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1.
王玉英  刘孟  昝明  郭能峰  傅皞 《中国康复》2013,28(4):274-275
目的:观察佩戴踝足矫形器(AFO)对脑卒中患者步行能力改善的程度。方法:脑卒中偏瘫患者32例,给予佩戴50S1动态踝足矫形器7d后,采用三维步态分析系统评测佩戴AFO前后的步态空间域参数和步态时间域参数。结果:佩戴7d后,脑卒中患者步态空间域参数中平均步幅宽患、健侧均较佩戴前下降(P〈O.05),平均步幅长、步伐长和平均步向角患、健侧均较佩戴前增大(P〈0.05,0.01);步态时间域参数中步速、步频和双支撑相百分比患侧、健侧均较佩戴前明显增加,(P〈O.01),单支撑相和摆动相百分比患侧较佩戴前明显增加、健侧较佩戴前下降(P〈O.01)。结论:佩戴AFO可以改善脑卒中患者步态的稳定性,患、健侧的步速、步频均明显提高,并且佩戴后即刻发挥作用。  相似文献   

2.
目的 观察半掌踝足矫形器和足跟镂空踝足矫形器对脑卒中患者步态的影响。方法 选取符合标准的脑卒中患者25例,采用步态分析系统分别对25例脑卒中后步行功能障碍患者裸足、佩戴半掌踝足矫形器和佩戴足跟镂空踝足矫形器时的步行状态进行分析,记录三种状态下患者的步速、步频、健侧摆动相、患侧摆动相、跌倒风险和3 m起立计时行走时间,并进行统计学分析。 结果 受试者佩戴足跟镂空踝足矫形器时的步频为(86.718±17.947)Hz,较裸足和佩戴半掌踝足矫形器时均显著加快,差异均有统计学意义(P<0.05)。受试者佩戴足跟镂空踝足矫形器时的步态不对称系数为(0.086±0.070),与裸足时比较,差异有统计学意义(P<0.05)。受试者佩戴半掌踝足矫形器和佩戴足跟镂空踝足矫形器时的3 m起立计时行走时间较裸足时均显著缩短,差异均有统计学意义(P<0.05)。受试者佩戴半掌踝足矫形器和佩戴足跟镂空踝足矫形器时的跌倒风险均显著低于裸足时,差异均有统计学意义(P<0.05);且受试者佩戴足跟镂空踝足矫形器时的跌倒风险亦显著低于佩戴半掌踝足矫形器时,差异有统计学意义(P<0.05)。 结论 佩戴半掌踝足矫形器和足跟镂空踝足矫形器均可有效纠正脑卒中患者的步态,降低其跌倒风险,且佩戴足跟镂空踝足矫形器的优势更加明显。  相似文献   

3.
目的 观察功能性电刺激同步踝足矫形器步态训练对脑卒中后偏瘫患者下肢运动功能、步态时-空参数和关节角度参数的影响。 方法 将符合入选标准的脑卒中患者32例随机分为对照组(n=10)、支具组(n=10)和联合组(n=12)。3组患者均接受常规药物治疗和常规康复训练,对照组在此基础上增加步态训练,支具组则增加佩戴AFO行步态训练,联合组在常规药物和常规康复训练的基础上增加FES治疗,且在FES治疗的同时佩戴AFO行步态训练。3组患者均接受为期4周的治疗,并于治疗前和治疗4周后(治疗后)采用下肢Fugl-Meyer评定量表(FMA-LE)、下肢Brunnstrom运动恢复分期量表(BRL)、步行功能评定表(FAC)对其下肢运动功能和步行能力进行评估,同时使用三维步态分析仪获取3组患者步态参数,比较其治疗前、后偏瘫步态的变化。 结果 治疗4周后,3组患者的FMA-LE、FAC、BRL评分、时-空参数和各关节最大屈曲角度较组内治疗前均显著改善,差异均有统计学意义(P<0.05)。治疗后,联合组患者的FMA-LE评分[(28.42±1.38)分]、FAC评分[(4.33±0.49)分]、BRL评分[(5.41±0.67)分]、步频[(79.58±19.08)步/min]、步速[(56.97±19.08)cm/s]、步幅[(77.33±15.20)cm]、步行周期[(1.42±0.29)s]、双支撑相[(34.00±5.39)%]以及髋、膝、踝关节最大屈曲角度均显著优于对照组和支具组治疗后,差异均有统计学意义(P<0.05)。 结论 功能性电刺激的同时行踝足矫形器步态训练可显著改善脑卒中后偏瘫患者的下肢运动和步行功能,增加其关节活动度。  相似文献   

