Archives of physical medicine and rehabilitation最新文献

{"title":"Retrospective Examination of Referral Patterns and Predictors of Referral to Cancer Rehabilitation at Canada's Largest Cancer Centre 8256","authors":"Jennifer Jones,&nbsp;Lisa Avery,&nbsp;Michelle Weller,&nbsp;Rogih Andrawes,&nbsp;Adrienne Lam,&nbsp;Danielle Rodin,&nbsp;Gilla Shapiro","doi":"10.1016/j.apmr.2025.01.020","DOIUrl":"10.1016/j.apmr.2025.01.020","url":null,"abstract":"<div><h3>Objectives</h3><div>To describe the sociodemographic and clinical characteristics and symptom burden of patients who were referred to the Princess Margaret Cancer Rehabilitation and Survivorship (CRS) Program between 2017 and 2019 (n=2783), and compare these variables between patients who were referred to CRS and matched cases who were not referred (n=17,025) over this period.</div></div><div><h3>Design</h3><div>A retrospective case-control secondary analysis of data extracted from the Princess Margaret Cancer Registry, electronic patient records, and patient-reported outcome data (ESAS-r and ECOG status) was performed. Summary statistics describe the patients referred to the CRS program. Multivariable logistic regression modeling was used to identify factors associated with the likelihood of referral.</div></div><div><h3>Setting</h3><div>Princess Margaret Cancer Centre (CANADA); Canada's largest cancer center.</div></div><div><h3>Participants</h3><div>Patients diagnosed with cancers of the oropharynx, gastrointestinal tract, respiratory system, breast, gynecologic system, genitourinary system, hematologic and lymphatic systems at Princess Margaret Cancer Centre. Cases were patients newly diagnosed or with recurrence from January 1, 2012 and referred to the CRS program between January 2017 and December 2019 (n=2783). Controls were all unreferred patients, diagnosed in the same months at the same sites (n=17,025).</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Summary statistics were used to describe the patients referred to the CRS program. After this, our analysis was conducted using 4 separate models, to allow us to identify important factors associated with CRS referral and to build a single comprehensive model incorporating both registry and patient-reported factors.</div></div><div><h3>Results</h3><div>Most referred patients were women (75%), English speakers (93%), and 52% lived within 15 km of Princess Margaret. The most common reasons for referral were musculoskeletal impairment (44.3%), lymphedema (30%), and deconditioning (28%). The mean time from diagnosis to referral was 20.7+19.2 months. Cancer site, age, distance from hospital were the strongest predictors of referral to CRS. Completion of PROMS was also an important predictor; patients who were older, living further from the hospital, from neighborhoods with the least material resources, and incomes in the bottom 80% were least likely to complete the PROMs.</div></div><div><h3>Conclusions</h3><div>Encouraging and assisting PROM completion, increasing awareness of CRS programming in sites that have lower referrals rates, and addressing referral bias regarding age and distance may increase access to cancer rehabilitation services.</div></div><div><h3>Disclosures</h3><div>none.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages e7-e8"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761281","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":"Identifying What Matters to Adults with Mobility Limitations Regarding Their Experiences with Medications: A Concept Mapping Study 1131","authors":"Sara Guilcher,&nbsp;Lauren Cadel,&nbsp;Amanda Everall,&nbsp;Anita Kaiser,&nbsp;Stephanie Cimino,&nbsp;Rasha El-Kotob,&nbsp;Lisa McCarthy,&nbsp;Colleen O'Connell,&nbsp;Crystal MacKay,&nbsp;James Milligan,&nbsp;Aisha Lofters,&nbsp;Sander Hitzig,&nbsp;Diana Zidarov","doi":"10.1016/j.apmr.2025.01.056","DOIUrl":"10.1016/j.apmr.2025.01.056","url":null,"abstract":"<div><h3>Objectives</h3><div>To develop potential items for a patient-reported experience measure related to medication use for adults with mobility limitations.</div></div><div><h3>Design</h3><div>Mixed methods, concept mapping study.</div></div><div><h3>Setting</h3><div>General community, Canada.</div></div><div><h3>Participants</h3><div>Participants were required to: self-identify as having a mobility limitation, take at least one medication recommended by a prescriber in the preceding 3 months, live in the community (ie, not in a long-term care home or acute hospital), live in Canada, be 18 years of age or older, and speak and read English or French. Forty-five individuals participated in this study, who were recruited between June 2022 and July 2023 using purposive and convenience sampling strategies.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Perspectives on items for a patient-reported experience measure related to medication use for adults with mobility limitations.