Archives of physical medicine and rehabilitation最新文献

{"title":"Evaluation of Inadequate Response to Ultrasound-Guided Subacromial Corticosteroid Injection in Shoulder Impingement Syndrome: Treatment Failure or Central Sensitization?","authors":"Büşra Şirin Ahısha MD ,&nbsp;Nurdan Paker MD ,&nbsp;Nur Kesiktaş MD, PhD ,&nbsp;Nazlı Derya Buğdayci MD ,&nbsp;Yiğit Can Ahısha MD","doi":"10.1016/j.apmr.2025.01.469","DOIUrl":"10.1016/j.apmr.2025.01.469","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate whether central sensitization (CS), pain catastrophizing, and psychological factors are associated with inadequate response to ultrasound-guided subacromial corticosteroid injection in patients with chronic shoulder impingement syndrome.</div></div><div><h3>Design</h3><div>This study was designed as a prospective observational study, combining analytical cross-sectional and prospective elements to evaluate associations and treatment responses.</div></div><div><h3>Setting</h3><div>Secondary care outpatient clinic.</div></div><div><h3>Participants</h3><div>A total of 72 patients aged 18-75 years with shoulder impingement syndrome and at least 6 months of shoulder pain, planned to undergo ultrasound-guided subacromial corticosteroid injection, were included in the study.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measure(s)</h3><div>Treatment response was defined as a ≥50% reduction in pain (visual analog scale [VAS]) at 4 weeks postinjection. The presence of CS was assessed using the Central Sensitization Inventory (CSI) and pressure pain threshold via algometry (ipsilateral deltoid, contralateral deltoid, and contralateral vastus lateralis). Negative thoughts related to pain were evaluated with the pain catastrophizing scale, and mood status was assessed using the Hospital Anxiety and Depression Scale (HADS).</div></div><div><h3>Results</h3><div>Forty-eight patients (responders) experienced ≥50% VAS reduction, whereas 24 (nonresponders) did not. Nonresponders had significantly higher CSI (<em>P</em>=.000), HADS depression (<em>P</em>=.001), and HADS anxiety (<em>P</em>=.000) scores. The pressure pain threshold values were significantly lower in nonresponders at ipsilateral deltoid (<em>P</em>=.030), contralateral deltoid (<em>P</em>=.045), and contralateral vastus lateralis (<em>P</em>=.036). The CSI was significantly correlated with pressure pain threshold at ipsilateral deltoid (r=-0.400, <em>P</em>=.001), contralateral deltoid (r=-0.354, <em>P</em>=.002), and contralateral vastus lateralis (r=-0.442, <em>P</em>=.000); pain catastrophizing scale total score (r=0.449, <em>P</em>=.000); HADS depression score (r=0.572, <em>P</em>=.000); and HADS anxiety score (r=0.618, <em>P</em>=.000). CSI was the most predictive factor for nonresponse area under the curve (AUC=0.755, 95% confidence interval [CI]: 0.635-0.875). Multivariate analysis identified CSI as an independent predictor (<em>P</em>=.022), with a predictive accuracy of 72.2%.</div></div><div><h3>Conclusions</h3><div>Inadequate response to subacromial corticosteroid injection in chronic shoulder impingement syndrome is strongly associated with CS, psychological distress, and altered pain perception. Integrating CS-targeted interventions into treatment strategies may improve outcomes.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 8","pages":"Pages 1227-1237"},"PeriodicalIF":3.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122040","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 Clinical Efficacy of Extracorporeal Shock Wave Therapy Combined With Platelet-Rich Plasma and Exercise for Lateral Epicondylitis: Prospective Randomized Sham-Controlled Ultrasonographic Study","authors":"Ali İzzet Akçin MD ,&nbsp;Nuran Eyvaz MD ,&nbsp;Ümit Dündar MD ,&nbsp;Hasan Toktaş MD ,&nbsp;Hilal Yeşil MD ,&nbsp;Selma Eroğlu MD ,&nbsp;Sevda Adar MD","doi":"10.1016/j.apmr.2025.01.420","DOIUrl":"10.1016/j.apmr.2025.01.420","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the combined effect of 2 different regenerative therapies, extracorporeal shock wave therapy (ESWT) and platelet-rich plasma (PRP), along with therapeutic exercise, in patients with lateral epicondylitis (LE).