Archives of physical medicine and rehabilitation最新文献

{"title":"Comparing Interventions Used in Randomized Controlled Trials of Upper Extremity Motor Rehabilitation Post-stroke in High-Income Countries and Low-to-Middle-Income Countries","authors":"Sarvenaz Mehrabi MD, MSc ,&nbsp;Cecilia Flores-Sandoval PhD ,&nbsp;Jamie L. Fleet MD ,&nbsp;Lindsay Cameron MSc ,&nbsp;Robert Teasell MD","doi":"10.1016/j.apmr.2024.11.001","DOIUrl":"10.1016/j.apmr.2024.11.001","url":null,"abstract":"<div><h3>Objective</h3><div>To identify and compare interventions for upper extremity (UE) motor recovery poststroke in randomized controlled trials (RCTs) conducted in high-income countries (HICs) and low-to-middle-income countries (LMICs).</div></div><div><h3>Data Source</h3><div>Systematic searches were conducted for RCTs published in English in 5 databases (CINAHL, Embase, PubMed, Scopus, and Web of Science) up to April 2021, in line with PRISMA guidelines.</div></div><div><h3>Study Selection</h3><div>RCTs, including crossover design, were included if they were in English and evaluated an intervention for poststroke UE motor rehabilitation, in an adult population (≥18y) diagnosed with stroke.</div></div><div><h3>Data Extraction</h3><div>Data on country of origin and type of intervention in each RCT were extracted using a data extraction template in Covidence software. Study screenings and data extraction were performed by 2 independent reviewers.</div></div><div><h3>Data Synthesis</h3><div>A total of 1276 RCTs met the inclusion criteria, with 978 RCTs conducted in HICs and 298 in LMICs. A significantly larger proportion of RCTs evaluating robotics and task-specific training interventions were conducted in HICs, compared to LMICs (<em>P</em>&lt;.009). In contrast, a higher proportion of RCTs conducted in LMICs examined acupuncture (<em>P</em>&lt;.001) and repetitive transcranial magnetic stimulation (rTMS) (<em>P</em>=.001) when compared to HICs.</div></div><div><h3>Conclusions</h3><div>Poststroke rehabilitation in LMICs is conducted in a lower resource environment when compared to HICs. Some differences exist in the use of UE motor rehabilitation interventions between LMICs and HICs such as robotics, task-specific training, rTMS, and acupuncture; however, there was no significant difference between HICs and LMICs for most interventions.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages 632-636"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Executive Function (Anticipation) Differences Between Soccer Players with and Without a History of Traumatic Brain Injury 4360","authors":"Akuadasuo Ezenyilimba","doi":"10.1016/j.apmr.2025.01.013","DOIUrl":"10.1016/j.apmr.2025.01.013","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To investigate a soccer player's ability to initiate judgment through postural-cues, implement perception through cue-detection, and perceive an oncoming action through cue-utilization.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Repeated-measures design, over the span of one 60-minute-session.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;Remotely.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;A total of 57 participants: 17 women, 40 men. Years of soccer experience: 13, 1-9 years; 44, 10+ years; athletic level: 15, high school; 37, collegiate; and 5, semiprofessional.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;Executive function assessments: 1. working memory: picture matching, 2. attentional control: self-report survey, 3. cognitive flexibility: task switching, and 4. anticipation: Brixton spatial anticipation test (BSAT) and temporal occlusion.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;(1) Planning, (2) self-monitoring, (3) execution, and (4) pattern detection and athletic cues.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;(1) Attentional control: the multivariate analysis of variance revealed significant effect of years of soccer experience on 2 out of 5 attentional control questions (alternating between 2 task; easily distracted while reading or studying if other people are talking in same room); F(2,54)=3.755, Wilks λ=0.878, &lt;em&gt;P&lt;/em&gt;=.030. (2) Anticipation: pattern detection (BSAT)—(i) The linear regression analysis performed on the second BSAT scores indicated one predictor explained 9.3% of the variance (&lt;em&gt;R&lt;/em&gt;&lt;sup&gt;2&lt;/sup&gt;=0.120, F[2,53]=2.406, &lt;em&gt;P&lt;/em&gt;=.078). The significant predictor was soccer athletic level (β=−0.126, &lt;em&gt;P&lt;/em&gt;=.045). (ii) The linear regression analysis performed on the BSAT Average scores indicated one predictor explained 8.9% of the variance (&lt;em&gt;R&lt;/em&gt;&lt;sup&gt;2&lt;/sup&gt;=0.093, F[2,53]=1.805, &lt;em&gt;P&lt;/em&gt;=.157). The significant predictor was soccer athletic level (β=−0.09, &lt;em&gt;P&lt;/em&gt;=.034). (3) Anticipation: athletic cues (temporal occlusion)—(i) The linear regression analysis performed on the temporal occlusion overall scores indicated one predictor explained 10.8% of the variance (&lt;em&gt;R&lt;/em&gt;&lt;sup&gt;2&lt;/sup&gt;=0.135, F[2,53]=2.746, &lt;em&gt;P&lt;/em&gt;=.052). The significant predictor was gender (β=−0.078, &lt;em&gt;P&lt;/em&gt;=.017). (ii) The linear regression analysis performed on the Temporal Occlusion Task One scores indicated one predictor explained 8% of the variance (&lt;em&gt;R&lt;/em&gt;&lt;sup&gt;2&lt;/sup&gt;=0.081, F[2,53]=1.554, &lt;em&gt;P&lt;/em&gt;=.211). The significant predictor was gender (β=−0.097, &lt;em&gt;P&lt;/em&gt;=.051).