</div></div><div><h3>Results</h3><div>Participants generated 694 statements, which were synthesized into 80 unique statements. The final map contained ten clusters: (1) medication-related financial considerations and support; (2) pharmacy-related services and supports; (3) access to medications and medication-related supports; (4) acceptance and stigma around medication use; (5) ability and ease of taking medications; (6) shared decision making and access to medication-related research and information; (7) medication effectiveness, side effects and risks; (8) knowledge, self-awareness and empowerment; (9) accessibility of health care providers; and (10) communication and relationships with health care providers. The most important cluster, rated by participants, was medication-related financial considerations and support.</div></div><div><h3>Conclusions</h3><div>Understanding what matters to individuals with mobility limitations about their medications will support quality improvement of health care delivery and outcomes for this population.</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 e22"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761304","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":"NIDILRR ARRT: Assessing Mobile Device Proficiency for a Smart Home Intervention in Individuals with Complex Disabilities","authors":"Gina Novario","doi":"10.1016/j.apmr.2025.01.005","DOIUrl":"10.1016/j.apmr.2025.01.005","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To determine whether an observation-based mobile device assessment is needed to assess mobile device skills of individuals with complex disabilities and used for treatment planning for using smart devices.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;This case series study, part of a larger research project, involved participants completing a short version of the Mobile Device Proficiency Questionnaire (MDPQ-16) and participating in an observational assessment of mobile device skills. The assessment included 5 tasks and observational guidelines on device positioning, manual and voice access, and cognitive aspects.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;Participants’ homes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;A convenience sample of 13 individuals who use a power wheelchair and have difficulty independently controlling or accessing their environment.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;Not applicable.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;MDPQ-16 and identified mobile device skill performance.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Eleven out of 13 participants completed the MDPQ-16, with an average score of 31±9 (range, 16-40; maximum 40 for top proficiency). Twelve completed the mobile device assessment. Five used Android and 8 used iOS. Five used voice input (voice control and voice assistant), 4 used touch, and 2 used both methods. Five participants (MDPQ range, 36-40) had no noted difficulties during mobile device assessment. The other 8 (MDPQ range, 16-39) exhibited diverse device skill performance stemming from device mounting and positioning challenges, motor impairments affecting touch gesture and/or typing precision, limited familiarity with the accessibility features, insufficient digital literacy, and outdated devices lacking necessary features.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Relying solely on the MDPQ-16 yielded inadequate insight into participants’ mobile device skills. The observation-based mobile device assessment revealed specific areas of knowledge or functional gaps, enabling clinicians to tailor necessary skill training and adaptation recommendations. The MDPQ-16 is an inadequate assessment to use alone when understanding participants’ mobile device skills but should be used in conjunction with an observation-based mobile device assessment to ensure foundational mobile device proficiency is achieved prior to smart technology training.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Disclosures&lt;/h3&gt;&lt;div&gt;Gina Novario, OTD, OTR/L, is the current Advanced Rehabilitation Research and Training Fellow in the Department of Rehabilitation Science and Technology at the University of Pittsburgh. She graduated from Slippery Rock University in 2021 with her Doctorate in Occupational Therapy. She is currently on the Smart Home Service Delivery and Funding and Policy Study Projects at the University of Pittsburgh's Rehabilitation Engineering Research Center on Wireless Technologies for People with Disabilities.