Archives of physical medicine and rehabilitation最新文献

{"title":"Decline in Physical Function Is Associated with Cognitive Impairment and Quality of Life in Pancreatic Cancer Patients Undergoing Chemotherapy 4359","authors":"Amornthep Jankaew, Po See Chen, Cheng-Feng Lin","doi":"10.1016/j.apmr.2025.01.042","DOIUrl":"10.1016/j.apmr.2025.01.042","url":null,"abstract":"<div><h3>Objectives</h3><div>(1) To investigate changes in physical function among older patients with pancreatic cancer receiving chemotherapy at baseline, 2-, 4-, and 6-month intervals, and (2) to observe the associations among physical function, cognitive function, and quality of life (QoL) in patients with pancreatic cancer.</div></div><div><h3>Design</h3><div>A 6-month longitudinal follow-up study.</div></div><div><h3>Setting</h3><div>Medical Center at National Cheng Kung University, Tainan, Taiwan.</div></div><div><h3>Participants</h3><div>A total of 117 patients with pancreatic cancer (N=117; 57 men, 60 women) with a mean age of 72.20±5.95 years and body mass index of 22.65±3.37 were enrolled.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Physical functional tests, including maximum grip strength, the 2-Minute Step Test, and the Timed Up and Go (TUG), were conducted by a licensed physical therapist at baseline (before chemotherapy), 2-, 4-, and 6-month during chemotherapy. Cognitive function and QoL were assessed using the total score of the Montreal Cognitive Assessment and the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire, respectively. One-way analysis of variance and Pearson correlation coefficient were employed to detect changes in physical function and assess correlations among the primary outcomes with a significance level of <em>P</em><.05.</div></div><div><h3>Results</h3><div>Throughout the chemotherapy course, a decline in physical functions was observed in maximum grip strength (F=4.410, <em>P</em>=.005) and Timed Up and Go (F=11.055, <em>P</em><.001), with no significant changes in 2-Minute Step Test (F=1.248, <em>P</em>=.292). Additionally, we noted that reduced maximum grip strength is associated with Montreal Cognitive Assessment scores at baseline and 4 months (<em>r</em>=0.327 and 0.340, respectively) and QoL at 6 months of chemotherapy (<em>r</em>=0.260). Meanwhile, an increased Timed Up and Go time exhibited a correlation with both Montreal Cognitive Assessment scores and QoL at baseline (<em>r</em>=−0.432 and −0.256), 4 months (<em>r</em>=−0.349 and −0.245), and 6 months of chemotherapy (<em>r</em>=−0.289 and −0.373).</div></div><div><h3>Conclusions</h3><div>This study presents evidence of decreased physical function in older adults with pancreatic cancer undergoing chemotherapy. Furthermore, we identified an association between declined physical function and cognitive impairment as well as QoL in patients with pancreatic cancer. Therefore, monitoring physical status, cognitive function, and QoL is crucial in clinical rehabilitation, particularly in the early stages of chemotherapy. Additionally, we recommend integrating rehabilitation strategies that combine both physical and cognitive training into cancer rehabilitation programs. This approach may contribute to enhancing coping mechanisms and the overal","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages e16-e17"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761110","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":"Co-development of a Toolkit to Improve Medication Self-management for Persons with Spinal Cord Injury: A Concept Mapping Approach 4350","authors":"Lauren Cadel,&nbsp;Rasha El-Kotob,&nbsp;Sander Hitzig,&nbsp;Lisa McCarthy,&nbsp;Shoshana Hahn-Goldberg,&nbsp;Tanya Packer,&nbsp;Chester Ho,&nbsp;Tejal Patel,&nbsp;Stephanie Cimino,&nbsp;Aisha Lofters,&nbsp;Sara Guilcher","doi":"10.1016/j.apmr.2025.01.034","DOIUrl":"10.1016/j.apmr.2025.01.034","url":null,"abstract":"<div><h3>Objectives</h3><div>To explore what content should be included in a medication self-management toolkit for adults with spinal cord injury/dysfunction, as well as considerations for delivery.</div></div><div><h3>Design</h3><div>Mixed methods, concept mapping study.</div></div><div><h3>Setting</h3><div>General community across Canada.</div></div><div><h3>Participants</h3><div>Participants were recruited between October 2022 and October 2023 using purposive and convenience sampling strategies. Participants included 21 adults with spinal cord injury/dysfunction, 12 health care providers, and 11 caregivers from 6 provinces across Canada (Ontario, Alberta, British Columbia, Manitoba, Saskatchewan, Nova Scotia).