Archives of physical medicine and rehabilitation最新文献

{"title":"Home Health Admission Source and Episode Timing Differ for People with Alzheimer's Disease and Related Dementias 4367","authors":"Sara Knox,&nbsp;Kit Simpson,&nbsp;Jada Johnson,&nbsp;Mary Dooley","doi":"10.1016/j.apmr.2025.01.011","DOIUrl":"10.1016/j.apmr.2025.01.011","url":null,"abstract":"<div><h3>Objectives</h3><div>People with Alzheimer's disease and related dementias (ADRD) experience significant barriers to accessing postacute care services. In 2020, Medicare implemented a new home health payment model, known as the Patient Driven Grouping Model (PDGM). The PDGM is concerning for people with ADRD because of it is heavy reliance on admission source and timing of episodes. Patient advocacy groups believe the PDGM disincentivizes agencies from admitting individuals who come from the community (vs an institutional setting) and require &gt;1 episode of care. Home health has been recommended as a strategy to prevent hospitalizations for people with ADRD and has been shown to be effective with more frequent and longer durations of care. Reimbursement under the PDGM appears be in conflict with this need. To determine if the PDGM has altered access and utilization patterns of people living with ADRD, we aimed to describe baseline data by applying components of the PDGM to 2019 home health data.</div></div><div><h3>Design</h3><div>Retrospective analysis of 100% of Medicare beneficiaries receiving home health care in 2019.</div></div><div><h3>Setting</h3><div>Home health care.</div></div><div><h3>Participants</h3><div>Two propensity score-matched groups of 153,957 individuals with and without dementia were created based on patient demographics, caregiver support, cognitive status, prior functional status, prior health care utilization, and Charlson comorbidity scores.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Main Outcome Measures</h3><div>A binary logistic regression was used to examine the relationship between ADRD and admission source. A negative binomial regression was used to examine the relationship between ADRD and the number of late episodes. Univariate regression with logit was used to examine the relationship between ADRD and the number of services provided. A gamma-distributed log link model was used to estimate the mean total charges.</div></div><div><h3>Results</h3><div>Individuals with ADRD had 1.095 greater odds (95% confidence interval, 1.083-1.109) of community admission. For the number of late episodes, individuals with ADRD had an estimated mean of 1.62 compared with 1.53 (<em>P</em>&lt;.0001). Individuals with ADRD had 1.081 greater odds of receiving more services than their matched peers without ADRD. The difference in the estimated means for total charges between individuals with ADRD and those without ADRD was $24.00 (<em>P</em>&lt;.0001).</div></div><div><h3>Conclusions</h3><div>Prior to the implementation of the PDGM, individuals with ADRD were more likely to be admitted to home health from the community, have more late episodes, and receive more services than their matched peers without ADRD. There was not a clinically meaningful difference in total charges between the 2 groups.</div><div>Supported by NIA KO1AG073538.</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 e4"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143760977","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":"Executive Function (Anticipation) Differences Between Soccer Players with and Without a History of Traumatic Brain Injury 4360","authors":"Akuadasuo Ezenyilimba","doi":"10.1016/j.apmr.2025.01.013","DOIUrl":"10.1016/j.apmr.2025.01.013","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To investigate a soccer player's ability to initiate judgment through postural-cues, implement perception through cue-detection, and perceive an oncoming action through cue-utilization.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Repeated-measures design, over the span of one 60-minute-session.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;Remotely.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;A total of 57 participants: 17 women, 40 men. Years of soccer experience: 13, 1-9 years; 44, 10+ years; athletic level: 15, high school; 37, collegiate; and 5, semiprofessional.