Archives of physical medicine and rehabilitation最新文献

{"title":"Archives I/EP Guidelines","authors":"","doi":"10.1016/S0003-9993(25)00895-0","DOIUrl":"10.1016/S0003-9993(25)00895-0","url":null,"abstract":"","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 10","pages":"Pages 1626-1628"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183893","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":"Mapping the Challenges and Facilitators Faced by Orthotists, Physiotherapists, and Prosthetists to Integrating Non-3D Gait Evaluation Into Routine Practice: A Scoping Review of Key Concepts and Knowledge Gaps","authors":"Julie Reay MSc,&nbsp;Malcolm H. Granat PhD,&nbsp;Sean Donald PhD,&nbsp;Richard K. Jones PhD","doi":"10.1016/j.apmr.2025.03.042","DOIUrl":"10.1016/j.apmr.2025.03.042","url":null,"abstract":"<div><h3>Objective</h3><div>To systematically map the existing literature on the challenges and facilitators associated with integrating non-3D gait evaluation into routine clinical practice by orthotists, physiotherapists, and prosthetists across diverse settings and contexts, while identifying gaps in the evidence base related to these challenges and facilitators.</div></div><div><h3>Data Sources</h3><div>Following PRISMA-ScR guidelines, we searched databases from 1980 to December 2024 (CINAHL, OVID [including APA PSYCH], PEDRO, and WEB OF SCIENCE—ALL DATABASES [including MEDLINE]). We also carried out secondary searching through reference lists and Google Scholar.</div></div><div><h3>Study Selection</h3><div>Two authors separately screened 100 sources for calibration. One author screened the remaining sources and referred ambiguous sources to 2 others. Included sources studied challenges and facilitators to non-3D gait evaluation.</div></div><div><h3>Data Extraction</h3><div>Two authors developed and piloted an Excel data extraction form using 20 sources. Thereafter, one author extracted data, spot-checked by a second author.</div></div><div><h3>Data Synthesis</h3><div>We screened 11,641 sources, selecting 11 for inclusion. Ten focused solely on physiotherapy, one examined physiotherapy and prosthetics, and none addressed orthotics.</div></div><div><h3>Conclusions</h3><div>This scoping review examines challenges and facilitators to the adoption of non-3D gait evaluation methods in orthotics, physiotherapy, and prosthetics. Despite benefits, these methods are underused because of clinician awareness, confidence, experience, motivation, environmental constraints, resource limitations (eg, cost), and time pressures. Gait evaluation methods may also be difficult to use, unrealistic, or lack meaningful data. Clearer guidelines, targeted education, and health care provider support are essential. Improving the usability of gait evaluation methods and their integration into clinical practice is critical. Research gaps in prosthetics, orthotics, and specific gait evaluation methods highlight the need for further investigation to enhance training and inform policy adjustments, improving patient outcomes. Future research should investigate clinician perspectives on specific gait evaluation methods, such as video vector and standardized observational gait assessments, across specialties and their different specialisms.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 10","pages":"Pages 1575-1593"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750874","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":"Educational Achievements, Labor Market Attachment, and Family Establishment in Children of Parents or Siblings With Acquired Brain or Spinal Cord Injury: A Nationwide Register Study","authors":"Mia Moth Wolffbrandt MSc ,&nbsp;Marie Kruse PhD ,&nbsp;Fin Biering-Sørensen MD, DMSc ,&nbsp;Trine Schow PhD ,&nbsp;Anne Norup PhD","doi":"10.1016/j.apmr.2025.06.004","DOIUrl":"10.1016/j.apmr.2025.06.004","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate long-term socioeconomic consequences on children experiencing acquired brain injury (ABI) or spinal cord injury (SCI) in a parent or sibling.</div></div><div><h3>Design</h3><div>Nationwide register-based study.</div></div><div><h3>Setting</h3><div>Through Danish national population register data, we identified an exposed cohort of children and a nonexposed reference population born in Denmark between 1977 and 2006.