positively impacted by improved mobility practices.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;Acute care/hospital settings both rural and large urban hospitals with impact on associated outpatient/ambulatory care settings.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;Employee injury data from 11 hospitals collected over a period of 15 years.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;Use of accurate coding of injuries to allow for accurate tracking of causes, and implementing injury prevention programs, including SPHM practices that also focused on patient initiatives and outcomes (eg, falls, pressure injuries).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;Decrease in frequency and severity of caregiver injuries associated with unit-specific and cause-specific SPHM interventions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;(1) Accurate coding and tracking of employee injuries led to (2) focused action plans and (3) implementing effective injury prevention programs and practices, which led to (4) significant and sustainable decreases in both frequency and severity of employee injuries and (5) improved patient outcomes through early and often mobilization using SPHM practices.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Obtaining enough information to accurately code and track the underlying causes of employee injuries leads to improved practice and safety for both caregivers and patients. More research is needed directly linking SPHM practices to improved patient outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Disclosures&lt;/h3&gt;&lt;div&gt;Teresa Boynton worked for Banner Health for 26+ years as the Ergonomics and Injury Prevention Specialist, and Safe Patient Handling and Mobility lead. She developed the Banner Bedside Mobility Assessment Tool linked to SPHM practices. She then worked for Hill-Rom as a Clinical Consultant and developed Banner Bedside Mobility Assessment Tool 2.0. She worked with hospital systems to implement SPHM practices that are unit-specific focused on caregiver and patient safety and avoiding complicati","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":"143761243","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":"Conducting Meta-analyses and Systematic Reviews in Long COVID: Challenges and Lessons Learned 4353","authors":"Eva Pettemeridou,&nbsp;Maria Loizidou,&nbsp;Jelena Trajkovic,&nbsp;Stefanie De Smet,&nbsp;Maria Constantinou,&nbsp;Fofi Constantinidou","doi":"10.1016/j.apmr.2025.01.052","DOIUrl":"10.1016/j.apmr.2025.01.052","url":null,"abstract":"<div><h3>Objectives</h3><div>To identify and address the methodological challenges and lessons learned in conducting meta-analyses and systematic reviews in the emerging field of long coronavirus disease 2019 (COVID).</div></div><div><h3>Design</h3><div>This study results from a larger systematic review in response to methodological difficulties, specifically related to participant inclusion/exclusion criteria, sample sizes and study comparability issues. Forty-one studies were included.</div></div><div><h3>Setting</h3><div>The study synthesized evidence from a wide range of settings, including hospital and outpatient clinics.</div></div><div><h3>Participants</h3><div>The intended participants were individuals suffering from long COVID, identified through variable inclusion/exclusion criteria across studies, with a focus on cognitive and psychological symptoms. Challenges were noted in the heterogeneous application of these criteria and in the variable sample sizes across studies.</div></div><div><h3>Interventions</h3><div>Five studies were included that reported on interventions aiming at alleviating cognitive and psychological symptoms in long COVID, although very few randomized controlled trials were identified, highlighting a gap in the literature.</div></div><div><h3>Main Outcome Measures</h3><div>Outcome measures varied across studies but generally included assessments of cognitive and psychological functioning through neuroimaging, neurophysiology, and clinical scales.</div></div><div><h3>Results</h3><div>Significant challenges were observed, including issues related to the Population, Intervention, Comparison, Outcomes framework, such as unequal sample sizes and inappropriate comparisons between large samples of neurotypical participants and small samples of long COVID participants. Additionally, the inclusion/exclusion criteria for long COVID were inconsistently applied, with few studies adhering to Centers for Disease Control and Prevention or World Health Organization guidelines.</div></div><div><h3>Conclusions</h3><div>These findings underscore the complexity of researching long COVID, particularly in synthesizing evidence across studies with varied methodologies, sample sizes, and clinical definitions. The findings highlight the need for standardized criteria for defining neuropsychological symptoms associated with long COVID and for designing studies with methodologies that can be more readily compared and aggregated in systematic reviews and meta-analyses. Guidelines for future research projects on long COVID will be discussed in more detail.</div></div><div><h3>Disclosures</h3><div>Eva Pettemeridou is acting as the Communications and Social Media Officer of the International Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine. All authors receive a salary from a joint research grant conducting work on long COVID.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages e20-e21"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761245","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":"Deborah L. Wilkerson Early Career Award: Using Clinical Data to Understand Recovery Trajectories and Optimize Patient Care","authors":"Alison Cogan","doi":"10.1016/j.apmr.2025.01.053","DOIUrl":"10.1016/j.apmr.2025.01.053","url":null,"abstract":"<div><h3>Objectives</h3><div>For the Deborah L. Wilkerson Award, Dr Alison M. Cogan will report on study that aimed to examine the associations among the time and content of rehabilitation treatment with patient rate of gain in self-care and mobility for adults with acquired brain injury. In the context of the shift to value-based payments for postacute rehabilitation services, it is critical to be able to demonstrate how specific rehabilitation services drive change on relevant patient outcomes.