Archives of physical medicine and rehabilitation最新文献

{"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}

{"title":"Autonomic Function Comparison Between Unvaccinated and Vaccinated Young Adults Infected with COVID-19: An Observational Study 4346","authors":"Michael Eleruja,&nbsp;Bruna Spolador Silva,&nbsp;Leonardo D'acquisto,&nbsp;Kelly Pritchett,&nbsp;Karen Roemer,&nbsp;Ana Elisa Von Ah Morano,&nbsp;Vanessa Ribeiro Dos Santos,&nbsp;Fabio Santos Lira,&nbsp;Ana Paula Freire","doi":"10.1016/j.apmr.2025.01.032","DOIUrl":"10.1016/j.apmr.2025.01.032","url":null,"abstract":"<div><h3>Objectives</h3><div>To compare heart rate variability (HRV) indexes between coronavirus disease 2019 (COVID-19) infected unvaccinated (UYA) and vaccinated young adults (VYA).</div></div><div><h3>Design</h3><div>Observational study evaluating differences in HRV between COVID-19 infected vaccinated and UYA.</div></div><div><h3>Setting</h3><div>General community of young adults infected with COVID-19 in São Paulo state, Brazil.</div></div><div><h3>Participants</h3><div>Twenty-three UYA and 10 VYA with mild to moderate clinical COVID-19 were evaluated. Eligibility criteria: men and women, 20-40 years. Recruitment was through the media and diagnosis was via polymerase chain reaction test. Mean age of UYA was 29.17±6.32 and 26.22±5.23 years for VYA. HRV indexes were measured via heart monitor (Polar RS800CX) and this took place in a quiet room maintained at room temperature following at least 24 hours of complete abstinence from exercise, alcohol, and caffeine intake. Participants were fitted with a chest strap for 25 minutes and HRV was performed on 256 consecutive intervals and of these the most stable tachogram was selected. The indexes are divided into time domain, frequency domain, and nonlinear variables. The major indexes of note were mean heart rate (HR), stress index, low frequency power (LF) representing sympathetic system; mean RR interval, high frequency power representing the parasympathetic system and low frequency power/high frequency power representing global variability (overall well-being).</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>HRV indexes of infected unvaccinated and vaccinated subjects.</div></div><div><h3>Results</h3><div>Statistically significant differences were observed only in mean HR and mean RR interval. UYA (83.5±12.6bpm) had higher mean HR compared with VYA (73.9± 4.91bpm); <em>P</em>=.004; mean difference (MD), −9.58±4.15 bpm; confidence interval, 3.34-15.81. Mean RR was higher in VYA (812.90±52.06ms) than UYA (735.43±123.78ms); <em>P</em>=.02; MD, −77.47±30.6 ms; confidence interval, −139.90 to −15.03. Although the above 2 variables indicate sympathetic and parasympathetic systems, respectively, other indexes were not statistically significant. Most indexes evaluating sympathetic and parasympathetic systems activities were not different between the groups, except for mean HR and RR.</div></div><div><h3>Conclusions</h3><div>This study suggests that vaccination could help to establish and maintain better autonomic function (lower mean HR and higher mean RR interval) after COVID-19, further experimental research is needed to establish a causal relationship.</div></div><div><h3>Disclosures</h3><div>none.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages e12-e13"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761257","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":"Engaging Rural Caregivers to Evaluate, Tailor, and Implement the Whole Health Caregiver THRIVE Program for Continuous Adaptation and Improvement","authors":"Jolie Haun,&nbsp;Julie McMahon-Grenz,&nbsp;Rachel Benzinger,&nbsp;Christopher Fowler,&nbsp;Justin McDaniel,&nbsp;Tali Schneider,&nbsp;S. Angelina Klanchar","doi":"10.1016/j.apmr.2025.01.077","DOIUrl":"10.1016/j.apmr.2025.01.077","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;Approximately 5.5 million informal caregivers in the United States (eg, family members) assist with activities of daily living and medical tasks. Caregivers are essential in providing support to veterans but often experience emotional and physical strain, which can result in burnout and impact caregiving capacity. This work aimed to engage rural caregivers to evaluate, tailor, and implement Transforming Health and Resiliency through Integration of Values-based Experiences (THRIVE) program for caregivers.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;A mixed-methods human-centered design approach was used to develop and evaluate intervention content.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;A Whole Health service flagship at a Veterans Affairs (VA) hospital within the southeast United States. Due to remote recruitment, participants were geographically dispersed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;Participants were informal caregivers (ie, cohort 1, n=13; cohort 2, n=22) to VA veteran patients.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;THRIVE is a 7-week, remotely delivered evidence-based VA program designed to provide access to complementary and integrative health (CIH) based self-care. This program was originally developed for veterans and VA employees. The adapted Caregiver THRIVE program addresses caregivers’ wellness and QoL including burnout; CIH and wellness; mindfulness; and values-based living.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;The main outcome measures include burnout, guilt, mindfulness, mental, and physical-related QoL.