Archives of physical medicine and rehabilitation最新文献

{"title":"Advancing the Implementation of Patient-Centered Outcomes in Rehabilitation Learning Health Systems: Insights From the 2024 LeaRRn Summit.","authors":"Margaret A French, Megan E Schliep, Jason M Beneciuk, Lisa Juckett, Claire Kalpakjian, Brocha Z Stern, Robert Cavanaugh, Kelly Daley, Pamela Dunlap, John S Magel, Jennifer Oshita, Sean D Rundell, Hallie Zeleznik, Linda Resnik","doi":"10.1016/j.apmr.2025.07.020","DOIUrl":"10.1016/j.apmr.2025.07.020","url":null,"abstract":"<p><p>Patient-centered outcomes can inform the delivery of value-based rehabilitation care; however, there are many barriers that affect their routine use in clinical care. Learning health systems-which focus on improving patient-centered outcomes through the iterative process of data collection, knowledge generation, and practice change-are well-positioned to overcome these barriers. In September 2024, the Learning Health Systems Rehabilitation Research Network and the Center on Health Services Training and Research hosted the Power of Patient-Centered Outcomes in Rehabilitation Learning Health Systems Summit. The Summit aimed to advance the science and practice of implementing patient-centered outcomes in learning health systems. It was organized around the following 5 stages of the patient-centered outcome lifecycle in learning health systems: (1) selecting measures, (2) capturing data, (3) accessing data, (4) analyzing data, and (5) using data. At the Summit, experts across the rehabilitation community presented current work related to each of these lifecycle stages, discussed challenges to implementing patient-centered outcomes in learning health systems during breakout groups, and generated potential solutions for improving implementation of patient-centered outcomes across the 5 stages. The purpose of this paper is to disseminate the central themes of the Summit, which include common challenges and potential solutions to implementing patient-centered outcomes in rehabilitation learning health systems. In doing so, this paper aims to serve as a catalyst for future efforts to incorporate patient-centered outcomes within learning health systems in rehabilitation care. List of abbreviations: EHR, electronic health record; LeaRRn, Learning Health Systems Rehabilitation Research Network; LHS, learning health system.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940288","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":"Domains, Trends, and Uptake of Common Data Elements in Intervention Studies Focused on Recovery of Consciousness in Severe Brain Injury from 1986 to 2020: A Scoping Review.","authors":"Jennifer A Weaver, Alison M Cogan, Vera Pertsovskaya, Parie Bhandari, Bint-E Z Awan, Sara Lewis, Angela Hartman, Kristen Maisano, Tom Harrod","doi":"10.1016/j.apmr.2025.07.021","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.07.021","url":null,"abstract":"<p><strong>Objective: </strong>The primary purpose of our scoping review was to evaluate the range and typology of primary clinical outcome assessments used in intervention studies promoting recovery of consciousness for patients with disorders of consciousness (DoC). A secondary aim was to examine the extent to which the introduction of common data elements (CDE) has reduced the heterogeneity of primary clinical outcome assessments in DoC studies.</p><p><strong>Data sources: </strong>We searched for articles across five databases: Cochrane, Embase, PsycInfo, PubMed, and Scopus.</p><p><strong>Study selection: </strong>We selected articles that focused on facilitating recovery of consciousness among adults with DoC following severe traumatic brain injury.</p><p><strong>Data extraction: </strong>We extracted the study year, primary clinical outcome assessment, and funding source.</p><p><strong>Data synthesis: </strong>We classified the primary clinical outcome by International Classification of Functioning, Disability and Health (ICF) domain and CDE status. 75 primary clinical outcome assessments were extracted from 307 included articles; 45 primary clinical outcome assessments (60%) aligned with the ICF Body Function domain. The proportion of articles with US federal funding that reported a CDE as the clinical outcome assessment did not differ by year published.