Archives of physical medicine and rehabilitation最新文献

{"title":"Ed Board page","authors":"","doi":"10.1016/S0003-9993(24)01375-3","DOIUrl":"10.1016/S0003-9993(24)01375-3","url":null,"abstract":"","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 1","pages":"Page A4"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143129759","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":"A Role for Health Literacy in Protecting People With Limited English Proficiency Against Falling: A Retrospective, Cohort Study","authors":"Natalie F. Douglas PhD, CCC-SLP ,&nbsp;Sarah E. Wallace PhD, CCC-SLP, ASHA Fellow ,&nbsp;Chin-I Cheng PhD ,&nbsp;Nancy Christensen Mayer MBA/HSA, CCC-SLP ,&nbsp;Ellen Hickey PhD, SLP-Reg. (NS), CCC-SLP ,&nbsp;Kate Minick PT, DPT, PhD","doi":"10.1016/j.apmr.2024.08.011","DOIUrl":"10.1016/j.apmr.2024.08.011","url":null,"abstract":"<div><h3>Objective</h3><div>To identify risk factors related to falls within the scope of speech-language pathology (SLP) using assessments from the Inpatient Rehabilitation Facility-Patient Assessment Instrument over a 4-month period in 4 inpatient rehabilitation facilities (IRFs).</div></div><div><h3>Design</h3><div>Observational retrospective cohort study.</div></div><div><h3>Setting</h3><div>Four IRFs as part of a larger learning health system.</div></div><div><h3>Participants</h3><div>Adults aged ≥18 years admitted to the IRFs from October 1, 2022 to February 28, 2023 were included.</div></div><div><h3>Intervention</h3><div>N/A.</div></div><div><h3>Main Outcome Measures</h3><div>Occurrence of falls.</div></div><div><h3>Results</h3><div>Analyses of 631 patient records revealed that the odds of falling were almost 3 times greater in people with limited English proficiency than in English speakers (odds ratio [OR], 2.92; 95% confidence interval [CI], 1.09-6.85). People with limited English proficiency who reported poorer health literacy had 4 times higher odds of falling (OR, 3.90; 95% CI, 1.13-13.44) than English speakers who reported adequate health literacy. People with limited English proficiency who reported adequate health literacy had the same risk of falling as English speakers (OR, 0.98; 95% CI, 0.16-6.12), suggesting the protective role of health literacy for people with limited English proficiency.</div></div><div><h3>Conclusions</h3><div>Language barriers have a significant effect on falls among patients in IRFs. SLPs improving health literacy and providing language support may play a crucial role in mitigating fall risk, thereby enhancing patient safety and outcomes.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 1","pages":"Pages 37-41"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11695147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Early Multiprofessional Mobilization on Quality Indicators of Intensive Care in a Less Economically Developed Country: An Action on “Rehabilitation 2030” in Brazil","authors":"Thaís Marina Pires de Campos Biazon PhD ,&nbsp;Henrique Pott Jr. PhD ,&nbsp;Flávia Cristina Rossi Caruso PhD ,&nbsp;José Carlos Bonjorno Jr. PhD ,&nbsp;Viviane Castello-Simões PhD ,&nbsp;Maria Thereza Bugalho Lazzarini MD ,&nbsp;Mariana Taconelli SD ,&nbsp;Audrey Borghi-Silva PhD ,&nbsp;Renata Gonçalves Mendes PhD","doi":"10.1016/j.apmr.2024.08.010","DOIUrl":"10.1016/j.apmr.2024.08.010","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the effects of implementing early multiprofessional mobilization on quality indicators of intensive care in Brazil.</div></div><div><h3>Design</h3><div>This is a retrospective cohort study.</div></div><div><h3>Setting</h3><div>A Brazilian educational and research-intensive care unit (ICU).</div></div><div><h3>Participants</h3><div>A total of 1047 patients were hospitalized from May 2016 to April 2018.</div></div><div><h3>Interventions</h3><div>Implementation of early multiprofessional mobilization using the MobilizAÇÃO Program (MAP).</div></div><div><h3>Main Outcome Measures</h3><div>Clinical, ventilation and safety quality indicators, and physical function before (preprogram period) and after (postprogram period) the MAP.