Archives of physical medicine and rehabilitation最新文献

{"title":"Overground robotic exoskeleton gait training in people with incomplete spinal cord injury during inpatient rehabilitation - a randomized control trial.","authors":"Chad Swank, Jaime Gillespie, Dannae Arnold, Lindsey Wynne, Monica Bennett, Faith Meza, Christa Ochoa, Librada Callender, Seema Sikka, Simon Driver","doi":"10.1016/j.apmr.2025.04.015","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.04.015","url":null,"abstract":"<p><strong>Objective: </strong>To examine the efficacy of a stakeholder-informed overground robotic exoskeleton (ORE) intervention to improve walking function after spinal cord injury (SCI) compared to usual care gait training.</p><p><strong>Design: </strong>Randomized Controlled Trial.</p><p><strong>Setting: </strong>Inpatient Rehabilitation Facility.</p><p><strong>Participants: </strong>Patients with subacute incomplete SCI.</p><p><strong>Interventions: </strong>ORE compared to usual care gait training approaches including body-weight support treadmill training and traditional overground modalities.</p><p><strong>Main outcome measures: </strong>Our primary outcome was walking performance defined by function [Walking Index for Spinal Cord Injury-Revised (WISCI-II)] and gait speed [10-meter walk test (10MWT)]. Secondary outcomes were functional independence [Spinal Cord Independence Measure (SCIM) and CARE Tool] and patient-reported outcomes of pain, fatigue, spasticity, depression, anxiety, and quality of life.</p><p><strong>Results: </strong>Patients (n=106; aged=51.5±18.5 years; male=78.3%; white=65.1%) were tetraplegia (56.6%) and ASIA Impairment Scale (AIS) B (17.9%), AIS C (28.3%), and AIS D (53.8%). Although improvement was observed in both the ORE and usual care groups across WISCI-II, 10MWT, and SCIM measures (all P<.001), there were no significant differences between ORE and usual care gait training on primary and secondary outcomes. Injury severity distinctions were observed for AIS C where the ORE group improved in WISCI-II and SCIM (P=.008 and P <.001, respectively) and the usual care group improved in SCIM (P=.002) only. For AIS D, both groups improved in the WISCI-II, 10MWT, and SCIM (all P<.001). Moderate effects sizes between ORE and usual care gait training were detected for transfer and walking CARE Tool items for people with AIS C injuries.</p><p><strong>Conclusion: </strong>Corollary to our overall equivalence findings between ORE and usual care gait training, ORE may be a more appropriate gait training intervention for patients with AIS C to promote recovery of walking function during inpatient rehabilitation.</p><p><strong>Clinical trial registration number: </strong>NCT04781621.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966141","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":"Transdisciplinary Approaches for Preserving Shoulder Health in Children and Adults with Spinal Cord Injury/Dysfunction","authors":"Brooke Slavens ,&nbsp;Amee Seitz ,&nbsp;Carrie Peterson ,&nbsp;Kathy Zebracki ,&nbsp;Alyssa Schnorenberg ,&nbsp;Karin Goodfriend ,&nbsp;Chris White ,&nbsp;Sergey Tarima ,&nbsp;Jonathan Samet ,&nbsp;Mark England ,&nbsp;Shubhra Mukherjee ,&nbsp;Lawrence Vogel","doi":"10.1016/j.apmr.2025.03.027","DOIUrl":"10.1016/j.apmr.2025.03.027","url":null,"abstract":"<div><div>Manual wheelchair mobility places high demands on the upper extremity, often leading to shoulder pain and injuries. Despite existing clinical practice guidelines for upper limb preservation following spinal cord injury/dysfunction (SCI/D), most still experience shoulder pain. These guidelines are applied to children with SCI/D without sufficient evidence of effectiveness over their lifespan. Individuals with pediatric-onset SCI/D live longer with secondary health conditions than those with adult-onset SCI, making it crucial to understand the relationship between shoulder function, pain, and pathology across ages. We are therefore investigating the relationship between pediatric-onset and adult-onset SCI/D manual wheelchair propulsion and their association with shoulder pain and pathology. Together our team is exploring innovative, transdisciplinary strategies to enhance shoulder health and function, leveraging insights from engineering, physiatry, radiology, behavioral science, and data analytics. We are working together to conduct a mixed-methods study integrating quantitative assessments of shoulder function and rotator cuff integrity, and qualitative insights from individuals with SCI/D. Our team is also determining the effects of age at onset and movement variability on rotator cuff and bony forces using personalized musculoskeletal simulations. Results suggest age of onset significantly affects shoulder dynamics and tendon integrity with decreased variability linked to increased shoulder pain and pathology. These findings will ultimately be used to develop age-appropriate rehabilitation guidelines, improving functional independence, participation, and quality of life for individuals with SCI/D. Our transdisciplinary approach is crucial for solving the multifactorial issue of alleviating shoulder dysfunction in manual wheelchair users across the lifespan to develop lasting rehabilitation impacts.