Archives of physical medicine and rehabilitation最新文献

{"title":"Reinforcement-Based Head Scan Training for Drivers With Homonymous Visual Field Loss: Improves Blind-Side Detection","authors":"Yi Ni Toh PhD,&nbsp;Jing Xu PhD,&nbsp;Patrick Baker BS,&nbsp;Alex R. Bowers PhD","doi":"10.1016/j.apmr.2026.04.038","DOIUrl":"10.1016/j.apmr.2026.04.038","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate whether a reinforcement-based head scanning training program improves blind-side hazard detection in drivers with homonymous visual field loss.</div></div><div><h3>Design</h3><div>Single-arm nonrandomized clinical trial with 1-month follow-up.</div></div><div><h3>Setting</h3><div>Research laboratory.</div></div><div><h3>Participants</h3><div>Inclusion criteria included ≥3 months post–onset hemianopia or quadrantanopia, no neglect or major cognitive decline, and current or former driving experience. Sixteen of 23 volunteers met criteria and completed the study (median age=52.5y; 56% left-sided field loss).</div></div><div><h3>Interventions</h3><div>Participants completed three 1-hour sessions of a reinforcement-based head scanning training program in a driving simulator. An auditory reminder cue served as immediate, error-contingent feedback, sounding from a loudspeaker on the participant’s blind-side if they failed to make a large, early head scan to their blind-side before an intersection.</div></div><div><h3>Main Outcomes Measures</h3><div>The primary outcomes were rates of proactive blind-side scanning (the proportion of intersections with an early large head scan) and blind-side hazard detection (the proportion of hazards detected) assessed without reminder cues at pretraining, 1 week posttraining, and 1 month posttraining. All hypotheses were prespecified.</div></div><div><h3>Results</h3><div>Proactive blind-side head scanning increased significantly from 17.5% (95% CI, 8.9%-26.0%) at pretraining to 83.6% (95% CI, 76.5%-90.7%) at 1 week posttraining and 72.6% (95% CI, 63.4%-81.9%) at 1 month posttraining. Likewise, blind-side hazard detection improved significantly from 55.6% (95% CI, 41.3%-69.9%) to 85.6% (95% CI, 76.3%-95.0%) at 1 week posttraining and 82.5% (95% CI, 70.1%-94.9%) at 1 month posttraining. Improvements were primarily because of fewer scanning-related errors.</div></div><div><h3>Conclusions</h3><div>Three sessions of reinforcement-based head scanning training significantly improved blind-side head scanning and hazard detection in drivers with homonymous visual field loss, with benefits lasting at least 1 month. These results support the promise of this rehabilitation approach for poststroke driving and warrant further evaluation in a randomized controlled trial.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 10","pages":"Pages 2713-2721"},"PeriodicalIF":4.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147947701","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":"Ed Board page","authors":"","doi":"10.1016/S0003-9993(26)00913-5","DOIUrl":"10.1016/S0003-9993(26)00913-5","url":null,"abstract":"","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 10","pages":"Page A2"},"PeriodicalIF":4.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149095331","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":"Response to Letter to the Editor: Pain Catastrophization and Fear of Movement Are Potential Moderators for Response to Treatment in Women With Fibromyalgia: Secondary Analyses of Randomized Controlled Trial","authors":"Felipe Araya-Quintanilla PT, PhD,&nbsp;Héctor Gutiérrez-Espinoza PT, PhD","doi":"10.1016/j.apmr.2026.05.020","DOIUrl":"10.1016/j.apmr.2026.05.020","url":null,"abstract":"","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 10","pages":"Pages 3034-3036"},"PeriodicalIF":4.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148194239","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":"An Observational Examination of Circumlocution Ability in Acute Left-Hemisphere Stroke Survivors as a Possible Estimative Behavioral Measure of Very Mild Aphasia","authors":"Victoria Tilton-Bolowsky PhD,&nbsp;Ashley Raman BS","doi":"10.1016/j.apmr.2026.05.010","DOIUrl":"10.1016/j.apmr.2026.05.010","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate whether measuring circumlocution ability may help identify very mild aphasia (VMA).</div></div><div><h3>Design</h3><div>A retrospective, cross-sectional analysis of a subset of data from an observational longitudinal study.</div></div><div><h3>Settings</h3><div>Two urban hospitals, research laboratory office rooms, participants’ homes, or on Zoom.