Archives of physical medicine and rehabilitation最新文献

{"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":"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}

{"title":"Culture Shift Within the Department of Defense Regarding Brain Injury Detection and Treatment","authors":"Deveney Ching,&nbsp;Areana Cruz,&nbsp;Jessica Ryan,&nbsp;Bridget Cotner,&nbsp;Risa Nakase-Richardson","doi":"10.1016/j.apmr.2025.01.066","DOIUrl":"10.1016/j.apmr.2025.01.066","url":null,"abstract":"<div><h3>Objectives</h3><div>To identify facilitators and barriers to implementing policy within the Department of Defense (DOD).</div></div><div><h3>Design</h3><div>Five DOD stakeholders participated in individual qualitative interviews and were recruited through presentations, emails, and snowball sampling. The interviews were conducted by 2 trained interviewers using a semistructured interview script. The interviews were audio-recorded and transcribed for analysis. Analysis was conducted using grounded theory then organized into themes.</div></div><div><h3>Setting</h3><div>Research activities were conducted in-person at the James A. Haley VA in Tampa, Florida, and virtually through Microsoft Teams.</div></div><div><h3>Participants</h3><div>Participants were administrative stakeholders from the Department of Defense.</div></div><div><h3>Interventions</h3><div>No intervention was used.</div></div><div><h3>Main Outcome Measures</h3><div>Demographic survey and semistructured qualitative interviews.</div></div><div><h3>Results</h3><div>Based on interview findings, the DOD has developed organizational goals related to changing the culture of the military regarding service member brain injury (reducing stigma associated with reporting injury and seeking care), ensuring consistent services across regions, and providing appropriate education and training across the operational and medical specialties within the military. Facilitators to supporting change included implementing policies, leadership buy-in, leveraging partnerships with operational and research communities, stakeholders, and families, changing language to reduce stigma, education, and training. However, implementing change is not without barriers. Participants listed several barriers to implementing change including inability to monitor implementation of policies, leadership changes, lack of buy-in, translating research into practice, overlap and confusion regarding new policies and existing policies, lack of standardized care, and staffing shortages.</div></div><div><h3>Conclusions</h3><div>Policy implementation within the DOD has supported a cultural shift in how service member brain injury is recognized and treated. The findings suggest a continued need for strategies to ensure effective policy implementation.</div></div><div><h3>Disclosures</h3><div>The authors have no disclosures to report. The views expressed in this abstract are those of the authors and do not necessarily represent the official policy or position of the Defense Health Agency, Department of Defense, or any other U.S. government agency. For more information, please contact [email protected].</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Page e26"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761259","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":"Age-associated Rate of Decline of Grip Strength in Adults: NHANES (2011-2014)","authors":"Cameron Lee,&nbsp;Inga Wang,&nbsp;Stephen Hou,&nbsp;Chiung-ju Liu,&nbsp;Mohammad Rahman,&nbsp;Md Samiul Haque Sunny","doi":"10.1016/j.apmr.2025.01.072","DOIUrl":"10.1016/j.apmr.2025.01.072","url":null,"abstract":"<div><h3>Objectives</h3><div>To (1) quantify the age-associated rate of decline in grip strength in adults aged ≥30 years (∆kg/y, ∆kg/5-y, ∆kg/10-y), (2) examine sex differences in the rate of decline, and (3) explore differences in the rate of decline among different racial/ethnic groups.</div></div><div><h3>Design</h3><div>This is a cross-sectional, observational study.</div></div><div><h3>Setting</h3><div>General community.</div></div><div><h3>Participants</h3><div>Observed hand grip strength data for both hands were extracted from the National Health and Nutrition Examination Survey (NHANES) 2011-2014 database, comprising 7328 noninstitutionalized participants aged 30-80 years.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>The muscle strength/grip test component measured isometric grip strength using a Takei Digital handgrip dynamometer. Best values (best from 3 trials) of the dominant hand were determined. The “Y2-Y1 rate of change” (in kg/y) was the grip strength difference between consecutive observations. Multiple regression analysis was used to estimate the constant rate of decline.