Archives of physical medicine and rehabilitation最新文献

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

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

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

{"title":"Balance Interventions to Improve Upright Balance Control and Balance Confidence in People With Motor-Incomplete Spinal Cord Injury or Disease: A Systematic Review and Meta-analysis","authors":"Natasha L. Benn MPT ,&nbsp;Hope Jervis-Rademeyer PhD ,&nbsp;Wagner H. Souza PhD ,&nbsp;Maureen Pakosh MISt ,&nbsp;Elizabeth L. Inness PhD ,&nbsp;Kristin E. Musselman PhD","doi":"10.1016/j.apmr.2024.07.013","DOIUrl":"10.1016/j.apmr.2024.07.013","url":null,"abstract":"<div><h3>Objectives</h3><div>To assist with clinical decision making, evidence syntheses are needed to demonstrate the efficacy of available interventions and examine the intervention components and dosage parameters. This systematic review and meta-analysis described the efficacy, components and dosage of interventions targeting upright balance control, balance confidence, and/or falls in adults with motor-incomplete spinal cord injury/disease (SCI/D).</div></div><div><h3>Data Sources</h3><div>A search strategy following the population, intervention, control, outcome framework was developed. Six databases were searched: APA PsychInfo, Cumulative Index to Nursing and Allied Health Literature, Embase, Emcare Nursing, Web of Science CC, and Medline.</div></div><div><h3>Study Selection</h3><div>Title, abstract, and full-text screening were conducted by 2 researchers independently. Inclusion criteria included the following: (1) adults with chronic, motor-incomplete SCI/D; (2) physical intervention targeting upright postural control; and (3) clinical and/or biomechanical measures of upright balance control and/or balance confidence and/or documentation of falls.</div></div><div><h3>Data Extraction</h3><div>Participant characteristics, balance intervention details, adverse events, and study results were extracted. The Downs and Black Checklist was used to assess methodological quality. Meta-analyses on pre-post intervention outcomes and a meta-regression of dosage were completed. Grading of Recommendations, Assessment, Development, and Evaluations approach was used to evaluate the quality of the evidence.</div></div><div><h3>Data Synthesis</h3><div>The search returned 1664 unique studies; 26 were included. Methodological quality was moderate to good. Participants were 500 individuals with SCI/D, aged 18-74 years (males: females = 2.4:1). Minor adverse events were reported in 8 studies (eg, muscle soreness and fatigue). Walking interventions and upright balance training with visual feedback had clinically meaningful and significant pooled effects on improving standing balance control. Only walking interventions had a significant pooled effect on improving balance confidence. There were no significant findings on dosage response. Few studies evaluated the effects of balance interventions on the occurrence of falls.</div></div><div><h3>Conclusions</h3><div>Walking interventions and upright balance training with visual feedback had greater effects on upright balance control than conventional physiotherapy; however, the quality of the evidence was very low.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 3","pages":"Pages 444-458"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141900802","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":"Four-Year Trajectories of Symptoms and Quality of Life in Individuals Hospitalized After Mild Traumatic Brain Injury","authors":"Kathleen Cairns BSc ,&nbsp;Simon Beaulieu-Bonneau PhD ,&nbsp;Valérie Jomphe MSc ,&nbsp;Marie-Ève Lamontagne PhD ,&nbsp;Élaine de Guise PhD ,&nbsp;Lynne Moore PhD ,&nbsp;Josée Savard PhD ,&nbsp;Marie-Josée Sirois PhD ,&nbsp;Bonnie Swaine PhD ,&nbsp;Marie-Christine Ouellet PhD","doi":"10.1016/j.apmr.2024.09.005","DOIUrl":"10.1016/j.apmr.2024.09.005","url":null,"abstract":"<div><h3>Objectives</h3><div>To (1) detect distinct trajectories of symptoms and quality of life (QoL) over the first 4 years after mild traumatic brain injury (mTBI); (2) assess the relationship between symptom trajectory membership and QoL trajectory membership; and (3) identify participant characteristics associated with QoL trajectory membership.</div></div><div><h3>Design</h3><div>Prospective longitudinal cohort study. Assessments occurred at 4, 8, 12, 24, 36, and 48 months after mTBI.</div></div><div><h3>Setting</h3><div>Recruitment occurred in Level 1 Trauma Centers; follow-up was completed in the community.</div></div><div><h3>Participants</h3><div>Participants were 143 adults (aged 18-65y) who sustained an mTBI and were hospitalized (≥24h) at a Level 1 Trauma Center.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Fatigue Severity Scale, Hospital Anxiety and Depression Scale, Insomnia Severity Index, Medical Outcomes Study Cognitive Functioning Scale, Quality of Life after Brain Injury questionnaire, presence/absence of headaches or dizziness.</div></div><div><h3>Results</h3><div>Group-based trajectory modeling revealed relatively stable symptom and QoL trajectories over time. Considerable percentages of participants were classified in trajectories of clinically significant symptoms throughout the full follow-up period: 62% for subjective cognitive issues, 54% for fatigue, 44% for anxiety, 43% for insomnia, 27% for depression, 23% for headaches, and 17% for dizziness. Sixty-six percent of participants belonged to trajectories of persistently poor QoL. For all symptoms, trajectories of greater severity were associated with trajectories of poorer QoL. None of the sociodemographic or injury-related variables examined were associated with QoL trajectory membership.