Archives of physical medicine and rehabilitation最新文献

{"title":"The relationship between physical activity domains by level and illness intrusiveness in people with multiple sclerosis.","authors":"Heather M DelMastro, Aaron P Turner, Kayla E Gomes, Lindsay O Neto, Zaenab Dhari, Elizabeth S Gromisch","doi":"10.1016/j.apmr.2025.09.014","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.09.014","url":null,"abstract":"<p><strong>Objective: </strong>To examine the associations between illness intrusiveness and physical activity level (i.e., time sitting, walking, moderate, and vigorous), and domain-specific physical activity (i.e., work, active transportation, domestic and garden, and recreation), with disability as a mediator, in people with multiple sclerosis (PwMS).</p><p><strong>Design: </strong>Secondary analysis of cross-sectional study.</p><p><strong>Setting: </strong>Community-based comprehensive MS Center.</p><p><strong>Participants: </strong>A total of 183 PwMS with a confirmed MS diagnosis and no recent injuries or relapses in the past 2 months completed a one-time visit. The mean (SD) age was 51.39 (12.15) years, 77% were women, and 90.2% had relapsing MS.</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcome measures: </strong>Physical activity over the past seven days was measured using the International Physical Activity Questionnaire-Long Form (IPAQ-LF), illness intrusiveness was measured using the Illness Intrusiveness Rating Scale (IIRS), and disability was measured using the Patient Determined Disease Steps (PDDS). Individual mediation models were run for each physical activity level, with illness intrusiveness (dependent variable), disability (mediator), and covariates (age, race, gender, disease duration, and high fatigue). Exploratory domain-specific models were then examined.</p><p><strong>Results: </strong>Greater overall vigorous physical activity, specifically recreational, and walking at work were directly associated with lower illness intrusiveness. Increased overall walking, specifically for recreation, as well as overall moderate physical activity, contributed to decreased illness intrusiveness through their effects on disability. More time spent sitting was also indirectly related to higher illness intrusiveness through disability.</p><p><strong>Conclusions: </strong>The findings further elucidate the connections between physical activity and illness intrusiveness, which may help inform future interventional approaches.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228411","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":"Optimal Exercise Modalities and Doses for Alleviating Dyspnea Symptoms and Enhancing Exercise Capacity in Patients With Chronic Obstructive Pulmonary Disease: A Network and Dose-Response Meta-analysis","authors":"Jingyi Xie PhD ,&nbsp;Jindong Guo MD ,&nbsp;Bin Wang PhD","doi":"10.1016/j.apmr.2025.05.001","DOIUrl":"10.1016/j.apmr.2025.05.001","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the optimal exercise modalities and doses for alleviating dyspnea and enhancing exercise capacity in patients with chronic obstructive pulmonary disease (COPD).</div></div><div><h3>Data Sources</h3><div><span>PubMed, Cochrane, </span>Embase, and Web of Science were searched until June 2024.</div></div><div><h3>Study Selection</h3><div>Randomized controlled trials on dyspnea and exercise capacity in patients with COPD were included.</div></div><div><h3>Data Extraction</h3><div>Exercises were compared using a network and dose-response meta-analysis. Two authors independently extracted the data and assessed bias risk.