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1.
Heather A. Feldner Darrin Howell Valerie E. Kelly Sarah Westcott McCoy Katherine M. Steele 《Archives of physical medicine and rehabilitation》2019,100(4):663-675
Objective
To examine the perceived value, benefits, drawbacks, and ideas for technology development and implementation of surface electromyography recordings in neurologic rehabilitation practice from clinical stakeholder perspectives.Design
A qualitative, phenomenological study was conducted. In-depth, semistructured interviews and focus groups were completed. Sessions included questions about clinician perspectives and demonstrations of surface electromyography systems to garner perceptions of specific system features.Setting
The study was conducted at hospital systems in a large metropolitan area.Participants
Adult and pediatric physical therapists, occupational therapists, and physiatrists from inpatient, outpatient, and research settings (N=22) took part in the study.Interventions
Not applicable.Main Outcome Measures
Interviews and focus groups were audio-recorded, transcribed verbatim, then coded for analysis into themes.Results
Four major themes emerged: (1) low-tech clinical practice and future directions for rehabilitation; (2) barriers to surface electromyography uptake and potential solutions; (3) benefits of surface electromyography for targeted populations; and (4) essential features of surface electromyography systems.Conclusions
Surface electromyography systems were not routinely utilized for assessment or intervention following neurologic injury. Despite recognition of potential clinical benefits of surface electromyography use, clinicians identified limited time and resources as key barriers to implementation. Perspectives on design and surface electromyography system features indicated the need for streamlined, intuitive, and clinically effective applications. Further research is needed to determine feasibility and clinical relevance of surface electromyography in rehabilitation intervention. 相似文献2.
Kiran Satpute Toby Hall Richa Bisen Pramod Lokhande 《Archives of physical medicine and rehabilitation》2019,100(5):828-836
Objectives
To evaluate the effect of spinal mobilization with leg movement (SMWLM) on low back and leg pain intensity, disability, pain centralization, and patient satisfaction in participants with lumbar radiculopathy.Design
A double-blind randomized controlled trial.Setting
General hospital.Participants
Adults (N=60; mean age 44y) with subacute lumbar radiculopathy.Interventions
Participants were randomly allocated to receive SMWLM, exercise and electrotherapy (n=30), or exercise and electrotherapy alone (n=30). All participants received 6 sessions over 2 weeks.Main Outcome Measures
The primary outcomes were leg pain intensity and Oswestry Disability Index score. Secondary variables were low back pain intensity, global rating of change (GROC), straight leg raise (SLR), and lumbar range of motion (ROM). Variables were evaluated blind at baseline, post-intervention, and at 3 and 6 months of follow-up.Results
Significant and clinically meaningful improvement occurred in all outcome variables. At 2 weeks the SMWLM group had significantly greater improvement than the control group in leg pain (MD 2.0; 95% confidence interval [95% CI], 1.4-2.6) and disability (MD 3.9; 95% CI, 5.5-2.2). Similarly, at 6 months, the SMWLM group had significantly greater improvement than the control group in leg pain (MD 2.6; 95% CI, 1.9-3.2) and disability (MD 4.7; 95% CI, 6.3-3.1). The SMWLM group also reported greater improvement in the GROC and in SLR ROM.Conclusion
In patients with lumbar radiculopathy, the addition of SMWLM provided significantly improved benefits in leg and back pain, disability, SLR ROM, and patient satisfaction in the short and long term. 相似文献3.