</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Perspectives on content to include in a medication self-management toolkit and considerations for the delivery of the toolkit.</div></div><div><h3>Results</h3><div>The final map contained 79 statements, which were organized into 8 clusters: (1) information-sharing and communication; (2) health care provider interactions and involvement; (3) peer and community connections; (4) supports and services for accessing prescription medications and medication information; (5) information on nonprescription medication and medication supplies; (6) safety and lifestyle considerations; (7) general medication information; and (8) practical information and strategies related to medication-taking. All statements were rated highly on importance and feasibility to include in the toolkit. Only 2 statements had a mean rating below neutral (moderate importance or feasibility). Safety and lifestyle considerations was rated as the most important and feasible cluster to include in the toolkit.</div></div><div><h3>Conclusions</h3><div>In the subsequent phases of this study, the toolkit will be refined through cognitive interviews and a mixed methods pilot evaluation will be conducted to assess the feasibility, acceptability, and appropriateness of the toolkit, as well medication knowledge, self-efficacy, and quality of life. Given the limited tools to help adults with spinal cord injury/dysfunction with managing their medications, there is great potential to better support this population across all areas of medication self-management.</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 e13"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761185","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":"Restoration of Upper-extremity Function After Intention-driven Functional Electrical Stimulation Using a Wearable Sleeve in 2 Adults with Chronic Stroke: A Case Series 4352","authors":"Eric Meyers,&nbsp;Michael Darrow,&nbsp;Bryan Schlink,&nbsp;Nicholas Tacca,&nbsp;Sam Colachis,&nbsp;Collin Dunlap,&nbsp;Philip Putnam,&nbsp;David Friedenberg,&nbsp;Lauren Wengerd","doi":"10.1016/j.apmr.2025.01.038","DOIUrl":"10.1016/j.apmr.2025.01.038","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To investigate the feasibility of using a wearable, high-density electrode sleeve to provide intention-driven functional electrical stimulation (FES) therapy, and to evaluate the preliminary effects on recovery in 2 adult chronic stroke survivors.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;During the 8-week intervention period, therapy was administered using the intention-driven FES sleeve during three 2-hour sessions. After the 8-week intervention period, subjects were monitored in a 10-week follow-up period during which task-oriented training was not administered. However, FES was delivered during this period to enable continued engineering development of the sleeve.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;This study was performed at Battelle Memorial Institute..&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;This study enrolled adults with upper limb hemiparesis, stroke-related hand impairment that interferes with the ability to complete activities of daily life, and who were classified as stage 1-6 on the hand subscale of the Chedoke McMaster Stroke assessment. Individuals actively participating in stroke-related upper limb rehabilitation, co-occurring neurological or neuromuscular conditions, or implanted electronic devices were excluded.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;The intervention was comprised of using an investigational device composed of a high-density grid of electrodes embedded in a sleeve to deliver FES during therapist (occupational therapist)-guided therapy. FES was delivered either (1) by an operator that matched FES to the subject's intention, or (2) by the wearer's own electromyographic signals. The operator-controlled FES system was used twice per week, and the electromyographic-controlled FES system used once per week. At each session, the occupational therapist chose functional tasks, graded them to an appropriate difficulty, and administered practice for approximately 20 minutes before moving on to a new task.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;Main outcome measures include the Action Research Arm Test, the Fugl-Meyer Assessment Upper Extremity, and the Box and Blocks test.