</div></div><div><h3>Results</h3><div>There was a reduction in sedation time (4 vs 1d), hospital stay (21 vs 14d) and ICU stay (14 vs 7d), mechanical ventilation (8 vs 4d), hospital death rate (46% vs 26%) (<em>P&lt;</em>.001), and ICU readmission (21% vs 16%; <em>P=</em>.030) from pre to post MAP. Successful weaning (42% vs 55%) and discharge rate (50% vs 71%) (<em>P</em>&lt;.001) increased after MAP. No differences were found to safety quality indicators between periods. After MAP, complex physical functions assessed using the Manchester Mobility Score (MMS) were more frequent. The in-bed intervention was a predictor for readmission (<em>P=</em>.009; <em>R²</em>=0.689) and death (<em>P=</em>.035; <em>R²</em>=0.217), while walking was a predictor for successful weaning (<em>P=</em>.030; <em>R²</em>=0.907) and discharge (<em>P=</em>.033; <em>R²</em>=0.373). The postprogram period was associated with the MMS at ICU discharge (<em>P&lt;</em>.001; <em>R²</em>=0.40).</div></div><div><h3>Conclusions</h3><div>Early mobilization implementation through changes in low mobility culture and multiprofessional actions improved quality indicators, including clinical, ventilation, and physical functional quality, without compromising patient safety in the ICU.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 1","pages":"Pages 51-60"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142118874","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 Effects of Near-Infrared Phototherapy Preirradiation on Lower-Limb Muscle Strength and Injury After Exercise: A Systematic Review and Meta-analysis","authors":"PeiQiang Peng MM ,&nbsp;XuFei Zheng MM ,&nbsp;YueTing Wang MM ,&nbsp;ShuNing Jiang MM ,&nbsp;JiaJu Chen MM ,&nbsp;Xin Sui MM ,&nbsp;LiJing Zhao MD ,&nbsp;Haiyan Xu MD ,&nbsp;Yuming Lu MD ,&nbsp;Shuang Zhang MD","doi":"10.1016/j.apmr.2024.04.013","DOIUrl":"10.1016/j.apmr.2024.04.013","url":null,"abstract":"<div><h3>Objective</h3><div>To assess near-infrared preirradiation effects on postexercise lower-limb muscle damage and function and determine optimal dosage.</div></div><div><h3>Data Sources</h3><div>PubMed, Embase, Cochrane Library, EBSCO, Web of Science, China National Knowledge Infrastructure, and Wanfang Data were systematically searched (2009-2023).</div></div><div><h3>Study Selection</h3><div>Randomized controlled trials of near-infrared preirradiation on lower-limb muscles after fatigue exercise were incorporated into the meta-analysis. Out of 4550 articles screened, 21 met inclusion criteria.</div></div><div><h3>Data Extraction</h3><div>The included studies’ characteristics were independently extracted by 2 authors, with discrepancies resolved through discussion or by a third author. Quality assessment was performed using the Cochrane risk of bias tool and the Grading of Recommendations, Assessment, Development, and Evaluation System.</div></div><div><h3>Data Synthesis</h3><div>In 21 studies, near-infrared preirradiation on lower-limb muscles inhibited the decline in peak torque (standardized mean difference [SMD], 1.33; 95% confidence interval [CI], 1.08-1.59; <em>p</em><span>&lt;.001; increasing 27.97±4.87N·m), reduced blood lactate (SMD, −0.2; 95% CI, −0.37 to −0.03; </span><em>p</em><span>=.272; decreasing 0.54±0.42mmol/L), decreased creatine kinase (SMD, −2.11; 95% CI, −2.57 to −1.65; </span><em>p</em>&lt;.001; decreasing 160.07±27.96U/L), and reduced delayed-onset muscle soreness (SMD, −0.53; 95% CI, −0.81 to 0.24; <em>p</em>&lt;.001). Using a 24-hour cutoff revealed 2 trends: treatment effectiveness depended on power and energy density, with optimal effects at 24.16 J/cm² and 275 J/cm² for energy, and 36.81 mW/cm² and 5495 mW/cm² for power. Noting that out of 21 studies, 19 are from Brazil, 1 from the United States, and 1 from Australia, and the results exhibit high heterogeneity.</div></div><div><h3>Conclusions</h3><div>Although we would have preferred a more geographic dispersion of laboratories, our findings indicate that near-infrared preirradiation mitigates peak torque decline in lower-limb muscles. Influenced by energy and power density with a 24-hour threshold, optimal energy and power densities are observed at 24.16 J/cm², 275 J/cm², 36.81 mW/cm², and 5495 mW/cm²<span>, respectively. Laser preirradiation also reduces blood lactate, creatine kinase, and delayed-onset muscle soreness.