</div></div><div><h3>Conclusions</h3><div>A substantial proportion of individuals hospitalized after mTBI experiences clinically significant persistent symptoms ≤4 years after injury, and those with more severe symptoms have poorer QoL. Further research is required to better understand the factors leading to symptom persistence and poor QoL.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 3","pages":"Pages 358-365"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142340049","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":"Association of Calf Circumference, Hand Grip Strength, and Physical Performance With Serious Adverse Events in Individuals With Subacute Stroke Hospitalized for Rehabilitation: An Observational Study","authors":"Takuro Ohtsubo PT ,&nbsp;Masafumi Nozoe PT, PhD ,&nbsp;Masashi Kanai PT, PhD ,&nbsp;Hiroki Kubo PT, PhD ,&nbsp;Katsuhiro Ueno PT, MSc ,&nbsp;Yosuke Morimoto PT, PhD","doi":"10.1016/j.apmr.2024.09.015","DOIUrl":"10.1016/j.apmr.2024.09.015","url":null,"abstract":"<div><h3>Objective</h3><div>To determine whether calf circumference, hand grip strength, and physical performance are linked to the incidence of serious adverse events (SAEs) in patients with subacute stroke.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>Single rehabilitation hospital.</div></div><div><h3>Participants</h3><div>Patients with stroke admitted for rehabilitation hospital.</div></div><div><h3>Intervention</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>The incidence of SAEs, such as death, cardiovascular events including recurrent stroke, and conditions requiring transfer to another hospital for specialized care or immediate treatment for an acute illness during hospitalization.</div></div><div><h3>Results</h3><div>A total of 341 patients (median age: 74y) participated in this study, with 232 patients (68%) exhibiting low-physical performance. In the adjusted model, low-physical performance was significantly associated with SAEs (hazard ratio [HR], 3.01; 95% confidence interval [CI], 1.04-8.68; <em>P</em>=.042). However, low calf circumference (HR, 1.60; 95% CI, 0.76-3.38; <em>P</em>=.219) and low hand grip strength (HR, 0.98; 95% CI, 0.39-2.42; <em>P</em>=.960) did not show an independent association.</div></div><div><h3>Conclusions</h3><div>Low-physical performance was independently associated with the occurrence of SAEs during hospitalization for rehabilitation in patients with subacute stroke.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 3","pages":"Pages 397-403"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387459","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":"Association Between Depressive Symptoms in Spousal Caregivers and Falls in Care Recipients With Disability: A Nationwide Population-Based Cohort Study.","authors":"Rixiang Xu, Dandan Chen, LiJiangshan Hua, Tingyu Mu, Guiyue Ma","doi":"10.1016/j.apmr.2025.02.015","DOIUrl":"10.1016/j.apmr.2025.02.015","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the association between depressive symptoms in spousal caregivers and both fall risk and the frequency of falls requiring medical treatment in care recipients with disabilities.</p><p><strong>Design: </strong>A retrospective cohort study.</p><p><strong>Setting: </strong>Data from the China Health and Retirement Longitudinal Study.</p><p><strong>Participants: </strong>1357 patient-caregiver dyads.</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcome measures: </strong>The incidence of falls and the frequency of falls requiring medical treatment among care recipients.</p><p><strong>Results: </strong>The mean (standard deviation) age of care recipients was 61.6 (9.1) years, and 62.1% of them were women. After adjusting for covariates, it was found that caregiver depressive symptoms were associated with a 32% higher risk of falls (relative risk [RR], 1.32; 95% confidence interval [CI], 1.08-1.61). Moreover, caregivers who exhibited depressive symptoms only at follow-up had a RR of falls requiring medical treatment of 2.74 (95% CI, 1.28-5.88), whereas those who had depressive symptoms at both the baseline and follow-up had a RR of 2.13 (95% CI, 1.19-3.80). The likelihood ratio test showed that grouping depressive symptoms significantly improved the model fit for both fall risk (likelihood ratio [LR] χ²(3)=8.89, P=.031) and falls requiring medical treatment (LR χ²(3)=14.50, P=.002).</p><p><strong>Conclusion: </strong>Caregiver depressive symptoms are significantly associated with an increased risk of falls and a higher frequency of falls requiring medical treatment among care recipients with disabilities. Addressing the mental health of caregivers may help reduce fall-related risks in this population.