Archives of physical medicine and rehabilitation最新文献

{"title":"A 5-Year Longitudinal Retrospective Cohort Study of Health Care Use and Costs Before and After Incident Traumatic Spinal Cord Injury","authors":"Paul Lin MS ,&nbsp;Adit Doza PhD ,&nbsp;Zoe C. Gurney BS ,&nbsp;Gianna M. Rodriguez MD ,&nbsp;Elham Mahmoudi PhD","doi":"10.1016/j.apmr.2025.02.012","DOIUrl":"10.1016/j.apmr.2025.02.012","url":null,"abstract":"<div><h3>Objective</h3><div><span>To examine trends in health care use and cost before and after incident </span>traumatic spinal cord injury (TSCI) in the United States.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>Using 2012-2019 claims data from the Health Care Cost Institute, we identified adults (45+) with a diagnosis of incident TSCI (n=251). Using age, sex, and a set of chronic conditions, we matched 2480 adults without TSCI (controls) with our cases. Health care use and costs were analyzed for cases and controls for 5 years. We used 2-part generalized estimating equations to predict any health care use/costs and positive use/costs in inpatient, outpatient, professional, and prescription drug settings, as well as total and out-of-pocket health care costs.</div></div><div><h3>Participants</h3><div>Adults with and without TSCI.</div></div><div><h3>Intervention</h3><div>Not applicable.</div></div><div><h3>Main Outcomes Measures</h3><div>Health care use and costs.</div></div><div><h3>Results</h3><div>Incident TSCI was associated with an increase in total and out-of-pocket costs of health care (excluding the month of injury) during the first year of injury compared with the matched controls by odds ratio=7.72 (95% CI: 5.86, 10.16) and odds ratio=2.02 (95% CI: 1.59, 2.55), respectively. Higher costs were mainly attributed to inpatient ($55,494; 95% CI: $40,230, $76,549) and professional services ($17,973; 95% CI: $13,525, $23,885). TSCI was associated with a decrease in health care costs in the 3 years after the incident but was also associated with higher costs than those of controls. TSCI was associated with an increase in the number of outpatient (7.44-9.01) and inpatient services (1.25-1.96) during the fifth year. Health care use and costs remained stable among controls throughout the 5-year study period.</div></div><div><h3>Conclusions</h3><div>TSCI was associated with a higher total and out-of-pocket cost of health care in the year of incident compared with controls. After the first year, the associated costs of TSCI sharply declined but remained slightly higher than those of controls.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 9","pages":"Pages 1331-1338"},"PeriodicalIF":3.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522566","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 Synchronous Versus Asynchronous Telerehabilitation Programs for Chronic Nonspecific Low Back Pain: A Three-Arm Randomized Controlled Trial","authors":"Rayan Ahmed Tawfek MSc, PT,&nbsp;Elif Tuğçe Çil PhD, PT","doi":"10.1016/j.apmr.2025.05.012","DOIUrl":"10.1016/j.apmr.2025.05.012","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the effectiveness of synchronous and asynchronous telerehabilitation programs in managing chronic nonspecific low back pain (CNLBP).</div></div><div><h3>Design</h3><div>A three-arm parallel group randomized trial</div></div><div><h3>Setting</h3><div><span>University Hospital, Department of Orthopedics and </span>Traumatology</div></div><div><h3>Participants</h3><div>This randomized controlled trial was carried out on individuals (N=72) (31 women, 41 men; mean age, 41.26±10.97y) with CNLBP.</div></div><div><h3>Interventions</h3><div>Participants were randomly assigned to 3 groups: (1) a synchronous telerehabilitation group (STG) (n=24), (2) an asynchronous telerehabilitation group (ASTG) (n=24), and (3) a control group (CG) (n=24). A structured exercise program was delivered in real-time to the STG via prerecorded videos to the ASTG and through a digital book to the CG (12wk).</div></div><div><h3>Main Outcome Measures</h3><div><span>Pain levels as the prespecified primary outcome were measured using the visual analog scale. Disability was assessed with the </span>Roland Morris Disability Questionnaire<span> and Oswestry Disability Index<span>. Fear of movement was evaluated with the Tampa Scale, and quality of life was determined using the SF-12.</span></span></div></div><div><h3>Results</h3><div>Pain levels, disability status, fear of movement, and quality of life showed improvement at week 12 in all groups (<em>P</em><span>&lt;0.05). In addition, the STG showed greater improvements than the CG in the visual analog scale (mean difference, 1.28; 95% CI, 0.50-2.05). Moreover, the ASTG obtained more significant results than the CG group only in the subparameters of SF-12 (physical component summary and mental component summary).</span></div></div><div><h3>Conclusions</h3><div>A real-time synchronous telerehabilitation program was superior in improving pain, disability, fear of movement, and quality of life, whereas the asynchronous group was superior compared with an unsupervised home exercise program in improving quality of life only. These results imply that remote therapy could be introduced in clinical practice to improve patient outcomes and resource utilization and eventually be used more broadly.