Archives of physical medicine and rehabilitation最新文献

{"title":"Longitudinal Goal Attainment With Repeat Injections of AbobotulinumtoxinA in Adults With Lower Limb Spasticity: Results From a Prospective Observational Study","authors":"Alberto Esquenazi MD ,&nbsp;Richard D. Zorowitz MD ,&nbsp;Stephen Ashford PhD ,&nbsp;Mathieu Beneteau MSc ,&nbsp;Pascal Maisonobe MSc ,&nbsp;Christian Hannes PhD ,&nbsp;Jorge Jacinto MD ,&nbsp;AboLiSh Study Group","doi":"10.1016/j.apmr.2024.10.017","DOIUrl":"10.1016/j.apmr.2024.10.017","url":null,"abstract":"<div><h3>Objective</h3><div>To assess longitudinal goal attainment with repeat abobotulinumtoxinA (AboBoNT-A) injections for lower limb spasticity (LLS) over 16 months.</div></div><div><h3>Design</h3><div>Prospective, longitudinal, international, multicenter, observational study (NCT04050527).</div></div><div><h3>Setting</h3><div>Specialist neurorehabilitation centers.</div></div><div><h3>Participants</h3><div>Ambulatory adults with unilateral LLS able to take ≥5 steps with/without assistance (effectiveness population, N=384).</div></div><div><h3>Interventions</h3><div>Participants received ≥1 AboBoNT-A treatment cycle administered in accordance with local prescribing guidelines to achieve individualized treatment goals.</div></div><div><h3>Main Outcome Measures</h3><div>The primary endpoint was goal attainment as assessed using the cumulated Goal Attainment Scaling-Leg (GAS-leg) T score, across all treatment cycles for each patient.</div></div><div><h3>Results</h3><div>Overall, participants underwent a median of 5 lower limb injection cycles (median dose 600U, range 100-1475U) with a mean±SD injection interval of 18.3±6.1 weeks. Participants generally achieved their goals as expected over repeated cycles; the mean (95% CI) GAS-leg T score at cycle 1 baseline was 38.0 (37.7, 38.3) and the mean cumulated GAS-leg T score at 16 months was 48.2 (47.4, 48.9) (mean change from a baseline of 9.9 [9.1, 10.7]). Participants injected with a guidance technique at baseline were more likely to attain their cycle 1 primary treatment goals (odds ratio: 1.9 [95% CI 1.1, 3.1], <em>P</em>=.02). Overall, 56 (13.5%) participants reported ≥1 adverse event, of which 6 participants (1.4%) had a treatment-related adverse event.</div></div><div><h3>Conclusions</h3><div>Findings from this large, international study provide evidence for the benefit of repeated cycles of AboBoNT-A for LLS. Multivariate analyses indicated that goal attainment during the first cycle was better with those injected using injection guidance than those injected without guidance.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 6","pages":"Pages 894-901"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142685827","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":"Effect of a Community-Based Peer-Led eHealth Wheelchair Skills Training Program: A Randomized Control Trial","authors":"Ed Giesbrecht PhD ,&nbsp;Krista L. Best PhD ,&nbsp;William C. Miller PhD ,&nbsp;François Routhier PhD ,&nbsp;Kara-Lyn Harrison MSc ,&nbsp;Julie Faieta PhD ,&nbsp;Maude Laberge PhD","doi":"10.1016/j.apmr.2024.12.011","DOIUrl":"10.1016/j.apmr.2024.12.011","url":null,"abstract":"<div><h3>Objective</h3><div>To measure the effect of a community-based peer-led eHealth manual wheelchair (MWC) skills training program on community participation, wheelchair skills capacity and performance, wheelchair-specific self-efficacy, and health-related quality of life.</div></div><div><h3>Design</h3><div>Randomized control trial with wait-list control group.</div></div><div><h3>Setting</h3><div>Community.</div></div><div><h3>Participants</h3><div>Community-dwelling MWC users aged 18 years or older who propel using both arms (N=50).</div></div><div><h3>Interventions</h3><div>The 4-week MWC skills training intervention was comprised of 3 virtual sessions with a peer trainer and a self-directed eHealth home training application delivered via a computer tablet. Peer trainers were experienced MWC users who had received structured training for intervention delivery. Participants were provided with required equipment and encouraged to involve a care provider during home training. Peer trainers tailored the program to life activities participants identified as relevant. The control group were placed on a 4-week no intervention wait-list (reflecting typical clinical practice) and after postintervention data collection were offered the training program.