Archives of physical medicine and rehabilitation最新文献

{"title":"History of Childhood Traumatic Brain Injury and Potential Risk Factors for Future Incarceration 8268","authors":"Juliet Haarbauer-Krupa, Jill Daugherty, Drew Nagele, Judy Dettmer, Kim Gorgens PhD, ABPP, Hollis Lyman, Carmen Ashley, Amber Medina, Isabelle Tomita, Lauren Lambert","doi":"10.1016/j.apmr.2025.01.031","DOIUrl":"10.1016/j.apmr.2025.01.031","url":null,"abstract":"<div><h3>Objectives</h3><div>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.</div></div><div><h3>Design</h3><div>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.</div></div><div><h3>Setting</h3><div>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.</div></div><div><h3>Participants</h3><div>Participants are parents who have completed the National Health Interview Survey during 2020-2021 (N=10,277).</div></div><div><h3>Interventions</h3><div>Recommendations for interventions are to better monitor children who experience a TBI to their ensure health and well-being.</div></div><div><h3>Main Outcome Measures</h3><div>Behavioral health, social, academic, and ACES are the primary outcome measures.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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":"Infographics on Sex and Gender Topics in Traumatic Brain Injury to Raise Awareness and Promote Quality Care: A Co-creation Study 1141","authors":"Thaisa Tylinski Sant'Ana, Alina Rodrigues, Farrah Schwartz, Angela Colantonio, Tatyana Mollayeva","doi":"10.1016/j.apmr.2025.01.024","DOIUrl":"10.1016/j.apmr.2025.01.024","url":null,"abstract":"<div><h3>Objectives</h3><div>To create a series of evidence-based infographics on sex and gender topics in traumatic brain injury (TBI) to improve patient-family member communication and promote gender-transformative care after brain injury.</div></div><div><h3>Design</h3><div>We used an iterative participatory design consisting of 7 phases: (1) knowledge users’ needs assessment and evidence syntheses; (2) adaptation of content as simple text and visuals; (3) prototype design; (4) feedback from internal stakeholders; (5) infographic revisions; (6) feedback from external stakeholders; and (7) infographic optimization.</div></div><div><h3>Setting</h3><div>Scientific and knowledge translation activities were carried out at the largest rehabilitation research-teaching hospital in North America. Feedback on infographics was requested at a local, national, and international scale through brain injury organizations and networks.</div></div><div><h3>Participants</h3><div>People with lived experience of traumatic brain injury, professionals, scientists, and other brain injury and education experts.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>We evaluated the infographics using accessibility measures, including the Flesch Reading-Ease score to assess readability and color contrast criteria as established in the Web Content Accessibility Guidelines. We also sought feedback from internal and external stakeholders on infographic content and design.</div></div><div><h3>Results</h3><div>We created a total of 6 infographics containing evidence-based information and actionable messages for injury prevention and providing quality care. The infographics contain text in a range of formats, such as paragraphs, lists, and blurbs, complemented by visual elements including cartoons, tables, and diagrams. The materials had an overall Flesch Reading-Ease score of 60.1, which is equivalent to grade 7/8 reading level, and color schemes met Web Content Accessibility Guidelines contrast criteria. The vast majority of participants found that the infographics facilitated understanding of complex topics and that they were useful, engaging, and visually appealing.</div></div><div><h3>Conclusions</h3><div>Engaging diverse stakeholders in iterative participatory design process facilitates the creation of knowledge translation materials that meet the unique needs of knowledge users, promote equity in information access, and enhance quality of care after traumatic brain injury.</div><div>This research was supported by the Cass Family Grants for Catalyzing Access and Change and, in part, Canada Research Chairs Programs (CRC-2021-00074, CRC-2019-00019) and the Global Brain Health Institute (GBHI), Alzheimer's Association, and the Alzheimer's Society UK Pilot Award for Global Brain Health Leaders (GBHI ALZ UK-23-971123). The funders had no role in study design, data collection and analysis, decision to publish, or prepara","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages e9-e10"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761285","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":"ACRM Excellence in Health Equity Research Award: Barriers People with Disabilities Experience When Accessing Health Care 5794","authors":"Jessica Jarvis,&nbsp;Amy Houtrow","doi":"10.1016/j.apmr.2025.01.025","DOIUrl":"10.1016/j.apmr.2025.01.025","url":null,"abstract":"<div><h3>Objectives</h3><div>To characterize access to health care experiences reported by people with disabilities living in the United States since 2014.