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;At the conclusion of the 8-week therapy schedule, both subjects demonstrated improvements that exceeded the minimal clinically important difference on the Action Research Arm Test, Fugl-Meyer Assessment Upper Extremity, and the Box and Blocks test. These improvements were sustained during the 10-week follow-up period.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;These results provide an initial, preliminary demonstration in 2 stroke survivors of using intention-driven FES therapy incorporating multiple FES-enabled movements using a wearable forearm sleeve. Larger studies are needed to validate these findings. This device has not been approved or cleared as safe or effective by US Food and Drug Administration. This device is limited by US federal law to investigational use.&lt;/div&gt;","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Page e15"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761189","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":"Exploring Geospatial Barriers and Facilitators to Community Integration Among Burn Injury Survivors 4354","authors":"Pyung Kim,&nbsp;Karen Kowalske,&nbsp;Dohyeong Kim","doi":"10.1016/j.apmr.2025.01.049","DOIUrl":"10.1016/j.apmr.2025.01.049","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To explore the spatial disparities in community integration (CI) of burn injury survivors in North Texas and identify barriers and facilitators to inclusion.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;A cross-sectional study analyzing data from the National Institute on Disability, Independent Living, and Rehabilitation Research, this study conducted geographical information system mapping to assess neighborhood characteristics for better CI.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;The study is set in the general community of North Texas, using outpatient medical data records to analyze the environmental context of CI among burn injury survivors.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;Participants include burn injury survivors from North Texas, managed by the UT Southwestern Medical Center. We studied 285 adult patients hospitalized between 2015 and 2022.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;Not applicable as this study is observational, focusing on existing data analysis rather than implementing new interventions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;The primary variable under examination in this study is the CI score, provided by the BMS database. These scores are derived from questionnaires that assess various dimensions of community engagement, including financial support, shopping habits, participation in leisure activities, visits to friends and relatives, social interactions during leisure activities, and the presence of a best friend. The CI score, ranging from 0 to 12, serves as an indicator of the level of CI, with higher scores indicating stronger integration. To analyze changes in CI over time, we computed the average CI score for each county in North Texas at the time of discharge and 6 months after discharge. The difference between the CI score at discharge and 6 months later was then calculated to determine whether integration scores increased or decreased. Subsequently, we visualized these changes at the county level before and after community reentry.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Counties with improved CI scores display higher levels of educational attainment, enhanced health care access, superior transportation infrastructure, and increased availability of nutritious food, alongside improved public safety measures. Additionally, these counties demonstrate lower levels of racial segregation and reduced exposure to environmental stressors such as extreme heat, sunlight, and UV radiation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Enhanced community-based interventions and policies are recommended to improve CI for burn injury survivors in North Texas. Additional research is needed to further refine these recommendations.&lt;/div&gt;&lt;div&gt;The authors received funding from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). However, the opinions presented in this document do not necessarily coincide with the policies of NIDILRR, nor do they automat","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Page e19"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761192","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":"Long-term Comparative Effectiveness of Surgical Versus Non-surgical Treatment for Rotator Cuff Tears: 5-Year Follow-up of a Prospective Cohort Study 8265","authors":"Xiaoyu Pan,&nbsp;Wenting Liu,&nbsp;Folefac Atem,&nbsp;Nitin Jain","doi":"10.1016/j.apmr.2025.01.014","DOIUrl":"10.1016/j.apmr.2025.01.014","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the long-term effect of operative versus conservative treatments for rotator cuff tears (RCTs), because insufficient long-term evidence exists for the decision-making process.