</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome was community participation measured by the Wheelchair Outcome Measure. Secondary outcomes included skill capacity and performance on the Wheelchair Skills Test-Questionnaire, self-efficacy on the Wheelchair Use Confidence Scale, and health-related quality of life on the Short-Form 36 Health Survey Enabled.</div></div><div><h3>Results</h3><div>The intention-to-treat (n=50) primary analysis revealed a statistically significant Time*Allocation interaction for community participation (mean <em>P</em>=.046 and η_p²=0.09), increasing by 24%. Per protocol (n=42) secondary analyses indicated significant improvements of 16.1% in the skill capacity (<em>P</em>=.004), 11.4% in self-efficacy (<em>P</em>=.017), and 7% relative improvement in quality of life (<em>P</em>=.012).</div></div><div><h3>Conclusions</h3><div>The findings indicate that an eHealth MWC training program incorporating peer and tablet application training components was effective in improving community participation, skill capacity, self-efficacy, and quality of life for a wide range of MWC users. An eHealth delivery format offers considerable potential from both an access and resource perspective.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 6","pages":"Pages 821-827"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871173","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 and Validation of a Novel Nomogram for Predicting Mechanical Ventilation After Cervical Spinal Cord Injury","authors":"Guozhen Liu MD ,&nbsp;Lei Liu MD ,&nbsp;Ze Zhang BA ,&nbsp;Rui Tan MS ,&nbsp;Yuntao Wang PhD","doi":"10.1016/j.apmr.2024.09.016","DOIUrl":"10.1016/j.apmr.2024.09.016","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the risk factors relating to the need for mechanical ventilation (MV) in isolated patients with cervical spinal cord injury (cSCI) and to construct a nomogram prediction model.</div></div><div><h3>Design</h3><div>Retrospective analysis study.</div></div><div><h3>Setting</h3><div>National Spinal Cord Injury Model System Database (NSCID) observation data were initially collected during rehabilitation hospitalization.</div></div><div><h3>Participants</h3><div>A total of 5784 patients (N=5784) who had a cSCI were admitted to the NSCID between 2006 and 2021.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measure(s)</h3><div>A univariate and multivariate logistic regression analysis was used to identify the independent factors affecting the use of MV in patients with cSCI, and these independent influencing factors were used to develop a nomogram prediction model. The area under the receiver operating characteristic curve (AUROC), calibration curve, and decision curve analysis (DCA) were used to evaluate the efficiency and the clinical application value of the model, respectively.</div></div><div><h3>Results</h3><div>In a series of 5784 included patients, 926 cases (16.0%) were admitted to spinal cord model system inpatient rehabilitation with the need for MV. Logistic regression analysis demonstrated that associated injury, American Spinal Cord Injury Association Impairment Scale (AIS), the sum of unilateral optimal motor scores for each muscle segment of upper extremities (sUEM), and neurologic level of injury (NLI) were independent predictors for the use of MV (<em>P</em>&lt;.05). The prediction nomogram of MV usage in patients with cSCI was established based on the above independent predictors. The AUROC of the training set, internal verification set, and external verification set were 0.871 (0.857-0.886), 0.867 (0.843-0.891), and 0.850 (0.824-0.875), respectively. The calibration curve and DCA results showed that the model had good calibration and clinical practicability.