</div></div><div><h3>Design</h3><div>We conducted a systematic review of research published since 2014 and also interviewed people with disabilities living in Pittsburgh, Pennsylvania.</div></div><div><h3>Setting</h3><div>Not applicable.</div></div><div><h3>Participants</h3><div>Twenty-one individuals living in or near Pittsburgh, Pennsylvania that are disabled and/or care for someone who is disabled.</div></div><div><h3>Interventions</h3><div>Systematic literature review and interviews.</div></div><div><h3>Main Outcome Measures</h3><div>The screening protocol identified a total of 5007 articles. Eighty-three articles met inclusion criteria and were included. Articles were of varying quality of reporting, but none were excluded based on their score. Twenty-six percent (26%) (n=22) of the articles captured data from individuals with developmental disabilities, 17% (n=14) with a physical disability, 16% (n=13) from those with mental illness, 16% (n=13) did not restrict any disability type, 13% (n=11) with a sensory disability, 10% (n=8) collected data from multiple types, and only 2% (n=2) were from those with cognitive disabilities. Most studies (n=45, 54%) did not focus on a specific aspect of health care but looked broadly at the system. Dental (n=8) and primary care (n=6) were the next most common services examined.</div></div><div><h3>Results</h3><div>There are multiple themes identified from across the access to health care factors: approachability, availability/accommodations, affordability, acceptability, and appropriateness of health care services. Additionally, we identified the following themes on how access to care impacts people with disabilities: unmet needs, delayed care, negative impact on well-being, and fractured trust in the health care system.</div></div><div><h3>Conclusions</h3><div>Findings confirm that access to health care is limited and unjust for people with disabilities and that limited access does widespread harm. Notably, beyond the very real and direct harms caused to an individual's health by inadequate health care, when accessing care is difficult, it increases experiences of stress and depression, drains individual and societal resources, and negatively impacts relationships, careers, and other necessary components of life.</div><div>This resulted from work supported by the FISA Foundation.</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 e10"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Intersection Model Between Rehabilitation Medicine and Complementary and Integrative Medicine Sciences","authors":"Sonya Kim PhD, CRC, BCB, FACRM,&nbsp;Patricia C. Heyn PhD, FGSA, FACRM","doi":"10.1016/j.apmr.2024.11.007","DOIUrl":"10.1016/j.apmr.2024.11.007","url":null,"abstract":"","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages 637-640"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715312","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":"Systematic Review: Returning to School After Traumatic Brain Injury 4347","authors":"Adrienne McElroy Bratcher,&nbsp;Emilee Montes","doi":"10.1016/j.apmr.2025.01.009","DOIUrl":"10.1016/j.apmr.2025.01.009","url":null,"abstract":"<div><h3>Objective(s)</h3><div>To complete a systematic review of research regarding returning to school after traumatic brain injury (TBI) to (1) determine recommendations for a successful return to school after a TBI according to the implications of children returning to school after sustaining a TBI, and (2) determine the impact of the lasting effects of TBI on children's success in an academic environment when returning to school.</div></div><div><h3>Data Sources</h3><div>PubMed, ProQuest, Sage Journals, NIH, ResearchGate, Europe PMC, JAMA, Lippincott Williams &amp; Wilkins, and Frontiers with time restrictions between 1980 and 2023.</div></div><div><h3>Study Selection</h3><div>Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and a 3-phase review process, the principal investigator completed the initial records search, yielding 9 databases. The second phase included an article search and records review by 2 investigators with inclusion criteria pulling articles for signs and symptoms of mild TBI in school-aged children from 1980 to 2021, yielding 24 articles narrowed down to 4 that met the criteria for a full review. The third phase of the review searched “return to school” or “re-entry to school” or “return to learn” and “TBI” or “traumatic brain injury” or “brain injury” or “head injury” and “in school-age children” by a single investigator with a follow-up review by the principal investigator. This yielded 168 articles from 1980 to 2021, narrowed down to 45 articles that met the criteria for a full review completed by both investigators.</div></div><div><h3>Data Extraction</h3><div>The records review was completed initially on October 29, 2020, and the final review was completed on July 31, 2023, yielding 49 articles from 36 journals reviewed to include years from 1993 to 2021.