Archives of physical medicine and rehabilitation最新文献

{"title":"Psychophysiological Effects of an Expressive Arts-based Intervention in Young and Pre-elderly Stroke Survivors: A Randomized Controlled Trial.","authors":"Rainbow T H Ho, Temmy L T Lo, Ted C T Fong, Caitlin K P Chan, Marco Y C Pang, Adrian H Y Wan, Pamela P Y Leung, Gary K K Lau","doi":"10.1016/j.apmr.2025.04.008","DOIUrl":"10.1016/j.apmr.2025.04.008","url":null,"abstract":"<p><strong>Objective: </strong>To examine the psychophysiological effects of an 8-week expressive arts-based intervention (EABI) on young and pre-elderly stroke survivors.</p><p><strong>Design: </strong>A parallel-group randomized controlled trial.</p><p><strong>Setting: </strong>Public hospitals and community sites.</p><p><strong>Participants: </strong>Community-dwelling participants (N=157) aged between 18 and 64 years who experienced a major stroke event in the past 10 years with mild to moderate post-stroke impairments (modified Rankin scale level=1-4).</p><p><strong>Interventions: </strong>Participants were randomly assigned to an 8-week EABI group (N=75) once per week for 90 minutes or a treatment-as-usual waitlist control group (CG) (N=82).</p><p><strong>Main outcome measures: </strong>Outcomes of psychophysiological functioning, including depression, anxiety, perceived social support, hope, self-esteem, generic and stroke-specific quality of life (QOL), and salivary cortisol, were measured at three assessment waves: baseline (T0), 2 months after baseline (T1), and 8 months after baseline (T2). The short-term (T0-T1) and long-term (T0-T2) effects of the EABI were analyzed by latent change analysis. Mediation analysis was conducted to explore the potential mechanisms of the short-term and long-term EABI effects.</p><p><strong>Results: </strong>From T0 to T1, the EABI group showed significant improvements in perceived social support, hope, and self-esteem (Cohen d=0.32-0.48) compared with the CG. From T0 to T2, there were significant improvements in anxiety symptoms and self-esteem, physical QOLs, and wake-up cortisol (d=0.34-0.46). Short-term improvements in perceived social support and hope partially mediated the long-term EABI effects on physical QOLs. The beneficial effects of EABI showed heterogeneity across gender and stroke types.</p><p><strong>Conclusions: </strong>This study found short-term effects for the EABI on perceived social support and hope and long-term effects on self-esteem and physiological functioning. Future research should develop tailored EABI as multifaceted support for rehabilitation practice for stroke survivors.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957627","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":"Relationship Between Step Count and the Timed Up and Go and L Test of Functional Mobility Among Adults With Transtibial Amputation.","authors":"Kyle R Leister, Tiago V Barreira","doi":"10.1016/j.apmr.2025.04.007","DOIUrl":"10.1016/j.apmr.2025.04.007","url":null,"abstract":"<p><strong>Objective: </strong>To explore the relationship between daily steps measured by the activPAL 3 and Fitbit Inspire 3 accelerometers and performance on the Timed Up and Go test (TUG) and L Test of Functional Mobility (L test) in adults with transtibial amputation.</p><p><strong>Design: </strong>Observational design.</p><p><strong>Setting: </strong>Six outpatient prosthetic clinics located in the United States and the participant's home environment.</p><p><strong>Participants: </strong>Adults (n=96) with unilateral transtibial amputation.</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcome measures: </strong>Each participant wore the activPAL and Fitbit concurrently for 7 days. Pearson correlation was used to assess the relationship between daily steps from each device and TUG and L test completion times. Regression was employed to control for sex, body mass index, age, and type 2 diabetes status.</p><p><strong>Results: </strong>Moderate negative correlations were observed between daily steps recorded by the activPAL and TUG (r=-.52) and L test (r=-.51) times. Moderate negative correlations were also found between daily steps from the Fitbit Inspire 3 and TUG (r=-.55) and L test (r=-.56) times. These relationships remained statistically significant with minimal influence by the included covariates.</p><p><strong>Conclusions: </strong>Participants who performed well on the TUG and L test tend to have higher daily step counts, highlighting a meaningful association between clinical mobility performance and free-living physical activity. This finding provides evidence that TUG and L test completion times may reflect both functional capacity in a clinical setting and real-world ambulatory behavior. Although step counts and clinical performance measures are not interchangeable, together they offer complementary insights that can enhance the evaluation and monitoring of mobility in individuals with transtibial amputation.