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1.

Objective

To evaluate the effectiveness of noninvasive brain stimulation (NIBS)—repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS)—on hemispatial neglect and performance in activities of daily living (ADL) after stroke.

Data Sources

MEDLINE (PubMed), EMBASE, Cochrane CENTRAL, Scopus, SciELO, and Physiotherapy Evidence Database were searched from database inception to December 2016.

Data Selection

Randomized controlled trials or crossover trials focused on determining the effects of tDCS or rTMS combined or not combined with other therapies for hemispatial neglect after stroke.

Data Extraction

Methodological characteristics of the studies, number of participants, comparison groups, interventions, and outcomes were extracted.

Data Synthesis

Ten trials comprising 226 participants had data that were suitable for the meta-analysis. Meta-analysis showed that NIBS combined with other therapies significantly improves hemispatial neglect (standardized mean difference [SMD]=–1.91; 95% confidence interval [CI], –2.57 to –1.25; I2=71%). A sensitivity analysis showed that rTMS (SMD=–2.16; 95% CI, –3.00 to –1.33; I2=76%) and tDCS (SMD=–1.07; 95% CI, –1.76 to –0.37; I2=0%) had positive effects on hemispatial neglect. Furthermore, both excitatory (SMD=–2.34; 95% CI, –3.56 to –1.12; I2=65%) and inhibitory (SMD=–1.69; 95% CI, –2.49 to –0.88; I2=75%) stimulations were effective.

Conclusions

This meta-analysis reveals moderate-quality evidence for the effectiveness of NIBS protocols combined with other therapies on hemispatial neglect and performance in ADL after stroke.  相似文献   

2.
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3.

Objective

To evaluate the current evidence of the effectiveness of dry needling of myofascial trigger points (MTrPs) associated with low back pain (LBP).

Data Sources

PubMed, Ovid, EBSCO, ScienceDirect, Web of Science, Cochrane Library, CINAHL, and China National Knowledge Infrastructure databases were searched until January 2017.

Study Selection

Randomized controlled trials (RCTs) that used dry needling as the main treatment and included participants diagnosed with LBP with the presence of MTrPs were included.

Data Extraction

Two reviewers independently screened articles, scored methodologic quality, and extracted data. The primary outcomes were pain intensity and functional disability at postintervention and follow-up.

Data Synthesis

A total of 11 RCTs involving 802 patients were included in the meta-analysis. Results suggested that compared with other treatments, dry needling of MTrPs was more effective in alleviating the intensity of LBP (standardized mean difference [SMD], ?1.06; 95% confidence interval [CI], ?1.77 to ?0.36; P=.003) and functional disability (SMD, ?0.76; 95% CI, ?1.46 to ?0.06; P=.03); however, the significant effects of dry needling plus other treatments on pain intensity could be superior to dry needling alone for LBP at postintervention (SMD, 0.83; 95% CI, 0.55–1.11; P<.00001).

Conclusions

Moderate evidence showed that dry needling of MTrPs, especially if associated with other therapies, could be recommended to relieve the intensity of LBP at postintervention; however, the clinical superiority of dry needling in improving functional disability and its follow-up effects still remains unclear.  相似文献   

4.

Objective

To compare the efficacy of intra-articular (IA) steroid injection and distension in patients with frozen shoulder.

Data Sources

Databases, including MEDLINE (via PubMed), Embase, Scopus, and Cochrane Library, were searched for studies published up to November 2016.

Study Selection

We included all published randomized controlled trials (RCTs), quasi-experimental studies, and observational studies investigating the effectiveness of IA steroid injection, distension, and physiotherapy in patients with frozen shoulder. Sixteen RCTs and 1 observational study were enrolled in meta-analysis.

Data Extraction

Full texts were independently reviewed, and quality of RCTs was assessed with The Cochrane Collaboration's tool. The primary outcome was functional improvement; the secondary outcomes included pain reduction and external rotation (ER) improvement.