</div></div><div><h3>Data Synthesis</h3><div>The study included 46 randomized controlled trials (2363 participants). Continuous aerobic training<span><span> (mean difference [MD]=55.2; 95% credible interval [CrI], 28.1-84.5; Grading of Recommendations Assessment, Development and Evaluation [GRADE]: Low), interval training (MD=84.5; 95% CrI, 24.6-145; GRADE: Low), Qigong (MD=33.3; 95% CrI, 10.4-58.1; GRADE: Low), and resistance training (MD=41.5; 95% CrI, 7.27-77.7; GRADE: Low) improved 6-minute walk distance (6MWD). Qigong (MD=−8.20; 95% CrI, −15.6 to −1.50; GRADE: Low) and yoga (MD=−28.3; 95% CrI, −48.1 to −8.61; GRADE: Low) showed significant improvements in St. George’s Respiratory Questionnaire (SGRQ). Resistance training (MD=12.1; 95% CrI, 4.62-18.7; GRADE: Low) correlated positively with </span>forced expiratory volume<span> in 1 second (FEV1), while Qigong correlated positively with forced vital capacity<span> (FVC) (MD=0.378; 95% confidence interval, 0.087-0.620; GRADE: Low). Interval training, yoga, resistance training, and Qigong ranked the highest in 6MWD, SGRQ, FEV1, and FVC. The dose-response curve revealed an increasing trend in the effect of exercise intensity on enhancing 6MWD with intensified exercise levels. Regarding SGRQ scores, the optimal effect was observed at an exercise intensity of 620 metabolic equivalent of task (MET)-min/wk (MD=−7.07, 95% CrI, −12.23 to −1.87). The optimal exercise intensity was 350 MET-min/wk for FEV1 (MD=0.44, 95% CrI, 0.09-0.80) and FVC (MD=0.44, 95% CrI, 0.09-0.80).</span></span></span></div></div><div><h3>Conclusions</h3><div>Low quality evidence shows that interval training, yoga, resistance training, and Qigong effectively improved dyspnea and exercise capacity in patients with COPD. Optimal exercise doses vary across outcomes, necessitating personalized adjustments based on health status.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 10","pages":"Pages 1594-1602"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962966","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":"Relationships Between Wheelchair-Provision Time for Hospital Inpatients and Their Lengths of Stay and Costs of Hospitalization: A Cohort Study","authors":"Ronald Lee Kirby MD ,&nbsp;Kim Parker MASc ,&nbsp;Alistair Lloyd Maksym BEng ,&nbsp;Suzanne Patricia Frances Salsman MD ,&nbsp;Christopher John Theriault BEng ,&nbsp;Bahareh Yavarizadeh PhD ,&nbsp;Fitsum Hadgu Woldeyohannes MSc","doi":"10.1016/j.apmr.2025.04.019","DOIUrl":"10.1016/j.apmr.2025.04.019","url":null,"abstract":"<div><h3>Objectives</h3><div>To test the hypotheses that wheelchair-provision time (WPT) (from when a loaner wheelchair was ordered to when the wheelchair arrived at the hospital site) has a significant relationship with length of stay (LOS) and total cost of hospitalization (COH).</div></div><div><h3>Design</h3><div>Cohort study.</div></div><div><h3>Setting</h3><div>Hospital inpatient units.</div></div><div><h3>Participants</h3><div>Hospital inpatients (N=97).</div></div><div><h3>Intervention</h3><div>Order for loaner wheelchair placed during their admissions.</div></div><div><h3>Main Outcome Measures</h3><div>Demographic, clinical, and process data from 4 available databases, from which we derived WPT, LOS, and COH. To test the hypotheses, we used Spearman correlation coefficients, negative binomial regression for LOS (n=90), and linear regression for COH (n=69).</div></div><div><h3>Results</h3><div>The median values for WPT, LOS, and total COH were 3.8 days, 51.0 days, and $43,062 Canadian dollars. Multivariable regression revealed that WPT was associated to a statistically significant extent with LOS (<em>P</em>=.0049) (a 18% increase in LOS for each additional day in WPT), but not with COH. However, LOS was associated to a statistically significant extent with COH (<em>P</em>&lt;.0001). The Spearman correlation between LOS and COH was 0.8915 (P&lt;.0001).</div></div><div><h3>Conclusions</h3><div>Statistically significant associations exist between WPT and LOS and between LOS and COH. Although this study does not establish causality and further research is needed, our findings suggest that more rapid provision of loaner wheelchairs to hospital inpatients could have a positive effect on the health care system.