Archives of physical medicine and rehabilitation最新文献

{"title":"Enhancing Accessibility and Precision in Multiple Sclerosis Rehabilitation: A Transdisciplinary Approach to Digital Health Solutions","authors":"T. Bradley Willingham,&nbsp;George Collier,&nbsp;Jacob Cartwright,&nbsp;Deborah Backus","doi":"10.1016/j.apmr.2025.03.031","DOIUrl":"10.1016/j.apmr.2025.03.031","url":null,"abstract":"<div><div>Rehabilitation and exercise can have a profound impact on health, function, and quality of life in people living with multiple sclerosis (MS). However, people with MS often experience physical, psychosocial, environmental, and economic barriers that limit their ability to participate in rehabilitation programs. These barriers often result in significant health disparities, underscoring the urgent need for accessible and effective strategies that promote sustained participation in health-enhancing physical activities for people with MS. Advancements in digital health technologies, such as internet-based tele-rehabilitation platforms and wearable sensors, offer promising solutions to address health inequities and expand access to rehabilitation programs. Yet, the translation of digital health tools into clinical practice is often impeded by challenges in data integration, the extraction of actionable insights, and the effective dissemination of critical information to both clinicians and patients. To address these issues, we have assembled a transdisciplinary team comprising clinical research scientists, engineers, data scientists, and clinicians to bridge the gap between technological innovation and practical application in rehabilitation care. Through a rigorous co-innovation approach, our team has developed a novel digital health solution that automatically captures and integrates multicomponent health information from state-of-the-art remote monitoring technologies to deliver a comprehensive approach to managing remote treatment strategies. Additionally, we demonstrate how intelligent analytics and user-friendly dashboards can be leveraged to rapidly deliver actionable insights to clinicians and patients. This initiative not only democratizes access to evidence-based care for individuals with chronic conditions but also opens new avenues for scientific inquiry into the daily, lived experiences of people with MS.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 5","pages":"Page e8"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143887784","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":"Finding Predictive Factors of Stabilization Exercise Adherence in Randomized Controlled Trials on Low Back Pain: An Individual Data Reanalysis Using Machine Learning Techniques","authors":"Ann-Christin Pfeifer PhD ,&nbsp;Paul Schröder-Pfeifer PhD ,&nbsp;Marcus Schiltenwolf MD ,&nbsp;Lutz Vogt PhD ,&nbsp;Christian Schneider MD ,&nbsp;Petra Platen MD ,&nbsp;Heidrun Beck MD ,&nbsp;Pia-Maria Wippert PhD ,&nbsp;Tilman Engel PhD ,&nbsp;Monique Wochatz PhD ,&nbsp;Frank Mayer MD ,&nbsp;Daniel Niederer PhD","doi":"10.1016/j.apmr.2024.12.015","DOIUrl":"10.1016/j.apmr.2024.12.015","url":null,"abstract":"<div><h3>Objective</h3><div>To identify predictors of adherence in supervised and self-administered exercise interventions for individuals with low back pain.</div></div><div><h3>Design</h3><div>Cohort study.</div></div><div><h3>Setting</h3><div>Rehabilitation.</div></div><div><h3>Participants</h3><div>This preplanned reanalysis within the Medicine in Spine Exercise Network included 1511 participants with low back pain (57% female, mean age 40.9 years, SD ±14 years).</div></div><div><h3>Interventions</h3><div>Participants underwent an initial 3-week supervised phase of sensorimotor exercises, followed by a 9-week self-administered phase.</div></div><div><h3>Main Outcome Measures</h3><div>Biological, psychological, and social factors potentially impacting training adherence were evaluated. During the supervised phase, adherence was tracked through a standardized training log. During the self-administered phase, adherence was monitored via a diary, with adherence calculated as the percentage of scheduled versus completed sessions. Adherence was analyzed both as an absolute percentage and as a dichotomized variable (adherent vs nonadherent, with a 70% adherence cut-off). Predictors for adherence were identified using Gradient Boosting Machines and Random Forests (R package caret). Seventy percent of the observations were used for training, whereas 30% were retained as a hold-out test-set.</div></div><div><h3>Results</h3><div>The average overall adherence was 64% (±31%), with 81% (±28%) adherence during the supervised phase and 58% (±39%) in the self-administered phase. The root mean square error for the test-set ranged from 36.2 (<em>R</em>²=0.18, self-administered phase) to 19.3 (<em>R</em>²=0.47, supervised phase); prediction accuracy for dichotomized models was between 64% and 83%. Predictors of low to intermediate adherence included poorer baseline postural control, decline in exercise levels, and fluctuations in pain intensity (both increases and decreases).</div></div><div><h3>Conclusion</h3><div>Identified predictors could aid in recognizing individuals at higher risk for nonadherence in low back pain exercise therapy settings.