</div></div><div><h3>Design</h3><div>Prospective, randomized, sham-controlled trial.</div></div><div><h3>Settings</h3><div>Outpatient clinic.</div></div><div><h3>Participants</h3><div>Ninety-one patients (N=91) with LE for &gt;3 months were randomly allocated into 3 groups.</div></div><div><h3>Interventions</h3><div>Participants were assigned to PRP+ESWT, Sham PRP+ESWT, or ESWT only treatment group. All groups received exercise therapy.</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome was the visual analog scale (VAS) pain score. Secondary outcomes included handgrip strength, Patient-rated Tennis Elbow Evaluation (PRTEE), Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH), Short Form 36, ultrasonographic assessments (common extensor tendon [CET] measurement and total ultrasonography scale score [TUSS]), and isokinetic evaluation. Participants were evaluated 3 times: pre-treatment (T0), after 4 weeks (T1), and after 12 weeks (T2).</div></div><div><h3>Results</h3><div>The PRP group showed superiority over other groups in terms of VAS (activity and night) scores at follow-ups. With regard to the secondary outcomes, in the short term, the PRP group demonstrated a statistically significant difference in the PRTEE-function. In the 12th week, PRP outperformed only against ESWT in all PRTEE parameters, and also showed superior Quick DASH scores to the other groups. In handgrip strength, the PRP group demonstrated superiority over the Sham PRP group at T1 and over both groups at T2. In the isokinetic evaluation, PRP group showed superiority over the Sham PRP group in both wrist flexion/extension peak torque scores during follow-ups. No significant differences were found in any of the ultrasonographic parameters, including CET thickness and TUSS scores, between the groups at the 4th and 12th week.</div></div><div><h3>Conclusions</h3><div>The combined application of ESWT and PRP in the management of LE has demonstrated superior efficacy, as evidenced by significant improvements in clinical parameters.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 8","pages":"Pages 1173-1182"},"PeriodicalIF":3.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021997","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":"Reconceptualizing Disorders of the Self as Disorders of Relationship","authors":"Brick Johnstone PhD ,&nbsp;Daniel Cohen PhD ,&nbsp;Raeda Anderson PhD ,&nbsp;Andrew Cullen Dennison MD ,&nbsp;Laura Bosque MPH","doi":"10.1016/j.apmr.2024.12.019","DOIUrl":"10.1016/j.apmr.2024.12.019","url":null,"abstract":"<div><h3>Objective</h3><div>To validate a universal neuropsychological model that suggests that disorders of the self are best conceptualized as disintegrated neuropsychological processes (ie, sensations, mental experiences) that lack a sense of relationship to the unified experience/sense of self.</div></div><div><h3>Design</h3><div>Cross-sectional observational study.</div></div><div><h3>Setting</h3><div>Rehabilitation hospital outpatient clinics.</div></div><div><h3>Participants</h3><div>A total of 73 individuals including 33 with acquired brain injury and 40 with multiple sclerosis.</div></div><div><h3>Intervention</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>On the basis of the Cambridge Depersonalization Scale, a measure of general disintegration of sensations and mental experiences, a team of rehabilitation clinicians and researchers proposed 6 clinically derived indices of specific disintegrated neuropsychological inputs (ie, sensations), outputs (ie, mental experiences), and experiences of disintegration (ie, space, time, context).</div></div><div><h3>Results</h3><div>As hypothesized (1) a confirmatory factor analysis supported the proposed factors including disintegrated bodily sensations (root mean square error of approximation [RMSEA]=0.193, <em>P</em>=.009; comparative fit index [CFI]=0.909; Tucker-Lewis index [TLI]=0.819), disintegrated context (RMSEA=0.143, <em>P</em>=.129; CFI=0.970; TLI=0.911), disintegrated emotions (RMSEA=0.090, <em>P</em>=.266; CFI=0.967; TLI=0.902), disintegrated cognition (RMSEA=0.091, <em>P</em>=.210; CFI=0.963; TLI=0.939), disintegrated smell/taste, and disintegrated spatial perception (measures of model fit for these last 2 factors could not be determined given they included only 2 items); and (2) Pearson correlations indicated that all 7 Cambridge Depersonalization Scale indices were negatively correlated with a measure associated with right hemisphere functioning, with 5 achieving/approaching statistical significance.