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;The results of this study concluded that when traumatic brain injury-history, gender, and soccer athletic level are factors, athletes with a soccer level of collegiate and semiprofessional had decrements related to pattern detection anticipation; meaning athletes at higher levels had lower average scores on the BSAT. Additionally, women athletes showed more anticipation decrements related to ath","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Page e5"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143760979","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":"Preliminary Evidence of the Prevalence of Pelvic Floor Disorders in Veterans with Major Lower Limb Amputation 1139","authors":"Sheila Clemens,&nbsp;Anna Urbanowitz,&nbsp;Meryl Alappattu,&nbsp;Stacey Slone,&nbsp;Ignacio Gaunaurd,&nbsp;Ben Darter","doi":"10.1016/j.apmr.2025.01.047","DOIUrl":"10.1016/j.apmr.2025.01.047","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To provide evidence of the magnitude and impact of pelvic floor disorders in people with lower limb amputation (LLA). To examine associations between the pelvic floor disorders, low back pain, and prosthetic mobility.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Cross-sectional, national survey-based study of male and female Veterans with LLA. Because of limitations in the number of female Veterans with LLA, women were oversampled. Additionally, Veterans of color (ie, non-White race, Hispanic ethnicity) and those under 60 years old were also oversampled.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;Utilization of the Veterans Affairs Computer Data Warehouse to identify potential study participants. Study was completed from the participants personal environment.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;Eighty-five male and female veterans with unilateral LLA who had been issued a prosthetic leg completed the study. Inclusion criteria: unilateral LLA at the transtibial level or higher, use of a prosthetic leg for &gt;6 months for daily mobility, English literate. Exclusion criteria: bilateral LLA any level above toes, significant cognitive deficit.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;None.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;Pelvic Floor Disability Index-20 (PFDI-20) assessed distress related to PFD symptoms. Prosthetic Limb Users Survey of Mobility assessed perceived prosthetic mobility. Oswestry Disability Index assessed disability related to low back pain.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Scores on the PFDI-20 indicate that 98% of study participants are reporting some level of PFD symptoms. Mean age of participants was 51.1 (13.6) years, mean time since amputation was 15.2 (20.7) years. Study sample consisted of 54% females, 40% of participants reported being Veterans of color. Seventy-one percent of participants were under 60 years old. Examining results by sex, 61.5% of males and 60.9% of females reported mild distress related to PFD symptoms, 35.9% of males and 32.6% of females reported moderate distress, 2.6% of males and 2.2% of females reported severe distress. Notably, 4.4% of females, and no male participants, reported no distress from symptoms. Seventy-five percent of participants reported being treated for low back pain in the past. Moderate correlations were observed between PFDI-20 scores and scores on the Oswestry Disability Index (&lt;em&gt;r&lt;/em&gt;=0.56, &lt;em&gt;P&lt;/em&gt;&lt;.01) and the Prosthetic Limb Users Survey of Mobility (&lt;em&gt;r&lt;/em&gt;=−0.51, &lt;em&gt;P&lt;/em&gt;&gt;.01).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;This is the first study to report on the occurrence of PFDs in the LLA population. Results indicate that a significant number of nonelderly male and female Veterans with major LLA are experiencing some level of distress related to PFDs. Undetected PFDs may be influencing low back pain and mobility deficits in this population. Further investigation is warranted to explore the impact of PFD symptoms on qual","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages e18-e19"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761115","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":"Evidence for Care of Persons with Disorders of Consciousness: An Environmental Scan of Existing Guidelines, Policies, and Recommendations 8271","authors":"Natalie Gilmore,&nbsp;Lori Kennedy,&nbsp;Jennifer MacDonald,&nbsp;Caroline Schnakers,&nbsp;Risa Nakase-Richardson,&nbsp;Amy Shapiro-Rosenbaum,&nbsp;Andrea Kurasz","doi":"10.1016/j.apmr.2025.01.048","DOIUrl":"10.1016/j.apmr.2025.01.048","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To identify existing guidelines, policies, and recommendations to guide care for persons with disorders of consciousness (DoC).