Journal of Rehabilitation Medicine

Rehabilitation with intensive attention training early after acquired brain injury promotes better long-term status on health-related quality of life, daily activities, work ability and return to work

Gabriela Markovic, Aniko Bartfai, Marie-Louise Schult, Jan Ekholm — Fri, 12 Jan 2024 00:00:00 -0800

Objective: To describe long-term effects on activity, participation, and quality of life (i) at different post-injury starting time points of attention training and (ii) of two different types of rehabilitation with attention training in patients after stroke or traumatic brain injury; and to describe their functioning level.

Design: 2 years after rehabilitation intervention, comparisons were made in one cohort receiving attention training subacute (< 4 months) or post-acute (4–12 months) and in one cohort with two different training methods, a process-based and an activity-based method respectively.

Patients: 100 patients were recruited from our earlier RCT study. They had mild to moderate stroke or traumatic brain injury with relatively limited symptomatology, and all had moderate to severe attention impairment.

Methods: A questionnaire-based interview: EuroQol 5 dimensions, Occupational Gaps Questionnaire, Work Ability Index, self-assessed work status, self-reported employment conditions, sick leave, and experienced cognitive limitations in work performance.

Results: An advantage for patients receiving subacute attention training regarding daily activities, work ability and returning to work.

Conclusion: The results indicate that subacute rehabilitation with attention training (< 4 months) is preferable compared to post-acute intervention (4–12 months). There were only minor differences between the training methods.

Unmet rehabilitation needs in the first 6 months post-injury in a trauma centre population with moderate-to-severe traumatic injuries

Mon, 27 May 2024 00:00:00 -0700

Objective: To describe the needs for subacute inpatient rehabilitation and community-based healthcare services, rehabilitation, and social support in patients with moderate-to-severe traumatic injury in the first 6 months post-injury. Further, to explore associations between sociodemographic and clinical characteristics and unmet needs.

Design: Multicentre prospective cohort study.

Subjects: Of 601 persons (75% males), mean (standard deviation) age 47 (21) years, admitted to trauma centres in 2020 with moderate-to-severe injury, 501 patients responded at the 6-month follow-up and thus were included in the analyses.

Methods: Sociodemographic and injury-related characteristics were recorded at inclusion. Estimation of needs was assessed with the Rehabilitation Complexity Scale Extended–Trauma and the Needs and Provision Complexity Scale on hospital discharge. Provision of services was recorded 6 months post-injury. Multivariable logistic regressions explored associations between baseline variables and unmet inpatient rehabilitation and community-based service needs.

Results: In total, 20% exhibited unmet needs for subacute inpatient rehabilitation, compared with 60% for community-based services. Predictors for unmet community-based service needs included residing in less central areas, profound injury severity, severe head injury, and rehabilitation referral before returning home.

Conclusion: Inadequate provision of healthcare and rehabilitation services, particularly in the municipalities, resulted in substantial unmet needs in the first 6 months following injury.

Prediction of long-term functional outcome following different rehabilitation pathways after stroke unit discharge

Malin C. Nylén, Tamar Abzhandadze, Hanna C. Persson, Katharina S. Sunnerhagen — Tue, 21 May 2024 00:00:00 -0700

Objective: To investigate whether referral for different types of rehabilitation on discharge from Swedish stroke units can predict functional outcomes at 1 and 5 years after a stroke.

Design: A longitudinal and registry-based study.

Subjects/patients: A total of 5,118 participants with index stroke in 2011 were followed-up at 1 and 5 years after the stroke.

Methods: Ordinal logistic regression models were developed to predict the category of functional outcome: independent, dependent, or dead. The primary predictors were planned rehabilitation in a home setting, inpatient rehabilitation, and outpatient rehabilitation, with no planned rehabilitation as the reference category.

Results: Planned outpatient rehabilitation predicted independence (compared with death) at 1 year. Planned rehabilitation in the home setting predicted independence (compared with death) at 1 and 5 years. Compared with other planned pathways, participants planned for inpatient rehabilitation had more severe conditions, and planned inpatient rehabilitation did not predict independence.

Conclusion: Planning for outpatient or home-based rehabilitation appeared to lead more effectively to participants achieving independence over the course of 1–5 years. This may have been due to the less severe nature of these participants’ conditions, compared with those requiring inpatient rehabilitation.

Perceived and physiological strains of societal participation in people with multiple sclerosis: a real-time assessment study

Mon, 24 Jun 2024 00:00:00 -0700

Objective: To examine the relationship between perceived and physiological strains of real-time societal participation in people with multiple sclerosis.

Design: Observational study.

Subjects/Patients: 70 people with multiple sclerosis.

Methods: Perceived and physiological strain of societal participation (10 participation-at-location and 9 transport domains) were measured in real time using the Whereabouts smartphone app and Fitbit over 7 consecutive days. Longitudinal relationships between perceived (1 not strenuous to 10 most strenuous) and physiological strains (heart rate reserve) were examined using mixed-model analyses. Type of event (participation-at-location or transport) was added as covariate, with further adjustments for fatigue and walking ability.

Results: Median perceived strain, summarized for all societal participation domains, varied between 3 and 6 (range: 1–10), whereas physiological strain varied between 18.5% and 33.2% heart rate reserve. Perceived strain (outcome) and physiological strain were not associated (β -0.001, 95%CI -0.008; 0.005, with a 7-day longitudinal correlation coefficient of -0.001). Transport domains were perceived as less strenuous (β -0.80, 95%CI -0.92; -0.68). Higher fatigue levels resulted in higher perceived strain (all societal participation domains) (β 0.05, 95%CI 0.02; 0.08).

Conclusion: Societal participation resulted in low-to-moderate perceived and physiological strain. Perceived and physiological strain of societal participation were unrelated and should be considered different constructs in multiple sclerosis.

Evaluation of treatment parameters for focused-extracorporeal shock wave therapy in knee osteoarthritis patients with bone marrow lesions: a pilot study

Tue, 12 Mar 2024 00:00:00 -0700

Objectives: To evaluate the effect of different dosage parameters of focused-extracorporeal shock wave therapy on pain and physical function in knee osteoarthritis patients with bone marrow lesions. In addition, to investigate pathophysiological changes based on imaging and biomarker measures.

Methods: Using a single-case experimental design, a total of 12 participants were randomly allocated in 4 equal groups of 3 to receive different dosages of focused-extracorporeal shock wave therapy. Each group received either 4 or 6 sessions of 1500 or 3000 shocks over 4 or 6 weekly sessions. Participants underwent repeated measurements during the baseline, intervention, and post-intervention phases for Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, aggregated locomotor function score and pressure pain threshold. Imaging and inflammatory biomarker outcomes were measured at baseline and 3 months following the intervention.

Results: The group receiving the highest dosage of focused-extracorporeal shock wave therapy showed clinical improvements superior to those of participants in the other 3 groups. Statistically significant changes during the follow-up phase in contrast to baseline measurements for the WOMAC score (Tau-U= –0.88, p < 0.001), aggregated locomotor function score (Tau-U= –0.77, p = 0.002), and pressure pain threshold (Tau-U= 0.54, p = 0.03) were observed. Bone marrow lesion and inflammatory cytokines demonstrated no change.

Conclusion: A dose-dependent effect for focused-extracorporeal shock wave therapy on osteoarthritis-related symptoms was suggested. However, these improvements were not associated with changes in the underlying pathophysiological mechanisms.

Identifying profiles of stroke patients benefitting from additional training: a latent class analysis approach

Wed, 21 Feb 2024 00:00:00 -0800

Objective: To identify profiles of stroke patient benefitting from additional training, using latent class analysis.

Design: Retrospective observational study.

Patients: Patients with stroke (n = 6,875) admitted to 42 recovery rehabilitation units in Japan between January 2005 and March 2016 who were registered in the Japan Association of Rehabilitation Database.

Methods: The main outcome measure was the difference in Functional Independence Measure (FIM) scores between admission and discharge (referred to as “gain”). The effect of additional training, categorized as usual care (no additional training), self-exercise, training with hospital staff, or both exercise (combining self-exercise and training with hospital staff), was assessed through multiple regression analyses of latent classes.

Results: Applying inclusion and exclusion criteria, 1185 patients were classified into 7 latent classes based on their admission characteristics (class size n = 82 (7%) to n = 226 (19%)). Patients with class 2 characteristics (right hemiparesis and modified dependence in the motor-FIM and cognitive-FIM) had positive FIM gain with additional training (95% confidence interval (95% CI) 0.49–3.29; p < 0.01). One-way analysis of variance revealed that training with hospital staff (95% CI 0.07–16.94; p < 0.05) and both exercises (95% CI 5.38–15.13; p < 0.01) led to a significantly higher mean FIM gain than after usual care.

Conclusion: Additional training in patients with stroke with right hemiparesis and modified dependence in activities of daily living was shown to improve activities of daily living. Training with hospital staff combined with self-exercise is a promising rehabilitation strategy for these patients.

Post-polio syndrome – somatosensory dysfunction and its relation to pain: a pilot study with quantitative sensory testing

Daniel Dahlgren, Kristian Borg, Eva Melin — Tue, 25 Jun 2024 00:00:00 -0700

Objective: To explore and characterize somatosensory dysfunction in patients with post-polio syndrome and chronic pain, by conducting examinations with Quantitative Sensory Testing.

Design: A cross-sectional, descriptive, pilot study conducted during 1 month.

Subjects/patients: Six patients with previously established post-polio syndrome and related chronic pain.

Methods: All subjects underwent a neurological examination including neuromuscular function, bedside sensory testing, a thorough pain anamnesis, and pain drawing. Screening for neuropathic pain was done with 2 questionnaires. A comprehensive Quantitative Sensory Testing battery was conducted with z-score transformation of obtained data, enabling comparison with published reference values and the creation of sensory profiles, as well as comparison between the study site (more polio affected extremity) and internal control site (less affected extremity) for each patient.

Results: Derived sensory profiles showed signs of increased prevalence of sensory aberrations compared with reference values, especially Mechanical Pain Thresholds, with significant deviation from reference data in 5 out of 6 patients. No obvious differences in sensory functions were seen between study sites and internal control sites.

Conclusion: Post-polio syndrome may be correlated with a mechanical hyperalgesia/allodynia and might be correlated to a somatosensory dysfunction. With lack of evident side-to-side differences, the possibility of a generalized dysfunction in the somatosensory system might be considered.

Long-term functional and clinical outcome of combined targeted muscle reinnervation and osseointegration for functional bionic reconstruction in transhumeral amputees: a case series

Tue, 21 May 2024 00:00:00 -0700

Objective: To describe and evaluate the combination of osseointegration and nerve transfers in 3 transhumeral amputees.

Design: Case series.

Patients: Three male patients with a unilateral traumatic transhumeral amputation.

Methods: Patients received a combination of osseointegration and targeted muscle reinnervation surgery. Rehabilitation included graded weight training, range of motion exercises, biofeedback, table-top prosthesis training, and controlling the actual device. The impairment in daily life, health-related quality of life, and pain before and after the intervention was evaluated in these patients. Their shoulder range of motion, prosthesis embodiment, and function were documented at a 2- to 5-year follow-up.

Results: All 3 patients attended rehabilitation and used their myoelectric prosthesis on a daily basis. Two patients had full shoulder range of motion with the prosthesis, while the other patient had 55° of abduction and 45° of anteversion. They became more independent in their daily life activities after the intervention and incorporated their prosthesis into their body scheme to a high extent.

Conclusion: These results indicate that patients can benefit from the combined procedure. However, the patients’ perspective, risks of the surgical procedures, and the relatively long rehabilitation procedure need to be incorporated in the decision-making.

Functional outcomes following surgery for spastic hip adductor muscles in ambulatory and non-ambulatory adults

Fri, 22 Mar 2024 00:00:00 -0700

Objective: To evaluate functional outcomes of surgery of spastic hip adductor muscles (obturator neurotomy with or without adductor longus tenotomy) in ambulatory and non-ambulatory patients, using preoperatively defined personalized goals.

Design: Retrospective observational descriptive study.

Patients: Twenty-three patients with adductor spasticity who underwent obturator neurotomy between May 2016 and May 2021 at the Clinique des Cèdres, Cornebarrieu, France, were included.