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 9","pages":"Pages 1392-1401"},"PeriodicalIF":3.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149037","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":"Cognitive Rehabilitation Improved Self-Reported Cognitive Skills in Individuals With Long COVID: An Observational Study","authors":"Marie Saxon MS, CCC-SLP ,&nbsp;Steven Jackson PT, PhD ,&nbsp;Manasi Seth PhD ,&nbsp;Igor J. Koralnik MD ,&nbsp;Leora R. Cherney PhD","doi":"10.1016/j.apmr.2025.02.009","DOIUrl":"10.1016/j.apmr.2025.02.009","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the effects of cognitive rehabilitation provided to patients with lingering cognitive difficulties or “brain fog” after coronavirus disease 2019 (COVID-19).</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>Outpatient rehabilitation setting.</div></div><div><h3>Participants</h3><div>Seventy consecutive patients with Long COVID<span> who were referred from a Neuro-COVID clinic and evaluated and treated by speech-language pathologists.</span></div></div><div><h3>Interventions</h3><div>Usual care cognitive rehabilitation.</div></div><div><h3>Main Outcome Measures</h3><div><span>Patients completed the Quality of Life in </span>Neurological Disorders<span> Cognition Function Short Form and the Rivermead Behavioral Memory Test Story Recall assessments before and after treatment. Demographics, goals, treatment frequency/duration, and interventions were analyzed to determine treatment outcomes and patterns of care.</span></div></div><div><h3>Results</h3><div>Of 70 patients, 83% were never hospitalized for COVID-19, the average age was 46.5 years, 77% were women, and 69% were White. There were no differences in demographics, race, ethnicity, or objective cognitive measures before starting treatment between the 50 individuals who completed their plan of care (POC) versus the 20 who did not. However, patients who did not complete their POC reported higher anxiety before treatment. Patients with higher anxiety before treatment demonstrated less improvement in cognitive quality of life measures<span><span> after treatment. Of the 50 patients who completed their POC, 45 (90%) met all short-term goals. There was a significant increase in Quality of Life in </span>Neurological Disorders Cognition Function scores from pre- to post- cognitive rehabilitation in 36 patients tested, but no significant differences in objective measures of memory in 23 patients tested.</span></div></div><div><h3>Conclusions</h3><div><span>Cognitive rehabilitation resulted in self-reported improvement in functional cognition. However, anxiety limited the favorable effect of treatment and should be addressed in conjunction with </span>cognitive therapy to maximize outcomes.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 9","pages":"Pages 1367-1374"},"PeriodicalIF":3.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490530","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 Sensor-Derived Features From a Wrist-Worn Wearable Device as Indicators of Upper Extremity Function in Individuals With Cervical Spinal Cord Injury","authors":"Tessa C. Johnson MS ,&nbsp;Cole Hagen BS ,&nbsp;Donna L. Coffman PhD ,&nbsp;Melissa Nunn BA ,&nbsp;Mary Schmidt-Read PT, DPT, MS ,&nbsp;Kelly M. Heath MD ,&nbsp;Ralph J. Marino MD ,&nbsp;Shivayogi V. Hiremath PhD","doi":"10.1016/j.apmr.2025.03.003","DOIUrl":"10.1016/j.apmr.2025.03.003","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the relationship between sensor-derived features and upper extremity function in individuals with acute and chronic cervical spinal cord injury (cSCI) and to assess the reproducibility of these features in chronic cSCI.</div></div><div><h3>Design</h3><div>Prospective, longitudinal study. Participants completed the Capabilities of Upper Extremity Test (CUE-T)—a measure of upper extremity function—at 2 time points, 4 weeks apart, while wearing a wrist-worn inertial measurement unit device on their most-used upper extremity. The device recorded 3-axis accelerometer and gyroscope data from which metrics (features) were derived. Distance correlations (dCorr) assessed associations between features and CUE-T hand and arm function scores. Intraclass correlation coefficients (ICCs) assessed the reproducibility of CUE-T scores and features in the chronic subgroup.</div></div><div><h3>Setting</h3><div>Inpatient rehabilitation facility (acute cSCI) and community (chronic cSCI).</div></div><div><h3>Participants</h3><div>Forty adults (N=40) with cSCI were enrolled, and 33 provided data.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Correlations between CUE-T scores and features; ICCs of CUE-T scores and features (chronic group).