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;Executive function assessments: 1. working memory: picture matching, 2. attentional control: self-report survey, 3. cognitive flexibility: task switching, and 4. anticipation: Brixton spatial anticipation test (BSAT) and temporal occlusion.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;(1) Planning, (2) self-monitoring, (3) execution, and (4) pattern detection and athletic cues.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;(1) Attentional control: the multivariate analysis of variance revealed significant effect of years of soccer experience on 2 out of 5 attentional control questions (alternating between 2 task; easily distracted while reading or studying if other people are talking in same room); F(2,54)=3.755, Wilks λ=0.878, &lt;em&gt;P&lt;/em&gt;=.030. (2) Anticipation: pattern detection (BSAT)—(i) The linear regression analysis performed on the second BSAT scores indicated one predictor explained 9.3% of the variance (&lt;em&gt;R&lt;/em&gt;&lt;sup&gt;2&lt;/sup&gt;=0.120, F[2,53]=2.406, &lt;em&gt;P&lt;/em&gt;=.078). The significant predictor was soccer athletic level (β=−0.126, &lt;em&gt;P&lt;/em&gt;=.045). (ii) The linear regression analysis performed on the BSAT Average scores indicated one predictor explained 8.9% of the variance (&lt;em&gt;R&lt;/em&gt;&lt;sup&gt;2&lt;/sup&gt;=0.093, F[2,53]=1.805, &lt;em&gt;P&lt;/em&gt;=.157). The significant predictor was soccer athletic level (β=−0.09, &lt;em&gt;P&lt;/em&gt;=.034). (3) Anticipation: athletic cues (temporal occlusion)—(i) The linear regression analysis performed on the temporal occlusion overall scores indicated one predictor explained 10.8% of the variance (&lt;em&gt;R&lt;/em&gt;&lt;sup&gt;2&lt;/sup&gt;=0.135, F[2,53]=2.746, &lt;em&gt;P&lt;/em&gt;=.052). The significant predictor was gender (β=−0.078, &lt;em&gt;P&lt;/em&gt;=.017). (ii) The linear regression analysis performed on the Temporal Occlusion Task One scores indicated one predictor explained 8% of the variance (&lt;em&gt;R&lt;/em&gt;&lt;sup&gt;2&lt;/sup&gt;=0.081, F[2,53]=1.554, &lt;em&gt;P&lt;/em&gt;=.211). The significant predictor was gender (β=−0.097, &lt;em&gt;P&lt;/em&gt;=.051).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;The results of this study concluded that when traumatic brain injury-history, gender, and soccer athletic level are factors, athletes with a soccer level of collegiate and semiprofessional had decrements related to pattern detection anticipation; meaning athletes at higher levels had lower average scores on the BSAT. Additionally, women athletes showed more anticipation decrements related to ath","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Page e5"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143760979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preliminary Evidence of the Prevalence of Pelvic Floor Disorders in Veterans with Major Lower Limb Amputation 1139","authors":"Sheila Clemens,&nbsp;Anna Urbanowitz,&nbsp;Meryl Alappattu,&nbsp;Stacey Slone,&nbsp;Ignacio Gaunaurd,&nbsp;Ben Darter","doi":"10.1016/j.apmr.2025.01.047","DOIUrl":"10.1016/j.apmr.2025.01.047","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To provide evidence of the magnitude and impact of pelvic floor disorders in people with lower limb amputation (LLA). To examine associations between the pelvic floor disorders, low back pain, and prosthetic mobility.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Cross-sectional, national survey-based study of male and female Veterans with LLA. Because of limitations in the number of female Veterans with LLA, women were oversampled. Additionally, Veterans of color (ie, non-White race, Hispanic ethnicity) and those under 60 years old were also oversampled.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;Utilization of the Veterans Affairs Computer Data Warehouse to identify potential study participants. Study was completed from the participants personal environment.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;Eighty-five male and female veterans with unilateral LLA who had been issued a prosthetic leg completed the study. Inclusion criteria: unilateral LLA at the transtibial level or higher, use of a prosthetic leg for &gt;6 months for daily mobility, English literate. Exclusion criteria: bilateral LLA any level above toes, significant cognitive deficit.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;None.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;Pelvic Floor Disability Index-20 (PFDI-20) assessed distress related to PFD symptoms. Prosthetic Limb Users Survey of Mobility assessed perceived prosthetic mobility. Oswestry Disability Index assessed disability related to low back pain.