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Majority of participants are rurally located (38.31%), white (74.67%), an average age of 61 years old, married, female caregivers (86.36%), with an associate's degree or higher (64.29%). Caregiver THRIVE was generally well-received and perceived helpful. Outcomes included improvements (as measured by standardized mean differences [SMD]) in burnout (SMD, −0.13), guilt (SMD, 0.23), mindfulness (SMD, 0.46), mental health-related quality of life (HRQoL) (SMD, 0.25), and physical HRQoL (SMD, 0.24). Preprogram to postprogram change scores indicated possible improvements for (QoL) (SMD, 0.24; ES, small).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Caregiver THRIVE has the potential to assist caregivers in acquiring knowledge and skills to maintain a healthy lifestyle, create community, and reduce burnout, particularly for rurally located caregivers. Periodic evaluation with caregivers appears crucial for continuous adaptation and program improvement.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Disclosures&lt;/h3&gt;&lt;div&gt;This work is supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, Veterans Rural Health Resource Center Veterans Health Administration, Office of Rural Health, Veterans Rural Health Resource Center – Iowa City, Iowa City (NOMAD PROJ-03860) with IRBNet #1714908-2. This is the result of work supported with resources and","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Page e30"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761334","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":"Assessing the Use of Dry Needling for Integrative Pain Management During Inpatient Therapy 1142","authors":"Jacqueline LaBarbera,&nbsp;Sarah Fitz-Maurice","doi":"10.1016/j.apmr.2025.01.057","DOIUrl":"10.1016/j.apmr.2025.01.057","url":null,"abstract":"<div><h3>Objectives</h3><div>Although dry needling (DN) has been used in a variety of outpatient settings to address pain, this is the first study analyzing DN with adults during inpatient rehabilitation. Primary objectives: to examine the effects of DN for pain management. Secondary objectives: to explore the effects of DN on daily activities, sleep, anxiety, therapy compliance, and medication usage.</div></div><div><h3>Design</h3><div>This was a randomized controlled trial with a parallel-group design and 1:1 allocation ratio.</div></div><div><h3>Setting</h3><div>The study was conducted at Atrium Health's Carolinas Rehabilitation in Charlotte, North Carolina, which is a non-profit inpatient rehabilitation hospital in an urban setting attached to a Trauma-1 Medical Center.</div></div><div><h3>Participants</h3><div>Forty-two adults were enrolled from a sample of convenience while undergoing inpatient rehabilitation in a facility that serves a diverse patient population including individuals post brain injury, spinal cord injury, oncological disease, and a variety of complex medical diagnoses.</div></div><div><h3>Interventions</h3><div>The 2 groups in this study were randomized to receive DN with manual therapy or manual therapy treatments only for pain management. All subjects received the “usual care” of the inpatient rehabilitation hospital including physical, occupation, and/or speech therapy treatments as well as nursing and medical interventions.</div></div><div><h3>Main Outcome Measures</h3><div>Outcomes included the Visual Analog Scale for Pain, Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaire for Pain Interference, Sleep Disturbance, and Emotional Distress-Anxiety, the amount of time patients refused therapy due to pain, and PRN pain medication use.</div></div><div><h3>Results</h3><div>Both groups demonstrated significant improvements pre-post treatment on visual analog scale for pain, PROMIS for pain interference, and PROMIS for emotional distress-anxiety. No changes were found for PROMIS—sleep disturbance, therapy refusals, or use of pain medication. There were no significant differences between groups on any outcome measure after treatment.</div></div><div><h3>Conclusions</h3><div>This research highlights the benefits of both MT and DN as an adjunct treatment for pain during inpatient therapy. No adverse events occurred showing that DN is safe and feasible during inpatient rehabilitation with adults in a complex medical state.</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 e22"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761305","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":"Effect of Telerehabilitation-Based Motor Imagery Training on Pain and Related Factors in People With Multiple Sclerosis: Randomized Controlled Pilot Trial","authors":"Hilal Karakas MSc ,&nbsp;Turhan Kahraman PhD ,&nbsp;Asiye Tuba Ozdogar PhD ,&nbsp;Cavid Baba MD ,&nbsp;Serkan Ozakbas MD","doi":"10.1016/j.apmr.2024.10.009","DOIUrl":"10.1016/j.apmr.2024.10.009","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the effect of telerehabilitation-based graded motor imagery (MI, GMI) training on pain and pain-related factors in people with multiple sclerosis (MS).</div></div><div><h3>Design</h3><div>Randomized controlled, assessor-blind pilot trial with repeated-measure design.</div></div><div><h3>Setting</h3><div>Neurology outpatient clinic.</div></div><div><h3>Participants</h3><div>Thirty-two people with MS were randomly allocated to intervention (n=16) and control (n=16) groups.</div></div><div><h3>Interventions</h3><div>During the 8-week GMI training period, the first 2 weeks involved implicit MI training while 6 weeks of explicit MI training were conducted.