</div></div><div><h3>Data Synthesis</h3><div>Research found that many professionals and caregivers often did not know how to support children as they returned to school, thus requiring more training and education. Increased preparation and interdisciplinary support were associated with better academic and social outcomes.</div></div><div><h3>Conclusions</h3><div>General recommendations have been summarized; further research is recommended to establish procedures to reintegrate children into the school environment with proper modifications, accommodations, and other necessary supports based on current symptomology and encourage advocacy for services.</div></div><div><h3>Disclosures</h3><div>Adrienne McElroy Bratcher serves on the New Mexico Brain Injury Advisory Council as appointed by the Governor and teaches Neurogenic Language Disorders at Eastern New Mexico University. Emilee Montes is a Graduate Assistant in the Communicative Disorders Program at Eastern New Mexico University.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Page e3"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143760975","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":"Implementing 3-Steps Workout for Life to Support Patient Functional Outcomes in Home Health: Facilitators, Barriers, and Preliminary Findings 4363","authors":"Chiung-ju Liu,&nbsp;Consuelo Kreider,&nbsp;Santanu Datta","doi":"10.1016/j.apmr.2025.01.012","DOIUrl":"10.1016/j.apmr.2025.01.012","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To investigate how to adapt the 3-Step Workout for Life, a task-oriented resistance exercise program, to be used by home health therapy practitioners.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;A mixed-methods action research design consisting of a single-site, pragmatic, quasi-experimental trial.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;Home health care agency.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;A rehabilitation therapy team (1 director, 3 occupational therapy practitioners, 5 physical therapy practitioners) and 10 home health patients (mean age, 77y; women, 5; White, 5) from a local home health agency participated in the study. Patients were excluded if they had a neurological condition or major surgical procedure.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;Individual interviews were conducted with administrators and therapy practitioners before and after the implementation of the modified 3-Step Workout for Life, which consisted of structured resistance exercise and principle-based activity exercise. Implementation barriers and facilitators were identified based on the interview results using directed qualitative content analysis, which was guided by the Consolidated Framework for Implementation Research. Different delivery models were developed to accommodate the type of therapy services provided to each patient. The modified 3-Step Workout for Life was implemented in eligible patients by the home health therapy team during in-person visits.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;Patient outcomes were assessed with Activity Measure for Post-Acute Care and EQ-5D-5L, and were analyzed using the Wilcoxon singed-rank test. Patient satisfaction was measured using an exit survey.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;External policy changes (ie, the new Medicare payment model) were identified as a potential implementation barrier due to concerns about limited therapy visits. However, multiple implementation facilitators were identified regarding perceived positive strength and quality of the intervention, strong inner agency networks and communication, positive office culture, good compatibility of the intervention, great knowledge and belief about the intervention, and self-efficacy in delivering the intervention. Patients pre-post tests showed improved mobility (&lt;em&gt;Z&lt;/em&gt;=−2.52, &lt;em&gt;P&lt;/em&gt;=.01), daily activities (&lt;em&gt;Z&lt;/em&gt;=−2.37, &lt;em&gt;P&lt;/em&gt;=.02), and quality of life (&lt;em&gt;Z&lt;/em&gt;=−1.87, &lt;em&gt;P&lt;/em&gt;=.07).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Although identifying potential barriers before implementation was helpful in modifying the intervention program, additional barriers were raised during the implementation process, such as patients being discharged before program completion or changes in referrals of eligible patients due to the new Medicare payment model. Although home health patients may benefit from the 3-Step Workout for Life program, addressing existing practice habits and understanding the new Medica","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":"143760978","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":"NIDILRR ARRT: A Culturally Informed Lens on Assistive Technology Provision","authors":"Stacy Hsueh","doi":"10.1016/j.apmr.2025.01.004","DOIUrl":"10.1016/j.apmr.2025.01.004","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To investigate the experience of assistive technology (AT) for people with disability from cultural backgrounds, particularly those rooted in a collectivist framework prevalent in many Asian, South American, African, and Middle Eastern countries. The project seeks to explore the tensions that may arise for multicultural AT users when navigating a Western-centric AT provision ecosystem. The goal of the study is to explore alternative understandings of assistance, providing a more inclusive examination of AT use and disuse from a multicultural perspective.