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Scores on the PFDI-20 indicate that 98% of study participants are reporting some level of PFD symptoms. Mean age of participants was 51.1 (13.6) years, mean time since amputation was 15.2 (20.7) years. Study sample consisted of 54% females, 40% of participants reported being Veterans of color. Seventy-one percent of participants were under 60 years old. Examining results by sex, 61.5% of males and 60.9% of females reported mild distress related to PFD symptoms, 35.9% of males and 32.6% of females reported moderate distress, 2.6% of males and 2.2% of females reported severe distress. Notably, 4.4% of females, and no male participants, reported no distress from symptoms. Seventy-five percent of participants reported being treated for low back pain in the past. Moderate correlations were observed between PFDI-20 scores and scores on the Oswestry Disability Index (&lt;em&gt;r&lt;/em&gt;=0.56, &lt;em&gt;P&lt;/em&gt;&lt;.01) and the Prosthetic Limb Users Survey of Mobility (&lt;em&gt;r&lt;/em&gt;=−0.51, &lt;em&gt;P&lt;/em&gt;&gt;.01).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;This is the first study to report on the occurrence of PFDs in the LLA population. Results indicate that a significant number of nonelderly male and female Veterans with major LLA are experiencing some level of distress related to PFDs. Undetected PFDs may be influencing low back pain and mobility deficits in this population. Further investigation is warranted to explore the impact of PFD symptoms on qual","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages e18-e19"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence for Care of Persons with Disorders of Consciousness: An Environmental Scan of Existing Guidelines, Policies, and Recommendations 8271","authors":"Natalie Gilmore,&nbsp;Lori Kennedy,&nbsp;Jennifer MacDonald,&nbsp;Caroline Schnakers,&nbsp;Risa Nakase-Richardson,&nbsp;Amy Shapiro-Rosenbaum,&nbsp;Andrea Kurasz","doi":"10.1016/j.apmr.2025.01.048","DOIUrl":"10.1016/j.apmr.2025.01.048","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To identify existing guidelines, policies, and recommendations to guide care for persons with disorders of consciousness (DoC).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;An environmental scan of guidelines, policies, and recommendations for persons with DoC was conducted.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;Four electronic databases (ie, Embase, Ovid MEDLINE, Scopus, and Cochrane) were searched by a medical librarian on May 25, 2023. Search terms were tailored for each database (eg, Ovid strategy: “clinical decision-making,” “guideline,” “consciousness disorders,” “consciousness,” “consciousness monitors,” “practice patterns,” “brain diseases,” “traumatic brain injuries,” “brain,” “consciousness disorders,” “diagnosis [maximizes sensitivity],” and “brain death”).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;Written products (eg, guidelines, position statements) that guide clinician behavior for DoC (eg, coma, minimally conscious state) across etiologies (eg, traumatic brain injury, stroke) within a health care setting (eg, acute care, long-term care) were included. Case reports, literature reviews without recommendations, editorials, and brain death determination documents were excluded. Two reviewers screened titles and abstracts; articles with consensus for inclusion advanced to the full-text phase. Two reviewers independently reviewed the full text; articles with consensus for inclusion advanced to the data extraction phase.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;Two reviewers extracted the following data from articles that met criteria: publication information; document type and aim; etiology; population; age; setting; recommendation number, methodology, and evidence; quality assessment process; risk of bias assessment; and organizing group.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;Not applicable (no intervention provided to measure).