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968188","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 Progressive Resistance Training on Cardiovascular Risk Factors in People With Progressive Multiple Sclerosis.","authors":"Arianne S Gravesteijn, Heleen Beckerman, Marloes Willig, Hanneke E Hulst, Vincent de Groot, Brigit A de Jong","doi":"10.1016/j.apmr.2025.04.004","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.04.004","url":null,"abstract":"<p><strong>Objective: </strong>To explore the natural fluctuations in cardiovascular risk factors over a 16-week extended baseline period and to investigate the effect of a 16-week progressive resistance training intervention on cardiovascular risk factors in people living with secondary progressive multiple sclerosis.</p><p><strong>Design: </strong>Secondary analysis of a single-arm nonrandomized clinical trial with extended baseline.</p><p><strong>Setting: </strong>Outpatient physiotherapy and rehabilitation clinics.</p><p><strong>Participants: </strong>30 people living with secondary progressive multiple sclerosis (mean age, 54 years; 67% female).</p><p><strong>Interventions: </strong>16-week progressive resistance training intervention (PRT).</p><p><strong>Main outcome measures: </strong>Systematic COronary Risk Estimation (SCORE), Framingham Risk Score, and individual cardiovascular risk factors (ie, anthropometrics, blood pressure, lipids and lipoproteins, and glycemic controls markers) measured at week 0 (baseline), week 16 (extended baseline), and week 32 (post-PRT).</p><p><strong>Results: </strong>Despite significant improvement in muscle strength after PRT, PRT did not yield statistically significant or clinically relevant changes in any of the cardiovascular risk parameters. Natural fluctuations during the extended baseline period were small, with intraclass correlation coefficient (ICC) values ranging from 0.717 to 0.983, except for systolic blood pressure (ICC: 0.471).</p><p><strong>Conclusions: </strong>Our findings indicate that a 16-week PRT program did not lead to improvements in cardiovascular risk among individuals with secondary progressive multiple sclerosis. The observed natural fluctuations in cardiovascular risk factors were small in this population, with overall baseline cardiovascular risk comparable to Dutch norms.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Enablement Theory in Rehabilitation Practice, Education, and Research.","authors":"Shanti M Pinto, John Whyte, Andrew Packel, Susan E Fasoli, Sue Ann Sisto, Carla Tierney-Hendricks, Jeanne M Zanca","doi":"10.1016/j.apmr.2025.04.003","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.04.003","url":null,"abstract":"<p><p>Enablement theory refers to the theoretical framework that describes the interrelationships among different areas of functioning, such as those illustrated by the International Classification of Functioning, Disability, and Health (ICF). Enablement theory is necessary to explain causal relationships and predictions of how changes in one aspect of function impact distal outcomes. This is in contrast with treatment theory, which describes how the active ingredient(s) of an intervention directly impact a measurable target. Enablement theory helps clinicians articulate their rehabilitation treatment plans by identifying the underlying targets necessary to achieve a patient's desired outcomes and monitor the response to treatment. In this manner, enablement theory can also support the education of novice and experienced clinicians and/or trainees in their clinical reasoning process. Enablement theory helps researchers articulate the relationships they hypothesize between the aspects of function they seek to change with an intervention and the immediate and distal outcomes of that intervention. Researchers can then design the rehabilitation intervention and identify key outcome measures to rigorously test their conceptual framework, including the important mediators of the intervention's effects, and aid in the interpretation of study results. The use of enablement models has not been well-described in the rehabilitation literature, and formal research focused on understanding the nature and strength of the relationships within these enablement models is necessary to advance the field of rehabilitation. We discuss how enablement theory contributes to our understanding of rehabilitation interventions in the context of clinical practice, health professions education, and rehabilitation research.