Data Synthesis

In pairwise meta-analysis, pooled standardized mean difference (SMD) of functional improvement and pain reduction revealed equal efficacy at 3 follow-up time points. With respect to ER improvement, distension has a superior effect compared with IA steroid injection in the short term [(2–4wk; SMD, ?.36; 95% confidence interval [CI], ?.68 to ?.04) and medium term (6–16wk; SMD, ?0.80; 95% CI, ?1.32 to ?0.29). The network meta-analysis indicated a better efficacy for distension than for IA steroid injection in ER improvement only in the medium term (6–16wk; SMD, ?0.70; 95% CI, ?1.19 to ?0.21).

Conclusions

IA steroid injection was as effective as distension in shoulder function improvement, pain reduction, and increasing ER of the shoulder. Distension yielded better ER improvement in the medium term but to a minor extent in the long term. For patients with predominant ER limitation, early distension could be considered the primary choice of treatment.  相似文献   

5.

Objective

To investigate the therapeutic interventions reported in the research literature and synthesize their effectiveness in improving upper limb (UL) function in the first 4 weeks poststroke.

Data Sources

Electronic databases and trial registries were searched from inception until June 2016, in addition to searching systematic reviews by hand.

Study Selection

Randomized controlled trials (RCTs), controlled trials, and interventional studies with pre/posttest design were included for adults within 4 weeks of any type of stroke with UL impairment. Participants all received an intervention of any physiotherapeutic or occupational therapeutic technique designed to address impairment or activity of the affected UL, which could be compared with usual care, sham, or another technique.

Data Extraction

Two reviewers independently assessed eligibility of full texts, and methodological quality of included studies was assessed using the Cochrane Risk of Bias Tool.

Data Synthesis

A total of 104 trials (83 RCTs, 21 nonrandomized studies) were included (N=5225 participants). Meta-analyses of RCTs only (20 comparisons) and narrative syntheses were completed. Key findings included significant positive effects for modified constraint-induced movement therapy (mCIMT) (standardized mean difference [SMD]=1.09; 95% confidence interval [CI], .21–1.97) and task-specific training (SMD=.37; 95% CI, .05–.68). Evidence was found to support supplementary use of biofeedback and electrical stimulation. Use of Bobath therapy was not supported.

Conclusions

Use of mCIMT and task-specific training was supported, as was supplementary use of biofeedback and electrical simulation, within the acute phase poststroke. Further high-quality studies into the initial 4 weeks poststroke are needed to determine therapies for targeted functional UL outcomes.  相似文献   

6.

Objective

To evaluate the effectiveness of activity-based, nonactivity-based, and combined activity- and nonactivity-based rehabilitative interventions for individuals presenting with unilateral spatial neglect (USN) and hemianopia.

Data Sources

We searched CINAHL, Cochrane Library, EMBASE, MEDLINE, and PubMed from 2006 to 2016.

Study Selection

Randomized controlled trials (RCTs) with a score of 6 or more in the Physiotherapy Evidence Database Scale that examined the effects of activity-based and nonactivity-based rehabilitation interventions for people with USN or hemianopia. Two reviewers selected studies independently.

Data Extraction

Extracted data from the published RCTs. Mean differences (MD) or standardized mean differences (SMD), and 95% confidence intervals (CIs) were calculated. Heterogeneity was assessed using the I2 statistic.

Data Synthesis

A total of 20 RCTs for USN and 5 for hemianopia, involving 594 and 206 stroke participants respectively, were identified. Encouraging results were found in relation to activity-based interventions for visual scanning training and compensatory training for hemianopia (MD=5.11; 95% confidence intervals [95% CI], 0.83-9.4; P=.019; I2=25.16% on visual outcomes), and optokinetic stimulation and smooth pursuit training for USN (SMD=0.49; 95% CI, 0.01-0.97; P=.045; I2=49.35%) on functional performance in activities of daily living, (SMD=0.96; 95% CI, 0.09-1.82; P=.031; I2=89.57%) on neglect.