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 10","pages":"Pages 1471-1479"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960038","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":"Reductions in Therapy Provision in Skilled Nursing Facilities After Medicare Payment Reform and During the COVID-19 Pandemic: An Interrupted Time Series Analysis","authors":"Rachel A. Prusynski DPT, PhD ,&nbsp;Harsha Amaravadi MPH ,&nbsp;Cait Brown MA, CCC-SLP ,&nbsp;Natalie E. Leland PhD, OTR/L ,&nbsp;Debra Saliba MD, MPH ,&nbsp;Bianca K. Frogner PhD ,&nbsp;Janet Freburger PT, PhD ,&nbsp;Tracy M. Mroz PhD, OTR/L","doi":"10.1016/j.apmr.2025.05.020","DOIUrl":"10.1016/j.apmr.2025.05.020","url":null,"abstract":"<div><h3>Objective</h3><div>To examine how rehabilitation service provisions (ie, physical therapy [PT], occupational therapy [OT], speech language pathology [SLP]) changed in skilled nursing facilities (SNFs) after Medicare implemented the Patient-Driven Payment Model (PDPM) and the COVID-19 pandemic began, while comprehensively accounting for changes in patient clinical characteristics.</div></div><div><h3>Design</h3><div>Secondary interrupted time series analysis of 100% Medicare data from January 2018 to September 2021 with interruptions for PDPM implementation (October 2019) and COVID-19 (March 2020).</div></div><div><h3>Setting</h3><div>United States SNFs.</div></div><div><h3>Participants</h3><div>All SNF stays for fee-for-service Medicare beneficiaries admitted to SNF within 3 days of hospitalization with complete data from SNF assessments and hospital claims. Stratified analyses included stays with facility data on ownership status and rural versus urban location.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Average total minutes of therapy per day (MTD) provided by assistants or therapists and MTD by discipline (ie, PT, OT, SLP).</div></div><div><h3>Results</h3><div>For 3,917,261 SNF stays, PDPM implementation was associated with a decline of 28.9 total MTD, representing a relative reduction of 23.7%, compared to pre-PDPM averages. PT declined by 12.8 MTD (−23.5%), OT by 12.9 MTD (−24.3%), and SLP by 3.1 MTD (−21.7%). PDPM-associated declines were larger in for-profit SNFs versus not-for-profit and government-owned SNFs and in rural versus urban SNFs. Compared to what would have occurred if post-PDPM negative trends continued, COVID-19 was associated with a 15.3 minute (15.9%) increase in total MTD, a 5.4 minute (12.8%) increase for PT, a 5.1 minute (12.3%) rebound for OT, and a 4.5 minute (38.9%) increase for SLP, with greater relative increases in urban and for-profit SNFs.</div></div><div><h3>Conclusions</h3><div>Even when accounting for changing patient characteristics over time, PDPM implementation was associated with substantial declines in therapy provision, particularly in for-profit and rural SNFs. After COVID-19, these steep declines stabilized, with a slight recovery for SLP, but lower levels of PT and OT MTD persisted well into the pandemic.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 10","pages":"Pages 1480-1489"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246106","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":"Establishing Consensus for Prescription of Prosthetic Components for Transfemoral Bone-Anchored Limbs: An International Delphi Method Study","authors":"Eric J. Earley PhD ,&nbsp;Dan W. Milius CPO ,&nbsp;Mohamed E. Awad MD, MBA ,&nbsp;Danielle H. Melton MD ,&nbsp;Kirstin Ahmed PhD ,&nbsp;Ruud A. Leijendekkers PT, PhD ,&nbsp;Benjamin K. Potter MD ,&nbsp;Phillip M. Stevens MEd, CPO ,&nbsp;Brecca M.M. Gaffney PhD ,&nbsp;Cory L. Christiansen PT, PhD ,&nbsp;Jason W. Stoneback MD","doi":"10.1016/j.apmr.2025.06.011","DOIUrl":"10.1016/j.apmr.2025.06.011","url":null,"abstract":"<div><h3>Objective</h3><div>To guide prosthetic componentry prescription for patients with bone-anchored limbs (BALs), we established the first international consensus on prosthetic component selection for transfemoral BALs using the Delphi method.</div></div><div><h3>Design</h3><div>Three-round Delphi study taking place between November 2023 and September 2024.</div></div><div><h3>Setting</h3><div>Anonymous digital surveys were distributed to delegates in the United States, Sweden, the Netherlands, Australia, and Canada.</div></div><div><h3>Participants</h3><div>Eighteen (N=18) worldwide clinical experts in prosthetic care for patients with BAL participated as delegates.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Main Outcome Measures</h3><div>Thematic statement consensus was defined as delegate agreement of at least 80%.