</span></div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 1","pages":"Pages 74-90"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140847696","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":"Glenohumeral Internal Rotation Deficit and Risk of Upper Extremity Injury in Overhead Athletes: Systematic Review","authors":"Sabika Minhaj BS-PT, D-DPT, MSc PT ,&nbsp;Zahra Khan Afridi DPT ,&nbsp;Summaiya Rubab DPT ,&nbsp;Zarmina Qazi DPT ,&nbsp;Maha Siddiqui DPT","doi":"10.1016/j.apmr.2024.05.027","DOIUrl":"10.1016/j.apmr.2024.05.027","url":null,"abstract":"<div><h3>Objective</h3><div>To systematically review the literature on the efficacy of addressing glenohumeral internal rotation deficit (GIRD) and risk of upper-extremity injury in overhead athletes.</div></div><div><h3>Data Sources</h3><div>A search was conducted for relevant studies published in PubMed, Medline, CINAHL, Cochrane, Embase, Ovid, Google Scholar, and Web of Science.</div></div><div><h3>Study Selection</h3><div>The review focused on randomized controlled trials (RCTSs) and quasi-experiments conducted in English language that assessed the effectiveness of GIRD and the risk of upper-extremity injury in athletes performing overhead movements. The review included 7 RCTs and 2 quasi-experiments out of 5403, which involved a total of 360 participants.</div></div><div><h3>Data Extraction</h3><div>Two reviewers independently screened the articles, assessed methodological quality, and extracted data for analysis. The review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews. All studies were assessed in duplicate for risk of bias using the Physiotherapy Evidence Database Scale for RCTs.</div></div><div><h3>Data Synthesis</h3><div>The efficacy of different types of techniques was evaluated, including joint mobilization, sleeper stretch, cross-body stretch, myofascial release, kinesio taping, and rigid taping. These techniques showed improvement in pain score and range of motion. Furthermore, self-myofascial release tends to improve internal rotation; sleeper stretch and cross-body stretch tend to improve internal rotation with 40 percent decline in pain. However, kinesio taping and rigid taping showed positive results for internal rotation. Acute results determined that the metabolic equivalent (MET) group had significantly more horizontal adduction range of motion posttreatment compared with the control group (<em>P</em>=.04). No significant differences existed between MET and joint mobilizations or between joint mobilizations and the control group for horizontal adduction (<em>P</em>&gt;.16). No significant between-group differences existed acutely for internal rotation (<em>P</em>&gt;.28). There were no significant between-group differences for either horizontal adduction or internal rotation at the 15-minute posttests (<em>P</em>&gt;.70).</div></div><div><h3>Conclusions</h3><div>The study evaluated the efficacy of various techniques in improving pain score and range of motion in individuals with GIRD. Joint mobilization, sleeper stretch, cross-body stretch, myofascial release, kinesio taping, and rigid taping all showed improvements in pain score and range of motion. However, no significant between-group differences were found for horizontal adduction or internal rotation at the 15-minute posttests. These findings suggest that a combination of these techniques may be effective in treating individuals with GIRD.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 1","pages":"Pages 91-97"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141426125","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":"High-Intensity Interval Training Programs Versus Moderate-Intensity Continuous Training for Individuals With Heart Failure: A Systematic Review and Meta-analysis","authors":"Xiankun Chen PhD ,&nbsp;Tong Zhang MM ,&nbsp;Xiaoyue Hu GS ,&nbsp;Zehuai Wen PhD ,&nbsp;Weihui Lu PhD ,&nbsp;Wei Jiang PhD","doi":"10.1016/j.apmr.2024.05.028","DOIUrl":"10.1016/j.apmr.2024.05.028","url":null,"abstract":"<div><h3>Objective</h3><div>To explore the effect sizes of different high-intensity interval training (HIIT) protocols on cardiorespiratory parameters when compared with moderate-intensity continuous training (MICT) in different heart failure (HF) subtypes.