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reimbursement Opportunities for Caregiver Training in Rehabilitation: Using New CMS Training Service Codes.","authors":"Joan M Griffin, Adrianne Smiley, Brystana G Kaufman, Beth Fields","doi":"10.1016/j.apmr.2025.03.047","DOIUrl":"10.1016/j.apmr.2025.03.047","url":null,"abstract":"<p><p>Family caregivers of patients with rehabilitation and chronic care needs are often instrumental in helping to minimize patient risks for safety and other adverse health events and to avoid unnecessary health care utilization. In the United States, outside of the inpatient rehabilitation unit, they often undertake complex care tasks with minimal training. Heretofore, caregiver training in outpatient, home health, or other care settings has not been a priority, because of lack of reimbursement by insurance payers. In this special communication, we describe novel new codes and reimbursement policies approved by the Centers for Medicare and Medicaid Services for caregiver training, discuss their advantages over previous policies, and present potential practice improvements and research opportunities to assess the effect of these codes on patient and caregiver outcomes.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Return to Work After Medical Rehabilitation for Musculoskeletal Disorders in Times of the COVID-19 Pandemic: A Retrospective Cohort Study.","authors":"Jan Mathis Elling, Nadine Sänger, Betje Schwarz, Nico Seifert, Christian Hetzel","doi":"10.1016/j.apmr.2025.04.001","DOIUrl":"10.1016/j.apmr.2025.04.001","url":null,"abstract":"<p><strong>Objective: </strong>To describe and explain the effect of the coronavirus disease 2019 pandemic and its related measures on return to work (RTW) outcomes after multimodal medical rehabilitation for musculoskeletal disorders.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Three cohorts: reference (rehabilitation and RTW prepandemic), pandemic 1 (rehabilitation prepandemic, RTW during pandemic), and pandemic 2 (rehabilitation and RTW during pandemic).</p><p><strong>Participants: </strong>Individuals who underwent multimodal medical rehabilitation for musculoskeletal disorders through the German Pension Insurance system between January 2018 and December 2021 (N=688,127).</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcome measures: </strong>A successful and stable RTW was operationalized as having employment subject to social insurance contributions from 9 to 12 months after rehabilitation.</p><p><strong>Results: </strong>Descriptive analysis revealed an RTW rate of 67.2% in the reference cohort, a slight decline in pandemic cohort 1 (66.3%), and a more pronounced decrease in pandemic cohort 2 (63.1%). In contrast, average marginal predictions from a logistic model including various covariates showed that both pandemic cohorts (63.8% and 64.4%) exhibited similarly reduced predicted probabilities of RTW compared with the reference cohort (66.5%). Individuals with sick leave durations exceeding 6 months, compared with those with shorter sick leaves, were more negatively affected by pandemic cohort 1; however, this effect recovered in pandemic cohort 2. The interaction between cohort and income did not show any amplifying effect of the pandemic.</p><p><strong>Conclusions: </strong>The logistic model revealed no differences in predicted probabilities of RTW between pandemic cohort 2 and pandemic cohort 1, suggesting that orthopedic rehabilitation remained robust in maintaining RTW outcomes despite pandemic-related challenges. The findings offer mixed evidence regarding the question of whether the pandemic amplified preexisting barriers to RTW.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802388","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":"Refining Maximal Heart Rate Estimation to Enhance Exercise Recommendations for Persons With Parkinson Disease.","authors":"Anson B Rosenfeldt, Amanda L Penko, Amy Elizabeth Jansen, Cielita Lopez-Lennon, Eric Zimmerman, Peter B Imrey, Tamanna K Singh, Leland E Dibble, Jay L Alberts","doi":"10.1016/j.apmr.2025.03.046","DOIUrl":"10.1016/j.apmr.2025.03.046","url":null,"abstract":"<p><strong>Objective: </strong>To derive and evaluate an alternative equation to estimate maximal heart rate in persons with Parkinson disease (PD) in the absence of structured exercise testing using observed maximal heart rate data from a maximal cardiopulmonary exercise test (CPET) and basic demographic and clinical data.</p><p><strong>Design: </strong>Baseline data from a randomized controlled trial.</p><p><strong>Setting: </strong>Academic Medical Center.</p><p><strong>Participants: </strong>Eighty-two persons with mild-to-moderate PD who completed a CPET.