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;An environmental scan of guidelines, policies, and recommendations for persons with DoC was conducted.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;Four electronic databases (ie, Embase, Ovid MEDLINE, Scopus, and Cochrane) were searched by a medical librarian on May 25, 2023. Search terms were tailored for each database (eg, Ovid strategy: “clinical decision-making,” “guideline,” “consciousness disorders,” “consciousness,” “consciousness monitors,” “practice patterns,” “brain diseases,” “traumatic brain injuries,” “brain,” “consciousness disorders,” “diagnosis [maximizes sensitivity],” and “brain death”).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;Written products (eg, guidelines, position statements) that guide clinician behavior for DoC (eg, coma, minimally conscious state) across etiologies (eg, traumatic brain injury, stroke) within a health care setting (eg, acute care, long-term care) were included. Case reports, literature reviews without recommendations, editorials, and brain death determination documents were excluded. Two reviewers screened titles and abstracts; articles with consensus for inclusion advanced to the full-text phase. Two reviewers independently reviewed the full text; articles with consensus for inclusion advanced to the data extraction phase.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;Two reviewers extracted the following data from articles that met criteria: publication information; document type and aim; etiology; population; age; setting; recommendation number, methodology, and evidence; quality assessment process; risk of bias assessment; and organizing group.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;Not applicable (no intervention provided to measure).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;With publication dates spanning 1991 to 2020, 14 documents met inclusion criteria, including 9 from the United States, 3 from the United Kingdom, and 2 with international authorship. Most recommendations were relevant to adults with DoC after traumatic or nontraumatic brain injury (11/14). Pediatric patients were explicitly mentioned in 6 of 14 studies. The most common setting was acute care (10/14) with the least common settings being prehospital (1/14) and subacute rehabilitation (1/14). Recommendations relevant to diagnosis and prognosis (12/14) were most frequently included, followed by treatment/management (10/14), family/caregiver needs (8/14), policy/legal (8/14), research (7/14), and finally, ethics (3/14).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Most existing recommendations for care of persons with DoC are appropriate for acute care in the United Status after acquired brain injury. Most guidelines in DoC pertain to diagnosis/prognosis and treatment/clinical management. Gaps exist within each domain; however, there is a clear need ","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Page e19"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761116","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":"Screening by Pediatric Therapists Establishes Hospital-wide Burden of Delirium in Children 4357","authors":"Margaret Scholl,&nbsp;L. David Wittkower,&nbsp;Chani Traube","doi":"10.1016/j.apmr.2025.01.033","DOIUrl":"10.1016/j.apmr.2025.01.033","url":null,"abstract":"<div><h3>Objectives</h3><div>To identify the rate of positive delirium screens in children across pediatric hospital settings. A secondary objective was to establish feasibility of delirium screening by pediatric therapists (physical therapists, occupational therapists, speech therapists) during routine clinical assessments of hospitalized children.</div></div><div><h3>Design</h3><div>Quality Improvement Project.</div></div><div><h3>Setting</h3><div>Free-standing, academic-affiliated health care system that includes 2 pediatric campuses in the Southern United States.</div></div><div><h3>Participants</h3><div>All children referred for therapy (physical therapy, occupational therapy, and/or speech therapy) between February 19, 2023, to June 4, 2023. Therapy services are provided in all in-patient pediatric units.</div></div><div><h3>Interventions</h3><div>All physical, occupational, and speech therapists in our acute care pediatric medical center were trained to use the Cornell Assessment of Pediatric Delirium (CAPD), an observational delirium screening tool validated for use in children of all ages and developmental stages. Delirium screening was then implemented as standard of care hospital-wide. Each child had a CAPD scored at the end of every therapy session.