Tessa Hart John Whyte Monica Vaccaro Amanda R. Rabinowitz 《Archives of physical medicine and rehabilitation》2019,100(5):987-989
Objective
Determine agreement between self-reported dose and dose reflected in administrative records of outpatient physical, occupational, and speech therapies at 6 and 12 months after severe traumatic brain injury (TBI), for the purpose of examining accuracy and predictors of accuracy of self-reported health care utilization in this population.Design
Secondary analysis of survey used in a larger study; participants were queried about therapy doses using a structured interview, either alone or assisted by relatives if they so chose, with responses compared to administrative records.Setting
Rehabilitation center providing outpatient TBI therapies.Participants
Sixty-five people with severe TBI living in the community provided 6-month data (N=65); 54 provided 12-month data.Interventions
Not applicable.Main Outcome Measures
Degree of agreement with administrative records of scheduled and billed therapy appointments, measured using intraclass correlation coefficients (ICCs), with linear regression used to predict accuracy from demographic variables and cognitive status.Results
ICCs were in the moderate range at 6 months, but were more variable, with some in the poor range, at 12 months. Agreement was higher for scheduled than for billed (attended) appointments. Assisted and unassisted patients provided comparable agreement with records. No demographic factors were associated with accuracy, but lower cognitive FIM scores, as hypothesized, tended to predict lower agreement at 6 months.Conclusions
People with severe TBI can provide reasonable estimates of commonly prescribed outpatient therapy doses at 6 months postinjury. Accuracy may be improved by inviting patients to request assistance from relatives and by asking them to consider attended (vs scheduled) sessions. 相似文献4.
Jessica M. Jarvis Karen Choong Mary A. Khetani 《Archives of physical medicine and rehabilitation》2019,100(4):703-710
Objective(s)
Determine the associations between having participation-focused strategies and receiving rehabilitation services in the pediatric intensive care unit (PICU) with caregiver stress over 6 months post-PICU discharge.Design
Substudy of a data from Wee-Cover, a prospective cohort study.Setting
Two PICU sites.Participants
Caregivers (N=168) of children 1-17 years old admitted into a PICU for ≥48 hours.Main Outcome Measures
Data were collected from caregivers at enrollment and 3 and 6 months post-PICU discharge. Caregiver stress was assessed using the Pediatric Inventory for Parents. Having strategies to support their child’s participation in home-based activities was assessed using the Participation and Environment Measure (PEM). In PEM, caregivers report on strategies used to support their child’s participation in home-based activities. Data were dichotomized (yes, no) to denote having participation-focused strategies and if their child received PICU rehabilitation services. Additional covariates were history of a preexisting condition, child age, length of PICU stay, and change in functional capacities at PICU discharge.Results
History of a preexisting condition, time, and change in functional capacities significantly predicted caregiver stress frequency and difficulty. The interaction of having strategies-by-rehabilitation-by-time significantly predicted caregiver stress frequency and difficulty.Conclusion(s)
Results highlight the role of early rehabilitation and the importance of working with caregivers to develop participation-focused strategies to support their child’s functioning post-PICU. Families of children with a preexisting condition or those who experience a decrease in function during a PICU stay are susceptible to higher levels of stress and may be a priority population to target for rehabilitation services. 相似文献5.
Ting-ting Yeh Ku-chou Chang Ching-yi Wu 《Archives of physical medicine and rehabilitation》2019,100(5):821-827
Objective
To investigate the efficacy of a sequential combination of aerobic exercise and cognitive training on cognitive function and other health-related outcomes in stroke survivors with cognitive decline.Design
Intervention study and randomized controlled trial.Setting
Hospital-based rehabilitation units.Participants
Survivors of stroke with cognitive decline (N=30) were randomized to sequential combination training (SEQ) (n=15) or an active control (n=15) group.Interventions
The SEQ group received 30 minutes of aerobic exercise, followed by 30 minutes of computerized cognitive training. The control group received 30 minutes of nonaerobic physical exercise, followed by 30 minutes of unstructured mental activities.Main Outcome Measures
The primary outcome measure was cognitive function. Secondary outcome measures included physical function, social participation, and quality of life.Results
Compared with the control group, the SEQ group had significantly improved Montreal Cognitive Assessment scores (P=.03) and Wechsler Memory Scale span scores (P=.012) after training. The endurance and mobility level measured by the 6-minute walk test (P=.25) was also enhanced in the SEQ group relative to the control group. However, the transfer of sequential training to social participation (Community Integration Questionnaire) and quality of life (EuroQoL questionnaire) was limited (P>.05 for both).Conclusions
Aerobic exercise combined with computerized cognitive training has better effects on the cognitive functional status of survivors of stroke than an active control. The cognitive functional status of stroke survivors was better after participation in aerobic exercise combined with computerized training than after active control therapy, demonstrating the clinical significance of this combination therapy. 相似文献6.