</div></div><div><h3>Participants</h3><div>The study population (N=111,405) comprised children who experienced familial injury before the age of 18, divided into 4 groups: (1) children of a parent with ABI (n=74,227); (2) children with a sibling with ABI (n=32,664); (3) children of a parent with SCI (n=3557); and (4) children with a sibling with SCI (n=957). They were compared with the reference population (n=2,180,207) using linear and logistic regression models.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>(1) Lower secondary school achievements and upper secondary educational attainment; (2) labor market attachment; and (3) family establishment and disruption.</div></div><div><h3>Results</h3><div>Children affected by familial injury achieved significantly lower grade point average in lower secondary school, with the highest adjusted mean difference in group B (–0.44 [–0.47 to –0.41]). Children had a lower probability of commencing and completing upper secondary education, with the lowest adjusted odds ratio for these outcomes in group D (0.47 [0.25-0.90]) and group B (0.48 [0.46-0.49]), respectively. In addition, these children had a higher probability of long-term sick leave and disability pension, lower probability of establishing a family, and higher risk of divorce by age 26.</div></div><div><h3>Conclusions</h3><div>This study documented that children exposed to familial injury were significantly affected across several socioeconomic parameters. These findings highlight the risk of social inequality and emphasize the need for supportive interventions to safeguard their social security.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 10","pages":"Pages 1539-1547"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301019","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":"Opioid and Benzodiazepine Use Among a Population-Based Cohort of Adults With Chronic Spinal Cord Injury: Correspondence Between Self-report and State Prescription Monitoring Data","authors":"Nicole D. DiPiro PhD ,&nbsp;David Murday PhD ,&nbsp;Samantha Donnelly MSPH ,&nbsp;James S. Krause PhD","doi":"10.1016/j.apmr.2025.04.017","DOIUrl":"10.1016/j.apmr.2025.04.017","url":null,"abstract":"<div><h3>Objective</h3><div><span>To compare self-reported opioid and benzodiazepine use to rates of prescriptions dispensed among persons with chronic </span>spinal cord injury (SCI), to evaluate the extent of potential underreporting.</div></div><div><h3>Design</h3><div>Cross-sectional self-report assessment (SRA) and retrospective review of prescription monitoring program (PMP) data.</div></div><div><h3>Setting</h3><div>Community dwelling adults in the Southeastern United States.</div></div><div><h3>Participants</h3><div>In total, 345 adults (N=345) (&gt;18y) with chronic (&gt;1y) SCI who were identified through a state population-based SCI registry and who responded to SRA opioid use questions in a parent study.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Self-reported prescription pain reliever, sedative, and tranquilizer use, and prescriptions dispensed based on PMP data. We compared self-reported past year utilization with records of dispensed prescriptions to assess potential underreporting, defined as reporting “never” using either opioids (pain relievers) or benzodiazepines (sedatives/tranquilizers) in the past year, but having had 2 or more respective prescriptions dispensed in the year before the SRA.</div></div><div><h3>Results</h3><div><span>Among the 345 participants who responded to the opioid use questions, we were able to match 252 to the PMP; reasons for not matching include not filling a controlled substance prescription in-state, either because of lack of reportable prescriptions or the prescription was dispensed out of state. Evaluating each </span>prescription medication<span><span><span><span>, rates of underreporting for each drug ranged from 0.4% to 4% for hydrocodone, </span>oxycodone<span>, tramadol, codeine, </span></span>buprenorphine<span>, and hydromorphone. There was 100% agreement in the self-reported use and dispensed records for </span></span>fentanyl<span>, oxymorphone<span>, meperidine, and methadone. The rates of potential underreporting of benzodiazepines were &lt;2%. Overall, of the 252 matched individuals, 11% underreported opioids (2 or more prescriptions dispensed) and 1% underreported benzodiazepines.