Methods: Postoperative functional results were evaluated in accordance with the Goal Attainment Scaling method. Patients were considered “responders” if their score was ≥ 0. Secondary outcomes included spasticity, strength, hip range of motion and change in ambulatory capacity. When data were available, a comparison of pre- and postoperative 3-dimensional instrumented gait analysis was also performed.

Results: Among the 23 patients only 3 were non-walkers. Seventeen/22 patients achieved their main goal and 14/23 patients achieved all their goals. Results were broadly similar for both walking goals (inter-knee contact, inter-feet contact, fluidity, walking perimeter, toe drag) and non-walking goals (intimacy, transfer, pain, posture, dressing).

Conclusion: Surgery of spastic hip adductor muscles results in functional improvement in ambulation, hygiene, dressing and posture and can be offered to patients with troublesome adductor overactivity. The use of a motor nerve block is recommended to define relevant goals before the surgery.

The association between physical activity and neck circumference with cardiovascular disease risk in older wheelchair users

Jeonghyeon Kim, Inhwan Lee, Hyunsik Kang — Wed, 19 Jun 2024 00:00:00 -0700

Objective: To examine the association between physical activity, neck circumference, and cardiovascular disease risk in older wheelchair users.

Design: A cross-sectional study.

Subjects/Patients: Sixty-one Korean wheelchair users aged 50 years and older.

Methods: Physical activity was assessed using a self-administered questionnaire. Neck circumference was measured with a tape ruler. Cardiovascular disease risk was evaluated by calculating the Framingham risk score (FRS) for estimating 10-year cardiovascular disease risk, which was classified as low–moderate (19% or less) or high risk (20% or more).

Results: The FRS for 10-year cardiovascular disease risk was inversely related to physical activity (beta [SE] = –0.213 (0.103), p = 0.043) and positively related to neck circumference (beta [SE] = 1.331 ± 0.419, p = 0.003). Binary logistic regression showed that those with low physical activity (odds ratio [95% confidence interval] = 4.256 (1.188~15.243), p = 0.026) or a large neck circumference (odds ratio [95% confidence interval] = 3.645 (1.172~11.338), p = 0.025) had a higher risk for high cardiovascular disease risk compared with those with high physical activity or normal neck circumference.

Conclusion: The current study findings suggest that an intervention targeting physical inactivity and upper-body obesity should be implemented to reduce cardiovascular disease risk in older wheelchair users.

Impact of the Covid-19 pandemic and lockdowns on the education and mental health of physiotherapy students in France: a descriptive cross-sectional study with national online survey

Wed, 10 Jan 2024 00:00:00 -0800

Objective: To determine the impact of the SARS-CoV-2 (COVID-19) pandemic and lockdowns on the mental health status, training, perceptions of the physiotherapy profession, and career plans of French physiotherapy students.

Design: A descriptive cross-sectional study was conducted, representing the first and only survey of its kind, using a national online survey.

Subjects: A total of 2678 French physiotherapy students participated in the study.

Methods: Mental health status was assessed using the validated French versions of established depression, anxiety, and insomnia scales.

Results: The survey revealed that female sex, age below 21 years, living alone, and having a psychiatric history or COVID-19 risk factors were associated with more severe symptoms of depression, anxiety, and insomnia in the surveyed students. In addition, stress, anxiety, and depression induced by the COVID-19 crisis were linked to apprehension about continuing practical training in physiotherapy. These factors also affected students’ perceptions of the profession and the initially envisioned mode of practice, particularly among fifth-year students (odds ratio (OR) = 2.25, 95% confidence interval (95% CI) = (1.69, 2.99), p < 0.001). Notably, the pandemic significantly reduced the desire of these students to pursue a career as physiotherapists (adjusted OR (aOR) 1.41 (1.06, 1.86)).

Conclusion: French physiotherapy students, especially those in their fifth year, have experienced significant impacts from the COVID-19 pandemic, affecting their mental health, education, perceptions of the physiotherapy profession, and career plans.

Physical strain of walking in people with neuromuscular diseases is high and relates to step activity in daily life

Fri, 07 Jun 2024 00:00:00 -0700

Objective: To determine the physical strain of walking and assess its relationship with daily steps and intensity of daily activity in people with neuromuscular diseases.

Design: Cross-sectional study.

Subjects/patients: Sixty-one adults with neuromuscular diseases.

Methods: Physical strain of walking, defined as oxygen consumption during comfortable walking relative to peak oxygen uptake. Daily step count and daily time spent in moderate and vigorous physical activity were assessed using accelerometry and heart rate measurements, respectively. Regression analyses assessed the relationships between log daily step count and log daily time spent in moderate and vigorous physical activity, and physical strain of walking.

Results: The mean (standard deviation) physical strain of walking was 73 (20)% Log daily step count and physical strain were negatively associated (β = –0.47). No association was found with log daily time spent in moderate and vigorous physical activity.

Conclusions: The highly increased physical strain of comfortable walking indicates that walking is very demanding for people with neuromuscular diseases and is associated with a reduction in daily step activity. The absence of a relationship between intensity of activities and physical strain indicates that, despite a reduction in daily step activity, strenuous daily activities may still be performed.

Repetitive peripheral magnetic stimulation combined with transcranial magnetic stimulation in rehabilitation of upper extremity hemiparesis following stroke: a pilot study

Thu, 01 Feb 2024 00:00:00 -0800

Objective: To investigate the effect of combined repetitive peripheral magnetic stimulation and transcranial magnetic stimulation on upper extremity function in subacute stroke patients.

Design: Pilot study.

Subjects: Subacute stroke patients.

Methods: Included patients were randomized into 3 groups: a central-associated peripheral stimulation (CPS) group, a central-stimulation-only (CS) group, and a control (C) group. The CPS group underwent a new paired associative stimulation (combined repetitive peripheral magnetic stimulation and transcranial magnetic stimulation), the CS group underwent repetitive transcranial magnetic stimulation, and the C group underwent sham stimulation. All 3 groups received physiotherapy after the stimulation or sham stimulation. The treatment comprised 20 once-daily sessions. Primary outcome was the Fugl-Meyer Assessment Upper Extremity (FMA-UE) score, and secondary outcomes were the Barthel Index and Comprehensive Functional Assessment scores, and neurophysiological assessments were mainly short-interval intracortical inhibition. A 3-group (CPS, CS, C) × 2-time (before, after intervention) repeated measures analysis of variance was conducted to determine whether changes in scores were significantly different between the 3 groups.

Results: A total of 45 patients were included in the analysis. Between-group comparisons on the FMA-UE demonstrated a significant improvement (group × time interaction, F_2,42 = 4.86; p = 0.013; C vs CS, p = 0.020; C vs CPS, p = 0.016; CS vs CPS, p = 0.955). Correlation analysis did not find any substantial positive correlation between changes in FMA-UE and short-interval intracortical inhibition variables (C, r = –0.196, p = 0.483; CS, r = –0.169, p = 0.546; CPS, r = –0.424, p = 0.115).

Conclusion: This study suggests that the real-stimulus (CS and CPS) groups had better outcomes than the control (C) group. In addition, the CPS group showed a better trend in clinical and neurophysiological assessments compared with the CS group.

Interdisciplinary pain rehabilitation for patients with Ehlers-Danlos syndrome and hypermobility spectrum disorders

Wed, 07 Feb 2024 00:00:00 -0800

Objective: Chronic pain is a common manifestation of Ehlers-Danlos syndrome and hypermobility spectrum disorders; thus it is often suggested that patients undergo generic interdisciplinary pain rehabilitation, despite there being little evidence to support this decision. The aim of this study is to examine the effectiveness of standard rehabilitation programmes for chronic pain on patients with Ehlers-Danlos syndrome and hypermobility spectrum disorders, compared with patients with other chronic pain disorders.

Subjects: Data, collected between 2008 and 2016, were extracted from a Swedish national registry. The patient data comprised of 406 cases with Ehlers-Danlos syndrome or hypermobility spectrum disorders, 784 cases with a whiplash-related diagnosis, 3713 cases with diagnoses relating to spinal pain, and 2880 cases of fibromyalgia.

Methods: The differences between groups on key outcome measures from pre- to 1-year follow-up after interdisciplinary pain rehabilitation were analysed using linear mixed effects models. Sensitivity analysis in the form of pattern-mixture modelling was conducted to discern the impact of missing data.

Results: No significant differences were found in improvements from pre- to 1-year follow-up for patients with Ehlers-Danlos syndrome or hypermobility spectrum disorder compared with other diagnostic groups regarding measures of health-related quality of life, mental health, or fatigue. At follow-up, differences in pain interference (d = –0.34 (95% confidence interval [95% CI] –0.5 to –0.18)), average pain (d = 0.22 (95% CI 0.11–0.62)) and physical functioning (d = 2.19 (95% CI 1.61–2.77)) were detected for the group with spinal-related diagnoses in relation to those with EDS/HSD, largely due to pre-treatment group differences. Sensitivity analysis found little evidence for missing data influencing the results.

Conclusion: This study suggests that patients with Ehlers-Danlos syndrome/hypermobility spectrum disorders may benefit from inclusion in an interdisciplinary pain rehabilitation programme.

Revision of the brief international classification of functioning, disability and health core set for multiple sclerosis: a study of the comprehensive icf core set for multiple sclerosis with participants referred for work ability assessment

Thu, 07 Mar 2024 00:00:00 -0800

Objective: To evaluate the Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for multiple sclerosis with regard to the Brief ICF Core Set for multiple sclerosis.

Design: Descriptive cross-sectional single-centre study.

Subjects: A total of 151 participants (99 females/52 males, mean age 49 years) referred for work ability assessment.

Methods: Data were collected from clinical recordings and by telephone interview.

Results: Among 33 Body Functions, 14 were impaired in over 60% of the participants, and 6 in over 75%. These 6 most impaired functions were related to exercise tolerance (b455), urination (b620), muscle power (b730), motor reflex (b750), control of voluntary movement (b760) and gait pattern (b770). Among 54 Activities and Participation categories, 8 were impaired in over 60% of the participants, and 3 were impaired in over 75%. The latter activities were related to walking (d450), moving around (d455) and moving around using equipment (d465). Among the 36 Environmental categories, most were facilitators, except for temperature (e2250) and employment (e590). The latter category was both a facilitator and a barrier.

Conclusion: These results suggest additional categories that should be included into the Brief ICF Core Set, to improve its representation of the complex disability of multiple sclerosis.

Efficacy of focused shockwave therapy in patients with moderate-to-severe carpal tunnel syndrome: a preliminary study

Thu, 08 Feb 2024 00:00:00 -0800

Objective: To evaluate the efficacy of focused extracorporeal shockwave therapy for symptoms and function in patients with moderate-to-severe carpal tunnel syndrome.

Design: A single-blind randomized controlled trial.

Subjects: Twenty-four outpatients with moderate-to-severe carpal tunnel syndrome.

Methods: Patients were randomly allocated into 2 groups: a focused extracorporeal shockwave therapy group and a control group. The focused extracorporeal shockwave therapy group received conservative treatment in addition to focused extracorporeal shockwave therapy with an energy flux density ranging from 0.01 to 0.15 mJ/mm², a frequency of 4–5 Hz, and 1500 pulses per session once a week for a total of 3 sessions. The control group received only conservative treatment, which comprised gliding exercises for carpal tunnel syndrome, a night wrist splint, and lifestyle modification. The Thai version of the Boston Carpal Tunnel Questionnaire (T-BCTQ), a nerve conduction study, and ultrasonography of the median nerve cross-sectional area were performed before treatment and at 3 and 6 weeks after baseline.

Results: The T-BCTQ symptom and function scores had significantly decreased in both groups, favouring focused extracorporeal shockwave therapy at all time-points. In addition, distal sensory and motor latency were significantly different between the groups at 3 weeks from baseline.

Conclusion: Focused extracorporeal shockwave therapy plus conservative treatment effectively provided short-term improvement in symptoms, hand function, and nerve conduction in patients with moderate-to-severe carpal tunnel syndrome compared with conservative treatment alone.

Prevalence and trajectories of neuropsychological post-COVID-19 symptoms in initially hospitalized patients

Tue, 12 Mar 2024 00:00:00 -0700

Objective: To investigate the prevalence and trajectories of post-COVID-19 neuropsychological symptoms.

Design: Prospective longitudinal multicentre cohort study.

Subjects: A total of 205 patients initially hospitalized with SARS-CoV-2 (COVID-19).