</div></div><div><h3>Results</h3><div>At Time 1, 2 features showed strong correlations with CUE-T hand score (dCorr, 0.53-0.58), while 9 showed strong correlations with CUE-T arm score (dCorr, 0.54-0.62). At Time 2, 3 features showed strong correlations with CUE-T hand score (dCorr, 0.53-0.57), while 29 showed strong correlations with CUE-T arm score (dCorr, 0.50-0.72). Types of features were distinct for hand and arm conditions. For the chronic subgroup, CUE-T scores showed excellent reproducibility (ICC, 0.94-0.99), and 16 features demonstrated moderate to good reproducibility (ICC, 0.50-0.77).</div></div><div><h3>Conclusions</h3><div>Sensor-derived features can indicate upper extremity function in cSCI, supporting their use for monitoring recovery and functional outcomes. Future research should focus on validating features of upper extremity function to support digital biomarker development and clinical adoption.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 9","pages":"Pages 1348-1358"},"PeriodicalIF":3.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633327","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":"Measurement Properties of Surface Topography for Scoliosis Assessment: A Systematic Review and Meta-Analysis.","authors":"Shihan Li, Shan Liu, Xianglin Zhao, Weijie Chen, Bin Fan, Man Sang Wong, Jiaying Li, Mingtao Jiang","doi":"10.1016/j.apmr.2025.08.009","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.08.009","url":null,"abstract":"<p><strong>Objective: </strong>To comprehensively evaluate the validity, responsiveness, and feasibility of surface topography (ST) indices and provide insights into their potential integration into clinical scoliosis assessment.</p><p><strong>Data sources: </strong>A systematic literature search was performed in PubMed and Web of Science for studies published between January 2010 and April 2024.</p><p><strong>Study selection: </strong>Studies reporting on the validity, responsiveness, and feasibility of ST indices were screened and selected by two independent researchers.</p><p><strong>Data extraction: </strong>Data extraction and analysis followed the COSMIN guideline framework. Two independent reviewers extracted study characteristics, methodological quality, measurement properties, and evidence levels. Methodological quality was assessed using the COSMIN Risk of Bias checklist, supplemented with QUADAS-2 items. Measurement properties were assessed using COSMIN quality criteria, and the quality of evidence was graded using the GRADE approach. A meta-analysis was conducted to synthesize the measurement properties.</p><p><strong>Data synthesis: </strong>A total of 23 studies were included. Scoliosis angle and asymmetry index received sufficient ratings for criterion validity, supported by high-quality evidence. The construct validity of both thoracic kyphosis and lumbar lordosis in the sagittal plane, when compared with similar parameters measured from X-rays, was rated as sufficient with high-level evidence. However, compared with measurements from X-ray/MRI, the construct validity of vertebral rotation was rated as insufficient with low-quality evidence. For responsiveness, the scoliosis angle compared with the Cobb angle in the coronal plane showed inconsistent results, with a very low quality of evidence.</p><p><strong>Conclusions: </strong>This review highlighted the potential of ST as a radiation-free and informative tool for scoliosis assessment, particularly in screening settings. While the scoliosis angle and asymmetry index demonstrated sufficient criterion validity, challenges remain regarding vertebral rotation validity, responsiveness, and correlations with patient-reported outcomes. Further advancements in standardization and methodological quality are necessary for the broader clinical adoption of ST systems.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of a Digitally Monitored Walking Program on Functional and Psychological Outcomes in Individuals with Mild Traumatic Brain Injury: A Randomized Controlled Trial.","authors":"Hsin-Ya Tzeng, Cheng-Chun Chang, Sy-Chou Chen, Dueng-Yuan Hueng, Chi-Ming Chu, Hui-Hsun Chiang","doi":"10.1016/j.apmr.2025.08.014","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.08.014","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effects of a 12-week digital walking exercise program on functional capacity and psychological health in individuals with mild traumatic brain injury (mTBI) and examine the influence of exercise adherence.</p><p><strong>Design: </strong>Randomized controlled trial with repeated measures.</p><p><strong>Setting: </strong>Medical center-based recruitment with home-based intervention.</p><p><strong>Participants: </strong>Fifty-two adults (mean age 43.98 ± 14.94, 57.7% female) diagnosed with mTBI (Glasgow Coma Scale score, 13-15) within 6 months post-injury.</p><p><strong>Interventions: </strong>Participants were randomly assigned to either a digitally monitored walking program group (structured walking ≥30 min/session, ≥3 times/week, supported by a wearable fitness tracker and personalized feedback) or an active control group receiving standard exercise education.