Archives of physical medicine and rehabilitation最新文献

{"title":"Negative Economic Impact of Work Disability Because of Chronic Low Back Pain From the Patient Perspective: A French Cross-sectional Study of 195 Patients.","authors":"Charlotte Logiou, Agnès Ostertag, Jean-Francois Vergnol, Pascal Richette, David Petrover, Louis Jacob, Johann Beaudreuil","doi":"10.1016/j.apmr.2025.08.010","DOIUrl":"10.1016/j.apmr.2025.08.010","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the economic effect of work disability because of chronic low back pain (cLBP) from the patient's perspective.</p><p><strong>Design: </strong>We conducted a retrospective monocentric cross-sectional study from January 2010 to December 2019.</p><p><strong>Setting: </strong>The study was conducted in a university hospital in a tertiary care setting.</p><p><strong>Participants: </strong>The study included 195 patients (N=195) with cLBP and work disability who were referred for unit multidisciplinary rehabilitation using functional restoration from January 2010 to December 2019.</p><p><strong>Interventions: </strong>All data were collected at a single point in time, immediately before beginning a functional restoration program. They were demographic, socio-professional, economic (change in income, a negative value indicated a loss of income at the time of work disability), and LBP-related data.</p><p><strong>Main outcome measures: </strong>The main outcome measure was change in income because of work disability, related or unrelated to work injury and unemployment.</p><p><strong>Results: </strong>We studied 195 workers (mean age, 42.6y; 47.7% women; duration of work disability because of cLBP, 11mo). We observed a median decrease in income of -14.3% (interquartile range [IQR], 29.9) in the study population. Loss of income appeared higher for unemployed patients (-29.82% IQR 15.6) and lower for those on sick leave related to work injury (-9.5% IQR 24). Two subgroups of patients were described according to the level of income loss: high-income loss and low-income loss, on the basis of the main outcome measure dichotomized using the median.</p><p><strong>Conclusions: </strong>Work disability because of cLBP has a negative economic effect from the patient's perspective. Loss of income differs between different compensation categories. Further investigations remain necessary to identify factors associated with loss of income in larger samples of patients with cLBP.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940215","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":"Noncardiac Pain Prevalence, Pain Intensity, Pain Interference, Sleep, and Cardiopulmonary Function in Outpatient Cardiac Rehabilitation.","authors":"Elena Crooks, Carolina Pavlenco, Lindsey Miller, Laura Wambold, Shaina Schroeder, Douglas L Weeks","doi":"10.1016/j.apmr.2025.08.006","DOIUrl":"10.1016/j.apmr.2025.08.006","url":null,"abstract":"<p><strong>Objectives: </strong>To examine relationships between noncardiac pain, cardiopulmonary function, and sleep quality in the context of outpatient cardiac rehabilitation (CR). A secondary purpose was to determine whether sleep quality was predictive of pain and cardiopulmonary function.</p><p><strong>Design: </strong>A cross-sectional cohort study.</p><p><strong>Setting: </strong>Outpatient cardiac rehabilitation program.</p><p><strong>Participants: </strong>A total of 100 participants (N=100) were enrolled.</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcome measures: </strong>Participants completed the Brief Pain Inventory, Pittsburgh Sleep Quality Index (PSQI), and 6-Minute Walk Test (6MWT) near CR admission. The 6MWT was completed again near CR discharge (11wk).</p><p><strong>Results: </strong>Of the 72% of participants who reported the presence of noncardiac pain, the mean (±SD) Brief Pain Inventory pain intensity was 5.04 (±2.69) at its worst, 2.06 (±2.00) at its least, and 3.67 (±1.90) on average. The mean total PSQI score was 8.81 (±4.57), and significantly greater (poorer) for those with the presence of pain (9.54±4.57) than those with the absence of pain (6.81±3.88). Those with poor sleep (total PSQI score >5; \"sleeper status\") had greater pain intensity on all pain scales (P<.05), more pain interference on all interference items (P<.02), and a trend toward poorer 6MWT scores at baseline (P=.06). Total PSQI score and sleeper status each independently predicted the presence versus absence of pain (χ²=4.11; P=.04; χ²=7.09; P<.01, respectively). Additionally, total PSQI score predicted pain intensity (R²=0.09-0.22; P<.01 for all pain scales) and 6MWT scores at baseline (R²=0.07; P<.01) but not at follow-up (R²≤0.01; P=.61).