</div></div><div><h3>Conclusion</h3><div>The results suggest that (1) neuropsychological abilities should be conceptualized in terms of relatively singular neuropsychological domains (ie, affect, behavior, cognition, sensation) and the experience of relationship that is created when they are integrated, and (2) disorders of the self are best conceptualized as disorders of disintegration that are associated with decreased relationship between specific neuropsychological processes and the unified experience/sense of self.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 8","pages":"Pages 1198-1206"},"PeriodicalIF":3.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926301","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":"Caregiver Resilience Through the First 2 Years After Traumatic Brain Injury: A Traumatic Brain Injury Model Systems Study","authors":"Daniel W. Klyce PhD ,&nbsp;Jennifer H. Marwitz MA ,&nbsp;Robert A. Perera PhD ,&nbsp;Laura E. Dreer PhD ,&nbsp;Stephanie D. Agtarap PhD ,&nbsp;Katherine Abbasi MA ,&nbsp;Dawn M. Neumann PhD ,&nbsp;Flora M. Hammond MD ,&nbsp;Thomas F. Bergquist PhD ,&nbsp;Jean Lengenfelder PhD","doi":"10.1016/j.apmr.2025.01.464","DOIUrl":"10.1016/j.apmr.2025.01.464","url":null,"abstract":"<div><h3>Objective</h3><div>To examine: (1) the trajectory of caregiver resilience over 2 years after onset of a care-recipient's moderate-to-severe traumatic brain injury (TBI), (2) caregiver-related outcomes associated with resilience, and (3) changes in associations between caregiver resilience, other caregiver characteristics, and care-recipient variables across time.</div></div><div><h3>Design</h3><div>Prospective cohort.</div></div><div><h3>Setting</h3><div>TBI Model System (TBIMS) centers.</div></div><div><h3>Participants</h3><div>TBIMS participants (care-recipients) were approached to enroll in this study and identify a caregiver. Two hundred fifty-eight (N=258) care-recipient and caregiver dyads were enrolled.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Caregiver data included demographics, health history, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7, Zarit Burden Interview (ZBI), Family Needs Questionnaire-Revised, and Connor-Davidson Resilience Scale 10 (CD-RISC-10). All caregiver data were self-reported via phone interview or mailed surveys at 6, 12, and 24 months after injury. At all 3 timepoints, care-recipients with TBI also completed their own CD-RISC-10, PHQ-9, Generalized Anxiety Disorder-7, and Disability Rating Scale.</div></div><div><h3>Results</h3><div>Linear mixed-effects models indicated that the trajectory of resilience was stable within caregivers over 2 years after injury. There were significant, positive associations for all caregiver Family Needs Questionnaire-Revised subscales (all <em>P</em>&lt;.001) with care-recipient and caregiver CD-RISC-10 scores (<em>P</em>=.001), indicating that more caregiving needs endorsed as “met” corresponded with higher resilience. Caregiver PHQ-9 and ZBI scores were found to be negatively associated with resilience (both <em>P</em>&lt;.001). When all covariates were included in the multivariable model, met emotional needs was positively associated with caregiver resilience (<em>P</em>&lt;.0001). Negative associations with caregiver resilience included higher caregiver PHQ-9 scores (<em>P</em>=.001) and perceptions of caregiving burden (<em>P</em>=.003).</div></div><div><h3>Conclusions</h3><div>Caregiver levels of resilience were generally stable over 2 years post-TBI. Caregivers’ resilience was positively associated with perceptions of their needs being met and negatively associated with caregiving burden and emotional distress. Further research is needed to develop and evaluate the utility and feasibility of interventions to enhance resilience, meet family needs, and improve long-term outcomes after brain injury.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 8","pages":"Pages 1217-1226"},"PeriodicalIF":3.