</div></div><div><h3>Design</h3><div>Retrospective cohort study using electronic health record and billing data. Our team extracted demographic data, functional measures at admission and discharge, and all billed therapy services for patients’ first rehabilitation admission following a brain injury or stroke event.</div></div><div><h3>Setting</h3><div>Inpatient rehabilitation unit at a large academic medical center.</div></div><div><h3>Participants</h3><div>A total of 799 (N=799) adults with acquired brain injury who received inpatient rehabilitation services.</div></div><div><h3>Interventions</h3><div>Standard rehabilitation therapy.</div></div><div><h3>Main Outcome Measures</h3><div>Average change in self-care and mobility items from the Functional Independence Measure per length of stay day.</div></div><div><h3>Results</h3><div>Median length of rehabilitation stay was 10 days (interquartile range, 8-13d). Patients received 10.62 units of therapy (SD, 2.05) per day, on average. For self-care care gain per day, the best fitting model accounted for 32% of the variance. Only occupational therapy activities of daily living units were positively associated with gain rate. For mobility gain per day, the best fitting model accounted for 37% of the variance. Higher amounts of physical therapy bed mobility training were inversely associated with both self-care and mobility gain rate.</div></div><div><h3>Conclusions</h3><div>The transition to a value-based payment model in IRFs will shift more risk of patient outcomes to therapists, and facilities will need to make decisions about costs and service delivery to produce optimal results. In this changing context, rehabilitation teams have an opportunity to utilize their data to support informed decisions about what kinds of rehabilitation therapy drive improved patient outcomes, thus generating better value for patients and meeting facility goals. Dr Cogan will also discuss the benefits and challenges of using electronic health record data in research.</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 e21"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761246","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":"Police Officers’ Return to Work Experiences Following a Musculoskeletal Injury in Aotearoa New Zealand: A Phenomenological Study 4348","authors":"Liané de Klerk,&nbsp;Robin Griffiths,&nbsp;Fiona Graham","doi":"10.1016/j.apmr.2025.01.026","DOIUrl":"10.1016/j.apmr.2025.01.026","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To investigate the return to work experiences of police officers after a musculoskeletal injury in Aotearoa New Zealand.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Interpretive Phenomenological Analysis was used, which draws on phenomenology, hermeneutics, and idiography with a focus on understanding meaning of a given phenomenon from the individuals perspective. Semistructured interviews were undertaken and data analyzed using Interpretive Phenomenological Analysis process.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;Policing within Aotearoa (New Zealand).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;Eligibility criteria were deployable staff who become temporarily undeployable due to a musculoskeletal injury within selected districts and has completed a return to work program within the last 6 months to 5-year period (as of September 2021). Purposive sampling was used, recruiting officers with a recent return to work experience after a musculoskeletal injury. Six police officers were recruited (men, 4; women, 2). One participant identified as Māori; the rest identified as NZ European. The sample included perspectives from 2 large urban police stations, 2 small urban police stations, and 2 small rural police stations.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;Not applicable.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;The Interpretive Phenomenological Analysis process was used to analyze data and processes were in place to ensure validity and rigor throughout the analysis process.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Results identified 4 main themes from participants accounts: Return to Work is a Mystery, Making Sense of the Ghetto, Good Rehabilitation Looks Like Valuing the Person, and Questioning Belonging to the Police “Family.”&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Analysis of interviews revealed that being on a return to work program has a profound impact on injured officers’ identity, in part due to challenges arising from the police culture and rehabilitation processes. Expert vocational rehabilitation practitioners are an important resource in the rehabilitation context. Existing inequalities within the police organization, such as differential treatment of women and minimal attention to cultural needs, are exacerbated by the internal return to work process of the police service.