</p><p><strong>Conclusions: </strong>Poor sleep and noncardiac pain are highly prevalent in CR and are therefore targets for therapeutic intervention. Poor sleep, as assessed by the PSQI, is predictive of pain and cardiopulmonary function at the initiation of CR.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940259","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":"Achilles' Tendon Experiences Reduced Depth and Volume After 3 Months of Recovery From 60 Days Bedrest.","authors":"T Mark Campbell, Mohamed Thabet, Gerd Melkus, Gabriele Armbrecht, Guy Trudel","doi":"10.1016/j.apmr.2025.08.004","DOIUrl":"10.1016/j.apmr.2025.08.004","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the effect of 60-days of bedrest on morphologic changes in the Achilles' tendon using magnetic resonance imaging in 24 adults, and to explore the effects of artificial gravity (AG) by centrifugation intervention to counteract the effect of 60-days' bedrest on such changes.</p><p><strong>Design: </strong>Randomized controlled trial evaluating the effect of 30 minutes AG application, either continuously daily, or intermittently 6×5 minute sessions daily.</p><p><strong>Setting: </strong>Experimental bedrest facility.</p><p><strong>Participants: </strong>Healthy participants (N = 24) aged 24-55 years.</p><p><strong>Interventions: </strong>continuous AG (N = 8), intermittent AG (N = 8).</p><p><strong>Main outcome measures: </strong>Achilles' tendon dimensions: depth, width, and cross-section area, volume at 2, 4, and 6 cm proximal to the tendon calcaneal insertion as baseline (baseline data collection), bedrest day-30 (HDT30) or 60 (HDT60), and during reambulation days 8, 90, and 450 (R8, R90, R450).</p><p><strong>Results: </strong>Neither continuous nor intermittent AG interventions had any statistically significant effect on the Achilles' tendon dimensions. No changes in the Achilles' tendon were observed during bedrest. After 90-days of reambulation Achilles' tendons were thinner at 2 cm with reduced volume at 2-4 cm and 4-6 cm and reduced volume 2-4 cm, 4-6 cm and 2-6 cm after 450-days of reambulation compared with baseline. Compared with day 8 of reambulation, Achilles' tendons were thinner at 2, 4, and 6 cm from insertion and had decreased volume 2-4 cm, 4-6 cm and 2-6 cm after 450-days of reambulation.</p><p><strong>Conclusions: </strong>This randomized controlled trial found no difference between control and AG interventions on Achilles' tendon dimensions during 60-days of bedrest. Following 90- and 450-days of reambulation after bedrest, participants had thinner and smaller Achilles' tendons, not prevented by AG. This study suggests that tendon changes can occur and persist after bedrest well into the reambulation phase and that clinicians should remain longitudinally vigilant for Achilles' injury.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940232","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":"Correction.","authors":"","doi":"10.1016/j.apmr.2025.08.001","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.08.001","url":null,"abstract":"","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940367","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":"Temporal Association Between Reported Use of Psychoactive Substances and Cognitive Function in Individuals With Multiple Sclerosis.","authors":"Jeeyeon Kim, Dawn M Ehde, Kevin N Alschuler, Nora E Fritz, Anna L Kratz","doi":"10.1016/j.apmr.2025.08.005","DOIUrl":"10.1016/j.apmr.2025.08.005","url":null,"abstract":"<p><strong>Objective: </strong>The study aimed to examine same-day within-person associations between psychoactive substance use and cognitive function in people with multiple sclerosis (MS) using ecological momentary assessment.</p><p><strong>Design: </strong>This secondary analysis used data collected over 14 days from people with MS.</p><p><strong>Setting: </strong>Community.</p><p><strong>Participants: </strong>Ambulatory adults with MS (N=257).</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcome measures: </strong>Participants completed daily ecological momentary assessment via smartphone, reporting use of psychoactive substances (alcohol, cannabis, opioids, nicotine, and caffeine) and perceived cognitive function. Objective cognitive performance was assessed using the Dot Memory Test (working memory) and Symbol Search Tests (processing speed).