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063447","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":"Repetitive Transcranial Magnetic Stimulation Strategies for Poststroke Dysphagia: A Systematic Review and Network Meta-analysis","authors":"Xiaomin Wu MD ,&nbsp;Baixiang Zhang MD ,&nbsp;Gareth Ambler PhD ,&nbsp;Qingfa Chen MD ,&nbsp;Huayao Huang MD ,&nbsp;Huiying Lin MD ,&nbsp;Shuangfang Fang MD ,&nbsp;Nan Liu MD ,&nbsp;Houwei Du MD, PhD","doi":"10.1016/j.apmr.2024.12.018","DOIUrl":"10.1016/j.apmr.2024.12.018","url":null,"abstract":"<div><h3>Objective</h3><div>Repetitive transcranial magnetic stimulation (rTMS) is a promising approach in improving swallowing function after stroke. However, comparative efficacy of different rTMS protocols for poststroke dysphagia (PSD) remains unclear.</div></div><div><h3>Data Sources</h3><div>PubMed, Embase, and Cochrane database were systematically searched for eligible random controlled trials (RCTs) from inception to August 30, 2024.</div></div><div><h3>Study Selection</h3><div>RCTs comparing rTMS with control or head-to-head comparisons of 2 rTMS protocols in patients with PSD.</div></div><div><h3>Data Extraction</h3><div>Data were extracted by 2 independent reviewers. A network meta-analysis combining direct and indirect evidence was conducted to assess the pooled findings of RCTs with standard mean difference (SMD) with 95% credible interval (CrI).</div></div><div><h3>Data Synthesis</h3><div>Eighteen RCTs involving 760 participants (mean age of 62.4 [range 49.7-74.7] years; 45.7% women) were included. Pooled data showed that high frequency (HF)/ipsilesional hemisphere (ipsi-hemi) (SMD, −0.94; 95% CrI, −1.51 to −0.44), HF/bilateral hemisphere (bi-hemi) (SMD, −2.59; 95% CrI, −3.50 to −1.72), HF/ipsilesional cerebellar (ipsi-CRB) (SMD, −0.79; 95% CrI, −1.55 to −0.10), HF/bilateral cerebellar (bi-CRB) (SMD, −1.02; 95% CrI, −1.83 to −0.29), and HF/ipsi-hemi + low frequency (LF)/contralesional hemisphere (contra-hemi) (SMD, −2.72; 95% CrI, −4.12 to −1.41) rTMS all significantly improved swallowing function compared with control. For patients with acute stroke, HF/ipsi-hemi rTMS had a positive effect (SMD, −1.36; 95% CrI, −2.86 to −0.02); in subacute stage, HF/ipsi-hemi + LF/contra-hemi rTMS showed the best efficacy (SMD, −2.68; 95% CrI, −4.26 to −1.26). However, rTMS failed to improve swallowing function in chronic stage.</div></div><div><h3>Conclusions</h3><div>This network meta-analysis showed that most of the rTMS protocols (HF/ipsi-hemi, HF/bi-hemi, HF/ipsi-CRB, HF/bi-CRB, and HF/ipsi-hemi + LF/contra-hemi) may improve swallowing function in patients with PSD. The HF/ipsi-hemi rTMS had a positive effect in acute stage and the HF/ipsi-hemi + LF/contra-hemi protocol seemed to have the best efficacy when applied in subacute stroke.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 8","pages":"Pages 1248-1257"},"PeriodicalIF":3.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913603","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":"Prevalence and Impact of Postexertional Malaise on Recovery in Adults With Post-COVID-19 Condition: A Systematic Review With Meta-analysis","authors":"Dimitra V. Pouliopoulou MSc ,&nbsp;Myranda Hawthorne MSc ,&nbsp;Joy C. MacDermid PhD ,&nbsp;Nicole Billias BSc ,&nbsp;Erin Miller PhD ,&nbsp;Kieran Quinn MD, PhD ,&nbsp;Simon Décary PhD ,&nbsp;Fahad A. Razak MD ,&nbsp;Angela Cheung MD, PhD ,&nbsp;Panagis Galiatsatos MD ,&nbsp;Tiago V. Pereira PhD ,&nbsp;Pavlos Bobos PhD","doi":"10.1016/j.apmr.2025.01.471","DOIUrl":"10.1016/j.apmr.2025.01.471","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;To assess the prevalence of postexertional malaise (PEM) in people with post-COVID-19 condition (PCC); and the change in prevalence of PEM after rehabilitation interventions in people with PCC.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Data Sources&lt;/h3&gt;&lt;div&gt;We searched MEDLINE, Embase, CENTRAL, CINAHL, PsychINFO, and clinical trial registries from inception until February 11, 2025.