</span></span></span></div></div><div><h3>Conclusions</h3><div>The findings suggest considerable agreement between self-reported and dispensed prescription medication use, and only minimal potential underreporting of select opioids and benzodiazepines, confirming the appropriateness of self-report of these prescription medications with people with SCI.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 10","pages":"Pages 1490-1497"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075751","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":"Performance-Based Functional Outcomes 12 and 24 Months After Transfemoral Osseointegration in Service Members With Traumatic Unilateral and Bilateral Lower Limb Loss","authors":"Brad D. Hendershot PhD ,&nbsp;Morgan Armes PTA ,&nbsp;Binni Khatri PT, DPT ,&nbsp;Alison L. Pruziner PT, DPT ,&nbsp;Barri L. Schnall MPT ,&nbsp;Meghan Tullos PTA ,&nbsp;Christopher L. Dearth PhD ,&nbsp;Benjamin K. Potter MD ,&nbsp;Jonathan A. Forsberg MD, PhD","doi":"10.1016/j.apmr.2025.04.021","DOIUrl":"10.1016/j.apmr.2025.04.021","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate functional outcomes at 12 months and 24 months after transfemoral osseointegration (OI) using established performance-based assessments.</div></div><div><h3>Design</h3><div>Pre-post observational single cohort.</div></div><div><h3>Setting</h3><div>Military treatment facility.</div></div><div><h3>Participants</h3><div>Forty-seven (N=47) service members (mean age ± SD, 38±9y) with traumatic unilateral (n=22) and bilateral (n=25) lower limb loss. Before OI, n=2 unilateral and n=7 bilateral were not ambulatory on full-length prostheses.</div></div><div><h3>Interventions</h3><div>Transfemoral OI (2-stage threaded implant).</div></div><div><h3>Main Outcome Measures</h3><div>Six-Minute Walk Test (6MWT), timed Up and Go (TUG), 4 Square Step Test (4SST), (Bilateral) Amputee Mobility Predictor ([B]AMP), and Comprehensive High-level Activity Mobility Predictor (CHAMP).</div></div><div><h3>Results</h3><div>For both unilateral and bilateral cohorts, the median performance-based functional outcomes were similar at 12 months and 24 months after vs before OI: 6MWT (373 and 385 m vs 417 m; <em>p</em>&gt;.31), TUG (9.7 and 9.6s vs 9.8s; <em>p</em>&gt;.53), 4SST (9.5 and 10.6s vs 10.8s; <em>p</em>&gt;.11), and CHAMP (12.6 and 10.6 vs 12.3; <em>p</em>&gt;.44). Median BAMP scores were greater at 12 months (<em>p</em>=.029) and 24 months (<em>p</em>=.014) after vs before OI among the bilateral cohort (30 and 35 vs 16); median AMP scores were similar (<em>p</em>&gt;.10) among the unilateral cohort across time points (39 and 43 vs 40). Among the 9 participants not ambulating with full-length prostheses before OI, 8 became capable of ambulation on full-length prostheses 24 months after OI.</div></div><div><h3>Conclusions</h3><div>While a lack of improvement in these particular outcomes is not exclusively suboptimal, particularly considering the median scores at baseline reported here generally exceeded those of other cohorts (both before and sometimes even after OI), these findings contrast with previous self-reported improvements in function after OI among service members with traumatic lower limb loss. As such, these data seemingly emphasize the importance of a comprehensive approach with both subjective and objective (multidisciplinary) outcomes to more fully characterize OI, particularly within unique patient populations like young service members with traumatic lower limb loss.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 10","pages":"Pages 1557-1564"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061986","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":"Predictors of Response to Cognitive Behavioral Therapy for Sleep Disturbance and Fatigue After Acquired Brain Injury: A Secondary Analysis of a Randomized Controlled Trial","authors":"Lucy Ymer DPsych ,&nbsp;Adam McKay PhD ,&nbsp;Dana Wong PhD ,&nbsp;Kate Frencham PhD ,&nbsp;Natalie Grima DPsych ,&nbsp;Monique Roper DPsych ,&nbsp;Jennie Ponsford PhD","doi":"10.1016/j.apmr.2025.03.040","DOIUrl":"10.1016/j.apmr.2025.03.040","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate factors associated with response to cognitive behavioral therapy<span> for sleep disturbance and fatigue (CBT-SF) in individuals with acquired brain injury.