</div></div><div><h3>Main Outcome Measures</h3><div>A CAPD score of 9 or higher is consistent with a diagnosis of delirium.</div></div><div><h3>Results</h3><div>During the 15-week study period, 1259 delirium screens were completed on 791 unique patients. Twenty-five percent of delirium screens were positive (316/1259). When considering only the first delirium screen per unique patient, incidence of delirium remained similar at 20% (162/791 patients). Delirium was diagnosed in every pediatric unit, with highest rates noted in the pediatric and neonatal intensive care units. Therapists were able to complete delirium screening in more than 95% of patient encounters (1305/1361 screens performed).</div></div><div><h3>Conclusions</h3><div>In this cohort, delirium rate was 20% overall, suggesting that there may be a role for delirium screening in all inpatient pediatric units. Our single-center experience demonstrates that delirium screening by pediatric therapists is highly feasible. Therapists may be a practical, underleveraged, and valuable resource to operationalize pediatric delirium screening hospital-wide.</div></div><div><h3>Disclosures</h3><div>none.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Page e13"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761258","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":"National Intensive Evaluation and Treatment Program (IETP) for Persons With Mild to Moderate Traumatic Brain Injury (TBI) 8269","authors":"Jolie Haun,&nbsp;Tali Schneider,&nbsp;Justin McDaniel,&nbsp;Julie McMahon-Grenz,&nbsp;Rachel Benzinger,&nbsp;Risa Nakase-Richardson,&nbsp;Mary Jo Pugh","doi":"10.1016/j.apmr.2025.01.019","DOIUrl":"10.1016/j.apmr.2025.01.019","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;An evidence-based approach characterized an inpatient national Intensive Evaluation and Treatment Program (IETP) for service members and veterans with mild to moderate traumatic brain injury (TBI). This work illustrates IETP characterization, determinants, mechanisms, and outcomes that influence implementation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;A concurrent mixed methods evaluation design using a participatory approach was implemented to characterize the program and understand implementation. Methods and analytics were guided by implementation science frameworks including the Consolidated Framework for Implementation Research and RE-AIM.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;IETP is delivered in an interdisciplinary comprehensive TBI inpatient rehabilitation, peer supported setting within Veterans Affairs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;Participants included program key informants (n=12), IETP patients (n=47), DoD referral representatives (n=13), focus groups with IETP teams (n=8), and site observations (n=5).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;The intervention being characterized, IETP, is an interdisciplinary evidence-based comprehensive TBI inpatient rehabilitation program, in concordance with existing guidelines for TBI and common co-occurring comorbidities.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;Key informant interviews, patient interviews, DoD referral representative interviews, focus groups with IETP teams, and site observations were used to complete aims.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;IETP is an innovative, interdisciplinary evidence-based comprehensive inpatient rehabilitation program, as defined by the delivery of integrated patient-centered rehabilitation services to improve higher-level functioning, well-being, and brain health for eligible service members and veterans with a complex history of mild to moderate TBI. IETP provides integrated services to manage physical injuries, posttraumatic stress disorder, and/or emotional dysregulation to improve health and wellness, including outcomes associated with pain, function, participation, and mental health. Although IETP is a national program, findings indicate each site has unique attributes such as program length, specialty services, staffing, space, and equipment. Analyses and stakeholder feedback resulted in identification of IETP-specific determinants including: intervention characteristics, characteristics of the individual, inner setting, process, and outer setting. Data informed identification of implementation strategies, patient- and site-level mechanisms, and outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Data informed IETP characterization, who the program serves, determinants, mechanisms, and outcomes. Recommendations can inform program implementation and adaptations that could enhance IETP implementation and outcomes.