</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome was the general pain intensity over the past 2 days, assessed with a visual analog scale, with a minimum clinically important difference (MCID) of 23 mm. Secondary outcomes included general pain and specific body parts’ pain intensity over the past 7 days, neuropathic pain intensity, MI ability, fatigue, depression, anxiety, quality of life, sleep quality, daytime sleepiness, and cognitive functions scores. Assessments were conducted at baseline, at weeks 8 (post-treatment) and 12 (follow-up).</div></div><div><h3>Results</h3><div>The intervention group demonstrated a significant reduction in pain intensity over the past 2 days compared with control group (<em>P</em>&lt;.05). Furthermore, at the 8-week assessment, the intervention group surpassed the MCID in pain intensity over the past 2 and 7 days (<em>P</em>&lt;.05), whereas no significant change was observed in the control group (<em>P</em>&gt;.05). Significant effects were observed post-treatment on general pain over the past 7 days, neuropathic pain, MI ability, fatigue, depression, quality of life, processing speed, and visuospatial memory within intervention group compared with control group (<em>P</em>&lt;.05). However, the effect on anxiety, sleep quality, daytime sleepiness, and verbal memory between groups was not significant (<em>P</em>&gt;.05).</div></div><div><h3>Conclusions</h3><div>Telerehabilitation-based GMI training stands out as viable for the management of chronic pain and pain-related psychosocial symptoms for people with MS.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages 562-572"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567259","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 of a Community-Based Exercise Program for Ambulatory Individuals With Spinal Cord Injury: A Randomized Controlled Trial","authors":"Sungchul Huh PhD ,&nbsp;Yuna Kim BS ,&nbsp;Hyun-Yoon Ko PhD ,&nbsp;Mi Sook Yun PhD ,&nbsp;Yong Il Shin PhD ,&nbsp;Jung Lim Lee MS ,&nbsp;Sung-Hwa Ko PhD","doi":"10.1016/j.apmr.2024.11.003","DOIUrl":"10.1016/j.apmr.2024.11.003","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the effectiveness of a community-based structured exercise program, compared with usual care, in enhancing physical, functional, and psychological outcomes for ambulatory individuals with spinal cord injury (SCI).</div></div><div><h3>Design</h3><div>Randomized controlled trial comparing exercise group with usual care group.</div></div><div><h3>Setting</h3><div>One university-affiliated rehabilitation hospital.</div></div><div><h3>Participants</h3><div>Fifty-seven participants with chronic SCI who could walk more than 10 m.</div></div><div><h3>Interventions</h3><div>A supervised 20-session program focusing on flexibility, aerobic, and strengthening exercises was provided over 8 weeks for the exercise group, whereas the usual care group maintained their regular daily exercise routines.</div></div><div><h3>Main Outcome Measures</h3><div>Primary outcome included 6-minute walk test, and secondary outcomes assessed EuroQol-5 Dimensions 5-Level, Spinal Cord Independence Measure III, Berg Balance Scale, Timed Up and Go, grip strength, 30-second sit-to-stand test, sit and reach test, Beck Anxiety Inventory, Beck Depression Inventory, and bioelectrical impedance analysis.</div></div><div><h3>Results</h3><div>The 51 participants were allocated to intervention (n=36) and usual care (n=15) groups, consisting of 34 males and 17 females (average age, 59.78±13.19y). The participants included 24 with cervical, 17 with thoracic, 8 with lumbar, and 2 with sacral lesions, with all participants having motor incomplete injuries. The exercise group showed significant improvement compared with the usual care group in the 6-minute walk test by 49.80 m (95% confidence interval [CI], 13.04-86.55), Berg Balance Scale scores by 3.50 (95% CI, 0.96-6.03), 30-second sit-to-stand by 2.38 (95% CI, 0.29-4.47), and sit and reach test by 3.89 cm (95% CI, 0.96-6.82). The adherence rate was remarkably high at 89.6%, suggesting the feasibility of community exercise programs for this population. However, no significant changes were observed in psychological and quality-of-life measures.</div></div><div><h3>Conclusions</h3><div>Community-based structured exercise programs have been shown to be both feasible and effective in improving walking capacity, balance, lower extremity strength, and flexibility in ambulatory individuals with SCI.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages 481-490"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692491","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":"Mixed Methods Analysis of Social Support Experiences and Priorities Among Adults with Traumatic Brain Injury 8254","authors":"Jessica Kersey","doi":"10.1016/j.apmr.2025.01.017","DOIUrl":"10.1016/j.apmr.2025.01.017","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To examine the social support experiences and priorities of community-dwelling adults with chronic traumatic brain injury (TBI).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Convergent parallel mixed methods design with a cross-sectional examination of quantitative data to describe social network size and perceived social support, and qualitative interviews to examine values and priorities related to social support structure and quality.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;Community-based day rehabilitation program.