</p><p><strong>Conclusion: </strong>Implementation of CDEs in 2010 did not substantively change the utilization of clinical outcome assessments that are CDEs because these were already more likely to be reported than non-CDEs. Overall, the wide variation in primary clinical outcome assessments utilized in intervention studies facilitating recovery of consciousness limits the ability to conduct meta-analyses, which are needed to increase the strength of evidence for DoC interventions.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940364","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":"Dual-Site Transcranial Direct Current Stimulation Combined With Exercising Improves Fatigue and Sleep Quality in People With Fibromyalgia: A Randomized Sham-Controlled Clinical Trial.","authors":"Rafael Velasco-Velasco, Juan Avendaño-Coy, Elena Labrador-García, Elisabeth Bravo-Esteban, Rubén Arroyo-Fernández","doi":"10.1016/j.apmr.2025.07.022","DOIUrl":"10.1016/j.apmr.2025.07.022","url":null,"abstract":"<p><strong>Objective: </strong>The study aimed to evaluate the effectiveness of a combined program of unihemispheric concurrent dual-site anodal-transcranial direct current stimulation (UHCDS a-tDCS) + therapeutic exercise (TE) on fatigue and sleep quality in people with fibromyalgia syndrome (FMS).</p><p><strong>Design: </strong>Double-blind, randomized, sham-controlled trial.</p><p><strong>Setting: </strong>Primary health care center.</p><p><strong>Participants: </strong>A total of 90 volunteers diagnosed with fibromyalgia. Nine participants dropped out of the study.</p><p><strong>Intervention: </strong>Participants were randomly allocated in a 1:1:1 ratio to active UHCDS a-tDCS+TE, sham UHCDS a-tDCS+TE, or control receiving TE. The intervention was delivered in 10 sessions over 6 weeks.</p><p><strong>Outcome measures: </strong>Fatigue, sleep quality, and quality of life.</p><p><strong>Results: </strong>Fatigue score decreased significantly in the active group compared with the sham (-9.8 points; 95% CI, -18.9 to -0.8; P=.028) and control groups (-9.9 points; 95% CI, -18.9 to -0.9; P=.027) at posttreatment and compared with the control group at follow-up (-11.5 points; 95% CI, -20.8 to -2.1; P=.01). Sleep quality improved in active group compared with sham and control groups at posttreatment (sham: -14.4 points; 95% CI, -24.2 to -4.5; P=.002; control: -19.5 points; 95% CI, -29.4 to -9.7; P<.001) and at follow-up (sham: -11.2 points; 95% CI, -21.1 to -1.3; P=.02; control: -15.5 points; 95% CI, -25.3 to -5.6; P<.001). Quality of life enhanced in the active group compared with the other groups, both at posttreatment (sham: -15.2 points; 95% CI, -26.6 to -3.9; P=.005; control: -13.7 points; 95% CI, 25.0 to -2.3; P=.012) and at follow-up (sham: -14.5 points; 95% CI, -25.2 to -3.7; P=.004; control: -17.4 points; 95% CI, -28.1 to -6.6; P<.001). Effect sizes for intergroup comparisons were medium across all outcomes: fatigue (η²=0.10; P=.01), sleep quality (η²=0.12; P<.01), and quality of life (η²=0.13; P<.01). No intergroup differences in any outcome were found between the sham and control groups.</p><p><strong>Conclusions: </strong>Combining UHCDS a-tDCS with TE can result in clinically significant improvements in fatigue, sleep disorders, and quality of life in people with FMS.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862067","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":"Clinical Utility of Remote Teleassessment of Motor Performance in Individuals With Neurologic Disabilities: A COSMIN Systematic Review.","authors":"Andrea Baroni, Gabriele Perachiotti, Andrea Carpineto, Giulia Fregna, Annibale Antonioni, Maria E Flacco, Sofia Straudi","doi":"10.1016/j.apmr.2025.07.013","DOIUrl":"10.1016/j.apmr.2025.07.013","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the feasibility and measurement properties of measurement tools for remote evaluation of motor performance in people with neurologic conditions requiring only synchronous or asynchronous video conferencing without sensors or other complex technological tools.</p><p><strong>Data sources: </strong>A systematic search was conducted in PubMed, Embase, the Cumulative Index for Nursing and Allied Health Literature (CINHAL), and ScienceDirect. The search strategy included keywords related to any neurologic population, telerehabilitation, and motor performance outcome measure; papers in Italian or English language on adults were included, without time restrictions.