Methods: Validated questionnaires were administered at 9 months (T1) and 15 months (T2) post-hospital discharge to assess fatigue, cognitive complaints, insomnia, anxiety, depression, and post-traumatic stress symptoms.

Results: Analyses included 184 out of 205 patients. Approximately 50% experienced high cognitive complaints at T1 and T2, while severe fatigue affected 52.5% at T1 and 55.6% at T2. Clinically relevant insomnia scores were observed in 25% of patients at both time-points. Clinically relevant anxiety scores were present in 18.3% at T1 and 16.7% at T2, depression in 15.0% at T1 and 18.9% at T2, and PTSD in 12.4% at T1 and 11.8% at T2. Most symptoms remained stable, with 59.2% of patients experiencing at least 1 persistent symptom. In addition, 31.5% of patients developed delayed-onset symptoms.

Conclusion: Post-COVID-19 cognitive complaints and fatigue are highly prevalent and often persist. A subgroup develops delayed symptoms. Emotional distress is limited. Screening can help identify most patients experiencing long-term problems. Future research should determine risk factors for persistent and delayed onset symptoms.

Individualized goals expressed by patients undergoing stroke rehabilitation: an observational study

Tue, 16 Jan 2024 00:00:00 -0800

Objectives: To explore the rehabilitation goals measured with the Patient-Specific Functional Scale (PSFS) in patients undergoing acute and subacute stroke rehabilitation. In addition, to assess whether PSFS goals corresponded to impairments and activity limitations, as identified by standardized measures.

Design: Observational study.

Participants: A total of 71 participants undergoing inpatient stroke rehabilitation.

Methods: The PSFS goals were linked to second-level categories in the International Classification of Functioning, Disability and Health (ICF), using established linking rules. Frequencies of the linked ICF categories were calculated. Frequencies of participants with limitations in walking, activities of daily living (ADL), vision, language, and cognition, were calculated, along with goals in corresponding areas of functioning.

Results: The participants’ goals were linked to 50 second-level ICF categories, comprising areas such as walking and moving, ADL, language, vision, and cognition. The most frequent ICF categories were “Moving around in different locations” (n = 24), “Walking” (n = 23), “Toileting” (n = 16), “Hand and arm use (n = 12) and “Fine hand use (n = 12)”. Of participants with limitations in walking, cognition, and vision, 85%, 10%, and 16%, respectively, had goals in these areas.

Conclusion: Participants’ goals included walking, ADL, language, vision, and cognition. Few with impairments in cognition or vision had goals in these corresponding areas on the PSFS.

Trajectories of fatigue and related outcomes following mild acquired brain injury: a multivariate latent class growth analysis

Wed, 20 Mar 2024 00:00:00 -0700

Objective: Fatigue is a common symptom following acquired brain injury although the severity and course differs for many individuals. This longitudinal study aimed to identify latent trajectory classes of fatigue and associated outcomes following mild brain injury.

Methods: 204 adults with mild traumatic brain injury (159; 78%) or minor stroke (45; 22%) were assessed 4 times over 1 year. Subjective measures of fatigue, anxiety, depression, cognitive complaints and societal participation were collected. Multivariate Latent Class Growth Analysis identified classes of participants with similar longitudinal patterns. Demographic and injury characteristics were used to predict class membership.

Results: Analysis revealed four classes. Class 1 (53%) had mild, decreasing fatigue with no other problems. Class 2 (29%) experienced high persistent fatigue, moderate cognitive complaints and societal participation problems. Class 3 (11%) had high persistent fatigue with anxiety, depression, cognitive complaints and participation problems. Class 4 (7%) experienced decreasing fatigue with anxiety and depression but no cognitive or participation problems. Women and older individuals were more likely to be in class 2.

Conclusion: Half the participants had a favourable outcome while the remaining classes were characterised by persistent fatigue with cognitive complaints (class 2), decreasing fatigue with mood problems (class 4) or fatigue with both cognitive and mood problems (class 3). Fatigue treatment should target combinations of problems in such individual trajectories after mild brain injury.

Characterization of an Italian population with neurological disorders in a rehabilitation setting using ClinFIT

Thu, 18 Jan 2024 00:00:00 -0800

Objective: To examine the functioning profile of people with neurological disorders who access rehabilitation services through ClinFIT Generic-30.

Methods: The functioning profile of people with neurological disorders accessing rehabilitation services was examined using the ClinFIT Generic-30, and the results compared with existing core set (neurological health conditions acute and post-acute,stroke, Multiple Sclerosis, Traumatic Brain Injury,Spinal Cord Injury).

Results: Data for 364 people were analysed. The 10 most commonly impaired ICF categories included 3 for Body Functions (exercise tolerance functions (b455), mobility of joint functions (b710), and muscle power functions (b730)) and 7 for Activities and Participation (carrying out daily routine (d230), handling stress and other psychological demands (d240), changing basic body position (d410), maintaining a body position (d415), transferring oneself (d420), walking (d450), and moving around (d455)), while the ICF categories that were severely impaired (ICF qualifiers 3 and 4) in more than 30% of the study cohort were: muscle power functions (b730), carrying out daily routine (d230), walking (d450), moving around (d455), doing housework (d640), and assisting others (d660).

Discussion: The current study data suggests that ClinFIT Generic-30 appears to effectively identify impairments and/or restrictions, as perceived by individuals affected by selected health conditions.

Conclusion: ClinFIT Generic-30 is a tool that can be used to characterize functioning profile in people with different neurological disorders and to collect important information not addressed by the disease-specific core sets (neurological health conditions acute and post-acute,stroke, Multiple Sclerosis, Traumatic Brain Injury,Spinal Cord Injury).

Early functional factors for predicting outcome of independence in daily living after stroke: a decision tree analysis

Tue, 07 May 2024 00:00:00 -0700

Objective: This study aimed to investigate the predictive functional factors influencing the acquisition of basic activities of daily living performance abilities during the early stages of stroke rehabilitation using classification and regression analysis trees.

Methods: The clinical data of 289 stroke patients who underwent rehabilitation during hospitalization (164 males; mean age: 62.2 ± 13.9 years) were retrospectively collected and analysed. The follow-up period between admission and discharge was approximately 6 weeks. Medical records, including demographic characteristics and various functional assessments with item scores, were extracted. The modified Barthel Index on discharge served as the target outcome for analysis. A “good outcome” was defined as a modified Barthel Index score ≥ 75 on discharge, while a modified Barthel Index score < 75 was classified as a “poor outcome.”

Results: Two classification and regression analysis tree models were developed. The first model, predicting activities of daily living outcomes based on early motor functions, achieved an accuracy of 92.4%. Among patients with a “good outcome”, 70.9% exhibited (i) ≥ 4 points in the “sitting-to-standing” category in the motor assessment scale and (ii) 32 points on the Berg Balance Scale score. The second model, predicting activities of daily living outcome based on early cognitive functions, achieved an accuracy of 82.7%. Within the “poor outcome” group, 52.2% had (i) ≤ 21 points in the “visuomotor organization” category of Lowenstein Occupational Therapy Cognitive Assessment, (ii) ≤ 1 point in the “time orientation” category of the Mini Mental State Examination.

Conclusion: The ability to perform “sitting-to-standing” and visuomotor organization functions at the beginning of rehabilitation emerged as the most significant predictors for achieving successful basic activities of daily living on discharge after stroke.

Effect of traditional rehabilitation programme versus telerehabilitation in adolescents with idiopathic scoliosis during the COVID-19 pandemic: a cohort study

Mon, 26 Feb 2024 00:00:00 -0800

Background: Telerehabilitation has become increasingly popular since the SARS-CoV-2 (COVID-19) outbreak. However, studies are needed to understand the effects of remote delivery of spine treatment approaches.

Objectives: To verify and compare the effects of traditional rehabilitation programmes (in-person) and telerehabilitation (online) on the progression of scoliotic curvature in adolescents with idiopathic scoliosis during the COVID-19 pandemic, and to verify the acceptability, appropriateness, and feasibility among patients and physiotherapists regarding both treatments.

Methods: This is a cohort study (prospective analysis of 2 intervention groups: telerehabilitation (online) and traditional rehabilitation (in-person). A total of 66 adolescents with idiopathic scoliosis were included. Recruitment was conducted through the Clinical Center in Scoliosis Care (January–December 2020). Participants were divided into 2 intervention groups: telerehabilitation (online) (n = 33) and traditional rehabilitation programme (in-person) (n = 33). Both groups also were supplied with a spinal orthopaedic brace. Scoliosis was confirmed by a spine X-ray examination (Cobb angle). Radiographic parameters measured were: Cobb angles (thoracic and lumbar). The method of Nash and Moe (thoracic and lumbar) was also evaluated based on the relationship between the vertebral pedicles and the centre of the vertebral body in the X-rays. Assessments were performed at baseline (T0) and after 6 months of the intervention protocol (T6). Patient and physiotherapist reports were evaluated on the acceptability, appropriateness, and feasibility of the interventions.

Results: Adolescents with idiopathic scoliosis showed a significant decrease in the Cobb angle (main scoliotic curvature), with a 4.9° for the traditional rehabilitation programme and 2.4° for the telerehabilitation. Thoracic and lumbar Cobb angles did not show significant changes after the intervention in both groups or between groups. Thoracic and lumbar Nash and Moe scores scores also did not show significant differences after 6 months of in-person or telerehabilitation intervention, or between groups. The intervention by telerehabilitation was acceptable, appropriate, and feasible for patients and physiotherapists.

Conclusion: Use of the rehabilitation programme for adolescents with idiopathic scoliosis, delivered via telerehabilitation during the COVID-19 pandemic, was encouraging for future applications due to the improved effect on reducing the Cobb angle, preventing progression of scoliosis. In addition, telerehabilitation showed good acceptability among patients and physiotherapists. Traditional rehabilitation programmes (in-person) in adolescents with idiopathic scoliosis also showed a reduction in the Cobb angle.

Factors associated with fatigue among people who have returned to work after stroke: an exploratory study

Anna Norlander, Ingrid Lindgren, Christina Brogårdh — Thu, 14 Mar 2024 00:00:00 -0700

Objective: To explore the associations between fatigue impact and (a) personal and stroke-related characteristics, (b) functional impairments and (c) work-related factors among individuals who have returned to work after stroke.

Design: A cross-sectional exploratory study.

Subjects: 87 working stroke survivors.

Methods: This study comprises data from a postal survey targeting work ability and perceived stroke-related consequences 1 year after stroke. Fatigue was evaluated using the Fatigue Severity Scale (FSS). Factors associated with having fatigue (FSS total score ≥ 4) were identified using univariable and multivariable logistic regression analyses. Three domain-specific multivariable models and 1 final combined model were created.

Results: Fatigue was reported by 43% of the participants. Several factors representing all the investigated domains were associated with fatigue. In the final combined regression model, self-perceived low cognitive functioning, low decision control at work and high quantitative job demands had the strongest independent effects on the odds of having fatigue.

Conclusion: Among people who were working 1 year after stroke, fatigue was associated with both personal and stroke-related characteristics as well as functional impairments and work-related factors. This highlights the complex nature of post-stroke fatigue. Fatigue management interventions should have a comprehensive approach and also consider the work environment.

Effects of semi-immersive virtual reality and manipulation of optic flow speed on gait biomechanics in people post-stroke

Wed, 10 Jan 2024 00:00:00 -0800

Objectives: To investigate how people post-stroke and healthy people experience the addition of semi-immersive virtual reality (VR) and optic flow speed manipulation while walking on a treadmill, and if optic flow speed manipulation could be used in rehabilitation to elicit changes in post-stroke gait biomechanics.

Methods: Sixteen people post-stroke and 16 healthy controls walked on a self-paced treadmill. After 2 habituation trials (without and with VR), participants walked 3 more trials under the following conditions of optic flow: matched, slow, and fast. Primary outcome measures were spatiotemporal gait parameters and lower limb kinematics. Secondary outcomes (simulator sickness and enjoyment) were assessed with the Simulator Sickness Questionnaire (SSQ) and visual analogue scales (VAS).

Results: VR did not influence the gait biomechanics, and optic flow manipulation had a limited effect. Both groups significantly increased their walking speed with the slow optic flow and decreased their speed with the fast optic flow. For the other gait parameters, only small changes were found. Only people post-stroke had a significant increase on the SSQ and the enjoyment-VAS.