Adam T. Booth Annemieke I. Buizer Jaap Harlaar Frans Steenbrink Marjolein M. van der Krogt 《Archives of physical medicine and rehabilitation》2019,100(4):598-605
Objective
To investigate the immediate response to avatar-based biofeedback on 3 clinically important gait parameters: step length, knee extension, and ankle power in children with cerebral palsy (CP).Design
Repeated measures design.Setting
Rehabilitation clinic.Participants
Children with spastic paresis (N=22; 10.5±3.1y), able to walk without assistive devices.Intervention
Children walked on a treadmill with a virtual reality environment. Following baseline gait analysis, they were challenged to improve aspects of gait. Children visualized themselves as an avatar, representing movement in real time. They underwent a series of 2-minute trials receiving avatar-based biofeedback on step length, knee extension, and ankle power. To investigate optimization of biofeedback visualization, additional trials in which knee extension was visualized as a simple bar with no avatar; and avatar alone with no specific biofeedback were carried out.Main Outcome Measures
Gait pattern, as measured by joint angles, powers, and spatiotemporal parameters, were compared between baseline and biofeedback trials.Results
Participants were able to adapt gait pattern with biofeedback, in an immediate response, reaching large increases in ankle power generation at push-off (37.7%) and clinically important improvements in knee extension (7.4o) and step length (12.7%). Biofeedback on one parameter had indirect influence on other aspects of gait.Conclusion
Children with CP show capacity in motor function to achieve improvements in clinically important aspects of gait. Visualizing biofeedback with an avatar was subjectively preferential compared to a simplified bar presentation of knee angle. Future studies are required to investigate if observed transient effects of biofeedback can be retained with prolonged training to test whether biofeedback-based gait training may be implemented as a therapy tool. 相似文献7.
Objective
To evaluate the effect of implementing hourly rounds on a mother–baby unit (MBU) on the perception of care by women admitted to the hospital for birth or with pregnancy complications.Design
Retrospective, quantitative, before–after study.Setting/Local Problem
The MBU of a large metropolitan hospital in the northeastern United States was the setting. With considerable resources allocated to hourly rounding implementation, there was a need to examine whether hourly rounds influenced the perception of communication with nurses by women admitted to the hospital for prenatal care and women's likelihood to recommend the hospital.Participants
Women ages 18 years and older discharged from the MBU.Intervention/Measurements
Hospital Consumer Assessment of Healthcare Providers and Services (HCAHPS) survey responses collected from women at discharge, before and after hourly rounds implementation on the MBU, were compared. Aggregate data were retrieved from Press Ganey reports.Results
No significant change in women’s perceptions of nursing care and communication was found when comparing pre- and postintervention samples.Conclusion
Although we found no statistically significant change in perception of care, we have identified opportunities for future research. More research is need to explore what approaches for hourly rounds implementation and sustainability are most effective. Additionally, there is a need to study whether vital aspects of care identified by pregnant women admitted to the hospital are similar or different compared with other populations. 相似文献8.