&lt;/div&gt;&lt;div&gt;This work was funded by the Veterans Health Administration Health Services Re","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Page e7"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761280","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":"Implementation of an Electronic Prospective Surveillance System for Cancer Rehabilitation: Preliminary Results of a Mixed Methods Study 8258","authors":"Christian Lopez,&nbsp;Sarah Neil-Sztramko,&nbsp;Kristin Campbell,&nbsp;David Langelier,&nbsp;Gillian Strudwick,&nbsp;Jacqueline Bender,&nbsp;Jonathan Greenland,&nbsp;Tony Reiman,&nbsp;Jennifer Jones","doi":"10.1016/j.apmr.2025.01.021","DOIUrl":"10.1016/j.apmr.2025.01.021","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To evaluate the implementation of an electronic prospective surveillance system, called REACH, into routine cancer care, and understand barriers and facilitators to implementation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;A 16-month, single-arm, mixed methods, formative evaluation of implementation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;REACH was implemented at 4 regional cancer centers in Canada.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;Adult (≥18y) breast, colorectal, lymphoma, or head and neck cancer survivors, defined as from the date of diagnosis until 2 years after completing all treatments.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;REACH is a web-based application that systematically screens for and identifies cancer-related impairments and links patients to rehabilitation resources based on reported needs. Registered patients are prompted via email at regular intervals to complete a brief assessment throughout treatment and during follow-up surveillance. The specific impairments assessed, and frequency of assessments are tailored to each cancer type and vary by treatment status. The REACH system then automatically provides patients with suggestions based on their assessment scores, cancer type, and demographic information. The resources offered to patients follow a tiered approach based on the assessment with 3 distinct levels: (1) self-management education (ie, links to videos, handouts, and websites); (2) suggested community workshops and programs (online or in-person); and (3) a recommendation to schedule a visit with their oncologist or family physician for further assessment and management of the impairment identified.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;Data collection is ongoing. Implementation outcomes include system uptake, acceptability, appropriateness, feasibility, fidelity, and sustainability. System usage data and documentation of meetings with clinic leadership were analyzed up to 12 months postimplementation. Qualitative data were categorized using the Consolidated Framework for Implementation Research.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;We report on the preliminary results for the implementation at the first and largest center (Princess Margaret Cancer Centre). To date, n=320 patients have registered to REACH at Princess Margaret Cancer Centre, and n=266 (68% women; 42% breast; mean age, 58+13y; 43% currently receiving treatment) have provided consent for research. Preliminary analyses indicate REACH is feasible (mean duration to complete assessments is 5min, n=6 patient inquiries related to technical issues), and has high fidelity (87% assessments completed, 70% of patients viewing ≥1 resource recommended by REACH). Meaningful clinic leadership engagement, compatibility with clinic workflows and systems, and relative priorities among clinic staff have been identified as critical for successful implementation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Preliminary results suggest th","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Page e8"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761282","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 Researchers Learning Health Systems Needs Assessment Survey: A Follow-up Assessment of Research Competencies","authors":"Pamela Dunlap,&nbsp;Kathleen Poploski,&nbsp;Kristin Ressel,&nbsp;Linda Resnik,&nbsp;Melissa Clark,&nbsp;Janet Freburger,&nbsp;Peter Coyle,&nbsp;Christine McDonough","doi":"10.1016/j.apmr.2025.01.022","DOIUrl":"10.1016/j.apmr.2025.01.022","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To conduct a follow-up survey to identify interest and knowledge in learning health system (LHS) competencies among rehabilitation professionals. This survey included all items from the first survey wave (dates) and additional items related to health and health care equity and justice.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;A cross-sectional Rehabilitation Researchers Learning Health Systems Needs Assessment Survey was fielded by the Learning Health Systems Rehabilitation Research Network.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;Not applicable.