Conclusion: Adding semi-immersive VR did not influence the gait pattern, was well tolerated, and enjoyable. Both groups altered their gait parameters when the optic flow speed was adjusted during the protocol. Incorporating such manipulations into treadmill training is feasible, but further research about the type of manipulation and level of immersion is needed.

Effects of upper limb vibratory stimulation training on motor symptoms in Parkinson’s disease: an observational study

Mon, 26 Feb 2024 00:00:00 -0800

Objectives: Parkinson’s disease is characterized by motor and non-motor symptoms. Tremor is one of the motor symptoms that can affect manual skills and have an impact on daily activities. The aim of the current study is to investigate the effect of upper limb training provided by a specific vibratory device (Armshake^®, Move It GmbH - Bochum, Germany) on tremor and motor functionality in patients with Parkinson’s disease. Furthermore, the training effect on global cognitive functioning is assessed.

Design: An uncontrolled before-after clinical trial.

Patients: Individuals with diagnosis of Parkinson’s disease, motor upper limbs deficits, and absence of dementia.

Methods: Participants underwent a 3-week programme (3 times a week) and was evaluated before, after, and at 1 month follow-up by motor (Fahn Tolosa Marin Tremor Rating Scale, Unified Parkinson’s Disease Rating Scale – part III, Purdue Pegboard Test, Disability of the Arm, Shoulder and Hand Questionnaire) and cognitive (Montreal Cognitive Assessment) scales.

Results: Twenty subjects are included. After treatment a statistically significant improvement in tremor, manual dexterity and activities of daily living was found. The data indicated no effects on global cognitive functioning.

Conclusion: These findings suggest positive effects of vibratory stimulation training on upper limb motor symptoms in Parkinson’s disease.

Relative aerobic load of walking in people with multiple sclerosis

Wed, 14 Feb 2024 00:00:00 -0800

Objective: To examine the energy demand of walking relative to aerobic capacity in people with multiple sclerosis.

Design: Cross-sectional cohort study.

Patients: A total of 45 people with multiple sclerosis (32 females), median disease duration 15 years (interquartile range (IQR) 9; 20), median Expanded Disability Status Scale 4 (min–max range: 2.0; 6.0).

Methods: Aerobic capacity, derived from a cardiopulmonary exercise test and gas exchange measurements, assessed during a 6-min overground walk test at comfortable speed, were analysed. The relative aerobic load of walking was determined as the energy demand of walking relative to oxygen uptake at peak and at the first ventilatory threshold. Healthy reference data were used for clinical inference.

Results: People with multiple sclerosis walk at a mean relative aerobic load of 60.0% (standard deviation 12.8%) relative to peak aerobic capacity, and 89.1% (standard deviation 19.9%) relative to the first ventilatory threshold. Fourteen participants walked above the first ventilatory threshold (31%). Peak aerobic capacity was reduced in 45% of participants, and energy demands were increased in 52% of participants.

Conclusion: People with multiple sclerosis walk at a relative aerobic load close to their first ventilatory threshold. A high relative aerobic load can guide clinicians to improve aerobic capacity or reduce the energy demands of walking.

Gait speed at the acute phase predicted health-related quality of life at 3 and 12 months after stroke: a prospective cohort study

Mon, 15 Apr 2024 00:00:00 -0700

Objective: To investigate the association between acute-phase gait speed and health-related quality of life (HRQoL) at 3 and 12 months post-stroke.

Design: Prospective cohort study.

Subjects/Patients: 1,475 patients with first-ever ischaemic stroke.

Methods: The patients were divided into 3 groups according to tertiles of gait speed, namely ≤0.8, 0.8–1.1, ≥1.1 m/s. Gait speed was assessed by the 10-m walking test within 2 weeks of hospitalization for acute stroke and before the rehabilitation programme. HRQoL measurements include the 3-level EuroQol five dimensions (EQ-5D-3L) index and EuroQoL visual analogue scale (EQ-VAS) scores. Linear and logistic regression analyses were used to identify associations between gait speed and HRQoL.

Results: Adjusted for all covariates, the highest gait speed tertile group were associated with higher EQ-5D-3L index (B = 0.0303 and B = 0.0228, respectively, p < 0.001), and higher EQ-VAS (B = 3.3038 and B = 3.8877, respectively, p < 0.001), and lower odds of having problems with mobility (OR = 2.55 [95% CI: 0.141–0.458] and 0.485 [0.289–0.812], respectively, p < 0.01), self-care (OR = 0.328 [95% CI: 0.167–0.646] and 0.412 [0.217–0.784], respectively, p < 0.01), and usual activities (OR = 0.353 [95% CI: 0.211–0.590] and 0.325 [0.198–0.536], respectively, p < 0.0001) at 3 and 12 months, and pain/discomfort at 12 months (OR = 0.558 [95% CI:0.335–0.930], p < 0.05).

Conclusion: Acute-phase gait speed was predictive of post-stroke HRQoL at 3 and 12 months, especially when associated with domain-specific EQ-5D-3L.

Interdisciplinary pain rehabilitation for immigrants with chronic pain who need language interpretation

Mon, 26 Feb 2024 00:00:00 -0800

Objective: To investigate outcomes in patients with chronic pain after participation in an interdisciplinary pain rehabilitation programme with language interpreters, and to investigate the outcomes in women and men separately.

Design: Prospective multi-centre cohort study.

Patients: Ninety-five patients in Sweden with chronic pain who have insufficient knowledge of the Swedish language.

Methods: Duration and intensity of pain, anxiety and depression, health-related quality of life and fear of movement were evaluated before and after the programme. Patients were compared with a reference group comprising Swedish-speaking patients participating in an ordinary interdisciplinary pain rehabilitation programme.

Results: Before the interdisciplinary pain rehabilitation programme with language interpreters, all variables except pain duration differed significantly to the detriment of the studied group. The studied group showed significant improvements after the interdisciplinary pain rehabilitation programme with language interpreters, with regards to pain intensity, depression and fear of movement. The reference group improved significantly for all variables. The women in the studied group showed significant improvements for the same variables as the whole group, while the men in the studied group did not improve in any of the variables.

Conclusion: This study indicates that patients with chronic pain, and especially women, who have insufficient knowledge of Swedish seem to benefit from participating in an interdisciplinary pain rehabilitation programme with language interpreters. The result may be of value for the further development of rehabilitation programmes with language interpreters.

Effectiveness of a classification-based approach to low back pain in primary care – a benchmarking controlled trial

Anna Sofia Simula, Antti Malmivaara, Neill Booth, Jaro Karppinen — Sat, 20 Apr 2024 00:00:00 -0700

Objective: The aim of this study was to assess the effectiveness of classification-based approach for low back pain care in Finnish primary care.

Design: A benchmarking controlled trial design was used.

Subjects/patients: Three primary healthcare areas and 654 low back pain patients with or without sciatica.

Methods: Classification-based care (using the STarT Back Tool) was implemented using organizational-, healthcare professional-, and patient-level interventions. The primary outcome was change in Patient-Reported Outcomes Measurement Information System, Physical Function (PROMIS PF-20) from baseline to 12 months.

Results: No difference was found between the intervention and control in change in PROMIS PF-20 over the 12-month follow-up (mean difference 0.33 confidence interval –2.27 to 2.9, p = 0.473). Low back pain-related healthcare use, imaging, and sick leave days were significantly lower in the intervention group. Reduction in intensity of low back pain appeared to be already achieved at the 3-month follow-up (mean difference –1.3, confidence interval –2.1 to –0.5) in the intervention group, while in the control group the same level of reduction was observed at 12 months (mean difference 0.7, confidence interval –0.2 to 1.5, treatment*time p = 0.003).

Conclusion: Although classification-based care did not appear to influence physical functioning, more rapid reductions in pain intensity and reductions in healthcare use and sick leave days were observed in the intervention group.

A backward cycling programme for people with Parkinson’s disease: a feasibility and preliminary results study

Suzanne K. O'Neal, Stephanie A. Miller, Megan C. Eikenberry, Elizabeth S. Moore — Tue, 11 Jun 2024 00:00:00 -0700

Objective: To assess the feasibility of backward cycling for people with Parkinson’s disease. Secondary objectives were to assess changes in gait and balance following a 6-week program.

Design: A single-group prospective pre-test, post-test study with 1-month follow-up.

Subjects/Patients: Twenty-six people with Parkinson’s disease (mean age: 69 (7.74) years, gender: 83% males, time since diagnosis: 6 (4.44) years).

Methods: Participants pedaled backward on a stationary bicycle for 30 minutes at moderate intensity twice a week for 6 weeks. Feasibility was assessed by acceptability, suitability, and burden. Data collected at pre- and post-intervention with 1-month follow-up included backward stepping response variables, forward/backward gait variables, Mini-Balance Evaluation Systems Test (MBT), and 6 Minute Walk Test.

Results: There was a high retention rate (95.8%) and adherence rate (100%) with one adverse event and minimal burden. Significant improvements were seen in step count and excursion distance during backward stepping responses, forward and backward gait velocity, forward step length, and the Mini-BESTest.

Conclusion: Backward cycling was a feasible intervention for people with Parkinson’s disease, demonstrating low burden with high retention and adherence rates, and it is a safe exercise with the potential for benefits in gait and balance variables.

Psychometric properties of the Danish version of the Caregiver Burden Scale: Investigating predictors and severity of burden after stroke, spinal cord injury, or traumatic brain injury

Thu, 02 May 2024 00:00:00 -0700

Objective: To investigate (i) psychometric properties of the Danish version of the Caregiver Burden Scale, (ii) predictors of burden in caregivers of persons with stroke, spinal cord injury, or traumatic brain injury, and (iii) severity of caregiver burden, and compare level of severity of burden in caregivers of persons with stroke, spinal cord injury, or traumatic brain injury.

Design: Cross-sectional study.

Participants: Pooled sample of 122 caregivers.

Methods: Psychometric properties including internal consistency, floor and ceiling effects, inter-item and item-total correlation were investigated using the Caregiver Burden Scale. Severity of burden was compared using Fisher’s exact test and ANOVA, and predictors of burden were investigated using multiple linear regression models.

Results: The total burden score exhibited good internal consistency (α = 0.93), with no floor or ceiling effects. Longer time as a caregiver was a significant predictor of higher total score. The majority (52.2%) reported a low level of caregiver burden (below cut-off of 2.00). Mean scores on the Caregiver Burden Scale were not significantly different among caregivers across diagnostic groups. Differences were found when comparing spinal cord injury caregivers with brain injury caregivers (traumatic brain injury and stroke, collectively), χ²(2) = 6.38, p = 0.04, as spinal cord injury caregivers were more likely to report low levels of burden.

Conclusion: Good psychometric properties were reported, and most caregivers reported a low level of burden, and longer time as a caregiver was associated with higher burden. Consequently, the Caregiver Burden Scale is a valid measure to use when measuring burden in caregivers of stroke, spinal cord injury, and traumatic brain injury patients.

Association between cognitive dysfunction and diabetes in patients over 65 years old: a cross-sectional study using propensity score matching

Wed, 21 Feb 2024 00:00:00 -0800

Objectives: To investigate the association between diabetes and cognitive dysfunction in the elderly population, and examine the impact of cognitive dysfunction on level of activities of daily living (ADL) in patients with diabetes.

Methods: Data analysis was conducted on 2,951 individuals aged over 65 years from the Chinese Longitudinal Healthy Longevity Survey cohort. Propensity score matching was utilized to mitigate selection bias. Multivariate binary logistic regression was performed to analyse the association between diabetes and cognitive dysfunction in the study subjects. In addition, the relationship between ADL and cognitive function in patients with diabetes was analysed using the Wilcoxon rank-sum test.

Results: A significant association (p = 0.017) was found between diabetes and the occurrence of cognitive dysfunction in older adults. Subgroup analyses revealed that diabetes patients with cognitive dysfunction exhibited a worse ADL dependence compared with those without cognitive dysfunction (p < 0.001).

Conclusion: These findings indicate that diabetes is associated with cognitive dysfunction in older adults. Meanwhile, there is an association between cognitive impairment and ADL level in subjects with diabetes. As such, healthcare professionals should pay close attention to the occurrence of cognitive dysfunction and ADL decline during diagnosis and treatment, and proactive prevention and intervention strategies should be implemented.