</div></div><div><h3>Conclusions</h3><div>The nomograph prediction model based on sUEM, NLI, associated injury, and AIS can accurately and effectively predict the risk of MV in patients with cSCI, to help clinicians screen high-risk patients and formulate targeted intervention measures.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 6","pages":"Pages 853-862"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387469","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":"Physical Activity Variability in Patellofemoral Pain: Relationships With Clinical and Psychological Outcomes","authors":"Sungwan Kim MS ,&nbsp;Neal R. Glaviano PhD","doi":"10.1016/j.apmr.2024.10.008","DOIUrl":"10.1016/j.apmr.2024.10.008","url":null,"abstract":"<div><h3>Objectives</h3><div>To (1) compare physical activity variability between individuals with patellofemoral pain (PFP) and pain-free individuals and (2) evaluate the relationships of physical activity variability with pain severity, symptom duration, disability, and pain catastrophizing in PFP cohorts.</div></div><div><h3>Design</h3><div>Cross-sectional case-control study.</div></div><div><h3>Setting</h3><div>University research laboratory.</div></div><div><h3>Participants</h3><div>Individuals with PFP (N=34) and pain-free individuals (N=34) aged 18 to 40 years.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main outcome measures</h3><div>We assessed physical activity (daily steps and moderate-to-vigorous physical activity [MVPA]) over a period of 14 consecutive days using a triaxial accelerometer. Variability (coefficient of variation) for daily steps and MVPA was calculated, where higher coefficient of variation values indicate greater physical activity variability. We evaluated pain severity (numeric pain rating scale), symptom duration (months), disability (Knee Injury and Osteoarthritis Outcome Score-Patellofemoral subscale), and pain catastrophizing (Pain Catastrophizing Scale). Independent <em>t</em> tests or Mann–Whitney <em>U</em> tests evaluated group differences in physical activity variability. Spearman ρ correlation coefficients were calculated to determine the relationships of physical activity variability with pain severity, symptom duration, disability, and pain catastrophizing in PFP cohorts. Correlation coefficients were interpreted as <em>weak</em> (&lt;0.40), <em>moderate</em> (0.40-0.70), and <em>strong</em> (&gt;0.70).</div></div><div><h3>Results</h3><div>Age, height, and mass did not differ between individuals with PFP and pain-free individuals (<em>P</em>&gt;.05). Individuals with PFP displayed greater variability in daily steps (<em>P&lt;</em>.001) and MVPA (<em>P</em>=.001) compared to pain-free individuals. In individuals with PFP, greater variability in daily steps was moderately related to higher pain severity (ρ=0.41, <em>P</em>=.016), while greater variability in MVPA was weakly related to higher pain severity (ρ=0.36, <em>P</em>=.037).</div></div><div><h3>Conclusions</h3><div>Individuals with PFP demonstrated greater variability in physical activity compared to pain-free individuals, which positively related to more severe pain. Future PFP research should explore the underlying factors contributing to increased physical activity variability and their potential implications for pain management.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 6","pages":"Pages 863-870"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567343","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":"Psychosocial Responses to a Cardiovascular Exercise Randomized Controlled Trial: Does Intensity Matter for Individuals Post-stroke?","authors":"Lynden Rodrigues MSc ,&nbsp;Kevin Moncion PT, PhD ,&nbsp;Sotiria Anna Angelopoulos BSc ,&nbsp;Bernat De Las Heras MSc ,&nbsp;Shane Sweet PhD ,&nbsp;Janice J. Eng PT, PhD ,&nbsp;Joyce Fung PhD ,&nbsp;Marilyn MacKay-Lyons PT, PhD ,&nbsp;Ada Tang PT, PhD ,&nbsp;Marc Roig PhD","doi":"10.1016/j.apmr.2025.01.468","DOIUrl":"10.1016/j.apmr.2025.01.468","url":null,"abstract":"<div><h3>Objective</h3><div>This study compared the effect of cardiovascular high-intensity interval training (HIIT) vs moderate-intensity continuous training (MICT) on psychosocial responses to exercise, motivation, and enjoyment, in individuals with chronic stroke.