Conclusions

Activity-based interventions are effective and commonly used in the treatment of USN and hemianopia. Nonactivity-based and combined approaches, for both impairments, have not been refuted, because more studies are required for substantiated conclusions to be drawn.  相似文献   

7.

Objective

To investigate the effectiveness of physical activity–based interventions using electronic feedback in reducing pain and disability compared to minimal or no interventions in patients with chronic musculoskeletal pain.

Data Sources

The following electronic databases were searched: EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus, Web of Science, Physiotherapy Evidence Database, and main clinical trial registers.

Study Selection

Randomized controlled trials investigating the effect of physical activity interventions using electronic feedback (eg, physical activity monitors) on pain and disability compared to minimal or no interventions in adults with chronic musculoskeletal pain were considered eligible.

Data Extraction

Pooled effects were calculated using the standardized mean difference (SMD), and the Grading of Recommendations Assessment, Development and Evaluation system was used to assess the overall quality of the evidence.

Data Synthesis

Four published randomized controlled trials and 4 registered unpublished randomized controlled trials were included. At short-term follow-up, pooled estimations showed no significant differences in pain (2 trials: n=116; SMD=?.50; 95% confidence interval, ?1.91 to 0.91) and disability (2 trials: n=116; SMD=?.81; 95% confidence interval, ?2.34 to 0.73) between physical activity–based interventions and minimal interventions. Similarly, nonsignificant results were found at intermediate-term follow-up. According to Grading of Recommendations Assessment, Development and Evaluation, the overall quality of the evidence was considered to be of low quality.

Conclusions

Our findings suggest that physical activity–based interventions using electronic feedback may be ineffective in reducing pain and disability compared to minimal interventions in patients with chronic musculoskeletal pain. Clinicians should be cautious when implementing this intervention in patients with chronic musculoskeletal pain.  相似文献   

8.

Objectives

(1) To determine the effect of transcutaneous electrical nerve stimulation (TENS) on poststroke spasticity. (2) To determine the effect of different parameters (intensity, frequency, duration) of TENS on spasticity reduction in adults with stroke. (3) To determine the influence of time since stroke on the effectiveness of TENS on spasticity.

Data Sources

PubMed, PEDro, CINAHL, Web of Science, CENTRAL, and EMBASE databases were searched from inception to March 2017.

Study Selection

Randomized controlled trial (RCT), quasi-RCT, and non-RCT were included if (1) they evaluated the effects of TENS for the management of spasticity in participants with acute or subacute or chronic stroke using clinical and neurophysiological tools; and (2) TENS was delivered either alone or as an adjunct to other treatments.

Data Extraction

Two authors independently screened and extracted data from 15 of the 829 studies retrieved through the search using a pilot tested pro forma. Disagreements were resolved through discussion with other authors. Quality of studies was assessed using Cochrane risk of bias criteria.

Data Synthesis

Meta-analysis was performed using a random-effects model that showed (1) TENS along with other physical therapy treatments was more effective in reducing spasticity in the lower limbs compared to placebo TENS (SMD ?0.64; 95% confidence interval [95% CI], ?0.98 to ?0.31; P=.0001; I2=17%); and (2) TENS, when administered along with other physical therapy treatments, was effective in reducing spasticity when compared to other physical therapy interventions alone (SMD ?0.83; 95% CI, ?1.51 to ?0.15; P=.02; I2=27%). There were limited studies to evaluate the effectiveness of TENS for upper limb spasticity.

Conclusion

There is strong evidence that TENS as an adjunct is effective in reducing lower limb spasticity when applied for more than 30 minutes over nerve or muscle belly in chronic stroke survivors (review protocol registered at PROSPERO: CRD42015020151).  相似文献   

9.

Objective

To assess the effectiveness of exercise programs on disease activity and function in ankylosing spondylitis (AS) by a systematic review and meta-analysis of randomized controlled trials (RCTs).

Data Sources

Medline via PubMed and Cochrane Library.