Exploring the impact of cognitive dysfunction, fatigue, and shortness of breath on activities of daily life after COVID-19 infection, until 1-year follow-up

Tue, 25 Jun 2024 00:00:00 -0700

Objective: Despite expanding knowledge on COVID-19, the long-term effects on daily-life activities remain unclear. The prevalence and changes in fatigue, cognitive dysfunction, and activity limitations in the first year after COVID-19 infection in hospitalized and non-hospitalized patients were explored.

Subjects: A total of 122 patients were recruited from hospital care and 90 from primary care.

Method: Baseline data comprised the Montreal Cognitive Assessment and Trail Making Test. Participants were followed up at 3 and 12 months using these tests and a semi-structured interview to identify symptoms and how they affected participation in daily-life activities. Both within- and between-group analyses were performed to explore changes over time and compare groups.

Result: High levels of fatigue and cognitive dysfunction were found in both groups, which persisted for 12 months. A significant impact on daily-life activities was also observed, with marginal change at the 12-month follow-up. The hospital care group performed worse than the primary care group in the cognitive tests, although the primary care group perceived a higher level of fatigue and cognitive dysfunction. Activity limitations were higher in the primary care group than in the hospital care group.

Conclusion: These findings highlight the need for long-term follow-up and further investigation of the impact of persistent deficits on rehabilitation.

Normative values in healthy adults for the 6-minute and 2-minute walk tests in Belgium and Vietnam: implications for clinical practice

Tue, 19 Mar 2024 00:00:00 -0700

Objective: To establish reference values for the 6-minute walk test (6MWT) and 2-minute walk test (2MWT) distances, to investigate the correlation between these 2 tests, and to establish prediction equations for these distances in healthy populations of Belgium and Vietnam.

Design: Cross-sectional study.

Subjects and methods: The 6MWT and 2MWT were administered to a convenience sample of 239 Belgian and 303 Vietnamese participants between the ages of 18 and 80 years.

Results: The mean (standard deviation; SD) 2MWT distances were 215 (32.8) m for Belgian participants and 156 (25.5) m for Vietnamese participants. The mean (SD) 6MWT distances were 625 (90.7) m for Belgian participants and 449 (70.4) m for Vietnamese participants. The Pearson correlation coefficient between the 2 tests was 0.901 (p < 0.001) for Belgian participants and 0.871 (p < 0.001) for Vietnamese participants. Age and sex were the 2 most important predictors of walking distance, followed by body mass index for Belgium and height for Vietnam. The adjusted R² ranged from 0.31 to 0.49 across 4 predictive equations.

Conclusion: These results can be used to determine the presence of walking performance deficits and to guide future studies. The 2MWT is suggested as a useful and convenient alternative to the 6MWT for assessing walking performance in clinical practice.

Handcycling with concurrent lower body low-frequency electromyostimulation significantly increases acute oxygen uptake in elite wheelchair basketball players: an acute crossover trial

Sat, 08 Jun 2024 00:00:00 -0700

Objective: Wheelchair basketball (WCB) demands high-intensity training due to its intermittent nature. However, acute oxygen uptake (V˙O₂) in handcycling is restricted. Combining handcycling with low-frequency electromyostimulation (LF-EMS) may enhance V˙O₂ in elite WBC athletes.

Design: Randomized crossover trail.

Subjects: Twelve German national team WCB players (age: 25.6 [5.6] years, height: 1.75 [0.16] m, mass: 74.0 [21.7] kg, classification: 2.92 [1.26]).

Method: Participants underwent 2×5 min of handcycling (60 rpm, ¾ bodyweight resistance in watts) (HANDCYCLE) and 2×5 min of handcycling with concurrent LF-EMS (EMS_HANDCYCLE). LF-EMS (4Hz, 350µs, continuous stimulation) targeted gluteal, quadriceps, and calf muscles, adjusted to individual pain thresholds (buttocks: 69.5 [22.3] mA, thighs: 66.8 [20.0] mA, calves: 68.9 [31.5] mA).

Results: Significant mode-dependent differences between HANDCYCLE and EMS_HANDCYCLE were found in V˙O₂ (17.60 [3.57] vs 19.23 [4.37] ml min^-1 kg^-1, p = 0.001) and oxygen pulse (16.69 [4.51] vs 18.41 [5.17] ml, p = 0.002). ΔLactate was significantly lower in HANDCYCLE (0.04 [0.28] vs 0.31 [0.26] mmol l^-1). Although perceived effort did not differ (p = 0.293), discomfort was rated lower in HANDCYCLE (1.44 [1.28] vs 3.94 [2.14], p = 0.002).

Conclusion: LF-EMS applied to the lower extremities increases oxygen demand during submaximal handcycling. Thus, longitudinal application of LF-EMS should be investigated as a potential training stimulus to improve aerobic capacity in wheelchair athletes.

Functional outcomes of accelerated rehabilitation protocol for anterior cruciate ligament reconstruction in amateur athletes: a randomized clinical trial

Thu, 22 Feb 2024 00:00:00 -0800

Background: Anterior cruciate ligament (ACL) rupture is the most common knee injury among athletes, and can result in long-term complications and career-ending conditions for sportspeople. There is no consensus in the literature on the effectiveness of rehabilitation after ACL reconstruction, or the best protocol to follow for functional outcome improvement.

Objective: To determine the impact of an accelerated rehabilitation protocol on knee functional outcomes in amateur athletes with anterior cruciate ligament reconstruction (ACLR).

Design: Two-arm, parallel-group randomized comparative design.

Patients: A total of 100 amateur male athletes (mean age 22.01 ± 1.79 years) with ACLR were randomly divided into experimental and control groups (n = 50/group).

Methods: An accelerated rehabilitation protocol and a conventional rehabilitation protocol were used for the experimental group. In contrast, only the conventional rehabilitation protocol was used for the control group. The rehabilitation was delivered in 5 weekly sessions for 22 weeks. The primary outcome measure, knee pain, was measured using a visual analogue scale (VAS). Extensive test batteries, for hop tests, Knee Injury and Osteoarthritis Outcome Score (KOOS), and knee effusion, were measured, aiming to add more objective criteria to determine functional performance.

Results: Both groups (n = 50/group) were well-matched (p = 0.816), with insignificant differences in their demographic characteristics (p > 0.05). A multivariate analysis of variance (MANOVA) test showed no significant difference between the 2 groups (p = 0.781) at baseline. A 2-way MANOVA (2 × 2 MANOVA) of within- and between-group variations indicated overall significant treatment, time, and treatment × time interaction effects (p < 0.001) in favour of the accelerated rehabilitation group.

Conclusion: The accelerated rehabilitation protocol was more effective in improving functional outcomes than a conventional rehabilitation protocol in amateur athletes with ACLR.

Usefulness of the cardiopulmonary exercise test up to the anaerobic threshold for pati-ents aged ≥ 80 years with cardiovascular disease on cardiac rehabilitation

Wed, 19 Jun 2024 00:00:00 -0700

Objective: A cardiopulmonary exercise test provides information regarding appropriate exercise intensity, but there have been few reports on its use in patients over 80 years of age.

Design: Retrospective observational study.

Patients: A total of 511 cardiovascular disease patients who performed a cardiopulmonary exercise test from February 2011 to January 2020 were investigated.

Methods: Patients were stratified according to age: < 70 years, 70–79 years, and ≥ 80 years, and the results of the cardiopulmonary exercise test up to anaerobic threshold were compared.

Results: Patients in the < 70 age bracket showed higher oxygen consumption, carbon dioxide output, and ventilatory volume and lower ventilation equivalents per oxygen consumption and carbon dioxide output in all time periods. However, there were no significant differences in these parameters or the work rate (70–79 years of age: 41.4 ± 11.7 watts, vs ≥ 80 years: 42.2 ± 10.9 watts, p = 0.95) or oxygen consumption per body weight at anaerobic threshold (12.2 ± 0.2 ml/min/kg, vs 12.1 ± 0.4 ml/min/kg, p = 0.97) between the 70–79 year age bracket and the ≥ 80 year age bracket.

Conclusion: Even for cardiovascular disease patients age ≥ 80 years, a cardiopulmonary exercise test up to anaerobic threshold can supply useful information for guiding cardiac rehabilitation.

Social participation, resilience, and coping tendency in a sample of stroke survivors: a multi-centre cross-sectional study in China

Xuan Zhou, Ying Wang, Lanshu Zhou — Thu, 04 Jan 2024 00:00:00 -0800

Objectives: To investigate the association between resilience and social participation and examine the mediation of resilience on coping strategies and social participation.

Design: A multi-centre cross-sectional study performed from April to July 2022.

Participants: The study sample comprised 239 stroke survivors (53.1% male). The mean age of participants was 65.4 years.

Methods: The study was conducted at 3 neurorehabilitation centres in Shanghai, China. The Utrecht Scale for Evaluation of Rehabilitation Participation (USER-P) was used to measure both objective and subjective social participation. Resilience was evaluated using the Connor-Davidson Resilience Scale (CD-RISC), while positive coping tendency was assessed using the Simplified Coping Style Questionnaire (SCSQ). Multivariate linear regression was employed, taking into account confounding factors. In cases where a significant interaction effect was observed, simple slope analysis was conducted to explore the relationship between positive coping tendency and social participation at different levels of resilience.

Results: The mean scores of social participation frequency, restriction, and satisfaction were 21.80 ± 15.13, 38.92 ± 26.48, and 63.34 ± 22.35, respectively. Higher resilience level was independently associated with higher social participation frequency (B = 0.210, p < 0.001), less participation restriction (B = 0.584, p < 0.001), and higher participation satisfaction (B = 0.250, p < 0.001). Moreover, higher resilience was correlated with more positive coping tendency. More positive coping tendency was related to higher social participation frequency and less participation restriction, but not to social participation satisfaction. Furthermore, individuals at different resilience levels moderated the effect of positive coping tendency on social participation frequency.

Conclusion: This study underlines the importance of resilience as a potential intervention in enhancing both objective and subjective social participation in stroke survivors, and provides insights into increasing the efficacy of positive coping strategies on social participation.

Community integration and its predictors in people with stroke: a multicenter longitudinal study

Thu, 25 Apr 2024 00:00:00 -0700

Objective: To investigate the community integration of patients following stroke and determine the predictors of their level of community integration at 1-year follow-up.

Design: A multicenter, longitudinal, and observational study.

Subjects: Sixty-five inpatients (41 men) with a mean age of 56.9 (standard deviation = 17.0) years, who had their first stroke at least 1 month prior to this study were recruited from 4 rehabilitation inpatient wards in China.

Methods: In the initial assessment, the participants were evaluated using the Community Integration Questionnaire, the Fugl-Meyer Assessment, the Berg Balance Scale, the Modified Barthel Index, the Mini Mental State Examination, and the Modified Ashworth Scale. In the follow-up assessments, which were conducted via telephone no less than 1 year after discharge, the participants were evaluated using the Community Integration Questionnaire and also assessed for other disease-related conditions.

Results: The participants’ scores on the Community Integration Questionnaire in the follow-up assessment were significantly greater than those at the initial assessment (p < 0.05). In addition, the participants’ Community Integration Questionnaire scores in the follow-up assessment were significantly correlated with their ages, numbers of years of education, and Modified Barthel Index, Berg Balance Scale, Mini Mental State Examination scores in the initial assessment (p < 0.05), and marginally significantly correlated with their scores on Fugl-Meyer Assessment in the initial assessment (p = 0.058). The participants’ ages, numbers of years of education, and Modified Barthel Index, Berg Balance Scale, Mini Mental State Examination, Fugl-Meyer Assessment of the lower extremity, and Fugl-Meyer Assessment scores in the initial assessment were predictive of their Community Integration Questionnaire scores at follow-up, with coefficients of determination ranging from 0.254 to 0.056 (p < 0.05).

Conclusions: The level of community integration of the participants was generally low, but it was greater at 1-year follow-up than it was initially. Balance function and daily living ability may be key predictors of community integration of patients following stroke.

Stressful life events are associated with self-reported fatigue and depressive symptoms in patients with mild traumatic brain injury

Mon, 04 Mar 2024 00:00:00 -0800

Abstract

Objective: To examine the associations between recent stressful life events and self-reported fatigue and depressive symptoms in patients with mild traumatic brain injury.

Design: Observational cohort study.