</div></div><div><h3>Design</h3><div>A secondary analysis of motivation and enjoyment outcomes collected from a randomized controlled trial (NCT03614585) comparing 12 weeks of HIIT vs MICT in participants with chronic stroke (6-60mo post-stroke) was conducted.</div></div><div><h3>Setting</h3><div>General community.</div></div><div><h3>Participants</h3><div>Seventy-one individuals (N=71) with chronic stroke (mean ± SD, age: 65.5 ± 8.4y, 19.4 ± 13.4mo post-stroke, 38% women) and mild disability (median ± interquartile range, National Institutes of Health Stroke Scale score 1 ± 2).</div></div><div><h3>Interventions</h3><div>Twelve-week, 3 per week progressive cardiovascular HIIT or MICT program conducted on NuStep recumbent steppers.</div></div><div><h3>Main Outcome Measures</h3><div>Motivation (Behavioral Regulation in Exercise Questionnaire-3) was measured at weeks 1, 6, and 12. Enjoyment outcomes comprised of affective response (Feeling Scale) assessed at each training session, and post-exercise enjoyment (Physical Activity Enjoyment Scale) assessed at weeks 6 and 12. Linear mixed models, examining group, time and group × time point interactions in motivation constructs and composite scores, mean affective response per session, and post-exercise enjoyment were used to compare the effect of HIIT vs MICT.</div></div><div><h3>Results</h3><div>HIIT elicited a lower affective response (mean difference [95% CI]: –1.18 [–1.90 to –0.47]; <em>P=</em>.002), that also progressively declined during sessions, in contrast to MICT (group × time point interaction: F [2,63.5]=3.99, <em>P=</em>.02). HIIT and MICT did not elicit any significant difference between groups or change over time for post-exercise enjoyment or any motivation constructs (<em>P</em>&gt;.05).</div></div><div><h3>Conclusions</h3><div>Despite lower affective response during exercise, HIIT elicits equivalent motivation and post-exercise enjoyment compared to MICT. This study provides further support for the implementation of HIIT in stroke rehabilitation by demonstrating sustained responses of motivation and post-enjoyment. Future studies should consider potential strategies that positively reinforce these important psychosocial responses to implement HIIT in post-stroke rehabilitation.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 6","pages":"Pages 828-836"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078250","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 Between Depressive Symptoms in Spousal Caregivers and Falls in Care Recipients With Disability: A Nationwide Population-Based Cohort Study","authors":"Rixiang Xu PhD ,&nbsp;Dandan Chen MSc ,&nbsp;LiJiangshan Hua MSc ,&nbsp;Tingyu Mu PhD ,&nbsp;Guiyue Ma MSc","doi":"10.1016/j.apmr.2025.02.015","DOIUrl":"10.1016/j.apmr.2025.02.015","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Design</h3><div>A retrospective cohort study.</div></div><div><h3>Setting</h3><div>Data from the China Health and Retirement Longitudinal Study.</div></div><div><h3>Participants</h3><div>1357 patient–caregiver dyads.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>The incidence of falls and the frequency of falls requiring medical treatment among care recipients.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 6","pages":"Pages 941-948"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","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":"Center of Pressure in Relation to Foot Morphology and Knee Symptoms in Older Women With Medial Knee Joint Deformity: A Cross-Sectional Study","authors":"Kaede Nakazato MSc ,&nbsp;Todd Pataky PhD ,&nbsp;Masashi Taniguchi PhD ,&nbsp;Junya Saeki PhD ,&nbsp;Masahide Yagi PhD ,&nbsp;Yoshiki Motomura MSc ,&nbsp;Shogo Okada MSc ,&nbsp;Sayaka Okada MSc ,&nbsp;Yoshihiro Fukumoto PhD ,&nbsp;Masashi Kobayashi PhD ,&nbsp;Kyoseki Kanemitsu PhD ,&nbsp;Noriaki Ichihashi PhD","doi":"10.1016/j.apmr.2024.10.015","DOIUrl":"10.1016/j.apmr.2024.10.015","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the correlations amongst center of pressure (COP) trajectories, foot morphology, and knee symptoms in older women with medial knee deformity.