Study Selection

Reports of RCTs examining the effectiveness of exercise programs for AS published up to May 2017.

Data Extraction

Outcomes were evolution of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) after the completion of exercise programs. Modalities of exercise were compared and the use of biologic therapy was reported.

Data Synthesis

After screening 190 abstracts, we selected 26 reports for detailed evaluation and finally investigated 8 trials that assessed a home-based exercise program (2/8), swimming (1/8), Pilates training (1/8), or supervised exercises (4/8), for a total of 331 patients with AS. Four trials included patients receiving antitumor necrosis factor therapy. All trials except one showed a decrease in BASDAI and BASFI with exercise. The weighted mean difference was ?0.90 (95% confidence interval, ?1.52 to ?0.27; I2=69%; P=.005) for the BASDAI and ?0.72 (95% confidence interval, ?1.03 to ?0.40; I2=0%; P<.00001) for the BASFI in favor of exercise programs.

Conclusions

Despite the small number of patients and the heterogeneity of exercise programs in the RCTs included in this meta-analysis, its results support the potential of exercise programs to improve disease activity and body function in AS.  相似文献   

10.

Objective

To describe physical function before and six months after Total Knee Replacement (TKR) in a small sample of women from China and the United States.

Design

Observational.

Setting

Community environment.

Outcomes

Both groups adhered to the Osteoarthritis Research Society International (OARSI) protocols for the 6-minute walk and 30-second chair stand. We compared physical function prior to TKR and 6 months after using linear regression adjusted for covariates.

Participants

Women (N=60) after TKR.

Interventions

Not applicable.

Results

Age and body mass index in the China group (n=30; 66y and 27.0kg/m2) were similar to those in the U.S. group (n=30; 65y and 29.6kg/m2). Before surgery, the China group walked 263 (95% confidence interval [CI], ?309 to ?219) less meters and had 10.2 (95% CI, ?11.8 to ?8.5) fewer chair stands than the U.S. group. At 6 months when compared with the U.S. group, the China group walked 38 more meters, but this difference did not reach statistical significance (95% CI, ?1.6 to 77.4), and had 3.1 (95% CI, ?4.4 to ?1.7) fewer chair stands. The China group had greater improvement in the 6-minute walk test than did the U.S. group (P<.001).

Conclusions

Despite having worse physical function before TKR, the China group had greater gains in walking endurance and similar gains in repeated chair stands than did the U.S. group after surgery.  相似文献   

11.

Objective

To establish the feasibility and effectiveness of a 6-week ballistic strength training protocol in people with stroke.

Design

Randomized, controlled, assessor-blinded study.

Setting

Subacute inpatient rehabilitation.

Participants

Consecutively admitted inpatients with a primary diagnosis of first-ever stroke with lower limb weakness, functional ambulation category score of ≥3, and ability to walk ≥14 m were screened for eligibility to recruit 30 participants for randomization.

Interventions

Participants were randomized to standard therapy or ballistic strength training 3 times per week for 6 weeks.

Main Outcome Measures

The primary aim was to evaluate feasibility and outcomes included recruitment rate, participant retention and attrition, feasibility of the exercise protocol, therapist burden, and participant safety. Secondary outcomes included measures of mobility, lower limb muscle strength, muscle power, and quality of life.

Results

A total of 30 participants (11% of those screened) with mean age of 50 years (SD 18) were randomized. The median number of sessions attended was 15 of 18 and 17 of 18 for the ballistic and control groups, respectively. Earlier than expected discharge to home (n=4) and illness (n=7) were the most common reasons for nonattendance. Participants performed the exercises safely, with no study-related adverse events. There were significant (P<.05) between-group changes favoring the ballistic group for comfortable gait velocity (mean difference [MD] 0.31m/s, 95% confidence interval [CI]: 0.08-0.52), muscle power, as measured by peak jump height (MD 8cm, 95% CI: 3-13), and peak propulsive velocity (MD 64cm/s, 95% CI: 17-112).