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Selection&lt;/h3&gt;&lt;div&gt;We included observational studies that measured the prevalence of PEM in adults with PCC and interventional studies that measured the change in prevalence of PEM after rehabilitation interventions in adults with PCC. Two independent researchers screened titles and abstracts. Any discrepancies underwent full text review. Two independent researchers screened the articles included at the full text level.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Data Extraction&lt;/h3&gt;&lt;div&gt;Two independent researchers extracted data from eligible studies. We extracted point prevalence from the cross-sectional studies; and period prevalence from the longitudinal studies. Two independent reviewers assessed the risk of bias. Discrepancies were resolved with a senior research team member. For the prevalence studies we used the ROBINS-E tool. For randomized controlled trials we used the RoB2 tool. For non-randomized interventional studies we used the ROBINS-I tool to assess the non-randomized studies. We used the GRADE system to assess the certainty of the evidence.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Data Synthesis&lt;/h3&gt;&lt;div&gt;We performed a single-arm proportional meta-analysis to synthesize prevalence estimates using logit transformation. We conducted a sensitivity analysis using multilevel-mixed-effects logistic regression. We used a random effects model. Results were reported as proportions with corresponding 95% confidence intervals (95% CI) or presented descriptively when statistical analysis was not applied. This study is registered with PROSPERO (CRD42024516682). The prevalence of PEM in community-dwelling adults living with PCC was 25% (95% CI: 0.17-0.36; 10 studies; 4,076 low certainty after the word participants). Five of the included studies (193 patients) found a decrease in the frequency and intensity of PEM episodes in adults with PCC after a tailored rehabilitation program centered on integrating pacing approaches. Eight studies (1080 patients) measured PEM as an adverse event following an individually tailored rehabilitation intervention with a therapeutic exercise component. Seven of these studies did not find indications of post exertional symptom exacerbation related to the exercise component of the intervention. All of the studies had high to very high risk of bias.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Our research confirms that there is a large burden of PEM in adults living with PCC, highlighting a critical challenge for health care systems and an urgent need for more inclusive and rigorous research, to offer safe and effective therapeutic solutions and meet t","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 8","pages":"Pages 1267-1278"},"PeriodicalIF":3.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373477","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":"Individualized Physiotherapy and Activity Coaching in Multiple Sclerosis (IPAC-MS): Results of a Randomized Controlled Trial","authors":"Sarah J. Donkers PhD ,&nbsp;Charity Evans PhD ,&nbsp;Michael C. Levin MD ,&nbsp;Kyra Ives MD ,&nbsp;Ha Le PhD ,&nbsp;Hyun J. Lim PhD ,&nbsp;Katherine B. Knox MD","doi":"10.1016/j.apmr.2025.02.005","DOIUrl":"10.1016/j.apmr.2025.02.005","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate if a novel intervention involving individualized behavior change strategies delivered by physiotherapists has an effect on physical activity levels in people with multiple sclerosis (MS) who were previously inactive compared with usual care.</div></div><div><h3>Design</h3><div>Prospective, assessor-blinded, parallel-group, randomized controlled trial.</div></div><div><h3>Setting</h3><div>Community settings across Saskatchewan, Canada.</div></div><div><h3>Participants</h3><div>Individuals diagnosed with MS, &gt;18 years of age, and able to walk with or without aids were invited to participate from an MS Saskatchewan database.</div></div><div><h3>Intervention</h3><div>The intervention group received individualized physical activity behavioral coaching for 12 months compared with a usual care control group. There were 3 consistent features of the intervention: behavior change techniques, recommendations for physical activity, and ongoing physiotherapist support. However, these components were tailored to each participant.