</div></div><div><h3>Results</h3><div>The decline in handgrip strength varied by sex, with a consistent rate of decline observed as age increased. In male adults, the annual decline rate of the handgrip strength was estimated at 0.353 kg/year, 1.742 kg/5 years, and 3.620 kg/10 years. Conversely, in female adults, the annual decline rate of the handgrip strength was 0.221 kg/year, 1.095 kg/5 years, and 2.243 kg/10 years. Among males, handgrip strength declined 0.353 kg/year for Mexican Americans, 0.358 kg/year for Other Hispanic, 0.377 kg/year for non-Hispanic Whites, and 0.390 kg/year for non-Hispanic Blacks. Similarly, among females, handgrip strength declined at the rate of 0.205 kg/year for Mexican Americans, 0.216 kg/year for Other Hispanic, 0.248 kg/year for non-Hispanic Whites, and 0.244 kg/year for non-Hispanic Blacks.</div></div><div><h3>Conclusions</h3><div>Grip strength declines at a systematic and predictable rate as the population ages. Here, we estimated the age-associated rate of decline in grip strength.</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 e28"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761266","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":"Using Integrated Clinical Data and Work-related Traumatic Brain Injury Narratives to Inform Sex-specific Injury Prevention: A Concurrent Mixed Methods Study 8253","authors":"Sarah Trick,&nbsp;Thaisa Tylinski Sant'Ana,&nbsp;Angela Colantonio,&nbsp;Tatyana Mollayeva","doi":"10.1016/j.apmr.2025.01.018","DOIUrl":"10.1016/j.apmr.2025.01.018","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To examine sex differences in preinjury Person-Environment-Occupation (PEO) factors and provide recommendations for primary prevention of work-related traumatic brain injury (wrTBI).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Concurrent mixed methods study. The PEO model served as a theoretical framework for analyses of clinical and injury narratives data. We applied a theme-based approach to analyze qualitative data and calculated the proportion of male versus female workers for each PEO factor stratifying by external cause of injury in quantitative data analyses.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;Rehabilitation research—teaching hospital.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;Adult participants (n=93, 51% women, 67% aged &gt;40y) who sustained a wrTBI at least 3 months prior and were referred to a rehabilitation research-teaching hospital for brain injury assessment and management.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;Not applicable.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;PEO factors implicated in wrTBI.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Qualitative analysis of injury events revealed distinct patterns between male and female workers within 2 themes: (1) nature of occupational activity and (2) physical and/or social load of activity performed at the time of injury. Regarding the nature of occupational activity, more male workers were engaged in direct work activities, and more female workers were engaged in indirect work activities at the time of injury. Regarding the physical and/or social load of activity, male workers sustained injury while operating heavy machinery, and female workers during tasks requiring frequent changes in head position or when interacting with others. Quantitative analysis of injury data enhanced our understanding of these sex differences across PEO factors. We identified statistically significant differences between sexes in terms of employment in specific industries, hours worked per week, and supervisor-worker relationships.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;The integration of qualitative and quantitative methodologies in analyzing clinical and injury narrative data facilitated a comprehensive exploration of injury events and enhanced the quantification of sex differences observed across PEO factors. Our results suggest the importance of prevention strategies that address sex-specific occupational hazards, especially in industries that remain predominantly male- or female-dominated, as they expose workers to distinct risks of wrTBI.&lt;/div&gt;&lt;div&gt;This research received funding support from the Ontario Ministry of Labour Research Opportunities Program: Research for Workplace (R4W), the CIHR Institute for Health and Sex (CGW-126580), and in part from Canada Research Chairs Programs (CRC-2021-00074, CRC-2019-00019) and the Global Brain Health Institute (GBHI), Alzheimer's Association, and the Alzheimer's Society UK Pilot Award for Global Brain Health Leaders (GBHI ALZ","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Page e7"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761279","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}