Laura C. Simko Liang Chen Dagmar Amtmann Nicole Gibran David Herndon Karen Kowalske A. Cate Miller Eileen Bulger Ryan Friedman Audrey Wolfe Kevin K. Chung Michael Mosier James Jeng Joseph Giacino Ross Zafonte Lewis E. Kazis Jeffrey C. Schneider Colleen M. Ryan 《Archives of physical medicine and rehabilitation》2019,100(5):891-898
Objective
Common data elements (CDEs) promote data sharing, standardization, and uniform data collection, which facilitate meta-analyses and comparisons of studies. Currently, there is no set of CDEs for all trauma populations, but their creation would allow researchers to leverage existing databases to maximize research on trauma outcomes. The purpose of this study is to assess the extent of common data collection among 5 trauma databases.Design
The data dictionaries of 5 trauma databases were examined to determine the extent of common data collection. Databases included 2 acute care databases (American Burn Association’s National Burn Data Standard and American College of Surgeons’ National Trauma Data Standard) and 3 longitudinal trauma databases (Burn, Traumatic Brain Injury, Spinal Cord Injury Model System National Databases). Data elements and data values were compared across the databases. Quantitative and qualitative variations in the data were identified to highlight meaningful differences between datasets.Setting
N/A.Participants
N/A.Interventions
N/A.Main Outcome Measures
N/A.Results
Of the 30 data elements examined, 14 (47%) were present in all 5 databases. Another 9 (30%) elements were present in 4 of the 5 databases. The number of elements present in each database ranged from 23 (77%) to 26 (86%). There were inconsistencies in the data values across the databases. Twelve of the 14 data elements present in all 5 databases exhibited differences in data values.Conclusions
This study demonstrates inconsistencies in the documentation of data elements in 5 common trauma databases. These discrepancies are a barrier to database harmonization and to maximizing the use of these databases through linking, pooling, and comparing data. A collaborative effort is required to develop a standardized set of elements for trauma research. 相似文献9.
Jonathan Tsehaie Kim R. Spekreijse Robbert M. Wouters Reinier Feitz Steven E.R. Hovius Harm P. Slijper Ruud W. Selles 《Archives of physical medicine and rehabilitation》2019,100(5):844-850
Objectives
(1) To identify predictive factors for outcome after splinting and hand therapy for carpometacarpal (CMC) osteoarthritis (OA) and to identify predictive factors for conversion to surgical treatment; and (2) to determine how many patients who have not improved in outcome within 6 weeks after start of treatment will eventually improve after 3 months.Design
Observational prospective multicenter cohort study.Setting
Xpert Clinic in the Netherlands. This clinic comprises 15 locations in the Netherlands, with 16 European Board certified (FESSH) hand surgeons and over 50 hand therapists.Participants
Between 2011 and 2014, patients with CMC OA (N=809) received splinting and weekly hand therapy for 3 months.Intervention
Not applicable.Main Outcome Measures
Satisfaction and pain were measured with a visual analog scale and function with the Michigan Hand Questionnaire at baseline, 6 weeks, and 3 months posttreatment. Using regression analysis, patient demographics and pretreatment baseline scores were considered as predictors for the outcome of conservative treatment after 3 months and for conversion to surgery.Results
Multivariable regression model explained 34%-42% of the variance in outcome (P<.001) with baseline satisfaction, pain, and function as significant predictors. Cox regression analysis showed that baseline pain and function were significant predictors for receiving surgery. Of patients with no clinically relevant improvement in pain and function after 6 weeks, 73%-83% also had no clinically relevant improvement after 3 months.Conclusion
This study showed that patients with either high pain or low function may benefit most from conservative treatment. We therefore recommend to always start with conservative treatment, regardless of symptom severity of functional loss at start of treatment. Furthermore, it seems valuable to discuss the possibility of surgery with patients after 6 weeks of therapy, when levels of improvement are still mainly unsatisfactory. 相似文献10.
11.
Natalie A. Fini Angela T. Burge Julie Bernhardt Anne E. Holland 《Archives of physical medicine and rehabilitation》2019,100(5):883-890
Objective
The aim of this study was to determine the duration of physical activity (PA) monitoring required for reliable measurements following stroke.Design
Single-center, prospective, observational study.Setting
PA was measured in a community setting.Participants
Adults (N=70) poststroke.Main Outcome Measures
The SenseWear armband was used to monitor PA for 5 days (≥10 hours wear per day).Data Analysis
Variance among 2, 3, 4, and 5 days of consecutive measurements for PA variables was examined using intraclass correlation coefficients (ICCs). The minimum number of days to achieve acceptable reliability (ICC ≥0.8) was calculated. Differences between weekdays and weekend days were investigated using paired t tests and Wilcoxon signed rank tests.Results
Two days of measurement was sufficient to achieve an ICC ≥0.8 for daily averages of total energy expenditure, step count, and time spent sedentary (≤1.5 metabolic equivalent tasks [METs]) and in light (1.5-3 METs) and moderate- to vigorous-intensity (>3 METs) PA. At least 3 days were required to achieve an ICC ≥0.8 when investigating the number of and time spent in bouts (≥10 minutes) of moderate to vigorous PA and sedentary behavior. Participants took significantly more steps (P=.03) and spent more time in light PA (P=.03) on weekdays than weekends.Conclusion
Following stroke, 2 days of measurement appears sufficient to represent habitual PA for many simple variables. Three or more days may be necessary for reliable estimates of bouts of PA and sedentary behavior. Consistent inclusion or exclusion of a weekend day is recommended for measuring step count and light PA. Short periods of monitoring provide reliable PA information and may make PA measurement more feasible in the clinical setting. 相似文献12.