</div></div><div><h3>Data Sources</h3><div>Electronic databases were searched from their inception date until January 23, 2023.</div></div><div><h3>Study Selection</h3><div><span>Randomized controlled trials (RCTs) were included if they compared HIIT with MICT in patients with HF. The primary outcome was peak oxygen consumption (Vo</span>₂peak). Two reviewers independently evaluated 99 initially identified studies, resulting in the selection of 15 RCTs that met the eligibility criteria.</div></div><div><h3>Data Extraction</h3><div>Data were extracted independently by 2 observers using a data extraction form drafted based on the CONSORT statement and the Template for Intervention Description and Replication; the methodological quality of the studies was analyzed individually based on the Tool for the Assessment of Study Quality in Exercise scale.</div></div><div><h3>Data Synthesis</h3><div><span>Fifteen RCTs with 553 patients with HF were included in the systematic review. The included studies had moderate to good overall methodological quality. The results showed that HIIT was generally more effective than MICT at improving Vo</span>₂peak in patients with HF (n=541, 15 RCTs; MD: 1.49 mL/kg/min; <em>I²</em>=66%; <em>P</em><span>&lt;.001). However, the effect size varied depending on the HF subtype and HIIT protocol used. For patients with HF with reduced ejection fraction (HFrEF), the long-interval (high-intensity interval lasting ≥4 min) and high-volume HIIT (high-intensity efforts in total ≥15 min) showed the largest benefits over the MICT (n=261, 6 RCTs; MD: 2.11 mL/kg/min; </span><em>P</em>&lt;.001); followed by the short-interval (≤1 min) and high-volume HIIT (≥15 min; n=71, 3 RCTs; MD: 0.91 mL/kg/min; <em>P</em>=.12), and the short-interval and low-volume HIIT showed the least superiority over MICT (n=68, 3 RCTs; MD: 0.54 mL/kg/min; <em>P</em><span>=.05). For patients with HF with perceived ejection fraction, there was a modest beneficial effect from HIIT over MICT (n=141, 3 RCTs; MD: 0.55 mL/kg/min; </span><em>P</em>=.32).</div></div><div><h3>Conclusions</h3><div>The long-interval and high-volume HIIT protocol may produce greater benefits than MICT for improving cardiopulmonary fitness in patients with HFrEF. Further research is needed to determine the optimal HIIT protocol for different HF subtypes and to provide definitive recommendations for clinical practice.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 1","pages":"Pages 98-112"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141305251","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":"Disability Ethics and Education in the Age of Artificial Intelligence: Identifying Ability Bias in ChatGPT and Gemini","authors":"Jacob T. Urbina BS,&nbsp;Peter D. Vu MD,&nbsp;Michael V. Nguyen MD, MPH","doi":"10.1016/j.apmr.2024.08.014","DOIUrl":"10.1016/j.apmr.2024.08.014","url":null,"abstract":"<div><h3>Objective</h3><div>To identify and quantify ability bias in generative artificial intelligence large language model chatbots, specifically OpenAI's ChatGPT and Google's Gemini.</div></div><div><h3>Design</h3><div>Observational study of language usage in generative artificial intelligence models.</div></div><div><h3>Setting</h3><div>Investigation-only browser profile restricted to ChatGPT and Gemini.</div></div><div><h3>Participants</h3><div>Each chatbot generated 60 descriptions of people prompted without specified functional status, 30 descriptions of people with a disability, 30 descriptions of patients with a disability, and 30 descriptions of athletes with a disability (N=300).</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Generated descriptions produced by the models were parsed into words that were linguistically analyzed into favorable qualities or limiting qualities.</div></div><div><h3>Results</h3><div>Both large language models significantly underestimated disability in a population of people, and linguistic analysis showed that descriptions of people, patients, and athletes with a disability were generated as having significantly fewer favorable qualities and significantly more limitations than people without a disability in both ChatGPT and Gemini.