</div></div><div><h3>Design</h3><div>This was a cross-sectional study.</div></div><div><h3>Setting</h3><div>Participants were recruited from 2 local orthopedic clinics.</div></div><div><h3>Participants</h3><div>Female patients with medial knee deformity (Kellgren–Lawrence grade ≥1) aged 60 years or older (<em>N</em>=84).</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>COP trajectories during comfortable gait were obtained using a plantar pressure distribution platform. As foot morphology metrics, hallux valgus angle, navicular/foot ratio, and leg-heel alignment were measured. The knee society scoring system was used to evaluate knee symptom severity. We used statistical parametric mapping for COP trajectory analysis to reduce the bias caused by data extraction. Multiple linear regression in statistical parametric mapping was used to determine the correlations amongst foot morphology, knee symptom severity, and COP trajectories.</div></div><div><h3>Results</h3><div>There was a correlation between higher navicular/foot ratio and medial shift on COP at initial contact (0%∼3.0% stance phase, <em>P</em>&lt;.05) and at toe-off (95.3%∼100% stance phase, <em>P</em>=.04). Also, higher navicular/foot ratio was associated with lateral shift of COP during single leg stance phase (8.3%∼80.1% stance phase, <em>P</em>&lt;.01). We also found a significant correlation between lateral shift of COP during loading response phase (6.8%∼19.0% stance phase) and knee symptom severity (<em>P</em>=.03).</div></div><div><h3>Conclusions</h3><div>Our results indicated that patients with severe knee symptoms may benefit from intervention to modify the foot arch and to medially shift the COP, which may be capable of relieving knee symptoms. Although our results do not directly show pain reduction, a medial COP shift could indeed reduce pain in cases where knee adduction moment is responsible for pain. These findings may contribute to the further development of conservative intervention, which focus on foot morphology of patients with knee osteoarthritis.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 6","pages":"Pages 887-893"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643300","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 I/EP Guidelines","authors":"","doi":"10.1016/S0003-9993(25)00698-7","DOIUrl":"10.1016/S0003-9993(25)00698-7","url":null,"abstract":"","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 6","pages":"Pages 978-980"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190276","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":"Increased Stiffness Is Evidenced in the Deep But Not Superficial Lumbar Multifidus Muscle in Professional Athletes With Chronic Low Back Pain","authors":"Emma Feng Ming Zhou MPT ,&nbsp;Arnold Yu Lok Wong PhD ,&nbsp;Guohui Lin MSc ,&nbsp;Jianhui Fang MM ,&nbsp;Tao Wen MM ,&nbsp;Juhua Peng CP ,&nbsp;Siu Ngor Fu PhD","doi":"10.1016/j.apmr.2024.11.004","DOIUrl":"10.1016/j.apmr.2024.11.004","url":null,"abstract":"<div><h3>Objectives</h3><div>Elevated lumbar multifidus stiffness has been observed in populations with chronic low back pain (LBP). However, the modulation of deep (DLM) and superficial (SLM) lumbar multifidus stiffness, considering their distinct structural characteristics and functions, remains unaddressed, especially in athletes. This study aimed to compare differences in DLM and SLM stiffness in professional athletes from different sports with and without chronic LBP.</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Setting</h3><div>This study was conducted at a provincial sports training center.</div></div><div><h3>Participants</h3><div>Ninety-nine professional athletes (age: 18-27 years) from weightlifting, badminton, and track and field teams were recruited. Thirty-eight had chronic bilateral LBP.