Hsiu-Yun Hsu Ta-Shen Kuan Hsiu-Ching Yang Ching-Liang Tsai Chien-Hsien Yeh Chih-Chun Lin Li-Chieh Kuo 《Archives of physical medicine and rehabilitation》2019,100(4):620-626
Objectives
To investigate the reliability and validity of a modified pinch apparatus devised with 3 surface textures and 2 different weights for clinical application.Design
Case-controlled study.Setting
A university hospital.Participants
The participants (N=32) included carpal tunnel syndrome (CTS) patients (n=16) with 20 sensory neuropathy hands, and an equal number of age-sex matched volunteers without CTS, as well as young volunteers without CTS (n=16 with 20 hands) used to analyze both the testing validity and reliability of the modified device.Interventions
Not applicable.Main Outcome Measures
The Semmes-Weinstein monofilament (SWM) and two-point discrimination (2PD) tests were conducted, and the force ratio between the FPpeak (peak pinch force during lifting phase) and FLmax (maximum load force at maximum upward acceleration onset) detected from a pinch-holding-up activity (PHUA) under various testing conditions was obtained.Results
The range of the intraclass correlation coefficient of this pinch device was 0.369-0.952. The CTS patients exhibited poorer force modulation ability according to the inertial change in a dynamic lifting task when compared to the controls under all testing conditions (P<.001). The area under the receiver operating characteristic force ratio curve was 0.841, revealing high accuracy of the test for diagnosing CTS neuropathic hands under the testing condition in which the 125-g coarse texture device was used. In addition, the weight factor was shown to have significant effects on the sensitivity and accuracy of the PHUA assessment.Conclusions
This study showed that the PHUA test via the modified pinch apparatus is a sensitive tool that can be used in clinical practice for detecting neuropathic CTS hands. In addition, changing the weight of the pinch device has a significant effect on the sensitivity and accuracy of the PHUA assessment. 相似文献13.
Sarah E. Reedman Roslyn N. Boyd Stewart G. Trost Catherine Elliott Leanne Sakzewski 《Archives of physical medicine and rehabilitation》2019,100(4):676-686
Objective
To determine the efficacy of a participation-focused therapy (ParticiPAte CP) on leisure-time physical activity goal performance and satisfaction and habitual physical activity (HPA) in children with CP.Design
Randomized waitlist-controlled trial.Setting
Home and community.Participants
Children classified at Gross Motor Function Classification System (GMFCS) levels I-III were recruited (n=37; 18 males; mean age ± SD, 10.0±1.4y) from a population-based register.Interventions
Participants were randomized to ParticiPAte CP (an 8-wk goal-directed, individualized, participation-focused therapy delivered by a physical therapist) or waitlist usual care.Main Outcome Measures
The primary outcome was Canadian Occupational Performance Measure. Accelerometers were worn for objective measurement of HPA (min/d moderate-to-vigorous physical activity [MVPA], sedentary time). Barriers to participation, community participation, and quality-of-life outcomes were also collected. Data were analyzed by intention-to-treat using generalized estimating equations.Results
ParticiPAte CP led to significant improvements in goal performance (mean difference [MD]=3.58; 95% confidence interval [95% CI], 2.19-4.97; P<.001), satisfaction (MD=1.87; 95% CI, 0.37-3.36, P=.014), and barriers to participation (MD=26.39; 95% CI, 6.13-46.67; P=.011) compared with usual care at 8 weeks. There were no between-group differences on minutes per day of MVPA at 8 weeks (MD=1.17; 95% CI, ?13.27 to 15.61; P=.874). There was a significant difference in response to intervention between participants who were versus were not meeting HPA guidelines at baseline (MD=15.85; 95% CI, 3.80-27.89; P<.0061). After ParticiPAte CP, low active participants had increased average MVPA by 5.98±12.16 minutes per day.Conclusion
ParticiPAte CP was effective at increasing perceived performance of leisure-time physical activity goals in children with CP GMFCS I-III by reducing modifiable barriers to participation. This did not translate into change in HPA on average; however, low active children may have a clinically meaningful response. 相似文献14.