</p><p><strong>Results: </strong>Of the 274 enrolled participants, 257 completed the 14-day monitoring phase, yielding over 14,000 assessments with >76% completion across measures. At the between-person level, no significant associations were observed between average substance use and cognitive outcomes. However, within-person analyses revealed that caffeine use was associated with better perceived cognitive function (B=-3.31; P<.001) and faster processing speed (B=-32.58; P=.01). Cannabis use predicted worse perceived cognitive function (B=3.38; P=.049) and alcohol use was linked to poorer working memory performance (B=0.05; P=.02). No significant within-person effects were found for nicotine or opioid use.</p><p><strong>Conclusions: </strong>Caffeine may produce short-term cognitive benefits, whereas cannabis and alcohol are related to negative cognitive effects. Findings highlight the importance of developing personalized, evidence-based guidance for people with MS who may consume psychoactive substances for symptom management, recreation, or other reasons.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940254","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":"Advancing the Implementation of Patient-Centered Outcomes in Rehabilitation Learning Health Systems: Insights From the 2024 LeaRRn Summit.","authors":"Margaret A French, Megan E Schliep, Jason M Beneciuk, Lisa Juckett, Claire Kalpakjian, Brocha Z Stern, Robert Cavanaugh, Kelly Daley, Pamela Dunlap, John S Magel, Jennifer Oshita, Sean D Rundell, Hallie Zeleznik, Linda Resnik","doi":"10.1016/j.apmr.2025.07.020","DOIUrl":"10.1016/j.apmr.2025.07.020","url":null,"abstract":"<p><p>Patient-centered outcomes can inform the delivery of value-based rehabilitation care; however, there are many barriers that affect their routine use in clinical care. Learning health systems-which focus on improving patient-centered outcomes through the iterative process of data collection, knowledge generation, and practice change-are well-positioned to overcome these barriers. In September 2024, the Learning Health Systems Rehabilitation Research Network and the Center on Health Services Training and Research hosted the Power of Patient-Centered Outcomes in Rehabilitation Learning Health Systems Summit. The Summit aimed to advance the science and practice of implementing patient-centered outcomes in learning health systems. It was organized around the following 5 stages of the patient-centered outcome lifecycle in learning health systems: (1) selecting measures, (2) capturing data, (3) accessing data, (4) analyzing data, and (5) using data. At the Summit, experts across the rehabilitation community presented current work related to each of these lifecycle stages, discussed challenges to implementing patient-centered outcomes in learning health systems during breakout groups, and generated potential solutions for improving implementation of patient-centered outcomes across the 5 stages. The purpose of this paper is to disseminate the central themes of the Summit, which include common challenges and potential solutions to implementing patient-centered outcomes in rehabilitation learning health systems. In doing so, this paper aims to serve as a catalyst for future efforts to incorporate patient-centered outcomes within learning health systems in rehabilitation care. List of abbreviations: EHR, electronic health record; LeaRRn, Learning Health Systems Rehabilitation Research Network; LHS, learning health system.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940288","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":"Domains, Trends, and Uptake of Common Data Elements in Intervention Studies Focused on Recovery of Consciousness in Severe Brain Injury from 1986 to 2020: A Scoping Review.","authors":"Jennifer A Weaver, Alison M Cogan, Vera Pertsovskaya, Parie Bhandari, Bint-E Z Awan, Sara Lewis, Angela Hartman, Kristen Maisano, Tom Harrod","doi":"10.1016/j.apmr.2025.07.021","DOIUrl":"https://doi.org/10.1016/j.apmr.2025.07.021","url":null,"abstract":"<p><strong>Objective: </strong>The primary purpose of our scoping review was to evaluate the range and typology of primary clinical outcome assessments used in intervention studies promoting recovery of consciousness for patients with disorders of consciousness (DoC). A secondary aim was to examine the extent to which the introduction of common data elements (CDE) has reduced the heterogeneity of primary clinical outcome assessments in DoC studies.