</span></div></div><div><h3>Design</h3><div>Participants took part in a parent randomized controlled trial<span> comparing an 8-week CBT-SF program with a health education control, face-to-face or via videoconferencing, and adapted for cognitive impairments. They were assessed at baseline, posttreatment, 2 months posttreatment, and 4 months posttreatment. A secondary analysis was conducted to identify which demographic, injury-related, neuropsychological, and pretreatment variables, as well as mode of treatment delivery, were associated with response to CBT-SF.</span></div></div><div><h3>Setting</h3><div>Community dwelling.</div></div><div><h3>Participants</h3><div>Eighty-six participants (<em>N</em><span>=86) with a traumatic brain injury (TBI) or stroke who received CBT-SF in a parent randomized controlled trial.</span></div></div><div><h3>Interventions</h3><div>CBT-SF.</div></div><div><h3>Main Outcome Measures</h3><div>Pittsburgh Sleep Quality Index and Fatigue Severity Scale.</div></div><div><h3>Results</h3><div>Greater improvements in sleep after CBT-SF were associated with higher baseline sleep disturbance, less time since injury, and telehealth mode of delivery. Larger reductions in fatigue were associated with less time since injury and higher education. Injury type (TBI and stroke) and cognitive variables were not associated with treatment outcomes.</div></div><div><h3>Conclusions</h3><div>These findings highlight that an adapted CBT-SF intervention can be equally effective for individuals with TBI and stroke; however, gains are greater earlier after injury. Although individuals with severe symptoms at baseline show the greatest benefit, the intervention can be effective across a range of symptom presentations.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 10","pages":"Pages 1531-1538"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is Mild Cognitive Impairment (MCI)? A Guide for Patients, Families, and Caregivers","authors":"Patricia C. Heyn PhD, FGSA, FACRM,&nbsp;Monika Gross BFA, M.STAT, M.Am, SAT, M.ATI, MSME/T,&nbsp;Urvashy Gopaul PhD,&nbsp;Elisa Ogawa PhD,&nbsp;Catherine Diaz-Asper PhD,&nbsp;Hannes Devos PhD. PT, DRS, FACRM,&nbsp;Elizabeth A. Terhune MS,&nbsp;J Taylor Harden PhD, RN","doi":"10.1016/j.apmr.2025.05.007","DOIUrl":"10.1016/j.apmr.2025.05.007","url":null,"abstract":"","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 10","pages":"Pages 1621-1625"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ed Board page","authors":"","doi":"10.1016/S0003-9993(25)00883-4","DOIUrl":"10.1016/S0003-9993(25)00883-4","url":null,"abstract":"","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 10","pages":"Page A2"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183652","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 Racial Disparities in Food Access and Their Impact on Body Mass Index Among Individuals With Traumatic Spinal Cord Injury","authors":"Jia Li PhD ,&nbsp;Huacong Wen PhD ,&nbsp;Ceren Yarar-Fisher PT, PhD ,&nbsp;Yuying Chen MD, PhD, MPH","doi":"10.1016/j.apmr.2025.02.013","DOIUrl":"10.1016/j.apmr.2025.02.013","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate racial disparity<span> in food access and its effect on obesity (measured by body mass index<span>, BMI) among individuals with traumatic spinal cord injury (tSCI).</span></span></div></div><div><h3>Design</h3><div>Cross-sectional analysis of data from the U.S. National Spinal Cord Injury Database linked with the United States Department of Agriculture Food Access Research Atlas, examining participants’ residences in low-income, low-access (LILA) areas and their BMI.</div></div><div><h3>Setting</h3><div>Data were collected from U.S. Spinal Cord Injury Model Systems centers, with participants living in various communities.