4.
踝足矫形器对足下垂患者下肢功能影响的分析   总被引:8,自引:7,他引:8  
目的观察和分析足下垂患者穿戴踝足支具(AFO)前后对下肢稳定性、负重能力、步行中膝、踝关节活动的影响.方法20例足下垂患者(男14例,女6例),其中右侧足下垂者9例,左侧足下垂者13例.患者中有6例需在辅助下行走,14例已具备独立行走的条件.对所有患者分别在穿戴和不穿戴踝支具状态下进行步行能力、下肢活动能力、身体平衡功能测定.其中5例患者在穿戴支具1个月左右进行步态分析.结果穿戴AFO后即刻患者的步行速度和步幅影响与穿戴支具前比较无显著差异(P>0.05);踏车时间和上楼的速度比不戴支具有明显提高(P<0.05),而起蹲、下楼时间、足抬高距离无显著差异(P>0.05);穿戴AFO对患肢负重无明显改善(P>0.05),但可使患者身体左右的稳定性及患腿前后的稳定性有明显改善(P<0.05);步态分析结果发现,5例患者穿戴支具前后患侧下肢垂直峰力矩、步速无明显影响(P>0.05);穿戴AFO后患侧膝关节在步行周期中最大伸膝度数较不穿支具明显减少(P<0.05);患侧踝关节在步态周期中最大趾屈度数较不穿支具明显减少(P<0.01).结论AFO对下肢功能的影响主要表现在改善足下垂和膝过伸程度;增强身体稳定性及患侧下肢稳定性;穿戴AFO对患者下肢日常功能活动无明显影响;对患者即刻和1个月以后的步速、步幅、患腿负重能力的改善不明显.  相似文献   

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目的 评价机器人辅助步态训练对脑卒中患者步态功能的干预效果,为其制定下肢功能锻炼方案提供循证依据。方法 计算机检索Cochrane Library、PubMed、Web of Science、Embase、中国生物医学文献数据库(CBM)、中国知网、维普、万方8个中英文数据库,纳入从建库至2022年5月符合纳入标准与排除标准的随机对照试验,进行质量评价及资料提取后采用RevMan5.3软件进行Meta合并数据分析。结果 共纳入22项随机对照试验,总计902例患者,文献质量等级均为B级。Meta分析结果显示,干预组机器人辅助步态训练对脑卒中患者的步速[MD=0.08,95%CI (0.06,0.09),P<0.001]、步长[MD=3.58,95%CI(2.01,5.15),P<0.001]、步频[SMD=0.77,95%CI(0.36,1.18),P<0.001]、步幅[MD=2.35,95%CI(1.12,3.57),P<0.001]、耐力[MD=26.75,95%CI (6.89,46.60),P=0.008]、平衡功能[MD=3.29,95%CI (1.6...  相似文献   

6.
重新训练偏瘫患者的行走能力是脑卒中后康复训练的一个主要目标。有各种器具和助行器被推荐使用。其中 ,踝足矫形器被推荐用于减轻由脑卒中所致的肌张力降低及膝踝无力所带来的偏斜步态 ,并可用于纠正偏瘫及轻瘫患者中常见的痉挛性足下垂及马蹄足。本试验主要研究脑卒中患者康复后在出院时几项功能评价得分的结果与用踝足矫形器之间的相关性。资料与方法 患者来源为 1986年 1月 1日~1995年 12月 31日的 10年间在St Joseph′s健康中心的康复医院住过院并参加康复训练的脑卒中患者 ,共 4 2 8例 ,其中除去 5例非局限性蛛网膜下腔出血和硬膜…  相似文献   

