Archives of physical medicine and rehabilitation最新文献

{"title":"Repeatability and Validity of the Prosthetic Observational Gait Scale in Patients with Bilateral Lower Limb Amputations 4345","authors":"Oleh Burii","doi":"10.1016/j.apmr.2025.01.029","DOIUrl":"10.1016/j.apmr.2025.01.029","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the repeatability and validity of the Prosthetic Observational Gait Scale (POGS) in individuals with bilateral lower limb amputations. Establishing its repeatability and validity underscored the significance of POGS in clinical practice, providing a simple yet reliable means of quantitative gait assessment accessible to a broad range of clinicians.</div></div><div><h3>Design</h3><div>Prospective observational cohort study on the interrater and intrarater validation and repeatability of POGS.</div></div><div><h3>Setting</h3><div>The study participants were obtained from the Superhumans Center (Vynnyky, Lviv, Ukraine)—a medical center for prosthetics, reconstructive surgery, and the rehabilitation of people affected by the war. Outpatient rehabilitation and follow-up post discharge.</div></div><div><h3>Participants</h3><div>In the current study were observed 12 male patients (N=12), who had bilateral lower limb amputees due to combat actions: 4 TF bilateral, 4 TT bilateral, 3 hip disarticulation+TF, and 1 TF+TT. The average age of participants was 37±11 years.</div></div><div><h3>Interventions</h3><div>Six observers, all of whom were physiotherapists, scored the patients’ videos using the observational gait scale. All had access to video playback facilities, enabling pause and slow-motion viewing. These videos were then reassessed in a new, randomly selected order at least 1 week after the initial analysis.</div></div><div><h3>Main Outcome Measures</h3><div>The study aimed to investigate the consistency of gait assessments made by different observers (interrater) and the same observer over time (intrarater).</div></div><div><h3>Results</h3><div>The intraobserver (COR) had an average coefficient of 8.7 (range, 6.1-11.7), indicating poor repeatability over time. Observers: 1 COR, 6.9; 2 COR, 7.2; 3 COR, 10.4; 4 COR, 6.1; 5 COR, 9.6; and 6 COR, 11.7. Two-way analysis of variance for the factor “observer,” <em>P</em>=.0009. The overall percentage agreement ranged from 43% to 93%. Kappa statistics for the 26 items, 5 showed good agreement, 11 moderate agreement, 6 fair agreement, and 4 poor agreement.</div></div><div><h3>Conclusions</h3><div>In summary, the study reveals concerns regarding the scale's (POGS) reliability in individuals with bilateral lower limb amputations. Intraobserver repeatability demonstrated significant variability over time, with each observer showing varying levels of consistency. The interobserver repeatability also raised concerns, indicating poor agreement among different observers. Given these limitations, it is advisable to integrate instrumental video analysis into clinical practice for individuals with bilateral lower limb amputations.</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 e11"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Actionability of Physical Activity Guidelines for Multiple Sclerosis Care: A Systematic Review and AACTT Framework Analysis","authors":"Claudia H. Marck PhD ,&nbsp;Isabelle V. Weld-Blundell BSc(Hons) ,&nbsp;Marlena Klaic PhD ,&nbsp;Robert W. Motl PhD ,&nbsp;Yvonne C. Learmonth PhD","doi":"10.1016/j.apmr.2024.09.020","DOIUrl":"10.1016/j.apmr.2024.09.020","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to conduct a systematic review of clinical guidelines, guidance documents and consensus statements regarding physical activity (PA) promotion by health care providers (HCPs) to people with multiple sclerosis (MS) and to assess the methodological quality, and actionability of the recommendations. The protocol was registered with Prospero (CRD42023495137).</div></div><div><h3>Data Sources</h3><div>Clinical guidelines, guidance documents and consensus statements (hereafter guidelines) published in English between 2013 and 2023 were identified through extensive gray and scientific literature searches, and through contacting relevant HCP organizations in English speaking countries.</div></div><div><h3>Study Selection</h3><div>Two researchers independently screened titles and abstracts of the 939 identified records and included 19 guidelines, which were developed for PA promotion as part of MS clinical management and for which the target user was HCPs.</div></div><div><h3>Data Extraction</h3><div>Two researchers independently extracted data and appraised the methodological quality using the Appraisal of Guidelines for Research and Evaluation (AGREE-II). Behavioral actionability was analyzed using the Actor, Action, Context, Target and Time (AACTT) framework.