</div></div><div><h3>Participants</h3><div>A final sample of individuals with tSCI (n=4177) was included, selected based on their completion of follow-up assessments between October 2006 and November 2021. Participants were aged &gt;19 years and self-identified as non-Hispanic White, non-Hispanic Black, or Hispanic. Other racial/ethnic groups were excluded because of small sample sizes.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome measure was obesity, defined as BMI ≥30 kg/m². Food access was categorized using the United States Department of Agriculture criteria for LILA tracts.</div></div><div><h3>Results</h3><div>Significant racial disparities in food access were observed, with 21.7% of non-Hispanic Black and 13.9% of Hispanic individuals residing in LILA tracts, compared with 7.9% of non-Hispanic White individuals (<em>P</em>&lt;.05). However, living in a LILA tract was not significantly associated with increased obesity risk (odds ratio, 1.22; 95% confidence interval, 0.97-1.54; <em>P</em>=.09).</div></div><div><h3>Conclusions</h3><div>Our data revealed racial inequity in food access among individuals with tSCI, with minoritized groups being disproportionately affected. However, no significant association was found between food access and obesity. Future studies are needed to explore how food access interacts with other factors affecting health outcomes in this population.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 10","pages":"Pages 1498-1504"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536555","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":"Association of Patient Characteristics With Recovery in Adults With Disorders of Consciousness","authors":"Alison M. Cogan PhD ,&nbsp;Patricia Grady-Dominguez PhD ,&nbsp;Caitlin G. Dobson MS ,&nbsp;Joseph T. Giacino PhD ,&nbsp;Yelena G. Bodien PhD ,&nbsp;Katherine O’Brien PhD ,&nbsp;Jennifer A. Weaver PhD","doi":"10.1016/j.apmr.2025.04.011","DOIUrl":"10.1016/j.apmr.2025.04.011","url":null,"abstract":"<div><h3>Objective</h3><div><span>To describe the characteristics of patients enrolled in disorders of consciousness<span> (DoC) rehabilitation programs and to examine factors associated with improvement beyond measurement error on neurobehavioral function. Outcomes for adults with DoC after severe brain injury<span> are highly variable and difficult to predict. Applying a minimal detectable change (MDC) threshold to change measures can identify help to distinguish true improvement or decline from random fluctuation</span></span></span><em>.</em> We also evaluated whether change in neurobehavioral function during the first 2 weeks of rehabilitation was associated with change between 2 and 4 weeks.</div></div><div><h3>Design</h3><div>Retrospective cohort study. Data were generated as part of standard clinical care.</div></div><div><h3>Setting</h3><div>Postacute inpatient facilities with specialized DoC programs at 2 large, urban health care systems.</div></div><div><h3>Participants</h3><div>Adults with DoC after severe brain injury (N=696).</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measure</h3><div>Improvement beyond measurement error, calculated as the MDC with a 90% confidence interval (9 units) on the Coma Recovery Scale-Revised (CRS-R), using an equal-interval 0-100 unit transformed total measure. The MDC threshold was applied to change in CRS-R total measure from first to last CRS-R administration (up to 60 elapsed).</div></div><div><h3>Results</h3><div>Two-thirds of the sample (n=445) improved beyond the MDC on the CRS-R; 23 participants declined beyond measurement error, and 228 participants changed less than the MDC. Patients with less time elapsed between injury and first CRS-R assessment were more likely to improve beyond the MDC. Change during the first 2 weeks of rehabilitation was not associated with change between 2 and 4 weeks.</div></div><div><h3>Conclusions</h3><div>Our results underscore the importance of measuring change with greater precision for adults with DoC, as within-state change (or lack thereof) could inform rehabilitation treatment decisions about whether interventions are working as intended.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 10","pages":"Pages 1514-1522"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952954","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}