</div></div><div><h3>Design</h3><div>A multicenter prospective longitudinal cohort study with a follow-up of over 5 years. Follow-up visits were set at 3, 6, 12, 18, 24, 36, 48, and 60 months. Inverse probability weighting was used to balance differences in baseline characteristics of the operative and nonoperative groups. Generalized linear mixed model and 3-way interaction were applied in the main and subgroup analysis.</div></div><div><h3>Setting</h3><div>Sports or shoulder clinics in 3 academic settings and 1 community setting between March 2011 and February 2015.</div></div><div><h3>Participants</h3><div>Patients over 45 years of age who were diagnosed with RCTs.</div></div><div><h3>Interventions</h3><div>Not applicable because it is a prospective cohort study.</div></div><div><h3>Main Outcome Measures</h3><div>Assessments included the Shoulder Pain and Disability Index, the American Shoulder and Elbow Surgeons form, magnetic resonance imaging, and a detailed health history questionnaire.</div></div><div><h3>Results</h3><div>After Inverse probability weighting, both groups (operative, n=50; nonoperative, n=77) displayed similar baseline demographics. Outcomes were comparable between groups until 18 months after intervention. Beyond this period, the operative group demonstrated significantly improved outcomes in both Shoulder Pain and Disability Index and American Shoulder and Elbow Surgeons scores. Adjusted mean differences in Shoulder Pain and Disability Index scores were −11.6 (95% confidence interval [CI], −23.3 to 0.137; <em>P</em>=.0527) at 12 months, −12.75 (95% CI, −22.6 to −2.957; <em>P</em>=.0107) at 18 months, and −9.48 (95% CI, −14.5 to −4.41; <em>P</em>&lt;.0001) at the 5-year mark. Subgroup analyses revealed that women (<em>P</em>=.0126) and patients with traumatic RCTs (<em>P</em>&lt;.0001) benefitted more from surgical interventions than from nonoperative treatment.</div></div><div><h3>Conclusions</h3><div>Surgical intervention for RCTs leads to more substantial functional improvement than nonoperative methods after 18 months and remains stable up to 5 years. Female patients and those with traumatic RCTs are more likely to experience better long-term functional outcomes after surgery. This research provides insights into recovery timelines, which can support patient-centered decision making.</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 e5"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761239","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":"“Slipping Away”: A Qualitative Study of Gender in Lived Experiences of Community Integration After Traumatic Brain Injury 1140","authors":"Rachael Coupland,&nbsp;Lulu (Guangjia) Lian,&nbsp;Thaisa Tylinski Sant'Ana,&nbsp;Angela Colantonio,&nbsp;Tatyana Mollayeva","doi":"10.1016/j.apmr.2025.01.016","DOIUrl":"10.1016/j.apmr.2025.01.016","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate community integration challenges after traumatic brain injury (TBI) through a gender lens.</div></div><div><h3>Design</h3><div>A reflexive thematic analysis of semistructured interview data with men and women with a primary diagnosis of mild or moderate-severe TBI, in the acute or chronic stages after injury. The data were coded and analyzed according to Braun and Clarke's thematic analysis.</div></div><div><h3>Setting</h3><div>The largest rehabilitation research-teaching hospital in North America.</div></div><div><h3>Participants</h3><div>Adult participants (22 men and 20 women) undergoing rehabilitation after TBI.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Expression of gender in community reintegration after TBI.</div></div><div><h3>Results</h3><div>Three overarching themes emerged: (1) lack of a “graduated home plan”: difficulty enacting gendered roles and responsibilities at home, (2) “Something that I can't handle”: mismatch between occupational demands and abilities, and (3) “Slipping away”: disrupted connections with self and others. The transformative nature of gender was particularly evident in the home domain of community reintegration, with inabilities to fulfill household tasks traditionally assigned to men and women on the basis of their sex. In the productivity domain, more women reported an inability to meet work demands and more men indicated a limited ability to do so. Both genders encountered disruptions in recreational and leisure activities, but women tended to emphasize obstacles related to social engagement, whereas men leaned toward withdrawal due to anticipated stigma or shame. Across all themes, a pervasive sense of diminished community contributions was observed.