</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome was change in physical activity levels at 12 months on the Godin Leisure Time Exercise Questionnaire. Secondary measures included MS symptoms (Multiple Sclerosis Impact Scale-29), confidence with managing MS (Multiple Sclerosis Self-Efficacy Scale), and exercise self-efficacy (Exercise Self-Efficacy Scale).</div></div><div><h3>Results</h3><div>A total of 120 participants (mean age 53 years, 78% female, average disease duration 14.7 years) were enrolled and 117 completed primary outcome. At month 12, the mean (95% confidence interval) difference between intervention and control group for Godin Leisure Time Exercise Questionnaire was 15.9 (12.5-28.4). This improvement occurred regardless of age, gender, if on an MS drug, time since relapse, or comorbidity history. In the intervention group, 33.9% were sufficiently active for substantial health benefits compared with 6.9% in the control group at month 12 (<em>P</em>&lt;.001). At baseline, these proportions were 3.4% and 4.9% respectively. Improvement occurred on the Multiple Sclerosis Self-Efficacy Scale and Exercise Self-Efficacy Scale at 12 months in favor of the intervention group.</div></div><div><h3>Conclusion</h3><div>Physical activity levels and exercise self-efficacy improved clinically and significantly with neurophysiotherapist led individualized coaching.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 8","pages":"Pages 1145-1154"},"PeriodicalIF":3.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439752","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 Role of Enablement Theory in Rehabilitation Practice, Education, and Research","authors":"Shanti M. Pinto MD, MSCS ,&nbsp;John Whyte MD, PhD ,&nbsp;Andrew Packel PT, NCS ,&nbsp;Susan E. Fasoli OT, ScD, OTR ,&nbsp;Sue Ann Sisto PT, MA, PhD, FACRM ,&nbsp;Carla Tierney-Hendricks PhD, CCC-SLP ,&nbsp;Jeanne M. Zanca MPT, PhD, FACRM","doi":"10.1016/j.apmr.2025.04.003","DOIUrl":"10.1016/j.apmr.2025.04.003","url":null,"abstract":"<div><div>Enablement theory refers to the theoretical framework that describes the interrelationships among different areas of functioning, such as those illustrated by the International Classification of Functioning, Disability, and Health (ICF). Enablement theory is necessary to explain causal relationships and predictions of how changes in one aspect of function impact distal outcomes. This is in contrast with treatment theory, which describes how the active ingredient(s) of an intervention directly impact a measurable target. Enablement theory helps clinicians articulate their rehabilitation treatment plans by identifying the underlying targets necessary to achieve a patient’s desired outcomes and monitor the response to treatment. In this manner, enablement theory can also support the education of novice and experienced clinicians and/or trainees in their clinical reasoning process. Enablement theory helps researchers articulate the relationships they hypothesize between the aspects of function they seek to change with an intervention and the immediate and distal outcomes of that intervention. Researchers can then design the rehabilitation intervention and identify key outcome measures to rigorously test their conceptual framework, including the important mediators of the intervention’s effects, and aid in the interpretation of study results. The use of enablement models has not been well-described in the rehabilitation literature, and formal research focused on understanding the nature and strength of the relationships within these enablement models is necessary to advance the field of rehabilitation. We discuss how enablement theory contributes to our understanding of rehabilitation interventions in the context of clinical practice, health professions education, and rehabilitation research.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 8","pages":"Pages 1285-1293"},"PeriodicalIF":3.