Participants: Patients (aged 18–68 years) with mild traumatic brain injury (n = 99) or lower extremity orthopaedic injury (n = 34).

Methods: Data on stressful life events and self-reported symptoms were collected 3 months post-injury. Stressful life events in the last 12 months were assessed as part of a structured interview using a checklist of 11 common life events, self-reported fatigue with Barrow Neurological Institute Fatigue Scale, and depressive symptoms with Beck Depression Inventory – Fast Screen.

Results: Median number of stressful life events was 1 (range 0–7) in the mild traumatic brain injury group and 1.5 (range 0–6) in the orthopaedic injury group. The groups did not differ significantly in terms of fatigue or depressive symptoms. In the mild traumatic brain injury group, the total number of recent stressful life events correlated significantly with self-reported fatigue (r_s = 0.270, p = 0.007) and depressive symptoms (r_s = 0.271, p = 0.007).

Conclusion: Stressful life events are associated with self-reported fatigue and depressive symptoms in patients with mild traumatic brain injury. Clinicians should consider stressful life events when managing patients who experience these symptoms, as this may help identifying potential targets for intervention.

Diaphragmatic strengthening exercises for patients with post COVID-19 condition after mild-to-moderate acute COVID-19 infection: a randomized controlled study

Tue, 11 Jun 2024 00:00:00 -0700

Objective: To assess the clinical effects of incentive spirometry (IS) and diaphragmatic breathing (DB) in patients with post COVID-19 condition and diaphragmatic dysfunction as compared with the standard care alone.

Methods: The present longitudinal randomized study included 60 patients with post COVID-19 condition and diaphragmatic dysfunction. Patients were equally randomized to receive standard care plus IS (G1), standard care plus DB (G2) or standard care alone (G3) for 8 weeks. The primary outcome is clinical improvement as evaluated by the modified Medical Research Council (mMRC) dyspnoea scale.

Results: Comparison between the studied groups revealed significant improvement in G1 and G2 in all parameters at the end of follow-up. However, no significant improvement was found in G3. At the end of follow-up, 15 patients (75.0%) in G1, 11 patients (55.0%) in G2, and 3 patients (15.0%) in G3 showed improvement on the mMRC dyspnoea scale. Multivariate logistic regression analysis identified mild acute COVID-19 infection (p = 0.009), use of IS (p < 0.001), and use of DB (p = 0.023) as significant predictors of improvement on the mMRC dyspnoea scale.

Conclusions: IS or DB training in addition to the standard care in post COVID-19 condition was associated with better clinical improvement as compared with the standard care alone.

Rasch analysis of the forgotten joint score in patients with total hip arthroplasty

Wed, 10 Jan 2024 00:00:00 -0800

Objective: To assess the internal construct validity, including local independence, unidimensionality, monotonicity, and invariance, reliability, and targeting of the Forgotten Joint Score within the Rasch Measurement Theory framework.

Design: Cross-sectional study.

Patients: A total of 111 patients with total hip arthroplasty at least 3 months after surgery.

Methods: The Forgotten Joint Score was submitted to each subject during their rehabilitative treatment in an Italian centre and then to Rasch analysis.

Results: The base Rasch analysis showed a satisfactory fit to the model with strict unidimensionality and no differential item functioning. However, monotonicity (11 out of 12 items showed disordered thresholds) and local independence were violated. After rescoring 10 items and creating 5 subtests to account for local dependence, the scale satisfied all the other Rasch model requirements (i.e. invariance, local independence, monotonicity, unidimensionality, and multi-group invariance), with reliability indexes (> 0.850) for measurement at the individual level and proper targeting. A raw-score-to-measure conversion table was provided.

Conclusion: After structural (i.e. collapsing items categories) and non-structural (i.e. creating subtests) strategies, the Forgotten Joint Score satisfied the measurement requirements of the Rasch model, and it can be used in patients with total hip arthroplasty in clinical and research settings.

The effects of moderate-intensity aerobic exercise on cognitive function in individuals with stroke-induced mild cognitive impairment: a randomized controlled pilot study

Tue, 02 Jul 2024 00:00:00 -0700

Objective: To assess the impact of moderate-intensity aerobic exercise on working memory in stroke-induced mild cognitive impairment (MCI).

Design: Randomized, double-blind controlled study.

Subjects and methods: Twenty MCI patients from the Fifth Affiliated Hospital of Guangzhou Medical University (December 2021 to February 2023), aged 34–79, 2–12 months post-stroke, were divided into an experimental group (EG) and a control group (CG), each with 10 participants. The EG underwent standard rehabilitation plus 40 minutes of aerobic exercise, while the CG received only standard therapy, 5 times weekly for 2 weeks. Working memory was tested using the n-back task, and overall cognitive function was measured with the MOCA and MMSE Scales before and after the intervention.

Results: The EG showed higher 3-back correctness (71.80 ± 14.53 vs 56.50 ± 13.66), MOCA scores (27.30 ± 1.57 vs 24.00 ± 3.13), and improved visuospatial/executive (4.60 ± 0.52 vs 3.30 ± 1.06) and delayed recall (4.30 ± 0.82 vs 3.00 ± 1.56) on the MOCA scale compared with the CG.

Conclusion: Moderate-intensity aerobic exercise may enhance working memory, visuospatial/executive, and delayed recall functions in stroke-induced MCI patients.

Exercise- and education-based prehabilitation before total knee arthroplasty: a pilot study

Mon, 08 Jan 2024 00:00:00 -0800

Objective: To determine the feasibility and estimates of effects of a supervised exercise- and education-based prehabilitation programme aiming to improve knee functioning compared with usual care in patients awaiting total knee arthroplasty.

Design: A randomized controlled pilot study.

Subjects: Patients receiving primary, unilateral total knee arthroplasty.

Methods: Patients randomized to the intervention group participated in a personalized 4–8-week prehabilitation programme before surgery. Feasibility of the intervention and self-reported knee functioning, pain, physical performance and hospital stay were assessed at baseline, immediately preoperatively, 6 and 12 weeks after surgery.

Results: Twenty patients (mean age 72.7±5.95 years) were enrolled in this study. The personalized prehabilitation programme was found to be feasible and safe, with an exercise adherence of 90%. Significant medium interaction effects between groups and over time favouring prehabilitation were reported for the sport subscale of the Knee Osteoarthritis Outcome Score (F(3/54) = 2.895, p = 0.043, η² = 0.139) and Tegner Activity Scale (F(2.2/39.1) = 3.20, p = 0.048, η² = 0.151).

Conclusion: The absence of adverse events and high adherence to the programme, coupled with beneficial changes shown in the intervention group, support the conduct of a full-scale trial investigating the effectiveness of prehabilitation.

Experiences of chain of care and rehabilitation after stroke: a qualitative study of persons discharged to skilled nursing facilities before returning home

Sofie Fors, Anna Bråndal, Hélène Pessah-Rasmussen, Ingrid Lindgren — Thu, 20 Jun 2024 00:00:00 -0700

Objective: To explore how people with stroke, discharged to skilled nursing facilities before returning home, experience the chain of care and rehabilitation.

Design: Qualitative, semi-structured interview design.

Methods: Thirteen stroke survivors discharged from a stroke unit to a skilled nursing facility before returning to independent living participated. Semi-structured telephone interviews were conducted 2–5 months after stroke and analysed with content analysis.

Results: The analysis resulted in three categories, Organizational processes, critical and complex, Rehabilitation, the right support at the right time and Adaptation to the changed situation, with a total of 9 subcategories. The informants perceived low participation in planning and goalsetting and limited information. Support from the healthcare services was important to proceed with improvements although the amount of supported training varied. Factors hindering and facilitating managing everyday life were described, as well as lingering uncertainty of what the future would be like.

Conclusion: Support and rehabilitation as well as individuals’ needs varied, throughout the chain of care. To enable participation in the rehabilitation, assistance in setting goals and repeated information is warranted. Tailored care and rehabilitation throughout the chain of care should be provided, followed up at home, and coordinated for smooth transitions between organizations.

Implementation of evidence-based interventions according to the Swedish National Guidelines for Strokecare: a nationwide survey among physiotherapists

Sara Brycke, Anna Bråndal, Christina Brogårdh — Tue, 19 Mar 2024 00:00:00 -0700

Objective: To investigate (i) to what extent physiotherapists (PTs) working in stroke rehabilitation in various parts of the stroke care chain have implemented interventions according to the national guidelines for stroke (NGS), (ii) facilitating and hindering factors for the implementation, and (iii) differences between various care settings.

Design: A cross-sectional study.

Subjects: 148 PTs working in stroke rehabilitation in various parts of the care chain in Sweden.

Methods: Data were collected by a web-based survey.

Results: Task-specific training for walking (80–98%), impaired motor function (64–100%) and fall prevention (73–92%) were most implemented. Factors that facilitated implementation were: important to comply with the NGS, that PTs had confidence to perform the interventions, and that interventions were clearly described. Limited time, lack of resources, no clear goals or routines at the workplace hindered the implementation. Significant differences (p < 0.05) between the settings existed. Municipal and primary care reported most challenges in implementing the NGS and providing evidence-based interventions.

Conclusion: Most interventions, with high priority according to NGS, are provided by PTs working in stroke rehabilitation, although differences in various parts of the care chain exist. Knowledge, time, education and supportive management are important factors when implementing evidence-based interventions.

Preliminary effectiveness and production time and costs of three-dimensional printed orthoses in chronic hand conditions: an interventional feasibility study

Tanja Oud, Johannes A. Bogaards, Frans Nollet, Merel-Anne Brehm — Tue, 14 May 2024 00:00:00 -0700

Objective: To assess the preliminary effectiveness of three-dimensional printed orthoses compared with conventionally custom-fabricated orthoses in persons with chronic hand conditions on performance of daily activities, hand function, quality of life, satisfaction, and production time and costs.

Design: Interventional feasibility study.

Subjects: Chronic hand orthotic users (n = 21).

Methods: Participants received a new three-dimensional printed orthosis according to the same type as their current orthosis, which served as the control condition. Primary outcome was performance of daily activities (Patient-Reported Outcomes Measurement Information System–Upper Extremity; Michigan Hand Questionnaire). Secondary outcomes were hand function, quality of life, and satisfaction. Furthermore, production time and costs were recorded.

Results: At 4 months’ follow-up, no significant differences were found between three-dimensional printed orthoses and participants’ existing conventional orthoses on activity performance, hand function, and quality of life. Satisfaction with the three-dimensional printed orthosis was significantly higher and the production time and costs for three-dimensional printed orthoses were significantly lower compared with conventional orthoses. The three-dimensional printed orthosis was preferred by 79% of the participants.

Conclusions: This feasibility study in chronic hand conditions suggests that three-dimensional printed orthoses are similar to conventional orthoses in terms of activity performance, hand function, and quality of life. Satisfaction, and production time and costs favoured the three-dimensional printed hand orthoses.

Health-related quality of life and participation after inpatient rehabilitation of sepsis survivors with severe sequelae: a cohort study

Tue, 02 Jul 2024 00:00:00 -0700

Objective: To describe health-related quality of life and participation after rehabilitation of severely affected sepsis survivors.

Design: Cohort study.

Subjects/Patients: Patients with severe sequelae after sepsis treated in a multidisciplinary rehabilitation pathway were included.

Methods: Patient characteristics at the time of diagnosis, and the outcome 3 months after discharge from rehabilitation are described. At that time, health-related quality of life, social participation, and the rate of living at home were measured.

Results: Of the 498 patients enrolled, 100 severely impaired patients were transferred for a multidisciplinary rehabilitation approach. Fifty-five of them were followed up at 3 months. Descriptive and inference statistics showed that 69% were living at home with or without care. Health-related quality of life and participation scores were 0.64 ± 0.32 for the EQ-5D utility index and 54.98 ± 24.97 for the Reintegration of Normal Living Index. A multivariate regression model explaining health-related quality of life at 3 months included age, lower limb strength, and walking ability during rehabilitation (r² = 0.5511). Participation at 3 months was explained by age, body mass index, lower limb strength, and duration of tracheal intubation (r² = 0.6229).

Conclusion: Patients who have experienced serious sepsis with severe sequelae can achieve a moderate level of quality of life and participation within a multidisciplinary pathway.