</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcome measures: </strong>A linear regression model was fit to maximal heart rate from CPET using the relaxed least absolute shrinkage and selection operator (lasso) and 7 readily clinically accessible candidate covariables. Model fit was assessed by leave-one-out cross-validation. Maximal heart rates from the CPET were compared with estimates from the regression model and from 2 traditional age-based maximal heart rate estimators: (220 - age) and [208 - (0.7 × age)].</p><p><strong>Results: </strong>The regression-based heart rate estimator was [166 - (1.15 × age) + (0.60 × resting heart rate)] and most closely fit the observed maximal heart rate from the CPET. The (220 - age) and [208 - (0.7 × age)] equations overestimated maximal heart rate for 88% and 94% of the participants, respectively. The mean square error of the regression-based estimator was 63% and 75% lower than those of the 2 traditional age-based estimators, respectively.</p><p><strong>Conclusions: </strong>Overestimating maximal heart rate generates prescribed target heart rate zones that are likely unachievable during aerobic exercise. The proposed regression-based maximal heart rate estimator most closely fit observed maximal heart rates from the CPET. Adoption of this estimator, based on both age and resting heart rate, may improve estimated maximal heart rate accuracy and thus provide more appropriate and achievable exercise heart rate zones for persons with PD in the absence of a CPET.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802386","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":"Increased Free-Living Brisk Walking Cadence Following a Physical Activity Behavior Intervention After Total Knee Arthroplasty: A Secondary Analysis of a Randomized Controlled Trial.","authors":"Paul W Kline, Rashelle M Hoffman, Shawn L Hanlon, Vanessa Richardson, Elizabeth Juarez-Colunga, Edward L Melanson, Jennifer E Stevens-Lapsley, Cory L Christiansen","doi":"10.1016/j.apmr.2025.03.044","DOIUrl":"10.1016/j.apmr.2025.03.044","url":null,"abstract":"<p><strong>Objective: </strong>To compare the effects of physical activity behavior change intervention (PABC) on durations (total time and bouts of sitting, standing, and stepping) and free-living walking cadence patterns for people recovering from unilateral total knee arthroplasty (TKA).</p><p><strong>Design: </strong>Secondary analysis of a randomized controlled trial.</p><p><strong>Setting: </strong>Veterans Affairs Medical Center.</p><p><strong>Participants: </strong>Ninety-two (N=92) United States military Veterans.</p><p><strong>Interventions: </strong>Standardized rehabilitation for 12 weeks following TKA plus random assignment to either a PABC or attention-control intervention (CTL).</p><p><strong>Main outcome measures: </strong>Sitting, standing, and stepping patterns (daily total time and bouts) and free-living walking cadence patterns were measured using thigh-mounted triaxial accelerometry (activPAL3) for 10 consecutive days. Outcomes were analyzed with a linear mixed model that estimated mean between-group differences within 2-4 weeks pre-TKA and post-TKA at 8, 14, and 38 weeks.</p><p><strong>Results: </strong>No between-group differences were observed at any time point for sitting, standing, or stepping total times or average bout durations. The PABC group spent significantly more time walking at a brisk cadence compared to CTL (P<.001), with the largest group difference noted at 38 weeks, which was 24 weeks after intervention end (∆=8.36 min; 95% confidence interval, 4.83-11.88).</p><p><strong>Conclusions: </strong>The study suggests that PABC helped Veterans after TKA increase and sustain the duration of daily brisk cadence walking. Future investigations should incorporate the PABC to explore potential interventions to reduce sedentary behavior and assess how improvements in the duration of daily brisk cadence post-TKA affect long-term mobility, functional, and pain outcomes.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787537","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":"Home, but Homebound After Traumatic Brain Injury: Risk Factors and Associations With Nursing Home Entry and Death","authors":"Raj G. Kumar PhD, MPH ,&nbsp;Mary Louise Pomeroy PhD, MPH ,&nbsp;Katherine A. Ornstein PhD, MPH ,&nbsp;Shannon B. Juengst PhD ,&nbsp;Amy K. Wagner MD ,&nbsp;Jennifer M. Reckrey MD ,&nbsp;Kirk Lercher MD ,&nbsp;Laura E. Dreer PhD ,&nbsp;Emily Evans PhD, DPT ,&nbsp;Nicola L. de Souza PhD ,&nbsp;Kristen Dams-O'Connor PhD","doi":"10.1016/j.apmr.2024.09.012","DOIUrl":"10.1016/j.apmr.2024.09.012","url":null,"abstract":"<div><h3>Objective</h3><div>To examine risk factors associated with homeboundness 1-year after traumatic brain injury (TBI) and to explore associations between homebound status and risk of future mortality and nursing home entry.</div></div><div><h3>Design</h3><div>Secondary analysis of a longitudinal prospective cohort study.