Gong-Hong Lin Yi-Jing Huang Ya-Chen Lee Shih-Chieh Lee Chia-Yeh Chou Ching-Lin Hsieh 《Archives of physical medicine and rehabilitation》2019,100(5):899-907
Objective
The authors aimed to develop and validate the Computerized Adaptive Testing System for Assessing 5 Functions in Patients with Stroke (CAT-5F) based on the Barthel Index (BI), Postural Assessment Scale for Stroke patients (PASS), and Stroke Rehabilitation Assessment of Movement (STREAM) to improve the efficiency of assessment. The purposes of the CAT-5F assessment are to describe patients’ levels of impairments or disabilities in the 5 functions and to serve as an outcome measure in patients with stroke.Design
This is a data-mining study based on data from a previous study using simulation analysis to develop and validate the CAT-5F.Setting
One rehabilitation unit in a medical center in Taiwan served as the setting for this study.Participants
Data were retrieved from totals of 540 (initial assessment) and 309 (discharge assessment) participants with stroke assessed in a previous study. The assessment data (N=540) were from the BI, PASS, and STREAM.Interventions
Not applicable.Main Outcome Measures
The outcome measures for this study were from BI, PASS, and STREAM.Results
The CAT-5F using the optimal stopping rule (limited reliability increased <0.010) had good Rasch reliability across the 5 functions (0.86-0.96) and needed 12.7 items, on average, for the whole administration. The concurrent validity (Pearson product-moment correlation coefficient, r=0.91-0.96) and responsiveness (standardized response mean=0.33-0.91) of the CAT-5F were sufficient in the patients.Conclusion
The CAT-5F has sufficient administrative efficiency, reliability, concurrent validity, and responsiveness to simultaneously assess basic activities of daily living, postural control, upper extremity/lower extremity motor functions, and mobility in patients with stroke. 相似文献15.
Elke Pucks-Faes Heinrich Matzak Gabriel Hitzenberger Eleonora Genelin Lucas-Michael Halbmayer Elena Fava Josef Fritz Leopold Saltuari 《Archives of physical medicine and rehabilitation》2019,100(5):837-843
Objective
To report our experience using continuous intrathecal baclofen (ITB) administration prior to a possible ITB device implantation.Design
Retrospective open label study. Mean duration of follow-up 64 months.Setting
Primary-care and referral center, ambulatory and hospitalized care.Participants
Patients (N=116) undergoing continuous ITB trials between 2006 and 2017.Interventions
Continuous application of baclofen via a temporary intrathecal catheter connected to an external pump.Main Outcome Measures
Assessment of the modified Ashworth Scale and range of movement prior versus end of ITB trial. According to the Barthel Index, definition of high-level patients (60-100 scoring points) and low-level patients (0-55 scoring points). Calculation of the Rivermead Mobility Index in high-level patients prior versus end of ITB trial. Evaluation of occurring adverse events.Results
A total of 119 ITB trials were performed in 116 patients (78 men, mean age 41±16), 113 patients completed the trials (31 of 113 high level, 82 of 113 low level). The median modified Ashworth scale improved from 4 (interquartile range [IQR] 3-4) to 2 (IQR 1-2; P≤.001), the range of movement from 2 (IQR 1-3) to 3 (IQR 3-3; P≤.001). The Rivermead Mobility Index increased from 9 (IQR 6-12) to 10 (IQR 7-12.5; P=.004) in high-level patients. Eighty-eight out of 113 patients (78%) were appropriate candidates for ITB device surgery, 75 of 88 (85%) proceeded to an implantation. A total of 69 adverse events occurred in 57 of 119 trials (48%), 37 of 69 (54%) were drug related, 32 of 69 (46%) were procedure related, and 42 of 69 (61%) were minor. The ITB device was implanted in 69 of 75 patients (92%) at last follow-up.Conclusions
Continuous administration of ITB is an effective and useful alternative to ITB bolus application during ITB screening period. Half of the patients experienced adverse events; the majority were minor events. 相似文献16.