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 5","pages":"Pages 738-749"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930475","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":"Trial Ready: Informing a Mobility Intervention Trial for Infants with Down Syndrome","authors":"Ashley Collimore ,&nbsp;Marie Canty ,&nbsp;Izza Choudhry ,&nbsp;Anna Donato ,&nbsp;Erica Friedman ,&nbsp;Marc Maffei ,&nbsp;Katherine Pawlowski ,&nbsp;Sydney Reynders ,&nbsp;Nicole Baumer ,&nbsp;Jana Iverson","doi":"10.1016/j.apmr.2025.03.014","DOIUrl":"10.1016/j.apmr.2025.03.014","url":null,"abstract":"<div><div>Independent mobility is a key driver of infant exploration, communication, and caregiver interactions that support overall development. Infants with Down syndrome (DS) have significant motor delays and have difficulty leveraging mobility for these purposes. Cost-effective, caregiver-implemented interventions that enhance independent mobility are needed to address DS infants' developmental delays. The PUMA body-weight support harness (Enlighten LLC) shows promise in facilitating mobility for infants with motor delays. However, it lacks systematic evidence supporting home-based use, specifically for infants with DS. Our ongoing feasibility study aims to address two critical questions for clinical trial development: (1) Is the PUMA device feasible and desirable for home use for infants with DS? and (2) Which observational and developmental outcome measures are useful for assessing intervention efficacy in the home? To date, eight families (target n = 15), have completed 68 virtual and 30 in-person home data collections. Sessions included infant-caregiver play, capturing observational outcomes (locomotion, object exploration, communication), and standardized developmental assessments. Families also assembled the harness and completed a feasibility survey. Initial feedback indicates all caregivers find the PUMA enjoyable for their infants and foresee its potential to enhance mobility and foster new experiences. Most feel confident in independently using the device at home, with seven willing to commit to at least 30 minutes daily. Ongoing analyses include comparison of virtual and in-person observational outcome measures and monitoring developmental changes over time. The results set the stage for developing the first clinical trial of a home-based mobility intervention tailored for infants with DS.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 5","pages":"Page e4"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143886684","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":"Game On! CP Soccer Intensive Camp to Promote Self-Efficacy, Positive Attitudes Towards Physical Activity, and Fitness among Children and Adolescents with Cerebral Palsy","authors":"Katherine Dimitropoulou ,&nbsp;Brian Wishart ,&nbsp;Mara Yale ,&nbsp;Jacqueline Chen ,&nbsp;Hana Azizi","doi":"10.1016/j.apmr.2025.03.015","DOIUrl":"10.1016/j.apmr.2025.03.015","url":null,"abstract":"<div><div>Ambulatory children and adolescents with cerebral palsy (CP-GMFCS I-III) and other early life brain injuries, shy away from physical activity (PA). This mixed methods community based participatory research study examines the feasibility/preliminary effectiveness of the Game On soccer summer camp to improve fitness, attitudes towards PA, and develop social connections among participants. A total of 16 children and adolescents with CP participated. We used heart rate monitors (Polar monitors) to measure fitness before/after and during the camp. We used the Attitudes towards PA Scale, and the Self-efficacy towards PA Scale, before/after the camp. Exit interviews for children (individually) were conducted after camp. The Game On soccer camp (based on the Game On Framework) included an individualized program focused on: a) learning to self -monitor intensity through heart rate using wearable devices and an app; b) peer and near-peer mentorship and team support strategies to improve self-monitoring of fitness, game skills and specific movements important for the game; c) social interactions building reflection through activities organized primarily by campers; d) learning strategies to negotiate personal space conflicts and misunderstandings. The camp was administered for 5 hours/day for 5 consecutive days. Results reveal improved fitness (Cohen's d=0.92 for all participants but mostly those with low PA engagement), self-efficacy and attitude towards PA. Thematic analysis of qualitative data revealed that campers felt: a) confident about their skills; b) empowered to self-monitor their stamina; c) learned movement strategies and new soccer and game skills from peers, and d) developed friendships beyond the camp.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 5","pages":"Page e4"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143886685","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 Hospital Acquired Pressure Injury Prevention with a Data-Driven Transdisciplinary Model","authors":"Bridget Fowler King,&nbsp;Colleen Johnson,&nbsp;Matthew Grissom,&nbsp;Andrew Morris,&nbsp;Miriam Rafferty","doi":"10.1016/j.apmr.2025.03.025","DOIUrl":"10.1016/j.apmr.2025.03.025","url":null,"abstract":"<div><h3>Introduction</h3><div>Our project aims to reduce HAPI occurrences in spinal cord injury patients by translating risk identification research into effective quality improvement strategies.