Comparison of motion sensor and heart rate monitor for assessment of physical activity intensity in stroke outpatient rehabilitation sessions: an observational study

Stéphanie Goncalves, Stéphane Mandigout, Morgane Le Bourvellec, Noémie C. Duclos — Tue, 25 Jun 2024 00:00:00 -0700

Objective: To compare the estimation of time spent on 4 categories of physical activity intensity (sedentary behaviour, light physical activity, moderate physical activity, and vigorous physical activity) between a motion sensor and a heart rate monitor during a stroke outpatient rehabilitation session.

Design: A multicentre cross-sectional observational study.

Subjects/Patients: Participants with stroke (> 6 months) undergoing outpatient rehabilitation sessions.

Methods: Participants wore the SenseWear Armband motion sensor and the Polar H10 heart rate monitor during 2 rehabilitation sessions. The times estimated by each device were compared using a generalized linear mixed model and post-hoc tests.

Results: Ninety-nine participants from 29 clinics were recruited and data from 146 sessions were included in the analysis. The estimated times depended on the devices and the physical activity intensity category (F = 135, p < 0.05). The motion sensor estimated more time spent in sedentary behaviour and less time spent in moderate physical activity and vigorous physical activity than the heart rate monitor.

Conclusion: The motion sensor and heart rate monitor provide different estimates of physical activity intensity during stroke rehabilitation. Further research is needed to establish the most appropriate device for each physical activity category.

Profiles of executive functioning following traumatic brain injury and stroke using the assessment of participation and executive functions: combined cross-sectional and longitudinal designs

Rotem Eliav, Sivan Hason, Rachel Kizony — Thu, 18 Jan 2024 00:00:00 -0800

Objectives: The Assessment of Participation and Executive Functions (A-PEX) evaluates executive functioning through daily participation in complex daily activities. This study examines its ability to discriminate between executive functioning profiles post-traumatic brain injury and post-stroke and its sensitivity to changes.

Design: Cross-sectional with a longitudinal component.

Patients: Adults with post-traumatic brain injury (n = 28) and post-stroke (n = 26) in a rehabilitation facility.

Methods: Patients were administered the A-PEX, Multiple Errands Test-Hospital version and Color Trail Test at 2 time-points 1 month apart. The Montreal Cognitive Assessment was administered at the first time-point, and Executive Functions Performance Test’s Internet-based Bill Payment subtest at the second. The analysis used Mann–Whitney and Wilcoxon signed-rank tests.

Results: The stroke group’s A-PEX scores were higher than the traumatic brain injury group’s at the first time-point (p < 0.05). No differences were found in the other assessments. Within-group differences in both groups were significant in the A-PEX (–3.7 < r < – 2.3, p < 0.05) and Multiple Errands Test-Hospital version (–3.4 < r < –3.3, p < 0.01).

Conclusion: The A-PEX may provide valuable information about the uniqueness of executive functioning profiles and patients’ progress.

Patient experiences of physical activity and inactivity in the stroke unit: an interview study

Malin Reinholdsson, Gisela Herranen, Katharina S. Sunnerhagen, Annie Palstam — Thu, 08 Feb 2024 00:00:00 -0800

Objective: Stroke unit care is highly recommended after stroke, but patients in these units are often physically inactive. The aim of this study was to explore patient experiences of physical activity and inactivity in the stroke unit.

Design: Qualitative interview study.

Subjects: Sixteen participants with stroke; a heterogeneous sample with differences in sex, age, and stroke severity from 8 Swedish stroke units.

Methods: In-depth interviews 1–2 weeks after discharge analysed using thematic analysis.

Results: The analysis resulted in three themes: 1: Dealing with the challenges of a changed body while striving to become independent; 2: The stroke unit is crucial for physical activity; and 3: Physical activity is important for interaction with others, autonomy, and feeling seen. Participants described how they coped with a new situation when finding new ways to move and function. In addition, they wanted to be involved in their own stroke rehabilitation.

Conclusion: The participants expressed the following experiences of being in the stroke unit: movement is more important than physical activity and involves being seen and respected; physical activity and exercise are necessary to achieve independence; process involvement is of importance to regain abilities; physical activity offers the possibility of choosing between community and being alone and influences the ability to connect with others and the outside world.

Change characteristics of health-related quality of life and its association with post-stroke fatigue at four-year follow-up

Thu, 04 Jan 2024 00:00:00 -0800

Objective: To explore trajectories that describe change in post-stroke health-related quality of life with fatigue as outcome.

Design: Observational and prospective study.

Subjects: Stroke survivors (N = 144) with predominantly mild or moderate strokes.

Methods: The multidimensional Stroke-Specific Quality of Life scale was used at 1 and 4 years, and the Fatigue Severity Scale at 4 years post-stroke. Latent class growth analyses were used as person-oriented analyses to identify meaningful trajectories. Socio-demographic and stroke-related covariables provided customary adjustment of the outcome, as well as prediction of class membership.

Results: The latent class growth analysis models were estimated for “physical health”, “visual-language”, and “cognitive-social-mental” components of the Stroke-Specific Quality of Life scale, which extracted trajectories describing a variation in stable, deteriorating and improving functional patterns. The stable, well-functioning trajectory was most frequent across all components. More pronounced fatigue was associated with trajectories describing worse functioning, which was more prominent among females compared with males. Living alone implied more fatigue in the “cognitive-social-mental” component. Within the “visual-language” components’ trajectories, younger and older participants reported more fatigue compared with middle-aged participants.

Conclusion: Most participants belonged to the stable, well-functioning trajectories, which showed a consistently lower level of fatigue compared with the other trajectories.

Occupational performance one to five years after aneurysmal subarachnoid haemorrhage: a cohort study

Marcus Kessner, Jan Mehrholz, Svein Harald Mørkve, Tina Taule — Wed, 20 Mar 2024 00:00:00 -0700

Objective: To report on the self-perceived occupational performance of patients with aneurysmal subarachnoid haemorrhage and examine the associations between aneurysmal subarachnoid haemorrhage characteristics, socio-demographic factors and self-perceived problems.

Design: A single-centre cohort study design was combined with a cross-sectional analysis.

Subjects/patients: All patients with aneurysmal subarachnoid haemorrhage who were capable of performing activities of daily living before discharge from hospital were included.

Methods: The assessment of the patient’s occupational performance followed a patient-reported outcome measure 1 to 5 years after the subarachnoid haemorrhage. Secondary outcomes comprised scores from the Glasgow Outcome Scale, modified Rankin Scale, Fisher Scale, World Federation of Neurological Societies grading system, vasospasm, and hydrocephalus.

Results: Of the 62 patients included in the study (66% female, mean age 55 years), 79% reported experiencing issues with occupational performance, most frequently with regard to leisure and productivity. The problems reported were significantly associated with vasospasm (p = 0.021) and the Glasgow Outcome Scale score (p = 0.045).

Conclusion: Even patients who have had aneurysmal subarachnoid haemorrhage with a favourable outcome may encounter occupational performance difficulties for several years. It is vital to use patient-reported outcome measures to identify these issues. This research enhances our comprehension of aneurysmal subarachnoid haemorrhage patients’ self-perceived occupational performance and the factors that affect their performance.

Two-year course of walking adaptability in persons living with late effects of polio

Jana Tuijtelaars, Merel-Anne Brehm, Jos W.R. Twisk, Frans Nollet — Mon, 18 Mar 2024 00:00:00 -0700

Objective: To evaluate the 2-year course of walking adaptability in persons with late effects of polio.

Design: Prospective cohort study.

Patients: A total of 48 persons with late effects of polio (69% female, mean age 63.1 years) with a fall history and/or fear of falling.

Methods: Walking adaptability (i.e. variable target-stepping and reactive obstacle-avoidance) was assessed on an interactive treadmill at baseline, 1 year and 2 years. Further, leg-muscle strength and balance were assessed at baseline. The course of walking adaptability was analysed with linear mixed models. Based on median values, subgroups were defined for low vs high baseline walking-adaptability and for clinical characteristics. Tme by subgroup interactions were analysed.

Results: Variable target-stepping and reactive obstacle-avoidance did not change (p > 0.285). Reactive obstacle-avoidance improved for persons with a high balance score at baseline (p = 0.037), but not for those with lower scores (p = 0.531). No other time by subgroup interactions were found (p > 0.126).

Conclusion: Walking adaptability did not change in persons with late effects of polio over 2 years, and walking adaptability course did not differ between subgroups stratified for walking adaptability determinants, except for balance. Since falls are a major problem among persons with late effects of polio, future studies should investigate whether walking adaptability declines over a longer time and which persons are most at risk.

Assessment of visual problems after acquired brain injury: a survey of current practice in Danish hospitals

Tue, 14 May 2024 00:00:00 -0700

Objectives: To explore current hospital practice in relation to the assessment of vision problems in patients with acquired brain injury.

Design: A survey study.

Subjects: A total of 143 respondents from hospital settings, with background in occupational therapy and physical therapy, participated in the survey.

Methods: The survey questionnaire, developed collaboratively by Danish and Norwegian research groups, encompassed 22 items categorically covering “Background information”, “Clinical experience and current practice”, “Vision assessment tools and protocols”, and “Assessment barriers”. It was sent out online, to 29 different hospital departments and 18 separate units for occupational therapists and physiotherapists treating patients with acquired brain injury.

Results: Most respondents worked in acute or subacute hospital settings. Few departments had an interdisciplinary vision team, and very few therapists had formal education in visual problems after acquired brain injury. Visual assessment practices varied, and there was limited use of standardized tests. Barriers to identifying visual problems included patient-related challenges, knowledge gaps, and resource limitations.

Conclusion: The study emphasized the need for enhanced interdisciplinary collaboration, formal education, and standardized assessments to address visual problems after acquired brain injury. Overcoming these challenges may improve identification and management, ultimately contributing to better patient care and outcomes in the future.

Effects of motor imagery-based neurofeedback training after bilateral repetitive transcranial magnetic stimulation on post-stroke upper limb motor function: an exploratory crossover clinical trial

Thu, 07 Mar 2024 00:00:00 -0800

Objective: To examine the clinical effects of combining motor imagery-based neurofeedback training with bilateral repetitive transcranial magnetic stimulation for upper limb motor function in subacute and chronic stroke.

Design: Clinical trial following an AB/BA crossover design with counterbalanced assignment.

Subjects: Twenty individuals with subacute (n = 4) or chronic stroke (n = 16).

Methods: Ten consecutive sessions of bilateral repetitive transcranial magnetic stimulation alone (therapy A) were compared vs a combination of10 consecutive sessions of bilateral repetitive transcranial magnetic stimulation with 12 non-consecutive sessions of motor imagery-based neurofeedback training (therapy B). Patients received both therapies (1-month washout period), in sequence AB or BA. Participants were assessed before and after each therapy and at 15-days follow-up, using the Fugl-Meyer Assessment-upper limb, hand-grip strength, and the Nottingham Sensory Assessment as primary outcome measures.

Results: Both therapies resulted in improved functionality and sensory function. Therapy B consistently exhibited superior effects compared with therapy A, according to Fugl-Meyer Assessment and tactile and kinaesthetic sensory function across multiple time-points, irrespective of treatment sequence. No statistically significant differences between therapies were found for hand-grip strength.

Conclusion: Following subacute and chronic stroke, integrating bilateral repetitive transcranial magnetic stimulation and motor imagery-based neurofeedback training has the potential to enhance functional performance compared with using bilateral repetitive transcranial magnetic stimulation alone in upper limb recovery.

Association between fear of falling and falls following acute and chronic stroke: a systematic review with meta-analysis

Tue, 16 Jan 2024 00:00:00 -0800

Objectives: To examine the association between falls and fear of falling in people with stroke and to evaluate the differences between patients with acute stroke and those with chronic stroke with regard to any such association.

Methods: Articles were searched in Medline, CINAHL, AMED, Embase, PsycINFO, Cochrane Library of Reviews and PEDro from inception until March 2023. Experimental, observational or explorative studies investigating the association between fear of falling and falls in people with stroke were included. Articles were screened by 2 independent reviewers. Data were extracted by an independent reviewer.

Results: A total of 26 reports were included in this review (n = 2863). Fear of falling, assessed by a single-question survey, was significantly associated with falls (relative risk = 1.44; 95% confidence interval (95% CI) = 1.22, 1.70; I² = 0%) in people with acute stroke. Significant mean differences in fear of falling, based on the Falls Efficacy Scale (mean difference = 12.80; 95% CI = 1.81, 23.78; I² = 28%) and Activities-specific Balance Confidence Scale (mean difference = –9.99; 95% CI = –15.36, –4.62; I² = 57%), were also reported between fallers and non-fallers in people with chronic stroke.