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;The survey was disseminated through a listserv of Learning Health Systems Rehabilitation Research Network subscribers and researchers at Tier 1 universities and departments, rehabilitation professional organizations, newsletters, and social media to recruit rehabilitation professionals from varied fields.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;Not applicable.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;The survey included 70 items, organized by LHS domain, which were based on the core competencies developed by the Agency for Healthcare Research and Quality. The main outcomes were ratings of knowledge and interest (none, some, or a lot) for each LHS competency item. The survey also assessed the respondent's professional and demographic characteristics.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The sample included 637 participants who responded to at least one competency item or at least one demographic question. Most were women (75.4%), white (67.4%), and non-Hispanic (90.6%). Respondents were from varied professions including physical therapy (24.5%), research (21.6%), behavioral health (17.6%), and others. The top 10 items with the highest proportion of respondents indicating “a lot” of interest included items from the health and health care equity and justice, research methods, systems science, improvement and implementation science, informatics, and research questions and standards domains. The top 10 items with the highest proportion of individuals indicating “none” or “some” knowledge included items from the system science, engagement, leadership, and research management, informatics, and health and health care equity and justice domains. Competency items that were of high interest and low knowledge were related to designing studies, selecting outcome measures, and implementing research evidence into health systems. Also, promoting implementation of evidence-based care into routine practice, using approaches to foster engagement and to implement findings across settings to advance equity and justice in health and health care delivery were of high interest and low knowledge.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;We found that rehabilitation professionals had a lot of interest in health and health care equity and justice competency items and limited knowledge related to systems science competency items. The results of the survey c","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages e8-e9"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761283","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":"Functional and Physiologic Correlates of Opioid Reduction in a Chronic Pain Population with Control Cohort: Cause for Concern? 8250","authors":"Tyler Salanoa,&nbsp;Michelle McAllister,&nbsp;Jonathan Huefner,&nbsp;Gracyn Little,&nbsp;Giselle Cruz,&nbsp;Scott Johnson,&nbsp;Kurt Gold","doi":"10.1016/j.apmr.2025.01.058","DOIUrl":"10.1016/j.apmr.2025.01.058","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To investigate the functional and physiological effects of opioid dose reduction in a chronic pain population as compared with those who remained on a stable dose regimen.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Opioid dose reduction was offered to all prescribed opiates for chronic pain therapy, and provided for those agreeing to participation concurrent to those choosing not to do so while rigorously monitoring functional and physiologic outcomes of both groups in a similar fashion. The patients in the interventional group voluntarily had opioid reduction as tolerated of approximately 5% every other month, whereas control patients continued on their same regimen. Outcomes monitored over several years included prescribed average morphine mg dose equivalents (MME), blood pressure, strength, weight, and cognitive function, as well as self-reported Epworth sleepiness, sleep, work, and exercise hours, pain, nausea, constipation, pain disability index, and suicidality levels. Group outcomes were evaluated statistically using multivariate analysis of variance.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;Outpatient specialty clinic.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;Dose-stable chronic pain patients prescribed opiates agreeable to voluntary dose reduction (intervention group, n=103; baseline MME, 174mg/d), versus no dose reduction (control, 118; baseline MME, 144mg/d).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;Five percent reduction of prescribed medication doses approximately every other month as tolerated.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;Prescribed average MME, self-reported sleep, exercise, and work hours, Epworth Sleepiness scale, nausea, constipation, pain, anxiety (GAD7), depression (Patient Health Questionnaire-9 Scale), and suicidality (SBQ-R) levels, as well as pain disability index ratings, average blood pressures, body mass index, grip strengths, and Trails Making Test performances.