</div></div><div><h3>Objective</h3><div>To develop and implement a \"Pressure Injury Prevention Toolkit,\" enhanced by a HAPI reporting dashboard, to improve risk-based clinical decision-making and define clear roles for healthcare providers.</div></div><div><h3>Methods</h3><div>Using an 18-month Plan, Do, Study, Act (PDSA) cycle, we introduced new nursing workflows for identifying high-risk patients, real-time data visualization for HAPI metrics, and regular transdisciplinary meetings to refine patient care plans and interventions.</div></div><div><h3>Results</h3><div>The initial PDSA cycle highlighted areas for protocol refinement, such as increasing buy-in from floor managers and creating sustainable, adaptable work processes. Future cycles will focus on improving dashboard engagement, prevention compliance, and transdisciplinary discussion fidelity.</div></div><div><h3>Implications</h3><div>This approach integrates digital tools and transdisciplinary insights to revamp traditional HAPI prevention strategies, paving the way for broader implementation across the hospital.</div></div><div><h3>Conclusion</h3><div>Our project demonstrates the transformative potential of technology-enhanced, transdisciplinary strategies in improving patient care quality and reducing HAPI rates.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 5","pages":"Page e7"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143887657","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":"Implementation of Remote Therapeutic Monitoring into Physical Therapy at a Large Academic Healthcare System","authors":"Kevin McLaughlin","doi":"10.1016/j.apmr.2025.03.029","DOIUrl":"10.1016/j.apmr.2025.03.029","url":null,"abstract":"<div><div>Remote therapeutic monitoring (RTM) is an mHealth solution that allows physical therapists to communicate with patients who have musculoskeletal conditions and track their progress outside of clinic visits using a mobile application. By enhancing patients' engagement with their care, RTM stands to increase the effectiveness of physical therapy care for patients with musculoskeletal conditions. At the same time, RTM is very different than traditional physical therapy services as it is delivered through a mobile application outside of scheduled clinical visits. The procedural codes used to cover RTM services are also new, having been announced in 2022 by the Centers for Medicare and Medicaid Services. As such, best practice approaches for implementing RTM into clinical practice have not been established. Since early 2024, our team has been actively implementing a mobile application and RTM workflows across a large outpatient rehabilitation network. In this presentation, our team will describe our experiences implementing RTM services across our network. Guided by the RE-AIM framework, we will report on patient acceptance and utilization of these services, as well as provider uptake of RTM and utilization rates. We will also provide preliminary estimates regarding the influence of RTM on patient-reported outcomes, which are routinely collected at our institution. Lastly, we will discuss challenges we have experiences during implementation and recommendations for other institutions interested in implementing RTM services.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 5","pages":"Page e8"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143887782","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":"Building Context-Aware Digital Health Tools: A Framework for Evaluating Real-World Human Health and Behavior","authors":"Christopher DiCesare,&nbsp;Scott McLean","doi":"10.1016/j.apmr.2025.03.030","DOIUrl":"10.1016/j.apmr.2025.03.030","url":null,"abstract":"<div><div>Digital health tools that utilize innovative technologies (wearable / portable devices, human-centric artificial intelligence / machine learning [AI / ML], etc.) have enormous potential for targeted human performance monitoring, pain, disease, and/or disability management. Efforts in this space have, for the most part, yet to translate into clinically useful applications. For every potential opportunity that these tools present, challenges persist, including how to devise experimental protocols in unconstrained, real-world settings to ensure that meaningful data is captured, how to make sense of those data / reconcile with what we observe in the laboratory, and how best to integrate these insights within the clinical ecosystem. In this presentation, I discuss the generalized framework our team (EPIC Laboratory) has been developing that supports proactive planning for, anticipation of, and adaptation to real-world human behavior, with a specific emphasis on the principles of human movement and cognitive science, contextual design, and user experience evaluation as applied to engineering design and product development.