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;With publication dates spanning 1991 to 2020, 14 documents met inclusion criteria, including 9 from the United States, 3 from the United Kingdom, and 2 with international authorship. Most recommendations were relevant to adults with DoC after traumatic or nontraumatic brain injury (11/14). Pediatric patients were explicitly mentioned in 6 of 14 studies. The most common setting was acute care (10/14) with the least common settings being prehospital (1/14) and subacute rehabilitation (1/14). Recommendations relevant to diagnosis and prognosis (12/14) were most frequently included, followed by treatment/management (10/14), family/caregiver needs (8/14), policy/legal (8/14), research (7/14), and finally, ethics (3/14).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Most existing recommendations for care of persons with DoC are appropriate for acute care in the United Status after acquired brain injury. Most guidelines in DoC pertain to diagnosis/prognosis and treatment/clinical management. Gaps exist within each domain; however, there is a clear need ","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Page e19"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"History of Childhood Traumatic Brain Injury and Potential Risk Factors for Future Incarceration 8268","authors":"Juliet Haarbauer-Krupa,&nbsp;Jill Daugherty,&nbsp;Drew Nagele,&nbsp;Judy Dettmer,&nbsp;Kim Gorgens PhD, ABPP,&nbsp;Hollis Lyman,&nbsp;Carmen Ashley,&nbsp;Amber Medina,&nbsp;Isabelle Tomita,&nbsp;Lauren Lambert","doi":"10.1016/j.apmr.2025.01.031","DOIUrl":"10.1016/j.apmr.2025.01.031","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;Research shows that children who are currently involved in the juvenile justice system have a higher likelihood of reporting a lifetime history of traumatic brain injury (TBI) than children who are not incarcerated. This presentation describes the association between childhood TBI history and select risk factors known to contribute to the likelihood of future incarceration.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Data for this presentation come from the 2020-2021 National Health Interview Survey, a population-based national dataset based on an annual cross-sectional household survey. TBI symptoms, overall health, indicators of school functioning, and behavioral health issues were examined to describe lifetime TBI history, prevalence of developmental disabilities, functional limitations, and school-related services. Additionally, lifetime prevalence of TBI history was calculated and stratified by adverse childhood experiences (ACEs) to compare across subgroups.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;Data for this presentation come from the 2020-2021 National Health Interview Survey, a population-based national data set based on an annual cross-sectional household survey. TBI symptoms, overall health, indicators of school functioning, and behavioral health issues were examined to describe lifetime TBI history, prevalence of developmental disabilities, functional limitations, and school-related services. Additionally, lifetime prevalence of TBI history was calculated and stratified by ACEs to compare across subgroups.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;Participants are parents who have completed the National Health Interview Survey during 2020-2021 (N=10,277).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;Recommendations for interventions are to better monitor children who experience a TBI to their ensure health and well-being.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;Behavioral health, social, academic, and ACES are the primary outcome measures.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Approximately 8% of (n=10,277) children ages 5-17 years had a lifetime history of TBI according to parent reports. Children with a TBI history were twice as likely to have behavioral health issues, social and academic difficulties, and to have experienced ACEs compared with peers with no history of TBI, effects that align with risk factors identified for entering the justice system.