</div></div><div><h3>Conclusions</h3><div>The results emphasize the importance of raising awareness among researchers and practitioners on gender as a transformative process in community reintegration after brain injury. The challenges with community reintegration and critical needs based on gender call for rehabilitation approaches that consider changes in socially created roles, responsibilities, and relationships after TBI.</div><div>This research was supported by the Canadian Institutes of Health Research (CIHR) Institute of Gender and Health (#CGW-126580) and in part 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 UK-23-971123). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.</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 e6"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761241","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":"United States Veterans' Utilization of Spinal Cord Injuries and Disorders Annual Evaluation Services","authors":"Jennifer Sippel PhD ,&nbsp;Bella Etingen PhD ,&nbsp;Kevin Stroupe PhD ,&nbsp;Charlesnika Evans PhD, MPH ,&nbsp;Zhiping Huo MS ,&nbsp;Belinda Frazier BS ,&nbsp;Manosha Wickremasinghe MD ,&nbsp;Bridget Smith PhD","doi":"10.1016/j.apmr.2024.09.008","DOIUrl":"10.1016/j.apmr.2024.09.008","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate Veterans’ engagement in spinal cord injury and disorder (SCI/D) specialty annual evaluations (AEs).</div></div><div><h3>Design</h3><div>Cross-sectional retrospective cohort study.</div></div><div><h3>Setting</h3><div>SCI/D System of Care, United States Department of Veterans Affairs (VA).</div></div><div><h3>Participants</h3><div>Veterans with SCI/Ds (N=14,662).</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Receiving SCI/D AEs during the study period (fiscal years [FY] 2019 and 2020).</div></div><div><h3>Results</h3><div>A total of 14,662 Veterans with SCI/Ds were included in the sample; 32.8% (n=4811) received 2 AEs, 28.8% (n=4219) received 1 AE, and 38.4% (n=5632) received no AEs, with an average of 0.9 AEs per Veteran over the 2-year study timeframe (range, 0-2y). Black Veterans had an 8% higher number of AEs than White Veterans after adjusting for other variables (adjusted relative risk [RR], 1.08; 95% confidence interval [CI], 1.04-1.12). Veterans who lived ≥240 minutes away from a VA SCI/D System of Care Center had 45% fewer AEs than Veterans who lived within 30 minutes (adjusted RR, 0.55; 95% CI, 0.52-0.59). Veterans with more SCI/D specialty visits had 90% more AEs than those with fewer visits (adjusted RR, 1.90; 95% CI, 1.78-2.03), whereas Veterans with more outpatient visits in VA primary care had 28% fewer AEs (adjusted RR, 0.72; 95% CI, 0.69-0.76). Veterans with higher comorbidity scores had 9% more AEs than Veterans with lower scores (adjusted RR, 0.66; 95% CI, 0.61-0.70).</div></div><div><h3>Conclusions</h3><div>More than half (62%) of Veterans received ≥1 SCI/D AE during FY19-20. Veterans living closer to a VA SCI/D System of Care Center/Hub had more engagement in SCI/D AEs. Veterans with SCI/Ds who used VA primary care outside of the SCI/D System of Care had fewer AEs. There were no major racial, age-based, or sex disparities in SCI/D AE usage. Our findings suggest the need for targeted intervention efforts to promote AE use among Veterans.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages 507-516"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142340080","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":"Organizational Characteristics of Medical-legal Partnerships Serving People Living with HIV: Challenges and Opportunities","authors":"Allen Partono,&nbsp;Xiang Zhu,&nbsp;Omar Martinez","doi":"10.1016/j.apmr.2025.01.070","DOIUrl":"10.1016/j.apmr.2025.01.070","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate what characteristics and strategies of medical-legal partnerships (MLPs) proved to invaluable to improving outcomes for people with HIV (PWH). To understand the potential benefits of MLPs and challenges with their implementation.</div></div><div><h3>Design</h3><div>A mixed-method analysis was conducted using both categorical features of MLPs, including the person who carries out the screening for health harming legal needs, whether the MLP was community-based or an organization, and how legal services were provided, and number of services offered on-site or referral based on responses to a cross-sectional survey of MLPs. We conducted a multiple variable linear regression analysis with these variables in association to the main outcome measures.