</div></div><div><h3>Setting</h3><div>TBI Model Systems centers.</div></div><div><h3>Participants</h3><div>Community-dwelling TBI Model Systems participants (n=6595) who sustained moderate-to-severe TBI between 2006 and 2016, and resided in a private residence 1-year postinjury.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Homebound status (leaving home ≤1-2d per week), 5-year mortality, and 2- or 5-year nursing home entry.</div></div><div><h3>Results</h3><div>In our sample, 14.2% of individuals were homebound 1-year postinjury, including 2% who never left home. Older age, having less than a bachelor's degree, Medicaid insurance, living in the Northeast or Midwest, dependence on others or special services for transportation, unemployment or retirement, and needing assistance for locomotion, bladder management, and social interactions at 1-year postinjury were associated with being homebound. After adjustment for potential confounders and an inverse probability weight for nonrandom attrition bias, being homebound was associated with a 1.69-times (95% confidence interval, 1.35-2.11) greater risk of 5-year mortality, and a nonsignificant but trending association with nursing home entry by 5 years postinjury (RR=1.90; 95% confidence interval, 0.94-3.87). Associations between homeboundness and mortality were consistent by age subgroup (±65y).</div></div><div><h3>Conclusions</h3><div>The negative long-term health outcomes among persons with TBI who rarely leave home warrants the need to re-evaluate home discharge as unequivocally positive. The identified risk factors for homebound status, and its associated negative long-term outcomes, should be considered when preparing patients and their families for discharge from acute and postacute rehabilitation care settings. Addressing modifiable risk factors for homeboundness, such as accessible public transportation options and home care to address mobility, could be targets for individual referrals and policy intervention.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages 517-526"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387470","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":"Interpreting Variations in Fugl-Meyer Assessment Protocols: Results and Recommendations From a Nominal Group Consensus Process","authors":"Susan E. Fasoli OT, ScD, OTR ,&nbsp;Julia Mazariegos MS, OTR/L ,&nbsp;Kelly Rishe MSOT, OTR/L ,&nbsp;Sarah Blanton PT, DPT ,&nbsp;Julie A. DiCarlo MS ,&nbsp;David Lin MD ,&nbsp;Veronica T. Rowe PhD, OTR/L","doi":"10.1016/j.apmr.2024.10.004","DOIUrl":"10.1016/j.apmr.2024.10.004","url":null,"abstract":"<div><h3>Objective</h3><div>To identify variations among administration and scoring instructions of 6 upper extremity Fugl-Meyer Assessment (FMA-UE) protocols and to achieve consensus regarding optimal administration procedures.</div></div><div><h3>Design</h3><div>Nominal group consensus technique comprised of iterative independent reviews of protocol content, anonymous voting, and group consensus meetings.</div></div><div><h3>Setting</h3><div>Clinicians working in clinical practice and research settings participated in virtual meetings via Zoom.</div></div><div><h3>Participants</h3><div>Ten experts in stroke rehabilitation and administration of the FMA-UE contributed to the interprofessional consensus group.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Qualitative reviews of each FMA-UE protocol and rater responses (agree/disagree) regarding variations in general administration instructions (ie, instructions that could affect the scoring of many individual test items) were discussed and analyzed during a 3-phase consensus process. An a priori target of 80% or greater agreement was used to determine group consensus.</div></div><div><h3>Results</h3><div>Consensus was attained for 7 of 10 general administration instructions. Recommendations from our consensus group summarize “best practice” general instructions for researchers and clinicians. A case example, in which we found up to a 21-point difference between the highest and lowest FMA-UE scores, highlights the potential effect of these protocol variations.</div></div><div><h3>Conclusions</h3><div>Variations among FMA-UE administration protocols during stroke rehabilitation studies can lead to discrepancies in the interpretation and translation of research findings across institutions and limit the perceived value and uptake of standardized assessments for evidence-based practice. The results of this nominal group consensus provide a first step toward developing cohesive FMA-UE recommendations for wider dissemination and review.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages 573-579"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142493673","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}