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Youth with a history of TBI may experience health, behavioral, and social changes, many of which have been shown to be associated with risk of entering the justice system. Preventing and promoting better identification and management of TBI during childhood is critical. Such strategies, in addition to postinjury support and rehabilitation, may aid in disrupting the association between TBI and behavioral health difficulties experienced by many children. Preventing TBI in children and managing TBI effects may help you","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Page e12"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Virtual Reality-Based Rehabilitation on Mental Health and Quality of Life of Stroke Patients: A Systematic Review and Meta-analysis of Randomized Controlled Trials","authors":"Saikun Wang MS ,&nbsp;Hongli Meng BS ,&nbsp;Yong Zhang PhD ,&nbsp;Jing Mao MS ,&nbsp;Changyue Zhang MS ,&nbsp;Chunting Qian MS ,&nbsp;Yueping Ma BS ,&nbsp;Lirong Guo PhD","doi":"10.1016/j.apmr.2024.10.006","DOIUrl":"10.1016/j.apmr.2024.10.006","url":null,"abstract":"<div><h3>Objectives</h3><div>To conduct a meta-analysis to investigate the effect of virtual reality (VR)-based rehabilitation on the mental health and quality of life of stroke patients.</div></div><div><h3>Data Sources</h3><div>The search strategy was conducted in 5 databases (PubMed, Scopus, Web of Science, Embase, and Cochrane Library databases) from inception to December 2023.</div></div><div><h3>Study Selection</h3><div>Randomized controlled trials (RCTs) comparing the effectiveness of standard rehabilitation and VR-based rehabilitation for stroke patients.</div></div><div><h3>Data Extraction</h3><div>Data from the included articles were extracted independently by 2 authors, with any disagreements resolved through consultation with a third author. The extracted data included the first author's name, country/region, publication year, sample size, mean/median age of participants, sex distribution (the proportion of males), VR type, duration of rehabilitation, comparison, intervention, and assessment of outcome.</div></div><div><h3>Data Synthesis</h3><div>A total of 29 studies involving 1561 stroke patients were included. The results showed that compared with standard rehabilitation, VR-based rehabilitation remarkably reduced anxiety symptoms [SMD=−0.97 (95% CI [−1.84, −0.09], <em>P</em>&lt;.0001)], depression symptoms [SMD=−0.94 (95% CI [−1.46, −0.42], <em>P</em>&lt;.001)], and improved quality of life [SMD=0.94 (95% CI [0.42, 1.45], <em>P</em>&lt;.001)] of stroke patients. Subgroup analysis showed that immersive VR was particularly effective in reducing anxiety and depression symptoms compared to nonimmersive VR. The longer the duration of VR intervention, exceeding 6 weeks, the more significant the effect of improving anxiety and depression symptoms. Meanwhile, VR-based rehabilitation significantly improved the psychological state and quality of life of European patients.</div></div><div><h3>Conclusions</h3><div>VR-based rehabilitation significantly reduces anxiety and depression symptoms and enhances the quality of life in stroke patients compared to standard rehabilitation. The most notable improvements were observed with immersive VR-based rehabilitation programs over 6 weeks in duration, particularly among European patients.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages 607-617"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567351","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":"Can Lifestyle and Behavioral Interventions Improve Weight Management in Individuals With Spinal Cord Injury? A Systematic Review and Meta-analysis","authors":"Chien Chieh MSc ,&nbsp;Stevan Stojic MSc ,&nbsp;Gabriela Boehl MSc ,&nbsp;Samford Wong PhD ,&nbsp;Janina Lüscher PhD ,&nbsp;Alessandro Bertolo PhD ,&nbsp;Oche Adam Itodo PhD ,&nbsp;Gabi Mueller PhD ,&nbsp;Jivko Stoyanov PhD ,&nbsp;Armin Gemperli PhD ,&nbsp;Claudio Perret PhD ,&nbsp;Inge Eriks-Hoogland PhD ,&nbsp;Marija Glisic PhD","doi":"10.1016/j.apmr.2024.10.014","DOIUrl":"10.1016/j.apmr.2024.10.014","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the effect of lifestyle and behavioral interventions on anthropometric indices and body composition in individuals with spinal cord injury (SCI).</div></div><div><h3>Data sources</h3><div>MEDLINE, EMBASE, Web of Science, and Cochrane Library were searched from inception to January 22, 2024.</div></div><div><h3>Study Selection</h3><div>Randomized controlled trials (RCTs), non-RCTs, and pre-post studies on the effectiveness of lifestyle and/or behavioral interventions in improving body composition (including body mass index, waist circumference, fat mass, and lean mass) were eligible.</div></div><div><h3>Data Extraction</h3><div>Study design characteristics, number of participants, intervention/control characteristics, and outcomes were extracted.