7.
固定式踝足矫形器对下肢的影响   总被引:2,自引:4,他引:2  
目的:通过正常人体模拟穿戴矫形器的运动学和动力学分析,探讨固定式踝足矫形器的使用范围。方法:采用塑料制固定式踝足矫形器,通过12名正常女性穿戴矫形器和没有穿戴矫形器行走于10m的步态分析试验平台,采集受测试者身上相应的标志点和测力平台数据。结果:计算得出受测试者的穿戴矫形器和没有穿戴矫形器时相关的下肢运动角度和关节力矩等数据,并进行相应的对比分析。结论:只有充分考虑了患者各个关节的情况,才能制作出适合该患者的固定踝足矫形器。  相似文献   

8.
目的探讨功能性电刺激(FES)与踝足矫形器(AFO)改善脑卒中偏瘫患者步行功能的疗效对比。 方法采用随机数字表法将36例脑卒中偏瘫患者分为FES组及AFO组,每组18例。2组患者均给予常规药物治疗及康复干预。FES组患者在上述基础上采用步态训练矫正仪电刺激偏瘫侧下肢腓总神经及胫前肌,每天治疗30min,每周治疗5d,共持续治疗4周。AFO组患者则在上述常规治疗基础上通过佩戴固定式踝足矫形器进行步行训练,每天治疗30min,每周治疗5d,共持续治疗4周。于治疗前、治疗4周后分别采用10m最快步行速度测试(10MWT)、“起立-行走”计时测试(TUGT)、Holden步行功能评分(FAC)、踝趾屈肌肌张力评估及Brunnstrom运动功能分期对2组患者进行疗效评定。 结果治疗前2组患者10MWT、FAC、TUGT、踝趾屈肌肌张力、Brunnstrom运动功能分期组间差异均无统计学意义(P&rt;0.05)。分别经治疗4周后,发现2组患者10MWT、TUGT、FAC评分、Brunnstrom运动功能分期均较治疗前明显改善(P<0.05);进一步分析发现,治疗后FES组患者10MWT[(0.84±0.46)m/s]、FAC评分[(3.50±0.65)分]、Brunnstrom运动功能分期均显著优于AFO组,组间差异均具有统计学意义(P<0.05);治疗后2组患者TUGT、踝趾屈肌肌张力组间差异仍无统计学意义(P&rt;0.05)。 结论FES与AFO治疗均能促进脑卒中偏瘫患者步行功能恢复,并且FES较AFO能更显著改善脑卒中偏瘫患者下肢步行能力。  相似文献   

9.
摘要 目的:观察早期应用佩戴踝足矫形器(AFO)进行康复训练治疗脑卒中患者偏瘫步态的临床疗效。 方法:将63例脑卒中患者随机分为治疗组(Z组)和对照组(D组)。两组均按常规予以对症支持治疗和康复治疗,治疗组在对照组基础上加用AFO,康复训练4周后进行评定。治疗前后分别采用二维步态分析仪、表面肌电图机及相应量表评定两组患者的步行能力(包括步态参数及步行功能分级)、踝关节控制肌群(胫前肌及腓肠肌外侧头)的积分肌电值(iEMG)、运动功能、平衡功能、日常生活活动能力。 结果:治疗前后对比,治疗组步行能力的差异有显著性意义(P<0.01);对照组步行能力的差异也有显著性意义(P<0.01)。治疗后治疗组步行能力、下肢运动功能、平衡功能、日常生活活动能力、踝关节控制肌群肌力与对照组相比差异有显著性意义(P<0.05),治疗组优于对照组。 结论:早期佩戴AFO能够促进偏瘫患者步行能力、平衡功能、运动功能、日常生活活动能力、踝关节控制肌群肌力的恢复。  相似文献   

