Archives of physical medicine and rehabilitation最新文献

{"title":"Inequities in Physical Therapy Receipt of US Service Members and Veterans With Low Back Pain","authors":"Megan A. O'Connell DPT ,&nbsp;Patricia K. Carreño MA ,&nbsp;Brianna Johnson MD ,&nbsp;Janiece L. Taylor PhD ,&nbsp;Letitia E. Travaglini PhD ,&nbsp;Germaine F. Herrera MS ,&nbsp;Alexander G. Velosky MHI ,&nbsp;Maxwell Amoako MS ,&nbsp;Krista B. Highland PhD","doi":"10.1016/j.apmr.2024.12.017","DOIUrl":"10.1016/j.apmr.2024.12.017","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate inequities in time to physical therapy (PT) for patients with low back pain (LBP).</div></div><div><h3>Design</h3><div>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.</div></div><div><h3>Setting</h3><div>Military Health System, Veterans Health Administration, and civilian health care facilities.</div></div><div><h3>Participants</h3><div>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).</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measure(s)</h3><div>Time to-outpatient PT evaluation within 13 weeks of LBP diagnosis.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 5","pages":"Pages 657-666"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","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}

{"title":"Conservative Treatments of Carpal Tunnel Syndrome: A Systematic Review and Network Meta-analysis.","authors":"Yuanhao Chen Msc, Bin Han Msc, Xin Zhang Msc, Chao Guo Msc, Qinghui Han Msc, Zhanjia Zhang, Shilun Hou","doi":"10.1016/j.apmr.2025.04.002","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.04.002","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the comparative efficacy of various conservative treatments for Carpal tunnel syndrome (CTS), including manual therapy (MT), local steroid injections, platelet-rich plasma (PRP) injections, extracorporeal shock wave therapy (ESWT), and low-level laser therapy (LLLT), through a comprehensive network meta-analysis (NMA).</p><p><strong>Data sources: </strong>PubMed, Web of Science, Cochrane Library, Embase, SPORTDiscus and CNKI databases were searched to identify published studies until April 2024.</p><p><strong>Study selection: </strong>Randomized controlled trials (RCTs) comparing the efficacy of conservative CTS treatments in individuals with CTS were included.</p><p><strong>Data extraction: </strong>Data from the included articles were extracted independently by two researchers, with any disagreements resolved through consultation with a third author. The extracted data included the first author's name, country/region, publication year, sample size, participants' age, disease severity, symptom duration, intervention parameters, follow-up period, and reported outcomes.</p><p><strong>Data synthesis: </strong>A total of 49 RCTs involving 11 conservative treatments and 3,323 participants were included. The NMA showed that MT demonstrated the highest efficacy in both short-term and medium-term pain relief with surface under the cumulative ranking curve values of 87.6% and 99.3%, respectively. Dextrose 5% in water (D5W) and PRP followed closely in terms of efficacy. Compared to control groups, LLLT (standardized mean difference [SMD] = -1.45, 95% confidence interval [CI] = -2.16 to -0.74) and ESWT (SMD = -1.03, 95% CI = -1.86 to -0.20) also showed significant benefits.</p><p><strong>Conclusion: </strong>This study provides robust evidence that MT and D5W injections are the most effective conservative treatments for CTS which offer valuable insights for clinical decision-making. Further research is needed to assess long-term efficacy and cost-effectiveness of these interventions.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975203","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":"Echoes of the Battlefield: Five-Year Longitudinal Cognitive Trajectories show Trend of Recovery for Deployment-related mild TBI in the LIMBIC-CENC Cohort.","authors":"Sarah L Martindale, Victoria L O'Connor, William C Walker, Jason M Bailie, Chelsea Allen, Nicholas J Pastorek, David Tate, Elisabeth A Wilde, Jared A Rowland","doi":"10.1016/j.apmr.2025.04.009","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.04.009","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between deployment-related mild traumatic brain injury (TBI) and longitudinal changes in cognitive performance in the Long-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC) Prospective Longitudinal Study (PLS) cohort.</p><p><strong>Design: </strong>Longitudinal observational study.</p><p><strong>Setting: </strong>United States Veteran Affairs and Department of Defense Medical Centers.</p><p><strong>Participants: </strong>Active duty service members and Veterans who completed at least three annual Brief Test of Adult Cognition by Telephone (BTACT) assessments (N = 1,012).</p><p><strong>Interventions: </strong>Not Applicable.</p><p><strong>Main outcome measures: </strong>Both BTACT composite and individual test scores were evaluated as outcomes. Effect of deployment-related mild TBI on changes in cognitive function was evaluated using multilevel modeling. Probable PTSD diagnosis, time since PLS-derived index event, and demographic characteristics were evaluated as confounding factors.