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539848","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":"Comparison of the Efficacy of 2 Different Botulinum Toxin Injection Techniques in Gastrocnemius Muscle Spasticity in Hemiplegic Patients: A Randomized Double-Blind Controlled Study","authors":"Savaş Karpuz MD,&nbsp;Ramazan Yılmaz MD,&nbsp;Halim Yılmaz MD","doi":"10.1016/j.apmr.2024.09.011","DOIUrl":"10.1016/j.apmr.2024.09.011","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the efficacy of the innervation zone–targeted injection technique (EUROMUSCULUS/USPRM (Ultrasound Study Group of the International Society of Physical and Rehabilitation Medicine) spasticity approach) and the injection technique along the muscle length.</div></div><div><h3>Design</h3><div>A double-blind randomized controlled trial.</div></div><div><h3>Setting</h3><div>Department of rehabilitation medicine of a medical center.</div></div><div><h3>Participants</h3><div>One hundred patients with stroke experiencing ankle plantar flexor spasticity.</div></div><div><h3>Interventions</h3><div>In addition to conventional rehabilitation, eligible patients were randomly assigned to 2 groups. The experimental group was injected with botulinum toxin along the length of the muscle, whereas the control group was injected with the same dose and volume of botulinum toxin 25%-35% proximal to the medial head and 20%-30% proximal to the lateral aspect of the head of the gastrocnemius muscle.</div></div><div><h3>Main Outcome Measures</h3><div>Modified Ashworth scale, modified Tardieu scale, ankle range of motion measurement, and 10-meter walk test were used before and 1 month after injection.</div></div><div><h3>Results</h3><div>The study was completed by 60 participants with a mean age of 59.96±12.15 years. Both injection methods were found to be effective on range of motion, spasticity level, ambulation, and walking speed. There was no statistically significant difference between injection methods.</div></div><div><h3>Conclusions</h3><div>Both injection methods of botulinum toxin A produce similar clinical effects.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 3","pages":"Pages 327-332"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142340037","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":"Outpatient Rehabilitation Utilization After Major Limb Loss in Adults Receiving Care in the Military Health System From 2001 to 2017","authors":"Rebecca N. Schulz MPH ,&nbsp;Kalyn C. Jannace PhD ,&nbsp;Daniel B. Cooper MPH ,&nbsp;Michelle L. Luken DSc ,&nbsp;Alyssa R. Michel BS ,&nbsp;Tawnee L. Sparling MD ,&nbsp;Paul F. Pasquina MD","doi":"10.1016/j.apmr.2024.09.017","DOIUrl":"10.1016/j.apmr.2024.09.017","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate exposures associated with outpatient rehabilitation encounters among Military Health System (MHS) beneficiaries with major limb loss.</div></div><div><h3>Design</h3><div>Retrospective, cohort study.</div></div><div><h3>Setting</h3><div>American military treatment facilities and civilian health care facilities that accept TRICARE benefits.</div></div><div><h3>Participants</h3><div>Adult MHS beneficiaries with major limb amputation(s) acquired between January 2001 and September 2017 (N=5161).</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>This exploratory analysis investigated associations between outpatient rehabilitation care and demographic and amputation characteristics in MHS beneficiaries with major limb loss.</div></div><div><h3>Results</h3><div>Most beneficiaries were aged 55-64 (36%), male (73%) and retirees/dependents (60%) with enlisted sponsor rank (88%) and single limb loss (89%). The active/reserve beneficiaries were younger, majority male, and more likely to be diagnosed with incident behavioral health conditions. Unadjusted negative binomial regression models revealed increased rates of outpatient rehabilitation encounters in active-duty service members (ADSMs) than in retirees/dependents (rate ratio, 10.02; 95% confidence interval, 9.30-10.80). The rate ratios for sex, sponsor rank, limb(s) lost, incident behavioral health condition, incident traumatic brain injury, incident posttraumatic stress disorder, and outpatient care setting were attenuated after stratification by beneficiary category. Enlisted ADSMs had increased rates of outpatient rehabilitation encounter days compared with officers, whereas retirees/dependents with enlisted sponsors had decreased than those with officer sponsors. ADSMs who accessed outpatient care in direct and private care settings demonstrated high rates of outpatient rehabilitation encounters compared with those who only sought care from private care settings (rate ratio, 4.60; 95% confidence interval, 2.95-6.81).</div></div><div><h3>Conclusions</h3><div>This study suggests that MHS beneficiaries with major limb loss use outpatient rehabilitation services differently, based on active/reserve duty or retiree/dependent status. This study is the first of its kind to quantify outpatient rehabilitation utilization for military beneficiaries with all-cause major limb loss and may inform MHS policymakers on the rehabilitation needs for combat- and noncombat-related amputee populations.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 3","pages":"Pages 366-378"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387472","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":"Archives Supplements","authors":"","doi":"10.1016/S0003-9993(25)00516-7","DOIUrl":"10.1016/S0003-9993(25)00516-7","url":null,"abstract":"","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 3","pages":"Pages 477-479"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511167","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}