Conclusion: A small, but significant, association exists between falls and fear of falling in both acute and chronic stroke patients.

Systematization of rehabilitation interventions for neuro-oncological patients using international classification of health interventions: a scoping review

Anete Pètersone, Agnese Kārkliņa , Guna Berzina — Fri, 12 Jan 2024 00:00:00 -0800

Background: To ensure equitable and effective rehabilitation for neuro-oncological patients the development of an effective treatment strategy is necessary.

Objective: To identify evidence for interventions used in acute rehabilitation for patients with neuro-oncological conditions and to systematize them according to the International Classification of Health Interventions (ICHI) classification

Methods: A scoping review was conducted, comprising 3 parts: identification of interventions in publications; linking the interventions to ICHI classification; and identifying problems targeted by these interventions and linking them to International Classification of Functioning, Disability and Health (ICF) categories.

Results: The search strategy selected a total of 6,128 articles. Of these, 58 publications were included in the review. A total of 150 interventions were identified, 47 of which were unique interventions. Forty-three of the interventions were linked to the ICHI classification; 4 of these interventions were evidence level I, 18 evidence level II, 23 evidence level III, and 2 evidence level IV. Five interventions were linked to the ICF One-Level Classification, and the remaining 42 interventions were linked to the ICF Two-Level Classification. All interventions regarding the Body Systems and Functions were linked to the ICF Two-Level Classification. Only 5 interventions in the Activities and Participation domain, 3 interventions in the Health-related Behaviors domain, and 1 intervention in the Environment domain were linked to the ICF Two-Level Classification. Two identified problems (inpatient nursing and comprehensive inpatient rehabilitation) were not classified according to the ICF.

Discussion: A total of 47 unique interventions were identified, revealing a significant focus on addressing issues related to bodily functions and structures. The study also highlighted the challenge of linking specific interventions to ICHI codes, particularly when the source documentation lacked adequate detail. While this review offers valuable insights into rehabilitation for neuro-oncological patients and lays the groundwork for standardized coding and data exchange, it also emphasizes the need for further refinement and validation of the ICHI classification to better align with the multifaceted interventions used in rehabilitation.

Conclusion: There is evidence in the literature of 47 interventions used by various rehabilitation professionals in the acute rehabilitation of neuro-oncological patients. However, most of these interventions are evidence level II and III. Four interventions (virtual reality, mirror therapy, robotic upper extremity training to improve function, and cognitive group therapy) are not included in the ICHI. The problems analysed in the literature that are targeted by interventions often do not coincide with the purpose of the specific intervention or are too broadly defined and not specific. These findings emphasize the need for greater precision in describing and documenting interventions, as well as the importance of aligning interventions more closely with ICF categories, particularly in the domains of Activities and Participation. This work highlights the heterogeneity in the reporting of rehabilitation interventions, and the challenges in mapping them to standardized classifications, emphasizing the ongoing need for refining and updating these classification systems.

Biopsychosocial rehabilitation in the working population with chronic low back pain: a concept analysis

Tue, 16 Jan 2024 00:00:00 -0800

Objective: To identify the essential attributes of biopsychosocial rehabilitation for chronic low back pain in the working population.

Design: A concept analysis was conducted according to the 8-step method of Walker and Avant. This framework provides a clear concept and theoretical and operational definitions.

Methods: Five databases were searched, followed by a systematic screening. Subsequently, attributes, illustrative cases, antecedents, consequences and empirical referents were formulated.

Results: Of the 3793 studies identified, 42 unique references were included. Eleven attributes were identified: therapeutic exercise, psychological support, education, personalization, self-management, participation, follow-up, practice standard, goal-setting, social support, and dietary advice. Subsequently, illustrative cases were described. Antecedents, such as motivation, preparedness and a multidisciplinary team, were found, together with consequences such as decreased pain, less sick-leave and increased function and work status. Finally, examples of empirical referents were given.

Conclusion: This study identified the attributes that are necessary to develop biopsychosocial rehabilitation intervention programmes for chronic low back pain. The defined concept of biopsychosocial rehabilitation for chronic low back pain may serve as a solid base to further develop and apply interventions. Future research should focus on the objectification of biopsychosocial rehabilitation and conceptualization regarding how personalization is done.

Effects of physical exercise interventions on balance, postural stability and general mobility in Parkinson’s disease: a network meta-analysis

Thu, 01 Feb 2024 00:00:00 -0800

Objective: To assess which type of physical exercise intervention has the most beneficial effects on balance, postural stability and general mobility in patients with Parkinson’s disease. These parameters were assessed using the Activities-specific Balance Confidence (ABC) scale, Berg Balance Scale (BBS), Mini-Balance Evaluation Systems Test (MiniBESTest) and Timed Up and Go Test (TUG).

Design: Network meta-analysis.

Methods: The PubMed, Cochrane Central Register of Controlled Trials, and Web of Science databases were searched up to August 2022 to identify randomized controlled trials on the effects of physical exercise interventions on balance, postural stability, and general mobility. The network meta-analysis included pairwise and indirect comparisons of results on the ABC scale, BBS, MiniBESTest, and TUG across 8 categories of physical exercise.

Results: Eighty-six studies with a total of 4,693 patients were included. For the ABC scale, the indirect comparison showed that the highest effect size was observed for balance vs sensorimotor training without including endurance interventions (0.62; 95% confidence interval (95% CI) 0.06, 1.17). The highest effect sizes for BBS were observed for alternative exercises (1.21; 95% CI 0.62, 1.81), body-weight supported (BWS) interventions (1.31; 95% CI 0.57, 2.05), dance (1.18; 95% CI 0.33, 2.03) and sensorimotor training, including endurance interventions (1.10; 95% CI 0.46, 1.75) vs control groups. Indirect comparisons showed that the highest effect size for the MiniBESTest were observed for balance (0.75; 95% CI 0.46, 1.04) and resistance (0.58; 95% CI 0.10, 1.07) vs control groups. For the TUG, comparisons showed a significant effect size for alternative exercises (–0.54; 95% CI –0.82, –0.26), balance (–0.42; 95% CI –0.75, –0.08), resistance (–0.60; 95% CI –0.89, –0.31), and sensorimotor training including endurance interventions (–0.61; 95% CI –0.95, –0.27) vs control comparisons.

Conclusion: Balance interventions improve balance, postural stability, and general mobility in people with Parkinson’s disease. Moreover, alternative exercises, dance, BWS interventions, resistance, and sensorimotor training, including and not including endurance interventions, are also effective.

Early mobilization of patients with subarachnoid haemorrhage: a national survey of french intensive care units

Adéla Foudhaili, Damien Vitiello, Benjamin Glenn Chousterman — Mon, 08 Jan 2024 00:00:00 -0800

Objective: To describe French intensive care unit practices regarding the mobilization of patients with subarachnoid haemorrhage.

Design: A cross-sectional nationwide survey study.

Subjects: Intensivists and physiotherapists or nurses from French intensive care units managing patients with subarachnoid haemorrhage.

Methods: An online questionnaire survey was distributed through the Neurocritical Care and Neuro Anesthesiology French Speaking Society.

Results: The response rate was 89%. Of these, 90% did not have a mobilization protocol for patients with subarachnoid haemorrhage. Sixteen percent of departments prohibited all forms of motor physiotherapy for a predefined period. Nineteen percent systematically prohibited out-of-bed mobilization, regardless of the severity of subarachnoid haemorrhage and in the absence of any complication, for a predefined period. The main factors that would delay or interrupt physiotherapy prescription were intracranial hypertension (79%), currently treated vasospasm (59%), and suspicion of vasospasm (44%). Ninety-one percent of the centres identified at least one complication that could be associated with standing upright. These mainly included decreased cerebral perfusion (71%), dislodged external ventricular or lumbar derivations (68%), and haemodynamic instability (65%).

Conclusion: Mobilization of patients with subarachnoid haemorrhage is heterogeneous among French neuro-intensive care units and several barriers preclude improvement of mobilization practices. Interventional studies assessing mobilization practices, as well as education and training of staff, are crucial to ensure the proper management of patients with subarachnoid haemorrhage and to improve outcomes.

Italian translation and cultural adaptation of the Agitated Behavior Scale (ABS-I) in patients with acquired brain injuries

Thu, 04 Apr 2024 00:00:00 -0700

Objective: The objective of this study was to produce a cross-cultural adaptation in Italian of the Agitated Behavior Scale (ABS), originally developed in English, as the first of two stages that also include cross-cultural validation and allow a clinical scale to be used in the proper setting such as rehabilitation units.

Methods: In order to adapt the ABS scale to a different cultural environment, five consecutive steps were performed: (1) forward translations (n = 8), (2) synthesis of the 8 forward translations to obtain a first shared italian version (ABS_I_trial), (3) back translations (n = 3), (4) creation of an expert committee to evaluate forward and back translations and finally (5) the cognitive debriefing.

Results: After the five steps, including forward translations and back translations, the process of committee verification and judgement and the evaluative step of cognitive debriefing, high comprehensibility of all items was found, resulting in an Italian translation version of ABS suitable for application in a clinical setting.

Conclusion: ABS translation was produced by means of a standardized procedure aimed at minimizing cross-cultural gaps. The expert committee evaluated the version produced as highly understandable in Italian. Further steps, such as the subsequent validation of its psychometric properties, are needed to employ this translation in a clinical setting.

Inpatient multimodal rehabilitation and the role of pain intensity and mental distress on return-to-work: causal mediation analyses of a randomized controlled trial

Fri, 12 Jan 2024 00:00:00 -0800

Objective: Studies suggest that symptom reduction is not necessary for improved return-to-work after occupational rehabilitation programmes. This secondary analysis of a randomized controlled trial examined whether pain intensity and mental distress mediate the effect of an inpatient programme on sustainable return-to-work.

Methods: The randomized controlled trial compared inpatient multimodal occupational rehabilitation (n = 82) with outpatient acceptance and commitment therapy (n = 79) in patients sick-listed due to musculoskeletal and mental health complaints. Pain and mental distress were measured at the end of each programme, and patients were followed up on sick-leave for 12 months. Cox regression with an inverse odds weighted approach was used to assess causal mediation.

Results: The total effect on return-to-work was in favour of the inpatient programme compared with the control (hazard ratio (HR) 1.96; 95% confidence interval (95% CI) 1.15–3.35). There was no evidence of mediation by pain intensity (indirect effect HR, 0.98; 95% CI, 0.61–1.57, direct effect HR, 2.00; 95% CI, 1.02–3.90), but mental distress had a weak suppression effect (indirect effect HR, 0.89; 95% CI, 0.59–1.36, direct effect HR, 2.19; 95% CI, 1.13–4.26).

Conclusion: These data suggest that symptom reduction is not necessary for sustainable return-to-work after an inpatient multimodal occupational rehabilitation intervention.

Musician’s dystonia in a percussionist – clinical video analysis and botulinum toxin intervention: a case report

Thu, 14 Mar 2024 00:00:00 -0700

Objective: Musician’s focal hand dystonia is a painless task-specific focal dystonia, which presents with involuntary movements, abnormal postures, and loss of fine motor dexterity. We report here the case of a 63-year-old male, percussionist, with african ethnicity, with musician’s focal hand dystonia who was treated with botulinum toxin, and describe the results at 4-weeks follow up.

Methods: Clinical examination and video analysis revealed abnormal flexion of the 3^rd finger, followed by flexion of the 4^th and 5^th fingers while playing the congas. Based on these findings, a diagnosis of musician's focal hand dystonia was established. Ten units of botulinum toxin were injected into the muscle fibres of the flexor digitorum superficialis corresponding to the 4^th finger using electromyography and ultrasound guidance. Four weeks later, the patient reported a subjective 60% improvement in his performance. He emphasized the effect of botulinum toxin on performance speed and tension over the forearm and hand.

Conclusion: Botulinum toxin is not a definitive treatment for musician’s focal hand dystonia, but it may potentiate other definitive rehabilitation techniques. More research is needed to determine the long-term effects of botulinum toxin on function enhancement in musician’s focal hand dystonia.

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