</p><p><strong>Results: </strong>Veterans with a history of deployment-related mild TBI consistently performed worse on the BTACT over the observation period than those without such history. In addition, participants with deployment TBI history demonstrated a slower rate of improvement in the domain of executive function.</p><p><strong>Conclusion: </strong>The findings suggest that deployment-related mild TBI and PTSD are associated with cognitive performance over time. However, results more importantly demonstrate general improvement of cognitive function in individuals with PTSD or TBI history. This is encouraging and supports an overall trajectory of recovery, rather than brain health decline.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975091","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":"FEASIBILITY OF AN INTERACTIVE VIDEO-BASED TRAINING PROGRAM FOR LEARNING AND REVIEWING WALKING AID SKILLS.","authors":"Maureen O'Brien, Krista Best, Cheryl Barnabe, François Routhier, William Miller, Ranita Harpreet Kaur Manocha","doi":"10.1016/j.apmr.2025.04.005","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.04.005","url":null,"abstract":"<p><strong>Objectives: </strong>1) To assess the feasibility of a trial with a novel interactive video-based mobile application to teach safe walking aid use. 2) To explore the preliminary impact of the novel application on balance confidence, balance, mobility, and endurance.</p><p><strong>Design: </strong>Single-arm, pre-post feasibility study.</p><p><strong>Setting: </strong>University research laboratory.</p><p><strong>Participants: </strong>Adult walking aid users (N=13).</p><p><strong>Intervention: </strong>Participants used the novel application's fitting and gait training modules pertaining to their walking aid on two occasions (baseline, 2 weeks).</p><p><strong>Outcome measures: </strong>Trial feasibility indicators were collected for process (recruitment rate, consent rate, and retention rate), resources (duration of each data collection session), management (participant processing time), and safety. At baseline and at 2 weeks, participants completed the Activities-specific Balance Confidence (ABC) Scale, the Berg Balance Scale (BBS), the Timed-Up-and-Go (TUG), and the 2-minute Walk Test (2MWT).</p><p><strong>Results: </strong>Thirteen walking aid users (7 males; mean±SD age 55±15 years; mean±SD duration of walking aid use: 2.7±4.0 years) participated. Feasibility was attained on 3 out of the 6 trial feasibility indicators. Participants achieved statistically significant improvements in balance confidence (ABC; small to medium effect; p<0.001) and balance (BBS; small effect; p<0.001). Participants did not experience significant changes in mobility (TUG; no effect) or endurance (2MWT; small effect; p=0.25).</p><p><strong>Conclusion: </strong>Based on our criteria, a trial with the novel application may be feasible, with some modifications. Preliminary improvements in clinically relevant outcomes including balance confidence and balance were found. These findings will help inform a randomized controlled trial to evaluate the effect of the application on clinical outcomes.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959330","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":"Quick Guide of Manual Therapy Evidence for Rehabilitation Physicians.","authors":"Murdi Alanazi, Nazmul Hassan, Joan van Rotterdam, Sonya Kim, William R Reed","doi":"10.1016/j.apmr.2025.03.041","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.03.041","url":null,"abstract":"","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061989","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":"Effects of mirror visual observation priming on upper extremity motor recovery after stroke: a pilot randomized controlled trial.","authors":"Jinyang Zhuang, Jiali Lin, Qinying Li, Jie Jia","doi":"10.1016/j.apmr.2025.04.014","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.04.014","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the priming effects of mirror visual observation (MVO) on upper extremity (UE) motor recover after stroke.</p><p><strong>Design: </strong>Randomized, controlled, observer -blinded study.</p><p><strong>Setting: </strong>Rehabilitation Medicine Department in Tertiary Hospital.</p><p><strong>Participants: </strong>Twenty individuals with first unilateral stroke within 1 week to 6 months.</p><p><strong>Intervention: </strong>Participants were randomly divided into two groups: (1) the experimental group (EG) receiving MVO with task-oriented training (MVO+TOT); (2) the control group (CG) receiving sham MVO+TOT. The intervention consisted of 30 minutes of MVO or sham MVO, a 10-minute break, and 30 minutes of TOT daily, five days a week, for three weeks.</p><p><strong>Main outcome measures: </strong>The primary outcome was the Fugl-Meyer Assessment Upper Extremity Motor Function Subscale (FMA_UE). The change of FMA_UE (ΔFMA_UE) before and after the intervention was assessed for clinical significance. The secondary outcomes included grip strength, the Action Research Arm Test (ARAT), and the Modified Barthel Index (MBI).