</p><p><strong>Study selection: </strong>We included studies reporting data of at least one measurement property between reliability, validity, feasibility, or acceptability of measurement tools for remote motor assessment in neurologic disorders. We excluded studies that used wearable technologies, smartphones, or mobile applications. After duplicate removal, 2530 records were screened. Of the 461 remaining papers, 26 met the inclusion criteria and were included in the systematic review.</p><p><strong>Data extraction: </strong>Two independent reviewers extracted data from the included records, evaluated the risk of bias of the studies using the Consensus-based Standards for the selection of health Measurement Instruments tool, and applied the criteria for good measurement properties and clinical utility. Discordance was solved through discussion with a third reviewer.</p><p><strong>Data synthesis: </strong>Twenty-nine measurement tools were identified, and a narrative synthesis was conducted because of the heterogeneity of the included studies. The Fugl-Meyer Assessment for the Lower and Upper Extremity and the Tinetti Performance-Oriented Mobility Assessment Balance were suggested for the remote evaluation of people with stroke, whereas the Five Times Sit-to-Stand Test, the Nine-Hole Peg Test, and the Timed 25-Foot Walk Test were suggested for people with multiple sclerosis.</p><p><strong>Conclusions: </strong>Several measurement tools have been identified for remote evaluation of motor performance in people with neurologic disorders, but few of them can be suggested for clinical and scientific purposes. A higher methodological quality of studies would support the use of these tools in clinical practice.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788145","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":"Does Frequency of the Mechanical Vibration Matter? Evaluating the Impact of Whole-Body Vibration Training on Older Adults Strength, Balance, and Gait Performance: A Systematic Review and Network Meta-analysis.","authors":"Kailin Xing, Ran Duan, Zhu Fang, Xiangyang Sun, Dohoon Koo, Siddhartha Bikram Panday","doi":"10.1016/j.apmr.2025.07.015","DOIUrl":"10.1016/j.apmr.2025.07.015","url":null,"abstract":"<p><strong>Objective: </strong>To identify the optimal whole-body vibration training (WBVT) mechanical vibration frequency for enhancing muscle strength, static balance, dynamic balance, and gait performance among older adults through systematic review and network meta-analysis.</p><p><strong>Data sources: </strong>PubMed, Web of Science, Cochrane Library, Embase, and Scopus databases were systematically searched for randomized controlled trials (RCTs) up to December 2024.</p><p><strong>Study selection: </strong>The RCTs comparing low-frequency WBVT (LF-WBVT, frequency of the mechanical vibration, f<20 Hz), medium-frequency WBVT (MF-WBVT, 20 Hz≤f<30 Hz), and high-frequency WBVT (HF-WBVT, 30 Hz≤f≤40 Hz), and traditional training regarding their effects on strength, balance, and gait in healthy older adults were included.</p><p><strong>Data extraction: </strong>Methodological quality was assessed using the Physiotherapy Evidence Database scale, and evidence quality was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Continuous data were analyzed as mean differences (MD) or standardized mean differences (SMD) with 95% confidence intervals (CI) using Stata MP 15.1 (StataCorp).</p><p><strong>Data synthesis: </strong>Twenty-seven RCTs (1608 participants) were included. Ranking probability analysis indicated MF-WBVT was most effective for static balance (surface under the cumulative ranking curve [SUCRA]=98.5%; SMD=2.55; 95% CI, 0.85-4.24), HF-WBVT ranked highest for dynamic balance (SUCRA=75.8%; MD=0.60; 95% CI, 0.12-1.07) and gait performance (SUCRA=85.1%; MD=0.45; 95% CI, 0.15-0.75), and traditional training was optimal for improving muscle strength (SUCRA=80.1%; SMD=0.61; 95% CI, 0.27-0.95).</p><p><strong>Conclusions: </strong>Among the 3 mechanical vibration frequency types examined, HF-WBVT is optimal for improving dynamic balance and gait performance, MF-WBVT is recommended for static balance, and traditional training is preferable for enhancing muscle strength.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803303","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":"Psychological Transdiagnostic Processes in Mild Traumatic Brain Injury Recovery: A Scoping Review.","authors":"Caitlin Courchesne, Medha Amarnath Nair, Marc Gelineau, Liam McCloskey, Josh Faulkner, Molly Cairncross","doi":"10.1016/j.apmr.2025.07.014","DOIUrl":"10.1016/j.apmr.2025.07.014","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the extent to which psychological transdiagnostic processes have been investigated in relation to mild traumatic brain injury (mTBI) recovery outcomes, summarize methodological approaches, and evaluate consistency among transdiagnostic processes and outcome measures.