</div></div><div><h3>Data Synthesis</h3><div>Sixty-one interventional studies were included in the systematic review, among which 5 RCTs contributed to meta-analysis. Exercise, alone or combined with functional electrical stimulation (FES), supplements, or educational sessions, was the most studied intervention across the identified studies, accounting for 75% of studies. Exercise regimen compared with the usual activities yielded a decrease in BMI (mean difference [MD], −0.38 kg/m²; 95% CI, −0.57 to −0.19; I²: 0%; <em>P</em>_q:.45]) and waist circumference (MD, −2.93 cm; 95% CI, −3.98 to −1.88; I²: 0%; <em>P</em>_q: 0.59). No significant differences were observed when comparing changes in total body fat percentage nor lean body mass between the 2 groups. Exercise with FES and testosterone, exercise and personalized diet, high-protein diet, and α-lipoic acid supplementation were mapped as other potentially beneficial interventions, whereas studies targeting behavioral changes were inconclusive.</div></div><div><h3>Conclusions</h3><div>Exercise-based interventions alone or combined with FES or standardized/personalized dietary regimens show promise as effective strategies for improving anthropometric indices and body composition among individuals with SCI, emphasizing the potential benefit of the weight management program. The present findings may not be applicable to individuals with high SCI lesions. Further research to evaluate the effectiveness of a more complex lifestyle and/or behavioral interventions in individuals with SCI is warranted.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages 580-589"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613898","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":"Systematic Review of Upper Extremity Outcome Measures Assessed in Randomized Controlled Trials of Poststroke Upper Extremity Rehabilitation in Low-to-Middle-Income and High-Income Countries","authors":"Sarvenaz Mehrabi MD, MSc ,&nbsp;Jamie L. Fleet MD ,&nbsp;Mohamad R. Safaei-Qomi MD ,&nbsp;Sean P. Dukelow PhD ,&nbsp;Manuel Murie-Fernandez MD, PhD ,&nbsp;Amber Harnett RN, MSc ,&nbsp;Robert Teasell MD","doi":"10.1016/j.apmr.2024.08.029","DOIUrl":"10.1016/j.apmr.2024.08.029","url":null,"abstract":"<div><h3>Objective</h3><div>To systematically review randomized controlled trials (RCTs) of poststroke upper extremity (UE) motor rehabilitation interventions to identify the outcome measures used in studies in low-to-middle-income countries (LMICs) and high-income countries (HICs) and describe the differences in the context of the International Classification of Functioning, Disability and Health.</div></div><div><h3>Data Sources</h3><div>Five databases “Embase, PubMed, CINAHL, Scopus, and Web of Science” were searched from 1960 to April 1, 2021.</div></div><div><h3>Study Selection</h3><div>Studies were included if they were (1) RCTs or RCT crossovers in English; (2) with ≥50% participants affected by ischemic/hemorrhagic stroke; (3) participants aged ≥18 years; and (4) used an intervention for the hemiparetic UE as the primary objective of the study.</div></div><div><h3>Data Extraction</h3><div>Title and abstract screening and full-text studies were reviewed, and data for included studies were extracted by two independent investigators. The study quality was assessed using the Physiotherapy Evidence Database scale. Data analyses were performed using SPSS (V29.0).</div></div><div><h3>Data Synthesis</h3><div>Of 5408 records, 1276 RCTs were eligible, 298 RCTs were conducted in LMICs and 978 in HICs. A higher percentage of RCTs in LMICs employed body structure and function outcome measures for central nervous system (eg, Fugl-Meyer Assessment) and tone and range of motion (eg, modified Ashworth Scale) as well as activity outcome measures for general activities of daily living (eg, Barthel Index). In HICs, a higher percentage of RCTs used body structure and function outcome measures assessing strength (eg, Motricity Index), activity outcome measures examining motor specific activity (eg, Action Research Arm Test and Wolf Motor Function Test) and dexterity (eg, Box and Block Test), as well as participation outcome measures (eg, Stroke Impact Scale).</div></div><div><h3>Conclusions</h3><div>There were significant differences in the outcome measures chosen for assessing poststroke UE rehabilitation interventions by researchers in LMICs and HICs. This suggests that there might be potential resource and expertise as well as timing constraints that influences the choice of outcome measures in RCTs between HICs and LMICs and highlights the need for investigating the availability of resources, infrastructure, and expertise and their effect on the feasibility and practicality of employing different outcome measures in different countries.