</div></div><div><h3>Setting</h3><div>We used an online survey questionnaire to gather data for the study.</div></div><div><h3>Participants</h3><div>Data came from a cross-sectional survey of MLP providers through a national survey of clinics, community-based organizations, and hospitals across the United States. This data used for this study used survey data from a previous NIH study that was already completed with prior IRB approval done. The data did not collect identifiable information about themselves or their patients and were compensated with a $30 gift card. Inclusion criteria for this survey were organizations that had a patient population with over 50% of their patients living with HIV.</div></div><div><h3>Interventions</h3><div>No intervention was carried out.</div></div><div><h3>Main Outcome Measures</h3><div>Percentage of patients in their clinic that have achieved HIV viral suppression and percentage of patients completing a follow-up appointment every 6 months.</div></div><div><h3>Results</h3><div>Analysis showed that having clinician posing as the initial screener for health harming legal needs was associated with a lower likelihood of completing a follow-up appointment for PWH (<em>P</em>&lt;.05). We also found the community health organizations were associated with a greater number of patients achieving a suppressed HIV viral load (<em>P</em>&lt;.10). Finally, we found that that the number of on-site services were associated with an improvement with bout outcome measures.</div></div><div><h3>Conclusions</h3><div>Study findings highlight factors impacting outcomes in HIV care. Notably, clinician-led screening for health harming legal needs linked to reduced follow-up appointments for PWH, signaling an imperative for improved clinician training. The presence of community health organizations and on-site services emerged as key contributors to enhanced outcomes, emphasizing comprehensive care approaches in HIV care. Further research is needed to document best practices and approaches within medical-legal partnerships to improve HIV care outcomes.</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 e27"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761264","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 Training in Visual Motor Imagery to Improve Reaching and Gripping Actions for a Single Subject with Stroke in the Supplementary Motor Area 4344","authors":"Gen Koyama,&nbsp;Kaori Ito,&nbsp;Nobuya Maeda","doi":"10.1016/j.apmr.2025.01.061","DOIUrl":"10.1016/j.apmr.2025.01.061","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the effect of my rehabilitation using visual motor imagery training on a subject with stroke in the supplementary motor area. The subject had disorders with reaching and gripping actions, cognitive decline, and attention deficit.</div></div><div><h3>Design</h3><div>This report is a single case intervention study of before-after trial of my rehabilitation.</div></div><div><h3>Setting</h3><div>The setting is hospitalized acute phase rehabilitation for a single subject. The study was approved by the local ethics committee and conducted in accordance with the Declaration of Helsinki. The patient gave written, informed consent.</div></div><div><h3>Participants</h3><div>The study was a 70-year-old subject with stroke on the right side of the supplementary motor area. The disease caused the subject to have a disability in reaching and gripping actions. Also, the subject had symptoms of cognitive decline and attention deficit. The physical finding was Fugl-Meyer Assessment upper extremity on the left side (10/66). The neuropsychologic findings were Raven's Colored Progressive Matrices (20), Token Test (15), Trail Making Test (impossible).</div></div><div><h3>Interventions</h3><div>The intervention was visual motor imagery training for the subject 1 time a day for 40 minutes per day, 5 days, for a period of 3 weeks. The motor imagery training consisted of 2 steps. Firstly, the subject was shown 3 videos, which showed motor actions of the hand grasping, hand rotation, and reaching and gripping a ball. These videos also showed the therapist's own hand movements. During this process, the subject mentally rehearsed these actions without overt movement. After this, the subject attempted to execute these motor actions physically.