</div></div><div><h3>Participants</h3><div>We recruited stroke survivors and controls via convenience sampling and word-of-mouth. For eligibility, stroke survivors required a formal diagnosis of a primary acute ischemic left cerebrum stroke, normal/corrected-to-normal hearing and vision, and needed to be proficient English speakers. Controls had to have an unremarkable MRI and/or report no history of stroke, traumatic brain injury, or other neurologic conditions. Our sample consisted of 3 groups: 12 stroke survivors with mild to severe aphasia per the Western Aphasia Battery-Revised (WAB-R), 15 stroke survivors without aphasia per the WAB-R, and 15 controls. Ten of the 15 stroke survivors without aphasia per WAB-R had subjective and/or objective evidence of VMA.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>The total number of informative features and the average number and type of informative features participants produced per item description during a task created to measure participants’ circumlocution ability.</div></div><div><h3>Results</h3><div>There were significant differences in the total number of informative features produced between all three groups, <em>F</em>(2, 39)=14.75, <em>P</em>&lt;.001. There was a significant interaction between group and informative feature type, <em>F</em>(5.11, 99.55)=5.76, <em>P</em>&lt;.001. Adding our circumlocution measure to a predictive model accounted for more of the variance in discourse informativeness than the base model with naming ability only, ∆<em>F</em>(1, 22)=15.86, <em>P</em>&lt;.001, ∆Adjusted <em>R²</em>=0.22.</div></div><div><h3>Conclusions</h3><div>Measuring circumlocution ability, which can be done using a simple naming task, may help identify VMA. However, larger samples of acute stroke survivors will be needed to evaluate diagnostic potential.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 10","pages":"Pages 2788-2797"},"PeriodicalIF":4.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13505611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148013185","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":"Characteristics and Reasons for Non-attendance at Exercise Therapy and Self-Management Support Among Patients With Multimorbidity. An Exploratory Cross-sectional Study From the MOBILIZE Trial","authors":"Susie M. Kaalund MSc,&nbsp;Søren T. Skou PhD,&nbsp;Sofie R. Mortensen PhD,&nbsp;Mette Dideriksen MSc,&nbsp;Mette Nyberg MSc,&nbsp;Alessio Bricca PhD","doi":"10.1016/j.apmr.2026.06.008","DOIUrl":"10.1016/j.apmr.2026.06.008","url":null,"abstract":"<div><h3>Objective</h3><div>To describe and compare the characteristics of people living with multimorbidity randomly assigned to personalized exercise therapy and self-management support (the MOBILIZE intervention) stratified by low-to-medium and high attendance.</div></div><div><h3>Design</h3><div>Cross-sectional study from the MOBILIZE randomized controlled trial, following a prespecified statistical analysis plan (<span><span>https://osf.io/tsmjf/</span><svg><path></path></svg></span>).</div></div><div><h3>Setting</h3><div>The intervention was delivered by physiotherapists across 5 municipalities.</div></div><div><h3>Participants</h3><div>A total of 114 patients (N=114) with multimorbidity (≥2 chronic conditions).</div></div><div><h3>Interventions</h3><div>Twenty-four sessions of exercise therapy and self-management support.</div></div><div><h3>Main Outcome Measures</h3><div>We compared the characteristics of the low-to-medium (&lt;75% of 24 sessions) and high (≥75%) attendance groups using <em>t</em> test, chi-square test, or the Mann-Whitney <em>U</em> test, and reasons for non-attendance were identified through participant diary entries.</div></div><div><h3>Results</h3><div>Among 114 randomly assigned patients (mean age: 70.0y; 39% women; mean chronic conditions: 7, range 2-19), 76% had high attendance. The low-to-medium attendance group was younger (−6y; 95% CI, −9.44 to −1.67; <em>P</em>=.006), had lower self-efficacy (Self-Efficacy for Managing Chronic Disease 6-Item Scale −1.5 points; z=−2.5; <em>P</em>=.01), and reported more depressive symptoms (Personal Health Questionnaire Depression Scale +2 points; z=3.1; <em>P</em>&lt;.001) and higher treatment burden (Multimorbidity Treatment Questionnaire +7.5; z=2.7; <em>P</em>=.01). In 61% of missed sessions, the reason for non-attendance was unknown. Common reasons for non-attendance included illness (18%), vacation (5%), and planned health care visits (5%).</div></div><div><h3>Conclusions</h3><div>Patients with low-to-medium attendance were younger, had lower self-efficacy, higher depressive symptoms, and higher treatment burden compared with those with high attendance. Reasons for non-attendance varied widely and should be addressed when prescribing exercise therapy and self-management support for patients with multimorbidity.