Conclusions

Ballistic training was safe and feasible in select ambulant people with stroke. Similar rates of retention and attrition suggest that ballistic training was acceptable to patients. Secondary outcomes provide promising results that warrant further investigation in a larger trial.  相似文献   

12.

Objective

To examine associations between organizational characteristics of home health agencies (eg, profit status, rehabilitation therapy staffing model, size, and rurality) and quality outcomes in Medicare beneficiaries with rehabilitation-sensitive conditions, conditions for which occupational, physical, and/or speech therapy have the potential to improve functioning, prevent or slow substantial decline in functioning, or increase ability to remain at home safely.

Design

Retrospective analysis.

Setting

Home health agencies.

Participants

Fee-for-service beneficiaries (N=1,006,562) admitted to 9250 Medicare-certified home health agencies in 2009.

Interventions

Not applicable.

Main Outcome Measures

Institutional admission during home health care, community discharge, and institutional admission within 30 days of discharge.

Results

Nonprofit (vs for-profit) home health agencies were more likely to discharge beneficiaries to the community (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.13–1.33) and less likely to have beneficiaries incur institutional admissions within 30 days of discharge (OR, .93; 95% CI, .88–.97). Agencies in rural (vs urban) counties were less likely to discharge patients to the community (OR, .83; 95% CI, .77–.90) and more likely to have beneficiaries incur institutional admissions during home health (OR, 1.24; 95% CI, 1.18–1.30) and within 30 days of discharge (OR, 1.15; 95% CI, 1.10–1.22). Agencies with contract (vs in-house) therapy staff were less likely to discharge beneficiaries to the community (OR, .79, 95% CI, .70–.91) and more likely to have beneficiaries incur institutional admissions during home health (OR, 1.09; 95% CI, 1.03–1.15) and within 30 days of discharge (OR, 1.17; 95% CI, 1.07–1.28).

Conclusions

As payers continue to test and implement reimbursement mechanisms that seek to reward value over volume of services, greater attention should be paid to organizational factors that facilitate better coordinated, higher quality home health care for beneficiaries who may benefit from rehabilitation.  相似文献   

13.

Background

The incidence of contact isolation for multidrug-resistant organisms is increasing in acute hospitals and inpatient rehabilitation units alike. There is limited evidence on the effect of contact isolation on functional outcomes during inpatient rehabilitation.

Objective

To determine whether the use of a modified contact isolation protocol (MCI) resulted in noninferior functional outcomes compared with children without contact isolation (NCI) on inpatient rehabilitation.

Design

This is a retrospective noninferiority study.

Setting

One academically affiliated pediatric inpatient rehabilitation unit located in a children’s hospital.

Patients

All children with any diagnosis admitted to inpatient rehabilitation from January 1, 2007, to December 31, 2014.

Methods or Interventions

We compared functional outcomes for 2 groups of children.

Main Outcome Measurements

Primary outcome measures included the Functional Independence Measure for Children (WeeFIM) efficiency and the change in the Developmental Functional Quotient (DFQ) for the WeeFIM. Noninferiority margins of 0.63 for the WeeFIM efficiency and 0.092 for the change in DFQ for the WeeFIM were used.

Results

There were a total of 949 patients of whom 899 were NCI, 48 MCI, and 2 excluded due to missing information. Patients with MCI had functional outcomes that were noninferior to those with NCI including the WeeFIM efficiency (mean difference 0.002, 95% CI –0.38 to 0.404) and the change in DFQ for the WeeFIM (mean difference –0.05, 95% CI –0.058 to 0.003).

Conclusions

The modified contact isolation protocol, having resulted in noninferior functional outcomes in inpatient rehabilitation may provide adequate contact isolation while allowing for noninferior functional outcomes. This may be a guide in the face of an ever-increasing need for contact isolation.

Level of Evidence

III  相似文献   

14.

Objectives

To determine the association between therapy intensity and discharge outcomes for aged Medicare skilled nursing facilities (SNFs) fee-for-service beneficiaries and to determine the association between therapy intensity and time to community discharge.