</p><p><strong>Main outcome measures: </strong>Primary outcome was functional capacity measured by the 6-minute walk test (6MWT). Secondary outcomes included depressive symptoms (Beck Depression Inventory-II) and quality of life (QoL; WHOQOL-BREF). Assessments were conducted at baseline, 4, 8, and 12 weeks. Generalized estimating equations assessed between-group differences. Subgroup analyses evaluated outcomes in participants with ≥80% adherence to moderate-intensity exercise.</p><p><strong>Results: </strong>The intervention group demonstrated significantly greater improvements in 6MWT distance at 4 weeks (+41.65 m, p = .02), 8 weeks (+61.31 m, p = .001), and 12 weeks (+65.29 m, p = .003) compared to controls. Between-group differences in depressive symptoms and psychological QoL were not statistically significant. However, in the high-adherence subgroup (≥80%), significant improvements were observed in functional capacity, as measured by the 6-Minute Walk Test (6MWT), as well as in depressive symptoms, and overall QoL.</p><p><strong>Conclusions: </strong>A 12-week digital walking program significantly improved functional capacity in individuals with mTBI. Psychological health benefits were evident among those with high adherence to moderate-intensity walking. These findings support integrating wearable technologies and remote monitoring tools into structured rehabilitation to promote functional recovery in mTBI.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940354","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":"Group Versus Individual Therapy for Neurologic Recovery: A Systematic Review and Meta-analysis.","authors":"Tharika Rodrigo, Susan Hillier, Ines Serrada, Ashraf Gerges, Joyti Zwar, Saran Chamberlain, Brenton Hordacre","doi":"10.1016/j.apmr.2025.08.007","DOIUrl":"10.1016/j.apmr.2025.08.007","url":null,"abstract":"<p><strong>Objective: </strong>To investigate evidence for group-based interventions compared with individual-based interventions for sensorimotor rehabilitation in adults with neurologic conditions.</p><p><strong>Data sources: </strong>Medline, Embase, Emcare, and PsychINFO were searched from inception to July 2024.</p><p><strong>Study selection: </strong>Randomized controlled trials that compared group versus individual delivery of the same type of sensorimotor rehabilitation for adults with neurologic conditions were included.</p><p><strong>Data extraction: </strong>Two reviewers independently screened, assessed methodological quality, and extracted data. Study characteristics, participant details, intervention/control characteristics, and clinical outcomes were extracted.</p><p><strong>Data synthesis: </strong>Ten trials were included in the review. Participant groups included people with Parkinson disease (2 trials), multiple sclerosis (1 trial), and stroke (7 trials). Meta-analyses found significant effects in favor of group interventions for 6-minute walk test distance (mean difference, 36.18m; 95% CI, 14.58-57.77; P=.001), and gait speed (mean difference, 0.2m/s; 95% CI, 0.13-0.27; P<.0001). No difference was found for other clinical measures.</p><p><strong>Conclusions: </strong>Group-based rehabilitation appears to deliver improved ambulation speed and distance in people with neurologic conditions. Further research is required to understand whether group-based rehabilitation has additional benefits for motivation and social support. Delivery of rehabilitation in a group appears worthy of consideration in clinical settings.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939736","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":"Guiding Technology Adoption in Rehabilitation: A Framework From the Rehabilitation Technology Implementation for Promising Solutions (Rehab TIPS) Workgroup.","authors":"Michelle R Rauzi, Swapna Balakrishnan, Sheryl M Flynn, Julie J Keysor, Helen M Hoenig","doi":"10.1016/j.apmr.2025.08.008","DOIUrl":"10.1016/j.apmr.2025.08.008","url":null,"abstract":"<p><p>There is an unprecedented growth in health and rehabilitation technologies influencing service delivery. Although adopting emergent or existent technologies may add value to rehabilitation services and outcomes, clinicians face uncertainties on whether and how to adopt new technologies. Because of these challenges, rehabilitation stakeholders need to be active agents in the development, adoption, and ongoing evaluation of a given technology's effect. This special communication presents the Rehabilitation Technology Implementation for Promising Solutions (Rehab TIPS) Framework. This Framework, designed by the multidisciplinary Rehab TIPS workgroup, integrates established theories toward guiding rehabilitation clinicians in a systematic process of selecting and adopting valuable technologies. This special communication details the underlying models that informed the Rehab TIPS Framework. Then, the 2 components of the Rehab TIPS Framework are outlined: (1) a decision-making process to guide the selection of appropriate technologies for adoption, and (2) the 3 phases of technology adoption by individuals within a socioecological context. Finally, we discuss how the Rehab TIPS Framework can be used in the rehabilitation field, including future directions for advancing the science and practice of technology adoption in rehabilitation.