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953278","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":"Reimbursement Opportunities for Caregiver Training in Rehabilitation: Using New CMS Training Service Codes","authors":"Joan M. Griffin PhD ,&nbsp;Adrianne Smiley EdD, OTD, OTR/L ,&nbsp;Brystana G. Kaufman PhD ,&nbsp;Beth Fields PhD, OTR/L, BCG","doi":"10.1016/j.apmr.2025.03.047","DOIUrl":"10.1016/j.apmr.2025.03.047","url":null,"abstract":"<div><div>Family caregivers of patients with rehabilitation and chronic care needs are often instrumental in helping to minimize patient risks for safety and other adverse health events and to avoid unnecessary health care utilization. In the United States, outside of the inpatient rehabilitation unit, they often undertake complex care tasks with minimal training. Heretofore, caregiver training in outpatient, home health, or other care settings has not been a priority, because of lack of reimbursement by insurance payers. In this special communication, we describe novel new codes and reimbursement policies approved by the Centers for Medicare and Medicaid Services for caregiver training, discuss their advantages over previous policies, and present potential practice improvements and research opportunities to assess the effect of these codes on patient and caregiver outcomes.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 8","pages":"Pages 1279-1284"},"PeriodicalIF":3.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953118","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":"Effectiveness, Feasibility, Acceptability, and Safety of Digital Interventions in Post-Stroke Rehabilitation: A Systematic Review and Meta-analysis of Randomized Controlled Trials.","authors":"Shuangyue Liu, Min Li, Jilin Ding, Qipei Ji, Yanning Niu, Xiao Yang, Shuangchun Ai, Siyuan Li","doi":"10.1016/j.apmr.2025.07.004","DOIUrl":"10.1016/j.apmr.2025.07.004","url":null,"abstract":"<p><strong>Objective: </strong>To assess the effects of digital interventions on cognition, emotion, and activities of daily living (ADL) in stroke survivors, alongside evaluating feasibility, acceptability, and safety metrics.</p><p><strong>Data sources: </strong>We systematically searched 11 English databases for eligible studies published between 2000 and May 2025.</p><p><strong>Study selection: </strong>Randomized control trials that focused on poststroke digital therapeutics were included. Experimental groups received digital interventions, while control groups underwent standard therapies or placebo. The outcomes included cognition, emotion, ADL, feasibility, acceptability, and safety.</p><p><strong>Data extraction: </strong>Two researchers independently extracted key data from eligible studies. Risk and methodology were assessed using the Cochrane Risk of Bias v2.0 and the PEDro scale. The meta-analysis was conducted using CMA v3.7, following the PRISMA 2020 guidelines.</p><p><strong>Data synthesis: </strong>Sixty-three studies (3297 participants) demonstrated significant improvements in overall cognition (g=0.46; 95% CI, 0.24-0.67; P<.001), ADL (g=0.38; 95% CI, 0.19-0.57; P<.001), and specific domains (global cognition, language, visuospatial; all P<.05). Exergaming and computer cognitive training significantly improved overall cognition and memory compared to other digital interventions. Medical sites-based interventions significantly enhanced overall/global cognition versus home-based protocols. Shorter sessions (≤30min) demonstrated superior efficacy in overall cognition to longer durations. Robot-assisted and computer cognitive training maximized ADL gains. Despite significant between-subgroup heterogeneity in emotion outcomes, no within-subgroup efficacy emerged for any digital interventions. Results showed varied recruitment (4.97%-100%) and retention (mostly >75%) across digital interventions. Adherence and attendance were generally high, while safety profiles were mostly favorable with mild adverse events like fatigue or dizziness in some cases.</p><p><strong>Conclusions: </strong>Digital interventions significantly enhance cognition when delivered via clinic-based exergaming or computer cognitive training (≤30min/session), while maximizing ADL improvements through robot-assisted or computer cognitive training in stroke patients. Robust feasibility, acceptability, and favorable safety supports clinical integration.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717350","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}