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 10","pages":"Pages 2906-2914"},"PeriodicalIF":4.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148238599","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":"Repetitive Transcranial Magnetic Stimulation for Dizziness, Balance, and Postural Stability in Adult Patients With Chronic Peripheral Vestibular Dizziness","authors":"Reham Ali Mohamed Ahmed PhD, MPT, PT,&nbsp;Ayman A. Mohamed PhD, MPT, DPT,&nbsp;Ahmed Youssef PhD, MPT, PT,&nbsp;Ebtesam Fahmy MD,&nbsp;Hussein Sherif Hamdy MD,&nbsp;Hesham Nafia MD,&nbsp;Islam H. Fayed PHD, MPT, PT,&nbsp;Sara S. El-Din PhD, MPT, PT","doi":"10.1016/j.apmr.2026.02.005","DOIUrl":"10.1016/j.apmr.2026.02.005","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) on dizziness, balance, and postural stability in adult patients with chronic vestibular dizziness.</div></div><div><h3>Design</h3><div>A double-blind randomized controlled trial.</div></div><div><h3>Setting</h3><div>Outpatient clinic.</div></div><div><h3>Participants</h3><div>Fifty-six adults with chronic vestibular dizziness were randomly assigned to study group and control groups. Baseline symptoms had persisted for a mean of (14.3mo), median (14mo), and range (6-28mo; N=56).</div></div><div><h3>Intervention</h3><div>The study group received rTMS and vestibular rehabilitation (VR), whereas the control group received sham stimulation as rTMS and VR. The treatment period lasted for 8 weeks. The rTMS was applied at a frequency of 10 Hz and 90% of the resting motor threshold. The rTMS and VR were implemented 3 sessions per week (24 VR sessions per participant).</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome measures included Visual Vertigo Analogue Scale (VVAS) and Berg Balance Scale(BBS). The secondary outcome measures included computerized dynamic posturography (somatosensory component, visual component, vestibular component, preference component, and total equilibrium composite).</div></div><div><h3>Results</h3><div>After 8 weeks, the study group showed significant improvements more than the control group in all outcomes measures, including VVAS, BBS, and all domains of computerized dynamic posturography (<em>P</em>&lt;.05). Notable effects included VVAS (−2.1; 95% confidence interval [CI], −2.8 to −1.4; d=1.02), BBS (+6.3; 95% CI, 4.2-8.4; d=1.15), and total equilibrium composite (+6.9; 95% CI, 4.7-9.1; d=1.10), indicating large clinical impact. Clinically meaningful changes included: VVAS reduction of 2.1 points (95% CI, −2.8 to −1.4; Cohen's d=1.02, large effect), BBS improvement of 6.3 points (95% CI, 4.2-8.4; Cohen's d=1.15, large effect). These effect sizes represent clinically significant improvements in symptom severity and balance function.</div></div><div><h3>Conclusion</h3><div>These findings suggest that rTMS may enhance VR outcomes and support its potential as a clinical application in patients with chronic vestibular dizziness.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 10","pages":"Pages 2637-2646"},"PeriodicalIF":4.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148676987","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":"EuroQol 5-Dimension 5-Level Index Value Changes Associated With Clinically Important Functional Improvement in Individuals With Traumatic Spinal Cord Injury: Insights From Mean Change Analysis","authors":"Takayuki Sasaki BSc,&nbsp;Kazuhiro Miyata PhD,&nbsp;Ryuichiro Koga MSc,&nbsp;Kenji Iwahashi OT,&nbsp;Ryosuke Ideta PT,&nbsp;Kenichi Yoshikawa PhD,&nbsp;Kensuke Kubota MD, PhD,&nbsp;Takeshi Maeda MD, PhD","doi":"10.1016/j.apmr.2026.04.037","DOIUrl":"10.1016/j.apmr.2026.04.037","url":null,"abstract":"<div><h3>Objective</h3><div>To quantify changes in the EuroQol 5-Dimension (EQ-5D) index value associated with clinically important functional improvement in patients with traumatic spinal cord injury (SCI).</div></div><div><h3>Design</h3><div>Secondary longitudinal analysis.</div></div><div><h3>Setting</h3><div>SCI center in Japan using data from the Japan Single-Center Study for Spinal Cord Injury Database.</div></div><div><h3>Participants</h3><div>Patients with traumatic SCI (N=163) registered in the Japan Single-Center Study for Spinal Cord Injury Database between 2015 and 2024.