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 5","pages":"Page e8"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143887783","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":"Walking Exercise Sustainability through Telehealth for Veterans with Lower-Limb Amputation","authors":"Rachael Akay ,&nbsp;Brecca Gaffney ,&nbsp;Ryan Stephenson ,&nbsp;Elizabeth Juarez-Colunga ,&nbsp;Paul Cook ,&nbsp;Cory Christiansen","doi":"10.1016/j.apmr.2025.03.020","DOIUrl":"10.1016/j.apmr.2025.03.020","url":null,"abstract":"<div><h3>Background</h3><div>The VA Durability of Rehabilitation Interventions for Veterans (DRIVE) funding mechanism supports novel, multimodal rehabilitation approaches, including clinician-directed interventions and Veteran self-managed components, to improve long-term durability of rehabilitation outcomes. This trial funded by the DRIVE mechanism focuses on sustained walking exercise after lower-limb amputation. While conventional lower-limb amputation rehabilitation effectively improves functional capacity, healthy levels of walking are not sustained post-rehabilitation.</div></div><div><h3>Objective</h3><div>The \"Walking Exercise Sustainability Training (WEST)\" trial examines a Veteran home-based self-maintenance intervention after lower-limb loss. The WEST trial, designed by a transdisciplinary team of patients, physical therapists, occupational therapists, physicians, psychologists, nurses, and bioengineers, is a psychologically informed approach based on behavioral frameworks and patient-centered communication. Wearable sensors and peer support are used in a telehealth environment to deliver the intervention with the aim of sustaining walking exercise.</div></div><div><h3>Methods</h3><div>WEST is a randomized controlled superiority trial that tests an 18-month telehealth walking exercise self-management program. Veteran participants will complete six one-on-one intervention sessions, and six peer-support group sessions. The experimental arm will receive a self-management program focused on sustaining walking exercise and the control group will receive attention-control health education. Daily walking step count (primary outcome; actigraphy) will be continuously monitored during study participation. Secondary outcomes assess potential translation of the WEST intervention into conventional VA amputation care. IMPACT The unique rehabilitation paradigm in this trial addresses the problem of persistent sedentary lifestyles following lower-limb amputation through a telehealth self-management model. The novel transdisciplinary strategy will inform implementation potential, including a signal for clinical effectiveness.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 5","pages":"Pages e5-e6"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143887913","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":"It's All About Communication! Teaching Researchers to Talk to Clinical Collaborators","authors":"Melissa Briody ,&nbsp;Bridget Fowler King ,&nbsp;James Silwa ,&nbsp;Richard Lieber","doi":"10.1016/j.apmr.2025.03.006","DOIUrl":"10.1016/j.apmr.2025.03.006","url":null,"abstract":"<div><div>Effective clinician-researcher partnerships rely on clear communication, yet these two groups often struggle to speak a common language. We have developed what we term, \"The IdeaLab,\" an initiative of Shirley Ryan AbilityLab and the Center for Smart Use of Technology to Assess Real World Outcomes (C-STAR), that provides a platform for investigators to present early-stage research ideas and receive expert guidance from clinicians. From 2021-2024, we held 20 IdeaLabs with an average of 35 employees per event (35.4±10.2). Participants included 45.6% Researchers/Engineers, 32.6% Allied Health, 11.4% Other staff, 9.0% Physicians, and 1.3% Registered Nurses (n=708). The success of these events hinges on presenters effectively communicating their research ideas to the interdisciplinary audience to produce valuable discussions of usability, feasibility, clinical applicability and potential impact. Drawing from our experience, we identified three key concepts and incorporated them into a template for successful IdeaLab presentations: (1) Start with the idea. Presenters must concisely articulate their idea and their understanding of its significance. (2) Simplify the content. Presenters must provide essential information with minimal technical jargon. Overly detailed methodology distracts from the clinical need and impact. (3) Focus on the nail. Presenters should aim to identify real clinical problems and tailor their solution (\"the hammer\") accordingly to increase the potential for impact. For some investigators, the IdeaLab may be their first meaningful interaction with clinical counterparts. By equipping researchers with effective interdisciplinary communication skills, we foster a culture of collaboration that empowers both researchers and clinicians to address real-world challenges for rehabilitation populations.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 5","pages":"Pages e1-e2"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143887918","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":"Archives Supplements","authors":"","doi":"10.1016/S0003-9993(25)00645-8","DOIUrl":"10.1016/S0003-9993(25)00645-8","url":null,"abstract":"","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 5","pages":"Pages 817-819"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143887962","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}