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages 618-631"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638256","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":"Consensus-Based Recommendations for Designing, Delivering, Evaluating, and Reporting Exercise Intervention Research Involving People Living With a Spinal Cord Injury","authors":"Matteo Ponzano PhD ,&nbsp;Mark S. Nash PhD ,&nbsp;James Bilzon PhD ,&nbsp;Vanesa Bochkezanian PhD ,&nbsp;Glen M. Davis PhD ,&nbsp;Gary J. Farkas PhD ,&nbsp;Sonja de Groot PhD ,&nbsp;Jooyeon Jin PhD ,&nbsp;Camilla M. Larsen PhD ,&nbsp;James Laskin PhD ,&nbsp;Jasmin Ma PhD ,&nbsp;Tom Nightingale PhD ,&nbsp;Karin Postma PhD ,&nbsp;Brett M. Smith PhD ,&nbsp;Vegard Strøm PhD ,&nbsp;Rita van den Berg-Emons PhD ,&nbsp;Matthijs Wouda PhD ,&nbsp;Kathleen A. Martin Ginis PhD ,&nbsp;ISCoS Physical Activity Special Interest Group","doi":"10.1016/j.apmr.2024.11.006","DOIUrl":"10.1016/j.apmr.2024.11.006","url":null,"abstract":"<div><h3>Objectives</h3><div>To establish recommendations for designing, delivering, evaluating, and reporting exercise intervention research to improve fitness-related outcomes in people living with spinal cord injury (PwSCI).</div></div><div><h3>Design</h3><div>International consensus process.</div></div><div><h3>Setting</h3><div>(1) An expert panel was established consisting of 9 members of the governing panel of the International Spinal Cord Society Physical Activity Special Interest Group and 9 additional scientists who authored or co-authored ≥1 exercise randomized controlled trial paper involving PwSCI. (2) We invited the panelists to draft an outline of the recommendations for 1 intervention component. (3) The panel reviewed the draft outlines and determined whether they fit the scope and objectives of the project, whether they were evidence-based, and whether they were sufficiently detailed. (4) We interviewed 7 PwSCI who had participated in ≥1 exercise trial to gather insights on their experiences within the trials, what they liked, and what they would change. (5) A first draft of the recommendations was approved by the panel and circulated to the general members of the International Spinal Cord Society Physical Activity Special Interest Group to gather their suggestions and opinions via an online survey. (6) The member feedback was used to revise the recommendations and panel members approved a final version.</div></div><div><h3>Participants</h3><div>N/A.</div></div><div><h3>Interventions</h3><div>N/A.</div></div><div><h3>Main Outcome Measure(s)</h3><div>N/A.</div></div><div><h3>Results</h3><div>We generated 33 recommendations regarding participant recruitment, study sample size determination, outcome measurement, potential confounders, exercise intervention prescription and delivery, supporting adherence to the intervention, monitoring and reporting adherence and retention, fidelity of the delivery of the intervention, monitoring and reporting adverse events, study design, and registration of study protocol and preparation of a protocol paper.</div></div><div><h3>Conclusions</h3><div>International experts have come to consensus on recommendations for conducting exercise intervention research involving PwSCI. Adopting these recommendations will increase the quality of the research and the overall certainty of the evidence regarding the effects of exercise on health outcomes in PwSCI.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages 491-506"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738303","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":"Managing Emotions After Your Stroke: A Practical Guide","authors":"Olivia Crozier BHSc,&nbsp;Monika Gross BFA, M.ATI, M.AmSAT, M.STAT, MSME/T,&nbsp;Anahita Amirpour MSc, RNA,&nbsp;Pooja Jethani DrOT, OTR/L,&nbsp;Marina Charalambous SLT, MSc, PhD,&nbsp;Abe Snaiderman MD, FRCP(C),&nbsp;Mark Bayley MD, FRCPC,&nbsp;Urvashy Gopaul PT, MSc, PhD","doi":"10.1016/j.apmr.2024.12.006","DOIUrl":"10.1016/j.apmr.2024.12.006","url":null,"abstract":"","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages 649-653"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930478","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}