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>The primary patient-reported outcome was the EQ-5D index value from the EuroQol 5-Dimension 5-Level questionnaire at 2 weeks and 3 months after injury. As reference measures, we used previously reported minimal important change thresholds for the Spinal Cord Independence Measure version III (SCIM-III) subscale scores to compare EQ-5D index value changes between improvement and nonimprovement groups. Patients were classified into improvement and nonimprovement groups for the Walking Index for SCI version II and for upper and lower extremity motor scores derived from the International Standards for Neurological Classification of SCI motor score, based on established smallest real difference values; these were evaluated as supportive indices. Using these classifications, receiver operating characteristic analyses identified EQ-5D index value change thresholds.</div></div><div><h3>Results</h3><div>In patients with cervical SCI (American Spinal Injury Association Impairment Scale C/D), analyses using previously reported Spinal Cord Independence Measure version III subscale minimal important change thresholds yielded EQ-5D index value change thresholds of 0.182 (95% confidence interval, 0.112-0.253) for “self-care” and 0.173 (95% confidence interval, 0.107-0.284) for “respiration and sphincter management.” Other functional measures did not meet criteria for anchor validity and were not used to identify EQ-5D thresholds.</div></div><div><h3>Conclusions</h3><div>In patients with cervical SCI with incomplete motor paralysis, this study quantitatively demonstrated the extent to which functional recovery is reflected in changes in EQ-5D index values. The findings provide reference thresholds to support clinical interpretation of EQ-5D index changes in the SCI field.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 10","pages":"Pages 2722-2729"},"PeriodicalIF":4.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147959422","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":"Bridging Perspectives: Guiding the Selection of Patient-Centered Outcomes in Rehabilitation Learning Health Systems","authors":"Megan E. Schliep PhD, CCC-SLP, MPH,&nbsp;Pamela M. Dunlap DPT, PhD,&nbsp;Jason Beneciuk PT, PhD, MPH,&nbsp;Julia Carpenter MA, CCC-SLP,&nbsp;Natalie F. Douglas PhD, CCC-SLP,&nbsp;Jessica Edelstein PhD, OTR/L,&nbsp;Linda Ehrlich-Jones PhD, RN,&nbsp;Therese E. Johnston PT, PhD, MBA, FAPTA,&nbsp;Samannaaz Shamsuddin Khoja PT, PhD,&nbsp;Chiung-ju Liu PhD, OTR/L,&nbsp;Chih-Ying Li PhD, OTR/L,&nbsp;Rachel A. Prusynski DPT, PhD,&nbsp;Fenan S. Rassu PhD,&nbsp;Linda Resnik PT, PhD, FAPTA,&nbsp;Anne Thackeray PhD,&nbsp;Lisa Juckett PhD, OTR/L","doi":"10.1016/j.apmr.2026.04.032","DOIUrl":"10.1016/j.apmr.2026.04.032","url":null,"abstract":"<div><div>Patient-centered outcomes (PCOs) are health indicators that reflect what is meaningful and impactful to patients and are foundational to the success of learning health systems. PCO measures for rehabilitation learning health systems offer granular insights into patients’ functional goals and quality of life, enabling clinicians to personalize care and researchers to evaluate what truly matters to patients. Despite their value, selecting appropriate PCO measures remains complex, requiring careful consideration of multiple shareholder perspectives. This paper, informed by discussions from the LeaRRn and CoHSTAR Summit on \"The Power of Patient-Centered Outcomes in Rehabilitation Learning Health Systems,\" presents a framework for navigating these challenges in rehabilitation. We examine key considerations from the vantage points of patients, researchers, clinicians, and administrators that range from PCO measure feasibility, burden, and interpretability to psychometric rigor, workflow integration, and organizational priorities. Case examples illustrate how projects have engaged diverse shareholders to select PCO measures for use in clinical practice and research. The paper concludes with practical guidance for rehabilitation researchers seeking to align outcome selection with shareholder needs, optimize data utility across the learning health system cycle, and advance patient-centered care in complex rehabilitation contexts.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 10","pages":"Pages 3016-3023"},"PeriodicalIF":4.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13474260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147810064","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":"The AbilityQuotient: Impact of Utilizing a Patient-Specific Composite Rehabilitation Outcome Score on Patient Outcomes","authors":"James A. Sliwa DO,&nbsp;Julia Carpenter SLP,&nbsp;Andrew Bodine PhD,&nbsp;Caitlin Deom DPT,&nbsp;Richard L. Lieber PhD","doi":"10.1016/j.apmr.2026.05.003","DOIUrl":"10.1016/j.apmr.2026.05.003","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the impact of utilizing a composite rehabilitation outcome score (cROS), the AbilityQuotient (AQ), on patient outcomes.