</p><p><strong>Results: </strong>All patients completed the trial without adverse reactions. The EG had a better treatment experience than the CG. Both groups showed improvements in FMA_UE, grip strength, ARAT, and MBI scores from baseline (P<0.05 for all). Post-intervention, there were no differences between the groups in grip strength, ARAT, and MBI scores (P>0.05 for all). However, the EG showed a better improvement in FMA_UE scores compared to the CG (P=0.044). The ΔFMA_UE of both groups surpassed the minimal clinically important difference (MCID). The average ΔFMA_UE difference between the groups was 10.80 (95% CI: 6.31 to 15.29), exceeding the MCID with statistical significance (P<0.001).</p><p><strong>Conclusions: </strong>MVO demonstrates a priming effect that enhances the recovery of UE motor impairments post-stroke with clinical significance.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062061","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":"Four Comparative Effectiveness of Rehabilitation Methods Combined With rTMS on Cognition, Mood, and Quality of Life in Stroke Patients.","authors":"Haojie Li, Xinyu Lin, Nan Chen, Xie Wu","doi":"10.1016/j.apmr.2025.04.013","DOIUrl":"10.1016/j.apmr.2025.04.013","url":null,"abstract":"<p><strong>Objective: </strong>To conduct systematic review and network meta-analysis to evaluate the effectiveness of combining repetitive transcranial magnetic stimulation (rTMS) with various rehabilitation methods in improving cognitive function, negative mood, and quality of life in stroke patients.</p><p><strong>Data sources: </strong>A systematic search was conducted across six databases to identify relevant studies. The time frame of the search was from January 1980 to September 2024.</p><p><strong>Study selection: </strong>A total of 21 randomized controlled trials involving 1074 stroke patients were included in the analysis based on predefined eligibility criteria.</p><p><strong>Data extraction: </strong>Outcome indicators assessed included cognitive function, negative mood, and quality of life. Data were extracted and analyzed using Stata for net meta-analysis to evaluate the relative effectiveness of each combined intervention.</p><p><strong>Data synthesis: </strong>Registration number: CRD42024603130. The results indicated that speech rehabilitation (SR) combined with rTMS was the most effective in improving cognitive function (SMD=0.40; 95% CI, -0.08 to 0.87; SUCRA=95.1%). Cognitive rehabilitation (CR) combined with rTMS was found to be the most effective in reducing negative mood (SMD=0.91; 95% CI, 0.45-3.23; SUCRA=84.5%) and improving quality of life (SMD=0.49; 95% CI, -0.33 to 1.30; SUCRA=99.4%).</p><p><strong>Conclusions: </strong>The combination of SR with rTMS is effective for enhancing cognitive function, whereas CR with rTMS is superior in alleviating negative emotions and improving quality of life. These findings suggest prioritizing these combined interventions in clinical rehabilitation settings.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964840","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 High Intensity Focused Electromagnetic Therapy on Balance and Quality of Life in Elderly Type 2 Diabetic Men: A Randomized Controlled Trial.","authors":"Saher Lotfy Elgayar, Ahmed M N Tolba, Mohammed Youssef Elhamrawy","doi":"10.1016/j.apmr.2025.04.010","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.04.010","url":null,"abstract":"<p><strong>Objective: </strong>To assess the effect of high-intensity focused electromagnetic therapy (HIFEMT) on balance, core strength, fall risk, and quality of life (QoL) in elderly men with type 2 diabetes.</p><p><strong>Design: </strong>A prospective randomized controlled trial with a single-center focus.</p><p><strong>Settings: </strong>This study was conducted at a private geriatric rehabilitation unit from April to December 2024.</p><p><strong>Participants: </strong>Eighty elderly men with type 2 diabetes were randomly allocated into two equal groups.</p><p><strong>Interventions: </strong>For 12 weeks, the HIFEMT group received HIFEMT in addition to balance training, while the control group received balance training only.</p><p><strong>Main outcome measures: </strong>Balance was assessed using the Berg Balance Scale (BBS), core strength was assessed using the double-leg lowering test (DLLT), fall risk was evaluated using the Fall Risk Questionnaire (FRQ), and QoL was measured using the Scale of Older People's Quality of Life-brief (OPQoL-brief).</p><p><strong>Results: </strong>At post-study, the HIFEMT group demonstrated significantly greater BBS scores (mean difference between groups = 4.84; 95% CI = 2.6, 7.05; p = 0.001), DLLT scores (mean difference between groups = 0.59; 95% CI = 0.17, 1.02; p = 0.007), and OPQoL-brief scores (mean difference between groups = 4.18; 95% CI = 0.99, 7.35; p = 0.01), along with significantly lower FRQ scores (mean difference between groups = -1.07; 95% CI = -1.83, -0.31; p = 0.006), compared to the control group.</p><p><strong>Conclusion: </strong>In elderly type 2 diabetic men, HIFEMT could enhance balance control, core strength, and QoL, while also reducing the risk of falls.