</p><p><strong>Data sources: </strong>We searched for articles across five databases: Cochrane, Embase, PsycInfo, PubMed, and Scopus.</p><p><strong>Study selection: </strong>We selected articles that focused on facilitating recovery of consciousness among adults with DoC following severe traumatic brain injury.</p><p><strong>Data extraction: </strong>We extracted the study year, primary clinical outcome assessment, and funding source.</p><p><strong>Data synthesis: </strong>We classified the primary clinical outcome by International Classification of Functioning, Disability and Health (ICF) domain and CDE status. 75 primary clinical outcome assessments were extracted from 307 included articles; 45 primary clinical outcome assessments (60%) aligned with the ICF Body Function domain. The proportion of articles with US federal funding that reported a CDE as the clinical outcome assessment did not differ by year published.</p><p><strong>Conclusion: </strong>Implementation of CDEs in 2010 did not substantively change the utilization of clinical outcome assessments that are CDEs because these were already more likely to be reported than non-CDEs. Overall, the wide variation in primary clinical outcome assessments utilized in intervention studies facilitating recovery of consciousness limits the ability to conduct meta-analyses, which are needed to increase the strength of evidence for DoC interventions.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940364","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":"From Impairment to Disability: Unveiling Predictors for Movement Control Impairment Subgroup of Nonspecific Low Back Pain.","authors":"Manju Kaushik, Irshad Ahmad","doi":"10.1016/j.apmr.2025.08.003","DOIUrl":"10.1016/j.apmr.2025.08.003","url":null,"abstract":"<p><strong>Objective: </strong>To identify the factors influencing the functional disability among individuals with the movement control impairment (MCI) subgroup of nonspecific chronic low back pain (NSCLBP).</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Setting: </strong>Outpatient department of physiotherapy under a rehabilitation institute.</p><p><strong>Participants: </strong>The study recruited 66 individuals (N=66) with NSCLBP related to the MCI, specifically with sagittal plane impairment, based on the eligibility criteria.</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcome measures: </strong>After adjusting for potential confounders, the multiple linear regression analysis was performed by regressing the functional disability on a subset of predicting variables such as sagittal lumbosacral (L5-S1) intervertebral rotation and translation motions, pain intensity, fear-avoidance beliefs, and health-related quality of life (physical and mental health).</p><p><strong>Results: </strong>Individuals with MCI had moderate to severe functional disability with a mean score of 41.41% (SD, 9.69). Multivariable linear regression analysis showed that factors such as high values of pain intensity (B=3.57; t=4.10) and L5-S1 translation motion (B=1.76; t=2.50) alongside low values of L5-S1 rotation motion (B=-0.71; t=-2.72), physical health (B=-0.57; t=-3.53), and mental health (B=-0.38; t=-4.54), all account for 62.1% (adj. R²=0.621) of the overall variance in functional disability among individuals with MCI, excluding the fear-avoidance beliefs.</p><p><strong>Conclusions: </strong>The functional disability among individuals with the MCI subgroup of NSCLBP is predicted by pain intensity, sagittal L5-S1 intervertebral motions, and health-related quality of life, whereas fear-avoidance beliefs do not. Mental health is the strongest predictor of disability, followed by pain intensity, physical health, and sagittal L5-S1 intervertebral rotation and translation motions among individuals with MCI. This highlights the importance of addressing these factors to manage disability among individuals with MCI effectively.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871152","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":"Comprehensibility in Measurement of Neurobehavioral Function in Disorders of Consciousness: Integrating Data Visualization and Change Indices for the Coma/Near-Coma Scale.","authors":"Patricia Grady-Dominguez, Trudy Mallinson, Theresa Bender Pape, Jennifer A Weaver","doi":"10.1016/j.apmr.2025.07.019","DOIUrl":"10.1016/j.apmr.2025.07.019","url":null,"abstract":"<p><strong>Objective: </strong>To apply a comprehensible, person-centered measurement principle to the reporting of the 8-item Coma/Near-Coma Scale (CNC-8), a measure of neurobehavioral function (NBF) for patients with disorders of consciousness. We developed Rasch equal-interval measures and change indices on a 0-100 equal-interval scale to support comprehensibility and applied data visualization techniques to enhance transparency for interpreting change in CNC-8 measures over time.