</div></div><div><h3>Design</h3><div>Observational convenience sample of interrupted time series data with independent groups defined by discharge year. Study included all adults admitted to an inpatient rehabilitation hospital pre- and postimplementation of the AQ.</div></div><div><h3>Setting</h3><div>Inpatient rehabilitation hospital.</div></div><div><h3>Participants</h3><div>A total of 13,397 inpatients admitted from calendar years 2019-2023.</div></div><div><h3>Intervention</h3><div>Incorporation of the AQ into clinical decision making during team conferences.</div></div><div><h3>Main Outcome Measures</h3><div>Mobility and Self-Care Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) Form GG change scores, and length of stay pre- and post-AQ implementation.</div></div><div><h3>Results</h3><div>Post-AQ implementation, the IRF-PAI Form GG mobility score rose by 6.64 points, self-care score increased by 2.28 points, and length of stay decreased by ∼2.3 days (natural log of length-of-stay decreased by 0.10 ln-days). All changes in years 2021-2023 were significantly different from values measured in 2019, before AQ implementation.</div></div><div><h3>Conclusions</h3><div>Incorporation of the AQ was associated with improved functional outcomes and reduced length of stay. Thus, this study demonstrates that a cROS such as the AQ, integrated into clinical workflows, represents a potential step toward precision rehabilitation and value-based care.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 10","pages":"Pages 2746-2754"},"PeriodicalIF":4.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148004219","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":"Knee Osteoarthritis in the Intact- and Amputation-Side Knees of UK Military Personnel and Veterans With Traumatic Unilateral Transtibial Limb Loss 8 and 11 Years Postinjury: The ADVANCE Cohort","authors":"Fraje C.E. Watson PhD,&nbsp;Oliver O’Sullivan PhD,&nbsp;Alex N. Bennett PhD,&nbsp;Susie Schofield MSc,&nbsp;Diana Toderita PhD,&nbsp;Fearghal P. Behan PhD,&nbsp;Christopher J. Boos PhD,&nbsp;Nicola T. Fear PhD,&nbsp;Paul Cullinan PhD,&nbsp;Harriet Kemp PhD,&nbsp;Anthony M.J. Bull PhD","doi":"10.1016/j.apmr.2026.02.497","DOIUrl":"10.1016/j.apmr.2026.02.497","url":null,"abstract":"<div><h3>Objective</h3><div>To compare knee osteoarthritis (OA) in people with unilateral transtibial (UTT) limb loss (LL) between (1) intact- and amputation-side knees and (2) ∼8- and ∼11-years post-LL and to report knee OA in the reference population.</div></div><div><h3>Design</h3><div>Inception cohort.</div></div><div><h3>Setting</h3><div>UK military.</div></div><div><h3>Participants</h3><div>Volunteers with UTT LL (n=36) and matched controls (n=36).</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Kellgren-Lawrence (KL; 0-4 [none–severe]) score and Knee Injury and Osteoarthritis Outcome Score (100-0 [no problems–severe problems]) for pain and symptoms.</div></div><div><h3>Results</h3><div>At baseline, ∼8 years after LL, the mean age was 32.9±4.2-years. Participants used dynamic–passive prosthetic limbs for daily activities and exercise. At baseline, KL was not different between intact- and amputation-side knees (<em>P</em>=.220). At follow-up, KL was worse on the amputation side than intact-side knee (<em>P</em>=.021). Rank-biserial correlation indicated that, for a randomly chosen pair, the amputation-side knee was 67% more likely to have a higher KL score than the intact-side knee. On both the intact- and amputation-side knees, KL was not different between baseline and follow-up (<em>P</em>=.706 and .138). Knee Injury and Osteoarthritis Outcome Score pain and symptoms were not different between intact- and amputation-side knees at baseline (pain: median, 100.0 vs 100.0; <em>P</em>=.253; symptoms: median, 90.0 vs 86.5; <em>P</em>=.573) or follow-up (pain: median, 94.4 vs 97.2; <em>P</em>=.291; symptoms: median, 90.0 vs 90.0; <em>P</em>=.247). Knee Injury and Osteoarthritis Outcome Score Pain (<em>P</em>=.619 and .557) and Symptoms (<em>P</em>=.664 and .580) were not different between baseline and follow-up for the intact- and amputation-side knees.</div></div><div><h3>Conclusions</h3><div>For the first time, we have compared OA of the intact- and amputation-side knee of people with UTT LL. Contrary to current opinion, radiographic OA was worse on the amputation-side knee 11 years post-LL. Modern military populations may be unique in their access to rehabilitation and prosthetic technology, resulting in different patterns of OA. Clinical care should focus on the intact- and amputation-side knee of people with UTT LL.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 10","pages":"Pages 2673-2681"},"PeriodicalIF":4.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147455004","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}