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 5","pages":"Page e7"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143887661","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 Central Research Infrastructure that Supports Interdisciplinary Clinical Research and the Adoption of Evidence-Based Practices in the Healthcare Settings","authors":"Henry Hrdlicka,&nbsp;Pete Grevelding,&nbsp;David Rosenblum,&nbsp;Amanda Meyer,&nbsp;Lorraine Cullen,&nbsp;Roslyn Gilhuly,&nbsp;Diana Pernigotti,&nbsp;John Corbett,&nbsp;Socheata Morley,&nbsp;Emily Meise,&nbsp;Raquel Conklin","doi":"10.1016/j.apmr.2025.03.008","DOIUrl":"10.1016/j.apmr.2025.03.008","url":null,"abstract":"<div><div>Healthcare professionals in non-academic settings, at all levels of training and experience, have the ability to identify gaps in knowledge, develop novel research ideas, and adapt known protocols to meet patient needs. However, acting upon these ideas is often daunting, involving hours of discretionary time and effort. To address this, Gaylord Specialty Healthcare invested in the development of a centralized research infrastructure–The Milne Institute for Healthcare Innovation. The Milne Institute supports Gaylord's healthcare professionals in conducting clinical research, evidence-based projects (EBPs), and quality initiatives (QIs) to improve patient care and outcomes. To offset the extraclinical nature of research, the Milne Institute's fulltime research staff not only mentor, educate, and guide Gaylord's healthcare professionals, but they also assist them through all project phases, including: idea development; study design; IRB application preparation; participant enrollment; data collection and analysis; and preparation and submission of conference abstracts and manuscripts. Since 2020, this emphasis has increased Gaylord's annual average number of IRB-approved research projects (from 7-to-24), accepted conference submissions (from 4-to-10), and accepted manuscripts (from 0-to-3). Further, this investment has resulted in a broader culture of innovation, with 52 healthcare professionals, representing 14 different departments, currently acting as a co-investigator on one or more IRB-approved research studies, with even more staff supporting research, QIs, and EBPs in other ways. By adopting a centralized research infrastructure, a culture of research and innovation can be created. This allows healthcare professionals to further engage in meaningful initiatives and improve patient outcomes through the development of new EBPs.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 5","pages":"Page e2"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143887525","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":"Characterization, Outcomes, and Time to Event Predictors of Urinary Tract Infections Acquired During Postacute Stroke Inpatient Rehabilitation: A Comprehensive Cohort Study","authors":"Alejandro García-Rudolph PhD ,&nbsp;Sergiu Albu PhD ,&nbsp;Mark Andrew Wright MSc ,&nbsp;Maria del Mar Laya MD ,&nbsp;Claudia Teixido MD ,&nbsp;Eloy Opisso PhD ,&nbsp;Gunnar Cedersund PhD ,&nbsp;Montserrat Bernabeu MD","doi":"10.1016/j.apmr.2024.10.007","DOIUrl":"10.1016/j.apmr.2024.10.007","url":null,"abstract":"<div><h3>Objectives</h3><div>To (1) compare baseline clinical and demographic characteristics of postacute stroke inpatients who were diagnosed with first-time urinary tract infection (UTI) versus inpatients who were not; (2) compare rehabilitation outcomes between both groups; and (3) examine associations between time to UTI event and risk factors.</div></div><div><h3>Design</h3><div>Retrospective observational cohort study.</div></div><div><h3>Setting</h3><div>Institution for inpatient neurologic rehabilitation.</div></div><div><h3>Participants</h3><div>Inpatients (n=1683) admitted within 3 months poststroke to a rehabilitation facility between 2005 and 2023.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Functional independence measure (FIM), functional ambulation categories (FACs) at admission. Cox proportional hazard models analyzed the association between UTI event timing and risk factors.