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Ultrasound shear wave elastography measured Young's modulus (stiffness indicator) of DLM and SLM at the L4/5 facet joint level. Two-way analysis of variance examined the effects of chronic LBP and sport type on DLM and SLM stiffness while considering proper confounders. Significance was set at <em>P&lt;.</em>05.</div></div><div><h3>Results</h3><div>Athletes with chronic LBP demonstrated significantly higher DLM stiffness on the dominant (by 17.73%, mean difference [MD]=2.52 kPa, <em>P=.</em>001) and nondominant sides (by 13.54%, MD=1.83 kPa, <em>P=.</em>046) compared with pain-free counterparts. SLM stiffness varied significantly among the 3 athlete groups. Post-hoc analyses revealed greater SLM stiffness on the nondominant side in weightlifters than in badminton players (by 51.76%, MD=8.97 kPa, <em>P=.</em>010) or track and field athletes (by 72.01%, MD=11.01 kPa, <em>P=.</em>008).</div></div><div><h3>Conclusions</h3><div>Chronic LBP and sport type significantly impact multifidus muscle stiffness, suggesting the need for targeted clinical assessments and reconditioning strategies focusing on DLM for chronic LBP and SLM for athletes in trunk extension-intensive sports.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 6","pages":"Pages 902-909"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695239","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 Interview and Online Self-Report Versions of Motor and Sensory Components of a Neurological Exam for Classifying Spinal Cord Injury (One-SCI).","authors":"Thomas N Bryce, Laiba Afzal, Stephen P Burns, Marcel P Dijkers, Steven Kirshblum, Ralph J Marino, Jayme O'Connor, Arianny Ramirez, Brittany Snider, Lisa Spielman, Chung-Ying Tsai","doi":"10.1016/j.apmr.2024.10.021","DOIUrl":"https://doi.org/10.1016/j.apmr.2024.10.021","url":null,"abstract":"<p><strong>Objective: </strong>To develop a patient-reported outcome (PRO) survey measure of the motor, sensory, and anorectal components needed for classifying spinal cord injury (SCI) according to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) DESIGN: Questionnaire development through an iterative process of review, feedback provision, and consensus revision incorporating two rounds of cognitive interviewing (CI) SETTING: Community PARTICIPANTS: 34 individuals with SCI who were English-speaking and aged 18 and older were recruited nationally through social media and advertisements to complete CI. Purposive sampling was used to ensure participants with complete and incomplete injuries in six cohorts based upon neurological level of injury (C1-4, C5-6, C7-T1, T2-T6, T7-T12, and L1-S5) were enrolled.</p><p><strong>Interventions: </strong>Not applicable MAIN OUTCOME MEASURE: Online Neurological Exam for Spinal Cord Injury (One-SCI) RESULTS: A group of SCI clinicians, a graphic artist, ISNCSCI experts, researchers with expertise in questionnaire development, cognitive interviewing, and statistics; and a person with SCI who has lived experience with SCI developed the initial One-SCI questionnaire. A CI script with pre-determined verbal probing questions was developed, designed to assess language appropriateness, vocabulary, concept simplicity, grammar, question structure, visual aids, emotional and mental burden both in the instructions and in the questions and available responses. Participants completed an online or interview version of the survey during two rounds of CI. After each round, changes were made to the instructions, questions, responses, and graphics. The final survey has a minimum of 154 and a maximum of 210 items, depending on branching logic driven by previous answers.</p><p><strong>Conclusions: </strong>One-SCI allows online or interviewer-administered self-report documentation of the motor and sensory components of a neurological examination for classifying SCI. Developed using an in-depth CI process, it may allow remote assessments of the elements required by an individual trained to interpret ISNCSCI examination findings to determine neurological status and classify SCI when an in-person ISNCSCI examination is not obtainable.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144214774","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}