</div></div><div><h3>Conclusions</h3><div>Generative artificial intelligence chatbots demonstrate quantifiable ability bias and often exclude people with disabilities in their responses. Ethical use of these generative large language model chatbots in medical systems should recognize this limitation, and further consideration should be taken in developing equitable artificial intelligence technologies.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 1","pages":"Pages 14-19"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103830","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":"Staff-Perceived Barriers to Patient Mobilization Vary by Hospital, Discipline, and Experience: A Multisite Cross-Sectional Survey","authors":"Julie A. Adsett PhD ,&nbsp;Prue J. McRae MPhil ,&nbsp;Alison M. Mudge PhD","doi":"10.1016/j.apmr.2024.09.004","DOIUrl":"10.1016/j.apmr.2024.09.004","url":null,"abstract":"<div><h3>Objective</h3><div>To describe staff-perceived barriers to progressive patient mobilization.</div></div><div><h3>Design</h3><div>Cross-sectional staff survey.</div></div><div><h3>Setting</h3><div>Ten internal medicine wards in 4 hospitals in a large health service.</div></div><div><h3>Participants</h3><div>Nursing, medical, and allied health staff (n=208).</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Patient Mobilization Attitudes and Beliefs Survey. An overall barriers score and subscale scores for knowledge, attitudes, and behaviors were calculated and compared between hospitals, discipline, and years of clinical experience.</div></div><div><h3>Results</h3><div>The survey was completed by 208 participants (123 nurses, 27 medical, 58 allied health), of whom 104 (50%) had &lt;5 years of experience. The greatest perceived barriers included nursing workload, medical orders not being in place, and patient and family resistance to mobilization. Overall barrier scores differed between hospitals, discipline (mean nursing score ± SD 50±7; mean medical score ± SD, 51±7; mean allied health score ± SD, 43±7), and years of clinical experience (&lt;5y mean score ± SD, 50±7; 5-9y mean score ± SD, 47±7; ≥10y mean score ± SD, 46±8); significant differences by hospital and discipline persisted in multivariate analysis. The behavior subscale had the highest barriers score and knowledge the lowest across all subgroups.</div></div><div><h3>Conclusions</h3><div>Staff-perceived nursing workload, lack of medical orders, and patient and family resistance to be the greatest barriers to patient mobilization. Barrier scores differed between disciplines, experience levels, and across hospitals within a single health service. Lower scores on the knowledge subscale highlight the need for multicomponent strategies beyond education that address culture and systems; education may particularly benefit medical staff.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 1","pages":"Pages 20-25"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142340079","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 a Multicomponent Exercise Intervention on Recovery of Walking Ability in Stroke Survivors: A Systematic Review With Meta-analysis","authors":"Songshuang Yan MM ,&nbsp;Xuemei Zhang MM ,&nbsp;Jing Zhang MM ,&nbsp;Juying Lu BSN ,&nbsp;Qianfeng Que BSN ,&nbsp;Lijuan Jiang BSN ,&nbsp;Yan Sang MM ,&nbsp;Yawei Yu BSN ,&nbsp;Xiaojuan Xu BSN ,&nbsp;Chunfeng Xing BSN","doi":"10.1016/j.apmr.2024.06.023","DOIUrl":"10.1016/j.apmr.2024.06.023","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate whether multicomponent exercise (MCE) is more effective than single exercise in improving walking ability in patients with stroke.</div></div><div><h3>Design</h3><div>A systematic review and meta-analysis.</div></div><div><h3>Data Sources</h3><div>A systematic search of PubMed, Embase, Web of Science, Cochrane Library, and CINAHL from the establishment of each database to February 2024 was performed. A combination of medical subject headings and free-text terms relating to stroke and exercise were searched.