</p><p><strong>Data sources: </strong>Five databases (Ovid MEDLINE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Scopus, and Web of Science) were searched from inception to October 2024. Eleven transdiagnostic processes were identified for inclusion based on a review of existing systematic reviews and meta-analyses establishing transdiagnostic relevance across a range of psychological disorders: attentional bias, avoidance, emotion regulation, flexibility, interpretation bias, intolerance of uncertainty, neuroticism, perfectionism, repetitive negative thinking, self-discrepancy, and shame.</p><p><strong>Study selection: </strong>Peer-reviewed, empirical studies published in English were included if they involved human participants with mTBI predominantly aged ≥18 years and reported ≥1 association between a transdiagnostic process and an mTBI recovery outcome.</p><p><strong>Data extraction: </strong>Three reviewers extracted data on study design, sample characteristics, transdiagnostic processes and their associated mTBI outcome measures, and analytical approaches using a standardized extraction form.</p><p><strong>Data synthesis: </strong>Sixty-seven studies published between 1995 and 2024 were included, yielding 118 transdiagnostic process-outcome associations. Avoidance (29%), flexibility (29%), and interpretation bias (25%) were the most frequently investigated transdiagnostic processes; symptom severity (36%) and disability (18%) were the most frequently reported outcomes. No studies examined associations involving attentional bias, emotion regulation, or perfectionism. Substantial heterogeneity in transdiagnostic processes and outcome measurement was observed. While most studies employed quantitative analysis methods, qualitative approaches uniquely captured less represented transdiagnostic process-outcome associations (eg, intolerance of uncertainty, self-discrepancy, shame).</p><p><strong>Conclusions: </strong>Although interest in transdiagnostic processes and mTBI recovery is growing, current investigations are centered on a narrow range of psychological constructs. Broader investigation of transdiagnostic processes known to maintain psychopathology and greater methodological consistency are needed.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144798040","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":"Health Care Utilization in Veterans With Tetraplegia in the First Year After Cervical Spinal Cord Injury: Identifying Opportunities for Dissemination of Treatment Information.","authors":"Katharine Tam, Daniel Eaton, Amanda Mayo, Aimee James, Candace Tefertiller, Katherine C Stenson, Catherine Curtin, Doug Ota, Flora Laurent, Michael J Berger, Jana Dengler, Ida K Fox","doi":"10.1016/j.apmr.2025.07.011","DOIUrl":"10.1016/j.apmr.2025.07.011","url":null,"abstract":"<p><strong>Objective: </strong>To describe Veterans Affairs (VA) utilization patterns by Veterans with tetraplegia during the first year after cervical spinal cord injury (SCI) and explore differences among subpopulations. A secondary objective of this study was to develop a process map to guide targeted clinician education about upper limb treatment information.</p><p><strong>Design: </strong>Retrospective cohort study using the Veterans Health Administration (VHA) Spinal Cord Injury and Disorders (SCI/D) Registry and the VHA Corporate Data Warehouse.</p><p><strong>Setting: </strong>Outpatient setting in the VHA.</p><p><strong>Participants: </strong>Veterans (N=884) with traumatic, C5-C8 neurologic level of injury, and American Spinal Injury Association Impairment Scale A-C classification who received care at a regional VA SCI/D Center between October 1, 2012, and September 30, 2019.</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcome measures: </strong>VA health care utilization as defined by ≥1 VA outpatient visit within the first year of SCI using VHA administrative data. We also examined predictors of care interactions using multivariate logistic regression models.