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Thirty-seven decreased MME was demonstrated in opioid reduction group (vs no change among controls: &lt;em&gt;P&lt;/em&gt;=.002), as well as lesser (&lt;em&gt;P&lt;/em&gt;&gt;.05) improvements in Epworth sleepiness and Pain Disability Index scores. However, there was also a significant decrease in overall exercise among the reduction participants (&lt;em&gt;P&lt;/em&gt;=.004) not seen among controls, as well as several nonsignificant changes including decreased sleep, increased constipation, nausea, slower cognitive function, and increased suicidality scores among dose reduction participants compared with the others. Pain increased slightly in all.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Opioid dose reduction was significant in this previously stable-dose volunteer cohort, who also demonstrated a significant decrease in exercise participation. There were also nonsignificant trends of less sleep, more constipation and nausea, slower cognitive function and increased suicidality despite improved pain disability index r","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Page e23"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761287","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":"Functional MRI Evaluation of Hyperbaric Oxygen Therapy Effect on Hand Motor Recovery in a Chronic Poststroke Patient 4356","authors":"Amir Hadanny","doi":"10.1016/j.apmr.2025.01.060","DOIUrl":"10.1016/j.apmr.2025.01.060","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To investigate neural mechanisms and reorganization underlying hyperbaric oxygen therapy in a patient with chronic stroke.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Study included a 61-year-old right-handed male who suffered hemiparesis and physical weakness in the right upper limb, 2 years after acute insult treated with 60 daily HBOT sessions. Motor task fMRI activation and resting-state functional connectivity (rsFC), Fugl–Meyer assessment (FMA) and handgrip maximum voluntary contraction (MVC) were assessed at baseline and the end. Results were compared with a matched healthy control subject.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;Study was conducted within a hospital-based research facility using a multiplace Starmed-2700 chamber to administer HBOT protocol.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;One 61-year-old right-handed man with right hemiparesis, speech, and cognitive impairments due to left frontal chronic ischemic stroke. One 64-year-old, right-handed man without history of neurologic impairments or upper-limb movement limitations participated. Participants signed written informed consent.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;HBOT protocol comprised of 60 daily sessions, 5 per week over 2 months. Protocol included breathing 100% oxygen by mask at 2ATA for 90-min with 5-min air breaks every 20-min. Compression/decompression rates were 1.0 m/min. Patient received physical and occupational therapy twice a week during therapeutic phase. The physical therapy focused on lower limb mobility, transitions between body positions, enhancing walking pace with and without a cane, proprioceptive training to augment coordination, reflexes, and balance. Occupational therapy incorporated activities of daily living (ADLs).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;Primary study outcome was functional activation changes using motor task fMRI.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;After HBOT, the FMA score improved from 17 (severe) to 31 (moderate). After the intervention during trials involving the affected hand, there was an observed increase in fMRI activation in both the supplementary motor cortex (SMA) and the premotor cortex (PMA) bilaterally. The lateralization index (LI) decreased from 1 to 0.63, demonstrating the recruitment of the contralesional hemisphere. The region of interest, ROI-to-ROI, analysis revealed increased postintervention interhemispheric connectivity (&lt;em&gt;P&lt;/em&gt;=.002) and a between-network connectivity increase (&lt;em&gt;z&lt;/em&gt;-score, 0.35±0.21 to 0.41±0.21; &lt;em&gt;P&lt;/em&gt;&lt;.0001). Seed-to-voxel-based rsFC analysis using the right SMA as seed showed increased connectivity to the left posterior parietal cortex, the left primary somatosensory cortex, and the premotor cortex.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Study provides additional insights into HBOT-induced brain plasticity and functional improvement in patients with chronic poststroke.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Disclosures&lt;/h3&gt;&lt;div&gt;AH, VE, and S","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages e23-e24"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761289","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}