Amy Hammerich Julie Whitman Paul Mintken Thomas Denninger Venu Akuthota Eric E. Sawyer Melissa Hofmann John D. Childs Joshua Cleland 《Archives of physical medicine and rehabilitation》2019,100(5):797-810
Objective
To examine the effectiveness of epidural steroid injection (ESI) and back education with and without physical therapy (PT) in individuals with lumbar spinal stenosis (LSS).Design
Randomized clinical trial.Setting
Orthopedic spine clinics.Participants
A total of 390 individuals were screened with 60 eligible and randomly selected to receive ESI and education with or without PT (N=54).Interventions
A total of 54 individuals received 1-3 injections and education in a 10-week intervention period, with 31 receiving injections and education only (ESI) and 23 additionally receiving 8-10 sessions of multimodal PT (ESI+PT).Main Outcome Measures
Disability, pain, quality of life, and global rating of change were collected at 10 weeks, 6 months, and 1 year and analyzed using linear mixed model analysis.Results
No significant difference was found between ESI and ESI+PT in the Oswestry Disability Index at any time point, although the sample had significant improvements at 10 weeks (P<.001; 95% confidence interval [CI], ?18.01 to ?5.51) and 1 year (P=.01; 95% CI, ?14.57 to ?2.03) above minimal clinically important difference. Significant differences in the RAND 36-Item Short Form Health Survey 1.0 were found for ESI+PT at 10 weeks with higher emotional role function (P=.03; 95% CI, ?49.05 to ?8.01), emotional well-being (P=.02; 95% CI, ?19.52 to -2.99), and general health perception (P=.05; 95% CI, ?17.20 to ?.78).Conclusions
Epidural steroid injection plus PT was not superior to ESI alone for reducing disability in individuals with LSS. Significant benefit was found for the addition of PT related to quality of life factors of emotional function, emotional well-being, and perception of general health. 相似文献17.
Neda Orakifar Mohammad Jafar Shaterzadeh-Yazdi Reza Salehi Mohammad Mehravar Neda Namnik 《Archives of physical medicine and rehabilitation》2019,100(5):851-858
Objective
To investigate impairment in the activity pattern of some muscles involved in sit to stand (STD) and stand to sit (STS) among 2 low back pain (LBP) subgroups of the Movement System Impairment (MSI) model.Design
Case-control study.Setting
A university medical center.Participants
Fifteen women without chronic LBP and 22 women with chronic LBP (N=37) in 2 subgroups (15 into the lumbar extension rotation (LER) and 7 into lumbar flexion rotation [LFR]) voluntarily participated in this study.Interventions
Participants were asked to perform STD and STS at a preferred speed. Surface electromyography (EMG) were measured bilaterally from the internal oblique (IO), lumbar erector spine (ES), medial hamstring (MH), and lateral hamstring (LH) muscles.Main Outcome Measures
Changes in mean and maximum amplitude, time to peak amplitude, duration of muscle activity, and bilateral asymmetry of these variables.Results
During STD, bilateral asymmetry in mean amplitude of MH in the LER subgroup (P=.031) and bilateral asymmetry in duration of LH in the LFR subgroup (P=.026) were exhibited. Also, in this task reduced time to peak left MH activation were found in the LFR subgroup than 2 other groups (control; P=.028/LER; P=.004). During STS, increased left ES maximum amplitude were observed in the LFR subgroup than LER subgroup (P=.029). Also, reduced time to peak right ES (P=.035) and left LH (P=.038) activation in the LER subgroup than control subjects and reduced time to peak left LH activation in LFR subgroup than control subjects (P=.041) were observed during STS.Conclusions
The differences between the 2 LBP subgroups may be a result of impairment in the activity pattern of some muscles during functional activity. 相似文献18.