</div></div><div><h3>Study Selection</h3><div>Randomized controlled trials treating stroke survivors with MCE were included. The control groups received conventional treatments such as conventional treatment or no intervention or sham training; the experimental groups received MCE. The outcome measures were walking endurance, gait speed, and balance ability.</div></div><div><h3>Data Extraction</h3><div>The data extraction form was completed by 2 independent reviewers. The risk of bias was assessed using the Cochrane Risk of Bias Tool for randomized controlled trials. Review manager 5.4 software was used for data analysis. Subgroup analysis and sensitivity analysis were used to supplement the results with higher heterogeneity. The preferred reporting project for systematic reviews and meta-analyses 2020 guidelines were followed.</div></div><div><h3>Data Synthesis</h3><div>Twelve studies were included. Meta-analyses found that compared with the control group, the MCE significantly affected gait speed (mean difference=0.11; 95% CI, 0.06-0.16; I²=0%), but the effect on balance ability was not statistically significant. Subgroup analysis showed that MCE (≥60min) was effective in improving walking endurance. These results suggest that MCE improves walking endurance and walking speed in patients with stroke.</div></div><div><h3>Conclusions</h3><div>MCE helps improve the gait speed of stroke survivors. Prolonging the MCE time may have a better effect on improving the walking endurance of patients with stroke.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 1","pages":"Pages 124-133"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995190","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":"Inequities in Physical Therapy Receipt of US Service Members and Veterans With Low Back Pain.","authors":"Megan A O'Connell, Patricia K Carreño, Brianna Johnson, Janiece L Taylor, Letitia E Travaglini, Germaine F Herrera, Alexander G Velosky, Maxwell Amoako, Krista B Highland","doi":"10.1016/j.apmr.2024.12.017","DOIUrl":"10.1016/j.apmr.2024.12.017","url":null,"abstract":"<p><strong>Objective: </strong>To investigate inequities in time to physical therapy (PT) for patients with low back pain (LBP).</p><p><strong>Design: </strong>Retrospective observational study using data from the Department of Defense and Veterans Health Administration clinical and administrative data repositories derived from medical records, claims, and enrolment data.</p><p><strong>Setting: </strong>Military Health System, Veterans Health Administration, and civilian health care facilities.</p><p><strong>Participants: </strong>Active duty service members, veterans, and retirees seeking health care for LBP between January 2017 and December 2020, with no LBP diagnoses for at least 1 year prior (N=1,252,959).</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcome measure(s): </strong>Time to-outpatient PT evaluation within 13 weeks of LBP diagnosis.</p><p><strong>Results: </strong>Approximately 9.4% of included patients received an outpatient PT evaluation from a physical therapist within 13 weeks of diagnosis. In a piecewise exponential additive model, many covariates were time-varying, such that the probability of PT receipt varied throughout the 13-week period. Black, Latinx, and American Indian and Alaskan Native patients had lower probabilities of PT receipt than White patients from 1 to 3-6 weeks after index diagnosis. At 5 and 7 weeks, Black and Latinx patients, respectively, were more likely to receive PT than White patients, which continued until the end of the observation period. Patients assigned female relative to patients assigned male relative had a higher probability of initiating PT across the entire observation window, as did active duty service members, relative to retired service members and veterans.</p><p><strong>Conclusions: </strong>Inequities in the timing and receipt of PT exist in the US Military Health System and Veterans Health Administration by race and ethnicity, assigned sex, and beneficiary group. Standardizing referral and practice patterns, improving accessibility of PT services, and encouraging health-seeking behavior may help alleviate the inequities in initiating PT.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142920717","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}