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;This is an observational and interview study for understanding current practices in matching people with disabilities with the right AT. During observations of and interviews with people who use AT and people who provide them, we focus on identifying barriers and challenges associated with the use of ATs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;This study was carried out at Open Doors for Multicultural Families, a Seattle-based nonprofit organization that provides services to help people with disability find the right ATs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;We interviewed people with disabilities who receive support services to find AT. We used convenience sampling and included participants who regularly use AT for disability or accessibility reasons. The types of AT being used range from those that address vision, hearing, mobility, and developmental disabilities. We also interviewed case managers who provide AT support services at Open Doors.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;Not applicable.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;We asked people with disabilities and caregivers about the challenges they encounter in getting the AT they need. We asked case managers and AT professionals about how they handle language or cultural barriers in supporting families in getting AT and how they adapt AT solutions to meet individual needs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The participants seeking AT reported that they are often unaware of the services available to them and the kinds of AT that could benefit them. AT professionals reported that case managers often construe individual needs in a way that leads to delayed consideration or oversight of AT despite their potential to effectively address the needs of individuals with disabilities. This study demonstrates that the decision to adopt AT as a solution to an access problem is far from a straightforward process. It involves a complex interplay of structural forces and power relations among various interest groups informed by differing values and priorities. We argue that by attending to the AT provision pipeline as a site for critical examination, we can bring valuable knowledge to AT practitioners and designers in exploring alternative approaches using cultural lens.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;In this study, we adopt a cultural lens on AT provi","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Page e1"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761078","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":"Archives I/EP Guidelines","authors":"","doi":"10.1016/S0003-9993(25)00563-5","DOIUrl":"10.1016/S0003-9993(25)00563-5","url":null,"abstract":"","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages 654-656"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761087","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":"Analysis of Conclusiveness over Time of Cochrane Systematic Reviews in Physiotherapy: A Methodological Study 0413","authors":"Kailei Eustis,&nbsp;Ana Paula Freire,&nbsp;Gordon Smilanich,&nbsp;Italo Ribeiro Lemes,&nbsp;Mark Elkins,&nbsp;Rafael Zambelli Pinto","doi":"10.1016/j.apmr.2025.01.046","DOIUrl":"10.1016/j.apmr.2025.01.046","url":null,"abstract":"<div><h3>Objectives</h3><div>To determine the proportion of conclusive Cochrane reviews relevant to the field of physiotherapy and to investigate whether conclusiveness has been increasing over time.</div></div><div><h3>Design</h3><div>Methodological study.</div></div><div><h3>Setting</h3><div>PEDro database.</div></div><div><h3>Participants</h3><div>Two hundred Cochrane systematic reviews were randomly selected, with 50 from each of the 4 publication periods: 2000-2005, 2006-2010, 2011-2015, and 2016-2020.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Two independent reviewers extracted: year of publication, country, Cochrane Review Group, participants, intervention, comparators, primary outcomes, number of randomized controlled trials, total cumulative number of patients enrolled, and the need for further studies. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE), ranging from very low to high. GRADE data from primary outcomes were used if available, otherwise reviewers applied the GRADE approach to remaining outcomes after a set of prespecified criteria. To analyze change over time, chi-square tests of independence were used for GRADE proportions, criteria for downgrades, study conclusiveness, and reported need for further studies.