Emer Gunning Marcin K. Uszynski 《Archives of physical medicine and rehabilitation》2019,100(5):980-986
Objective
To review the current evidence for the effectiveness of proprioceptive neuromuscular facilitation (PNF) techniques on gait parameters in patients with stroke.Data Sources
The electronic platforms of CINAHL, MEDLINE, PubMed, and the Physiotherapy Evidence Database were searched using the relevant search terms.Study Selection
Intervention studies that had gait parameters as an outcome and in which PNF techniques were used in a poststroke population were reviewed. The studies were reviewed by both authors and a consensus was reached. The literature search identified 84 studies. Following screening, there were 5 studies that met the inclusion criteria for this review.Data Extraction
Data were extracted from the studies by both authors and independently reviewed. Methodological quality was assessed with the Physiotherapy Evidence Database scale of randomized controlled trials and with the Quality Assessment Tool for Quantitative Studies for nonrandomized controlled trials.Data Synthesis
Treatment using the PNF method led to a statistically significant improvement in gait outcome measures in patients with stroke in all the studies. Three of the studies also found that groups treated with PNF techniques had a significantly greater improvement in outcome measures than groups that received routine physiotherapy treatment.Conclusions
Although some limitations were identified in the methodological quality of the studies, current research suggests that PNF is an effective treatment for the improvement of gait parameters in patients with stroke. Further research is needed to build a robust evidence base in this area. 相似文献19.
Megan E. Narad Stacey Raj Keith O. Yeates H. Gerry Taylor Michael W. Kirkwood Terry Stancin Shari L. Wade 《Archives of physical medicine and rehabilitation》2019,100(5):811-820
Objective
To examine parent and family outcomes of a randomized controlled trial (RCT) comparing Teen Online Problem-Solving with Family (TOPS-F), Teen Online Problem-Solving-Teen Only (TOPS-TO), or access to Internet resources alone (Internet resource comparison [IRC]).Design
Three-arm RCT.Setting
Four children’s hospitals and 1 general medical center in Ohio and Colorado.Participants
Children and adolescents (N=152), 11-18 years old, hospitalized for complicated mild to severe traumatic brain injury in the previous 18 months.Interventions
Intervention groups: TOPS-F, TOPS-TO, and IRC.Main Outcome Measure
Parental depression (CES-D), parental psychological distress (SCL-90-GSI), family functioning (FAD-GF), cohesiveness (PARQ), and conflict (IBQ) were assessed pre- and post-treatment. Treatment effects and the moderating effect of the number of parents in the home (single vs 2-parent families).Results
Number of parents moderated treatment effects with effects ranging from trending to statistically significant for depression, family functioning, cohesion, and conflict. Among single parents, TOPS-TO reported better family functioning than TOPS-F and greater cohesion and less conflict than IRC. Among 2-parent families, TOPS-F reported less depression than IRC and less depression and greater cohesion than TOPS-TO. The effect of family composition was also noted within TOPS-TO and TOPS-F. In TOPS-F, 2-parent families reported less depression than single-parent families. In TOPS-TO single parents reported greater cohesion and better family functioning than 2-parent families.Conclusions
Findings support the TOPS intervention improves family outcomes, with differential effects noted for single vs 2-parent households. The TOPS-TO format appeared more beneficial for single-parent households, while TOPS-F was more beneficial for 2-parent households, highlighting the importance of considering family composition when determining the best treatment modality. 相似文献20.
James S. Krause David Murday Elizabeth H. Corley Nicole D. DiPiro 《Archives of physical medicine and rehabilitation》2019,100(5):938-944