</p><p><strong>Results: </strong>In total, 489 Veterans (55%) had ≥1 VA outpatient visit in the first year after SCI whereas 395 Veterans (45%) did not receive outpatient VA care within their first year after SCI. Veterans who used VA health care received a median of 41 outpatient visits in the first year after SCI. Veterans had the highest median number of visits and shortest time interval from SCI to initial visit with therapists (physical, occupational, and recreational) compared to other health care providers. No significant predictors of care were identified with adjusted and unadjusted multivariate logistic regression.</p><p><strong>Conclusions: </strong>Health care utilization patterns of Veterans with tetraplegia identified physical, occupational, and recreational therapists as the health care providers who had visits early and often with these Veterans. Therapists are uniquely positioned in health care systems to facilitate communication of treatment opportunities to persons with tetraplegia.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774560","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":"Risk Factors for Dysphagia After Traumatic Cervical Spinal Cord Injury: A Retrospective Study","authors":"Iris Meißner BSc ,&nbsp;Stephanie Dietmann ,&nbsp;Gerrit Hüller MSc ,&nbsp;Orpheus Mach MSc ,&nbsp;Matthias Vogel MD ,&nbsp;Matthias Ehret ,&nbsp;Anke Scheel-Sailer MD ,&nbsp;Ludwig Aigner PhD ,&nbsp;Doris Maier MD ,&nbsp;Iris Leister PhD","doi":"10.1016/j.apmr.2024.12.014","DOIUrl":"10.1016/j.apmr.2024.12.014","url":null,"abstract":"<div><h3>Objective</h3><div>To identify risk factors for dysphagia in individuals who sustained traumatic cervical SCI. The pathophysiologic mechanisms of dysphagia in individuals with traumatic cervical spinal cord injury (SCI) are not well understood yet. Several risk factors for developing dysphagia after SCI were postulated including mechanical ventilation, tracheostomy, age, female sex, anterior surgical approach, SCI severity, and multilevel spinal fusion.</div></div><div><h3>Design</h3><div>Retrospective analysis: Candidate explanatory variables, including injury severity, age, neurological level of injury, surgical approach, number of fused spinal segments, and tracheostomy including its type, were analyzed using univariate and multivariable statistical analyses.</div></div><div><h3>Setting</h3><div>We included patients, who were treated at the BG Trauma Center Murnau between 2013 and 2022.</div></div><div><h3>Participants</h3><div>Datasets of a total of 407 patients with traumatic cervical SCI were included.</div></div><div><h3>Main Outcome Measures</h3><div>Dysphagia prevalence and identification of associated risk factors.</div></div><div><h3>Results</h3><div>Our analysis included 407 individuals, of whom 22.6% had dysphagia. Tracheostomy and age were identified as the main risk factors for dysphagia after traumatic cervical SCI. Contrary to previous literature, injury severity, an anterior surgical approach, the type of tracheostomy, a higher neurological level of SCI, and multilevel spinal fusion did not show an increased risk after accounting for other factors.</div></div><div><h3>Conclusions</h3><div>Our study identifies age and tracheostomy as primary risk factors for dysphagia after SCI, allowing to identify patients at risk and inform early-stage clinical management.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 8","pages":"Pages 1189-1197"},"PeriodicalIF":3.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906328","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":"Lower Limb Strength Differentiates Between Fallers and Nonfallers With Multiple Sclerosis","authors":"Heather M. DelMastro MS ,&nbsp;Tracy Wall PT, PhD ,&nbsp;Deirdre J. McPartland PT, DPT ,&nbsp;Erik S. Plaia PT, DPT ,&nbsp;Naomi J. Trimble PT, DPT ,&nbsp;Jennifer A. Ruiz PT, DPT ,&nbsp;Katherine Harris PT, PhD ,&nbsp;Elizabeth S. Gromisch PhD","doi":"10.1016/j.apmr.2025.01.001","DOIUrl":"10.1016/j.apmr.2025.01.001","url":null,"abstract":"<div><h3>Objective</h3><div>To determine whether hip flexion (HF), extension (HE), abduction (HA), knee flexion (KF) and extension (KE), and ankle plantarflexion (APF) and dorsiflexion maximum voluntary contraction (MVC) differentiates between nonfall and fall history in persons with multiple sclerosis (PwMS) after accounting for age, gender, fatigue, disability, and disease duration.</div></div><div><h3>Design</h3><div>Secondary analysis of a cross-sectional study.</div></div><div><h3>Setting</h3><div>Community-based comprehensive MS center.</div></div><div><h3>Participants</h3><div>A total of 172 PwMS who completed a 1-time visit.