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939746","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":"Exercise Impact on Cardiovascular Autonomic, Cerebrovascular, and Cognitive Dysfunction in Individuals With Spinal Cord Injury.","authors":"Wenjie Ji, Gino S Panza, Jill M Wecht, Nancy D Chiaravalloti, Hang Jin Jo, Sue Ann Sisto","doi":"10.1016/j.apmr.2025.08.011","DOIUrl":"10.1016/j.apmr.2025.08.011","url":null,"abstract":"<p><p>Spinal cord injury (SCI) disrupts autonomic nervous system (ANS) function, leading to cardiovascular, cerebrovascular, and cognitive impairments that significantly reduce quality of life. Although exercise is known to improve cardiovascular health in the general population, limited research has explored its effects on ANS function in persons with SCI (pwSCI). This communication uniquely synthesizes the current evidence on exercise effects on ANS-related cardiovascular (ANS-CV) function, cerebrovascular health, and cognitive performance in individuals with chronic SCI, addressing critical gaps in the literature. We highlight that moderate to high-intensity exercise, particularly arm cycling, improves ANS-CV function in this population. Long-term active exercise training may also introduce benefits to cerebrovascular and cognitive function. Key challenges in drawing definitive conclusions are the limited number of available studies, inconsistency in exercise protocols (eg, type, intensity, duration), and variability in measurement approaches across studies. Therefore, future studies should specifically define exercise type, intensity, and duration, ensuring the use of more precise measures to enable more conclusive findings. Studies should also focus on clarifying the effects of exercise on cerebrovascular function and exploring the physiological mechanisms underlying exercise-induced improvements in ANS-CV, cerebrovascular, and cognitive function. A better understanding of these effects could inform the development of targeted exercise interventions to address the complex health challenges faced by pwSCI. Based on the current evidence, clinicians may consider incorporating moderate to high-intensity exercise programs into rehabilitation protocols to address ANS dysfunction in SCI.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939696","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":"PROPREDICT Decision Support Tool: Using Evidence to Guide Precision Prosthesis Prescription and Rehabilitation Planning.","authors":"Daniel C Norvell, David C Morgenroth, Joseph M Czerniecki, Elizabeth G Halsne, Wayne Biggs, Joseph Webster, Aaron P Turner, Rhonda M Williams, Alison W Henderson","doi":"10.1016/j.apmr.2025.08.012","DOIUrl":"10.1016/j.apmr.2025.08.012","url":null,"abstract":"<p><strong>Objective: </strong>To translate the previously validated AMPREDICT PROsthetics prediction model into a web-based, clinical decision support tool (DST) for use at the time of initial prosthetic evaluation to predict 4 levels of prosthetic mobility 12 months after prescription.</p><p><strong>Design: </strong>The previously validated AMPREDICT PROsthetics prediction model provided the predictors with corresponding coefficients to develop an online DST. The content and aesthetics of the DST was created by the authors with iterative input from an expert panel gathered via a user-friendly input page and access to a DST simulation with graphic display of predicted mobility levels. This beta DST underwent formal usability testing using a think aloud approach with a quantitative assessment of usability and qualitative interviews to address user-friendliness, readability, functionality, and potential implementation challenges.</p><p><strong>Setting: </strong>The Veterans Health Administration.</p><p><strong>Participants: </strong>Twelve clinicians (N=12), who regularly participate in prosthetic prescription and represent the intended target users of the PROPREDICT DST, were included.</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcome measures: </strong>Qualitative themes and the Post-Study System Usability Questionnaire (PSSUQ).</p><p><strong>Results: </strong>The PSSUQ overall (and subscale scores) were highly favorable, with a mean overall score of 1.58 from a potential range 1.0-7.0 (lower score greater usability). Participant feedback identified the following potential clinical utility of the DST: (1) assisting in counseling patients on prosthesis selection; (2) setting expectations for future mobility; and (3) sharing DST input with the clinical team to aid in rehabilitation planning.</p><p><strong>Conclusions: </strong>The PROPREDICT DST (www.prodecide.org) was successfully developed and tested for usability and clinical relevance. Rehabilitation providers are optimistic about its potential.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940276","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}