</div></div><div><h3>Results</h3><div>Outcomes rated very low significantly increased over the 23 period from 14% in 2000-2005 to 34% in 2016-2020 (<em>P</em>&lt;.001). Low-rated outcomes trended downward over the same period and outcomes rated moderate or high remained consistent. Proportion of high-rated outcomes never exceeded 5% per time period and composed 3% of the entire sample. Risk of bias was the most prevalent reason for downgrade, composing 45% of all outcome downgrades. Inconsistency demonstrated a time-wise increase from &lt;1% in 2000-2005 to 9% in 2016-2020 (<em>P</em>&lt;.001). Study conclusiveness remained unchanged (<em>P</em>&gt;.05) and consisted of 4% of all studies in the sample. Proportion of conclusive studies was highest in 2016-2020 with 4 out of 50 (8%). Studies reporting no further research needs were also unchanged (<em>P</em>&gt;.05) and did not exceed 14% of studies per time period, or 9% overall.</div></div><div><h3>Conclusions</h3><div>The proportion of Cochrane reviews deemed conclusive has not changed over time and remains a very small proportion of those published. Outcomes with high certainty of evidence are also few and remain unchanged. Further research is necessary in the physiotherapy field to provide higher quality evidence and improve conclusiveness in systematic reviews.</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 e18"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761114","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":"Lessons from Refining a Focus Group Protocol with Veterans: Adapted Think-alouds and Accommodated Focus Groups for Persons with Traumatic Brain Injury 8263","authors":"Rebecca Campbell-Montalvo,&nbsp;Jennifer Bogner,&nbsp;Tracy Kretzmer,&nbsp;Jolie Haun,&nbsp;Megan Moore,&nbsp;Risa Nakase-Richardson","doi":"10.1016/j.apmr.2025.01.027","DOIUrl":"10.1016/j.apmr.2025.01.027","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To improve research involving people with traumatic brain injury (TBI), Project I-HEAL sought to refine a focus group guide for those who may have cognitive challenges. Think-alouds (Van Someren et al., 1994) were used, but were adapted so participants could best evaluate the guide. The guide's purpose was to elicit data on acceptable practices during in-patient rehabilitation from veterans with TBI.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Four mixed-method qualitative sessions were used: 1 unstructured focus group (Brinkmann, 2014), 2 adapted think-alouds, and 1 structured focus group guide pilot.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;The setting was virtual (ie, Teams). Participants were a veteran research engagement group from a VA hospital.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;Seven participants (4 persons with TBI and 3 caregivers) participated in the first and fourth session. The second and third sessions each comprised a subsample of 2 couples (1 person with TBI and their caregiver).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;The first session included study overview and participant-driven discussion about practices in which researchers should engage. This was followed by adapted think-aloud sessions in which real-time modifications to the guide based on feedback were made. Then, a pilot was done to test focus group guide usability.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;Outcome measures were the feedback given in the first session (ie, general advice about veterans with TBI and their caregivers participating in research), the second and third sessions (ie, specific item rephrasing offered by participants), and the fourth session (ie, determinations of whether people understood items).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;In session 1, participants’ comments coalesced around 2 themes: researchers should provide materials to participants in advance; researchers should allow plenty of time for participants’ cognition. In sessions 2-3, participants offered rephrasing of items to reduce cognitive burden, such as by suggesting direct and shorter sentences. In session 4, the refined guide was piloted successfully, although it took more time than other focus groups due to cognitive processing time needed and requests for redirection and repetition.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;This novel, adapted think-aloud procedure offers advantages over others that organize and analyze think-aloud data using codebooks with feedback being used to later revise measures (eg, Ahmadi et al., 2022; Kleyen et al., 2017). Using the present novel approach, researchers can ensure they are understanding feedback accurately and participants can articulate whether changes speak to their feedback. In addition, to allow for participant cognition (Norman et al., 2019), research using focus groups with participants with TBI may benefit from allotting 50% more time and including fewer members (ie, 4 participants rather than ","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages e10-e11"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761250","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}