</div></div><div><h3>Results</h3><div>Of the (n=1683) included patients, 196 (11.6%) experienced a UTI. In 32.1% of cases, the UTI occurred during the first week after admission to rehabilitation and 47.9% of UTIs occurred during the first 2 weeks. The median (interquartile range) time to UTI was 16 (5-37) days since admission. Most common germs were <em>Escherichia coli</em> (40.5%), <em>Klebsiella pneumoniae</em> (23.7%), and <em>Pseudomonas aeruginosa</em> (6.4%). Patients who acquired a UTI had older age, higher stroke severity, higher proportion of dysphagia, hypertension, neglect, bilateral affectation, atrial fibrillation, hemiplegia, lower levels of functional independence, and lower FAC. We identified no differences in gender, type of stroke (ischemic or hemorrhagic), time to admission, aphasia, diabetes, dyslipidemia, chronic obstructive pulmonary disease, dominant side affected, and educational level between both groups. Patients with UTI presented significantly poorer rehabilitation outcomes including lower discharge FIM and FAC, larger length of stay, lower FIM efficiency, and decreased FIM effectiveness.</div><div>Multivariable Cox proportional hazards identified hypertension HR=1.60 (1.13-2.27), admission FIM HR=0.98 (0.97-0.99), admission body mass index HR=0.96 (0.93-0.99), and admitted with catheter HR=1.80 (1.22-2.64) as significant predictors of time to first UTI event (Concordance-index=0.754).</div></div><div><h3>Conclusions</h3><div>UTIs identification, characterization, and predictive factors can support postacute stroke mitigation strategies to minimize UTI-related complications and optimize rehabilitation outcomes.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 5","pages":"Pages 729-737"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567244","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":"The 24-Hour Physical Activities in Adults With Cerebral Palsy and Their Adherence to the 24-Hour Movement Guideline","authors":"Ilse Margot van Rijssen Msc ,&nbsp;Jan Willem Gorter MD, PhD ,&nbsp;Johanna Maria Augusta Visser-Meily MD, PhD ,&nbsp;Manin Konijnenbelt MD ,&nbsp;Marieke van Driel Msc ,&nbsp;Mandy Geertruda Cornelia Carina van Drunen Msc ,&nbsp;Olaf Verschuren PhD","doi":"10.1016/j.apmr.2024.12.021","DOIUrl":"10.1016/j.apmr.2024.12.021","url":null,"abstract":"<div><h3>Objective</h3><div>To describe 24-hour physical activities (sleep and physical activity) in adults with cerebral palsy (CP), explore potential influencing factors, and compare 24-hour physical activities with controls.</div></div><div><h3>Design</h3><div>Cross-sectional, observational internet study involving adults with CP and a convenience sample of adults without CP.</div></div><div><h3>Setting</h3><div>Individuals residing in the Netherlands.</div></div><div><h3>Participants</h3><div>A total of 110 adults with CP (median age: 42, range: 28-77 years; 64 [58%] ambulant; 40% men) and 89 adult controls (median age; 43, range: 18-78 years; 29% men).</div></div><div><h3>Main Outcome Measures</h3><div>Sleep quantity and quality measured by the Pittsburgh Sleep Quality Index, physical activity measured using the International Physical Activity Questionnaire- Short Form, and health status using the 5-level EuroQol-5D.</div></div><div><h3>Results</h3><div>Most recurrent sleep problems for adults with CP included falling asleep, waking up, needing the toilet, having nightmares, and experiencing pain during the night. Sleep quality was significantly worse for adults with CP than controls. A total of 64% of adults with CP met the physical activity guidelines. Total physical activity was similar between adults with CP who are ambulatory and controls. A total of 44% of adults with CP, compared with 51% controls, met both sleep and physical activity guidelines. No factors influencing the 24-hour activities were found for level of severity, age, sex, pain/discomfort, and anxiety/depression.</div></div><div><h3>Conclusions</h3><div>Given the prevalence of worse sleep quality and modest adherence to the 24-hour movement guideline, this study emphasizes the importance for clinicians to assess problems in physical activities during clinical encounters with adults with CP.