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Disclosures&lt;/h3&gt;&lt;div&gt;Liané de Klerk has previously provided rehabilitation services to the selected districts, and 3 of the 6 participants were known to Liané. Potential conflict of interest was disclosed in the Participant Information Sheet, noting that participation would have no impact on future treatment. Liané was not providing active treatment to any of the participants and was exiting clinical practice. Robin Griffiths has previously worked at the Police College, which was made explicit in the study invitation. Robin was not directly involved in any of the interviews with participants. Fiona Graham has no conflic","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Page e10"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761249","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":"Disparities in Postacute Care Utilization for Individuals with Traumatic Brain Injury 8255","authors":"Amol Karmarkar,&nbsp;Alexandra Ulbing,&nbsp;Amit Kumar","doi":"10.1016/j.apmr.2025.01.054","DOIUrl":"10.1016/j.apmr.2025.01.054","url":null,"abstract":"<div><h3>Objectives</h3><div>To examine disparities in postacute care transitions across inpatient rehabilitation facility, skilled nursing facility, and home health care in individuals with traumatic brain injury.</div></div><div><h3>Design</h3><div>Secondary analysis of All-Payer Claims Data (2017-2021) from Virginia. We linked the individual-level data, with provider- and region-level data.</div></div><div><h3>Setting</h3><div>Acute hospitals and postacute settings in Virginia.</div></div><div><h3>Participants</h3><div>Patients with traumatic brain injury discharged to inpatient rehabilitation facility, skilled nursing facility, or home health care (N=8662).</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Main Outcome Measures</h3><div>Postacute settings, adjusting for patient-level covariates (sociodemographic characteristics, type of insurance, acute length of stay, Elixhauser comorbidity index, hospital-acquired complications), and region-level covariates (postacute availability, county ranking, and population). We constructed hierarchical generalized linear mixed models and Blinder-Oaxaca models for decomposing race and region effects.</div></div><div><h3>Results</h3><div>Approximately, 35% of our sample population did not receive any postacute care after hospitalization. For Hispanics and others, this rate was 46%. There were differences by race/ethnicity in types of postacute care settings. We also found variation in use of postacute care by region.</div></div><div><h3>Conclusions</h3><div>In the era of value-based payment models, it is important to examine long-term outcomes associated with postacute care transitions and develop care coordination models to eliminate disparities in access of postacute rehabilitation care.</div><div>Supported by the Commonwealth Neurotrauma Initiative (CNI): Transitions and Disparities in Care and Outcomes (TDCO) for Neurotrauma (Award # A262-90012).</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 e21"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761255","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":"Gait Training with Robotic Exoskeleton: A Case Report on the Treatment of Neurological Patients with Ataxia","authors":"Monnivon Morrow,&nbsp;Alivia Thorn,&nbsp;Monnivon Morrow","doi":"10.1016/j.apmr.2025.01.069","DOIUrl":"10.1016/j.apmr.2025.01.069","url":null,"abstract":"<div><h3>Objectives</h3><div>To assess treatment of gait instability in the subacute and chronic phase after a cerebral infarction as well as chronic brain injury after tumor removal, by focusing on postural impairment and gait ataxia, with the use of robotic overground ambulation. Treatments such as virtual reality, biofeedback, and postural stability training have shown some promise to treat ataxia, but specific efficacy needs to be further investigated (Marquer, 2014). Santos et al looked at therapist-assisted gait training versus bodyweight supported robotic-assisted gait training, which concluded that one was not better than the other (Santos 2018). No current studies have looked at the efficacy of robotic-assisted overground gait training without body weight support when not done in the intensive (5d/wk) setting.</div></div><div><h3>Design</h3><div>This is a 2-subject qualitative case study. There was no follow-up after discharge.</div></div><div><h3>Setting</h3><div>Outpatient neurological physical therapy.</div></div><div><h3>Participants</h3><div>Two patients with subacute cerebral infarction and chronic brain injury participated in this observational study.</div></div><div><h3>Interventions</h3><div>Both patients participated in outpatient neurological physical therapy. Over the span of 12 weeks, patients underwent an Ekso training program that included 10 sessions walking with decreasing assistance levels followed by overground ambulation between 100 and 200 feet each session.</div></div><div><h3>Main Outcome Measures</h3><div>Ataxia deficits were quantified by ataxia scores on the scale for the assessment and rating of ataxia (SARA), performed at every 8th to 10th visit. Standing balance and gait were also assessed through the Berg Balance Scale (BBS), Six-Minute Walk Test (6MWT), and the Ten Meter Walk Test (10MWT).</div></div><div><h3>Results</h3><div>In the subacute and chronic phase, patients showed severe ataxia through the use of the SARA. Subject 2 was formally assessed and scored 21 of 50. Both subjects were initially nonambulatory, or required maximum assistance to stand and walk. After 12-weeks between the start of treatment with the exoskeleton and the re-evaluation of patients, the patients demonstrated meaningful improvement on the BBS, 6MWT, and 10MWT. Subject 1 improved his BBS from 16 of 56 to 23 of 56, meeting MDC of 4 points. Subject 2 did not meet MDC for the BBS (3-point improvement). However, subject 2 did increase 6MWT distance from 0 feet at initial evaluation to 198 feet. Both subjects discharged as household ambulators. SARA scores remained unchanged.</div></div><div><h3>Conclusions</h3><div>Although gait training with robotics for ataxia has promising preliminary results to decrease fall risk, future studies are needed to investigate efficacy of this treatment.</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 e27"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761263","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}