</div></div><div><h3>Main Outcome Measures</h3><div>The subject's upper limb function was evaluated as follows: reaching and gripping action times to a ball which was held at 40 cm in front of the subject (30.31s), reaching and gripping action times to a cup (impossible), and reaching and gripping action times to a bowl (impossible).</div></div><div><h3>Results</h3><div>These reaching and gripping actions were changed after my rehabilitation period of 3 weeks. The reaching and gripping action times to a ball (5.11s), the reaching and gripping action times to a cup (9.89s), and reaching and gripping action times to a bowl (7.82s).</div></div><div><h3>Conclusions</h3><div>Visual Motor imagery training had a positive effect on the single subject with supplementary motor area stroke to improve the reaching and gripping actions, although the subject had cognitive decline and attention deficit.</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 e24"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761290","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":"Psychometric Properties and Clinical Utility of the Boston Cognitive Assessment (BOCA) on an Acute Rehabilitation Unit","authors":"Jeffrey Wertheimer,&nbsp;Ann Gottuso PhD, ABPP-CN,&nbsp;Mia Wertheimer,&nbsp;Dov Gold","doi":"10.1016/j.apmr.2025.01.082","DOIUrl":"10.1016/j.apmr.2025.01.082","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To elucidate the psychometric properties of the Boston Cognitive Assessment (BOCA) in a sample of inpatients in an Acute Rehabilitation Unit (ARU). To introduce the clinical utility of the BOCA, a digital cognitive screen on an ARU.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Retrospective cross-sectional design.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;Acute Rehabilitation Unit at a free-standing, 138-bed inpatient medical rehabilitation hospital.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;Hospital records from 32 patients were identified wherein individuals completed the BOCA and Montreal Cognitive Assessment (MoCA). Admission diagnoses included neurological and nonneurological injuries.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;The BOCA and MoCA test administration were 10 and 15 minutes, respectively. BOCA Total Score and individual subtest scores were examined, along with demographic and clinical variables. Exploratory factor analysis, internal consistency, concurrent validity, and known-group validity were examined.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;The BOCA is a computerized, self-administered measure of global cognition (Gold et al., 2021; Vyshedskiy et al., 2022) and evaluates immediate recall, delayed recall, language reasoning, visuospatial reasoning, executive functioning, attention, mental math, and orientation. The MoCA is a paper-and-pencil screening instrument for cognition (Nasreddine, 2005) and evaluates wordlist recall, visuospatial and executive functions, language, attention, and orientation. For both measures, the maximum score is 30; lower scores reflect greater cognitive difficulties.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Average age was 59.13 years (SD, 16.49y; range, 25-85y). Average years of education was 14.9 years (SD, 3.46y). Average BOCA total score was 25.13 (SD, 4.46) and average MoCA total score was 23.44 (SD, 4.59). Similar to studies of outpatients, the BOCA demonstrated a unitary factor structure accounting for a plurality of the variance, adequate internal consistency (&lt;em&gt;a&lt;/em&gt;=0.73), and strong concurrent validity with the MoCA (&lt;em&gt;r&lt;/em&gt;=0.57; &lt;em&gt;P&lt;/em&gt;=.003). This study explored differences in BOCA performance among those admitted with primary brain injuries compared with those admitted for nonneurologic conditions. Those admitted to the ARU with brain injuries scored significantly lower than those admitted for nonneurological etiologies (&lt;em&gt;U&lt;/em&gt;=67.50, &lt;em&gt;P&lt;/em&gt;=.025).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;There is increasing need to access novel and efficient cognitive screening tools within an inpatient rehabilitation setting. This study provides initial evidence that the BOCA maintains similar factor structure, reliability, and validity in inpatient samples compared with what has been observed in outpatient samples. These findings provide preliminary support for deploying the BOCA in inpatient settings. The BOCA is a useful screening instrument for assessing ","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Page e32"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761312","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}