&lt;/div&gt;&lt;/","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages e1-e2"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761088","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":"NIDILRR ARRT: Intersecting Marginalized Identities Among People with Disabilities: Impact on Access to Employment Support Resources and Employment Outcomes","authors":"Suyoung Kwon,&nbsp;Ivan R. Molton","doi":"10.1016/j.apmr.2025.01.006","DOIUrl":"10.1016/j.apmr.2025.01.006","url":null,"abstract":"<div><h3>Objectives</h3><div>To examine if demographic factors impact the disparity of resources supporting employment (RSE) and employment among people with disabilities (PWD).</div></div><div><h3>Design</h3><div>Prospective cohort study with a 2-year follow-up.</div></div><div><h3>Setting</h3><div>A nationwide disability research registry at the University of Washington used convenience sampling to recruit community-dwelling individuals with multiple sclerosis, muscular dystrophy, spinal cord injury, or postpolio syndrome, resulting in a sample size of over 2000 individuals from 2009 to 2017.</div></div><div><h3>Participants</h3><div>This study comprised 920 working-age individuals from 2014 to 2017, with more non-Hispanic White participants (86%) than Black, Indigenous, and People of Color.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>RSE (unawareness and level of availability, score range, 0-15) was assessed using 3 questions from the environmental item bank, covering disability accommodation, job placement and training, as well as information on work and volunteer opportunities. Additionally, participants’ employment status (employed and working hours for pay) was determined by their reported weekly hours worked for pay.</div></div><div><h3>Results</h3><div>PWD who belong to marginalized groups based on race, sex, age, education, and household income reported lower access to RSE and worse employment outcomes. One point higher in RSE was associated with lower unemployment (odds ratio, 0.61; 95% confidence interval, 0.46-0.81) after adjusting for confounding variables and demographics. Significant interactions on employment were found between RSE and education, as well as between RSE and household income. The impact of RSE on employment status was more substantial for PWD with a bachelor's degree or high household income compared with their counterparts with a high-school education or lower and those with low household income.</div></div><div><h3>Conclusions</h3><div>Results suggest that marginalized PWD have less access to RSE, and this inequality directly affects subsequent employment rates, particularly PWD with lower education and household income. Ensuring equitable job opportunities requires increased allocation of RSE for marginalized PWD.</div></div><div><h3>Disclosures</h3><div>none. The contents of this report were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number H133B130018). National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this report do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Page e2"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761089","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":"Living Longer and Stronger with SCI: Using Participatory Research to Develop an Online Group Health Promotion Program for People Aging with SCI 1144","authors":"Susan Robinson-Whelen,&nbsp;Rosemary Hughes,&nbsp;Diana Gonzalez,&nbsp;Linda Norah-Davis,&nbsp;Garett Parrish,&nbsp;Heather Taylor","doi":"10.1016/j.apmr.2025.01.036","DOIUrl":"10.1016/j.apmr.2025.01.036","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To develop and beta-test an online group health promotion program for people aging with spinal cord injury (SCI) in preparation for a national randomized controlled trial.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;People with SCI participated in a beta-test of the intervention to provide feedback on acceptability and ways to improve the program.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;The group program was implemented online via Zoom.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;Meeting the same criteria to be used in the full trial, the 6 beta-testers were community-residing adults with SCI who were either 45+ years of age or had been living with their SCI for 15+ years. Beta-testers were diverse in terms of gender, race/ethnicity, level of injury, and geographic location.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;The investigators partnered closely with community advisors with SCI and a multidisciplinary medical advisory board to develop the Living Longer and Stronger with SCI program. The 8-session program, cofacilitated by a person with SCI and a coinvestigator, addresses physical and psychosocial health of people aging with SCI. Community advisors and the multidisciplinary team codeveloped and reviewed each session to assure relevance, usability, and sensitivity for people with SCI. Sessions included educational content, group discussion, action planning, and relaxation exercises. The team developed intervention materials including PowerPoints, a Participant Handbook, and a detailed Facilitator Manual.