</p><p><strong>Design: </strong>Secondary data set using the partial credit Rasch measurement model and a case example.</p><p><strong>Setting: </strong>Post-acute care rehabilitation.</p><p><strong>Participants: </strong>Participants (N=40) with disorders of consciousness after a severe brain injury.</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcome measures: </strong>CNC-8.</p><p><strong>Results: </strong>We transformed CNC-8 raw total scores to 0-100 equal-interval measures so that lower values indicated less NBF and higher values indicated more NBF. Indices of responsiveness, including minimal detectable change (MDC) of 15 units and conditional MDC, ranged from 16-62 units.</p><p><strong>Conclusions: </strong>Conditional MDCs provide a more precise method for examining NBF change; however, without an electronic approach to data visualization, a single MDC is easier and quicker to apply in clinical practice. Person-centered measurement emphasizes the need for assessment results that are comprehensible to all relevant parties, including clinicians and family care partners. Integration of Rasch equal-interval measures, change indices, and modern data visualization techniques can facilitate comprehensibility of interpreting CNC-8 assessment results in real time at the bedside.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862066","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":"Dual-Site Transcranial Direct Current Stimulation Combined With Exercising Improves Fatigue and Sleep Quality in People With Fibromyalgia: A Randomized Sham-Controlled Clinical Trial.","authors":"Rafael Velasco-Velasco, Juan Avendaño-Coy, Elena Labrador-García, Elisabeth Bravo-Esteban, Rubén Arroyo-Fernández","doi":"10.1016/j.apmr.2025.07.022","DOIUrl":"10.1016/j.apmr.2025.07.022","url":null,"abstract":"<p><strong>Objective: </strong>The study aimed to evaluate the effectiveness of a combined program of unihemispheric concurrent dual-site anodal-transcranial direct current stimulation (UHCDS a-tDCS) + therapeutic exercise (TE) on fatigue and sleep quality in people with fibromyalgia syndrome (FMS).</p><p><strong>Design: </strong>Double-blind, randomized, sham-controlled trial.</p><p><strong>Setting: </strong>Primary health care center.</p><p><strong>Participants: </strong>A total of 90 volunteers diagnosed with fibromyalgia. Nine participants dropped out of the study.</p><p><strong>Intervention: </strong>Participants were randomly allocated in a 1:1:1 ratio to active UHCDS a-tDCS+TE, sham UHCDS a-tDCS+TE, or control receiving TE. The intervention was delivered in 10 sessions over 6 weeks.</p><p><strong>Outcome measures: </strong>Fatigue, sleep quality, and quality of life.</p><p><strong>Results: </strong>Fatigue score decreased significantly in the active group compared with the sham (-9.8 points; 95% CI, -18.9 to -0.8; P=.028) and control groups (-9.9 points; 95% CI, -18.9 to -0.9; P=.027) at posttreatment and compared with the control group at follow-up (-11.5 points; 95% CI, -20.8 to -2.1; P=.01). Sleep quality improved in active group compared with sham and control groups at posttreatment (sham: -14.4 points; 95% CI, -24.2 to -4.5; P=.002; control: -19.5 points; 95% CI, -29.4 to -9.7; P<.001) and at follow-up (sham: -11.2 points; 95% CI, -21.1 to -1.3; P=.02; control: -15.5 points; 95% CI, -25.3 to -5.6; P<.001). Quality of life enhanced in the active group compared with the other groups, both at posttreatment (sham: -15.2 points; 95% CI, -26.6 to -3.9; P=.005; control: -13.7 points; 95% CI, 25.0 to -2.3; P=.012) and at follow-up (sham: -14.5 points; 95% CI, -25.2 to -3.7; P=.004; control: -17.4 points; 95% CI, -28.1 to -6.6; P<.001). Effect sizes for intergroup comparisons were medium across all outcomes: fatigue (η²=0.10; P=.01), sleep quality (η²=0.12; P<.01), and quality of life (η²=0.13; P<.01). No intergroup differences in any outcome were found between the sham and control groups.</p><p><strong>Conclusions: </strong>Combining UHCDS a-tDCS with TE can result in clinically significant improvements in fatigue, sleep disorders, and quality of life in people with FMS.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862067","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}