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;Sixteen community-dwelling adults with moderate-severe TBI, &gt;6 months postinjury.&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;The size of social networks was measured as the number of close social contacts who can be regularly relied upon, and the number of total social contacts. Overall perceived frequency of social support was measured by a transformed total score on MOS Social Support Survey (range, 0-100; higher scores indicate greater support). We also examined subscales on the following MOS Social Support Survey domains: tangible support, emotional and instrumental support, affectionate support, and positive social interaction. Subscale scores are the mean score of the items on each subscale (range, 1-5; higher scores indicate greater support).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Participants had small social networks, which were comprised primarily of family members (mean of 4.3 close social contacts and 8.5 total social contacts). Participants had low perceived frequency of social support (mean, 28.4; SD, 24.7). Their greatest perceived social support was in the tangible support domain (mean, 2.9; SD, 0.8) and the lowest perceived social support was in the affectionate support domains (mean, 1.8; SD, 1.0). The size of the social network and perceived frequency of social support did not align. We identified 3 themes to describe participant values related to the quality of social support: commitment versus indifference, doing things with and for others adds meaning, and “they just love me.”&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Although participants had small social networks and low frequency of social support, they did identify several characteristics of social support that contributed to their social support satisfaction. Participants valued people who seemed committed to being there for them, people with whom they share a reciprocal relationship with shared contributions and shared activities, and people who love value them. These priorities align closely with affectionate support and positive social interaction, which are low among people with TBI. These results suggest that rehabilitation interventions should focus on strengthening relationships with close family members and identifying strategies for sustainable, loving, reciprocal relationships within the context of a new TBI.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;D","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Page e6"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761242","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":"Identifying and Prioritizing Recommendations to Optimize Transitions Across the Care Journey for Hip Fractures: Results From a Mixed-methods Concept Mapping Study in Ontario, Canada 1130","authors":"Sara Guilcher,&nbsp;Lauren Cadel,&nbsp;Amanda Everall,&nbsp;Walter Wodchis,&nbsp;Susan Bronskill,&nbsp;Kednapa Thavorn,&nbsp;Kerry Kuluski","doi":"10.1016/j.apmr.2025.01.055","DOIUrl":"10.1016/j.apmr.2025.01.055","url":null,"abstract":"<div><h3>Objectives</h3><div>To create a list of actionable and prioritized recommendations to improve care transitions for individuals with hip fracture from the perspectives of persons with lived experience, care partners, health care providers, and decision-makers.</div></div><div><h3>Design</h3><div>Mixed methods, concept mapping study.</div></div><div><h3>Setting</h3><div>Ontario, Canada.</div></div><div><h3>Participants</h3><div>Participants included persons who had experienced a hip fracture, care partners, health care providers, and decision-makers. All participants were required to be ≥18 and speak English. Persons with lived experience were required to have received care for a hip fracture in Ontario; care partners were required to have provided care for an individual who experienced a hip fracture; health care providers and decision-makers were required to have provided care in a paid capacity for individuals with hip fracture or to influence policy or procedures relating to hip fracture. We used a multipronged purposive sampling strategy to recruit participants.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Perspectives of key stakeholders on what is needed to improve care transitions for hip fracture.</div></div><div><h3>Results</h3><div>The final cluster map selected by participants was an 8-cluster map, with the following cluster labels: (1) access to inpatient services and supports across the care continuum; (2) informed and collaborative discharge planning; (3) access to transitional and outpatient services; (4) communication, education and knowledge acquisition; (5) support for care partners; (6) person-centered care; (7) physical, social, and cognitive activities and supports; and (8) provider knowledge, skills, roles and behaviors. Provider knowledge, skills, roles and behaviors was rated by participants as the most important cluster.</div></div><div><h3>Conclusions</h3><div>Our study findings highlight the importance of person-centered care, with active involvement of persons with lived experience and their care partners throughout the care journey. This study provides insights for future interventions and quality improvement initiatives for enhancing transitions in care among hip fracture populations.</div></div><div><h3>Disclosures</h3><div>none.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages e21-e22"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761256","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}