Design

Retrospective observational design.

Setting

SNFs.

Participants

Aged Medicare fee-for-service beneficiaries (N=311,338) in 3605 SNFs.

Interventions

The total minutes of physical therapy, occupational therapy, and speech therapy per day were divided into intensity groups: high (≥60min); medium-high (45–<60min); medium-low (30–<45min); and low (<30min).

Main Outcome Measures

Four discharge outcomes—community, hospitalization, permanent placement, and death—were examined using a multivariate competing hazards model. For those associated with community discharge, a Poisson multivariate model was used to determine whether length of stay differed by intensity.

Results

High intensity therapy was associated with more community discharges in comparison to the remaining intensity groups (hazard ratio, .84, .68, and .433 for medium-high, medium-low, and low intensity groups, respectively). More hospitalizations and deaths were found as therapy intensity decreased. Only high intensity therapy was associated with a 2-day shorter length of stay (incident rate ratio, .95).

Conclusions

High intensity therapy was associated with desirable discharge outcomes and may shorten SNF length of stay. Despite growing reimbursements to SNFs for rehabilitation services, there may be desirable benefits to beneficiaries who receive high intensity therapy.  相似文献   

15.

Objective

To critically evaluate the rehabilitative effects of mindful exercises for poststroke patients.

Data Sources

Six databases (PubMed, Physiotherapy Evidence Database, Cochrane Library, Web of Science, Wanfang, Chinese National Knowledge Infrastructure) and reference lists of relevant articles were searched.

Study Selection

Randomized controlled trials on the effects of mindful exercises on rehabilitative outcomes such as sensorimotor function, gait speed, leg strength, aerobic endurance, cognitive function, and overall motor function.

Data Extraction

Two investigators independently screened eligible studies according to the eligible criteria, extracted data, and assessed risk of bias.

Data Synthesis

A total of 20 studies that satisfied the eligibility criteria were finally included. The sum scores of 5-9 points in the adapted Physiotherapy Evidence Database scale indicates low-to-medium risk of bias. The study results of meta-analysis indicate that mindful exercise intervention was significantly associated with improved sensorimotor function on both lower limb (standardized mean difference=0.79; 95% confidence interval, 0.43-1.15; P<.001; I2=62.67%) and upper limb (standardized mean difference=0.7; 95% confidence interval, 0.39-1.01; P<.001; I2=32.36%).

Conclusions

This review suggests that mindful exercises are effective in improving sensorimotor function of lower and upper limbs in poststroke patients. The effects on gait speed, leg strength, aerobic endurance, overall motor function, and other outcomes (eg, cognitive function, gait parameters) require further investigation for allowing evidence-based conclusions.  相似文献   

16.

Objective

To investigate whether oldest-old age (≥85y) is an independent predictor of exclusion from stroke rehabilitation.

Design

Retrospective cohort study.

Setting

Stroke unit (SU) of a tertiary hospital.

Participants

Elderly patients (N=1055; aged 65–74y, n=230; aged 75–84y, n=432; aged ≥85y, n=393) who, between 2009 and 2012, were admitted to the SU with acute stroke and evaluated by a multiprofessional team for access to rehabilitation. The study excluded patients for whom rehabilitation was unnecessary or inappropriate.

Interventions

Not applicable.

Main Outcome Measures

Access to an early mobilization (EM) protocol during SU stay and subsequent access to postacute rehabilitation after SU discharge. Analyses were adjusted for prestroke and stroke-related characteristics.

Results

32.2% of patients were excluded from EM. Multivariable-adjusted odds ratios (ORs) of EM exclusion were 1.30 (95% confidence interval [CI], .76–2.21) for ages 75 to 84 years and 2.07 (95% CI, 1.19–3.59) for ages ≥85 years compared with ages 65 to 74 years. Of 656 patients admitted to EM and who, at SU discharge, had not yet fully recovered their prestroke functional status, 18.4% were excluded from postacute rehabilitation. For patients able to walk unassisted at SU discharge, the probability of exclusion did not change across age groups. For patients unable to walk unassisted at SU discharge, ORs of exclusion from postacute rehabilitation were 3.74 (95% CI, 1.26–11.13) for ages 75 to 84 years and 9.15 (95% CI, 3.05–27.46) for ages ≥85 years compared with ages 65 to 74 years.