10.
目的 探讨痉挛型脑性瘫痪(脑瘫)患儿分别佩戴静态踝足矫形器(SAFO)和调谐静态踝足矫形器(TAFO)对患儿异常步态的影响。 方法 选取符合条件且具有行走能力的痉挛型脑瘫患儿23例,分别个性化定制和佩戴SAFO和TAFO,每例患儿穿戴适应期2周后,对所有患儿在赤足、佩戴SAFO、佩戴TAFO三种条件下相关的时空参数(包括步频、步速、步长)、运动学参数(包括首次触地膝关节屈曲角度、站立期最大膝关节屈曲角度、站立中期最大膝关节伸展角度、膝关节活动度、摆动期最大踝关节背屈角度)以及动力学参数(包括膝关节最大屈力矩、膝关节最大伸力矩、踝关节最大背屈力矩、踝关节最大跖屈力矩)进行步态分析和相关参数比较。 结果 ①对比赤足、佩戴SAFO、佩戴TAFO三种条件下患儿的步频[(116.37±18.25)、(118.17±12.64)和(121.38±13.24)steps/min]、步长[(0.44±0.11)、(0.48±0.15)和(0.51±0.12)m]、步速[(0.86±0.54)、(0.94±0.39)和(1.02±0.36)m/s]均有明显提高(P<0.05);佩戴SAFO与佩戴TAFO相比,佩戴TAFO条件下的步频、步速和步长均有显著增加(P<0.05)。②与佩戴SAFO条件下相比,佩戴TAFO条件下患儿的膝关节活动度明显增大(P<0.05),站立期最大膝关节伸展角度和摆动期最大踝关节背屈角度亦显著增大(P<0.05)。③与赤足和佩戴SAFO条件下相比,佩戴TAFO条件下的伸膝力矩显著减少(P<0.05);而佩戴TAFO条件下与佩戴SAFO相比,踝关节跖屈力矩显著增大(P<0.05)。 结论 佩戴TAFO和佩戴SAFO对改善痉挛型脑瘫儿童异常步态均起到积极作用,但佩戴TAFO更能优化脑瘫儿童异常步态,增强其步态的稳定性和流畅性。  相似文献   

11.
目的:探讨社区康复专业人员介入对上海市适配辅助器具家庭组合的影响。方法:将上海市杨浦区12个街道筛选持有上海市残疾证明的脑卒中患者120例随机分为2组各60例,对照组进行常规辅助器具家庭组合适配。观察组在此服务的基础上,对社区康复专业人员、脑卒中患者和家属进行相关培训,然后由经过培训的社区康复医生参与整个适配过程。在辅具适配开始前及适配后3个月,采用巴氏指数(BI)及健康状况调查问卷(SF-36)分别对2组患者进行相关功能评定,同时评定辅助器具使用的满意度(魁北克辅助科技使用者满意度评估量表(QUEST)和辅具使用率。结果:干预3个月后,2组BI评分及SF-36各维度得分均较干预前明显提高(P0.05);且观察组更高于对照组(P0.05)。干预后,观察组QUEST评分明显高于对照组(P0.05)。结论:整合社区康复资源,增加对社区康复人员、脑卒中患者及家属进行相关的培训,可以明显提高脑卒中患者对辅助器具家庭组合适配后的独立生活能力及生存质量,提高辅具的使用率及对辅具适配服务的满意度。  相似文献   

12.
The purpose of this study was to investigate the effects of selected assistive devices on normal standards of gait. The gait characteristics of stride length, step length, step width, and foot angle were analyzed for 24 right-dominant, healthy men under four conditions: right ankle-foot orthosis (AFO), right hemiplegic arm sling (HAS), both devices (AFO+HAS), and no devices. The dependent variables were measured by a standard method from ink traces left by subjects walking on newsprint. Order of conditions was controlled, and cadence remained consistent across all four conditions for each subject. The AFO and AFO+HAS conditions produced statistically significant changes from normal gait characteristics. The HAS alone did not produce significant changes. Data from the study may be used as a basis for goal setting and as a guideline for the optimal level of function possible for a person wearing these devices. The extent of the patient's orthopedic and neurologic involvement should of course be considered.  相似文献   

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Abstract

Aim: The aim of this study was to verify the prevalence of falls in frail users of ambulatory assistive devices (AAD) and compare with controls.

Materials and methods: Nineteen frail elderly users of AAD (G1) and 31 non-users (G2) participated in the study. The occurrence of falls, at the last 6 months, was collected by an interview with the patient and the caregiver. Cognitive status was assessed by the Mini Mental State Examination, functional capacity by the Pfeffer’s Questionnaire and Modified Barthel’s Index, the frail level by a functional stratification and the risk of falls by the Timed Up and Go (TUG) test. T-Student test was used to compare independent variables. The significance level was set at 5%.

Results: Both groups G1 and G2 were homogeneous in relation to the functional and sociodemographic variables. G1 reported more falls in the last 6 months, but most of the participants did not use AAD at the time of the fall. Transferences were the main reason for falls in G1 and stumble in the street in G2.