</div></div><div><h3>Results</h3><div>Thirty-four out of 48 thematic statements pertaining to individual prosthetic components and prescriptions for patients with BALs achieved general agreement consensus. There was strong agreement that prosthesis prescription should not change on the basis of sex or age, but rather on the physical ability and desired functional activities of the patient. The consensus reached aligns with current clinical practice guidelines for lower limb socket prostheses, such as the use of microprocessor knees. Other findings highlighted areas of uncertainty among experts, such as whether the implant and bone should be protected against high loads in the coronal or sagittal planes with prosthetic safety hardware.</div></div><div><h3>Conclusions</h3><div>The themes identified here can serve to guide clinicians in the selection of prosthetic components as further evidence is created to promote safety and functional outcomes for individuals with BALs. This consensus provides a basis for structuring future clinical practice guidelines and identifying knowledge gaps for future research studies.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 10","pages":"Pages 1565-1574"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526246","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 of Sports Injuries Among Athletes With Disabilities: A Meta-analysis","authors":"Tongnian Yang ,&nbsp;Jie Ren","doi":"10.1016/j.apmr.2025.05.018","DOIUrl":"10.1016/j.apmr.2025.05.018","url":null,"abstract":"<div><h3>Objectives</h3><div>To synthesize the prevalence and risk factors of sports injuries in athletes with disabilities through a meta-analysis.</div></div><div><h3>Data Sources</h3><div>Web of Science, PubMed, EBSCO, SpringerLink, China National Knowledge Infrastructure, and Wanfang Data.</div></div><div><h3>Study Selection</h3><div>We selected cross-sectional studies on the prevalence of sports injuries in athletes with disabilities published between 2006 and 2024.</div></div><div><h3>Data Extraction</h3><div>Two researchers independently performed literature screening, data extraction, and literature quality assessment. The Joanna Briggs Institute Prevalence Critical Appraisal Tool was selected for the study to assess the methodological quality of the included studies. Literature publication bias was assessed using funnel plots, Begg's, and Egger's tests in Stata 17.0 software.</div></div><div><h3>Data Synthesis</h3><div><span>A total of 20 studies were included (n=25,683). The meta-analysis revealed a 30.9% (95% CI, 26.9%-34.9%) prevalence of sports injuries in athletes with disabilities. Subgroup analyses showed a higher prevalence of acute traumatic injuries<span><span> than chronic traumatic injuries and acute chronic traumatic injuries, a higher prevalence of upper extremity injuries than lower extremity injuries, trunk and </span>head and neck injuries, and a higher prevalence of athletic injuries in sample sizes &lt;1000 than in sample sizes ≥1000 (</span></span><em>P</em>&lt;.001).</div></div><div><h3>Conclusions</h3><div>The prevalence of sports injuries in athletes with disabilities was 30.9%, with a higher prevalence of acute traumatic injuries and upper extremity injuries. Preventive measures for acute trauma and upper limb injuries include increasing cushioning coverage in site design, introducing dynamic electromyography (EMG) monitoring techniques, developing injury risk prediction systems, among others. In interpreting the results of these studies, the large heterogeneity among the source studies is taken into account, which may limit the generalizability of the pooled estimates. Future studies should use standardized injury surveillance protocols (eg, consensus definitions and exposure time reporting) and stratify analyses by disability type and sport to develop more targeted injury prevention strategies.