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Lower limb (LL) MVC was measured for each muscle group as isometric peak torque (Newton-meter: Nm) of both limbs (Strongest: S; Weakest: W) using a Biodex Dynamometer and normalized by body weight (Nm/kg). Falls in the past 6 months were retrospectively collected and participants were classified as nonfall history (0 falls [nonfallers]; n=78) or fall history (≥1 falls [fallers]; n=94). Fall history was further categorized as occasional (1-2 falls [occasional fallers]; n=51) and recurrent (≥3 falls [recurrent fallers]; n=43).</div></div><div><h3>Results</h3><div>Overall differences between participants with and without a fall history were noted on both limbs, with post-hoc analyses showing that those with a fall history had significantly lower strength (<em>P</em>&lt;.05) on all LL-W and HF-S, HE-S, HA-S, KF-S, and APF-S. When separated out by fall frequency, recurrent fallers had diminished strength on all LL-W and HF-S, HE-S, HA-S, and APF-S, whereas occasional fallers exhibited reductions on HA-W, KE-W, and KF-W compared with nonfallers. Recurrent and occasional fallers differed on HE-W.</div></div><div><h3>Conclusion</h3><div>All LL-W and aspects of LL-S differentiated between fallers and nonfallers, with further differences observed when fall history was separated by frequency. These findings provide the necessary information to clinicians to inform their plans of care to address falls in MS and provide education on the importance of maintaining LL strength.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 8","pages":"Pages 1207-1216"},"PeriodicalIF":3.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969259","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":"Randomized Trial Assessing Prospective Surveillance and Exercise for Preventing Breast Cancer-Related Lymphedema in High-Risk Patients","authors":"Karol Ramírez-Parada PT, MSc, MBA ,&nbsp;Cesar Sánchez MD ,&nbsp;Irene Cantarero-Villanueva PT, MSc, PhD ,&nbsp;Álvaro Reyes PT, MSc, PhD ,&nbsp;Mauricio P. Pinto PhD ,&nbsp;M. Loreto Bravo PhD ,&nbsp;Denise Montt-Blanchard MSc ,&nbsp;Francisco Acevedo MD ,&nbsp;Benjamín Walbaum MD ,&nbsp;Margarita Alfaro-Barra PT ,&nbsp;Margarita Barra-Navarro PT ,&nbsp;Scarlet Muñoz-Flores PT ,&nbsp;Constanza Pinto ,&nbsp;Sabrina Muñiz RN ,&nbsp;Felipe Contreras-Briceño PT, MSc, PhD ,&nbsp;Tomás Merino MD ,&nbsp;Gina Merino MSc","doi":"10.1016/j.apmr.2025.03.002","DOIUrl":"10.1016/j.apmr.2025.03.002","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate if combining a prospective surveillance model (PSM) with a supervised multimodal exercise program prevents breast cancer-related lymphedema (BCRL) and its effect on the functional capacity and quality of life (QoL) of high-risk breast cancer (BC) patients undergoing treatment.</div></div><div><h3>Design</h3><div>Two-arm parallel superiority randomized controlled trial.</div></div><div><h3>Setting</h3><div>Outpatient physical therapy service in a public hospital.</div></div><div><h3>Participants</h3><div>116 adult women (N=116; age ≥18y) diagnosed with stage I-III BC were enrolled. Inclusion criteria included recent surgery and indication for adjuvant chemotherapy. Exclusion criteria were significant arm volume difference, previous cancer, exercise contraindications, and extreme body mass index values.</div></div><div><h3>Interventions</h3><div>Participants were randomized into experimental (n=61) or control groups (n=55) in a 1:1 ratio. The experimental group received PSM with a supervised multimodal exercise program for 12 weeks. The control group received PSM alone.</div></div><div><h3>Main Outcome Measures</h3><div>Arm volume, grip strength, 6-minute walk test, and QoL were blindly assessed at baseline, 3, 6, and 9 months.</div></div><div><h3>Results</h3><div>The combination of PSM with a supervised multimodal exercise program significantly reduced arm volume and body weight and improved grip strength, functional capacity, and the QoL of patients.</div></div><div><h3>Conclusions</h3><div>Combining PSM and physical exercise reduces arm volume, prevents BCRL, and improves physical performance and QoL in high-risk patients. The combination of PSM and STRONG-B was superior to PSM alone, validating the study's superiority design.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 8","pages":"Pages 1163-1172"},"PeriodicalIF":3.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623349","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}