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 5","pages":"Pages 696-703"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969335","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":"Protecting Your Health and Brain Against Climate Change: An Information Page for Older Adults","authors":"Patricia C. Heyn PhD, FGSA, FACRM,&nbsp;Elizabeth A. Terhune MS,&nbsp;Keshav Godha MD,&nbsp;Mark A. Hirsch PhD, FACRM, FPRD","doi":"10.1016/j.apmr.2025.01.418","DOIUrl":"10.1016/j.apmr.2025.01.418","url":null,"abstract":"","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 5","pages":"Pages 813-816"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363439","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":"Provider Experiences with Integrative Medical Group Visits for Chronic Pain","authors":"Mary Jackson ,&nbsp;Paula Gardiner ,&nbsp;Jennifer Leeman ,&nbsp;Isabel Roth","doi":"10.1016/j.apmr.2025.03.033","DOIUrl":"10.1016/j.apmr.2025.03.033","url":null,"abstract":"<div><h3>Purpose</h3><div>The well-being of healthcare teams is an important consideration when seeking to improve patient experience and quality of care. Prior studies have found that changes to working conditions are most effective to improve provider well-being. Integrative Medical Group Visits (IMGVs) modify working conditions in ways that may impact provider well-being. However, little is known about healthcare teams' experience with the implementation and maintenance of IMGVs in clinical settings.</div></div><div><h3>Method</h3><div>Interviews were conducted via Zoom and telephone with 21 clinicians, administrators, and staff from safety-net healthcare settings throughout the country who have implemented IMGVs for patients with chronic pain. To be considered an IMGV, patients received care concurrently by a licensed clinician who documented the visit, patients interacted, and clinicians provided integrative healthcare in the form of mind-body practice. Interviews included questions about provider experience, well-being, and satisfaction with the IMGV model. Interviews were recorded, transcribed, and coded using thematic content analysis by a team of trained qualitative researchers.</div></div><div><h3>Results</h3><div>The authors identified four themes describing how IMGV positively affected provider well-being: horizontal power dynamic, collaboration with an interprofessional team, guideline-concordant care, and enhanced meaning and purpose. An additional fifth theme identified organizational supports that directly impact provider well-being during IMGV delivery.</div></div><div><h3>Conclusion</h3><div>The current study was the first to use interviews from healthcare teams who have implemented IMGV to assess their experience and understand the effect on well-being. The themes identified warrant further investigation into IMGVs as a strategy to promote provider well-being and mitigate aspects of burnout.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 5","pages":"Page e9"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143887786","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":"Rehabilitation & Engineering Center for Optimizing Veteran Engagement & Reintegration (RECOVER): Transdisciplinary Collaborations to Drive Change in Participation in Veterans","authors":"Tonya Rich ,&nbsp;Sara Koehler-McNicholas ,&nbsp;John Looft ,&nbsp;Erin Krebs ,&nbsp;Andrew Hansen","doi":"10.1016/j.apmr.2025.03.019","DOIUrl":"10.1016/j.apmr.2025.03.019","url":null,"abstract":"<div><div>The Rehabilitation &amp; Engineering Center for Optimizing Veteran Engagement &amp; Reintegration (RECOVER) is a newly funded VA Rehabilitation Research &amp; Development Center where our mission is to maximize Veteran participation in important lifelong roles and activities through development, evaluation, and clinical translation of practical rehabilitation interventions and technologies. This work is being conducted in Veterans with amputation or spinal cord injuries and disorders. Our team consists of transdisciplinary rehabilitation researchers and Minneapolis VA clinicians, allowing for the unique conceptualization of participation and clinically relevant approaches to our projects. Our team conducts research into the barriers and facilitators of participation in our studied populations. Our studies are now being designed for longitudinal follow up of participation outcomes. The team uses our research to inform the design of new rehabilitation interventions. Identifying barriers/promoters of participation, paired with a user-centered approach, guides medical device innovation where we seek stakeholder input (e.g., end user, clinicians, and industry partners) at all phases of device development. Using this approach, we have licensed 6 technologies to industry partners supporting Veteran needs for innovation in skin care, novel prosthesis components, and prosthesis management. Within RECOVER, we now have a Veteran &amp; Caregiver Engagement Panel for additional stakeholder feedback throughout the research process. Finally, RECOVER supports future VA rehabilitation researchers through mentorship and training. Taken together, the work of RECOVER is intended to advance our understanding and interventions to support participation in desired activities and roles for Veterans with disabilities and contribute to the field of rehabilitation research.