</div></div><div><h3>Data Synthesis</h3><div>Seventy-eight recommendations from 19 guidelines were identified. Two guidelines had high methodological quality. Actor, Action, Context, Target and Time were clearly specified in 57 (73%), 45 (58%), 0 (0%), 51 (65%), and 24 (31%) of the 78 recommendations, respectively. Guidelines with the highest methodological quality did not always score well on actionability, and vice-versa.</div></div><div><h3>Conclusions</h3><div>Our comprehensive analysis of guidelines for PA promotion in MS reveals the need for more actionable recommendations and better reporting of guideline development, which has the potential to improve the translation of evidence into practice. &lt;END ABSTRACT&gt;</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages 590-606"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142493674","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":"Feasibility Randomized Controlled Trial of the Toolkit for Optimal Recovery After Concussion: A Live Video Program to Prevent Persistent Concussion Symptoms in Young Adults With Anxiety","authors":"Jonathan Greenberg PhD ,&nbsp;Nadine S. Levey BA ,&nbsp;Molly Becker MS ,&nbsp;Gloria Y. Yeh MD, MPH ,&nbsp;Joseph T. Giacino PhD ,&nbsp;Grant Iverson PhD ,&nbsp;Noah D. Silverberg PhD ,&nbsp;Robert A. Parker ScD ,&nbsp;Ana-Maria Vranceanu PhD","doi":"10.1016/j.apmr.2024.10.011","DOIUrl":"10.1016/j.apmr.2024.10.011","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To assess the feasibility of the &lt;em&gt;Toolkit for Optimal Recovery after Concussion&lt;/em&gt; (&lt;em&gt;TOR-C&lt;/em&gt;), the first mind-body program aiming to prevent persistent concussion symptoms among young adults with anxiety, and an active control (&lt;em&gt;Health Enhancement after Concussion&lt;/em&gt; [&lt;em&gt;HE-C&lt;/em&gt;]). We also tested preliminary improvements in outcome measures and putative mechanistic targets.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Single-blind, 2-arm, randomized controlled trial (RCT).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;Academic medical center in the US Northeast.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;Fifty young adults (aged 18-35 years) with a recent concussion (3-10 weeks prior) and anxiety (≥5 on the Generalized Anxiety Disorder-7 [GAD-7] questionnaire).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;Both interventions consisted of four 45-minute 1:1 sessions with a clinician over Zoom. &lt;em&gt;TOR-C&lt;/em&gt; (n=25) taught mind-body, cognitive-behavioral, and return-to-activity skills. &lt;em&gt;HE-C&lt;/em&gt; (n=25) taught health education (eg, sleep, nutrition) without skills.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;Primary: feasibility outcomes (eg, recruitment, credibility, expectancy, acceptability, safety, feasibility of assessments, fidelity, satisfaction, and &lt;em&gt;TOR-C&lt;/em&gt; homework adherence) with a-priori-set benchmarks. Secondary: intervention outcomes were concussion symptoms (&lt;em&gt;Post-Concussion Symptom Scale&lt;/em&gt;), physical function (&lt;em&gt;World Health Organization Disability Assessment Scale&lt;/em&gt;), anxiety (GAD-7/anxiety subscale of the Hospital Anxiety and Depression Scale), depression (&lt;em&gt;depression subscale of the Hospital Anxiety and Depression Scale&lt;/em&gt;) and pain (&lt;em&gt;Numerical Rating Scale&lt;/em&gt;). &lt;em&gt;TOR-C&lt;/em&gt; mechanistic targets were pain catastrophizing (&lt;em&gt;Pain Catastrophizing Scale&lt;/em&gt;), mindfulness (&lt;em&gt;Cognitive and Affective Mindfulness Scale-Revised&lt;/em&gt;), fear avoidance (&lt;em&gt;Fear Avoidance Behavior after Traumatic Brain Injury&lt;/em&gt;), limiting behavior and all-or-nothing behavior (&lt;em&gt;Behavioral Response to Illness Questionnaire&lt;/em&gt;).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Both interventions met all feasibility benchmarks and were associated with significant improvements in outcomes (concussion symptoms, physical function, anxiety, depression, and pain; &lt;em&gt;d=&lt;/em&gt;0.44-1.21) and &lt;em&gt;TOR-C&lt;/em&gt; mechanistic targets (pain catastrophizing, mindfulness, fear-avoidance, and limiting behavior; Cohen's &lt;em&gt;d=&lt;/em&gt;0.41-1.24). Improvements in all-or-nothing behavior were only significant in &lt;em&gt;TOR-C&lt;/em&gt; (&lt;em&gt;d&lt;/em&gt;=0.52). Improvements in all mechanistic targets except all-or-nothing behavior after &lt;em&gt;TOR-C&lt;/em&gt; were significantly associated with improvements in at least one outcome.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Findings provide strong support for the feasibility of &lt;em&gt;TOR-C&lt;/em&gt; and &lt;em&gt;HE-C&lt;/em&gt;, and preliminary evidence for improvements in mechanistic targets and outcomes. Findings in","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages 527-536"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589701","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":"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":"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}