Conclusion: Elderly users of AAD fall out when they are not using the walk device.
  • IMPLICATIONS FOR REHABILITATION
  • Falling is the second leading cause of death from unintentional injuries in the world. Fall prevention programmes prescribe ambulatory assistive devices, such as walking sticks, crutches and walkers device and walking training with a physiotherapist to provide independence, safety, satisfaction, adherence and psychosocial benefits. However, studies have showed a higher prevalence of falls in frail elderly users of ambulatory-assistive devices.

  • In our study, we verified if users of the ambulatory-assistive devices were using it at the moment of the fall. We found that frail elderly fall down when they are not using the walk device during their activities of day living. Thus, education strategies should be developed to encourage the use of ambulatory-assistive devices by the frail elderly previously evaluated by physiotherapists. Prevalence of falls in this population could reduce if frail elderly users of ambulatory assistive devices really use it during the activities of daily living.

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16.
BackgroundEnd-stage ankle arthritis is a debilitating condition that often requires surgical intervention after failed conservative treatments. Ankle arthrodesis is a common surgical option, especially for younger and highly active patients; however, ankle arthroplasty has become increasingly popular as advancements in implant design improve device longevity. The longitudinal differences in biomechanical outcomes between these surgical treatments remain indistinct, likely due to the challenges associated with objective study of a heterogeneous population.MethodsPatients scheduled for arthroplasty (n = 27) and arthrodesis (n = 20) were recruited to participate in this three-year prospective study. Postoperative functional outcomes were compared at distinct annual time increments using measures of gait analysis, average daily step count and survey score.FindingsBoth surgical groups presented reduced pain, improved survey scores, and increased walking speed at the first-year postoperative session, which were generally consistent across the three-year follow-up. Arthrodesis patients walked with decreased sagittal ankle RoM, increased sagittal hip RoM, increased step length, and increased transient force at heel strike, postoperatively. Arthroplasty patients increased ankle RoM and cadence, with no changes in hip RoM, step length or heel strike transient force.InterpretationMost postoperative changes were detected at the first-year follow-up session and maintained across the three-year time period. Despite generally favorable outcomes associated with both surgeries, several underlying postoperative biomechanical differences were detected, which may have long-term functional consequences. Furthermore, neither technique was able to completely restore gait biomechanics to the levels of the contralateral unaffected limb, leaving potential for the development of improved surgical and rehabilitative treatments.  相似文献   

17.
Total knee arthroplasty (TKA) is a surgical procedure used in patients with Osteoarthritis to improve their state. An understanding about how gait patterns differ from patient to patient and are influenced by the assistive device (AD) that is prescribed is still missing. This article focuses on such purpose. Standard walker, crutches and rollator were tested. Symmetric indexes of spatiotemporal and postural control features were calculated. In order to select the important features which can discriminate the differences among the ADs, different techniques for feature selection are investigated. Classification is handled by Multi-class Support Vector Machine. Results showed that rollator provides a more symmetrical gait and crutches demonstrated to be the worst. Relatively to postural control parameters, standard walker is the most stable and crutches are the worst AD. This means that, depending on the patient’s problem and the recovery goal, different ADs should be used. After selecting a set of 16 important features, through correlation, it was demonstrated that they provide important quantitative information about the functional capacity, which is not represented by velocity, cadence and clinical scales. Also, they were capable of distinguishing the gait patterns influenced by each AD, showing that each patient has different needs during recovery.
  • Implications of Rehabilitation
  • An understanding about how gait patterns of post-surgical patients differ from person to person and how they are influenced by the type of device that is prescribed during their recovery might help in physical therapy. Research specifically addressing these issues is still missing.

  • Inter-limb asymmetry and postural control features can be evaluated in an outpatient setting, supplying important additional information about individual gait pattern, which is not represented by gait velocity, cadence and scales usually used.

  • The features calculated in this study are able to provide complementary information to gait velocity, cadence and clinical scales to assess the functional capacity of patients that passed through TKA. The selected parameters make a new clinical tool useful for tracking the evolution of patients’ recovery after TKA.