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 5","pages":"Page e5"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143887912","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":"The WeeBot: Development of a Unique Powered Mobility Device for Very Young Infants through Transdisciplinary Collaboration","authors":"Sharon Stansfield,&nbsp;Carole Dennis","doi":"10.1016/j.apmr.2025.03.023","DOIUrl":"10.1016/j.apmr.2025.03.023","url":null,"abstract":"<div><div>In this presentation we will discuss the transdisciplinary research approach used to develop a powered mobility device for infants and why collaborations between technologist and clinicians should start early, and on the clinical side. The WeeBot is a powered mobility device shown to provide independent, hands-free, and self-directed movement to infants as young as 6 months old. The control method is innovative: The device moves in the direction that the child leans, making it a more intuitive device than anything currently available. Additional safety features reduce the risks inherent in providing powered mobility to infants this young. The origin of the WeeBot as a research project began with a collaboration between a pediatric Occupational Therapist whose experience in early intervention provided the unsolved problem Roboticist with an interest in solving real world problems. Providing mobility is now viewed as a beneficial aspect of therapy, but the general approach is \"movement for movements sake\". The WeeBot team which had added a Pediatric Physical Therapist and Development Psychologist, believed that movement with purpose was the key to gains in future milestones. Current technologies struggle to provide this – most infants can't fully control devices that use joysticks/switches. The technologist understanding the problem but not bound by disciplinary history, could provide a unique perspective on the a solution and hence the WeeBot came to be. A start-up company, Assistance in Motion, founded by the core of the research team is now working to commercialize and make this device available to clinicians and parents.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 5","pages":"Page e6"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143887916","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":"Prevalence, Trajectory, and Predictors of Poststroke Fatigue in Older Adults","authors":"Hongmei Huang MD ,&nbsp;Mengxia Lu MD ,&nbsp;Jinghui Zhong MD ,&nbsp;Yingjie Xu MD ,&nbsp;Yiran Dong MD ,&nbsp;Xinfeng Liu MD, PhD ,&nbsp;Wen Sun MD, PhD","doi":"10.1016/j.apmr.2024.11.012","DOIUrl":"10.1016/j.apmr.2024.11.012","url":null,"abstract":"<div><div><strong>Objective:</strong> To explore the prevalence, trajectories, and predictors of poststroke fatigue in older adults after a first ischemic stroke.</div><div><strong>Design:</strong> A longitudinal observational cohort study.</div><div><strong>Setting:</strong> Two hospitals.</div><div><strong>Participants:</strong> A total of 381 patients aged ≥65 years with their first ischemic stroke were included. The mean (standard deviation) age was 71.1 (4.27) years, with 96 patients (25.2%) being women and 285 (74.8%) being men.</div><div><strong>Interventions:</strong> Not applicable.</div><div><strong>Main Outcome Measures:</strong> Patients were assessed using the Fatigue Severity Scale at admission, 3 months, and 12 months. Growth mixture models were used to identify distinct fatigue trajectories, and baseline variables were analyzed to determine their association with these trajectories.</div><div><strong>Results:</strong> The prevalence of clinical fatigue was 39.11%, 33.33%, and 22.31% at admission, 3 months, and 12 months, respectively. Five distinct fatigue trajectories were identified: persistently low fatigue (class 1, 49.1%), persistently high fatigue (class 2, 21.5%), initial high but early decreasing fatigue (class 3, 15.0%), initial high but late decreasing fatigue (class 4, 8.7%), and increasing-then-decreasing fatigue (class 5, 5.8%). Multinomial logistic regression analysis revealed that several factors were significantly associated with high and persistent fatigue (class 2), including older age, lower social support, decreased physical activity, higher depression and anxiety scores, cognitive impairment, and greater stroke severity.</div><div><strong>Conclusions:</strong> These findings indicate significant variability in the progression of fatigue among stroke survivors. Further research is necessary to determine the outcomes linked to these fatigue trajectory subgroups and to identify the most effective treatment strategies tailored to each specific subgroup.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 5","pages":"Pages 704-712"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142778733","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}