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975411","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":"Daily Bidirectional Associations Between Sleep and Fatigue, Depression, and Anxiety in Stroke Survivors: A 7-Day Intensive Longitudinal Study.","authors":"Shouqi Wang, Hong Jiang, Huanhuan Zhang, Wenhong Yang, Jiao Xu, Pengcheng Liu, Jie Wang, Guoxia Zhang, Ying Wu","doi":"10.1016/j.apmr.2025.04.012","DOIUrl":"10.1016/j.apmr.2025.04.012","url":null,"abstract":"<p><strong>Objective: </strong>To examine the bidirectional relationship between sleep quality and mood states including fatigue, depression, and anxiety in stroke survivors.</p><p><strong>Design: </strong>A prospective observational study using ecological momentary assessment (EMA) surveys conducted 3 times daily over a 7-day period.</p><p><strong>Setting: </strong>A tertiary-level, class A hospital.</p><p><strong>Participants: </strong>Thirty-four stroke survivors (N=34).</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcome measures: </strong>EMA measures of mood symptoms (fatigue, depression, anxiety) and sleep, including subjective and objective total sleep time (TST), sleep onset latency (SOL), total wake after sleep onset (WASO), number of awakenings (NWK), sleep efficiency (SE), and sleep quality.</p><p><strong>Results: </strong>Multilevel models revealed that more frequent NWK and increased TST were associated with greater fatigue, whereas higher SE was linked to lower depression levels. EMA analyses showed that greater daytime fatigue and evening anxiety were unexpectedly associated with improved same-night sleep quality, whereas better sleep quality was linked to increased next-day fatigue. No significant associations were found between sleep quality and next-day depression or anxiety. Fatigue and anxiety peaked in the morning and decreased significantly by evening, whereas depression showed reductions in the afternoon and evening compared with morning levels. However, no significant interaction was observed between sleep quality and time of day in their effects on mood.</p><p><strong>Conclusions: </strong>This study provides preliminary evidence of the intricate and dynamic relationship between sleep and mood in stroke survivors, highlighting the bidirectional associations and time of day effects. These findings emphasize the need for targeted, personalized, and multifaceted interventions to improve both sleep and mood in stroke patients. Further research is necessary to validate these observations and explore mechanisms underlying these associations.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959857","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":"Association of Patient Characteristics With Recovery in Adults With Disorders of Consciousness.","authors":"Alison M Cogan, Patricia Grady-Dominguez, Caitlin G Dobson, Joseph T Giacino, Yelena G Bodien, Katherine O'Brien, Jennifer A Weaver","doi":"10.1016/j.apmr.2025.04.011","DOIUrl":"10.1016/j.apmr.2025.04.011","url":null,"abstract":"<p><strong>Objective: </strong>To describe the characteristics of patients enrolled in disorders of consciousness (DoC) rehabilitation programs and to examine factors associated with improvement beyond measurement error on neurobehavioral function. Outcomes for adults with DoC after severe brain injury are highly variable and difficult to predict. Applying a minimal detectable change (MDC) threshold to change measures can identify help to distinguish true improvement or decline from random fluctuation. We also evaluated whether change in neurobehavioral function during the first 2 weeks of rehabilitation was associated with change between 2 and 4 weeks.</p><p><strong>Design: </strong>Retrospective cohort study. Data were generated as part of standard clinical care.</p><p><strong>Setting: </strong>Postacute inpatient facilities with specialized DoC programs at 2 large, urban health care systems.</p><p><strong>Participants: </strong>Adults with DoC after severe brain injury (N=696).</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcome measure: </strong>Improvement beyond measurement error, calculated as the MDC with a 90% confidence interval (9 units) on the Coma Recovery Scale-Revised (CRS-R), using an equal-interval 0-100 unit transformed total measure. The MDC threshold was applied to change in CRS-R total measure from first to last CRS-R administration (up to 60 elapsed).</p><p><strong>Results: </strong>Two-thirds of the sample (n=445) improved beyond the MDC on the CRS-R; 23 participants declined beyond measurement error, and 228 participants changed less than the MDC. Patients with less time elapsed between injury and first CRS-R assessment were more likely to improve beyond the MDC. Change during the first 2 weeks of rehabilitation was not associated with change between 2 and 4 weeks.</p><p><strong>Conclusions: </strong>Our results underscore the importance of measuring change with greater precision for adults with DoC, as within-state change (or lack thereof) could inform rehabilitation treatment decisions about whether interventions are working as intended.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952954","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}