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18.
重庆市残疾人辅助器具需求分析   总被引:2,自引:0,他引:2  
目的:调查重庆市残疾人辅助器具的需求情况,为辅助器具配送和补助政策的制定提供客观依据.方法:以2006年全国第2次残疾人抽样调查重庆市的4990名残疾人为研究对象,调查其辅助器具需求现状.结果:重庆市残疾人的辅助器具需求比例较高,而且辅助器具是许多残疾人生活中必不可少的,目前提供的服务不能满足其需要.结论:残疾人能借助辅助器具独立参与社会生活,应重视残疾人辅助器具配送工作,以提高其生存质量.  相似文献   

19.
摘要 目的:基于软管喉镜吞咽功能评估(flexible endoscopic evaluation of swallowing, FEES),比较经鼻留置胃管管饲(nasal indwelling gastric tube feeding, NGT)与间歇性经口至食管管饲法(Intermittent oro-esophageal tube feeding, IOE)在减少鼻胃管综合征发生率、改善咽期吞咽功能和气道保护功能方面是否存在疗效差异。 方法:选取脑卒中后吞咽障碍患者54例,根据营养摄入方式分为NGT组28例,IOE组26例。其中NGT组中有14例患者由NGT转变为IOE,将这些患者归为NGT-IOE亚组,另外14例继续沿用NGT,为NGT-NGT亚组。采用FEES评定各组患者的咽喉部生理结构情况,包括会厌形状、杓状软骨黏膜水肿程度、声带运动能力;咽喉部分泌物情况,包括分泌物严重程度分级(Murry secretion severity scale, MSS);咽期吞咽功能-喉部感觉功能、吞咽反射能力、食物残留等级(Yale pharyngeal residue severity rating scale, YPR-SRS)、Rosenbek渗漏/误吸等级(penetration-aspiration scale, PAS),并使用吞咽功能性交流测试评分(functional communication measure swallowing, FCM)评定患者整体的吞咽能力。 结果:NGT组与IOE组患者的各项评分比较,NGT组患者的MSS、PAS、FCM评分显著低于IOE组(P<0.05),且会厌形状异常和杓状软骨黏膜水肿程度显著高于IOE组(P<0.05)。NGT-IOE亚组患者拔管后MSS、YPR-SRS(会厌谷)、YPR-SRS(梨状窝)、PAS、FCM评分较拔管前显著提高(P<0.05),提示存在鼻胃管综合征的会厌形状异常情况、杓状软骨黏膜水肿和声带外展受限均较拔管前显著降低(P<0.05),另外,喉部感觉功能也较拔管前显著改善(P<0.05)。NGT-NGT亚组两周前、后的各项评分比较均无显著性意义(P>0.05)。 结论:与NGT相比,IOE可以减少脑卒中后吞咽障碍患者鼻胃管综合征的发生率,并改善咽期吞咽和气道保护功能,故对于长期留置鼻饲胃管的患者,有必要尽早考虑转变为IOE的可能性。  相似文献   

20.
Background and Purpose . The aim of the present study was to analyse the co‐variation of different tests commonly used in stroke rehabilitation, and specifically used in a recent randomized, controlled study of two different physiotherapy models in stroke rehabilitation. Method . Correlations of the performed tests and recordings from previous work were studied. The test results from three‐month, one‐year and four‐year follow‐up were analysed in an SPSS Version 11 statistical package with Pearson and Spearman correlations. Results . There was an expected high correlation between the motor function tests, both based on partial and total scores. The correlations between Nottingham Health Profile Part 1 and Motor Assessment Scale (MAS), Sødring Motor Eevaluation Scale (SMES), the Berg Balance Scale (BBS) and Barthel Activities of Daily Living (ADL) index were low for all items except physical condition. The correlations between registered living conditions, assistive devices, recurrent stroke, motor function (MAS, SMES), ADL (Barthel ADL index) and balance (BBS) were high. The same variables showed weak or poor correlation to the Nottingham Health Profile (NHP). Conclusions . The co‐variations of motor function tests and functional tests were high, but the co‐variations of motor, functional and self‐reported life‐quality tests were poor. The patients rated themselves on a higher functional level in the self‐reported tests than was observed objectively in the performance‐based tests. A possible reason for this is that the patients may have been unaware they modified their performance to adjust for physical decline, and consequently overestimate their physical condition. This result underlines the importance of both performance‐based and self‐reported tests as complementary tools in a rehabilitation process. Copyright © 2006 John Wiley & Sons, Ltd.  相似文献   

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