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 10","pages":"Pages 1603-1614"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257274","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":"New Diagnostic Criteria for Mild Traumatic Brain Injury: Medical-Legal Considerations","authors":"Grant L. Iverson PhD ,&nbsp;Kristen Dams-O'Connor PhD ,&nbsp;William J. Panenka MD ,&nbsp;Jaclyn A. Stephens PhD, OTR/L ,&nbsp;Steven D. Lockman MD ,&nbsp;Zainab Al Lawati MD, MEd ,&nbsp;Anthony H. Lequerica PhD ,&nbsp;Jacob I. McPherson DPT, PhD ,&nbsp;Joshua Kamins MD ,&nbsp;Noah D. Silverberg PhD","doi":"10.1016/j.apmr.2025.06.015","DOIUrl":"10.1016/j.apmr.2025.06.015","url":null,"abstract":"<div><div>The new American Congress of Rehabilitation Medicine diagnostic criteria for mild traumatic brain injury (mTBI) were published in 2023. The criteria are designed to be used across clinical settings. This article discusses some medical-legal issues and implications relating to the use of the new ACRM diagnostic criteria. First, the new criteria differ from previously published definitions. Second, the criteria can be applied weeks, months, or years after an injury through a clinical interview and review of records. Third, when there is diagnostic uncertainty, and the “suspected” mTBI classification is used, this is not meant to convey a level of diagnostic certainty, from a medical-legal perspective. Fourth, the diagnostic process could be influenced by subjectivity or biases on the part of the person or the examiner. Finally, the new criteria are diagnostic, not prognostic. They are designed to determine whether a person sustained an mTBI, but they are not designed to determine if a person’s health problems months or years after an injury are related to that injury.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 10","pages":"Pages 1615-1619"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582929","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":"Bilateral Vocal Cord Abduction Paralysis after C1 Laminectomy in a Child with Type 1 Arnold Chiari Malformation.","authors":"Aliyar Zahedi Vafa, Stéphane Hans, Mohamad Khalife, Jérôme R Lechien","doi":"10.1177/01455613231151499","DOIUrl":"10.1177/01455613231151499","url":null,"abstract":"<p><p><b>Background:</b> Type 1 Arnold Chiari is a neurological malformation that may be associated with vocal cord paralysis in Children. In most cases, the vocal cord paralysis is related to protrusion of medulla and cerebellum in the foramen magnum, which led to compression on the vagus nerve.<b>Case report:</b> A 12-year-old child underwent suboccipital decompression and C1 laminectomy for a symptomatic type 1 Arnold Chiari malformation. After the surgery, patient reported severe dyspnea, aphonia, and dysphagia. The videolaryngostroboscopy and neurological examinations reported a postoperative bilateral vocal cord abduction paralysis due to bilateral IX and X cranial nerve paralyzes and a bilateral paralysis of the tongue.<b>Discussion:</b> The type 1 Arnold Chiari malformation clinical picture may present with unilateral or bilateral vocal cord paralysis, which may resolve with an adequate management of the disease. However, the neurosurgical decompression and C1 laminectomy may result in bilateral lesion of the IX, X, and XII cranial nerves, and related severe swallowing, aspiration and vocal cord disorders.<b>Conclusion:</b> We reported the first case of bilateral vocal cord abduction paralysis occurring post-neurosurgical decompression and C1 laminectomy in a child with type 1 Arnold Chiari malformation. This case highlights the importance of surgical steps of the procedure in front of the C1 vertebrae where there are IX, X, and XII cranial nerves.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"88 1","pages":"634-637"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75886587","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":"Behavioral Fluctuation in Disorders of Consciousness: A Retrospective Analysis","authors":"Alice Barra PhD ,&nbsp;Yelena G. Bodien PhD ,&nbsp;Can Ozan Tan PhD ,&nbsp;Geraldine Martens PhD ,&nbsp;Christopher Malone PsyD ,&nbsp;Joseph T. Giacino PhD","doi":"10.1016/j.apmr.2025.03.038","DOIUrl":"10.1016/j.apmr.2025.03.038","url":null,"abstract":"<div><h3>Objectives</h3><div>To assess the frequency of behavioral fluctuations in patients with prolonged disorders of consciousness (DoC), characterize the stability of consciousness ratings, and characterize the stability of behavioral signs of consciousness.