Conclusions

Oldest-old age is an independent predictor of exclusion from stroke rehabilitation.  相似文献   

17.
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18.

Objective

To determine the association between quadriceps rate of force development (RFD) and decline in self-reported physical function and objective measures of physical performance.

Design

Longitudinal cohort study.

Setting

Community-based sample from 4 urban areas.

Participants

Osteoarthritis Initiative participants with or at risk for knee osteoarthritis, who had no history of knee/hip replacement, knee injury, or rheumatoid arthritis (N=2630).

Interventions

Not applicable.

Main Outcome Measures

Quadriceps RFD (N/s) was measured during isometric strength testing. Worsening physical function was defined as the minimal clinically important difference for worsening self-reported Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function subscale score, 20-m walk time, and repeated chair stand time over 36 months.

Results

Compared with the slowest tertile of RFD, the fastest tertile had a lower risk for worsening of WOMAC physical function subscale score at 36-month follow-up, with an odds ratio (OR) of .68 (95% confidence interval [CI], .51–.92) after adjustment for age, sex, body mass index, depression, history of chronic diseases, and knee pain. In women, in comparison with the slowest tertile of RFD, the fastest tertile had a lower risk for worsening of WOMAC physical function subscale score at 36-month follow-up, with an adjusted OR of .57 (95% CI, .38–.86). This decreased risk did not reach statistical significance in men (OR, 0.81; 95% CI, 0.52–1.27). No statistically significant associations were detected between baseline RFD and walk or chair stand times.

Conclusions

Our results indicate that higher RFD is associated with decreased risk for worsening self-reported physical function but not with decreased risk for worsening of physical performance.  相似文献   

19.
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20.

Objectives

To evaluate the prognostic utility of serial assessment on the Coma Recovery Scale–Revised (CRS-R) during the first 4 weeks of intensive rehabilitation in patients surviving a severe brain injury.

Design

Prospective cohort study.

Setting

An intensive rehabilitation unit.

Participants

Patients (N=110) consecutively admitted to the intensive rehabilitation unit. Inclusion criteria were (1) a diagnosis of unresponsive wakefulness syndrome (UWS) or minimally conscious state (MCS) caused by an acquired brain injury, and (2) aged >18 years.

Interventions

All patients underwent clinical evaluations using the Italian version of the CRS-R during the first month of hospital stay.

Main Outcome Measures

Behavioral classification on the CRS-R and the score on the Glasgow Outcome Scale (GOS) at final discharge. Patients transitioning from UWS to MCS or emergence from MCS (E-MCS), and from MCS to E-MCS were classified as patients with improved responsiveness (IR).

Results

After a mean ± SD hospital stay of 5.3±2.7 months, 59 of 110 patients (53.6%) achieved IR. In the multivariable analysis, a higher CRS-R score change at week 4 (odds ratio =1.99; 95% confidence interval [CI], 1.49–2.66; P<.001) was the only significant predictor of IR at discharge. Fifty-three patients (48.2%) were classified as severely impaired at discharge (GOS=3). In the multivariable analysis, higher GOS scores were related to a higher CRS-R score at admission (B=.051; 95% CI, .027–.074; P<.001), a higher CRS-R score change at week 4 (B=.087; 95% CI, .064–.110; P<.001), and an absence of severe infections (B=–.477; 95% CI, –.778 to –.176; P=.002).

Conclusions

An improvement on the total CRS-R score and on different subscales across the first 4 weeks of inpatient rehabilitation discriminates patients who will have a better outcome at discharge, providing information for rehabilitation planning and for communication with patients and their caregivers.  相似文献   

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