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;Beta-testers completed brief evaluation surveys after each session. At the end of the program, they were asked to rate, on a 5-point scale, the program overall and the extent to which each aspect of the program (content, discussion, action planning, relaxation exercises, participant handbook) was helpful. They also responded to open-ended questions asking for suggestions for improving the program overall, the program materials, and the Zoom platform. They were also invited to share additional comments.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The Living Longer and Stronger with SCI program was well received. All 6 beta-testers (100%) rated the program overall as excellent. The majority rated all aspects of the program as helpful: content (100% “very” helpful), discussion (100% “very” helpful), action planning (83% “very,” 17% “somewhat” helpful), relaxation (33% “very,” 50% “somewhat,” 17% “undecided”), and participant handbook (66% “very,” 17% “somewhat,” 17% “undecided”). Although open-ended responses were positive, a few beta-testers suggested more time for group interaction.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Participatory research methods were successful in the development and review of the Living Longer and Stronger with SCI program. Beta-test results were positive and provided additional suggestions that will be used to improve the program prior to the randomized con","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Page e14"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761187","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":"Attention Allocation Impacts Postural Control in Patients with Diabetes","authors":"Chun-Kai Huang,&nbsp;Kai Cheng,&nbsp;Carl Luchies,&nbsp;Hannes Devos,&nbsp;John Miles","doi":"10.1016/j.apmr.2025.01.065","DOIUrl":"10.1016/j.apmr.2025.01.065","url":null,"abstract":"<div><h3>Objectives</h3><div>To identify how attention allocation impact postural control between patients with diabetes mellitus (DM) and age-matched healthy adults when engaging in an attention-demand task.</div></div><div><h3>Design</h3><div>Cross-sectional and observational study.</div></div><div><h3>Setting</h3><div>Hospital and Research Institute Setting.</div></div><div><h3>Participants</h3><div>Data from 10 patients with DM (age, 59±10y; 4 females) and 10 healthy age-matched adults (age, 62±12y; 7 females) were analyzed. Key inclusion criteria of patients with DM included: (1) age ranged from 19 to 79 years; (2) can stand independently; (3) no other neuromuscular conditions that impact the balance.</div></div><div><h3>Interventions</h3><div>Participants were well-secured with a harness system and instructed to stand still with eyes open: (1) on a force plate, and (2) on a foam pad that mimicked the unstable surface. To reallocate participants attention, an auditory Stroop test (AST) that consisted of high and low pitch sound was administered concurrently during the trials. Participants were instructed to answer the correct pitch of the sound instead of the heard words.</div></div><div><h3>Main Outcome Measures</h3><div>Participants’ postural sway (regarding the center of press and its rambling and trembling) was quantified using the linear (root mean square) and nonlinear analyses (Sample Entropy). The pupil dilation was converted into the Index of Cognitive Activity (ICA). Lastly, the AST correctness was documented (%).</div></div><div><h3>Results</h3><div>When compared with age-matched healthy adults, DM showed increased center of pressure movement in the anteroposterior direction. When compared with task difficulty within group, DM presented decreased rambling and trembling Sample Entropy in both anteroposterior and mediolateral directions when standing on a unstable surface. Similarly, both DMs ICA and correctness decreased when standing on a unstable surface.</div></div><div><h3>Conclusions</h3><div>This study demonstrated that DM reallocated the attention to postural control while engaging in an attention-demand task by presenting the decreased ICA and AST correctness. Although DMs attention reallocation represented the strategy adopted to maintain balance in a challenging condition, it is notably that the decreased rambling and trembling Sample Entropy may imply a high predictability and regularity of postural control that differs from the age-matched healthy adults.</div></div><div><h3>Disclosures</h3><div>none.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages e25-e26"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761218","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}