</div></div><div><h3>Design</h3><div>Prospective observational analysis.</div></div><div><h3>Setting</h3><div>Specialized DoC program in an inpatient rehabilitation facility and a long-term acute care hospital.</div></div><div><h3>Participants</h3><div>Patients in a vegetative state/unresponsive wakefulness state, minimally conscious state<span>, and emerging from a minimally conscious state followed weekly by the Coma Recovery Scale-Revised (CRS-R) between 28 and 90days postinjury (N=241).</span></div></div><div><h3>Main Outcome Measures</h3><div>Change in CRS-R subscale scores and consciousness ratings.</div></div><div><h3>Results</h3><div>Behavioral fluctuation was observed in &gt;80% of patients and was most common in the CRS-R motor subscale and least common in the communication subscale (83% and 54% of patients experienced ≥1 fluctuation over the 3wk study period, respectively, with a 1-point change observed most frequently). Among patients who were conscious at baseline assessment, 25% were subsequently rated as unconscious at least once. Localization to pain and object manipulation were the most stable signs of consciousness, recurring at least 3 times after the first occurrence in ≥97% of the sample. Reproducible command-following and intelligible verbalization were the least stable, recurring at least 3 times after the first occurrence in ≤27% of the sample.</div></div><div><h3>Conclusions</h3><div>Patients with prolonged DoC who undergo serial assessment demonstrate a high rate of fluctuation in behavioral signs of consciousness. These findings highlight that repeated assessments are essential in this population, both to capture the highest level of consciousness and to help distinguish spontaneous fluctuation from response to treatment in interventional studies.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 10","pages":"Pages 1505-1513"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727521","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":"Qualitative Examination of Chronic Care Needs of Individuals With Traumatic Brain Injury","authors":"Jessica Kersey PhD, OTR/L ,&nbsp;Wendy Wang BS ,&nbsp;Noemi Rojas Serrano BS ,&nbsp;Maureen Cunningham CFRE ,&nbsp;Flora M. Hammond MD, PhD ,&nbsp;John D. Corrigan PhD, ABPP","doi":"10.1016/j.apmr.2025.06.012","DOIUrl":"10.1016/j.apmr.2025.06.012","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the chronic care needs of patients with traumatic brain injury (TBI) and development of a Chronic Care Model for TBI.</div></div><div><h3>Design</h3><div>Focus groups to examine unmet needs, priorities for long-term support, and recommendations for chronic care management of TBI. We used thematic analysis to generate themes describing key concepts and synthesized needs to support chronic care management of TBI.</div></div><div><h3>Setting</h3><div>Brain injury support groups, community settings, and Zoom.</div></div><div><h3>Participants</h3><div>47 participants: people with chronic TBI (&gt;6mo post-TBI; n=25), their family members (n=16), and TBI community service providers (n=6).</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Not applicable.</div></div><div><h3>Results</h3><div>We found that people with TBI, their family members, and their providers are all unprepared to manage TBI as a chronic condition. Although participants identified numerous valuable services within their communities, there are extensive barriers to accessing them. There are also unmet needs for community and social participation, mental health, and family support.</div></div><div><h3>Conclusions</h3><div>To successfully implement a chronic care approach to TBI management, we must reduce the barriers to accessing services and resources for people with TBI. We must implement stronger initial brain injury education practices, develop structures to support the transition from health systems to community levels of care and provide sustained access to therapy services, family-caregiver support, and employment advocacy and support.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 10","pages":"Pages 1548-1556"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526245","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}